How Hangovers Work

by Lacy Perry

Brow se the article How Hangovers Work

Introduction to How Hangovers Work

It's no secret that intoxication has a number of immediate negative consequences. Among other things, it impairs Drug Image Gallery
judgment, it impairs the ability to do most things and it can bring on a depressed mood. But even after a drinker has
sobered up, alcohol can still be causing the body trouble. 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.

In this article, we'll explain what causes hangover symptoms and examine the
Learn More science of the popular prevention methods and morning-after remedies.

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What is a Hangover?

The formal name for a hangov er is veisalgia, from the Norwegian word for "uneasiness following debauchery" (kveis)
and the Greek word for "pain" (algia) -- an appropriate title considering the uncomfortable symptoms experienced by
In the Most Surprising Places
the average drinker. The common hangover includes some or all of the following:
Hangovers have plagued people throughout
Headache history. The Bible even makes mention of the
Poor sense of overall well-being pain that follows a night of heavy drinking:
Sensitivity to light and sound "Woe unto them that rise up early in the
Diarrhea morning, that they may follow strong drink"
Loss of appetite (Isaiah 5:11). And Shakespeare knew the
Trembling unwanted effects of alcohol, as shown in his
Nausea play Macbeth (Act 2 scene 3):
Fatigue
Increased heart rate and blood pressure Macduff: What three things does drink
Dehydration(dry mouth, extreme thirst, dry eyes) especially promote?
Trouble concentrating
Porter: Marry sir, nose-painting, sleep,
Anxiety
and urine.
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 a drinker consumes, the worse the hangover will be.

It usually takes five to seven cocktails 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, for example)
Dehydration before drinking
Poor health
 Related Quiz
The reason for some symptoms isn't fully understood, but research has led scientists to have a pretty good understanding of the
Alcohol Quiz primary causes of a hangover. In the next sections, we'll find out what's going on in the body to cause these problems.

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 (also known as the antidiuretic hormone).
Without this chemical, the kidneys send water directly to the bladder instead of reabsorbing it into the body. This is why drinkers have to make frequent trips to the bathroom after
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 the form of 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 If You Need Help
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 Alcoholism is a serious medical condition. If
addition, the diuretic effect expels vital electrolytes such as potassium and magnesium, which are necessary for proper you often drink more than you mean to, you
cell function. suffer from memory lapses while drinking or
you feel drinking is negatively impacting your
Different types of alcohol can cause different types of hangover. In the next section, we'll look at the differences.
life in any way, please contact Alcoholics
Biology of a Hangover: Congeners Anonymous.

Different types of alcohol can result in different hangover symptoms. This is

because some types of alcoholic drinks have a higher concentration of
congeners, byproducts of fermentation in some alcohol.

The greatest amounts of these 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 one 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 alcoholic drinks (beer, wine, liquor) have different congeners,
combining the various impurities can result in particularly severe hangover
symptoms. Additionally, the carbonation in beer actually speeds up the
absorption of alcohol. As a result, following beer with liquor gives the body even
less time than usual to process the toxins.

Biology of a Hangover: Acetaldehyde

Dark wines and liquors have
A product of alcohol metabolism that is more toxic than alcohol itself, higher levels of certain toxins.
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. In the next section, we'll see what this aftereffect is all about.

Biology of a Hangover: Glutamine Rebound

After a night of alcohol consumption, a drinker won't sleep as soundly as normal because the body is rebounding from alcohol's depressive effect on the system. When
someone is drinking, alcohol inhibits glutamine, one of the body's natural stimulants. When the drinker stops 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 the drinker is trying to sleep, keeping them 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. This mechanism can
actually lessen hangover symptoms in the long run because vomiting gets rid of the alcohol in the stomach and reduces the number of toxins the body has to deal with. 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. In the following sections, we'll look at the science behind the most common hangover "cures."

Food and Drink Remedies - Fact or Fiction?

Hangover remedies include everything from "a hair of the dog that bit you" (drinking a little more alcohol the next morning), to burnt toast and black coffee to an over-the-counter
product like Chaser. Which of all the endless theoretical remedies actually have truth behind them?

Hair of the Dog

Contrary to popular belief, more of the "hair of the dog that bit you" only delays the inevitable. One of the reasons hangovers are so unpleasant is 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

At first, the burnt toast remedy may seem that it's actually based on scientific fact. The culprit behind this fictional cure is the carbon in the
charred bread. Carbon can act like a filter in the body. While it's true that activated charcoal (which is a treated form of carbon) is used to
treat some types of poisonings, it's not currently used to treat alcohol poisoning (something that is vastly different from a regular
hangover).

The carbon/charcoal found on burnt toast is not the same as activated charcoal.

Conclusion:

FICTION - Prevention and Remedy

Black Coffee

Coffee contains a high amount of caffeine, which is a stimulant and therefore helps fight fatigue. But
when the caffeine wears off, a drinker may be even more tired than before. Coffee can help alleviate
a 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 the head hurt in
the first place. Unfortunately, caffeine is also a diuretic like alcohol and can make a drinker even
more dehydrated than before, thereby increasing the severity of the hangover. Overall, coffee isn't a
good hangover cure.

Conclusion:

FICTION - Remedy

Fried or Fatty Foods

Although eating fried or fatty foods the morning after will probably only irritate a drinker's stomach further, eating them b efore drinking can
actually be helpful. Putting anything in the 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 a drinker's 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. 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, which is the primary benefit. But eggs do 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 potentially 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

Replenishing the body's water supply after a night of drinking combats dehydration, and it also helps
dilute the leftover byproducts in the stomach. Adding salt and sugar to water helps replace the sodium
and glycogen lost the night before. Non-caffeinated, non-carbonated sports drinks can achieve the
same effect.

As a prevention method, drinking a glass of water for every alcoholic beverage slows down drinking,
providing more time for the body to deal with the alcohol (the body can only process about three-
quarters of an ounce of alcohol in an hour). Drinking a few glasses of water before going to bed helps
fight dehydration after the body finishes breaking down the alcohol.

Conclusion:

FACT - Prevention and Remedy

Fruit Juice

The fructose -- fruit sugar -- in fruit juice helps to naturally

increase the body's energy. Studies have proven that it also
increases the rate at which the 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's high in vitamins and nutrients
that were depleted the night before because of alcohol's diuretic
effect. Vitamin supplements high in vitamins C and B are also
effective.
Conclusion:

FACT - Remedy

Other Remedies - Fact or Fiction?

Painkillers

Certain painkillers are more

effective at combating a
hangover than others. For
instance, Excedrin can be
helpful for a 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're classified as dietary supplements, meaning:

They contain vitamins and minerals.

They don't require a prescription.
They're usually taken in pill form.

The manufacturers claim these products work 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" in the last section for the science on that one). 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 plus a few other vitamins and oddities such as "young barley grass juice powder," but it's 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 a drinker ingests when taking 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 with a full glass of water. The hydration alone greatly improves the chances of having little-to-no hangover, and the vitamins in the pills just give it a little, albeit expensive,
boost.

Conclusion:

FICTION - Prevention and Remedy

Time

The only complete cure for a hangover is time. No matter what a drinker does, the body still has to clean up all the toxic byproducts left over from the evening before. But the
above factual remedies can help speed up the process.

Conclusion:

FACT - Remedy

Hangover Remedy Overview

The only fool-proof way to avoid a hangover, of course, is not to drink alcohol. But from a scientific perspective,
researchers have found the following general regimen minimizes the symptoms of a hangover.
If You Need Help
Before Drinking
Alcoholism is a serious medical condition. If
Eat a full meal - A full stomach slows down the absorption of alcohol, giving the body more time to process the
you often drink more than you mean to, you
toxins. Fatty foods and carbohydrates increase this effect. Having food in the stomach also decreases stomach
suffer from memory lapses while drinking or
irritation, in turn reducing the likelihood that a drinker will vomit. (See Biology of a Hangover.)
you feel drinking is negatively impacting your
life in any way, please contact Alcoholics
Drink a glass of water - This ensures the body is hydrated before the diuretic effect takes hold. Anonymous.
Take multivitamins - This better prepares the body for the depletion of vitamins caused by frequent urination.

Before Drinking

Drink in moderation - Ideally, drinkers should limit themselves to one drink per hour because the body takes about an hour to process a single drink.

Drink a glass of water after every alcoholic beverage - In addition to helping keep a drinker hydrated, this will give the body more time to process the alcohol,
dilute the toxins and reduce irritation of the stomach. A sports drink like Gatorade or Propel will also replenish electrolytes, salts and sugars lost in the urine.
 Watch your drink choice - Drinkers generally fare better when they stick with one drink. Each new type of alcohol a drinker puts into his or her system makes the
body work that much harder and puts that many more toxins in the body, leading to a more severe hangover. Here's a rundown of the major types of alcohol and
their effects:

Beer has the lowest percentage of alcohol (4 to 6 percent), but it's also carbonated, which speeds up the absorption and can lead to toxin buildup.
Wine has a higher percentage of alcohol (7 to 15 percent) than beer, but it's usually not carbonated. White wine is safer than red or blush because
it has fewer congeners. In general, the cheaper the wine, the higher the congener content and the worse the hangover.
Liquor has the highest alcohol content (40 to 95 percent) and therefore increases the likelihood of a hangover. 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. Generally, cheaper liquor will
result in a worse hangover than more expensive liquor.

After Drinking

Before Bed

Take two aspirin with a full glass of water - The prostaglandin inhibitors in the aspirin can decrease hangover severity.

In the Morning

Take two more aspirin with a full glass of water - This has been shown to minimize headaches as well as decrease inflammation from leftover prostaglandin.

Take another multivitamin - Replenishing C and B vitamins in particular can help get rid of the rest of the toxins.

Eat breakfast - A meal that includes eggs (for the cysteine), a banana (for the potassium), and fruit juice (for the fructose) or a sports drink (for the electrolytes,
sugars and salts) can get the body on the road to recovery. Keep in mind that caffeinated coffee, tea and soda will further dehydrate a drinker.

For more information on hangovers, alcohol and related topics, check out the links on the next page.

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More Great Links

Alcoholics Anonymous
WebMD: Hangovers More of a Headache Than You Think
MSN Women: How do I get over a hangover?
BBC: h2g2: Hangover Cures