Season 2 | Episode 7
>> Joe: Hello, and welcome to the Merck Manuals Medical Myths podcast, where we set the record straight on today’s medical topics and questions. I’m your host, Joe McIntyre, and, on this episode, we welcome Dr. Rika O’Malley. Dr. O’Malley is an emergency medicine physician at Einstein Medical Center in Philadelphia. And, actually, in just a few months, she’s moving to Grand Strand Hospital in Myrtle Beach, South Carolina. Dr. O’Malley, thanks for coming on the show.
>> Dr. O’Malley: Thank you for having me.
>> Joe: Now, as an emergency room doctor, we could probably talk to you, Dr. O’Malley, about a whole host of topics. But, today, we’re going to talk to you about something that affects many of us, hopefully over the age of 21, mostly through our own fault of course, and that’s alcohol hangovers. There are probably more myths surrounding alcohol hangovers and cures than any other ailment out there. I certainly have dealt with my fair share of hangovers, as, I’m sure, many of our listeners have as well. But, Dr. O’Malley, you have a pretty interesting experience or, quite frankly, lack thereof with hangovers. Tell us a little bit about that.
>> Dr. O’Malley: Well, you know, I’d love to say I have plenty of personal experience; however, I actually have never had a hangover in my life. And, I do drink, but somehow, maybe I don’t drink enough, or it’s something to do with my genetics. I never get hungover.
>> Joe: I’m going to say you’re very, very lucky that you don’t have to deal with all the side effects that the rest of us have had to deal with. But, obviously, as an emergency room doctor, I’m sure you’ve dealt with your fair share of patients who have come in with either some form of alcohol poisoning or some effects of hangovers that you’ve seen over the years.
>> Dr. O’Malley: Yes, I see a patient with some form of alcohol poisoning or intoxication pretty much every day. The interesting thing is, actually, unless the patient is not really telling me, I don’t get that many patients with a hangover. Once in a while, I see young people coming in telling me, yeah, I had a big party. I usually drink, not much, but, I did, and I think that’s in terms of a hangover, headache, aches, feeling sick in general, vomiting, low belly cramps. I’ve been practicing medicine for over 10 years, but I don’t think I’ve given the diagnosis of hangover that many times.
>> Joe: So, I guess can you start off by telling us what exactly hangovers are, and why do people get these feelings after a night of drinking alcohol?
>> Dr. O’Malley: So, symptoms of hangovers are headache, dizziness, sleepiness. At the same time, you can’t sleep, although you’re very tired and want to sleep, or abdominal cramping, nausea, vomiting, or some people actually get diarrhea with that, too. And, it is related to alcohol, but not just alcohol itself. That is why a hangover doesn’t start while you are actually drinking and having fun or right after you finish drinking. The symptoms start several hours later. The dominant player of a hangover is acetaldehyde, which is a metabolize of alcohol. The alcohol undergoes two steps of a metabolic process in the body. After your body absorbs alcohol from the stomach, alcohol is changed into another chemical called acetaldehyde in your liver. Then, the acetaldehyde is changed into another chemical called acetate. Usually, the change from acetaldehyde to acetate happens very quickly, so you have only a small amount of acetaldehyde in your blood stream. That’s why you don’t get sick when you consume very small amounts of alcohol. But, when you drink more, your liver needs to work harder, and you make more acetaldehyde in your body. Symptoms like sweating, flashing, nausea, vomiting, are due to this aldehyde.
>> Joe: Now, I’m sure we’ve all seen this myth that, as we get older, our hangovers get worse. I can probably attest to that quite a little bit. Is there any science or medical evidence behind the fact that, as you age, your body is less able to break down alcohol and leads to worse hangovers?
>> Dr. O’Malley: Actually, it seems to be worse when you are younger. So, the one study comparing hangover symptoms between young drinkers and older drinkers, the conclusion of the study was the younger drinkers experienced more a more severe hangover compared to the more aged drinkers. And, of course, the study showed the more they consumed and the more severe the hangover was, so maybe, when you are older, you learn and are wiser so you drink less.
>> Joe: Now, how about when it comes to different sexes. Are women more susceptible to hangovers than men are, or vice versa? Is there any difference there?
>> Dr. O’Malley: So, women weigh less than men in general, so women have a smaller sized liver and a smaller amount of alcohol dehydrogenase, an enzyme that breaks down alcohol into this metabolized mass, aldehyde. So, these are the reasons why women are shown to be more vulnerable to hangovers, but recent studies do not show any statistical differences. So, it seems that many hangover studies were done using a number of alcohol beverages rather than using the actual dosage of consumed alcohol. An alcohol dosage is used in other climates that are controlled, the study failed to show the difference in the severity of hangover symptoms.
>> Joe: Interesting. Now, there is a saying that, almost all of us know at this point, whether we heard it going into college, afterwards or even before, this idea that beer before liquor, never sicker, liquor before beer, you’re in the clear. Is that long-time phrase actually true, or does it really not matter in what order you consume your different types of alcohol drinks when it comes to hangovers?
>> Dr. O’Malley: Well, it is not true. Some study tried to prove what you drink first and at the end makes a big difference in hangover, but, sorry, neither order of alcohol beverages affect how sick you get from the hangover.
>> Joe: Good to know. Now, I’m going to go back to something you mentioned at the very beginning, these other additives that people add to drinks, whether it’s lime juice for a margarita or a ton of sugar for some other drinks. Do high sugar cocktails lead to stronger hangovers? Does sugar have any effect on someone’s hangover or lack thereof?
>> Dr. O’Malley: Well, you have to be careful about the sweet, sugary alcoholic beverages. The sweet drinks are definitely easier to consume, so you tend to drink more amounts more quickly, and, of course, you’re ingesting more alcohol in that case. Consuming a large amount of sugar can elevate your insulin level. So, insulin is a hormone to decrease your blood sugar level. After you drink lots of alcohol and sugar, and the effects of alcohol intoxication begin to fade, now the hangover kicks in. You’re blood sugar level might become too low for you now. Low blood sugar can cause headache, dizziness, sweating, nausea, symptoms just like a hangover. So, my answer is, no. Sweet drinks do not prevent hangover.
>> Joe: Now, how about the difference between so-called top shelf alcohol and bottom-shelf, if you will, alcohol? Is there any difference in whether you get a hangover more severely with bottom-shelf alcohol versus the super expensive, high-priced stuff?
>> Dr. O’Malley: So, like I said earlier, one of the reasons why people get hangover is this additives to alcohol to add the taste and smell and look. So, something like a gin and vodka, which is like more clean alcohol, may cause fewer hangover symptoms. And, something like a whiskey, and wine seems to cause the worst hangover. However, interesting thing is you can still get hangover even if you drink 100% pure alcohol. So, again, the answer is going to be it depends. How much you drink probably matters more than what actually you drink.
>> Joe: Let’s talk about prevention a little bit. You mentioned this theory that we’ve all heard that you should consume some food while you’re drinking, one, because it’ll keep you in line a little bit and maybe prevent you from getting a little too tipsy, but also when it comes to preventing hangovers. How about consuming a meal before drinking? Does it actually soak up alcohol? What is the actual effect of eating while you’re drinking or eating before you’re drinking?
>> Dr. O’Malley: Eating high-fat containing food may prevent alcohol absorption, but you need to eat before you drink, not after you drink. After you drink alcohol it doesn’t’ help. But, there is a neuropeptide called galanin in your brain. This chemical is found in your brain and the digestive system, and also other mammals like dogs and cats and rats. So, the galanin is shown to be related to how much you eat that rich food, and some studies show increased secretion of galanin when alcohol is injected into the bloodstream. So, maybe when you drink, you make get the craving for the greasy food.
>> Joe: Now, along that same vein, we’ve all heard, and you’ve just said it a few minutes ago, that you get severely dehydrated when you consume significant amounts of alcohol. What effect does water consumption and other liquid consumption have on hangovers?
>> Dr. O’Malley: It depends how much you will get dehydrated. Like I said earlier, when you are drinking alcohol, you’re probably not going to ask for a nice, cold glass of water or iced tea between the glasses of beer and some other liquors. So, by drinking water between the alcoholic drinks, yes, that will cut down the amount of alcohol you’re going to drink, so that will help a hangover because you’re decreasing the overall consumption of alcohol, and, also, putting time between each alcohol consumption. You’re body needs time to metabolize the alcohol, and by drinking water between each class of alcohol, you can give your body time.
>> Joe: So, all those tips I got from my parents about the need to drink water when I’m drinking alcohol actually were true? They weren’t making that stuff up?
>> Dr. O’Malley: I think so.
>> Joe: Whether you’re a parent or a seasoned professional, a medical student or a caregiver, the Merck Manuals has the right medical information in the best format, and it’s always free, easy to access and readily available for you.
>> Joe: Alright, now let’s get to what happens the day after. We’ve already made the mistake of drinking too much alcohol. Is throwing up, vomiting the day after, does that rid your body of alcohol, or does it rid your body of the hangover? What effect does vomiting have on your ability to clear your body of alcohol or clear your body of a hangover?
>> Dr. O’Malley: Unfortunately, when you put the alcohol in your stomach, it absorbs pretty quickly, so, by the time you wake up the next morning, it’s all absorbed in your system, and, by the next morning, it’s all metabolized. So, it really doesn’t help to get rid of the alcohol from your body or all the metabolism that’s actually making you feel sick. And the throwing up is going to bring all the stomach acid to your esophagus and your throat, that’s going to cause burning and discomfort. So, honestly, I don’t think that’s going to help the overall symptoms of the hangover.
>> Joe: Now, I’m sure a handful of us, myself included, will go out for a night of drinking and then wake up the next morning and either go to brunch or try out the theory of hair of the dog, the fact that, if you have some alcohol the next morning, it’ll clear your body of all of your pains and all of your issues right away. Is there any scientific evidence behind the hair of the dog theory that you should have a bloody mary or a mimosa the day after to help with your hangover?
>> Dr. O’Malley: So, this hair of the dog message came from two theories. One is because of the methanol, which is one of the congeners in alcohol. The methanol is a toxic alcohol. It looks like and smells like consumable alcohol, but methanol is not intended to drink. When you drink more than a certain amount of methanol, it can damage your vision, so please do not. A tiny amount of methanol seems to be contained in some alcohol beverages as a congener. So methanol and alcohol. Alcohol is a chemical called ethanol. Both actually share the same enzyme, alcohol dehydrogenase for their metabolism. By competing against each other for the same enzyme, adding consumable alcohol may prevent the toxic effects from the metabolized methanol. So, the other theory is the dog hair drinking could be alleviated mild alcohol withdrawal symptoms. So, the alcohol withdrawal is typically seen in people who often consume a large amount of alcohol. If you regularly drink, your body gets used to having alcohol all the time, and alcohol has a sedative effect. So when you stop drinking alcohol abruptly, your brain does not have a chemical that is calming your brain anymore, and now you feel anxious, nauseous, you becoming shaky and sweaty, and, sometimes, you develop hallucinations and seizures. So, you don’t have severe symptoms like hallucinations or seizures from hangover. Still, you get the mild symptoms of alcohol withdrawal, and that sounds almost like hangover. So, either way, the name hair of the dog just came from the old time remedy from rabies dog bite treatment. They were putting hair of the rabid dog that bit you into the bite wound, and so that was the treatment for the rabies. But with drinking, it may have been the cure for the hangover, but not anymore. So, there’s also the concern that adding more alcohol to help hangover symptoms may actually promote the bad drinking habit. So, I do not recommend dog hair.
>> Joe: Now, how about when you wake up the next morning. Is it better to stay in bed, sleep off a hangover, or is it more beneficial to get out of bed, get moving, potentially get some exercise, go for a walk, do some light calisthenics, does it really matter whether you stay in bed or you get some exercise after a night of drinking?
>> Dr. O’Malley: How energetic did you feel when you had the hangover?
>> Joe: Not very, I’ll say.
>> Dr. O’Malley: So, if you feel well enough, then go ahead and do what you need to do, but with hangover, you don’t feel well, so you decrease your productivity. So, if you feel well enough to wake up, get up and do something, and I think that would probably be a good thing but not staying in bed all day. But, I think it depends on how well you feel. And, you know, in general, even when you don’t have a hangover, a reasonable amount of exercise makes you feel good. So, if you feel well enough, go ahead. Get up and move around.
>> Joe: Sometimes it just seems impossible, though. So, I’ll take your advice that it’s not fully necessary. Now, I’m sure this next question is something you’ve dealt with in the hospital. So, I’m sure we’ve all seen IV hangover treatments, whether it’s near a club or people toting this IV treatments to cure hangovers the next day. Obviously, as an emergency room doctor, you’ve dealt with your fair share of IV treatments. What effect does an IV have on someone’s hangover or, essentially, their alcohol consumption? Does it cure it, or what effect does it have?
>> Dr. O’Malley: I wish that I would say, oh, yes, absolutely, the IV treatment will cure hangover, but the truth is there is no cure for the hangover. There is no medication. There is no treatment to cure hangover. The only cure for the hangover is actually time. You just sit tight and wait and it gets better. But, of course, some people get really sick. Some people can’t stop vomiting, and then they get severely dehydrated and lose all these electrolytes like salt and potassium from their body, and that will make them sick. And, in that case, yes, those people need IV fluid and maybe medication to stop vomiting. Otherwise, I don’t think, unless you’re severely dehydrated or you become hypoglycemic, which means your sugar level goes down significantly, and I do not think an IV treatment will particularly help.
>> Joe: Alright, so Dr. O’Malley, you mentioned in the very beginning the difference between women’s bodies and men’s bodies when it comes to alcohol tolerance. What about two people who have similar body types, are the same sex, but one says they’re more tolerant to alcohol, have a higher tolerance. Is there any evidence to people having a higher tolerance based on genetics?
>> Dr. O’Malley: Yes, there are two factors controlling alcohol tolerance: genetic factors and environmental factors. For example, one in three people of East Asian descendants are actually missing an enzyme called aldehyde dehydrogenase 2. If you remember, alcohol is metabolized into acetaldehyde about after the hangover, so acetaldehyde is changed into acetate by this enzyme, aldehyde dehydrogenase. If you do not have much aldehyde dehydrogenase, you will quickly build up acetaldehyde in your body and, of course, you’re going to get the hangover, and the more acetaldehyde, you’re going to get worse hangover. So, these people quickly learn that they cannot drink because they get sick with small amounts of alcohol, so that’s what we generally call the tolerance.
>> Joe: So, Dr. O’Malley, before we wrap up, I’m sure there are people who have gone to countless websites looking for information on hangover remedies, hangover cures, how to mitigate the effects of alcohol. What resources would you recommend for someone who is looking for information about how to mitigate the effects of alcohol or how to handle your hangover?
>> Dr. O’Malley: So, first of all, listen to your parents when you’re young. Don’t drink too much, and that’s what they’re going to say. And, of course, the Merck Manuals has a lot of good information about alcohol intoxication and also how to deal and prevent the hangover.
>> Joe: Well, Dr. O’Malley, thank you so much again for joining us. This has been a super interesting conversation, and one that is going to be relevant for a lot of people out there, perhaps not you as someone who doesn’t deal with hangovers, but someone like me who does deal with hangovers more than I’d like to admit. So, thank you for sharing this information, these resources for mitigating hangovers and curing them. As we say at the Merck Manuals,
>> Dr. O’Malley: Medical knowledge is power. Pass it on.
>> Joe: Thanks so much.