Hangovers: Why they occur and how to avoid them

First, I'll go ahead and say that at the moment, there is probably no full-proof method to avoiding a hangover other than limiting your intake; so drink responsibly!

To begin, we should probably understand why people get hangovers before we try to treat it. Though it's not completely understood, there are several factors that are thought to play important roles in causing hangovers. Dehydration, acetaldehyde intoxication, and things called "congeners," among others, are thought to be a large part of the reason why some people suffer the nasty side effects of alcohol consumption the next morning.

Dehydration
From the evidence I've seen, this might be the most important mechanism of a hangover, and re-hydrating is also the easiest approach to avoid them (other than not drinking, of course). The process by which alcohol causes such drastic dehydration is detailed a little more here. Basically, the alcohol suppresses the release of vasopressin, which in turn decreases the absorption of water in the collecting tubules of the kidney. Fluid is then free to pass straight through your body, depriving your cells of the watery environment they need, and making you feel sick. In fact, people drinking alcohol actually pee out more liquid than they take in.

Acetaldehyde Intoxication
Well, once you start putting poison in your body, it wants to get rid of it. So, your liver works hard by producing multiple enzymes and products, like alcohol dehydrogenase, acetaldehyde dehydrogenase and glutathione to aid in detoxification of the blood. Alcohol dehydrogenase converts alcohol into acetaldehyde, which is then converted to acetic acid by acetaldehyde dehydrogenase and glutathione. Our body does a fantastic job of getting rid of the toxin, that is, until too much alcohol is consumed. Eventually, the gluthione stores in the liver become depleted, resulting in a buildup of the toxin acetaldehyde. And, as you can probably guess, a long exposure to a toxin won't make anyone a happy camper!

Congeners
Turns out, there's more than just ethanol in alcoholic drinks. Surprise! Byproducts of fermentation, called congeners, are present in varying amounts among different types of alcohol. These range from esters and aldehydes, to the acetaldehyde we just talked about, and, interestingly enough, studies have shown they, too, play a role in hangovers. Generally, the more congeners present in an alcoholic beverage, the worse the hangover will be when consumed. Dark liquors, like bourbon, generally have more congeners than clear liquors, like vodka. And, as expected, studies have found that people suffer much milder hangovers when drinking vodka compared to whiskey. Note: The amount of ethanol is much more important in causing hangovers than the amount of congeners, so don't drink more just because you're drinking vodka instead of whiskey one night!

There are likely more reasons for hangovers than this, but my "cures" mostly address these processes.

How to avoid a hangover
Unfortunately, once you have a hangover, your only option is to basically wait it out. Of course, you should drink water and eat food to replenish the things you lost, but that won't be a fast way to get rid of it. The best (current) methods are from being proactive and avoiding a hangover, not treating it. As a result, my best suggestions will be preventative. Here are some ideas:

Don't drink! Okay, well that's probably not a good reason to read all the way through this, but definitely don't go crazy with it.

As I mentioned earlier, dehydration is probably one of the biggest reasons people get hangovers. So all you have to do to help avoid one is drink water then, right? Well, yeah, pretty much. But wait, don't you excrete more liquid when you're drinking alcohol than you take in? So the water will just go straight through you? Exactly, water that goes right through you won't do the best job in re-hydrating you. That's why the best way to combat this would be to drink a bottle of water about 4-5 hours after your last drink, when the alcohol has less of an inhibitory effect on the release of vasopressin. By this time, the water will be able to stay in your system and give your cells the environment they need. Just set an alarm if you'll be sleeping by that time. I'm sure most people would rather wake up for a few minutes than suffer the consequences of what they did that night. In the morning, just have a nice meal and drink some more water or maybe even a sports drink to replace electrolytes and you should be good to go.

As research has indicated, drinking things with fewer congeners results in milder hangovers than drinking things with more. So lean toward drinking your vodkas and rums instead of your whiskeys and tequilas.

There is also research being done in pursuit of a hangover cure. One study combined the enzymes alcohol oxidase and catalase in nanoparticles to combat the effects of alcohol, aiding the breakdown already performed by the liver. The alcohol oxidase breaks the alcohol down into hydrogen peroxide, which is then converted to water and oxygen by the catalase. The research was performed in rats, and showed promise by significantly reducing blood alcohol levels, as well as alanine transaminase, a biological marker for liver damage. This likely won't be on the market any time soon, so don't get your hopes up.

Drinking more alcohol is not an effective way to treat a hangover. It will only delay it, and might even encourage addiction.

That's about all I have to say, so drink responsibly and don't drink and drive!


References:
Rohsenow D, Howland J. The Role of Beverage Congeners in Hangover and Other Residual Effects of Alcohol Intoxication: A Review.Current Drug Abuse Reviews [serial online]. June 2010;3(2):76-79. Available from: Academic Search Alumni Edition, Ipswich, MA.

Orcutt M. Nanocapsules Sober Up Drunken Mice. Technology Review [serial online]. May 2013;116(3):21. Available from: Academic Search Complete, Ipswich, MA

Thirdhand Smoke Causes DNA Damage

Yepp, you read the title right. Researchers from the Lawrence Berkeley National Laboratory found that Thirdhand smoke, not just secondhand smoke, can break DNA strands and can cause oxidative damage to a cell's DNA, which can lead to genetic mutations (and as a result, cancer). Thirdhand smoke refers to the residue produced from smoking cigarettes. You know, the nasty smelly stuff that sticks to your clothes, carpet, counters, and well, just about everything! Exposure to these carcinogens can come from not only ingestion and inhalation, but skin contact as well. And even worse? Studies have found this residue isn't easily eradicated, and that with standard cleaning methods, it can take up to two months to completely get rid of the residue.

                               
If you're interested in the science of how smoke residue could damage DNA, one of the more popular residual ingredients, nicotine, is a carcinogen in that it reacts with nitrous acid to produce nitrosamines like N'-nitrosonornicotine (NNN) and 4-(N-methyl-N-nitrosamino)-4-(3-pyridyl)-1-butanal (NNA), which have mutagenic potential and can react with DNA.

People really argue the smoking bans in public places? Is it really okay to put a person's health at risk because of another's bad habit? There is a tremendous amount of evidence that demonstrates smoking can be harmful (in more ways than one, it seems), so why is it even an issue?

This research is just more evidence that smoking around others who choose to avoid the habit are, well, a little inconsiderate.


References: http://mutage.oxfordjournals.org/content/28/4/381

There's a Cure for Cancer...There's Just no Money in it!!

A funny thing I hear pretty often is that cures for cancer have already been discovered, but the pharmaceutical companies are keeping them to themselves because they wouldn't make any money off of them. A truly face-palm-worthy statement that only serves to highlight the ignorance of the people who mention it.

These people aren't only too ignorant to understand the mechanisms of cancer or fathom a way to treat it, but they also have the audacity to imply an actual cure would be easy and cheap? Funny stuff!

Take, for example, chronic myelogenous leukemia. We know that a translocation between chromosomes 9 and 22 (known as the Philadelphia chromosome) results in the condition of CML. So basically, curing this would require changing someone's DNA (and I'll go ahead and give you a hint that curing likely any cancer would require this, as well). Well guess what, last time I checked, we couldn't willfully change someone's DNA to whatever we desired. If we could, you can bet your bottom that these same pharmaceutical companies that are "hiding our cures" would be marketing it to give people any traits they wanted and would be making bank from it, too. Oh, but they're not, because they can't!

But let's go ahead and assume there is a cure for cancer (there's not) that the big pharmaceutical companies are keeping from us. So why is it that CEOs for these companies fall victim to cancer? Surely they could treat themselves if they knew how! Also, if they're hiding a cure so they can keep charging patients and making money from them, why is it that they can't develop a decent enough treatment to keep them alive long enough to keep charging them? But they can develop a cure? Really? The logic among some astounds me.

Note: I've emphasized the word "cure" several times because I don't think many people really understand the complete implications of the word. You can treat a disease to the point where it isn't harming the patient or causing any problems, but that doesn't mean it's been cured.

The Effect of Alcohol on Renal Collecting Tubule Permeability

Why do you feel like you need to pee so much when you drink alcohol? Well, part of the answer is that you're consuming more liquid than usual, so of course there's going to be more coming out of the other end. But there's more to it than that. I'll go ahead and give a short, simple answer, and then you can read in detail if you want.

In short: Alcohol inhibits the release of a hormone that usually keeps water in the body. So when alcohol is present, water basically just goes straight through you.

Let's start in the brain. The hypothalamus is a very important brain structure with a multitude of different functions in the human body. The function important in this discussion is its role in stimulating the pituitary gland, particularly the posterior pituitary in this case. In the posterior pituitary gland are two main hormones: vasopressin, aka anti-diuretic hormone (ADH), and oxytocin. Normally, the hypothalamus stimulates the pituitary to release vasopressin, which then plays a major role in the kidneys among other things. When you ingest alcohol, however, it interacts with the hypothalamus, resulting in an inhibition of the hormone and ultimately less ADH in the kidneys.

Here's a simple picture of the hypothalamic-pituitary system:



Now we'll move on to what usually happens in the kidney (well, just what's important anyway, there's a lot more to it than this and I don't feel like writing a book!). The kidney is composed of many structures called nephrons. There are about 1 million of these in each kidney! When plasma enters into the kidney, it is filtered in the glomerulus, which is basically just some specialized capillaries. The constituents of the filtered fluid are then either reabsorbed into the bloodstream, or pass through the nephron and into the bladder, where it is eventually excreted. Normally, most of the water that passes through the nephron is eventually reabsorbed. Some of this water is absorbed in the collecting tubule of the nephron, which you can see pictured below. When vasopressin is present, the hormone increases the permeability of these tubules, and thus water is readily absorbed back into the blood. In the absence of vasopressin, the tubules are less permeable, so water isn't as easily absorbed and instead goes into the ureters and then the bladder.



We'll put it all together now. Alcohol interacts with the hypothalamus, inhibiting the release of vasopressin (ADH) from the posterior pituitary gland. As a result, the collecting tubules in the kidney are less permeable to water, so the liquid will be more likely to pass through the nephron, into the bladder, making you have to pee more than usual. It's as simple as that!

The Role of Vaccination in Reducing Infection

The introduction of a number of vaccines across the world in the past century has played a tremendous role in reducing infections, and more importantly, death. From rabies to polio, vaccines have nearly eliminated many pathogens that used to pose a threat to people's lives on a daily basis. Though the ethics and safety of vaccinations (I may write a separate blog on this) have been argued over the years, the one thing that cannot be argued is the role they have played in reducing, and in some cases, eradicating worldwide infection (okay, well, there are people who try to argue this too, but it's better to just ignore them). This can be demonstrated easily with statistics of infections from before and after the introduction of each vaccine.

Smallpox is the perfect example of what we hope to achieve with immunizations. With the proper and complete implementation of smallpox vaccines, the disease was completely eliminated and we no longer need to be immunized against it! Smallpox was no minor illness, either. Just in the 20th century, it was responsible for 300-500 million deaths, as well as millions and millions more throughout history. Now think about that number, and now think how we no longer need to worry about this terrible disease. Thanks to vaccinations, we don't really have to worry about a number of diseases today.

Below are some other examples of how well vaccines are doing their job in reducing infections.

Meningitis (Haemophilus influenzae)
There used to be about 20,000 cases of Haemophilus influenzae (type b) in children and infants each year, but after the introduction of the Hib vaccine in 1987, the incidence of this infection decreased by 98%.

Polio
Through the 1940's and 50's, there was an average of around 16,000 paralytic cases of polio each year just in the United States. Paralysis was only seen in about 1% of cases, though, with more people being asymptomatic or experiencing mild symptoms. Still, the virus spread so easily that thousands were severely affected each year. Just ten years after the introduction of the Salk vaccine in the United States, only 61 cases had been reported. Although the United States experienced a lot of success from the vaccine, the rest of the world was still experiencing the polio endemic through the 80's, until the World Health Organization decided to try and eradicate the disease in 1988. Since then, the worldwide totals have declined from 350,000 cases to just 187 in 2012, nearing ever so closely to the goal of eradication.

Here is a nice graph of the cases of polio in the United States.

Diphtheria
There were about 200,000 cases of diphtheria each year in the U.S. before a vaccine was developed. Now, there have only been 5 total cases in the past 10 years!

Mumps
Mumps is a (usually) mild virus that is covered by our MMR (Measles, Mumps and Rubella) vaccine. It is a major cause of deafness in children though, and can also cause orchitis (swelling of the testes) in males. Before a vaccine was developed, we saw about 300,000 cases each year, reduced to under 300 cases in 2001.

Hepatitis B
The Hepatitis B Virus has infected 2 billion people in the world at some point. 2 billion! This is a virus that is associated with liver problems, and about 25% of people who catch it would be expected to die as a result of it sometime in their lives. In the 80's, more than 450,000 people were infected with the virus each year. Now, this number has been reduced to less than 80,000 each year thanks to vaccination.

Rubella
Rubella, another virus covered by the MMR vaccine, is heavily associated with causing miscarriages and birth defects in pregnant women who acquire the illness. In 1964, before routine use of a vaccine against Rubella, there were 11,000 miscarriages and 20,000 infants born with defects as a result of the virus. By 2,000, there were only 6 reported cases.

These are only a few of the illnesses covered by vaccines today. To learn about more, I'd suggest visiting CDC-Vaccine-Preventable Diseases

Well since we barely see these things anymore, can't we just stop vaccinating?

Well, no. Luckily there were other places "courageous" enough to have this same line of thinking to make answering this easier. Sure we're seeing fewer and fewer cases through the years, but this doesn't mean the pathogenic agent has just disappeared, and it certainly doesn't mean it can't easily be brought over from another country. Take, for example, the Soviet Union. Before its collapse, it had similar vaccination programs to ours, and as a result, the diseases vaccinated against were uncommon. But, when the USSR collapsed, several things went with it, including their record keeping and the standards of their immunization program. Shortly after, the area experienced an epidemic of diphtheria, with about 200,000 cases being reported.

Japan also provided a wonderful example of why you can't just stop vaccinating until a pathogen is completely eradicated. In the 70's, rumors spread about the pertussis vaccine's efficacy and safety, so people stopped getting them. In just a few years, the incidence of pertussis in Japan increased by 3,200%! And, of course, shortly after, Japan's government learned from their mistake and began mandating the vaccine.

I know people who don't get vaccinated, and they've never caught any of these things.

Of course not everyone is going to catch these illnesses, that would still be the case even if nobody got vaccinated. The fact is that people who are immunized are less likely to become sick, and in the event that they still do, they most often suffer very mild symptoms compared to their unvaccinated counterparts. People who do not get vaccinated fortunately still benefit from everyone else that does, a concept known as herd immunity. In herd immunity, the large majority of a population is immune to a pathogen, thus, it is much harder for said pathogen to transmit person to person and infect those who aren't immune. If everyone stopped getting immunizations, herd immunity would soon become irrelevant. Wiki has a nice table demonstrating how many people need to be immunized for herd immunity to be effective. 


Conclusion: vaccination is important!

Case Fatality Rates and Modern Medicine's Role in Reducing them

I have read a few places recently where people have pointed out that medicine is ineffective, doesn't work, there's no point in using it, etc.Well, you'd have to be pretty ignorant to believe that, but it made me wonder just how our infections might be if we didn't receive the treatments we have available today. I figured a good indication of that would be to compare the case fatality rates of untreated diseases to those that were treated. If a treatment significantly reduces the CFR, it's obviously doing its job. This doesn't even take into account the less-severe symptoms that are usually experienced when treated, but that's a lot more subjective and harder to judge with numbers. I wasn't able to find a comprehensive list of what I was looking for so I have decided to compose a list of different diseases including their case fatality rates when left untreated as well as the CFR when they are treated. Below I have highlighted a few things, and at the bottom is the table of multiple diseases and their CFRs. I plan on adding more and updating this over time.

Ebola
The Ebola virus is weird because we still don't even know where it come from. We are sure of a few things, though. It's found in Africa and it's almost certainly a zoonosis, meaning it comes from an animal. The case fatality rates among incidence of the ebola virus averages about 68%, though it varies from 30-90% depending on the outbreak. Most current treatment is just supportive, though there has been research on a treatment (in rhesus monkeys) which reduced the CFR to 33%. The strain used in the research previously had a CFR of almost 100%.

Bubonic Plague
Yersinia pestis is the culprit here, and when treated, only causes death in 1-15% of infected individuals. When left untreated, it's associated with a 40-60% fatality rate. With modern medicine and sanitary habits, this organism doesn't really cause many problems. This is the same organism that is thought to have wiped out 1/3 of Europe's population in the 14th century!

Smallpox
The Smallpox virus was declared officially eradicated in 1979. Now, only a select few places are holding onto the virus (one being the CDC), and they are under secure protection to prevent bio-terrorist events. When smallpox was prevalent, a CFR of about 30% was observed. This varied, however, with some strains being almost a guaranteed death. Even people who are vaccinated can be susceptible to the disease they've been immunized against, and this was no different for smallpox. However, those who are vaccinated typically experience milder symptoms, as is supported by the lower, 3% CFR of people who contracted the virus that had been previously immunized against it.

                                        An average case of smallpox. Glad this isn't still around!

HIV/AIDS
It is true that an infection of HIV doesn't directly kill you. This in no way means that it's not deadly, though. HIV infects and destroys your CD4+ Helper T Cells to a point that it renders your immune system useless. Once a person's CD4+ count drops to a certain point (<400/uL), they are diagnosed with AIDS. Without a properly functioning immune system, a person is susceptible to being severely infected by pathogens that normal people live with each and every day without any problems, such as Pneumocystis jiroveci and Candida albicans. Treatment is continuing to improve, fortunately. Twenty years ago, only 20% of people diagnosed with the condition could expect to live for 5 years. Now, that number is over 80%.

Cancer
Cancer is a debilitating condition caused by the uncontrolled growth of abnormal cells. When it goes untreated, it will almost always eventually result in death because it impairs the normal function of the body. Early detection of cancer is the best thing you can do to stop it. Cancer becomes more deadly the longer you leave it uncontrolled, and by the time it metastasizes it will be deadly more often than not, even when given the best treatments. Many years ago, being diagnosed with cancer was basically a death sentence. With today's treatments, many people will survive the illness without a problem, especially when caught early. There is so much promising research being done that I believe will essentially make cancer a non-issue in the future. Because of the relative difficulty of finding cases that went untreated combined with the fact it is almost always deadly when not treated, I didn't fill in the CFR (untreated) section for cancers.

Note: Though case fatality rate and mortality rate aren't technically the same, you will often see them used synonymously. Case fatality rate refers to how likely an infection will result in death. For example, 100 people are diagnosed with AIDS, and 50 die, giving a CFR of 50%. Mortality rate is the measurement of deaths in a population. For example, AIDS kills 2.7 out of every 100,000 people.

Disease	CFR (untreated)	CFR (treated/vaccinated)
Acute Lymphoblastic Leukemia	---	15%*
Acute Myelocytic Leukemia	---	30-40%*
Bone Cancer	---	30%*
Breast Cancer	---	16%*
Bubonic Plague	40-60%	1-15%
Chronic Myelocytic Leukemia	---	20-40%*
Colorectal Cancer	---	41%*
Diphtheria	5-20%	0%
Ebola	68%	---
HIV/AIDS	80-90% (5 yrs)	15% (5 yrs)
Leishmaniasis	10%	0%
Liver Cancer	---	72%*
Malaria (P. falciparum)	20-25%	<1%
Measles	15-25%	0-1%
Melanoma	---	21%**
Pertussis	3.7%	0-1%
Prostate Cancer	---	1%*, 2%**
Rabies	~100%	~0%
Smallpox	30%	3% (vaccine)
Syphilis	25%	0%
Testicular Cancer	---	1-4%*
Tetanus	58%	0-10%
Trypanosomiasis	80%	6%
Tuberculosis (active)	>50%	<18%

Note: Cancer numbers are fatality rates, not survival rates
*Cancer CFRs based on a 5 year survival rate among early stages (through stage 2)
**Cancer CFRs based on a 10 year survival rate among early stages (through stage 2)

References

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA430462
http://www.cancer.org/
http://emedicine.medscape.com/article/829233-overview#a0199
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9557424
http://www.mass.gov/eohhs/docs/dph/aids/2006-profiles/dying-aids.pdf
http://ci.vbi.vt.edu/pathinfo/pathogens/falciparum.html

My First Blog

I don't plan on posting that much (then again I don't really know how much is considered often since this is my first blogging experience), but I figured this would be a nice place to gather my thoughts, ideas and research. It won't be too boring (or so Kaitlin assured me), so feel free to read!