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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 21, 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.

No company deals with as many hangovers on a daily basis than we do.

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, 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. These comments often reveal trends, such as what people think causes hangovers, how to prevent them, and so forth.

Over the course of the past few years, we have seen a number of themes in the comments. Here are some of the 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.”

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

Why hangovers are not “just dehydration.”

People who believe that hangovers are caused primarily by dehydration are quick to point out that alcohol is a diuretic and thus makes you urinate more often. This then, over the course of an evening, will dehydrate you. And then, it’s this dehydration that causes you to wake up hungover the following day.

The logic goes like this:

Premise 1: Alcohol causes dehydration.
Premise 2: Alcohol causes hangovers.
Conclusion: Therefore, dehydration causes hangovers.

While it is true that 1) alcohol is dehydrating — albeit more mildly than most people think, and 2) that alcohol causes hangovers, this does not automatically mean that the conclusion that dehydration causes hangovers is true.

For this conclusion to be true, one would have to show that dehydration of any source leads to similar symptoms of alcohol hangovers. Many things are dehydrating, but they do not lead to all of the symptoms of a hangover:

The fact of the matter is that dehydration leads to dehydration symptoms — which include dry mouth, thirst, fatigue, and even mild headaches. The vast majority of dehydration cases can be resolved within a few hours — with only extreme, near death cases taking longer.

I once had a friend who wrestled at a Division 1 college that would cut 10 pounds of water weight hours before weighing in for his competition. This only caused dehydration — not a hangover. And this was far more dehydration than you would have from heavy drinking one night.

When was the last time you got drunk and woke up 10 pounds lighter?

When it comes to hangovers, the dehydrating aspects of alcohol lead to the dehydration symptoms sometimes present within a hangover. Dehydration does not account for all of the other symptoms of a hangover, such as severe nausea, anxiety, and inflammation.

Another way to pose this question is to ask if you can have a hangover without ever getting dehydrated. The answer is, unfortunately, yes.

Pure alcohol is a diuretic. But, unless you’re consuming 190 proof pure grain alcohol — like Everclear — most of the alcohol you consume contains other non-alcoholic fluids within it. For example, light beer contains roughly 4% alcohol-by-volume, or “4% ABV”. This means that for every 12oz of light beer you consume, 11.5oz of the can are non-alcoholic fluids.

In fact, there are some studies showing that you can actually rehydrate using light beer. How is this possible? It comes down to the “net” hydration of a beverage in the presence of a diuretic.

The 0.5oz of alcohol in light beer is a diuretic and thus dehydrating, the other 11.5oz of fluids are hydrating. As it turns out, the net effect is that light beer can actually be more hydrating than dehydrating. By the time you get down to 2% ABV, or extremely light beers such as Miller 64, it appears that it is about as hydrating as water. Functionally, this means that if you have a water between each ~4% ABV light beer, then you should never experience any dehydration, and would actually end up more hydrated at the end of the evening than you started.

Sounds fool-proof, right? Unfortunately for my college years, not even taking extreme measures to stay over-hydrated while drinking prevented the full experience of hangovers.

Besides getting rid of a little dry mouth when I woke up, all over-hydration managed to do was slow my drinking down a little because I had to chug waters between each beer. After 10+ solo cups full of Milwaukee’s Best (4.1% ABV) and 10+ solo cups of water, and few extra cups of water for good measure before going to bed, I’d still wake up cursing the sun for shining so bright and the birds for chirping so loud. My friends and I tried this a few times, and they had the same results, with the only difference being that some of them had to dry out their beds and change their sheets.

So, what actually causes 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.

When you look at the US government’s National Institute of Alcohol Abuse and Alcoholism (NIAAA) page on alcohol hangovers, you will see that they recognize that hangovers are the culmination of multiple causes stemming from alcohol’s negative effects. One thing that the NIAAA does specifically well in this section is the recognition 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 and restlessness.

So, if you effectively hydrate before, during, and after alcohol consumption like I tried in college, you can negate the mild dehydration symptoms caused by alcohol — such as thirst. But, you will not reduce all of the other causes and their effects, such as alcohol withdrawal and the anxiety it leads to — or “hangxiety” as we often call it.

I had a friend once tell me about his worst hangover after a weekend of heavy drinking. Here’s what he 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 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 — whereas normally when I haven’t drank alcohol it says I average about 55 bpm. I felt hot, almost feverish, and my hands were extremely clammy and almost felt shaky. I had a feeling of terrible anxiousness — like something in my life was wrong.

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.

I was tired — but I couldn’t really sleep. I was hungry — but I couldn’t really eat. And I was thirsty — but I couldn’t really drink. I choked down a sports drink and some ibuprofen, but it didn’t really make my head feel any better. It ended up making my stomach hurt more because I took pain relievers without any food.

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.

While most of the intense 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, the symptoms of a bad hangover 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.

One problem with how the NIAAA classifies the causes of hangover symptoms 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 — as we sometimes call it), acetaldehyde exposure, and dehydration.

Hangovers are like soup.

If we were to rank the root causes of a hangover based on how much worse they make you feel the next day, we would argue that the order should look like this:

  1. Short-term alcohol withdrawal
  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. If you really over did it, these causes give you full gamut of a bad hangover:

By the same token, when you remove ingredients from this soup, you do not get rid of the entire soup. A very 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 — just without the vegetables.

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.

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.

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. Some may argue that it’s the vitamins and electrolytes in a Bloody Mary that makes you feel better. But, if you’ve ever tried it, simply drinking tomato juice doesn’t cut it.

So, what’s the secret sauce in a Bloody Mary? The answer is the alcohol. 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 8am in an airport bar on your way home from Las Vegas just tends to be more socially acceptable than ordering a double shot of tequila.

If dehydration was the sole cause of hangovers, then the “hair of the dog” would never work. Since alcohol causes dehydration, and hard alcohol is dehydrating, it would make no sense for the “hair of the dog” to do anything but make hangovers worse. But as millions of people know, it does work. 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 first 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 brain, 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. The longer you put off dealing with it, the greater the debt is going to be and the more it’s going to hurt paying 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. While I might not notice the withdrawal from 1–2 drinks while I sleep, my Apple Watch’s sleep app will typically point out the next morning that I didn’t sleep as well as normal. 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. A big heavy-drinking bender one weekend can be enough to give you the gamut of withdrawal: anxiety, sweating and clammy hands, increased body temperature, heart palpitations, shakiness, and both headaches and body aches.

The acetaldehyde problem.

When people think of alcohol as a “poison”, they often don’t understand that alcohol isn’t as inherently toxic to human cells as one might think. The main toxic culprit is actually acetaldehyde.

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

Unfortunately, the liver can only turn acetaldehyde into acetate so fast; your body can process up to about 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 working to clear this acetaldehyde in your body, all the acetaldehyde the liver hasn’t yet cleared flows throughout your bloodstream and nearly every cell in your 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 isn’t limited to East Asians. Flushing caused by alcohol can affect anyone who has a limited capacity to break down acetaldehyde.

Image source: Wikipedia

While most people won’t turn visibly red while drinking alcohol, under your skin this toxic acetaldehyde is still being transported throughout your bloodstream and coming into contact with cells 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.

You may want the alcohol, as it gives you a buzz, but you don’t want the acetaldehyde.

Cheers on Shark Tank Season 9’s finale in 2018.

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. Each cause contributes to its own symptoms:

  1. Alcohol withdrawal: Light/sound sensitivity, tachycardia (fast heart rate and/or heart palpitations), anxiety and restlessness, nausea and lack of appetite, depression and poor mood, headache and malaise, and poor sleep despite being tired.
  2. Acetaldehyde Exposure: Inflammation, upset stomach and GI distress, headaches, and even body aches.
  3. Dehydration leads to thirst, decreased urine output or dark urine, mild increases in heart rate, and even generalized headaches.

And beyond that, there are some other potential miscellaneous causes that heighten the effect of particular symptoms. For example, sugary alcoholic drinks tend to exasperate next-day sugar imbalances, and some wines contain more sulfites which some people are sensitive to. But none of these matter as much or as universal as the big 3 above.

At the end of the day, understanding hangovers take nuance. It’s not as simple as pointing to this or that, but rather to understand 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.

Sláinte! 🍻 (“Cheers” in Irish ☘️ — translates literally as “to health”)
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.