Dr. Charles Cochran

The medical term for the hangover is Veisalgia. Kveis is Norwegian and is defined as uneasiness following debauchery. And, algia is Greek meaning pain. The hangover defined is having, at least, two of the following listed symptoms with sufficient severity to disrupt the performance of daily task and responsibilities (percentage of population experiencing each symptom): headache (66%), poor sense of overall well being (60%), diarrhea (36%), anorexia (21%), tremulousness (20%), fatigue (20%), and nausea (9%). Experimentally an alcohol dose of 1.5 - 1.75 gms/kg body weight (5 to 7 standard cocktails) will almost always produce hangover symptoms in those susceptible individuals .

Wouldn’t it be wonderful if the hangover were a result of dehydration as many of us thought when we first started drinking? Unfortunately preventing a hangover is much more complicated than just drinking lots of fluids along with our alcoholic beverages. Aside from dehydration, hangovers are a result of alterations in endocrine function, dysregulation of cytokine pathways, and proper elimination of toxins produced during alcohol preparation and normal liver metabolism.

Anti-diuretic hormone (ADH) is produced by the pituitary gland and causes the body to retain water. While drinking and during acute intoxication, ADH production is decreased and so we see an increase in urination resulting in dehydration. However, during the hangover phase, ADH production is increased causing a retention of body fluids resulting in puffiness in tissues for example in the face and around the eyes .

Other hormonal alterations include the adrenal cortex hormones, aldosterone and cortisol. Aldosterone helps regulate blood levels of sodium, chloride, and potassium. During drinking aldosterone levels decrease causing a decrease in sodium and an increase in potassium levels resulting in decreased blood volumes and a temporary decrease in blood pressure. However, during the hangover period aldosterone increases causing an increase in serum sodium levels and an increase in blood volumes and blood pressure. These electrolyte imbalances can be responsible for muscle weakness, fatigue, vomiting, and loss of appetite experienced during the hangover.

Cortisol is a regulator of fat, carbohydrate, and protein metabolism. It also works with aldosterone to balance electrolytes, and functions as an important anti-inflammatory. During times of hangover, cortisol causes an increase in blood sugar levels by converting amino acids into glucose in the liver known as gluconeogenesis. Increased blood sugar levels would cause in increase in insulin production and abnormal stress on pancreatic and liver function. Cortisol also decreases protein in skeletal muscles and causes a redistribution of body fat from the legs and arms to the trunk and shoulder blade regions of the body.

Next, rennin production, an enzyme produced by the kidneys and responsible for regulating blood pressure, is increased. Rennin acts on angiotensin to form a vasopressor substance known as angiotensin I. This causes an increase in blood pressure and an increase in heart rate and left ventricular ejection . This may be responsible for increases noted in mortality rates due to myocardial infarction during hangover periods.

Other important factors involved in the intensity and production of hangover symptoms include the production and elimination of toxins (conversion of ethanol into acetaldehyde and acetate in the liver) and the increased production of thromboxanes. Thromboxanes are products of fatty acid metabolism and are responsible for blood vessel constriction (raising blood pressure), blood platelets sticking together (increase in clot formation), and decreases of natural killer cells (decreased immunity). An increase in thromboxane-B2 during the hangover has also been found to cause symptoms similar to those in a viral infection, including nausea, headache, and diarrhea .

Lastly, the level of congeners found in alcoholic beverages can be a major causative factor in the production of hangover symptoms . Congeners are the by-products of alcohol preparations. Higher concentrations are found in dark liquors such as brandy, wine, dark tequila, and whiskey. Lower concentrations are found in clear liquors, such as rum, vodka, clear tequila, and gin. Experimental studies revealed that 33% of test subjects who consumed 1.5 gms/kg of bourbon experienced hangover symptoms while only 3% of those who consume the same volume of vodka experienced symptoms .

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