December 28, 2011
The company of family and friends, a few days off from work, the cheerful holiday spirit, and easy access to festive holiday drinks set the stage for increased alcohol consumption this time of year. Sip just a little bit more than the body can handle and the good times are followed by that uncomfortable, party-ending, I’m-never-going-to-drink-again…holiday hangover.
With the high prevalence of hangover — more than 75% of people who have ever consumed alcohol report that they have experienced a hangover at least once and 15% of ever-drinkers experience a hangover at least monthly1 — it is no surprise our readers have been asking what they can do to avoid the holiday hangover!
Home Remedies: Do they work?
Purported hangover home remedies fill endless webpages, blogs, newspaper articles, and casual conversations. Just a sampling of the hailed “cures” include aspirin, bananas, Bloody Mary (and other alcoholic “eye openers”), cabbage, coffee, eggs, exercise, fresh air, green tea, honey, hot bath, ibuprofen, pizza, shower, sleep, bread, and water. Heart-slowing medication (propranolol), artichoke extracts, and purified derivatives of exotic plants like Opuntia ficus indica (prickly pear) also have made way into the headlines as hangover relievers.
Whether any of these methods work has piqued the interest of researchers. One group of British researchers analyzed the findings from all of the randomized trials they could find about interventions that may prevent or treat alcohol hangover.
But despite hundreds of websites devoted to the subject, only a small sampling of studies of questionable quality and generalizability were available. While some studies showed modest effects, the authors concluded that based on the available studies, no compelling evidence exists to suggest that any intervention is effective in preventing or treating an alcohol hangover2.
Given the limited evidence, it may be hard to say for sure whether or not a particular substance helps to decrease the hangover. But an understanding of what causes a hangover and what is going on in the body may help us figure out what can help make the dreaded feeling go away.
What exactly is a hangover?
A “hangover” refers to the uncomfortable symptoms — headache, diarrhea, decreased appetite, shakiness, fatigue, and nausea — that occur after heavy drinking.
Symptoms tend to peak when blood alcohol concentration reaches zero, which is why the morning after a night of heavy drinking can be so painful. Generally, hangovers are more severe with larger amounts of alcohol consumption (women who drink more than about three to five drinks, and men who drink more than about five to six drinks are pretty much guaranteed a hangover), but there are other factors:
- Congeners. When certain beverages such as brandy, wine, tequila, whiskey, and other dark liquors are metabolized by the body, they produce metabolic by-products called congeners. These congeners may be responsible for a large proportion of hangover symptoms. Alcoholic beverages that do not produce congeners when they are metabolized by the body, such as rum, vodka, gin, and other clear liquors cause hangover much less frequently.
- Hydration status. Alcohol affects several hormonal pathways in the body leading to effects on multiple organs, including the kidneys. Specifically, alcohol induces the kidneys to increase urination. The resulting dehydration causes release of a hormone called antidiuretic hormone, which causes the kidneys to retain more water. High levels of this hormone are associated with increased hangover severity. One way to avoid a bump in this hormone is to replace fluid losses and maintain very good hydration.
- Mitigating factors. Factors frequently associated with worsened hangover include poor food intake, decreased sleep, increased physical activity while intoxicated, and overall poor physical health. The key here to decrease the morning hangover is to avoid getting too rowdy and accompany alcohol intake with a balanced meal and a good night’s sleep.
- The unproven. Other than pairing alcohol consumption with ample hydration, no other hangover preventives have been well proven. However, several potential hangover antidotes have been studied with some modest results. For example, one study of 17 men and women showed that Vitamin B6 decreased hangover severity by 50 percent3. Tolfenamic acid, a non-steroidal anti-inflammatory medication used to treat migraines reduced headache, nausea, vomiting, irritation, and thirst in one study of 30 volunteers who either took a placebo or the tolfenamic acid after drinking alcohol and prior to sleep4. (Other less-studied NSAIDs like ibuprofen may also do the trick, but use these pain relievers cautiously since they can damage the liver when combined with alcohol.) While high-carb snacks that counter the sugar-lowering effects of alcohol have long been believed to help decrease hangovers, so far research has not supported this. In theory, drinking Gatorade or other sports drinks might help counteract electrolyte disturbances from drinking alcohol, but it is most likely the hydrating effects that offer most of the hangover relief. While some believe that an alcoholic morning “eye opener” will fend off a hangover, attempting to avoid hangover by drinking more alcohol poses far more risks than potential benefit.
Ultimately, despite all our scientific advances, a true understanding of what causes and how to prevent a hangover still remains largely a mystery. The only sure way to avoid a hangover is to not drink at all, but if that’s not on the agenda, then at least ensure ample hydration, aim for moderation, and identify a sober designated driver. These few precautionary measures will help keep you in the celebrating spirit all holiday long.
Did you know alcohol eats away at muscle mass? Before you tie another few drinks on this holiday season, keep your health and fitness goals in mind and remember moderation is key. Happy Holidays!
- Wiese JG, Shlipak MG, Browner WS. The alcohol hangover. Ann Intern Med. Jun 6 2000;132(11):897-902.
- Pittler MH, Verster JC, Ernst E. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials. Bmj. Dec 24 2005;331(7531):1515-1518.
- Khan MA, Jensen K, Krogh HJ. Alcohol-induced hangover. A double-blind comparison of pyritinol and placebo in preventing hangover symptoms. Q J Stud Alcohol. Dec 1973;34(4):1195-1201.
- Kaivola S, Parantainen J, Osterman T, Timonen H. Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid. Cephalalgia. Mar 1983;3(1):31-36.
By Natalie Digate Muth
Natalie Digate Muth, MD, MPH, RD, FAAPNatalie Digate Muth, MD, MPH, RD, FAAP is the Senior Advisor for Healthcare Solutions for the American Council on Exercise, a board-certified pediatrician and Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Obesity Medicine, registered dietitian and board-certified specialist in sports dietetics, and ACE Certified Health Coach. She is the author of "Eat Your Vegetables and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters" and the textbook "Sports Nutrition for Health Professionals." She has been ACE certified since 1998.