How to handle a hangover

It is easy to overindulge during the holiday season. You can carol until you get a sore throat, or eat a lot and gain a few pounds. Or sometimes, you just might have had too much to drink of wine or champagne on New Year’s Eve. But don’t despair. Here are a number of easy cures on how to survive the morning after. Before you know it, you’ll feel ready to deck the halls all over again.

When you hoist one too many

 Indeed, a glass of your favorite pinot noir seemed like a perfect way to celebrate the season. But that second bottle probably wasn’t such a good idea. Now you have a classic hangover: headache, nausea, fatigue, and shakiness. Otherwise, known as veisalgia, these symptoms are the result of dehydration (because alcohol impairs the kidney’s ability to hold on to fluids), poor sleep (because alcohol alters levels of certain neurotransmitters, causing brain cells to be hyperexcitable), and inflammation (because the impurities in most alcoholic drinks lead to an inflammatory response that produces flu-like symptoms like achy muscles), says hangover researcher Jeffrey Wiese, MD, an associate professor of medicine at the Tulane University Health Sciences Center in New Orleans.

Here is Dr. Wiese’s own get-better-fast plan:

• Sleep in or take a nap. “It may help to get a couple of extra hours of sleep in the morning,” Weise says. “Every additional hour you can get will help you recover.”

• Sip right. Replenishing fluids is important. Sports drinks, which contain essential nutrients, are best, followed by juices, and then water, Weise says. “The more you can drink, the better since it will help the hangover go away faster. Start before you go to sleep.”

• Take vitamins. Popping 50 to 100 mg. of thiamine or B1 and 10 mg. of B6 per day may make up for deficits and ease hangover symptoms, says Bankole Johnson, MD, chairman of the department of psychiatric medicine at the University of Virginia in Charlottesville. Keep taking them for a couple of days to restore the losses caused by overindulging.

• Relieve pain. It’s fine to take ibuprofen to reduce aches and underlying inflammation, Weise says. You can even take it at bedtime. But “stay away from acetaminophen,” he adds, “because it won’t help with inflammation and can damage the liver if used with alcohol.”

Hangover: physiology and chemistry

Hangovers seem to be the body’s way of reminding us about the hazards of over-indulgence. Physiologically, it’s a group effect: Diarrhea, fatigue, headache, nausea, and shaking are the classic symptoms. Sometimes, systolic blood pressure goes up, the heart beats faster than normal, and sweat glands overproduce — evidence that the “fight or flight” response is revved up. Some people become sensitive to light or sound. Others suffer a spinning sensation (vertigo).

The causes are as varied as the symptoms. Alcohol is metabolized into acetaldehyde, a substance that’s toxic at high levels, although concentrations rarely get that high, so that’s not the complete explanation.

Drinking interferes with brain activity during sleep, so a hangover may be a form of sleep deprivation. Alcohol scrambles the hormones that regulate our biological clocks, which may be why a hangover can feel like a jet lag, and vice versa. Alcohol can also trigger migraines, so some people may think they’re hung over when it’s really an alcohol-induced migraine they’re suffering.

Hangovers begin after blood alcohol levels start to fall. In fact, according to some experts, the worst symptoms occur when levels reach zero.

The key ingredient seems to be “drinking to intoxication”; how much you drank to get there is less important. In fact, several studies suggest that light and moderate drinkers are more vulnerable to getting a hangover than heavy drinkers. Yet, there’s also seemingly contradictory research showing that people with a history of alcoholism have worse hangovers. Researchers say some people may end up with drinking problems because they drink in an effort to relieve hangover symptoms.

A SWIFT RESPONSE

Dr. Robert Swift, a researcher at the Providence Veterans Affairs Medical Center in Rhode Island, coauthored one of the few review papers on hangovers in 1998. It’s still one of the most frequently cited sources on the topic. The rundown on hangover remedies that follows is based on that review.

• Hair of the dog. Drinking to ease the symptoms of a hangover is sometimes called taking the hair of the dog, or hair of the dog that bit you. The notion is that hangovers are a form of alcohol withdrawal, so a drink or two will ease the withdrawal.

There may be something to it, says Dr. Swift. Both alcohol and short-acting sedatives, such as benzodiazepines like diazepam (Valium), interact with GABA receptors on brain cells, he explains, and it’s well documented that some people have withdrawal symptoms from short-acting sedatives as they wear off. Perhaps the brain reacts similarly as blood alcohol levels begin to drop.

Even so, Dr. Swift advises against using alcohol as a hangover remedy. “The hair of the dog just perpetuates a cycle,” he says. “It doesn’t allow you to recover.”

• Drink fluids. Alcohol promotes urination because it inhibits the release of vasopressin, a hormone that decreases the volume of urine made by the kidneys. If your hangover includes diarrhea, sweating, or vomiting, you may be even more dehydrated. Although nausea can make it difficult to get anything down, even just a few sips of water might help your hangover. 

• Get some carbohydrates into your system. Drinking may lower blood sugar levels, so theoretically, some of the fatigue and headaches of a hangover may be from brain working without enough of its main fuel. Moreover, many people forget to eat when they drink, further lowering their blood sugar. Toast and juice are a way to gently nudge levels back to normal.

• Avoid darker-colored alcoholic beverages. Experiments have shown that clear liquors, such as vodka and gin, tend to cause hangovers less frequently than dark ones, such as whiskey, red wine, and tequila. The main form of alcohol in alcoholic beverages is ethanol, but the darker liquors contain chemically related compounds (congeners), including methanol. According to Dr. Swift’s review paper, the same enzymes process ethanol and methanol, but methanol metabolites are especially toxic, so they may cause a worse hangover.

 • Take a pain reliever but not Tylenol. Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help with the headache and the overall achy feelings. NSAIDs, though, may irritate a stomach already irritated by alcohol. And as previously mentioned, don’t take acetaminophen (Tylenol). If alcohol is lingering in your system, it may accelerate acetaminophen’s toxic effects on the liver.

 • Drink coffee or tea. Caffeine may not have any special anti-hangover powers, but as a stimulant, it could help with the grogginess. Coffee is a diuretic, though, so it may exacerbate the dehydration.

 • Vitamin B6. A study published over 30 years ago found that people had fewer hangover symptoms if they took a total of 1,200 mg. of vitamin B6 before, during, and just after drinking to get drunk. But it was a small study and doesn’t seem to have been replicated. In a sense, taking vitamins is similar to the previous treatment recommended by Dr. Johnson and Dr. Weise.

 • Artichoke extract. Supplement makers have promoted artichoke extract for a variety of ills, including hangovers, because it supposedly has beneficial effects on the liver. But a small study published in the Canadian Medical Association Journal in 2004 concluded that it isn’t effective for hangovers.

 But as anything in medicine, an ounce of prevention is always better than a pound of cure. So, know how to handle your drinks. Know your limits. Avoid imbibing too much alcohol to the point of intoxication.

 Cheers! May we all have a happy and healthy new year. And let’s all drink to that!