You wake up the morning after a holiday party and your head is pounding, your tongue is stuck to the roof of your mouth and your eyes are bloodshot. You stagger out of bed up feeling dizzy and nauseous as you stumble towards the bathroom. Hopefully, unlike the movie, you do not find a tiger (or strange human) in your house. Usually one’s prevailing thoughts are: “what did I drink?”, “what did I do”, and “how can I feel better?”
The medical word for hangover is veisalgia. Many cures have been anecdotally reported, from commercial pills and packets to word of mouth and folklore remedies: Hair of the Dog (gin and hot sauce), Blood Mary, Alka Seltzer Morning After, pickle juice, greasy eggs and bacon breakfast, exercise, caffeine, fruit juice, ginger root, milk thistle, vitamins, pain medications, lemon juice in the armpits, Prairie Dog (raw egg and Worcestershire sauce ), raw owl eggs and fried canary (ancient Romans), and the list goes on. Do any of these really work?
What causes a hangover?
Alcohol (ethanol), in addition to mind altering has many other effects on the body. It is rapidly absorbed by the gut and metabolized by the liver at a constant rate of about .02 g/dl/hour, which is approximately 1 drink. A toxic intermediate is produced, acetaldehyde, which is rapidly broken down to acetic acid. Some of the toxic effects may be due to the acetaldehyde and small amounts of other byproducts of reactions, which are produced in greater concentrations with dark liquors such as whisky, tequila, and brandy.
Now for some biochemistry (not to worry-there’s no test). Acute ethanol ingestion alters hormones, including the inhibition of anti-diuretic hormone (ADH) leading to increased loss of water through urination causing dehydration. Glucose availability is decreased, and other hormones are affected, including aldosterone, renin and cortisol. The pH of the blood becomes more acidic (metabolic acidosis).
Interestingly, many of these effects are reversed during the “hangover” phase, presumably the body is working to correct itself. Ethanol also alters cytokine pathways, which are releases of minute quantities of factors important in inflammation and healing. How each of these contributes to the malaise, nausea and headaches experienced is poorly understood.
How can one prevent a hangover?
Obviously the first answer is not to drink, or do it in moderation. Food slows the absorption of ethanol. Count the number of drinks and pace yourself, considering the body eliminates about one drink an hour. Merely as an illustration, the legal blood alcohol limit for Virginia driving (indicating intoxication) is .08 (g etoh/100 g blood), which is about 3 drinks before metabolism (although any alcohol use should prohibit driving).
Keeping hydrated by drinking other fluids such as water or sports drinks in additional to alcoholic beverages may help. There is some evidence that fructose can be beneficial, which is especially abundant in honey. Avoid mixing many beverages, and consider clear liquors if you are imbibing. Vitamin B6, 400 mg every 3 hours for a total of 3 doses (before, during, and after a party) was shown to decrease hangover symptoms in one study.
Are there any effective remedies?
Dr. Weise et al in 2000 in the Annals of Internal Medicine performed a Medline search of all studies on hangover treatments. They found that most purported treatments did not work, with a few exceptions. Hydration is helpful as well as prostaglandin inhibitors such as ibuprofen. This is preferable to Tylenol, which is metabolized by the liver, an organ already stressed from the alcohol. Two trials found that eating carbohydrates had no effect on veisalgia symptoms and others do not support treatment by drinking even more alcohol.
So it looks like the only sure answer is to drink responsibly. How about drinking small amounts of a really good beer, wine, or liquor; let’s say Chateau Lafite 1787 – $160,000! I would settle for a glass of Hennessey cognac.
Do you have any hangover remedies or stories of waking up after drinking a little too much you would like to share?