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Hangover

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For other uses, see Hangover (disambiguation).

A hangover (pronounced /'hæŋoʊvɜr/) (veisalgia) describes the sum of unpleasant physiological effects following heavy consumption of a drug. The most commonly reported characteristics of a hangover include headache, nausea, sensitivity to light and noise, lethargy, dysphoria, diarrhea and thirst.

Hypoglycemia, dehydration, acetaldehyde intoxication, and vitamin B12 deficiency are all theorized causes of hangover symptoms. Hangovers may last up to two or three days after alcohol was last consumed.[1] 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 to electrodes implanted in the lateral hypothalamus) following ethanol injection.[3]

Etymology

The term hangover was originally a 19th century expression describing unfinished business—something left over from a meeting—or ‘survival.’ In 1904, the meaning "morning after-effect of drinking too much" first surfaced.[4][5]

Symptoms

An alcohol hangover is associated with a variety of symptoms that may include dehydration, fatigue, headache, nausea, vomiting, diarrhea, flatulence, weakness, elevated body temperature, hypersalivation, difficulty concentrating, sweating, anxiety, irritability, sensitivity to light and noise, erratic motor functions (including tremor), trouble sleeping, severe hunger, 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 after consumption of alcohol. Alcohol's effect on the stomach lining can account for nausea.

Another factor contributing to a hangover are the products from the breakdown of ethanol via 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,[6] as well as being cocarcinogenic (not carcinogenic solely by itself) and mutagenic.[7]

These two reactions also require the conversion of NAD+ to NADH. With an excess of NADH, the lactate dehydrogenase reaction is driven to produce lactate from pyruvate (the end product of glycolysis) 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 supply glucose to tissues, especially the brain. Because glucose is the primary energy source of the brain, this lack of glucose contributes to hangover 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[8] and other reductive detoxification agents,[9] 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.[10]

There are various nervous system effects: the removal of the depressive effects of alcohol in the brain probably account for the light and noise sensitivity.

In addition, it is thought that the presence of other alcohols (such as fusel oils), by-products of the alcoholic fermentation also called congeners, exaggerate many of the symptoms (congeners may also be zinc or other metals added primarily to sweet liqueurs to enhance their flavor); this probably accounts for the mitigation of the effects when distilled alcohol, particularly vodka, is consumed instead[11].

Red wines have more congeners than white wines, and some people note less of a hangover with white wine. Some individuals have a strong negative reaction to red wine, distinct from hangover, called red wine headache that can affect them within 15 minutes after drinking a single glass of red wine. The headache is usually accompanied by nausea and flushing [citation needed].

In alcohol metabolism, one molecule of ethanol (the primary active ingredient in alcoholic beverages) produces 2 molecules of NADH, utilizing vitamin B12 as a coenzyme. Over-consumption of ethanol may cause vitamin B12 deficiency as well.

Possible remedies

There is debate about whether a hangover might be prevented or at least mitigated. There is currently no known proven mechanism for making oneself sober short of waiting for the body to metabolize ingested alcohol, which occurs via oxidation through the liver before alcohol leaves the body. However, drinking a large amount of water or a rehydration drink prior to sleep will effectively reduce a large proportion of the symptoms. It may also be helpful to replenish with electrolytes via food to avoid aggravating electrolyte disturbances induced by alcohol through consuming only water. This increases the need to urinate in the relevant timeline, thus cleaning the body and ridding it of many chemicals more quickly, including those that cause or heighten hangover symptoms. [citation needed]

A four page literature review in British Medical Journal on hangover cures by Max Pittler of the Peninsula Medical School at Exeter University and colleagues 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."[12] However, a study published in April 2009 from Great Britain publicizes the benefits of consuming a bacon sandwich as an actual means to cure a hangover, which is attributed to the benefits of high amounts of amino acids.[13]

Potentially beneficial remedies

  • Food and water: Simple 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, egg and cheese sandwich has also been known to effectively relieve hangovers [14]
  • Milk and orange juice. The Calcium, re-hydration properties, and vitamin C contained in each product respectively is found to combat the symptoms of a hangover if taken shortly after consumption.[citation needed] Milk is also a dietary source of cysteine.
  • Rehydration: "Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6".[15]
  • Sodium bicarbonate; A slightly heaped teaspoon of baking soda suspended in a glass of water when consumed deals very effectively with the nausea, and indirectly with 'the shakes' associated with a hangover.[citation needed]
  • Exercise: Light exercise helps the heart pump blood around the body and increases the amount of oxygen in the body.
  • Opioids: Opioids such as hydrocodone, codeine, and oxycodone can potentially provide relief to the pain associated with a hangover. Caution should be exercised when using opioids that are combined with acetaminophen, as the combined effects of alcohol and acetaminophen can be toxic to the liver.
  • Oxygen: In a double-blind random study of 231 patients at two Vienna hospitals, published in Anesthesiology in 1999 and reported by The New York Times, it was found that the side-effects of general anesthesia could be diminished by giving patients a mix of 80 percent oxygen and 20 percent nitrogen during the surgery, and for two hours afterward. Only 17 percent of the patients receiving supplemental oxygen experienced nausea and vomiting, compared with 30 percent of the group who were given the standard 30 percent oxygen and 70 percent nitrogen.[16] The study's leader characterized the results for the Times, "Extra oxygen is cheap, risk-free and reduces the incidence of nausea as well as any known drug." A related study by members of Dr. Sessler's team, published in Anesthesiology in October 1999, indicated that patients given oxygen in amounts up to 80 percent did not suffer impaired lung function. In addition, there have been anecdotal reports, from doctors, nurses and SCUBA divers, 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.[17]
  • 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)."[18]
  • Vitamin B1 (thiamine): there are claims[citation needed] that apart from helping prevent Wernicke-Korsakoff syndrome, thiamine supplements may substantially enhance the activity of alpha-ketoglutarate dehydrogenase and so prevent a build up of glutamate and hence GABA in the cerebellum of the brain (thus reducing some symptoms of hangovers).
  • Vitamin B6 (pyritinol): Some studies have found large doses of Vitamin B6 (several hundred times the recommended daily intake) can help to reduce hangovers.[15][19]
  • 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."[20] "However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group."[21]
  • Rosiglitazone: [Study in rats] "Rosiglitazone alleviated the symptoms of ethanol-induced hangover by inducing ALD2 expression…"[22]
  • Acetylcysteine: There are claims that N-acetylcysteine can relieve or prevent symptoms of hangover through scavenging of acetylaldehyde, particularly when taken concurrently with alcohol. [23][24] Additional reduction in acetaldehyde toxicity can be achieved if NAC is taken in conjunction with vitamin B1 (thiamine). [6]

Ineffective remedies

  • Antipokhmelin: Also known under its tradename RU-21, it is an over-the-counter dietary supplement whose primary active ingredient is succinic acid, an extract of amber. It has been touted by internet marketers as a miracle cure for alcohol hangovers, alleged to have been produced by Soviet scientists for a KGB spy program. To-date, however, no double-blind, placebo-controlled scientific studies confirming the marketers' claims have been released.
  • Globe artichoke (Cynara scolymus) extract: "Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover."[25]
  • Artichoke and Sarsaparilla extract: A November 2004 issued U.S. Patent No. 6,824,798 states that the method described in the patent "results in complete elimination of veisalgia (hangover) in more than 80% of individuals". These plant extracts, when administered separately, do not seem to have a similar effect. The patent further states that the right combination of the extracts of both of these plants are required and that they then contain a complex of polyphenols, flavonoids, and phytosterols that are effective. However, no evidence is required for such statements to appear in a patent application or in the patent itself. The existence of a patent is merely legal evidence of intellectual property, not evidence of efficacy.
  • Fructose and glucose: A 1976 research has come 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."[28] Nevertheless, consumption of honey (a significant fructose and glucose source) is often suggested as a way to reduce the effect of hangovers.[29]
  • Kudzu (Pueraria lobata): 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."[30]
  • Hair of the dog: The belief that consumption of further alcohol after the onset of a hangover is a viable treatment of the symptoms. Some say that this is based upon the theory that hangover symptoms are likened to withdrawal symptoms and that by satiating the body's need for alcohol they will be assuaged.

References

  1. ^ Federal Aviation Administration. Pilot Safety Brochure
  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 reward 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. ^ Online Etymology Dictionary Hangover
  5. ^ Frank Kelly Rich On the Cuff & Under the Table: The Origins and History of Drinking Words and Phrases Modern Drunkard Magazine 2008 FOR SURE HOMIE
  6. ^ 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)
  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. ^ 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)
  9. ^ 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)
  10. ^ 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)
  11. ^ Wiese JG, Shlipak MG, Browner WS (2000). "The alcohol hangover". Ann. Intern. Med. 132 (11): 897–902. PMID 10836917. {{cite journal}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Pittler MH, Verster JC, Ernst E (2005). "Interventions for preventing or treating alcohol hangover: systematic review of randomised 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)
  13. ^ Telegraph.co.uk [1] 2009; Retrieved 4-8-09
  14. ^ Telegraph.co.uk [2] 2009;
  15. ^ 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)
  16. ^ Dr. Daniel Sessler Extra Oxygen for Anesthesia's Hangover The New York Times 9 November 1999
  17. ^ Timothy Walker and Mary Fitzgerald A drinker's guide to hangover cures The Independent 17 April 2007
  18. ^ S. Kaivola1, J. Parantainen, T. Österman and H. Timonen "Hangover headache and prostaglandins: Prophylactic treatment with tolfenamic acid". Cephalalgia. 3: 31. 1983. doi:10.1046/j.1468–2982.1983.0301031.x. {{cite journal}}: Check |doi= value (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help); Unknown parameter |month= ignored (help)
  19. ^ 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)
  20. ^ 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)
  21. ^ Castleden CM, George CF, Sedgwick EM (1979). "Chlormethiazole—no hangover effect but not an ideal hypnotic for the young". Postgrad Med J. 55 (641): 159–60. doi:10.1136/pgmj.55.641.159. PMC 2425402. PMID 379841. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  22. ^ Jung TW, Lee JY, Shim WS; et al. (2006). "Rosiglitazone relieves acute ethanol-induced hangover in Sprague-Dawley rats". Alcohol Alcohol. 41 (3): 231–5. doi:10.1093/alcalc/agl013. PMID 16554376. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  23. ^ Fawkes, SW CERI: Living with Alcohol Smart Drug News 1996 Dec 13
  24. ^ Ozaras R, Tahan V, Aydin S, Uzun H, Kaya S, Senturk H (2003). "N-acetylcysteine attenuates alcohol-induced oxidative stess in rats". World J. Gastroenterol. 9 (4): 791–4. PMID 12679934. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  25. ^ 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)
  26. ^ Bogin RM, Nostrant TT, Young MJ (1986). "Propranolol for the treatment of the alcoholic hangover". Am J Drug Alcohol Abuse. 12 (3): 279–84. doi:10.3109/00952998609007397. PMID 3503570.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. ^ Bogin RM, Nostrant TT, Young MJ (1987). "Propranolol for the treatment of the alcoholic hangover". Am J Drug Alcohol Abuse. 13 (1–2): 175–80. doi:10.3109/00952998709001507. PMID 3318398.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. ^ 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)
  29. ^ UMDNJ Experts Suggest Remedies for Holiday Headaches
  30. ^ 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)

See also

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