Thursday, 22 April 2010

Everything you wanted to know about Hangovers (but were too afraid to ask)

ResearchBlogging.orgRecently, I read a statement by the American Heart Association about Alcohol, saying that although moderate alcohol reduces your risk of stroke, if you don't already drink you should not begin drinking because drinking raises your risk of cancer. This is an interesting statement, because I think it is incorrect. Cancer is rare, Stroke is common. Even though alcohol increases the probability of those cancers by quite a large amount, many times a small value is still a very very small value. Where as a minor reduction on the probability of stroke results in major gains in life expectancy.

However, while I was challenging myself to back up this mathematical statement with numbers (maybe I'll make a second post about it with the math!) I took a diversion off into hangover land. I rarely get hangovers - I suppose I'm lucky in that respect - but I was curious what promotes hangovers. So I read "The Alcohol Hangover" by Wiese et al. 2000. It's a review paper of the state of Hangover Science, in 2000. If anyone has a newer paper, I'd be curious to read it.

First, I was shocked to find out how much hangovers cost the economy - 148 Billion Dollars a year in decreased productivity and absenteeism. That's staggeringly huge, and so it seems to suggest whatever we can do to treat hangovers is well advised, to reduce this economic burden.

Second,  there isn't a very good definition of what a Hangover is. Some symptoms include Headache, Poor sense of being, Diarrhoea, Loss of Apatite, Fatigue and Nausea, but even the most common feature, headache, is only reported in 66% of hangovers. I wonder if people who suffer, say, Diarrhoea when they are hungover one one instance are more likely to have it in other hangovers. Does it vary person to person, or episode to episode? Sadly, anecdote fails me here; I think a full study would be needed.

A study referenced in Wiese's paper suggests that far from reduce alcohol intake, not only is there no evidence that hangover incidence decreases rates of alcohol intake, but there are indications that it may prompt further alcohol intake! Think of "The Hair of the Dog" type of treatment. Obviously, if we consider this early morning drinking a societal ill, we should work on reducing the overall incidences of hangovers.

Here's something else counter-intuitive: According to a variety of sources cited in the paper, light to moderate drinkers (those of 0 to 3 drinks/day for men, and 0 to 1 for women) are 70% more likely to experience hangover symptoms than heavier drinkers.

Very little is known about about hangover causes, since it's not strictly dose-dependant with respect to the Ethanol (alcohol) content of a drink. Those sayings about never mixing beer with wine are all total garbage, more or less. There are some factors, among which are Acetaldehyde, a metabolite of ethanol, and congeners, which are impurities from ethanol production that include tannins, acetone, phenolics, etc. But it seems clear from this paper (and another that I read) that it's all a bit of a black box, still. What does and doesn't cause it is terribly mysterious. And Wiese et al. is very clear that the research into hangover alleviation is suggestive, but muddy still.

But if you do want to prevent hangovers, there's one other thing you can do; I'd offer you this quote, then:
Clear liquors, such as rum, vodka, and gin, tend to cause hangover less frequently, which may explain why patients with chronic alcoholism use these liquors disproportionately. In an experimental setting, 33%% of patients who consumed 1.5 g/kg of body weight of bourbon (which has high congeners) but only 3%% of those who consumed the same dose of vodka (which has low congeners) experienced severe hangover (41).
Maybe all those vodka snobs are onto something. But I would caution you, before you throw out all your bourbon, that a 2010 paper didn't replicate those results.

Wiese JG, Shlipak MG, & Browner WS (2000). The alcohol hangover. Annals of internal medicine, 132 (11), 897-902 PMID: 10836917


Arvay said...

I've found that the best prevention and cure for a hangover is drinking a lot of water.

Cate said...

Cancer is rare? I thought that cancer was the #1 cause of non-accidental death in the US? It feels like everyone in the midwest eventually gets it, not a matter of if but when. There is standing-room only in some of the chemo clinics, no joke. But you are the one up on the numbers, not me... just doublecheck? :)

TwoYaks said...

@Avery - That's the advice my brother gave me. I don't know if it's scientific, but I very rarely get hungover.

@Cate - Overall, "Cancer" is a major cause of death, but cancer isn't a single thing. There are many cancers, and they're all very different. Lung Cancer is the number one cancer, and in 2004 caused 158,664 deaths. The next most common was Breast Cancers (41,210) and Colorectal Cancer (53,549). Alcohol raises the incidence of three very rare cancers - Mouth and Oropharynx (7,720), and Oesophagus (13,686).

Contrast those two cancers with "heart attack," which in 2004 killed 141,462.

Most lung cancers derive from tobacco smoke (inhaled directly or secondhand) and so the biggest gains in cancer mortality can be made in tobacco control.

in 2006, Heart Disease (which, like cancer, isn't a single disease) killed 200.2/100,000, whereas all Cancers, the 2nd most common killer, come in around 180.7/100,000. "Cancer" is common. Types of cancers are common or rare.

Alaskan Dave Down Under said...

Arvay is spot-on!

Whenever I felt a really bad head cold coming on in the evening, I knew I was going to feel like sh*t the next day. That was my signal to start imbibing! My theory was that if I'm gonna have a "morning after" then I was damned well gonna have a "night before"!

Cate said...