Shakespeare, in describing the increasing decrepitude which overtakes everyone, overlooked one important, but pleasurable, advantage about growing old; 'sans everything' includes hangovers. The inevitable atrophy of the brain in old age also has the great advantage of allowing room for the organ to swell after a heavy evening's drinking. In earlier life, the brain fits snugly in the skull and, when swollen with excess fluid (oedema), becomes compressed within the unyielding bony cranium, thereby causing a racking headache. For most people aged over 60, their brains have shrunk like an old walnut in its shell and this painful aspect of the hangover is, like the sexual exploits of youth, only a memory.The headache may be the most celebrated aspect of a hangover, but sufferers know just as well of other symptoms. Next day the heavy drinker feels over-tired, irritable, depressed, has a loss of appetite combined with bouts of nausea, shakes and sweats and is troubled by a highly sensitive gut.People become intoxicated because they have drunk more than their metabolism can cope with. It doesn't matter if the drink is of good, or poor quality, it doesn't matter if grape and grain are mixed, and both helped down with beer. An unwise mixture may make you feel sick, but it won't make you any more, or less, inebriated. Hangovers, on the other hand, are very dependent on the nature of the drink, its quality, as well as its quantity. The hangover in part is not only related to the amount of alcohol taken but also to the congeners in the drink. These are the complex, organic chemicals which exist in all drinks and give them the distinctive flavour, about which we can either eulogise, or screw up our noses.The congeners may, if taken in excess, cause a host of symptoms next morning but the consolation is that they don't cause lasting damage. The general simple rule is: the lighter the drink in colour the less prone it is, drink for drink, to give rise to a bad hangover. Pale malt whiskies are not so likely, for instance, to cause a headache as some of the darker blended brands. Whisky, for most people, induces less of a headache than brandy – one of the reasons why malt whisky is a better night cap than brandy. Everybody's tastes differ and, equally, their reaction to the congeners may vary. It would be a very dull world if our choice of malt whisky were limited by the strength of the congeners it contained. I have always found that Glenmorangie, Talisker and Glenlivet left me, even when younger and with a youthful brain, free of a hangover. And I have never liked to miss out on the peaty malts of Lagavulin or Laphroaig, however rich they are in congener. The vatted malts such as Poit Dhubh (pronouced 'potch ghoo') are reasonably peaty, but I have always found are compatible with a bright and early start next day. Although I am assured that the term whisky means 'water of life', most people, unless they are of course my patients, have never learned that it is better for them than, for instance, a gin and tonic. Few realise that the mixers used with gin are loaded with sugar. Sweet drinks predispose one to gall bladder disease, while the refined sugars in the mixers also increase the tendency to hypoglycaemia.
When the body metabolises congeners, they are reduced to methanol, wood alcohol, the noxious methylated spirits which used to cause so much trouble for tramps. Later the wood alcohol turns to formic acid and formaldehyde. Formic acid is the chemical which gives the ant's bite such an unpleasant sting, and formaldehyde is the pickling liquid remembered by any pupil who has done biology. It shouldn't be forgotten, either, that artist Damien Hirst used formaldehyde to preserve his man-eating shark – little wonder then it makes the grey cells of the brain swell, and renders the lining of the stomach and gut, vivid red and oozy.The effects of alcohol, as opposed to those of congeners, are dose related, but even so their extent is partially dependent on the drinker's reaction to them. Younger, pre-menopausal, women become drunk quicker, and with less alcohol, than men, even after allowances are made for their smaller size and different build. Experience counts. It used to be believed that the seasoned drinker metabolised alcohol 25 per cent faster than the inexperienced, but research a few years ago showed that, in fact, they metabolise it 33 per cent faster and can, therefore, drink more without suffering.
The effect of experience on the psyche is even greater. The seasoned drinker, whose system is accustomed to suppressing the effects of too much alcohol, can summon up such reserves that it they met their Great Aunt Lottie, they would appear sober. Conversely, the novice drinker with the same level of circulating alcohol would be a slurring, slumped individual. Although excitement may make somebody appear drunk more readily, a study published in the British Medical Journal recently showed that negative emotions have an adverse effect on a hangover. When a drinker is depressed, angry or stressed the hangover is greater than it would have been if they had been cheerful and relaxed while drinking.Except in extreme circumstances neurological damage caused by alcohol is reversible, as the brain has remarkable powers of recuperation. The effect of alcohol on the brain is to cause transitory damage to the nerve cells. Not unnaturally, if the experience is repeated frequently, the damage may occasionally be longer lasting. After a heavy night's drinking, the memory next morning may be poor, the head may be thumping, the temper may be shot to pieces, but with a rest from the drink all will be well.Too much alcohol disturbs our sleep pattern, but there is no better night cap than a glass of whisky, when taken in reasonable quantities. However if the drinker overdoes it, he or she will fall into a dream-laden, restless sleep and may suffer a drunkard's false dawn – only to awake sweating uncomfortably after just three or
four hours.The sweating experienced during a hangover is the result of another effect of alcohol. After heavy drinking the pancreas produces an excess of insulin. In consequence, the blood sugar falls too far, causing the sufferer not only to sweat, but also to develop muscular weakness, giddiness, and the characteristic shake. The low blood sugar level also helps to account for the ragged memory. The troop sergeant during training would recommend to the recruits that they should have a hearty breakfast as a cure for a hangover. These chaps are not the type either to know, or care about the scientific basis for this traditional advice. However if they were they would have realised that an old fashioned breakfast raises the blood sugar slowly and consistently, counteracting hypoglycaemia without causing an insulin rush.Alcohol causes dehydration in every part of the body except the brain. The drinker not only sweats more, but alcohol is a diuretic and encourages the kidneys to drain the body dry, thereby creating a mouth as parched as a desert the following morning. So the best advice for whatever age you are is: if you are determined to excess, get in some pints of water before hitting the pillow.