Hangover: Most have suffered but no one truly understands

Hangover: Most have suffered but no one truly understands

Alcohol can be a good thing and a bad thing. In moderation, according to the Mayo Clinic, there is some evidence that it can help lower your risk of developing diabetes, heart disease, or stroke. Their definition of moderate drinking is one alcoholic beverage per day for women of all ages and men older than 65 years or two alcoholic beverages per day for men younger than 65 years.

However, even with light drinking, people can have a slight increase in the risk of esophageal cancer. And, with heavy drinking, risks become much worse. Drinking in excess can potentially contribute to cancers such as breast or throat, pancreatitis, stroke, nerve injuries such as peripheral neuropathy, heart muscle damage, high blood pressure, liver disease, mood disorders including depression and anxiety, and suicide.

Here are some statistics that can really highlight the damage done by excessive drinking: According to the CDC, in 2010, excessive alcohol consumption contributed to an estimated $249 billion in economic cost, in terms of lost productivity, workplace absenteeism, and accidents. Possibly even more striking, heavy drinking contributed to approximately 88,000 deaths, shortening the lives of those who died by about 30 years from 2006 to 2010. Clearly, alcohol is not a benign substance to be consumed carefree.

For most people, alcohol is almost a rite of passage, especially in college. It is not uncommon for college students to overindulge on weekends, whether underage, with your buddies, or at a fraternity or sorority party. In addition, a lot of different professions work hard but then play hard as well. According to the Substance Abuse and Mental Health Services Administration, several professions were found to have significant alcohol consumption, including mining, construction, food services, healthcare, law, etc.

Being a healthcare provider myself, unfortunately, I am not above this. I should have known better, but I have overindulged before, especially in college and medical school. In my mind, it was a way for me to relieve the stress of school and work, etc. Now that I am more aware and, I think, smarter, I no longer drink alcoholic beverages in excess or binge drink, and I find other ways to relieve my stress, such as meditation, hobbies, and exercise. I would now categorize myself as a very light drinker where I can hopefully receive some of the benefits of light drinking but not overexpose myself to the risks involved with excessive drinking.

As most people have experienced drinking in excess at some point in their lives, most people have also experienced the subsequent hangovers. This is defined as a variety of physiological and psychological effects that follow the consumption of alcohol, occurring several hours after drinking ends (approximately ten hours) and lasting several hours to over 24 hours. Symptoms may include nausea, fatigue, headache, impaired attention, anxiety, sweating, and poor memory. Studies have been performed in the past trying to better understand the multitude of biochemical and neurochemical changes that occur during and after drinking in excess.

The metabolism of alcohol involves multiple enzymes for its breakdown. It is initially metabolized by alcohol dehydrogenase or ADH to acetaldehyde which is highly toxic to the body but it is quickly metabolized to acetate by aldehyde dehydrogenase or ALDH. The Asian flush is a result of a genetic variant of the mitochondrial acetaldehyde dehydrogenase which impairs the metabolism of acetaldehyde into acetate. Approximately 36% of East Asians have this genetic alteration which results in flushing, nausea, tachycardia, and headaches after ingestion of only a small amount of alcohol.

Certain biochemical and neurochemical factors can influence and contribute to the development and severity of hangover symptoms. However, not one is solely responsible for the pathology of hangovers. These can include dehydration, sleep disturbance, and genetic factors. Dehydration can contribute through vasopressin and acid-base status to thirst, dizziness, headaches, and concentration and memory problems. Sleep disturbance can contribute as well. Alcohol disrupts the circadian rhythm and impacts the quality and quantity of sleep. Genetics also play a role. In a study, they found approximately 8.1% of drinkers were hangover resistant. Not enough is known about this genetic resistance though.

In addition, compounds within alcoholic beverages known as congeners can contribute to hangover severity. These are substances that are created from the production process of distillation and fermentation. The darker beverages, such as brandy and red wine, typically have more of these substances. Congeners include amines, amides, acetones, acetaldehyde, polyphenol, methanol, histamines, fusel oil, esters, and tannins. Of these, some suggest methanol is probably one of the biggest contributors to hangover severity but they all seem to contribute to some degree.

The neurotransmitter system is affected as well. The different neurotransmitters that are suspected of being involved are GABA, glutamate, dopamine, brain-derived neurotrophic factor, serotonin, and endocannabinoids. The early stimulating effects of alcohol intoxication occur due to alterations of dopamine and brain-derived neurotrophic factor. There is also a change in the balance between inhibitory GABAergic and excitatory glutamatergic neurotransmitters, which has been shown to correlate with the severity of alcohol withdrawal symptoms.

Additionally, alcohol affects inflammation within the body, centrally and peripherally. It is a very complex relationship. Some studies show it minimizes cytokine response to antigens, whereas others show it ramps up cytokine response to bacterial challenge. One of the profound ways it has been shown to increase inflammation within the body is through ethanol-induced dysbiosis within the gastrointestinal system associated with the leaky gut syndrome which triggers endotoxins from the leaky gut which then causes inflammation and oxidative stress throughout the body. This also contributes to inefficient absorption of nutrients and vitamins, while contributing to dehydration. Some animal models also revealed selective neuronal damage caused by oxidative stress and activation of the inflammatory response, specifically in the hippocampi and cortex.

This inflammatory response leads to a number of symptoms, including nausea, vomiting, headache, confusion, tremor, clinical depression, and memory deficits. Interestingly, a nonsteroidal anti-inflammatory drug called tolfenamic acid was shown to help reduce the severity of some hangover related symptoms in one study.

Alcohol has a significant role in modern society for most people, whether it is meeting friends for drinks at Beer on the Wall in Park Ridge, having a first date over drinks at The Stained Glass in Evanston, partaking in a glass of wine with dinner at home, celebrating a special occasion with a glass of champagne, etc. As described above, in moderation, alcohol may have a few good benefits. However, anything heavier can have adverse effects. Neuroinflammation is a real thing, and alcohol contributes to inflammation throughout the body. We are learning more and more about what contributes to hangover symptoms.

Maybe someday we will have treatments that specifically target the cytokines and inflammation that contribute to hangover symptoms, but at this point, we do not. At StrIVeMD Wellness & Ketamine, we utilize intravenous (IV) hydration therapy to alleviate all of the symptoms that we can quickly. Our enhanced intravenous vitamin therapy helps replete vital vitamins, minerals, and fluids that are lost during hangovers or episodes of severe dehydration. We add medications that can resolve nausea, so people can keep fluids and nutrients in their bodies.

It is recommended to only drink in moderation; however, if you do overindulge, make sure you get the help your body needs.

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