The True Toll of Drinking

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The true toll of that alcohol: Hour by hour, how excess plays havoc with your mind and body

Why is that first drink so cheering — and why can’t you stop there? And what exactly makes you feel so dreadful the morning after?

As the summer season gets into full swing, we ask the experts what happens to the body during and after drinking alcohol — and how you can minimize its effects.


When that first drink reaches your stomach, the alcohol enters your bloodstream, where it makes a beeline straight for your brain’s pleasure centres.

After just one drink, alcohol boosts the levels of four key brain chemicals — dopamine, serotonin, naturally occurring opioids and gamma-aminobutyric acid.

‘These combine to induce feelings of euphoria, relaxation and disinhibition,’ explains Dr Bhaskar Punukollu, a specialist addiction psychiatrist at the Clinical Partners practice, and at Camden and Islington NHS Foundation Trust in London.

‘This euphoria is at its peak when you first start drinking. However, after several more drinks, the brain receptors for these chemicals become saturated, and drinking more alcohol doesn’t produce a greater high.

‘The brain simply can’t generate enough of the same level of dopamine or other chemicals again to make you feel as happy as when you first started.’

There’s some truth behind the claims you should line your stomach with food.

‘Roughly, you absorb about one unit of alcohol an hour, but drink after some food and the rate it enters your bloodstream is slowed,’ Dr Punukollu says.

‘Food absorbs some of the alcohol, and while the gut is absorbing key nutrients from the food, it’ll be far less efficient in absorbing the alcohol.’

Despite having the same number of drinks, someone who starts on an empty stomach can have three times more alcohol in their blood compared with those who have eaten a small meal beforehand, he says: ‘Alternating alcoholic with soft drinks can also slow down the effects.’



After two hours of drinking, now is the time you hit the dance floor and start saying things you might regret the next morning.

Blame this lack of inhibition on the way alcohol interferes with communication between the nerve cells in the cerebral cortex. This part of the brain is responsible for processing information, and also initiates the majority of muscle movements.

‘That’s why you feel more confident, but actually you make potentially poor judgments, your co-ordination goes and you have a higher pain threshold,’ explains Paul Wallace, professor of primary care at University College London and chief medical adviser for the charity Drinkaware.

Your natural self-protection mechanism is affected, as the alcohol masks warning signals from other parts of your body.

If you’ve continued drinking, your liver will now be going into overdrive — and it might not be able to metabolize the alcohol fast enough, says Dr. Punukollu. This increases alcohol concentration in the body, causing further disorientation, nausea and lack of coordination.

And if you suffer from memory blanks the next day, blame the effect alcohol has on the hippocampus and septal areas of your brain — these are responsible for emotional responses and registering and storing memories.

‘This also explains why people cry or become aggressive when drinking,’ says Professor Wallace.


At this point, there is the temptation to feel all is well with the world, and to move from beer or wine to stronger spirits to try to maintain your mental state.

But if you do hit the stronger stuff, stick with clear drinks, such as vodka, which have lower levels of harmful impurities from the fermentation process.

‘While alcohol is responsible for many of the symptoms we associate with hangovers, congeners found in dark drinks such as whisky, port and brandy can linger in your system for up to 24 hours and make a bad situation worse,’ says Professor Wallace.



For most of us, it’s this time that the body’s self-preservation signals start to override the over-stimulated brain centres, and you become aware of the intoxicating effects of the alcohol you’ve drunk and start to want to go to bed.

This is affected by a range of factors, explains Dr Martin Prince, a heptologist at BMI The Alexandra Hospital in Cheadle, Cheshire. As a general rule, if you’re larger or male, your body can process alcohol faster.

But some people seem to have higher levels of the liver enzymes needed to break down alcohol, so they can go on drinking for longer — and if you’re a consistent, heavy drinker, your body develops higher levels of these enzymes.

‘Having a tolerance to alcohol simply means you feel you can handle the effects better — you’re still doing yourself potentially irreparable damage,’ says Dr Prince.

Women’s bodies are made up of more fat and less water (they carry 52 per cent water, versus 61 per cent in men).

This means a man’s body will automatically dilute the alcohol more than a woman’s, even if they weigh the same. Women also have less dehydrogenase, the liver enzyme that breaks down alcohol.


There’s a reason why kebabs and curries are so popular after drinking, explains Dr. John de Caestecker, gastroenterologist at the University Hospitals of Leicester.

‘The pancreas pumps insulin into your system to break down alcohol in your blood, and the delayed reaction is a slump in blood sugar levels, leaving you ravenous, especially for high-calorie, fatty foods.’

However, if you eat too much — such as a large curry — and then vomit later, you risk suffering a tear at the junction between the stomach and your gullet, says Dr. de Caestecker.

‘Normally, there is a mechanism where you brace yourself before you’re sick — the retching protects you by holding the gullet in place. But this is by-passed because of alcohol’s effects on your brain. You start vomiting blood as the lining of your esophagus is damaged.’

This tear normally heals itself with time, but you still need to go to Emergency for proper assessment.

‘A heavy session can also affect the movement of food through the gut,’ explains Dr de Caestecker, adding that the gullet, responsible for preventing acid from rising, can relax and malfunction, causing severe heartburn.


It doesn’t matter what time you get to bed — alcohol leaves you feeling totally exhausted because it has a sedativearticle-2076283-0F1EC08200000578-742_468x286 effect, says Dr. Punukollu.

‘When it reaches a certain level, alcohol makes you feel sedated because of a slump in the same brain chemicals that induced euphoria.

You’ll drop into a deep sleep very quickly, but your sleep will be so deep you won’t achieve any of the restorative REM-stage of sleep, which we need to make us feel rested the next morning.’

It’s also likely you’ll wake in the middle of the night with a full bladder and a raging thirst — alcohol is a diuretic, meaning you expel more fluid in your urine than you’ve taken in along with your alcohol.


Processing one unit of alcohol an hour could still leave you with a blood alcohol level high enough to put you over the legal drink-driving limit, even if you stopped drinking at midnight.

Blame your headache on dehydration, together with the way your liver has converted the alcohol into a chemical called acetaldehyde and then acetate as it tries to purge the poison from your body.



Alcohol has robbed you of a restorative sleep, which triggers continued low blood sugar levels when you wake — and, in turn, the appeal of a greasy fry-up followed by chocolate to get you through the day.

But anything too heavy or fatty will aggravate an upset stomach by stimulating an over-production of stomach acids.

‘You need a combination of slow-release, low-glycaemic index carbohydrates, such as those found in whole meal bread or porridge, combined with a little protein from some low-fat dairy like yoghurt,’ says Azmina Govindji, from the British Dietetic Association.


Ever found that your hangover gets worse throughout the day? Here’s why: ‘Your liver, kidneys and other organs will have been processing the alcohol out of your system since last night,’ says Dr. Prince.

‘But because of the relentless attack, it’s only when your blood alcohol levels are back around zero that the most acute hangover symptoms will be felt.’

It’s also around now you might be experiencing physical withdrawal symptoms from the alcohol overload, says Dr. Punukollu.

‘The levels of the mood-altering brain chemicals which caused your “high” when you first started drinking will be lower than normal now, which can lead to irritability, depression and anxiety, as well as increased body temperature, a racing heart rate, increased blood pressure and the “shakes”,’ he says.


You should be starting to feel better around now, but you’ll still be suffering the effects of sleep deprivation and potentially an upset stomach.

‘In most cases a regular antacid will help calm an inflamed stomach lining,’ says Dr. de Caestecker.


Your upset stomach can take up to two days to settle down says Dr. de Caestecker.

And if you’re one of the estimated 25 per cent of people who don’t suffer hangovers, you might not be as lucky as you think, Dr. Prince says.

‘Years of regular drinking weaken the liver’s reaction to alcohol, so a hangover could actually be a sign your body’s well enough to tell you how it’s feeling and that you’re actually pretty healthy,’ he says.

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By Matthew Barbour, December 20, 2011

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