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.

02

09 2009

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