Never again...

Ever wondered what's causing you all that pain the morning after the night before? Michael Foxton, who wrote our junior doctor column, on the biochemistry of hangovers

I can't help feeling that medical science has somehow failed to engage with the more serious problems of our age. For example, how is it possible that two different forms of booze, such as whisky and vodka, both containing the exact same booze molecule, can promote two completely different brands of drunkeness?

I mean, pharmacodynamically speaking, however long ago medical school was, I can understand how a slow afternoon spent drinking warm, flat English beer might give a different plasma-concentration profile over time than the sudden, practically intravenous blast of alcohol from champagne. But somehow all those boffins, far more intelligent than me, in their clever academic teaching-hospital jobs, seem to have neglected the important questions. Like the whisky-vodka paradox.

Right now, for example, I have a hangover. Apparently I'm not alone. According to reports last week, three out of 10 people in the UK binge-drink - more than a bottle of wine in one sitting. That's five times more than our more decorous cousins across the channel. Alcohol related crime costs £7.3bn a year, and 17m working days are lost to hangovers, at a cost to employers of £6.4bn, along with 2m NHS bed days.

If that wasn't enough, according to another study last week, it now seems that women get worse hangovers than men, although that could just be because they're smaller, or have a lower pain threshold: it was a self-report questionnaire, after all. But maybe they have some weird physiological susceptibility. I don't know. Nobody knows. Collectively - and I shoulder my fair portion of the blame - we might know a lot about cancer, but we have neglected the most important questions.

So back to my hangover. If there was any sense of order or justice in the world, after five years at medical school, I'd be able to offer myself some kind of prescription or advice, preferably more imaginative than abstinence, to relieve this biblical misery. I am not entirely empty-handed. Allow me, as a form of penitence, to present you with the very best that modern medical science can offer on the subject.

It's a bit thin. But in the manner of a degenerate's textbook of medicine, let me give you, in order, the symptoms, pathology, and gold-standard management of the syndrome. The symptoms, I can tell you for nothing, are nausea, dehydration, headache, aches and pains, fatigue and, lastly, paradoxically, and perhaps most cruelly, restlessness.

Alcohol is an evil blunderbuss of a drug. Any other drug, like frusemide, or amphetamine, is taken in a teeny pill, where each molecule runs to its little receptor to exert its effect. Which is not to say that either of them are safer. But when you drink, as I did last night, a 40% alcohol drink such as whisky, then 40% of what you ingest is pure drug. In the case of a litre bottle, which two of us unwisely made a pretty good stab at polishing off between us, that's more than a Coke can of pure drug. It doesn't go to a neat little receptor site. It enters every cell in your body and stops it working properly, and just happens to hit the GABA cells in your brain first, rendering the subject, for want of a better word, pissed.

But it's what happens afterwards that we're interested in. Alcohol is broken down in the liver, first to acetaldehyde, and then to ethanoic acid, or vinegar. Acetaldehyde can cause sweats, flushes, nausea, vomiting, and a rapid pulse: in most people it probably gets turned into vinegar pretty quickly, but hangs around long enough to have an effect.

However, the yeast that makes naturally fermented alcohol produces a mixture of ethanol and methanol. Methanol is worked on by the same enzymes that break down ethanol, but to make formaldehyde and formic acid. Formic acid is the same stuff as what's in ant sting, and it is, as molecules go, no fun at all. Not that I'm recommending hair of the dog, but you might want to bear in mind that alcohol dehydrogenase prefers to work on ethanol than methanol, so it only moves on to the methanol when all the ethanol is gone. So if you can get another drink down you before the ethanol runs out of your system, you can stop the enzyme even getting a look at the methanol, and avoid bathing every tissue in your body in ant sting, putting off the inevitable, or hoping you can keep it up long enough for the methanol to come out in your kidneys.

But alcohol's got a few more tricks up its sleeve. It causes increased acid production in the stomach and irritates the stomach lining, causing gastritis. Word that something bad is afoot down below gets sent from here to the vomiting centre of the medulla in the brain, making you feel nauseous and, if you're unlucky, bring it all back. There are pills to manage this if you're really determined, but we can talk about that later.

The dehydration is a nasty one. Alcohol messes with anti-diuretic hormone to make you piss all your water away: that's why your wee stops being yellow. As well as dehydration, you get electrolyte imbalances, made worse by diarrhoea, vomiting, and sweating. Worried yet? Drink a pint of water, or maybe reach for the first-aid travelling pack and pinch some dioralyte. The World Health Organisation's oral rehydration recipe, one pint of water with a teaspoon of salt and eight of sugar, is the intervention that has saved more lives than any other in the history of mankind, and by God can you taste the goodness.

The fatigue is largely sleep deprivation. Alcohol is a sedative that promotes sleep onset, but when it wears off you get rebound excitation. That's the bit where you wake up inexplicably in the middle of the night, sweating. You get less rapid eye movement (REM) sleep, and more slow-wave sleep, but alcohol also relaxes the throat muscles, causing snoring and sometimes sleep apnoea, or rather, every now and then you just stop breathing for a while. Not a good night's sleep. Especially when it also messes with your thermostat, making your body temperature abnormally low with intoxication, and abnormally high with the hangover. Oh, and it also interferes with growth-hormone production, all you stunted alcopop kids.

Lastly, there's that headache to deal with. Remember your head is sitting in a bath of ant sting. All that stuff about the dehydration making your brain shrink and rattle around inside your skull is made up, although it is a very arresting visual metaphor. If anything, it looks like the vasodilatory effects of alcohol make the pressure in your skull higher. That would certainly account for the pulsating effect. And it has also been shown that red wine, because of the stuff in it other than alcohol, can increase plasma histamine and serotonin levels, which can trigger headaches in susceptible people. Pass the paracetamol.

Drugs have nasty side effects and can make things far worse. But let's say you were on a sudden, unexpected, time-critical mission (for the SAS perhaps, or you had the opportunity to eradicate third-world debt and end the arms trade before lunchtime) and you wanted to throw caution to the wind and risk taking a nasty blend of dodgy pharmaceuticals, with all their side effects, to render yourself fleetingly functional again - it would be this:

* a proton pump inhibitor for the gastritis (which will give you nasty gastro side effects and mask your ulcers and stomach cancer in the long run)

* a non-steroidal for the pain (and to make your gastritis even more dangerous)

* an anti-emetic for the nausea (treat yourself to ondansetron - you're worth it - but watch out for the constipation, headache, hypersensitivity, transient visual disturbances and dizziness, involuntary movements, seizures, chest pain, arrhythmias, hypotension and bradycardia); or maybe just have a fry-up

* caffeine for the fatigue

* sugar for the low glucose

* fluids, perhaps intravenously, for the dehydration, or at least the WHO rehydration fluid

* there's always dialysis for when you get back from the pub

* you could try milk thistle, raw egg, drinking a Slush Puppy, eating Skips, or visit and try breast milk, voodoo on the cork, rabbit-poo tea, bitter almonds and dried eel

* on the other hand, you could just have some toast, a pint of water, and try to drink more sensibly. Like I do.

·To order a copy of Bedside Stories by Michael Foxton for £7.99 with free UK p&p, call the Guardian Book Service on 0870 066 7850.