Here’s what pharmacists can tell patients who have overindulged during the festive season, writes Rod Tucker
During the festive season, many of our patients (and no doubt some of us pharmacists, too) indulge in the odd tipple or two. After all, it’s Christmas; a few days off work and the opportunity to spend time with the family – although I suspect the prospect of the latter may cause some to reach for the bottle! Of course, as health professions, we can justify having a drink or two because it can lower risk of cardiovascular disease and may even stave off dementia.
But having too many drinks, which is easily done as alcohol affects our memory, invariably leads to veisalgia the following day. The word veisalgia is derived from the Norwegian kveis (uneasiness following debauchery) and the Greek, algia (pain). It’s a fitting description for the splitting headache, nauseous sensation and dehydration which we more commonly refer to as a hangover that begins once blood alcohol levels approach zero.
Alcohol is metabolised in the body by two enzymes; alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). ADH converts ethanol into acetaldehyde, which is toxic but fortunately further broken down by ALDH to acetate, which is then eliminated from the body. Despite the misery induced from over imbibing alcohol, there is still no consensus as to the precise cause. It is thought that alcohol metabolites, alterations in neurotransmitters, inflammatory factors and mitochondrial dysfunction are the most likely factors that contribute to the symptoms of a hangover.
How to alleviate the misery
Various aphorisms have been advanced as a means of avoiding a hangover. For instance, ‘beer before wine and you’ll be fine’ or ‘wine before beer and you’ll feel queer’ – though these promulgations were recently the subject of scientific scrutiny and finally dispelled as myths.
The usefulness of dietary factors as a potential cure for a hangover is legendary and culturally diverse. For instance, Outer Mongolians advocate eating pickled sheep eyes in tomato juice, whereas Romanians swear by tripe cooked with vegetables, garlic, vinegar and cream.
In fact, the influence of various nutrients on hangover severity has gained scientific credibility in recent years. One review in 2016 concluded that several natural herbal products can attenuate the symptoms of a hangover and a more recent study found that higher intake of both zinc and nicotinic acid reduced the severity of hangovers. The influence of food intake on alcohol levels has been known for over 40 years, when it was shown that either eating a big breakfast before drinking alcohol or drinking before a big breakfast reduces blood alcohol levels.
Though food intake affects blood levels, another focus of research has been to explore compounds that accelerate alcohol metabolism. I was interested to read a recent study in Current research in food science that examined the effect of a wide range of foods on the activity of ADH and ALDH. The authors tested dairy products such milk and cheese, pulses and spices to determine the effect of these foods on enzyme activity. The palatability of the different mixtures that they produced were assessed by a panel of 15 individuals in the age range 22-28 years.
The results showed that the most acceptable formulation contained a mixture of pear (65%), sweet lime (25%) and coconut water (10%). The authors stated that this concoction would increase the activity of ADH by 23% and ALDH by 70%, thus enhancing the breakdown and elimination of alcohol and therefore might serve as an effective hangover cure.
What was even more remarkable was the impact of different foods on enzyme activity. For instance, cereals and pulses did not increase the activity of either enzyme, whereas ascorbic acid (vitamin C) decreased the activity of ADH and coffee decreased the activity of both enzymes. Unfortunately, the final anti-hangover beverage was not tested on those who had overindulged, so it remains to be seen whether it proves to be an effective remedy.
Although it is best to advise patients to drink sensibly over the festive period, those with a hangover might benefit from pear juice topped up with coconut water and lime juice, because sweet limes are difficult to obtain in the UK.
Though it may not prove to be a panacea, from a scientific perspective, it is likely to be more effective than a bowl of cereal and coffee in the morning in an effort to fend off a hangover. However, the latter approach does have the added benefit that with food in the stomach, patients can safely take anti-inflammatory painkillers to numb their throbbing heads as they mutter those immortal words, ‘never again’.