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Hangovers - Causes, Prevention, and Remedies

We almost always consume alcohol in moderation. On rare occasions, some of us overindulge. I thought it might be interesting to explore the topic of remedies for “the day after.” Much of what follows is taken from the internet; these aren’t exactly peer reviewed publications.

What causes hangovers? (The following have been suggested by numerous sources)
1. Dehydration - Alcohol is a diuretic, ie a drug that increases urination and flushes fluids from the body. Drinking coffee the next morning may increase this problem as coffee is also a diuretic (however, caffeine has a possible advantage, which will be discussed later).

2. Mild poisons in the drink - A hangover may be a toxic reaction or even a mild form of alcohol poisoning. Complex organic molecules such as methanol and acetone are found in some drinks and are said to be responsible for hangovers rather than ethanol (alcohol). This view is supported by researcher Dr. Ian Calder of the National Hospital for Neurosurgery (London).

3. Too much alcohol depletes the body of necessary substances required to stay healthy, including blood sugar, vitamins and minerals.

4. “There’s good evidence emerging that the chief cause of hangover is acute withdrawal from alcohol,” says Mack Mitchell, M.D., vice president of the Alcoholic Beverage Medical Research Foundation in Baltimore, and assistant professor of medicine at Johns Hopkins University. “The cells in your brain physically change in response to the alcohol’s presence; when the alcohol is gone, you go through withdrawal until those cells get used to doing without the alcohol.” Couple that with the effects alcohol has on the blood vessels in your head (they can swell significantly), and you end up living through a day after that you’d rather forget.

Which form of alcohol is worse?
From worst to best: bourbon, whiskey, brandy, rum, red wine, white wine, gin and vodka. The British Medical Journal did tests that showed drinking bourbon whiskey is twice as likely to cause a hangover than the same amount of vodka.

What about Wine? (The following has appeared in the popular press. Who knows if it's true?)

1. A bad harvest. If you are drinking wine that comes from a country where a small change in the climate can make a big difference to the quality of wine (France, Germany, New Zealand), then in a bad season the wine contains many more substances that cause hangovers.

2. Drinking it too young. Almost all red wines and Chardonnay are matured in oak barrels so that they will keep and improve. If you drink this wine younger than three years there will be a higher level of nasties that can cause hangovers. If left to mature these nasties change to neutral substances and don’t cause hangovers. As a rule of thumb, wine stored in oak barrels for six months should be acceptable to drink within the first year. If the wine is stored for twelve months or more in oak barrels, it should then be aged at least four years. Some winemakers have been known to add oak chips directly into the wine to enhance flavors (especially in a weak vintage and especially in cheaper wines); this can take years to become neutral.

How to Avoid a Hangover
A hangover once is a hangover never wanted again. But it doesn’t mean that you have to avoid alcohol to have a fun night out and feel good the next day. So how do you avoid it all?

1. Of course the best and safest way to prevent hangovers is to limit yourself to 1-2 drinks.

2. Drink slowly. The slower you drink, the less alcohol reaches the brain (even if you end up consuming more). The reason is simple math: Your body burns alcohol at a fixed rate—about an ounce an hour. Give it more time to burn that alcohol, and less reaches your blood and brain.

3. Drink on a full stomach. “This is probably the single best thing you can do besides drinking less to reduce the severity of a hangover,” Dr. Mitchell says. “Food slows the absorption of alcohol, and the slower you absorb it, the less alcohol actually reaches the brain.” The kind of food you eat doesn't matter much. Eating well before you go out, during alcohol consumption, and sometimes after is important. Breads and pasta particularly slow absorption of alcohol into the blood stream. So do milk and other dairy products.

4. Take some extra vitamin C before retiring. Some even suggest taking extra vitamin C for a few days before imbibing a lot.

5. Drink the right drinks. What you drink can play a major role in what your head feels like the next morning, according to Kenneth Blum, Ph.D. The chief villains are congeners. “Congeners are higher order alcohols. (ethanol is the one we commonly call ‘alcohol’ but there are many others.) They are found in essentially all alcoholic beverages,” Dr. Blum says. “How they work isn’t known, but they’re closely related to the amount of pain you experience after drinking.”

6. The least perilous concoction is vodka. The most perilous is bourbon. Cognac and other brandies as well as single malt scotches are close behind. These are followed by blended scotch and other whiskeys and champagnes of all kinds (here it’s the bubbles that are the problem). Red wine can be a problem, but for a different reason. It contains tyramine, a histamine-like substance that can produce a killer headache. Gin and white wine are almost as benign as vodka, but in sufficient quantity, any form of alcohol can do you in. Avoid sweet tropical mixed drinks such as zombies and pina coladas, Also, avoid eating sugary foods such as cookies, cakes and chocolate. You tend to drink more than you realize, because the sugar makes it difficult to sense how much alcohol you are consuming.

7. Avoid the bubbly. And that doesn’t mean just champagne. Dr. Mitchell and Dr. Blum agree. Anything with bubbles in it (rum and Coke is just as bad as champagne) is a special hazard. The bubbles put the alcohol into your bloodstream much more quickly. Your liver can’t keep up; the alcohol overflow pours into your bloodstream.

8. Be size sensitive. With few exceptions, there's no way a 110-pounder can go one-on-one with a 250-pound drinker and wake up the winner. So scale down your drinks. To come out even, the 110-pounder can handle about half the alcohol of the 250-pounder.

9. A new over-the-counter supplement called Zeo is now available. We sell it. An Initial report from one of our employees (who shall remain nameless) is that it seems to help.

10. Take Alka-Seltzer at bedtime. “There's no hard scientific data on this, but my own clinical experience and that of a lot of others says that water and Alka-Seltzer before going to bed can make your hangover much less of a problem,” says John Brick, Ph.D. Others claim that two aspirin tablets (which is really Alka-Seltzer without the fizz) can also help. However, non-prescription pain relievers can be tough on the stomach, especially when there is alcohol in the system. Plain water is always a good idea for rehydration. Some recommend flat ginger ale.

Once you have a hangover, how can you minimize the effects?

From the medical professionals:
There is no one thing that cures a hangover except time. But there are a few things you can do to relieve the symptoms—the headache, nausea, and fatigue.

1. Drink fruit juice. “Fruit juice contains a form of sugar called fructose, which helps the body burn alcohol faster,” explains Seymour Diamond, M.D., director of the Diamond Headache Clinic in Chicago, Illinois. A large glass of orange juice or tomato juice, in other words, will help accelerate removal of the alcohol still in your system the morning after.

2. Eat crackers and honey. Honey is a very concentrated source of fructose. Believe it or not, sauerkraut juice is said by some to neutralize congeners. (More proof that sometimes the cure is worse than the disease!)

3. Get some pain relief. A headache is invariably a part of the package that goes with a hangover. “You can take aspirin, acetaminophen, or ibuprofen but you don’t want anything stronger,” Dr. Diamond says. “With more potent pain relievers, you run the risk of habituation, and you don’t want the first problem to start another problem.”

4. Willow bark is a natural, organic pain reliever, according to Kenneth Blum, Ph.D., chief of the Addictive Diseases Division at the U. of Texas Health Sciences Center at San Antonio. “It contains a natural form of salicylate, the active ingredient in aspirin.”.

5. Drink bouillon. Broth made from bouillon cubes or any homemade soup broth will help replace the salt and potassium your body loses when you drink, Dr. Diamond says.

6. Replenish your water supply. “Alcohol causes dehydration of your body cells,” says John Brick, Ph.D., chief of research at the Center of Alcohol Studies of Rutgers State University of New Jersey. “Drinking plenty of water before you go to bed and again when you get up the morning after may help relieve discomfort caused by dehydration.”

7. Take B-complex vitamins. Drinking drains the body of these valuable vitamins. Research shows your system turns to B vitamins when it is under stress—and overtaxing the body with too much booze, beer, or wine definitely qualifies as stress, says Dr. Blum. Replenishing your body with a B-complex vitamin capsule can help shorten the duration of your hangover.

8. Eat amino acids. Amino acids are the building blocks of protein. Like vitamins and minerals, they can also be depleted by use of alcohol. Dr. Blum says that replenishing amino acids plays a role in repairing the ravages of a hangover. Amino acids are also available in capsule form at most health food stores.

9. Have two cups of coffee. (I know this contradicts previous advice, but you didn’t expect consistency, did you?) “Coffee acts as a vasoconstrictor—something that reduces the swelling of blood vessels that causes headache,” Dr. Diamond says. “Coffee can do a great deal to relieve the headaches associated with hangovers.” But don’t drink too much.

10. If you have a headache, cool/cold compresses may help.

11. Eat a good meal. If you can tolerate it, that is. A balanced meal will replace the loss of essential nutrients, explains Dr. Blum. But keep the meal light; no fats or fried foods. Toast, cereal, fruit and yogurt are easier to digest than eggs and dairy. (Chicken soup, anyone? It may not help, but it couldn’t hurt!)

PANEL OF ADVISORS: a) Kenneth Blum, Ph.D., is chief of the Addictive Diseases Division of the University of Texas Health Sciences Center at San Antonio; b) John Brick, Ph.D., is chief of research in the Division of Education and Training at Rutgers State University of New Jersey’s Center of Alcohol Studies in Piscataway, New Jersey; Seymour Diamond, M.D., is director of the Diamond Headache Clinic and the inpatient headache unit at Louis A. Weiss Memorial Hospital in Chicago, Illinois. He also is executive director of the National Headache Foundation. He has co-written several books on headaches. c) Van Lierer, Ph.D., is director of research and owner of Decision Systems, a research and development firm in Stanford, California. He is a former cognitive psychologist at Stanford U; d) Mack Mitchell, M.D., is a vice president of the Alcoholic Beverage Medical Research Foundation in Baltimore, Maryland, and assistant professor of medicine at Johns Hopkins University.

From the Nutritionists:
Try some of the following herbs before and after drinking to reduce toxins and free radicals produced by them as well as herbs to nourish the nervous system. V-8 juice along with cucumber is an excellent carrier for your herbs and the two alone will help to replenish salts, vitamins, minerals and water your body is screaming for.

1. Willow bark; 2) Scullcap; 3) Ginseng; 4) Chamomile; 5) Green Tea; 6) Nux vomica; 7) Kava and Valerian (take these two only after all the alcohol has cleared your system.)


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