Moaning after the night before
It's happened to the best of us. An evening of excess and alcohol turns overnight into a wretched morning mess. You slink through the remainder of the day hating life. The queasiness, the raging headache, the multiple trips to the bathroom, the onset of flu-like symptoms, that odd feeling that your insides have been pickled - it is enough to make you swear off drinking forever. Until the next time.
Friends will offer up their secret hangover cures, each nastier than the next: a big greasy breakfast, pickle juice, chocolate milk, a whole cabbage, sauerkraut with tomato juice, or more tequila. Another old fallback, known as 'the prairie oyster', calls for a raw egg with vinegar, Worcestershire sauce, salt, pepper and Tabasco sauce. The strategy is based less on science than witchcraft and works by simply distracting you from your alcohol-induced nausea with an even more stomach-churning concoction.
Remedies are notoriously unreliable because the reason for hangovers is not well understood. While dehydration is commonly thought to be the culprit, alcohol acts on the body in a number of ways, all of which contribute to the development of the hangover.
'Hangovers don't get a lot of attention in the medical community because [they are] your own fault,' says Brenna Haysom, founder of New York-based pharmaceutical company Rally Labs. 'Most doctors don't want to encourage drinking and there are more worthy causes to spend their time on.'
Haysom had been studying hangovers for over a year before she developed Blowfish, a morning-after remedy she claims is effective. She didn't plan to make this her life's work. Before graduating from business school, Haysom was working in finance in New York and leading a lifestyle not unlike many professionals in Hong Kong - long work hours, socialising late at night, drinking, more drinking, wretched hangover and repeat. Frustrated with the 'hocus-pocus hangover products' available on the market, she decided to make her own.
Of course, the best way to deal with a hangover is avoid drinking so much in the first place, which is not quite so helpful while you're in the throes of misery. The body can only process a certain quantity of alcohol in a given time. But just how much is too much depends on the drinker's body mass, gender and genetics. Also, certain types of alcohol (such as whisky, brandy or red wine) contain a higher quantity of compounds called congeners than clear spirits (gin and vodka). Congeners not only lend flavour to the liquor, they also contribute to the effects of a hangover. Typically, a hangover hits several hours after you stop drinking and your blood alcohol levels drop. So by the time you're feeling it, it's often too late for precautions.
Many East Asians may be more susceptible to hangovers because of the way they metabolise alcohol, according to a 2005 study by Masako Yokoyama of the Mitsukoshi Health and Welfare Foundation in Tokyo. Generally, the body handles alcohol in a two-step process: an enzyme converts ethanol into a toxic compound, acetaldehyde, which is then further broken down into acetate by a second enzyme. Roughly 40 per cent of East Asians have what is commonly known as 'Asian flush syndrome', wherein a genetic variation affects the rate at which these alcohol-metabolising enzymes perform, resulting in an acetaldehyde buildup and a whole host of unpleasant physiological reactions, such as nausea, headache, accelerated heart rate, sweating, shortness of breath and flushing of the skin.
Haysom makes no secret of the Blowfish formula, which is simply an effervescent tablet made from common items you could purchase from your local supermarket.
'Sure, I guess you could get the same results by taking two aspirin, a cup of coffee, water, an antacid and [a sports drink],' she says. 'But you'd have to go through all those separate steps.'
The first thing to remember is that alcohol will dehydrate you. It inhibits the release of an antidiuretic hormone called vasopressin, which increases urinary output. It can also cause gastrointestinal distress leading to diarrhoea, vomiting or worse. Some studies have shown that even well-hydrated subjects will develop hangover headaches, suggesting that there is more at play than simply dehydration. But dehydration can certainly exacerbate the severity of hangover symptoms. So sufferers would be well advised to keep a clear path to the bathroom and have something on hand - such as water, oral electrolyte solutions, coconut water or sports drinks - to replenish additional fluid loss.
A 2008 report by Joris Verster, assistant professor at Utrecht University in the Netherlands, says a hangover might be a type of immune system activation which is independent but concurrent with dehydration that follows after drinking alcohol.
'To your body, alcohol is essentially a poison,' Haysom says. 'So it makes sense that it will produce an immune response. This is why you can stay hydrated while drinking vodka all night, but still develop flu-like symptoms.'
Non-steroid anti-inflammatory medications such as aspirin, ibuprofen or naproxen can relieve head pain, but they are tough on the stomach and should be used cautiously. Drinkers should avoid taking acetaminophen after a binge because of extra damage to the liver.
Dr Michael Oshinsky of Thomas Jefferson University in Philadelphia this year led a team of scientists to induce hangover headaches in well-hydrated rats. The experiments showed that acetate, which was once thought to be a relatively harmless metabolite of pure alcohol, actually contributes to hangover pain. As the revellers in Lan Kwai Fong are most certainly concerned about acetate levels, they would be relieved to know that, in this study, caffeine and Ketorolac (a non-steroid anti-inflammatory drug) blocked ethanol-induced hypersensitivity. In other words, aspirin and a cup of coffee might just be the thing to keep the hangover headache at bay.
Many people avoid coffee for fear of dehydration and stomach irritation. However, caffeine not only alleviates headache pains but also combats fatigue from poor sleep. As blood-alcohol level drops, so do the sedative effects, leaving the body in a highly charged state. After people come home drunk and crash in bed, they will often wake up in the middle of the night and continue until morning in fitful sleep.
The fatigue, dizziness, and irritability might also be related to hypoglycaemia. Alcohol impedes the ability of the body to regulate blood-glucose levels. As low blood sugar may contribute to hangover intensity, many people swear by fruit juice, sports drinks or a high-carb breakfast.
And if all else fails, you could always try the 'hair of the dog that bit you', an idiomatic reference to a folk remedy for rabies, which in hangover parlance simply means to have another drink. The idea may not be far-fetched, as some researchers support the idea that hangovers are in part a mild form of alcohol withdrawal.
'That Saturday morning bloody mary might help,' Haysom says. 'You'll still be suffering the consequences, but it will let you come down a bit easier.'