The Science of Hangover Cures


The search for hangover cures has been around for as long as alcohol has been. Although many cures and prophylactic agents are available, scientific evidence for their effectiveness is generally lacking. Most remedies do not significantly reduce overall hangover severity, and the search for a hangover cure has led people to claim they have found a solution through treatments as exotic as Korean pear juice, artichoke extract, yeast, the Japanese raisin tree, and Siberian ginseng.


When trying to come up with a hangover cure, it’s logical to assess what stage in the metabolism of alcohol should be targeted. Should hangover cures be administered in a prophylactic sense (i.e. before drinking)? Should they be given during consumption? Right before bed? Upon waking up? When you wake up after a night of drinking, the alcohol has mostly been metabolized. It’s actually the absence of alcohol in your system and the final drop of BAC (blood alcohol content) to 0 that causes you to wake up. The hangover is already there, so any hangover cures administered upon waking would likely fall in the realm of painkillers, which stress an already strained liver and endocrine system (as a brief PSA, all over-the-counter painkillers are a bad choice after drinking, but if you have to have something, have Tylenol, as the more common Advil or Ibuprofen increases the risk of gastrointestinal complications (1)). Because of this, hangover cures should come into play before and during the bout of drinking. Although solid evidence for a magical cure-all is hard to come by, there are a few steps you can take to minimize the dreaded morning-after feeling.

Nicotinamide and Zinc


Alcohol is metabolized in the liver via a two-step reaction. First, ethanol is oxidized (chemically combined with oxygen) to produce the intermediate product of acetaldehyde, a highly toxic substance that contributes largely to the severity of a hangover. Secondly, acetaldehyde is oxidized into acetate and water. This process is facilitated by the addition of a compound called nicotinamide adenine dinucleotide, which works as the energy behind this process. Without it, everything would grind to a halt, and you would be left with the toxic intermediate products that cause your hangover.


So how does knowing about this process have anything to do with a hangover cure? Well, we can speed it up. By increasing the amount of nicotinamide adenine dinucleotide, we give the metabolization process more energy, and the rate of the two-step reaction is proportionally increased. That special compound, nicotinamide adenine dinucleotide, is made from nicotinic acid, which is a fancier name for Niacin, a vitamin you can find at any grocery store or pharmacy (note: nicotinic acid has nothing to do with nicotine, so smoking is NOT a viable hangover cure). Along with Niacin, Zinc is essential to this metabolic pathway. It plays a role in the first step of the reaction, the preliminary conversion of ethanol to acetaldehyde. So, consumption of abundant amounts of Niacin and Zinc speed up the metabolization of alcohol, and importantly, decrease the number of toxic intermediate byproducts of the reaction that cause the hangover. The association of nicotinic acid and zinc intake with lessened hangover severity has been clinically shown in a peer-reviewed study in the Journal of Clinical Medicine, a reputable source (2). The study reported that social drinkers who had a higher dietary intake of nicotinic acid and zinc had significantly less severe hangovers (for those with some knowledge of statistics, the p-value for these tests was < 0.002) than those who had lower intake. Although the study had sample size limitations and relied on self-reporting of alcohol administration, it provides encouraging evidence that two cheap and widely-available nutrients can act as a viable hangover cure.


Water


The importance of hydration cannot be overstated. It’s not as fun as some magical pill that you can take and have your hangover disappear, but the extent of water’s importance as a countermeasure to hangovers is severely underemphasized. As a result of the diuretic nature of alcohol, on average, for every alcoholic beverage ingested, 250mLs (about 8.5oz) of water will be expelled (3). This means that if you are not offsetting that with 250mLs of water, you are working with a deficit, and this deficit will add up quickly over the course of a night. The best advice that anyone can give on preventing a hangover is one that has been around for as long as alcohol has been: for every alcoholic drink, have a glass of water. In social settings or at a crowded bar, this can be difficult, but the simple truth is that there are few shortcuts around hydrating, and nothing will work better.


Is “Hair of the Dog” Real?


Actually yes… kind of. Many enjoy continuing to drink the morning after, purporting that it is the best way to cure a hangover. Somewhat regretfully, I must admit that it is actually partly true. The science of a hangover, which I covered in a previous article, is complicated because of the many nuanced causes. One important cause is that the presence of high levels of methanol, a minor component of almost all alcohol, contributes to alcohol severity. Darker alcohols like red wine and whiskey have high levels of methanol and can give worse hangovers than clearer spirits like vodka or gin. Methanol is metabolized through the same process as ethanol (the major component of alcohol), but the body prioritizes the metabolization of ethanol over methanol. If we drink a substantial amount of alcohol, methanol metabolization, and thus our hangovers, occurs several hours after drinking. Readministration of ethanol through drinks in the morning further delays the metabolization of methanol, so we postpone the hangover. There are two important caveats. The first is that obviously, this doesn’t cure the hangover, it just puts it off for a few more hours; the dreaded symptoms will always just be right around the corner, waiting until the body runs out of ethanol and starts metabolizing methanol finally. The second is that it’s important to remember what hangover cures should be used for. The goal with hangover cures should not be to “cheat” the body by allowing us to drink more and feel better, as alcohol will always be a minor toxin and can hurt us internally no matter the severity of the external hangover. The goal is to figure out what we can take that allows us to drink but that minimizes the harmful effect of alcohol.

Myths


Although there is mixed evidence of the acute effects of dietary nutrients on hangover severity, increasing evidence points towards pre-drinking nutrient intake as a good target for a hangover cure. Anecdotal evidence would point us in the direction of large fatty and oily breakfasts for the morning after, and many would swear by a Gatorade before bed. However, there is little evidence to support that behavior. Food in general after waking up should start to replenish some of the nutrient stores that have been depleted, and Gatorade is just a less effective water (the sugar in it likely makes your hangover worse and offsets any benefit you may receive from an injection of low-levels of electrolytes). Pedialyte is another “cure” that has been adopted by young adults and although it undoubtedly contains high levels of electrolytes, no studies have been done on the chronic consumption of Pedialyte in the setting of a hangover. Pedialyte is a medication designed to manage fluid loss in young children after heavy bouts of diarrhea and vomiting. By drinking it, especially in the context of a hangover in which you have not vomited, you are likely ingesting far more electrolytes than needed, and this can cause a host of problems itself.


Failures and Causes for Hope


The market for hangover cures is enormous, so there are thousands of products in testing and it is very likely that standard hangover antidotes or lesseners will be widely available for the future. Currently, there are hundreds of products on the market. However, few have been studied using an independent, peer-reviewed, placebo-controlled, double-blind process. SJP-001, a new potential hangover cure, gives us a good example. A study was conducted to test its efficacy and compared to placebo, it reduced overall hangover severity (4). However, upon closer infection, we can see that the study, although placebo-controlled, had a tiny sample size of 13, and used a drug that contained naproxen, a common painkiller that can cause stomach bleeding when combined with alcohol. Another popular product called “Rapid Recovery” was recently put to the test in a double-blind, placebo-controlled, randomized study, and failed (5). While these serve as just two examples standing in for hundreds of others that have also been disproven, the sheer number of products being manufactured means that something will likely stick. More often than not, when enough scientists put their heads together and have a large financial incentive to create, they succeed. Just look at the COVID-19 vaccine: as a result of billions and billions of dollars in funding from private companies and federal governments, we are just a few months away from one of my most impressive scientific accomplishments, ever. Imagine if all that money went to hangover cures… we’d never be hungover again.


In summary...


Hangovers, as horrible as they feel, are important as a reminder to the body that overconsumption of alcohol is dangerous. We tend to have short-term memory when it comes to drinking, and most of the time, that’s okay. Once in a while, though, it’s good to give your body a break. So, what is the scientifically-supported cure for a hangover? Drink at least 250mLs of water for every alcoholic drink, avoid Gatorade, Pedialyte, and painkillers, and if you are expecting to have a particularly heavy night of drinking, take Niacin and Zinc pills. Or, if you have some quirky cure that you swear by, the placebo effect is real and if it works for you, keep doing it. Either way, enjoy the next day.

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