There’s actually a medical term for hangovers after drinking – “veisalgia”. Most of what you feel during a hangover are down to 2 factors – dehydration, and a toxic byproduct of alcohol called acetaldehyde circulating in your system. In fact, there’s an anti-alcohol abuse drug (disulfiram) that works by inhibiting the liver enzyme which breakdowns acetyledehyde. This makes addicts who continue drinking feel like shit even faster.
Doctors are not known for abstaining – various surveys have noted medical professionals to be one of the most likely to abuse alcohol. Experience working in London and Singapore tells me that while these results probably hold true for the UK, I can assure you that 7 am hospital starts in Singapore (vs 9 am in the UK) is a sufficient deterrent against late night booze sessions. Just in case you were suddenly paranoid about drunk Singaporean doctors running loose in hospitals.
I’m often asked how doctors prevent hangovers, and what we use to treat our own hangovers. Below I’ve compiled a list of evidence-based hangover prevention methods to ensure you have a good night out, minus the hangover the day after:
1. Pig out before alcohol
Heavy meals 1-2 hours prior to drinking help to slow down alcohol absorption into your blood. Studies have shown that your blood alcohol concentration (BAC) can be up to 30% higher when you drink on an empty stomach.
It’s incidentally a great excuse to stuff yourself silly with char kway teow before a binge session. Most of you probably already know this one, so I won’t elaborate further.
2. Water parade before, during, and after the booze
Probably the single best trick in my book. The easiest hack to prevent hangovers is to drink a full cup of water in between each alcoholic beverage – I’ve rarely gotten drunk while sufficiently hydrated this way.
If you’re too high to remember to top up on water while drinking, make it a point to drink a pint of water before.
Also, if your friend is practically passed out at the end of the night, make sure that he drinks as much water as he can before hitting the sack – I’ve saved more than a few friends from a nasty hangover by doing this.
3. Pace your drinking
Limit your drinks to one every hour – your body takes about 60 minutes to metabolize each drink. The faster you consume alcohol, the more time alcohol toxins spend in your body before being metabolized. These toxins are more likely to affect your brain tissues and cause a bad hangover headache the next day.
Secondly, stretching out your drinks will reduce the total amount of booze consumed. Whether you suffer a hangover or not at the end of the day is really down to the cumulative amount of alcohol you drink.
4. Drink clear-coloured spirits, and don’t mix your beverages
Although I’m fond of a good Long Island Tea myself (because it’s one of the few drinks that tastes good and hits you for an instant buzz), it’s generally a bad idea to go mixing your alcohols.
Of course you are probably not going to listen to this piece of advise, so the next best tip is: Avoid the dark-coloured spirits, and pick the clear or transparent ones.
Dark-coloured spirits like red wine and whisky get their colour from congeners, which are particulates picked up during the aging process. Alcoholic beverages that contain less congeners (eg. vodka and gin) are associated with a lower incidence and severity of hangovers than darker beverages that contain more congeners (eg. port, brandy, whiskey and red wine). This may explain why patients with chronic alcoholism abuse vodka and gin disproportionately.
It probably also accounts for why as a gin and tonic kind of guy, I don’t get hangovers nearly as often as my “sophisticated” whisky-loving friends.
Cheaper/low quality booze are sometimes also known to contain more congeners than higher end spirits (say, your triple distilled Grey Goose vodka). A former flatmate of mine polished off an entire bottle of Tesco Value vodka while still a broke-ass medical student. Of course he suffered a terrible hangover after – we still laugh at him about it today.
5. Go easy with bubbly drinks and mixers
Ever wondered why drinks like beer and champagne have a low alcohol content, but still seem to get you high relatively quickly?
The answer is that gassy drinks such as beer, champagne and soda mixers with your liquor speed up the rate of alcohol absorption into your bloodstream. It’s hypothesized that carbon dioxide in the drink rapidly pushes alcohol from your stomach into your small intestine.
The two studies conducted were admittedly small-scale (with 12 subjects and 21 participants respectively), but for those who are always laughed at for not being able to hold your beer – at least now you have a good comeback.
6. NSAIDs (Ibuprofen, Nurofen etc)
I couldn’t find any strong studies per se in support of using NSAIDs as a prophylactic measure, but it’s a common enough hack that I feel obliged to give it a mention. I also know of many doctor friends who swear by it’s effectiveness.
A super old study revealed NSAID to be more effective than a placebo at lowering hangover symptom scores. The theory goes that high levels of alcohol in the brain causes neuro-inflammation, which is why anti-inflammatory medicines such as ibuprofen can help.
Funnily enough, the guy who invented ibuprofen originally tried it on himself as a hangover cure. Do note that NSAIDS can further irritate your gastric lining, so if you must, I’d take them before going to sleep, rather than in the morning at the onset of your hangover. Two tablets (200 – 400 mg) before you get into bed will generally do the trick.
7. Vitamin B6
Vitamin B6 before drinking has been shown to reduce the number of hangover symptoms by approximately 50%. This was only a small scale study with 17 participants, so I’d take the findings with a pinch of salt.
According to that study, here is what you have to do: 400 mg of Vitamin B6 when you start drinking, 400 mg three hours later and 400 mg at the end of the night – good luck with remembering that. I’ve never bothered to try this ever.
8. Prickly pear cactus extract
Don’t ask me where you can buy this stuff in Singapore, but prickly pear cactus holds the distinction of being one of the few hangover remedies to undergo proper clinical testing.
In a double-blind crossover trial, 64 participants received either prickly pear cactus extract or placebo 5 hours before alcohol consumption. Prickly pear cactus extract didn’t reduce overall hangover symptoms, but it did reduce the risk for severe hangover by 50%.
The hypothesis is that similar to NSAIDs, prickly pear extract works as an anti-inflammatory in preventing hangovers.
Bonus: Famotidine prevents flushing (and possibly hangovers)
A personal dermatologist friend of mine always takes famotidine before drinking. He claims that he has never flushed when he does this. Conversely, he always quickly flushes when he doesn’t remember to take famotidine prior.
Let me explain this sorcery. Recall how I mentioned at the start that alcohol is broken down to acetaldehyde? Well, acetaldehyde stimulates the release of histamines. Histamines dilate blood vessels in your face, causing flushing. If you were wondering why you flush particularly easily compared to your friends, it’s because 40% of Asians have a mutation in the enzyme that properly processes acetaldehyde. This causes a massive buildup of acetaldehyde and histamines, which triggers your flushing.
Famotidine is a type of anti-histamine that inhibits stomach acid production, normally used for indigestion and acid reflux. A 4 participant study found prophylactic famotidine to be effective against flushing, echoing a separate study that showed anti-histamines taken before alcohol prevented redness. The former study also concluded that famotidine may reduce or prevent hangovers.
You could try 20 mg of famotidine 1 hour before starting to drink. This is an off-label use of the medication, so do not quote me on this. Also, never take it with alcohol.
That sums up my 8 preventative hacks against getting a hangover. Allow me to reiterate that no matter how many of these measures you adopt, if you consume too much alcohol, you will still end up smashed. I’ll be covering 6 useful hangover cures in my next post.
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PS This dated post from 2012 mentions that NTUC was actually selling prickly pear cactus at some point for $3.55 per pop. Go knock yourself out.