Hangovers: Q&A with Dr. Stephen Harding

After indulging in alcohol during the holidays or during a big event like a sports championship, people may start to think twice about their drinking habits, often because of the aftereffects. Drinking can cause hangovers, hindering the ability to function properly for a few days. Dr. Stephen (Alex) Harding, assistant professor of emergency medicine at Baylor, explains the science behind hangovers and the most effective ways to overcome them.

What is a hangover?

The medical term is veisalgia. The real cause for hangovers is the inflammation from the alcohol that is consumed and the congeners that are present in the drink. Congeners are small molecules found in small quantities in beverages that give them taste, flavor, color and aroma, but also can contribute to hangovers.

In addition, biomechanical mechanisms in the brain cause you to urinate more frequently when consuming alcohol, which increases the risk for dehydration.

There are also some genetic components for hangovers. Individuals from different ethnic groups do not metabolize alcohol in the same way, causing some individuals to be more prone to headaches, flushing and dizziness while drinking, in addition to hangover symptoms later.

What is the best way to prevent a hangover?

Drinking less or not drinking at all is the best way to avoid a hangover. It is best to space out drinks and alternate an alcoholic beverage and water to maintain constant hydration. Taking breaks between drinks can help you drink less alcohol overall, preventing a potential hangover.

You absorb alcohol more rapidly on an empty stomach. If someone skips their meals and just drinks alcohol, it can affect their metabolism to a point where their blood sugar may drop, which can cause worsening hangover symptoms. It is important in all alcohol intoxication states to have carbohydrates because they are the preferred source of sugar for the body. Consuming carbohydrates can prevent that blood sugar from dropping.

Alcohol should not be consumed on an empty stomach. Although we do not know of specific foods that would counteract a hangover, greasy foods are well-tolerated and seem to be helpful in replenishing carbohydrates.

Taking painkillers before going to bed might help you prevent a hangover headache. However, you have an increased risk of stomach inflammation or bleeding if you take these medications with alcohol.

Alcohol is metabolized inside the liver, so be aware of potential liver damage from acetaminophen as well. You may be doing double damage to your liver by consuming both. It is best to take medicine when you experience hangover symptoms the next morning.

What is the best way to cure a hangover?

Most hangover prevention tips or cures are myths. There may be a placebo effect, but there is no conclusive data about the effectiveness of hangover pills.

If you feel hungover, treat your dehydration and sleep deprivation. You may feel tired and have a dry mouth, so make sure to hydrate and take a nap.

Specific symptoms can be addressed by taking medications:

• Upset stomach: Tums
• Nausea: Zofran
• Body ache or headache: pain killers such as Tylenol or Motrin

Drinking Liquid IV, Gatorade, Powerade, Pedialyte or water help best with rehydration. Choose whichever is most palatable for you.

Many beverages are marketed as more hydrating and contain electrolytes. The number of electrolytes should not make a difference on hangover symptoms, but rehydrating is important overall.

The hair of the dog can temporarily make you feel better at the cost of potentially feeling worse later. When hung over, there is some degree of fight or flight response since the alcohol acts as a sedative when being taken, which is why people feel more sociable and eventually sleepier while drinking alcohol.

Once it becomes metabolized, the body rebounds. Studies show blood pressure and heart rate increase, and some of the inflammatory stress markers increase as well. By taking the hair of the dog, you get that small amount of intoxication that brings you closer to a baseline.

How do hangovers affect sleep?

Alcohol intoxication affects the ability to sleep effectively. You may fall asleep when intoxicated, but once you clear that alcohol and become nearly sober, rebound anxiety occurs, leading to an awake state. The alcohol is being metabolized into sugar that would potentially give you enough energy to wake up and not fall back asleep.

Does sugar worsen hangovers?

The biggest effect sugar content has on you is that drinks may taste better and go down more easily. The body is efficient at dealing with glucose, unless you have a medical condition like diabetes, so sugar itself does not play a role in hangovers. However, sugary alcoholic drinks don’t provide hydration so you may end up more dehydrated, which can worsen hangover symptoms.

What is the role of sulfites?

Some wines use sulfites as a preservative. Some people are sensitive to them and get hangovers when drinking wines that contain sulfites. Depending on the sulfite levels and congeners, you could see differences in the level of hangover between different products.

There are sulfite-removing products, and some people who are sensitive to sulfites may find this helps to prevent some hangover headaches. Most of these products have yet to be studied in a scientific, double-blinded method.

Do certain types of alcohol have stronger effects on hangovers?

Typically, the darker the alcohol, the worse the hangover due to the higher levels of congeners. Overall, the biggest contributor is the amount of alcohol consumed.

Does mixing alcohol affect your hangover?

If you mix several different drinks, it might affect your gastrointestinal system, but should not affect hangovers from the alcohol content perspective. There also is no correct order for alcohol consumption, such as “beer before liquor.”

Do hangovers become worse as you grow older?

People who have been drinking over time for 10 or 20 years may have higher alcohol tolerance, so they may be able to drink more than when they were younger, and more alcohol equals worse hangovers. However, there is no scientific claim to hangovers worsening as you age.

Can hangovers last more than one day?

The body needs time to eliminate all the byproducts (congeners and sulfites), rehydrate and recover from the inflammation that was caused by the alcohol. It may take a few days to feel some sense of normal. Overall, the degree of the hangover is due to how much alcohol you drank.

How will dry January affect future tolerance and hangovers?

Abstaining from alcohol during dry January or any other time will have no effect on future hangovers. Be aware of the amount you drink before dry January. If someone is a chronic alcoholic, that puts them at risk for alcohol withdrawal when they stop. Someone might mistake alcohol withdrawal for hangovers due to their similar symptoms: sweatiness, tremors, jitteriness, headaches and anxiety. If you are considering abstaining for any length of time, you may want to speak with your physician to avoid running into side effects that come along with withdrawals, such as seizures.

Overall, Harding emphasizes that moderation is the key to feeling best in the morning.

By Homa Shalchi