Dear Doctor: My wife overindulged on her birthday and wound up with a pretty fierce hangover – headache, nausea, brain fog, the works. She got so much weird advice that it got us to wondering, what exactly is a hangover? Are there any remedies that actually work?
Dear Reader: Your question is one for the ages – literally. References to the unique state of distress we call a hangover date back thousands of years. So does the quest for a cure. Yet despite the best efforts of modern science, the cause of a hangover – as well as a remedy – remains unclear.
Let’s start with what we do know. A hangover occurs when you drink too much alcohol. For some, a few glasses of wine can lead to profound regret the morning after. For others, getting a hangover takes a night of excessive drinking of hard liquor. No matter the amount of alcohol, the symptoms remain the same. These include the headache, nausea and cognitive issues that your wife suffered from, as well as dry mouth, thirst, fatigue, dizziness, vertigo, diarrhea, tremors, disturbed sleep, rapid heartbeat, excessive perspiration, anxiety, low mood and sensitivity to light and sound.
Research suggests that genetics play a role in how much you can drink before you’ve earned yourself a hangover. So do a person’s age, sex and physical health; the state of their immune system; and how quickly they drink. The specific type of alcohol may also be a factor. Darker-colored drinks — such as bourbon, dark beer and red wine — contain higher concentrations of compounds known as congeners. The body metabolizes these into toxic substances such as formaldehyde and formic acid, which can add to hangover misery.
Dehydration was long considered a prime culprit in hangover symptoms, but recent research has found no difference in electrolyte levels among people who are hung over and those who are not. Although a toxic compound known as acetaldehyde, produced when the body breaks down ethanol, had been implicated in hangover misery, more recent research now points to the role of cytokines. These are small proteins associated with inflammation, which the immune system uses for signaling. The theory is that drinking triggers the release of cytokines, which in turn unleash the full fury of the immune system.
As for how to cure a hangover, science hasn’t gotten that far. The best you can do is manage the symptoms for the eight to 24 hours it takes for a hangover to play out. First, skip hair-of-the-dog therapy. More alcohol may give a temporary boost, but soon enough leads to the throes of even more misery. Instead, drink plenty of water, eat complex carbs to boost low blood sugar and fend off nausea, use antacids if needed for stomach upset, and get some sleep. Aspirin and other non-steroidal anti-inflammatories can help with headache, but can also irritate the stomach. Never take Tylenol during or right after drinking, as it can cause liver damage when mixed with alcohol. No one who has ever had a hangover wants to hear this, but the only certain cure is time.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
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