Hangovers: Can They Be Prevented & Treated Naturally?

By Tim N. Ziegenfuss, Ph.D., C.S.C.S., &
Gene Bruno, B.S., M.H.S., A.H.G.

Let’s face it; most of us like to toss back a few drinks every now and then. Unfortunately, overdoing it is not at all uncommon, and neither are hangovers. A small hangover is no big deal. But a big hangover, the kind that makes you miserable the entire next day, is another story. We’re talking about the kind of hangover that makes you miss your job, work, or school, and sabotages your workouts for days on end. [i] That’s it you think, I’m done with booze forever. But invariably another social gathering comes along (or an old friend comes to town for a visit, etc.) and before you know it, you are spiraling down the same (hangover) path as before.

So can anything be done to significantly reduce or eliminate hangover symptoms? The internet and the popular press promote all different types of dietary supplements for this purpose; but do they really work? We’ll examine answers to this question shortly. But first, let’s take a closer look at the symptoms and causes of hangovers.

Symptoms and Causes of Hangovers

Although most hangover symptoms are all too familiar (headache, nausea, fatigue, tremors, poor appetite, fatigue) a constellation of physiological manifestations are present as well. These include: decreased brain wave activity, dehydration, diminished visual-spatial skills, decreased dexterity, cognitive impairment, increased antidiuretic hormone release, acid base and electrolyte disturbances, and decreased growth hormone release.1

Although it’s true that drinking higher amounts of alcohol can lead to more severe hangover symptoms, the amount of alcohol consumed is not the sole factor. [ii] Hangovers are thought to be caused by a number of interrelated factors: increases in acetaldehyde (the dehydrogenated byproduct of alcohol metabolism), cogeners, alterations in various cytokine pathways, hormonal disturbances, and metabolic acidosis.

Acetaldehyde

In adults, ethanol (the predominant form of alcohol found in alcoholic beverages) is metabolized (broken down) into acetaldehyde, and then into acetate; a vinegar-like substance which the body can then use to make fat or water and carbon dioxide. Acetaldehyde can result in oxidative damage to body tissues, and might be responsible (in part) for hangover symptoms.[iii] However, it likely that cogeners play an even greater role in certain types of hangovers.

The cogener methanol is another form of alcohol which is only present in very small amounts in alcoholic beverages. Methanol is highly toxic and causes permanent blindness if taken in larger amounts. Deaths and injuries have resulted as a consequence of mistakenly substituting methanol for ethanol in beverages. The metabolism byproducts of methanol are formaldehyde and formic acid. These substances are thought to be primary culprits in hangover symptoms.

Cogeners

Congeners are byproducts of the production of spirits or wines. They are complex organic molecules such as polyphenols, including histamine and methanol [iv], and give the drink a distinct flavor. Cogeners have been shown to increase the frequency and severity of hangover. [v] [vi] [vii] Cogeners are found primarily in brandy, wine, tequila, whiskey, and other dark liquors. Clear liquors, such as rum, vodka, and gin, tend to cause hangover less frequently. For example, in one study, 33% of patients who consumed bourbon (which has high congeners) experienced severe hangover, but only 3% of those who consumed the same dose of vodka (which has low congeners) experienced severe hangover. [viii] Hence, your choice of alcoholic beverage can have an effect on the severity of your hangover. Following is a list of alcoholic beverages listed in order of those most likely to provide the most severe hangover symptoms:

Brandy
Red Wine
Rum
Whisky
White Wine
Gin
Vodka [ix]

Problems with cytokine pathways

Despite which alcohol you choose to drink, they are all likely to have an adverse effect upon your cytokine pathways. (Cytokines are hormone-like substances involved in cell-to-cell communication and behavior.) Viral infections also cause an adverse effect upon cytokine pathways, which results in the symptoms of nausea, headache and diarrhea. This is the same effect and symptoms seen in a hangover.[x] Alcohol causes the adverse effect on cytokine pathways by elevating levels of prostaglandin E2 (a pro-inflammatory hormone-like substance) and thromboxane B2. Not surprisingly, levels of these prostaglandins have been shown to be elevated during a hangover.[xi]

Hormonal alterations

In addition to the hormone-like effects of prostaglandins, variations in hormone concentrations will also have an effect on hangover. This is seen most significantly in the case of antidiuretic hormone. As the name suggests, the function of antidiuretic hormone is to prevent the kidneys from creating an excess of urine. Excess urine production would be problematic since it could result in dehydration and electrolyte imbalance. Unfortunately, alcohol inhibits the effect of antidiuretic hormone on the kidneys, thereby inducing urine production that is out of proportion to the volume of fluid ingested. Research has clearly shown that hangover severity is proportional to antidiuretic hormone (ADH) concentration. [xii] In other words, the less ADH you have, the worse your hangover is likely to be.

There are other hormones whose levels are altered during alcohol intoxication. However, we won’t review them here since they haven’t been shown to correlate with hangover symptoms.[xiii]

Metabolic acidosis

Both alcohol intoxication and hangover result in metabolic acidosis. This is a condition where the body’s pH is more acidic than it should be. This is a problem since one of the requirements for healthy functioning is for the body to maintain, or quickly restore, the acid-base (alkaline) balance of its fluids. A deviation away from the normal acid-base balance can disturb normal cellular chemical reactions. Furthermore, research has demonstrated that metabolic acidosis is directly proportional to hangover severity. [xiv]

Prevention and treatment of hangovers

Now that we know about some of the causes of hangovers, let’s examine the question of whether or not any dietary supplements might be helpful in reducing or eliminating hangover symptoms. The answer is that there is a least one combination of natural substances that seems to show promise. A two-capsule serving of the combination consists of 400 mg calcium carbonate, 500 mg of the blue-green algae Spirulina, 200 mg of the herb Aralia mandshurica and 200 mg of Neem leaf powder.

How does it work?

There is not a clear cut answer to this question. Assuming that future clinical research will yield similar positive results, it seems there may be a number of different reasons why this formula has demonstrated effectiveness with regard to hangovers. Let’s take a closer look at each of the ingredients in the supplement, and examine what role each of these ingredients might play. Keep in mind while reading that these are only possible reasons why these ingredients may work in reducing hangovers, not well-established facts.

Calcium carbonate

Calcium carbonate is a natural source of the essential mineral calcium, and is commonly used in dietary supplements. Although typically associated with helping to build healthy bones, calcium carbonate may also help to prevent and treat hangover symptoms. Here’s how. Since metabolic acidosis is directly proportional to hangover severity, preventing it seems like a reasonable goal. That’s where calcium carbonate comes in. Research on patients with kidney disorders has demonstrated that with calcium carbonate, which is very alkaline, can prevent acidosis. [xv] [xvi] As a matter of fact, in one study, the authors stated, “CaCO3 [aka, calcium carbonate] ameliorates metabolic acidosis.” [xvii]

Spirulina

Spirulina (Spirulina platensis) is a blue-green algae that contains a special type of protein called C-Phycocyanin (C-PC). C-PC has significant antioxidant and free radical scavenging properties, and also has shown anti-inflammatory properties. [xviii] [xix] [xx] Since, as discussed earlier, acetaldehyde from alcohol results in oxidative damage to body tissues, these properties may be particularly beneficial in this situation. The mechanism by which C-PC acts as an anti-inflammatory agent is by inhibiting certain prostaglandins (recall that elevated prostaglandins are associated with hangover). Also, some research has shown that spirulina may be beneficial with regard to the normalizing cytokine pathways [xxi]; another biochemical process discussed earlier that is adversely affected by alcohol consumption. Finally, Spirulina has some alkaline properties which may also have benefit with regard to acidosis. [xxii]

Aralia mandshurica

Aralia mandshurica is a plant found only in the Far East. It contains a natural component called aralosides [xxiii], which is similar in effect to ginsenosides from ginseng. [xxiv] As a matter of fact, some research has even done a side-by-side comparison of Aralia mandshurica, Panax ginseng, Panax quinquefolius (American Ginseng), and Eleutherococcus senticosus (Eleuthero; previously called Siberian Ginseng). Aralia compared favorably. [xxv] Aralosides stimulate the central nervous and immune systems, they show adaptogenic (i.e., anti-stress) effects, protect an organism from unfavorable environmental conditions, hypoxia (low oxygen) and toxic agents. [xxvi] In terms of its potential benefit for hangovers, Aralia’s contribution may have to do with its adaptogenic properties, or its ability to protect against damage caused by oxidation. In one study, various combinations of natural substances, including Aralia, were shown to be effective against lipid peroxidation (i.e., oxidation). [xxvii]

Neem

Neem (Azadirachta indica) is used in East Indian medicine for a variety of purposes, including digestive problems.[xxviii] Like Spirulina, Neem also reduces oxidation and inflammation.[xxix] Furthermore, research has shown that Neem was able to protect against damage to the liver by an agent known to promote liver damage.[xxx]

Conclusion

Hangovers are not trivial events. Recent studies have shown that alcohol use accounts for billions of dollars in lost wages due to hangover-related absenteeism and poor job performance.[xxxi]

Although taking handfuls of ibuprofen or aspirin and drinking water before going to bed is not an unusual approach the treatment of hangover, it is potentially dangerous. If future clinical research turns out to support the use of the supplement for hangovers, then it might present a safe, natural alternative that may also be effective. In any case, these ingredients won’t prevent intoxication or treat and prevent the consequences of excessive alcohol consumption. Please don’t use this type of supplement as an excuse to drink irresponsibly. Certainly you shouldn’t drink alcohol if you are pregnant or nursing. Finally, these natural ingredients in no way should be considered a treatment for alcoholism (consult a physician if you believe you have a dependence on alcohol).

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[iv] http://wine.about.com/library/encyc/glossary/bl_gl_cog.htm

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[xv] Bongiorno P, Caligaris F, Montalcini G, et al. Use of calcium carbonate as an intestinal chelator of phosphorus] Utilizzo del calcio carbonato (CaCO3) come chelante intestinale del fosforo. Minerva urologica e nefrologica = The Italian journal of urology and nephrology 1990; 42(1):55-7.

[xvi] Ueda H, Ikeda H, Sasaki Y, Shioji R. Effect of oral administration of calcium carbonate, aluminum hydroxide gel and dihydrotachysterol on renal acidosis. Tohoku journal of experimental medicine 1978; 124(1):1-11.

[xvii] Anelli A, Brancaccio D, Damasso R, et al. Substitution of calcium carbonate for aluminum hydroxide in patients on hemodialysis. Effects on acidosis, on parathyroid function, and on calcemia. Nephron 1989; 52(2):125-32.

[xviii] Reddy CM; Bhat VB; Kiranmai G, et al. Selective inhibition of cyclooxygenase-2 by C-phycocyanin, a biliprotein from Spirulina platensis. Biochemical and biophysical research communications 2000; 277(3):599-603.

[xix] Reddy Madhava C, Subhashini J, Mahipal SVK, et al. C-Phycocyanin, a welective cyclooxygenase-2 inhibitor, induces apoptosis in ipopolysaccharide-stimulated RAW 264.7 macrophages. Biochemical and biophysical research communications 2003; 304(2):385-92.

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[xxiv] Manchurian aralia, Manchurian spikenard - Aralia mandshurica Rupr. et Maxim. http://www.limonnik.ru/eng_pages/plants_eng/aralia.htm.

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[xxvi] Manchurian aralia, Manchurian spikenard - Aralia mandshurica Rupr. et Maxim. http://www.limonnik.ru/eng_pages/plants_eng/aralia.htm.

[xxvii] Iakubovskii MM, Pentiuk AA, Khmelnitskii OK, Oleinik VN. [The activity of the lipid peroxidation processes in the mucosa of the rat small intestine and its morphofunctional state under acute irradiation and the administration of combined preparations created on a base of highly dispersed silica] Radiatsionnaia biologiia, radioecologiia / Rossiiskaia akademiia nauk 1997; 37(3):366-71.

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[xxx] Yanpallewar SU, Sen S, Tapas S, et al. Effect of Azadirachta indica on paracetamol-induced hepatic damage in albino rats. Phytomedicine. 2003; 10(5):391-6.

[xxxi]Wiese JG, Shlipak MG, Browner WS. The Alcohol Hangover. Ann Intern Med 2000; 132(11): 897-902.