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No, hangovers are not just dehydration.

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

Brooks Powell

November 22, 2021

KEY TAKEAWAYS

One morning during my sophomore year at Princeton I woke up with a terrible hangover and swore I’d find a way to outsmart this problem that has existed since as long as alcohol was invented—which is at least 4500 years.

At first, I thought the problem could be solved by dehydration. The logic was simple enough:

Premise 1: Alcohol causes hangovers.
Premise 2: Alcohol causes dehydration.
Conclusion: Dehydration causes hangovers.

Therefore, if you prevent the dehydration caused by drinking alcohol, you prevent the hangover. Right?

Pure alcohol has a diuretic effect. So the most dehydrating alcohol you could consume would be grain spirits, such as Everclear, which clocks in at 190 proof—or 95% pure alcohol. Most alcoholic drinks are not this pure in alcohol. For example, light beer typically comes in at around 4% ABV. If a can of beer is 12oz, and its ABV is 4%, that means that 11.5oz of the beer is not alcohol. While 0.5oz of the beer is dehydrating, the other 11.5oz are hydrating.

Some studies have shown that once beer gets to under 4% ABV, the net effect of drinking it is that it actually will hydrate you—albeit slowly. By the time you get to super light beers at around 2%, such as Miller 64, the net effect is that this beer is almost as hydrating as water.

One evening, I got together with a group of friends around a case of Natty Light (4.2% ABV) for a little science experiment. For every 12oz of beer have 16oz of water—this effectively makes the beer hanging out in your belly less than 2% ABV. Thus, we would actually end the evening more hydrated than we started.

After about 10+ Natty Lights and 10+ pints of water, and a few extra pints of water for good measure before bed, we all passed out.

The next morning we all woke up—and the sun was way too damn bright and the birds were somehow way too damn loud. But no one was thirsty—which didn’t feel like a big deal compared to our heads feeling like a gong that was perpetually ringing.

It was the same for everyone—except one kid who now had to to change his sheets and dry out his mattress.

While my early college experiments didn’t work, I eventually started working on the problem with my professors. Fast forward a few years, and today we are quite successful. Here’s some stats since we debuted Cheers Restore, our “after-alcohol aid” on the season finale of Shark Tank in 2018:

-16 million doses sold
-8,000 4 & 5-star Amazon reviews
-Half of our revenue comes from repeat customers

After working on the challenge of hangovers for nearly a decade, with some of the best researchers in the United States, I think it’s fair to say that there’s very few people in the world that know as much about hangovers as us.


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.

According to the US government’s National Institute of Alcohol Abuse and Alcoholism (NIAAA) page on alcohol hangovers, you will see that they list out 6 causes of hangovers—each of which contributes to a different hangover effect.

  1. Mild dehydration -> Thirst, fatigue, headache.
  2. Disrupted sleep -> Fatigue.
  3. Gastrointestinal irritation -> Nausea and stomach discomfort.
  4. Inflammation -> Malaise and pain.
  5. Acetaldehyde exposure -> Inflammation.
  6. Mini-withdrawal -> Restlessness and anxiousness.
It’s these 6 things, that when combined, culminate in the total experience of a hangover.

One bone that I have to pick with the description given by the NIAAA is that they did a poor job of splitting our primary causes from secondary causes. For example, if the main effect is that acetaldehyde exposure leads to inflammation, then why not just list acetaldehyde exposure and explain that it’s effects are inflammation, which lead to malaise and pain?

In reality, all that really matters are the primary causes, of which there are 3:


Of these 3 causes, “mini-withdrawal”, or “alcohol withdrawal” as we typically call it, is the biggest contributor to the symptoms of a hangover.

Most people intuitively know this. If you’ve ever had a big night of drinking and wake up feeling like you got ran over—nausea, sensitive to light and sound, both headaches and body aches, anxious, and tired—what is the easiest way to start immediately feeling better? It’s the “hair of the dog”… drinking more alcohol the next morning as a way to quell this withdrawal.

This method is so widespread and well-known that there is a drink for it typically sold in the morning—the Bloody Mary.

The fact of the matter is that drinking more alcohol the next morning works wonders. All the sudden the nausea starts to go away, sensitivity to light and sound dulls, your head begins to feel better, and some of your energy comes back.

This is all great—until you start withdrawing from that alcohol. Staying drunk for the rest of your life isn’t a sustainable strategy. So, in the end, there’s no escaping the withdrawal—only delaying it.

Withdrawal is like a debt, and the longer you don’t pay it, the worse it gets. So as a general rule of thumb, don’t drink more alcohol in the morning.

Ultimately, your hangover is relative to the amount of alcohol you drank (BAC %) and how long you stayed at different levels of BAC (length of time). Some people might not consciously feel the withdrawal from 1–2 drinks, but it’s there. I will see my sleep affected on my Apple Watch data even with a single drink.

Once you start having more, it’s easy to see the effects of this withdrawal. 4–5 drinks will definitely start making most people toss and turn while sleeping. By the time you get to a weekend of binge drinking, you’ll really start to feel what it’s like to undergo full blown withdrawal. Dehydration is a small part of the overall pain!

Beyond short-term alcohol withdrawal, there’s acetaldehyde exposure. While alcohol is toxic to cells, it’s only a drop in the bucket relative to acetaldehyde. When you drink alcohol, alcohol must be converted into acetaldehyde before it can then be converted to acetate and passed through your urine.

Acetaldehyde is ~20x more toxic than alcohol is. And when you drink alcohol, your body is only able to remove about 1 drink’s worth of the resulting acetaldehyde per hour. This means that if you have a few drinks, this acetaldehyde ends up circulating in your bloodstream and affecting almost every cell in your body for hours.


This acetaldehyde is so problematic that if someone has a genetic deficiency that slows down their ability to break down acetaldehyde their skin will turn red. This is typically referred to as “Asian flush” or “Asian glow” as it affects roughly 2/5ths of East Asians. This isn’t limited to Asians however and can affect anyone whose body breaks down acetaldehyde at reduced rates.

Even if your skin doesn’t glow red, the harmful effects of acetaldehyde are still present. Acetaldehyde’s toxicity causes inflammation, and it’s this inflammation that also works in tandem with withdrawal to give you malaise, headaches and body aches, and an overall terrible feeling.

Putting it all together

The way to think about hangovers is that they are not caused by any one single thing. Instead, they are the culmination of multiple causes stemming from alcohols negative effects.

Mild dehydration caused by alcohol leads to dehydration symptoms—such as thirst and a mild headache—but not the gong-ringing, shut the blinds, put me in a cold, dark room pain that comes from alcohol withdrawal. Or the inflammation and aches that comes from acetaldehyde exposure.

If you prevent dehydration, then you prevent dehydration symptoms, and that’s it.

To learn more about how we think about feeling better from alcohol consumption, check out our website. If you haven’t heard about our products yet, we’re being seen by millions of new people every year, so chances are that you will soon!


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.