No quick answer to brighten the ‘morning after’ , says S.Ananthanarayanan.

New Year’s eve is past and those of us who celebrated would have recovered from excess, if any, of alcohol that helped one year pass into the next. But drinkers the world over would cover in gold anyone who could show them a way to lessen the agony of the hangover.

Although science says it cannot be done, there are several prescriptions, in legend, rumour, old wives’ tales, that promise relief – relief from fatigue, dehydration, acid stomach, a powerful headache, and dullness and the inability to focus - in stark contrast to the euphoria of the ‘evening before’. So much so, that Addiction, the journal of the UK based Society for the Study of Addiction, reports a formal study, “a systematic review of the evidence from randomised placebo-controlled trials,” to see if any of the legendary remedies actually work.

The paper by Emmert Roberts, Rachel Smith, Matthew Hotopf, and Colin Drummon of King’s College, London and the South London and the Maudsley NHS Foundation Trust, an independent body of the National Health Service in England, reports “very low quality evidence of efficacy,” of different preparations, although the team did find hesitant benefits of some. None of the well-known remedies, like ‘raw egg and brandy,’ ‘Worcestershire sauce and red peppers,’ ‘absinthe and iced champagne’, figure in the list, but there are three that the study says may be worth looking at. The first is clove extract, and relieving hangover is a new application, apart from the traditional one of toothache. And there are two from the world of medicine, tolfenamic acid, which is used to relieve migraines, and pyritinol, which is used to treat brain disorders. Others, with mild signs of efficacy, are Hovenia dulcis fruit extract, a traditional Korean and Chinese medicine said to reduce blood alcohol levels, L-cycsteine, a form of the amino acid, cysteine. red ginseng, a herb believed to be anti-inflammatory, and Korean pear juice.

The root cause of the dreaded hangover, of course, is the high level of the alcohol in the blood stream that drinking sets up for some hours. Alcohol can pass through the blood-brain barrier its presence in the blood slows down the functioning of brain cells. The first cells affected are those that promote caution and inhibit behavior. The drinker hence feels free and powerful. But brain cells that control speech and motor functions are also affected, and there is slurred speech and loss of balance

This is the effect in the brain. And then, the effects on the rest of the body. With the high alcohol content of the bloodstream, the force of osmosis causes water, which is the main content of the body cells, to rush out of the cells to dilute the bloodstream. And the body is dehydrated for hours on end.

The other effect is that on the liver. The normal function of the liver is to maintain a steady level of sugar in the bloodstream. One function is to pull out excess sugar, which is after we eat, particularly something sweet. The reverse function is to pump sugar back in when sugar level are low, perhaps the more important function, as low sugar is dangerous. But the liver does more than regulate sugar, it extracts other various toxins from the bloodstream, and one of these is alcohol. And this function get the liver quite busy when there is a large presence of alcohol in the blood. The result is that the task of replenishing the sugar level in the blood is neglected, and sugar levels fall.

Now, glucose in the blood is the only source of energy for the brain cells. When the person awakes a few hours after the drinking binge, there is still alcohol to be extracted, but there is little sugar for the brain. The person hence feels blank, vacant and incoherent. And an acid stomach, headache and fatigue from unrestrained activity during the celebration, ar usual accompanying conditions. The combination is a feeling such discomfort and helplessness that the person often swears never again to ‘touch the stuff’.

Alcohol-induced hangover, a condition medically known as veisalgia, has been considered to be a global hazard and socio-economic burden. The papaer cites estimates that in the USA, hangovers have an annual cost of $ 2,000 for every employee. A method to reduce severity is hence not just a favour to the drinker, but an economic priority.

The paper points out that while there are several ‘remedies’ that are claimed and marketed, there has not been a systematic, and quantitative study, which could guide both professionals and the general public. “Accurate information as to what, if any, pharmacologically active interventions are evidence-based options,” the paper says.

Getting hold of reliable data, to assess the severity of hangovers and the relief, if any, brought on by specific remedies, of course, was no simple matter. The team undertook a survey of vast documented studies, to extract from them the data that was reliable, and could be considered as bases for a ‘randomised and placebo based’ study. That is to say, the subjects were not from groups that could be biased, and that the effect of a substance, as a hangover relieving agent, could be identified by the absence of the same effect when a comparable hangover was treated with a ‘dummy’ substance, with controls, to ensure that the subject did not know what was going on, etc.

Data was extracted and tabulated by independent researchers, with recourse to a third, a ‘referee’, in case the researchers did not agree, the paper says. Along with data extraction, the quality of the data was assessed and classified as high, moderate, low or very low, based on criteria of bias,inconsistency, indirectness, imprecision, etc. And in this way, the search resulted in 269 records, 21 studies and 389 participants. And 38% of the participants were women.

The results, as stated, were ‘statistically significant’ efficacy of clove extract, tofenamic acid and pyritinol, with lesser efficacy of the four others, but based on evidence of ‘low quality’, with no cross-checks or validation. A saving grace is that the ‘remedies’, which were available ‘off the shelf,’ had no or mild side effects, the paper says.

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