Ask the Pharmacist

Q. Even though we are once again in lockdown and unable to go anywhere, I still managed to overindulge and now suffer from a hangover. Any suggestions?

A. “Tis the season to be merry” and many of us are looking for ways to feel joy during this holiday season with the restrictions that are upon us. It is fabulous that technology allows us to stay connected while in the midst of the pandemic. Zoom calls are not just for business conference calls anymore as many people have resorted to using this platform for social events with friends and family and enjoying a quarantine or other zoom cocktails.

According to the Canadian Centre on Substance Abuse and Addiction, alcohol consumption has increased since the start of the pandemic. For most men, the reason behind the increased consumption is boredom whereas women have reported it is due to the increased stress. Regardless of the underlying reason, the end result is the same; alcohol intake has increased. The liquor stores have been deemed an essential service making this new “habit” easy to maintain. It is not surprising then that more and more of us find ourselves waking up feeling a little under the weather and seeking a remedy for this self-induced infliction.

As many have experienced, the most common symptoms of a hangover are fatigue, headache, nausea, diarrhea, tremor, dizziness and/or increased heart rate. The reason we experience this multitude of symptoms, other than for the body to remind itself of the over consumption the day prior, is complex and involves a number of chemicals. When we drink alcohol, our bodies metabolize the ethanol into a toxic, carcinogenic by-product called acetaldehyde which is what causes the flushing many experience when they drink (this is particularly common in Asians due to genetic factors). Alcohol by-products are famous for interrupting our normal sleep patterns (i.e. our circadian rhythms) which manifests itself as brain fog and sleepiness the next day. This is unfortunate because alcohol is often resorted to as a means of relaxation to enable a good night sleep after a stressful day. While it does help many of us initially relax and fall asleep, this escape inevitably backfires even with moderate consumption when the alcohol stimulates our brains at 2am and we are unable to get into a deep restorative type of sleep.

So, what is the best way to treat a hangover? Of course, it goes without saying that avoidance is the surest way to avoid the hangover in the first place. However, for whatever the reason, the indulgence occurred and now you are left feeling awful, perhaps considering a New Year’s Resolution to reduce or abstain from alcohol in 2021. Time will be your ally as you will continue to feel better as time passes. In the short-term, drinking plenty of water is key. Since alcohol leads to dehydration, through increased urination and the possible hangover symptoms of diarrhea and perhaps vomiting, it is no surprise that hydrating your body with plain old water is crucial. There is no evidence that other rehydration solutions such as sports drinks (Gatorade) are more effective than water. Coffee may help shake your fogginess and help you feel more awake but will not help your hangover otherwise. In fact, since coffee is a diuretic and makes you urinate more, it can in fact dehydrate you even further.

If you are not too nauseous, try eating some food or snacks that are rich in carbohydrates such as toast or crackers and juice. It is common for your blood sugar to drop with an alcohol binge and your body and brain might need some fuel in the form of carbohydrates to get through the day.

Headaches and general aches often go hand in hand with the hangover so it is no surprise many of us search for pain killers such as Advil (ibuprofen) or Tylenol (acetaminophen). Bear in mind that alcohol can make your stomach sensitive and adding an anti-inflammatory (NSAIDs) like ibuprofen or naproxen might irritate your stomach further and very rarely cause a GI bleed. Use cautiously if you feel nauseous.

Another thing to consider before reaching for the headache remedy is your liver. Alcohol is mainly metabolized in your liver so it has likely taken a beating already. Since acetaminophen also goes through your liver, the state of your liver needs to be considered before taking it. As a general rule of thumb, to reduce the toxic effects on your liver from the acetaminophen, avoid taking it if alcohol is still lingering in your body. Regular binge drinkers should avoid acetaminophen to protect the liver and chronic heavy drinkers, which is described as three or more drinks per day, should avoid both acetaminophen and NSAIDs to prevent liver damage and GI bleeds respectively.

  • You may have heard of the “hair of the dog” approach to treating a hangover. The idea behind this theory is that your body is undergoing withdrawal from the alcohol and having another alcoholic beverage will indeed stop the withdrawal and hence the hangover. This is just a short term fix and only delays the eventual hangover which usually peaks when your blood alcohol reaches zero.

Many people swear by taking supplements to reduce their hangovers. A very small study reported in The Journal of Clinical Medicine mentioned that diets higher in B vitamins and zinc during the 24 hour period before and after alcohol consumption resulted in hangovers that were less intense. As for other hangover “cures” such as milk thistle, N-acetylcysteine (NAC), activated charcoal, kudzu among others, there isn’t enough evidence to support their effectiveness.

Besides looking for foods rich in Vitamin Bs and zinc to consume before your next evening out, or in rather, consider these helpful tips to reduce or prevent the hangover.

  • Avoid or keep alcohol to a minimum. That is quite obvious but I thought it should be stated. To achieve this, while still partaking in “drinking”, consider trying the many beers or wines on the market that contain zero or very little alcohol and still taste good.
  • Never drink alcohol on an empty stomach. If you are not able to achieve the vitamin B/zinc rich foods, at least be sure to put something in your belly. Food slows the absorption of alcohol, giving your liver a little more time to perform its detoxifying role.
  • Drink plenty of fluids. Try to include water or a non-alcoholic and non-carbonated beverage in between your alcoholic drinks which will keep you more hydrated. It is also wise to drink a full glass of water before going to bed.
  • Choose to drink clear liquors (vodka, gin) over dark ones (red wine, whiskey). Some experiments have shown that the dark liquors may contain methanol metabolites which are known to cause worse hangovers due to their toxicity.

With the New Year around the corner, it is a good time to assess our drinking habits. The two terms that are coined in reference to alcohol are binge drinking and heavy drinking. Binge drinking refers to the amount of alcohol consumed on one occasion. Women who consume four or more drinks and men who consume five or more drinks would be considered binge drinkers. Women who drink eight or more alcoholic beverages a week and men who drink 15 alcoholic beverages a week would be described as heavy drinkers. Many of us might fit this description during the festive holiday season, however if you seem to fit into either of these profiles more often than that, perhaps it is time to consider other activities to help with the dog days of this pandemic.

For more information on this or any other topic, contact your pharmacist.