opinion / To your good health: in vino sanitas The rules, myths,


and facts of hangovers Dr Erik Skovenborg


life.” Alcohol affects first the functions of the prefrontal cortex, the part of the brain responsible for judgment, reasoning, and suppressing impulsive behavior. That’s why after a few drinks you lose some of your inhibitions and feel more confident venturing out of your comfort zone. People use alcohol as an aid to conviviality, and the early effects make them feel “new.” Since they want to drink, too, the intake is apt to increase and may be excessive.


A


Hangover susceptibility A hangover develops when blood alcohol concentration (BAC) returns to zero, and it is characterized by symptoms provoked by having drunk too much (which varies by drinker). The 2010 Alcohol Hangover Research Group consensus paper defined a cutoff BAC of 110mg of alcohol per 100ml of blood as a toxicological threshold indicating that sufficient alcohol had been consumed to develop a hangover. The cutoff was based on previous research and applied mostly in studies comprising students. However, a substantial number of participants reported hangovers at comparatively lower BAC levels. Recent research has shown that subjective intoxication—that is, the level of severity of reported drunkenness—and not BAC is the most important determinant of hangover severity.1 To make matters more complicated, the presence and severity of alcohol hangovers are influenced by many factors other than the amount of alcohol: 1. Individual susceptibility to hangovers. a. Sex: In younger age groups, subjective intoxication and hangover severity are higher in women; however, the sex differences become significantly smaller or absent in the older age groups. b. Age: With increasing age, drinkers report significantly lower levels of intoxication and experience less severe hangovers correcting for BAC. The results


108 | THE WORLD OF FINE WINE | ISSUE 79 | 2023


ccording to George Bernard Shaw, “Alcohol is the anaesthesia by which we endure the operation of


suggest that with increasing age, tolerance develops for both subjective intoxication and the aftereffects of alcohol consumption, in addition to a gradual decline in pain sensitivity.2 c. Psyche: “Wine is only sweet to happy men,” wrote an unhappy John Keats to his sweetheart. An analysis of the relationship between affective states and hangover symptoms found that factors such as guilt about drinking, a neurotic personality, becoming angry or depressed while drinking, and having suffered “negative life events” within the past 12 months were better predictors of symptoms of hangover than the amount of ethanol drunk.3 d. Resistance: A literature review to assess the incidence of hangover suggests that around 23 percent of alcohol drinkers may be resistant to hangover.4 2. Congeners in alcoholic drinks. Congeners are complex organic substances such as polyphenols that contribute greatly to the aroma and flavor of most alcoholic beverages. Dark drinks, which contain more congeners than light drinks, produce more severe alcohol hangovers. In a study with 20 volunteers, the severity of hangover symptoms declined in the order of brandy, red wine, rum, whisky, white wine, gin, and vodka.5 3. Lack of sleep. Drinking time often goes at the expense of sleep time, and drunkenness is associated with disrupted sleep. Some hangover symptoms are related to sleep duration and quality, and not to the amount of alcohol consumed.6 4. Smoking. The number of cigarettes consumed on the day of a heavy drinking episode (BAC  110mg/100ml) predicted the presence and severity of hangover symptoms the following day, heavier smoking predicting greater hangover.7


Symptoms and signs of hangover The exact biological mechanisms that produce the symptoms of a hangover after alcohol is eliminated from the body are not well understood, so let’s skip the intriguing hypotheses and go directly


to the long list of hangover sufferings: • loss of appetite and nausea; • heartburn and sour belching; • headache and muscle aches; • fatigue and general malaise; • dehydration and thirst; • palpitations and the shakes; • apathy and drowsiness; • anxiety and remorse.


How to prevent or cure a hangover Unfortunately, the search for a hangover cure has always had very limited success. A recent review reveals that the research on hangover cures is so inconclusive that it is difficult to make any legitimate scientific conclusions about what actually works. This is not to say that any “cure” is without merit; rather, the problem is that the quality of the scientific studies on possible hangover treatments is very poor.8


In the absence of a hangover cure


with proven efficacy, you are better served with a set of rules first and foremost to prevent hangovers, and another set of rules to mitigate a hangover as backup.


Rules to prevent a hangover: • Eat a ham-and-cheese sandwich before drinking;


• Drink more water and less alcohol; • Go slow on dark drinks with congeners; • Drink a pint of water when you get home, and keep a jug of water on hand through the night;


• Eat a hot dog or burger before bed; • If headachy, take simple analgesics.


Rules to mitigate a hangover: • Drink plenty of water, juice, or tea; • Eat whatever your appetite craves; • Take a hot shower or a warm bath; • Go for a long walk, come rain or shine; • If headachy, take simple analgesics.


Role of water, food, and sleep A royal water cure has been attributed to Princess Diana. After a Champagne party, prior to retiring, she would prepare a bag of orange segments and mini-bottles of


Illustration by Dan Murrell


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