Hangover

Hangover
Other names	veisalgia from Norwegian: kveis, "discomfort following overindulgence", and Greek: ἄλγος álgos, "pain"[1]
The Day After by Edvard Munch, 1894–95
Pronunciation	/ˈhæŋoʊvər/
Specialty	Neurology, Psychiatry, toxicology

A hangover is the experience of various unpleasant

Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating hangovers.[5]^[6] Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover.^[5] The socioeconomic consequences of hangovers include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also impair performance during potentially dangerous daily activities such as driving a car or operating heavy machinery.^[7]

Signs and symptoms

An alcohol hangover is associated with a variety of

After being ingested, the ethanol in

Alcohol also induces the CYP2E1 enzyme, which metabolizes ethanol and other substances into more reactive toxins. In particular, in binge drinking the enzyme is activated and plays a role in creating a harmful condition known as oxidative stress which can lead to cell death.^[12]

Acetaldehyde

Acetaldehyde, the first by-product of ethanol, is between 10 and 30 times more toxic than

Acetaldehyde may also influence glutathione peroxidase, a key antioxidant enzyme, and increases the susceptibility to oxidative stress.^[12] Likewise, acetic acid (or the acetate ion) can cause additional problems. One study found that injecting sodium acetate into rats caused them to have nociceptive behavior (headaches). In addition, there is a biochemical explanation for this finding. High acetate levels cause adenosine to accumulate in many parts of the brain. But when the rats were given caffeine, which blocks the action of adenosine, they no longer experienced headaches.^[18][19]

Congeners

In addition to ethanol and water, most alcoholic drinks also contain

One potent congener is methanol. It is naturally formed in small quantities during fermentation and it can be accidentally concentrated by improper distillation techniques. Metabolism of methanol produces some extremely toxic compounds, such as formaldehyde and formic acid, which may play a role in the severity of hangover. Ethanol slows the conversion of methanol into its toxic metabolites so that most of the methanol can be excreted harmlessly in the breath and urine without forming its toxic metabolites. This may explain the temporary postponement of symptoms reported in the common remedy of drinking more alcohol to relieve hangover symptoms.^[10][26] Since methanol metabolism is effectively inhibited by consumption of alcohol, methanol accumulates during drinking and only begins to be metabolized once ethanol has been cleared. This delayed action makes it an attractive candidate explanation for delayed post-intoxication symptoms and correlations between methanol concentrations and the presence of hangover symptoms that have been found in studies.^[4]

Vitamin and electrolyte loss

The metabolic processes required for alcohol elimination deplete essential vitamins^[27] and electrolytes.^[28] Furthermore, alcohol is a diuretic, causing excretion of electrolytes through urination. After a night of drinking, the resulting lack of key B and C vitamins, as well as potassium, magnesium, and zinc may cause fatigue, aching and other hangover-like symptoms.^{[citation needed]}

Dehydration

Ethanol has a dehydrating effect by causing increased urine production (diuresis), which could cause thirst, dry mouth, dizziness and may lead to an electrolyte imbalance. Studies suggest that electrolyte changes play only a minor role in the genesis of the alcohol hangover and are caused by dehydration effects. Drinking water may help relieve symptoms as a result of dehydration but it is unlikely that rehydration significantly reduces the presence and severity of alcohol hangover.^[4] Alcohol's effect on the stomach lining can account for nausea because alcohol stimulates the production of hydrochloric acid in the stomach.

Low blood sugar

Studies show that alcohol hangover is associated with a decrease in blood glucose concentration (less than 70 ml/dl), but the relationship between blood glucose concentration and hangover severity is unclear.^[4] Also known as insulin shock, hypoglycemia can lead to coma or even death.^[29]

Immune system

In current research, the significant relationship between immune factors and hangover severity is the most convincing among all factors so far studied.

Several factors which do not in themselves cause alcohol hangover are known to influence its severity. These factors include personality, genetics, health status, age, sex, associated activities during drinking such as smoking, the use of other drugs, physical activity such as dancing, as well as sleep quality and duration.[4]

• Genetics: alleles associated with aldehyde dehydrogenase (ALDH) and flushing phenotypes (alcohol flush reaction) in Asians are known genetic factors that influence alcohol tolerance and the development of hangover effects. Existing data shows that drinkers with genotypes known to lead to acetaldehyde accumulation are more susceptible to hangover effects.^[33] The fact that about 25% of heavy drinkers claim that they have never had a hangover is also an indication that genetic variation plays a role in individual differences of hangover severity.^[7]
• Age: some people experience hangovers as getting worse as one ages. This is thought to be caused by declining supplies of alcohol dehydrogenase, the enzyme involved in metabolizing alcohol. Although it is actually unknown whether hangover symptoms and severity change with age, research shows that drinking patterns change across ages, and heavy drinking episodes that may result in hangover are much less often experienced as age increases.^[7]
• Sex: at the same number of drinks, women are more prone to hangover than men, and this is likely explained by sex differences in the pharmacokinetics of alcohol. Women attain a higher
  blood alcohol concentration (BAC) than men at the same number of drinks. At equivalent BACs, men and women appear to be indistinguishable with respect to most hangover effects.^[33]
• Cigarette smoking: acetaldehyde which is absorbed from cigarette smoking during alcohol consumption is regarded as a contributor to alcohol hangover symptoms.[12]

Management

Hangovers are poorly understood from a medical point of view.^[34] Health care professionals prefer to study alcohol abuse from a standpoint of treatment and prevention, and there is a view that the hangover provides a useful, natural and intrinsic disincentive to excessive drinking.^[35]

Within the limited amount of serious study on the subject, there is debate about whether a hangover may be prevented or at least mitigated. There is also a vast body of

Some sources indicate there is no evidence that any treatments for hangovers are effective.[5]^[36]

• Rehydration: Drinking water before going to bed or during hangover may relieve dehydration-associated symptoms such as thirst, dizziness, dry mouth, and headache.^{[4][22][37][38][39][40]}
• liver damage.^[36]
• Tolfenamic acid, an inhibitor of prostaglandin synthesis, in a 1983 study reduced headache, nausea, vomiting, irritation but had no effect on tiredness in 30 people.^[36]
• Pyritinol: A 1973 study found that large doses (several hundred times the recommended daily intake) of Pyritinol, a synthetic Vitamin B₆ analog, can help to reduce hangover symptoms.^[22] Possible side effects of pyritinol include hepatitis (liver damage) due to cholestasis and acute pancreatitis.^[41][42]
• Yeast-based extracts: The difference in the change for discomfort, restlessness, and impatience were statistically significant but no significant differences on blood chemistry parameters, blood alcohol or acetaldehyde concentrations have been found, and it did not significantly improve general well-being.^[36]

Unsupported remedies

Recommendations for foods, drinks and activities to relieve hangover symptoms abound. The ancient

• Fernet Branca^[51] and Bloody Mary.^[52]
• Kudzu (葛): the root ("lobata") been touted in the West as a remedy, though it's the flower ("flos") that is actually used in traditional remedies. A 2007 review finds evidence for the flower being potentially useful, but the root being likely harmful, as the latter is an inhibitor of ALDH2.^[53]
• Artichoke: Research shows that artichoke extract does not prevent the signs and symptoms of alcohol-induced hangover.^[36]
• abnormal heart rhythms.^[54]
• Oxygen: There have been anecdotal reports from those with easy access to a breathing oxygen supply—medical staff, and military pilots—that oxygen can also reduce the symptoms of hangovers sometimes caused by alcohol consumption. The theory is that the increased oxygen flow resulting from oxygen therapy improves the metabolic rate, and thus increases the speed at which toxins are broken down.^[55] However, one source states that (in an aviation context) oxygen has no effect on physical impairment caused by hangover.^[56]
• Fructose and glucose: Glucose and fructose significantly inhibit the metabolic changes produced by alcohol intoxication; nevertheless they have no significant effect on hangover severity.^[36]
• Vitamin B₆: No effects on alcohol metabolism, peak blood alcohol and glucose concentrations have been found and psychomotor function is not significantly improved when using Vitamin B₆ supplements.^[36]
• Caffeinated drinks: No significant correlation between caffeine use and hangover severity has been found.^[57]

Epidemiology

Hangovers occur commonly.

• A 1990 study of students at a rural New England university found that 25% had experienced a hangover in the previous week and 8% reported losing classes.^[58]
• Fifteen percent of men and women who have consumed alcohol experience hangovers at least monthly and 10% of British men reported hangover-related problems at work at least monthly.^[22]
• An estimated 9.23% (11.6 million workers) of the U.S. labor force work with a hangover.^[59]
• About 23% of drinkers do not report any hangover after drinking to intoxication.^[10]

Society and culture

A somewhat dated French idiomatic expression for hangover is "mal aux cheveux", literally "sore hair" (or "[even] my hair hurts").^[60] Some terms for 'hangover' are derived from names for liquor, for example, in Chile a hangover is known as a caña^[61] from a Spanish slang term for a glass of beer.^[62] Similar is the Irish 'brown bottle flu' derived from the type of bottle common to beer.^[63]

Alcohol hangover has considerable economic consequences. In Finland, a country with a population of 5 million persons, over 1 million workdays are lost each year because of hangovers. The average annual opportunity cost due to hangovers are estimated as 2000 (USD) per working adult.^[22] The socioeconomic implications of an alcohol hangover include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. Potentially dangerous daily activities such as driving a car or operating heavy machinery are also negatively influenced.^[7]

In mid-2017, it was reported that one company in the UK allows sick days when hung over.^[64]

As of 2019, South Korea's 'hangover-cure product' market, which comes in various formulations such as beverages, pills, and jelly, is a 250 billion won (US$213 million) industry.^[65]

Research

Psychological research of alcohol hangover is growing rapidly.^{[citation needed]} The Alcohol Hangover Research Group had its inaugural meeting in June 2010 as part of the Research Society on Alcoholism (RSA) 33rd Annual Scientific Meeting in San Antonio, Texas, USA.^[66]

In 2012, Éduc'alcool, a Quebec-based non-profit organization that aims to educate the public on the responsible use of alcohol, published a report noting hangovers have long-lasting effects that inhibit the drinker's capabilities a full 24 hours after heavy drinking.^[67]

See also

• Auto-brewery syndrome
• Comedown (drugs)
• Food drunk
• Rebound effect

References

Further reading

• "Hangovers Factsheet".
  NIAAA
  . March 2019. Retrieved 17 May 2019.
• Swift R, Davidson D (1998). "Alcohol hangover: mechanisms and mediators" (PDF). Alcohol Health and Research World. 22 (1): 54–60.
  PMID 15706734
  .
• Francis Bacon
  .

External links

Look up hangover or veisalgia in Wiktionary, the free dictionary.

Wikimedia Commons has media related to Hangover.