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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. Hangover symptoms may be felt for a variable period of time after alcohol consumption, and may persist for a short period of time (12 to 36 hours), or even longer (48 to 72 hours after the last alcoholic drink is consumed).
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Symptoms
An alcohol hangover is associated with a variety of symptoms that may include dehydration, tiredness, headache, nausea, diarrhea, weakness, hypersalivation, 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.
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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 acetic acid by the enzyme acetaldehyde dehydrogenase. Acetaldehyde is 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 appearance, often referred to as the "drunk blush". However, when the hangover starts, the capillaries will close up again, contributing to 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, due to the increased blood flow to the skin.
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.
Nicotine consumption 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.
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Possible remedies
There is debate about whether a hangover might be prevented or at least mitigated. It has been speculated that imbibing even more alcohol than consumed the night before will vanquish the hangover, the so-called "hair of the dog" remedy. 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. 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." However, only eight interventions were reviewed.
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Potentially beneficial remedies
Rehydration: "Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6."
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." "However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group."
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Probably ineffective remedies
Globe artichoke (Cynara scolymus) extract: "Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover."
Propranolol: "We conclude that propranolol does not prevent the symptoms of hangover."
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."
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Supposed remedies
Note: Most of these have not been scientifically tested or reviewed in the above articles.
A glass of buttermilk. Though many people dislike buttermilk it will calm down your stomach and add liquid to your system. Tests have been done on monkeys and humans.
Having sexual relations may increase the release of endorphins, which in turn may help reduce the effect of a hangover.
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. Coffee has also been shown in some studies to have a protective effect on the liver, effective in preventing alcoholic liver disease.
Nicotine, once again much like caffeine, increases the effectiveness of analgesics and its stimulant effects diminishes many 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 or Pepsi-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 inhibition of the gluconeogenesis.
Taking a shower and oscillating between extreme cold and hot temperatures. This practice has no effect on the hangover and can be unhealthy. Seen in the movie The Princess Bride.
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 relieve the effects of alcohol. This may be the practice, but there is no reason to believe ginseng will help.
Eating whole jalapeños will help you awaken from a hangover.
Common folk medicine has a wide variety of supposed hangover cures. A good hangover cure should replace essential nutrients lost by the body while counteracting the influence of residual poisons; very few cures do both at once. Among the more common proposed cures are:
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. Consumption of Vitamin Water, which contains high amounts of B vitamins and electrolytes often proves effective also. Pedialyte contains more electrolytes than almost 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.
Drinking pickle juice, the solution in which cucumbers were pickled, in the morning (a staple hangover remedy in Russia and Poland). It is sometimes suggested to add honey to the solution.
Eating anything substantial, especially before going to bed, to "soak up" the alcohol in the stomach (e.g. a pizza, Doner Kebab or sandwich)
Orange juice, which is rich in vitamin C. However, the acidic qualities of orange juice can also make hangovers worse.
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 Scotland. It is believed that the high amount of sugar is the reason for this.
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.)
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 supposedly reduce hangover effects dramatically; however, the truth is that long term (longer than two weeks) use of ibuprofen increases the risk of stomach ulcers. Mixing ibuprofen and alcohol can cause stomach irritation and bleeding, and is highly recommended against. The adverse effects of alcohol are amplified when ibuprofen, which also can cause trouble with the liver, is taken with it. In fact, most medicines should not be taken with alcohol, so it is best to consult a medical professional before using this supposed "remedy".
Sleep. Some people argue that sleep only prolongs the negative effects of alcohol due to slower metabolism while asleep. However, others refute this by pointing out that one doesn't notice the negative effects of the hangover while asleep.
Exercise. Exercise can be painful with a hangover, but is usually very effective. It increases blood flow to the entire body, especially the head, and induces sweating, which helps the body purge alcohol. The feeling of lethargy dissipates and there is a strong mental and emotional effect where mood will improve.
Greasy food is a fairly effective remedy, though not as effective as "preemptive strikes" like the aforementioned Ibuprofen at night.
Going for a swim in cold water feels painful, but often helps to manage the headache.
Pot Noodles.Not known how but does help
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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.
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See also
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