Does choice of drink affect severity of hangovers?

Question

I'm sure there are big effects from obvious things like amount of alcohol consumed, individual susceptibility, hydration, and so on.

But holding all that constant, I've also seen some unsupported claims that different drinks can cause varying severity of hangovers, due to different chemical composition - additives (e.g. sulfites) or other naturally produced organic compounds besides the ethanol.

Easily found mass-media articles (e.g. this one and this one) pretty much exclusively talk about congeners. It's unclear whether that's just because that's the one thing that's been established in studies or because it's the dominant factor, and it's unclear how strong the effects are.

Is there research to either suggest that congeners are the dominant factor (not just one of many), or that there are other factors? And how strong is the variation in severity, whatever the causes may be?

Answer 1

We were taught in medical school that the single biggest contributor to hangovers is dehydration. The degree of dehydration is caused by the percent concentration of ETOH/ethanol which is a diuretic (i.e. it makes you take many trips to restroom.)

Dehydration from drinking causes a drop in cerebral spinal fluid (CSF) pressure. This is why a hangover headache is worse when you sit up or stand up. Your brain has less fluid support and is almost "dangling" on its suspensory supports. (This is an overstatement.)

Thus the effect of a hangover is almost purely correlated to the percent alcohol you are consuming rather than the class.

At the risk of increasing drinking - this also suggests the number one way to avoid a hangover: fluid and salt. If you just drink water, your body cannot hold onto it. If you drink fluid with salt (i.e. gatorade, broth, or similar) - your headache will be substantially diminished because you will counteract the dehydration.

That said - alcohol is also toxic to the brain and liver. That's why your liver can hurt after drinking. If we draw LFTs lab tests on you, your liver enzymes will actually be elevated! (Michael Crichton, the author of Jurassic Park actually did that when he was a medical student at Harvard. You can read about it in his book Travels.) The liver damage is why people get scarred cirrhotic livers. You actually lose brain neurons every time you drink. Unfortunately...that part of the damage is not reversed with Gatorade and may account for some of the headache.