When it comes to hangovers, it seems everyone has advice. And you can get plenty of it this time of year.
There's the cold shower, the strong cup of coffee. Or just drinking lots of water. And then there are the remedies that can only be called bizarre — more on them in a moment.
When there are this many solutions to a common problem, it's likely none of them works very well. Otherwise, we'd only be talking about the one that works. In fact, the case could be made that a single "hangover cure" is elusive because it does not exist. It's a myth — at least so far.
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Why Do We Get Hangovers?
Believe it or not, no one really knows the cause of hangovers. Even the definition of a hangover varies in different studies. In general, a hangover is an unpleasant state that occurs after drinking alcohol as the blood alcohol level drops. Common symptoms include:
- Sensitivity to light and sound
- Dry mouth ("cotton mouth") or excessive thirst
- Muscle aches
- Nausea or abdominal pain
- "Brain fog" (inability to concentrate, slow thinking)
We know a lot about the effects of alcohol on the body (including the potentially dangerous alcohol withdrawal syndromes common in alcoholics). But what we know doesn't explain hangover symptoms very well.
For example, alcohol:
- Dehydrates you. It interferes with antidiuretic hormone (ADH) that prevents urination; so, the more alcohol you drink, the more you urinate. Even though alcoholic beverages are largely water, you lose more than you drink. This could explain the headache and dry mouth. Excessive urination could also lead to loss of potassium, sodium and other minerals.
- Can irritate the stomach. It can cause stomach inflammation called gastritis. This could explain nausea or heartburn, but the connection between gastritis and any hangover symptoms is uncertain.
- Can lead to increased levels of acid in the blood (a condition called lactic acidosis), low blood sugar and a buildup of "toxins." These are a result of the break down of alcohol in the body, dehydration and lack of food overnight. The effects could leave you feeling fatigued, drowsy or generally unwell.
- Alters normal body rhythms. This includes sleep, body temperature and cortisol, a key hormone involved in regulating normal circadian rhythm. If you've ever awakened at 3 a.m. after a night of drinking and found yourself wide awake, this is the insomnia that can accompany a falling blood alcohol level. At least some of the fatigue and "jet lag" feeling the day after drinking may be due to interrupted and poor quality sleep.
- May lead to loss of minerals. This is particularly problematic for long-term heavy drinkers. Potassium, magnesium and calcium are just a few examples. However, it's far from clear that these effects contribute prominently to hangover symptoms.
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Perhaps you've noticed that some people seem to be more prone to hangovers than others. It's true of women and people of Asian descent. And some people seem to be resistant to hangovers. There is likely a genetic component to this tendency.
What you drink may matter when it comes to hangovers. Limited research suggests that "clear" alcohol (such as beer, vodka or gin) has less of a tendency to cause hangovers than darker drinks (such as wine, whiskey or brandy). This may be due to "cogeners" — byproducts of alcohol fermentation — rather than the alcohol itself. Still, it's clear that hangovers can occur if you drink enough of any alcoholic beverage.
The pace and quantity of alcohol you drink also matter. Generally, the severity of a hangover is closely linked to how much alcohol you drink and how quickly you drink it.
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The History of Hangover Cures
Historians estimate that humans have been drinking at least since 10,000 B.C. So the notion that hangovers can be cured may be among the oldest of all medical myths. At least I assume that's true; I wasn't there. And there aren't good records of the first suggested hangover cure.
Ancient man probably sought out hangover remedies to end the misery. But modern man can seek relief for another good reason: Hangovers are expensive.
One estimate put the cost in lost wages related to hangovers at $3.5 billion per year in the United Kingdom and $23 billion each year in the United States.
One reason the cost of hangovers is so high is that over-indulging is so common. A 2010 survey from the Centers for Disease Control and Prevention found that 1 in 6 Americans admitted to binge drinking (at least 4 or 5 alcoholic beverages over 2 hours) at least once a week. The true prevalence may be higher, as some people don't admit to how much they really drink on surveys.
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Which Cures Work?
Only a few studies have carefully examined hangover treatments. There is at least some evidence of benefit for:
- Borage – This nutritional supplement was found to be better than placebo with respect to headaches, fatigue and loss of motivation.
- Yeast-based preparations – At least one study found that dried yeast and a combination of vitamins reduced irritability and restlessness when compared with a placebo.
- Tolfenamic acid – This is an anti-inflammatory medication. It's in the same family of medicines as ibuprofen. It's approved in many European countries for migraine though it's also used for other painful conditions. There is evidence that this drug may lessen a number of hangover symptoms, including irritability, shakiness, dry mouth, nausea and headache as compared with a placebo.
- Prickly pear – A study of 55 subjects found that nausea, dry mouth and poor appetite improved somewhat after treatment with an extract of prickly pear; however, 6 other symptoms were unaffected.
Unfortunately, these studies were small and far from definitive. And there are also studies challenging these and many other remedies. For example, other studies show that artichoke, prickly pear and table sugar (yes, table sugar) provided no clear benefit for hangovers.
Despite the uncertain link between the effects of alcohol and hangover symptoms, many hangover cures are based on a direct connection.
For example, people are often told to eat eggs because they're a good source of cysteine. Here's the logic:
- The body converts alcohol to acetaldehyde, which is toxic in high levels.
- Glutathione is one of the body's toxin fighters. It helps neutralize acetaldehyde. But that leaves stores of glutathione low.
- Cysteine helps replace gluathione.
Does any of this matter in reversing a hangover? That's uncertain, but cysteine (or its building blocks) is a common component of hangover remedies sold worldwide.
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Popular Remedies Could Be Harmful
Some commonly recommended remedies could be bad for people with hangovers. Acetaminophen (such as Tylenol) is not great for the liver. It could be particularly troublesome in high doses among regular, heavy drinkers.
Pain relievers like ibuprofen (as in Advil) or naproxen (as in Aleve) may irritate the already unhappy stomach. Occasionally, even more serious complications develop, such as stomach perforation or internal bleeding.
Most hangover remedies sold commercially in the United States are simply over-the-counter vitamin supplements of one sort or another. But, as with other over-the-counter supplements, most are not well studied and do not carry Food and Drug Administration approval for their claims.
Even the most popular remedy, coffee, might not be the best idea. While caffeine could counter some of the fatigue and lethargy the day after the big party, it can worsen dehydration because it is also a diuretic. And coffee can also worsen heartburn and upset stomach.
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Some of the More Strange Remedies
For reasons I can't figure out, people are willing to subject themselves to some pretty outrageous stuff in the hopes of curing a hangover. Perhaps it's just misery or desperation. It's highly unlikely that any of the following work. And I don't recommend them:
- Pickle juice
- Tea with rabbit dung
- Rubbing a half-lemon under the arm with which you hold your drink
- Burnt toast
- Calcium carbonate with activated charcoal – Calcium carbonate is a common heartburn medication (as in TUMS). And activated charcoal has long been given in emergency rooms to counter certain types of overdoses. But I found no published evidence that this combination reverses, prevents or gets rid of hangovers.
- Pickled sheep eyes in tomato juice
- Having a drink or two – This is a temporary fix. Sometimes it's called "hair of the dog." (The name appears to come from the belief that to treat a bite from a rabid dog you should put hair from the dog in the person's wound. In case you're wondering, it doesn't work).
Other remedies based on this principle include one called, appropriately enough, "The Suffering Bastard."
It's worth noting that health professionals consider drinking more alcohol to counter side effects of drinking a possible indication of a drinking problem.
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What's a Drinker To Do?
Think of a hangover as an unpleasant experience that actually serves a good purpose: to remind you to drink in moderation. The problem is that many of us never learn.
There are only a few approaches that clearly work, or are so harmless they seem worth recommending:
- Don't drink at all.
- Don't drink too much.
- Don't drink too fast.
- Eat something before or while you are drinking; fatty foods, in particular, slow absorption of alcohol.
- Drink water or a sports drink before and between alcoholic beverages.
- Get some rest.
So, how much alcohol is too much? That's not clear, but one glass of wine with dinner seems much less likely to cause a hangover than drinking enough to get drunk. Research studies often focus on "binge drinking." This is considered having 5 or more drinks in a 6-hour period or at least 4 drinks in an hour or two.
But, it's also true that even 2 or 3 drinks over several hours can lead to headaches, fatigue and "cotton mouth" the next morning. But that's probably the exception rather than the rule.
When it comes to hangover remedies, the number of "cures" and the amount of marketing far exceed the science.
If you find yourself with a bad hangover, there's no quick fix. That said, I think it makes sense to drink plenty of water and sports drinks, eat something bland, and give it some time. Soon, you'll feel better no matter what you do. Until next time.
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.