The Unfortunately Essential Guide To Hangovers

Illustrated by Serafine Frey.
This article was originally published on December 14, 2014.
Well, here we are. Again. Staring into the mirror on a bleary-eyed Sunday morning and asking ourselves why we just had to have that last round. This time, though, we're not going to let it go. That's not our style. Instead, we're going to figure out what kind of horrible curse the hangover actually is — and whether there's any way to make it stop.
The medically accepted symptoms of a hangover include feeling fatigued, thirsty, extra sensitive to light, nauseous, unable to concentrate, dizzy, achy, sleepy, depressed, anxious, and/or irritable. Translation: Pretty much every system in your body feels like crap.
Part of this is due to the fact that ethanol, the psychoactive substance in alcohol, affects almost every neurotransmitter system in the brain. These include the heavy-hitters you’ve probably heard about, such as dopamine. Ethanol also affects the excitatory glutamate and the major inhibitory neurotransmitter, GABA. Feeling drunk is partly a product of glutamate’s activities being suppressed and GABA’s activity increasing — double the depressant effect.
All those hangover symptoms don't just come from your brain, though. Alcohol messes with your body all over the place — especially your liver. As a detoxifying organ, the liver has a pretty big job, one that’s even bigger when it has to deal with acetalaldehyde, a toxin that’s created when we digest alcohol. Using two enzymes and the antioxidant glutathione, the liver is able to break down acetylaldehyde pretty efficiently. The problem is that we’ve got a limited amount of glutathione to work with, and it takes time for the liver to get more. This means that if we’re drinking a lot, the acetylaldehyde can be stuck hanging out for a while, causing damage.

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Illustrated by Serafine Frey.
Over time, the liver is repaired, but it's left with scar tissue. That scar tissue can accumulate so much that it interferes with the liver’s ability to do its big, important job. This is termed “cirrhosis of the liver” and commonly develops after long-term, heavy drinking.
Our bodies have yet another response to drinking alcohol — one that scientists are only beginning to understand. This response, as Wired’s Adam Rogers explained, is an inflammatory one, and it might be the true hangover culprit. Research has shown that hangovers usually come with elevated levels of cytokines. This diverse group of proteins plays a huge role in the immune system, signaling the need for inflammation to fight off intruders (including allergens). Our cytokine levels also change when we have a viral or bacterial infection, such as appendicitis. Unlike acetaldehyde, dehydration, or electrolyte levels, cytokine levels are actually correlated with the severity of a hangover, Rogers explains.
What does aging have to do with feeling even worse the day after drinking? Well, as we age, we tend to undergo a few important physical changes. The first happens in our old friend, the liver. Our capacity to generate glutathione decreases as we age, so the liver's ability to break down things (such as alcohol) also decreases. This is one reason why older people can be so much more sensitive to drugs than those of us in our "prime."
Many of us also experience changes in body weight (in either direction) as we get older, and these changes can interfere with how we process drinks. Gaining weight can lead to a lower BAC than we're used to, causing us to inadvertently drink even more; losing weight can cause us to become intoxicated faster.
Illustrated by Serafine Frey.
Aging also has specific implications for the immune system. Getting older is associated with decreased functioning (or just plain weird functioning) in this system, leading to changes in our inflammatory responses — including slowed production of those important cytokines. Research has yet to specifically examine these age-related inflammatory-response changes, but they could be responsible for making our hangovers worse as we get older. Your best bet for beating the morning-after blues? Target that inflammatory-response system itself.
Bona fide hangover cures and prevention methods still elude scientific consensus. We hear you telling us to "just not drink," but that's easier said than done — especially during the holiday season. We acknowledge that abstaining is an option, but what about those of us who just want to have a couple of eggnogs?
Well, Richard Stephens, Phd, a senior lecturer at Keele University, explains that there may be some psychological factors at play, too. His research has shown that the frequency of both hangovers and drinking decrease as we slide from our 20s into our 30s. That doesn't mean our hangovers are less severe — we've just learned not to drink as much. As we continue to age, drinking ramps back up again, but hangovers don't. So, the secret to drinking without a hangover could simply lie in your drinking habits: Do you spread that drinking out over a week's worth of classy dinners? Or, do you stuff it all into one crazy Friday night?
Dr. Stephens also says we might be suffering from a certain amount of selective memory; namely, we aren't great at remembering trauma. Hangovers might be less frequent as we age, but they're still probably worse than we remember. Even if our current-day hangover isn't physically any worse than those of our college days, Dr. Stephens says "we’re comparing it with something we don’t remember very well."
Illustrated by Serafine Frey.
Go-to hangover fixes (a greasy breakfast, coffee, or a brunch-time Bloody Mary) may work for some of us, but we don't really have solid, scientific evidence backing up their powers. There is, however, evidence that eggs could help: They contain cysteine, a compound that helps glutathione form. So, if you've still got some acetylaldehyde in your system, eggs could lessen the load. There's also some evidence to suggest that taking B and C vitamins could aid in this process, but your mileage may vary.
There are about a thousand supplements out there designed to cure hangovers, too. Many of these claim to break down acetylaldehyde, including those same glutathione-increasing compounds. Still, if acetylaldehyde levels aren't completely responsible for a hangover, then just processing the toxin faster won't help. Could it save your liver? Maybe. Will it save you from the next morning's wrath? Probably not.
Because the cytokine response results in inflammation, it makes sense that an anti-inflammatory drug (such as ibuprofen) would curb those symptoms. But, this advice doesn't necessarily extend to other over-the-counter painkillers. For instance, those containing acetaminophen (such as Tylenol) may cause your already-compromised liver more harm than good.
Keep in mind that different types of drinks do have different effects on us, according to some research. In one study, participants who drank vodka performed better on tests the next day than those who drank bourbon, even though their blood-alcohol concentration levels were within the same range.
Of course, you should tackle those holiday parties (and mornings after) in whatever way works best for you. And, while they may not be cure-alls or even very exciting, it does seem like the old standbys — eat first, go slowly, drink water, and accept that punishment may await you in the morning regardless — are the most reliable solutions at any age.

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