Drinking fluids may help with the morning-after misery from getting drunk.
Hangovers seem to be the body's way of reminding us about the hazards of overindulgence. Physiologically, it's a group effort: Diarrhea, fatigue, headache, nausea, and shaking are the classic symptoms. Sometimes, systolic (the upper number) blood pressure goes up, the heart beats faster than normal, and sweat glands overproduce — evidence that the "fight or flight" response is revved up. Some people become sensitive to light or sound. Others suffer a spinning sensation (vertigo).
The causes are as varied as the symptoms. Alcohol is metabolized into acetaldehyde, a substance that's toxic at high levels, although concentrations rarely get that high, so that's not the complete explanation.
Drinking interferes with brain activity during sleep, so a hangover may be a form of sleep deprivation. Alcohol scrambles the hormones that regulate our biological clocks, which may be why a hangover can feel like jet lag, and vice versa. Alcohol can also trigger migraines, so some people may think they're hung over when it's really an alcohol-induced migraine they're suffering.
Hangovers begin after blood alcohol levels start to fall. In fact, according to some experts, the worst symptoms occur when levels reach zero.
The key ingredient seems to be "drinking to intoxication"; how much you drank to get there is less important. In fact, several studies suggest that light and moderate drinkers are more vulnerable to getting a hangover than heavy drinkers. Yet there's also seemingly contradictory research showing that people with a family history of alcoholism have worse hangovers. Researchers say some people may end up with drinking problems because they drink in an effort to relieve hangover symptoms.
Dr. Robert Swift, a researcher at the Providence Veterans Affairs Medical Center in Rhode Island, coauthored one of the few review papers on hangovers in 1998. It's still one of the most frequently cited sources on the topic. The rundown on hangover remedies that follows is based on that review, an interview with Dr. Swift, and several other sources.
1. Hair of the dog. Drinking to ease the symptoms of a hangover is sometimes called taking the hair of the dog, or hair of the dog that bit you. The notion is that hangovers are a form of alcohol withdrawal, so a drink or two will ease the withdrawal.
There may be something to it, says Dr. Swift. Both alcohol and short-acting sedatives, such as benzodiazepines like diazepam (Valium), interact with GABA receptors on brain cells, he explains, and it's well documented that some people have withdrawal symptoms from short-acting sedatives as they wear off. Perhaps the brain reacts similarly as blood alcohol levels begin to drop.
Even so, Dr. Swift advises against using alcohol as a hangover remedy. "The hair of the dog just perpetuates a cycle," he says. "It doesn't allow you to recover."
2. Drink fluids. Alcohol promotes urination because it inhibits the release of vasopressin, a hormone that decreases the volume of urine made by the kidneys. If your hangover includes diarrhea, sweating, or vomiting, you may be even more dehydrated. Although nausea can make it difficult to get anything down, even just a few sips of water might help your hangover.
3. Get some carbohydrates into your system. Drinking may lower blood sugar levels, so theoretically some of the fatigue and headaches of a hangover may be from a brain working without enough of its main fuel. Moreover, many people forget to eat when they drink, further lowering their blood sugar. Toast and juice is a way to gently nudge levels back to normal.
4. Avoid darker-colored alcoholic beverages. Experiments have shown that clear liquors, such as vodka and gin, tend to cause hangovers less frequently than dark ones, such as whiskey, red wine, and tequila. The main form of alcohol in alcoholic beverages is ethanol, but the darker liquors contain chemically related compounds (congeners), including methanol. According to Dr. Swift's review paper, the same enzymes process ethanol and methanol, but methanol metabolites are especially toxic, so they may cause a worse hangover.
5. Take a pain reliever, but not Tylenol. Aspirin, ibuprofen (Motrin, other brands), and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help with the headache and the overall achy feelings. NSAIDs, though, may irritate a stomach already irritated by alcohol. Don't take acetaminophen (Tylenol). If alcohol is lingering in your system, it may accentuate acetaminophen's toxic effects on the liver.
6. Drink coffee or tea. Caffeine may not have any special anti-hangover powers, but as a stimulant, it could help with the grogginess. Coffee is a diuretic, though, so it may exacerbate dehydration.
7. Vitamin B6. A study published over 30 years ago found that people had fewer hangover symptoms if they took a total of 1,200 milligrams of vitamin B6 before, during, and just after drinking to get drunk. But it was a small study and doesn't seem to have been replicated.
Ginkgo biloba: What's the verdict?
Q: A friend recently recommended that I take the herb ginkgo biloba to protect against getting dementia. Is it effective, and is it safe?
A: The first thing you should consider is that the FDA doesn't regulate the manufacture of any herbal remedy, so the purity and potency of the ginkgo biloba you buy hasn't been checked.
Studies looking at the potention health benefits of ginkgo have shown conflicting results. Some research suggests that it may slow the progression of Alzheimer's disease and dementia caused by multiple strokes. Ginkgo may improve leg pain caused by atherosclerosis of arteries in the legs and speed recovery after a stroke. Positive results have been reported for ringing in the ears (tinnitus), vertigo, and even attacks of pain from hemorrhoids. Yet there are also studies that conclude that ginkgo doesn't have beneficial effects on these various conditions. In short, the results are mixed.
What about risks? Some people are allergic to ginkgo, which is more likely if you react to poison ivy or poison oak easily.
A more serious potential problem is an increased risk of bleeding, particularly if you're taking a medicine that "thins the blood," such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix). Taking ginkgo with certain other herbal remedies, such as garlic (Allium sativum), or vitamins (particularly vitamin E) poses the same problem. In addition, there's some evidence that ginkgo may increase the frequency of seizures in people who have epilepsy and could cause dangerously low blood sugar levels in people taking sugar-lowering medications or the herb bitter melon (Momordica charantia).
Ginkgo has been used by millions of people over thousands of years. Many people must have believed that they benefited from it, and told their friends. In my view, that means we should be studying ginkgo with the same rigor that we study pharmaceutical drugs — not dismissing it because it's an "alternative medicine." It takes time and many studies before a consensus emerges on the benefits and risks of any treatment. For ginkgo, that time has not yet arrived.
— Anthony L. Komaroff, M.D.
Harvard Health Letter Editor in Chief