Hangovers are the body's way of reminding us about the hazards of overindulgence. In this podcast, I’ll delve into what goes on behind the scenes to cause a hangover. I’ll then explore what science has to say about all those supposed ‘hangover cures’. And finally, I’ll outline the practical things that are in your control to help prevent and treat a hangover.
The dreaded hangover. That painful period between trying to get out of bed without hating life and once again being a normal, contributing member of society. If you have ever experienced a nasty hangover, then you know just how much the combination of tiredness, headache, nausea and poor concentration can hit you for six.
Hangovers ‘happen’ because of alcohol (which is a toxin after all) and its effects on the brain and the rest of the body. So, let’s look at what is going on to explain the classic collection of hangover symptoms.
To start with, alcohol is a diuretic which explains the dehydration and much of the regret you feel the next day from drinking too much. Frequent trips to the toilet during the night means sleep disturbances which makes you even more tired the next day. This isn’t helped because alcohol firstly makes you sleepy and wanting to go to bed, but as it's metabolised out of your system as you sleep, you can find yourself more wakeful than usual, which can lead to worse sleep quality.
But the symptoms of a hangover cannot all be blamed on dehydration and poor sleep. Alcohol irritates the stomach which leads to inflammation, and also causes the digestive system to produce more gastric acid. This contributes to the nausea and queasy stomach of a hangover.
Hangovers could also be driven by the way alcohol messes with your immune system. Studies have found strong correlations between high levels of cytokines – which are molecules that the immune system uses for signalling - and hangover symptoms. Normally, the body might use cytokines to trigger a fever of inflammatory response to battle an infection, but it seems that excessive alcohol consumption can also provoke cytokine release, leading to symptoms like muscle aches, fatigue, headache or nausea, as well as cognitive effects like memory loss or irritation.
It gets worse. When the body metabolises alcohol, it creates a toxic by-product called acetaldehyde which is estimated to be between 10 and 30 times as toxic as alcohol itself. The build-up of acetaldehyde leads to sweating, skin flushing, nausea, vomiting, and headaches. And it seems in people who have a genetic variant in one of the enzymes involved in alcohol metabolism, called aldehyde dehydrogenase-2, have greatly increased levels of acetaldehyde levels along with surprisingly face flushing. These people may get hit with a hangover even worse.
The alcohol hangover is associated with many hormonal and metabolic changes that are plausible causes of fatigue and brain fog. Here, you can see changes in insulin, cortisol, testosterone, aldosterone, and growth hormone. And it can even spill over into brain neurotransmitters such as epinephrine (adrenaline), dopamine, serotonin, and the endocannabinoid system which responsible for regulating and balancing many processes in the body, including immune response, communication between cells, appetite and metabolism, memory, and more.
You may have heard that dark coloured spirits such as whiskey and rum as well as red wine can make your hangover worse. And you heard correctly. These types of drinks are high in distillation and fermentation products called congeners. Congeners are responsible for most of the taste and aroma of distilled alcoholic beverages and contribute to the taste of non-distilled drinks. They are also considered a likely culprit to contributing to hangovers. So, there could just be something to be said for opting for white wine over red wine or vodka instead of bourbon.
Okay, enough of the hangover science – it is probably causing way too many traumatic flashbacks for many of you. Can you cure it? Let’s look at some of the popular options.
The greasy breakfast is a popular hangover cure to help put a ‘lining back on your stomach’. The benefit the next day is probably more a placebo effect which if it makes you feel better, then that’s not such a bad thing. With food though, you get the greatest benefit for your hangover by having it the night before as foods helps to slow down the absorption of alcohol from the stomach.
One thing that will certainly help with a hangover is to rehydrate. This is where those popular sports drinks may just help as they speed up water absorption and replace electrolytes lost through increased urination. Having it before bed may just be a good preventative measure too.
What about a strong cup of coffee? Caffeine will help make you more alert but will do little to help sober you up. A study that looked at the effects of caffeinated versus non-caffeinated alcoholic drinks on a simulated driving task and alertness found that caffeine did not improve the effects of alcohol on driving ability or reaction time. And I’ll link to this study in the show notes. http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03219.x/full
Then there is the popular ‘hair of the of the dog’ where you attempt to drink yourself out of a hangover. All this does is delay the hangover as your body switches to metabolising the new alcohol you’ve ingested. Once it has done that job, then you’re back to square one and even worse, you’ve got more by-products of alcohol metabolism in your system.
No foods or supplements are proven to prevent hangovers (at least supplements that have been tested at least more than once), yet the Internet is full of supposed cures. Ginseng, Japanese raisin tree, prickly pear cactus, Korean pear, and a mixture of pear, green grape, and the Japanese herb Ashibata have all been tested and have at least one study to support them, but few have been replicated and more so, they only look at certain aspects of a hangover and are normally tested in a controlled situation which may not replicate that well a classic ‘big night out’ on the beers.
The British Medical Journal has also weighed into the elusive search for a hangover cure with a systematic review of randomised-controlled trials which I’ll link to in the show notes. But their comprehensive search for any medical therapy that could prevent or treat hangover came up with nought. Their conclusion? The most effective way to avoid the symptoms of a hangover is to practise abstinence or moderation. It may not be what you want to hear, but it is the most effective cure we have yet. https://www.bmj.com/content/331/7531/1515
One final question to ponder though is if there could there be any health benefits to be gained from the pain that alcohol can cause you. The health harms about alcohol are long indeed so I won’t go into a lot of detail about those in this podcast, but every now and then you see something surface about the health benefits of alcohol. Is there any truth to this? A low level of alcohol consumption may offer a small benefit in reducing overall earlier mortality rates – mostly by offering some degree of protection against coronary heart disease in those with existing risk factors. Alcohol can raise the levels of HDL-cholesterol (the ‘good’ type of cholesterol which removes cholesterol from the blood) and reduce the ‘stickiness’ of blood and the risk of blood clots forming.
Scientists call the observed small health benefit of alcohol 'the J curve effect' where a benefit is seen with light to moderate amounts of consumption (1-2 drinks per day), but skyrocketing health risks with increasing consumption. There is debate though if the J curve effect may be from other factors such as healthier lifestyles of light drinkers, rather than the alcohol itself. The reality though is that any health benefits are limited to men over the age of 40 and women over the age of 50 and who drink one to two standard drinks daily or less. Younger people do not get the same health benefits from drinking.
So, let’s wrap things up. If you can’t cure a hangover, you can do some things to help reduce it the night before. And for that, make sure you:
Eat food when drinkingAlternate your drinks with waterTry a sports drink before bed and the morning afterGet plenty of sleepGet active the next day – the endorphin release will make you feel better
Once you have a hangover, there’s no magic pill to cure it, but something as simple as aspirin and a strong coffee can help to clear your head and perk you up a little as you bunker down and wait it out.
So that’s it for today’s show. You can find the show notes either in the app you’re listening to this podcast on if it supports it, or else head over to my webpage www.thinkingnutrition.com.au and click on the podcast section to find this episode to read the show notes.
If you find this podcast of value, then please consider sharing it with your friends and colleagues. Or maybe even leave a review. This all helps increase the ranking and reach of the podcast which means a big win for credible evidence-based nutrition messages while helping to dilute out the crazy and making the world a slightly less confusing place.
I’m Tim Crowe and you’ve been listening to Thinking Nutrition.