Alcohol at Altitude

What causes alcohol to have more influence on you at altitude? Is it the lack of oxygen, the inability of your body to adapt quickly, or is it just a perceived feeling? 

I received my undergraduate degree at the University of Wyoming, found at an elevation of 7,200 ft. Our school always said any opponent who chooses to take us on at 7,200 ft. would surely lose because of the altitude. The same was said for drinking. We would challenge our “sea level friends” to drinking games where they repeatedly lost because of our alcohol tolerance at altitude. 

After several years of living at sea level, I am back at an elevation of 9,000 ft, studying pediatric medicine in Frisco, CO. On the weekends I enjoy having a drink with new friends and coworkers to wash away the weekly stress. As the drinks start flowing, I find myself thrust back into my undergraduate days, but this time I feel like the opponent where a single beer gets me tipsy and I am unable to keep up. 

Beer and Backcountry: Best Friends Forever?

This got me thinking. 

In a study done by Harold S. Ballard, MD, he states “Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia” (Harold S. Ballard).

Red blood cells (RBC) are responsible for carrying oxygen throughout your body. Anemia is a decrease in RBCs, and this condition can have several symptoms like fatigue, lightheadedness, pallor, and headaches. At high altitudes there is less oxygen, so your body goes into overdrive to produce more red blood cells to compensate. Alcohol interferes with RBC production and thus your body’s ability to carry oxygen to the brain. Is it possible that because of this process you are more affected by alcohol at high altitude? Possibly, but the effects of alcohol on RBCs usually occur with heavy alcohol consumption or chronic alcoholism; rarely does this occur with the occasional beer. 

It has been argued that the effect of alcohol at altitude is more of a perceived feeling of drunkenness rather than a true physiologic affect. Ray Isle, Food & Wine Executive Editor, says that you are not actually getting drunker, but “what does happen is because you’re at altitude – even if you don’t get altitude sickness – you’re still not getting as much oxygen, so you often feel a little lightheaded and dizzy. Combine that with alcohol and you start to feel more messed up than you normally would” (Speigel, 2018). To reduce this combined effect and the feeling of being drunker at altitude, recommends waiting 48 hours after you ascend to start drinking (Staff, 2019).

To further substantiate these findings, a highly acclaimed study completed in 1987 measured the blood alcohol level of individuals at 12,500 feet and those at sea level. When consuming the same amount of alcohol the study found that there was no difference in blood alcohol levels between the two groups (Collins, Mertens, & Higgins, 1987). This suggests that despite the perceived feeling, physiologically, there is no difference when drinking at altitude versus sea level. 

Snacking on the deck of one of Colorado’s backcountry cabins after a mild hike in at over 10,000 ft.

As I sit here completing my single beer that feels like three, I am surprised to know that this feeling has relatively little physiological merit to it. However, I still don’t think I would challenge a high altitude native to a drinking game!

Katherine Peter is currently a Physician Assistant student at Des Moines University. She hopes to work in Orthopedics in Houston, TX following graduation. Throughout her clinical year, she has traveled around the U.S. to several states including Florida, Iowa, Colorado, and Nebraska. She enjoys meeting new people and is always up for a new adventure. 


  1. Collins, W., Mertens, H., & Higgins, E. (1987). Some effects of alcohol and simulated altitude on complex performance scores and breathalyzer readings. Aviation, Space, and Environmental Medicine, 328-332.
  2. Harold S. Ballard, M. (n.d.). The Hematologic Complications of Alcohol. National Institute of Health .
  3. Speigel, A. (2018, June 13). How to Drink at Altitude . Retrieved from Food & Wine:
  4. Staff, E. (2019, January). Is Altitude Sickness Worse When Consuming Alcohol? Retrieved from

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