The science of the midlife hangover… and how to deal with it

UK Prime Minister Boris Johnson holding up a pint last week to celebrate the easing of coronavirus restrictions across the country. Photo / AP

On April 12, with snow still falling in many parts of the UK, pub gardens reopened and the nation's drinkers took full advantage, with sales of alcohol in pubs, bars and restaurants leaping by 113.8 per cent compared with the same day in 2019. Soon, on May 17, drinkers will be able to venture inside pubs, too, and that can only mean one thing – the return of the hangover.

A new study, conducted by academics from Utrecht University's Institute for Pharmaceutical Sciences in the Netherlands, has found that the severity of hangovers, as well as the frequency, actually declines with age, with research showing that those in the 18-25 age group experienced, on average, 2.2 hangovers per month, while those in the 56-65 bracket had just 0.3, falling to a mere 0.1 by the time they reached the age of 66.

The issue, of course, is what to do when you are in the sweaty hell of your 0.3 of a hangover and all of the attendant unpleasantness that accompanies it: nausea, irritability, dehydration, headaches, vomiting – it makes you wonder why we bother drinking in the first place.

"Alcohol is the most commonly used drug in the world but we still don't really understand all the effects it has," says neurologist Dr John Janssen. "What makes it interesting, however, is that relative to other drugs, the dose we tend to consume is simply enormous."

And that can take its toll, especially on the ageing brain.

"The brain is much like the skin," adds Janssen. "A baby's skin is soft and perfect but as it ages it becomes a bit tougher, and then, as you get older, it becomes wrinkly and less elastic and slower to heal. It's the same with the brain, which becomes less efficient with age, with less reliable connections and slower performance. Not surprisingly, alcohol will only serve to make that performance even worse."

As with any other drugs acting on the brain, alcohol's effects, in terms of hangovers, can vary hugely. Some drinkers will deal it with by simply lying in bed and sleeping it off, while the less fortunate will present the full gamut of symptoms.

Dr Sally Adams, assistant professor in health psychology at the University of Bath and a specialist in the psychopharmacology of alcohol, believes that our expectations can also influence our experience of a hangover.

"If we expect to feel terrible," she says, "we may spend the day on the sofa, feeling sorry for ourselves."

That said, Adams also believes the single most important factor in determining how a person feels the day after drinking, especially in terms of mood and cognition, is the amount of alcohol they have consumed – nothing more, nothing less.

"During hangover, we produce a toxic substance – acetaldehyde – created when our body is metabolising alcohol," she adds. "Not only is this responsible for the vomiting, nausea and heart-racing during your hangover, it can also interact with neurotransmitters in the brain pathways involved in mood and cognition. So if age influences metabolism of alcohol, then we might expect poorer cognition in older drinkers during hangovers."

On April 12, UK pub gardens reopened. Soon, on May 17, drinkers will be able to venture inside pubs, too. Photo / AP

Acetaldehyde is the villain of the piece when it comes to hangovers, a byproduct of your liver oxidising the alcohol in your system. The bad news is that acetaldehyde is carcinogenic and can cause tissue and cell damage, too. The good news, however, is that it doesn't really stick around in the body for that long, its exit being aided by acetate – which is toxic, too.

If you are finding that the day after the night before is getting more unbearable as you get older, don't be surprised. By the time you hit middle age, you are in a markedly different place – physically, mentally and even professionally – than you were in the drink-till-dawn days of your 20s. For one, you are more likely to have a higher percentage of body fat than you did when you were younger and, as fat can't absorb alcohol, your tolerance to it will decrease. You are also going to have less water in your body, increasing the chance of dehydration and allowing the alcohol to stay in your system for longer, wreaking its havoc.

Sleep also plays a major part, as Janssen explains.

"Sleep issues are commonplace among the middle-aged," he says. "We tend to drink socially at the end of the day, and if you then go to bed and you're already experiencing disturbed sleep patterns, alcohol disrupts it still further. Inevitably, it's going to have an impact the following day."

It's not just the physical manifestation of over-indulgence that gets worse as you hit middle-age. Heavy drinking followed by the inevitable hangover can affect everything from your memory to your attention levels and your co-ordination.

And then there is so-called "hangxiety", that unshakeable fug of gloominess and sometimes dread that takes over your every waking thought. It's not simply the fear of what you might have done or said as you knocked them back the night before, but those booze-induced worries about everything else that's going in your life, be that work or relationships, money or your kids.

"In middle age, there are often other issues in play, such as stress at work, with all the pressures and responsibilities that brings, and they can lead to irregular eating and poor sleep," says Janssen. "Add alcohol to that mix, and it's easy to see how people in midlife can begin to really suffer the day after drinking."

UK revellers outside a pub in Soho, London, on the day some of England's third coronavirus lockdown restrictions were eased. Photo / AP

You might also be one of the unlucky people who are simply more predisposed to hangovers than others.

"It's thought that the headache component of a hangover is actually migrainous, and it's often the case that those that do suffer with severe headaches or migraines can also be incredibly sensitive to alcohol, to the point where even a sniff of it can induce one," adds Janssen.

But prevention is better than cure, and eating is key, as Harley Street nutritionist Lily Soutter explains. "A balanced meal containing all key food groups prior to drinking is essential to slow the release of alcohol into the bloodstream," she says. "It also helps to protect your stomach lining."

Your choice of drink can also have an impact. Avoid brown spirits, wine and anything mixed with energy drinks, and opt instead for vodka or gin, with a low-sugar mixer such as soda water and a squeeze of lemon or lime.

"Clear spirits also contain lower levels of congeners, which can increase the intensity of any hangover," says Soutter.

If you do succumb to temptation and awake the following morning (or afternoon) feeling as though you want the world to end, then reach for the water (at least two litres over the course of the day) and, tempting though it may be to go for something fried and greasy, try and have some slow-release carbohydrates such as eggs on wholegrain toast, pasta, rice, or sweet potatoes with their skins on. "A good breakfast to keep blood sugar stable is also important to supply a steady release of glucose to the body and brain," she says.

The best cure by far, however, is simply not drinking as much the night before. That said, you could always take the advice of the late Lemmy, the legendary carouser from the heavy metal group Motörhead. "To get hangovers," he once said, "you have to stop drinking."