31-01-2019

HEALTH
THURSdAy,
Why alcohol gives us anxiety
JANUARy 31, 2019
5
Amy Fleming
If you are looking forward to your
first stiff drink after a dry January,
be warned: it may feel bittersweet.
You may feel you deserve an
alcoholic beverage after toughing it
out all month - but have you
forgotten what it feels like to wake up
haunted by worries about what you
said or did the night before? These
post-drinking feelings of guilt and
stress have come to be known
colloquially as "hangxiety". But what
causes them?
David Nutt, professor of
neuropsychopharmacology at
Imperial College, London, is the
scientist who was fired in 2009 as
the government's chief drug adviser
for saying alcohol is more dangerous
than ecstasy and LSD. I tell him I
By drinking less you can avoid anxiety.
have always assumed my morningafter
mood was a result of my brain
having shrivelled like a raisin
through alcohol-induced
dehydration. When Nutt explains
the mechanics of how alcohol causes
crippling anxiety, he paints an even
more offputting picture.
Alcohol, he says, targets the Gaba
(gamma-aminobutyric acid)
receptor, which sends chemical
messages through the brain and
central nervous system to inhibit the
activity of nerve cells. Put simply, it
calms the brain, reducing
excitement by making fewer
neurons fire. "Alcohol stimulates
Gaba, which is why you get relaxed
and cheerful when you drink,"
explains Nutt.
The first two drinks lull you into a
blissful Gaba-induced state of chill.
When you get to the third or fourth
drink, another brain-slackening
effect kicks in: you start blocking
glutamate, the main excitatory
transmitter in the brain. "More
glutamate means more anxiety,"
says Nutt. "Less glutamate means
less anxiety." This is why, he says,
"when people get very drunk, they're
even less anxious than when they're
a bit drunk" - not only does alcohol
reduce the chatter in your brain by
stimulating Gaba, but it further
reduces your anxiety by blocking
glutamate. In your blissed-out state,
you will probably feel that this is all
good - but you will be wrong.
The body registers this new
imbalance in brain chemicals and
attempts to put things right. It is a
little like when you eat a lot of sweets
and your body goes into insulinproducing
overdrive to get the blood
sugar levels down to normal; as soon
as the sweets have been digested, all
that insulin causes your blood sugar
to crash. When you are drunk, your
body goes on a mission to bring
Gaba levels down to normal and turn
glutamate back up. When you stop
drinking, therefore, you end up with
unnaturally low Gaba function and a
spike in glutamate - a situation that
leads to anxiety, says Nutt. "It leads
to seizures as well, which is why
people have fits in withdrawal."
It can take the brain a day or two to
return to the status quo, which is
why a hair of the dog is so enticing.
"If you drank an awful lot for a long
time," says Nutt, "it might take
weeks for the brain to readapt. In
alcoholics, we've found changes in
Gaba for years."
To add to the misery, the anxiety
usually kicks in while you are trying
to sleep off the booze. "If you
measure sleep when people are
drunk, they go off to sleep fast. They
go into a deeper sleep than normal,
which is why they sometimes wet the
bed or have night terrors. Then, after
about four hours, the withdrawal
kicks in - that's when you wake up all
shaky and jittery."
Imbalances in Gaba and glutamate
are not the only problem. Alcohol
also causes a small rise in
noradrenaline - known as the fightor-flight
hormone. "Noradrenaline
suppresses stress when you first take
it, and increases it in withdrawal,"
says Nutt. "Severe anxiety can be
considered a surge of noradrenaline
in the brain."
Another key cause of hangxiety is
being unable to remember the
mortifying things you are sure you
must have said or done while
inebriated - another result of your
Photo: princigalli
compromised glutamate levels. "You
need glutamate to lay down
memories," says Nutt, "and once
you're on the sixth or seventh drink,
the glutamate system is blocked,
which is why you can't remember
things." If this isn't ringing any bells,
it may be because hangxiety does not
affect us all equally, as revealed by a
study published in the journal
Personality and Individual
Differences. Researchers quizzed
healthy young people about their
levels of anxiety before, during and
the morning after drinking alcohol.
According to one of the authors,
Celia Morgan, professor of
psychopharmacology at the
University of Exeter: "The people
who were more shy had much higher
levels of anxiety [the following day]
than the people who weren't shy."
The team also found a correlation
between having bad hangxiety and
the chance of having an alcohol use
disorder. "Maybe it's playing a role in
keeping problematic drinking
going," says Morgan.
One theory as to why very shy
people might be more at risk of
hangxiety and alcoholism is the
possibility that alcohol's seesaw
effect on Gaba levels is more
pronounced in them. Their baseline
Gaba levels may be lower to start
with, says Morgan. "It could also be a
psychological effect - people who are
more highly anxious are more prone
to rumination, going over thoughts
about the night before, so that's
another potential mechanism."
However, the study's findings have
wider implications - after all, most
drinkers lean on alcohol as social
lubrication to some degree.
The bad news is that there seems
to be little you can do to avoid
hangxiety other than to drink less,
and perhaps take painkillers - they
will at least ease your headache.
"Theoretically, ibuprofen would be
better than paracetamol," says Nutt,
"because it's more antiinflammatory
- but we don't know
how much of the hangover is caused
by inflammation. It's something
we're working on, trying to measure
that."
Morgan suggests trying to break
the cycle. "Before drinking in a social
situation you feel anxious in, try fastforwarding
to the next day when
you'll have much higher anxiety
levels. If you can't ride that out
without drinking, the worry is that
you will get stuck in this cycle of
problematic drinking where your
hangxiety is building and building
over time. Drinking might fix social
anxiety in the short term, but in the
long term it might have pretty
detrimental consequences."
Exposure therapy is a common
treatment for phobias, where you sit
with your fear in order to help you
overcome it. "By drinking alcohol,
people aren't giving themselves a
chance to do that," says Morgan.
But there might be hope for the
future. Nutt is involved in a project
to develop a drink that takes the
good bits of alcohol and discards the
damaging or detrimental effects.
"Alcosynth", as it is currently called,
drowns your sorrows in the same
way as alcohol, but without knocking
the Gaba and glutamate out of kilter.
"We're in the second stage of
fundraising to take it through to a
product," he says. "The industry
knows [alcohol] is a toxic substance.
If it was discovered today, it would
be illegal as a foodstuff."
Until Alcosynth reaches the
market, Nutt says his "strong"
message is: "Never treat hangxiety
with a hair of the dog. When people
start drinking in the mornings to get
over their hangxiety, then they're in
the cycle of dependence. It's a very
slippery slope."
Workaholics tend to die younger.
Photo: Caiaimage
Performative workaholism
negatively effects human body
Thank GodIt'sMonday! This is the rallying
cry of a new movement of work obsessives,
according to a widely shared opinion piece
on "performative workaholism" in the New
York Times. These ergomaniacs encourage
each other to "hustle harder". They drink
from water coolers containing floating
cucumbers carved with pro-work slogans,
such as "Don't stop when you're tired, stop
when you're done."
"No one ever changed the world on 40
hours a week," Elon Musk, the patron saint
of the TIGM movement announced on
Twitter. Musk recommends "80, sustained'"
hours a week, "peaking [at] about 100".
e haven't always been so work-obsessed.
During the middle ages in England, peasants
could work just 150 days a year. Until
relatively recently, work was seen as painful
toil, and best avoided.
But something changed in the 16th century
- we started to think that work was morally
good. Five hundred years on,
#ThankGodIt'sMonday has made it saintly.
Now we have a Protestant work ethic
without the pressure of taking Sunday off to
go to church. Instead, we should toil 24/7,
taking #workinglate selfies to prove it.
But is putting in long hours any good for
us? We know that not working can make us
miserable. People who work tend to be
healthier. Work can give us a sense of
purpose and meaning. It connects us with
other people. At a minimum, work provides
money as well as something to do with our
time.
But too much work can be toxic. Working
very long hours can be bad for our health.
Ultra-long hours can kill. Ergomania can
lead to problems such as depression, anxiety
and addiction and can cut us off from friends
and family, leaving us with only colleagues. If
work disappears, work obsessives often have
nothing to fall back on.
A job loss can become a deep existential
crisis. Instead of boasting about the hours we
work, we would be better off listening to
Bruce Daisley, an executive at Twitter: "Go to
lunch," "Get a good night's sleep," and:
"Shorten your work week.
How to beat
a sore throat
in winter
Elle Hunt
Sore throats are very common and usually
get better by themselves within a week.
Getting a good night's sleep always helps to
help fight off infection. The NHS advises
those with a sore throat to stay well hydrated,
although hot drinks should be avoided.
Sucking on ice cubes, ice lollies or hard
sweets can soothe the inflammation.
If you feel uncomfortable, take paracetamol
or ibuprofen. There are also medicated sorethroat
lozenges and anaesthetic sprays
available over the counter that claim to target
pain in the throat with anti-inflammatories.
The NHS cautions that "there's little proof
they help", but a 2011 study of two different
kinds of medicated lozenge found they
brought relief and eased soreness and
difficulty swallowing within minutes; effects
lasted up to two hours post-dose.
Gargling with warm salt water may help to
reduce inflammation. (It is not
recommended for children.) Dissolve half a
teaspoon of salt in a glass of partly cooled
boiled water, gargle with the solution, then
spit it out. Repeat as necessary. "It's
inexpensive and everyone can do it at home -
I recommend this to most patients," says
Abraham Khodadi, a prescribing pharmacist
who vlogs weekly about health on YouTube
as Abraham the Pharmacist.
Most sore throats are caused by a virus, so
they cannot be treated by antibiotics - even
though in many cases they are prescribed
anyway. Last year, sore throats accounted for
nearly a quarter of inappropriate antibiotic
prescriptions in England. Such prescriptions
contribute to the global threat of antibiotic
resistance. US researchers reported in 2013
that, from 1997 to 2010, about 60% of
patients with sore throats received
antibiotics, even though only about 10%
needed them. Viral sore throats are
accompanied by other cold symptoms that
may include a runny nose, cough, red or
watery eyes, and sneezing. The symptoms of
streptococcal pharyngitis, "strep throat", a
bacterial infection, are similar, but likely to be
more severe, and possibly accompanied by a
high temperature or feeling hot and shivery.
Smoking cigarettes can cause a sore throat
by irritating the windpipe. "When an irritant
is introduced in the system, the body tries to
get rid of it by coughing, which can result in
more inflammation," says Khodadi. Smoking
Getting a good night's sleep is a great way to beat infection.
also lowers immunity, which can lead to
recurrent viral and bacterial infection, and
weakens the lower oesophageal sphincter
between the stomach and oesophagus (or
food pipe), causing acid reflux from the
stomach, which can irritate the throat. Other
causes of a sore throat include pollution or
irritants in the air, allergies, dry air, and
changes in temperature, such as going from a
warm office to the icy outdoors.
You can safeguard against sore throats by
eating a healthy balanced diet, says Khodadi,
as well as by having a flu jab. This should
alleviate the need for supplements in
otherwise healthy people, he says - although
Public Health England has suggested taking
a daily vitamin D supplement in winter,
which may help to boost immunity.
Photo: Getty Images
Follow some basic health tips to defy ageing and keep the mind sharp.
Photo: martinleonbarreto
Stave off the brain
from mental decline
Kayt Sukel
THE studies are cruelly consistent: by the
age of 45, your basic cognitive abilities begin
to slip. As we get older, the crucial brain
regions involved in memory, attention and
perception begin to shrink and no longer
communicate with one another as efficiently
as they once did. You may find that you
aren't quite as quick as you once were. It
takes longer to recall where you left your
keys, more effort to help your kids with their
maths homework.
Except that isn't the final word. There are
plenty of science-backed strategies for
keeping your brain fitter for longer. And it is
never too late to begin.
The brain is often likened to a muscle, and
for good reason: give it a good workout and
it will stay strong. But what does that really
mean? A few years ago, headlines were full
of claims about brain-training apps and
computer games that offered a shortcut to
improved cognitive fitness. But these have
largely been debunked. "There's no magic
activity that will do it," says Yaakov Stern, a
neuropsychologist at Columbia University
in New York.
Instead, the trick seems to be to find
activities that boost what's known as
cognitive reserve. You can think of this as
spare mental capacity, a kind of extra
padding that allows your brain to sustain
more damage before you feel the effects. The
concept has been used to explain why two
people with Alzheimer's disease, and the
same amount of damaging protein plaques
in their brain, may not be equally affected.