DISCLAIMER: THIS IS NOT MEDICAL ADVICE.
What is a hangover?
The truth is we don’t really know. We all know the symptoms: headache, lack of appetite, fatigue, nausea, jitters, just feeling like crap, etc.. Some estimates put the cost in terms of poor work performance in the billions of dollars range. Yet, despite years of research, we don’t know the specific biologic mechanism which leaves us with a hangover. The most commonly referenced contenders are acetaldehyde build-up (a byproduct of alcohol metabolism), congeners, poor sleep, alterations in cytokine production (cell signaling molecules), and inhibition of antidiuretic hormone/dehydration (1). So unfortunately there’s no single smoking gun, but there are ways to combat some of these symptoms. Somewhat surprisingly, though with little definite results, there has been much research into the cause of hangovers, while work on cures is extremely limited.
We’ve tried to put together a list of all the remedies we could find that have had good quality scientific studies performed to assess their efficacy. The studies mentioned below were all double blinded cross-over studies unless otherwise mentioned. That means a group of people blindly took both the test remedy and a placebo on separate occasions of controlled environment drinking. We won’t get too much into the specifics to save you the boring technicalities, but trust us, these are the best we’ve got thus far.
Remedies that work and have high quality studies to prove it
NSAID’s (pain relievers): Everyone knows to take ibuprofen, naproxen, or a similar kidney-metabolized pain killer when you have a hangover to help get rid of your headache (Note: don’t take Tylenol (Acetaminophen) as it can compound liver damage). But what you should be doing is taking one BEFORE you go out drinking. Studies have shown that taking an NSAID both before and after an evening’s drinking significantly reduces not just headache, but also nausea, vomiting, irritation, tremor, thirst, and dry mouth (2). The mechanism of this is likely related to reducing certain prostaglandins (PGE2 and TXB2) that are associated with headache and inflammation.
Vitamin B6: A lot of people have heard of taking a B-complex vitamin for hangover, but B6 is the one likely to actually give you benefit. Again, this is best taken before and after drinking. How much you should take is somewhat unclear as the original study was performed in 1973 with a weird form of the vitamin, but one of your B-complexes of choice should suffice. Hangover symptoms were reduced by half in this study with taking a form of B6 called pyritinol (3). Also, enjoy the fluorescent urine!
Prickly Pear (Opuntia ficus indica): Surprisingly enough, taking 1600 IU of prickly pear extract, a species of cactus, 5 hours before drinking significantly reduced nausea, dry mouth, anorexia, and the risk of a severe hangover (4). What isn’t apparent is what type of extract they used and if it was from the fruit or the leaves of the cactus. This study was particularly interesting as it related levels of C-reactive protein, a marker of inflammation, as well as cortisol to severity of the hangover. The authors theorize that the ability of prickly pear to increase production of some protective proteins, called heat shock proteins, as well as the antioxidant properties of the extract may be responsible for the positive effects.
Drinking water: I don’t have a study to prove this, but it is one of the best ways to combat dehydration. Some people swear by coffee as well, and the caffeine would certainly help wake you up if you’re sleep deprived, but may end up dehydrating you more by its diuretic effect if you drink a lot quickly. As far as electrolyte replenishment, such as Gatorade or Pedialyte, I have no scientific proof that these help but they are never a bad idea and would certainly aid in re-hydration. Gatorade or another sugar and electrolyte containing beverage actually gets the water into your bloodstream faster than by drinking plain water.
Not drinking: Duh, but where’s the fun in that?
Remedies that might work
NAC (n-acetylcysteine): Honestly, this one is confusing. The most common claim is that NAC either enhances or improves the ability of your body to eliminate acetaldehyde. Often it is implied, or directly stated, that it is directly involved in the clearance of this nasty ethanol metabolite. The trouble is, this isn’t really correct. First of all, ethanol is metabolized in a 2-step fashion. Ethanol is converted to acetaldehyde by an enzyme called alcohol dehydrogenase, and then that acetaldehyde (which is toxic so your body wants to get rid of it) is then converted to acetate by acetaldehyde dehydrogenase. Acetate is a mostly friendly substance (it’s what’s in vinegar) that is soluble in blood and can be metabolized into carbon dioxide and water by the Krebs cycle. Do you see NAC there? Me either. However, the molecules required to let these enzymes work do end up generating something called reactive oxygen species (ROS) aka “free radicals.” They are essentially lonely oxygen molecules, which are normally in pairs, which are desperate for something to satisfy their now negative charge. These are best known for damaging DNA and otherwise wreaking havoc by oxidizing things. These are a normal part of your body, and are even products of the production of ATP (the energy source for most things cells do), so we have lots of ways to get rid of them. The one that is applicable in this case is glutathione. Glutathione is an antioxidant, and essentially serves to help get rid of oxidants, like ROS. NAC is a precursor to glutathione, so taking NAC would serve to raise your levels of glutathione. Great, now what does that do for you? Well, we don’t really know. As far as I could find there has never been any evidence or studies showing that NAC can reduce or prevent a hangover. There are a few more convincing articles out there showing that NAC may have a protective effect on the liver by reducing the aforementioned ROS, but only in animal models (5). For now, put this one in the “couldn’t hurt” pile as far as a liver “protectant” and in the “no evidence” category for hangovers.
Milk Thistle: The active compound silymarin (no, Tolkien didn’t make that up) being sought from this plant is a flavonoid, which is a fancy word for a molecule having a double bonded oxygen hanging off of it. The idea behind these is similar to NAC, in that they provide a mechanism to get rid of ROS. For the most part these are short lived in the bloodstream and haven’t been able to show any significant effects in terms of acute alcohol induced liver damage. Long term use, especially in high doses, may have some advantages for chronic liver injury, but as far as hangovers and a night out, this goes in the bunk pile for now. There are really no documented side effects though, so it isn’t something to fret over.
Korean pear juice: This study had a lot of problems, not the least of which being where to find Korean pear juice. It was a small group studied, all were Korean (more on that in a second), and their results were just barely significant (6). They show that drinking 220 mL 2 hours before drinking reduced hangover severity mildly (16%) and reduced blood levels of alcohol while drinking. They don’t even show this data though which is suspect. Also, people of Asian ancestry often have variations or deficiencies in the enzymes that process alcohol (especially acetaldehyde dehydrogenase) compared to those of other ancestry. The paper goes into this and ends up finding that this juice only works on people with certain the genotypes (variations) for that enzyme. So if you’re of Asian decent and have a source for Korean pear juice, it’s worth a shot.
Red Ginseng: We are without access to the full text of this article, but the summary says drinking 100 mL of red ginseng anti-hangover drink reduces alcohol concentration after drinking as well as has “positive effects on hangover symptoms.” (7) They only drank 100 mL of whiskey for the study, which is two airplane bottles, so it’s unsure how anyone could even get a hangover from that. This, again, was a study done in Asia, so it may have to do with the reduced ability to process alcohol. So this may work in some cases, but don’t take it to the bank.
A greasy meal: There’s no proof that this one works, but, man, does it always feel good. The only study I could find consists of a questionnaire posed to students about whether or not eating a heavy breakfast or fatty food gave them relief from their hangovers (8). The results were a modest improvement, and obviously this was not a controlled study; however, I’m going to continue to eat my bacon, egg, and cheese biscuits.
Remedies that don’t work
Basically anything else someone tries to sell you. Now, I’m not saying that you should abandon something you’ve been using for years and always works for you, but do consider the placebo effect. If you really want something to work, or feel like it’s doing you good, you are way more likely to feel better irrespective of the actual effects. There have been specific studies showing that propranolol, artichoke extract, and fructose/glucose specifically don’t work (not going to put in these references, but can send them to you if you want. “Hair of the dog” (starting to drink again) is always a bad idea as you are just delaying the inevitable, but it works short term. Anything else out there is uncharted territory, and if it works for you, wonderful, but there isn’t any non-proprietary science to back it up.
What should I do?
Let’s be clear again, we are not providing any of this as medical advice. We just wanted to see what was out there in terms of hard science that might help you through your next bad morning. We at BOTB have always utilized something we call “The Protocol.” It consists of a multivitamin, a B-vitamin, and NSAID’s with dinner followed by a liter of Pedialyte or Gatorade, a heartburn pill, and another B-vitamin after drinking. There’s one secret ingredient in there that we can’t share (no, it’s not illegal!), but come find us at an event sometime, and we’ll tell you about it. Something that wasn’t mentioned anywhere we could find was protection of your stomach lining. Both alcohol and NSAID’s are hard on your stomach, and we’d be interested in a preventative remedy that addressed this. Perhaps something like licorice root? Maybe we need to get to work on a marketable version of The Protocol. Anyhow, the most important lesson from all of this is to remember to take your remedy BEFORE you drink if possible. Some combination of an NSAID, vitamin B6, and prickly pear seems to have the most evidence, and a little NAC couldn’t hurt. Remember though that despite some positive results, no study has shown complete prevention of a hangover, just reduction in the symptoms.
There are a couple products we’re taking with us to the Bourbon Classic to try out, which put a lot of these together. DrinkWel has B6, NAC, and a hodgepodge of other potential aids in convenient pill form, and ResQwater puts together B6, prickly pear, NAC, and sundry electrolytes. One of these combined with an NSAID of your choice would likely help. We’ll give you a full report on both after the Bourbon Classic. Until then, let us know in the comments what works for you, and we hope this helps ease your suffering on a morning in the near future! Cheers!
1. Wiese, JG et al. The Alcohol Hangover. Annals of Internal Medicine. 2000; 132(11): 897-902.
2. Kaivola, S et al. Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid. Cephalagia. 1983; (3): 31-36.
3. Khan, MA et al. Alcohol-Induced Hangover: A Double-Blind Comparison of Pyritinol and Placebo in Preventing Hangover Symptoms. Quart. J. Stud. Alc. 1973; (34): 1195-1201.
4. Wiese, J et al. Effect of Opuntia ficus indica on symptoms of the alcohol hangover. Arch Intern Med. 2004; (164): 1334-1340.
5. Wang, AL et al. A dual effect of N-acetylcysteine on acute ethanol-induced liver damage in mice. Hepatol Res. 2006 Mar;34(3):199-206.
6. Lee, H et al. Effect of Korean pear (Pyruspyrifolia Shingo) juice on hangover severity following alcohol consumption. Food and Chemical Toxicology. 2013; (58): 101-10
7. Lee, MH et al. Red ginseng relieves the effects of alcohol consumption and hangover symptoms in healthy men: a randomized crossover study. Food Funct. 2014; (3): 528-534.
8. Kosem, Z et al. The impact of consuming food or drinking water on alcohol hangover. Addiction. Abstract P.6.b.008.