From the archives
In his latest guest post GP Jonathan Tricker explains why we get hangovers, how to avoid them and how to get over them.
You open an eye, the ceiling wobbles. Your mouth, so dry. There’s no water to hand. You need a wee. The bathroom is way too far away. You sit up. Big mistake. Feel dizzy. A wave of nausea thwacks you. Saliva thickens in your mouth. You are sweating. You lie back down. Your heart is pounding. You roll over. Is that guilt you’re feeling? No wait, it’s indigestion. Urrgh. Too much thinking. You’re never drinking again.
Feels familiar? You may ask yourself, why does this always feel so bad?
What causes a hangover? How can you prevent it? How can you treat it if you get one?
Truth be told, if you don’t want to read to the end of this post, here are the abbreviated answers. We’re not too sure, we don’t really know and there’s no proven treatment. And strangely, given their frequency, they’ve received surprisingly little formal scientific enquiry.
And hangovers are common. There’s been a lack of large (and recent) epidemiological studies, though one Dutch study has shown 92% of the respondents were drinkers and 61% reported a monthly average of 2.7 hangovers. Another US study concluded 25% college students had experienced a hangover the previous week. 10% British men have reported having a hangover in the previous month.
Hangovers comprise a menacing array of symptoms including: stomach pain, nausea, vomiting, thirst, dry mouth, dizziness, fatigue, weakness, irritability, short-term memory problems, fast heart rate and headache. These start when blood alcohol concentration (BAC) approaches zero and will usually abate in 8-24 hours. But how often have these symptoms affected your everyday life, not to mention your ability to work productively?
The economic costs are hard to disentangle from the more general cost of alcohol, but through work absenteeism and reduced job performances the estimated cost of hangovers to the UK economy in 1987 was around £2 billion a year. More recently it has been estimated in the US, the annual opportunity costs of hangover at $2000 per working adult. Staggering stuff, really.
Why hangovers make you feel so bad
The stomach pain, nausea, and vomiting can probably be explained by the direct effect of alcohol on the gut. Alcohol irritates the lining of the stomach, delays the emptying of the stomach, relaxes the muscles at the bottom of the oesophagus (that’s the food pipe from the mouth to the stomach), allowing acid to regurgitate backwards, increasing stomach and pancreas secretions, and causing fat to accumulate in the liver.
Alcohol is also a potent diuretic (which means it increases the amount of urine produced) through inhibiting the production of a hormone called Anti Diuretic Hormone (or ADH). Consuming 50g alcohol (around 6 units) diluted in 250ml of water, causes elimination of 600-1000mL of water over several hours. There are probably additional mechanisms at work mucking around with the body’s salt (electrolytes) and acid balance which may, in part at least, explain the thirst, dry mouth and dizziness you experience. The severity of a hangover does somewhat correlate with the concentration of ADH. The good and bad news is that whilst hydration can reduce the severity of a hangover, it cannot cure it.
Glucose is the brain’s main form of energy. Alcohol prevents its production in the liver, which may account for some of the fatigue, weakness and mood disturbance you experience. And yet the body is actually rather good at regulating our blood sugar level, and there is usually a good supply of glucose in the liver. Normally one only sees true hypoglycaemica (low blood sugar) in alcohol-dependent persons who’ve been on a bender for several days, not eaten, and consequently exhausted their liver’s supply of glucose. It is uncommon to be truly hypoglycaemic after a big night out, and frustratingly, in two small studies, administration of glucose at the time of alcohol ingestion has not been shown to reduce the intensity of a hangover. Because of the ways alcohol interacts with sugars individuals with diabetes are especially vulnerable to alcohol-induced alternation in their blood sugar level.
How alcohol affects your sleep
Alcohol has numerous effects on sleep. The sedative effect induces sleep, but the sleep is usually of shorter duration and of reduced quality. Alcohol reduces the amount of dream sleep (called REM sleep) and increases deep-sleep. The balance between these states is really important for good quality sleep. Most boozing occurs in the evening and night and competes with normal sleep time, so further reducing the duration of sleep. It has been suggested that acute intoxication muddles with the body’s circadian rhythm (the sunlight-dependent natural 24 hour clock that regulates almost every automatic bodily function) therefore inducing a jet-lag-like state. Also, alcohol relaxes the back of the throat (which is why you may snore when you go to bed intoxicated), and the floppy back of the throat could block your airway, causing or worsening a condition called sleep apnoea. All of which culminates in understandable fatigue.
We are not too sure what causes headaches in hangovers. It may partially result from dehydration. Other explanations include alcohol-induced dilatation of the blood vessels in the brain (called vasodilation), alcohol’s effects on chemicals in the brain called neurotransmitters, or the ways alcohol interacts with our immune system. Who knows for sure?
We do know that alcohol is broken down in the liver to a product called acetaldehyde. When you give animals acetaldehyde or drugs to humans that makes acetaldehyde accumulate (the basis of a drug called disulfiram (or “Antabuse”), sometimes given to patients’ with alcohol addiction. It is also the reason you really mustn’t drink alcohol when taking the antibiotic metronidazole.), it causes flushing, nausea, vomiting, and fast pulse – effects not dissimilar to a hangover. Because of these similarities, it is attractive to think that small concentrations of the stuff may play a role in hangovers. However, acetaldehyde’s role remains frustratingly elusive since it is usually broken down quickly in the liver.
There is considerable individual difference in hangover severity so it seems likely that genetics plays an important role as well. More enigmatically, people who experience shame or guilt during a hangover may experience a worse one.
The role of congeners
When you drink alcohol (unless for some inexplicable reason you’ve chosen to drink pure alcohol) there are other biologically active compounds in the glass called congeners, which account for most of the drink’s smell and taste. Drinks will vary widely in congener content. It has been shown that alcohol low in congeners can lessen the severity of hangovers. Vodka usually has the lowest congener content, bourbon whiskey the highest.
The presence of congeners might explain the theory behind the hair of the dog. Methanol is a congener. Methanol and its breakdown products may cause some hangover symptoms. Alcohol inhibits the breakdown of methanol, so it can stay around in the body longer than one would normally expect. The morning after, as BAC has dropped, methanol is then broken down. Consuming more alcohol would once again inhibit methanol’s breakdown, delaying the effect methanol and its breakdown products may have. Personally I wouldn’t recommend it. Virgin Mary anyone?
So what’s the best way to prevent a hangover?
This may sound obvious, but hangover symptoms are much less likely to occur if you drink small non-intoxicating amounts of alcohol. If you do drink to excess the stronger the drink, the greater the chance of a hangover.
Drinking alcohol low in congeners (good news if you like gin, less good if you’re a fan of red wines) may reduce the severity.
Other things that have been shown to worsen hangovers include: lack of food, not enough sleep, increased physical activity whilst intoxicated, dehydration and poor physical health. It stands to reason that the opposites may improve hangovers. Avoid strenuous physical activity when drunk, try and be in general good-shape, drink plenty of water, and have some food with your drink.
Eating fatty food when ingesting alcohol may be helpful in reducing the severity of a hangover. Fat delays the absorption of alcohol from the gut into the bloodstream, thereby reducing the peak BAC. Peak BAC correlates with the severity of a hangover.
As we have seen, alcohol has an effect on glucose, so it may be pragmatic to ingest some long-acting carbohydrates such as fruits and non-starchy vegetables, nuts, and minimally processed grains whist imbibing alcohol.
If you are unfortunate enough to experience a hangover, what’s the best way to cure it?
There are only a few randomized control trials (the standard to try and determine if an intervention is effective) looking at hangover cures. None have shown any clear benefit I’m afraid.
So what may help? Drinking lots of water. Perhaps a light easily digestible meal, if it doesn’t exacerbate the gastric effects of your hangover. If you can, sleep for longer.
If you are used to a coffee in the morning, going without may induce a caffeine withdrawal headache, and perhaps make the hangover headache worse. So it may be sensible to have one - if you are the morning-coffee type. Otherwise, it’s probably of no benefit.
As with tablets and supplements, there are no proven effective hangover meals. Despite the popularity of the Full English Breakfast as a cure, there is no systematic evidence it works. Pragmatically ingestion of fresh juice (which contains water, salts and fructose – a sugar) may help tackle to diuretic effects of last night’s alcohol. Eating other forms of long-acting carbohydrates, like oats, may be of some benefit given what we have seen of alcohol’s effect on the body’s sugars so a bowl of porridge might be beneficial.
Be careful if taking Ibuprofen or other anti-inflammatory medication. Whilst they may improve some hangover symptoms, they can cause stomach irritation and may well worsen your gastric symptoms. Paracetamol is also harmful in overdose to the liver. We have already seen alcohol has a direct damaging effect on the liver so I would caution the use of paracetamol, especially if you have a history of liver problems. (Then again, if you have a history of liver problems you should not be drinking alcohol, certainly not to excess). In small doses in usually well people, paracetamol may alleviate some of the symptoms.
I’m afraid, as with so much about hangovers, the paucity of studies means we move swiftly from evidence to opinion. So, for what it’s worth, this is what I would pragmatically recommend in a hangover situation, appreciating there is no clear evidence basis:
My advice in a nutshell
Whilst out of an evening drink plenty of water. (And I do mean plenty -- like 1 pint water for every 2 units of alcohol). Enjoy your alcohol with delicious food. When you get in, drink a pint of squash or water. Make sure there’s another by your bed. Take ranitidine (a drug that reduces the amount of acid in the stomach, it is available over the counter, sometimes branded as Zantac) before going out or before bed. When you wake up, drink more water, perhaps some tea and maybe 2 paracetamol. If your stomach can manage, try a light breakfast of juice, toast with honey, or porridge. Then go back to sleep. And sleep and sleep. Until you feel better.
Dr Jonathan Tricker is a practising GP. You may also find his piece on how much you should drink useful.
Photo ©TheVisualsYouNeed at fotolia.com
A post from the archives, but an excellent one: food and wine writer Marc Millon, author of Flavours of Korea suggests what to pair with your favourite Korean dishes.
I love Korean food and I love wine! And, like Laurel and Hardy, or, well, kimchi and rice, I consider the two to be absolutely inseparable. I must confess that it’s rare that we ever enjoy any meal without wine (except perhaps breakfast), so it goes without saying that when we’re feasting on my favourite cuisine in the world, Korean, then we always make sure and enjoy some good if not great wines alongside the food. Indeed, whether we’re in restaurants in London, or, better still, when we’re at home, eating family style or with friends and guests, then it’s always a pleasure to pair Korean foods with wines that really complement and enhance the pleasure of eating.
One of the best features about eating Korean food is that it is always a convivial and gregarious communal activity. A table laid out with a sumptuous array of panchan invites the sharing of not just food but of conversation and friendship, preferably over a bottle of wine…or two…or three...
So what wines work best with Korean food as we enjoy them, Western style?
Matching wines and food
Korean food is nothing if not robust, full-flavoured and direct. The pungent and delicious flavours of garlic, ginger, chilli, toasted sesame seed and kochujang give Korean food its earthy character and spicy, sometimes fiery warmth. No one ever claims that Korean cuisine is overly delicate, fussy or particularly subtle; everyone agrees that it’s full of flavour, satisfying, comforting, and wholly delicious. As such it cries out for wines that offer big flavours that are similarly robust and forthright, man enough to stand up and be counted.
Take kimchi, the most famous of all Korean foods. Certainly winter kim chi, crunchy and deliciously sour, with its fermented aromas and heady, nasal-cleansing flavours of garlic, ginger, soused anchovies and lots of ground red chilli pepper, is hardly the easiest food to match with wine. But in truth, a number of wines work well, though as always, it’s often foremost a question of personal taste. For example, I like to try and match the aromatic pungency of kim chi with a wine that is equally assertive, perhaps a New World Sauvignon Blanc from South Australia or Marlborough, New Zealand. In such cases, I’m not looking for restrained delicacy: rather I want a Sauvignon with a pronounced herbaceous or gooseberry character that has enough flavour, body and alcohol to cut through the intense aromas of the kim chi, and add a touch of grassy, razor-sharp freshness.
When we have friends around, we like nothing better than serving platters of mixed Korean ‘tapas’ with drinks before a meal. Fried foods such as pa’jon and pindaettok always go down well with everyone. I love serving nibbles of kosarinamul, the deep flavours of the fiddlehead ferns delicious dressed in soya sauce and toasted sesame oil. We live by the sea so it’s always good to serve raw or just seared shellfish — perhaps a platter of Starcross oysters served on ice together with a fiery kochuchang dipping sauce or some barely seared local diver’s scallops. For wines with Korean ‘tapas’, why not stick to the Spanish theme. The full and intense flavour of sherry, one of the great wines of the world, goes extremely well with Korean food. Try serving a fresh, chilled bone dry fino sherry, or else a salty, seafresh manzanilla with seafood tapas. For a wine to go with more robustly flavoured foods, try a dry amontillado or dry oloroso: these are great classic styles of sherry that are often overlooked and undervalued, and which have enough alcohol and rich, caramelly flavour and character to stand up to the assertiveness of Korean food.
Fish and shellfish
There is no better way to enhance the salty, fresh flavours of fish and shellfish than to serve with an appropriate wine. Take saengsonhoe, for example. This much loved raw fish favourite is by definition incredibly fresh, the seafresh taste delicate and never overly strong. I have found that modern Italian whites can work particularly well here, especially unoaked cool-fermented and vinified to be enjoyed while young and zingy. I adore the wines of Friuli; among my favourite are simple varietals such as Tocai from Collio, as well as Pinot Grigio and Ribolla Gialla from Colli Orientali. Verdicchio dei Castelli di Jesi is another Italian white that can be outstanding with seafood. As an alternative to accompany raw or lightly cooked shellfish, oysters, scallops, lobster and crab, you can’t go too far wrong sticking with a Blanc de Blancs Champagne, the delicacy and the bubbles combining with the shellfish to give a real hit of luxury.
There is nothing better on earth — no nothing at all — than charcoal grilled bulgogi or kalbi. Don’t we all agree? You can have your filet mignon and your tournedos Rossini, thank you very much, but give me a platter of Korean barbequed meats any day of the week. The pungent flavours of soy sauce, plenty of crushed garlic and ginger, and toasted sesame seeds and sesame oil, combined with the smoky, charred flavours of meat and fat, dripping onto an open fire is simply irresistible. We sometimes marinade a large piece of aged rump steak, cook briefly over charcoal, then slice on the slant and arrange the meat over a platter of salad and wild greens. We cook down the marinade and mix with a red wine reduction to make an intriguing East/West sauce.
The wines that work best with Korean barbequed meats are fruity and full-bodied, not overly tannic and harsh. I adore some of the wines being made in Italy’s deepest southern outpost, Puglia. Wines made from the ancient Primitivo grape as well as the beefier Negroamaro are redolent of sun-drenched flavours, and offer dense, concentrated fruit, with plenty of alcohol and body to stand up well to the robust flavours of the grilled meat. Primitivo di Manduria or Salice Salentino are wines to look out for. Or head over to the Iberian peninsula. Portuguese reds are today among the most exciting in the world. I’m thinking of good examples from Alentejo and Douro: full, fruity and with velvety tones that can be beautifully seductive, almost sweet. Rioja and Ribera del Duero wines from Spain, smooth with the soft tones and vanilla scent of new American oak, also partner Korean grilled meats perfectly.
Marc and Kim Millon are the authors of Flavours of Korea — with stories and recipes from a Korean Grandmother’s Kitchen (André Deutsch, London 1991) as well as numerous books on the wines of Spain, Italy and France. He lives in Devon with his photographer wife Kim. For more information visit his website www.quaypress.com
With temperatures falling well below freezing over the coming week it’s a timely reminder that matching drinks is not just about flavour but temperature and alcohol levels too.
A glass of crisp Mosel riesling for example may be a great aperitif and a fine match for smoked trout or a spicy Asian salad but it just doesn’t feel right in this type of weather, just as a 14.5% Shiraz can be overwhelming in the middle of a heat wave.
Obviously it still depends on the food you’re eating and that itself tends to be robust at this time of year but there are subtle changes you can make to make your drinking frostproof. Here are my top 10 tactics
1. Serve your whites a degree or two warmer. We do have a tendency to serve whites overchilled, particularly if you leave a half-open bottle in the fridge.
2. Carafe your fuller whites. Oak-aged whites such as barrel-matured chardonnays benefit from decanting just as much as a full-bodied red
3. Bring out those blockbuster reds! Just as winter is the time of year to be eating hearty roasts, stews and casseroles so it is for drinking what the wine trade loves to call ‘winter warmers’ (and the Australians ‘grunty wines’) Think big Cabs, Aussie and South African Shiraz, Zinfandel, Pinotage, Jumilla, Madiran, Amarone and big porty Douro reds.
4. Drink warming nutty amontillado or palo cortado sherry with your tapas instead of chilled manzanilla or fino.
5. Drink malt whisky instead of champagne with your smoked salmon. (And Lagavulin rather than Sauternes with your Roquefort . . .)
6. Treat yourself to a Whisky Mac. And go to bed with a hot toddy - even if you haven’t got the flu.
7. Rediscover (if you’ve ever forgotten them) the joys of ‘brown’ spirits like Cognac, Armagnac and Demerara Rum. Delicious with dark chocolate or rich, dense fruit cake
8. Learn howto make a Blazer. Or - perhaps a safer strategy - go to a bar where they know how to make one . . .
9. Drink porter, stout and other hearty winter brews with your stews and pies. (Possibly even make them with them too). Smoked beers are also a great pick when it's cold outside.
10. Drink iced vodka shots. Sounds chilly but the alcohol will make you feel warm inside as any Russian or Pole I’m sure will tell you. Invite friends round for zakuski (Russian-style tapas) and make a party of it.
Chinese tea on the face of it would seem the perfect drink to welcome in the Chinese New Year but it’s slightly more complicated than that as Lu Zhou and Timothy d’Offay of Postcard Teas explain.
“Happy Chinese New Year! This year is The Year of the Dog and it begins on February 16th so the 15th is the day to get ready by tidying up the house, preparing a family feast and staying up to see the New Year in with fire crackers.
Traditionally you might also make and eat some sticky rice cakes and dumplings. Though these delicacies sound like the perfect accompaniment to tea, tea is not a major tradition during the festival and alcohol is the traditional drink of the New Year meal and most fine dining.
Usually in China, good tea is not drunk with food because Chinese people think the strong tastes as well as the oil from food will interfere with the purity of teas. In one memorable tea scene from China’s most celebrated novel “Dream of the Red Chamber” the heroine Dai Yu has dinner with the Jia family for the first time and after the meal, unused to such a grand occasion, commits a faux pas by drinking the lower quality tea meant for rinsing out one’s mouth before the special tea is served.
When drinking fine Chinese tea, the tea takes centre stage and so is often accompanied by a simple selection of nuts, melon seeds, and dried fruits. But if those New Year’s dumplings or sweet cakes are still crying out for some Chinese tea here are some options.
As it is winter, a roasted oolong tea may be appropriate as the roasting would be considered to give the tea a warming quality whereas a white or green tea would be considered to be cooling and more appropriate for summer. We would suggest a Wuyi Oolong from last summer which needs about 6 months to settle down before being enjoyed or maybe an aged Pu-erh or a Chinese black tea like Keemun if heavily roasted teas are not your thing.
All these teas can be easily brewed with just boiled water between 90-100°C. Indeed even Chinese green tea if it is of a high standard can be brewed with water between 85-90°C, much hotter than is appropriate for Japanese green teas.
The major tea pairing obsession in China has historically been with water. Lu Yu,the original Sage of Tea, believed that water taken from mountain streams was the best and well water the worst.
Through the ages tea connoisseurs have matched local waters to teas. Two famous pairings we have tried and been impressed by were West Lake Long Jing with Hupao Spring water and Wuyi Oolong teas with water from the source of the Jiuqu Yi River.
So why not celebrate by brewing some tea with a new source of water? At our shop we use a mixture of tap water, Volvic and Highland Spring, depending on the tea, but we also enjoy a local Sussex mineral water called Pear Tree Well. Although not widely available it is still easier to obtain than the water from melted snow from plum blossom branches aged for five years mentioned in another famous tea chapter of 'Dream of the Red Chamber'!"
(Postcard Teas has a charming shop and tea room in Dering Street, just off the Oxford Street end of New Bond Street - one of my favourite places to drink tea in London. Tim also has a lovely new book called Easy Leaf Tea you should definitely buy if you're into tea. )
Photo © Michael Freeman
I’m always in two minds about whether to write about the beginning of the grouse season. After all only a tiny number of people will be sufficiently interested - or well-heeled - to bag the first birds that arrive on restaurant tables this evening.
However grouse will feature on menus over the next few weeks and I’ve been rethinking my recommendations. Up to now my view has been that grouse is such an expensive luxury that it deserves a venerable bottle of top red burgundy or Bordeaux. "I'd go for a burgundy like a Chambolle-Musigny but a mature red Bordeaux or a Côte Rôtie would be equally delicious" was what I wrote a couple of years ago.
But the fact is that most chefs now cook grouse as rare as roast beef and I’m not sure that a younger bottle of the same type of wine mightn’t be better with the season’s first birds. And that could easily be pinot from less traditional areas such as Central Otago and Martinborough in New Zealand, Australia’s Mornington Peninsula or Yarra Valley, Oregon or from California’s Anderson or Russian River Valleys whose wines often outperform mediocre burgundies. Or a vivid young syrah rather than a venerable one. Just because you’re paying a fortune for your bird doesn’t mean you should necessarily pay over the odds for your wine, especially if you're eating out.
Later in the season when grouse gets gamier you might want to reach for more complex wines - the 1994 Domaine Tempier Bandol I wrote about recently would be fabulous but younger less expensive southern French mourvèdres would be fine too.
I found restaurateur Tim Hart of Hambleton Hall in Rutland was with me on the mature mourvèdre front but was still basically a burgundy man "The same whether it’s August or November" So is cookery Rowley Leigh who used to offer a special selection of burgundies 'at prices way below normal margins' at his former restaurant Le Cafe Anglais because, he said, 'we heartily believe in drinking Burgundy with grouse'.
Henry Harris, formerly of Racine in Knightsbridge was prepared to concede "there might be some difference in a couple of weeks as the birds get more fragrant and the heather seems stronger" but was still inclined to stick to France. "Day one an elegant Bordeaux, as the season progresses a Rhône."
So, there you go. Maybe I’m now out on a limb but if you’re lucky enough to be having grouse more than once I’d try it both ways.
If you want to have a go at grouse yourself there's a great recipe here from Bristol chef Stephen Markwick with whom I collaborated on A Well-Run Kitchen.