What actually happens to our bodies during a hangover? And is there anything (scientifically proven) to ease the effects of this unique form of self-inflicted hell?
It’s a phenomenon that has plagued humanity since our ancestors first stumbled upon fermentation more than 10,000 years ago. The dreaded, guilt-inducing agony that follows a heavy night of drinking: a hangover.
Characterised by insatiable thirst, a throbbing headache, dry mouth and nausea, the hangover is also often accompanied by a sense of utter despair and self-loathing: “hangxiety”. At times, the symptoms can be so severe that the sufferer lies in bed gripped by the feeling that the end is nigh.
With the festive season upon us, some of us might over-indulge in booze at social gatherings. What actually happens to our bodies when the drinking stops and a hangover begins? And is there a (scientifically proven) cure?
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What is a hangover?
If we associate a hangover with bad or irresponsible behaviour of our past selves, it is fitting that the medical term for it is veisalgia, from the Norwegian kveis (uneasiness following debauchery) and the Greek algia (pain).
The condition was first documented more than 3000 years ago in the Sushruta Samhita, an Indian textbook on Vedic medication, where it was described as paramada, a post-drinking condition marked by thirst and pain in the head and joints.
Despite literally thousands of years of hangovers, experts say the biological basis of the condition is still unclear. By today’s medical definition, a hangover is simply a collection of symptoms, physiological and psychological, that occur after heavy drinking when your blood alcohol has actually worked its way back to (or is approaching) zero and your body is dealing with the fallout.
What causes the physical symptoms of a hangover?
“It remains quite an enigma,” says Associate Professor Yvonne Bonomo, an addiction medicine specialist at St Vincent’s Hospital, “but we think it could be a combination of things.”
As our body breaks down alcohol, it produces its own toxins.
The active ingredient in booze – the thing that gets us drunk – is ethanol, a clear, colourless, organic chemical compound. The liver is where more than 90 per cent of ethanol is metabolised. Two liver enzymes (alcohol dehydrogenase and aldehyde dehydrogenase) begin to break apart ethanol molecules. One of the compounds they convert them into is acetaldehyde – which is between 10 and 30 times as toxic as alcohol itself. Studies on lab animals have shown it can cause flushing, nausea, memory impairment, palpitations and sweating, all symptoms of hangovers. Over time, the acetaldehyde is turned into acetate, which is then broken down into water and carbon dioxide so the body can excrete it.
If the amount of alcohol you drink has outpaced your liver’s ability to process it – generally, our liver can process only one drink per hour – then acetaldehyde and acetate can build up in your body. And even as the traces wear off, your body remains engaged in an elaborate rebalancing act as it returns to normal function.
To complicate the picture, alcoholic drinks also contain very small amounts of methanol, another fermentation byproduct that is highly toxic, which the body breaks down into formaldehyde and formic acid about 10 hours after drinking. Formaldehyde has traditionally been used to preserve bodies, thus to feel “pickled”.
Another theory is that hangovers are caused by an exaggerated response from our immune system, which releases elevated levels of cytokine cells, regulating inflammation.
In other words, our bodies respond to booze much as they would to a virus. When cytokines get busy, the immune system begins firing. Cue headaches, chills, fatigue and nausea. Higher-than-normal cytokine levels are also suspected of interfering with memory formation – which might account for ethanol-related lapses in recall as well.
Some scientists suspect alcohol may even disrupt the blood vessels in the gut and damage the immune cells that line the intestines. A 2015 study found that binge drinking can reduce infection-fighting white blood cells hours after peak intoxication, perhaps weakening the immune system during a hangover.
But what of the splitting headache after a night on the sauce? “A big part of that headache is dehydration,” says Bonomo. Ethanol’s diuretic effect, which means it increases the amount of water, salt, vitamins and minerals excreted through the kidneys, is likely to wind up hurting your head.
But there are plenty of other potential culprits: electrolyte imbalances, the effects on various hormones as well as the effects on neurotransmitters in the brain, and vasodilation. As well as causing blood vessels in the brain to widen, alcohol can alter the effects of serotonin on nerve endings – both are symptoms known to occur in migraines. There is also some suggestion that acetate can trigger a headache, as hangover symptoms seem to be at their worst when acetaldehyde levels are low (and, remember, the body converts acetaldehyde into acetate).
It’s a myth that drinking kills brain cells. But alcohol can hurt the brain in other ways – for instance, by damaging the ends of neurons called dendrites, making it hard for neurons to relay messages to one another. Professor Steve Allsop of the National Drug Research Institute at Curtin University says blackouts are an indication you’ve done some damage to your brain. “But it doesn’t mean it’s permanent,” he says. “However, the more often you do that and the more severe it is, the more likely it’s going to become a significant problem long term.”
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Where does the anxiety, the sense of dread, come from?
Alcohol, as with any drug, changes chemical levels in your brain. It triggers increases in feel-good dopamine, for example, which then sends signals to increase heart rate and blood pressure. And it boosts production of a neurotransmitter called GABA (gamma-aminobutyric acid), prompting brain receptors to adapt by reducing GABA output. By the time you’re hungover, says Allsop, you have depleted GABA levels – not to mention disrupted levels of an amino-acid called glutamate – and it’s thought these changes can contribute to a range of things, including anxiety.
Alcohol also causes a small rise in noradrenaline, better known as the fight-or-flight hormone, which can influence mood and increase anxiety.
Drinking affects our limbic system, the part of the brain involved in memory (what did I say last night?), emotion (think tunnel vision) and behaviour (enough said).
“As the amount we consume goes up, the level of exposure in the brain goes up, so we move from disinhibition to a more generalised taking over of the brain function, which is when people experience things like blackouts,” says Bonomo.
Then there’s being sick: booze sets off a part of the brain known as the chemoreceptor trigger zone, which stimulates vomiting, a survival instinct.
“When we consume alcohol there is lots of stimulation of different circuits and different pathways that we don’t normally have operating,” Bonomo says. “In a sense, alcohol has changed the neurotransmitter balance, and then it’s worn off. It takes a while for the brain to recalibrate.” Some experts believe it can take a day or two. “During that time you might feel a certain sense of dysphoria or panic or fear.”
This experience is “very exaggerated” in people who drink heavily then suffer from alcohol withdrawal. “They get really anxious, they shake, their heart’s racing and they feel like something terrible is going to happen,” she says. “But if you wind back that extreme picture, one can assume that what people are experiencing when they feel anxiety during a hangover is a milder form of that imbalance.”
Can you die from a hangover? While they can make you feel like death warmed up, they’re unlikely to kill you – but consuming too much booze on a night out can be fatal.
Does popping a multivitamin or rehydrator help?
Dissolving a multi-vitamin or rehydrating tablet in a glass of water is often the first remedy a person will reach for. Does it work? Not really, says Monash University physician and scientist Merlin Thomas. He says people often assume the gamut of hangover symptoms are caused purely by dehydration. Dehydration can worsen some symptoms but it’s not the only factor at play.
And hangovers are not caused by vitamin deficiency. “Vitamins have been studied quite extensively and most vitamins are very quickly removed by the body,” Thomas says. “Even if you give somebody a mega-dose of vitamins the morning of their hangover, they’re so quickly cleared by the body into the urine that they actually have very little effect.” (For vitamins to have an effect on a person’s overall health, they have to be taken regularly.)
Thomas says while a hydrating tablet or sports drink may help to rehydrate you by replenishing lost electrolytes (which help regulate nerve and muscle function), it will not be enough on its own to cure your hangover.
What about hair of the dog?
An old British folk remedy for a rabid dog bite gives this “drinking recovery” method its name – hair from the dog was placed in the wound.
But if there is any perceived benefit to waking up with a hangover and proceeding to down a Bloody Mary, Thomas says it is only temporary. You are simply replenishing the body … with toxins. “The hair of the dog simply makes you intoxicated,” he says. “So you are just prolonging or delaying the process of going through the hangover.”
In fact, you may be increasing the risk of experiencing health harms because you are drinking more, and increasing the risk of becoming alcohol dependent.
Surely painkillers and coffee take the edge off?
While painkillers, such as paracetamol and anti-inflammatories, may have an effect, Thomas says they are unable to cure a hangover in the way that simply going back to sleep might. But he does say some studies suggest a combination of caffeine and over-the-counter anti-inflammatories could block some lingering effects of acetaldehyde or acetate, and this may be one reason they give relief.
There’s also the fact that coffee “wakes you up”. “What really works quite well for jet lag actually helps for hangovers as well,” he says. “Your brain, after a hangover, wants to be asleep but your body is awake and walking around in the daylight so there is this disconnect and, just like sleep deprivation from jetlag, it makes you feel really lousy.”
But some experts warn coffee is another diuretic that could increase dehydration and irritate your stomach.
Yes, what about sleep?
While an intoxicated person can often easily pass out from drinking too much, their sleep quality is markedly impaired. On a sober night, your body clock will slip into a restorative rapid eye movement (REM) sleep about 90 minutes after you fall asleep. But growing research shows while alcohol depresses your nervous system, helping you fall asleep faster, the quality of your sleep suffers.
“You’re unconscious as it were, but you’re not getting that restful sleep,” Allsop says. “You might sleep for a long time, but you wake up feeling horrible and exhausted.”
But, as Thomas says, a nap the day after a big night out, when your blood-alcohol content is back to zero, will help. Hooray!
Could a cold shower or quick dip do the trick?
Thomas believes resetting your body clock through either black coffee or having a cold shower or swim can help significantly more than other so-called remedies. “It’s not a perfect cure but much better than hair of the dog or multi-vitamins and all those other sorts of drinks.”
While there are no robust scientific studies on this, much as with a shot of coffee, the burst of water from a cold shower or swim may shock your body (and your brain) into waking up, he says. “Waking your body up is part of the process of getting over the hangover because the brain wants to sleep after all it has gone through in recent hours and missed out on the night before,” he says. “You have to try and essentially tell your brain, ‘It’s time to wake up and get on with things.’
“My advice is always to either do something to wake up – or go back to sleep for a few hours.”
Should you eat greasy food?
A large, fatty meal – say, a cheeseburger and hot chips – is far better at preventing a hangover by slowing the absorption of alcohol than it is at curing it. Our stomachs are still churning from a night of heavy drinking, and the lining of our guts are irritated. Alcohol irritating the stomach lining can cause electrolyte imbalance and interfere with glucose production, leading to low blood sugar, which could be contributing to your hangover.
“Instead of being beautifully organised like a train track going through one carriage after another, our stomachs are like a hodgepodge of contractions that can make you feel really sick,” Thomas says.
So, what should we be eating? Protein-rich foods such as eggs and peanuts work better at settling the stomach. “I often ask, ‘What food would you give to a woman who was experiencing morning sickness?’ The advice is to eat something small and easy to digest.”
Are traditional remedies worth a try?
The cult of Dionysus, the ancient Greek god of wine and ritual madness, worshipped by drinking to excess. Ancient Greeks fed sheep lungs and two owl eggs to “drunkards” to act as a “preventative to inebriety”. The cure was tweaked by the Roman Pliny the Elder, who suggested also eating a fried canary. The ancient Sicilians recommended chowing down on dried bull penis.
By the Middle Ages, a go-to remedy was to guzzle raw eel and bitter almonds. Mongolians have been known to traditionally feast on pickled sheep eyeballs in tomato juice. Nowadays, their hangover dish is more likely to be a soup called bantan, made of meat and dough crumbs.
Meanwhile, cattle ropers in the Old West of the US are said to have sipped tea brewed from rabbit dung. In Haiti, some voodoo practitioners have been reported to stick 13 black-headed pins into the cork of the bottle that caused the hangover.
To avoid the Sunday scaries, modern-day Russians have been known to consume pickled cucumbers and sour cabbage and to drip vodka over fatty sausage into a tumbler then knock it back. Koreans have a soup called haejangguk, meaning “stew to cure a hangover”, with hero ingredients of dried anchovies and water. And in Japan, drinking hepalyse, a mix of turmeric and beef liver extract, was traditionally an attempt to heal the liver of the drinker.
If hangovers make us feel bad, why do we keep drinking?
Australians spent more time drunk in 2020 than any other nation, according to the annual, independent Global Drug Survey. They drank to the point of drunkenness an average of 27 times a year, almost double the global average of 15. Nearly a quarter reported feeling regret for becoming intoxicated. The pandemic has seen a surge in adults reaching for the booze, reflected in a rise in alcohol-related ambulance callouts.
There is a darkness inherent in our drinking culture; a major study in 2019 found alcohol causes the most overall harm to the community, surpassing crystal methamphetamine and heroin.
Allsop believes despite hangovers, we reach for the bottle because it offers immediate gratification; solace, celebration or commiseration in a glass. “The fun is now, the hangover is tomorrow,” he says.
The only real way to avoid it is to drink less, ensuring that you’re hydrated and drinking alcohol only with or after food. “A hangover is your body’s way of saying you drank too much,” he says. “Prevent it by drinking less alcohol next time.”
Bonomo says younger Australians are opting to start drinking later; it is the older generations she is most concerned about. If you continue to drink heavily as you get older, you can develop neuro-adaptation, an increased tolerance to a drug. “You can tolerate more alcohol but you have the longer-term effects of alcohol – so the liver damage, the heart damage and the brain damage,” says Bonomo. “It can also affect your mental state; we know that people who drink heavily for a long time do get anxiety and are more prone to depression.”
There is some suggestion that about one in 10 people are resistant to hangovers, says Bonomo, and there are some signs they may have genetically determined different levels of enzymes that break down alcohol, leaving them less prone to feeling sick the next day. But this is not always a good thing: “The problem with that is that they may be at risk of developing alcohol problems because they don’t have a reason to turn the switch off.”
Meanwhile, a hangover cure one day is not impossible.
“It may not be in my lifetime, but I think one day we will have a cure,” she says. “That’s the beauty of science. You keep looking, you keep understanding more and then you have that ‘aha’ moment.”
If you need help, talk to your GP; seek an appropriately trained counsellor; phone the Alcohol and Drug Foundation on 1300 85 85 84; Alcoholics Anonymous on 1300 222 222 or Lifeline on 13 11 44.
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