How Much Alcohol Causes a Hangover?

Medically, the condition is called "veisalgia" -- from the Norwegian kveis or "uneasiness following debauchery," and the Greek algia, otherwise known as "pain."

But you probably just call it a hangover.

The helpful PR coordinators at the American College of Physicians resent information about a review, published back in 2000, titled simply The Alcohol Hangover. "More than 4700 articles have been written about alcohol intoxication (from 1965 to 1999), but only 108 have addressed alcohol hangover," the researchers, all at UC San Francisco at the time, wrote.

But you don't care about how much research has been done, you want to know how many drinks cause a hangover.

Let's get to it:

• For men, a dose of "five to seven standard cocktails" consumed over a four-to-six-hour period, is "almost always followed by hangover symptoms."
• For women, the dose is three to five drinks. Women feel the effects of alcohol on a smaller dose not because they are smaller (in general) than men, but because they metabolize alcohol differently.

For the purposes of their review, the researchers defined a hangover as having at least two of the following not-so-surprising symptoms: headache, "poor sense of overall well-being" (in other words, feeling crappy), diarrhea, anorexia, tremulousness, fatigue, nausea.

What the researchers had trouble defining was how a hangover happens. There are theories, but no one is sure. The researchers dismissed the popular idea that a hangover is caused by "alcohol withdrawal." The researchers say that the physical changes in a hangover are different from those that happen when a chronic alcohol abuser stops drinking alcohol.

Curiously, a hangover is not "solely dose-related," the researchers wrote, although the more alcohol a person drinks, the more severe the symptoms might be. Some possible culprits as to a hangover's pain include:

• Acetaldehyde: this is a byproduct of alcohol metabolism and can contribute to hangover symptoms
• Congeners: this byproduct in many dark liquors — such as brandy, tequila, wine and whiskey — can increase the "frequency and severity of hangover," the researchers reported. Conversely, clear liquors such as rum, vodka and gin generally cause hangover less frequently and could explain why people with more severe alcoholism favor these liquors.

Treating the Hangover: No Easy Solutions

Alcohol consumption promotes excessive urination, out of proportion to the liquid consumed. That sets you up for dehydration, but as the alcohol wears off, a hormone that limits urination increases. Drinking water can help, but "in our clinical experience, hydration attenuates but does not completely relieve hangover symptoms."

So drinking water is not a big help.

Some evidence showed that people who took tolfenamic acid when they were consuming the alcohol had fewer hangover symptoms. Tolfenamic acid is an "NSAID," a non-steroidal anti-inflammatory drug. It's not sold in the U.S. (apparently available in Britain; very helpful). "Other non steroidal agents are frequently used to treat hangover symptoms but have not been studied."

Because no other NSAIDs have been studied, I can't give you names of drugs that could treat hangover symptoms, but I can suggest what you should avoid. In general, do not take acetaminophen — brand name Tylenol — when you drink alcohol. The combination can cause severe liver damage.

Another study showed taking vitamin B6 before, during and after drinking alcohol reduced hangover symptoms.

Hangover Carries Its Own Health Risks

I was surprised to learn that the hangover is about more than just feeling yucky. The researchers quantified costs in impaired job performance, but the hangover patient is at increased risk of injury because of "diminished visual-spatial skills and dexterity even after alcohol can no longer be detected in the blood" (emphasis mine). Visual-spatial skills are what you need when you're driving or operating any heavy machinery. Use caution.

Note to anyone who is Tahoe-bound for the New Year's holiday: Skiers may also be at higher risk of injury due to the hangover.

Also troubling is that hangover puts stress on the heart. People with a hangover have an increase in heart rate and blood pressure. There is some evidence that people suffering from a hangover are at increased risk of dying from a heart attack.

The Hangover Through the Ages

The researchers opened their review by citing the Bible: "Woe unto them that rise up early in the morning, that they may follow strong drink." (Isaiah 5:11) and closed by citing Homer:

Hangover's historical past may predict its future. Homer provided one of the first descriptions of the disorder. A companion of Odysseus, Elpenor, awoke from a drunken sleep, sprang up, and jumped off a roof, falling to his death (62–63). Of interest, Elpenor “returned from the dead, begging Odysseus to bury his body,” a sentiment we have often heard echoed by patients with hangover. The most extreme form of hangover, a psychiatric dissociation characterized by irrational behavior, has since become known as the Elpenor syndrome.

Happy New Year! Drink wisely.