What is a hangover?
Although there is no precise scientific definition, we all know it when we have it. In general, an alcohol hangover involves two or more the following symptoms: headache, nausea, diarrhea, lack of appetite, shakiness, feeling tired and an overall feeling of being unwell. Simply put, it feels like the "flu".

There are numerous changes in the balance of hormones, neurotransmitters and other biological substances in the body. This neurobiological imbalance leads not only to the symptoms described above, but also in a rapid heart rate and increased work load on the heart. The latter is responsible for increased cardiac mortality.

There is a diffuse slowing of the brain waves as seen on EEG several hours 16 hours after all alcohol has cleared the body. Neuromuscular performance is also impaired long after alcohol is undetectable in blood.

Socioeconomic Consequences

Alcohol hangovers are not just a nuisance, and their socio-economic impact is not insignificant. In the U.S. alone, the cost of alcohol use is a staggering $148 billion dollars each year, much of it due to work missed or decreased occupational productivity due to hangover.

Hangovers account for an average annual opportunity cost of $2000 per working adult. Contrary to popular misconception, light to moderate drinkers account for the most work related costs.

Causes of Hangover

Hangovers are a poorly understood clinical entity despite their existence since ancient times. Scientists now believe the cause is multi-factorial and their occurrence is not solely related to the amount of alcohol consumed.

Other factors include empty stomach, lack of sleep, psychosocial factors, increased physical activity while drinking, and dehydration. Persons in otherwise poor health have a greater likelihood of developing a hangover. Children of alcoholic parents report greater hangover symptoms than the children of non-alcoholics.

Beware, 6 drinks in an 80 kg male and 3-5 drinks in a 60 kg woman will almost always lead to hangover. Simply put, not drinking enough to get drunk will dramatically reduce the likelihood of hangover.

Some people believe that a hangover is nature's way of punishment to prevent future drinking. However, studies have found that hangovers do not deter drinking. In contrast, it may encourage the person to drink more, also known as an "eye opener". One study showed that many people with hangover, drink more alcohol to reverse its effects.

Prevention of Hangover

The only thing that can absolutely guarantee a hangover will not occur is to avoid drinking. Most of us ignore this warning.

1. Ladies, don't try to act macho and compete with the guys. I am not being sexist here. Just that biologically speaking, men can tolerate more alcohol than women, even if they are of same height and weight.

2. Do not mix different types of drinks. Avoid drinking on empty stomach. Food in the stomach prevents rapid absorption of alcohol into the blood stream. Thus, the more food you have before and during drinking, the less the impact of alcohol.

As much as possible, drink "clear" alcohols. One study showed that for the same amount of alcohol ingested, 33% of bourbon drinkers suffered hangovers, compared to only 3% of those who drank vodka. Brandy, red wine, tequila and rum are more likely to cause hangover than white wine, vodka and gin.

3. Dark or colored alcohols have small quantities of other toxic substances or congeners that are created during the fermentation process. Congeners are implicated in the causation of hangovers. These congeners include methyl alcohol, aldehydes, histamine, tannins, iron, lead and cobalt.

4. Drink plenty of water. Make sure to drink water or other fluids such as apple juice or Gatorade before going to sleep, in order to prevent dehydration.

5. Do not drink while using sauna. Saunas and alcohol do not mix well together andlead to increased health risk.
When You Have a Hangover

It is never too late to start damage control. The preventative measures described above are still helpful.

Do not drink more in order to reverse the hangover. It will make matters worse.
Drink plenty of water or other fluids but avoid orange or grapefruit juice. Many people drink coffee; its efficacy has not been studied but many people recommend avoiding it as its diuretic effect may further worsen the fluid imbalance in the body.

Eat light, nutritious food and stay away from greasy, fatty foods. I recommend bananas and yogurt etc.

Avoid sauna to relieve hangover. It may sound appealing, but can have adverse effects on your heart and blood pressure.

Liv52, an herbal remedy (Himalaya Drug Co., India) has been demonstrated to decrease the symptoms of a hangover. Another study showed that prophylactic use of pyritinol (similar to vitamin B6) reduces the symptoms of a hangover by about 50 percent.

Over the counter medications like acetaminophen, aspirin and ibuprofen are frequently used by hangover sufferers, although their effectiveness has not been studied. Tolfenamic acid, a drug with similar pharmacological action, has been shown to ameliorate the symptoms of hangover. Its best to check with your doctor before trying any such remedies. For your own safety and others, don't drive a vehicle or operate heavy machinery.