Health & Wellness
Drinking After 40: Why Hangovers Hit Harder
The Reasons Moderate Alcohol Consumption Gets More Complicated in Middle Age
By Andrea Petersen
Nov. 18, 2013 7:14 p.m. ET
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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.
Stephanie Draeken used to enjoy a glass or two of wine several nights a week. "I have four kids. I need my wine," says the stay-at-home mother in Austin, Texas. But since turning 40 nearly two years ago, Ms. Draeken says if she has even one glass of wine now she'll "wake up in the middle of the night with a horrible headache and the next day is like a college-style hangover without the college-style fun," she says.
She tried switching to higher-priced wine, then stuck with white wine. She tried champagne. "It didn't matter," she says. She says she now rarely drinks wine and limits herself to an occasional vodka and soda.
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. Photo: F. Martin Ramin for The Wall Street Journal.
"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."
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.
"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.
Stephanie Draeken used to enjoy a glass or two of wine several nights a week. "I have four kids. I need my wine," says the stay-at-home mother in Austin, Texas. But since turning 40 nearly two years ago, Ms. Draeken says if she has even one glass of wine now she'll "wake up in the middle of the night with a horrible headache and the next day is like a college-style hangover without the college-style fun," she says.
She tried switching to higher-priced wine, then stuck with white wine. She tried champagne. "It didn't matter," she says. She says she now rarely drinks wine and limits herself to an occasional vodka and soda.
Alcohol-drug interactions can become more of a problem, too, since older people are more likely to take medications. Alcohol and many medications are metabolized by the same enzymes in the liver, which can enhance the effects of alcohol or the medications. Heartburn drugs like Zantac interfere with the metabolism of alcohol, thus raising blood-alcohol levels. Acetaminophen (Tylenol) poses another problem because, combined with alcohol, it can damage the liver.
Mixing alcohol with blood thinners like Coumadin can be particularly dangerous, causing bleeding. "People on Coumadin shouldn't really drink at all," says Dr. Oslin. And taking alcohol with some pain medications and benzodiazepines (antianxiety drugs) can make you "more prone to sedation, more prone to cardiovascular risk and more prone to overdose," Dr. Oslin says.
People with certain medical conditions should also be cautious with alcohol, doctors say. Long-term alcohol use can raise blood pressure. And alcohol tends to irritate the stomach.
Barring health problems and medication interactions, doctors generally become concerned when people drink more than a moderate amount of alcohol. That is defined as up to two drinks per day for men and up to one drink per day for women, according to the latest federal Dietary Guidelines for Americans. (A standard drink is about 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor, according to the CDC.)
In fact, there's some evidence that a moderate amount of alcohol can have health benefits. Studies have linked moderate alcohol consumption with a reduced risk of cardiovascular problems and death overall. Excessive alcohol consumption increases the risks of liver disease, stroke, high blood pressure, certain types of cancer and dementia, beyond the obvious accidents and injuries.
Particularly beginning in the 50s and 60s, the brain is more sensitive to alcohol. Booze basically enhances normal age-related cognitive decline. Neurons lose speed. Specifically, the insulating myelin sheaths around the axons of neurons—the parts responsible for transmitting information to other neurons—get smaller. As people age, "neurons are not as efficient. So you impair them with a little bit of alcohol, they are that much more inefficient," says Dr. Oslin. "Somebody who goes to a cocktail party at 65 can have one or two drinks and be really impaired."
Older people are also more affected by alcohol's impact on sleep, a fact that can turn a mild hangover into a must-stay-in-bed-all-day affair. "Alcohol in all ages wrecks our REM sleep," says Alison A. Moore, professor of medicine and psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles. "Older adults are more likely to have poor sleep. [Alcohol] can make sleep even more fragmented."
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