Why Alcohol Affects You More As You Age

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It was March 2020, the early days of the pandemic. When uncertainty about, well, everything, was too much to bear, I found solace in a glass of wine. My husband and I took our weekend wine-and-cheese tradition and made it an everyday event. We started skipping the cheese, and one glass would morph into two, and sometimes into a bottle. Soon, I found myself drinking almost every day.

I wasn’t alone. A RAND corporation study found a 41% increase of heavy drinking (four or more drinks on one occasion) among women during the pandemic.

But at 38 years old, I couldn’t escape the consequences of drinking. Within a few months, I had gained 20 pounds. At night, my mind raced with anxious thoughts and I never felt well-rested. The day after drinking, even just one glass of wine, I’d feel groggy, hungover and just sad. Back in my 20s, it would have taken four or five drinks to make me feel this way. Pounding water and electrolytes like I did when I was younger was no longer a fix.

Why age and alcohol don’t mix

There’s a reason that our alcohol tolerance gets lower as we grow older, and it’s worse for women than it is for men.

“As we age, we lose total water volume and are thus less able to dilute the impact of alcohol in our system,” explained Cathleen Morrow, M.D., chair and associate professor of community and family medicine at Dartmouth Hitchcock Medical Center. “Women are already more at risk due to their smaller size and lower levels of enzymes that metabolize alcohol compared to men.”

Unfortunately, the already low levels of these enzymes continue to decrease as women age, meaning that alcohol is metabolized (changed into a form your body can use) much more slowly.

Muscle holds more water than fat and is able to absorb and dilute some of the alcohol from your blood in a way that fat can’t. Beginning in our 30s, women start losing lean muscle mass at a rate of 3% to 8% per decade, while body fat typically increases. More body fat and less muscle means that the same couple of glasses of wine you had in your 20s may leave you with a higher blood alcohol level in your 40s and 50s.

Alcohol and menopause

Beyond causing hangovers more easily, drinking alcohol has a laundry list of other downsides for women in perimenopause or transitioning to menopause.

“Mood swings, sleep disruption and hot flashes are some of the more common and troubling symptoms of this time period that can all be [made worse] by alcohol,” explained Morrow. The good news: She’s had patients who saw these symptoms improve when they eliminated alcohol.

While drinking may help some people fall asleep, it ultimately leads to a less restful night’s sleep, which can be debilitating when combined with other menopause symptoms.

“The metabolism of alcohol continues as you sleep and is directly related to sleep disruption, often leading to early awakening and poorer overall quality of sleep,” Morrow said. “This issue is tough for patients, because many say they cannot get to sleep without their evening nightcaps, but there is plenty of data that reveals that alcohol is not helpful for sleep.”

It’s no secret that unwanted weight gain can be a reality of menopause. Not only does an increase in body fat continue to slow down the metabolization of alcohol, but drinking alcohol, in turn, increases body fat.

“It is very common for women to gain weight during menopause — a function of metabolic slowing as we age — and chronic regular alcohol use can certainly contribute to the overall gain,” Morrow said. “I always remind women about the ‘empty’ calories of alcohol. If you have two glasses of wine per night, that’s an additional 225 or so calories. If you are drinking two beers a night, that’s about 300 plus calories, and though that might not sound like a lot, it adds up.”

If you were thinking it’s enough to swap out dessert for a cocktail to account for the added calories, think again. There’s evidence that alcohol affects your stress-response pathways, activating your fight-or-flight response and increasing your cortisol (your primary stress hormone) levels. High cortisol levels not only contribute to insomnia, but can also increase belly fat and cause you to stress-eat junk food, which just keeps the cycle going — a particularly cruel side effect because many of us reach for a drink to combat stress.

Alcohol is a depressant, which is why it can initially help you snooze — but that means it can also worsen mood swings. Women prone to or experiencing depression should consider minimizing or avoiding alcohol, advised Juliana Kling, M.D., M.P.H., assistant director of the Women’s Health Center at the Mayo Clinic.

Additionally, around the age of menopause, women start to have increased risk of cancer, heart disease and other negative health outcomes. Alcohol only increases the risks even further, Kling said, adding, “It is advised that women be mindful of their alcohol intake.”

How much alcohol is safe?

According to U.S. Department of Agriculture and U.S. Department of Health and Human Services 2020-2025 dietary guidelines, women are advised to consume one drink or less a day. One drink is considered 5 ounces of 12% alcohol by volume (ABV) wine, 12 ounces of 5% ABV beer, or 1.5 ounces of 40% ABV distilled spirits such as rum, vodka or tequila. When drinking wine at home or even at your favorite restaurant, the pour is often much heavier than the recommended 5 ounces, and with a mix of spirits, one cocktail can easily take you over your daily limit.

The guidelines acknowledge that even these small amounts don’t eliminate the risks of alcohol, noting that “emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”

One global study found that no amount of alcohol is completely safe and that alcohol was the biggest risk factor for disease worldwide. Another more recent study found that any amount of alcohol causes harm to the brain.

These studies are adding fuel to a growing sober-curious movement, with the non-alcohol spirits market growing 31% year over year in 2021. If you’re not quite ready to hang up your glasses — drinking is, after all, a pleasurable sensory and social experience — Morrow seconds Kling’s advice to drink mindfully, which is imperative as you age.

“I encourage women to pay attention to their consumption. One of the most insidious qualities of alcohol use is the tendency for increasing intake over time,” she said. “Don’t drink every night. Be sure to take days, weeks or months off from drinking, and seek advice and counsel if you are concerned about your drinking.”

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Kling also suggests implementing other healthy lifestyle habits, including regular exercise and a heart-healthy diet. “If alcohol has been used to help with stress,” she noted, “identifying other strategies to help with stress will be important to assure success.”