Vitamins for Alcohol Detox: Do "Hangover Pills" Work?

The health and fitness realm is getting trendier by the day, and the recent surge of companies selling "hangover pills" is another example of why that is. Quite plainly, hangover pills are just supplements with ingredients like milk thistle, prickly pear, and B vitamins that purportedly help treat hangover symptoms. 

Admittedly, these supplements are marketed as panaceas that prevent hangovers. They're equivalent to "plan B pills" for people who enjoy drinking alcohol to excess.

But what does science have to say about the best hangover pills? Can simple plant extracts and micronutrients really act as hangover cures? Read on and find out.

The Search for the "Best Hangover Pill"

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) maintains that there are currently no over-the-counter remedies that are scientifically proven to prevent or cure hangovers. The only herb they even mention for "potentially" treating alcoholism (not the same as acute hangovers) is kudzu extract.

Yet, countless "natural hangover remedies" are perpetuated across the Internet and social media platforms. Many of these so-called hangover cures involve the use of essential nutrients found in everyday foods and beverages, such as B vitamins and electrolytes. Occasionally, they include herbal medicines like prickly pear extract, milk thistle, and Hovenia dulcis.

As one would expect, that has led to the proliferation of supplements being marketed as "hangover pills." Sadly, these are not the miracle hangover prevention pills that companies tout, nor are they likely to make the day after a night of drunken fun any less unpleasant.

At best, supplements branded as hangover pills will have a diuretic effect that might help expedite ethanol elimination from the blood. Still, the significance of that effect on hangover symptoms has yet to be validated in clinical studies.

DHM Detox: Does it Work for Hangover Prevention?

Among the most popular natural ingredients purported to treat hangover symptoms is dihydromyricetin (DHM), a flavonoid found in Hovenia dulcis. This is the putative compound responsible for the alleged anti-hangover effects of herbal remedies outlined in traditional Chinese medicine [1].

As such, DHM is frequently identified as the key ingredient in hangover pills. Research in recent years has tested the notion that DHM can counteract the side effects of alcohol intoxication and facilitate alcohol clearance.

Though most of the studies on DHM have been in rodents and cell cultures, the findings thus far are generally promising, albeit with some caveats. For starters, a "DHM detox" isn't necessarily going to significantly reduce the acute symptoms of a hangover since dihydromyricetin appears to modulate the neuronal response to alcohol with likely minimal impact on alcohol metabolism [2].

The hangovers and toxic effects of alcohol are primarily caused by the accumulation of acetaldehyde, the immediate byproduct of alcohol metabolism in the liver. DHM works by increasing a person's tolerance for alcohol at the receptor level through a complex series of GABA-mediated actions; it's a veritable natural benzodiazepine.

Moreover, DHM is only likely to be effective for hangover prevention if you take it before drinking since its primary mechanism of action is reducing your cravings for alcohol. Intuitively, anything that makes you less likely to drink to excess can be considered a preventative aid for hangovers.

The most practical application of DHM is in treating alcohol use disorders since it can help with GABA-mediated withdrawal effects of chronic ethanol consumption. In any case, claiming that DHM is a "hangover cure" is a bit of a stretch based on current evidence.

The bottom line is that the best hangover remedy is not getting drunk in the first place. Taking a hangover pill/supplement before or after going on a bender isn't going to do a whole lot.

Does Fructose Cure Hangovers?

Okay, so there may be one home remedy for hangovers that has a reasonable scientific basis: consuming fructose. Several studies have shown that giving subjects fructose (0.25 g/kg body weight) has been shown to significantly reduce the duration and severity of hangovers [3, 4, 5].

Fructose (fruit sugar) appears to limit the amount of ethanol that reaches circulation and also accelerates the rate at which its eliminated. The catch is that most people will need to consume about 20 grams of fructose (the amount found in roughly 2.5 tablespoons of honey) to notice much benefit.

How Long Does it Take Alcohol to Leave Your System?

The majority of ingested ethanol is metabolized, with only 2-5% of the remaining ethanol being eliminated in the breath, urine, and sweat [6]. The rate at which alcohol is metabolized and leaves the body varies widely between individuals; some people are "fast metabolizers" of ethanol and others are "slow metabolizers" due to genetic differences in the expression of alcohol-metabolizing liver enzymes.  

At low-to-moderate doses, ethanol metabolism exhibits putative zero-order elimination kinetics, which means that a finite amount is cleared from the blood per unit of time no matter how much you drink [7]. As an analogy, think of pouring out a gallon jug of water with a tiny bottleneck; only so much liquid can leave the jug at once, no matter how full it is or how hard you shake the jug.

Large doses of alcohol (e.g., getting drunk) appear to induce a non-linear elimination kinetics that helps clear ethanol from the body quicker [8]. Note that this does not mean you're better off drinking heavily than modestly; your body, especially the liver, puts in "extra work" to bring blood-alcohol concentrations down if you drink excessively. 

On average, for a healthy adult that consumes 0.4 grams of ethanol per pound of body weight, on an empty stomach, their breath will test near-zero for alcohol within 6-8 hours [9]. (Eating some food before or while drinking will reduce that time.) This does not mean all the alcohol in the body has been eliminated within eight hours of pounding a six pack of beer since some of it will be filtered through the kidneys and excreted in urine. 

Note that the typical alcoholic beverage contains about 14 grams of ethanol. So, for someone weighing 200 lbs, it'll take about 5-6 drinks to reach 80 grams (which will likely intoxicate them).

So, after a night of indulging in drunken fun, how long does alcohol stay in your urine? 

How Long Does Alcohol Stay in Your Urine?

Technically speaking, alcohol that gets filtered into the urine stays there until the urine has been excreted. The concentration of alcohol in urine tends to peak the day after a day/night of heavy drinking and can be detected in samples for several days [10]. Moreover, urinary metabolites of ethanol, such as ethyl glucuronide and ethyl sulfate, may be present in urine for a week or longer [11]. 

While urinating more frequently will ensure that you're eliminating as much alcohol as possible, it won't necessarily speed up the clearance of ethanol from your blood. Therefore, your urine will be less concentrated with alcohol (metabolites) the more frequent you pee and vice versa. 

Even non-drinkers can test positive for ethanol (metabolites) in a urine sample due to microbial and endogenous synthesis (hence, urinary sampling of ethanol alone isn't very reliable to determine alcohol use). 

Alcohol Metabolism and Liver Health

The liver produces several enzymes, namely alcohol dehydrogenase, CYP450, and aldehyde dehydrogenase, that metabolize ethanol into metabolites that are ultimately eliminated in the urine and breath. The rate-limiting (saturable) step of ethanol metabolism, catalyzed by alcohol dehydrogenase, is the conversion of ethanol to acetaldehyde (pictured above) [12].

Acetaldehyde is the putative noxious compound responsible for acute and chronic side effects of alcohol intoxication [13]. The body converts acetaldehyde to acetate with the helping hand of aldehyde dehydrogenase. Finally, acetate is broken down into water and carbon dioxide.

A major toxic effect of alcohol abuse is cirrhosis of the liver, a consequence of fat infiltrating hepatic tissue. Ethanol induces fat deposition by stimulating the activity of alcohol dehydrogenase. In turn, levels of NADH increase which then promotes fatty acid synthesis in liver cells (hepatocytes).

Fatty liver happens in everyone who drinks alcohol, to a degree. However, it is reversible and, in most people, it doesn't impact liver health.

Chronic alcohol abusers display extensive fatty infiltration, which leads to liver inflammation and necrosis (liver cells die). Hepatocytes are then replaced by fibrosis (connective tissue) and liver function begins to fail, marking the onset of cirrhosis. 

In the worst cases, chronic alcoholism can cause irreversible loss of neurons in the brain, leading to a condition known as Korsakoff's psychosis. While the odd night of overindulging in libations isn't going to destroy your brain cells or cause cirrhosis, it can lead to poor drinking habits. Over time, your urge to drink heavily may increase.

Do's and Don'ts When Drinking Alcohol (Excessively)

Again, the best hangover remedy is not getting one in the first place. However, there are a handful of strategies you can follow (and things to avoid) if you end up drinking too much.

Let's start with what not to do when drinking alcohol or dealing with hangover symptoms:

• Don't drink alcohol on an empty stomach; fasting increases the rate of alcohol absorption from the stomach into the duodenum, thereby resulting in higher peak blood-alcohol concentrations [14].
• Avoid the use of antacids, painkillers, and other anti-inflammatory drugs before you drink alcohol. These substances reduce alcohol dehydrogenase activity in the stomach and can irritate the lining of the gastrointestinal tract, leading to greater blood-alcohol concentrations [15].
• After a night of heavy drinking, do not have another drink the next morning to combat the hangover. You'll simply delay the inevitable if you continue to drink.
• If you're taking prescription medications, don't take any hangover prevention pills without first consulting a licensed physician. The ingredients in these supplements may cause untoward interactions that make your hangover even worse.

Here's what you should do when you drink heavily:

• Eat a wholesome meal before you start drinking and again 3-5 hours later to ensure your body metabolizes and eliminates ethanol more efficiently.
• Drink plenty of fluids to help facilitate alcohol elimination. Aim for a glass of water every 30-45 minutes.
• Spread your drinks out over several hours to reduce peak blood-alcohol concentrations.
• Plan to have a designated driver for the night.
• Limit your consumption of energy drinks and coffee. These can actually exacerbate the symptoms of a hangover and make it harder to stay hydrated.
• Anti-nausea medications like Pepto Bismol can help after a night of drinking, but don't rely on them to make you feel better.
• Eating some fruit or honey before and after drinking may help expedite alcohol clearance and elimination according to a handful of studies mentioned in this article.
• After your last drink, start shopping for the best hangover pills on the market...(just kidding).

The Bottom Line about Anti-Hangover Pills

The short answer to the question "Do hangover pills work?" is no. Hangover remediation is complicated. If you're planning on drinking alcohol to get hammered, odds are you're going to wake up feeling not so great and there's not much you can do to avoid that.

Realistically, taking a hangover pill with small doses of milk thistle, B vitamins, and other rudimentary ingredients won't make the symptoms of a hangover significantly less enduring or harsh. Modesty, if not abstinence, really is the key when it comes to alcohol consumption.

There are virtually no benefits of getting drunk, aside from the temporal loss of social inhibitions (which is usually not a good thing, either).