Posts Tagged ‘Hangover’

The Hangover: Make it go away!

by Joshua Goldman, MD, MBA

the-hangover-wallpaperIt’s 9am and you’re cuddling your fire truck-esk alarm as you wake up to realize that you’re already an hour late for work.  You sit up and immediately notice the pounding sensation in your head, reminding you of your alcoholic escapades from the night before.  It’s official, you’re hungover.  The question is “What do you do now?”  We’re here to offer a few suggestions to help mitigate hangovers with some preventive steps before and during drinking, and some hangover-relieving tricks for the morning after.

Rather than accepting a hangover as the unfortunate side effect of a night out, there are a few tricks to help reduce the likelihood of ever becoming hungover.  Here’s our recommendations:

  • Drink slowly (obviously).  Frank the Tank is well on his way to a hangover after beer bong number 3.

  • Eat a full meal before drinking.  One study showed that glucose (which your body gets from food) effectively inhibits the metabolic disturbances induced by ethanol (i.e. a hangover).  The glucose in the meal also helps build up a store of energy so you won’t feel as weak the next day.

  • Drink in moderation. For those of you who aren’t sure what this means, The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day (one drink = a 12-ounce bottle of beer, a 4-ounce glass of wine, or a 1 1/2-ounce shot of liquor).  WaterAlso, the average individual can process one of these alcoholic beverages per hour.  Two drinks in one hour makes you one drink drunk.  Five drinks in two hours make you three drinks drunk.  You follow?

  • Drink a glass of water in between alcoholic drinks. This will help you drink less alcohol while simultaneously hydrating you (remember that a large part of your hangover is dehydration).

We realize that these tips are not ideal for those of you looking to get a little wild during your night out on the town.  As such, here are some additional tips to help mitigate the pounding in your head that you will experience the next morning once the hangover has set in:

  • Replace all the fluids and electrolytes you lost. If you remember, alcohol is Rehydrating with Electrolyte Drinkdehydrating and, unfortunately, you lose a lot of electrolytes along with the fluid (mainly sodium, potassium, and magnessium).  There are a number of great electrolyte drinks (pedialyte, Gatorade Performance, Powerade, Smart Water, etc.) that can replace both water and electrolytes simultaneously.  If you prefer a more natural approach, water plus bananas and a salty snack can help replenish your fluids as well as the missing sodium and potassium.  You can also take a multivitamin to rapidly (and thoroughly) get all your needed minerals back on board.

  • Replenish your energy stores. Consume foods and drinks that contain fructose (such as fruit juice or honey). There is some evidence that fructose will help your body break down and eliminate the alcohol faster.  Also, remember that alcohol inhibits your body’s production of glucose (your body’s form of gasoline).  When you wake up the next morning, your body is in desperate need of glucose replenishment.  A healthy carbohydrate-rich meal will quickly replenish these glucose stores.  Add some protein (think eggs) to breakfast and you can simultaneously boost your body’s cysteine level which will help counteract the brutal effects of alcohol’s metabolites.

  • Stock up on Vitamin C. Vitamin C has been shown to increase your body’s level of glutathione, the chemical needed to breakdown alcohol that becomes depleted in hangovers (1).  Vitamin C also neutralizes free radicals (which are formed at an increasing rate during drinking) that can cause damage to your body in the aftermath of a night out.  Oranges or those tasty chewable Vitamin C tablet will both do the trick.

  • Get your liver back on track. In addition to Vitamin C, milk thistle is an excellent way to replace your liver’s glutathione stores (which you need to process all the alcohol you consumed).  You can also find glutathione in asparagus and spinach.  Eggs are rich in cysteine which is a building block of glutathione.  Vitamin B6, riboflavin, and selenium are required in the manufacture of glutathione (they can be found in most multivitamins) and are essential to getting your body back to normal.

  • Upset StomachBe gentle on your stomach. You spent a good portion of last night dumping the equivalent of battery acid into your digestive track.  It’s understandable that it’s not feeling so hot the next morning.  The alcohol you consume irritates the lining of your digestive track much like the way it is irritated with very spicy foods.  This irritation causes you to feel nauseous and makes it hard to eat.  To help your stomach heal, eat bland foods the next day and save the spicy peppers and chili sauce for another day.  If your upset stomach is sucking your will to live, try Pepto-Bismol (it acts as a temporary stomach lining protecting your irritated gut from its natural acid while it heals…yes, the picture on the pink bottle is true).

  • Get plenty of rest. Alcohol inhibits your ability to reach your most deep and restful phase of sleep.  As such, you will be tired regardless of the number of hours you spent in bed.  Try to take a midday nap to allow your body time to catch up on some much needed deep sleep.

  • Take an aspirin. Aspirin (as well as ibuprofen and naproxen) has been proven to be effective in minimizing the pain in many types of headaches including a hangover headache.  Avoid taking any medications for your hangover that contain acetaminophen (such as Tylenol), because it may cause liver damage when combined with alcohol.  Your liver is already angry; no need to push it over the edge with Tylenol.

House Call, MD’s Hypothetical Hangover Remedy:

In simplified terms, this is our best (scientifically supported) guess at what can get you back on track:

  1. A carbohydrate-rich breakfast with eggs on the side (but remember to keep it bland)

  2. Electrolyte-enhanced fluids…lots of them

  3. A multivitamin (make sure it has Vit B6, B12, riboflavin, and selenium)

  4. Vitamin C – Consume any way you’d like (OJ or oranges will kill two birds with one stone)

  5. Aspirin – One dose in the AM is probably all you need

  6. Rest – Try an afternoon nap…you look like you need it.

1. Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993
2. Kera Y, Ohbora Y, Komura S (1989). “Buthionine sulfoximine inhibition of glutathione biosynthesis enhances hepatic lipid peroxidation in rats during acute ethanol intoxication”. Alcohol Alcohol. 24 (6): 519–24.


10 2009

The Anatomy of a Hangover

by Joshua Goldman, MD, MBA

The Hangover

Anyone who drinks alcohol has woken up the morning after a big night out feeling like death (if you have no idea what we are referring to we recommend you see the recent hit The Hangover).  Yes, this is the hangover you masterfully crafted during your night out on the town.  We’re here to help you understand what causes you to feel so bad and recommend some tips to get you back to 100% as quickly as possible.

Apparently proving the underlying physiologic cause of a hangover is not at the top of the NIH’s To Do List.  As such, the verdict is still out as to the exact mechanism of a hangover but scientists believe it is a combination of four effects in your body:

1. Vasopressin Inhibition: Your Ticket to Dehydration
One of alcohol’s effects on the brain is to decrease the amount of vasopressin it produces.  Vasopressin, also known as anti-diuretic hormone (ADH), is produced in the pituitary gland and, when released into your bloodstream, prevents your body from excreting water in your urine.  When under the influence of alcohol, you body’s vasopressin level decreases and you lose more water in your urine (yes, this is why you pee so much when you’re drinking).  The effect is so strong that for every pint of beer you drink, you can lose up to 4 pints of water.  This is why you will undoubtedly be dehydrated the next morning. The vasopressin-induced hangover effects are from dehydration and include:

  • Dry Mouth – Your body’s signal that you are dehydrated

  • Headache – Less water in your body means less water in your brain.  As your brain shrinks from dehydration, it pulls on the membranes surrounding it causing pain.  Enter the headache.

  • Fatigue & Nausea – When water is lost in the urine, sodium, potassium, and magnesium go with it. Loss of these vital electrolytes can cause feelings of nausea and fatigue

2. Congeners of Alcohol: Inevitable Toxins
Congeners are alcohol derivatives that form as byproducts of the fermentation process utilized in alcohol production.  Congeners of alcohol are toxic and cause a number of damaging effects on the body leading to typical hangover symptoms.  These congerners are found in higher concentrations in darker alcohols such as red wine, whiskey, bourbon, and brandy.  One study found that when subjects drank and equivalent amount of bourbon and vodka, 33% of bourbon drinkers reported hangover symptoms while only 3% of vodka drinkers reported such symptoms.

3. Acetaldehyde: Toxins that Keep on Giving

The breakdown process of alcohol is quite complex.  What you need to know is that acetaldehyde, one of the products formed in a step in the process, wreaks havoc on your body.  Your body requires another chemical, glutathione, to breakdown acetaldehyde and clear it from your body.  The problem is that when you drink a LOT of alcohol, you run out of glutathione and are stuck with the toxic acetaldehyde in your system while your liver makes more glutathione.  Women have fewer of the necessary enzymes and less glutathione than men, making their hangovers longer and more painful.  The miserable effects of acetaldehyde include headache, nausea, and vomiting.

4. Glutamine Rebound: The Sleep Buster
Another one of alcohol’s effects on the brain is to suppress a chemical stimulant in your brain called glutamine.  When you stop consuming alcohol, your brain counters the suppressive effects of alcohol by secreting more glutamine that normal.  The increased level of glutamine stimulating your brain prevents you from sleeping as deeply as you normally would and leads to fatigue the next day.  If your glutamine rebound is especially strong, you may experience tremors, anxiety, and restlessness from glutamine’s stimulant effects.

Now you know why hangovers are so miserable, and knowing is half the battle.  Stay tuned for an upcoming article about hangover cures: myths, miracles, and proven remedies.


09 2009

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