Hangover

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For other uses, see Hangover (disambiguation).

A hangover (veisalgia) describes the sum of unpleasant physiological effects following heavy consumption of drugs, particularly alcoholic beverages. The most commonly reported characteristics of a hangover include headache, nausea, sensitivity to light and noise, lethargy, dysphoria 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] Roughly 25-30% of drinkers are resistant to hangover symptoms.[2] Some aspects of hangover can be 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]

Contents

[edit] Symptoms

An alcohol hangover is associated with a variety of symptoms that may include dehydration, fatigue, headache, nausea, vomiting, diarrhea, weakness, elevated body temperature, hypersalivation, difficulty concentrating, anxiety, irritability, sensitivity to light and noise, erratic motor functions, trouble sleeping, lack of depth perception and/or hair loss. Many people will also be repulsed by the thought or taste 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 affect cognitive abilities[citation needed].

[edit] Causes

Hangovers are multi-causal. Ethanol has a dehydrating effect by causing increased urine production (such substances are known as diuretics), which causes headaches, dry mouth, and lethargy. Dehydration causes the brain to shrink away from the skull slightly.[4] This can be mitigated by drinking water or an oral electrolyte solution after consumption of alcohol. Alcohol's effect on the stomach lining can account for nausea. Because of the increased NADH production during metabolism of ethanol by the enzymes alcohol dehydrogenase and aldehyde dehydrogenase, excess NADH can build up and slow down gluconeogenesis in the liver, thus causing hypoglycemia.

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 mildly toxic, contributing to hangover. 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.

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[citation needed].

The amount of congeners in the drink may also have an effect. 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.

[edit] 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.

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 practice moderation."[5]


[edit] Hangover Prevention Clinical Study

HPF Hangover Prevention Formula contains a patented herbal extract that was clinically proven to have a moderate effect at reducing hangover symptoms by inhibiting the production of inflammatory mediators. The double blind study, conducted, among graduate medical students at Tulane University, was peer-reviewed by the American Medical Association and published in the Archives of Internal Medicine.2004;164:1334-1340-- The Original Investigation is from the General Internal Medicine Section and Department of Medicine, Tulane Health Sciences Center, New Orleans, LA ( Drs Wiese and McPherson); and General Internal Medicine Section and Departments of Medicine Section and Departments of Epidemiology, and Biostatistics, University of California, San Francisco (Ms Odden and Dr Schlipak. The authors had no financial interest in the study.

[edit] Potential beneficial remedies

  • Rehydration: "Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6".[6]In Scotland, the drink Irn-Bru is known as a hangover remedy
  • Narcotics: Codeine, dihydrocodeine, tilidine and other such medication directly work against many of the effects of alcohol hangover. It is believed that analgesic preparations containing acetaminophen (paracetamol/Tylenol) may predispose people to the risk of potentially fatal hepatotoxicity. Consumption of narcotics along with alcohol or shortly after consumption thereof is potentially dangerous in itself because of added depressant effects on the central nervous system.
  • Exercise: It is known that exercise after heavy intoxication helps the heart pump blood around the body and increases the amount of oxygen in the body. A light jog that allows the heart rate to increase can help your body get over a hangover.
  • Oxygen: In a double-blind random study of 231 patients at two Vienna hospitals, published in Anesthesiology in 1999 and reported on 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.[7] 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.[8]
  • Magnesium: It is well studied that excessive alcohol consumption can lead to a magnesium deficiency, or reduce levels of magnesium, as well as depleting zinc and other minerals. Individuals with lower magnesium levels may experience more severe hangovers. A healthy diet that contains an adequate intake of magnesium and other minerals may help in the long term to reduce the effects of hangovers. The hangover symptoms of headache, and light and sound sensitivity, are very similar to those of migraine. A common treatment for chronic migraine headaches is magnesium. Some scientists hypothesize that a hangover may be exhibiting at least some symptoms of an acute magnesium deficiency.
  • 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)."[9]
  • Vitamin B6 (pyritinol): Some studies have found that Vitamin B6 reduces hangovers.[6][10]
  • 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."[11] "However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group."[12]
  • Rosiglitazone: [Study in rats] "Rosiglitazone alleviated the symptoms of ethanol-induced hangover by inducing ALD2 expression…"[13]
  • Acetylcysteine: There are claims that N-acetylcysteine can relieve or prevent symptoms of hangover through scavenging of acetylaldehyde.
  • 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 glass of Milk, water 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.

[edit] Possibly 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."[14]
  • 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.
  • Propranolol: "We conclude that propranolol does not prevent the symptoms of hangover."[15][16]
  • 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."[17] Nevertheless, consumption of honey (a significant fructose and glucose source) is often suggested as a way to reduce the effect of hangovers.[18]
  • Kudzu (Pueraria lobata): With respect to preventing hangovers, "The evidence regarding kudzu's effectiveness is mixed" and "There are no studies to demonstrate that kudzu can serve as a morning-after potion for eliminating hangovers as used in traditional Chinese practice."[19]

[edit] Etymology

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

The term hangover was originally a 19th century expression describing unfinished business—something left over from a meeting—or ‘survival.’ In 1904, the meaning "after-effect of drinking too much" first surfaced.[20][21]

[edit] See also

[edit] References

  1. ^ Federal Aviation Administration. Pilot Safety Brochure
  2. ^ PMID 18412754
  3. ^ PMID 16938626
  4. ^ The effects of dehydration on brain volume – preliminary results’, International Journal of Sports Medicine 2005; 26:481–485
  5. ^ Max H Pittler, et al.Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials BMJ 2005;331:1515-1518 (24 December), doi:10.1136/bmj.331.7531.1515
  6. ^ a b Jeffrey G. Wiese, Michael G. Shlipak, Warren S. Browner The Alcohol Hangover Annals of Internal Medicine 6 June 2000 Volume 132 Issue 11 pp897–902
  7. ^ Dr. Daniel Sessler Extra Oxygen for Anesthesia's Hangover The New York Times 9 November 1999
  8. ^ Timothy Walker and Mary Fitzgerald A drinker's guide to hangover cures The Independent 17 April 2007
  9. ^ S. Kaivola1, J. Parantainen, T. Österman and H. Timonen Hangover headache and prostaglandins: Prophylactic treatment with tolfenamic acid Cephalalgia Volume 3 Page 31 - March 1983 doi:10.1046/j.1468–2982.1983.0301031.x
  10. ^ Khan MA, Jensen K, Krogh HJ. Alcohol-induced hangover: A double-blind comparison of pyritinol and placebo in preventing hangover symptoms Q J Stud Alcohol. 1973;34:1195–201
  11. ^ Myrsten AL, Rydberg U, Idestrom CM, Lamble R. Alcohol intoxication and hangover: modification of hangover by chlormethiazole Psychopharmacology (Berl). 1980;69(2):117–25.
  12. ^ Castleden CM, George CF, Sedgwick EM. Chlormethiazole--no hangover effect but not an ideal hypnotic for the young Postgrad Med J. 1979 Mar;55(641):159–60.
  13. ^ Jung TW, Lee JY, Shim WS, Kang ES, Kim SK, Ahn CW, Lee HC, Cha BS. Rosiglitazone relieves acute ethanol-induced hangover in sprague-dawley rats Alcohol Alcohol 2006 May-Jun;41(3):231-5. Epub 2006 Mar 22
  14. ^ 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)
  15. ^ Bogin RM, Nostrant TT, Young MJ. Propranolol for the treatment of the alcoholic hangover Am J Drug Alcohol Abuse. 1986;12(3):279–84.
  16. ^ Bogin RM, Nostrant TT, Young MJ Propranolol for the treatment of the alcoholic hangover Am J Drug Alcohol Abuse. 1987;13(1-2):175–80.
  17. ^ Ylikahri RH, Leino T, Huttunen MO, Poso AR, Eriksson CJ, Nikkila Effects of fructose and glucose on ethanol-induced metabolic changes and on the intensity of alcohol intoxication and hangover Eur J Clin Invest 1976 Jan 30;6(1):93–102.
  18. ^ UMDNJ Experts Suggest Remedies for Holiday Headaches
  19. ^ The latest review suggests that Kudzu root may be linked to negative health outcomes if taken at the same time as alcohol in much the same way as other alcohol aversion drugs, such as Disulphram. It may lead to increased risk of development of throat cancer if consumed chronically with alcohol(Ref Alcohol Vol 41 November issue pages 469-478). http://www2.potsdam.edu/hansondj/HealthIssues/1127332920.html Kudzu and Alcohol Consumption]
  20. ^ Online Etymology Dictionary Hangover
  21. ^ Frank Kelly Rich On the Cuff & Under the Table: The Origins and History of Drinking Words and Phrases Modern Drunkard Magazine

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