Waking up with a hangover can trigger a spiral of negative thoughts and emotions.
“I shouldn’t have had that last drink.”
“I’m never drinking again!”
“I should have drank more water!”
“I’m so mad at myself.”
These mental symptoms, in addition to the physical symptoms, can be a reminder of the consequences that follow overindulging. While there is no real cure, there are hangover remedies that can help improve symptoms after a night of drinking.
An alcohol hangover is defined as the combination of mental and physical symptoms experienced the day after a single episode of heavy drinking. The hangover begins as your blood alcohol level (BAC) starts to fall, and is at its worst when the BAC reaches zero. During a hangover, one may experience various unpleasant physiological and psychological effects. Although previous studies found that a hangover most often occurs when a BAC of 0.11% is reached the night before, more recent data shows that a hangover can occur even after alcohol consumption levels and BACs are considerably lower. How quickly you consume alcohol is also a key factor. On average, the body can break down one drink per hour (or about 14 grams), and any more than that can increase the likelihood of a hangover occurring. Hangovers typically go away within 24 hours but can last up to 72 hours after drinking. The duration of the hangover depends on how much was consumed, how dehydrated you became, your nutritional status, ethnicity, gender, the state of your liver, and medications.
Symptoms of a hangover are varied, but most commonly people experience:
The causes of a hangover are still poorly understood. However, several factors are known to be involved, including acetaldehyde accumulation, changes in the immune system and glucose metabolism, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation, and malnutrition. Beverage-specific additives or byproducts, such as congeners, in alcohol also play an important role in a hangover.
What you drink is far less important than how much, but there’s some evidence that darker beverages — whiskey, brandy, red wine — cause more problems than clear drinks, such as gin and vodka. This is because they are thought to contain chemicals called congeners.3 Congeners, which result from the fermenting process, give many types of alcoholic beverages their flavor, and can add to ethanol’s harmful effects, contributing to or worsening the hangover’s severity. Congeners occur when sugars are converted into alcohol and the number of congeners depends on the type of sugars used to make the alcohol (for example, grapes for wine). The amount of congeners varies per alcohol but in general, the more distilled a spirit is, the lower the congeners. This is why some people find that “top shelf” liquors that are highly distilled may give them less of a hangover than a lower-priced alternative. Because the body is already breaking down ethanol from the alcohol, adding congeners into the detoxification process can make it more complex, allowing congeners to linger in the body for longer and contribute to hangovers. Finally, congeners may stimulate the body to release stress hormones, such as norepinephrine and epinephrine, causing an inflammatory response and worsening symptoms., 8
Alcohol is a diuretic, which means it increases urinary output by reducing hormones that prevent your kidneys from conserving water– which is why you may need to urinate more often when consuming alcohol. Frequent urination and dehydration can lead to thirst, weakness, dizziness, lightheadedness, headache, a dry mouth, and red, sandpaper eyes. Studies suggest that electrolyte changes play only a minor role in a hangover and are caused by dehydration effects. Drinking water may help relieve symptoms as a result of dehydration, but it is unlikely that rehydration significantly reduces the presence and severity of a hangover. The metabolic process the body goes through to process alcohol depletes essential vitamins and electrolytes. Electrolytes like sodium, potassium, zinc, and magnesium are electrically charged minerals in your body that help you stay hydrated, balance pH, and move nutrients into and waste out of cells. Dehydration can cause an imbalance of electrolytes, and vomiting and diarrhea can further deplete them in your body. Electrolyte depletion can induce the symptoms of fatigue, lethargy, fast or irregular heartbeat, nausea, vomiting, diarrhea, or constipation that are experienced with a hangover.
A number of studies have shown that following a night of heavy drinking there is an upregulation of cytokines and prostaglandins, showing a significant relationship between immune factors and hangover severity. An imbalance of the immune system, specifically in cytokine metabolism, has been identified as playing a role in a hangover. Mediated changes in the immune system could lead to the most prevalent hangover symptoms of nausea, headache, and fatigue.5, 7, 11 Most importantly, the serum levels of these inflammatory markers were directly related to the degree of hangover symptoms.6 This association has been supported by evidence that treatment with cyclooxygenase inhibitors leads to a decrease in these inflammatory factors and a subsequent decrease in hangover symptoms.5 Those who metabolize alcohol more slowly are likely to have more severe hangovers than those who metabolize it faster, likely due to greater oxidative stress and inflammation. How you metabolize alcohol depends on your genes, biology, age, sex, and other factors. Inflammation could lead to more pronounced hangover symptoms and malaise—that unsettling feeling of not being well.
Drinking suppresses the central nervous system by increasing the activity of the calm-inducing neurotransmitter GABA and suppressing the activity of the excitability neurotransmitter glutamate. As alcohol leaves your bloodstream, GABA decreases and glutamate is no longer inhibited, and it can almost mimic mini-withdrawal.* This can lead to hangover symptoms of tremors, anxiety, sweating, nausea, vomiting, and/or sensitivity to sound and light.
*Of note, a hangover is not the same phenomenon as acute alcohol withdrawal. Alcohol withdrawal is secondary to the development of physiological alcohol dependence over the course of many drinking episodes, whereas the hangover occurs after one night of drinking and does not require alcohol dependence.
Alcohol inhibits the production of glucose in the body, depletes glucose reserves in the liver, and causes a buildup of lactic acid in body fluids, which further inhibits glucose production. Blood sugar is your body’s primary energy source, and your brain relies on it to process information, record memories, and think clearly. Symptoms include weakness, sweating, fatigue, shakiness, moodiness, and a sluggish, cloudy brain. While studies show that a hangover is associated with a decrease in blood glucose concentration, the relationship to hangover severity is unclear.
There are several factors that, while not causative of a hangover, are known to influence the severity.
A quick Google search may tell you about popular next-day hangover remedies, like over-the-counter pain relievers, drinking pickle juice, hydrating with sports drinks or Pedialyte, hair of the dog (drinking alcohol again), or eating carb-rich foods. However, we have some strategies that may help prevent the hangover altogether. Consider taking these steps to lower your risk before and while drinking:
It is obvious that not drinking in the first place is the ultimate hangover cure. Drinking has been linked to liver disease, heart disease, cancer, high blood pressure, stroke, dementia, anxiety, depression, and premature aging, and yet some 61 million Americans report binge drinking at least once a month.8, 11 On the contrary, the sobriety movement has taken over many bars across the United States – and abroad! For those who are not familiar, “new sobriety” is a trend not to drink. These people choose to be sober, but not because they necessarily have a substance abuse disorder.
As we’ve discussed, alcohol has physiological effects on the brain and body at different levels of consumption, and over time. Taking a break from alcohol not only prevents hangovers, but also may prevent damage to the gut microbiome, hormone imbalances, cognitive changes, mood shifts, and inflammation. For those who are sober-curious, or just curious about a Saturday morning without a headache, abstaining from alcohol can help many stay aligned with their mental and physical health goals.
If you do choose to drink, we recommend implementing the steps listed above to prevent a hangover, and to keep you as healthy as possible.
Learn more ways to support your body during a hangover in this recent Livestrong article we supported.