How to ‘cure’ your hangover
In 2019, the UK-based Institute of Alcohol Studies released a survey which estimated that between 75,000-89,000 workers are hungover or intoxicated on any given work day in the UK. The annual cost to the economy was put at between £1.2bn and £1.4bn a year.
Despite this, scientific study into the condition remains a niche interest.
Dr Sally Adams of The University of Birmingham has a PhD in the effects of alcohol intoxication and is one of the few academics involved in hangover research, and a leading UK expert.
“There is so much research on the effects of alcohol on the body but nothing on the effects the following day,” she says. “This is an area that potentially has really serious consequences for physical and mental health. It costs the economy a fortune. It is an under-investigated topic, probably because we look at it in a trivial way.”
Anyone who has suffered a hangover knows that there is nothing trivial about them.
What causes a hangover?
Hangovers are a combination of conditions, both physical and psychological, caused by the excessive consumption of ethanol, which is the form of alcohol found in consumer beverages. Different processes in the body contribute to different symptoms which vary in intensity depending on several factors including the amount and type of alcohol consumed and the circumstances in which it is drunk.
Dr Adams says: “There are so many things that are going on. For example, alcohol is a diuretic, so quite often there is dehydration and an electrolyte imbalance, particularly if you have been sick; 80 per cent of alcohol is absorbed by the stomach and small intestine, so the inflammation of those areas can also cause gastric symptoms.”
One of the ways alcohol is metabolised in the body is by an enzyme called alcohol dehydrogenase (ADH). This breaks down the ethanol and creates a compound called acetaldehyde during the process.
“This is toxic for humans and is responsible for the sweating, heart-racing, vomiting and nausea you feel,” says Adams.
Alcohol also interacts with receptors in the brain and causes the release of neurotransmitters, which influence mood, muscle movement, heart rate, and many other functions. Excessive consumption creates an imbalance in neurochemicals.
“The brain will try to put that right and get everything back to correct levels but sometimes that doesn’t happen, and we get a lot of neurotransmitters released that cause us to feel anxious and low the next day,” adds Adams. This psychological aspect of a hangover creates what has been termed “hangxiety” or “beer fear” and, according to Adams, can affect judgment and reactions long after a breathalyzer will deem it safe for you to drive.
Other factors that cause hangovers are inflammation and mitochondrial damage, particularly in the liver. Mitochondria are the energy-producing elements in every cell and are susceptible to damage from the free radicals produced by acetaldehyde.
What are the symptoms of a hangover?
As hangovers are not a specific illness but are a combination of different reactions to the way your body reacts to excessive alcohol consumption, and as everyone reacts to alcohol in different ways, people experience hangovers in different ways. Genetics also play a role as genes determine how efficiently or not people metabolize ethanol.
A survey of 1,410 Dutch students listed 47 symptoms: the top 10 were fatigue, thirst, drowsiness, sleepiness, headache, dry mouth, nausea, weakness, reduced alertness and concentration problems. Also listed were apathy, agitation, gastrointestinal problems, tremors, regret, guilt, depression, anxiety and vomiting.
Symptoms will also depend on how much you’ve drunk and what you’ve drunk. Cask-aged and matured beverages like whisky and cognac for example, contain complex compounds called congeners.
In his book, Drink? The New Science of Alcohol and Your Health, Prof David Nutt, professor of neuropsychopharmacology, writes: “The longer whisky is stored, or aged, the more some of the alcohols will join together to form more complex alcohols called congeners.” It is thought that these may create worse hangovers.
What are the best scientifically-backed hangover cures and why do they work?
The bad news is, there is no definitive cure. But there is plenty you can do to treat the symptoms.
“If there was a miracle hangover cure it would have to address all the symptoms,” says Adams, “and it would be very difficult for one thing to address the stomach irritation, the dehydration, the anxiety, the effect on the brain.”
Some products, such as Myrkl, market themselves as cures. It contains a range of compounds including “bacteria, L-Cysteine and vitamin B12” and claims to “contribute to the reduction of tiredness and fatigue and helps to support the immune system and contributes to normal energy levels”. Adams is cynical as Myrkl is a food supplement, not a medicine, and so can make claims without having to undergo rigorous peer reviewed testing.
In Las Vegas, Hangover Heaven is a hangover clinic which also sends medics to hotel rooms to deliver a regime of treatments that promises to get even the most debilitated revellers back on their feet within two hours. But the process is not simple. “Patients” are treated with a combination of drugs and therapies which include oxygen, Propranolol, a beta-blocker that slows heart rate, vitamin infused IV drips, Zofran, an anti-nausea medicine widely used in chemotherapy recovery and Torodol, a powerful painkiller.
But in the absence of prescription meds and IV drips, there are simple measures you can take to treat the main symptoms.
Seven of the best hangover cures
Water (with added electrolytes)
This can be in the form of a sports drink or a sachet of Dioralyte. Dr Howard LeWine, from Harvard Medical Publishing, says: “Alcohol promotes urination because it inhibits the release of vasopressin, a hormone that decreases the volume of urine made by the kidneys. If your hangover includes diarrhoea, sweating, or vomiting, you may be even more dehydrated. Although nausea can make it difficult to get anything down, even just a few sips of water might help your hangover.”
Anti-inflammatories
Prof Nutt recommends: “Take ibuprofen when you go to bed and/or when you wake up, ideally with food as it can be harsh on the stomach lining.”
Stomach settler
Heartburn from an irritated stomach can be treated with an antacid such as Alka-Seltzer, which also helps to rehydrate. The XS version also contains aspirin and paracetamol for headaches and pain and caffeine for drowsiness.
Positivity
Low mood and anxiety are overlooked symptoms but can also be profound, lasting long after physical symptoms abate. Adams recommends doing something that is gentle but enjoyable, like watching a comedy. “Psychologically, it helps to do something that is going to make you feel good. Whatever normally helps you if you feel low or anxious, engage in that,” she says.
Sleep
Alcohol has sedative properties which work for around four hours after which people commonly wake with a headache, feeling alert and unable to get back to sleep. “This is because your brain knows being intoxicated is potentially dangerous,” explains Nutt. “As soon as you started drinking the night before your brain started to change.” Alcohol blocks glutamate receptors and the brain up-regulates the glutamate system to compensate. As the alcohol levels reduce the receptors remain high, leading to too much glutamate activity, which causes sleeplessness. As the other symptoms kick in, any sleep you do get is poor quality and so the next day you will inevitably have a sleep deficit.
Food
While it may be hard to keep food down initially, it is a good idea to try and eat something. One study investigated the effect of the amino acid L-cysteine on alcohol/acetaldehyde related after-effects. It concluded a dose of between 600mg and 1,200 mg could help with symptoms of nausea, headache, stress, and anxiety. L-cysteine is found in high protein food including pork, eggs and cheese. If you can’t stomach a full English, the NHS recommends bouillon soup as a good source of vitamins and minerals, which can top-up depleted resources. It is also easy for a fragile stomach to digest. Carbohydrates such as toast can also help replenish depleted blood sugar levels. Flat Coca-Cola can also be beneficial as it provides carbs, fluid and caffeine.
B vitamins and zinc
A study published in The Journal of Clinical Medicine evaluated diets for 24 hours before and after excessive drinking occurred. Although it was a small cohort, with results based on the participants describing what they ate, rather than them being fed under supervision, the study did find that people whose food and beverage consumption contained greater amounts of zinc and B vitamins had less severe hangovers.
Hangover myths
“One of the biggest myths is that water will solve everything, and that a hangover is only dehydration.,” says Adams. “Water isn’t a miracle cure.”
Experts also dismiss drinking more alcohol to alleviate a hangover, a practice commonly known as “hair of the dog”. Prof Nutt describes it “as the very worst thing you can do”.
“You are delaying your hangover by putting alcohol back into your brain,” he writes.
Adams adds: “You are just chasing the drugs.” She says that while reaching for more alcohol the next day may not indicate addiction, the transition from using alcohol to experience pleasure to using it to escape feelings is an unhealthy pattern of behaviour.
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