Can we cure the common hangover?

We got drunk in Vegas... for science

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We start with shots of Jameson at 9:45PM, because Las Vegas feels like a place to do shots. I move on to Four Roses on the rocks, while Casey Newton gets started on Old Fashioneds. My notes indicate a long and serious discussion about the attractiveness of Jarvis Cocker at 10:30PM, followed by Casey stealing a colleague's drink at 10:43PM.

these people smdh

"I’m not leaving this bar until your handwriting looks like you’ve had a stroke," Casey informs me around 11:00PM. "You’re just going to have to keep ordering those roses." I order my fourth drink immediately. By 11:20PM, Casey and another colleague are deep in discussion regarding their romantic lives. Then the notes get sparse. At 12:47AM, I have the hiccups, but by 12:51AM, I’m cured. Shortly after that, Casey and I get in a cab headed back to our hotel.

I suspect there was a minimum of 40 roses between Casey and me by the time the evening was out, plus another shot of Jameson to send us into the cab, and then beers with the video crew when we got back to the hotel. I meant to keep track of how much I was drinking, but then I got drunk.

Ordinarily, I like a glass of wine with dinner, but that’s about it. That night, though, I was actually looking to get hungover. I’d heard about an IV hangover treatment and I wanted to see if it actually worked.

Wait, but how do hangovers work?

Even though about three-quarters of people who drink experience at least one hangover a year, we don’t really know how they work. Which is strange, because hangovers contribute to workplace absenteeism, worsen job performance (which matters a lot if you’re, say, operating heavy machinery while hungover), impair memory and learning, and lead to what researchers refer to as "a feeling of general misery." About 10 percent of adults in the US — 11.6 million workers — are hungover on the job, a 2006 study found.

Here’s what we do know: If your BAC gets above .10, you’re probably going to be hungover. You’ll feel your worst when you get close to zero, about 12 to 16 hours later. The hangover happens when a person’s blood alcohol concentration falls sharply; the nadir of symptoms occurs when the BAC is close to zero. The symptoms that clinically signify a hangover will be familiar: thirst, dizziness, nausea, headache, concentration problems, and headache — and I would experience them all the following morning. But no model exists for why these things happen in the first place.

Hangovers also affect the mood — they make people anxious and depressed. This is what Kingsley Amis called "the metaphysical hangover" in Everyday Drinking: "When that ineffable compound of depression, sadness (these two are not the same), anxiety, self-hatred, sense of failure and fear for the future begins to steal over you, start telling yourself that what you have is a hangover," Amis writes. "You are not sickening for anything, you have not suffered a minor brain lesion, you are not all that bad at your job, your family and friends are not leagued in a conspiracy of barely maintained silence about what a shit you are, you have not come at last to see life as it really is." It is worth noting that Amis’ family and friends were leagued in a barely maintained silence about what a shit he was; Amis was an alcoholic.

casey is hungover

A lot of people think dehydration causes hangovers. Dehydration probably does have some effect — alcohol does affect the levels of a hormone called vasopressin that regulates how the body retains water (this is why people urinate more often while drinking). But the levels of minerals called electrolytes that help water function in the body don’t differ between the hungover and the un-hungover, which suggests dehydration isn’t the primary cause. Other theories for the origin of a hangover include low blood sugar and acetaldehyde, but there’s not great evidence for them, either.

There are a few other things that may affect how serious a hangover is, without necessarily causing the condition. Sleeping badly probably doesn’t cause hangovers, but it certainly doesn’t help: alcohol messes up most people’s sleep patterns. There are also compounds called congeners, found in grains, wine skins, or casks used in making the beverages, that appear to make hangovers worse (I drank bourbon with Casey because it’s tasty, but also because it was likely to give me a bad hangover; whiskey has a lot of congeners). And while most booze we drink is composed of ethanol, traces of other kinds of alcohols slip into some drinks. One of those compounds, called methanol, metabolizes into formaldehyde and formic acid, neither of which are going to make someone feel good.

The main suspect in causing a hangover is the immune system

And the main suspect in causing a hangover is the immune system. Proteins called cytokines — part of how the immune system talks to itself — had already been identified as a likely cause by a 2000 overview paper on hangovers in The Annals of Internal Medicine. Cytokines also, as a special bonus, can make a person feel really bad. You know how miserable it is to have a cold? That’s not the virus’s fault — that’s your immune system. In a recent study of 20 men who got drunk and then had their blood tested while they were hungover, Korean scientists found higher levels of cytokines associated with autoimmune disease. These included tumor necrosis factor alpha, which is also responsible for rheumatoid arthritis and inflammatory bowel disease.

Fortunately, if immune inflammation is the root cause of the hangover, the cure may be pretty simple: anti-inflammatories. Some anti-inflammatories are available over the counter, like aspirin, ibuprofen (Advil), or naproxen (Aleve). Upon discovering researchers had made this connection, writer Adam Rogers — whose excellent Proof is a must-read for alcohol-loving nerds — began dosing himself with ibuprofen after drinking, before going to bed. This is similar to what Casey did; he took Aleve before bedtime.

So, we don’t know a lot about how hangovers work, which makes it very hard to design a good cure. There is no data on the usefulness of an IV in fixing a hangover. That’s not to say it won’t work; it might. But I have no way of knowing in advance whether I’ll be wasting my time and The Verge’s money at Hangover Heaven.

hungover liz

My hangover goes to heaven

I wake up around 7AM after Casey’s and my rampage. It’s a bad scene. The hotel room is too bright and smells like stale beer. My head hurts. My tongue is the texture, approximately, of felt. My eyeballs feel as though they’d been pulled from my skull, rolled around in some grit, and ineptly replaced — even my eyelids hurt. I fumble for my sunglasses and discover that very small porcupines had apparently crept down my gullet in my sleep; they are now using my stomach as a bounce castle.

I feel bad.

I meet Casey for breakfast, in the sense that I watch him eat his. For me, hot coffee is untenable. Even the very bland oatmeal I’ve chosen is too much for me. Casey is in better shape, the shit.

So then it’s time. I take a cab to Hangover Heaven. The driver accelerates and brakes so sharply I am in danger of puking. I also manage to leave my phone in the back seat while I pay for the cab — something I don’t realize until about half an hour later. Nausea, check. Concentration problems, check.

i feel bad

Hangover Heaven is located in an unpromising-looking strip mall; a van and what appears to be a decommissioned ambulance with the Hangover Heaven logo are parked outside. The clinic is run by Jason Burke, 44, an anesthesiologist who noticed that people who are recovering from anesthesia seem an awful lot like hungover people.

hangover heaven exterior

"Basically, this started when I was working in a recovery room," Burke says. "I was seeing people in the recovery room with postoperative nausea and vomiting, headache, dizziness — that type of thing. They’re exactly the same ones people have with a hangover. So I thought, these same medications would work well for hangovers."

When we arrive for my 10AM appointment, the place is mostly empty, and Burke greets us warmly; he speaks with a slight drawl. He has expensive-looking teeth, which I see often, since he smiles readily and widely. His shoulder-length brown hair is pulled into a ponytail. Burke, who favors Bordeaux and California cabernets, has the air of a surfer bro who just happens to have gone to medical school.

I am steered into a dim room, where I sit down in a large leather recliner. I am asked to rate my symptoms — nausea, headache, anxiety, and overall hangover severity — on a scale from 1 to 10; the medics determine my hangover is severe enough to warrant the "Rapture Package," the most expensive one on the menu. I am hooked up to an oxygen tank, and an IV is inserted into my right arm, where I receive an anti-emetic (to keep me from vomiting), an anti-inflammatory (ibuprofen in IV form), and heartburn medication. I’m also getting alpha-lipoic acid, an antioxidant that interacts with my blood sugar. The fluid from the IV makes my upper right arm cold.

the medics determine my hangover is severe enough to warrant the "rapture package"

After a trial run with volunteers, Burke purchased a bus as a kind of soft opening for his business. Real estate in Las Vegas often requires a five-year lease, he says — he didn’t know if the business was going to work, and he didn’t want to get stuck paying the lease if Hangover Heaven went bust. With a bus, if things didn’t work out, he could just sell it.

Things worked out; Burke leased the site where I was treated. Hangover Heaven treats 10,000 people a year. But more than half of Burke’s clients never enter the clinic at all — for a $200 fee, a physician or nurse practitioner will come to your hotel room. His clientele generally stay at high-end casinos and are spending about $800 a day on their vacation ("To miss a day of their vacation is a big issue," Burke says). Hangover Heaven does its best business during convention season, March Madness, and Super Bowl Sunday. The treatments range in cost from $99 for an IV plus vitamins, to the Rapture package at $239. This seems expensive. On the other hand, I had actual drugs given to me by actual medical professionals. That’s pretty much always expensive.

Burke views his work as a harm-reduction strategy; people are going to drink no matter what. He hopes to make them less miserable — and turn a profit doing it.

hangover heaven IV

"It’s just the nature of Las Vegas," he says. "People come here to drink. They want to blow off some steam. Alcohol is part of that." The conference circuit can be particularly brutal; some of Burke’s clientele are performers and executives who are puking their guts out just hours before they’re due onstage for their keynote.

Partway through the interview with Burke, a female nurse comes over and interrupts — time for my vitamin B-12 shot. We retire to the restroom, for privacy-type reasons. As I slide my leggings down, I realize that getting a vitamin B shot in the ass is the closest I will ever come to being a Kennedy. The shot is basically painless. I return to the recliner, wheeling my IV with me.

Burke chalks up some of the misery of hangovers to vitamin deficiency. From what I can tell in the research literature, a vitamin B-6 analog called pyritinol does have positive effects on hangovers. There doesn’t seem to be much else on the role of vitamins. Burke’s business hinges, in part, on selling vitamins — his supplements, $5 a packet of four, claim to prevent hangovers for "one night of moderate drinking." He clearly believes in what he’s selling, but the research I’ve seen doesn’t back it up. I email him after our meeting to ask if I’ve missed anything; he admits the science is scant. "So little good science has been done on hangovers that extrapolation is necessary," he writes.

By the end of the interview — about 45 minutes after I sit down — I’ve improved, though I’m still a little queasy. I had been wondering, given the relative emptiness of Hangover Heaven, how this was a viable business. But just as I’ve recovered, things start to get busy — of course, 10AM is a little early for the painfully hungover to heave themselves upright.

Burke walks me to the counter as a group of 20-somethings come in. He greets them warmly; Hangover Heaven has frequent fliers, and this crew had been in the day before.

Back at the hotel, the cabbie from the morning arrives to drop off my phone. I meet Casey. I feel great, and I am ready to gloat about it. How’s he doing? "Oh, I feel fine," Casey says. "I took more Aleve."

I wish hangovers were taken more seriously by the research community. They’re so common that knowing more about them would probably benefit most of the population. The relatively scant research into hangovers means that I can’t say, conclusively, whether Casey’s method of handling his hangover was better than mine. It means I also can’t tell whether Jason Burke is right about the role of vitamins and antioxidants in hangover recovery; though anti-hangover vitamin pills make me deeply suspicious. Vitamin studies are notorious among the research community for being inconclusive.

Anyway, if you’ve got the money, getting an IV and medical care probably can’t hurt. But for the rest of us plebs, there’s always painkillers and water.


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