Liz Hoggard asks the experts to assess the damage and share their tips for recovering from a big night faster - or avoiding a hangover in the first place.
I wake with a groan, remembering last night’s free-flowing champagne. The guests were lovely but the canapés were in short supply, and I’d rushed straight from work.
Today everything hurts. And the world seems much too loud.
The anatomy of a mid-life hangover doesn’t make for fun reading. Make that a whole weekend of partying at Christmas - and our poor body doesn’t know what’s hit it.
But why do we suffer more in mid-life? The irony is we drink less, and better, and pride ourselves on taking alcohol-free days. But that doesn’t save us from a weekend of binge drinking.
“You don’t go out to get drunk in the way people do when they’re younger. You want to relax and enjoy nice alcohol. And that can be done to a moderate level without any obvious physiological effect - i.e. drunkenness - but you’re still going to screw your sleep, absolutely burden your liver and impact your gut microbiome,” clinical nutritional therapist Stephanie Moore tells me bluntly.
Moore is no killjoy. She relishes her red wine - but the reason she drinks in moderation is because she understands the science.
It seems hard to believe as we pour that delicious glass of pinot, but alcohol is totally toxic – so every time you drink, your body has to work to get rid of it from your system.
“Let’s put it this way. If you were to discover ethanol [alcohol] today, and think, ‘Wow, this is a wonderful food additive to put in a trifle, and you put it through the food safety testing requirements, the maximum recommended limit would be a single glass of wine per year,” says Professor David Nutt, director of the Neuropsychopharmacology Unit in the Division of Brain Sciences, Imperial College London.
He’s no prohibitionist either - he enjoys a “very small” malt whisky and co-owns a wine shop. But he stresses we need to learn how to use alcohol more safely. “It’s definitely more toxic than cannabis or MDMA.”
Once alcohol does leave your bloodstream, blood vessels - which constrict when you get drunk, raising blood pressure - return to normal. But alcohol will still remain in your body as it travels from the bloodstream to the digestive system, placing the burden on your poor old liver.
And mid-life tipplers suffer more, explains Dr Megan Rossi, a research fellow at King’s College London and an expert on the gut microbiome. An enzyme called alcohol dehydrogenase (ADH) helps break down alcohol in the liver, making it possible to eliminate it from the body. But from age 50, we lose ADH. “It gets less effective at its job. And therefore more of the aldehyde, which can be toxic, lingers in the body. And that’s when people get more nausea symptoms and headaches.”
While the liver is heroically processing alcohol, it shuts up shop. Only when it has filtered alcohol from the blood can it return to its other functions, including digestion and metabolising vitamins and minerals.
It takes the average adult liver an hour to break down one unit of alcohol (10ml), which sounds reassuring. But multiple drinks slow how quickly your body can metabolise ethanol and pass it, and it can take up to 12 hours to completely leave your bloodstream.
But this - dear friends - is the 12-hour mark when the hangover proper sets in, as the feel-good brain hormone dopamine plummets and we’re filled with self-loathing.
“As we age our body mass changes, our muscle mass changes over time and that has an impact on what speed alcohol is processed through your system,” says Karen Tyrell, Drinkaware’s chief executive officer. “Older drinkers are often on medication, and the way it interacts with the way they’re drinking isn’t talked about enough.”
It can take 72 hours for brain and body to return to equilibrium. But the good news is there are ways of recovering faster. Or avoiding a hangover in the first place. Here we ask the experts to assess the party damage - and offer solutions.
Brain inflammation
Alcohol can cause initial feelings of relaxation - the so-called liquid confidence which makes us warmer and more flirtatious, but what’s actually happening is alcohol is suppressing activity in parts of the brain associated with inhibition. Even after you’ve stopped drinking, your brain and central nervous system are still affected while they process the alcohol.
“We see neuro-inflammation,” says Moore. “The brain is coated with an incredibly sophisticated blood-brain barrier, which decides what to allow into the brain that’s safe, and sieves out what’s not allowed. And so imagine a sieve that has tears in it, and chunky stuff that shouldn’t be getting through into the brain now can.”
Impaired cognitive skills
“It’s not just that it’s slowly pickling your brain, but people’s judgments tend to get disorganised when drunk,” says Nutt. “So it’s a question of whether you run the risk of doing really stupid things like falling over or getting mugged. Alcohol damps down your ability to stick to the rules.”
The dodgy belly
According to Rossi, alcohol makes our gut lining a little bit more leaky or permeable, “which means things that normally can’t get into our blood system from our gut start to move in, causing low-grade inflammation in the body, which makes us feel unwell”.
You might suffer stomach pain, constipation and high stomach acid for 72 hours. “It’s a sign your digestive tract is inflamed and overactive,” says Moore, “and that you’ve almost definitely killed off some of your healthy microbes.”
You might find you’re dashing to the loo. “Alcohol influences the motility in the oesophagus, stomach and small bowel. Plus that leaky gut can lead to low-level inflammation, which means that your gut muscles don’t coordinate as effectively and everything becomes a bit loose,” Rossi says. “That’s also why people get reflux.”
The pounding headache
“When toxins and nasty stuff that should stay in the gut leak into the bloodstream, you’ve got toxic blood, so to speak, and that is what causes you to feel very headachy, very delicate,” says Moore. “Your whole body can ache because the inflammation is systemic. It isn’t just in the liver and the gut, now it’s circulating around the body.”
Wrecked sleep
“Delta sleep, particularly as we age because we’re having less of it, is critical for our long-term neurological health because that’s where our brain mends,” says Moore. “In order to get that deep cleaning, the body has to be cold enough. And while the liver, a huge organism, is processing alcohol, it generates a lot of heat, which stops your body cooling down.”
Carb cravings
“Alcohol stops us fat-burning at night,” explains Moore. “The body’s priority is to break down that ethanol, so while the liver is prioritising that as an absolute must, it can’t do many of its other jobs around detoxification and turning body fat into ready fuel (one of the liver’s jobs at night).
“We are very metabolically active at night, there are lots of jobs to be done that require fuel. So that leads to people waking up at 3am because their blood sugar has crashed. They’re getting an adrenaline surge, their heart’s pounding. And when they wake up ravenous, they just want that carb hit.”
Anxiety and depression
At the party you may feel on top of the world, but the more you drink in a session, the more you’ll experience feelings of tension and anxiety later because of the effects on our brain chemicals.
“The effects of alcohol are generally considered to be biphasic,” says Dr Craig Gunn, a lecturer at the School of Psychological Sciences at the University of Bristol. “At low to moderate blood alcohol concentrations, people may experience a stimulant-like effect where they have increased sociability, relaxation, and a sense of euphoria. However, as blood alcohol concentration increases, it acts as a depressant.
“Dopamine is often lower during a hangover. This may contribute to a negative mood and some of the negative effects on our thought processes.”
What you can do to protect yourself
Eat beans on toast
The morning before a party, Rossi eats high-fibre foods (legumes, quinoa, wholegrain bread, nuts, seeds) to strengthen the gut lining. Next morning to beg gut forgiveness, she’ll fibre-load with baked beans: “The saltiness rehydrates in terms of making you drink more water and the legumes are like a good fertiliser for the gut bacteria.”
“Have a fatty protein-y snack before you go out,” says Moore, “because that stays in the stomach for a nice long time and gives the alcohol a sort of bed. A chunk of cheese or a handful of peanuts, which are way better than crisps because they’ve got fat, protein and fibre. Something rich in your stomach not only slows how quickly alcohol is absorbed into your bloodstream, but reduces how much is absorbed.”
Go for darker drinks
Rossi recommends red wine and dark beers that contain polyphenols (plant chemicals that feed our good gut bacteria, which help us fight infections).
Moore opts for a good tequila.
“Serve light beer, or Campari, something that’s long, but not too strong,” says Nutt.
Avoid bubbles to spare your liver
“Champagne and Prosecco make you drunk faster because bubbles increase the speed of the alcohol absorption in our gut,” says Rossi. “And the higher our blood alcohol at any one point, the worse the hangover, because we drink faster than our liver can actually metabolise it.”
“Champagne is problematic,” says Nutt, “because it actually gets into the body faster, so you get that peak of drunkenness. And once you start getting disinhibited with Champagne, then what’s to stop you doing all the other things you want to do, because you’re already on that slippery slope.
“That’s why alcohol is such a challenging drug. Because if it dampens down your ability to stick to the rules, and of course, that’s why a lot of us drink - just to be liberated from the worries and the stresses of work.”
Start drinking later
Never serve anything before the meal - no aperitifs or Champagne, says Professor Nutt. “Don’t give people alcohol until after the meal if you can. Then afterwards, when you’re sitting back, savour your wine with the mince pie because we know fatty food slows down stomach emptying, and that slows down the uptake of alcohol, so that reduces the likelihood of getting drunk fast.”
Take milk thistle
“Milk thistle is very supportive of these phases of ethanol detoxification in the liver. So take a bit with water before your big night out, or leave it on your bedside,” advises Moore.
Avoid sugary mixers
“Any tonic or mixer has high fructose corn syrup (brewed fruit sugar),” says Moore. “Instead, go for vodka with soda and lime. Or a superior gin ... which is so aromatic you only need ice and a slug of tonic. You also sip slower. Bland alcohol is easy to overconsume.”
Don’t take Paracetamol without food
“Paracetamol or any of these non-steroidal medications can actually cause an irritated stomach,” warns Rossi. “That’s why the recommendation is always to have them with food. If you can’t have both, don’t take non-steroidals because they will increase your risk of stomach ulcers.”
Have four days off
“If you are going out to party, for goodness sake give yourself two or three days, ideally four, before you go at it again, because then your body has half a chance to mend,” says Moore. “The gut lining replenishes every two to three days, so if you have damaged it, you’re giving it a chance to reboot.”
Pimp up the soft drinks
“Any office party should offer kombucha or a water kefir as a non-alcoholic option, or for mixing with spirits because they’re actually good for you,” says Moore.
Professor Nutt has invented a very clever zero-alcohol botanical spirit, Sentia, that closely mimics the “conviviality” effects of alcohol, so we can have fun without regret. “Alcohol works on the frontal part of the brain to relax you, and the chemical transmission in that part of the brain is through a system called GABA (the inhibitory neurotransmitter Gamma-aminobutyric acid). So if you target GABA, you can give people that first-drink effect, which takes away stress and tension.”
And the good news?
“To be honest, if you don’t drink more than the recommended limit, or don’t drink that in one go, the harms of alcohol are relatively small,” says Nutt. “Loneliness takes years off your life and if there’s anything we can do to minimise that, we should do it.”
“There is zero benefit to drinking alcohol from a physiological point of view, because it is gut, liver and brain toxic,” says Moore. “However, there seems to be a benefit because of the pleasure. And so teetotallers tend to come out less well, compared to moderate alcohol drinkers. And the only reason for that must be the sociability, the coming together, and that’s a valid gain.”
Calories in alcohol
Pint of 4% beer: 182 kcal; 2.3 units of alcohol
Pint of 4.5% cider: 216 kcal; 2.6 units
125ml glass of 12% champagne: 89 kcal; 1.5 units
175ml glass of 13% wine: 159 kcal; 2.3 units
330ml bottle of beer: 159 kcal; 2.3 units
25ml measure of 40% spirit: 61kcal; 1 unit
- If you want to run your own drinking check, take this survey at www.drinkaware.co.uk