A hangover prevention pill: does it exist, and does it work?

What is a hangover?

To answer this question, we must first succinctly establish what constitutes a hangover, no easy task. Though considered an ‘adverse medical condition’ in the UK and other countries, the ‘hangover’ is a complex affliction - it is vague in its definition, and involves a number of factors in and around the consumption of alcohol. Included are the usual suspects: dehydration, fatigue, depletion of important vitamins, minerals, and compounds - to the more exotic: an imbalance in blood sugar levels, the glutamate rebound effect, variations in different alcohol types, and the addition of extraneous toxins in the alcohol distillation or fermentation process, such as sulphites, tannins, and congeners.

Arguably, the most crucial and important factor behind hangovers - as well as a lot of the long-term damage behind alcohol consumption, is even less well-known by laymen: acetaldehyde. The latter is the first byproduct of alcohol (ethanol) when it is broken down by the liver, and is approximately forty times more toxic than alcohol itself. It acts as an inflammatory agent, causes trouble across your system, is behind the infamous ‘Asian flush’, and it is this inflammatory property that causes long-term damage.

As you drink alcohol, its is fairly rapidly (within half an hour) turned into acetaldehyde - naturally the more you drink, the more acetaldehyde accumulates. The goal, then, is to break down ethanol (EtOH) and acetaldehyde as quickly as possible - the longer these remain unprocessed in the body, the more time they have to cause damage.

What are ‘anti hangover pills’ available on the market?

A brief Google reveals forums thousands of pages long prescribing a circus-worth of pills and cures for hangover. These can range from the mundane - vitamin capsules, minerals, to painkillers, infusions, certain teas, a full English Breakfast, to the more exotic: Ginkgo leaf, Artichoke extract, caviar masks, etc.

Do anti hangover pills work?

In short, no. There is no such thing as a hangover cure. A hangover cure suggests that you can treat and cure a hangover after you already ‘contracted’ this ‘adverse medical condition’. However, as noted previously, the main problem has already occurred - the accumulation of ethanol and acetaldehyde. Every moment they remain in your system, the more time they have to cause damage - the next day, the damage has been done.

What about painkillers? Though they can help deal with the following day’s suffering, pain killers still would not count as a ‘cure’, as they only work to suppress the symptoms, rather than the root causes, of a hangover, and indeed the damage caused by alcohol consumption. A particularly effective painkiller for those suffering a hangover is ibuprofen: as an anti-inflammatory, it usefully helps manage the inflammation caused by acetaldehyde and any other additional toxins. However, again, it merely suppresses the manifestation of that inflammation, rather than breaking down the root cause of that inflammation - acetaldehyde. Additionally, like other painkillers, ibuprofen risks further burdening an already struggling liver and other parts of the body working to clear out the aftermath of alcohol consumption. On top of this, many painkillers have some worrying side effects: for instance, ibuprofen risks causing severe gastrointestinal bleeding if taken on an empty stomach. Taking acetaminophen (sold as Tylenol in the US) in large quantities with alcohol can lead to liver damage as the liver is left unable to process the toxic metabolites of either.

And dealing with dehydration? Most importantly, dehydration is not so much a cause of a hangover, but rather a symptom of it. Hydrating oneself is always key, however it does not deal with the critical issue - breaking down acetaldehyde, which must occur in the liver, through the enzyme acetaldehyde dehydrogenase (ALDH). Secondly, the point is moot - try stuffing one liter of water in a pill...

Finally, there are a ton of products that are little more than multivitamins, touted to deal with hangovers. The problem with alcohol is that it is a diuretic - encouraging the excretion of water from the body. Not only does it flush nutrients out of the body, but it also makes it more difficult for nutrients to be absorbed by the body. Even then, nutrients such as vitamins need to be taken for days before a drinking session to be significantly absorbed. All in all, vitamins are helpful to a certain extent before drinking if taken properly, and in the long run after drinking - however no effect is immediate.

Can a pill prevent a hangover?

Taking measures to prevent a hangover is a rather more interesting, and promising proposition.

Some necessary disclaimers: there is no way of making drinking alcohol healthy, besides not drinking at all - so there is no perfect solution. Alcohol is still massively disruptive to the body and mind, your bodily functions, energy metabolism, sleep quality, decision-making, etc. However, there is a lot that can be done to mitigate some of the damage caused by alcohol, and protect the body.

By working to tackle the main factor behind alcohol-induced damage - namely acetaldehyde buildup - by looking to accelerate the breakdown of ethanol and acetaldehyde, and clearing it as rapidly out of the system, you can potentially make a serious difference in the severity of your hangover, as well as long-term damage caused by alcohol. This can be done by supporting your body’s natural capacity to break down acetaldehyde: the liver, and within that, the enzyme ALDH, which works to break down acetaldehyde to the benign metabolite acetate. There are various ways of supporting your liver - making sure it is in full functioning form by keeping it topped up with necessary vitamins and minerals - for instance a number of vitamins in the B complex. Some amino acids can be particularly helpful as well, for instance L-Taurine has been known to be an incredibly powerful hepatoprotective (liver-protecting) agent, with the potential even to reverse a fatty liver - for instance in Miyazaki et al. 2012, Heidari et al. 2016, and Woo et al. 2009 - see our article on Taurine for more.

Arguably, some of the most powerful tools one could put to use are two plant extracts: dihydromyricetin (from either Ampelopsis grossedentata or Hovenia dulcis), and Puerariae lobatae Flos. A search on PubMed and Google Scholar reveals more than 279 and 158 different studies on these respectively, discussing potential effects ranging from a decrease in voluntary alcohol consumption, controlling blood alcohol levels, alcohol intoxication, hepatotoxicity (liver damage), and protecting against neurological changes. A particularly strong case was made for protecting the liver and working to breakdown inflammation across a number of studies: Hase et al., 1997; Du et al. 2009; Qui, Dong, Zhu et al., 2019, and so forth.

Indeed, one study directly ties in the effects of Hovenia dulcis on preventing hangovers: in a randomised, controlled, and crossover trial, Kim et al. (2017) also assessed hangover symptoms, such as impaired memory, depression, trouble sleeping and concentrating, nausea, headache and sleepiness. One hour after consuming alcohol participants who were treated with H. Dulcis fruit showed no difference in hangover symptoms compared to controls. However, after four and twelve hours, the total hangover scores were significantly decreased in the group treated with Hovenia dulcis.

The conclusion is that hangover prevention is eminently more likely than a hangover cure.

Works Cited.

Miyazaki et al., 2012, https://link.springer.com/article/10.1007/s00726-012-1381-00E91D3851345CEF4746B10406908F52
Heidari et al. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615919/
Woo et al. 2009, https://www.ncbi.nlm.nih.gov/pubmed/19239162
Hase et al., 1997, https://www.jstage.jst.go.jp/article/bpb1993/20/4/20_4_381/_article/-char/ja/
Du et al. 2009, https://www.tandfonline.com/doi/full/10.3109/13880200903300196
Qui, Dong, Zhu et al., 2019, https://www.ncbi.nlm.nih.gov/pubmed/30599911
Kim et al., 2017, https://www.ncbi.nlm.nih.gov/pubmed/28750942

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