Pretty much everyone has experienced a hangover. Whether it’s waking up feeling groggy in the early afternoon after one too many at the pub the night before, or violent heaving to the tune of the dawn chorus after sinking more than a few drinks in the club at 2am, the combination of mental and physical symptoms that cause a hangover are symptoms you want to go away as soon as possible. Dr Sally Adams, an associate professor at the University of Birmingham says: “In a worst case scenario these symptoms include vomiting, sweating, thirst, as well as low mood, distress and anxiety.” This is a lot to deal with when you’re hungover, so you should consider exactly what is going on in your body the night before, as you drink.
You know when you wake up the morning after a big night, and all you can think of is that you did something awful, or embarrassed yourself. That is known as hangxiety, and David Nutt, a professor of neuropsychopharmacology at University College London, and author of Drink? explains the science behind this. “Drinking has a sedative effect, so when you are drinking your brain tries to combat this by turning on the excitatory system.
“This means that as your alcohol levels rise, your glutamate function does as well.” Glutamate is the neurotransmitter that makes you feel anxious. “When your alcohol levels fall,” he continues, “your glutamate doesn’t fall down with, but remains high. This is why you wake up with increased anxiety.” This also explains why hungover people are more sensitive to bright lights and loud noises. The high glutamate puts you in a hyperexcitable state.
Dr Adams explains another reason behind hangxiety. “Alcohol does a really good job of actually reducing anxiety once it’s in your system. It interacts with an inhibitory neurotransmitter called GABA. As you drink, GABA levels rise, and then try to rebound in the morning, once the alcohol is out of your system.
“I actually stopped drinking because the hangxiety got so bad,” she confessed, “I know people aren’t drinking so much these days, and this is probably the most common reason, they want to protect their mental health.”
This hyperexcitable state is not the only reason behind hangovers. One key symptom is headaches, stomach aches, and nausea. This is because of the inflammatory effect of alcohol. “Your body cannot get rid of alcohol in the form it enters you as ethanol,” Dr Adams explains, “so it has to metabolise it into a substance called acetaldehyde. This is a substance that is toxic to humans, causing cell damage and inflammation in the stomach, intestines and brain.
“One way of looking at this inflammation is looking at what happens when you put alcohol on a cut,” Professor Nutt suggests “It hurts, so you can imagine that spraying it through your body and across your brain isn’t good for you. It’s like having arthritis in the brain.”
One of the biggest myths surrounding hangovers is that they are just dehydration, however this doesn’t mean that this isn’t an aspect that comes into play. “Alcohol is a diarrhetic,” Dr Adams explains. “It makes you lose water by vomiting, sweating and urinating.” There are ways to combat this however. “You could do what the Romans do,” suggests Professor Nutt, “and vomit, so you can replace it with water.” By doing this, the effects of the alcohol already consumed can be reduced, and also you can maintain your hydration.
“As an interesting side note, vomiting is actually a reason that alcohol has survived in human culture for thousands of years. If alcohol poisoning didn’t make us throw up, then the death toll from it wouldn’t be so much higher, and its use wouldn’t be so prominent in our culture.”
Another key driver of hangovers is lack of sleep. Interestingly, alcohol is actually a very good promoter of deep sleep, however for sleep to be effective, there needs to be a good mix of all types of sleep. “What alcohol actually does is lead to less REM sleep,” explains Dr Adams, “just because you fall asleep quickly, it doesn’t mean that it’s good sleep.”
Professor Nutt expands on this, explaining that “despite the fact that you get more deep sleep, the effects of alcohol wear off while you go to sleep, and you go into withdrawal.
“This is what wakes you up, as it truncates your sleep. And this is why hangovers are so unpleasant, as well as everything else you feel really tired.”
Dr Adams warns that if you are tired while hungover, it is important not to drink caffeine unless you regularly do so, “this will increase your anxiety. If it’s part of your daily routine you probably should carry on, you don’t also want to be dealing with caffeine withdrawal.”
So you’re awake now, and your hungover. You can lie in bed and regret the night before, but that won’t change anything. So what do you do? As Dr Adams points out, “there is no convincing evidence to date on a cure for hangovers, but if you wanted to feel better you would have to make a cure, piece by piece based on everything that is going on in your body.
“If you feel dehydrated, it’s definitely a good idea to drink some water. It’s also a good idea to do this before you go to sleep on the night you’ve been drinking. A sports drink may be even better, because it can help address the electrolyte imbalance.
“For inflammation,” she continues, “an anti-inflammatory like ibuprofen, or something probiotic for your stomach could help. It is also important to have some rest and catch up on sleep, but obviously only if you have time.
“I’ve been to work hungover before,” she confesses, “but I have to say ‘this is my own fault’ and suck it up.”
Unfortunately, for the psychological symptoms, like low mood and anxiety, it is best to leave them. “It’s very difficult to treat this medically,” says Professor Nutt, “unless you go back to drinking alcohol. This is called hair of the dog and it is a very slippery slope. It can leave you chasing this constant cycle of anxiety, and drinking to get rid of it. This creates a dependency on drinking.
At the end of the day a hangover, as Professor Nutt says, is a mistake, and most people have their own way of dealing with them. It goes without saying that there is only one real way to avoid a hangover, and that is to not drink at all, or drink in moderation.
