Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Alcohol, bone osteoporosis and bone fracture risk

Alcohol and bones? Does alcohol help or hurt bones? Modest drinking helps against osteoporosis as compared to abstainers and heavy drinkers. Don't you love it!

Berg and colleagues examined the literature studying effect of alcohol drinking hip fracture, bone density, non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling. They found that as compared to abstainers, subjects imbibing 0.5 to 1.0 drinks per day had lower hip fracture risk. In contrast, the risk was higher in subjects enjoying more than 2 drinks per day. Modest drinking is thus better than no drinking or heavy alcohol drinking.

The investigators also found a positive impact alcohol consumption on bone density.

Now that you know that alcohol tends to prolong life and may build healthy bones, are you more likely to enjoy a drink a day, to keep the doctor away. Please share your thoughts. Cheers!

Alcohol prolongs life, Cheers!

Several studies have shown that moderate drinking is beneficial for cardiovascular health. However, its impact on longevity or mortality continues to be mired in debate. Now comes the study providing the strongest evidence thus far that moderate drinking contributes to longevity.

Dr. Di Castelnuova and colleagues from Italy conducted a meta-analysis of 34 prospective studies done on this subject. They pooled the data from these studies yielding 1,015,835 subjects and 94,533 deaths. They analyzed the data from this large group and published their findings in the Archives of Internal Medicine (Dec 2006).

These investigators found a J-shaped relationship between alcohol and total mortality. Men drinking up to 4 drinks and women consuming up to 2 drinks per day had lower mortality. The reduction in death rate was 18% and 17% in women and men respectively.

In contrast, people who consumed alcohol more than above had a higher mortality suggesting that the beneficial effects of alcohol are overwhelmed by its deleterious effects if consumed in excess.

Thus if you are drinking too much, it is never too late to cut it down. On the other hand, low to moderate drinking is good for you! The best way might be to drink small amounts of alcohol with meal.

I will drink to that. Cheers!

Treatment of alcohol hangover

Alcohol may prolong life but hangover is a problem. Okay, you have been drinking alcohol out all night and now you have hangover with throbbing headache, aches and pains with no energy. Don't you wish there was a cure for your alcohol hangover? Treatments for alcohol hangover are limited although it is never too late to start damage control. The preventative measures based on causes of alcohol  hangover are still helpful. Some of important points to remember are as follows:

1. Do not drink more alcohol in order to reverse the hangover. It will make matters worse.
2. Take a tablet of multivitamin tablet.
3. Drink plenty of water or other fluids but avoid orange or grapefruit juice.
4. Many people drink coffee; its efficacy has not been studied but many people recommend avoiding it as its diuretic effect may further worsen the fluid imbalance in the body.
5. Eat light, nutritious food and stay away from greasy, fatty foods. I recommend bananas and yogurt etc.
6. Avoid sauna to relieve hangover. It may sound appealing, but can have adverse effects on your heart and blood pressure.
7. Liv52, an herbal remedy (Himalaya Drug Co., India) has been demonstrated to decrease the symptoms of a hangover. Another study showed that prophylactic use of pyritinol (similar to vitamin B₆) reduces the symptoms of a hangover by about 50 percent.
8. Over the counter medications like acetaminophen, aspirin and ibuprofen are frequently used by hangover sufferers. Tolfenamic acid, a drug with similar pharmacological action, has been shown to ameliorate the symptoms of hangover. It is best to check with your doctor before trying any such remedies.
9. For your own safety and others, don't drive a vehicle or operate heavy machinery.

Other home remedies:

1. Eat bananas, tomatoes and strawberries
2. Eat dry toast with black coffee
3. Take a tablet of vitamin C
4. Drink half a glass of tomato juice with fresh lemon/lime squeezed into it every one to two hours.
5. Take plenty of rest, and if possible sleep.

Bottomline: Drink plenty of fluids, eat a few bites at a time, take 1-2 aspirin and sleep!

What has your experience been with alcohol hangover? Have you tried any tricks or remedies that work best for you? Please feel free to share your tips here with the readers.

How to prevent hangover?

First of all, the only absolute way to prevent alcohol hangover is not to drink at all. Most of us ignore this warning especially since it is known to be good for health also. So let us be realistic especially during the Holiday season since alcohol drinking especially at social gatherings may be a fact of life for most of us.

1. Take a nap in the afternoon before going out for the night.
2. Take a multivitamin tablet before going out.
3. Ladies, don't try to act macho and compete with the guys. I am not being sexist here. Just that biologically speaking, men can tolerate more alcohol than women can, even if they are of same height and weight.
4. Do not mix different types of drinks.
5. Do not drink on empty stomach. Food in the stomach prevents rapid absorption of alcohol into the blood stream. Thus, the more food you have before and during drinking, the less the impact of alcohol.
6. As much as possible, drink "clear" spirits or alcohol. Dark or colored alcohols have small quantities of other toxic substances or congeners that are created during the fermentation process. Congeners are implicated in the causation of hangovers. These congeners include methyl alcohol, aldehydes, histamine, tannins, iron, lead and cobalt.One study showed that for the same amount of alcohol ingested, 33% of bourbon drinkers suffered hangovers, compared to only 3% of those who drank vodka. Brandy, red wine, tequila and rum are more likely to cause hangover than white wine, vodka and gin.
7. Beer lovers have an advantage somewhat. Beer has lesser amount of congeners, although the heavier the beer, the more the congeners.
8. Drink slow. No more than one drink per hour would be a good strategy.
9. Drink plenty of water while drinking alcohol. A simple rule of thumb is to drink one glass of water for every alcoholic drink you have.
10. Avoid coffee while or after drinking. It has diuretic effects and can contribute to dehydration.
11. Do not drink while using sauna. Saunas and alcohol do not mix well together and lead to increased health risk.
12. Make sure to drink water or other fluids such as apple juice or Gatorade before going to sleep, in order to prevent dehydration.
13. Drink less than your normal at high altitudes or when flying in an airplane since you are more likely to get hungover as compared to drinking at sea level.
14. Many hangover prevention pills are on the market but there is limited data to support the use. Artichoke despite the notoriety has not been found to be helpful in controlled studies.

Positive studies of interest (Review article: Pittler et al)

1. Rosiglitazone (Avandia) has been shown to alleviate the symptoms of ethanol-induced hangover in rats.
2. One study examined the use of prophylaxis with tolfenamic acid, an inhibitor of prostaglandin biosynthesis. Subjects consumed alcohol at their own pace. However, they did not measure the amount of alcohol and food ingested.. The intervention group had lower scores of headache, nausea, vomiting, thirst, dry mouth, tremor, and irritation as compared to placebo.
3. Prophylactic use of extract of the Opuntia ficus indica (OFI) plant has also shown promising results. In this double-blind, placebo-controlled, crossover trial involving 64 healthy, young subjects, the investigators found that the symptoms of nausea, dry mouth, and anorexia-were significantly reduced by prophylactic use of 1600 I.U. of OFI. The risk of severe hangover was also reduced by half.
4. Prophylactic use of pyritinol (similar to vitamin B6) reduces the symptoms of a hangover by about 50 percent.
5. Use of a combination preparation containing 250 mg dried yeast, 0.5 mg thiamine nitrate, 0.5 mg pyridoxine hydrochloride, and 0.5 mg riboflavin per tablet has been tested in subjects who consumed vodka equivalent to a total of 100 g absolute alcohol. The yeast preparation resulted in lesser discomfort, restlessness, and impatience.

What causes alcohol hangover?

Alcohol hangover is a poorly understood clinical entity despite its existence since ancient times. Prevention of alcohol hangover is discusssed elsewhere. Treatment of alcohol hangover is of limited help.

Alcohol hangover is multi-factorial and their occurrence is not solely related to the amount of alcohol consumed. The type of spirit is important too because of various impurities or additives in the particular alcohol (methyl alcohol, aldehydes, histamine, tannins, iron, lead and cobalt).

Other factors include drinking on an empty stomach, lack of sleep, psychosocial factors like stress and psychiatric illnesses, increased physical activity while drinking, and dehydration.

Persons in otherwise poor health have a greater likelihood of developing a hangover. Children of alcoholic parents report greater hangover symptoms than the children of non-alcoholics.

There are major gender differences too! Beware, 6 drinks in an 80-kg male and 3-5 drinks in a 60-kg woman will almost always lead to hangover. Simply put, not drinking enough to get drunk will dramatically reduce the likelihood of hangover.

Some people believe that a hangover is nature's way of punishment to prevent future drinking. However, studies have found that hangovers do not deter drinking. In contrast, it may encourage the person to drink more, also known as an "eye opener". One study showed that many people with hangover drink more alcohol to reverse its effects.

From your experience, what do you think causes hangover or is among the important factors causing hangover in you or those around you. Feel free to share an interesting anecdote.