Why Does Alcohol Affect Us Differently As We Age?

Why do bartenders make terrible comedians? They keep slurring their punchlines.

While we might chuckle at that (or not), the truth is that as we age, our relationship with alcohol becomes less of a punchline and more of a concern. Whether you’re a die-hard wine enthusiast or just enjoy a casual drink on weekends, understanding how your body processes alcohol over time is crucial — not just for those late-night laughs but also for your overall health.

AGING & ALCOHOL METABOLISM

You’re not just imagining it; there’s a reason hangovers become more brutal as we age. First off, our bodies undergo various metabolic changes. One of the most significant is how our liver processes alcohol. The liver, a vital organ for detoxification, is responsible for breaking down alcohol into less harmful substances.

As we age, our liver function begins to decline, which can lead to slower processing times for alcohol. This may lead to immediate risks, worsening health conditions, and adverse medication reactions.

Alcohol is the most abused substance among individuals over 65, representing a silent yet significant problem that is frequently ignored. A notable instance of this is the way symptoms of depression can mimic those caused by alcohol misuse. Abusing alcohol can hasten the natural changes that come with aging, making this a growing area of concern.

Changes in Liver Function

1. Reduced Enzyme Activity: Aging decreases the enzyme production that breaks down alcohol. For the same quantity of alcohol consumed, older adults may experience a higher blood alcohol concentration (BAC) than younger ones.
2. Increased Fat Accumulation: With age, the liver tends to accumulate fat, leading to a condition known as fatty liver disease. This condition further impairs liver function and can result in complications when consuming alcohol.
3. Decreased Blood Flow: Age can reduce blood flow to the liver, which can hinder its ability to filter out alcohol effectively.

These changes can lead to an increased sensitivity to alcohol’s effects. It’s not uncommon for older adults to feel the impact of a drink much sooner or harsher than they did in their younger years, making it essential to be mindful of consumption.

The increased sensitivity to alcohol means there’s an increased chance of alcohol poisoning, impaired vision, and slowed reaction time. In older people who may already suffer from poor balance, this can easily lead to falls and other accidents.

THE BODY’S CHANGING COMPOSITION

In addition to liver changes, our overall body composition shifts as we age. Here are a few noteworthy transformations:

• Decreased Muscle Mass: Muscle tissue is denser than fat and helps the body absorb alcohol. As we age, muscle mass decreases, resulting in a higher alcohol concentration in the bloodstream.
• Increased Body Fat: The percentage of body fat tends to increase, and since alcohol is not absorbed well by fat, it remains in the bloodstream for extended periods, leading to prolonged effects.
• Hydration Levels: Aging often comes with decreased hydration levels. Less water in the body can amplify the effects of alcohol, as there’s less fluid to dilute it.

These physiological changes can mean that even a glass of wine or a couple of beers can have a more pronounced effect than in our younger years.

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INCREASED HEALTH RISKS

The presence of alcohol in the blood can cause havoc with pre-existing conditions such as orthostasis (problems with blood pressure leading to dizziness), osteoporosis leading to risk of hip fracture, disturbed sleep, higher risk of stroke, cirrhosis, fatty liver, depression, and more.

In addition, oxidative stress and DNA damage resulting from chronic alcohol abuse can contribute to increased risk of cancer, liver disease, and heart disease.

WOMEN & ALCOHOL DEPENDENCE

“The 2020 to 2025 Dietary Guidelines for Americans advise no more than one drink per day for nonpregnant females, guidelines that largely match those from the National Institute on Alcohol Abuse and Alcoholism.  Of note, a safe dose of alcohol is likely to be lower in females than in males.” says Erin DeLaney, M.D., associate professor in the University of Alabama at Birmingham Department of Family and Community Medicine.

While the effects of alcohol are significant for everyone as they age, the situation can be particularly complex for women. There are several reasons for this:

Biological Differences

Women typically have a higher percentage of body fat, lower muscle mass, and lower amounts of water compared to men, meaning that when both genders consume the same amount of alcohol, women often experience higher blood alcohol levels. Additionally, hormonal fluctuations during menstruation, pregnancy, or menopause can affect how alcohol is metabolized, compounding these effects.

Women also tend to have a slower gastric emptying time, meaning that alcohol can stick around in its more toxic form for longer than it does in men.

The Growing Problem of Alcohol Dependence

In recent years, there has been a notable rise in alcohol dependence among women. According to various studies, women are not only drinking more but also facing increasing health risks associated with alcohol consumption.

Those over 65 years are from the generation of Baby Boomers, a generation where women started to drink more and where most grew up learning that some alcohol was good for the body. The gender gap in drinking has now decreased due to socio-cultural changes, and we are seeing the result in our elderly group. However, drinking just isn’t the same for women because of unique physical and emotional factors that lead to women forming an unhealthy relationship with it.

There’s something else that most of us aren’t aware of. Researchers are suggesting that women become dependent on alcohol more quickly and easily than men do. In this phenomenon known as telescoping, the timeline between starting to abuse alcohol and becoming dependent on it is shorter than that in men.

While women tend to drink because of depression, men usually develop depression because of alcohol abuse. This suggests that alcohol may be serving as self-medication more often in women than men.

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What leads women to over-indulge in alcohol? Studies find that women are more likely to suffer from anxiety and depression than men. They are also more commonly victims of sexual violence, domestic violence, and other trauma. Alcohol abuse may be a way of coping.

• Underdiagnosed Issue: Alcohol dependence in women is often underdiagnosed. Because the symptoms can manifest differently — such as anxiety or depression rather than overt intoxication — many women may not receive the necessary interventions.
• Treatment Mismatch: Historically, treatment programs and recovery methods have been designed primarily around men, meaning that women’s specific needs and experiences can be overlooked. Women respond differently to standardized treatment. This mismatch can lead to a feeling of isolation for women seeking help and a higher chance of reversion to harmful drinking behaviors.

Dr. DeLaney speaks of the symptoms that may not immediately make us think of alcohol consumption. “There are many symptoms that women may experience because of the longer-lasting effects of alcohol, and in some cases could represent development of disease related to alcohol consumption and aging. Sleep disturbances, weight gain, mood swings, anxiety, depression, and difficulties concentrating or remembering things are all common symptoms,” she explains.

“Other potential symptoms include headache, chest pain, palpitations, abdominal pain, nausea and vomiting,” adds Dr. DeLaney. “These may suggest a disease process such as high blood pressure, arrhythmias, stomach ulcers or irritation, liver damage, and even breast cancer. There is consistent evidence that breast cancer risk is higher for individuals consuming both low (>1 drink per day) to high (≥3 drinks per day) levels of alcohol compared with abstainers.”

THE IMPORTANCE OF AWARENESS

I asked Dr, DeLaney which among the symptoms she mentioned would warrant a visit to a physician. “If any of the above symptoms become persistent and do not resolve  with reduction or removal of alcohol from your diet, then you should see your primary care physician,” she says, “particularly if you have ongoing headaches, chest pain, irregular heartbeat, abdominal pain, nausea/vomiting, or breast pain.”

With alcohol’s effects varying significantly with age and gender, awareness is key. Understanding how our bodies process alcohol over time can empower individuals to make informed decisions about their drinking habits.

Here are some practical steps to consider:

1. Listen to Your Body: Pay attention to how your body reacts to alcohol. If you notice that you feel the effects more strongly than before, it might be time to reassess your consumption.
2. Seek Support: If you find that alcohol is becoming a crutch or a source of stress, don’t hesitate to reach out for help. Support groups are available specifically for women, providing a space to connect and share experiences.
3. Advocate for Yourself: If you feel that your concerns about alcohol use are not being recognized, advocate for yourself. Seek professionals who understand the unique challenges women face with alcohol dependence.
4. Educate Yourself: Understanding the risks associated with alcohol consumption, especially as you age, can help you make proactive choices.

Future research should focus on assessment tools that consider existing conditions and prescription medications. We should always seek to reduce barriers to care and study specific needs, including elderly-specific and women-specific treatments. Physicians might use an annual wellness exam to screen for unsafe drinking habits.

Aging is natural, but it comes with its own set of challenges — one of which can be our relationship with alcohol. The changes in metabolism, body composition, and the challenges faced by women can complicate this relationship. By educating ourselves and remaining aware of these changes, we empower ourselves to make healthier choices.

When it comes to alcohol, moderation might just be the punchline we all need to focus on!

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