It has been used to aid in social situations and as a feel good factor. It is effectively however a poison, and should be treated with caution if its negative effects are to be avoided.

Alcohol and the hangover

When alcohol is drunk it enters the stomach where it can be absorbed. However the surface area of the stomach is not that great and normally most alcohol is absorbed further down the gastro-intestinal tract in the small intestines. Here there is a large surface area and the alcohol is quickly absorbed and taken to the liver for detoxification. If there is too much alcohol, then this will remain in the bloodstream where it will affect the brain, causing symptoms of drunkeness. The liver will get to work converting the alcohol, first to an extremely toxic intermediate substance called acetaldehyde, and then to a harmless product called acetate.

Hangover causes:

• The intermediate product of alcohol breakdown, acetaldehyde, is responsible for many of the hangover symptoms.
• Other substances in drink unrelated to the alcohol content, called congeners, are also thought to worsen hangovers. These include tannins in wine and propanols and glycols. Generally the darker drinks contain more congeners.
• Dehydration leads to sickness, nausea and weakness and occurs as alcohol reduces the amount of anti-diuretic hormone leading to increased water loss.
• Low blood sugar occurs as alcohol stimulates an insulin response that shunts all our blood sugar into cells. The brain then gets short on its major fuel, sugar. This can lead to the shakes and lethargy.

Hangover Cures:

• Drink plenty of water. In fact the rule of one glass of water for every drink both reduces the total amount of alcohol consumed and reduces the dehydration. If you can't manage this then at least drink a pint of water before bed if you've been drinking a lot.
• Line your stomach. If you eat fatty foods before or during drinking, the alcohol becomes trapped in your stomach where it is absorbed more slowly than in the intestines. This gives the liver more time to detoxify what comes in and avoids a build up of toxic substances in the bloodstream. This reduces levels of drunkeness and reduces the subsequent hangover.
• Eat after drinking. The low blood sugar caused by drinking can be countered by having something to eat. Eating anything should help, but a low GI snack including some fat and protein should provide a blood sugar boost. Perhaps some porridge oats before retiring to bed and then have eggs for breakfast. Eggs contain the amino acid cysteine, which binds to some of the toxins in drink.
• Avoid carbonated beverages such as fizzy lagers. Carbonation speeds up the absorption of alcohol.
• Supplements and medicines can be used for hangovers. Examples include milk thistle for liver detoxification, n-acetyl-cysteine, borage, propranolol, tropiseton and tolfenamic acid. However resorting to and paying for supplements and drugs would seem unneccessary if the advice in the first 4 points was utilised. Perhaps you should consider drinking less?

Health problems related to alcohol: Chronic overuse of alcohol is associated with many unpleasant outcomes including early death. Binge drinking is also associated with significant health problems, both in the short term, and later on in life. Moderate drinking has differing effects depending upon the person, their genetics and the amount that is considered "moderate". In small regular doses there can even be some benefits. Let's have a look at some of the health issues that can result from alcohol.

• Mental health problems.
• Depression. Alcohol leads to a reduction in the brain chemical serotonin. The level of serotonin is related to mood and low levels lead to depression. Also low blood sugar may have the same effect in some.
• Violence. Equally the pre-frontal cortex of the brain controls our impulsivity. Alcohol enhances the effects of the inhibitory brain chemical, GABA which prevents the pre-frontal cortex controlling our impulses. This results in erratic behaviours including violence. Not all people react this way however as brain chemistry differs.
• Weight problems and heart disease.
• Obesity. Alcohol contains calories and is converted into a chemical called acetate in the liver. Multiple units of acetate are then either then built up into fat or burnt as fuel. Given that sleeping is a common activity after heavy drinking, you can see that the creation of fat is the most likely outcome.
• Heart disease. The extra fat that results from excessive drinking is a risk factor for heart disease. Also binge drinking can lead to an irregular heart rhythm that can cause heart attacks in those already with poor health. This is the reason for the glut of heart attacks in Glasgow every Monday morning when people are recovering from their drink fuelled spree over the weekend.
• Cancers and liver disease.
• Alcohol is associated with a number of cancers including liver cancer and cancer of the oesophagus and throat. It is the intermediate breakdown product of alcohol, acetaldehyde that is particularly associated with cancer, and this chemical is also responsible for some of the symptoms of hangover. It is a sobering thought that the discomfort of the hangover caused by acetaldehyde is doing you no good at all!
• Liver disease is a well known consequence of chronic alcohol abuse. The liver gradually becomes inflamed by all the toxins it has to deal with. This is known as hepatitis. If chronic abuse continues cirrhosis can occur where parts of the liver turn into scar tissue and stop functioning.
• Fertility and skin condition.
• Fertility is affected by alcohol. Studies have shown that women drinking 6 units per week were 1/6th less likely to conceive than those who were teetotal. The more that was drunk, the bigger the effect on fertility. Given that alcohol also affects the sperm motility of men, it is best to limit yourself to very modest levels of drinking if you are trying to conceive. I would suggest less than 5 units per week for women and less than 10 for men.
• Skin condition is affected by alcohol, with the skin disease rosacea being one possible outcome. This leads to a red blotchy appearance. On top of this a dilation of the blood vessels in the skin of the face can lead to the typical ruddy complexion of the archetypal drinker.

What is a sensible level of drinking?

The truth is that some people are better able to cope with alcohol than others. In general women and people of East Asian origin have less capacity to cope with alcohol as they have less of the enzymes needed to detoxify the alcohol. However, every individual is different, and if there is a history of alcohol related problems in your family then it is probably wise to treat alcohol with extreme care. Regular heavy drinking and regular binge drinking inevitably takes a heavy toll in time. Very few people will get away with large amounts of drink without experiencing serious health issues. This can be approximated as greater than 50 units per week for men and 35 units per week for women. However just because you have less than this does not ensure you are out of harms way. That is why the UK Government guidelines are a maximum of 28 units per week for men and 21 units for women. Even these amounts may lead to adverse health outcomes for some. The daily units associated with those weekly maximum recommended figures are 3-4 units for men and 2-3 units for women. The reason the Government came out with daily guidelines as well as weekly ones was in recognition of the fact that binge drinking was particularly harmful. My advice is that if you enjoy a drink and want to avoid any health damage then drink between 1-3 units for women or 1-4 units for men. Do this 2-4 times per week, but avoid going over this amount. Obviously having more than this leads to possible harm, but the amount of harm will vary between people. Ultimately you must judge for yourselves what value you are getting from exceeding sensible drinking levels as any enjoyment or thrill will be at some cost to your health. As a quick reminder: 1 unit is about 1/2 pint of a 3.8% "session" beer, 1 25ml single measure of spirits and less than a small 125ml glass of 12% wine (about 90ml).

Robin Dowswell
Nutritional Therapist based near Milton Keynes, UK
see http://www.drdobbin.co.uk for more.