The Wrath of Grapes

The Bible warned about it in Isaiah and Homer wrote of its most unfortunate effect, accidental death. It is the hangover, that acute post-alcohol morning-after illness that many of us first experience as undergraduates. The hangover differs, of course, from the effects of acute alcohol intoxication ("I promise...God...if you stop the room from spinning I'll never drink this much again") in that it occurs later on when your blood alcohol is zero and would pass a sobriety test. It also differs from the infamous post-red wine headache that is not related to the morning-after alcohol effect discussed here.

It is likely that the hangover is older than recorded time, in that it was first experienced in prehistory many times amongst peoples on different continents when they independently discovered (by accident) that fermented carbohydrates produced a substance that made you feel...how shall we say...unusual.


Moving from the Neolithic to the present, my good friend Donna N. asked me to try and separate out truth from fiction regarding this phenomenon. And the fact that Donna asked me about this subject does not indicate that she repeatedly drinks herself into a sorry state only to awaken the next morning feeling miserable; Donna is a modest drinker who nonetheless suffers these symptoms.


This illustrates an important point that will often run through these columns, namely that we all have highly individual reactions to environmental determinants of both our short- and long-term health. That's right, although "we're all different" sounds trite, it is certainly true when it comes to health and disease. So, while some of us will be "hungover" after two glasses of wine the night before, others can bolt out of bed at 6:30 the next morning--after having had three shots of tequila, two scotches and a brandy nightcap the night before--and get to the gym with no problem. On the other hand, there is evidence that the more one drinks, the more likely the occurrence of a hangover (what pharmacologists call a dose response), but this rule does not work for everyone.

The Symptoms

About 2/3 of sufferers will have a headache and just feel lousy overall ("poor sense of general well-being"). One-third will have diarrhea, whereas one in five individuals will have either loss of appetite, tremulousness or fatigue (though these symptoms can occur together). Ten per cent also complain of nausea (this seems a bit low to me!). These numbers come from a table in an article in the Annals of Internal Medicine that forms the main basis for this column.

Where do the Symptoms Come From?

One long-standing theory has been that the acute alcohol hangover is the first stage of alcohol withdrawal; that is, the syndrome alcoholics suffer when they abruptly stop drinking. While the hangover and withdrawal do share some symptoms (e.g., headache, fatigue and feeling lousy) this theory has been discounted; however, this hypothesis has likely contributed to the legendary "hair of the dog" treatment for hangovers (that is, having some alcohol the morning after) that should not be tried!

Alcohol ingestion decreases the secretion of an important hormone that helps control our body's water content, namely antidiuretic hormone. Therefore, if levels of this hormone decrease, water is lost through the kidneys since unopposed diuresis now occurs and dehydration results--with resulting symptoms.

Acetaldehyde, a product of alcohol metabolism, may also be responsible for some of the symptoms. Individually, we all produce varying rates of acetaldehyde depending on the genetically-programmed levels of the necessary enzyme that we possess. Another possible cause of hangover symptoms are compounds related to alcohol called congeners, and these are specific to the process whereby individual spirits are produced. Since "see-through" spirits (gin, vodka and rum) have less than the dark liquors and wine, it is thought that the former are better than the latter for avoiding hangovers.

Further suspects for the hangover symptoms are hormonal derangements, altered glucose metabolism and neurologic dysfunction. We likely will never know for sure what the most important cause(s) is (are) since this is not a high research priority of the NIH or the pharmaceutical industry.

What to Do

First, do not drink to excess; but, if a long night of festivities cannot be avoided, make sure you eat! Food in ones' stomach during times of ethanol ingestion has been associated with less in the way of hangover symptoms. Second, drink plenty of water (the water mixed in with the Scotch does not count) during your drinking, or at least before you go to bed that night. This will help offset the morning headache that is likely the result of the aforementioned dehydration. This should be especially adhered to whenever the drinking environment is independently associated with water loss (a long flight, a hot afternoon at the company picnic or a day at the beach).

Propranolol, a beta-blocker, has been tested to no avail for the treatment of hangover; glucose solutions have also shown no effect. Positive effects have been shown for certain NSAIDS (drugs in the ibuprofen/Advil class) and B-vitamins.

Recommendations

All right: you've awoken with a dreadful hangover. What to do?

• Have 8 ounces of water
• 20 minutes later, have another 8 ounces of water, this time accompanied by an NSAID (Advil or equivalent ibuprofen or the longer-acting Aleve; dose of ibuprofen 400 to 600 mg; be sure to take with at least 8 oz water for stomach protection)
• Do not take Tylenol or equivalent; not good for liver with the alcohol in the rear view mirror
• Take a multi-vitamin or B-complex (there is a small study that showed a positive effect here; at any rate, as my grandma would say: "It couldn't hurt")
• As soon as you feel up to it, have a banana, cereal or eggs over easy and some toast
• Continue to rehydrate with water

Here's to ya!

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