A salty solution to dehydration and a deeper look at when drinking goes too far 

Getting to Know your Hangover

click to enlarge Symptoms of a hangover are the same as dehydration. The headaches, the nausea, the cramping, vomiting, all these symptoms are signs of dehydration.

Jonathan Boncek

Symptoms of a hangover are the same as dehydration. The headaches, the nausea, the cramping, vomiting, all these symptoms are signs of dehydration.

Your hangover has a name. That throbbing feeling in your head mixed with nausea is what's referred to as veisalgia — from the Norwegian word kveis, meaning "uneasiness following debauchery," and the Greek algia, which denotes "pain."

Now that you've been introduced, you should know that there is one surefire way to avoid a hangover: Don't drink alcohol. It's just that simple, but at the same time, it's not.

A good way to look at it is to imagine alcohol as your fun friend from school and a hangover is its annoying boyfriend or girlfriend who has to get up early for work the next day. You and your buddy just want to stay up all night listening to Chumbawamba, but there is a price to pay come morning. For me, that price is that my head feels like a giant thumb that somebody slammed in a car door and my stomach has lost all sense of reason. I believe something may have crawled in my mouth and died. These are the perils of bottom-shelf bourbon and whatever else happened to be in my fridge. According to an entry in the Annals of Internal Medicine, headache and "poor sense of overall well-being" are the most common symptoms of a hangover, followed by our old friend diarrhea finishing in third.

As most of you probably know, these symptoms aren't really conducive to productivity in the workplace, so the effects of heavy drinking on the economy are widespread. According to a study released by the Centers for Disease Control and the Lewin Group, excessive alcohol consumption cost the United States more than $223 billion in 2006, 72 percent of that coming from losses in workplace activity. That equals about $1.90 per drink or $746 per person in the country that year. Binge drinking, defined as "consuming four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men," was the leading contributing factor for the nation's massive bar tab.

Although alcohol takes a heavy toll on productivity, it would be a lie to say that drinking doesn't serve a purpose in the modern American workplace. In Sir Kingsley Amis' 1972 ode to all things alcoholic, On Drink, the British humorist wrote, "Nowadays, in the era of the business lunch, the dinner party, the office party, the anything-and-everything party, strangers pour over the horizon all the time. The reason why I, and most others, usually turn out to enjoy meeting such creatures is simply and obviously the co-presence of drink. The human race has not devised any way of dissolving barriers, getting to know the other chap fast, breaking the ice, that is one-tenth as handy and efficient as letting you, the other chap, or chaps, cease to be totally sober at about the same rate in agreeable surroundings." In case you didn't notice, Amis was very British, and the only thing dry about him was his wit, but he touches on an important part that drinking plays in everyday life. And as alcohol's role in civilization has evolved, so to have our attempts to avoid the nasty aftereffects.

According to a 2009 article from Time, ancient Assyrians used a mixture of myrrh and crushed bird beaks to counteract the effects of overindulgence, while European doctors during the Middle Ages favored raw eel and almonds. Luckily, we now have better options. Among those modern remedies is BANa, a beverage developed in Charleston that serves as a way to replenish the fluids lost during athletic activities or just a night of heavy drinking.

Created by Dr. Benjamin Yoo in 2008, the idea for BANa came after he noticed numerous football players coming into his clinic with severe cases of dehydration. Those athletes would receive IV fluids, which is essentially just sodium and water. Realizing the need for a less-invasive solution, Yoo began to investigate other sports drinks to see where they fell short.

"In my opinion as a physician, the only electrolyte you really need is salt — sodium chloride," says Yoo. "You look at an IV of normal saline, it has 9,000 milligrams of salt in one liter of fluid. Some of these athletes, I'd be giving them two to three bags of normal saline. ... That's tons of salt. My premise was there's not enough salt in these drinks and that was the problem with hydration."

BANa is advertised as a way to rehydrate your body after it has been drained of electrolytes following extensive physical activity, sickness, or a period of heavy drinking. A key part of this process is restoring the body's sodium levels without adding excessive sugars and calories. From my experience, BANa does help you recover in as far as you start to feel like a functioning human being again. It has a bit of a chewable vitamin taste upon first sample, but after that initial sip, it goes down as smooth as your usual sports drink.

"Alcohol is a diuretic, so what it does is block this hormone that activates when you're dehydrated," says Yoo. "Symptoms of a hangover are the same as dehydration. The headaches, the nausea, the cramping, vomiting, all these symptoms are signs of dehydration. That's why my drink works very effectively. It's got four times more salt than, say, Gatorade. Four bottles equals one normal saline [IV] as far as salt content."

According to Yoo, the science behind BANa is simple. It's no different than the reason why mothers give their children soup when they're sick. As the doctor says, "A little salt goes a long way."

Developing problems, finding solutions

Many times alcohol has been described as a good servant and a bad master. As IV clinics pop up around town and hangover remedies populate store shelves, it's important to remember the dangerous repercussions of frequent heavy drinking. According to experts that study the effects of alcohol on the brain, people should be weary when considering these products and services as the regular solution to overindulging.

"The whole idea of providing fluids and electrolytes really is designed to replenish the body with things that are depleted as a function of heavy alcohol consumption, so that's not necessarily a bad thing in that it will in fact reduce the severity of things like hangovers. It also could potentially reduce the intensity of withdrawal symptoms experienced by individuals who have a history of heavy drinking, but at the same time that is not the approach one should take to managing their alcohol consumption," says Dr. Howard Becker, director of the Charleston Alcohol Research Center at MUSC, which recently received a five-year, $7 million grant from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health.

Full disclosure: Dr. Becker is my wife's work colleague, but as the director of one of only 20 such centers in America and the only one located in South Carolina, he's the person to talk to about the problems of alcoholism and alcohol research.

"We certainly don't want to have the message out there that, 'Yes, you can drink heavily or in excess because there's a place a few blocks down the street where you can get fluid and electrolytes pumped into your veins and that will solve all of your problems," he says. "In connection with that, the main thing to understand is that heavy drinking leads to serious consequences in the brain. That's what our Alcohol Research Center is focused on. It's focused on understanding changes that are produced in the brain as a result of prolonged heavy alcohol use."

For those who may get defensive when it comes to talking about the problems that come with alcohol use, researchers readily acknowledge why people enjoy drinking. The euphoria, the energizing and pleasurable effects of intoxication — these are a big part of what attracts individuals to alcohol. While most people can drink responsibly and enjoy all that comes along with it, some cannot control their intake and that becomes a problem that should not be ignored.

"There is a certain number of people in the population who have difficulty controlling their alcohol consumption, and those are the individuals we're concerned about. What our research is doing in the center is trying to better understand risk factors that may make some individuals more vulnerable to heading down a trajectory of alcohol addiction, whereas others tend to mature out of that kind of behavior, can better control their consumption, and are more aware of the circumstances in which they are drinking," says Becker. "That's what our center research is about — understanding risk factors and mechanisms that reflect changes in the brain that will promote transition to more uncontrolled, excessive levels of drinking. The important thing that most people don't realize is that alcohol-use disorder is really a disorder of brain function. It's not a reflection of personal weakness, a lack of willpower, or something along those lines."

Continued heavy drinking produces a change in the brain that then changes motivation for drinking. It goes from chasing a high to becoming all about alleviating the negative emotional state produced by chronic alcohol exposure. For adolescents, whose brains are undergoing dynamic changes, there is a greater likelihood of engaging in what are described as "high risk-like behaviors" that can cause lifelong repercussions.

"Because the brain is not fully developed, it reacts differently to alcohol than an adult reacts to alcohol. For example, adolescents tend to be less sensitive to the types of things that provide adults feedback that 'Yes, you've had too much to drink,'" says Becker. "They're less sensitive to the sedative effects of alcohol. They're more sensitive to the more stimulating, energizing effects of alcohol. Those kinds of things also contribute to their greater likelihood of using more alcohol and running into the problems and consequences of heavy, binge-like drinking."

So, while research on the effects of alcohol use continues and companies are working on ways to curb the negative effects of heavy drinking, it's important to remember that the possibility of alcohol dependency could exist in us all. Fortunately, research is fueling the discovery of new strategies for more effective treatments to help those susceptible to the perils of excessive drinking.

"We have some treatments that are effective, but not enough," says Becker. "However, with new discoveries that are occurring in the field of neuroscience, which basically focuses on how the brain functions, the development of new treatments is looking more and more promising. The Charleston Alcohol Research Center is at the leading edge of that work. We are learning more and more about how alcohol and other drugs influence the way the brain operates, and it's through that research that a number of new and promising medications are being developed that will assist individuals in being able to temper their alcohol consumption."


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