By Natasha Persaud
Having a hangover is miserable: You may feel nauseous, thirsty, dizzy, achy, tired, and perhaps worse. You may also experience negative emotions such as anger or irritability. So why do these symptoms occur? “Our current understanding is alcohol may directly promote hangover symptoms through its effects on the digestive tract, blood sugar levels, urine production, sleep patterns and biological rhythms,” explains Robert Swift, M.D., Ph.D., associate director of the Center for Alcohol and Addiction Studies at the Warren Alpert Medical School of Brown University in Providence, RI.
According to one theory, hangover is a form of alcohol withdrawal; it excites the brain and causes a rebound effect, including headaches and sensitivity to light and sound. Another theory holds that substances in alcohol called congeners are to blame. Congeners include the tannins in wine (in general, darker beverages such as wine, whiskey and brandy contain more congeners). Some congeners are toxins that harm the body. A third theory suggests that hangover symptoms are due to inflammation caused by alcohol metabolism. “Most likely, multiple factors are at work,” says Dr. Swift.
Ironically, symptoms occur after blood alcohol levels (BAC) have started dropping, “typically within several hours after a person has stopped drinking,” says Dr. Swift. Symptoms are at their worst when BAC approaches zero.
Here, Dr. Swift explains the truth behind some popular hangover myths:
Myth: Having the hair of the dog that bit you (more alcohol) can reduce hangover symptoms.
Fact: "Your hangover symptoms may temporarily subside if you continue to drink alcohol but they’ll return later on—likely more numerous or stronger due to the effects of additional alcohol. Instead of feeling slightly queasy, you may feel worse stomach upset, for example. Instead of having just a headache, you may have increased sensitivity to light and sound and other symptoms. The bottom line: If you have a hangover, leave the bottle behind."
Myth: Wine is less intoxicating than beer.
Fact: "Intoxication is ultimately the result of the amount of alcohol you consume," Dr. Swift says. "A standard 5-ounce glass of wine and a standard 12-ounce mug of beer contain on average about the same amount of alcohol."
That said, the type of wine or beer matters. "The alcohol content of wine can vary from 8 percent in sweet Riesling or white Zinfandel to about 13 percent in Cabernet Sauvignon. The alcohol content of beer also varies, from about 4 to 7 percent on average, and champagne ranges from about 8 to 14 percent."
In the United States, beer manufacturers are not required to list alcohol content. Several groups have compiled lists giving the alcohol contents of beers, including this list from Realbeer.com, a for-profit website owned by Real Beer Media, Inc.
Myth: Diet cocktails are less intoxicating.
Fact: Not so, says Dr. Swift. "Since diet cocktails contain the same amount of alcohol as regular cocktails, they are equally intoxicating. The amount of sugar has nothing to do with it."
It's also possible that diet alcoholic drinks made with artificial sweeteners may be more intoxicating than regular alcoholic drinks because they may be digested more quickly, according to a small study in the American Journal of Medicine.
Myth: A woman will become intoxicated at the same rate as a man, if she weighs the same as he does.
Fact: "A woman will always have a higher blood alcohol level than a man even if she weighs the same and drinks the same amount of alcohol," says Dr. Swift. The reason: "Men have more water in their bodies than women do, per pound of body weight. Also, men have more of the enzyme—alcohol dehydrogenase—that breaks down alcohol in the stomach. As a result, more alcohol makes it to a woman’s intestines for absorption into the blood. For these reasons a woman’s blood will have a higher concentration of alcohol, and her brain and organs will be exposed to more alcohol and more of its toxic byproducts. Bottom line: It's best not to attempt to''keep up with the boys.'"
Myth: As you grow older, you’re better able to handle alcohol’s effects.
Fact: "You’re probably more sensitive to the effects of alcohol as you age; it’s the same with other types of drugs," says Dr. Swift. "The same amount of alcohol will have a greater effect on you than it does on someone younger."
The reason: "After age 25 your body and mental functions begin a slow decline, which is perfectly normal. Your body retains less water, so you have a higher blood alcohol content when you drink compared to a younger person. Your brain is also more sensitive to alcohol intoxication due to changes in neurotransmitters."
"Your body also becomes less resilient: It takes longer for wounds to heal, for example, and it takes longer to recover from a hangover. All of these changes are normal and to be expected."
On the other hand, some research suggests that men and women may benefit from moderate alcohol drinking because it helps protect the heart from cardiovascular disease. "The key here is moderate drinking," says Dr. Swift. "No more than two drinks a day for men, and one drink a day for women, according to 2005 U.S. Dietary Guidelines for Americans." According to the American Heart Association, how alcohol or wine affects cardiovascular risk merits further research, but right now the association cautions people not to start drinking alcohol to gain these potential benefits if they don’t already drink. And if they do drink, again, moderation is key. A drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.
Myth: I can't get a hangover from drinking just one beer.
Fact: "In general, the more alcohol you drink, the greater your chances of a hangover," says Dr. Swift. "Yet some individuals become intoxicated after just one drink and experience hangover symptoms. The chances of intoxication depend, in part, on your body size, gender, age and sensitivity to alcohol."
Remarkably, you can experience hangover symptoms even when you're not legally intoxicated: "Hangover symptoms can occur after BAC is just 20 mg per deciliter, which can occur after having as few as two drinks, depending in part on how quickly the drinks are consumed. A person will be slightly impaired (lightly dizzy, feeling good) at that low blood alcohol level due to alcohol's sedative effects." (According to the National Highway Traffic Safety Administration, it is illegal in every state to drive with a BAC of 80 mg of alcohol per deciliter or higher. In other parts of the world, intoxication is defined as a BAC of 50 mg per deciliter or lower.)
MYTH: Eating fatty foods will help you sober up.
Fact: "A hangover occurs well after alcohol has left your digestive system and has entered your bloodstream, so eating anything at this point won’t reduce your chances of hangover and it won’t help you sober up. In fact, if you have a hangover, eating fatty foods may actually irritate your stomach further.
"The key is to eat food—any type—before you drink and while you’re drinking," says Dr. Swift, "to slow down the rate at which your stomach delivers alcohol to the small intestine to be absorbed. That way, it takes, say, an hour to be absorbed, instead of mere minutes. The alcohol in your bloodstream also peaks at a lower level."
Myth: Eat burnt toast or an over-the-counter (OTC) charcoal remedy to reduce your hangover symptoms.
Fact: "If you already have a hangover, consuming charcoal or burnt toast won’t help you," says Dr. Swift. "Charcoal only absorbs impurities from the stomach, not the bloodstream. Besides, burnt toast tastes bad. Why would you want to eat it?
"Despite popular belief, there are no scientifically-proven hangover remedies. No folk remedies or over-the-counter treatments have been scientifically tested in well-designed clinical trials, so it's impossible to tell whether any of them truly work."
Myth: Have strong coffee or an energy drink after you drink to keep you alert enough to drive.
Fact: "Drinking and driving is dangerous no matter how much alcohol you've consumed. You may feel more alert with coffee or an energy drink, but alcohol may slow your reaction time and impair judgment and coordination—skills you need to drive safely. The more alcohol you consume, the greater your impairment.
"You may feel better during the first 20 minutes or so after having a cup of coffee or an energy drink, but that effect quickly dissipates."
Myth: Popping a pain reliever can help you overcome a hangover.
Fact: While taking ibuprofen or naproxen for a headache or muscle pain brings temporary relief, it's short-lived at best, and you may experience unpleasant side effects from the medication such as stomach upset—which will only leave you feeling worse.
"Avoid acetaminophen entirely," says Dr. Swift. The drug is found in many over-the-counter medications, such as headache remedies, pain relievers and cough and cold remedies. "Alcohol impairs the liver’s ability to get rid of a toxic byproduct of acetaminophen, making it more likely that you’ll experience harmful effects. And it doesn’t matter when you take it, whether it’s before, during or after you drink; you may have a reaction if the acetaminophen is in your bloodstream. If you need to take acetaminophen or a product containing the drug, don’t drink for the next 24 hours; also wait hours after you’ve stopped drinking before taking it."
In conclusion, the only known cure for a hangover is time. "Given time, your body will begin to break down the alcohol and return to a normal state, typically within 8 to 24 hours after you’ve stopped drinking," says Dr. Swift.
If you plan on drinking, aim to prevent a hangover in the first place. These steps can help:
- Limit your drinking to one or two drinks that you really want.
- Avoid having more than one drink of wine, brandy or whiskey, since they have large amounts of congeners.
- Eat a full meal before you have a drink, and never drink on an empty stomach.
- Sip your drink, don’t gulp, to slow the pace at which alcohol is digested and enters your bloodstream.
- Drink a full glass of water in between each drink. Remember that drinking is not the main event.
If you still end up with a hangover, these steps may be mildly helpful in reducing some of your symptoms:
- Drink water and other nonalcoholic beverages to replace body fluids you’ve lost.
- Drink fruit juices and eat fruit to restore your blood sugar levels and relieve some of the nausea. Also, try eating bland complex carbohydrates, such as whole grain bread or crackers.
- Sleep to help ease the fatigue.
- Try an antacid containing bismuth subsalicylate (such as Pepto Bismol) to relieve stomach upset.
Medication and Alcohol Don’t Mix
"Many medications interact with alcohol," says Dr. Swift. "Whether you’re taking an OTC or prescription medication, it’s important to be aware of potential interactions with alcohol."
You might be surprised how seemingly safe medications and supplements produce harmful effects when combined with alcohol, including certain herbal supplements and OTC cold remedies.
The danger: Alcohol can diminish the effect of your medication or, in some cases, prolong it. Here are two particularly dangerous interactions:
Taking a sleeping pill or an antihistamine (or any other sedative) along with alcohol can increase the depressive effect and lead to breathing difficulty, coma, even death. Taking the pain reliever acetaminophen before, during or after you drink alcohol can result in liver damage.
For other potential interactions with alcohol, check out this page from the National Institute on Alcohol Abuse and Alcoholism.
Currently taking medication? Read the pamphlet describing your medication (or check the box or bottle label) and review the section on drug interactions, or “contraindications,” to see how consuming alcohol may interfere with your medication. If you have any questions, consult your pharmacist.