I'm pretty sure I never got a single hangover before my late 20's, but ever since then I've gotten plenty; in fact, I seem more prone to them then the average person. And, sure, there have been lists of so-called "hangover cures" circulating since the dawn of the printing press. But if they worked for everyone, we probably wouldn't be complaining about them anymore, right?
I wanted to learn more about hangovers, what causes them, and why some people get them more often (and more severely) than others. So I decided to invite an actual medical professional to the west coast Chill The Glass headquarters for a discussion on the topic. Luckily for me, I didn't need to look far to find one; my wife, Alexis Rheinwald-Jones, is a clinical nurse practitioner who specializes in nutrition-based medicine, metabolism, and other food- (and drink-) related issues.
Here's what she had to say about the chemistry behind the morning-after blues.
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When I'm having a hangover, what's actually going on in my body?
Well, there are several ways in which alcohol disrupts your normal physiology. One of the main factors is dehydration; alcohol pulls water out through your cell membranes and into your bloodstream, where it gets excreted out by your kidneys. That's why you have to pee so much when you drink. The dehydration is the main thing that causes your headaches the day after, so it's really important to hydrate as much as possible while you're drinking. Alcohol also causes your blood vessels to dilate, which contributes to headaches as well.
What about queasiness and nausea? Is that also caused by dehydration?
It can be, but there are several other factors as well. Alcohol irritates your stomach and the lining of your intestines; it causes your blood sugar to fluctuate quite rapidly -- moreso than most foods; and it generally causes an inflammatory response in your immune system, and all those things can make you feel nauseated. Also, in the morning you're coming off the neurotransmitter high that makes you feel good when you're drinking, and that dip can make you queasy (as well as depressed and irritable).
Why do some people get worse hangovers than others?
Food allergies (and your immune system's response to them) are one factor. If you're allergic to potatoes, and you drink a bunch of potato-based vodka, you're obviously not going to feel good because your immune system is working hard to combat it. And people with a lot of food allergies are definitely going to be more prone to hangovers, assuming they're regularly being exposed to those allergens, because their immune system is always on overdrive and therefore their body can't devote as many resources to processing alcohol.
Aside from that, differences in your genetics and your environment can make your body more or less efficient at fixing the imbalances that alcohol causes (dehydration and so forth). In functional medicine, we're always looking for the most "upstream" cause; in other words, the most basic thing in the body that's causing the symptom. So, if someone is more prone to a hangover, their cell membranes could be having more trouble holding in water (which would cause more dehydration). Or they could have a hormonal imbalance that causes their blood vessels to dilate more easily, which would also make them more prone to headaches.
What are some possible ways to prevent a hangover from happening the next day, either while drinking or after drinking?
Again, if there's something else in your health that's out of balance, you can bet that
that thing is contributing to whatever you're feeling during your hangover. So it's a good idea to try to find and address that issue. But in the short term, there are some things you can do to generally help the organs that are responsible for getting things back into balance after you drink.
For most people, it's a good idea to drink about twelve ounces of water per serving of alcohol (i.e., an ounce and a half of hard liquor, five ounces of wine, or twelve ounces of beer). Ideally, you should drink water in between alcoholic drinks, because you'll be more effective at getting in a greater volume of water if you spread it out of a longer time; also, you won't be consuming alcohol in such a concentrated dose at once, so you're giving your body more time to process it. Eating food while you're drinking can be helpful too; again, you're giving your body more time to process the alcohol.
Beyond that, some specific supplements can be helpful in preventing hangovers. Fish oil (omega-3 fatty acid) and gamma linoleic acid (an omega-6 fatty acid that's found in evening primrose oil) are both anti-inflammatory and can help to combat the inflammation that alcohol causes. Milk thistle and dandelion root are some of the supplements that help speed up liver function and get your body to process alcohol more quickly. There are also enzymes in your liver that de-activate the toxins in alcohol so they can be excreted, and some of the nutrients that help with that de-activation are B-vitamins, SAM-e, and N-acetyl cystine.
With the supplements you mentioned, is it typically more effective to take them before drinking, or after drinking?
In my personal experience, it's most effective to take them both before
and after (and both of those should be before you go to sleep). And then if there are lingering effects in the morning, maybe try another dose.
Because of the differences in genetics, food sensitivity, etc. that you mentioned before, will some of these supplements be more effective or less effective from person to person?
Definitely. For example, if you're someone who's more prone to dehydration due to your cell membranes releasing water too easily, the fatty acids I mentioned could be the most helpful. Or, if your liver isn't processing alcohol as efficiently, the milk thistle/dandelion root will be more effective.
Why is it that I never seem to get hangovers two days in a row, even if I drink again the second day?
I think this is just a self-moderation effect. Even if you're not consciously trying to temper your drinking the second night, your body is sending you messages to remind you of how you felt that morning, and that can affect your choices. So even if you're drinking a fair amount on day two, you're probably not going to add the bag full of Cheetos or big handful of M&Ms or whatever else might compound the effects of alcohol and give you another hangover.
Some people (such as Roger Sterling) think that clear liquors are less likely to give you a hangover than dark liquors. Is there any reason why that would be true?
Yeah, there is some truth to that, at least for some people. Dark liquors get their coloring from something called congeners, which are a byproduct of the fermentation process; clear liquors usually have them filtered out. And some people are sensitive to congeners; their immune system perceives them as a toxin and fights them, so those people would definitely feel worse drinking dark liquors. It's possible that, since congeners are a yeast byproduct, people who are sensitive to them might have candida or another yeast colonization. But there's also an argument for a genetic component; if you're better at processing congeners, maybe you had ancestors who had more of them in their diets.
Okay, now let's hear your thoughts on some of the more popular day-after hangover cures. Tell me what might make each of these effective (or not).
Hair of the dog (generally):
This can be useful for the anesthesia effect, since alcohol generally helps you be less attentive to things that are bothering you. But there's also some discomfort produced by the effect of alcohol rapidly leaving your system, so having a little extra the next day can slow down that process so it doesn't feel as bad. That being said, even if it does make you feel better, you are making a little more work for your body by giving it more alcohol.
Having a Bloody Mary at brunch the next day:
It works because you're getting the anesthesia plus electrolytes, which can help with the dehydration issue. And the nutrients in the tomato juice might help your liver and kidneys be slightly more effective at speeding up the clean-up process. But the same caveat applies about the alcohol ultimately taxing your body a little more.
Greasy diner food:
Actually, even though it's not that great for you, there certainly are some reasons why this would help. There's a lot in eggs that's helpful -- the lecithin helps with cell membrane repair, and good quality eggs are fairly anti-inflammatory and can be a good source of omega-3. Consuming fat, in general, causes a domino effect that makes your gallbladder contract and enables your liver to empty a little more of the toxins you took in the night before, so that can help speed things along. And the carbs in the diner food (potatoes and toast and whatnot) certainly can help re-equilibrate your blood sugar, which might be low after a night of drinking.
In general, you're probably just going to need more food the day after heavy drinking, so if you're trying to stick to a strict diet, be aware that it's going to be pretty hard to get right back on immediately after a bender.
Coconut water:
Again, it can be helpful in restoring your blood sugar, and also the specific blend of electrolytes in coconut water is very absorbable, so for a lot of people this can be a way to feel better quickly. Potassium also leaves your body when you get dehydrated, and coconut water is usually fortified with it.
Pain medication:
I'm not a big fan of most pharmaceutical pain meds because they all have negative side effects. That said, the anti-inflammatory element of ibuprofen can certainly make you feel better. (But don't take it on an empty stomach.) Tylenol isn't the best thing to take after drinking because it taxes your liver the same way alcohol does.
Vigorous exercise:
This can definitely help some people feel better. Exercise can be a remedy for a lot of issues because it causes your body to make all its chemical reactions happen faster; it increases production of enzymes to speed up your metabolism.
Just staying in bed:
Sure. Your headache isn't going to kill you, which means it's going to go away eventually. Time is the great healer.
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Alexis Rheinwald-Jones is the founder and lead practitioner of Alexis Health. Check out her website for more health tips and information on her practice, or click here to subscribe to her monthly newsletter. On Twitter, she's @alexishealth.
