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This Is What Really Happens When You Drink

By Joe Donatelli ; Updated February 08, 2018

TEQUILA: Last night was crazy. Do you remember anything? I blacked out, dude.

BEER: Of course you blacked out. Tequila always blacks out!

TEQUILA: I’m serious. We were at a work holiday party, and some guy who was talking really loud drank me, and then you were there a few seconds later, and then lights out!

BEER: You’re wondering why you’re soaked in urine.

TEQUILA: I feel I have a right to know.

BEER: OK, I’ll walk you through it. The guy from the party last night was Jerry. Jerry, to put it mildly, drank beyond moderation.

TEQUILA: Jerry! Jerry! Jerry!


BEER: Much like you, Jerry has no idea what happened last night either. That’s why he’s sleeping it off on the hood of his car. You see, Jerry’s body was having a perfectly enjoyable night enjoying shrimp cocktail, contemporary Christmas music and conversation with co-workers when he decided to have a glass of wine. His body was cool with that because it can metabolize one glass of wine an hour.

TEQUILA: Whoa, whoa, whoa. Metabolize? Are you like a scientist or something?

BEER: I’m beer. I’ve been around for 10,000 years. I’ve picked up some stuff.

TEQUILA: Continue, Professor Beer.

BEER: So after his glass of wine, Jerry decides he’s drinking on the boss’ nickel, and he orders you, my friend. Then, he chases you with me, and this is where our adventure began.

Alcohol enters and stimulates the pleasure center of the brain. The brain is like, 'Give me more of this toxic chemical that my body is working hard to eliminate, please.'

TEQUILA: I recall a great darkness.

BEER: Yep, we went down the gullet. About 20 percent of you and me were absorbed by the stomach, and the rest was absorbed by the small intestine.


BEER: No one said our job was pretty. An enzyme in the mucous membrane of the stomach metabolized some of the alcohol, and this same enzyme was also in the liver. Jerry’s liver can metabolize about 1 ounce of liquor per hour.


BEER: Go easy. It’s about the same for most human beings on earth. Food slows absorption and reduces alcohol’s concentration in the bloodstream because alcohol remains in the stomach longer where its enzymes can metabolize it.

TEQUILA: Sounds like the dude should have eaten more than five shrimp.

BEER: Agreed. Only a small amount of alcohol was metabolized by Jerry’s stomach and liver before it entered the bloodstream. Question: When you go on spring break, where’s the place to be?

TEQUILA: The water! Cannonball!

BEER: Same with us, bro. We headed straight for the watery part of the blood called the serum. Dudes carry more body water, which dilutes the alcohol better, which is one reason why women get drunk faster and harder. The liver metabolizes at a steady rate whether you’re going wild or not. It’s like a tunnel that only one car an hour can go through. But when you’re partying like Jerry was last night, it isn’t just one car: It’s three or six.

TEQUILA: I think I saw some rum on a tiny tricycle.

BEER: No matter what kind of alcohol, we all get wrung through the liver and come out of the other side as acetaldehyde. Acetaldehyde is basically alcohol after alcohol has had a few drinks and wants to hit someone with a pool stick. It’s toxic.

TEQUILA: Let me guess. There were some enzymes and whatnot involved, heretofore.

BEER: Yes. Acetaldehyde was created when the alcohol in the liver was broken down by an enzyme called alcohol dehydrogenase. The acetaldehyde eventually got hit by another enzyme, acetaldehyde dehydrogenase, plus another substance called glutathione.

TEQUILA: Do I have to remember any of this?

BEER: No. Together, the acetaldehyde dehydrogenase and the glutathione created this nontoxic acetate—similar to vinegar—that’s essentially harmless. The problem is that the liver's supply of glutathione runs out fast when lots of booze enters the system. Toxic acetaldehyde built up while the body made more glutathione.

TEQUILA: Kind of like at Chipotle when they run out of chicken and the line backs up.

BEER: Yes, except the kitchen at Chipotle reacts way faster than the human body.

TEQUILA: OK, question: Why was Jerry in the bathroom like 98 times last night? Is it because he broke the seal?

BEER: There is no seal. The presence of alcohol keeps the kidneys from releasing a hormone called vasopressin. When this hormone isn’t around, it sends water straight to the bladder. Alcohol is also a diuretic, which causes cells to shrink and push out water, and that also sent Jerry to the bathroom, where—as you may recall—he dropped his phone in the urinal.


TEQUILA: I can’t help but feel at least partially responsible for Jerry’s metabolic predicament.


BEER: Alcohol is a strange drug. Taken at low doses in red wine, alcohol is an antioxidant, which has health benefits. At high doses, alcohol is a pro-oxidant, which isn’t good. Not many drugs can make that flip. It’s like the Walter White of drugs. It’s “Breaking Bad.”

TEQUILA: So what happens to all the, uh, ace-to-let’s-all-hide.

BEER: Mitochondrial aldehyde dehydrogenase (ALDH2) steps up and turns acetaldehyde into acetic acid, that vinegar stuff I mentioned. The acetic acid is finally converted into carbon dioxide and water, and this generates calories, which is why you don’t see a lot of guys who binge-drink in the Olympic marathon event. When acetaldehyde isn’t converted quickly to acetate, it leads to a rapid blood flow to the skin and face, neck and chest, as well as headache, nausea and drowsiness. It’s the acetaldehyde running through your brain that causes hangovers.

TEQUILA: That jerk.

BEER: You’re responsible for that jerk.

TEQUILA: Oh, right.

BEER: But let’s not forget that we’re not inherently bad guys. At low doses, alcohol does nice things for the brain. It reduces inhibitions, which leads to things like fun conversations and dancing, often in that order. Booze also releases dopamine, which elevates mood.

TEQUILA: But too much booze messes your brain up, which is why so many city buses have advertisements for DUI lawyers, right?

BEER: Yep. The brain is protected by the blood-brain barrier, which is like a bloody football helmet.

TEQUILA: Awesome.

BEER: Some things—such as alcohol, caffeine and nicotine—can get through the blood-brain barrier. Alcohol enters and stimulates the pleasure center of the brain. The brain is like, “Give me more of this toxic chemical that my body is working hard to eliminate, please.” Jerry obliged. His brain flooded with toxins that his brain asked for and those toxins impaired the communication pathways of his brain. The part of Jerry’s brain that should have warned him that his fifth shot of tequila was a bad idea had been silenced by another part of his brain that thought it was a great idea.

TEQUILA: I’d say that’s a Catch-22, but I’m not sure what that is.

BEER: Close enough. And it’s not only the liver and brain. We hit many parts of the body, even the heart. Last night, when we got in there, Jerry experienced a temporary increase in heartbeat and blood pressure.

TEQUILA: Yeah, the warm-and-fuzzy feeling. I like that feeling.

BEER: It was actually Jerry’s peripheral blood vessels dilating, which caused heat loss and feelings of warmth.

TEQUILA: I get it.

BEER: You get what?

TEQUILA: I get the whole thing. Drinking is like when alcohol gets invited to a house party where the house doesn’t want more than one guest. But it’s a house. It can only do so much. And so the alcohol is in the living room breaking really old vases and stuff, and the host—the brain—really should kick everyone out, but instead he invites more guests.

BEER: Exactly.

TEQUILA: And if there are too many guests, the house tries to force everyone back out through the front door, and then the host is like, “Uh, maybe this wasn’t such a good idea.” The booze—they don’t want to leave. “We’re good, buddy,” they say. “We’re staying.” Now the house is a mess and the host feels bad because it’s going to take him all day tomorrow to clean up.

BEER: Let’s get some waffles. We’ve got a big night ahead.

NOTE: This article is based in large part—but not entirely—on an interview with Dr. Amitava Dasgupta, a professor at the University of Texas Medical School, and information from his book “The Science of Drinking: How Alcohol Affects Your Body and Mind.” The rest of the sources are listed below.



Joe Donatelli is a freelance journalist. Follow him @joedonatelli.

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