Once upon a time, a drink or two at a holiday party went down the hatch with no problems. Now, it's a recipe for misery the next morning.
Sound familiar? Dr. Monica Christmas of the University of Chicago Medicine says it's a common lament as people enter middle age.
"You are not alone," Christmas says. "I am in that age range too and absolutely, [drinks] need to be spread out or it's all going to go straight to my head and I will need to sleep half the day away the next day."
There are physiological explanations for why our ability to tolerate alcohol wanes with age. For one thing, studies show the liver enzymes that break down alcohol become less efficient.
"That means that our bodies metabolize alcohol a little bit differently," she says. "We also lose more muscle as we get older, and that muscle is replaced by fatty tissue."
That's important, because muscle stores water and that water dilutes alcohol in our blood, says Johannes Thrul, an alcohol and substance abuse researcher and associate professor at Johns Hopkins Bloomberg School of Public Health. He says having less muscle mass means alcohol will hang around in our bodies longer.
"What this means is that the same drink that previously maybe felt just fine now leads to a higher blood alcohol level," Thrul says. "You feel the effects for longer."
These changes happen to both men and women as they enter middle age. But for women in perimenopause, alcohol can exacerbate the symptoms that come with hormonal fluctuations — like mood swings and irritability, says Christmas, who directs the Menopause Program and Center for Women's Integrated Health at the University of Chicago.
"Alcohol already is known to be a depressant," she says. "It can all also increase baseline anxiety symptoms. Alcohol can disrupt sleep too. If you're already experiencing all of those symptoms, it's just that much more compounded."
While worse hangovers as you age might not seem like a good thing, think of it as your body nudging you in the right direction. Cutting back is a good idea, says Dr. Ken Koncilja, a geriatrician with the Cleveland Clinic, because the risks of drinking alcohol increase with age. That includes an increased risk of cancer, liver disease, worsened high blood pressure, memory problems and cognitive decline.
"Alcohol use can cause dementia," he says. It can also interfere with many medications and lead to balance problems and more falls.
Koncilja says he makes it a point to discuss the benefits of cutting back with his patients.
"These conversations about alcohol use — being proactive in people with people in their 50s and 60s — has a huge impact on their health and wellbeing when they're in their 80s and 90s," he says.
Johannes Thrul of Johns Hopkins says many people don't realize that alcohol is classified as a Group 1 carcinogen — in the same category as tobacco and asbestos. "Every drink you have essentially increases your cancer risk for multiple types of cancer," he says.
Thrul says while the healthiest option is to not drink at all, even small changes to cut back can offer health benefits. For example, during holiday parties, he says try alternating alcoholic drinks with mocktails or other non-alcoholic options. And make sure to drink plenty of water to help your body metabolize the alcohol you do imbibe.
"Why don't you just give it a try and see how it feels?" Thrul says. "Because you might be surprised how good it actually is when you sleep better, you have less anxiety the next day."
He says your body will thank you.
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