Written in 1768 by British writer William Hickey:
“My first return of sense or recollection was upon waking in a strange, dismal-looking room, my head aching horridly, pains of a violent nature in every limb, and deadly sickness at the stomach. From the latter I was in some degree relieved by a very copious vomiting.
“Getting out of bed, I looked out of the only window in the room, but saw nothing but the backs of old houses, from which various miserable emblems of poverty were displayed…At that moment I do not believe in the world there existed a more wretched creature than myself. I passed some moments in a state little short of despair…”
In a research paper (pdf) written by Robert Swift M.D., PH.D., associate professor in the Department of Psychiatry and Human Behavior at Brown University, along with Dena Davidson, PH.D., assistant professor of psychiatry at Indiana University of Medicine, Swift and Davidson explore what is known about the hangover, the physiological factors, and treatment options.
Swift and Davidson’s research indicates hangover symptoms and their intensity may vary from person to person. In addition, hangover characteristics depend on the type of alcoholic beverage consumed and the amount a person drinks.
“Generally, the greater the amount and duration of alcohol consumption, the more prevalent is the hangover.”
We all know what a hangover feels like. Symptoms include fatigue, headache, increased sensitivity to light and sound, muscle aches, and thirst, rapid heartbeat, tremor, and sweating, dizziness, depression, anxiety, and irritability.
While most of us are familiar with the symptoms associated with a hangover, less of us know what specifically causes those symptoms. Based on information gleaned from their report, alcohol may directly contribute to a hangover in several ways, including the following.
Causes of Hangover Symptoms
Alcohol causes the body to increase urinary output and promotes urine production by inhibiting the release of a hormone from the pituitary gland. Reduced levels of antidiuretic hormone prevent the kidneys from reabsorbing water and thereby increase urine production.
¢ Electrolyte Imbalance
Sweating, vomiting, and diarrhea can result in additional fluid loss and electrolyte imbalances. “Symptoms of mild to moderate dehydration include thirst, weakness, dryness of mucous membranes, dizziness, and lightheadedness all commonly observed during a hangover.”
¢ Gastrointestinal Disturbances
Alcohol directly irritates the stomach and intestines, causing inflammation of the stomach lining and delayed stomach emptying, especially when beverages with a high alcohol concentration are consumed.
High levels of alcohol consumption also can produce fatty liver, an accumulation of fat compounds called triglycerides and their components in liver cells. In addition, alcohol increases the production of gastric acid as well as pancreatic and intestinal secretions.
¢ Low Blood Sugar
Several alterations in the metabolic state of the liver and other organs occur in response to the presence of alcohol in the body and can result in low blood sugar levels. Alcohol metabolism leads to fatty liver and a buildup of an intermediate metabolic product, lactic acid, in body fluids.
Both of these effects can inhibit glucose production. Alcohol-induced hypoglycemia generally occurs after binge drinking over several days in alcoholics who have not been eating.
In such a situation, prolonged alcohol consumption, coupled with poor nutritional intake, not only decreases glucose production but also exhausts the reserves of glucose stored in the liver in the form of glycogen, thereby leading to hypoglycemia.
Because glucose is the primary energy source of the brain, hypoglycemia can contribute to hangover symptoms such as fatigue, weakness, and mood disturbances.
Diabetics are particularly sensitive to the alcohol-induced alterations in blood glucose. However, it has not been documented whether low blood sugar concentrations contribute to hangover symptomatically.
¢ Sleep and Biological Rhythm Disturbances
Although alcohol has sedative effects that can promote sleep onset, the fatigue experienced during a hangover results from alcohol’s disruptive effects on sleep. Alcohol induced sleep may be of shorter duration and poorer quality because of rebound excitation after BAC’s fall, leading to insomnia.
Furthermore, when drinking behavior takes place in the evening or at night, it can compete with sleep time, thereby reducing the length of time a person sleeps. Alcohol also disrupts the normal sleep pattern, decreasing the time spent in the dreaming state (REM sleep) and increasing the time spent in deep sleep.
Alcohol also relaxes the throat muscles, resulting in increased snoring and, possibly, periodic cessation of breathing, and interferes with other biological rhythms as well, and these effects persist into the hangover period.
For example, alcohol disrupts the normal 24-hour rhythm in body temperature, inducing a body temperature that is abnormally low during intoxication and abnormally high during a hangover. Alcohol intoxication also interferes with the circadian nighttime secretion of growth hormone, which is important in bone growth and protein synthesis.
Although there are innumerable folk remedies and recommendations, few treatments have undergone rigorous investigation. “Time is the most important component, because hangover symptoms will usually abate over 8 to 24 hours.”
Alcohol Quantity and Quality
Swift and Davidson contend the quantity and quality of alcohol consumed can have a significant effect on preventing hangover, and suggest hangover symptoms are less likely to occur if a person drinks only small, nonintoxicating amounts.
Even among people who drink to intoxication, those who consume lower amounts of alcohol appear less likely to develop a hangover than those who drink higher amounts.
The type of alcohol consumed also may have a significant effect on reducing hangover. Alcoholic beverages that contain few congeners (chemical constituent that gives a wine or liquor its distinctive character), such as pure ethanol, vodka, and gin, are associated with a lower incidence of hangover than are beverages that contain a number of congeners like brandy, whiskey, and red wine.
Fruit Juices, Toast or Crackers
Consumption of fruits, fruit juices, or other fructose-containing foods is reported to decrease hangover intensity. Also, bland foods containing complex carbohydrates, such as toast or crackers, can counter low blood sugar levels in people subject to hypoglycemia and can possibly relieve nausea.
In a separate study, researchers claim eating a bacon sandwich cures a hangover by boosting the level of amines which facilitates clear thinking.
Amines occur as a result of the breakdown of amino acids, and many neurotransmitters are amines, including epinephrine, norepinephrine, dopamine, serotonin, and histamine.
“Many drugs are designed to mimic or to interfere with the action of natural amine neurotransmitters, exemplified by the amine drugs”
Researchers claim food also speeds up the metabolism helping the body get rid of the booze more quickly.
Certain medications may provide symptomatic relief for hangover symptoms. For example, antacids may alleviate nausea and gastritis.
Aspirin and other nonsteroidal anti-inflammatory medications (e.g., ibuprofen or naproxen) may reduce the headache and muscle aches associated with a hangover but should be used cautiously, particularly if upper abdominal pain or nausea is present.
Anti-inflammatory medications are themselves gastric irritants and will compound alcohol-induced gastritis.
Hair of the Dog
The “hair of the dog that bit you remedy reportedly cures a hangover, but Swift and Davidson recommend that people experiencing a hangover should avoid further alcohol use.
“Additional drinking will only enhance the existing toxicity of the alcohol consumed during the previous bout and may increase the likelihood of even further drinking.”