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Science

No, hangovers are not just dehydration.

Debunking some of the strongest held, but poorly understood misconceptions about alcohol's next-day effects.

Brooks Powell

November 19, 2021

KEY TAKEAWAYS

To our knowledge, Cheers is the most successful alcohol-related health company in the United States. By “alcohol-related health” we mean products that exist at the intersection of alcohol and health.

We sell anything from liver supplements designed with drinkers in mind to preventative products that help you feel better the day after drinking alcohol. Our best-selling product is Cheers Restore, our “after-alcohol aid” that is designed to be taken following alcohol consumption but before going to bed.

In total, we have sold over 16 million doses of our products, have over 8,000 4 & 5-star Amazon reviews, and generate over half of our revenue from repeat customers.

On Facebook/Instagram alone, Cheers’ ads have been seen by 50m Americans (about 1/5 of the US adult population) an average of 10x each. In other words, our ads have been seen 500m times on Facebook/Instagram alone, and these numbers continue to grow each day. If someone hasn’t yet heard of Cheers, it’s only a matter of time before they do.

Because of our extensive social media outreach, we receive tens of thousands of comments, which often reveal trends, such as what people think causes hangovers, how to prevent them, and so forth. Here are just a few of those trends:

“Hangovers are caused by dehydration. Just drink water.”
“I don’t get hangovers because I drink responsibly.”
“Only cheap alcohol gives you hangovers. Expensive stuff won’t.”
“Just take pain relievers.”

While these are just a handful of the objections we regularly receive, in this article, we want to offer a rebuttal and breakdown of the most common theme: the notion that hangovers are just dehydration.

Why hangovers are not “just dehydration.”

Alcohol is a diuretic — this is true. But, do diuretics make you hungover? Those who believe that hangovers are caused by dehydration are quick to point out that alcohol causes more frequent urination, which then, over the course of an evening, will dehydrate you. And then it’s this dehydration that causes you to wake up hungover.

Ever used this argument before?

There is one glaring problem with this logic. For this logic to work, one should be able to replace the “alcohol” part with any other dehydrating activity or substance and it should also produce a hangover similar to alcohol.

Take working out as an example. Participating in sports or working out without proper hydration causes you to feel fatigued, thirst, and lightheadedness — otherwise known as dehydration symptoms. Do you feel hungover when you’re working out under these conditions? I’m guessing no.

Sure, alcohol will dehydrate you, but this just leads to dehydration, and dehydration leads to dehydration symptoms, such as a dry mouth and a mild headache — not all the other symptoms of a hangover as well. In other words, dehydration from alcohol only leads to dehydration symptoms present within a hangover.

The next day effects of alcohol are far more complex than just dehydration. To understand how hangovers work, we need to understand how alcohol affects both your brain and your liver in different ways, resulting in different hangover symptoms. Each of these symptoms has a different weight of impact on your body and comes from a different cause or source.

So, what actually causes hangovers?

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/hangovers. Like much government literature written for a mass audience, the department omitted citations in their explanations, but the science supported by this section in particular is sound.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recognizes hangovers as the culmination of multiple causes stemming from alcohol’s negative effects. One thing that the NIAAA does well is recognizing that different causes lead to different effects. Mild dehydration leads to symptoms such as thirst, fatigue, and a headache, whereas alcohol withdrawal leads to anxiousness (or, “hangxiety” as we often call it) and restlessness.

Now, one problem with The NIAAA’s classification of hangover causes is that they fail to distinguish the tangential relationship between certain causes. For example, “mini-withdrawal” or “short-term alcohol withdrawal,” is actually the main culprit behind “disrupted sleep.” So, if you could reduce alcohol withdrawal then you could also reduce disrupted sleep.

Therefore, alcohol withdrawal is the primary cause, and disrupted sleep is the secondary cause.

A better way to look at this model, I would argue, would be to take those 6 different causes and categorize them out into primary and secondary causes. And when you do that, you can see that it really narrows in on 3 main causes of hangovers: short-term alcohol withdrawal (or GABAa rebound), acetaldehyde exposure, and dehydration.

I had a friend once tell me about his worst hangover after a weekend of heavy drinking. Here’s what they said:

As I peeled away the pillow covering my face, I realized the splitting pain in my head. The curtains were open and the light was too intense. The sunlight glaring into the room made my eyes feel like they wanted to fall back in my head — there was a tension that pulled down and back on my eyes whenever I looked at the light. I have never had a seizure, but it felt like it could be the beginning of one every time too much light came across my face.
I checked my phone and it was almost 11am. I checked my sleep app and it said I tossed and turned all night and that my heart rate average while sleeping was just shy of 80 bpm — normally when I don’t drink alcohol it says I average 55 bpm. I felt hot, almost feverish, and my hands were extremely clammy and almost felt shaky. As I got up and reached over to put my pants on, my muscles felt stiff and achy, and the mere act of bending down made me dizzy and like I was going to throw up. My pulse felt fast and heavy, like it was throbbing throughout my chest and brain as if my blood pressure was off the charts. The small noises of opening and closing my drawers to grab a t-shirt and socks rung painfully throughout my body. My chest felt tight and breathing felt forced.
I was tired but I couldn’t really sleep. And I was hungry but I couldn’t really eat. I choked down a sports drink and ibuprofen, but it only made my head feel a little better — at the cost of my stomach hurting more because I took pain relievers on an empty stomach.
My whole body hurt, I had an existential dread that I had done something terribly wrong the day before, and beyond that I had an anxiousness that there was medically something wrong with me. Which, as an otherwise healthy male in my late 20s, is not a feeling that I was used to. While most of the pain subsided by the following morning, the effects still lingered for about 3 days — a little less each day. I didn’t feel completely normal until 4 days later. It was legitimately a 3+ day hangover.

I share this extreme story to get one point across, these symptoms are vastly beyond that of mild dehydration. Dehydration does not cause sensitivity to light and sound, give you anxiety, severe nausea, or put you at greater risk of seizures. Still, it’s important to hydrate while consuming alcohol. In fact, we even have a product for this — Cheers Hydrate. But it’s necessary to understand that this product just deals with hydration and not all of the other problems as well.

Hangovers are like soup.

If we were to rank the causes of a hangover based on how much worse they make you feel the next day, we would argue that the primary causes in order are:

  1. Short-term alcohol withdrawal (or GABAa rebound)
  2. Acetaldehyde exposure
  3. Dehydration

Each cause of a hangover is kind of like an ingredient within a soup. Together, all of these ingredients give you the finished product of feeling terrible the day after consuming alcohol.

By the same token, when you remove ingredients from this soup, you do not get rid of the entire soup. A basic chicken noodle soup is made up of broth, chicken, noodles, and vegetables. If you get rid of the vegetables, then you still have the rest of the soup.

With hangovers, the same is true. If you hydrate effectively before, during, and after alcohol consumption then you can reduce the effects of dehydration, but you’re not going to reduce the effects of alcohol withdrawal or acetaldehyde exposure.

Short-term alcohol withdrawal — the debt has to be paid.

The Bloody Mary is one of the most popular cocktails in the United States — consisting primarily of vodka and tomato juice. It is typically consumed in the morning, especially to ease the effects of a hangover. So what’s the secret sauce in a Bloody Mary? A common term for this method is “hair of the dog” — or drinking more alcohol the next day. It certainly doesn’t have to be a Bloody Mary (as any form of alcohol will help do the trick) — but ordering a large Bloody Mary at 8 am in an airport bar on your way home from Las Vegas just tends to be a bit more socially acceptable than ordering a double shot of tequila.

If dehydration was the sole cause of hangovers, the “hair of the dog” would never work. Since alcohol causes dehydration, and a Bloody Mary contains alcohol, it would make no sense for a Bloody Mary to do anything but make hangovers worse. To better understand this conundrum, we have to understand the effects alcohol has on your body.

How does “hair of the dog” work?

When you drink alcohol and it enters your bloodstream, it eventually reaches your brain and its GABAa receptors. This is what triggers alcohol’s positive effects (i.e. relaxed, brave — aka “liquid courage”, friendlier).

But, when you’re done drinking and alcohol leaves your system, your GABAa receptors go into rebound, i.e, withdrawal, causing adverse effects. This is when lights become too bright, sounds become too loud; you may get a splitting headache, and you may become nauseous and get sweaty palms.

Drinking more alcohol the next morning temporarily reduces the alcohol withdrawal that you are experiencing from the day before. While effective for a moment, the strategy fails once the alcohol starts wearing off. Then it becomes a slippery slope — either keep drinking to keep the hangover at bay or bite the bullet and deal with it.

Generally speaking, the severity and duration of a hangover is relative to the amount of alcohol consumed and the timeline it was consumed under. For example, 1–2 drinks one evening might not even cause a noticeable withdrawal, but will still be there nonetheless. For some people such as myself, withdrawing from 4–5 drinks one evening is enough to wake you from your sleep and cause you to toss and turn all evening.

Even in extreme examples, the withdrawal response continues to be relative to the amount consumed and the timeline thereof.

The acetaldehyde problem.

To clear alcohol from your bloodstream, your body must first convert alcohol into acetaldehyde. This conversion occurs in both your stomach and liver — with likely some interaction between the gut-liver axis and the portal vein, which goes between the digestive organs and liver. Then, enzymes called acetaldehyde dehydrogenase (ALDH) turn acetaldehyde into acetate, which is harmless. After acetaldehyde becomes acetate, it passes harmlessly out of your body.

Unfortunately, the liver can only turn acetaldehyde into acetate so fast; your body can process up to 1 drink’s worth of acetaldehyde per hour, on average. If you’ve had 3 drinks in one night, you’re going to have acetaldehyde in your body for about 3 hours. If you’ve had 5 drinks, that’s 5 hours. While your liver is processing some of the acetaldehyde in your body, all the acetaldehyde the liver isn’t actively working on enters the bloodstream and flows throughout your entire body.

Acetaldehyde is roughly 20x more toxic than alcohol itself. The toxic effects of acetaldehyde are so apparent that when someone has genetics that reduce their ability to process acetaldehyde, known as an ALDH2 deficiency, that you can see their skin flush whenever they drink alcohol. This is typically referred to as “asian flush” as it affects roughly 36% of East Asians. However, flushing caused by alcohol can affect anyone who has a limited capacity to break down acetaldehyde.

Acetaldehyde is transported throughout your bloodstream and comes in contact with every cell in your body. This is likely one of the reasons that alcohol causes so much inflammation and makes everything in your body hurt the next day.

Putting it all together.

When someone asks what hangovers are it’s not as easy as answering with a single thing, such as: “alcohol withdrawal” or “acetaldehyde exposure” or “dehydration”. The truth is that it is a mixture of all of these elements.

Beyond that, there are some other specific tangential causes that heighten the effect of particular symptoms. For example, sugary alcoholic drinks tend to exasperate next-day sugar imbalances. And so on.

At the end of the day, understanding hangovers takes nuance. It’s not as simple as pointing to this or that, but rather to understanding that hangovers are a complex phenomenon. At Cheers, we spend each and every day striving to learn more about how alcohol affects the body and what we might do about it.

Cheers,

Brooks Powell (Founder/CEO)


References

About Cheers

Cheers is the leading alcohol-related health brand focused on developing products that support your liver and help you feel great the next day. As a student at Princeton, Cheers’ founder Brooks Powell discovered the potential advantage of incorporating the natural plant extract Dihydromyricetin (DHM) into an after-alcohol consumption regimen and began working with his professors to make products that addressed the unique challenges of alcohol-related health. . Since its official launch in 2017, Cheers has sold more than 13 million doses  to over 300 thousand customers. The research-backed line of products includes three versions of supplemental pills and powders – Restore, Hydrate and Protect. Cheers is now releasing read-to-drink versions of their products—starting with Cheers Restore. Each product is equipped to meet different health needs such as rehydration, liver support, and acetaldehyde exposure. Cheers places an equal emphasis on the responsibility and health aspects of its mission and vision. The brand’s mission is bringing people together by promoting fun, responsible, and health-conscious alcohol consumption. The vision is a world where everyone can enjoy alcohol throughout a long, healthy, and happy lifetime. For more information, visit cheershealth.com or join the social conversation at @cheershealth.

These statements have not been evaluated by the Food and Drug Administration.
These products are not intended to diagnose, treat, cure or prevent any disease.