This is a quick guide to alleviating or completely avoiding hangover symptoms through an understanding of alcohol itself, physiological changes related to alcohol consumption, and a variety of suggested remedies for specific hangover symptoms.
[Warning: First and foremost let me at least mention that you should always try to drink responsibly and arrange having a designated driver if you will be using your personal vehicle for transportation.]
Classes of Alcoholic Beverages
Alcoholic beverages are divided into three general classes: beers, wines, and spirits. Beer and wine are produced by fermentation of sugar- or starch-containing plant material. Beverages produced by fermentation followed by distillation have higher alcohol content and are known as liquor or spirits. The alcoholic strength of beer is usually 4% to 6% alcohol by volume (ABV), but it may be less than 2% or greater than 25%. Beers having an ABV of 60% (120 proof) have been produced by freezing brewed beer and removing water in the form of ice, a process referred to as "ice distilling". Beer is part of the drinking culture of various nations and has acquired social traditions such as beer festivals, pub games, and pub crawling (sometimes known as bar hopping).
Wine is produced from grapes, and from fruits such as plums, cherries, or apples. Wine involves a longer fermentation process than beer and also a long aging process (months or years), resulting in an alcohol content of 9%-16% ABV. Sparkling wine can be made by means of a secondary fermentation. Fortified wine is wine (such as port or sherry), to which a distilled beverage (usually brandy) has been added.
Unsweetened, distilled, alcoholic beverages that have an alcohol content of at least 20% ABV are called spirits. Spirits are produced by the distillation of a fermented base product. Distilling concentrates the alcohol. For the most common distilled beverages, such as whiskey and vodka, the alcohol content is around 40%. Spirits can be added to wines to create fortified wines, such as port and sherry.
A 2009 study provided evidence that darker-colored liquors, such as bourbon, cause worse hangovers than lighter-colored liquors, such as vodka. The higher amount of "congeners" found in darker liquors compared to lighter ones was indicated as the cause. Studies that attempt to compare hangover producing potential and hangover severity of different alcoholic drinks suggest the following ordering (starting with the least hangover-inducing):
Distilled ethanol diluted in fruit juice, beer, vodka, gin, white wine, whisky, rum, red wine, and brandy.
Alcohol and its Effects, the Basics
Now let's cover some basics about alcohol. What is alcohol? Alcohol is a distilled or fermented beverage that transforms a grain, fruit, vegetable, or wood into ethanol. Ethanol, glucose, and sucrose are all in the same group of alcohols. Ethanol is the most common form of alcohol one finds in alcoholic beverages.
Alcohol is a psychoactive drug that has a depressant effect. Alcohol also stimulates insulin production, which speeds up glucose metabolism and can result in low blood sugar, causing irritability and (for diabetics) possible death. Alcohol intoxication affects the brain and causing symptoms such as slurred speech, delayed reflexes, vomiting or unconsciousness. Alcohol also limits the production of vasopressin (ADH) from the hypothalamus and the secretion of this hormone from the posterior pituitary gland. This is what causes the intense thirst that goes along with a hangover.
Now when alcohol builds up in the bloodstream faster than it can be metabolized by the liver, we enter a physiological state known as drunkenness or inebriation. Alcohol is metabolized by a normal liver at the rate of about one ounce (one two-ounce shot of spirits, a normal beer, a regular sized glass of wine) every 90 minutes. An "abnormal" liver with conditions such as hepatitis, cirrhosis, gall bladder disease, and cancer will have a slower rate of metabolism.
Ethanol's acute effects are largely due to its nature as a central nervous system depressant, and are dependent on blood alcohol concentrations. Here's a breakdown of what effects one can expect to experience from alcohol consumption according to the quantity you consume:
20-99 mg/dL - Impaired coordination and euphoria
100-199 mg/dL - Ataxia, poor judgment, labile mood
200-299 mg/dL - Marked ataxia, slurred speech, poor judgment, labile mood, nausea and vomiting
300-399 mg/dL - Stage 1 anesthesia, memory lapse, labile mood
400+ mg/dL - Respiratory failure, coma
In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycemia occurs due to ethanol's inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis and acute renal failure.
Some effects of alcohol intoxication are central to alcohol's desirability as a beverage. For example, some desirable effects from small quantities of alcohol consumption are euphoria and lowered social inhibitions. Other symptoms include slurred speech, impaired balance, loss of muscle coordination (ataxia), flushed face, dehydration, vomiting, reddened eyes, and erratic behavior. Other effects are unpleasant or dangerous because alcohol affects many different areas of the body at once.
This last point, the fact that alcohol affects many different areas of the body at once, is crucial to understanding the nature of a hangover. Why? Because everyone experiences different symptoms from their hangover, each hangover has to be dealt with individually. Here are 2 reasons underlying hangovers with completely different characteristics.
Older people report that their hangovers grow worse as they age. This is caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.
So what we've come to is the fact that there is currently no empirical proof for hangover prevention except reducing the amount of ethanol consumed or waiting for the body to metabolize the alcohol ingested. This only happens when the liver oxidizes the alcohol. So what this means is that the most effective way to avoid any of the symptoms of alcohol-induced hangover is to control or avoid drinking.
Thus, no two hangovers are the same.
The Physiology of a Hangover
Excessive consumption of alcohol causes a delayed effect called a hangover. The hangover starts after the euphoric effects of ethanol have subsided. Hypoglycemia, dehydration, acetaldehyde intoxication, and glutamine rebound are all theorized causes of hangover symptoms. Hangover symptoms may persist for several days after alcohol was last consumed. Some aspects of a hangover are even viewed as symptoms of acute ethanol withdrawal, similar to the longer-duration effects of withdrawal from alcoholism.
Because alcohol impairs the ability of the liver to compensate for a drop in blood glucose levels, especially for the brain, it can result in the depletion of the liver's supply of glutathione, a detoxification agent, reducing its ability to effectively remove alcohol and its byproducts from the bloodstream. Since glucose is the primary energy source of the brain, this lack of glucose (hypoglycemia) contributes to symptoms such as fatigue, weakness, mood disturbances, and decreased attention and concentration related to a hangover.
The human body is a system of systems so physiological changes in one system changes others. That's why the best approach is to try to handle several symptoms by resolving alcohol-related issues in multiple body systems simultaneously. For example, when you ingest alcohol, the salivary glands secrete enzymes to combine with the alcoholic beverage to make it more suitable for processing in the stomach and intestines. As the alcohol circulates throughout the digestive system and blood stream it moves from one system to another. Just one drink affects the central nervous system, the digestive system, the endocrine system, the muscular system, the immune system, and the respiratory system, so with each additional drink the effects compound and the potential dangers increase. Because the alcohol moves around in the body rather than remaining in an organ, region, or system, its produces a wide range of negative physiological effects.
The most commonly reported characteristics of a hangover include headache, nausea, sensitivity to light and noise, lethargy, dehydration, fatigue, body aches, vomiting, diarrhea, flatulence, weakness, elevated body temperature and heart rate, hypersalivation, difficulty concentrating, sweating, anxiety, irritability, erratic motor functions (including tremor), trouble sleeping, severe hunger, halitosis, and lack of depth perception. Many people will also be repulsed by the thought, taste or smell of alcohol during a hangover. The symptoms vary significantly from person to person, and it is not clear whether hangovers directly affect cognitive abilities. The effects of a hangover subside over time.
Just as with lesser cases of low alcohol consumption, cases where excessive amounts of alcohol have been consumed such as with alcohol poisoning treatment strives to stabilize the patient and maintain a clear airway and respiration, while waiting for the alcohol to metabolize. In general, health care professionals will provide treatment for hypoglycemia (low blood sugar) with 50ml of 50% dextrose solution and saline flush, administer the vitamin thiamine to prevent seizure, check electrolytes to guide fluid replacement, apply hemodialysis (blood transfusion)if the blood concentration is dangerously high, or provide oxygen therapy.
Ineffective or unproven remedies
Recommendations for foods, drinks and activities to relieve hangover symptoms abound, here are some that have been found to be ineffective or unproven.
The "Prairie Oyster" restorative, introduced at the 1878 Paris World Exposition, calls for raw egg yolk mixed with Worcestershire sauce, Tabasco sauce, salt and pepper.
And in 1938, the Ritz-Carlton Hotel provided a hangover remedy in the form of a mixture of cola and milk. By some accounts, cola beverages are believed to have been invented as a hangover remedy.
Alcoholic writer Ernest Hemingway relied on tomato juice and beer.
The "Black Velvet" consists of equal parts champagne and flat Guinness Stout.
A 1957 survey by a Wayne State University folklorist found widespread belief in the efficacy of heavy fried foods, tomato juice and sexual activity.
Activities said to be restorative include a shower-alternating very hot and very cold water, exercise, and steam bath or sauna (although medical opinion holds this to be very dangerous, as the combination of alcohol and hyperthermia increases the likelihood of dangerous cardiac arrhythmias).
A 1976 research came to the conclusion that "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." Nevertheless, consumption of honey (a significant fructose and glucose source) is often suggested as a way to reduce some of the effects of hangover.
Food and Alcohol Metabolism
Studies have found that when food is eaten before drinking alcohol, alcohol absorption is reduced and the rate at which alcohol is eliminated from the blood is increased. The mechanism for the faster alcohol elimination appears to be unrelated to the type of food. The likely mechanism is food-induced increases in alcohol-metabolizing enzymes and liver blood flow. While this may not decrease your chances for getting a hangover, it's a good idea to eat before you drink, but know that doing so will eliminate the alcohol from your system faster than normal.
Scientifically Based Remedies
Earlier I said that because alcohol affects many different areas of the body at once, each hangover has to be dealt with individually. Why? Because everyone experiences different symptoms from their hangover, different from everyone else, and even from one state of drunkenness compared to another time of drunkenness. So the conclusion here is that there is currently no empirical proof for hangover prevention except reducing the amount of ethanol consumed or waiting for the body to metabolize the alcohol ingested. What this means is that the most effective way to avoid any of the symptoms of alcohol-induced hangover is to control or avoid drinking.
But what are we supposed to do if we get a hangover? Sometimes it's not possible to wait for the effects of the hangover to wear off, while coping with the symptoms. We need a way to effectively deal with this situation. You're right, we do. Here's the realization I've come to about how to handle the symptoms of a hangover.
The primary realization is that a hangover is not a thing, instead it's a series of symptoms related to excessive alcohol consumption. That's key.
The second important point is that in order to deal with any one hangover experience effectively you have to deal with the exact symptoms you're going through during a specific hangover. Although there are many common symptoms experienced by most people routinely, sometimes new symptoms appear that were never part of previous hangovers. This is why it's best to handle the symptoms vs. trying to recover from a "hangover."
So below is a list of practices, substances, and products that deal with specific symptoms that should help you fight the effects of hangover whenever they occur. You may also want to go back and re-read this article as there were remedies - such as eating before drinking, timing one's intake per ounce of ingestion, and preventing vomiting by abstinence in order to protect the stomach lining from erosion by alcohol - mentioned earlier that will not appear in this list.
Rehydration: Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6.
Milk thistle: A small dosage before and after alcohol consumption has been found to alleviate the some of the effects of a hangover such as headaches, sluggishness and nausea. Milk thistle works to regenerate liver cells and when combined with an excessive vitamin D intake from the sun, subjects have experienced rapidly decreasing hangover effects.
Tolfenamic acid is useful for nausea, vomiting, irritation, tremor, thirst, and dryness of mouth.
Vitamin B6 (pyritinol) can help to reduce some, but not all, of the symptoms of hangovers. For this Brewers' yeast or a B6 supplement are recommended.
Chlormethiazole was found to lower blood pressure and adrenaline output and, furthermore, to relieve unpleasant physical symptoms, but did not affect fatigue and drowsiness. Subjects with severe subjective hangover seemed to benefit more from the chlormethiazole treatment than subjects with a mild hangover.
Pedialyte may be an effective remedy for hangovers due to its replacement of lost electrolytes.
Candy or sugar: to raise lowered blood sugar levels caused by alcohol intake. Other options for sweeteners to use are honey, brown sugar, maple syrup, agave nectar, and fructose.
Alcohol: There is a belief that consumption of additional alcohol in decreasing quantity over a period of hours after the onset of a hangover will relieve symptoms. This is based upon the theory that the hangover represents a form of withdrawal and that by satiating the body's need for alcohol the symptoms will be relieved. Certainly the additional alcohol has a sedating and anesthetic effect, which also helps with symptoms. The professional medical opinion holds that the practice merely postpones the symptoms, and courts alcohol dependence and addiction.
Medical marijuana: It is commonly believed that THC, the active chemical in marijuana, is an effective hangover remedy. THC may help ease the main symptoms of hangovers: nausea and headache. The advantage is two-fold; as once a sufferer's nausea has abated, and his appetite is stimulated, hypoglycemia becomes easier to resolve.
A traditional hangover remedy from India is to drink coconut water for the natural electrolytes which will assist in rehydration.
Acetyl-leucine sold under the brand name of Tanganil is believed to help pull you out of the "whirling pit" or spinning sensation felt by people under the influence of alcohol. This is caused by a dysfunction between the nerves which control the notion of balance in the ears and the brain. Tanganil is the standard remedy prescribed to people suffering from chronic vertigo.
Oxygen: There have been anecdotal reports from those with easy access to a breathing oxygen supply - medical staff, SCUBA divers and military pilots - that oxygen can also reduce the symptoms of hangovers caused by alcohol consumption. The theory is that the increased oxygen flow resulting from oxygen therapy improves the metabolic rate, and thus increases the speed at which toxins are broken down.
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