Thursday, January 1, 2015

Happy New Year Hangover Cures - 8 Cures That Work + Two Dozen Purported "Cures" That Have No Scientific Backup

Happy New Year! In case this guy looks anywhere similar to how you feel after yesterday's party night, today's SuppVersity article is for you!
"Happy New Year", health, love, ... you know the whole litany, so let's get over it and straight to the things that are really important, today. The hangover cures. In the following I have compiled an extensive yet probably by no means complete list of scientifically proven hangover cures that may help better than aspirin and plenty of water (Harvard Health Letter. 2006), alone.

Apropos aspirin, it's actually not too bad to start with 400-800mg of it, if you are having a hangover. It has after been shown to block the increased prostaglandin synthesis in response to alcohol ingestion and thus counter at least the inflammatory aspect of the hangover (George. 1979).
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The latter cannot be said of another common pain killer: Acetaminophen, which failed to inhibit ethanol-induced subjective effects in human volunteers in a 1992 study by Pickworth et al. The same study by George et al. would yet also suggest that aspirin may also prolong the time it takes for the alcohol to leave your system completely... and this may not be your only problem, because the coingestion of aspirin and alcohol has been associated with an increased risk of gastrointestinal haemorrhage (Needham. 1971).

So what do you do if water and aspirin are not enough? Well, here are a couple of suggestions - in a more or less random order, since there are hardly any studies that compare the efficacy of one to another.
  • Figure 1: Effects of 200mg tolfenamic acid on hangover symptoms in man (Kaivola. 1983).
    Tolfenamic acid - Tolfenamic acid is a very specific prostaglandin biosynthesis inhibitor that lead to significant reductions in hangover symptoms in a 1983 study by Kaivola, et al. (see Figure 1).

    The only problem is: The subjects consumed the 200mg of the anti-migraine drug tolfenamic acid before they started binge drinking. Whether the effects are similarly pronounced if you take it the day after remains to be elucidated.
  • Gamma linoleic acid (GLA) - The omega-6 fatty acid from vegetable oils like rapeseed/canola oil and soy beans, walnuts, flax seed (linseed oil), perilla, chia, and hemp seed effectively reduced the hangover symptoms of human volunteers in a study the results of which have unfortunately never been officially published (Moesgaard; based on Pittler. 2005).

    In view of the fact that I have only 2nd hand access to the results I cannot tell you how much GLA you would need. Considering the effect that the supplement contained B officinalis aka Borage, which contains 26-36% GLA, if it's not specifically enriched, I would yet assume that 100-300mg should do.
Figure 2: Symptoms and possible contributers of hangover (Swift. 1998).
  • Yeast + B-Vitamins: Another trial tested the efficacy of 250 mg dried yeast, 0.5 mg thiamine nitrate, 0.5 mg pyridoxine hydrochloride, and 0.5 mg riboflavin in participants who consumed vodka (40% volume alcohol) amounting to a total of 100 g absolute alcohol (Laas. 1999). The difference in the change for the symptoms discomfort, restlessness, and impatience was statistically significant in favor of the yeast preparation and appear to suggest that the corresponding supplement aka "Morning Fit" works.

    Moreover, corresponding research from the Chungnam National University in Korea shows that a preparation of combined glutathione-enriched yeast and rice embryo/soybean extracts constitutes a  "a promising candidate for improvements of alcoholic hangover" (Lee. 2009), as well.
  • Oh!K - A hangover cure with green ginger, turmeric, pepper, and green tea extract, along with salt, citric and ascorbic acid and fructose as the carrier worked pretty well in a recent study by Gopi et al. (2014).
  • Sprite! Or rather a sprite-like herbal drink - In the media you may have read about Sprite, when in fact the two drinks researchers from the Sun Yat-Sen University in China tested and found to be effective in increasing the production of the enzyme that helps our bodies to get rid of alcohol were xue bi, a fizzy lemon and lime drink of which the researchers did not declare that it was indeed Sprite and hui yi su da shui, probably a type of soda water (Li. 2014).
  • After Affect(R): Another commercially available anti-hangover cure "proved" to be effective in a non-randomized non-controlled trial from the Utrecht University (Vester. 2012).
    Table 1: Rationale for the ingredients included in After-Effect©. 1 - Total dose of 5 capsules. 2 - Only those symptoms that showed a significant improvement during alcohol hangover are listed. GLA: gamma-linolenic acid, EPA: eicosapentaenoic acid (EPA), and DHA: docosahexaenoic acid (Verster. 2012).
    If it were not for the reasonable ingredient profile (see Table 1), I probably wouldn't have listed it, but with GLA, magnesium, B-vitamins & co it does contain a bunch of ingredients that may actually help.
  • Party Smart (carbonate mix) - Yet another commercial preparation that contains calcium carbonate (615 mg) and vegetable carbon (345 mg) and has - unfortunately - to be consumed while you are drinking.

    More specifically, the subjects in the 2004 study by Manu et al. consumed their first serving of two caplets with first drink and two more caplets every 2 to 3 hours (or 5 to 6 drinks).
    Figure 3: Mean hangover score and mean blood alcohol 10h after drinking (Manu. 2004).
    The data in Figure 3 does yet indicate that this alkalization regimen worked pretty well (I wonder if sodium bicarbonate would to the same ;-) is a pretty effective means to (a) keep the hangover in check and (b) help your body clear the alcohol from your bloodstream.
  • Aging! Ok, I know this does not really help you today, but maybe on New Year's Eve 2065! Tolstrup et al. found that hangover following engagement in binge drinking is much more common in the young than in the older age groups (Tolstrup. 2014). For women, similar results were obtained.

    As the scientists point out, "[t]his finding could not be explained by the usual amount of alcohol consumption, frequency of binge drinking, or the proportion of alcohol consumed with meals" (Tolstrup. 2014).
List of anti-hangover remedies from the Internet - all w/out scientific evidence that they work (Pittler. 2004).
You still feel like dying? If all these cures didn't help and you feel as if you were about to die, today, you may have inherited a special gene variant from of Aldehyde Dehydrogenase (ALDH2) an Asian ancestor that makes you extra susceptible to more severe hangovers (Wall. 2000).

And if you are totally desperate you may want to give C scolymus aka Artichoke leaves and O ficus-indica extracts a final try. While two randomized controlled trials did not intergroup differences for their main outcome measures (Pittler. 2003; Wiese. 2004), both are often hailed as natural hangover remedies. The same can be said of most of the other remedies you will find if you google anti-hangover cures on the Internet (see table on the right). As Pittler et al. highlight in their 2005 review of the literature, none of them has reliable scientific evidence that would confirm that they are working | Comment on Facebook!
  • George, Frank R., and Allan C. Collins. "Prostaglandin synthetase inhibitors antagonize the depressant effects of ethanol." Pharmacology Biochemistry and Behavior 10.6 (1979): 865-869.
  • Gopi, Sreeraj, et al. "Studies on the effectiveness, safety and tolerability of two doses of Anti Hangover Drink in Reducing Alcohol Induced Hangover Symptoms in Adult Male Social Drinkers." Int.J.Cur.Res.Aca.Rev. 2.8 (2014): 125-131.
  • Harvard Health Letter. How to handle a hangover: drinking fluids may help with the morning-after misery from getting drunk. Harvard Health Letter 31.3(2006):3. 
  • Kaivola, S., et al. "Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid." Cephalalgia 3.1 (1983): 31-36. 
  • Laas I. A double-blind placebo-controlled study on the effects of Morning Fit on hangover symptoms after a high level of alcohol consumption in healthy volunteers. J Clin Res 1999;2: 9-15. 
  • Lee, Heon-Sik, et al. "Effects of a preparation of combined glutathione-enriched yeast and rice embryo/soybean extracts on ethanol hangover." Journal of medicinal food 12.6 (2009): 1359-1367.
  • Li, Sha, et al. "Effects of herbal infusions, tea and carbonated beverages on alcohol dehydrogenase and aldehyde dehydrogenase activity." Food & function 5.1 (2014): 42-49. 
  • Manu, M. B., and S. A. Kolhapure. "Evaluation of the Efficacy and Safety of “PartySmart” in the Prevention of Alcohol-induced Hangover: A Prospective, Randomized, Double Blind, Comparative, Phase III Clinical Trial." INDIAN JOURNAL OF CLINICAL PRACTICE 15.7 (2004).
  • Moesgaard S, Hansen NV. GLA effectively reduces hangovers. Pharma Nord Research, unpublished report. 
  • Needham, C. D., et al. "Aspirin and alcohol in gastrointestinal haemorrhage." Gut 12.10 (1971): 819-821. 
  • Pickworth, Wallace B., et al. "Acetaminophen fails to inhibit ethanol-induced subjective effects in human volunteers." Pharmacology Biochemistry and Behavior 41.1 (1992): 189-194.
  • Pittler, Max H., et al. "Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial." Canadian Medical Association Journal 169.12 (2003): 1269-1273.
  • Pittler, Max H., Joris C. Verster, and Edzard Ernst. "Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials." Bmj 331.7531 (2005): 1515-1518.
  • Swift, Robert, and Dena Davidson. "Alcohol hangover." Alcohol Health Res World 22 (1998): 54-60. 
  • Tolstrup, J. S., Stephens, R. and Grønbæk, M. (2014), Does the Severity of Hangovers Decline with Age? Survey of the Incidence of Hangover in Different Age Groups. Alcoholism: Clinical and Experimental Research, 38: 466–470. doi: 10.1111/acer.12238.
  • Verster, J. C., and O. Berthélemy. "Consumer Satisfaction and Efficacy of the Hangover Cure After-Effect©." Advances in preventive medicine 2012 (2012).
  • Wall, Tamara L., et al. "Hangover symptoms in Asian Americans with variations in the aldehyde dehydrogenase (ALDH2) gene." Journal of Studies on Alcohol and Drugs 61.1 (2000): 13.