Drinking After 40: Why Hangovers Hit Harder

Wednesday, 20 November, 2013
Andrea Petersen, The Wall Street Journal
Why is it so much harder in your 40s to bounce back from a night of drinking than it was in your 30s or 20s? What happened? Andrea Petersen has answers on Lunch Break.
When you're in your 40s, it's pretty common to need reading glasses. You might need smaller wine glasses, too.

That's because alcohol hits people harder in their 40s and 50s than it did during their 20s and 30s. The reasons for this include changes in body composition to brain sensitivity and liver functioning. Lifestyle factors are at play, too. And since people tend to take more medications—both prescription and over-the-counter—as they age, there are more chances for uncomfortable and even dangerous booze-drug mixing.

"All of the effects of alcohol are sort of amplified with age," says David W. Oslin, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. "Withdrawal is a little bit more complicated. Hangovers are a little bit more complicated."

Part of the issue is that people in their 40s and older simply tend not to drink as much or as often as those in their 20s and 30s, which lowers tolerance. "You're becoming more work-oriented, more family-oriented," says Robert Pandina, director of the Center of Alcohol Studies at Rutgers University.

So when you do drink "you might have a more sensitive response to alcohol because you've lowered your exposure to alcohol over all."

Some people swear that only certain types of alcohol—red wine, tequila—are a problem. Generally, doctors say there's little science indicating that some drinks make people drunker or lead to more miserable hangovers. It is true, however, that people at any age can develop sensitivities to sulfites and tannins in wine, which can cause headaches and an upset stomach, Dr. Pandina says. And the carbonation in sparkling wines or even in mixed drinks like whiskey and Coke "seems to increase how rapidly alcohol is absorbed," says Reid Blackwelder, president of the American Academy of Family Physicians and a practicing family doctor in Kingsport, Tenn.

About 52% of people age 45 to 64 are "regular" drinkers, meaning they had at least 12 drinks in the previous year, according to the Centers for Disease Control and Prevention's 2011 National Health Interview Survey.

Body composition starts to change as early as the 30s. As people age, they tend to lose muscle mass, while fat content increases. Alcohol isn't distributed in fat. People also have less total body water as they get older. So if several people have the same amount to drink, those with more fat and less muscle and body water will have more alcohol circulating in their bloodstream. (This is also partly why women of any age tend to feel alcohol's effects more than men.)

"A lot of older people are borderline dehydrated. They have less body water just from the natural effects of aging," Dr. Blackwelder says. It helps to drink water and have a full stomach when knocking one back.

The majority of alcohol is metabolized by the liver, which changes when people hit their 50s. (A small amount is metabolized in the stomach and mouth.) The liver gets bigger as people get older, but the organ becomes less efficient. Blood flow decreases, as do the number of hepatocytes, the liver's functional cells, says Gary Murray, acting director of the Division of Metabolism and Health Effects at the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health.

Certain enzyme levels dip, too, including one type of the enzyme alcohol dehydrogenase, which breaks down alcohol. Women of all ages tend to have lower levels of this enzyme in the stomach. But between the ages of 50 and 60, men see their levels slide, too. All these changes mean "you have a prolonged exposure to alcohol and possibly a little bit bigger buzz," when you drink, Dr. Murray says. There's also some evidence that hormonal changes around menopause can increase women's sensitivity to alcohol. Healthy young people tend to metabolize about one drink per hour, Dr. Murray says.

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