Is there really no help for hangovers?

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The British Medical Journal has a reputation for publishing serious science, but its Christmas edition is traditionally a lighter-hearted affair, comprising articles and studies that would generally be considered too frivolous to make it into regular editions of the journal. One of this year’s offerings comes from Rachel Vreeman and Aaron Carroll, assistant professor and associate professors respectively in paediatrics at the Indiana University School of Medicine, Indianapolis, USA. Their article purports to explode some seasonal medical myths [1]. Their approach is to demonstrate the lack of scientific evidence for ‘myths’ such as the concept that not wearing a hat can cause disproportionate loss of heat from the body and suicide rates increase over the Christmas season.

One of the subjects the authors give their attention to is hangovers. Specifically, they set about deconstructing the ‘myth’ that hangovers can be prevented or cured using conventional or traditional approaches. For their ‘evidence’ here they rely on a previous review [2] which assessed just one study for each of eight approaches (propranolol, tropisetron, tolfenamic acid, sugar, Borago officinalis (borage), Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear), and a yeast based preparation). On the basis of one single double-blind study, the authors of this review consigned each of these approaches to the dustbin. The authors of this week’s myth-buster in the BMJ go on to conclude, A hangover is caused by excess alcohol consumption. Thus, the most effective way to avoid a hangover is to consume alcohol only in moderation or not at all.

This may indeed be true, but it will be a fat lot of good for those of us who may not want to exercise self-restraint in this department. For those individuals who find themselves consuming alcohol in more than moderate amounts professors Vreeman and Carroll give the impression that there is nothing that can be done to help matters. Yet experience shows that there is indeed potential to reduce the ill-effects of a drinking binge with a few simple strategies.

I’m not one to encourage excessive drinking, but the reality is that for some of us this time of year can lead to some over-indulgence in this department. Over the years I have experienced (sometimes first hand) a number of simple strategies that really do seem to help dull the after-effects of an evening of excess. Some of these I have distilled into a previously published piece that I have pasted in below.

These approaches may not have been subjected to rigorous scientific study, but that does not mean they cannot and do not work. As far as benefits care concerned, absence of evidence does not mean evidence, after all. For an example of a scientist falling foul of this simple fact see here. This example concerns detox regimes, which may have particular relevance to individuals contemplating such things in the New Year.


1. Vreeman RC, et al. Festive medical myths. BMJ 2008;337:a2769

2. Pittler MH, et al. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials. BMJ 2005;331:1515-1518

Simple strategies for combating hangovers – 29th December 2003

New Year’s Eve looms, and many of us will be brewing up for the bout of heavy drinking this night of celebration traditionally entails. Such intoxicating pleasures tend to come with some pain too, however, usually in the form of the hangover from hell the morning after the night before. Alcohol in excess has a number of undesirable effects in the body including an ability to up the toxic load on the system, dehydrate the body and induce subnormal levels of sugar in the bloodstream. Once the morning comes, these imbalances can show up as a barrelful of undesirable symptoms such as a thumping headache, queasiness in the stomach, and feelings of general weakness and fragility. Those of us who plan to drink like fishes this New Year’s eve can probably count on feeling distinctly green around the gills the next day too.

Fortunately, there is much that can be done to bolster our defences against an onslaught of alcohol. One way to reduce the toxic shock alcohol can induce in the body is to name our poison with some care. Some alcoholic beverages such as port, brandy and cheap red wine tend to be loaded with substances called congeners that are believed to contribute to the thick head and feelings of internal pollution brought on by a big night. Vodka is relatively pure spirit and generally the best for those attempting to make New Year’s day a hangover-free affair. For those wedded to beer, it may pay to opt for German varieties such as Holsten and Becks: the lacing of these beers with potentially toxic additives is strictly verboten.

Because alcohol and congeners are detoxified in the liver, another approach to preventing hangovers is to support this organ in its house-clearing duties. The herb Milk thistle (Silybum marianum) is renowned for its ability stimulate and protect the liver, and taking 500 mg of this even just a few hours before a serious session can buy some grace. However, if you can, I recommend taking this herb from today, as a few daily doses before a drinking binge does seem to work better than a one-off hit on the day.

Matching each alcoholic drink with a glass of water is another prime tool for reducing internal toxicity as it helps to dilute alcohol and other toxins in the system, and speed their elimination from the body. Water also combats the desiccating effects of alcohol, and can help ensure that wetting our whistle does not leave us feeling like we’ve been hung out to dry. Those seeking a simple but effective way of diluting alcohol’s impact on the body should just add water.

Alcohol tends to cause quite brisk release of sugar into the bloodstream, though this can cause blood sugar levels to come crashing down some time later. Sugar lows can disrupt sleep and may contribute to the pounding head and feelings of fatigue that can come with a hangover. I recommend downing a fruit smoothie or perhaps some tomato juice before collapsing into bed as this may help maintain blood sugar levels throughout the night and aid restful sleep. More of the same in the morning may help to restore sugar levels and help with rehydration too. These and other healthy drinking games can help make having one over the eight a much cushier number for the body.

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