Do you sometimes feel chest pain after drinking? If so, you may have alcohol intolerance. Here’s what you need to know.
Drinking is associated with a range of different effects, some appealing and others undesirable. Those undesirable effects are often associated with the gut or the brain, and may include nausea, disorientation, hangovers, headaches, among many other issues. People who regularly consume beverages containing ethanol come to expect the potential for these symptoms.
Most people don’t, however, connect the chest with drinking. Which is why you may find it quite strange to realize you’re experiencing chest pain every time you drink.
What is the reason for chest pain after consuming beverages? Is it a warning sign of alcohol intolerance or simply a rare side effect of consumption?
What is Alcohol Intolerance?
Alcohol intolerance is a condition in which the body is unable to efficiently process ethanol due to an underlying metabolic issue, typically involving enzyme deficiencies. Unlike an alcohol allergy, which is an immune system reaction, intolerance primarily involves the digestive and metabolic systems.
This condition is mainly caused by the deficiency or malfunction of enzymes involved in metabolism (specifically alcohol dehydrogenase (ADH) and aldehyde dehydrogenase 2 (ALDH2)). These enzymes are crucial for breaking down ethanol — the active compound in alcoholic beverages — into less harmful substances. A deficiency, particularly in ALDH2, results in the buildup of acetaldehyde, a toxic byproduct responsible for many of the uncomfortable symptoms associated with intolerance.
There are a number of common symptoms of alcohol intolerance, including:
- Flushing: Facial redness and warmth, often extending to the neck and chest.
- Headaches: Often severe, triggered by the body’s response to the toxins produced during metabolism.
- Nausea: Digestive struggles, leading to irritation of the gastrointestinal tract.
These symptoms are not always recognized as signs of intolerance, since they can also occur when a person drinks too much, regardless of whether they are intolerant.
However, there are other symptoms associated specifically with this condition. They include an increase in heart rate (also called tachycardia) and chest pain.
It’s understandable that someone suffering from these symptoms might become concerned. It is important to pay attention to them, as they can be indicators of issues more severe than intolerance.
Are There Other Causes of Chest Pain After Drinking?
A person experiencing symptoms of intolerance should stop drinking immediately. This will usually solve the issue as the chest pain dissipates and their heart rate returns to normal.
However, intolerance is not always the cause of chest pain. There could be a number of serious underlying issues.
Potential causes of chest pain after drinking include:
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, or GERD, occurs when stomach acid flows back into the esophagus, causing discomfort and pain. Ethanol can aggravate this condition by relaxing the muscles at the base of the esophagus, making it easier for acid to escape upward. Symptoms of GERD often mimic those of a heart attack, including sharp or burning chest pain.
Cardiovascular Health Problems
Consuming beverages affects the heart immediately by increasing heart rate and altering blood pressure. This rapid shift can put stress on the cardiovascular system, potentially triggering symptoms like chest pain. For someone with an existing heart condition, drinking may lead to serious complications, including arrhythmias (irregular heartbeats) or angina (chest pain due to reduced blood flow to the heart muscle).
Esophageal Spasms
Consuming ethanol can irritate the esophagus, leading to sudden, painful muscle contractions known as esophageal spasms. These spasms can cause sharp, squeezing chest pains that may be mistaken for heart-related issues. Limiting intake is often an effective way to prevent these spasms and reduce discomfort.
Anxiety and Panic Attacks
Sometimes, the problem is not entirely physical but has a psychological aspect as well. Drinking can heighten feelings of anxiety, leading to panic attacks. These attacks typically involve chest pain, rapid heartbeat, shortness of breath, and a feeling of dread or panic. The impact on the nervous system can exacerbate these symptoms.
How Do You Know if It’s Alcohol Intolerance or Something Else?
Since it’s so important to determine the cause of the chest pain, how do you differentiate between intolerance and other conditions?
Intolerance does not only cause chest pain. There are usually other distinctive symptoms, such as facial flushing and nausea. In contrast, GERD-related chest pain often manifests as a burning sensation, worsening when lying down or bending over. Cardiac-related chest pain usually feels like pressure or tightness in the chest and can radiate to other parts of the body, including the arms or jaw.
Chest pain that comes from a panic or anxiety attack, on the other hand, generally includes feelings of intense fear, rapid heartbeat, and difficulty breathing.
If you are experiencing chest pain with other symptoms of intolerance, you may want to speak to a medical professional just to be safe. However, if there are symptoms of other conditions or you have never suffered chest pain when drinking in the past, seek medical attention immediately.
Is Alcohol Intolerance Common?
This condition is more common than many people think. One study using self-reports found that 7.2% of the sample group suffered from it. That being said, some populations are at much higher risk, potentially inflating the statistics.
Experts have found that genetic, environmental, and medical factors can all increase the risk of intolerance. One of the most significant genetic risk factors is an enzyme deficiency known as aldehyde dehydrogenase 2 (ALDH2) deficiency. This deficiency is particularly prevalent among individuals of East Asian descent, affecting approximately 36% of this population. People with ALDH2 deficiency cannot efficiently metabolize ethanol, resulting in an accumulation of acetaldehyde, a toxic substance responsible for symptoms like flushing, nausea, and chest pain.
Environmental and lifestyle factors also play a critical role. Regular heavy consumption can exacerbate symptoms in individuals with partial intolerance. Certain dietary habits and exposure to environmental toxins can also influence the severity of reactions.
It is possible to become more intolerant as you get older. This is because the ability to metabolize effectively often declines with age. Older adults might notice symptoms, even if they previously tolerated drinks well.
Lastly, coexisting medical conditions such as asthma, allergies, or gastrointestinal disorders can heighten sensitivity. Individuals with asthma or allergies, for instance, might experience worsened respiratory or inflammatory responses after drinking, contributing further to symptoms like chest pain and discomfort.
How Serious is Alcohol Intolerance?
In theory, this condition is not a serious issue. Just like with intolerance to any other foods, the simple solution is to stop consuming it. Ethanol is certainly not a basic necessity and its use can lead to many other serious problems. In addition, for many people with intolerance, it is possible to continue drinking if they are willing to face the discomfort.
However, severe intolerance can lead to intense and debilitating symptoms that may necessitate medical intervention. Plus, continual exposure despite intolerance can exacerbate existing health conditions, such as gastrointestinal disorders or cardiovascular issues.
The underlying issue causing the condition — the difficulty metabolizing — is also bad for the long-term health of people who continue drinking anyway. They face an increased risk of developing certain cancers, particularly esophageal cancer, due to chronic exposure to acetaldehyde.
It is therefore necessary to take this condition seriously. If your symptoms are persisting, seek medical advice and consider making lifestyle changes, including avoiding consumption.
Should I Stop Drinking?
Drinking is a socially accepted and often expected activity. Colleagues drink together after a long day at work. Friends drink together on weekends. Beverages flow at parties and clubs, where getting drunk is the norm for many people.
It makes sense in this context that people with intolerance might be resistant to stopping altogether. In certain scenarios, they may even face peer pressure that makes it feel difficult to say no.
The reality is that consuming beverages with intolerance will always lead to discomfort. Over time, it can exacerbate or cause severe health issues. However, it is unlikely to do so on the odd occasion. This leads to many intolerant individuals deciding to continue anyway.
But, before long, the symptoms might not seem worth it. It does not feel good to battle chest pains and nausea while others seem to be having a good time.
So, while stopping when intolerant is not an urgent necessity, it may end up seeming like the best choice in any case.
Conclusion
Chest pain can be a sign of alcohol intolerance, especially when it comes with flushing, nausea, and a rapid heart rate. It is not usually an urgent medical condition but it does cause discomfort. However, there are other causes of chest pain when drinking that can be signs of a matter of life and death. If you are uncertain about the cause of the chest pain, seek medical attention immediately.
Sources
NIAAA: Alcohol’s Effects on the Body. Accessed March 2025.
PubMed: Racial differences in alcohol sensitivity. Accessed March 2025.
Mayo Clinic: Alcohol Intolerance — Symptoms & Causes. Accessed March 2025.
