Ask the doctors: Time is the best cure for a hangover

Dear Doctors: I always thought that you get a hangover from drinking too much. But when I have a single mixed drink, or sometimes even just one glass of wine, I wake up feeling nauseated and with a bad headache. What causes a hangover? Is there a cure?

Dear Reader: The term “hangover” refers to the collection of deeply unpleasant (and sometimes debilitating) symptoms that can occur after drinking too much alcohol.

The specific symptoms, as well as their intensity and duration, vary from person to person. They include headache, stomach upset, fatigue, muscle aches, dizziness, sweating, nausea, vomiting, persistent thirst, rapid heartbeat and an increased sensitivity to light and sound. A hangover can also affect someone emotionally, leaving them feeling anxious, irritable or depressed. People sometimes find that their motor skills and cognition take a temporary hit as well.

While we typically associate a hangover with being overserved, the amount of alcohol needed to cause one varies from person to person. For some, it takes multiple drinks to excess and beyond to reach hangover territory. Others, like yourself, find that even a modest amount of alcohol causes the body to revolt. A wide range of factors have been found to contribute to the development of a hangover. These include the person’s sex, age, body mass and general health; the amount and pace of their drinking; dehydration; gastrointestinal issues; inflammation; and even the state of their gut microbiome.

Also at play is how the body metabolizes alcohol. This is carried out primarily by the liver in a two-step process. First, the liver converts alcohol into acetaldehyde – a toxic byproduct that contributes to inflammation in the liver, pancreas, gastrointestinal tract and brain. In the second step of alcohol metabolism, the enzymes in the liver turn acetaldehyde into acetate, a nontoxic substance. But there’s a catch. The liver can process only about one drink per hour. Drink any faster than that, and you’re creating a buildup of toxic acetaldehyde. More recent research adds small proteins called cytokine to the hangover equation. Cytokines alert the immune system to potential threats. The theory is that drinking triggers the release of cytokines, which sends the immune system into defense mode.

As for whether science has come up with a hangover cure, the answer is not yet. You wouldn’t know that from the astonishing – and ever-expanding – array of hangover products that claim to help suffering drinkers. Unfortunately, the only real cure for a hangover is time, typically 24 hours or more. While waiting that out, you can take steps to manage the symptoms. This includes rest, antacids to calm the stomach, complex carbs to boost low blood sugar and plenty of water and other nonalcoholic fluids for hydration. Headache can be eased with nonsteroidal anti-inflammatories. However, never take Tylenol during or right after drinking, as when mixed with alcohol, liver damage is possible. And ignore advice that urges easing a hangover with an alcoholic drink. The boost it may give is temporary, and merely lengthens recovery time.

Send your questions to askthedoctors@mednet.ucla.edu.