For hangovers, best treatment still prevention

Monday, June 12th 2000, 12:00 am
By: News On 6

Every so often, even James Bond wakes up feeling shaken, not stirred.

But scientists, aided by volunteers with spirits of goodwill, are working on a cure for the hangover. The bad news on this Monday morning is that there is little success to report.

"The best way to treat a hangover is prevention," said Dr. Jeffrey Wiese of the Veterans Affairs Medical Center in San Francisco. That advice, he recognizes, "is kind of unsatisfying."

Last week, in the journal Annals of Internal Medicine, Dr. Wiese and his colleagues from the University of California, San Francisco, described the results of 108 studies on hangovers conducted since 1965.

The conclusions: Hangovers are not well understood, and not treatable. Only one study, which suggested that vitamins taken before drinking might thwart hangover symptoms, offers hope of escape. They cost the economy billions of dollars annually from missed work time. Too many of them, and a person may risk cardiovascular damage.

And hangovers are quite common. One study found that 25 percent of college students said they had felt hung over in the previous week. More than 75 percent of adults who drink say they have had a hangover at least once, and 15 percent say they experience them monthly.

Hangovers also tend to affect people who don't drink frequently.

"The chronic abusers almost never get a hangover," Dr. Wiese said, giving little credence to the idea that hangovers evolved as a way to deter excess.

An alcohol hangover actually has a medical name, "veisalgia." The strange word, which no one with a hangover should ever try to pronounce, is a combination of a Norwegian term meaning "uneasiness following debauchery" and a Greek word meaning simply "pain." True to its billing, the most common symptoms are a headache and a "poor sense of overall well being."

The reasons hangovers occur aren't clear.

"It surprised us that there's more that goes into the hangover than dehydration and alcohol withdrawal," Dr. Wiese said. Too much alcohol also disrupts the body's chemical balance. And liquor components called congeners contribute to hangovers.

Congeners are extra ingredients in alcohol - the impurities that darken Kahlúa or brandy - that help explain why some liquor is more apt to cause a hangover. In general, the clearer the alcohol, the lower the concentration of congeners. The lower the congeners, the lower the risk of a hangover.

In one experiment, 33 percent of participants who overindulged in bourbon awoke with a pounding hangover, compared with 3 percent of those who drank the same amount of vodka. The clearer-is-safer scheme also is true for beer and wine, Dr. Wiese said. For hangover purposes, it's better to be tipsy on chardonnay than chianti. Next to one from Coors, a Guinness hangover can feel like a world record.

Once afflicted, there's little to do but wait. Home remedies are handed down, and handed out, but few really work, research has found. Some might make the symptoms worse. Coffee, for example, can cause a person to become dehydrated, and dehydration is one of a hangover's major accomplices.

"What's common to all the remedies is it involves some fluid volume," Dr. Wiese said. "It rehydrates you."

Some painkillers like acetaminophen and ibuprofen can dull the headache, but as these can irritate the liver (already spent from a night of revelry), they should be taken with care. Other medications are in the pipeline, Dr. Wiese said, but their usefulness is still being investigated.

Even after the noticeable symptoms subside, the effects of a hangover can linger. Studies of pilots have found that mental sharpness and visual skills can be measurably impaired more than 12 hours after drinking.

"These are carry-over effects even though you may feel OK," said Dr. Jerome Yesavage of Stanford University School of Medicine, who has conducted research on pilots.

Hangovers also may have more permanent effects. One study suggested that people who have frequent hangovers may be at an increased risk of dying from a heart attack.

Absent good treatment, there is always prevention. Abstinence is, of course, foolproof in this regard. Beyond teetotaling, though, doctors offer a few precautions. One is to make sure drinking doesn't lead to dehydration. Sip glasses of water along with the alcohol and before going to bed, Dr. Wiese advises. Also, food in the stomach will help absorb those pesky congeners, lessening the severity of hangover symptoms.

There's no medicine that will prevent hangovers in those who are susceptible, but one study has found that, for whatever reason, volunteers who took vitamin B{-6} before attending a party eased the symptoms of a hangover by half.

And know when you're nearing a danger zone. In most studies, participants get hangovers after consuming more than 1.5 grams of alcohol per kilogram of body weight. For a 150-pound man, this works out to about five or six drinks. Generally, legal intoxication would occur after having about four drinks in an hour. Don't assume that because you don't feel inebriated you've eluded a hangover, Dr. Wiese cautioned. Even if those drinks are spaced out enough to keep a person from getting drunk, the body might not be fooled come morning.

A hangover cure may await in the future. Some doctors question whether this would be a benefit to medicine, Dr. Wiese said, because fear of a hangover may be all that keeps some people from drinking too much.

He isn't swallowing this argument.

When in the throes of a hangover, Dr. Wiese said, everyone swears off alcohol. "But when you see them a couple of weeks later, they're drinking again. It has never been an effective deterrent."