The role of thiamine (vitamin B1) in preventing hangovers
Causes of Hangovers Consequences The Role of Thiamine Avoiding Alcohol-Induced Brain Damage The Serious Drinker's Approach Dosage Source Collateral_Issues The Politics of Thiamine Postscript Related Web Pages
Several factors are responsible for "hangovers" which are the most obvious evidence that alcohol consumption has caused injury. These causal factors include alcoholic dehydration of the brain, high levels of intermediate metabolites of alcohol in the blood (but not alcohol itself), and the neurological consequences of thiamine depletion. Hangovers are avoidable because all of these collateral effects of alcohol consumption are avoidable.
The long-term effects of the damage to which a hangover alerts you include all the classic symptoms of advanced alcoholism. "Hard cases" who over a long period, tend to drink rather than eat and tend to imbibe volumes of spirits or fortified wines, exhibit muscle wasting, impaired speech, memory and reasoning, show ataxic (stiff and awkward) gait, enlarged liver (a liver that can be felt distinctly beneath the diaphragm) and numerous spider naevi (distended skin capillaries radiating from a single point like legs of a spider - don't worry if you have a couple, most people do. Advanced alcoholics have hundreds.)
Chronic heavy drinkers who do eat sufficiently, and particularly those who drink beer, unfortified wine or diluted spirit drinks, may exhibit less or perhaps even none of the above symptoms to a casual observer (if you don't have a bit of a feel of their liver!) but remain at risk of the same brain disorder. That is the condition known as Wernicke-Korsakoff syndrome.
The typical Wernicke-Korsakoff patient may have been living a relatively normal life, holding down a responsible, even complex job, but has a history of chronic alcohol abuse. They will have developed a slowly encroaching memory deficit, but since this does not apply to pre-existing knowledge or skills, it may have passed unnoticed. After one final binge, (otherwise undistinguished from many, many previous binges) they awake the next morning paralysed, severely confused and unable to speak. If they survive this "Wernicke" phase that may last several weeks, (and quite a few die) they enter the "Korsakoff" phase. They recover the use of most of their faculties, can speak and walk (at least as well as they could before) but part of their minds have been destroyed (apparently damage to the diencephalon/amygdala area of the midbrain.) These patients suffer amnesia, lose the ability to learn anything, and become passive, helpless basket cases. Their condition is both irreversible and largely untreatable.
The greatest tragedy is that Wernicke-Korsakoff syndrome is totally preventable, and is only indirectly attributable to chronic alcohol consumption. The direct cause of this syndrome is depletion of thiamine (vitamin B1).
Thiamine is one of a group of water soluble vitamins. It is heat-stable, but light-labile, meaning that it is unaffected by cooking but destroyed by sunlight. Being water-soluble, you cannot overdose on thiamine. If you consume an excess, you simply excrete the surplus in your urine. The only side effect of excessive consumption seems to be a few pimples, (acne bacteria love thiamine!) and at ten or twenty times the dose recommended here (!), a slight smell of sulphur in one's sweat, (although the volunteers who reported this were journalists, so the smell of sulphur may have had a more infernal origin!)
Thiamine is found naturally in a number of foods, particularly cereals and grains, and yeast. Bread, rice, peas, beans, nuts, vegemite, and breakfast cereals all contain thiamine, but so do animal tissues, especially pork. Wholemeal bread and brown rice are particularly good ways to obtain it.
All animals other than ruminants need a supply of thiamine in their diet, (which means by definition, thiamine is a vitamin for them.) In humans, the non-alcohol related dietary deficiency condition is called beriberi, which is characterised by weight loss, muscle wasting, neurological dysfunction including sensory and reflex functions and a characteristic masking oedema - the cause of the swollen abdomen of children often pictured in famine ravaged countries. Less than 1mg per day will totally prevent beriberi, and apparently many Western diets (excluding people who eat enriched breakfast cereals) provide less than 0.8mg per day with apparently little ill effect.
Thiamine also is produced during fermentation to make beer, (hence amber bottles to protect the thiamine from light.) The German government sensibly legislated centuries ago that this process not be interfered with, preserving not only taste but the essential vitamin. No such wisdom prevails in this country however, and chemical treatments such as clarification remove much of the thiamine from Australian brews.
Bavarians may be fat, but you don't find many with Wernicke-Korsakoff syndrome.
Thiamine is a vitamin essential to two entirely separate processes in humans: it is required for the oxygen-dependent part of the metabolism of carbohydrates (and alcohol) to produce energy and thiamine is also required for the membrane polarisation /depolarisation step in nerve transmission, (interestingly, the actual thiamine-dependent step is the same one blocked by the puffer fish nerve poison, tetrodotoxin.)
The effect of these two separate processes that both require thiamine means that alcohol consumption under conditions where the vitamin is limited, diverts available thiamine away from the brain to break down the alcohol. After this is exhausted, alcohol remaining is converted to fat, but in the interim, high levels of intermediate products of alcohol breakdown (prior to the thiamine-dependent step) float around in the blood and enter the brain. In order to dilute the alcohol and its breakdown products, water is drawn out of the tissues (including the brain) into the blood, dehydrating these tissues.
Clinical data indicates that 3mg thiamine per stubby of beer (375ml) is more than sufficient to prevent Wernicke-Korsakoff syndrome and around 90% of alcoholic brain damage, however hitherto unpublished findings of this researcher indicate that optimum hangover-eliminating doses are considerably larger.
This evidence would suggest that a third thiamine-dependent process may be a factor in hangovers. The most likely candidate appears to be a multienzyme complex called alpha-ketoglutarate dehydrogenase, which not only catalyses a critical thiamine-dependent step in the energy producing breakdown of alcohol, but is also at a point at which amino acid and carbohydrate metabolism interact. The substrate of this enzyme complex, alpha-ketoglutarate, can be converted to glutamate which in turn can be converted to gamma-aminobutyric acid, (GABA) an inhibitory neurotransmitter and the active metabolite of gamma-hydroxybutyrate, (GHB) with the street drug name "Fantasy".
It is because of this metabolic link that, while essential for normal brain function, glutamate is toxic in excess, (as anyone who has become ill after eating Chinese food with mono-sodium glutamate (MSG) can attest!)
Inhibition of alpha-ketoglutarate dehydrogenase under conditions of limited thiamine is likely to lead to a build-up of alpha-ketoglutarate formed from alcohol, which would be expected to drive the production of the alternative uninhibited glutamate pathway and hence to increase GABA production.
Speculation suggests that the much larger doses of thiamine than are necessary to prevent Wernicke-Korsakoff syndrome may substantially enhance the activity of alpha-ketoglutarate dehydrogenase and so prevent a build up of glutamate and hence GABA in the cerebellum of the brain.
This hypothesis might account for the observation that large thiamine doses during alcoholic binges also tend to reduce nausea and dizziness during drinking as well as reducing or eliminating headaches and memory loss the next day.
Maybe someone who goes to a particularly cheap and nasty Chinese Takeaway that uses MSG could try taking thiamine when they eat it and let me know if they still get a headache or feel sick!
Taking a thiamine supplement and restoring at least a measure of water balance is all that is necessary to prevent Wernicke-Korsakoff syndrome, and much of the damage your brain would otherwise suffer. (Of course, you can't expect to soak your brain in a poison for decades and show no effects, but if you take adequate thiamine you'll probably have died of something else long before you notice too much mental deterioration!)
Not surprisingly, all volunteers from studies conducted also report that taking sufficient thiamine will either substantially reduce or eliminate hangovers.
First, eat well. Combine a hearty mixture of the five food groups with special emphasis on wholemeal bread and brown rice. Lunch before an expected binge should also include vegemite or other yeast extract. Whilst drinking try to eat party/bar snacks containing cereals or eat "beer nuts" (it's those salty red husks that seem to go everywhere that contain most of the thiamine!) Second, try to take a thiamine tablet 40-60 minutes before the first drink (alcohol reduces thiamine absorption and besides, you may throw up later!) However, thiamine tablets anytime during the evening with food are OK. Third, before you go to bed, drink at least two large glasses of water and take another to bed with you, (along with a bucket if you are unfamiliar with your alcohol capacity.)
If you have any doubts about your thiamine intake, take another tablet at this point, (God knows, they're cheaper than a brain transplant!)
Finally, the next day during the recovery, try to restore your overall vitamin levels with a general multivitamin supplement which should include riboflavin (Vit B2, from green leafy vegetables or wheat germ) and special attention to that tasty favourite, wholemeal bread. For the truly dedicated sozzler, another tablet of thiamine may also be appropriate at this point.
A note of caution at this point: when to eat during the recovery seems to be a matter of individual preference, but from long personal experience, if you feel sick, I suggest that you consume nothing but small sips of room temperature water until this feeling subsides. The above recommendations for eating the next day should only be followed when you feel like eating. Don't rush it or... blugh!
The following is a useful guide to your thiamine supplementation:
100mg thiamine tablets are available from pharmacies at minimal cost. In Australia, "Betamin" seems to be the cheapest brand, typically costing around AUD$5 for 100 x 100mg tablets. For comparison purposes, you would have to eat around half a large jar of Vegemite to get the equivalent of a couple of Betamin tablets and each of these 5c tablets contains as much thiamine as four Beroccas.
Thiamine disulphides are actually better absorbed orally than the unmodified vitamin, as once alcohol consumption has started absorption can fall by up to 50%. However, these are more expensive and are only freely available in Japan. An alternate strategy is to increase thiamine dose per drink with increasing drink numbers or with increasing drink alcohol content. Roughly speaking, double thiamine dose when drinking straight spirits.
Production of synthetic thiamine is dominated by two companies: Roche Pharmaceuticals which accounts for 90% of world production and the Takita Chemical Company in Japan which makes the other 10% and also makes a number of useful bioactive disulphide derivatives.
Taking thiamine will not protect you against other possible health effects of chronic alcohol over consumption such as heart problems, cirrhosis of the liver, bowel cancer etc., but at least you'll be aware that you have them! (However, consuming generous quantities of wholemeal bread, brown rice and other cereals also means you will be eating a diet high in soluble and insoluble fibre, so this may be compensatory in actually preventing cardio-vascular disease and colonic cancer.)
In Australia, breakfast cereals and white flour are fortified with thiamine. The latter follows from Australian National Health and Medical Research Council recommendations of a decade or so ago. At the time, the NH & MRC also recommended that thiamine also be added to Australian beer and cask wine, however opposition from the brewing and wine producing industry led to this recommendation not being adopted.
The opposition from the "alcohol industry" to a move to make their products medically safer is particularly difficult to comprehend, given that the cost to them would be minuscule and such a move would effectively eliminate all new Wernicke-Korsakoff cases in the country and would massively reduce the medical and social cost of alcohol to the community.
Estimates by one research team several years ago put the cost of the thousands of W-K cases that clutter our psychiatric institutions, the additional costs to the public health system of other thiamine-depletion related conditions and the cost of working days lost to hangovers at up to AUD$600 million annually in Australia.
This figure can be contrasted with a cent or two on the price of a stubby of beer (375 ml) necessary to totally eliminate the problem.
The only reason that we haven't seen class actions by Wernicke-Korsakoff patients against breweries is probably because their mental condition requires them all to be institutionalised!
For those readers resident in Australia, if you can find the time, why not write to the Managing Director of Castlemaine-Tooheys or of Carlton and United and ask them why they think a few cents on the price of beer is more important than their consumers' health and wellbeing?
Rest assured that each of the aforesaid doses is the result of meticulous empirical studies by the author and a dedicated team of selfless volunteers.
In the interests of science, I and my fellow Grogonauts have tested the efficacy of these thiamine protocols regardless of personal risk or moral threat, in extraordinary circumstances of individual courage and sacrifice.
In fact, perhaps some of the largest doses of thiamine known to humanity have been quaffed by my research team and I, in our iron-willed determination to discover the truth, (inter alia, inter pocula!)
Thanks to this scientific Odyssey, be you Rechabite or Libertine, you may imbibe secure in the knowledge that the outer reaches of the human capacity to utilise thiamine have been plumbed and those concerned have returned safely to lead useful, or at least relatively useful lives.*
Vita brevis, vino longa!
Richard H Howard
* Statistically insignificant drooling vegetables were excluded from our conclusions.
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