What people get wrong about hangovers
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This message comes from Capital One. Say hello to stress-free subscription management. Easily track, block, or cancel recurring charges right from the Capital One mobile app. Simple as that. Learn more at CapitalOne.com slash subscriptions. Terms and conditions apply. You're listening to Life Kit from NPR. Hey everybody, it's Marielle. Today we're talking about that awful morning after feeling.

And if you're listening to this episode, you probably know what I'm talking about. You wake up and the sun's too bright. Your head is throbbing. Your heart's racing. Maybe you've got body aches or nausea or dry mouth. Or if you're really going through it, all of the above. You start replaying the night before in your head and panicking. What did I say to that person? Was I being too loud? Hangovers, man. They are not pretty. And I think intuitively, we know that it's not good for our bodies when we drink that much.

But to be honest with you, drinking alcohol in smaller amounts isn't exactly good for us either. Not to say that people need to give up their one drink with dinner. That's not my point. It's just that there is no safe amount. A small amount is not healthy. Dr. Ryan Marino is a medical toxicologist and emergency physician at University Hospital's Cleveland Medical Center. Alcohol is a toxin. All forms of alcohol are directly toxic to pretty much every cell in your body.

According to the CDC, alcohol is a leading cause of preventable death in the U.S. It's linked to several cancers, cardiovascular disease and driving fatalities. And yet we can hear the stats and still head out to happy hour with friends.

And I'm sure I don't have to spell out why. If you want to loosen up at a party, alcohol works. If you want to go to sleep, for most people, alcohol will make you sleepy. If you have anxiety, alcohol will take the anxiety off. If you want to de-stress after a long day, alcohol will do that.

And so it's effective until it becomes the problem. Dr. Nzinga Harrison is a physician specializing in psychiatry and addiction medicine. She's also the co-founder and chief medical officer of Eleanor Health, a company that provides mental health and substance use disorder treatment services. Now, this doesn't mean she came to this story riding on a high horse, though. I've definitely had a hangover. I'm personally familiar as well as professionally.

We want to acknowledge something up front. There is some thought in the medical community that by offering advice on hangovers, we might be glorifying alcohol or even enabling people to misuse it. But both Dr. Harrison and Dr. Marino agree not talking about hangovers isn't going to make the problem of binge drinking or alcohol misuse go away.

I am not in denial enough to think that people are going to hear that there's no safe amount of alcohol and everyone can stop drinking or is going to want to stop drinking. People really just need to know their risk-benefit profile. So on this episode of Life Kit, we're going to help you with exactly that. Reporter Andy Tegel will share helpful insights from Drs. Harrison and Marino on how to be smarter and more mindful about your drinking before, during, and after a night on the town.

We'll walk you through some alcohol science, help you understand your personal risk factors when you drink, and give you tools for assessing your relationship to alcohol. This message comes from Capital One. Say hello to stress-free subscription management. Easily track, block, or cancel recurring charges right from the Capital One mobile app. Simple as that. Learn more at CapitalOne.com slash subscriptions. Terms and conditions apply.

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Support for NPR and the following message come from the Wallace Foundation, working to develop and share practices that can improve learning and enrichment for young people and the vitality of the arts for everyone. Ideas and information at wallacefoundation.org. Hey, everybody, it's Marielle. Before we get back to the show, I want to take a moment and talk about what makes Life Kit and everything you hear from NPR possible. It's you.

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Okay, some quick trivia I just have to share to start. The medical term for a hangover is visalgia, which is a combination of the Greek word for pain and a Norwegian word meaning uneasiness following debauchery. It's a little on the nose, but a fittingly large umbrella because takeaway one, hangovers, like alcohol, affect everyone a little differently. And heads up, it's not just a battle against dehydration.

So we know there's no such thing as healthy consumption. But the U.S. Department of Health and Human Services does have a definition for safe drinking. And it's probably less than you think. One drink a day or less for women and two drinks a day or less for men. And one drink is like one shot or one four-ounce glass of wine, not these mega glasses that we have these days. The recommendation is actually five ounces of wine these days, but the point still stands here.

So that's your baseline to start, but: "Every person is going to have a different experience from their consumption from drinking as well as their hangover experience on top of that. So like your water volume, hydration status, your body composition, body fat to muscle tone." Your tolerance to alcohol can vary from day to day and from setting to setting, based on a bunch of different characteristics.

Your age, weight, gender, ethnicity, family history, nutritional status, smoker status, your mood, if you have any health conditions, big or small, or if you're taking any medications. And if we're just talking hangovers, according to one study, about 25% of people who drink to intoxication don't experience them at all.

For some people, one evening glass of wine could lead to vomiting, muscle aches, and anxiety. But for their sibling at the same dinner table, an entire night of mixed drinks could equal tiredness, dehydration, and not much more. And so even though we recognize this universal experience of a hangover, your hangover is going to be very different than everyone else that you know. What is universal? Most hangovers are a pain that can last in range from 8 to 24 hours.

although even that isn't a hard and fast. And they peak when your blood alcohol concentration returns to zero. End of list. Why is there so much variance in the hangover experience? The answer isn't super satisfying. - The short answer is nobody really knows, but the better answer is that we do know there are a lot of factors involved.

See, every hangover is a multi-part equation. The most important thing is the alcohol itself. And so there is no way to completely avoid a hangover if you're going to be drinking. And that is because one of the metabolites of alcohol, acetaldehyde, which is what your body first breaks the alcohol down into, causes these feelings that we describe as a hangover. Then there's sleep deprivation. Alcohol wrecks your sleep.

And not just for people staying up late bar hopping. The quality of sleep that you get if you have alcohol in your system is very low. People get less REM sleep. Next up, let's talk sugar and salt. Alcohol also causes pretty significant effects, especially in like binge drinking or chronic drinking on the way your body metabolizes sugars.

Sugars that are kind of the primary metabolic component for functioning of all processes within your body. And so you can be very low on sugar, and that's why people don't feel good after drinking. To be specific here, alcohol can cause hypoglycemia. That's when your blood sugar levels drop below standard range.

Essentially, your liver chooses to process the alcohol instead of maintaining your blood glucose levels. So your blood sugar drops, and that can give you some of those classic hangover symptoms. The shakes, the sweats, lightheadedness. So if any of those feelings sound familiar, it might be a good idea to lay off mixers or super sweet cocktails.

Alcohol can also, famously, cause dehydration and throw off your body's sodium balance. Certainly another factor of why hangovers can hurt. Dr. Marino says, yeah, it's important to stay hydrated. A Gatorade, Pedialyte, or similarly electrolyte-infused beverage before you go out or the morning after certainly won't hurt. But you shouldn't expect them to work miracles either.

Now, what about alternating between alcoholic drinks and water during a night out? The doctor says having a non-alcoholic drink for every alcoholic beverage is definitely a good starting tip. But that ends up then kind of encouraging people to drink more or just drinking large volumes of water or something, which can also have risks. And this brings us to the myth-busting portion of our story. Because there's like a lot of so-called hangover cures out there these days.

So I asked Dr. Marino, could preventing a hangover be as simple as a pregame vitamin, a party patch, or super-duper hydration packets? So the short answer I would say is no, and the long answer I would say is no. Fair enough, funny guy. I'm sorry, that was a terrible joke, but none of these are evidence-based, and there's no reason to believe that any single proprietary supplement exists.

is going to treat or prevent a hangover. The only way to reduce your hangover is to drink less alcohol. And that's takeaway two. The only cure for a hangover is to abstain from alcohol. But there may be some things that could make that hangover better or worse. Let's start with the old adage, beer before liquor couldn't be sicker. Liquor before beer in the clear.

What say you, Doc? In general, that's not going to affect anyone's ability to get or recover from a hangover. So Dr. Marino's verdict? There's no truth to this little ditty. Start with what you want. Mix things up if you like. It's the quantity, not the type of alcohol, that will make the difference for most people. That said, everyone reacts to alcohol differently, and some people will have sensitivities that others don't.

For example, an estimated 8% of the global population experience facial flushing when drinking.

You might have heard of this as Asian glow because this reaction, caused by a specific genetic mutation that makes it more difficult for the body to process acetaldehyde, largely affects people of East Asian descent. Red wine is often cited as a source of headaches, potentially due to sulfites or histamines, although no one's exactly sure. And in one study, it was found to be a common alcoholic trigger for people who suffered from migraines.

There's also some research that points to a specific troublemaker in hard liquor. Studies have shown that darker liquors like bourbon and brandy can make hangovers worse because they contain higher levels of congeners. These are the chemicals produced during the fermentation process that give an alcohol its distinctive taste, smell, and color. And generally speaking, the more congeners an alcohol has, the worse the hangover. So that buddy that swears by vodka just might have a point.

Now, what about popping a couple of painkillers before bed to get out in front of that headache? Short answer, not a good idea. According to the National Institute on Alcohol Abuse and Alcoholism, consuming just one drink a day with non-steroidal anti-inflammatory drugs like Advil, Motrin, or Aleve can increase your risk of gastrointestinal bleeding by about 37%.

When it comes to combining alcohol with drugs containing acetaminophen, like Tylenol, you can run the risk of liver damage if you ingest too much of one or both substances. That's why the FDA advises against drinking when taking any medicine that includes it.

And just in general, it's good to be mindful when you're on any meds. Even if your medication doesn't have a little sticker on the label, doesn't mean that you can't be affected. Now let's turn to food. Having a hearty meal before you drink is definitely a good idea. You don't want to drink on an empty stomach. Eating after a night out won't soak up the booze, as some people might claim. The only thing that sobers you up is time. But it should help with that blood sugar crash we were just talking about.

Now, are salty, carby, fatty foods the best for hangovers? Could french fries be the magic cure? Wishful thinking, I'm afraid. So I am a big fan of greasy food myself, but this is not going to help the hangover. It's natural to crave fatty, calorie-dense comfort foods, but those won't help you get up and running any faster.

Instead, opt for bland foods or the brat diet if you're feeling queasy. Bananas, rice, applesauce, toast. Or if stomach problems aren't an issue, go for vitamin-rich foods like fruits and vegetables to replenish what you might have lost. Finally, what about hair of the dog?

you know, cracking open a beer or ordering a tall Bloody Mary to drink away the pain of the night before. That's definitely not going to help your hangover. It might make people feel better because you're kind of getting some of the desirable effects from alcohol on board. And a lot of the hangover effects are kind of those things people don't like feeling, fight or flight reactions. And so having any sort of anxiety or that kind of thing, the alcohol might help with that temporarily, but you're kicking the can a little bit.

And this brings us to takeaway three. Be aware of and tend to anxiety. Thus far, we've talked a lot about the physical side of a hangover. Now, let's move into the realm of mood and emotions. Ever wake up after one too many and just feel like crying? Lump in your throat, butterflies in your stomach, an amorphous, roving sense of guilt or dread? Dr. Harrison says hangover anxiety symptoms like these are a common experience because of how alcohol works in the body.

Without getting too technical, alcohol binds to certain receptors in your body called GABA receptors that help you feel calm and uninhibited by slowing down certain signaling.

So when that alcohol is eventually cleared out of your system, you get that rebound phenomenon. GABA was turning down that heart rate. Once that alcohol is gone, the heart rate bounces back up. It was turning down that blood pressure. The blood pressure bounces back up. It was turning down that churn in your stomach. It bounces back up. This is the basis for anxiety.

And what makes anxiety extra tricky is that it doesn't require excessive or even heavy drinking to happen. So you might not even place it as a hangover symptom when it pops up. For some people, especially those who already experience things like anxiety, depression, or any other mental health condition, feelings like sadness, hopelessness, worry, or panic the day after drinking may be acute and therefore more obviously linked to alcohol consumption.

But for others… It can come before the physical symptoms come. It can come without physical symptoms at all. And you're just like, I don't even have a hangover, but why do I feel so on edge? Why do I feel so irritable? Why am I worrying about things? This is anxiety. Just like physical hangover symptoms, the only way to fully prevent hangover anxiety is to not drink.

But one first step to keep your dark cloud from getting too heavy is to simply realize that your hangover can come with significant emotional side effects.

And they'll need care, too. Just knowing arms people with the information to say like, oh, I know what this is. OK, I'm going to hydrate. I'm going to take some electrolytes. I'm going to go be with friends so that I can get dopamine from nurturing. I'm going to eat some delicious food so I can get dopamine from food. Right. Dr. Harrison says if you have lead time for an event where you know drinking's involved, prepare accordingly.

That means practicing good health and getting yourself in the best possible headspace. Like try to go into that cruise well-slept, well-hydrated, eating regularly around the clock with a good sense of connection, you know, feeling a sense of belonging, feeling positive. All of that biologically and psychologically may not prevent the anxiety entirely, but will decrease the severity.

From there, she says, if you find yourself going through the ringer, you might start with a warm bath. That'll help wash away the night before and feel more soothing than the potentially harsh sounds of a shower. Throw in some aromatherapy if you like. Her recommendation? Lavender and citrus because they can help the turnover of dopamine. So that's going to bring up that dopamine crater that you're experiencing. Mm.

Mindfulness and meditation brings down adrenaline. And so if you have a meditation practice or a mindfulness practice or a yoga practice, this will actually help your anxiety. Now, something you might note here, sometimes nourishing your emotional needs will be at odds with your physical ones. Only you can do the triage there. Like, okay, maybe your body is asking you for a dark, quiet morning and a lot of time in bed.

But at the same time, your brain won't stop yelling about all of last night's mistakes and worrying about the next month's problems.

In this case, rather than sitting in the dark berating yourself, the healthier choice might be to don some sunglasses, brave some movement, and ask your most soft-spoken friend if they're free to join you for lunch somewhere you can get some comfort food and some sun. And it's not just like because sunshine is nice. No, like actually the UV rays change your brain chemistry. Actually, the vitamin D changes your brain and body chemistry. Now, maybe you're wondering, when is anxiety or a hangover cause for concern?

Well, medically speaking, they're not usually. Alcohol poisoning, however, is very much a serious matter. Dr. Marino says if someone is vomiting uncontrollably, so intoxicated they can't protect their airway or their mental status is off, maybe they're confused, coming in and out of consciousness, it's time to call 911.

On the emotional side, if someone's behavior is putting them at risk of harming themselves or others, you can call or text 988 for free confidential support for people in emotional distress 24 hours a day. If your scenario doesn't quite meet those extremes, but something is still worrying you, Dr. Moreno says you can and should still ask a professional about it. You know your own brain and body best. And with that, we've reached takeaway four. Consider the cage.

Now that we've thoroughly dissected the effects of alcohol and hangovers, we want to introduce you to a tool to help you interrogate your relationship with alcohol. Something both doctors agree is a great thing to do whether or not you're at all worried about your drinking. It's called the CAGE questionnaire. It's an acronym for four simple questions.

If you answer yes to at least two questions... This is a real signal that I want to try to change the way I am drinking alcohol. Now, if you only answer one question with a yes... Even though you don't meet diagnostic criteria, it's telling you that the way you're using alcohol is presenting some risk to you. So like now this is an opportunity.

The first question, C, stands for have you ever thought about cutting back? A stands for annoyed. Have you ever been annoyed when someone else mentioned your drinking to you? G stands for guilt. As in, you said you were only going to drink one glass, but you drank the whole bottle. You had a few too many and said something you shouldn't have. And then E is for eye-opener. Have you ever needed to take a drink?

Dr. Harrison's score, for example, was 2 because she thought about cutting back. And she did, actually. She and her husband stopped drinking entirely about a year ago. And she's felt guilt from drinking in the past.

The example she gave us was the time she, as captain of her cheerleading squad, once passed out from binge drinking the night before the big homecoming game. So two represents a significant risk about the way I was drinking back in college and in medical school, right? I can use that information as an opportunity to make a different decision about the way I'm drinking, thankfully, before I developed an alcohol use disorder.

So if your score makes you feel like wanting to make a change of some kind, Dr. Harrison has some very simple advice. Just tell at least one other person because that secret makes it scarier than it has to be. And if you have support, that support is nurturing, gives you a dopamine signal that helps your brain think differently about your decisions around alcohol. That could be a best friend or a faith leader, a primary care doctor or EAP at work.

Anyone who makes you feel safe. And it doesn't have to be some big, formal conversation. You don't have to be like, I have trouble with drinking. If you drink every day, I would say just try not drinking every day and see how it is. And if you notice a difference in yourself, then maybe that's the beginning of thinking about how to make different choices. Of course, it might not just be that easy.

Dr. Harrison says it can be really hard to talk about this stuff with loved ones because there's so much misunderstanding around alcohol use disorder.

But maintaining that stigma only hurts people. The majority of people with alcoholism recover to controlled use. You don't have to go to 30-day rehab. You don't have to go to AA. Like the things that work for people are very different. And I just want people to know there are lots of options. And whether you give yourself a label or not, you have the right to choose the role that alcohol plays in your life.

And this is the exact message you can pass on if there's anyone in your life who might need it. Just make sure to lead with compassion. You just say, you know what? I was listening to NPR. I heard this doctor talking about the cage. And she said, think about somebody you might be worried about. And I thought about you.

And I just want you to know, if you're worried about it at all, I'm a person you can talk to about it. Then just leave the ball in their court. And they might take you up on it in the moment. They might take you up on it later. They may never take you up on it. But what you did was plant a seed of compassion.

which has an opportunity to grow. And even if you feel entirely unconcerned or simply neutral about your own alcohol consumption, it's worth remembering: cutting back on alcohol is a game of inches, not yards.

Meaning every bit less can be to your benefit. "If someone's able to drink one less drink a day, I mean this might be the difference between going into liver failure in 10 years or something like that. And so if people are open to having those nuanced discussions and conversations, there are plenty of ways we can modify the way people consume alcohol to better protect them." Ready for terrible hangovers to be a thing of the past for you and your people?

Dr. Harrison says we have to start deprogramming from our alcohol-obsessed culture and start practicing positivity around sobriety. When somebody says, I'm sober curious, be like, yeah, that's awesome. If somebody's like, I'm just only going to drink two drinks tonight, be like, cool. When I see you get into that third drink, I'm going to be like, you said you're only going to drink two, right? Like, how can we be supportive about this curiosity and just making it a normal part of the conversation?

Okay, let's recap. Takeaway one. Hangovers hit different for everyone. Because we're all different and because alcohol wreaks havoc on your body in a lot of different ways. Which is why, takeaway two, the only sure cure for a hangover is to abstain from alcohol. However, there may be a few factors, like congeners or sugar content, that may affect the severity of your hangover.

Takeaway three, anxiety is real. Prepare accordingly and don't forget to nourish your emotional needs too. Takeaway four, consider the cage questionnaire and share widely. You never know who you could be helping. And don't forget to spread some sober positivity where and when you can. And you're sure the answer still isn't french fries. I mean, I think french fries can help a lot of my anxiety. I'm not going to lie about that.

That was LifeKit reporter Andy Tagle. For more LifeKit, check out our other episodes. There's one on how to have fun on a budget and another on how to be a morning person. You can find those at npr.org slash LifeKit. And if you love LifeKit and want even more, subscribe to our newsletter at npr.org slash LifeKit newsletter. Also, we love hearing from you. So if you have episode ideas or feedback you want to share, email us at lifekit at npr.org.

This episode of Life Kit was produced by Sylvie Douglas. Our visuals editor is Beck Harlan, and our digital editor is Malika Garib. Megan Cain is our supervising editor, and Beth Donovan is our executive producer. Our production team also includes Claire Marie Schneider and Margaret Serino. Engineering support comes from David Greenberg and Kwesi Lee. I'm Mariel Seguera. Thanks for listening.

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