Hangover
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A hangover (veisalgia) is the sum of unpleasant physical effects following heavy consumption of alcohol. The most common reported characteristics of a hangover are feelings of extreme thirst, lethargy, nausea, sensitivity to sunlight and noise, and headache. Hypoglycemia, dehydration, and vitamin B12 deficiency are all theorized causes of hangover symptoms.
Symptoms
An alcohol hangover is associated with a variety of symptoms that may include dehydration, tiredness, headache, nausea, diarrhea, weakness, difficulty concentrating, anxiety, irritability, sensitivity to light and noise and trouble sleeping. The symptoms vary from person to person, and occasion to occasion, usually beginning several hours after drinking. It is not clear whether hangovers affect cognitive abilities.Causes
Hangovers are multi-causal. Ethanol has a dehydrating effect (such substances are known as diuretics), which causes headaches, dry mouth, and lethargy. Dehydration causes the brain to shrink away from the skull slightly. This can be mitigated by drinking water after consumption of alcohol. Alcohol's impact on the stomach lining can account for nausea. Due to the increased NADH production during metabolism of ethanol by alcohol and aldehyde dehydrogenases, excess NADH can build up and slow down gluconeogenesis in the liver, thus causing hypoglycemia.Another factor contributing to a hangover is what results from the breakdown of ethanol via two chemical reactions, aided by enzymes produced by the cells of the liver. Ethanol is converted to acetaldehyde by the enzyme alcohol dehydrogenase, and then from acetaldehyde to acetate by the enzyme acetaldehyde dehydrogenase. Acetaldehyde and acetate are both mildly toxic, contributing to the hangover.
The two aforementioned reactions also require the conversion of NAD+ to NADH. With an excess of NADH, the lactate dehydrogenase reaction is driven to produce lactate from pyruvate (the end product of glycolysis) in order to regenerate NAD+ and sustain life. This diverts pyruvate from other pathways such as gluconeogenesis, thereby impairing the ability of the liver to supply glucose to tissues, especially the brain. Because glucose is the primary energy source of the brain, this lack of glucose contributes to hangover symptoms such as fatigue, weakness, mood disturbances, and decreased attention and concentration.
When one is drinking, the blood vessels in the face, the capillaries, will dilate, giving the person a flushed apperance, often refered to as the "drunk blush". However, when the hangover starts, the capillaries will close up again, creating the headache and fatigue that is often experienced in a hangover. People experiencing hangovers will often feel cold. This is because alcohol gives the person a type of hypothermia in which body heat is given off too rapidly.
Finally there are various nervous effects. The removal of the depressive effects of alcohol in the brain probably account for the light and noise sensitivity.
In addition, it is thought that the presence of other alcohols (such as methanol and fusel oils), by-products of the alcoholic fermentation also called congeners, exaggerates many of the symptoms; this probably accounts for the mitigation of the effects when distilled alcohol, particularly vodka, is consumed.
The amount of congeners in the drink may also have an effect. Red wines have more congeners than white wines, and some people note less of a hangover with white wine.
In alcohol metabolism, one molecule of ethanol (the primary active ingredient in alcoholic beverages) produces 2 molecules of NADH, utilizing Vitamin B12 as a coenzyme. Over consumption of ethanol may cause vitamin B12 deficiency as well.
Some people believe that sugar (often found in sweet cocktails) worsens hangovers.
Nicotine poisoning can often worsen hangovers, as smokers tend to smoke much more than usual while under the influence of alcohol.
Genetics also plays a part, as some people seldom, if ever, suffer hangover symptoms no matter how much they drink.
The psychosomatic nature of hangovers shouldn't be ignored either. If people expect a hangover, they tend to feel one.
Possible remedies
There is debate about whether a hangover might be prevented or at least mitigated. The most important thing to remember though, is that there is no remedy for making yourself sober. Alcohol must be oxidized through the liver before it leaves your body, though breathing deep breaths will sometimes help it go down a bit faster since there is actually alcohol on your breath. A four page literature review in British Medical Journal on hangover cures by Max Pittler of the Peninsular Medical School at Exeter University and colleagues concludes: "No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to practice abstinence or moderation." Max H Pittler, Joris C Verster, Edzard Ernst [Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials] BMJ 2005;331:1515-1518 (24 December), doi:10.1136/bmj.331.7531.1515 The following may be of some benefit:
- Rehydration: "Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6."Jeffrey G. Wiese, Michael G. Shlipak, Warren S. Browner [The Alcohol Hangover] Annals of Internal Medicine 6 June 2000 Volume 132 Issue 11 pp897-902
- Opuntia ficus indica: A 2004 clinical study suggests that taking an extract of a prickly pear cactus fruit (Opuntia ficus indica) five hours before drinking had a statistically significantly effect on three hangover symptoms. "Three of the 9 symptoms – nausea, dry mouth, and anorexia – were significantly reduced by OFI." (Anorexia in this context simply means loss of appetite, not be confused with anorexia nervosa.)Jeff Wiese, MD; Steve McPherson, MD; Michelle C. Odden, BS; Michael G. Shlipak, MD, MPH [Effect of Opuntia ficus indica on Symptoms of the Alcohol Hangover] Arch Intern Med. 2004;164:1334-1340.Shaoni Bhattacharya [Cactus extract offers hangover help] New Scientist 28 June 2004 The authors conclude, "The symptoms of the alcohol hangover are largely due to the activation of inflammation. An extract of the OFI plant has a moderate effect on reducing hangover symptoms, apparently by inhibiting the production of inflammatory mediators."
- Tolfenamic acid (TA): A study concludes, "TA was found significantly better than placebo in the subjective evaluation of drug efficacy (p<0.001) and in reducing the reported hangover symptoms in general (p < 0.01). In the TA group, significantly lower symptom scores were obtained for headache (p<0.01), and for nausea, vomiting, irritation, tremor, thirst and dryness of mouth (all p < 0.05)."S. Kaivola1, J. Parantainen, T. Österman and H. Timonen [Hangover headache and prostaglandins: Prophylactic treatment with tolfenamic acid] Cephalalgia Volume 3 Page 31 - March 1983 doi:10.1046/j.1468-2982.1983.0301031.x
- Vitamin B6 (pyritinol): Some studies that have found that Vitamin B6 reduces hangovers.Khan MA, Jensen K, Krogh HJ. [Alcohol-induced hangover: A double-blind comparison of pyritinol and placebo in preventing hangover symptoms] Q J Stud Alcohol. 1973;34:1195-201
- Chlormethiazole: "Chlormethiazole was found to lower blood pressure and adrenaline output and, furthermore, to relieve unpleasant physical symptoms, but did not affect fatigue and drowsiness. The cognitive test results were only slightly influenced by this agent, while psychomotor performance was significantly impaired. Subjects with severe subjective hangover seemed to benefit more from the chlormethiazole treatment than subjects with a mild hangover."Myrsten AL, Rydberg U, Idestrom CM, Lamble R. [Alcohol intoxication and hangover: modification of hangover by chlormethiazole] Psychopharmacology (Berl). 1980;69(2):117-25. "However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group."Castleden CM, George CF, Sedgwick EM.
- Rosiglitazone: [Study in rats] "Rosiglitazone alleviated the symptoms of ethanol-induced hangover by inducing ALD2 expression…"Jung TW, Lee JY, Shim WS, Kang ES, Kim SK, Ahn CW, Lee HC, Cha BS.
The following are of little or no benefit:
- Globe artichoke (Cynara scolymus) extract: "Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover."Max H. Pittler, Adrian R. White, Clare Stevinson and Edzard Ernst [Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial] CMAJ December 9, 2003; 169 (12)
- Propranolol: "We conclude that propranolol does not prevent the symptoms of hangover."Bogin RM, Nostrant TT, Young MJ. [Propranolol for the treatment of the alcoholic hangover] Am J Drug Alcohol Abuse. 1986;12(3):279-84.Bogin RM, Nostrant TT, Young MJ
- Fructose and glucose: "The results indicate that both fructose and glucose effectively inhibit the metabolic disturbances induced by ethanol but they do not affect the symptoms or signs of alcohol intoxication and hangover." Ylikahri RH, Leino T, Huttunen MO, Poso AR, Eriksson CJ, Nikkila [Effects of fructose and glucose on ethanol-induced metabolic changes and on the intensity of alcohol intoxication and hangover] Eur J Clin Invest 1976 Jan 30;6(1):93-102.
- Drinking coffee or other caffeinated beverages. Caffeine increases the effectiveness of analgesics, and therefore may reduce headache severity when used with aspirin or similar medicines. However, it is also a diuretic and will promote dehydration, possibly worsening other hangover symptoms.
- Cabbage leaves or tomato juice
- Mixing in a tall glass two raw eggs with pepper, tabasco sauce, and gin. Although the cysteine in the egg yolk may have a mild benefit, the pepper, tabasco, and gin will have a negative impact. Colloquially known as a "Prairie Oyster".
- Drinking more alcohol (see hair of the dog), a well-liked, though misguided remedy.
- Coca Cola, otherwise known as "Black Aspirin" (popular in Australia), also "The Red Ambulance" (Ireland); the caffeine, bubbles and sugar can be easier to hold down than pure water. Moreover, the low pH helps the enzymes in the stomach and the sucrose partially compensates the inhibitation of the gluconeogenesis. Again, caffeine can worsen effects of dehydration.
- Taking a shower and oscillating between extreme cold and hot temperatures. This practice has no effect on the hangover and can be unhealthy.
- Eating canned asparagus before going to bed, purportedly a good cure thanks to the diuretic effects of asparagus. Again, diuretics compound the problem.
- Ginseng tea is given to a drunkard to relieve the effects of alcohol. This may be the practice, but there is no reason to believe ginseng will help.
- drinking a sports drink such as Powerade or Gatorade, to re-hydrate and replenish lost nutrients in the body. Gatorade offers a high level of re-hydration and - if consumed before and after high amounts of drinking - can limit the effects of a hangover.* [Pedialyte] contains more electrolytes than most any over-the-counter drug. This will help you re-hydrate your body as quickly as possible.
- drinking a large amount of water before going to bed, and during the night, for rehydration (a little water is much better than none)
- eating as much food as you can hold down. Your pyloric valve will shrink in response to the large amount of food you consume thereby reducing any further absorption of alcohol. A large meal is likely to contain nutrients to replenish your body and may also cause drowsiness which will help you sleep while your body repairs.
- eating mineral-rich foods, like pickles or canned fish
- drinking pickle juice, the solution in which cucumbers were pickled, in the morning (a staple hangover remedy in Poland)
- eating anything substantial, especially before going to bed, to "soak up" the alcohol in the stomach (e.g. a pizza or sandwich)
- orange juice, which is rich in vitamin C
- taking a vitamin B1 (thiamin) supplement before going to bed
- (instant) chicken or vegetable soup provides salt, proteins and electrolytes which help attenuate hangover symptoms
- drinking homemade Sauerkraut juice, the solution in which the cabbage was fermented in, in the morning (a staple hangover remedy in Serbia, called rasol)
- Irn Bru is commonly regarded as a remedy in the UK.
- cysteine, which is available as the over-the-counter supplement N-acetylcysteine (NAC), is known to assist in processing acetaldehyde, best taken while already drinking and/or before going to bed. (Egg yolk is also rich in cysteine, and it is notable that many hangover folk remedies or morning-after breakfasts incorporate eggs.)
- consumption of an Ulster Fry (popular in Northern Ireland), an Irish Breakfast or a Breakfast Roll, a meal that is an all day breakfast.
- day/night cold and flu tablets - Be wary of ones that contain paracetamol as it should not be mixed with alcohol. Both alcohol and paracetamol can affect the liver, but combined are worse.
- taking a dose of ibuprofen before sleeping can reduce hangover effects dramatically; however long term (longer than two weeks) use of ibuprofen increases the risk of stomach ulcers.
- sleep
In 2003, a fad hangover cure was a Russian pill, sold in Russia as Antipokhmelin (Anti-Hangover), and marketed as RU-21 in the USA. It is also known as the KGB pill due to its supposed use by the KGB to allow spies to keep a clear head while drinking.
Etymology
The term hangover was originally a 19th century expression describing unfinished business – something left over from a meeting – or ‘survival.’ In 1904, the meaning "after-effect of drinking too much" first surfaced. Online Etymology Dictionary, Hangover [link] Modern Drunkard Magazine [link]See also
- Blood alcohol concentration
- Chaser (tablet) an anti-hangover pill
- Withdrawal
- List of iconic drinkers
- De-rex a hangover cure and liver health supplement
References
External links
- ["Alcohol Hangover: Mechanisms and Mediators"] [PDF] by Robert Swift, M.D., Ph.D. and Dena Davidson, Ph.D., NIAAA Alcohol Health and Research World, January 14, 2002, retrieved November 22, 2004.
- ["The party's over: Advice on treating hangovers"] by Dr. Thomas Stuttaford, The Times, December 13, 2004 retrieved August 24, 2005. A colorful article on hangovers, their cause and treatment along with reference to famous Soho drinkers, such as Jeffrey Bernard, Dylan Thomas and Francis Bacon.
- ["Hangover Remedies Flood Market"] by David J. Hanson, Ph.D., Potsdam, 2005, retrieved September 9, 2005.
- ["Kudzu and Alcohol Consumption"] by David J. Hanson, Ph.D., Potsdam, 2005, retrieved December 16, 2005.
- ["The ultimate hangover cure?"] by Becky McCall, BBC News Magazine, December 28, 2005, retrieved December 28, 2005.
- ["Hangover Prevention And Relief"]
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