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A hangover is the experience of various unpleasant physiological and psychological effects usually following the consumption of alcohol, such as wine, beer, and liquor. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (e.g., nausea, vomiting, diarrhea), absence of hunger, light sensitivity, depression, sweating, hyper-excitability, irritability, and anxiety.[2]

While the causes of a hangover are still poorly understood,[3] 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 effects of additives or by-products such as congeners in alcoholic beverages also play an important role.[2] The symptoms usually occur after the intoxicating effect of the alcohol begins to wear off, generally the morning after a night of heavy drinking.[4]

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Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating hangovers.[5][6] Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover.[5]The socioeconomic consequences of hangovers include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also impair performance during potentially dangerous daily activities such as driving a car or operating heavy machinery.[7]

An alcohol hangover is associated with a variety of symptoms that may include drowsiness, headache, concentration problems, dry mouth, dizziness, gastrointestinal complaints, fatigue, sweating, nausea, hyper-excitability, anxiety, and a feeling of general discomfort that may last more than 24 hours.[8] Alcohol hangover symptoms develop when blood alcohol concentration falls considerably and peak when it returns to almost zero.[7][9] Hangover symptoms validated in controlled studies include general malaise, thirst, headache, feeling dizzy or faint, tiredness, loss of appetite, nausea, stomach ache, and feeling as though one's heart is racing. Some symptoms such as changes in sleep pattern and gastrointestinal distress are attributed to direct effects of the alcohol intoxication, or withdrawal symptoms.[10] Drowsiness and impaired cognitive function are the two dominant features of alcohol hangover.[9]

The processes which lead to hangovers are still poorly understood.[3] Several pathophysiological changes may give rise to the alcohol hangover including increased levels of acetaldehyde, hormonal alterations of the cytokine pathways and decrease of the availability of glucose. Additional associated phenomena are dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation and insufficient eating.[2] Some complex organic molecules found in alcoholic beverages known as congeners may play an important role in producing hangover effects because some, such as methanol, are metabolized to the notably toxic substances formaldehyde and formic acid.[2]

After being ingested, the ethanol in alcoholic beverages is first converted to acetaldehyde by the enzyme alcohol dehydrogenase and then to acetic acid by oxidation and egestion process. These reactions also convert nicotinamide adenine dinucleotide (NAD+) to its reduced form NADH in a redox reaction. By causing an imbalance of the NAD+/NADH redox system, alcoholic beverages make normal bodily functions more difficult. Consequences of the alcohol induced redox changes in the human body include increased triglyceride production, increased amino acid catabolism, inhibition of the citric acid cycle, lactic acidosis, ketoacidosis, hyperuricemia, disturbance in cortisol and androgen metabolism and increased fibrogenesis. The metabolism of glucose and insulin are also influenced.[11] However, recent studies showed no significant correlation between hangover severity and the concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose in blood and urine samples.[4]

Acetaldehyde, the first by-product of ethanol, is between 10 and 30 times more toxic than alcohol itself[13] and can remain at an elevated plateau for many hours after initial ethanol consumption.[14] In addition, certain genetic factors can amplify the negative effects of acetaldehyde. For example, some people (predominantly East Asians) have a mutation in their alcohol dehydrogenase gene that makes this enzyme unusually fast at converting ethanol to acetaldehyde. In addition, about half of all East Asians convert acetaldehyde to acetic acid more slowly (via acetaldehyde dehydrogenase), causing a higher buildup of acetaldehyde than normally seen in other groups.[15] The high concentration of acetaldehyde causes the alcohol flush reaction, colloquially known as the "Asian Flush". Since the alcohol flush reaction is highly uncomfortable and the possibility of hangovers is immediate and severe, people with this gene variant are less likely to become alcoholics.[16][17]

In addition to ethanol and water, most alcoholic drinks also contain congeners, either as flavoring or as a by-product of fermentation and the wine aging process. While ethanol is by itself sufficient to produce most hangover effects, congeners may potentially aggravate hangover and other residual effects to some extent. Congeners include substances such as amines, amides, acetones, acetaldehydes, polyphenols, methanol, histamines, fusel oil, esters, furfural, and tannins, many but not all of which are toxic.[10] One study in mice indicates that fusel oil may have a mitigating effect on hangover symptoms,[20] while some whiskey congeners such as butanol protect the stomach against gastric mucosal damage in the rat.[21] Different types of alcoholic beverages contain different amounts of congeners. In general, dark liquors have a higher concentration while clear liquors have a lower concentration. Whereas vodka has virtually no more congeners than pure ethanol, bourbon has a total congener content 37 times higher than that found in vodka.[10]

Several studies have examined whether certain types of alcohol cause worse hangovers.[22][23][24][25] All four studies concluded that darker liquors, which have higher congeners, produced worse hangovers. One even showed that hangovers were worse and more frequent with darker liquors.[22] In a 2006 study, an average of 14 standard drinks (330 ml each) of beer was needed to produce a hangover, but only 7 to 8 drinks was required for wine or liquor (note that one standard drink has the same amount of alcohol regardless of type).[25] Another study ranked several drinks by their ability to cause a hangover as follows (from low to high): distilled ethanol diluted with fruit juice, beer, vodka, gin, white wine, whisky, rum, red wine and brandy.[24][25]

One potent congener is methanol. It is naturally formed in small quantities during fermentation and it can be accidentally concentrated by improper distillation techniques. Metabolism of methanol produces some extremely toxic compounds, such as formaldehyde and formic acid, which may play a role in the severity of hangover. Ethanol slows the conversion of methanol into its toxic metabolites so that most of the methanol can be excreted harmlessly in the breath and urine without forming its toxic metabolites. This may explain the temporary postponement of symptoms reported in the common remedy of drinking more alcohol to relieve hangover symptoms.[10][26] Since methanol metabolism is effectively inhibited by consumption of alcohol, methanol accumulates during drinking and only begins to be metabolized once ethanol has been cleared. This delayed action makes it an attractive candidate explanation for delayed post-intoxication symptoms and correlations between methanol concentrations and the presence of hangover symptoms that have been found in studies.[4]

The metabolic processes required for alcohol elimination deplete essential vitamins[27] and electrolytes.[28] Furthermore, alcohol is a diuretic, causing excretion of electrolytes through urination. After a night of drinking, the resulting lack of key B and C vitamins, as well as potassium, magnesium, and zinc may cause fatigue, aching and other hangover-like symptoms.[citation needed]

Ethanol has a dehydrating effect by causing increased urine production (diuresis), which could cause thirst, dry mouth, dizziness and may lead to an electrolyte imbalance. Studies suggest that electrolyte changes play only a minor role in the genesis of the alcohol 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 alcohol hangover.[4] Alcohol's effect on the stomach lining can account for nausea because alcohol stimulates the production of hydrochloric acid in the stomach.

Studies show that alcohol hangover is associated with a decrease in blood glucose concentration (less than 70 ml/dl), but the relationship between blood glucose concentration and hangover severity is unclear.[4] Also known as insulin shock, hypoglycemia can lead to coma or even death.[29]

In current research, the significant relationship between immune factors and hangover severity is the most convincing among all factors so far studied.[4] An imbalance of the immune system, in particular of cytokine metabolism has been identified as playing a role in the pathophysiology of the hangover state. Especially the hangover symptoms nausea, headache, and fatigue have been suggested to be mediated by changes in the immune system. The concentration of several cytokines have been found to be significantly increased in the blood after alcohol consumption. These include interleukin 12 (IL-12), interferon gamma (IFN) and interleukin 10 (IL-10).[30] Some pharmacological studies such as on tolfenamic acid[31] and Opuntia ficus-indica (OFI)[32] have also indicated an involvement of the immune system. These studies suggest that the presence and severity of hangover symptoms can probably be reduced by administration of a cyclooxygenase inhibitor such as aspirin or ibuprofen.[4] e24fc04721