As we get older, our tolerance to alcohol decreases. Photo / Getty Images
Jittery mood, thumping head and a feeling of unease... Recovering from a big night gets harder as we age, so what can we do about it?
Until the age of 32, my ability to bounce back after consuming large quantities of alcohol was like that of most other young adults. At its worst, the general malaise could be soothed within a few hours with the help of a lengthy nap, water and a decent meal.
Then something changed. Now 36, I’ve become increasingly wary of the consequences of a big night, which can linger in various ways for multiple days. After one wedding last year, where I admittedly got stuck into the ample cocktails and espresso martinis with a little too much vigour, the resulting stomach jitters, anxiety and the general sense of my insides corroding away lingered for at least 48 hours. In all honesty, I didn’t feel right for a week.
But of course, I’m not alone. As many people in their thirties, forties and beyond can testify, the misery of what’s been dubbed “the two-day hangover” is very much real.
In fact, in some cases, two days can be a walk in the park. The longest ever verified hangover, detailed in medical journal The Lancet, lasted more than a month and was endured by a 37-year-old man from Glasgow who reported more than four weeks of blurred vision and persistent dull headache after embarking on a drinking spree which saw him consume 60 pints of beer in four days.
Apart from this, there has been little in the way of hard science investigating multi-day hangovers. According to Ann-Kathrin Stock, a neuroscientist at Dresden University of Technology, who has studied hangovers for the past decade, existing research has typically shown that most hangovers peak somewhere between 17 and 19 hours after drinking. However, this may be influenced by the fact that almost all clinical studies on the topic are carried out in young people.
“The majority of hangover research has been carried out in university students,” says Stock. “We have very little data in older individuals.”
However, there are a number of theories for why the two-day hangover becomes progressively more of a threat over time. Genetics can play a role, but most of them relate to how well we’re ageing, and how that affects our body’s ability to process alcohol.
The Dutch professor Joris Verster, who runs an international Alcohol Hangover Research Group from Utrecht University in the Netherlands, has done arguably more than anyone else on the planet to shape our knowledge of hangovers. Verster’s studies have revealed that while hangovers are a universal human experience, they are also far more complex and varied than we might initially think.
My own hangover symptoms usually comprise the standard head throbbing and thirst, but also concentration issues and persistent hot flushes. But in total, Verster has identified 47 possible characteristics of a severe hangover which can range from apathy to impulsive urges, shivering, sensitivity to noise and light, and even suicidal thoughts.
While alcohol tolerance is typically a point of pride for many men, Verster’s studies have comprehensively ruled out any connection between hangover severity and mood, mental resilience or mindset. Instead, it seems that the length of your hangover is more related to other factors such as how much exercise you do, how well you’re typically sleeping and your underlying biology.
According to Sam Royle, a hangover researcher at the University of Salford, hangover symptoms are primarily driven by the immune system’s response to the influx of alcohol, and the inflammatory molecules which are subsequently released, making you feel sickly. “As we get older, our immune system becomes less effective, and we become more sensitive to inflammation, which could explain more severe and longer-duration hangover symptoms,” says Royle.
Stock points out that because of this connection, hangovers may be worse in people whose immune system is ageing faster. In particular, people who already have underlying chronic inflammation in their bodies, autoimmune conditions such as allergies and asthma, or inflammatory-related diseases will cope less well with alcohol. “You might end up with a rather large inflammatory response to smaller amounts of alcohol and take longer to dissipate that inflammation back down to normal, potentially lengthening and worsening the hangover,” says Stock.
Another explanation for why hangovers may start developing into multi-day events in your thirties, forties and beyond is that your liver function progressively declines over time. Royle explains that the liver uses two enzymes – alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) – to metabolise booze, and as we get older they become less efficient. “This leads to slower alcohol metabolism and thus an increased duration of exposure that is likely to elevate the inflammation associated with drinking,” he says.
There are also additional factors which drive lengthy hangovers. Stock points out that because alcohol disrupts your sleep architecture, shortening sleep and worsening sleep quality, people who already sleep poorly will find it harder to recover from heavy drinking episodes. Not only that, but after the age of 35, the majority of people start to lose muscle mass, which has a surprising impact on our ability to process alcohol.
Royle explains that this is because the loss of muscle means our bodies are less able to dilute alcohol and mitigate its effects. “It may lead to higher blood alcohol concentrations which are associated with worse hangovers,” he says.
For me, one of the most frustrating impacts of a multi-day hangover has been the impact on my concentration and productivity at work. Following the aforementioned wedding last year, I felt I was thinking and writing at half-speed.
Royle explains that if you have higher existing levels of inflammation in your body, you’re going to be more vulnerable to the cognitive effects of a hangover, affecting everything from your mind to your reaction times. “This may include reduced memory, attention and motor performance,” he says. Because chronic inflammation is a major driver of neurodegeneration, experiencing lengthy hangovers on a regular basis could even drive cognitive decline.
Some people are certainly more vulnerable to adverse health consequences than others. Alcohol is initially metabolised into a carcinogenic toxin called acetaldehyde, which the ALDH enzymes clear from the body. But some people, especially those of East Asian ancestry, have a genetic defect which impairs this capability, causing them to experience facial flushing and feeling violently ill after even small doses of alcohol. Stock says that it is recommended that those people stop drinking alcohol altogether.
Royle also points out that severe hangovers could reflect that you’re simply drinking too much and inflicting unnecessary excess stress on your body. “While we enjoy it, alcohol is a toxin which, when consumed in large amounts, causes a form of damage to your cells known as oxidative stress,” says Stock. “Brain cells are thought to be especially vulnerable to alcohol-induced oxidative stress which is one of several reasons why chronic alcoholism can lead to cognitive decline.”
There’s an additional possibility if you’re drinking regularly, and typically experiencing severe hangovers, it could actually be alcohol withdrawal.
Royle says that one of the key distinctions between hangover and withdrawal is the length of the symptoms. “Hangover is a more transient state whereas withdrawal tends to have a longer timeline, potentially over a week for more severe cases,” he says.
While the symptoms of withdrawal tend to overlap with those of a hangover, they are generally also significantly more severe, including pronounced tremors, sweating and abnormalities in heartbeat as well as anxiety, agitation, confusion and even seizures or hallucinations. “If you’re experiencing really bad symptoms after drinking, I’d advise speaking with a medical professional,” says Royle. “Alcohol withdrawal can be dangerous and even life-threatening.”
While there are plenty of supplements which claim to be hangover remedies being sold online, Verster’s research group has found that the evidence for them is distinctly dubious. In one study of 82 products, typically various cocktails of vitamins and herbal ingredients, Verster and colleagues found no conclusive evidence that any of them were both safe and effective in treating all hangover symptoms.
Instead, the best advice for now is simply rest and water. “Eat healthy meals if you can, do some light activity like going for a walk, and perhaps take an afternoon nap,” says Stock. “And drink plenty of water. If you drink a lot of alcohol, you tend to lose a bit more water via your kidneys and it’s that dehydration which can cause thirstiness but also contribute to hangover-related headaches in some cases.”
According to Stock, the best way in which myself and others can reduce risk of a two-day hangover is through lifestyle changes, such as a regular workout routine, more regular sleeping patterns and lowering inflammation in the body by taking steps to try and manage sources of chronic stress.
There are also some encouraging signs in the hangover prevention field. In particular, a pill developed by Swedish company Myrkl, which contains a mixture of fermented rice bran, a probiotic, vitamin B12 and the protein L-Cysteine, has attracted attention for its claims to reduce hangover symptoms by breaking down the majority of the alcohol you consume in the gut before it reaches the liver.
While researchers like Stock say that there is a need for more scientific studies to substantiate the claims, I have tried Myrkl on a few occasions with mixed results. The first time was at a music festival where I drank a lot of alcohol, but spread over a 12-hour period, and it seemed to work wonders. But at weddings, where the boozing has been more intensely concentrated over a few hours, I’ve still woken up the following day feeling awful.
Interestingly, when Myrkl carried out a study demonstrating the benefits of their pill in 24 men and women in their 20s, the participants were asked to take two capsules a day for a week prior to a drinking episode. Next time I have a big upcoming event like a work party or wedding, I may try this strategy.
Even more promisingly, a New York-based company called Sen-Jam Pharmaceuticals is currently carrying out clinical trials of a product called SJP-001, which aims to prevent the inflammatory reaction which is thought to be the main basis of hangovers through a combination of the antihistamine fexofenadine and a non-steroidal anti-inflammatory medicine called naproxen. A pilot study has previously shown that SJP-001 can reduce hangover symptoms such as thirst, headache, dizziness and nausea.
Royle believes it is possible that a medical-grade hangover prevention and treatment therapeutic will become available in the coming years, although he cautions that it is unlikely to have a complete panacea for all hangover symptoms.
“Some of the interventions being studied may reduce the presence or severity of some symptoms, but they may not be effective in treating others,” he says. “While immune responses and inflammation are a primary cause of hangovers, this isn’t the only thing going on.”
It’s certainly a field that I’ll be keeping a close eye on. In the meantime, my worsening hangover symptoms have certainly served as a useful biological signal, my body’s not-so-subtle hints that it’s time to start cutting down.