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October 25, 2017

Why do hangovers get worse with age?

'Infrequently Asked Questions' has the answer

Nothing puts a blemish on an otherwise fine day like a pulsating wine headache or a post-tequila-binge bout with nausea. 

And sadly, those blemishes only get bigger as we age and those hangovers worsen. What's happening in the body that makes the intensity so much worse over time? 

Curious, we reached out to Dr. John Liantonio, assistant professor of medicine with Jefferson Health's Department of Family and Community Medicine. 

For starters, what is a hangover? Boiling it down to the nitty-gritty. 

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The truth of the matter is doctors don't know much about what causes hangovers. There are lots of theories on what may be contributing but there is not a great scientific formula. Dehydration is certainly one key player in hangovers. By its nature, alcohol is a diuretic and can cause you to lose lots of water throughout the course of a night of drinking. Alcohol also can irritate your GI tract, causing you to feel nauseous and may induce vomiting the night of or the morning after. Alcohol also reduces the amount of REM sleep, which is the period of sleep during which your body gets the most rest. Bottom line is, there are lots of factors, just no perfect formula to recreate the perfect hangover.

Why do hangovers seem to intensify so greatly as we age? And why so abruptly? The difference just from 21 to 25 feels enormous. 

As we get older, the ability to metabolize anything from alcohol to carbohydrates changes. (Think: the metabolism of a 22-year-old is not that of a 42-year-old.) Our bodies certainly become more sensitive to alcohol with age; as the mass of our liver decreases with age, the enzymes that metabolize alcohol reduce in effectiveness and often blood flow to the liver may be reduced.

Is there an age in which the severity of a hangover hits a brick wall and doesn't really get any worse?

There is no specific cut-off point for any of these changes.   

What are some common factors that play into how hard we're hit by a hangover?

I think one of the things that effect our ability to tolerate alcohol is the condition that we start out drinking with. If we are poorly hydrated, have an empty stomach and haven't gotten a good night's sleep in a week, odds are you're set up for a rough morning. And while this may seem like common sense, the amount of alcohol you ingest on any given night will certainly play a role here.

What ingredients should we keep out of our drinks if we're looking to feel better next-day? 

Interestingly, during the fermentation process, not only are the desired alcohol products of ethanol produced but other alcohols including methanol and acetaldehyde. These byproducts are called congeners. The amount of and the types of congeners that are found in any given beverage often determine taste and smell of different alcohols. The theory has it that these may be the main culprits in causing hangovers.  Studies have been done comparing whiskey vs. vodka hangovers. In a very old study, whiskey was found to have the worse hangover and is also the alcohol of the two with the largest amount of congeners. Scientists in that study shared that whiskey and red wine have higher amounts of congeners and also higher amounts of hangovers in their users compared to gin and vodka drinkers.

Anything to add? Something new we've learned about alcohol? 

Bottom line, a hangover here and there is to be expected from intermittent social drinking. Being sure never to drive--we are in the age of Uber--and to surround yourself with reliable drinking buddies will certainly keep you safe. The bigger thing that worries me is long-term hard alcohol use. Long-term alcohol abuse can increase your risk of heart disease, stroke and even some types of cancers. If you or someone you know suffers from alcohol abuse, reach out to your local family physician or to a local AA group for help.