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What happens to your body during a hangover?

September 6, 2016

Kevin Morgan - Medical Student1, Matthew Vasey MD2


1MD Candidate, University of South Florida Morsani College of Medicine, Class of 2018
2Department of Emergency Medicine, Tampa General Hospital | TeamHealth, an affiliate of University of South Florida Morsani College of Medicine

Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author(s).


We've all been here. Friday night's jubilant, alcohol-fueled rager crashes into Saturday morning's nauseating, feels-like-I'm-dying body ache. From the ancient Chinese who first began "getting turnt" over 6000 years ago, to Bradley Cooper, Ed Helms, and Zach Galifianakis after a bachelor party in Las Vegas, man has consistently suffered through hangovers after long nights of binge-drinking. But what exactly is a hangover? Why do we feel so crappy? And if we can design Snapchat filters that can make us look like puppies, cheetahs, or Donald Trump, then why have we not invented a magical "hangover cure" by now? These questions and more can be answered by understanding the chemical processes that occur inside of our bodies when we drink alcohol.

As soon as the alcohol we consume reaches our stomach, a variety of processes occur. Alcohol is broken down into acetaldehyde primarily by an enzyme called alcohol dehydrogenase (ADH) [1]. Though the bulk of this metabolism occurs in our livers, there is some ADH in our stomachs too (men have much more ADH in their stomachs than women, hence why alcohol has a stronger effect on women) [2]. It is actually acetaldehyde not alcohol (remember alcohol ----ADH----> acetaldehyde), that is the jabroni behind the crappy hangover feeling (headaches, flushing) [3]. Acetaldehyde is then broken down into acetate by acetaldehyde dehydrogenase (different from alcohol dehydrogenase, which we will still call ADH). Acetate is chill and will not cause us any problems.

One of the worst parts about alcohol metabolism is that it follows what's called zero order elimination. Zero order elimination means that no matter how much alcohol we drink, we will still only breakdown about 13 mL of alcohol per hour. Most drugs are broken down through what's called first order elimination. This means that the more drug we consume, the more that drug gets broken down. This explains why you are that much more hungover with each extra fireball shot, and why our hangovers can often last a full day after the party [Figure 1].



Figure 1.


In addition to it's metabolic issues, alcohol also causes our stomaches to produce more acid, leading to inflammation of our stomach lining. Our stomach is essentially injured after a night of heavy drinking, hence why we experience, nausea, vomiting, stomach pain, and decreased appetite during a hangover.

Most of us are familiar with alcohol's diuretic properties (fancy way of saying alcohol makes you pee). Though drinking plenty of fluids is important to prevent dehydration, new studies have shown that electrolyte imbalances that result from increased diuresis plays a minimal role in hangover symptoms [4]. So while chugging water at the end of the night or stocking up on expensive pedialyte might quench your dry mouth, it does little to cure a hangover.

Though alcohol is notorious for putting people to sleep, it decreases our ability go through crucial sleep phase called REM sleep [5]. So even if you're that guy who falls asleep at the bar, don't expect to wake up feeling well rested [Figure 2].



Figure 2. #fail


Interestingly, new research has shown that hangovers may be at least partly mediated by an immune process. It has been demonstrated that many of the same chemical mediators that are increased in common diseases (common cold, flu) are also increased after alcohol consumption [6]. Luckily, these chemical mediaters can be lowered with NSAIDs such as aspirin and ibuprophen.

In summary, our hangovers are caused by many different processees that cause us to feel like poop. It's essentially a perfect storm of metabolic disturbance, slow elimination, stomach injury, dehydration, sleep disturbance, and immune dysregulation. Because it hits you with at so many different angles, it's difficult to throw any kind of immediate cure at it. With all this said, it's probably best to stick with the traditional approach of aspirin or ibuprophen, water, a box of pizza, and a healthy dose of regret.

REFERENCES:

1. Guze, S.B., et al., Alcoholism as a medical disorder. Compr Psychiatry, 1986. 27(6): p. 501-10.
2. Frezza, M., et al., High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med, 1990. 322(2): p. 95-9.
3. Korsten, M.A., et al., High blood acetaldehyde levels after ethanol administration. Difference between alcoholic and nonalcoholic subjects. N Engl J Med, 1975. 292(8): p. 386-9.
4. Penning, R., et al., The pathology of alcohol hangover. Curr Drug Abuse Rev, 2010. 3(2): p. 68-75.
5. Yules, R.B., D.X. Freedman, and K.A. Chandler, The effect of ethyl alcohol on man's electroencephalographic sleep cycle. Electroencephalogr Clin Neurophysiol, 1966. 20(2): p. 109-11.
6. Kim, D.J., et al., Effects of alcohol hangover on cytokine production in healthy subjects. Alcohol, 2003. 31(3): p. 167-70.





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