What exactly is a hangover anyway?

One of the popular movies was The Hangover. With us being in the midst of the holiday season, it seems that we might be seeing a few hangovers ourselves. One of the great tragedies of this year was the death of Amy Winehouse due to alcohol poisoning.

The social costs of hangovers include alcohol-related injuries and illness, loss of productivity through illness, absence from work, and alcohol-related impairment in the morning after the evening before! Lateness, accident risk, poorly performed work, absenteeism and the possible long-term effects of alcohol abuse are just some of the issues reviewed in the medical literature. There is even a study that says hangovers cost the U.S. economy $179 billion a year.

The medical literature cites the definition of a hangover as the presence of at least two symptoms out of headache, poor sense of wellbeing, diarrhea, anorexia, tremulousness, fatigue, and nausea that happens after you have fully metabolized the alcohol intake; these symptoms have sufficient severity to disrupt the activities of daily living.

So what exactly happens after you take in too much alcohol? After the alcohol is metabolized, there are increased levels of a breakdown product called acetaldehyde. Acetaldehyde will lead to many of the toxic symptoms we experience. Normal pathways are deregulated, including lack of the availability of sugar via processes that happen with insulin. There is dehydration, metabolic acidity, prostaglandin synthesis is disrupted which leads to the headache and there is an increase in cardiac output and vasodilation of our vessels.

According to studies, drinking about 250 milliliters of an alcoholic beverage causes the body to expel 800 to 1,000 milliliters of water; that’s four times as much liquid lost as gained. This diuretic effect decreases as the alcohol in the bloodstream decreases, but the aftereffects help create a hangover. There can be sleep deprivation and insufficient eating. In alcohol as well are other molecules called congeners which can add to the hangover effect. Congeners are byproducts of fermentation in some alcohol — methanol for example is metabolized to toxic substances such as formaldehyde and formic acid. Congeners are seen more in dark alcohols.

All this happens while the blood alcohol level is zero — that is the hallmark of the hangover. It is not during the presence of acute alcohol ingestion or intoxication. Studies show that there are poorer recall and an impact on higher cognitive functions. Attention is impaired as well.

There are lots of myths as to how to cure a hangover. The best method is prevention, meaning drink moderately on a full stomach and don’t overdo it. If you are suffering from a hangover, remember to rehydrate. Caffeine will also dehydrate you and is not a good idea. Repleting vitamins and minerals through a sports drink might be helpful as well. Try to eat something, but the true cure is time and hopefully the lesson that this is not worth repeating!