Why Do Hangovers Start Hurting Way Worse in Our 20s?

There was a time in my teenage years when I was invincible. I could dance and drink until the clubs shut, then roll into an 8 AM class and feel fine. But then I got older and along came hangovers. Over time what started off as a mild headache and nausea evolved into something much worse. These days even a tame night leaves me feeling like I've been beaten with a medicine ball.

So why do hangovers get worse with age? Before we try answer this question, it's important to understand how alcohol leads to hangovers in the first place.

Alcohol has a lot of different effects on the body, and several of these play a role in causing hangovers—although many of them still remain poorly understood. Alcohol has been shown to dilate brain blood vessels and suppress the release of antidiuretic hormone, leading to throbbing headaches and dehydration respectively. It also irritates the stomach lining, which causes nausea, vomiting, and increases the levels of inflammatory mediators prostaglandin E2 and thromboxane B2. These are chemicals known to cause nausea, diarrhea, and again, headaches.

That explains why you feel like death, but alcohol also inhibits the production of glutamine, a natural stimulant, which is why you feel so tired. But why does all this get worse as we age?

As an ex-chemist, the hangover contributor that interests me most isn't the direct impacts of alcohol, but how the body breaks it down. In the process to rid the body of alcohol, the liver first breaks alcohol down into something called acetaldehyde. This is where we get into trouble, as acetaldehyde is 10-30 times more toxic than alcohol and a known carcinogen. If only a small amount of alcohol is consumed, the liver quickly breaks acetaldehyde down into harmless acetate. But because the body can only process only a fixed amount of acetaldehyde every hour, drinking excessively leads to a backlog, which means cell and tissue damage and the associated effects of a hangover.

The theory—and it's not proven—is that as we age, the liver becomes less efficient: the number of liver cells decreases and blood flow to the organ reduces. This means that when we drink alcohol the liver quickly accumulates acetaldehyde, and wreaks havoc on the body.

Age also diminishes the body's capacity to make antioxidants to cope with the toxic effects of alcohol. This coupled with the phenomenon of immunosenescence (the gradual weakening of our immune systems as we age), means that our bodies cannot heal the inflammation and damage caused by alcohol as it once could.

As we age, other factors also begin to play an increasing role. Older adults are likely to not sleep as well due to a decreased production of the sleep hormone melatonin, and this can be exacerbated by alcohol. The body's composition also changes as we age, leading to decreased muscle mass and total body water and an increase in fat deposition. Alcohol is less likely to be distributed in fat compared to muscle (as you know, oil and water don't mix), which coupled with decreased water in our blood vessels means a higher blood alcohol concentration. Finally, as we get older the desire to binge subsides. This means when do drink; we're not as tolerant.

So what can we do to reduce hangovers? Many so-called "cures" have been discussed over the years, including this thing about drinking pear juice before hitting the booze coming from Australia's own CSIRO. Unfortunately, many of these cures are either in the preliminary stages of research (such as the pears discussed above), or are complete garbage. In fact, in 2005 the British Medical Journal published a systematic review of randomised control trials examining whether many potential hangover cures (including propanalol, tropisetron, tolfenamic acid, fructose, glucose, borage, artichoke, prickly pear, and yeast based preparations) had any benefit. The result: not one did.

So where does this leave the not-so-young who want to get drunk? Well, not drinking on an empty stomach and drinking water between drinks and before bed are good places to start. But until a miracle cure is discovered, the only way to stop that killer hangover is to just not.

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