What causes a hangover?

How to “cure” a hangover?
Symptoms, treatments
and prevention

What is a hangover and what are its symptoms?

Hangovers vary from person to person, but usually involve a headache, nausea, tiredness and dehydration. Dehydration is one of the main causes of your hangover symptoms.

A hangover can leave you struggling to concentrate, feeling irritable and sensitive to light – not a good combination if you were planning to make the most of the day and not spend it in bed.

The main cause of a hangover is ethanol – the alcohol in your drinks. It’s a toxic chemical that works in the body as a diuretic, which means it makes you pee more and you can become dehydrated as a result. Dehydration is one of the main causes of your hangover symptoms.

Ever wondered how much alcohol is too much?

How to prevent another hangover?

  • To avoid recurrence of hangovers, keep track of what you’re drinking and stay within the low risk drinking guidelines by not regularly drink more than 14 units of alcohol per week. If you do choose to drink as much as this it is best to spread your drinking evenly over three or more days and take several Drink Free Days during the week. The Drinkaware app can help you keep track how much you’re drinking in terms of units and provide support to help you cut down.
  • Avoid alcohol on an empty stomach as it increases the risk of experiencing hangover symptoms. Food helps slow down the rate your body absorbs alcohol.
  • Try not to get into rounds. They make it harder to control how much you drink.
  • Drink plenty of water or soft drinks in between alcoholic drinks to avoid dehydration, one of the most prevalent hangover symptoms.
  • Your body takes about one hour to process each unit of alcohol. Consider stopping drinking well before the end of the evening, so the process can begin before you go to bed and the chances of suffering a hangover the following day are kept to a minimum.
  • Drink plenty of water before hitting the sack and keep more by the bed.

How can you cure a hangover?

  • As well as water, drink fresh juice to give yourself a vitamin boost. If you really need it, take a painkiller and an antacid to settle your stomach and alleviate hangover symptoms. Try a rehydration treatment sachet – they replace lost minerals and salt.
  • Eat something – bananas and kiwis are examples of food you can eat to help cure a hangover as they are a source of potassium (a mineral you lose when you drink because of the diuretic effect of alcohol).
  • Avoid hair of the dog – it only delays the problem. Take a break from alcohol.

Need help cutting down? Check out some tips

New Year’s Eve is around the corner. For many of us, that means staying out late, dancing and drinking.

Thus, for some of us, the night of carousing also means a morning of hangovers.

Just in the nick of time, here’s our complete guide to the science of hangovers—what we know, what we don’t know, and how you can use this information to minimize your suffering.

Why Do Hangovers Happen?

Given that they’re such a widespread health phenomenon, it’s perhaps a bit surprising that scientists still don’t fully understand the causes of a hangover. (They do, however, have a scientific name for them: veisalgia.) It’s far from clear why, after all traces of alcohol have been fully expelled from your body, you can still experience a load of awful symptoms, including headache, dizziness, fatigue, nausea, stomach problems, drowsiness, sweating, excessive thirst and cognitive fuzziness.

The simplest and most familiar explanation is that drinking alcohol causes dehydration, both because it acts as a diuretic, increasing urine production, and because people who are drinking heavily for multiple hours probably aren’t drinking much water during that time period. But studies examining the link between dehydration and hangovers have turned up some surprising data. One, for instance, found no correlation between high levels of the hormones associated with dehydration and the severity of a hangover. It’s most likely that dehydration accounts for some of the symptoms of a hangover (dizziness, lightheadedness and thirst) but that there are other factors at work as well.

Most scientists believe that a hangover is driven by alcohol interfering with your body’s natural balance of chemicals in a more complex way. One hypothesis is that in order to process alcohol, your body must convert the enzyme NAD+ into an alternate form, NADH. With an excess buildup of NADH and insufficient quantities of NAD+, the thinking goes, your cells are no longer capable of efficiently performing a number of metabolic activities—everything from absorbing glucose from the blood to regulating electrolyte levels. But this hypothesis, too, has been contradicted by data: In studies, people with severe hangovers weren’t found to have lower levels of electrolytes or glucose in their blood.

The most compelling theory, at the moment, is that hangovers result from a buildup of acetaldehyde, a toxic compound, in the body. As the body processes alcohol, acetaldehyde is the very first byproduct, and it’s estimated to be between 10 and 30 times as toxic as alcohol itself. In controlled studies, it’s been found to cause symptoms such as sweating, skin flushing, nausea and vomiting.

Hangovers could also be driven by the way alcohol messes with your immune system. Studies have found strong correlations between high levels of cytokines—molecules that the immune system uses for signaling—and hangover symptoms. Normally, the body might use cytokines to trigger a fever of inflammatory response to battle an infection, but it seems that excessive alcohol consumption can also provoke cytokine release, leading to symptoms like muscle aches, fatigue, headache or nausea, as well as cognitive effects like memory loss or irritation.

( Photo by Burguy)

Why Do Some People Get Hangovers More Easily?

Life, alas, isn’t fair. Some people are extremely prone to hangovers, and some can drink with impunity.

It seems that genetics are partly to blame. Some people (disproportionately those of East Asian descent) have a mutation in their gene for the enzyme alcohol dehydrogenase that makes it much more effective in converting alcohol into the toxic acetaldehyde. Unfortunately, a significant part of this group also has a mutation in the gene for the enzyme that performs the next metabolic step, leading to a much slower conversion of acetaldehyde into acetic acid. As a result, excess buildup of acetaldehyde can happen quite rapidly. This is known to cause an immediate alcohol flush reaction (colloquially known as “Asian glow”), but might also play a role in hangovers the day after drinking.

There are other factors that affect who experiences hangovers most readily. After having the same number of drinks, women are more likely to experience hangovers than men, though this simply seems to be a result of the fact that women generally have a lower body weight as well: If you control for body weight and compare a man and woman with the same blood alcohol content, their chances of a hangover are similar.

There’s conflicting evidence over whether hangovers become more frequent with age. Some studies have suggested that adolescents are less likely to experience hangovers, but a recent large-scale survey showed the opposite—that, even controlling for total alcohol consumption, drinkers over the age of 40 experienced fewer and less severe symptoms. The authors noted that it’s possible, though, that they consume the same amount of alcohol but with less intensity, spreading their drinks out instead of binging.

Why Do Some Drinks Cause Hangovers More Easily Than Others?

Because the ultimate cause of a hangover is, after all, alcohol, drinks that pack more alcohol into a smaller volume are naturally more likely to give you a hangover. Shots of liquor, in other words, are more dangerous than mixed drinks, beer or wine.

(Image via Verster et al.)

Beyond that, though, some drinks happen to have higher levels of congeners—traces chemicals produced during fermentation—that contribute to hangovers. Studies have shown that high-congener, darker-colored liquors like bourbon and whiskey lead to more severe hangovers than lighter-colored or clear liquors like vodka, which has none. A Dutch study systematically looked at the congener content and hangover risk of a variety of types of alcohol, producing the ranking above. One particular congener called methanol—found in highest levels in whiskey and red wine—has received a large amount of the blame, due to studies showing that it can linger in the body after all alcohol has been eliminated, perhaps accounting for the enduring effects of a hangover.

This, incidentally, could explain widely-held belief that mixing different sorts of liquor can cause a hangover—a greater variety of congeners could well lead to a wider variety of effects. It can’t, however, explain any beliefs about the order of these drinks—despite the age-old adage “liquor-then-beer-you’re-in-the-clear, beer-then-liquor-you’ve-never-been-sicker.”

How Can You Prevent Hangovers?

The most effective solution is also the most obvious: Don’t drink alcohol. Or, at the very least, don’t drink to excess.

If you’re set on drinking a fair amount, though, there are certain things you can do to minimize your change of a hangover and the severity of its symptoms, and they’re all pretty intuitive. Don’t drink quickly, on an empty stomach; drink slowly, either on a full stomach or while eating. Food doesn’t literally absorb the alcohol, but having a full digestive tract slows down the rate at which your body absorbs the drug. Additionally, even though dehydration is only partly to blame, it still plays a role, so staying hydrated while drinking alcohol can help.

How Can You Quickly Cure a Hangover?

Eggs Benedict: not a real hangover cure. (Photo via Wikimedia Commons/Amadscientist)

Is there a super food/drink/ritual that can magically removes the after-effects of a night spent binge drinking? Well, according to various local legends, you can cure a hangover by eating shrimp (Mexico), pickled herring (Germany), pickled plums (Japan) or drinking coffee (U.S.), strong green tea (China) or tripe soup (Romania). A number of popular foods and beverages—like the Bloody Mary, Eggs Benedict and even Coca-Cola—were even developed specifically to “cure” hangovers.

Unfortunately, there’s no evidence that any of these homespun remedies do anything to help. There’s also no evidence that the so-called “hair of the dog” technique (that is, drinking the morning after) has any effectiveness whatsoever. It might temporarily dull your senses, making you less aware of the hangover symptoms, but it does nothing to resolve the underlying physiological problems—and, of course, it can just lead to another hangover.

Other drinkers vouch for a variety of seemingly scientific cures—Vitamin B or caffeine, for instance—but studies have also failed to show that these provide any relief either.

So what can you actually do? You can lessen some of the symptoms with well-known over-the-counter drugs: non-steroidal anti-inflammatories, such as aspirin or ibuprofen (Advil), can treat headaches and other pain, while you can take stomach relief medicines (say, Tums or Pepto-Bismol) to reduce nausea.

You should NOT take acetaminophen (Tylenol) because when the liver is processing alcohol, it’s especially susceptible to acetaminophen’s toxic effects. You can eat food, drink water, and rest. It’s boring, but at the moment, time is the only sure cure.

Is A Real Scientific Cure Around the Corner?

This past fall, the Web came alive with articles claiming that scientists are on the verge of developing a hangover-free beer. Unfortunately, a lot of the coverage overstated the science: So far, researchers have merely mixed electrolytes into light beer and showed that this caused less dehydration than normal beer. Because hangovers are the result of a bunch of other factors beyond dehydration, the new-fangled beer’s no more of a hangover “cure” than drinking water along with your alcohol.

Other researchers, at Imperial College London, are working on synthetic blend of chemicals that produce the pleasant effects of alcohol with much lower levels of toxicity—which, in theory, could reduce the chance of a hangover. But the research is in very early stages, and given the rigorous approval process for drugs that actually treat diseases, it’s easy to imagine that synthetic alcohol would take a while to get approval.

Some people get hangovers after a night of drinking, while others don’t, and the reason may be in their genes, a new study of twins in Australia suggests.

Researchers looked for links between the study participants’ genetic makeups and the number of hangovers the individuals reported experiencing in the past year. The results showed that genetic factors accounted for 45 percent of the difference in hangover frequency in women and 40 percent in men.

In other words, genetics accounts for nearly half of the reason why one person experiences a hangover and another person doesn’t, after drinking the same amount of alcohol, the study said. The other half probably comes from outside influences unrelated to DNA, such as how quickly a person drinks, whether they eat while they drink and their tolerance for alcohol.

The researchers also found that the people who had the gene variants involved in an increased risk of having hangovers also drank to the point of being intoxicated more frequently than people who didn’t have the hangover genes. That is, the genes that dictate how frequently a person gets hungover may also underlie how frequently someone gets drunk in the first place. This suggests that the findings could contribute to future research on alcohol addiction.

“We have demonstrated that susceptibility to hangovers has a genetic underpinning. This may be another clue to the genetics of alcoholism,” study leader Wendy Slutske, a psychology professor at the University of Missouri-Columbia, told Live Science in an email.

People who are less susceptible to having a hangover might have a greater risk for alcohol addiction, the researchers said.

In the study, about 4,000 middle-age people from the Australian Twin Registry participated in a telephone survey, reporting their experiences with hangovers and alcohol consumption. The participants recounted how many times they had gotten drunk in the past year, along with their “hangover frequency,” which is the number of days in the previous year they felt sick the day after drinking. They also reported their “hangover resistance,” which was whether or not they had ever experienced a hangover after getting drunk.

The researchers found a strong correlation between identical twins in reports of hangover frequency as well as hangover resistance, suggesting that the genetic similarities of some twins played a part in their hangover susceptibility.

Research into the biology of hangovers has gotten more attention in recent years, but there’s still surprisingly little work on the topic, Slutske said.

“With drinking alcohol, it is not ‘one size fits all,'” Slutske said. “People are different in their ability to consume alcohol without experiencing adverse consequences, such as having a hangover.”

The new findings suggest that people who frequently consume alcohol should observe the way their bodies react to it, she said. “It is not a good idea to try to pace your drinking to the people around you, because you might be more susceptible to hangover than the other people that you are drinking with,” Slutske said.

The study was limited, because people’s memories of their drinking and hangovers may not be completely accurate, she noted.

One of the next steps will be to identify the specific genes that contribute to hangover susceptibility, Slutske said. If the genes associated with alcoholism also underlie hangovers, identifying these genetic risk factors could help prevent addiction in the future.

Follow Jillian Rose Lim @jillroselim. Follow us @livescience, Facebook & Google+. Original article on Live Science.

Why Do We Get Hangovers?

Pounding headache, dry mouth, queasy stomach: You feel like you’re dying. But if you had a few too many drinks last night, you probably just have a hangover.

Beyond the fatigue and massive headache, physical symptoms of a hangover include increased sensitivity to light and sound, muscle aches, eye redness, and thirst, according to the National Institute on Alcohol Abuse and Alcoholism. You may also find yourself feeling sweaty, dizzy, and extra- irritable.

Such side effects usually set in several hours after you’ve stopped drinking, as your blood alcohol level (BAC) falls, and they peak when your BAC reaches zero. Some researchers explain the correlation as a “kind of mini withdrawal,” Robert Swift, PhD, professor of psychiatry and human behavior at Brown University and director of research at the Providence Veterans Administration Medical Center, told Newsweek. Hangover symptoms, which can last the entire following day, are similar to those that alcoholics experience when they stop drinking.

Blame Your Hangover On the Congeners

Congeners are chemical byproducts of the alcohol fermentation process, found more prominently in darker liquor such as red wine, bourbon, brandy, whiskey, and dark-colored beers. Think of them as your worst hangover nightmare. While they enhance the taste and smell of the alcohol, researchers believe congeners, essentially toxins to the body, also lead to hangovers. A 2009 study found that people who drank bourbon (which contains 37 times more congeners than vodka) experienced a more severe hangover than those who drank similar amounts of vodka.

But that doesn’t mean you should go around slugging vodka sodas all night. You can still get a hangover from drinking clear alcoholic beverages (vokda, gin, white wine, light-colored beers) if you drink too much of it.

The Science Behind the Symptoms

Biologically, hangover woes mostly come down to dehydration. “Alcohol is a diuretic, which means that it helps the body get rid of fluids. When you have a severe hangover, you’re often severely dehydrated, and the body can’t get rid of the byproducts of metabolizing alcohol (metabolites). And those metabolites are irritating,” Brandon Browne, MD, a staff physician in the department of emergency medicine at Scott & White Healthcare in Round Rock, Tex., told HealthDay. It’s the dehydration that causes the fatigue, dry mouth, nausea, and vomiting.

Aside from the severe lack of water in your body, Yul Ejnes, MD, chair of the American College of Physicians Board of Regents, notes that drinking heavily irritates the stomach lining, relaxes the muscles of the lower esophagus (causing reflux), and has a depressing effect on brain cells (hence the lack of coordination, decreased response time, and dizziness). It also lowers your blood sugar, and being hypoglycemic can also leave you feeling weak.

Why Do Some People ‘Never’ Get Hangovers?

Everyone has at least one friend who claims to never get hangovers. While it might be genetic, it’s more likely those people simply drink smartly. Individuals respond differently to alcohol, based on factors like body size, how fast you drink, and the amount of food and water you consume during a night out. Metabolism has something to do with it, too, Dr. Ejnes points out. The speed at which alcohol and its byproducts are metabolized can affect your level of drunkenness and the severity of your hangover.

On the other hand, some people may be genetically prone to get hangovers. “Some people break down a product of alcohol metabolism called acetaldehyde slowly, resulting in flushing and nausea from drinking alcohol,” says Ejnes. Research shows that this genetic trait occurs in almost half of people of Asian descent.

So, How Do You Prevent a Hangover?

The only surefire way not to get a hangover is to watch how much you drink (sorry). But chugging a glass of water between each alcoholic beverage is a great way to combat the dehydration. And it makes things a lot more bearable if you don’t have to wake up early the next morning. Getting enough sleep after a night of drinking can also help mitigate symptoms such as fatigue and headache, given the disruption of sleep caused by the alcohol, Ejnes says. You should also try to eat a meal before you hit the bar, so your body doesn’t absorb the alcohol as quickly as it would on an empty stomach. In the morning, drink lots water and eat something high carb and high sugar, such as toast with honey, to boost your blood sugar. Don’t overdo it on caffeine, but if you’re a java-addict, remember to have your morning cup of joe to avoid going through coffee withdrawal on top of your hangover.

A number of so-called hangover cures and preemptive products, from patches to effervescent tablets, have also hit the market. They claim to ease and prevent the dreaded morning after, but the health benefits aren’t proven.

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7 steps to cure your hangover

Drinking fluids may help with the morning-after misery from getting drunk.

Hangovers seem to be the body’s way of reminding us about the hazards of overindulgence. Physiologically, it’s a group effort: Diarrhea, fatigue, headache, nausea, and shaking are the classic symptoms. Sometimes, systolic (the upper number) 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. However, 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 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 family 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.

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, an interview with Dr. Swift, and several other sources.

1. 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 certain 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.”

2. 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.

3. 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 a 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 is a way to gently nudge levels back to normal.

4. 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.

5. Take a pain reliever, but not Tylenol. Aspirin, ibuprofen (Motrin, other brands), 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. Don’t take acetaminophen (Tylenol). If alcohol is lingering in your system, it may accentuate acetaminophen’s toxic effects on the liver.

6. 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 dehydration.

7. Vitamin B6. A study published over 30 years ago found that people had fewer hangover symptoms if they took a total of 1,200 milligrams 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.

Explore the many factors to consider when deciding how much (if any) alcohol is safe for you. Buy the Special Health Report, Alcohol Use and Abuse to get details of the dangers of alcohol misuse, from drunk driving to chronic, life-threatening health conditions.

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Hangover Headache

While not a disease we treat at the Johns Hopkins Headache Center, delayed alcohol-induced headaches are extremely common, disabling and costly to society. This material is provided for general education purposes.

  • How does alcohol affect the brain and the rest of the body?
  • How little is enough to make an impact the next day?
  • How long do the effects last?
  • Are there any effective treatments?

How does alcohol affect the brain and the rest of the body?

Alcohol adversely affects the brain, the liver, the kidneys, the heart, blood vessels, the lining of the stomach, and various hormonal and regulatory systems. Even the word “intoxicated” indicates alcohol’s true nature: a toxic substance.

The first symptoms of ethanol intoxication on the brain are quite pleasurable for most people. You feel relaxed and happy, and with another drink or two you become boisterously enthusiastic — the life of the party. With increased alcohol consumption, your vision blurs, your reaction times slow, your perceptions are unreliable, and you become unsteady and uncoordinated. You start to lose your inhibitions, which can lead to another consequence of drinking: poor judgment. Speech begins to slur, and concentrating and “thinking straight” becomes impossible. At higher concentrations in the blood, hiccups, vertigo, confusion, lethargy, memory “blackouts,” vomiting, stupor, coma, slowed breathing and even death can result.

No one is exactly sure how ethanol causes its various effects, but once absorbed from the stomach into the bloodstream it can freely cross out of the blood and into nerve cells of the brain. Once in the brain it causes a chemical release that leads to pleasurable feelings, and it lessens inhibitions by depressing certain frontal lobe functions. Motor pathways become overactive, and blood sugar is processed less efficiently in the brain. As more and more ethanol molecules enter the membranes of the nerve cells, sedating effects develop. The effects of alcohol intoxication are relatively predictable based on measured blood alcohol content.

Some of these effects are caused by ethanol itself, and others are from an even more toxic byproduct of its metabolism called acetaldehyde. This chemical builds up in the blood as the liver breaks down the alcohol into a form that can be eliminated from the body.

The effects on other body systems are also important in the symptoms of alcohol intoxication. The kidneys increase urination substantially, leading to dehydration. Blood vessels in the skin dilate, causing flushing and increased cardiac output. The liver starts working overtime to detoxify the blood of ethanol and acetaldehyde, and cannot keep blood sugar adequately regulated.

Repeated drinking can lead to liver scarring, known as cirrhosis. Certain inflammatory chemicals increase in the blood and affect various natural hormonal pathways. The stomach lining may become irritated, increasing nausea and the chance of bleeding. The extra calories consumed often become converted into fat.

Many of these disturbances of the body’s natural physiology persist the next day, long after the alcohol is gone. Dehydration plays a significant role, as does acetaldehyde. Effects on hormones, blood chemistry, the sleep-wake cycle and inflammatory chemicals are also important in the thoroughly lousy feeling we have come to know as a hangover.

Most people are well aware of the presence of headache, malaise, diarrhea, loss of appetite, tiredness, nausea and sensitivity to light, sound and motion the day after binge drinking. What may be less well recognized is that manual dexterity, memory, reaction time, visual-spatial skills and attention are all adversely affected, even when your alcohol level has fallen back down to 0.

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How little is enough to make an impact the next day?

Like so many other answers to science questions, “it depends.” Body weight and gender are very important factors. While five to eight drinks for the average man, and three to five drinks for the average woman, are enough to cause some degree of hangover, specific effects will vary greatly between individuals. Certain ethnic groups (Japanese, for example) have a genetically reduced ability to break down acetaldehyde, the main byproduct of alcohol, as it is first processed in the liver. This results in more reddening of the skin (““Asian flush”) and hangovers at lower amounts of alcohol.

People prone to migraines tend to have more problems with hangovers. People who drink alcohol regularly, or those who are taking certain specific medications that affect liver enzymes, may metabolize alcohol more quickly, having fewer problems with intoxication and hangover as a result. Conversely, there are many medications that interfere with the breakdown of alcohol and acetaldehyde, worsening the consequences of drinking. A thin, Japanese teetotaling woman taking prescription painkillers will clearly have more problems with a few drinks than a 250 pound linebacker who regularly drinks four beers a night.

How fast you drink is also important. Most of us can break down about one drink’s worth of alcohol each hour. What you drink is far less important than how much, but there’s some evidence that darker beverages — whiskey, brandy, red wine, tequila — cause more problems than clear drinks such as gin and vodka. They are thought to contain chemicals called congeners that add to ethanol’s harmful effects.

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How long do the effects last?

Hangovers can last up to 72 hours after drinking, but most are shorter in duration. Again it depends on how much was consumed, how dehydrated you became, nutritional status, ethnicity, gender, the state of your liver, medications, etc.

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Are there any effective treatments?

If you’ve consumed too much alcohol and have to work the next day, what do you do? In short, you suffer, and so does your job performance. Thinking about calling in sick? You’ll be in good company. Estimates of lost revenues due to reduced job productivity and absenteeism from alcohol run as high as $148 billion a year in the U.S. alone. Much of this expense is related to hangovers in light to moderate drinkers.

A quick Google search for “hangover cure OR treatment OR remedy OR prevention” pulls up over 2 million webpages. There are countless commercial products (Cheerz, Chaser) and homemade recipes with wildly unsubstantiated and pseudoscientific claims of benefits. It is important to note that a recent study from the British Medical Journal concluded that there was essentially no substantial scientific evidence that any substance has proven effectiveness in preventing or treating a hangover. That being said, the authors themselves admit that very few well-designed scientific studies have ever been conducted on the subject, so it is more than possible that some of these unproven treatments might work.

There is some evidence that vitamin B6 taken before drinking can be mildly helpful. An anti-inflammatory drug called tolfenamic acid has been shown to be somewhat helpful when taken during alcohol consumption. While this drug is not available in the U.S., other related medications, including ibuprofen, naproxen, and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be similarly helpful. However, when combined with alcohol they might increase the risk of stomach bleeding. Staying well-hydrated with plenty of water is helpful. Gatorade or other fitness drinks may be better than water alone, but there is no scientific proof. A chemical called N-acetyl-cysteine may be useful in detoxifying the body from acetaldehyde buildup, but this too is an unproven treatment. Light exercise may be helpful, provided you stay well-hydrated.

Here’s some advice on what to do after an evening of “overdoing it”:

  • Avoid more alcohol (“hair of the dog”) — this will only increase your misery.
  • Avoid further dehydration by drinking liquids (other than alcohol!) — water, chicken soup, Gatorade, whatever works for you.
  • Avoid acetaminophen (Tylenol) at all costs — it can overtax your already hard-working liver, leading to dangerous swelling or even liver failure.
  • Avoid unpalatable “recipes” that combine such ingredients as eggs, raw fish, Tabasco and sausage. You wouldn’t eat like that when you are at your best, so what makes you think you’ll stomach it when you’re hungover?

The very best prevention of a hangover? Don’t drink. The best cure? Time.

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Sant P. Singh, a professor and chief of endocrinology, diabetes and metabolism at the Chicago Medical School, explains.

The alcohol hangover has been known since Biblical times: “Woe unto them that rise up early in the morning, that they may follow strong drink” (Isaiah 5:11).

Approximately 75 percent of those who drink alcohol to intoxication will experience a hangover. Consumption of relatively large amounts of alcohol leads to more severe symptoms, which include headache, nausea, vomiting, thirst and dryness of mouth, tremors, dizziness, fatigue and muscle cramps. Often there is an accompanying slump in occupational, cognitive or visual-spatial skills. Other symptoms, such as tachycardia (rapid heartbeat) and changes in blood pressure, might go unnoticed by the sufferer.

Although still under debate, the cause and mechanism of a hangover seem to involve several factors. Hangover has been suggested to be an early stage of alcohol withdrawal. Acetaldehyde, a breakdown product of alcohol metabolism, plays a role in producing hangover symptoms. Chemicals formed during alcohol processing and maturation known as congeners increase the frequency and severity of hangover. Liquors such as brandy, wine, tequila, whiskey and other dark liquors containing congeners tend to produce severe hangovers, whereas clear liquors (such as white rum, vodka, and gin) cause hangovers less frequently. Researchers have shown that severe hangover occurred in 33 percent of subjects who ingested bourbon (which is high in congeners) but in only 3 percent of those who consumed the same dose of vodka (which is low in congeners). As a rule of thumb, the darker a liquor’s color, the more congeners it contains.

Patients with hangovers show changes in the blood levels of several hormones, which are often responsible for some of the hangover symptoms. For example, alcohol inhibits antidiuretic hormone, which leads to excessive urination and dehydration. Dehydration accentuates the symptoms of a hangover. Other factors that contribute to an alcohol hangover include consumption of larger quantities of alcohol than the person can tolerate. Individuals who drink alcohol rapidly, or without food, or without diluting it with nonalcoholic beverages, are more prone to developing a hangover. Mixing different alcoholic drinks can also cause a hangover. Additionally, smoking, loud music, flashing lights and decreased quality and quantity of sleep can exacerbate hangover headaches.

One can diminish the severity of the hangover by paying attention to the amount and type of alcohol consumed, as well as controlling other factors mentioned above. It is not clear that sugar-containing foods ease hangover symptoms, but sugar and fluids can help overcome hypoglycemia and dehydration, and antacids can help alleviate nausea. To reduce headache, anti-inflammatory drugs should be used cautiously. Aspirin may irritate the stomach and alcohol can amplify the toxic effects of acetaminophen on the liver. Other drugs have been used to treat hangovers, but most have questionable value. Propranolol, a beta blocker drug, has no beneficial effect on the symptoms of hangover. Tolfenamic acid, a prostaglandin inhibitor, produces some improvement in hangover symptoms when given prophylactically. The psychotropic sedative chlormethiazole has been reported to reduce symptoms of hangover, as have vitamin B6 and an herbal preparation called Liv.52 made by the Himalaya Drug Co. in Bombay, India.

Why Does Drinking Give You a Hangover?

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While we seem to know a lot about alcoholic beverages and their consumption, scientific research on hangovers is surprisingly limited. The current working theories offer only partial explanations or have been contradicted by research. So we don’t really know what causes hangovers, but we have some guesses. Let’s take a look at four popular theories that contribute to our hangover knowledge.

As you probably know, headaches and dry mouth are common hangover symptoms, and these probably stem from dehydration. Drinking alcohol makes you dehydrated because ethanol—alcohol in its purest form—is a diuretic: it makes you pee. However, there is no correlation between vasopressin (a hormone associated with dehydration) and the severity of a hangover. So there’s more to your hangover than just not having enough water in your system.

Another theory has to do with misallocated enzymes. When your body processes alcohol, the enzyme NAD+ transforms into an alternate form, NADH. Our bodies use NAD+ for metabolic functions, such as glucose absorption and electrolyte regulation. The more you drink, the less NAD+ your body has left over to perform these basic metabolic tasks. Pretty uncomfortable, right? But this theory has been contradicted by a study that found no correlation between lower electrolyte or glucose levels and more-severe hangovers. Maybe a lack of NAD+ isn’t the problem.

Some people think that certain types of alcohol cause worse hangovers than others. This may be true: the fermentation process produces a by-product called congeners, and our bodies don’t like them, since they contain chemicals that our bodies consider poisonous. Unfortunately, it’s these congeners that make everything from beer to brandy taste so dandy. We love these flavorful chemicals, even if the chemicals don’t love us!

The strongest theory at this time suggests that it’s not the alcohol that makes us feel hungover but rather what our bodies transform the alcohol into: acetaldehyde, a chemical that may be up to 30 times more toxic than alcohol. Some research has shown that our immune systems could be the reason acetaldehyde affects some of us worse than others, although this has yet to be proved.

If you’ve ever cracked open your eyes the morning after a boozy night, wondering why it feels like malicious elves with jackhammers are drilling through your skull, you know how dreadful hangovers can be. You may have also started to feel like your hangover symptoms are getting worse with age, which adds an extremely rude cherry to the top of this headache-filled sundae. But do hangovers actually get tougher to bear as you get older? Possibly, but not necessarily for the reasons you might think.

Let’s just take a moment to talk about the grab bag of pure awfulness that makes up your typical hangover symptoms.

Here are common hangover symptoms, which might sound familiar if you’ve enjoyed a drink or two in your life:

  • Fatigue and weakness
  • Excessive thirst and dry mouth
  • Headaches
  • Muscle aches
  • Nausea, vomiting, or stomach pain
  • Trouble sleeping
  • Sensitivity to light and sound
  • Feeling dizzy or like the room is spinning
  • Shakiness
  • A hard time concentrating
  • Mood issues like depression, anxiety, and irritability
  • Rapid heartbeat

Alcohol affects your body in multiple ways, according to the Mayo Clinic, which is why the hangover symptoms are so diverse. For instance, you can blame fatigue, weakness, shakiness, and mood disturbances on the way alcohol can make your blood sugar dip below a healthy threshold. Booze also expands your blood vessels, which can lead to headaches, and it hikes your urine production, which can cause dehydration that might make you want to drink all the LaCroix in a 10-mile radius. Then there’s the way alcohol prompts your body to produce more stomach acid but also slows how quickly your stomach empties its contents, which can lead to nausea and vomiting. Alcohol is clearly an excellent multi-tasker when it comes to affecting how your body functions, both when you’re drinking and the day after.

If you’re finding it harder to suffer through hangover symptoms with every passing birthday, you’re probably chalking it up to your body’s aging process. It might be a little more complicated than that.

There are all sorts of theories on why hangovers get worse with age. Perhaps you’ve cursed your liver enzymes, which have duties like metabolizing alcohol, after reading that they don’t do their job as well as you age. And that may be true, as your liver does get worse at its job over time. Or maybe you’ve wondered whether it’s all about your body composition—as you age, you have less total body water, which some experts posit can lead to a higher blood alcohol concentration when you drink.

The catch is that science hasn’t yet pinpointed these kinds of processes as being explicitly related to worsening hangovers with age. While there’s a ton of research into the short-term and long-term effects of alcohol on health, research on hangovers is limited. Studies that attempt to shed some light on whether hangovers actually get worse with age—and why—have, so far, fallen short of a definitive answer, addiction psychiatrist Mark Willenbring, M.D., tells SELF. Basically, the scientific jury is still out.

“Many parameters have been examined, including blood chemistries, minerals, glucose, hormones, inflammatory factors…and nothing has really popped up,” says Dr. Willenbring, who led the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism from 2004 to 2009 and was responsible for overseeing research on alcohol use disorder at universities around the United States. “The relationship between the amount and frequency of drinking isn’t even clear.”

One thing experts do know, however, is that your perception and memory of hangovers can change wildly as you age, making them seem so much worse than they used to be.

Richard Stephens, Ph.D., senior psychology lecturer at Keele University in the United Kingdom, has tested the hypothesis that hangovers change with age. After undertaking a cross-sectional study of over 50,000 men and women aged 18 to 94 years old, he and his fellow researchers concluded that you’re actually less likely to get hangovers as you age—and that’s precisely why you might feel like they’re worse.

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