It’s that time of the year again: The Holidays. Many people will imbibe this season if not because of the economy then in spite of it. What they will drink this season is much the subject of blog chatter this year as the financial roller coaster is having a marked impact on the wine and spirits industry.
No matter the economic climate, the day after the celebrations – be they with family, friends or in the office – brings regret and discomfort for many. So it is only natural that people seek out remedies and antidotes for these consequences of their hedonism.
I have decided to take on the myths that surround preventing and treating hangovers because I am doubly qualified to do so: I am a physician and I am Polish (’nuff said).
The causes of hangover symptoms are a consequence of a number of physiologic derangements including: dehydration, electrolyte loss, hypoglycemia, lactic acidosis, loss of REM sleep and possibly insufficient oxygen. It should also not be overlooked that some elements of a hangover fulfill the clinical criteria for withdrawal symptoms.
Causes of hangover symptoms
Alcohol blocks antidiuretic hormone causing the kidneys to produce more urine – and the person to loose water. Along with that water, the drunk person is also loosing electrolytes mostly sodium and potassium. Depletion of these electrolytes can make you pretty sick and, in extremes, may be life-threatening.
Alcohol also wreaks havoc with your fuel supply. First, it has been shown to cause a surge of insulin to be released. This results in hypoglycemia – which may not be critical but it may be significant enough to make a person feel lousy the day after. Additionally, alcohol prevents the release of glucose from storage in the liver. This is a double whammy indeed.
Alcohol also causes alteration in the energy-producing chain reaction known as Krebs Cycle (or TCA Cycle or Citric Acid Cycle): One of the two breakdown products of alcohol, acetaldehyde (which is itself toxic) impedes the production of energy from the breakdown of sugar. As a consequence of this effect, a build up of lactic acid is also observed.
In effect, what you have is a perfect storm of reduced blood sugar, reduced ability to produce energy from glucose and a build up of toxins. The key ingredient here is the acetaldehyde. The more alcohol is ingested the more acetaldehyde is generated and the system propagates itself.
But wait, there’s more.
Alcohol suppresses the Central Nervous System and that has two consequences. First is the suppression of REM sleep. REM sleep is restorative and its lack is linked to fatigue, cognition problems, poor learning, and impaired memory. REM sleep deprivation contributes to the hazy, headachy feeling of a hangover.
Secondly, alcohol lowers muscle tone. Along with CNS suppression, this causes snoring and sleep apnea (intermittent interruption of breathing during sleep) in some people who go to sleep drunk. The consequence of this is lowered oxygen delivery to the whole body (including the brain and the heart). Anyone one with sleep apnea will tell you just how crappy they feel in the morning if they do not use their breathing machine (CPAP or BiPAP) at night. However one only has to reach as far as their recollection of their last cold to get an idea of how trouble breathing at night makes one feel in the morning.
A common myth about preventing hangovers advises avoiding carbonated and sugary beverages. I don’t think there is any scientific basis for the beliefs that sugar or carbonation in the beverage augment the absorption or the effect of alcohol. [addendum, 12/18/2008: In fact, there is conflicting research evidence of how carbonation affects the rate absorption. Citing limited scope and design, some commentators raise questions about a relationship between a rise in blood alcohol levels and the rate of intake of carbonated versus still alcoholic beverages.] If anything, these things may make the beverage more palatable and lead to consumption of greater quantities. As a side note, the sugar in some sweet beverages may also allow a person to drink more by staving off some of the inevitable drop in blood sugar but will still lead to accumulation of lactic acid and acetaldehyde.
Many people also believe in drinking lots of water as a way to stave off the unpleasant consequences of imbibing to excess. I am all for hydration, but this measure does not counteract any of the effects of the alcohol. It is simply replacing the water you loose – but not the electrolytes mentioned earlier. That is why sports drinks may be helpful in diminishing a hangover (when consumed before going to bed) or treating it (when consumed the day after).
Drinking too much pure water (and I mean a LOT of water) could actually lead to water toxicity. This condition results when the electrolytes that remain in your system are diluted to unsafe concentrations. That may have very unpleasant consequences (that is an understatement).
There are some who believe that vitamin B12 loss is a cause of hangover symptoms. Luckily, B12 deficiency is not that common in itself and it is not very likely that a single night’s debauchery would lead to profound decreases in a body’s stores of this vitamin. Chronic debauchery, on the other hand, would do the trick nicely.
A number of commercial hangover prevention products and remedies are available today. The problem with these is that some people think of them as “antidotes”, drink more than they should and they end up getting drunk and with a hangover. Never mind that these products do not address the biochemical roots of hangovers but focus only on absorbing congeners in the stomach.
There may be some validity to the contribution of congeners to the symptoms of a hangover and I do not mean to dismiss this idea completely. However, there is only a finite amount of congeners that these products can absorb in the stomach. They still do not affect the absorption of alcohol itself.
The holidays are an opportunity for cutting loose and having a good time. Alcohol consumption has a place in that context. However, one should not expect to find ways to avoid or escape the consequences of overindulgence.
There is no escaping the effect of the alcohol you ingest. The less you consume, the less drunk you become and the lesser the hangover. There is no escaping biochemistry and physiology.
Eat while you drink.
Drink in moderation.
Know when to stop.
Sleep in the day after.
Avoid acetaminophen (paracetamol in Europe) because it’s toxic to the liver.
Avoid aspirin and ibuprofen because they irritate the stomach lining and alcohol does a good job of that on its own.
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