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The Bad News on Hangovers.

By Chris Rangel MD ⋅ January 3, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Hangover; The bad news.

Are you still recovering from celebrating a secular arbitrary calendar related holiday? Did you try to cure your hangover with every cockamamie treatment you found on the Internet or were told about by friends, family, or a local Irish priest? None of them worked worth a dam beyond the expected placebo effect, did they? Don’t act surprised.

A few hard partying English type persons took a look at this issue and published their results in The British Medical Journal (BMJ). Despite Billions spent on alcohol each year in the US and UK and Billions more in lost productivity and “sick days” from over indulgence in happy juice, very little research has been done on causes or cures for this very neglected condition.

What the BMJ review did find is that there is no definitive evidence that any of these cures makes any difference and even though some treatments (linolenic acid, dried yeast preparation, and tolfenamic acid) did show promising results, the studies were small and not well designed. In many studies the actual amounts of alcohol and food consumed were not monitored and physiologic changes were not measured. Only eight studies of various hangover “cures” were evaluated in this review.

So just what is a “hangover” and why does one feel overhung after consuming too much alcohol? The reason appears to be multifactorial. First off there is some experimental evidence that dark or colored drinks (wine, bourbon, scotch, and brandy) are more likely to cause a hangover because they contain impurities called congeners produced as a byproduct of the fermenting process. Red wine contains tyramine which can induce particularly bad headaches in the post-party period. Ergo, clearer spirits may reduce your hangover symptoms.

Eating just before consuming alcohol helps to reduce the rate of absorption and can reduce the peak blood alcohol concentration by 9-23%. Food causes the pyloric valve at the bottom part of the stomach to close in order for digestion to start. Since alcohol is mostly absorbed in the small intestine, eating delays and significantly reduces the absorption rate. In addition, since alcohol is eliminated by the body using zero order kinetics (a constant rate of reaction independent of the concentration) even small amounts of absorbed alcohol are quickly and effectively metabolized and removed (this is why it is important to imbibe slowly - about one drink per hour). The type of food does not make a difference but larger meals will delay absorption even more.

Since alcohol has a high affinity for water (i.e. it dissolves much better in water than fat), people with more body fat (i.e. those who are obese, female, older) will have lower blood alcohol levels even if the same amounts of alcohol are consumed as a person with low body fat. In addition to having higher body fat percentages, women may be able to absorb more alcohol because they tend to have lower levels of a stomach enzyme (alcohol dehydrogenase) that normally breaks down alcohol before it reaches the small intestine. Chronic alcoholics also appear to have lower levels of this enzyme.

Once absorbed alcohol causes several physiologic changes (other than intoxication). Ethel alcohol is metabolized (mostly by that poor suffering liver you too often abuse) into acetaldehyde, which may be responsible for many symptoms of hangover. Alcohol also elevates levels of chemicals called cytokines, which are known to be elevated by viral infections (or administration of alpha-interferon) and cause symptoms like nausea, headache, and diarrhea.

Every bar had a bathroom and for good reason. Alcohol blocks the effect of antidiuretic hormone (ADH) on the kidneys. ADH is normally produced by the pituitary gland and causes the kidneys to secrete less water (i.e. when the patient is dehydrated). Without the ADH effect the kidneys secrete large amounts of water that may exceed the amount of fluid consumed in the alcoholic beverages. This often leads to dehydration in the post-party period with symptoms of light-headedness, weakness, and “cotton mouth”. Most hangover therapies recommend liberal consumption of water and avoidance of caffeine that itself induces fluid loss and may worsen the condition. However, rehydration alone has not been shown to completely eliminate all hangover symptoms.

Alcohol may cause lower blood sugar levels when chronic use induces liver damage and alcohol itself may inhibit glycogen breakdown by the liver. However, the most common cause of lower blood sugar levels appears to be in alcoholics with poor nutrition or when someone is on a drinking binge during which they eat little and the liver exhausts it’s supply of glycogen which it breaks down into glucose for use by the body. However, low blood sugar levels have not been proven to be a main cause of hangover symptoms.

Alcohol causes the intestines to speed up. Gastric emptying is increased and transit time of food and fluid through the bowels is increased. In addition, alcohol impairs the absorption ability of the intestines. The end result is that diarrhea is a common component of the hangover (and of chronic alcoholism). Ironically many hangover cures include recommendations for a big breakfast with plenty of carbohydrates, grease, and fat. While this will help with nutrition, fatty meals actually increase intestinal mobility and thus will make a bad situation even worse.

The intoxicating effect of alcohol can be seen by a slowing of brainwaves on an electroencephalogram (EEG). What this causes during sleep when one is intoxicated is that less time is spent in REM (the dreaming and refreshing part of sleep) and more time is spent in what is called slow wave sleep. In addition, alcohol relaxes the throat muscles during sleep leading to greater snoring and possibly sleep apnea in susceptible individuals. The result is sleep that is not effective and leads to excessive daytime fatigue.

As many have already said, the best hangover cure appears to be prevention. I.e. avoid over indulging. Short of this, a few common sense pointers may work. Eat shortly before you drink. Try to stick to clear liquors or low alcohol drinks. Consume liberal amounts of water. Avoid caffeine and fatty foods. Try and get as much sleep as you can and remember “hair of the dog” (drinking some more alcohol the day after) is just a way to delay the unavoidable.