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Oh, my aching body: exploring a hangover, from the inside out

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Published Dec. 22, 2016

Editor's note: This article originally appeared on the New York Journal of Style and Medicine website (nyjsm.com). It has been edited for length and clarity.

We've all been there. Friday night's jubilant, alcohol-fueled outing crashes into Saturday morning's nauseating, feels-like-I'm-dying body ache. From the ancient Chinese who first began overindulging more than 6,000 years ago to Bradley Cooper, Ed Helms and Zach Galifianakis after a bachelor party in Las Vegas, man has consistently suffered through hangovers after long nights of binge-drinking. But what exactly is a hangover? Why do we feel so awful? And if we can design Snapchat filters that can make us look like puppies, cheetahs or Donald Trump, then why have we not invented a magical hangover cure by now? These questions and more can be answered by understanding the chemical processes that occur inside our bodies when we drink alcohol.

As soon as the alcohol we drink reaches our stomach, digestion begins to break down alcohol into a couple of by-products. The breakdown of alcohol is completed in the liver. It is actually acetaldehyde, one of the by-products, not alcohol specifically, that is behind the horrible and well-known hangover feeling. Alcohol certainly starts this process, but the hangover is actually created at the molecular level. As this happens simultaneously, acetaldehyde contributes symptoms while the other stuff breaks down to safely participate in nontoxic body chemistry.

One of the worst parts about alcohol metabolism is that it follows what's called zero order elimination. Zero order elimination means that no matter how much alcohol we drink, we will still only break down about 13 milliliters of alcohol per hour. Most drugs are broken down through what's called first order elimination. This means that the more drug we consume, the more that drug gets broken down. Not so with alcohol, which explains why you are that much more hung over with each extra Fireball shot, and why hangovers can often last a full day after a party.

In addition to its metabolic issues, alcohol also causes the stomach to produce more acid, leading to inflammation of the stomach lining. The stomach is essentially injured after a night of heavy drinking, hence we experience nausea, vomiting, stomach pain and decreased appetite.

Many of us are familiar with alcohol's diuretic properties. Though drinking plenty of fluids is important to prevent dehydration, new studies have shown that electrolyte imbalances that result from increased diuresis play a minimal role in hangover symptoms. So while chugging water at the end of the night or stocking up on expensive Pedialyte might quench your dry mouth, it does little to cure a hangover.

Though alcohol is notorious for putting people to sleep, it decreases our ability go through the crucial phase known as REM sleep. So even if you're that guy who falls asleep at the bar, don't expect to wake up feeling well rested.

Interestingly, new research has shown that hangovers may be at least partly mediated by an immune process. It has been demonstrated that many of the same chemical mediators that are increased in common illnesses such as the common cold and flu are also increased after alcohol consumption. Luckily, these chemical mediators can be tempered with NSAIDs such as aspirin and ibuprofen.

In a nutshell, a hangover is caused by many different processes that cause us to feel miserable. It's essentially a perfect storm of metabolic disturbance, slow elimination, stomach injury, dehydration, sleep disturbance and disruption of the immune system. Because it hits you at so many different angles, it's difficult to throw any kind of immediate cure at it. With all this said, it's probably best to stick with the traditional approach of aspirin or ibuprofen, water, a box of pizza and a healthy dose of regret.

Kevin Morgan is a third-year medical student at the USF Health Morsani College of Medicine. Dr. Matthew Vasey is with the department of emergency medicine at Tampa General Hospital | TeamHealth, an affiliate of the USF Health Morsani College of Medicine. Vasey established the New York Journal of Style and Medicine website (nyjsm.com) to educate the young, nonmedical, millennial community about preventive health and medicine with audience-appropriate articles. Born in Tampa, he completed medical school and residency in New York City. Vasey was delighted to return home and relocate the NYJSM concept to Tampa. (Disclosure: Opinions in NYJSM reflect neither the employer nor affiliated institutions, solely those of the authors.)

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