Avoiding hangovers

You didn’t mean to over-drink alcohol or you want to avoid a hangover! Avoiding a hangover, let's face it, is as simple as not over-indulging in alcohol. But if you do wake-up with a hangover, there are some solutions to help recovery. If you are predicting you may drink more than you should, or you’re not used to drinking alcohol, you can also take some precautions to avoid a hangover. Following are some suggestions which may help avoidance and aid a quick recovery. 

Symptoms of hangover

Feel a bit dusty… some, or all of the following symptoms in varying degree could be a result of excessive alcohol consumption.

• Headache – usually due to dehydration, electrolytes out of balance and/or vasodilation of blood vessels.
• Nausea – alcohol can irritate the gastrointestinal system and cause an increase in bile production. It can slow-down or speed-up digestion all of which can result in nausea, vomiting and diarrhoea.
• Fatigue – this again can be due to dehydration and also hypoglycaemia (low blood sugar). Low blood sugar can also cause dizziness and irritability.
• Sleep disturbance - resulting in next-day fatigue. Want to sleep but you can't.
• Anxiety – this can be influenced by personality – shyness is linked to Social anxiety disorder (SAD) and overly shy people may experience anxiety during a hangover.
• Sensitivity to light and noise.
• Balance issues – feel a bit wobbly on your feet.
• Immune system impairment – acute binge drinking can lower resistance to infection, whilst chronic drinking can make the body susceptible to respiratory infections, slow wound healing, liver disease, cancer and sepsis.

Why do you get a hangover?

Dehydration

This is most likely the main cause of hangover symptoms – the dry mouth, thirst, dizziness, headache and fatigue. Alcohol is a diuretic (meaning it makes you need to urinate more often). Hydrating before drinking alcohol and drinking plain or mineral water in-between alcohol drinks can help. Use a wine or spirit glass and add some ice cubes and a wedge of lemon and no-one will be the wiser (except you).

Your liver

It is the responsibility of liver enzymes to break down alcohol. Unfortunately, whilst the liver is busy dealing with alcohol, it is reducing or impairing other liver functions. This includes supplying glucose to the brain and other tissues of the body. Fatigue, weakness, inability to concentrate and bad mood are the result.

Your weight

The lower your weight the more likely you will suffer symptoms. Women will often feel the effects of alcohol before  men even when drinking the same amount. Not a good idea to try and match your drinks with a larger companion.

Oxidative stress

Hangover severity is significantly associated with oxidative stress. Consuming large quantities of alcohol results in an imbalance between the number of free radicals and antioxidants in the body. To counteract the resulting oxidative stress, more antioxidants are produced in the body. It is hypothesized that by providing nutrients which increase levels of antioxidants will help in preventing a hangover. Glutathione, vitamin C and vitamin E are antioxidants which can help.

Genetics and age. Some people just don’t tolerate alcohol and younger drinkers experience more severe hangovers

Immunity. Whilst drinking too much can lower your immunity, a poor health status can contribute to hangover. Don't drink alcohol if you are unwell. 

What you drink matters

Fermenting alcohol produces by-products and these by-products, called congeners, can make a hangover worse. Common congeners are methanol, tannins and acetaldehyde. Some alcohol beverages have more congeners than others.

The Darker spirits – such as bourbon, whiskey and brandy, have higher amounts, as does red wine.

Lower-end spirits (the cheaper ones) will often contain impurities due to a lower level of filtration.

Clear liquors such as vodka and gin have the lowest amounts of congeners or none at all.

The sweeter the drink – the more you might drink. Taste buds crave sugar and sweet drinks (cocktails) often mask alcohol or contain more alcohol.

Preventing hangovers

The rate of alcohol metabolism is an important determinant to the severity of a hangover – meaning the quicker the body can eliminate ethanol the less severe the hangover. This may be due to ethanol’s ability to cross the blood-brain barrier – so the more ethanol that is able to reach the brain equals the more severe the symptoms.

Alcohol dehydrogenase is the primary defence against alcohol. This enzyme is found in the stomach and liver and can detoxify approximately one strong drink per hour. Alcohol is converted to a more toxic molecule, acetaldehyde, which has to be quickly converted to acetate and other molecules for cells to use. Many types of alcohol dehydrogenase are created by the body and used for different task including providing protection against toxicity.

Nutrients which influence alcohol metabolism

Two important nutrients important in alcohol metabolism are nicotinic acid and zinc.

Vitamin B3 (nicotinic acid) 

Alcohol breakdown rate is largely determined by the presence of two enzymes vital in catalyzing the alcohol metabolism, alcohol dehydrogenase (ADH) and mitochondrial aldehyde dehydrogenase (ALDH). These processes rely on nicotinamide adenine dinucleotide (NAD+).

Vitamin B3 (nicotinic acid/nicotinamide) converts biochemically to NAD+, an essential biological molecule in the body that supports the functioning of cells. The results are energy, an alert brain and efficient detoxification. Recent studies have confirmed that NAC+ can reduce the effects of alcohol on the liver and prevent fat accumulation.

Zinc

Zinc is essential in the conversion of ethanol into acetaldehyde. Supplement with zinc before drinking or after alcohol. Zinc is best taken with food. 

Food before alcohol

Food intake has a significant impact on alcohol metabolism. Eating food before or during alcohol consumption reduces blood alcohol concentration, decreases absorption and slows metabolism. Choose highly nutritious foods and energy-rich foods full of phytonutrients and antioxidants, vitamins and zinc.

Ginseng

Ginseng can help clear alcohol from the blood and increase detoxification. It does this by removing toxic metabolites which are formed in the breakdown of alcohol. Choose Panax ginseng (Korean ginseng), Panax quinquefolius (American ginseng), Panax notoginseng and Chinese Notoginseng.

Siberian ginseng (Acanthopanax senticosus)

Siberian ginseng extract (not a true ginseng) is rich in polysaccharide with the potential to reduce the severity of a hangover by inhibiting the alcohol-induced hypoglycaemia and inflammatory response.

Points to ponder

Alcohol is toxic to the nervous system. It has to be made safe by the body through enzymes found in the liver and stomach. It can do this more efficiently if you eat healthily before and during drinking, and you remain hydrated. Some herbs and nutrients can help with this detoxifying process such as NAD+, Zinc, ginseng and Acanthopanax senticosus. Other support includes glutathione and vitamin C and E. Do not drink alcohol if you are not well. 

References

1. An Event-Level Investigation of Hangovers’ Relationship to Age and Drinking https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579002/
2. Shyness, alcohol use disorders and ‘hangxiety’: A naturalistic study of social drinkers https://www.sciencedirect.com/science/article/abs/pii/S0191886918305762?via%3Dihub
3. Perceived Immune Fitness, Individual Strength and Hangover Severity https://pubmed.ncbi.nlm.nih.gov/32517084/
4. The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692803/#B45-jcm-09-03421
5. Alcohol Dehydrogenase https://pdb101.rcsb.org/motm/13
6. Alcohol and the Immune System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590612/
7. Low sensitivity to alcohol: relations with hangover occurrence and susceptibility in an ecological momentary assessment investigation https://pubmed.ncbi.nlm.nih.gov/23036210/
8. The role of beverage congeners in hangover and other residual effects of alcohol intoxication: a review https://pubmed.ncbi.nlm.nih.gov/20712591/
9. Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: a randomized crossover study https://pubmed.ncbi.nlm.nih.gov/24458173/
10. Clinical effect of a polysaccharide-rich extract of Acanthopanax senticosus on alcohol hangover https://pubmed.ncbi.nlm.nih.gov/26012258/
11. Interventions for treatment and/or prevention of alcohol hangover: Systematic review https://pubmed.ncbi.nlm.nih.gov/28568743/
12. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/acetaldehyde
13. Nicotinamide riboside attenuates alcohol induced liver injuries via activation of SirT1/PGC-1α/mitochondrial biosynthesis pathway https://www.sciencedirect.com/science/article/pii/S2213231718300624
14. Dietary Nutrient Intake, Alcohol Metabolism, and Hangover Severity https://pubmed.ncbi.nlm.nih.gov/31461972/
15. The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692803/