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The Best Hangover Treatment: What is it?
October 5, 2009
Figure 1. Myth: Liquor before beer, never fear (2008). Note: Copyright WebMD.com, 2005-2009.
Google the terms “hangover treatment”, and in 0.07 seconds, you’ll get about 1,800,000 hits. Clearly, many people are eager to find the solution to that horrible feeling they get when they wake up after a night of heavy drinking. According to a survey by Harburg, Gunn, Gleiberman, DiFranceisco, & Schork (1993), approximately 75% of people who drank to intoxication had experienced hangovers some time in their life. The internet is a hotspot for those individuals who are seeking help. However, with so many different remedies offered on the net, as well as those suggested by friends, family, etc., how are we to know which ones really work? Here, we will investigate the various hangover treatments suggested on the web and compare them with controlled clinical studies on the topic.
What characterizes a hangover?
A hangover, which is medically known as veisalgia, is your body’s way of telling you that you’ve had too much to drink. According to Swift & Davidson (1998), there is an array of physical symptoms associated with hangovers, such as headache, fatigue, nausea, dehydration, increased sensitivity to light and sound, drowsiness, body aches, vertigo, and for some people, cognitive and mood disturbances, such as depression, anxiety, and irritability. Additional symptoms are gastrointestinal problems (such as stomach pain and vomiting), sleep disturbances, and sympathetic hyperactivity, such as sweating, tremor, and increased blood pressure (http://biology.about.com/od/physiology/ a/alcohol hangover.htm). The commonalities between symptoms of mild alcohol withdrawal and veisalgia have indicated that hangovers maybe a form of mild alcohol withdrawal. However, there still are clear distinctions between the two, such as time period of impairment, presence of hallucinations and seizures, and number of episodes of heavy drinking (Swift & Davidson, 1998).
Why do hangovers occur?
There are several aspects to heavy drinking that can lead to hangovers. A direct effect of alcohol is dehydration. Alcohol is a diuretic, which means that it naturally dehydrates the body because it causes the body to increase urinary output. Additionally, vomiting that occurs after excessive drinking further dehydrates the body and also leads to electrolyte imbalance. This combination of dehydration and electrolyte imbalance produces the hangover symptoms of thirst, headache, and dizziness (Swift & Davidson, 1998).
Another direct effect of alcohol is gastrointestinal disturbances, such as irritation of the stomach and intestines, inflammation of the stomach lining, and delayed stomach emptying. Furthermore, excessive consumption of alcohol can lead to an accumulation of fat compounds in liver cells, resulting in what is known as “fatty liver”. Alcohol also promotes excess gastric acid production. All of these factors can lead to the stomach pain and general queasy feeling experienced during a hangover (Swift & Davidson, 1998).
The symptoms of fatigue, mood disturbances, and weakness can be attributed to alcohol’s direct effect of lowering blood sugar levels. Alcohol metabolism causes the body to build up chemicals that hamper glucose production (Swift & Davidson, 1998), which would decrease the glucose in our bloodstreams. Additionally, alcohol breaks down glycogen, which is the body’s stored energy, in the liver to glucose, which is then expelled in urine (http://www.talkingalcohol.com/index. asp?pageid=116).
An important non-direct effect of alcohol is the accumulation of acetaldehyde, which is a toxin, during alcohol metabolism. When alcohol is broken down in the liver by the enzyme alcohol dehydrogenase (ADH), acetaldehyde is produced as a byproduct (refer to Figure 2). Acetaldehyde is a poison in our bodies, so it gets broken down further into the harmless product acetate by the combination of glutathione, which contains large quantities of cysteine (an amino acid), and acetaldehyde dehydrogenase (ALDH), which is another enzyme (http://health.howstuffworks.com/hangover4.htm). This acetate is excreted from the body in our urine. However, when we consume too much alcohol, our bodies are overwhelmed and cannot effectively metabolize all the acetaldehyde that is being produced. Essentially, our bodies cannot keep up because we don’t have enough ALDH or glutathione, so the acetaldehyde builds up. This toxin is what causes “sweating, rapid pulse, skin flushing, nausea, and vomiting” (http://findarticles.com/p/articles/mi_ g2603/is_0004/ai_2603000405/).
Figure 2. Metabolism of alcohol (2004). Note: Copyright American
Society of Health-System Pharmacy, 2004.
There are additional explanations for hangovers, such as personality type, compounds besides alcohol in drinks, family history for alcoholism, etc. (Swift & Davidson, 1998). However, the common prevention and treatment of veisalgia usually target the metabolism of acetaldehyde or direct effects of alcohol, which were discussed above.
What does the internet suggest?
Imagine opening your eyes slowly after waking from a long night of partying and drinking. You’re whole body hurts. Your head is pounding, your stomach is churning and aching, your breathe smells like vodka, and the room is spinning. You gradually get yourself out of bed and try not to throw up during the process. You make it to your desk, open your laptop, and search for hangover cures on the internet. One website offers a prevention pill for $16.95. It’s definitely too late for that. Another tells you to drink more alcohol (the hair of the dog technique). Another website tells you of different cures from around the world, ranging from drinking tomato juice with pickled sheep’s eyes to eating a dried bull’s penis (http://www.strangecosmos.com/content/item/140194.html). You groan as you read all the strange remedies. You’re stomach is not happy. Let’s see what else you find.
Website #1 – MedlinePlus
When you type in “hangover treatment” in your search engine, the first website you land on is MedlinePlus, which is accredited by the American Accreditation HealthCare Commission (also known as URAC). According to this site, you should drink slowly and in moderation to prevent hangovers, which makes sense because this will regulate the amount of alcohol consumed. Also, a glass of water is suggested between alcoholic drinks to decrease alcohol intake and dehydration.
If you already have a hangover, the website suggests you to “consume foods and drinks that contain fructose (such as fruit juice or honey)” because “there is some evidence that fructose will help your body burn the alcohol faster” (http://www.nlm.nih.gov/ medlineplus/ency/article/002041.htm). Another suggestion is to rest and eat well. An example of good food is bouillon soup to restore the depleted salt and potassium. They also discourage the use of medication containing acetaminophen, because it may cause damage to the liver in conjunction with alcohol (http://www.nlm.nih.gov/ medlineplus/ency/article/002041.htm).
Figure 3 . Relief of a hangover can be obtained by: taking over-the-counter-pain-relievers; drinking plenty of water; eating soup and foods that contain fructose; resting (2005). Note: Copyright HowStuffWorks Inc, 1998-2009.
There is no reference to any scientific study that supports these statements anywhere on the website, but it is a reputable website that is made for the sole purpose of providing accurate and useful information to the public. There is absolute no advertisement or endorsement of any company or product found on the website. On the bottom of the page, it states that the website “follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services” (http://www.nlm.nih.gov/medlineplus/ency/ rticle/ 002041.htm). Furthermore, the website gathers “authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations” and is a government agency (http://www.nlm.nih.gov/medlineplus/ aboutmedlineplus.html). With information from well known and official agencies, it’s difficult not to take the website’s recommendations for prevention and treatment for hangovers.
Website #2 – iloveindia.com
The second website from your search results offers home remedies for hangovers. According to iloveindia.com, “the best remedy to cure hangover at home would be to increase the intake of vitamin C in the body. Consume fresh citrus fruit juice in large amounts in the morning to cure hangover” (http://www.iloveindia. com/home-remedies/hangover.html). Similar to the first website, this page also recommends increasing your intake of water and consuming honey, which has high levels of fructose.
However, it also advises drinking “several cups of strong coffee. This would reduce or lessen the effect” (http://www.iloveindia.com/homeremedies/hangover.html). Since coffee is a diuretic and the body is already dehydrated from the alcohol, this seems a bit counterintuitive. Although coffee may act as a stimulant to counter the sluggish feeling during a hangover, it could ultimately worsen the hangover by further dehydration.
This webpage is covered with advertisements on all four sides of the page (top, bottom, left, and right), and there is absolutely no reference to any scientific study to substantiate the claims. From first glance, it is noticeable that the aim of the site is to sell a variety of products, such as cures for hangover, acne, prostate cancer, hair loss, etc. There is even a disclaimer (with a grammatical error) in very small letters on the bottom of the page stating, “iloveindia.com does not warrant or assume any legal liability or responsibility for the accuracy, completeness or usefulness of the information provided here. Please check with a expert before using any of the suggestions given in this article” (http://www.iloveindia. com/home-remedies/hangover.html). This statement alone indicates that the website probably has some unreliable suggestions.
Website #3 – HowStuffWorks.com
You stumble across a familiar website www.HowStuffWorks.com, owned by Discovery Communications, that reviews effective (factual) and ineffective (fictional) hangover cures (http://health. howstuffworks.com/hangover6.htm). The first common remedy they discuss is “the hair of the dog”, which involves consuming more alcohol during a hangover. This is a fictional remedy, according to the website. Although it may lessen hangover symptoms at first, you are just delaying the symptoms because more toxins are ingested into the body, which will eventually have to be processed. This rationale makes logical sense because the body will crash at some time after consuming too much alcohol.
The second myth the website exposes is the lessening of symptoms by eating burnt toast. People believe that the carbon in the burnt bread can “act like a filter in the body” (http://health.howstuffworks.com/hangover6.htm). Although it’s fact that activated charcoal (“which is a treated form of carbon”) is used in the absorption of certain kinds of poisons, “it’s not currently used to treat alcohol poisoning”, and the carbon from burnt toast is not equivalent to activated charcoal (http://health.howstuffworks.com/hangover6. htm).
Another fictional remedy posted is black coffee, because it acts as a diuretic and further dehydrates the body (this opposes the suggestion from iloveindia.com to drink plenty of coffee).
The effective remedies suggested on the website are eggs, water, and fruit juices. The explanations for water and fruit juices are similar to the ones written by the MedlinePlus website. Water rehydrates the body, and fruit juices, which contain high levels of fructose, have been proven to “increases the rate at which the body gets rid of toxins such as those left over from alcohol metabolism” (http://health. howstuffworks.com/ angover6. htm). Additionally, fruit juices are high in vitamins C and B, which are depleted during and after intoxication, so drinking juice can be effective in treating hangover symptoms. The eggs are suggested because they contain large amounts of cysteine, which aids acetaldehyde metabolism in the liver’s glutathione (which, as discussed before, is easily depleted).
Although the website has no references to experimental studies, the website claims that “HowStuffWorks, a wholly owned subsidiary of Discovery Communications, is the award-winning source of credible, unbiased, and easy-to-understand explanations of how the world actually works” (http://www.howstuffworks.com/ about-hsw.htm). Since the Discovery Channel, which is another subsidiary of Discovery Communications, is often viewed as a reputable source, many people may conclude that this website should also be reliable. However, there are advertisements for hangover cures and pills found on the webpage, which might be an indication that there may be another purpose for certain hangover suggestions. In spite of all the ads, nothing in their actual written explanation seems biased, so the main purpose of the site is probably to provide the public with unbiased information.
Website #4 - WebMD
There are about 1,799,997 more websites for your search results, so you decide to go to WebMD, which is known to offer credible news and information. According to this website, carbon has not been scientifically proven to target and block the absorption of hangover-inducing elements found in alcohol (http://www.webmd.com/balance/features/ hangover-helpers). Thus, it does not recommend buying products containing carbon that claim to do so. WebMD also discourages the hair of the dog remedy, much like the MedlinePlus website, because the body will eventually crash and the habit could possibly lead to a drinking problem. The only real remedy that the website suggests is time, because the body has to detoxify the excess alcohol on its own.
The information given by this website appears reliable, even though there are a few advertisements on the page (none of which promote a hangover cure). WebMD is reviewed by the Independent Medical Review Board, and their mission is to provide the public with “objective, trustworthy, and timely health information” (http://www. webmd.com/about-webmd-policies/default.htm?ss=ftr). Additionally, it is commonly known to give reliable information, so the suggestions can most likely be take as useful and based on science.
Although reputable (as well as not so reputable) websites have given suggestions for hangover treatments, which treatments actually work? In order to find the solution to this question, results of clinical research should be explored.
What do clinical studies suggest?
Here, we will look at different studies that have tested the effects of cysteine (the compound found in eggs), vitamin B, and sugars (glucose, sucrose, and fructose) in the alleviation of hangover symptoms.
Studies on Cysteine and Vitamin B
A study done by Sprince, Parker, Smith, & Gonzales (1974) investigated the protective effects of various concentrations and mixtures of L-cysteine, thiamine (vitamin B1), and L-MTCA (L-2-methylthiazolidine-4-carboxylic acid, which is a compound produced when L-cysteine interacts with acetaldehyde) on the absorption of acetaldehyde, which, as mentioned before, is a toxin. It is thought that all of these compounds soak up excess acetaldehyde in the body. Sprince et al. administered the LD-90 dose of acetaldehyde (the dosage that would kill about 90% of the rats in 24 hours) to 45 rats in 9 groups (1 control group using saline and 8 experimental groups; thus, 5 rats per group). The experimental groups were given L-cysteine, thiamine (vitamin B1), and L-MTCA alone, or different combinations of the compounds prior to the oral administration of the acetaldehyde. The tests were conducted on 3 consecutive days, so each group tested 15 rats in total (5 rats/groups x 3 days = 15 rats/group).
The results of the experiment indicated that the pre-treatment combination of L-cysteine and thiamine (vitamin B1) completely blocked the LD-90 dosage of acetaldehyde, which means that all of the rats given this mixture survived. Even when the thiamine concentration was decreased , this combination resulted in an 87% survival rate of the rats. The survival rates for rats solely given dosages of L-cysteine, L-MTCA, and thiamin were 80%, 75%, and 90% respectively. The findings suggest that all of these compounds, when given in the right concentration, may have protective effects against acetaldehyde poisoning. However, it’s important to note that results from animal testing may not mirror results that could be obtained from human testing. It would clearly be unethical to repeat this exact experiment on human beings, but a modified version would be useful. Based on this experiment, it seems as though cysteine (in eggs) and vitamin B are effective in soaking up the toxin acetaldehyde from the body.
In 2003, Ozaras, Tahan, Aydin, Uzun, Kaya, & Senturk studied the effect of a cysteine-derivative called N-acetylcysteine (NAC) on alcohol-induced free radical damage in the liver of rats. The researchers used 24 male Wistar-Albino rats and divided them into 3 groups. One group was given ethanol. The second group was given NAC and ethanol, which were respectively injected intragastrically 4 hours apart. The last group was given isocaloric dextrose. After a month since the start of the experiment, the rats were sacrificed, and their serum alcohol levels, glutathione peroxidase levels, and biochemistry were studied. The researchers found that the co-administration of NAC reduced ethanol-induced liver damage in rats. In other words, the protective effects of cysteine against alcohol were found again in this study. Ozaras et al. explains that NAC attenuates liver damage by elevating intracellular gluthathione concentrations, which is necessary for metabolizing acetylaldehyde. Although the results are favorable in supporting the use of cysteine for a hangover treatment, one must keep in mind that, like the previous study, this experiment was tested on animal subjects, not human beings. Furthermore, the sample size for each group was quite small (n=8 per group), so a larger sample size would provide stronger supporting data.
A study on the effectiveness of pyritinol (an analog of vitamin B6) in preventing hangover was launched by Khan, Jensen, & Krogh (1973). The researchers set up three parties, but only used the first two parties in their study. There were 11 healthy men and 6 healthy women who volunteered to participant, and at the parties, there was no restriction for their alcohol consumption. In the middle of the first party, half of the people were given placebos, while the remaining received pyritinol. At the second party, the participants received three dosages of pyritinol – at the beginning, middle, and end of the party. The next day, the participants were visited by an observer, who gave them a checklist of hangover symptoms. Khan et al. (1973) found that “participants developed fewer symptoms after pyritinol than after placebo” (p.1198). This study suggests that pyritinol, which is a form of vitamin B6, has protected effects against induced hangover symptoms. The strength of this study is in the naturalistic aspect of the experiment setting. Khan et al. was able to recreate a conventional party atmosphere, which decreases distractions in participants and allows them to act more normally than in a laboratory. If the procedure were repeated (including more subjects) and similar results were found, then this would further substantiate the idea that pyritinol can help in the prevention of hangovers.
Studies on Sugars (Glucose, Fructose, and Sucrose) and Hangovers
Ylikahri, Leino, Huttunen, Pösoö, Eriksson, & Nikkilä (1976) tested the effects of fructose and glucose on the intensity of alcohol intoxication and hangover in 109 male participants. The volunteers fasted for 10 hours and were then administered 1.75 g of ethanol per kilogram of body weight of ethanol for 3 hours under controlled laboratory conditions. Either fructose or glucose was given at the same time as ethanol administration or during the hangover period (12 hours after ethanol was given). Within the 20 hours of the experimental period, the intensity of alcohol intoxication and hangover was recorded 10 times using subjective and objective rating scales. Additionally, other physiological levels were measured.
The results of this experiment showed that there were no significant effects of either sugar on the intensity of alcohol intoxication and hangovers. Furthermore, fructose and glucose did not have a significant effect on ethanol elimination rate or on blood acetaldehyde concentration during the experiment. Although they significantly inhibited ethanol-induced metabolic disturbances (such as the decrease in blood sugar concentration, increase in blood lactate concentration during hangover, ketone body concentrations, etc.), the sugars did not significantly influence the symptoms of alcohol intoxication and hangover. These findings do not support the suggestions offered by MedlinePlus.com, iloveindia.com, and howstuffworks.com to drink fruit juices and consume high levels of fructose. Although HowStuffWorks.com and www.MedlinePlus.com both stated that there was evidence that fructose helped the body get rid of toxic byproducts, this study by Ylikahri et al. does not confirm this claim.
The strength of this experimental design is in the large number of participants with a relatively similar background concerning alcohol intake. In addition, Ylikahri et al. had done three studies on alcohol metabolism prior to this research study, which allowed the researcher to address and correct issues that had come up with the previous studies.
Another controlled experimental study by Seppälä, Leino, Linnoila, Huttunen, & YIikahri (1976) tested the efficacy of glucose or fructose in diminishing hangover symptoms. Out of a total of forty healthy male volunteers, 10 subjects served as controls and had no alcohol, while thirty consumed ethanol from 6 – 9 PM, which resulted in a hangover the following morning. 10 out of those 30 participants were only given ethanol (no sugar), and the remaining 20 subjects were administered fructose or glucose (1 g/kg) during the same evening or the next morning (0.5 g/kg). The researchers recorded psychomotor performance using three tests during the hangover phase, and the hangover intensity was determined subjectively (with rating scale I) and objectively (using rating scale II). Moreover, blood ethanol, acetaldehyde and glucose concentrations were examined, and the testing was done three times at 8 AM, 10 AM, and 12 PM.
Seppälä et al. found that there was no difference between the three alcohol groups on rating scale II, but the group that received both the alcohol and sugar during the evening had slightly higher ratings on rating scale I compared with the other alcohol groups. In addition, they found that people in the ethanol only group significantly made more mistakes on the reaction tests in the hangover phase, but this consequence was eliminated by when sugar was simultaneously administered. However, there were more mistakes on one coordination test for those who received both ethanol and sugars. Furthermore, the researchers could not find any significant difference in the blood concentrations of ethanol and acetaldehyde between the alcohol groups. The researchers concluded that the cause of impaired psychomotor skill may not be directly related to the pathophysiology of the hangover because there was no significant correlation between the intensity of hangover and the impairment of psychomotor performance. From the results of this study, fructose and glucose had neither preventative nor curative effects on the participants who drank and suffered from hangovers. These findings are similar to those found by Ylikahri et al., and yet again, the results do not suggest that there is any benefit of consuming fructose or glucose to alleviate hangover symptoms.
The problem with this study is the small number of subjects (n=10) in each of the experimental groups. With a small sample size, it would be difficult to eliminate or cancel out personal differences among the volunteers, such as tolerance levels, personality, family history of alcoholism, etc. Also, the objective rating scale only ranged from 0 to 2 for the determination of hangover symptoms, which seems like a small range.
Soterakis & Iber (1975) conducted a study to compare the effects of oral sucrose, fructose, and glucose on speeding up the elimination of alcohol from the blood. Eight chronic alcoholic males, who had been abstinent from alcohol for at least a week, participated in the study. After fasting over night, the volunteers consumed a lemon-flavored solution of glucose, fructose, or sucrose. After 30 minutes, intravenous alcohol was injected in the participants bloodstream. Blood samples were collected in the fasting state and then hourly for 6 hours after the alcohol was administered. The researchers found that fructose and sucrose had accelerated rates of alcohol disappearance from the blood compared to glucose, although all sugars lead to the removal of alcohol from the bloodstream. This study supports the idea that sugars, especially sucrose and fructose, can help alleviate hangover symptoms by removing alcohol from the blood faster than normal.
These findings contradict the previous two research results. Perhaps the small number of participants (n=8 in total) and type of participant (here, they had alcoholic male participants, while the other studies had healthy males) had an effect on the findings. To make sure that it was the effect of the sugars and not other confounding variables that reduced the alcohol content in the blood, this study should be repeated with more volunteers of good physical health.
The scientific studies that were reviewed indicated that vitamin B and cysteine were effective in soaking up the excess acetaldehyde in the body of rodents. A combination of the vitamin B and cysteine prevented deaths in all of the mice given a LD-90 dosage of acetaldehyde, and NAC protected the rat livers from ethanol-induced damage. In addition, pyritinol (a form of vitamin B6) was found to better prevent hangover symptoms compared to a placebo. Although these findings suggest some efficacy in the use of cysteine and vitamin B for hangover treatments, further research is necessary, preferably with human participants, before a definite answer is found. In the meantime, it would not be deleterious to take cysteine or vitamin B supplements. After a night of drinking and vomiting, your body will thank you for replenishing it with much needed nutrients.
Sugars were suggested by most websites for the prevention and alleviation of hangover symptoms. However, the literature seems a bit mixed in the effectiveness of glucose, sucrose, and fructose in treating hangovers or increasing the body’s rate of metabolizing alcohol. Although there appears to be a general consensus in the medical/scientific community that fructose aids in blood alcohol clearance, there are several studies that indicate otherwise. A meta-analysis is recommended to compare all the findings of research studies involving ethanol and sugars. This way, several results can be compared and summarized. Eating fruits or drinking juices may not be the magical cure to your hangover, but it will at least hydrate you and provide you with vitamins and antioxidants. Go ahead and enjoy your breakfast (or lunch…or maybe even dinner) with a glass of juice.
The best and foolproof way to avoid a hangover is to abstain from alcohol or limit intake. So next time you wake up with veisalgia, remind yourself that you should never drink that much again!
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