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|isbn = 978-0195165319}}</ref><ref>{{Cite web|url=http://www.annals.org/cgi/content/full/127/5/376 |title=Alcohol Metabolism in Asian-American Men with Genetic Polymorphisms of Aldehyde Dehydrogenase — Ann Intern Med |publisher=Annals.org |date=1997-09-01 |accessdate=2010-02-03}}</ref>
|isbn = 978-0195165319}}</ref><ref>{{Cite journal|url=http://www.annals.org/cgi/content/full/127/5/376 |title=Alcohol Metabolism in Asian-American Men with Genetic Polymorphisms of Aldehyde Dehydrogenase |journal= Ann Intern Med |date=1997-09-01 |accessdate=2010-02-03 | pmid=9273829}}</ref>


It is often said that hangovers grow worse as one ages; this is thought to be caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.<ref>{{Cite news|url=http://www.dailymail.co.uk/health/article-1226478/Medical-miscellany-Why-hangovers-worse-age.html |title=Medical miscellany: Why hangovers get worse with age &#124; Mail Online |publisher=Dailymail.co.uk |date=2009-11-10 |accessdate=2010-03-26 |location=London}}</ref>
It is often said that hangovers grow worse as one ages; this is thought to be caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.<ref>{{Cite news|url=http://www.dailymail.co.uk/health/article-1226478/Medical-miscellany-Why-hangovers-worse-age.html |title=Medical miscellany: Why hangovers get worse with age &#124; Mail Online |publisher=Dailymail.co.uk |date=2009-11-10 |accessdate=2010-03-26 |location=London}}</ref>


However, in a model of migraine, it was demonstrated that acetate is the primary metabolite of alcohol responsible for alcohol induced periorbital hypersensitivity. <ref>http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015963</ref> Furthermore, in the same model they recapitulated the effectiveness of caffeine, ketorolac for ameliorating this hypersensitivity. This model raises questions about the status quo hypothesis of hangover headache.
However, in a model of migraine, it was demonstrated that acetate is the primary metabolite of alcohol responsible for alcohol induced periorbital hypersensitivity. <ref>{{cite journal | pmid = 21209842 | year = 2010 | last1 = Maxwell | first1 = CR | last2 = Spangenberg | first2 = RJ | last3 = Hoek | first3 = JB | last4 = Silberstein | first4 = SD | last5 = Oshinsky | first5 = ML | title = Acetate causes alcohol hangover headache in rats | volume = 5 | issue = 12 | pages = e15963 | doi = 10.1371/journal.pone.0015963 | pmc = 3013144 | journal = PloS one | editor1-last = Skoulakis | editor1-first = Efthimios M. C. }}</ref> Furthermore, in the same model they recapitulated the effectiveness of caffeine, ketorolac for ameliorating this hypersensitivity. This model raises questions about the status quo hypothesis of hangover headache.


==Possible remedies==
==Possible remedies==

Revision as of 18:17, 19 July 2011

For other uses, see Hangover (disambiguation)
Hangover
SpecialtyNeurology, psychiatry, narcology Edit this on Wikidata

A hangover (Template:Pron-en) describes the sum of unpleasant physiological effects following heavy consumption of alcoholic beverages. The most commonly reported characteristics of a hangover include headache, nausea, sensitivity to light and noise, lethargy, dysphoria, diarrhea and thirst, typically after the intoxicating effect of the alcohol begins to wear off. While a hangover can be experienced at any time, generally speaking a hangover is experienced the morning after a night of heavy drinking. In addition to the physical symptoms, a hangover may also induce psychological symptoms including heightened feelings of depression and anxiety.

Hypoglycemia, dehydration, acetaldehyde intoxication, and glutamine rebound are all theorized causes of hangover symptoms.[1] Hangover symptoms may persist for several days after alcohol was last consumed. Approximately 25-30% of drinkers may be resistant to hangover symptoms.[2] Some aspects of a hangover are viewed as symptoms of acute ethanol withdrawal, similar to the longer-duration effects of withdrawal from alcoholism, as determined by studying the increases in brain reward thresholds in rats (the amount of current required to receive from two electrodes implanted in the lateral hypothalamus) following ethanol injection.[3] Dehydration is caused by alcohol's ability to inhibit the effect of anti-diuretic hormone on kidney tubules, which leads to a hyperosmolar state, which in turn causes shrinking of (by loss of water) the brain cells which causes hangover.[4]

Symptoms

An alcohol hangover is associated with a variety of symptoms that may include dehydration, fatigue, headache, body aches, vomiting, diarrhea, flatulence, weakness, elevated body temperature and heart rate, hypersalivation, difficulty concentrating, sweating, anxiety, dysphoria, irritability, sensitivity to light and noise, erratic motor functions (including tremor), trouble sleeping, severe hunger, halitosis, and lack of depth perception. Many people will also be repulsed by the thought, taste or smell of alcohol during a hangover. The symptoms vary from person to person, and occasion to occasion, usually beginning several hours after drinking. It is not clear whether hangovers directly affect cognitive abilities.

Causes

Ethanol has a dehydrating effect by causing increased urine production (diuresis), which causes headaches, dry mouth, and lethargy. Dehydration also causes fluids in the brain to be less plentiful. This can be mitigated by drinking water before, during and after consumption of alcohol. Alcohol's effect on the stomach lining can account for nausea.

Another contributing factor is the presence of products from the breakdown of ethanol by liver enzymes. Ethanol is converted to acetaldehyde by the enzyme alcohol dehydrogenase, and then from acetaldehyde to acetic acid by the enzyme acetaldehyde dehydrogenase. Acetaldehyde (ethanal) is between 10 and 30 times more toxic than alcohol itself.[5]

These two reactions also require the conversion of NAD+ to NADH. With an excess of NADH, three enzymes of the Citric Acid Cycle are inhibited (citrate synthase, isocitrate dehydrogenase, and alpha-ketoglutarate dehydrogenase) essentially shutting it down. Pyruvate (the end product of glycolysis) starts to accumulate, and the excess NADH drives lactate dehydrogenase to produce lactate from pyruvate in order to regenerate NAD+ and sustain life. This diverts pyruvate from other pathways such as gluconeogenesis, thereby impairing the ability of the liver to compensate for a drop in blood glucose levels, especially for the brain. Because glucose is the primary energy source of the brain, this lack of glucose (hypoglycemia) contributes to symptoms such as fatigue, weakness, mood disturbances, and decreased attention and concentration.

Alcohol consumption can result in depletion of the liver's supply of glutathione[6] and other reductive detoxification agents,[7] reducing its ability to effectively remove acetaldehyde and other toxins from the bloodstream. Additionally, alcohol induces the CYP2E1 enzyme, which itself can produce additional toxins and free radicals.[8]

In addition, it is thought that the presence of other alcohols (fusel oils) and other by-products of alcoholic fermentation (also called congeners), exaggerate many of the symptoms; this probably accounts for the mitigation of the effects when distilled alcohol, particularly vodka, is consumed instead.[9] A 2009 study provided evidence that darker-coloured liquors, such as bourbon, cause worse hangovers than lighter-coloured liquors, such as vodka. The higher amount of congeners found in darker liquors compared to lighter ones was indicated as the cause.[10] Studies that attempt to compare hangover producing potential and hangover severity of different alcoholic drinks suggest the following ordering (starting with the least hangover-inducing): distilled ethanol diluted in fruit juice; beer; vodka; gin; white wine; whisky; rum; red wine; brandy.[11] [12] In a 2006 study, an average of 14 standard drinks (330 ml bottles) of beer was needed to produce a hangover, compared with only 7 to 8 drinks of wine or liquor. [12] One potent congener is methanol. It is naturally formed in small quantities during fermentation and it can be accidentally concentrated by improper distillation techniques. Metabolism of methanol produces an extremely toxic compound, formaldehyde; however, its metabolism is suppressed when ethanol is present in the bloodstream. This is thought to provide a mechanism for hangover that starts when blood alcohol content approaches zero and can be "cured" by alcohol.

Most people of East Asian descent have a mutation in their alcohol dehydrogenase gene that makes this enzyme unusually effective at converting ethanol to acetaldehyde, and about half of such people also have a form of acetaldehyde dehydrogenase that is less effective at converting acetaldehyde to acetic acid.[13] This combination causes them to suffer from alcohol flush reaction, in which acetaldehyde accumulates after drinking, leading to immediate and severe hangover symptoms. These people are therefore less likely to become alcoholics.[14][15]

It is often said that hangovers grow worse as one ages; this is thought to be caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol.[16]

However, in a model of migraine, it was demonstrated that acetate is the primary metabolite of alcohol responsible for alcohol induced periorbital hypersensitivity. [17] Furthermore, in the same model they recapitulated the effectiveness of caffeine, ketorolac for ameliorating this hypersensitivity. This model raises questions about the status quo hypothesis of hangover headache.

Possible remedies

Hangovers are poorly understood from a medical point of view. Health care professionals prefer to study alcohol abuse from a standpoint of treatment and prevention, and there is a view that the hangover provides a useful, natural and intrinsic disincentive to excessive drinking.[18]

Within the limited amount of serious study on the subject, there is debate about whether a hangover might be prevented or at least mitigated; additionally, there is a vast body of folk medicine and simple quackery. There is currently no empirically proven mechanism for prevention except reducing the amount of ethanol consumed, or for making oneself sober other than waiting for the body to metabolize ingested alcohol, which occurs via oxidation through the liver before alcohol leaves the body. A four-page literature review in British Medical Journal concludes: "No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to avoid drinking."[19]

Potentially beneficial remedies

  • Rehydration: "Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6".[20]
  • Tolfenamic acid (TA): A study concludes, "TA was found significantly better than placebo in the subjective evaluation of drug efficacy (p < 0.001) and in reducing the reported hangover symptoms in general (p < 0.01). In the TA group, significantly lower symptom scores were obtained for headache (p < 0.01), and for nausea, vomiting, irritation, tremor, thirst, and dryness of mouth (all p < 0.05)."[21]
  • Vitamin B6 (pyritinol): Some studies have found large doses of Vitamin B6 (several hundred times the recommended daily intake) can help to reduce hangovers.[20][22]
  • Chlormethiazole: "Chlormethiazole was found to lower blood pressure and adrenaline output and, furthermore, to relieve unpleasant physical symptoms, but did not affect fatigue and drowsiness. The cognitive test results were only slightly influenced by this agent, while psychomotor performance was significantly impaired. Subjects with severe subjective hangover seemed to benefit more from the chlormethiazole treatment than subjects with a mild hangover."[23] "However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group."[24]
  • Pedialyte: Pedialyte may be an effective remedy for hangovers due to its replacement of lost electrolytes.
  • Hair of the dog: The belief that consumption of further alcohol after the onset of a hangover will relieve symptoms, based upon the theory that hangover represents a form of withdrawal[25] and that by satiating the body's need for alcohol the symptoms will be relieved. Certainly the additional alcohol has a sedating and anaesthetic effect.[26] While the practice is affirmed by tradition[27] and by many hospitality providers,[28] medical opinion holds that the practice merely postpones the symptoms, and courts addiction.[29] Favored choices include Fernet Branca[30] and Bloody Mary.[26]
  • Food and water: consumption of foods such as eggs, which contain cysteine, and water may be enough to replenish lost moisture and at least rehydrate the body, making a hangover shorter. A bacon sandwich has also been claimed to effectively relieve hangovers.[31]
  • Oxygen: There have been anecdotal reports from those with easy access to a breathing oxygen supply — medical staff, SCUBA divers and military pilots — that oxygen can also reduce the symptoms of hangovers sometimes caused by alcohol consumption. The theory is that the increased oxygen flow resulting from oxygen therapy improves the metabolic rate, and thus increases the speed at which toxins are broken down.[32] However, one source states that (in an aviation context) oxygen has no effect on physical impairment caused by hangover.[33]
  • Rosiglitazone: [Study in rats] "Rosiglitazone alleviated the symptoms of ethanol-induced hangover by inducing ALD2 expression..."[34]
  • Acetylcysteine: There are claims that N-acetylcysteine can relieve or prevent symptoms of hangover through scavenging of acetylaldehyde, particularly when taken concurrently with alcohol.[35] Additional reduction in acetaldehyde toxicity can be achieved if NAC is taken in conjunction with vitamin B1 (thiamine).[5]

Ineffective or unproven remedies

Recommendations for foods, drinks and activities to relieve hangover symptoms abound. The ancient Romans, on the authority of Pliny the Elder, favored raw owl's eggs or fried canary.[36] while the "Prairie Oyster" restorative, introduced at the 1878 Paris World Exposition, calls for raw egg yolk mixed with Worcestershire sauce, Tabasco sauce, salt and pepper.[37] By 1938, the Ritz-Carlton Hotel provided a hangover remedy in the form of a mixture of Coca-Cola and milk[37] (Coca-Cola itself having been invented, by some accounts,[38][39] as a hangover remedy). Alcoholic writer Ernest Hemingway relied on tomato juice and beer.[40] Certain mixtures were developed specifically for the purpose. The "Black Velvet" consists of equal parts champagne and flat Guinness Stout,[40] A 1957 survey by a Wayne State University folklorist found widespread belief in the efficacy of heavy fried foods, tomato juice and sexual activity.[27]

Activities said to be restorative include a shower—alternating very hot and very cold water,[41] exercise,[42] and steambath or sauna (although medical opinion holds this to be very dangerous, as the combination of alcohol and hyperthermia increases the likelihood of dangerous cardiac arrhythmias).[43]

Other untested or discredited treatments include:

  • Globe artichoke (Cynara scolymus) extract: "Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover."[44]
  • Propranolol: "We conclude that propranolol does not prevent the symptoms of hangover."[45][46]
  • Fructose and glucose: A 1976 research came to the conclusion that "The results indicate that both fructose and glucose effectively inhibit the metabolic disturbances induced by ethanol but they do not affect the symptoms or signs of alcohol intoxication and hangover."[47] Nevertheless, consumption of honey (a significant fructose and glucose source) is often suggested as a way to reduce the effect of hangovers.[48]
  • Kudzu (Pueraria montana var. lobata): The main ingredient in remedies such as kakkonto. A study concluded, "The chronic usage of Pueraria lobata at times of high ethanol consumption, such as in hangover remedies, may predispose subjects to an increased risk of acetaldehyde-related neoplasm and pathology. ... Pueraria lobata appears to be an inappropriate herb for use in herbal hangover remedies as it is an inhibitor of ALDH2."[49]

See also

References

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  2. ^ Howland J, Rohsenow DJ, Allensworth-Davies D; et al. (2008). "The incidence and severity of hangover the morning after moderate alcohol intoxication". Addiction. 103 (5): 758–65. doi:10.1111/j.1360-0443.2008.02181.x. PMID 18412754. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  3. ^ Schulteis G, Liu J (2006). "Brain rewghkjghkjghkard deficits accompany withdrawal (hangover) from acute ethanol in rats". Alcohol. 39 (1): 21–8. doi:10.1016/j.alcohol.2006.06.008. PMC 2266583. PMID 16938626. {{cite journal}}: Unknown parameter |month= ignored (help)
  4. ^ "Kidney Function". Retrieved 2011-05-19.
  5. ^ a b Sprince H, Parker CM, Smith GG, Gonzales LJ (1974). "Protection against acetaldehyde toxicity in the rat by L-cysteine, thiamin and L-2-methylthiazolidine-4-carboxylic acid". Agents Actions. 4 (2): 125–30. doi:10.1007/BF01966822. PMID 4842541. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ 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. PMID 2576368.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Stickel F, Schuppan D, Hahn EG, Seitz HK (2002). "Cocarcinogenic effects of alcohol in hepatocarcinogenesis". Gut. 51 (1): 132–9. doi:10.1136/gut.51.1.132. PMC 1773267. PMID 12077107. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Kessova I, Cederbaum AI (2003). "CYP2E1: biochemistry, toxicology, regulation and function in ethanol-induced liver injury". Curr. Mol. Med. 3 (6): 509–18. doi:10.2174/1566524033479609. PMID 14527082. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ Wiese JG, Shlipak MG, Browner WS (6 June 2000). "The alcohol hangover". Ann. Intern. Med. 132 (11): 897–902. PMID 10836917.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ 8:32 p.m. ET (2009-12-18). "Whiskey hangover worse than vodka, study says - Behavior- msnbc.com". MSNBC. Retrieved 2010-02-03.{{cite web}}: CS1 maint: numeric names: authors list (link)
  11. ^ Pawan GLS. Alcoholic drinks and hangover effects. Proc Nutr Soc 1973; 32:15A.
  12. ^ a b Verster J. C. Congeners and alcohol hangover: differences in severity among Dutch college students after consuming beer, wine or liquor. Alcoholism: Clinical and Experimental Research 2006;30 Suppl. 6:53A.
  13. ^ Xiao Q, Weiner H, Crabb DW (1996). "The mutation in the mitochondrial aldehyde dehydrogenase (ALDH2) gene responsible for alcohol-induced flushing increases turnover of the enzyme tetramers in a dominant fashion". J. Clin. Invest. 98 (9): 2027–32. doi:10.1172/JCI119007. PMC 507646. PMID 8903321.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Earleywine, Mitchell (1999). Mind-Altering Drugs: The Science of Subjective Experience. OUP USA. p. 163. ISBN 978-0195165319.
  15. ^ "Alcohol Metabolism in Asian-American Men with Genetic Polymorphisms of Aldehyde Dehydrogenase". Ann Intern Med. 1997-09-01. PMID 9273829. Retrieved 2010-02-03.
  16. ^ "Medical miscellany: Why hangovers get worse with age | Mail Online". London: Dailymail.co.uk. 2009-11-10. Retrieved 2010-03-26.
  17. ^ Maxwell, CR; Spangenberg, RJ; Hoek, JB; Silberstein, SD; Oshinsky, ML (2010). Skoulakis, Efthimios M. C. (ed.). "Acetate causes alcohol hangover headache in rats". PloS one. 5 (12): e15963. doi:10.1371/journal.pone.0015963. PMC 3013144. PMID 21209842.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  18. ^ Glater, Jonathan D. (2004-12-07). "Raw Eggs? Hair of the Dog? New Options for the Besotted". The New York Times.
  19. ^ Pittler MH, Verster JC, Ernst E (2005). "Interventions for preventing or treating alcohol hangover: systematic review of randomized controlled trials". BMJ. 331 (7531): 1515–8. doi:10.1136/bmj.331.7531.1515. PMC 1322250. PMID 16373736. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  20. ^ a b Wiese JG, Shlipak MG, Browner WS (2000). "The alcohol hangover". Ann. Intern. Med. 132 (11): 897–902. PMID 10836917. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ S. Kaivola1, J. Parantainen, T. Österman and H. Timonen Kaivola, S.; Parantainen, J.; Osterman, T.; Timonen, H. (1983). "Hangover headache and prostaglandins: Prophylactic treatment with tolfenamic acid". Cephalalgia. 3: 31. doi:10.1046/j.1468-2982.1983.0301031.x. PMID 6342813. {{cite journal}}: Unknown parameter |month= ignored (help)
  22. ^ Khan MA, Jensen K, Krogh HJ (1973). "Alcohol-induced hangover. A double-blind comparison of pyritinol and placebo in preventing hangover symptoms". Q J Stud Alcohol. 34 (4): 1195–201. PMID 4588294. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  23. ^ Myrsten AL, Rydberg U, Ideström CM, Lamble R (1980). "Alcohol intoxication and hangover: modification of hangover by chlormethiazole". Psychopharmacology (Berl.). 69 (2): 117–25. doi:10.1007/BF00427636. PMID 6779303.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  25. ^ New hangover treatments go beyond traditions 'hair of the dog' New York Times News Service Dec. 6, 2004 [1]
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  29. ^ "Hangover Myths Slideshow: Hangover Cures, Herbal Remedies, Hair of the Dog, and Other Common Myths". Webmd.com. 2008-11-14. Retrieved 2010-03-26.
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  31. ^ "Bacon sandwich really does cure a hangover". The Daily Telegraph. London. 7 April 2009. Retrieved 2 May 2010. [dead link]
  32. ^ Timothy Walker and Mary Fitzgerald A drinker's guide to hangovers The Independent 17 April 2007
  33. ^ Reihheart, Richard (2007). Basic Flight Physiology. McGraw-Hill Professional. p. 179. ISBN 0-7735-0801-5.
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  39. ^ "// Welcome To". Colamyths.com. Retrieved 2010-03-26.
  40. ^ a b [2]
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  44. ^ Max H. Pittler, Adrian R. White, Clare Stevinson and Edzard Ernst Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial CMAJ December 9, 2003; 169 (12)
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  47. ^ Ylikahri RH, Leino T, Huttunen MO, Pösö AR, Eriksson CJ, Nikkilä (1976). "Effects of fructose and glucose on ethanol-induced metabolic changes and on the intensity of alcohol intoxication and hangover". Eur. J. Clin. Invest. 6 (1): 93–102. doi:10.1111/j.1365-2362.1976.tb00498.x. PMID 1253812. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  48. ^ "UMDNJ Experts Suggest Remedies for Holiday Headaches". Umdnj.edu. 2007-12-20. Retrieved 2009-10-18.
  49. ^ McGregor NR (2007). "Pueraria lobata (Kudzu root) hangover remedies and acetaldehyde-associated neoplasm risk". Alcohol. 41 (7): 469–78. doi:10.1016/j.alcohol.2007.07.009. PMID 17980785. {{cite journal}}: Unknown parameter |month= ignored (help)

External links

Look up hangover in Wiktionary, the free dictionary.
Look up veisalgia in Wiktionary, the free dictionary.
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