Focus on Alternative and Complementary Therapies
www.pharmpress.com/fact
Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2004; 9: 265–8
The alcohol hangover has substantial economic and health consequences.1,2 In Britain, about 9% of males experience alcohol problems at work and it is estimated that the associated economic costs range up to £2 billion each year.3 In the USA, the total cost of alcohol abuse has been estimated at US$12 to 30 billion per year, whereas other figures, criticised for being inflated, range as high as US$148 billion per year.2 The rates of medically certified sickness absence seem to be higher in teetotallers, former drinkers and heavy drinkers than light drinkers.4 In the workplace the hangover patient experiences impaired memory retrieval and is at risk from the effects of impaired visual–spatial skills.5,6 The alcohol hangover may be due to a combination of ethanol’s main metabolic product acetaldehyde, congeners, dehydration and sleep disturbance7 and is characterised by a varying combination of symptoms, such as light-headedness, nausea and concentration difficulties.1 Substantially increased risks of all-cause mortality can occur even in people drinking less than the recommended limits, especially among younger adults.8,9 An increased likelihood of strokes has also been observed among young adults, especially during weekends and holidays.10 During celebrations at Christmas, for instance, alcohol consumption is increased and may lead to a rise in fatal alcohol poisonings by as much as 0.4% for every 1% increase in the sales of spirits.11
These considerations and the poor compliance with moderation or abstinence as the most effective way of preventing alcohol hangover emphasise the importance of effective and safe interventions. It is therefore not surprising to see the plethora of OTC supplements on offer that claim effectiveness in preventing or treating alcohol hangover.12–14 Searching the Internet on Google.com using the search term ‘hangover cure’ (14 July 2004) retrieved about 114 000 entries. Table 1 shows the interventions promoted on the first 20 websites. The aim of this focus article is to assess the evidence from clinical trials of the effectiveness of any type of complementary intervention for preventing or treating alcohol hangover.
I performed systematic literature searches to identify all RCTs of complementary therapies for preventing or treating alcohol-induced hangover. The following databases were searched (from their inception until July 2004): Amed, Embase, Medline and the Cochrane Library. There were no restrictions regarding the language of publication. In addition, we conducted hand-searches in bibliographies of all retrieved articles and our own files. To be included, studies had to be randomised trials. The selection of studies, data extraction, validation and the assessment of methodological quality were performed systematically. Methodological quality was evaluated using the system developed by Jadad.15
The results indicate evidence for the dietary supplements Borago officinalis (borage), Cynara scolymus (artichoke), Opuntia ficus-indica (prickly pear cactus) and yeast (Table 2).
Table 1. Interventions for alcohol hangover reported on the Internet
| Water/fruit juice/coffee/green tea | Sleep |
| Fresh air/exercise | Hot bath/shower/ice pack |
| Paracetamol/aspirin | Charcoal tablets |
| Cysteine | Calcium carbonate |
| Multivitamins | Ginseng |
| Bananas/honey/cabbage/eggs | Vegemite on toast/cold pizza |
| ‘Hair of the dog’ (i.e. an alcoholic drink) | Extract of Opuntia ficus-indica (prickly pear) |
| Blend containing dextrose, succinic acid, fumaric acid, L-glutamine, vitamin C | |
| Blend containing cardamon, amomum, tangerine peel, citrus peel, ginseng, atractylodes, poria, massa fermenata, dried ginger, polyporus, alisma, saussurea | |
| Various recipes containing ingredients such as olive oil, raw egg yolk, tomato ketchup, Tabasco sauce, Worcester sauce, lemon juice, buttermilk | |
| Berocca, containing vitamin B complex, vitamin C, calcium, sugar, salt |
The effectiveness of gamma-linolenic acid (GLA) from Borago officinalis was tested in a double-blind RCT.16 Forty individuals attended a private party and received eight capsules containing a total of about 1 g of GLA or placebo. Participants were given a questionnaire that was to be returned the next day. Data from 18 participants were analysed. The results indicated a significant reduction in the overall severity of hangover and in the individual symptoms of headache, laziness and tiredness (P < 0.01). Unfortunately, important details are missing for a full appraisal in this unpublished report.
Healthy adult volunteers were included in a randomised, double-blind, crossover trial.17 Participants received either three capsules (320 mg per capsule) of commercially available standardised Cynara scolymus extract or indistinguishable, inert placebo immediately before and after alcohol exposure. After a 1-week washout period the volunteers received the opposite treatment. Participants predefined the type and amount of alcoholic beverage to be consumed and ate the same meal prior to commencing alcohol consumption. The primary outcome measure was predefined as the difference in hangover scores between artichoke and placebo. Secondary outcome measures were the Profile of Mood States questionnaire and cognitive performance tests. Measurements were taken 1 h before and 10 h after alcohol exposure. Twenty-five volunteers were assessed for eligibility and 15 were included. The mean (SD) number of alcohol units consumed during treatment with artichoke and placebo was 10.7 (3.1) and 10.5 (2.4) equivalent to 1.2 (0.3) and 1.2 (0.2) g alcohol per kilogram of body-weight, respectively. The volume of non-alcoholic drink consumed and duration of sleep were similar during treatment with artichoke and placebo. There were no significant differences in any of the assessed outcome measures to suggest that artichoke extract was effective. Adverse events were rare, mild and transient.
Sixty-four healthy, young adult volunteers were included in a double-blind, placebo-controlled, crossover trial.18 Participants were randomly assigned to receive Opuntia ficus-indica and identical placebo, given 5 h before alcohol consumption. Over a period of 4 h, subjects consumed ‘up to 1.75 g of alcohol per kilogram body weight’. After a 2-week washout period the study protocol was repeated with O. ficus-indica and placebo reversed. The primary outcome measure was the mean overall hangover symptom index assessed on a seven-point scale. The secondary outcome measure was the incidence of a severe hangover, which was defined as one that would prevent the participant from attending work or school on time the following morning (symptom index ≥ 18). Fifty-five subjects completed both the O. ficus-indica and placebo arms of the study. Three of the nine symptoms evaluated for the mean hangover symptom index – nausea, dry mouth and anorexia –were significantly reduced by O. ficus-indica compared with placebo. Overall, the mean symptom index was reduced on average by 2.7 points (95% CI –0.2 to 5.5; P = 0.07) and the risk of a severe hangover was reduced by about half (OR 0.4; 95% CI 0.2–0.9; P = 0.02). C-reactive protein levels were strongly associated with hangover severity.
A combination preparation containing 250 mg dried yeast, 0.5 mg thiamine nitrate, 0.5 mg pyridozine hydrochloride and 0.5 mg riboflavine per tablet was tested in a double-blind RCT.19 Participants consumed vodka (40 volume percent alcohol) for a period of 3 h for a total amount of 100 g absolute alcohol. Immediately after the last drink the participants received three tablets of the preparation. A hangover questionnaire was administered at that point and 8 h thereafter. The difference in the change of the symptoms ‘uncomfortable feeling’, ‘restlessness’ and ‘impatience’ was statistically significant in favour of the yeast preparation.
Table 2. Randomised trials of complementary therapies for alcohol hangover
| First author | Design; Jadad score | Alcohol challenge | Intervention (brand name) | Dose regimen | Control duration | n randomised/n analysed | Main result | Adverse events in intervention group (cases) | Control of lifestyle factors |
|---|---|---|---|---|---|---|---|---|---|
| Moesgaard16 | Parallel, double-blind; 2 | Not reported | Borago officinalis extract (Bio-Glandin 25) | 990 mg γ-linolenic acid before alcohol challenge | Placebo, 1 day | 40/18 | Intergroup differences for overall severity of hangover (P < 0.01) | Not reported | Not reported |
| Pittler17 | Crossover, double-blind; 5 | 1.2 g per kg body-weight | Cynara scolymus extract LI 120 (Cynara Artichoke) | 960 mg before and after alcohol challenge | Placebo 2 days | 15/15 | No intergroup differences (P > 0.05) | Redness in the face (1) | A meal was given prior to alcohol challenge, non-alcoholic drinks were permitted |
| Wiese18 | Crossover, double-blind; 4 | Up to 1.75 g per kg body-weight | Opuntia ficus-indica extract (Tex-OE) | 1600 IU before alcohol consumption | Placebo 2 days | 64/55 | Intergroup differences for nausea, anorexia, dry mouth | Not reported | A meal was given prior to alcohol challenge, non-alcoholic drinks were permitted; smoking, non-steroidal pain-relief medications and aspirin were not allowed |
| Laas19 | Parallel, double-blind; 3 | 100 g absolute alcohol | Yeast, dried (Morning Fit) | 750 mg once, after alcohol challenge | Placebo 1 day | 61/58 | Intergroup differences for restlessness, impatience, feeling uncomfortable (P < 0.05) | Not reported | A meal was given after alcohol challenge, non-alcoholic drinks were permitted; smoking was allowed; caffeine was not allowed |
This review was aimed at identifying the evidence from all available RCTs for preventing or treating alcohol hangover. The data do not provide compelling evidence that any complementary intervention is effective for this condition.
O. ficus-indica in particular has recently received substantial interest from the media.20 The authors of the trial concluded that ‘an extract of the O. ficus-indica plant has a moderate effect on reducing hangover symptoms’.18 If truly effective this would be of considerable interest. However, critical appraisal of the data reveals that the findings are not as positive as they seem. For the primary outcome measure, which was defined as the mean overall hangover symptom index, the results indicate no significant difference between patients treated with O. ficus-indica and patients who received placebo. Only the secondary outcome measure and exploratory analyses show some positive results. However, this is not directly relevant to the primary objective, which was to test whether ‘O. ficus-indica might decrease the symptoms of alcohol hangover by dampening the inflammatory response to hangover’. Also, the authors’ conclusion that ‘the symptoms of the alcohol hangover are largely due to the activation of inflammation’ does not follow from their data. C-reactive protein as one indicator of an inflammatory process was measured as an additional outcome measure and correlated with hangover severity. However, correlations are not necessarily indications of causality. At present, therefore, it seems that the most effective way to avoid the symptoms of alcohol-induced hangover is to practise abstinence or enjoy alcohol in moderation.
