Talking hangovers with a medical expert

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.

Good booze for sipping

My booze preferences are nothing if not mercurial, and right now I find myself in a mode where I don't often feel like mixing an actual cocktail for myself. But I don't want my contributions to this blog to dry up just because I'm tending toward laziness, so instead I'll talk about some spirits that are great all by themselves, with nothing added but ice (and maybe not even that).

Sipping candidate #1: Bourbon

If you're ordering bourbon in any small-town bar in Kentucky, you ask for it straight up or you risk a lot of funny looks from the bartender and your fellow patrons. (I know this not because I've actually been to Kentucky, but because I am a regular viewer of "Justified.") Maybe you'd like to practice at home before you make the trip. Here are some of my favorite bourbons that stand up quite well on their own.

Pricey pick: Blanton's Single Barrel ($50)

Even the most pretentious of boozehounds will be impressed if they see a bottle of this on your shelf, and rightly so. It's rich, sweet, smooth, and delicious, and at 92 proof it'll take the edge off rather quickly but also won't burn your throat going down even if you drink it neat.

Affordable pick: Bulleit ($25)

Bulleit is very good bourbon, and it's also fairly ubiquitous (not advertised-during-NFL-games ubiquitous, but available-in-most-decent-liquor-stores ubiquitous). Great in an Old Fashioned or all by itself, and therefore a wise choice for your liquor cabinet.


Sipping candidate #2: Rum

Like tequila, rum is known to most people as strictly a cocktail ingredient (or something reluctantly gulped from a shot glass). That's because Bacardi has essentially cornered the international rum market, almost to the extent that "Bacardi" and "rum" are as interchangeable as "Kleenex" and "tissues." Bacardi is perfectly suitable in a mojito or a piña colada, but it's definitely not for sipping. If you want to consume rum straight-up, aged rum is the only way to go.

Because of its dark color, aged rum can easily be mistaken for dark rum, even though the two spirits are nothing alike. Dark rum is basically light (read: clear) rum with coloring and flavoring added. Aged rum, like bourbon or scotch, gets its amber tint from spending many years in a barrel. Therefore, a good aged rum might actually remind you more of whiskey than it does other types of rum, and that's not a bad thing at all.

Pricey pick: Ron Zacapa Centenario 23-year ($40)

Slightly-less-pricey pick: Cruzan Single Barrel ($30)

Either of these is a great choice for sipping on a warm summer evening. Throw in a lime wedge if you really want to live it up.


Sipping candidate #3: Mezcal

In the past few years mezcal has emerged from relative obscurity to become a popular component of many craft cocktails. The shorthand way of describing mezcal is to say that it's the scotch of tequila; it's aged much longer and tends to have the same kind of smoky flavor associated with scotch. Because it has such an intense and distinct taste, it'll come through strongly even in a cocktail where it's a minority ingredient. But once you've tried it in a cocktail, you may be tempted (as I was) to see what it's like on its own. The answer: Pretty damn fantastic.

Mega-pricey pick: El Jogorio Espadin ($80)

I know, I know. This is definitely a once-in-a-while purchase for once-in-a-while sipping. (Or you can go Full Gwyneth and give bottles out as party favors at your next locavore BBQ. Up to you.) It has some very distinct notes that separate it from even most top-tier mezcals, although I am neither knowledgable enough nor pretentious enough to be able to tell you exactly what those notes are.

Regular-pricey pick: Alipus San Baltazar Guelavila ($40)

Mezcal is priced pretty similarly to single-malt scotch, so there aren't a lot of good choices below this price point; however, the Alipus is great on its own or in cocktails, and it doesn't have the overly-smoky profile that I've tasted in some cheaper mezcals.


Sipping candidate #4: Aquavit

Here comes the weird one. Aquavit (or akvavit) is a very popular spirit in Scandinavia but a total unknown to most Americans. It's similar to vodka in that it's distilled from grain or potatoes and typically comes in at 80 proof, but the flavor is quite different. As with gin, herbal infusions help to take away the astringent alcohol-y taste, but the most unique (and noticeable) element is caraway. That's right, caraway. So if you're intrigued by hard liquor that tastes vaguely of rye bread, aquavit is your pick! (Seriously, it's worth a try. Twenty million beautiful blonde people can't all be wrong.)

Fairly-affordable pick that is also the only one I've seen for sale in the States: Linie ($30)

The Improved Dirty Martini

I love olives. Put pretty much any kind of olive in front of me and I'll eat it. I also love martinis, and I'll put as many olives in the glass as it will hold. So I'm very excited to try the Olives 7 Ways, as described in this New York Times article, "The Dirty Martini Cleans Up Well."

Fortunately, to tide me over until I have time to get to the East Village, the article included a home version of the recipe, "The Improved Dirty Martini," and I made my first one tonight.

I couldn't find Perry's Tot (I didn't look very hard) so I used Dorothy Parker, for the very scientific reason that it's made by the same distiller and has the same label design. I did get Noilly Prat and the Cerignola olives. In lieu of an eye dropper, I dipped a chopstick into a small dish of olive oil and kind of flung the drops onto the drink. The drops are smaller than in the Times photo, but it worked.

Instead of a dish of olives on the side, I put a single Sicilian olive in the glass.

You guys, this thing is amazing. It's incredibly smooth, and you can taste the olive and the salt without it being olivey or salty, if that makes sense. It has a slight bitterness and tang that I really like. It really is a far cry from the "slop of random brine" of the classic dirty martini. The olive oil adds a scent more than anything. I was worried about the drink being oily but it's really just a garnish. Even on the last sip I never felt like I was drinking oil.

With the 1:1 ratio of gin to vermouth, I can see why a stronger gin was recommended, and I'm looking forward to trying different ones and playing around with the proportions.

Brisa Frances

Okay, so you would not expect The Grove to be a place to find a good cocktail, and you certainly would not expect a bar called (ugh, I can barely even type this) Mixology 101 to be the establishment that would serve said cocktail. And yet, dear readers (both of you!) that is exactly the case. (Editor's note: I will be censoring the bar's name from now on because I find it that offensive.)

The menu at M******y 101 is pretty extensive, with a solid mix of the old-school and the new-fangled.  Since I'm perfectly capable of making the former at home, I opted for one of the modern drinks, the Brisa Frances. (I did ask the bartender if he could make a Holland Razor Blade, but alas, they had no cayenne.) And luckily for me, M******y 101 has the recipes for many of their cocktails printed on the walls, so I didn't have to awkwardly ask the bartender for the exact measurements.

I'm always partial to mezcal cocktails, as well as anything with a touch of absinthe (or a lot of absinthe, or just plain absinthe), and I also love a good cucumber margarita, so the Brisa Frances seemed like an ideal choice.  As expected, it was refreshing and delicious and just the right amount smoky.

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Recipe (transcribed from the walls at this place):

1.5 ounces mezcal

0.75 ounce agave syrup

0.75 ounce lime juice

0.25 ounce absinthe

0.5 ounce cucumber juice

Combine all ingredients in a shaker with ice and shake well. Strain into a highball glass with fresh ice cubes, and top with soda water and a cucumber peel.

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Some notes:

- Mezcal is easier to find than it used to be. BevMo sells a few varieties, and even less well-stocked liquor stores often have one or two. As with any other spirit, you can safely buy a cheaper variety if you're going to use it exclusively in cocktails like this one, but if you want one that's good for both mixing and sipping, you should probably get something in the $30-40 range.

- As far as making cucumber juice goes, if you don't have a juicer at home, you have a few options. You can put cucumber in a blender or food processor and strain it, or just go to a juice bar and have them juice you up a pint or so of cucumber-only.  It should keep in the fridge for at least a couple of weeks.

- There are a couple of brands of absinthe you can buy in 100-ml bottles like this one, which is ideal if you just want to be able to add a splash of it to a drink like this one (or for rinsing the glass to make a Sazerac). We'll get into sipping absinthe in a subsequent post.

- To make agave syrup, mix agave nectar (the squeeze-bottle stuff you buy at Whole Foods or Trader Joe's) with equal parts boiling water, stir it up, and let cool. You'll end up with a much thinner liquid that dissolves more easily in drinks (especially cold drinks), and it'll last longer too. (And don't worry, it's still insanely sweet even in diluted form.)

Ginger Sidecar

Adapted from this recipe for a Bourbon Sidecar from the New York Times.

4 oz bourbon

1 oz cointreau* or triple sec

juice of 1 lemon

2-3 teaspoons ginger syrup

Combine all ingredients in a shaker over ice. Shake very well. Strain into a rocks glass.

Makes "two" but let's not kid ourselves. 

The original recipe calls for a sweeter bourbon. I prefer something a little stronger (in flavor, not in alcohol content) so the triple sec doesn’t overpower it. (This may be the difference between using bottom shelf triple sec and actual Cointreau, but I haven’t tried the latter, so I can’t say*.)

I used a Meyer lemon. They have a nice herbal quality that I like. Also they were on sale.

Making ginger syrup (or any flavored or plain simple syrup) is super easy. Mix equal parts sugar and water (1 cup each is usually good) and a bunch of peeled, chopped ginger (or flavoring of your choosing, such as fresh mint) in a small saucepan. Bring to a low boil, stirring, just until the sugar is fully dissolved. Let cool and steep, then strain into an airtight container and store in the fridge. How much syrup you use in this drink will depend on your taste and on how strong your syrup is.

As previously discussed, I’ll serve any brown liquor with homemade cocktail cherries, because they are the best. More logical garnishes in this case would be lemon peel or candied ginger.

UPDATE: I've now made the original NY Times recipe with Cointreau and a sugared rim, and it's noticeably different and, to my taste, better. I had thought that Cointreau was needlessly expensive when cheap Triple Sec and Curacao abound, but I was wrong. It's worth the investment to stock it in your home bar. Your margaritas and sidecars will thank you.

Apple Pie Manhattan

Nick was kind enough to invite me to contribute to this site, but it took a while for me to feel like I had anything to contribute beyond "drinking good!" I haven’t been very adventurous lately, booze-wise. Unless you count putting a dash of bitters in some bourbon and calling it an Extra-Dry Manhattan, I'm not big on making up drink recipes; I spend too much money on liquor as it is, I don't want to risk wasting it on experiments. 

But I wanted to do something with some apple cider I'd bought for a recipe (I'm not a fan of apple juice or cider, but it's great for cooking with) and I remembered the bottle of cinnamon whiskey at the back of the bar we'd bought on a lark that was pretty undrinkable on its own. Apple pie! It worked.

Photo by Adam Grosswirth

4 oz bourbon

2 oz sweet apple cider

1 oz cinnamon whiskey

2-3 dashes cranberry bitters (optional)

cocktail cherries (optional)

candied ginger (optional)

tart apple, such as Granny Smith (optional)

Pour all liquid ingredients into a shaker. Shake with ice. Strain into a chilled cocktail glass with cherries. Garnish with a piece of candied ginger and/or a slice of tart apple.

Photo by Adam Grosswirth

I used Maker’s Mark, which is my go-to bourbon, but if you want a stronger bourbon flavor you could use something like Knob or even a rye.

The cranberry bitters were another thing I happened to have in the house, an “ooh, neat!” impulse buy that I can’t really do much with. It seemed like a good Thanksgivingy touch, and it was.

I also tried this with a spoonful of ginger simple syrup, thinking a little sweetness would cut the harsh Fireball nicely, but I found it too syrupy. If you like a sweeter drink, though, that’s a good solution. If you want to get fancy, you could rim the glass with cinnamon sugar or maybe ground ginger and sugar. I am too lazy for that, so let me know how it turns out if you try it!

There’s really no reason for this drink to have cherries, except that I love them and I put them in basically anything with bourbon, including otherwise straight bourbon. I make my own, not because I’m a snob (I love me a classic bright red maraschino cherry) but because they’re so easy and awesome. I use this recipe, ideally with sour cherries (I hoard and freeze them during their very short season at the farmers’ market) but Dole frozen cherries from the grocery store are great too. Hmmm, maybe I should try to concoct a cherry pie Manhattan next? 

Holland Razor Blade

Last month I was in Seattle visiting my friends Rossanna and Tiago, and as usual, a good portion of our time was spent eating and drinking.  The thing I've realized of late is that cold-weather towns inevitably have the best bars.  Portland, Seattle, Boston... even Minneapolis -- which, if you saw my tweets, you know I wasn't altogether thrilled with in most respects -- definitely holds its own in the booze department.  And I'm not just talking about having two or three really fantastic bars; I'm talking about the average level of alcoholic intelligence across a broad spectrum of places.  (This is specifically where L.A. falls short -- sure, we have a few really fantastic bars, but you have to seek them out.  Mostly what we have are the kinds of joints that have one kind of bourbon, two kinds of gin, and fifty-eight varieties of flavored vodka.)

Anyway, I'm getting off track.  Point being: Seattle has many great bars, and according to many people (or at least my friends), Canon is the king of them all.  Having now been there three times, I am more than willing to believe this.  You could get a mild buzz just scanning the massive shelves behind the counter, reading off the names of every bottle of liquor known to man (as well as some that I think the bartenders might have invented themselves).

Since Canon is the type of place where you can literally just say, "Surprise me!" to the bartender and end up with an amazing drink in front of you, I decided to solicit a suggestion.  I've long been curious about Genever, the Dutch spirit that's kind of a cross between gin and bourbon, so I asked the bartender for a Genever-based recommendation.  And this is how I ended up sipping a Holland Razor Blade, and then, upon my return to L.A., buying myself a bottle of Bols Genever so I could whip one up myself.

This drink is definitely a case of -- well, if not "less is more," then at least "less is plenty."  It's about as simple as a cocktail can possibly get (I might not even have ordered it if I'd realized how few ingredients it has, given my strong inclination toward ridiculously complicated drinks), but it doesn't taste simple at all.  And what a name, right?

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Recipe (from Food & Wine):

2 ounces Genever

0.75 ounce simple syrup

0.75 ounce lemon juice

pinch of cayenne pepper

Fill a cocktail shaker with ice. Add the genever, simple syrup and lemon juice and shake well. Strain the drink into a coupe glass and sprinkle with the pinch of cayenne.

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Some notes:

- Bols Genever is not the easiest spirit to find.  They don't have it any of the BevMos in Greater Los Angeles (as far as I can tell), but K&L Wines in Hollywood and Bar Keeper in Silver Lake both carry it.  K&L also ships.

- The coupe glass is another great bar staple, and also one that's not easily found.  (In fact, I still have yet to acquire any -- the glass I used is similar but not quite it.)  Most standard martini glasses range from 5 to 7 ounces in capacity, which means that if you make a drink like this one that tops off in the vicinity of 3 ounces, you're going to have some awkward empty space at the top of the glass.  Coupes are usually more like 3-3.5 ounces, so they're perfect for little drinks that pack a punch.