| Waking up after a late-night party, a special dinner out featuring a bottomless glass of wine or an especially heartbreaking football game you happened to watch at a sports bar, you shield your half-open eyes from the sunshine piercing through the blinds and put a hand to your throbbing head -- you have a hangover. And you are not alone: More than 75 percent of alcohol consumers have experienced a hangover at least once; 15 percent have one at least every month; and 25 percent of college students feel symptoms weekly.
Could all these hangover sufferers have avoided their pain by knowing what causes it in the first place? In this article, HowStuffWorks explains what causes the cocktail of hangover symptoms as well as the surprisingly simple prevention methods and morning-after remedies you can use to ease the pain.
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In the Most Surprising Places
Hangovers have plagued people throughout history. The Bible even makes mention of the pain that follows a night of heavy drinking: "Woe unto them that rise up early in the morning, that they may follow strong drink" (Isaiah 5:11). And Shakespeare knew the unwanted effects of alcohol, as shown in his play Macbeth (Act 2 scene 3):
Macduff: What three things does drink especially promote? Porter: Marry sir, nose-painting, sleep, and urine. |
The formal name for a hangover is veisalgia, from the Norwegian word for "uneasiness following debauchery" (kveis) and the Greek word for "pain" (algia) -- an appropriate title considering the motley of uncomfortable symptoms experienced by the average drinker. The common hangover includes some or all of the following:
- Headache
- Poor sense of overall well-being
- Sensitivity to light and sound
- Diarrhea
- Loss of appetite
- Trembling
- Nausea
- Fatigue
- Increased heart rate and blood pressure
- Dehydration (dry mouth, extreme thirst, dry eyes)
- Trouble concentrating
- Anxiety
- Difficulty sleeping
- Weakness
The most common symptoms are headache, fatigue and dehydration, and the least common is trembling. The severity and number of symptoms varies from person to person; however, it is generally true that the more alcohol is consumed, the worse the hangover will be. It usually takes five to seven cocktails imbibed over the course of four to six hours to cause a hangover for a light-to-moderate drinker (a man who drinks up to three alcoholic beverages a day or a woman who drinks up to one). It may take more alcohol for heavier drinkers because of increased tolerance. Other than the number of drinks consumed, hangovers can be made worse by:
- drinking on an empty stomach
- lack of sleep
- increased physical activity while drinking (dancing or rough-housing)
- dehydration before drinking
- poor health
The reason for some symptoms is still unknown, but research has led scientists to have a pretty good understanding of the primary causes of a hangover. In the next sections, we'll find out what's going on in the body to cause this morning-after discomfort.
Biology of a Hangover: Vasopressin Inhibition
When alcohol is consumed, it enters the bloodstream and causes the pituitary gland in the brain to block the creation of vasopressin. Without this chemical, the kidneys send water directly to the bladder instead of reabsorbing it into the body. This is why people have to make frequent trips to the bathroom after "breaking the seal" (urinating for the first time after drinking).
According to studies, drinking about 250 milliliters of an alcoholic beverage causes the body to expel 800 to 1,000 milliliters of water; that's four times as much liquid lost as gained. This diuretic effect decreases as the alcohol in the bloodstream decreases, but the aftereffects help create a hangover. The morning after heavy drinking, the body sends a desperate message to replenish its water supply, usually manifested in an extremely dry mouth. Headaches result from dehydration because the body's organs try to make up for their own water loss by stealing water from the brain, causing the brain to decrease in size and pull on the membranes that connect the brain to the skull, resulting in pain.
The frequent urination also expels salts and potassium that are necessary for proper nerve and muscle function; when sodium and potassium levels get too low, headaches, fatigue and nausea can result. Alcohol also breaks down the body's store of glycogen in the liver, turning the chemical into glucose and sending it out of the body in the urine. Lack of this key energy source is partly responsible for the weakness, fatigue and lack of coordination the next morning. In addition, the diuretic effect expels vital electrolytes such as potassium and magnesium, which are necessary for proper cell function.
Biology of a Hangover: Congeners
Have you noticed that certain alcohols have a tendency to cause a hangover, even if you drink less of them? This is because they have a higher concentration of congeners, byproducts of fermentation in some alcohols. The greatest amounts of these pesky toxins are found in red wine and dark liquors such as bourbon, brandy, whiskey and tequila. White wine and clear liquors such as rum, vodka and gin have fewer congeners and therefore cause less frequent and less severe hangovers.
In a study, 33 percent of those who drank an amount of bourbon relative to their body weight reported severe hangover, compared to 3 percent of those who drank the same amount of vodka. Because different alcohols (beer, wine, liquor, etc.) have different congeners, the various impurities can combine in less-than-pleasant ways, revealing the truth behind some popular reminders: "Don't mix the grape and the grain" (don't mix wine with liquor or beer) and "Beer before liquor, never been sicker. Liquor before beer, have no fear." The latter of the two also stems from the fact that the carbonation in beer actually speeds up the absorption of alcohol; therefore, following it with liquor gives the body even less time than usual to process the toxins -- often leading to a close encounter with "the porcelain god."
Biology of a Hangover: Congeners
Have you noticed that certain alcohols have a tendency to cause a hangover, even if you drink less of them? This is because they have a higher concentration of congeners, byproducts of fermentation in some alcohols. The greatest amounts of these pesky toxins are found in red wine and dark liquors such as bourbon, brandy, whiskey and tequila. White wine and clear liquors such as rum, vodka and gin have fewer congeners and therefore cause less frequent and less severe hangovers.
In a study, 33 percent of those who drank an amount of bourbon relative to their body weight reported severe hangover, compared to 3 percent of those who drank the same amount of vodka. Because different alcohols (beer, wine, liquor, etc.) have different congeners, the various impurities can combine in less-than-pleasant ways, revealing the truth behind some popular reminders: "Don't mix the grape and the grain" (don't mix wine with liquor or beer) and "Beer before liquor, never been sicker. Liquor before beer, have no fear." The latter of the two also stems from the fact that the carbonation in beer actually speeds up the absorption of alcohol; therefore, following it with liquor gives the body even less time than usual to process the toxins -- often leading to a close encounter with "the porcelain god."
You've probably heard about alcoholics ending up with liver problems.
Biology of a Hangover: Acetaldehyde
A product of alcohol metabolism that is more toxic than alcohol itself, acetaldehyde is created when the alcohol in the liver is broken down by an enzyme called alcohol dehydrogenase. The acetaldehyde is then attacked by another enzyme, acetaldehyde dehydrogenase, and another substance called glutathione, which contains high quantities of cysteine (a substance that is attracted to acetaldehyde). Together, the acetaldehyde dehydrogenase and the glutathione form the nontoxic acetate (a substance similar to vinegar). This process works well, leaving the acetaldehyde only a short amount of time to do its damage if only a few drinks are consumed.
Unfortunately, the liver's stores of glutathione quickly run out when larger amounts of alcohol enter the system. This causes the acetaldehyde to build up in the body as the liver creates more glutathione, leaving the toxin in the body for long periods of time. In studies that blocked the enzyme that breaks down acetaldehyde (acetaldehyde dehydrogenase) with a drug called Antabuse, designed to fight alcoholism, acetaldehyde toxicity resulted in headaches and vomiting so bad that even alcoholics were wary of their next drink. Although body weight is a factor (see How Alcohol Works), part of the reason women should not keep up with men drink-for-drink is because women have less acetaldehyde dehydrogenase and glutathione, making their hangovers worse because it takes longer for the body to break down the alcohol.
Some of the most common hangover symptoms -- fatigue, stomach irritation and a general sense of illness all over -- can be further attributed to something called glutamine rebound.
Biology of a Hangover: Glutamine Rebound
In addition to the fact that heavy drinking usually occurs during regular sleeping hours, when you do decide to crash you will not sleep as soundly because the body is rebounding from alcohol's depressive effect on the system. While you drink, alcohol inhibits glutamine, one of the body's natural stimulants; therefore, when you stop drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while you are trying to sleep, keeping you from reaching the deepest, most healing levels of slumber. This is a large contributor to the fatigue felt with a hangover. Severe glutamine rebound during a hangover also may be responsible for tremors, anxiety, restlessness and increased blood pressure.
Because alcohol is absorbed directly through the stomach, the cells that line the organ become irritated. Alcohol also promotes secretion of hydrochloric acid in the stomach, eventually causing the nerves to send a message to the brain that the stomach's contents are hurting the body and must be expelled through vomiting. Although less-than-pleasant, this mechanism can actually help your hangover in the long run because vomiting gets rid of the alcohol in your stomach and reduces the number of toxins the body has to deal with, ultimately making you feel better. The stomach's irritation may also be a factor in some of the other unpleasant symptoms of a hangover, such as diarrhea and lack of appetite.
So now we know why alcohol causes hangovers. But what can we do about it?
Food and Drink Remedies - Fact or Fiction?
Visit any college dorm on a Saturday or Sunday morning and you might hear that a great hangover cure is a little "hair of the dog that bit you," burnt toast and black coffee or an over-the-counter product like Chaser. But which of all the endless theoretical remedies actually have truth behind them? Read on and find out. Contrary to popular belief, more of the "hair of the dog that bit you" only delays the inevitable. Part of the reason you feel so bad during a hangover is because the liver is still processing the toxins left over from alcohol metabolism. Drinking more alcohol can make the symptoms seem to lessen at first but will only make the situation worse once the liver breaks the alcohol down, because it will have even more toxins to deal with.
Conclusion: FICTION - Remedy
Burnt Toast
Surprisingly enough, the burnt toast remedy is actually based on scientific fact. The secret behind this cure is the carbon in the charred bread. Carbon acts like a filter in the body, attracting the impurities released during alcohol metabolism. It does this so well, in fact, that emergency room patients with alcohol poisoning have a carbon mixture pumped into their stomachs to prevent them from dying of toxicity. This filtering effect is also behind the success of over-the-counter remedies such as Chaser and Sob'r-K HangoverStopper, which claim carbon as their main ingredient (more on over-the-counter remedies below). Carbon is effective as a preventative measure as well as a morning-after helper.
Conclusion: FACT - Prevention and Remedy
Black Coffee
Coffee contains a high amount of caffeine, which is a stimulant and therefore helps combat fatigue; however, when the caffeine wears off you may be even more tired than before. It can help alleviate your pounding head because caffeine is a vasoconstrictor, meaning it reduces the size of blood vessels. This counteracts the effect of the alcohol, which makes them swell, making your head hurt in the first place. Unfortunately, caffeine is also a diuretic like alcohol and can make you even more dehydrated than before, thereby increasing the severity of the hangover. Overall, coffee is not a good hangover cure.
Conclusion: FICTION - Remedy
Fried or Fatty Foods
Although eating fried or fatty foods the morning after will probably only irritate your stomach further, eating them before drinking can actually be helpful. Putting anything in your stomach prior to indulging in alcohol helps prevent a hangover, but fatty foods in particular stick to the stomach lining longer and therefore slow down the absorption of alcohol into the bloodstream. While that might make it take longer to feel the alcohol's effects, it also gives the body more time to process the byproducts and will increase your chances of feeling decent in the morning. So much so, in fact, that a Mediterranean folk tactic is to take a spoonful of olive oil before drinking alcohol. If you do wake up with a hangover, eating lighter food such as a fruit smoothie will provide energy and alleviate some symptoms by replenishing the electrolytes the body lost from dehydration.
Conclusion: FACT - Prevention; FICTION - Remedy
Eggs
Eating eggs the morning after provides energy like any other food; but eggs also contain large amounts of cysteine, the substance that breaks down the hangover-causing toxin acetaldehyde in the liver's easily depleted glutathione. Therefore, eggs can actually help mop up the left-over toxins.
Conclusion: FACT - Remedy
Bananas
Eating bananas the morning after a night of heavy drinking provides lost electrolytes like any food would, but it also specifically replenishes the potassium lost to alcohol's diuretic effect. Other potassium-rich foods such as kiwi fruit or sports drinks work just as well.
Conclusion: FACT - Remedy
Water
Since your body is dehydrated, replenishing its water supply after a night of drinking is certainly a good idea, and it also will help dilute the leftover byproducts in your stomach. To make water even more effective on the morning after, add salt and sugar to help replace the sodium and glycogen lost the night before; you could also drink a non-caffeinated, non-carbonated sports drink to achieve the same effect.
As a prevention method, drinking a glass of water for every alcoholic beverage you drink slows down your drinking, providing more time for the body to deal with the alcohol -- it can only process about three-quarters of an ounce of alcohol in an hour. Drinking a few glasses of water before going to bed can also help a lot, because once your body is finished breaking down the alcohol, leaving you dehydrated, your system will be desperate for water.
Conclusion: FACT - Prevention and Remedy
Fruit Juice
The fructose -- fruit sugar -- in fruit juice helps to naturally increase your energy, and studies have proven that it also increases the rate at which your body gets rid of toxins such as those left over from alcohol metabolism. Fruit juice is also a good idea the morning after because it is high in vitamins and nutrients that were depleted the night before because of alcohol's diuretic effect. If you choose to take a vitamin supplement instead, focus on those high in vitamins C and B.
Conclusion: FACT - Remedy
Other Remedies - Fact or Fiction?
Painkillers
This fairly obvious (and often necessary) remedy is actually more complicated than you might think when it comes to putting it into practice. Certain painkillers are more effective at combating a hangover than others. For instance, Excedrin can be helpful for headache because it combines acetaminophen for the pain and caffeine to reduce the size of the pounding blood vessels; however, prolonged combination of alcohol and acetaminophen has been shown to cause liver damage, and caffeine is a diuretic.
Aspirin is a non-caffeinated pain reliever and is also in a class of anti-inflammatory drugs known as prostaglandin inhibitors. High levels of prostaglandin have been associated with increased hangover severity. In one study, participants who took a prostaglandin inhibitor before bed reported less of a headache and less nausea and thirst than those who had drank the same amount of alcohol but did not take the prostaglandin inhibitor before bed. If you have a sensitive stomach, though, beware -- taking aspirin after drinking can make your stomach hurt even worse.
Conclusion: FACT - Prevention and Remedy if non-caffeinated and acetaminophen-free
Over-the-counter Remedies
Hangover remedies such as Chaser, Sob'r-K Hangover Stopper, RU-21, Berocca and Rebound are highly varied both in price and ingredients, so their effectiveness varies accordingly. They are classified as dietary supplements, meaning:
They contain vitamins and minerals.
They do not require a prescription.
They are usually taken in pill form.
According to Hangover Review, which did a study covering many of over-the-counter hangover cures on the market, the only "medically provable" supplements are Sob'r-K Hangover Stopper, Chaser and Uncle Rummie's Hangover Helper because they make use of the effective filtering qualities of carbon to reduce the number of impurities the body has to process (see "Burnt Toast" above). Sob'r-K Hangover Stopper is inexpensive compared to the others, uses the highest-grade carbon and the concoction is patented; therefore, Hangover Review deemed it the smartest choice. As for RU-21, marketed as a secret KGB pill, the manufacturer says specifically that it is not an anti-hangover pill but a supplement for detoxification. (By the way, its main ingredients -- dextrose, L-Glutamine and vitamin C -- can be found in high amounts in everyday foods). Rebound has the same ingredients as RU-21 (so much for a KGB secret) plus a few other vitamins and oddities such as "young barley grass juice powder," but it is still basically a multivitamin. Berocca, again, is not a hangover cure -- it's simply a multivitamin that claims to increase energy naturally (through vitamins).
The secret to most of these purported "miracle cures" may in fact be the amount of water you ingest when you take them. Many require taking a pill (or two) with a glass (or two) of water before drinking alcohol, and then continuing to take the pills over the course of the evening with full glasses of water, before bed with a full glass of water, and upon waking -- yes, you guessed it -- with a full glass of water. The hydration alone greatly improves your chances of having little-to-no hangover, and the vitamins in the pills just give it a little, albeit expensive, boost.
Conclusion: FACT - Prevention and Remedy for the carbon-based products; FICTION - Prevention and Remedy for the non-carbon based products
Time
The only complete cure for a hangover is time. No matter what you do, the body still has to clean up all the toxic byproducts left over from the evening before you will truly feel like yourself again; however, the above factual remedies do help speed up the process.
Conclusion: FACT - Remedy
Hangover Help - An Overview
So, given all this information, how do you best ease your hangover woes? The solution starts with prevention, continues with smart drinking and ends, finally, with simple morning-after helpers. Here's a hangover-fighting prescription:
Before You Drink
- Eat a full meal. A full stomach slows down the absorption of alcohol, giving your body more time to process the toxins. Fatty foods and carbohydrates increase this effect. Having food in your stomach also decreases stomach irritation, in turn reducing the likelihood that you will throw up
- Drink a glass of water. This will make sure the body is hydrated before the diuretic effect takes hold.
- Take a multivitamin. This will better prepare the body for the depletion of vitamins caused by frequent urination.
While You Drink
- Drink a glass of water after every alcoholic beverage. In addition to helping keep you hydrated, this will give the body more time to process the alcohol, dilute the toxins and reduce irritation of the stomach.
Variation: If you can't stand plain water, swap it out for a sports drink like Gatorade or Propel -- these also replenish electrolytes, salts and sugars lost in the urine.
- Drink in moderation. Ideally, you want to limit yourself to one drink per hour because the body takes about an hour to process a single drink. If you have trouble with this (or get tipsy and lose track of time), set a limit for yourself.
Translation: If you start to stumble, it's time to stop!
- Watch what you drink. Pick a drink and stick with it. Each new type of alcohol you put into your system makes the body work that much harder and puts that many more toxins in your body, leading to a more severe hangover. When choosing a drink, consider the alcohol content, ingredients and price:
- Beer: Beer is a good choice because it has the lowest percentage of alcohol (4 to 6 percent), but it is also carbonated, which speeds up the absorption and can lead to toxin build-up.
- Wine: Wine has a higher percentage of alcohol (7 to 15 percent) than beer, but it is usually not carbonated. If you choose to drink wine, white wine is a better bet than red or blush because it has fewer congeners. Do not be a bargain hunter when it comes to wine -- the cheaper the wine, the higher the congener content and the worse your hangover.
- Liquor: Liquor has the highest alcohol content (40 to 95 percent) and therefore increases the likelihood of a hangover. If you choose to drink liquor, clear liquors like vodka, rum and gin are better bets than dark or sweet liquors like bourbon, scotch or tequila because they have fewer congeners. Again, don't be a bargain hunter here; you will regret it in the morning if you buy cheap liquor.
After You Drink
Before Bed
- Take two aspirin with a full glass of water. You may have to wake up to use the bathroom, but your dehydrated body will thank you in the morning, and the prostaglandin inhibitors in the aspirin should decrease hangover severity.
In the Morning
- Take two more aspirin with a full glass of water. This will help with the headache as well as decrease inflammation from leftover prostaglandin.
- Take another multivitamin. Replenishing your C and B vitamins in particular will help get rid of the rest of the toxins.
- Eat breakfast. A meal consisting of eggs (for the cysteine), a banana (for the potassium), burnt toast (for the carbon) and fruit juice (for the fructose) or a sports drink (for the electrolytes, sugars and salts) should put you on the road to recovery. If you overindulged and don't think you can keep all this down, definitely drink the sports drink and combine the banana and some milk to make a smoothie. Avoid caffeinated coffee, tea and soda, as they will further dehydrate you.
- Go back to bed. If you still feel achy and exhausted after breakfast, go back to bed for an hour or so. It is likely that you did not reach deep sleep because of glutamine rebound, and as your glutamine levels return to normal you will get the restorative sleep you need to feel like yourself again.
Now why can't I every write about this for a class rather than research grants? |
