To Beth (with apologies)

We live in a society that encourages overindulgence in alcohol almost as much as overindulgence in food. When citizens drink too much, they can expect a hangover with adverse effects on productivity, health, and well being.

Hangover is characterized by a general sense of malaise accompanied by headache, digestive upset, nausea, fatigue, and irritability.

Hangover and the Pharmacology of Alcohol

Alcohol is processed by the body in two stages and has a fairly rapid half life under ideal conditions. In the first stage, alcohol is broken down to yield acetaldehyde — a nasty toxin that is partially responsible for hangover symptoms. This toxin is then broken down into harmless substances (acetic acid and water).

Most people can process one drink per hour so that if they keep their alcohol intake below that level they are unlikely to experience a hangover. Not going to bed immediately after drinking is helpful in forestalling hangovers because the liver works more efficiently during wakefulness than sleep.

In addition to many exotic treatments that are employed on the day after a drinking binge, some people religiously drink water before going to bed in the belief that this prevents hangover symptoms by preventing dehydration.

Aldous Huxley described science as the death of a beautiful theory at the hands of an ugly fact. The relevant ugly fact is that the severity of hangover symptoms is completely unrelated to physiological signs of dehydration (1).

In plain English, hangovers are not caused by dehydration and it is not hard to see why this might be. Given that water is a breakdown product of alcohol metabolism, one would expect tissues to be over-hydrated if anything.

If not dehydration, then what? Recent research is zeroing in on immune function as the cause of hangover symptoms.

Impaired Immune Function

The key evidence here is that hangover severity is correlated most strongly with prostaglandin synthesis. Hangover severity is reduced in experiments by inhibitors of prostaglandin synthesis (1).

A decade ago, scientists asserted that there was no good way to mitigate hangover except by drinking in moderation, or complete abstinence (2).

In the past decade, this dour Calvinistic assessment has mellowed out. Researchers have identified various exotic substances that produce a significant reduction in hangover severity. These include: red ginseng; sprouted peanut extract; and a combination of glutathione-enriched yeast and rice embryo/soybean extracts.

Of these experiments, only red ginseng was tested on humans (3), the other studies using rats. In the sprouted peanut extract and red ginseng studies, hangover was reduced by speeding alcohol metabolism. The other manipulation was designed to enhance immune function.

The Onward March of Science

Because hangovers have a major deleterious effect on absenteeism, as well as workplace performance, safety, and productivity, this is an active field of specialization with its own Alcohol Hangover Research Group.

Researchers are clearly making strides in understanding, and treating, hangover symptoms. So far, though, there is no magic bullet and red ginseng is based on a folk remedy. Soon, perhaps, pharmacies will stock a beautiful remedy for an ugly hangover. Science may not be restricted to ugly facts killing beautiful ideas. For now, moderation is the best option, however.

References

1 Prnning, R., van Nuland, M., Olivier, B., and Verser, J. B. (2010). The pathology of alcohol hangover. Current Drug Abuse Review, 3(2), 68-75.

2 Pittler, M. H., Verster, J. C., and Ernst, E. (2005). Interventions for preventing or treating alcohol hangover: Systematic review of randomied controlled trials. British Medical Journal, 331(7531), 1515-1518.

​3 Lee, M. H., Kwak, J. H., Jeon, G., et al. (2014). Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: A randomized crossover study. Food Function, 5(3), 528-534. doi: 10.1039/c3fo60481k

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