Why Do I Get Hangovers So Easily

Have you ever woken up in the morning after a night out and thought ‘why do I get hangovers so easily?’ Whilst going out for a few drinks with friends or family is an enjoyable pastime for a large proportion of the population, no one enjoys the inevitable hangover symptoms the next morning.

Hangovers are caused by numerous different factors, which all seem to interplay into causing various symptoms. The severity of a hangover depends on; 

• How much alcohol you drink
• What types of alcohol you drink 
• Your genetics
• Alcohol tolerance levels
• How you prepare yourself before and after drinking 

Understanding the causes of hangovers can identify ways of avoiding them, or at least lessen the symptoms.

Overview

There’s nothing worse than waking up after a night out and being hit with a hangover. Symptoms can be rough, but there are ways you can manage your hangover's severity. 

In this article, we review the causes of a hangover, signs and symptoms, risk factors, complications, and hangover management and treatment. 

Causes of hangovers

Studies have identified numerous factors which contribute to hangovers and their severity. These include; 

Acetaldehyde production

The cause of a hangover can be attributed to a combination of chemical reactions. Generally, alcohol is broken down in the liver, converting ethanol to an intermediate metabolite known as acetaldehyde. Acetaldehyde is toxic, with build-up causing side effects such as vomiting, headaches, fatigue, and stomach irritation. However, the body generally deals with this compound as it is produced by breaking down the acetaldehyde using enzymes (alcohol dehydrogenase and acetaldehyde dehydrogenase) and the antioxidant glutathione. This forms a nontoxic compound known as acetate. 

Prolonged drinking or binge drinking can quickly affect this mechanism, as glutathione from the liver is limited, causing the build-up of the toxic compound. Whilst it is debated in research whether acetaldehyde concentration correlates with hangover severity, some studies have shown a significant correlation between hangover severity and increased blood acetaldehyde concentration.^1,2 Therefore, the more alcohol an individual drinks, the more acetaldehyde is produced, and the more severe the hangover will be.   

Dehydration

Alcohol has a diuretic effect. A diuretic is a compound that increases urine production, and in the case of alcohol consumption, the compound inhibits the secretion of the antidiuretic hormone vasopressin. Due to this, the kidneys absorb more water and increase urination. Whilst this is a commonly attributed symptom of alcohol consumption, whether this contributes to a hangover or is a co-occurring process contributing to other hangover-causing factors is still yet to be confirmed in science. 

Congeners

A congener is produced during the distillation or fermentation of spirits. In chemistry, this refers to the production of active chemicals in addition to ethanol, which can affect the taste and smell of the spirit, including;

• Aldehydes, such as formaldehyde 
• Acids, such as formic acid
• Ketones
• Esters
• Alcohols, such as methanol

Research has identified that the number of congeners ingested may impact the severity of the hangover, generally, more refined light spirits such as vodka or white rum are low in congeners, whereas lesser refined darker spirits such as tequila, dark rum, or cognac are high in congeners. 

Immune system

Research has identified that alcohol causes changes in cytokine concentration in the immune system. Cytokines are protein messengers which interact with cells in the immune system to regulate the body's inflammatory responses to infection or disease. Studies have indicated that cytokines (such as interleukin 10, interleukin 12, and interferon-gamma) are associated with hangover symptoms due to cytokine dysregulation and increased oxidative stress.^3,4

Signs and symptoms of hangover

The symptoms of a hangover occur when blood-alcohol content within the body drops, typically reaching 0, or close to 0, by the morning after a night of drinking. This can vary depending on the amount of which an individual has drank, with symptoms including;

• Nausea and vomiting
• Stomach pain
• Sensitivity to light or sound
• Dizziness or spinning sensation
• Rapid heart rate
• Shakiness
• Headaches
• Muscle aches
• Excessive thirst / dry mouth
• Mood changes
• Decreased cognitive function
• Sweating 

Risk factors

There are factors identified by research which may affect a person's predisposition to develop more severe hangovers. This generally depends on how your body is able to process the alcohol. These can include; 

• Genetics

Your genetics can play a major role in hangover severity, with research indicating that individuals carrying specific genes (such as an ADH1B*2 allele) are more likely to suffer more severe hangovers and are less likely to develop alcohol use disorder.⁵ 

• Alcohol tolerance

This occurs when the body adapts to alcohol consumption to a certain amount of alcohol on a regular basis, such as a glass of wine or beer before bed. This can allow for increased alcohol consumption as tolerance is built up. Increased alcohol tolerance can be associated with the development of alcohol abuse and alcohol dependence. 

Complications

A major complication occurring with excessive alcohol consumption includes alcohol poisoning. Alcohol poisoning is considered a medical emergency and presents signs such as;

• Slowed or irregular breathing
• Blue tinged skin or pale colouration
• Lowered body temperature
• Inability to remain conscious or unconsciousness (cannot be woken up)
• Seizures 
• Excessive vomiting
• Confusion 

If anyone you know exhibits these signs after heavily drinking then seek medical attention immediately.

Other complications are associated with prolonged drinking over a longer period of time. Binge drinking or excessive alcohol intake can result in alcohol-related liver disease. This damage causes the liver to scar and affects its ability to function efficiently, leading to alcohol hepatitis and cirrhosis. 

Management and treatment for hangovers

When the inevitable has happened, learning to effectively manage and treat a hangover can help alleviate symptoms as quickly as possible. Some suggestions include; 

• Regulating your blood sugar. Low blood sugar can also be attributed to a worse hangover. Eating foods with complex carbohydrates boosts your blood sugar levels and can help alleviate nausea symptoms
• Getting enough sleep to help reduce fatigue
• Drinking plenty of water or fluids to reduce dehydration 
• Use painkillers, such as NSAIDs, to reduce headaches or muscle aches. However, these should be taken minimally to reduce irritating your digestive system
• Using antacids to settle an upset stomach
• Maintaining vitamin and mineral intake such as vitamin B and zinc, as these have both been identified to decrease hangover severity in individuals⁶

FAQs

Does my hangover get worse as I age?

Hangover severity has been attributed to be worse for someone who is older compared to a younger individual. A decrease in alcohol tolerance can be attributed to your weight, less efficient liver function, less total body water content, or medication usage. Psychologically, you may feel that your hangovers are worse because you may drink less at an older age than you did at a younger age, worsening the feeling of the hangover when you are less used to experiencing them.⁷ 

However, whilst these points may suggest that aging does affect how your body handles alcohol, some studies have indicated that generally, hangovers are subjective, and depend on the amount of alcohol consumed. Therefore, hangover severity can decline with age, due to a decreased amount of alcohol consumption and a lesser likelihood of ‘binge drinking’ as seen in younger individuals.^8,9,10

How can I prevent hangovers?

There are methods you can implement in order to reduce your chances of developing a hangover. 

• Monitor your alcohol intake. Avoiding buying drinks in ‘rounds’ and avoiding excessive drinking will allow your body to deal with the alcohol in your system quicker
• Avoid alcohol intake on an empty stomach
• Eating prior to, and after drinking alcohol will help slow the rate of alcohol absorption
• Drinking plenty of water to avoid dehydration

When to see a doctor?

As previously mentioned, if you or someone you know is experiencing symptoms of alcohol poisoning or liver failure you need to seek medical attention immediately. Ignoring these signs can lead to death if not properly treated by a medical professional. 

Summary

Managing your drinking and maintaining preventative measures can reduce the likelihood or at least lessen the severity of a hangover. As a short guide, try to;

• Understand what you are drinking
• Keep a watch on how much you are drinking
• Make sure that you are well fed before and after (simple carbohydrates) 
• Drink plenty of water
• Add some vitamins and minerals to your morning