The hangover is an interesting beast. Like Bigfoot, Sasquatch, and any other huge, hirsute crypto-hominid, nearly every culture and every nation has an extensive literature (whether it’s entombed in writing or not) on the subject of hangovers. After all, alcohol is the universal intoxicant, and hangovers are the inevitable consequence of overindulgence.
Or are they?
Mike, a reader, recently wrote to me with the tale of the missing hangover:
I have been following the Primal Blueprint for over 2 months now. My diet, fitness, etc – has been very strict with one exception – The occasional drink.
While I don’t particularly crave alcohol, when I am around it in social settings – I will indulge in 1 to several drinks, then walk home. This past week I have had 2 occasions where I have been under extreme duress while also finding myself in social settings with people buying me ‘drinks’ – mainly bourbons. In the past if I went on a binge I might find myself worshiping the porcelain goddess or at the minimum wake up with a headache, disoriented, and bubbly guts. I would then feel crappy for the most part of the day, and not want to eat anything. At 38, I would think that it would only get worse.
But something has changed.
I did a tally, 9 makers mark neat and 3 ‘lite’ beers over 5 hours. I walked home, went to bed, and woke up in plenty of time to go to work. Ate some breakfast, and never felt the worse for it. The following nite 7 beers and 3 wines over a 4 hour time period, I polished off the nite with some organic locally grown smoked ribs from one of the local farms that does ‘drunk food’ and walked home. This morning, no headaches, no problems. There was a minor loose stool movement and that was it. It’s off to work and sharp as a tack.
I have no plans of continuing this drinking trend and plan on drying out over the next week, however I am perplexed by the ‘lack’ of effect.
Is it because I more efficiently rid myself of toxins?
Is it because I have an increased metabolic rate?
Perhaps it’s how my body is burning fuel?
It is not the walk, the glass of water I have before going to bed, or the late night meat. These are all things I did before and when I would have that occasional binge, I would pay for it. I’m curious if others have had the same reaction or if they have insight as to why the ‘hangover’ has disappeared?
What is a hangover, exactly, why do they happen, and how can we prevent their occurrence or mitigate their severity?
Well, the obvious, absolutely foolproof way to prevent hangovers is to abstain from alcohol, but that’s not the focus of this post. We can avoid drink altogether and never get a hangover, sure, just like we can avoid any of the potentially negative consequences (unplanned pregnancy, disease) that accompany sexual intercourse by abstaining from any and all sex – but where’s the fun in that? People are going to drink, even healthy, Primal people, and it doesn’t help to simply say, “Don’t drink.” People drink. Let’s figure out how to manage this fact.
Your basic, garden variety hangover manifests in several classic symptoms: headaches, dry mouth, spacey-ness, fatigue, depressed mood, physical weakness, lack of concentration, sweating, anxiety, sensitivity to light and sound, irritability, extreme thirst, extreme hunger, among others. Some only get the headache and the fatigue, while others are sidelined with the whole shebang. Either way, a hangover absolutely and unequivocally sucks. Its only benefit may lie in its capacity as negative reinforcement for the next time you decide to binge.
Diuresis and Dehydration
The presence of ethanol (alcohol) in the body induces diuresis, or an increase in urination. We’ve all noticed this. You’re having a few with friends and having to head off to the bathroom in between each drink, where you find yourself expelling more liquid than you’re taking in. What gives? Ethanol inhibits the secretion of antidiuretic hormone (ADH, or vasopressin) by the pituitary; this is the hormone that keeps you from wetting yourself, and without it, the kidneys send water straight to the bladder, bypassing absorption by the body. When you urinate from ethanol-induced diuresis, it’s mostly water (notice the color – it’s very light), along with electrolytes necessary for proper bodily function. This leads to dehydration, which in turn leads to headaches (the thirsty body draws water from the brain, constricting it), fatigue, dizziness (lack of potassium and sodium will do that to ya), and dry mouth. Sound familiar?
Toxic Acetaldehyde Build-up
Another source of hangover woes comes from acetaldehyde, which is created when an enzyme called alcohol dehydrogenase breaks down ethanol in the liver. Acetaldehyde is far more toxic than ethanol itself, so the body then releases acetaldehyde dehydrogenase and glutathione to break down the acetaldehyde. If you stick to just a few drinks and space them out accordingly, your body’s natural enzyme production can keep up. If you start binging, though, glutathione stores become overwhelmed and the liver must produce more. Meanwhile, acetaldehyde, which is between 10-30 times more toxic than ethanol, accrues in your body. Certain groups are underequipped to deal with alcohol, however. Women, for example, produce smaller amounts of acetaldehyde dehydrogenase and glutathione than men, making them more susceptible to hangovers. Many people of East Asian descent possess incredibly efficient alcohol dehydrogenase genes, thus increasing the amount of acetaldehyde produced from ethanol. Roughly half of those folks have inefficient acetaldehyde dehydrogenase genes, however, thus decreasing the amount of acetaldehyde that can be broken down. When these people drink, acetaldehyde accumulates faster and stays there longer, leading to an instant hangover.
During fermentation and distillation, congeners – or byproducts of the processes – are produced. Congeners can include acetone, acetaldehyde, tannins, and even flavorants used to distinguish drinks. As a general rule, darker liquors contain higher levels of congeners, with brandy ranking highest. One study showed that whiskey drinkers suffered worse hangovers than vodka drinkers when both groups were given equal amounts of alcohol, with the higher levels of whiskey congeners taking the blame. Red wine, which tends to be high in tannins, is another famous hangover-inducer. The basic effect of ethanol-induced diuresis is enough to cause a hangover, but it seems that congeners can make things even worse.
Okay, so we’ve established why hangovers hurt as much as they do, but what can we do about them?
Basic Preventive Measures
There are some tried and trued methods of preventing hangovers from even occurring in the first place. Depending on your sensitivity to liquor (and, possibly, the congener levels in your drink of choice), you can usually avoid most hangover related problems by following some basic guidelines:.
- Drink until you’re buzzed, then stop. Drink, but avoid drunkenness. Let your glutathione catch up with your acetaldehyde.
- Drink water with your alcohol. Have a glass handy throughout the night. If you order a drink from the bartender, get a water with it and slam it down before your sip your liquor. This should help keep you hydrated. Even better – sprinkle a bit of mineral-rich sea salt in the water to provide electrolytes.
- Eat before you drink. An empty stomach makes for a cheap drunk, yeah, but also a bad morning.
- Eat while you drink. Something fatty, like a rich cheese, is perfect, especially with wine. An old trick in certain Mediterranean countries is to take a big spoonful of olive oil before a night of drinking.
- Drink two large glasses of water immediately before bed. Again, add sea salt for the electrolytes. You can also drink Pedialyte or coconut water for added electrolytes. Even if you’ve overdone it with the drinks, slamming the fluids before bed can mitigate the worst of what’s to come.
More Advanced Preventive Measures
- Take n-acetylcysteine supplements (at least 200 mg) a half hour before your first drink. NAC is known to reduce acetaldehyde toxicity and increase glutathione, and, since acetaldehyde toxicity represents a massive contribution to the hangover effects, it appears to be an effective way to combat hangovers. It’s even more effective when combined with thiamine (Vitamin B1). In fact, one of the more popular “hangover pills” uses both NAC and thiamine as its active ingredients. I’ve never tried it myself, but it fetches some impressive Amazon reviews.
- In rats, taurine also accelerates the breakdown of acetaldehyde into harmless acetic acid. It might be worth trying.
- A cup or two of green tea before embarking on a bar-hop appears to be good for one’s liver. It may also reduce hangover symptoms.
- Prickly pear (opuntia ficus indica) extract, given five hours before alcohol consumption, reduced hangover symptoms by inhibiting the production of inflammatory mediators. C-reactive protein levels were higher in the control group and strongly associated with hangover severity. Since the plant has historically been used to reduce inflammation, this result suggests that a hangover is actually a result of inflammatory processes in the body. Supplements are rare, however, and users report dizziness along with efficacy.
- Magnesium is an important anti-inflammatory mineral that many people are deficient in. Alcohol depletes magnesium. Hangovers seem to be connected to inflammation. Taking magnesium (which you should already be doing if your diet is lacking) on a heavy drinking day might be helpful, too.
- Milk thistle extract (active ingredient: silymarin) has also been shown to protect the liver from ethanol toxicity. The plant’s seeds have been used for centuries as an (apparently effective) folk treatment for jaundice (PDF), which is caused by liver dysfunction.
You can’t always avoid hangovers. For some, they are inevitable, along with death and taxes. If you’ve got a hangover, here are the basic ways to improve your situation, and I won’t mention the stuff annoying people always suggest, like “time” or “prevention” (however accurate they may be).
- Take an aspirin. It’s a basic anti-inflammatory that’s safe and relatively effective.
- Drink coffee, which can actually reduce the swelling of blood vessels in the head that may be causing your headache. It’s good for fatigue, too, and its reputation as a diuretic is highly exaggerated.
- Drink bone broth, which provides electrolytes and minerals.
- Drink something with electrolytes. Make the Primal electrolyte-enhanced beverage or drink the original: coconut water.
- Exercise. It may be the furthest thing from your mind, but a healthy bout of sweaty, intense activity (it could be anything, really) always seemed to help me deal with the aftermath. Keep it brief and intense.
- IV electrolyte drip. I’ve heard tales of nurses hooking themselves up to IV drips after a wild night and being right as rain after a few minutes. I’m sure it works, but how many of us have access to IV drips?
- Eat eggs, which are high in cysteine – think NAC. Although NAC is far more effective as a preventive measure, it appears to have some efficacy after the hangover has been established, too. NAC supplementation may work here, too, but I’ve also heard that it makes the hangover worse for some people. Exercise caution and see what works for you.
- Eat coconut, which is also high in potassium. If you’ve got a raging hangover, you’re probably low in potassium.
What Not to Do
- Drink more. The hair of the dog is a popular treatment (even Hemingway subscribed to it), but it’s just delaying the inevitable. As soon as the alcohol has been metabolized, you’re likely to descend back into hangover hell.
- Load up on acetaminophen, which is a painkiller than can put a ton of stress on the liver. Your liver has already experienced enough for one day. Give it a break.
To sum up, hangovers are incredibly easy to prevent, provided you plan ahead. I suspect that most people will get by just fine by leading an anti-inflammatory Primal lifestyle (diet, exercise, rest, stress, sleep, etc), keeping hydrated, eating something, and keeping the alcohol intake moderate. Anecdotal evidence seems to suggest that eating Primal or paleo improves alcohol tolerance (or at least reduces hangover incidence and severity), although some folks have had different results. If you’re more sensitive to the negative effects of liquor, and the basic preventive measures aren’t working, it’s probably worth checking out the more advanced strategies (or, you know, you could drink less).
As for Mike’s query, my best guess is that his way of eating, living, and exercising provides ample amounts of nutrients, antioxidants, minerals, and anti-inflammatory signaling, all of which contribute to his fortified hangover resistance.
Thanks for reading, everyone. Let me know what your experiences have been, drinking and leading a Primal lifestyle.