YOU can sense them circling above. If you’ve really overdone it, you might
even be able to see them: vultures, ready to pick at your poor wretched body as
it lies sodden with yuletide alcohol or wracked with self-inflicted hangover
pains—throbbing head, raging thirst, mind-numbing nausea and a body that
has turned to jelly. You long for a potion that turns carrion back into living
flesh before the vultures tuck in.
History is awash with hangover remedies. Pliny the Elder’s favourite fix back
in the first century AD was a couple of fresh owl eggs. Medieval rakes survived
on chopped eels garnished with bitter almond. Hollywood hellraisers of the 1950s
simply drank some more. And today there are the old dependables such as Bloody
Marys, prairie oysters, greasy fry-ups, sugary tea and black coffee. Yet where,
after centuries of alcohol-lubricated civilisation, is the science-based,
clinically tested, fail-safe cure for the second curse of the drinking
classes?
Perennial yuletide sufferers will be pleased to know that New
Scientist’s inquiries have shed some light on the age-old quest for
hangover relief, and turned up good reasons why some traditional tonics have
survived. They might be more alarmed to discover, however, that the search for a
magic bullet is doomed by a lack of will and cash.
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Best ally
None of the major brewers, vintners or distillers contacted by New
Scientist is developing hangover cures. They want to avoid the charge that
by supplying a morning-after pill, they will be tempting light drinkers to
overdo it. Governments already have enough trouble keeping the lid on the
widespread social and medical problems caused by alcoholism without neutralising
their best ally—nature’s own retribution for overindulgence. “Hangovers
have a useful deterrent value,” says Ian Calder, an anaesthetist at London’s
National Hospital for Neurology and Neurosurgery.
Ethical committees in hospitals and research institutes are another hurdle.
They are unlikely to approve research that would inevitably make people
paralytic. “The studies on hangovers are really few and far between, and those
that exist are primarily on how alcohol affects motor skills,” says Marrku
Linnoila, a researcher at the National Institute on Alcohol Abuse and Alcoholism
in Rockville, Maryland. Calder, who scoured the literature for a review of
hangover-related research in the British Medical Journal earlier
this year, agrees. He says that there was some rudimentary research around 30
years ago, but some experiments simply got out of hand. “Volunteers got so drunk
they were falling over and injuring themselves, and trying to crawl out of the
±ô˛ą˛ú´Ç°ů˛ąłŮ´Ç°ů˛â.”
So, ethics and well-founded fears about alcohol abuse are frustrating the
quest for a hangover cure. But sufferers can learn plenty from the underlying
science, some of which might point the way to concocting a decent DIY
remedy.
Swig it down
For a start, the metabolic fate of alcohol once we swig it down is well
known. Ethanol, to give it its chemical name, percolates through our whole body
after entering the bloodstream via the gut. A small amount has no adverse effect
and leaves completely raw. We breathe out alcohol that reaches our lungs, and
pee out any that arrives in the kidneys.
Most of it ends up in the liver, however
(see Diagram). Here, in cells
called hepatocytes, enzymes immediately go to work. First into the fray is
alcohol dehydrogenase, which converts the ethanol into a more poisonous
substance called acetaldehyde. Fortunately, before this has a chance to do much
damage, a second enzyme called aldehyde dehydrogenase wades in and converts the
acetaldehyde into relatively harmless acetic acid. This is then drained out of
the liver and finds its way into the bladder.
Some researchers believe that a hangover is caused by a backlog of
acetaldehyde waiting to be converted—particularly the queasy feeling and
throbbing head. The rationale for this is well-founded. Firstly, an effective
treatment for alcoholics is a substance called disulfiram or Antabuse,
which disables aldehyde dehydrogenase, allowing acetaldehyde to build up the
moment they imbibe. This causes headaches, vomiting and a nausea so horrendous
that even the most hardened alcoholic shies away from the bottle.
Further evidence that acetaldehyde is to blame comes from Japan. Here, half
the population carries a defective gene for aldehyde dehydrogenase and, after
too many glasses of beer or sake, they suffer the nausea and headaches normally
reserved for alcoholics on disulfiram. “It’s almost like built-in Antabuse,”
says Wayne Jones, a veteran of research on alcohol at the National Laboratory of
Forensic Toxicology in Linköping, Sweden.
Jones’s own experiments have shifted the blame for hangovers away from
ethanol and its breakdown products. His work also backs up the idea that a bit
more booze eases a hangover—the so-called “hair of the dog” approach.
Jones suggests that methanol, not ethanol, is the culprit. Methanol is found in
all alcoholic drinks in varying amounts. Darker wines and spirits such as cheap
red wine, cognac, fruit brandies and whiskies contain most methanol, sometimes
as much as 2 per cent by volume. Spirits such as vodka contain least.
In 1987, Jones and his colleagues showed that volunteers began suffering
symptoms of hangovers long after all ethanol and its breakdown products had been
excreted. The severity of their hangovers tallied with the amount of methanol in
the drinks they consumed. Jones proved that the enzymes alcohol dehydrogenase
and aldehyde dehydrogenase work both on ethanol and methanol, but that they
destroy ethanol more quickly
(see Diagram).FIG-mg21135901.JPG
While the ethanol breaks down into acetic acid fairly rapidly, the enzymes
take ten times as long to break down methanol into a substance called formic
acid, which is extremely poisonous and can cause symptoms typical of hangovers.
Sure enough, Jones found that the timing of methanol breakdown coincides with
the worst hangover symptoms.
Drinking a “hair of the dog” blocks the breakdown of methanol by switching
the enzymes to the priority task of breaking down ethanol. Methanol is later
broken down more gradually, and so hangover symptoms are eased. In fact, Jones
says that ethanol has long been used in emergencies for detoxifying people
poisoned with methanol.
Jones has also proposed another substance which blocks breakdown of methanol,
4-methyl pyrazole, as a possible way to prevent the misery of the morning after.
Thomas Gilg and colleagues at the University of Munich’s department of forensic
chemistry have proved it works. In 1993 they took 4-methyl pyrazole with plenty
of plum brandy and managed to avoid a hangover. However, the drug is being
developed only as a replacement for ethanol in methanol detoxification, not as a
hangover cure.
Herbal helper
One top tip for a scientific cure actually on the market is N-acetyl-cysteine
(NAC), an amino acid supplement available from most herbal medicine stores. NAC
may work by easing the strain on your body as it tries to cope with a flood of
alcohol. The enzymes which destroy ethanol and methanol need the assistance of
two “helper” substances. The first, nicotinamide adenine dinucleotide (NAD), is
responsible for taking away the hydrogen atoms snipped out of ethanol and
methanol. The body recycles this compound and it never runs out. But the second,
glutathione, is in limited supply. Glutathione is used up clearing away powerful
oxygen radicals—the toxic debris from the destruction of ethanol and
methanol. Left unchecked, the radicals damage tissues and, possibly, cause
hangover symptoms.
NAC might be valuable as a hangover treatment because it replenishes the body
with the amino acid cysteine, the main component of glutathione. When stocks of
glutathione start running low as the body tries to keep pace with the flow of
alcohol, a dose of NAC provides a fresh source of cysteine for making more
glutathione. “People I know who’ve taken NAC say that by taking 1 or 2 grams,
their head clears in 20 minutes,” says Carl Waltenbaugh, a researcher at
Northwestern University in Chicago, Illinois, whose research focuses on the link
between alcohol consumption and immunity. “But it’s only anecdotal,” he
cautions. These findings also prove that Pliny knew a thing or two—eggs
are rich in cysteine. Swilling prairie oysters doesn’t sound like such a bad
idea after all.
But the most likely cause of hangovers is the devastating dehydration that
gives you such a raging thirst. When alcohol arrives at the pituitary gland at
the base of the brain, it suppresses production of vasopressin, or anti-diuretic
hormone. This substance keeps the body’s fluid reserves in balance by ordering
the kidneys to reabsorb water from urine. Deprived of this chemical hydrostat,
the renal floodgates open and we start peeing out far more water than we take in
with the booze.
Faced with an internal drought, the body hastily redeploys what water it has
left by borrowing some from organs such as the brain, which shrinks as a result.
Calder says that although the brain itself has no pain sensation, it has a
covering called the dura which is connected to the skull by pain-sensitive
filaments. So, Calder says, if the brain shrinks through dehydration, the dura
could be deformed, possibly causing the headache. Over-the-counter painkillers
such as ibuprofen might help if the first dose is taken before losing
conciousness. But drinkers should note that the US Food and Drug Administration
announced last month that it intends to put a warning on these pills, alerting
users that they might increase the risk of liver damage when taken with
excessive alcohol. Linnoila says that to add to the problems of water loss,
vital electrolytes, such as sodium, potassium, calcium and magnesium are washed
out too. “This could possibly lead to subtle imbalances between different body
compartments, as well as contributing to certain symptoms such as headaches,” he
says.
In brain cells, meanwhile, alcohol upsets the flow of electrolyte ions
through the gamma-aminobutyric acid (GABA) receptors. This flow determines how
fast the neurons fire. A number of drugs, such as Valium and sleeping tablets,
slow this process down and so slow down signals in the brain. Researchers
suspect that alcohol works in the same way, dulling the senses and giving that
“foggy” feeling next day.
So the age-old precaution of drinking plenty of water before collapsing into
bed after a heavy drinking session has pretty solid scientific
credentials—it prevents dehydration and washes the alcohol out of your
brain. Linnoila goes slightly further and recommends a nightcap of so-called
“sports” drinks which contain fresh supplies of electrolytes as well as water.
“It might be a good idea, but this advice is not based on controlled studies,”
he says.
Sugar shortage
Alcohol wreaks one final form of havoc in our bodies by depleting blood
sugars, causing a condition known as hypoglycaemia. This is why you feel wobbly
and feeble with a hangover. Alcohol causes glycogen, the substance that serves
as a sugar store in the liver, to break down during an evening’s revelry.
Glycogen is rapidly converted into glucose, which is then peed out, leaving you
lacking your normal reserves of energy. Compounding this lethargy, the acids
produced when alcohol breaks down can build up in the blood and cause muscular
weakness, turning your body into a jelly-like wreck. Calder says that both
problems can be remedied by consuming extra sugar—unfortunately this does
nothing to curb the rest of the hangover symptoms.
So in spite of all the research on alcohol abuse, there is still no
scientifically watertight reviving elixir for the red-eyed and ragged. Calder’s
advice is to eat plenty before and during a drinkathon to slow the absorption of
alcohol, have plenty of water before going to bed, and brew a cup or two of
sugary tea in the morning. Alternatively, as you stock up for the festivities,
perhaps you should pick up a few extra eggs, some NAC tablets, and a crate of
sports drinks. And should all that fail, keep the vodka, tomato juice and
Tabasco sauce by the bed, just in case those vultures return.