Why am I so Tired in Early Sobriety? (E33)
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One of the more unexpected experiences when someone quits drinking is exhaustion. Shouldn’t you be feeling good now that you’re not blasting your body with poison anymore?
How is alcohol processed in the body?
When we drink alcohol, it is eventually broken down into a molecule called acetate. Most of the acetate produced by the liver is released back into circulation, and is quickly able to enter the brain. The brain can use acetate as an energy source instead of glucose, which is why you may feel a burst of energy when you begin drinking.
Chronic, heavy drinkers will show elevated acetate levels for about 24 hours after their last drink. The brain normally uses glucose as an energy source, but it can use acetate as an alternative. When you’re regularly exposing your brain to alcohol, it gets used to using alcohol (and acetate) as an energy source.
Here’s why you’re so tired when you stop drinking
The brain can become dependent on acetate as an energy source, making withdrawal even worse. Your brain has to relearn how to utilize glucose again, and this takes time. Acetate is converted into adenosine in the brain, which is a chemical that calms us and promotes sleep. When someone is trying to quit drinking they suddenly have a lack of acetate for energy and a lack of adenosine for sleep and relaxation. This can lead to exhaustion, anxiety and trouble sleeping; two things which can make someone go back to drinking.
How to cope with exhaustion after quitting drinking
If you’re struggling with exhaustion in early sobriety, then just know this will get better. You drank for years and over time your brain became reliant on alcohol, it’s not going to adjust back instantly as soon as you quit. Here’s what you can do in the meantime:
be kind to yourself and accept that you’re going to feel tired for a bit
reduce the number of commitments you have
ask your family members to help out with cleaning and cooking
watch some trashy reality TV shows and relax
practice good sleep hygiene by going to sleep at the same time each night and waking up at the same time each morning
go on a walk or do some other gentle exercise
get support from other sober people so you realize you are not alone
More information on early sobriety fatigue
E175: Tired after quitting drinking? Here’s how to boost your energy levels
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E157: Brain fog and fatigue in early sobriety
Listen on: Apple Spotify Other Apps
More advice on dealing with exhaustion after quitting drinking
Cite this page
Tietz, G. Episode 33: Does Alcohol Really Energize Us? Sober Powered. 2021
Sources
Ghrayeb, A., Gottlieb, E. & Mor, I. Alcohol-derived acetate modulates brain function. Nat Metab 1, 1036–1037 (2019).
Jiang, L. et al. Increased Brain Uptake and Oxidation of Acetate in Heavy Drinkers. JCI. 2013
Pardo, M. et al. Acetate as an Active Metabolite of Ethanol: Studies of Locomotion, Loss of Righting Reflex, and Anxiety in Rodents. Behav. Neurosci. 2013.
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A common complaint in early sobriety is fatigue. We feel tired all the time and annoyed because aren’t we supposed to be feeling amazing? Alcohol has calories, so it does provide our body with energy, but it actually does it in a more complex way than you think. I used to come home from work exhausted, and as soon as I got a little wine in me I became energetic and happy again. I called it “wine energy”. Now in sobriety I’m curious, is wine energy a real phenomenon or was it just a feeling I had from the buzz. Alcohol is processed by two enzymes. The first, alcohol dehydrogenase, converts ethanol into acetaldehyde, which is 10x more toxic. The second enzyme, aldehyde dehydrogenase converts this molecule into acetate. Most of the acetate produced by the liver is released back into circulation, and it is quickly able to enter the brain. Acetate is similar to acetic acid, which is basically vinegar. Chronic, heavy drinkers will show elevated acetate levels for about 24 hours after their last drink. In the brain, acetate can be converted into adenosine, which has similar sedating properties as alcohol. Adenosine is another inhibitory neurotransmitter and acts as a nervous system depressant. Adenosine promotes sleep and adenosine levels naturally rise during the day as part of our circadian rhythm. The brain normally uses glucose as an energy source, but it can use acetate as an alternative. Studies have shown that alcohol decreases the brain’s use of glucose and can lead to hypoglycemia. Chronic, heavy drinkers will likely always have high levels of acetate, since levels remain elevated 24 hours after our last drink. One study found that after 48 hours of sobriety, the baseline levels of acetate in the blood for heavy drinkers were more than twice the levels in light drinkers. Also, it’s important to note that the heavy drinkers consumed at least 8 drinks per week, so that’s not really even heavy drinking. The light drinkers drank a maximum of 2 drinks per week. High levels of acetate cause inflammation in the liver and brain, which causes damage over time. The brain can become dependent on acetate as an energy source, making withdrawal even worse. This makes it even harder to quit drinking. Remember, acetate is converted into adenosine in the brain, which is a chemical that calms us and promotes sleep. When someone is trying to quit drinking they all of a sudden have a lack of acetate for energy and adenosine for sleep and relaxation. This can lead to exhaustion, anxiety and trouble sleeping, two things which can make someone go back to drinking. One of the beliefs that we form around alcohol is that it gives us energy. This is because our bodies are using the alcohol as fuel. When I was drinking I could easily stay up until 2am, which is very unlike me, but wine gave me so much energy I didn’t even feel tired. When someone stops drinking, it’s easy to feel tired and bored because now you’re not providing your body with a major energy source that it’s used to receiving. High levels of acetate cause epigenetic effects too. Remember, some genes are turned on by environmental factors. This is called epigenetics. Epigenetics studies how DNA markers influence how and when cells express certain genes. We pick up these epigenetic markers throughout our lives as we interact with our environment. Epigenetic effects on our genes can be caused from things like trauma, stress, and substance abuse. Not all of our genes are turned on at the same time, and one way our genes are controlled is by histones. They are proteins that hang out with our DNA and condense it into the shape of a chromosome. This protects the DNA from damage and keeps the DNA compact. It’s estimated that humans have about 100 trillion meters of DNA, so if it wasn’t packaged into little structures, we couldn’t fit it in our bodies. Histones are signaled by other molecules to relax and open up the structure by putting a little tag on the histone, and similarly, signaled to close up tight when other proteins remove the tag. This exposes the DNA so that specific genes can be expressed. Turns out, all of this acetate floating around in our brains has an impact on gene expression. A 2019 study published in Nature Metabolism found that the acetate produced from alcohol is able to be turned in the tag that opens up histones in the hippocampus. This allows genes to be expressed that normally wouldn’t, and it has an effect on memory and learning. We know from previous episodes that alcohol has a big impact on our genes, and is able to cause all sorts of epigenetic changes, this being one of them. There’s an enzyme in the hippocampus called ACSS2, which adds the tag on histones and signals it to open up and expose certain genes. The easiest way to explain an enzyme is that it’s a protein that does work on other molecules. Alcohol dehydrogenase does work on alcohol to break it down, and ACSS2 does work on the excess acetate from alcohol. Anyway, mice were injected with radiolabeled ethanol so the carbon or hydrogen in this ethanol was different from all other carbon and hydrogen in the body. That allowed the researchers to track what happened to this ethanol. It was broken down into acetate and made its way to the brain. They found that this acetate was quickly used to tag histones. When the researchers knocked out ACSS-2 and tried this experiment again, they saw no effect on histones from the labeled acetate. The genes that were affected were genes known to be involved in behavior, learning, memory, addiction, and alcohol use. When treated with an ACSS2 inhibitor, the expression of these genes stopped. The researchers also found that the mice developed a place preference and spent much more time where they were given alcohol, but the mice without ACSS2 did not hang out in any particular spot. This suggests that the genes affected by acetate are involved in associative learning, which is one of the reasons quitting drinking is so difficult. We associate drinking with after work, the weekend, our living room, eating dinner, vacations, and these associations could be so powerful partly because of the excess acetate from heavy drinking changing the way our genes are expressed in the hippocampus. Alcohol-associated cues are a big cause of triggers and relapse, and it appears that the acetate generated from the breakdown of alcohol reinforces the associations we make about drinking. Not only is acetate strengthening our associations about drinking, but it also allows genes to be expressed that influence our behavior, making it easier to return to drinking. The researchers concluded that some of the genes expressed affected how the mice behaved when they were faced with an environmental cue. For us, this could be going to a restaurant we got drunk at all the time, hanging out with specific people, or being at a party. The epigenetic changes from all the excess acetate have caused changes that promote craving and drug seeking behavior. So, “wine energy” is a real phenomenon, and our brains can become dependent on “wine energy”. When we try to quit drinking, this is one reason why we feel exhausted. On top of all of that, the excess acetate potentially changes our brains in a way that makes the associations we form about drinking even more powerful.
