With the holidays comes more drinking. You will be buried in folk remedies for hangover but you want to know what has actually been studied, what actually works when compared to folks doing nothing (or taking a placebo).
First, know what does NOT cause a hangover. A hangover is not an electrolyte imbalance, not lactate, not ketones and, this will surprise you, markers of dehydration (e.g., vasopressin) are not significantly related to hangover severity. It is not just dehydration.
What is responsible for hangover (headache, diarrhea, loss of appetite, tremulousness, fatigue, or nausea)? It’s weird right, that more than 24 hours after your blood alcohol concentration is zero you still feel miserable. It’s about the inflammation, it’s an immune response. Many newer studies have helped us see the significant relationship between immune factors and hangover severity. This is key for you, as many studies show that hangover severity may be reduced by anti-inflammatories (which are inhibitors of prostaglandin synthesis). So know this.
1. The best studies are done on anti-inflammatories like NSAIDS (ibuprofen, Advil, Motrin, Aleve). Two over the counter tablets (200-400 mg) with water before you get in to bed will help decrease hangover severity. Remember, Tylenol (acetaminophen) is not an anti-inflammatory and won’t help nearly as much.
2. Symptom control. For nausea due to hangover Zofran (ondansetron) helps quite a bit. Pepcid, Zantac or Alka-Seltzer may help for some of the sour stomach you have the next day. Those won’t help at all for the drowsiness or fatigue obviously.
3. Prickly pear extract has actually been studied (on medical students which is funny) with results published in a scientific journal and it works! You take 2 capsules two hours before you start drinking and decrease the severity of your hangover in some cases by 50%. Prickly pear extract likely works as an anti-inflammatory. You can buy the capsules online but remember supplements and vitamins aren’t regulated so you have to hope you get the actual product.
4. Liv.52 is an herbal supplement that does have a published study where taking that supplement helped for hangover severity. Liv.52 is a capsule that contains a mixture of several herbs and again, hasn’t been tested for safety so you have to take a leap of faith on this. I’d go the NSAID route first.
5. Vitamin B6. Many of you wrongly think of vitamin B12 as a remedy for hangover, the studies show positive results only for Vitamin B6. Here is what you have to do: 400 mg of Vitamin B6 when you start drinking, 400 mg three hours later and 400 mg at the end of the night (good luck with remembering that).
6. Sleep. Sleep deprivation and quality affect your hangover. In fact, severity of hangover is related to sleep duration and quality not amount of alcohol consumed (what?!). Sleeping it off is a successful remedy. Don’t drink heavily on a night before you have to get up early to walk the dog, catch a plane, go to work or when you know you are going to be sleeping on a friends uncomfortable couch. You get the idea.
7. Avoid dark liquors to decrease your hangover severity. Dark liquors (red wine, brandy, whiskey, bourbon, etc.) give you worse hangovers than clear liquors. Dark liquors contain congeners which give those drinks their flavor and color. A hangover will be worse for the same amount of whiskey as compared to vodka. More congeners = more hangover. Mixing orange juice can lessen the effect of congeners (whiskey and orange juice, yuck—but this will lower your risk of hangover).
8. Avoid the aggravators. You will have a more severe hangover if you don’t eat, do physical activity while drinking (for example, beach volleyball tournament), or smoke.
9. Hydration will help, but not completely relieve, hangover symptoms.