A relatively brief post for me this month. It takes me a couple of weeks to produce these essays and a big chunk of the time I would usually spend on writing is going to be traveling. I most certainly lack the energy to blog and be a tourist. You know the saying, when in Rome, don’t work.
I must be on some sort of e-mail list. I receive many emails suggesting I interview providers of Supplements, Complementary and Alternative Medicines, aka SCAMs. Evidently, I am someone who is interested in promoting pet acupuncture or fascial maneuvers or, as an inspiration for this post, a hangover preventative. At no time in my writing or podcasting endeavors have I ever shown an interest in promoting these products and I have never done an interview.
Someone has not done their due diligence and reviewed my vast multimedia empire to see if I would be an appropriate sucker, er, I mean, person for the task. Reviewing these promotions was something that the late, great Harriet Hall used to do. I do miss her writing. It did occur to me that these emails would make good blog fodder, and while Harriet and I had different writing styles, we did share a similar skepticism. And maybe I will be removed from said mailing list as a result. I can wish.
The email in questions was for Jelly IV, a
plant-based, jelly-formatted hangover cure is designed to tackle the “hangover effect,”
since
Jelly IV combines the best of Eastern medicine with modern wellness trends, delivering a practical solution to a common workplace issue. With just one dose before bed, employees can wake up refreshed, reducing absenteeism and ensuring productivity the next day.
Ah, combining the best of both worlds, a la Hanna Montana. My kids loved that show. It is what one genius blogger referred to as the cow pie in apple pie effect. If you like intellectual shortcuts, such a declaration has almost perfect sensitivity and specificity that whatever is being touted is likely worthless and you need not read further. I get no such luxury, for read on I must.
Would I be interested in speaking with the inventor? Um, no. Did you read this blog or listen to the Quackcast? I think not. Just who generated this email list? I guess PR competence parallels SCAM practitioner competence. But it did bring up the question, how does one treat a hangover? An important topic if, say, one was about to travel to the land of pasta and wine.
As an aside, there are also red wine headaches, that are due to histamines found in red wines (20-200 times that found in white wine and some other alcoholic drinks) although there are other potential causes of red wine headaches. I notice of late the waiters now ask if you want a beverage instead of a drink. I want a drink. Anyway.
Headache can be induced by histamine in wine in patients suffering from histamine intolerance, a disease characterized by impaired histamine degradation based on reduced diamine oxidase activity or a lack of the enzyme.
A little non-sedating antihistamine may prevent the headache. It did save my dad’s wine tasting club.
But that isn’t a hangover. It has probably been 50 years since I have had a hangover. College, if I remember correctly. Been there, done that, and vowed never to do it again.
Before moving on to Jelly IV, and other hangover interventions, what is the cause of a hangover? I mean, besides drinking too much alcohol. What is the pathophysiology? Once we understand that, we can then determine the likelihood that a hangover cure is better than the hair of the dog what bit you. A curious expression, it comes from
The expression originally referred to a method of treatment for a rabid dog bite by placing hair from the dog in the bite wound.
The Wikipedia page also points out this is a ‘like cures like’ treatment, so beloved by homeopaths.
Hangovers were not an important part of my medical practice. ETOH withdrawal, overdose, and complications of cirrhosis (along with Chrohn’s and ophthalhmology, medical words where I never remember where the ‘h’ goes) were common enough, but I do not think I ever saw a hungover patient. I had it in my mind that hangovers were due to a combination of dehydration (alcohol is a diuretic) and a mild poisoning from acetaldehyde, as the liver’s alcohol dehydrogenase oxidizes ethanol to acetaldehyde, and then aldehyde dehydrogenase oxidizes acetaldehyde to acetate, the way ethanol is metabolized.
Turns out the literature on hangover is rather sparse. And the studies are often of poor quality
Many of the human studies of hangover are not well controlled, with subjects consuming different concentrations of alcohol over variable time periods and evaluation not blinded. Also, studies have measured different symptoms and use varying methods of measurement.
Not a surprise upon reflection, as it is a process that I think would be difficult to find volunteers to study. I would not want to deliberately, or accidentally, have another hangover.
In contrast, research on the pathology of the alcohol hangover remains limited. Reviews on this topic suggest a variety of possible causes of the alcohol hangover such as the role of the presence of ethanol and its metabolites in the blood, oxidative stress, and the immune response to alcohol consumption. However, the data presented in these reviews to support these hypotheses are limited.
These analyses showed that concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose were not significantly correlated with reported alcohol hangover severity. Also, markers of dehydration (e.g., vasopressin) were not significantly related to hangover severity. Some studies report a significant correlation between blood acetaldehyde concentration and hangover severity, but most convincing is the significant relationship between immune factors and hangover severity. The latter is supported by studies showing that hangover severity may be reduced by inhibitors of prostaglandin synthesis. Several factors do not cause alcohol hangover but can aggravate its severity. These include sleep deprivation, smoking, congeners, health status, genetics and individual differences.
Much to my surprise, even dehydration is likely not a major cause of a hangover
Survey data revealed that water consumption during or directly after alcohol consumption had only a modest effect in preventing next-day hangover. Also, the amount of water consumed during hangover was not related to changes of hangover severity and thirst. Thus, water consumption was not effective to alleviate the alcohol hangover.
So the cause of a hangover is likely multifactorial, although one review suggests that it is the rate at which you metabolize the alcohol that is important. The slower the metabolism, the more the alcohol poisoning (alcohol, unlike acetaldehyde, easily crosses the blood-brain barrier) and the greater the hangover:
The data summarized in this review suggest that the ethanol elimination rate is a critical determinant of hangover severity for a number of reasons. First, significant correlations have been found between ethanol concentration (but not acetaldehyde) and hangover severity. Second, nutrients, microbiota, and hangover treatments that speed up the conversion of ethanol into acetaldehyde are associated with less severe hangovers. Taken together, the data suggest that a more rapid conversion of ethanol to acetaldehyde and other aldehydes is associated with less severe hangovers.
It is not unreasonable to postulate that anything that increases alcohol metabolism could lead to less severe hangovers. But alcohol is a poison with widespread effects on many physiologic processes, so there is likely no simple solution to the physiology or treatment of a hangover, outside of the unacceptable choice of avoiding a vieux carre or negroni.
The most effective way to avoid the symptoms of alcohol induced hangover is to practise (sic) abstinence or moderation.
Moderation works for me. But let’s one does imbibe a wee bit too much and drives the porcelain bus. Are there SBM approved effective interventions for hangovers? Not really.
From these studies it must be concluded that most remedies do not significantly reduce overall hangover severity. Some compounds reduce specific symptoms such as vomiting and headache, but are not effective in reducing other common hangover symptoms such as drowsiness and fatigue. Hangover cures that showed positive effects were those inhibiting prostaglandin synthesis or accelerating alcohol metabolism. Future studies should elucidate the pathology of alcohol hangover. Until then, it is unlikely that an effective hangover cure will be developed.
There was a meta-analysis of all the double-blind studies in the BMJ
The agents tested were propranolol, tropisetron, tolfenamic acid, fructose or glucose, and the dietary supplements Borago officinalis (borage), Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear), and a yeast based preparation. All studies were double-blind.
And the findings?
No compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover.
There are many supplements and herbs, that purport to cure or prevent hangover. Not good data for any of them. Jelly iv, which inspired this essay, has a science page with non-referenced descriptions of the contents of the product. Jelly iv contains dihydromyricetin, which in high doses has many antagonistic effects on alcohol in rats. Although the data in rats, depending on the study, is iffy:
although the expected hepatoprotective effect of dhm was not fully achieved, dhm (in a concentration manner) proved to reduce the level of ros/rns in hepatocytes. however, no change in the rate of alcohol metabolism in vivo was found when rats were administered with a single or repeated dose of ethanol supplemented with dhm. in conclusion, the proposed positive effect of dhm during alcohol intoxication has not been proven.
Humans are not rats. Well, some of the time. I could not find studies to support the use of dihydromyricetin in humans.
Jelly IV also contains artichoke extract, which has been studied and
Our results suggest that artichoke extract is not effective in preventing the signs and symptoms of alcohol-induced hangover.
Although it is not used as such in this hangover preventative. It is used for liver protection and elimination of (unnamed) toxins.
At this point I grew bored. Outside of electrolytes, none of the included products seem to target the symptoms of hangovers or any alleged pathophysiology. They just provide ‘support’. So many alternative medicine treatments act as nothing more than a truss. It is usually unproductive to go down the rat hole of the evidence for any herbal products effectiveness. At best they are extrapolations from marginal basic science. All sound and fury, signifying nothing. I did wonder about the name. Jelly IV. It is not an intravenous product (I hope), since it is a jelly. The fourth iteration? Jelly. Jelly Jr. Jelly the third. Now Jelly IV.
There are a variety of homeopathic hangover treatments, at least 7, depending on the subtle variations in your symptoms. Splitting headache with movement or just a headache. Is there flatulence? Then a different nostrum. But no human studies on Pubmed to demonstrate efficacy.
Oddly, the most popular homeopathic cure for a hangover is 30C (i.e., nothing) of the wonderfully named Nux Vomica tree, but not ethanol. It would seem the perfect opportunity to demonstrate that like cures like. Nope. Nux Vomica is also used to treat digestive problems such as constipation, bloating, heartburn, and nausea, male infertility and impotence, colds and flu, particularly in the early stages of the virus, allergies, back pain, irritability, impatience, and high sensitivity to stimuli, caused by stress or mental strain, headaches and migraines symptoms such as a sore scalp, frontal pain, light sensitivity, or stomach problems, menstrual problems and insomnia. All processes with a similar underlying pathophysiology to hangover, he notes sarcastically.
Quite the wonder drug that works wonders.
Chiropractic will treat your hangover
By realigning the spine and promoting nervous system function, chiropractic adjustments can provide relief from headache pain and support your body’s natural healing processes.
I doubt it.
By addressing the root causes of hangover symptoms and promoting overall wellness, chiropractic adjustments can offer a natural solution for those post-party symptoms
The need for spinal adjustment is the root cause of a hangover? Here I thought it was drinking too much alcohol. Glad I wasn’t enjoying a beverage when I read that. I hate milk coming out my nose. The AI summary is very positive for using chiropractic for hangover, referencing, well, chiropractors who say they can treat hangovers. Go to Midas, get a muffler.
But the real root cause it not the spine. Nope. It is alcohol as
When you drink alcohol, it enters your Stomach and is digested by your Spleen and Stomach organ systems. Thus the nutrients that can be derived from it are processed, and the remaining elements excreted as waste. But because of the volatile Damp-Hot nature of booze, when you drink too much of it your ability to process the volatility becomes corrupted. When this happens, the Damp-Heat persists, and a few things can happen
What followed was a traditional Chinese pseudo-medicine explanation of persisting damp-heat aka gibberish. Yes, there are words there. Nouns. Verbs. Adjective. But no, they make zero sense. The site was interesting as it warned of the danger of using the wrong acupoints:
Once again it’s good advice to seek the proper diagnosis of a TCM practitioner, as taking the wrong herbs or using the wrong acupuncture points for your own personal pattern could lead to you feeling even worse.
I do not believe I have ever seen that warning before. Just how does one go about determining what constitutes a proper fictional diagnosis?
But there are a variety of acupoints and Chinese herbs used for the non-treatment of a hangover. Like chiropractic and homeopathy, none proven in clinical trials.
My browser AI summary was also quite positive for acupuncture for hangover. Looking at the links, it was because acupuncture sites were positive about using acupuncture for hangover. Using AI with SCAM is not a good combination, all garbage in/garbage out.
And if you search for naturopathic cures, you will find plenty of advice, often multiple and expensive, to cure your hangover.
It is safe to say that most SCAMs offer a treatment for hangovers, even reiki, although participating in reiki with the wrong people can induce a hangover-like state. So beware.
So my take home? Got me. Hangovers are a problem with no solution and prevention is not gonna happen if you drink too much. Salute.