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The hangover

The blood brain barrier acts as a gateway for substances like proteins and nutrients to get into the brain, but alcohol crosses this barrier very quickly, which is why acute alcohol exposure happens.



The holidays are just around the corner and pretty soon a lot of you are going to be getting more than your fair share of drinks. I figured a lot of my patients, relatives and friends are going to appreciate this column a little more than they should.

So before you indulge in your favorite brand of booze, hooch, tipple… before you get hammered, sloshed, wasted, tanked or plastered… Read on.

Got a headache and still reeling from last night’s generous pour of bubbly?

As common as they are, there is still much to be understood about hangovers. The long-term impact of alcohol is well-understood, but the mechanisms that occur during a hangover are a bit cloudier.

Here’s what we know

When you consume alcohol, it becomes absorbed into your bloodstream until the liver can break it down. Once in the bloodstream, it only takes roughly five minutes to reach your brain, and effects peak after 30 to 90 minutes.

Drinking too much can lead to dangerous impairment, sometimes called acute alcohol exposure. The blood brain barrier acts as a gateway for substances like proteins and nutrients to get into the brain, but alcohol crosses this barrier very quickly, which is why acute alcohol exposure happens.

Meanwhile, your liver works to break down the alcohol using enzymes. While your liver accounts for metabolizing roughly 90 percent of alcohol, small amounts may also be excreted through sweat, urine and your lungs (think breathalyzer test).

Alcohol also impacts the kidneys, which are responsible for removing waste and keeping you hydrated. When there’s too much alcohol in the system — more than three drinks in a day for women and four for men — the kidneys can no longer function properly. Alcohol is a diuretic, so it makes you dehydrated, and can even cause dizziness or generalized weakness.

So you see, your entire body has to process and eliminate alcohol. Various factors may be responsible for your hangover and lead to certain symptoms, including:

Dehydration. Your kidneys produce more urine, which can lead to dehydration and an imbalance of electrolytes. This results in thirst, dry mouth, a headache and nausea.

Gastrointestinal disturbances. Alcohol irritates the stomach, which causes inflammation. You may also experience an increase in stomach acid, which can cause abdominal pain or nausea. When you’re metabolizing alcohol, your liver releases a byproduct known as acetaldehyde, which may result in nausea or vomiting.

Lowered blood sugar. If your blood sugar drops, you may feel weak or tired. This is especially important for those who have diabetes, as it can become dangerously low.

Disruption of sleep. Alcohol prevents deep stages of sleep, which is necessary for letting your body restore itself.

How to recover

First things first: ‘Hair of the dog’ is not recommended. Not only is there no concrete evidence that more alcohol will help you feel better, it could also indicate a sign of dependency. You’re only going to overwhelm your liver, which is already working overtime.

The best approach to a hangover is to simply help your body recover. Try something like Gatorade to Pedialyte. These replenish nutrients more quickly than water and can help with dehydration and electrolyte imbalance. They contain sodium and potassium, substances that do a better job keeping you hydrated than just water, which is lost during urination.

Could a giant, greasy burger help curb your hangover? While food helps slow down the absorption of alcohol, it should be consumed before you start sipping. That said, if you’re feeling rough the next morning, bland foods or fruits can help raise your blood sugar as well as relieve nausea.

Certain medications may help ease symptoms, particularly headaches. However, acetaminophen (an alternative to aspirin) can cause liver damage. I’m pretty sure that if someone found a cure for a hangover, they’d be very wealthy. People have looked at a lot of things to prevent a hangover or treat the symptoms, but nothing has really stood out.

Long-term effects of alcohol

Though a hangover generally lasts 24 hours, there are several lingering effects of alcohol.

Alcohol impacts the brain’s pathways, affecting how the brain works. Repeated alcohol use can lead to neuropathy, which is damage to the peripheral nerves, causing numbness and pain in feet and hands. You’ll start to notice problems with imbalance and poor coordination. Some can even experience accelerated brain atrophy and memory problems.

Your liver’s significant role in breaking down waste comes at a cost. Alcohol abuse can cause lasting damage. A build-up of fat or prolonged inflammation can result in alcohol-induced liver disease, including fatty liver, alcohol hepatitis and cirrhosis. The build-up of fats in the blood can also be taxing on your heart, which increases blood pressure.

The true cure?

Though hangovers will eventually go away by themselves, the best approach is to drink in moderation. You wonder whether a remedy is needed at all, since the hangover is your body’s way of saying you shouldn’t be drinking that much and without that signal, it could lead to problems down the road, such as paving the way to addiction.

So before you grab that next drink, try to count (if you still can) how many you’ve had and maybe think twice before getting another round.