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Hangovers

Dr Nerys Williams's tips on hangovers gained from working in occupational health

Dr Nerys Williams's tips on hangovers gained from working in occupational health

1 The differential diagnosis for hangover is acute alcohol poisoning which causes repeated vomiting, reduced level of consciousness and complaints of feeling cold.

The differentiation is important because acute alcohol poisoning can be fatal, particularly in young people, and needs medical attention.

2 Alcohol absorption can be slowed by keeping it in the stomach for as long as possible, as only 20 per cent of total absorption takes place through the gastric wall, the other 80 per cent being through the small intestine.

Slower absorption can be achieved by eating a meal before consuming alcohol. Fat is also particularly efficient at preventing absorption.

3 Further delay can be achieved by avoiding fizzy drinks as the gas bubbles stimulate the gastric sphincter to open and facilitate gastric emptying.

It's true that drinks such as champagne do 'go straight to the head' in terms of their alcoholic effects.

4 Drinks containing congeners such as brandy, port and other dark-coloured drinks produce more hangovers than 'clear' drinks such as white wine and vodka. They magnify the effect of the hangover and can also cause more stomach irritation.

5 Women are more likely to be affected by hangovers than men due to their higher body fat and smaller size.

There are also ethnic differences in susceptibility to hangovers. Studies in Asian Americans have found that possession of the ALDH2 gene (aldehyde dehyrdogenase) accounted for significant variability in self-reported hangover symptoms.

6 Prevention of hangovers can be achieved with a three-step approach.

(i) Don't drink on an empty stomach.
(ii) Sip drinks, don't gulp. Keeping to one drink per hour is a reasonable rate as the liver detoxifies alcohol at about 15ml per hour ­ the equivalent of a small can of standard-strength lager.
(iii) Intersperse alcohol with water or a soft drink for every alcoholic drink consumed. This provides hydration.

7 Dehydration occurs from the passage of large volumes of urine, due to the action of vasopressin on the brain.

Pain relief can be obtained from paracetamol but if stomach irritation and indigestion are present then patients should be advised to avoid ibuprofen and other NSAIDs.

8 Artichoke (Cynara scolymus) is ineffective at preventing hangovers. A review found it produced no difference in self-reported hangover severity score, in mood questionnaire or cognitive performance tests when compared with placebo.

9 The 'hair of the dog' cure works and is based on sound scientific principles. The liver detoxifies alcohol; methanol is then broken down to formic acid which contributes to the hangover symptoms.

By drinking more alcohol the liver stops methanol and formic acid production to concentrate on the alcohol and so levels fall and symptoms abate ­ though this 'cure' only delays the inevitable.

10 Hangovers reduce mental function. Studies on the cognitive function of volunteers with an experimentally induced hangover state showed that higher cortical (memory and intellectual) and visual functions were impaired.

Nerys Williams is a former GP in the Midlands who now works in occupational health with an interest in work impairment

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