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To your health

Understanding what you've done to your body may help on the morning after

As I sit down to write this the first chills of the season's flu are radiating through my body. With the fever the nausea sets in and all my muscles feel like sand bags. The initial symptoms of flu are not unlike those of the dreaded, too often experienced effects of the overindulgence in alcohol, the hangover. At least with the flu the sympathy one receives is deserved - the hangover, a completely self-inflicted condition, is suffered in isolation. The holidays are often the precursor to overindulgence; the alcohol is freely poured and the frenzy of work and shopping leading up to these days is finally over. Celebrating the new year allows people to really let their hair down, get loose and enjoy. At least until the morning after.

The symptoms of hangover, thirst, fatigue, weakness, headache, nausea, vomiting, sleep deprivation, sensitivity to light, vertigo, depression, irritability and sweating, have been the bane of partying since alcohol was discovered. Along with the hangover, countless remedies have been thought up and put to the test to make the pain go away.

Kate, a very good friend of mine, told me once that her Godfather gave her two pieces of advice on her wedding day. The first was to spend the maximum amount of money that you can afford on those things that connect you with the ground - that is, shoes, a bed and tires for the car. The second bit of advice was that Coca Cola will cure any hangover. A friend of a friend swears by eating a dill pickle after drinking and before going to bed. Copious amounts of water are also old standbys, as is aspirin or Tylenol. To sift through some of these remedies and distinguish the realities from the myths, one needs to look at the science behind alcohol consumption.

To begin with, science doesn't completely understand the hangover state as it has not received systematic study. However, it is probably the result of many different factors. Hangover symptoms typically start several hours after a person has stopped drinking, when the blood alcohol concentration (BAC) is dropping. Symptoms are worst when BAC is zero.

There are several physiological factors contributing to hangover. Alcohol causes the body to increase urinary output, thereby increasing the symptoms of dehydration which are thirst, weakness, dryness, dizziness and lightheadedness. It also irritates the stomach and intestines, causing inflammation of the stomach lining. This can result in nausea, upper abdominal pain and vomiting. Metabolism of alcohol in the liver and other organs can result in low blood sugar levels. Many people experience the sedative effects of alcohol but it is precisely this effect that can disrupt the body's delicate circadian rhythms. Alcohol decreases the length of time spent dreaming (rapid eye movement sleep) which is necessary for "a good night's sleep", and prolongs the length of time in deep sleep. More often than not, partying happens at night, which generally shortens sleep time, causing fatigue the following morning. All these disruptions produce symptoms that are similar to those experienced during jet lag.

Alcoholic metabolism is a two-part process. First it is changed to acetaldehyde and then to acetate. The first compound is a chemically reactive substance that is toxic and causes increased pulse, sweating, nausea and vomiting. Fortunately, this is metabolized quite quickly in the bodies of most people. Some unlucky people have a genetic variation of the metabolizing enzyme and they feel very ill after consuming a very small amount of alcohol. So don't razz your "weak" friends, the condition exists.

The use of other drugs, especially nicotine, increases the symptoms of hangovers but the effects of various drug/alcohol combinations on hangovers are unknown.

Finally, ethanol, the intoxicating compound in alcoholic beverages, is often accompanied by many other compounds during the production of alcoholic beverages. These smaller amounts of biologically active compounds, including other alcohols, are called cogeners. Research shows that drinks that contain fewer cogeners and are comprised of more pure ethanol - gin or vodka for example - induce fewer hangover effects than beverages containing a large number of cogeners, such as whiskey, brandy or red wine. Red wine can increase serotonin and histamine levels which can induce headaches. White wine does not do this but the specific agents responsible for the increased levels are unknown.

Subscribing to the axiom of the hair of the dog that bit you, or having another alcoholic drink to alleviate the hangover, has science behind it. It just puts off the inevitable, unfortunately. Methanol, an alcoholic cogener, is present in many alcoholic beverages such as rye and brandy. The products of methanol metabolism, formaldehyde (yes, the stuff foetal pigs were kept in, in high school biology) and formic acid, are extremely toxic. In high concentrations it can produce blindness and death. Ethanol metabolizes faster than methanol, leaving the lingering toxic effects of the latter compound. This corresponds to the time course of hangover symptoms. Having another drink helps to block the effects of methanol but only until the ethanol runs out again. Hair of the dog is like a cat coughing up a fur ball - the discomfort is only alleviated by getting rid of all of it in the system, alcohol or fur ball. This usually takes between eight and 24 hours.

The best way to avoid a hangover is, of course, not to drink. Let's be pragmatic. Eat a good meal before starting to drink. This will help protect the stomach lining and prevent it from becoming irritated. A glass of milk also helps to coat the stomach, thereby, slowing alcohol metabolism down. In Africa, eating peanut butter before drinking is a well practised prevention technique.

While imbibing, stave off dehydration by switching up alcoholic drinks with non alcoholic ones. Avoid soda water or anything carbonated as the fizzy drinks aid the absorption of alcohol into the blood stream.

Before going to bed drink as much water as you can and a glass of orange juice. Vitamin C helps the liver to metabolize alcohol. Maybe the dill pickle remedy fits in here. Fresh air can also help; consider walking home if it is a safe, short walk. And of course, don't drive after drinking alcohol.

Is there no hope for the hangover inflicted? There are a few real life remedies that can help you get through the next 24 hours. Drinking fruit juices or eating fruits or other foods with a high fructose count can help alleviate symptoms. A virgin caesar works wonders.

Here is where the Coca Cola advice fits in with all its sugar. Eat bland foods with complex carbohydrates to restore blood sugar levels, like toast or crackers. This can help relieve nausea. Exercise helps the body to rid itself of toxins so if you can manage it, push yourself to get out there.

Take a pill, but be careful which one. Acetaminophen (Tylenol) and ibuprofen (Advil) are themselves stomach irritants and are hard on your liver, which at this point is already working overtime. Instead, aspirin is the lesser of the three evils. Antacids can alleviate nausea. Consult the instructions included with all these medications so I'm not liable for writing this stuff.

Drinking coffee can help relieve a headache but it irritates the stomach and is also a diuretic, so drink lots of water with it. Chamomile, peppermint or ginger herbal teas help with both nausea and dehydration. Try to get a good night's sleep.

Of course conservative management of the intake of alcohol will be your best strategy - that and time; hangover symptoms should abate by the next day. Party responsibly and here's wishing you a Happy New Year's day.