This summer an old high school friend of mine decided to quit drinking entirely. She didn’t want to, but she felt she had no choice.

“All of a sudden my body decided that alcohol is poison,” she told me recently over a bitter grapefruit mocktail at an Italian restaurant. “I can have as little as one drink, and I have a hangover.”

Like me, my high school friend was never a heavy drinker. She enjoyed having a glass of wine with dinner and a craft cocktail or two at a bar or restaurant with friends. If she had several drinks in a night she would expect to feel sluggish in the morning, but one or two was never a problem. Then, sometime in her mid-40s, her ability to tolerate alcohol plummeted.

“It’s that feeling of regret,” she said when I asked her about her post-drinking symptoms. “Headache, fatigue, I don’t know how to name that feeling in your stomach.”

The last time she had a margarita she felt so terrible that she ended up canceling her plans the following evening.

It’s a story I’ve been hearing from a growing number of my female friends since we entered our mid-40s a few years ago. Molly finds drinking wreaks havoc with her digestive system and her sleep. Alexis loads up on water and Motrin even if all she’s had was a half-glass of wine. Naama, who still makes the world’s most delicious batch cocktails, stopped drinking a few years ago after getting the sweats and a splitting headache halfway through a vodka soda.

I’ve experienced it as well. After even one drink, I find myself waking up at 3 in the morning with a dull ache in my stomach, wishing I’d made a different choice. Now, each opportunity to grab a beer at a barbecue, enjoy a cocktail at a restaurant or sip a glass of wine at a dinner party requires a cost-benefit analysis: How much do I want a drink now versus but how much am I willing to pay for it later?

To understand why my friends and I are finding alcohol more difficult to tolerate as we age, I reached out to George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

Koob pointed to studies that show that women are more sensitive to the toxic effects of alcohol — developing alcohol-related liver disease and high blood pressure due to drinking at higher rates than men — but added that scientists are still working out why that seems to be the case.

“This is a new area of research,” he said.

While Koob wasn’t aware of studies that looked specifically at how a woman’s ability to metabolize alcohol changes in middle age, he said any changes may be due in part to the natural and inevitable fact that our lean muscle mass decreases and our body fat increases as we get older.

Alcohol is drawn to water, Koob explained, and lean muscle mass has a higher percentage of water than fat does. Lean muscle mass, then, gives alcohol more space to dissipate throughout the body, making for less of it in the bloodstream, and a lower blood alcohol concentration. But as we age and lose lean muscle mass and gain fat, a higher concentration of alcohol winds up in our bloodstream. That makes for worse hangovers and extended recovery time.

“You might drink the same amount of alcohol that you used to drink, but now that one drink is more like having one and a half or two drinks, because the alcohol is hanging out in the bloodstream,” he said.

If it makes you feel any better, men also lose lean muscle mass and gain fat as they age, but men’s bodies have a higher concentration of water (55% to 65%) compared with women (45% to 50%) to begin with, so the effects may not be as obvious as they are for us.

Koob supports finding alternatives to drinking — “If you feel better when you don’t drink, then listen to your body,” he said. If you are going to drink, he offered that eating a snack beforehand can slow down the body’s absorption of alcohol and help blunt the irritation to the stomach that can cause the icky feeling I know so well. He also advised against using ibuprofen immediately after drinking, because it can also irritate the stomach. Drinking extra water will help dilute the alcohol, but ultimately, it’s the amount of alcohol you drink that will affect how you feel, not how much water you drink.

Because my friends and I are also firmly in the perimenopausal phase of our lives, I called up Dr. Monica Christmas, associate professor of obstetrics and gynecology at the University of Chicago and associate medical director of the Menopause Society, to see if our new challenges with alcohol might be related to hormonal changes as well.

The answer was a resounding yes.

She explained that alcohol triggers or exacerbates many of the symptoms of both menopause and “the menopause transition,” which can begin seven to 10 years before a woman’s period actually stops.

For example, 40% of women report mood instability during the menopause transition, which can include increased anxiety, depression, or not being motivated to do the things they once did.

“Alcohol exacerbates those things,” Dr. Christmas said. “So if you’re already experiencing mood instability, you’re only going to feel that much worse when you drink alcohol.”

I haven’t noticed my anxiety skyrocketing after having a drink or two, but my high school friend said that sounded familiar.

“There was an evil loop I was in, where I was like, I’m really anxious, maybe I’ll have another drink,” she said. “My husband was like, how’s that working out for you?”

To be clear, not all my friends feel this way. Some who have always consumed alcohol more regularly looked at me quizzically when I asked if they find it harder to drink these days. It’s possible they have developed a physiological tolerance to alcohol or may just be more used to hangovers, said MacKenzie Peltier, an assistant professor of psychiatry at Yale School of Medicine who studies sex differences in alcohol abuse disorders. It might also be that their experiences of the menopausal transition or aging are different. “But that’s complete speculation,” she said.

As for the rest of my friend group, we’re all handling this frankly unwelcome change in different ways. My high school friend has become a mocktail connoisseur. Molly hasn’t cut out alcohol completely, but she does do dry months to give her body a break. Alexis recently decided not to drink during the week anymore, but weekends are still up for debate. Naama is always on the hunt for a fancy nonalcoholic drink with low sugar content to sip at celebratory occasions.

“The only time I miss it is when we’re out with friends and the only option is Diet Coke,” she said. “And God forbid if that option is only Diet Pepsi. Then I’m really screwed.”

As for me, I’m trying to minimize the temptation to consume alcohol. Not only are pre-dinner cocktails expensive from a financial standpoint, they’re costly from a health perspective, too.

I do still love to have a drink at my Italian social club, however, and if that means a couple of rough nights a month in order to enjoy an Aperol Spritz or two — for me, that’s a trade-off I’m willing to make.

Groundbreaking weight-loss drugs like Ozempic and Wegovy have understandably generated a lot of excitement, bringing hope to the hundreds of millions of people grappling with obesity. When combined with a healthier diet and exercise, these drugs, which suppress appetite, deliver an average 10% reduction in body weight that can be sustained for years.

With more than two-thirds of adults in the United Kingdom and nearly three-quarters in the United States classified as overweight or obese — a health crisis that costs national economies billions of dollars annually — physicians and policymakers could be forgiven for embracing these drugs as a panacea. President Biden’s administration, for example, recently proposed requiring Medicare and Medicaid to cover the costs of weight-loss drugs, which would expand access for millions of Americans. But addressing obesity requires much more than a technological fix.

We ultimately also must address the root cause of the global obesity crisis: our broken food system.

The alarming rise in obesity over the past 30 years is not simply a byproduct of higher living standards or more sedentary lifestyles. The primary factor appears to be the transformation of our food environment, which has fundamentally altered both the types of food we consume and our eating habits.

In recent years, scientists and health experts have increasingly focused on foods high in fat, sugar and/or salt, which drive unhealthy dietary habits. Companies have reshaped the food system to produce ultraprocessed, hyperpalatable and highly profitable foods, leading people to snack more, eat larger portions and prepare fewer meals themselves. In the U.K., for example, the snack market has boomed while the time spent preparing meals has sharply declined.

These changes haven’t just fueled the rapid increase in consumption of salty, fatty, sweet foods. They have also led to a surge in meat consumption, especially in Europe and North America, where meat-heavy diets have become common.

Beyond the heightened risk of heart disease and related health conditions, excessive meat consumption has had devastating effects on the climate and biodiversity. Research shows that animal-based foods generate twice the greenhouse gas emissions of plant-based alternatives. Just as health experts urge us to reduce our intake of salt, fat and sugar, climate scientists consistently emphasize the importance of curbing meat and dairy consumption to keep global warming within safe limits.

In an effort to prevent a lasting change in people’s eating habits, the meat industry is seeking technological fixes to cut greenhouse emissions. For example, funding for research on cutting farm emissions — such as feed additives designed to reduce methane levels in cows’ burps — has increased markedly.

Such solutions are particularly attractive to governments reluctant to introduce measures that influence consumer behavior. Fearful of opposition from the Big Food lobby and wary of accusations of overreach, policies like sugar taxes or meat taxes are deemed political hot potatoes to be avoided at all costs.

But the overlapping crises our broken food system is fueling — from the billions of dollars spent each year on diet-related health problems to the environmental degradation pushing our planet to its limits — cannot be wished away or fixed with technological tweaks. Instead, what is needed is a major shift in dietary habits toward foods that nourish both people and the environment.

To this end, the Eat-Lancet Commission — comprising the world’s leading nutrition and sustainability experts — advocates consuming a diet rich in fresh fruits and vegetables, whole grains and plant-based proteins while reducing consumption of animal proteins, dairy and sugars. Taken together, these recommendations offer a clear blueprint for ensuring health and sustainability.

It is unrealistic to expect consumers — conditioned by food environments designed for profit rather than human or environmental health — to drive this transition on their own. With unhealthy foods widely available and aggressively marketed, many consumers struggle to moderate their food intake, and in some cases they even develop addictive behaviors.

Governments and food manufacturers must take proactive measures to reshape these environments, such as expanding the agendas of campaigns planned to take aim at reducing the consumption of salt, fat and sugar to also take aim at meat, thereby encouraging people to eat more plant-based whole foods and meat alternatives.

Another potential solution would be to extend some nations’ bans on promotions for unhealthy foods to cover meat products. Requiring food companies to report on the types of food they sell, including salty, fatty and sweet foods and the ratio of plant-based to animal proteins, would also help. These measures would encourage businesses to prioritize healthier, more sustainable options over less nutritious ones.

None of this is to suggest that the new generation of weight-loss drugs cannot benefit individuals living with obesity. For those trapped in a cycle of poor health, treatments such as Ozempic and Wegovy could even save lives, and efforts to make these treatments widely available are a welcome step.

But it is essential that we recognize that this approach merely interrupts one mechanism of obesity rather than eliminating the underlying pathology. Defusing the time bombs of ill health and environmental catastrophe requires fast, decisive action to remake our dysfunctional food system.

Emily Armistead is interim executive director of Madre Brava, a research and advocacy group.

Polio came for 5-year-old Lynn Lane when she was visiting her grandmother in rural Indiana. Suddenly, her arms and legs became weak, and by the time she got to a hospital in Indianapolis, she was totally paralyzed and in respiratory failure. Lane spent the next several months in an iron lung.

“I don’t really remember too much about that,” Lane, now 73, told me Monday from her home north of Sacramento. “The only memories I really have are mainly at night. You could hear the swooshing of all the iron lungs.”

Lane’s family moved to Northern California a few years after her bout with polio, when she was 8. “That’s when I started noticing I was different than other kids,” she said. “I was in leg braces and had to learn to walk all over again.”

Her parents took her to Shriners Hospital in San Francisco, where she lived on and off for the next eight years.

“It was kind of like a boarding school, except with surgeries,” Lane said. “They did all these muscle and tendon transfers. I think I had maybe 15 to 18 surgeries. They transferred my quads from the front to the back so I could stand.”

In her early 40s, Lane was diagnosed with post-polio syndrome, which afflicts between 25% and 40% of childhood polio survivors. It is similar to chronic fatigue syndrome and can range from mild to debilitating.

“I’m not in a wheelchair yet,” said Lane, who uses leg braces and crutches, “but it’s heading that way.”

The idea that anyone would question the polio vaccine now, she said, “makes me nuts.”

Last week, the New York Times reported that in 2022, Robert F. Kennedy Jr.’s attorney and close advisor Aaron Siri had petitioned the Food and Drug Administration to revoke approval of the polio vaccine in use for the last three decades until its safety can be studied further against an unvaccinated control group. Kennedy, President-elect Donald Trump’s pick for Health and Human Services secretary, is a longtime vaccine skeptic who spouts nonsense about the safety and efficacy of vaccines and a lot of other things. He is, in the view of many medical professionals, a danger to public health.

The Times’ report set off shock waves. Before Jonas Salk developed the first successful polio vaccine in the mid-1950s, the disease killed or paralyzed more than half a million people around the world each year. Many high-profile Americans who suffered from childhood polio, including Senate Republican leader Mitch McConnell and the actor Mia Farrow, immediately condemned the questioning of the vaccine. Kennedy and Trump were forced to reassure Americans that they support the lifesaving treatment.

As Kennedy met with Republican senators to shore up support for his nomination this week, he told reporters that he is “all for” the polio vaccine. Trump, in his first post-election press conference, insisted, “You’re not going to lose the polio vaccine. It’s not going to happen.”

And yet Trump also persisted in promulgating the oft-debunked lie that childhood vaccines are linked to autism, vowing to “look into” the conspiracy theory. Kennedy, he said, will “come back with a report as to what he thinks. We’re going to find out a lot.”

This fear-mongering is unconscionable. We already know a lot. In fact, we know more than a lot.

The autism question has “been studied to death in some ways,” said Richard Pan, a pediatrician and former California state senator who led the successful 2015 campaign to eliminate a “personal belief” exemption from vaccine requirements for the state’s schoolchildren.

“Do we know what causes autism? Not yet,” Pan said. But, he added, we do know what does not cause autism: the measles, mumps and rubella vaccine, which was implicated in a long-since-discredited 1998 paper based on 12 cases by the defrocked English physician Andrew Wakefield.

“What will it take to convince Trump and RFK Jr. that a retracted 12-subject study with fake data was actually wrong?” asked Pan.

In any case, he added, blaming the vaccine is an “ableist” response to autism by some parents. “They don’t want to accept that their child is neurodivergent,” Pan said. “You want to say your child is broken and my life has been ruined and it’s the fault of Big Pharma or whoever.”

People who do not vaccinate their children, he said, are risking the health of the very people they are supposed to protect.

“You are playing with your children’s lives,” he said. “All of these adults have already been vaccinated.”

Although polio has essentially been eradicated in the U.S., it still exists in parts of the world and could certainly make a comeback here if enough people refuse to vaccinate their children. In 2022, the Centers for Disease Control and Prevention reported that an unvaccinated New York man had contracted polio. And earlier this year, amid Israel’s war on Hamas, a 10-month-old child in Gaza contracted the virus, confirming fears about the war’s potential effect on preventable childhood disease.

As for the Kennedy advisor’s petition, Pan said, how could we withhold a potentially lifesaving treatment from children in a control group to test the efficacy of a vaccine that has been used successfully for decades?

“Sometimes a trial cannot be done safely or ethically, “ he said. “Are you willing to volunteer your child into the control group?”

Bluesky: @rabcarian.bsky.social. Threads: @rabcarian