Pod Insights Life Kit Plus What people get wrong about hangovers About this episode Do you feel anxious after a night drinking? Two doctors weigh in on how to treat hangover symptoms especially 'hangxiety' after drinking too much. Plus the science of alcohol's affect on your body and tips for reassessing your relationship to alcohol. Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy
Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
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0:23 Marielle Segarra? You're listening to Life Kit from NPR.
0:29 Marielle Segarra? Hey, everybody. It's Marielle. Today, we're talking about that awful morning after feeling. And if you're listening to this episode, you probably know what I'm talking about. You wake up and the sun's too bright, your head is throbbing, your heart's racing. Maybe you've got body aches, or nausea, or dry mouth, or if you're really going through it, all of the above. You start replaying the night before in your head and panicking. What did I say to that person? Was I being too loud? Hangovers, man, they are not pretty. And I think intuitively, we know that it's not good for our bodies when we drink that much. But to be honest with you, drinking alcohol in smaller amounts isn't exactly good for us either.
1:10 Speaker 02 Not to say that people need to give up their one drink with dinner. That's not my point. It's just that there is no safe amount. A small amount is not healthy.
1:19 Marielle Segarra? Dr. Ryan Moreno is a medical toxicologist and emergency physician at University Hospital's Cleveland Medical Center.
1:25 Speaker 02 Alcohol is a toxin. All forms of alcohol are directly toxic to pretty much every cell in your body.
1:32 Marielle Segarra? According to the CDC, alcohol is a leading cause of preventable death in the US. It's linked to several cancers, cardiovascular disease, and driving fatalities. And yet, we can hear the stats and still head out to happy hour with friends. And I'm sure I don't have to spell out why.
1:48 Speaker 03 If you want to loosen up at a party, alcohol works. If you want to go to sleep, for most people, alcohol will make you sleepy. If you have anxiety, alcohol will take the anxiety off. If you want to de-stress after a long day, alcohol will do that. And so, it's effective until it becomes the problem.
2:06 Marielle Segarra? Dr. Anzinga Harrison is a physician specializing in psychiatry and addiction medicine. She's also the co-founder and chief medical officer of Eleanor Health, a company that provides mental health and substance use disorder treatment services. Now, this doesn't mean she came to this story riding on a high horse, though.
2:23 Speaker 03 I have definitely had a hangover. I'm personally familiar, as well as professionally.
2:29 Marielle Segarra? We want to acknowledge something upfront. There is some thought in the medical community that by offering advice on hangovers, we might be glorifying alcohol or even enabling people to misuse it. But both Dr. Harrison and Dr. Marino agree not talking about hangovers isn't going to make the problem of binge drinking or alcohol misuse go away.
2:48 Speaker 02 I am not in denial enough to think that people are going to hear that there's no safe amount of alcohol and everyone can stop drinking or is going to want to stop drinking. People really just need to know their risk benefit profile.
3:02 Marielle Segarra? So on this episode of Life Kit, we're going to help you with exactly that. Reporter Andy Tagle will share helpful insights from Doctors Harrison and Marino on how to be smarter and more mindful about your drinking before, during, and after a night on the town. We'll walk you through some alcohol science, help you understand your personal risk factors when you drink, and give you tools for assessing your relationship to alcohol.
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6:22 Marielle Segarra? Okay, some quick trivia I just have to share to start. The medical term for a hangover is visalgia, which is a combination of the Greek word for pain and a Norwegian word meaning uneasiness following debauchery. It's a little on the nose, but a fittingly large umbrella, because, takeaway one, hangovers, like alcohol, affect everyone a little differently. And heads up, it's not just a battle against dehydration. So we know there's no such thing as healthy
6:54 Speaker 06 But the US Department of Health and Human Services does have a definition for safe drinking. And it's probably less than you think. One drink a day or less for women, and two drinks a day or less for men.
7:07 Speaker 03 And one drink is like one shot or one four-ounce glass of wine, not these mega glasses that we have these days.
7:16 Speaker 06 The recommendation is actually five ounces of wine these days, but the point still stands here. So that's your baseline to start, but...
7:23 Speaker 02 Every person is going to have a different experience from their consumption, from drinking, as well as their kind of hangover experience on top of that. So like your water volume, hydration status, your body composition, body fat to muscle tone.
7:40 Speaker 06 Your tolerance to alcohol can vary from day to day and from setting to setting based on a bunch of different characteristics. Your age, weight, gender, ethnicity, family history, nutritional status, smoker status, your mood, if you have any health conditions, big or small, or if you're taking any medications. And if we're just talking hangovers, according to one study, about 25% of people who drink to intoxication don't experience them at all. For some people, one evening glass of wine could lead to vomiting, muscle aches, and anxiety. But for their sibling at the same dinner table, an entire night of mixed drinks could equal tiredness, dehydration, and not much more.
8:20 Speaker 02 And so even though we recognize this universal experience of a hangover, your hangover is going to be very different than everyone else that you know.
8:28 Speaker 06 What is universal? Most hangovers are a pain that can last in range from eight to 24 hours. Although even that isn't a hard and fast. And they peak when your blood alcohol concentration returns to zero. End of list.
8:44 Speaker 06 Why is there so much variance in the hangover experience? The answer isn't super satisfying.
8:50 Speaker 02 The short answer is nobody really knows. But the better answer is that we do know there are a lot of factors involved.
8:56 Speaker 06 See, every hangover...
8:58 Marielle Segarra? Is a multi-part equation.
9:00 Speaker 02 The most important thing is the alcohol itself. And so there is no way to completely avoid a hangover if you're going to be drinking. And that is because one of the metabolites of alcohol, acetaldehyde, which is what your body first breaks the alcohol down into, causes these feelings that we describe as a hangover.
9:21 Marielle Segarra? Then there's sleep deprivation. Alcohol wrecks your sleep. And not just for people staying up late bar hopping.
9:28 Speaker 02 The quality of sleep that you get if you have alcohol in your system is very low. People get less REM sleep.
9:34 Marielle Segarra? Next up, let's talk sugar and salt.
9:36 Speaker 02 Alcohol also causes pretty significant effects, especially in like binge drinking or chronic drinking on the way your body metabolizes sugars. Sugars that are kind of the primary metabolic component for functioning of all processes within your body. And so you can be very low on sugar. And that's why people don't feel good after drinking.
9:59 Marielle Segarra? To be specific here, alcohol can cause hypoglycemia. That's when your blood sugar levels drop below standard range. Essentially, your liver chooses to process the alcohol instead of maintaining your blood glucose levels. So your blood sugar drops, and that can give you some of those classic hangover symptoms. The shakes, the sweats, lightheadedness. So if any of those feelings sound familiar, it might be a good idea to lay off mixers or super sweet cocktails. Alcohol can also famously cause dehydration and throw off your body's sodium balance. Certainly another factor of why hangovers can hurt. Dr. Moreno says, yeah, it's important to stay hydrated. A Gatorade, Pedialyte, or similarly electrolyte infused beverage
10:42 Marielle Segarra? before you go out or the morning after certainly won't hurt. But you shouldn't expect them to work miracles either. Now, what about alternating between alcoholic drinks and water during a night out? The doctor says having a non-alcoholic drink for every alcoholic beverage is definitely a good starting tip, but.
11:01 Speaker 02 That ends up then kind of encouraging people to drink more or just drinking large volumes of water or something which can also have risks.
11:09 Marielle Segarra? And this brings us to the myth busting portion of our story. Because there's like a lot of.
11:14 Speaker 06 So-called hangover cures out there these days. So I asked Dr. Moreno, could preventing a hangover be as simple as a pregame vitamin, a party patch, or super duper hydration packets?
11:24 Speaker 02 So the short answer, I would say, is no. And the long answer, I would say, is no.
11:32 Speaker 06 Fair enough, funny guy.
11:33 Speaker 02 I'm sorry, that was a terrible joke. But none of these are evidence-based, and there's no reason to believe that any single proprietary supplement is going to treat or prevent a hangover. The only way to reduce your hangover is to drink less alcohol.
11:50 Speaker 06 And that's takeaway two. The only cure for a hangover is to abstain from alcohol. But there may be some things that could make that hangover better or worse. Let's start with the old adage, beer before liquor couldn't be sicker. Liquor before beer, in the clear. What say you, doc?
12:08 Speaker 02 In general, that's not going to affect anyone's ability to get or recover from a hangover.
12:14 Speaker 06 So Dr. Moreno's verdict? There's no truth to this little ditty. Start with what you want, mix things up if you like. It's the quantity, not the type of alcohol, that will make the difference for most people. That said, everyone reacts to alcohol differently, and some people will have sensitivities that others don't. For example, an estimated 8% of the global population experience facial flushing when drinking. You might have heard of this as Asian glow, because this reaction, caused by a specific genetic mutation that makes it more difficult for the body to process acetaldehyde, largely affects people of East Asian descent. Red wine is often cited as a source of headaches, potentially due to sulfites or histamines, although no one's exactly sure.
12:58 Speaker 06 And in one study, it was found to be a common alcoholic trigger for people who suffered from migraines. There's also some research that points to a specific troublemaker in hard liquor. Studies have shown that darker liquors like bourbon and brandy can make hangovers worse because they contain higher levels of congeners. These are the chemicals produced during the fermentation process that give an alcohol its distinctive taste, smell, and color. And generally speaking, the more congeners an alcohol has, the worse the hangover. So that buddy that swears by vodka just might have a point. Now, what about popping a couple of painkillers before bed to get out in front of that headache? Short answer, not a good idea. According to the National Institute on Alcohol Abuse and Alcoholism,
13:41 Speaker 06 consuming just one drink a day with non-steroidal anti-inflammatory drugs like Advil, Motrin, or Aleve can increase your risk of gastrointestinal bleeding by about 37%. When it comes to combining alcohol with drugs containing acetaminophen, like Tylenol, you can run the risk of liver damage if you ingest too much of one or both substances. That's why the FDA advises against drinking when taking any medicine that includes it. And just in general, it's good to be mindful when you're on any meds.
14:10 Speaker 02 Even if your medication doesn't have a little sticker on the label, doesn't mean that you can't be affected.
14:16 Speaker 06 Now, let's turn to food. Having a hearty meal before you drink is definitely a good idea. You don't want to drink on an empty stomach. Eating after a night out won't soak up the booze, as some people might claim. The only thing that sobers you up is time, but it should help with that blood sugar crash we were just talking about. Now, are salty, carby, fatty foods the best for hangovers? Could french fries be the magic cure?
14:42 Speaker 06 Wishful thinking, I'm afraid.
14:43 Speaker 02 So I am a big fan of greasy food myself, but this is not going to help the hangover.
14:50 Speaker 06 It's natural to crave fatty, calorie-dense comfort foods, but those won't help you get up and running any faster. Instead, opt for bland foods or the BRAT diet if you're feeling queasy. Bananas, rice, applesauce, toast. Or if stomach problems aren't an issue, go for vitamin-rich foods like fruits and vegetables to replenish what you might have lost. Finally, what about hair of the dog? You know, cracking open a beer or ordering a tall Bloody Mary to drink away the pain of the night before.
15:17 Speaker 02 That's definitely not going to help your hangover. It might make people feel better because you're kind of getting some of the desirable effects from alcohol on board. And a lot of the hangover effects are kind of those things people don't like feeling, fight-or-flight reactions. And so having any sort of anxiety or that kind of thing, the alcohol might help with that temporarily, but you're kicking the can a little bit.
15:40 Speaker 06 And this brings us to takeaway three. Be aware of and tend to hangxiety.
15:45 Marielle Segarra? Thus far, we've talked a lot about the physical side of a hangover. Now, let's move into the realm of mood and emotions. Ever wake up after one too many and just feel like crying? Lump in your throat, butterflies in your stomach, an amorphous, roving sense of guilt or dread? Dr. Harrison says hangover anxiety symptoms like these are a common experience because of how alcohol works in the body. Without getting too technical, alcohol binds to certain receptors in your body, called GABA receptors, that help you feel calm and uninhibited by slowing down certain signaling. So, when that alcohol is eventually cleared out of your system...
16:24 Speaker 03 You get that rebound phenomenon. GABA was turning down that heart rate. Once that alcohol is gone, the heart rate bounces back up. It was turning down that blood pressure. The blood pressure bounces back up. It was turning down that churn in your stomach. It bounces back up. This is the basis for hangxiety.
16:46 Marielle Segarra? And what makes anxiety extra tricky is that it doesn't require excessive or even heavy drinking to happen. So, you might not even place it as a hangover symptom when it pops up. For some people, especially those who already experienced things like anxiety, depression, or any other mental health condition, feelings like sadness, hopelessness, worry, or panic the day after drinking may be acute, and therefore more obviously linked to alcohol consumption. But for others...
17:13 Speaker 03 It can come before the physical symptoms come. It can come without physical symptoms at all, and you're just like, "I don't even have a hangover, but why do I feel so on edge? Why do I feel so irritable? Why am I worrying about things?" This is hangxiety.
17:30 Marielle Segarra? Just like physical hangover symptoms, the only way to fully prevent hangover anxiety is to not drink. But one first step to keep your dark From getting too heavy is to simply realize that your hangover can come with significant emotional side effects. And they'll need care, too.
17:47 Speaker 03 Just knowing arms people with the information to say like, oh, I know what this is. Okay, I'm gonna hydrate. I'm gonna take some electrolytes. I'm gonna go be with friends so that I can get dopamine from nurturing. I'm gonna eat some delicious food so I can get dopamine from food. Right?
18:06 Marielle Segarra? Dr. Harrison says if you have lead time for an event where you know drinking is involved, prepare accordingly. That means practicing good health and getting yourself in the best possible headspace.
18:15 Speaker 03 Like try to go into that cruise well slept, well hydrated, eating regularly around the clock, with a good sense of connection, you know, feeling a sense of belonging, feeling positive. All of that biologically and psychologically may not prevent the hangxiety entirely, but will decrease the severity.
18:40 Marielle Segarra? From there, she says, if you find yourself going through the wringer, you might start with a warm bath. That'll help wash away the night before and feel more soothing than the potentially harsh sounds of a shower. Throw on some aromatherapy if you like. Her recommendation, lavender and citrus, because they can help the turnover of dopamine.
18:58 Speaker 03 So that's gonna bring up that dopamine crater that you're experiencing. Mindfulness and meditation brings down adrenaline. And so if you have a meditation practice, or a mindfulness practice, or a yoga practice, this will actually help your hangxiety.
19:16 Marielle Segarra? Now, something you might note here, sometimes nourishing your emotional needs will be at odds with your physical ones. Only you can do the triage there. Like, okay, maybe your body is asking you for a dark, quiet morning and a lot of time in bed. But at the same time, your brain won't stop
19:32 Speaker 06 Yelling about all of last night's mistakes and worrying about the next month's problems. In this case, rather than sitting in the dark berating yourself, the healthier choice might be to don some sunglasses, brave some movement, and ask your most soft-spoken friend, if they're free to join you for lunch somewhere, you can get some comfort food and some sun.
19:49 Speaker 03 And it's not just like because sunshine is nice. No, like actually the UV rays change your brain chemistry. Actually, the vitamin D changes your brain and body chemistry.
20:01 Speaker 06 Now, maybe you're wondering, when is anxiety or a hangover cause for concern?
20:07 Speaker 06 Well, medically speaking, they're not usually. Alcohol poisoning, however, is very much a serious matter. Dr. Moreno says if someone is vomiting uncontrollably, so intoxicated they can't protect their airway or their mental status is off, maybe they're confused, coming in and out of consciousness, it's time to call 911. On the emotional side, if someone's behavior is putting them at risk of harming themselves or others, you can call or text 988 for free confidential support for people in emotional distress 24 hours a day. If your scenario doesn't quite meet those extremes, but something is still worrying you, Dr. Moreno says you can and should still ask a professional about it. You know your own brain and body best. And with that, we've reached takeaway four. Consider the cage.
20:53 Speaker 06 Now that we've thoroughly dissected the effects of alcohol and hangovers, we want to introduce you to a tool to help you interrogate your relationship with alcohol, something both doctors agree is a great thing to do whether or not you're at all worried about your drinking. It's called the CAGE questionnaire. It's an acronym for four simple questions. If you answer yes to at least two questions...
21:14 Speaker 03 This is a real signal that I want to try to change the way I am drinking alcohol.
21:21 Speaker 06 Now, if you only answer one question with a yes...
21:23 Speaker 03 Even though you don't meet diagnostic criteria, it's telling you that the way you're using alcohol is presenting some risk to you. So like now, this is an opportunity.
21:33 Speaker 06 The first question, C, stands for, have you ever thought about cutting back?
21:37 Speaker 03 A stands for annoyed. Have you ever been annoyed when someone else mentioned your drinking to you?
21:46 Speaker 06 G stands for guilt, as in you said you were only going to drink one glass. But you drank the whole bottle. You had a few too many and said something you shouldn't have.
21:54 Speaker 03 And then E is for eye opener. Have you ever needed to take a drink? The moment your eyes open.
22:02 Speaker 06 Dr. Harrison's score, for example, was two. Because she's thought about cutting back. And she did, actually. She and her husband stopped drinking entirely about a year ago. And she's felt guilt from drinking in the past. The example she gave us was the time she, as captain of her cheerleading squad, once passed out from binge drinking the night before the big homecoming came.
22:23 Speaker 03 So two represents a significant risk about the way I was drinking back in college and in medical school, right? I can use that information as an opportunity to make a different decision about the way I'm drinking, thankfully, before I developed an alcohol use disorder.
22:41 Speaker 06 So if your score makes you feel like wanting to make a change of some kind, Dr. Harrison has some very simple advice.
22:47 Speaker 03 Just tell at least one other person, because that secret makes it scarier than it has to be. And if you have support, that support is nurturing, gives you a dopamine signal that helps your brain think differently about your decisions around alcohol.
23:04 Speaker 06 That could be a best friend, or a faith leader, a primary care doctor, or EAP at work. Anyone who makes you feel safe. And it doesn't have to be some big, formal conversation.
23:14 Speaker 03 You don't have to be like, I have trouble with drinking. If you drink every day, I would say just try not drinking every day and see how it is. And if you notice a difference in yourself, then maybe that's the beginning of thinking about how to make different choices.
23:30 Speaker 06 Of course, it might not just be that easy. Dr. Harrison says it can be really hard to talk about this stuff with loved ones because there's so much misunderstanding around alcohol use disorder. But maintaining that stigma only hurts people.
23:44 Speaker 03 The majority of people with alcoholism recover to controlled use. You don't have to go to 30-day rehab. You don't have to go to AA. Like, the things that work for people are very different. And I just want people to know there are lots of options. And whether you give yourself a label or not, you have the right to choose the role that alcohol plays in your life.
24:07 Speaker 06 And this is the exact message you can pass on if there's anyone in your
24:11 Speaker 04 Your life who might need it. Just make sure to lead with compassion.
24:15 Speaker 03 You just say, you know what? I was listening to NPR. I heard this doctor talking about the cage. And she said, think about somebody you might be worried about. And I thought about you. And I just want you to know, if you're worried about it at all, I'm a person you can talk to about it.
24:34 Speaker 04 Then just leave the ball in their court.
24:36 Speaker 03 And they might take you up on it in the moment. They might take you up on it later. They may never take you up on it. But what you did was plant a seed of compassion, which has an opportunity to grow.
24:50 Speaker 04 And even if you feel entirely unconcerned or simply neutral about your own alcohol consumption, it's worth remembering. Cutting back on alcohol is a game of inches, not yards. Meaning every bit less can be to your benefit.
25:03 Speaker 02 If someone's able to drink one less drink a day, I mean, this might be the difference between going into liver failure in 10 years or something like that. And so if people are open to having those nuanced discussions and conversations, there are plenty of ways we can modify the way people consume alcohol to better protect them.
25:24 Speaker 04 Ready for terrible hangovers to be a thing of the past for you and your people? Dr. Harrison says we have to start deprogramming from our alcohol obsessed culture and start practicing positivity around sobriety.
25:35 Speaker 03 When somebody says, I'm sober curious, be like, yeah, that's awesome. If somebody's like, I'm just only going to drink two drinks tonight, be like, cool. When you, I see you get into that third drink, I'm be like, you said you're only going to drink two, right? Like, how can we be supportive about this curiosity and just making it a normal part of the conversation?
25:59 Speaker 04 OK, let's recap. Takeaway one, hangovers hit different for everyone because we're all different and because alcohol wreaks havoc on your body in a lot of different ways. Which is why takeaway two, the only sure cure for a hangover is to abstain.
26:15 Marielle Segarra? From alcohol. However, there may be a few factors like chenilles or sugar content that may affect the severity of your hangover. Takeaway three, anxiety is real. Prepare accordingly and don't forget to nourish your emotional needs, too. Takeaway four, consider the cage questionnaire and share widely. You never know who you could be helping. And don't forget to spread some sober positivity where and when you can. And you're sure the answer still isn't french fries?
26:45 Speaker 02 I mean, I think french fries can help a lot of my anxiety. I'm not going to lie about that.
26:50 Marielle Segarra? That was Life Kit reporter Andy Tagle. For more Life Kit, check out our other episodes. There's one on how to have fun on a budget and another on how to be a morning person. You can find those at npr.org/lifekit. And if you love Life Kit and want even more, subscribe to our newsletter at npr.org/lifekitnewsletter. Also, we love hearing from you. So if you have episode ideas or feedback you want to share, email us at [email protected] . This episode of Life Kit was produced by Sylvie Douglas. Our visuals editor is Beck Harlan and our digital editor is Malika Gharib. Megan Cain is our supervising editor and Beth Donovan is our executive producer. Our production team also includes Claire Marie Schneider and Margaret Serino. Engineering support comes from David Greenberg
27:34 Marielle Segarra? and Kwasi Lee. I'm Mary El Segarra. Thanks for listening.
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