Is there really no help for hangovers?

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.

References:

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.

24 Responses to Is there really no help for hangovers?

  1. Tiggy 19 December 2008 at 3:04 pm #

    My hangover recommendations.

    Drink gin and tonic – I don’t think this has ever given me a hangover.

    Eat plenty of nibbles.

    Take a large glass of water to bed with you – if you can’t face it straightaway, it’s helpful for if you wake up in the night thirsty. Try to recognise that your thirst means you want water rather than another gin and tonic!

    Sleep for as long as possible – just sleep right through the hangover.

  2. Angie 19 December 2008 at 3:09 pm #

    It all depends on what is meant by a ‘hangover’. Even if alcohol is damaging in itself, much of what is said to be the result of alcohol is, I think, actually the result of all the additives associated with it. Those with a sensitivity to yeast caused by candida may also be especially allergic to the sulphur and additives used in the preparation of non-organic wine and beer, and may get a blinding headache from this (which, incidentally, only happens if you have a permeable gut). Organic wine/beer doesn’t have this effect, even when sulphur is used, because it is at much lower levels and the rest of the rubbish is prohibited.

    In my experience, you have to consume an awful lot of alcohol to feel ill from that alone (or the congeners) and, most likely, you will throw up before you get to that stage. Most of the problems don’t seem to me to derive from alcohol per se, which is why people who drink a lot tend to be happiest with vodka.

    If you have been poisoned by any of it, vitamin C (in substantial doses) detoxifies most things!

  3. Charles 20 December 2008 at 3:59 am #

    For many years, I have been using BHT. I originally heard that strategy from Durk and Sandy Pearson. It absolutely works. It basically clears the bad byproducts out of the system and the liver. Take it the morning after (never during or that night, it will keep you drunker longer.)

    Yes, I know it’s a “bad chemical,” but it’s basically a potent antioxidant, which is why it preserves food. I’ve been using it periodically for a couple of decades, and all of my blood tests are perfect and my health is great.

  4. Richard 20 December 2008 at 2:07 pm #

    I find tea made from fresh root ginger, a slice of lemon and a little honey really helps with nausea. And then maybe a shot of vodka!

  5. Ian 21 December 2008 at 1:45 am #

    There are no references in your 29/12/03 post.

    “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.”

    Where’s the evidence for this?

    “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.”

    Or this?

    “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.”

    Or this?

  6. Dr John Briffa 21 December 2008 at 11:07 am #

    Ian
    Let’s go back a bit: What is the “evidence” that I claimed there was any evidence that supports the basis of this advice and its potential benefits (other than anecdotal)?

  7. Ian 21 December 2008 at 4:34 pm #

    Where did I claim that you had claimed that there was evidence to support your statements?

    I asked what the evidence was. You say it is anecdotal. Any better evidence than that?

  8. helen 22 December 2008 at 2:45 am #

    i have seen it reported in the media that it is a medical myth that there is a cure for a hangover other than not getting drunk at all that is. however i don’t have any suggestions as in all my drinking years i have never suffered from a hangover no matter how leg-less i got. i don’t know if it was natural – genetics – all the water around one litre i used to drink before retiring to bed or what but i can not recall one hangover so guys if you suffer from them can i just suggest not drinking so much the night before & you should be right!!

  9. Angie 22 December 2008 at 2:55 am #

    I think the only help for hangovers is to have a couple of them. You then realize they aren’t very fun and you do whatever you can to avoid them at all costs. (i.e. not consume as much)

  10. RP 23 December 2008 at 12:38 am #

    I was a paramedic in my younger years. We usually self treated really bad hangovers with an IV of Ringer’s with a bolus of 50% dextrose followed by Thiamine. Worked like a charm. You usually felt better in about 10 minutes. I now drink a big bottle of a sport’s drink like Gatorade along with some B-vitamins for the same effect. It’s slower but it does seem to work.

  11. Dr John Briffa 23 December 2008 at 1:39 am #

    Ian
    Nope. Got any good evidence (other than anecdotal) that the approaches I advocated don’t work?

  12. Ian 23 December 2008 at 2:16 am #

    “Nope. Got any good evidence (other than anecdotal) that the approaches I advocated don’t work?”

    No. But I’m not the one giving medical advice to people.

    I’d imagine that it’s difficult to get anecdotal evidence to support the suggestion that milk thistle ‘stimulates and protects’ the liver. Got any good evidence for this?

    I find it a bit odd that there’s only anecdotal evidence for this stuff, surely somebody must have tested it? Where did you get the idea for it in the first place if it isn’t written up somewhere?

  13. Ian 23 December 2008 at 2:18 am #

    (BTW – congratulations on giving your first ever straight answer!)

  14. Dr John Briffa 23 December 2008 at 8:40 pm #

    Ian

    “No. But I’m not the one giving medical advice to people.”

    Is the suggestion here is that anecdotal evidence and personal experience don’t have a place in giving medical advice to people?

  15. Ian 23 December 2008 at 11:42 pm #

    Let’s go back a bit: I’d imagine that it’s difficult to get anecdotal evidence to support the suggestion that milk thistle ‘stimulates and protects’ the liver. Got any good evidence for this?

  16. Dr John Briffa 24 December 2008 at 11:04 am #

    Ian
    “I’d imagine that it’s difficult to get anecdotal evidence to support the suggestion that milk thistle ‘stimulates and protects’ the liver.”

    It’s the use of milk thistle for hangover prevention that is anecdotal. The regenerative/hepatoprotective effects of milk thistle has been demonstrated:

    Sonnenbichler J, et al. Stimulating influence of a flavonolignan derivative on proliferation, RNA synthesis and protein synthesis in liver cells. In Assessment and Management of Hepatobiliary Disease, ed. L Okolicsanyi, G Csomos, G Crepaldi. Berlin: Springer-Verlag, 1987, 265”72.

    Faulstich H, et al. Silibinin inhibition of amatoxin uptake in the perfused rat liver. Arzneim-Forsch Drug Res 1980;30:452”4.

    Tuchweber B, et al. Prevention by silibinin of phalloidin induced hepatotoxicity. Toxicol Appl Pharmacol 1979;51:265”75.

    There’s also human clinical work that has demonstrated benefits for the liver e.g.

    Salmi HA, et al. Effect of silymarin on chemical, functional and morphological alterations of the liver. Scand J Gastroenterol 1982;17:517”21.

  17. Ian 24 December 2008 at 2:13 pm #

    “The regenerative/hepatoprotective effects of milk thistle has been demonstrated”

    Not to any great effect, if a smattering of 30 year old studies is the best evidence you have.

    I couldn’t find the Sonnenbichler study, can you point me in the direction of the abstract?

    Faulstich was an in vitro study looking at the absorption of amatoxin in a perfused rats liver.

    Tuchweber poisoned 12 beagles with amanita phalloides and 4 died. When he did this again but administered silibinin they got ill less and none died.

    Salmi et al studied liver disease mostly caused by alcohol abuse and saw some better outcomes. There does seem to be some evidence that milk thistle could be useful as an adjuvant in alcoholic liver disease:

    Saller et al, The use of silymarin in the treatment of liver diseases 2001;61(14):2035-63 PMID: 11735632

    The studies you’ve referenced don’t really demonstrate ‘the regenerative/hepatoprotective effects of milk thistle” or that it ‘stimulates and protects’ the liver in any but a small number of very specific ways, and certainly not to the extent that it would support the generalised notion that ‘milk thistle is good for your liver’.

  18. Dr John Briffa 27 December 2008 at 4:17 am #

    Ian

    “The studies you’ve referenced don’t really demonstrate ‘the regenerative/hepatoprotective effects of milk thistle”

    This is clearly a matter of opinion. Your use of the word ‘really’ suggests even you are not definite in your opinion on this matter.

    “30 year old studies”

    Can you explain what it is about the age of this studies that is relevant here? The suggestion appears to be the older studies are somehow inferior to more recent ones. Could you clarify?

    “or that it ‘stimulates and protects’ the liver in any but a small number of very specific ways,”

    The number of ways the herb stimulates and protects the liver is irrelevant (it either does or it doesn’t).

    “and certainly not to the extent that it would support the generalised notion that ‘milk thistle is good for your liver’.”

    This is another matter of opinion, isn’t it?

  19. Ian 29 December 2008 at 2:55 am #

    “This is clearly a matter of opinion. Your use of the word ‘really’ suggests even you are not definite in your opinion on this matter.”

    It’s not a matter of opinion, they don’t (and I’ll remove the potential for you to take this down a semantic blind alley by removing the word ‘really’), demonstrate ‘the regenerative/hepatoprotective effects of milk thistle” or that it ‘stimulates and protects’ the liver in any but a small number of very specific ways, and certainly not to the extent that it would support the generalised notion that ‘milk thistle is good for your liver’.

    “Can you explain what it is about the age of this studies that is relevant here? The suggestion appears to be the older studies are somehow inferior to more recent ones. Could you clarify?”

    I’ll just repeat what I said in context as it was quite clear:

    You said: “The regenerative/hepatoprotective effects of milk thistle has been demonstrated”

    I said: “Not to any great effect, if a smattering of 30 year old studies is the best evidence you have.”

    Any better evidence than some irrelevant 30 year old studies?

    “The number of ways the herb stimulates and protects the liver is irrelevant (it either does or it doesn’t).”

    No, you were using these studies to claim that milk thistle stimulates and protects the liver in a good way for humans, not that it could be useful in specific poisoning cases.

    “and certainly not to the extent that it would support the generalised notion that ‘milk thistle is good for your liver’.”

    This is another matter of opinion, isn’t it?

    No. If it were generally good for your liver, as you claim, you’d have some good evidence. But you don’t.

  20. Dr John Briffa 30 December 2008 at 10:55 am #

    Ian

    “(and I’ll remove the potential for you to take this down a semantic blind alley by removing the word ‘really’)”

    You can disown what you originally wrote if you like (just be straight about it, that’s all).

    Can you answer why you thought it relevant to mention the age of the studies I quoted? I’m still not clear on the relevance of this. Can I ask you again to clarify?

    “If it were generally good for your liver, as you claim,”

    My original claim was that “(Silybum marianum) is renowned for its ability stimulate and protect the liver.” I have cited work which supports this statement, along with clinical work which supports the idea that the herb has benefits for the human liver.

    The other thing is (getting back to the point of the piece) is that my clinical experience is the herb is really very good for helping to prevent hangovers. Do you have any evidence that this advice is wrong? (Because if you don’t, then we’re just going to have to let it stand, aren’t we?)

  21. Ian 7 January 2009 at 9:32 pm #

    My original claim was that “(Silybum marianum) is renowned for its ability stimulate and protect the liver.” I have cited work which supports this statement

    No, you haven’t. As I pointed out:

    Faulstich was an in vitro study looking at the absorption of amatoxin in a perfused rats liver.

    Tuchweber poisoned 12 beagles with amanita phalloides and 4 died. When he did this again but administered silibinin they got ill less and none died.

    Salmi et al studied liver disease mostly caused by alcohol abuse and saw some better outcomes. There does seem to be some evidence that milk thistle could be useful as an adjuvant in alcoholic liver disease

    Have you got any good evidence?

  22. Dr John Briffa 8 January 2009 at 11:43 am #

    Ian

    My opinion is that the evidence I cited is good enough to support the claims I made, so we’re just going to have to agree to differ on this point.

    Can I ask you to answer the question I asked about your specific mention regarding the age of these studies? Why do you think their age was relevant enough to mention specifically?

    Also, what’s your view on the claim I made about Milk thistle being good for hangover prevention? Are you happy to let it stand or do you have some evidence that counters this claim?

  23. Joe 14 January 2009 at 7:23 am #

    This is similar to what Pearson and Shaw wrote about in their book, Life Extension. I’ve tested it many times (so have my friends) and it works.

    1200 mg NAC
    2000 mg Vitamin C
    100 mg Vitamin B-1

    Take a dose with your first drink and another with your last. If you are on a MAJOR bender take one in the middle too.

  24. Mander 28 April 2009 at 8:56 am #

    When I worked as a bartender (which entailed drinking a fair bit after Friday-night shifts), the bar staff all advocated taking a multivitamin, an aspirin, and a big glass of water before going to bed. It didn’t totally prevent hangovers, but it did seem to help.

    Of course, that could just be because of the aspirin.

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