You and your New Year’s Eve hangover

Or, everything you always wanted to know about drinking but the LA Times won’t tell you!

So, I spent several years teaching alcohol education and harm reduction at one of the top “party schools” in the US. While my program’s primary goal was to reduce problem drinking among students, our harm reduction focus meant that anything that reduced alcohol’s negative impacts – missed class, lowered academic performance, mess and destruction in the dorms, interpersonal violence and sexual assault, etc. – was useful even if it didn’t stop students from drinking.

So I took it on myself to learn as much as I could about what alcohol actually does in the body, and to make use of the research to figure out how to best reduce its harmful impacts, so if you do choose to drink, and you sometimes drink to excess, you can at least mitigate the negative results. And here’s what I’ve learned, and what I apply in my own life.

The best way to reduce your chances of getting a hangover is to not drink so much. Duh.  When in doubt, remember this rule.

It bears pointing out: Most people do not actually have that much fun when they are staggering, vomiting, blacking-out drunk. The goal of most drinkers is to “catch a buzz” and maintain it over time. The best way to do this is to slow down your alcohol intake, because alcohol takes time to be absorbed by the body. If you do three shots in quick succession, you won’t feel the full impact of that alcohol for up to 30 minutes, and if you’ve been drinking in the meantime, you’ll way over-shoot the mark.

Shots:  The best way I know to really, really hurt the next day.

So why do we get hangovers?  Hangovers are made up of seven primary effects: dehydration, inflammation, the effect of byproducts of alcohol metabolism, the effect of alcohol congeners, nutritional imbalances including low blood sugar, withdrawal, and bad sleep.

(if this post is TL, DR, skip ahead to “In Summary” for the takeaway points without the explanations)

1) Dehydration. Alcohol suppresses the production of vasopressin, a hormone that regulates kidney function. Essentially, this hormone tells the kidneys “concentrate the urine; don’t pass more fluid than is needed.” Without it, you start to excrete a much greater volume of urine than normal, which leaves you in a dehydrated state. Dehydration can lead to headaches, dry mouth, dizziness when you stand up, fatigue, and confusion. It can also throw off the balance of electrolytes in your blood, particularly sodium.

To combat dehydration: Hydrate! Alternating alcohol and non-alcoholic drinks while drinking will help, but when you stop drinking, it’s important to keep re-hydrating. It’s also important to restore your electrolyte balance, so something salty like crackers or cheese is a good pre-bedtime snack.

2) Inflammation. Alcohol produces an inflammatory response all over the body. The one we’re most aware of is inflammation (and mechanical irritation) of the stomach lining, which is part of the nausea drinkers feel the next day. But inflammation also extends to the membrane surrounding your brain (so you feel like your brain is bouncing off the inside of your skull), the optic nerves (hence the light sensitivity), and your joints and muscles (that all-over body ache that feels like the flu).

To combat inflammation: Take an anti-inflammatory. Asprin is not a great choice because it can irritate your stomach, and acetaminophen (Tylenol) should be AVOIDED as it can create liver toxicity in combination with alcohol. Your best choice is the over-the-counter dose of an NSAID like ibuprofen (Advil, Motrin). Don’t take a mega-dose as this can also hurt your liver; just take one or two as specified on the package. Take them before you go to bed, with your water, and take another dose in the morning.

3) Byproducts of alcohol metabolism. Alcohol is a complex molecule that takes several steps to break down in the liver. Each step requires a different enzyme, and each step takes time that can vary depending on your body weight, gender, ethnicity, age, and alcohol tolerance. The intermediate steps create acetaldehyde, then acetic acid. Acetaldehyde is a fairly severe irritant to your body tissues, and contributes to fatigue, sweating, nausea, and malaise. It also inhibits some energy production in your body’s cells.

To combat these byproducts: Be a young non-Asian male of a large build who drinks regularly. (Production of the enzymes that break down alcohol is related to gender, race, age, overall body size/weight, muscle/fat ratio, and alcohol consumption.  Regular consumption increases enzyme production as a protective mechanism, which sounds good… but this condition, called “tolerance,” can be a sign of problem drinking.  And breaking down alcohol molecules faster doesn’t protect you from all the other aspects of hangovers!)

Failing that, a B-complex vitamin, taken before bed with your water and NSAID, may help. B-12 may help with energy conversion, and B-6 seems to also be useful in binding to the toxins produced by metabolism, though its exact mechanism is unknown.

Also, slow down your drinking so you don’t overwhelm your body’s metabolism rate. Follow hard alcohol with low-proof, high-volume drinks like beer or cider; order highballs (alcohol plus a mixer like tonic, soda, Coke, etc. – e.g. rum and coke, gin and tonic) made “tall” with double the mixer, or just alternate alcoholic drinks with water. The old adage “liquor then beer, never fear; beer than liquor, never sicker” has truth to it – if you decrease the proof and increase the volume of your drinks as the night goes on, you’ll naturally slow down your intake, but if you drink harder and harder alcohol as your inhibitions get lowered and your perceptions get dulled, it’s easy to over-consume.

An associated tactic for slowing down your absorption rate is to eat a meal before drinking, reducing the surface area in the stomach and small intestine available for absorbing the alcohol. Fat molecules, being the most complex to break down, stick around and run interference the longest. Proteins are also helpful, and they can bind to toxins themselves.

4) Alcohol congeners. Congeners are all those molecules that give alcohol its various flavors and colors. Generally, darker drinks (red wine, bourbon, scotch) have more of them than lighter drinks (white wine, vodka, gin); however, the production process matters as well and a cheap vodka can have congeners that cause some people problems who are unfazed by drinking good bourbon. Everyone’s reaction to particular congeners is different, so only you know whether rum is your friend while gin always makes you miserable the next day or vice versa. The more types of alcohol you drink, the more congeners you’re introducing into your system, creating potential interactions (one of my worst hangovers was a night when I had one beer, one glass of red wine, one tequila, and one gin, over the course of 7 or 8 hours – I never even felt intoxicated!  But I suffered the next day.)

To combat congeners: Stick to one or two types of alcohol. Mixing really can create problems. B-vitamins may help some in binding to or blocking the effects of some congeners but this isn’t well understood.

5) Nutritional imbalances. As mentioned previously, dehydration can throw off your electrolytes. Alcohol metabolism also interferes with the body’s ability to compensate for a drop in blood glucose levels, and particularly if you’ve been drinking sweet drinks, their sugar may have driven your blood glucose sky high, producing a spike in insulin, producing a drop in blood glucose, leaving you hanging out to dry the next day. This results in fatigue, muscle weakness, mood disturbance, nausea, and shakiness.

To combat malnutrition: Eat before you go out drinking. Eat while you are drinking, particularly proteins and fats rather than simple carbs that will spike your blood sugar and then vanish. Eat something when you come home. Something like cheese and crackers or a chicken breast will help with blood sugar, electrolytes, and alcohol toxins. Take a multivitamin. In the morning, eat something simple and easily metabolized, like low-acid fruit juice (apple, peach, pear, grape) to start off with. As your blood sugar stabilizes, you’ll be able to figure out what kind of food you can tolerate if you’re having stomach issues, but eating something is important.

(If you’re trying to offset the calories of drinking by not eating:  DON’T.  That’s a one-way ticket to Hangover-ville, and it’s no way to treat your body.)

6) Withdrawal. When you drink, there are changes in the levels of two regulating chemicals in your brain, GABA (which regulates excitability or stimulation) and glutamate (which creates stimulation). Because alcohol is a depressant, the body attempts to counteract its effects by kicking up your glutamate levels and reducing your GABA levels. By the next day, the alcohol is gone but your brain hasn’t re-set itself yet, so you are still suffering the effects of too much glutamate, effectively producing short-term withdrawal symptoms like shakiness, weakness, and even mild heart palpitations in severe cases. (Severe withdrawal, like when a chronic alcoholic quits “cold turkey,” can be fatal and needs medical supervision.)

To combat withdrawal: This is why people (foolish, reckless people!) recommend “the hair of the dog,” or more alcohol. However, drinking again is only going to prolong the cycle. If you’re having severe withdrawal symptoms, a very small amount of alcohol might help in the short term, but in general, using a substance to combat the effects of withdrawal of that substance is a Very Bad Sign and should be avoided. The only real cure here is time, so your body can re-regulate itself.

(What, you thought there was a total cure for bad decision-making?  Dream on!  This is harm reduction, not harm insulation.  Remember the first rule:  DRINK LESS.)

7) Bad sleep. Alcohol interferes with REM sleep, the deep sleep where you feel rested. The GABA/glutamate imbalance mentioned previously can contribute to early awakening. So can getting up to use the bathroom during the night because your body is still over-producing fluid, or because you’re sick to your stomach.
To combat bad sleep: Create a good sleeping environment – dark and quiet. You will be sleeping more lightly and thus will be easier to arouse. Build in time for a nap. If you wake up and can’t sleep, get up for a while, use the time to hydrate and eat something, and then return to bed – lying down quietly, even if you’re not sleeping, is more restful than sitting up watching TV or playing video games. Don’t expect yourself to be functioning at peak efficiency the next day, regardless.

In summary:

Before you go out, eat something. Start the night off well-fed and well-hydrated. As you drink, pace yourself and alternate with non-alcoholic beverages. Stick with one or two types of alcohol. Continue to eat when possible throughout the night.

When you come home (safely please), drink a big glass of water. With that water, take a multivitamin, a normal dose of ibuprofin, and a B-complex vitamin. Eat something with some fat, salt, and protein. Toss the cat and dog out of the bedroom, pull the curtains, put on your sleep mask, and get what sleep you can.

When you wake up, take more ibuprofin, continue to hydrate, drink juice if your blood sugar is low, then feed yourself whatever sounds good.

And be careful out there.  Don’t go out without plans for a safe ride home, whether it’s a free tow and ride from Triple-A or a free cab ride or just staying in and being safe.  Have a happy, safe, harm-reduction-inspired New Year’s!