BBC NEWS, Thursday, December 24, 1998

Hangovers: The number one festive illness

A major preventable illness will affect 75% of people who drink to excess over the Christmas period.

Characterized by headache, nausea, dizziness, irritability, thirst and fatigue - and in some cases, tension, paleness, tremors, vomiting, heartburn, unsteady gait and loss of appetite - it is something most people will experience during the festive season - a hangover.

While everyone knows how to get one, few will agree on what cures them. The only thing doctors agree on is that if you want to avoid a hangover, drink only in moderation or not at all. However, hangovers will vary depending on the individual and the form in which the alcohol is consumed.

The cause of a hangover

Hangovers are thought to be caused by an excess of toxins in the blood system. The body cannot process and get rid of them as quickly as required.

"Dr. James Schaefer is a research professor at the department of anthropology at Union College in Schenectady, New York. He is also a specialist in the use of alcohol, and has conducted trials comparing different types of hangover cure. He says a hangover manifests itself in physical and psychological reactions that are normally associated with an overdose. However, the exact source of the toxins responsible is uncertain. "The toxins may be produced within the human system, may be introduced from outside, or a combination," he says. "Ethanol itself, and the by-products of alcohol metabolism (breakdown process) by the liver, especially acetaldehyde, which is thought to be highly toxic, are typical culprits. Our bodies produce enzymes to attack these agents but they only work at set rates, thus the accumulation - the excess - we have the next day makes us feel ill." Some of the toxins come from the drink itself, he says. "Alcoholic beverages themselves have toxins, the by-products of fermentation and distillation, called congeners." Some drinks have more congeners than others. Cheap spirits, and especially cheap whisky, and cheap champagnes are among the worst culprits. The drinks with the lowest number of congeners are the more expensive spirits that have been distilled three or four times, and in particular gin and vodka. Red wine can also cause a headache because it contains tyramine, a substance that can cause severe headaches.

Variations in individuals

The symptoms of a hangover are exacerbated by dehydration. This occurs because alcohol acts as a diuretic, which means it makes you urinate more than you consume. As a result, anyone who drinks a lot of alcohol may lose more fluid than they consume, even if they are drinking steadily. While 75% of those who drink to excess can expect a hangover, the other 25% of the population will not suffer, Dr. Schaefer estimates. Some people experience severe reactions to alcohol and acetaldehyde. He says: "Upwards of 50% of all people from the Far East, for example, show a facial - and sometimes a full body - flush. This is caused by an excess of capillary blood to the surface due to alcohol's dilatory effect to the veins - they get warm, sweat, have high heart rate and feel ill." This can be caused by just a few drinks and happens because they have a low metabolism rate for acetaldehyde, he says. Doctors also advise people of smaller build to drink less, as it takes their body longer to process the alcohol.

Is there a cure?

Once a hangover has kicked in, time is the only cure. There are, however, ways to alleviate the symptoms.

Most doctors advise: Aspirin or ibuprofen to take care of the headache; Drinking fluids - especially before going to bed - to offset dehydration; Eating light foods high in carbohydrates and fructose (a natural sugar in fruit juices and honey) to calm nausea. Ibuprofen may help more if the first dose is taken before going to sleep, although it may increase the risk of liver damage when taken with excessive alcohol.

Dr. Schaefer says many remedies have been tried. As a cure proves so elusive, most have focused on prevention. While some have some medical backing, such as drinking water before going to bed, taking vitamins and taking painkillers before going to bed, others are more bizarre. These include eating lard or butter before drinking to "grease the gut" and never starting or never stopping drinking.

Absorption rates

Other methods involve slowing down the rate at which the body absorbs alcohol, so that it can process it at a steady rate without a build up of excess toxins. One way of doing this is to avoid highly carbonated drinks such as champagne. Eating foods high in protein - like fish, nuts and beans - before drinking is also thought to slow down the alcohol absorption rate.

Pills are available over the Internet that claim to be able to prevent a hangover if taken regularly during a drinking session. They mimic the emergency treatment for alcohol overdoses, where the stomach is filled with a charcoal slurry and then pumped out. The pills, patented as "Sob'r-K, act as a "super absorbent in the gut, grabbing ethanol-hemoglobin compounds, congeners and related garbage", Dr. Schaefer says. These are then carried out of the body.

The best way to avoid a hangover is probably self-control, however, and if you get too many of them you should ask yourself why, he adds. "A hangover is always a sign that a person has consumed too much alcohol and should be used as a warning to examine reasons why alcohol consumption at those levels is needed in their lifestyle."Perhaps cutting back or not drinking are worthy alternatives."