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All you need to know about hangovers
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.
Sorry.
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

10 tips for cold weather drinking
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
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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.

Must grouse wine matches be classic?
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 Domaine Tempier Bandol I wrote about a while back would be fabulous but younger less expensive southern French mourvèdres would be fine too. And last year I successfully paired it with a dark brambly Georgian Saperavi.
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.
Photo © Robin Stewart at shutterstock.com

How to pair beer and food
I was recently asked the question: “What am i looking for when matching beer and food? Do I want a beer with a similar taste or should I be looking for a contrast?”
Good question because beer actually behaves differently in many ways from wine as my son Will and I explained in our book An Appetite for Ale:
“As you’ve probably already discovered beer behaves differently from wine when it comes to food. Most lack acidity and tannin, two qualities that help wine match well. But it has other qualities such as bitterness, sweetness, carbonation, lower levels of alcohol and, most importantly, a range of flavours you simply don’t find in wine (chocolate, smoke and caramel to name just three) that more than compensate.
The most significant of those is bitterness, not likely to bother you if you’re a beer lover but which may bother friends you’re trying to get to share your enthusiasm. So far as food is concerned it’s a double-edged sword. It can be intrusive and jarring, much as an over-exuberant use of oak can be in wine, but also incredibly refreshing especially with foods that are sour, salty, fatty or in other ways palate-coating like chocolate and cheese.
There are two types of bitterness, hop bitterness and roasted malt bitterness. Hop bitterness works fantastically well with spices which is why IPAs are such a great match for spicy food while roasted malt bitterness has a palate-cleansing quality which can help with such disparate foods as roast or barbecued meats, cheese and chocolate. With a rich chocolate dessert for example you don’t want yet more richness in your glass. You want something that is going to be refreshing like a bitter porter or a sour wheat beer.
Complement or contrast?
People often talk about complementing or contrasting flavours with beer but we think that’s an unnecessarily complicated approach. All you need to ask yourself is “What sort of a drink do I want with this dish or this meal?” And that’s a question of balance. If you know the flavours are going to be delicate like a salad or a seafood risotto you want a beer that won’t overwhelm them such as a pilsner or a wheat beer. If the flavours are full as they would be in a steak and ale pie or a beef stew you want a beer of equal weight like a traditional British or a Belgian trappist ale. If the flavours are extreme - very hot, spicy or sweet - you want a beer that offers some respite and refreshment.
A similar common sense approach applies to deciding the order in which you’re going to serve beers. In general it’s better to drink lighter, drier beers before richer, sweeter, more powerful ones just as you serve lighter dishes before more intensely flavoured foods.
Light or dark?
If you’re just getting into beer you may not have fully grasped that beers don’t always taste as they look. A light colour doesn’t necessarily mean a light beer as those of you who have tried strong Belgian golden ales like Duvel will know. Nor does the fact that a beer is dark mean that it’s powerful. (Think of traditional British brown ales like Mann’s or stouts like Mackeson). So let flavour rather than colour be your guide.
Carbonation - or the lack of it
The other factor to take into account when you’re matching beer and food is carbonation. Of course this is more pronounced in some beers like wheat beers or pilsners than in others such as traditional British ales and virtually non-existent in a few like strong barley wines. But, again, if your palate is likely to be under assault from deep-fried, spicy or fatty foods, look to a beer where it’s more pronounced.
Carbonated drinks also support flavours better than still ones. If you drink a peach flavoured dessert wine with a peach-flavoured dessert for example the dessert will strip the peach flavours from the wine. The carbonation of a peach flavoured lambic on the other hand will preserve the fruit flavours of the beer, cleansing the palate between each mouthful and echoing but not overwhelming those of the dessert. It means you can rely on flavour rather than strength or sweetness for the match which again makes for a more refreshing experience.

What sort of wine to buy in a bin end sale: 12 tips to help you bag a bargain
If friends and family have drunk you out of house and home over the holiday you may be looking to top up your stocks at this time of year, especially as many merchants have bin end or clearance sales. But is buying wine that way a good idea?
Supermarkets, of course, have cut price deals all the time but wine merchants generally have a promotion a couple of times a year to make way for new lines and vintages or clear Christmas stocks.
Sometimes they only have a few bottles left - not enough to put on display. Sometimes they want to shift rather more of a wine that’s simply not selling or that needs drinking up. It’s always a bit of a lottery but you stand a better chance of bagging a bargain if you follow these tips.
* With some merchants the best bargains go quickly so try and get an advance list of what’s on offer. Be ready to hit the phone as soon as the sale opens for the best bottles. If you miss them make sure to get on the merchant's mailing list for the next sale.
* Don’t take the store’s word for it that the price they're offering is the best one. Make a shortlist of the wines you fancy then compare the prices elsewhere either by Googling them or checking out a price comparison site like wine-searcher.com
* Check any ratings too. Third party endorsements are more reliable than what the merchant is saying about the wine. Of course they’re going to say it’s fabulous! Be wary of half price or greater than half price offers which smack of desperation or overpricing in the first place
* Check the vintages, bearing in mind that southern hemisphere harvests are six months ahead of northern hemisphere ones. Look for recent vintages (2015 at the time of writing) in the case of young, fresh, inexpensive wines like crisp whites and rosés. Older vintages e.g. 2010 Bordeaux should be fine with more expensive wines but it’s more of a lottery. if you’re planning to spend a fair amount check a vintage chart like Berry Bros & Rudd’s.
* If you’re in a shop look at the conditions under which the wines are kept - wine is not at its happiest stored under hot bright lights, for example. Examine older bottles for ullage - where the wine has fallen back down the neck of the bottle due to evaporation which might indicate a problem with the cork (see this rather fascinating technical explanation on the Sotheby’s website)
* Go for less familiar wine producing countries such as Bulgaria, Slovenia and Portugal or less well known regions of better known countries like Spain. Wine merchants love to take on obscure wines but can’t always shift them.
* Choose trusted producers in better known wine regions (which obviously doesn’t help if you don’t know who the trusted producers are. Which is why you need to get to know your wine merchant. Or do a quick Google search.)
* Look for deals on sweet and fortified wines like port and richer styles of sherry especially after Christmas when shops find it more difficult to sell this type of wine.
* Bear in mind that whites can age just as well if not better than reds. Old rieslings are a great buy in a wine sale. Chablis ages surprisingly well too.
* That said, bin ends tend to need drinking up - which is why they’re bin ends - so probably won't be suitable for medium to long term storage. Remember halves age faster than standard bottles and magnums more slowly
* Don’t buy your bin ends in the form of an unspecified mixed case where you don’t know the wines you’ll be getting. At least some of them will be duds. And don’t allow merchants to substitute for wines that have sold out without consulting you.
* Check the terms and conditions carefully: the delivery charge, whether there is a minimum order and whether you have to buy an unsplit case (and, if so, does that mean 6 or 12 bottles). Check whether the bottles are ‘in bond’ or inclusive of tax and duty
Finally even if you buy a wine in a sale it should be drinkable so if you get a corked bottle you have the right to return it. That said it’s easier to do so if you do it within weeks or months rather than years.
And if you have bin ends of your own at home that need drinking up how about forming a bin-end club? Here's an account of the inaugural dinner of ours!
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