Why Everything Feels Worse the Day After Drinking

Five minutes after the first drink, alcohol is already in your blood. It needs no digesting. Some of it passes straight through the stomach wall, which is why drinking on an empty stomach hits faster.

It is not a stimulant. It quietens the circuits that hold you back, which is why quiet people get loud.

The liver has one speed

Your liver clears roughly one drink an hour. Coffee, a cold shower, a walk and food do not change that.

The first thing the liver turns alcohol into is more toxic than the alcohol. That chemical is a large part of your hangover.

Same drink, different dose

Alcohol spreads through the water in your body. A smaller person, or a body with more fat and less water, reaches a higher level from the same glass.

Women also have less of the stomach enzyme that breaks alcohol down before it is absorbed. The same amount carries a higher risk, and not because anybody is weaker.

Age matters too. The share of your body that is water falls with age, so the same drink becomes a bigger dose. That is why a night costs more at 40 than at 25.

A blackout is not passing out

In a blackout the person is awake, talking and walking. Alcohol has switched off the part of the brain that writes new memories.

It is not forgetting. The recording was never made. It depends more on how fast the level rose than on the total.

The hangover is three things

• Dehydration. Alcohol blocks the hormone that tells your kidneys to hold water.
• The toxic breakdown product made by the liver.
• A night of sleep that was not really sleep.

Why you wake at 4 AM

You fall asleep faster after drinking. Then the second half of the night falls apart. You wake at four with a quick heart, as the sedative wears off and your nervous system rebounds.

The anxiety next day

Alcohol boosts the system that calms you, so the brain turns that system down. When the alcohol leaves, the dial is still down and you are running without brakes.

Your worries are the same size. You are just less able to put them away. It passes in a day.

Two dangerous combinations

• Paracetamol. It shares an overloaded pathway in the liver, so the gap between a normal dose and a harmful one narrows after a heavy night.
• Anything sedating, such as sleeping tablets, strong painkillers or some anxiety medicines. The effects multiply.

If you take any regular medicine, ask whoever prescribed it how it sits with alcohol.

Weeks, months and years

After four weekends, the liver has started to store fat, because processing alcohol takes priority over burning fat. It has almost no symptoms. At this stage it reverses completely within a few weeks without alcohol.

After six months, alcohol has thinned the lining of the gut, the immune system stays mildly switched on, and blood pressure sits a little higher every day.

After five years, memory formation is a little slower and new learning takes longer. Most of this improves with time away from alcohol.

Tolerance is not good news

Being able to drink more means the brain has turned down its own calming system. The baseline moved. You did not get tougher.

Damage to other organs follows the amount you drink, not how drunk you feel.

Do not stop suddenly if you drink heavily every day

For most people, stopping is uncomfortable for a few days and then better.

For people who drink heavily every day, stopping suddenly can be medically dangerous. It can cause seizures and can be fatal. It is preventable with supervision. Ask a doctor first.

Alcohol and cancer

Alcohol is a classified carcinogen. The chemical the liver makes first damages DNA directly, and the risk is real at levels most people think of as normal.

That is not a reason to panic. It is a reason to know what you are choosing.

Is red wine good for the heart?

That idea came from real studies in which light drinkers looked healthier than non-drinkers. But the non-drinking group included people who had stopped because they were already ill. When lifelong non-drinkers were separated out, most of the benefit disappeared.

A month off

It has been measured. Liver fat falls, blood pressure comes down, insulin handling improves and sleep recovers. Many people are still drinking less six months later.

The short answer

Almost all of this reverses early, and the earlier, the more completely. If the honest answer to how much you drink is one you would rather not say out loud, that is worth a conversation with a doctor. They have heard it before.