Lena Savoie
Hangovers are the unpleasant consequence of drinking too much alcohol. Symptoms typically appear when the body has reduced alcohol in the system to a minimal level, and can last for up to 24 hours. The more alcohol consumed, the more likely a hangover is, and the more severe the symptoms. Hangover symptoms include fatigue, weakness, thirst, headache, muscle aches, nausea, stomach pain, vertigo, sensitivity to light and sound, anxiety, irritability, sweating, and increased blood pressure. The cause of a hangover is alcohol, but other factors, such as dehydration, the way alcohol is metabolised in the body, and the presence of toxic byproducts and congeners, can contribute to the severity of symptoms.
| Characteristics | Values |
|---|---|
| Symptoms | Fatigue, weakness, thirst, headache, muscle aches, nausea, stomach pain, vertigo, sensitivity to light and sound, anxiety, irritability, sweating, increased blood pressure, tremors, increased heart rate, dry mouth, dizziness, low blood sugar, mild dehydration, inflammation, diarrhoea, etc. |
| Causes | Excessive drinking, dehydration, toxic byproducts of alcohol metabolism, congeners (toxic compounds found in alcoholic beverages), alcohol withdrawal, low blood sugar, inflammation, etc. |
| Risk Factors | Amount of alcohol consumed, gender, body weight, type of alcohol, timeframe of consumption, dilution of beverage, time since last meal, genetics, family history of AUD, personality traits, etc. |
| Treatment | Time, non-steroidal anti-inflammatory drugs (NSAIDs), drinking less alcohol, drinking water, eating before and during drinking, avoiding drinking in "rounds", limiting to one drink per hour, etc. |
| Driving | It is unsafe to drive with a hangover, even if your blood alcohol level is normal, due to impaired concentration and coordination. |
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What You'll Learn
Alcohol withdrawal
Withdrawal symptoms can range from mild to severe and typically begin within 6 to 24 hours after the last drink. Mild symptoms include headache, anxiety, insomnia, upset stomach, and excessive sweating. More severe symptoms can include hallucinations, tremors, increased heart rate, high blood pressure, and hyperthermia. The most severe form of alcohol withdrawal is delirium tremens, which can be life-threatening.
The timeline of alcohol withdrawal symptoms typically follows a pattern. Within 6 to 12 hours after the last drink, mild symptoms may appear. Within 24 hours, hallucinations may occur, and between 24 to 72 hours, symptoms typically peak for those with mild to moderate withdrawal. For those with severe withdrawal, the risk of seizures is highest during this period. Symptoms can last for several days and, in some cases, may persist for weeks or even months.
Treatment for alcohol withdrawal depends on the severity of symptoms. Mild-to-moderate cases can often be treated in an outpatient setting, while more severe cases may require hospitalisation or admission to a facility specialising in alcohol withdrawal treatment. It is important for individuals experiencing alcohol withdrawal to be monitored closely, especially for signs of delirium tremens. Total and lifelong abstinence from alcohol is recommended for those who have gone through alcohol withdrawal to prevent relapse and ensure long-term recovery.
While a hangover is not the same as alcohol withdrawal syndrome, some experts believe that certain hangover symptoms, such as sweating, anxiety, tremors, and increased heart rate, may be attributed to the mini-withdrawal effects of alcohol. Hangover symptoms typically occur when blood alcohol content has dropped considerably and is near zero, and they can last up to 24 hours. These symptoms include dehydration, fatigue, weakness, thirst, headache, nausea, stomach pain, sensitivity to light and sound, irritability, and increased blood pressure.
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Dehydration
However, some studies dispute this theory, arguing that hangover and dehydration are two co-occurring but independent consequences of alcohol consumption. While the symptoms are similar, the studies found that electrolyte levels in hungover people and control groups were roughly the same, and that water consumption did not effectively alleviate hangover symptoms.
Regardless of the exact role dehydration plays in causing hangovers, staying hydrated with water is still recommended when drinking alcohol. Drinking water between alcoholic drinks can help to reduce the risk of dehydration and may also help to reduce the severity of a hangover.
In addition to dehydration, there are several other factors that contribute to hangover symptoms. These include inflammation caused by alcohol metabolism, the toxic byproducts of alcohol metabolism such as acetaldehyde, mini-withdrawal from alcohol, low blood sugar, disrupted sleep, and the way alcohol is processed by the liver.
It is important to note that the more alcohol you drink, the more likely you are to experience a hangover. Limiting alcohol intake to the recommended number of standard drinks is the best way to avoid a hangover. Additionally, it is recommended to eat something before drinking and to drink at your own pace, rather than in "rounds."
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Toxic byproducts of alcohol metabolism
A hangover is a milder form of alcohol withdrawal. When the body processes alcohol, one of its byproducts is acetaldehyde, a highly reactive and toxic compound. While acetaldehyde is generally short-lived in the body, it can cause inflammation in organs, leading to uncomfortable symptoms such as a fast pulse, sweating, and nausea.
Acetaldehyde (CH3CHO) is a known carcinogen, and it is produced when the enzyme alcohol dehydrogenase (ADH) breaks down ethanol. This process occurs mainly in the liver, but also in other tissues, including the pancreas and brain. The toxicity of acetaldehyde is particularly evident in the liver, where the bulk of alcohol metabolism takes place, and it can contribute to tissue damage and the formation of damaging molecules known as reactive oxygen species (ROS).
Some individuals have a genetic inability to process acetaldehyde fast enough, a condition known as acute alcohol intolerance. This can lead to a greater intensity of hangover symptoms and unpleasant reactions, such as facial flushing, nausea, and a rapid heart rate, even after moderate alcohol consumption.
Acetaldehyde is further broken down into acetate (CH3COO-) by the enzyme aldehyde dehydrogenase (ALDH). Acetate is a less toxic compound that is eventually metabolized into carbon dioxide and water. However, acetate can cross the blood-brain barrier and impact GABA, an inhibitory transmitter, leading to impaired motor function.
The genetic makeup of an individual is a significant factor in how efficiently alcohol is broken down and eliminated. Variations in the enzymes ADH and ALDH can lead to a toxic buildup of acetaldehyde, causing dangerous or unpleasant effects.
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Inflammation
The inflammatory response to alcohol consumption is well-documented, with research suggesting that it plays a significant role in the pathology of a hangover. The presence of ethanol in the body, even several hours after drinking, can elicit an oxidative stress response and a more profound inflammatory response. This results in more severe hangover symptoms. The immune system also plays a role in the inflammatory response to alcohol, with elevated levels of cytokines in the blood and saliva associated with the presence and severity of a hangover.
In addition to the direct impact of alcohol on inflammation, the body's processing of alcohol can also contribute to inflammation. The liver breaks down alcohol in two steps, first converting it to acetaldehyde and then to the non-toxic substance acetate. This process can increase fatty substances in the liver and other organs, leading to inflammation and an upset stomach. The irritation of the stomach lining, or gastritis, caused by alcohol can lead to nausea, vomiting, and stomach pain.
The inflammatory response to alcohol consumption can be mitigated through the use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. These drugs can help ease the aches and pains associated with inflammation during a hangover. However, it is important to use them sparingly as they can upset the digestive system. While there is no quick cure for a hangover, staying hydrated, getting enough sleep, and allowing the body to clear the toxic byproducts of alcohol metabolism can help alleviate the symptoms associated with inflammation and overall hangover discomfort.
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Congeners
Research suggests that congeners may play a role in the occurrence and severity of hangovers. Drinking beverages with more congeners usually causes a worse hangover than drinks with fewer congeners. This is because the body has to break down the congeners, in addition to ethanol, which may cause hangover symptoms to last longer. However, congeners are not the only cause of hangovers, and ethanol itself is the main source of hangover effects.
Some drinks that are high in congeners include tequila, cognac, whiskey, and bourbon. Bourbon has a substantial amount of congeners, with 4,766 milligrams of methanol per liter. Rum has 3,633 milligrams of methanol per liter, and vodka has 102 milligrams per liter. In comparison, beer contains just 27 milligrams of methanol per liter.
To avoid a hangover, it is recommended to limit your consumption of dark alcohol, as these drinks tend to have higher congener levels. It is also important to drink on a full stomach, as this slows down alcohol absorption and gives the body more time to break down congeners and ethanol.
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Frequently asked questions
A hangover is a set of symptoms that occur as a consequence of drinking too much. Typical symptoms include fatigue, weakness, thirst, headache, muscle aches, nausea, stomach pain, vertigo, sensitivity to light and sound, anxiety, irritability, sweating, and increased blood pressure.
There are many factors that contribute to the symptoms of a hangover. These include dehydration, the way alcohol is metabolised in the body, inflammation, and toxic byproducts of alcohol metabolism.
Yes, alcohol is still in your system when you have a hangover. Symptoms tend to peak when your body has reduced the amount of alcohol in your system to zero, and can last for up to 24 hours afterward.
There is no scientifically proven cure for a hangover. The only way to get rid of a hangover is to wait for the body to finish clearing the toxic byproducts of alcohol metabolism, to rehydrate, to heal irritated tissue, and to restore immune and brain activity to normal.
The best way to prevent a hangover is to avoid alcohol or limit your intake. Other tips include not drinking on an empty stomach, drinking water between drinks, and avoiding drinking in "rounds" so that you can drink at your own pace.
