Tylenol for a Hangover = Toxic Liver!?

Having too much alcohol at a celebration is a sure-fire path to a next-morning hangover.  Headache, fuzzy thinking, dry mouth, nausea, poor focus, dizziness, GI upset….  All of these are evidence that our body is overcome with toxicity.

TSA cocktailMost people choose to consume an alcoholic beverage because of its numbing effect on the brain.  However, it is the liver which must deal with the bulk of alcohol (ethanol) detoxification. We each have varying levels of alcohol tolerance depending on our unique liver’s ability to process and get rid of a toxic alcohol metabolite called acetaldehyde.  Plus the liver may also be dealing with beverages’ other ingredients (e.g. tannins in red wine or chemical conditioner used in the barrels of aged whiskeys).

The liver has several biochemical pathways down which substances are processed to prepare them for exiting the body.  This is true for externally acquired toxins (e.g. drugs, heavy metals, pesticides) as well as internal substances that must be tightly regulated (e.g. hormones).  A very specific pathway for each substance must be open and nutritionally supported to prevent that substance from building up in the body and causing inflammatory symptoms or damaging the liver.  When multiple substances are competing for the same pathway and “clogging up the works” (think: too many cars trying to get on the turnpike at once), detoxification can slow, and the body suffers from the back-up and overload.  This is the primary reason for many contraindications against various combinations of drugs.

In response to a hangover, many people might reach for an over-the-counter “painkiller” drug (typically a non-steroidal anti-inflammatory drug) such as Advil, Motrin, or Tylenol.  But in the case of a hangover (in anticipation of or in reaction to one), especially a potent one, the choice can make the difference between relief and toxic misery.  Acetaminophen’s (the active ingredient in Tylenol) primary metabolite is also very toxic and uses the same liver enzyme pathway for detoxification as acetaldehyde (for the clinically minded, this is CYP2E1).  If the liver is too busy and overwhelmed?  Acetaminophen toxicity!  The first phase of this usually begins within a few hours of intake and can include nausea, vomiting and sweating.  Unfortunately these symptoms are often ignored as classic consequences of drinking too much. But if the toxicity progresses to phase 2, it will involve major upper-right-hand torso pain as the liver itself is damaged, along with malaise, confusion, and anxiety.  Unfortunately the progressive symptoms can motivate a person to take even more of the drug!  This can begin to put significant pressure on kidney function as well.   Other drugs can be competing, as well as other supplement or food substances (in this case, St. Johns Wort or significant amount of garlic – both poor choices to include alongside alcohol) which further exacerbates the risk of liver damage or dangerous and unanticipated drug overload/reduction in the body.

If you go to the emergency room with acetaminophen poisoning (which happens many thousands of times each year in the US), the ER staff will nearly always give you exactly what your liver needs to boost one of the clogged pathways and allow the liver to function:  n-acetyl cysteine (aka “NAC”).  NAC is a common, inexpensive supplement that boosts our level of a key amino acid called cysteine.  We need cysteine and other key aminos and minerals to make glutathione, a key detoxifier and extremely potent antioxidant which also happens to process acetaminophen’s metabolites.

Even in the absence of a medical emergency, however, ongoing intake of acetaminophen can be having a strong, damaging impact on the liver.  Acetaminophen is already potentially more toxic and dangerous than most of our clients realize.  The recommended max daily dose on the bottle is right at the acknowledged liver toxicity threshold!  And when pathways are clogged with other toxic tasks, toxicity can develop more quickly.  Unfortunately the other primary “painkiller” alternative, ibuprofen (e.g. Advil, Aleve), can have significant toxic effects on the GI tract such as internal bleeding.  Thus those with a sensitive gut and/or concerns about IBS, ulcers, etc. often choose acetaminophen.  Overall, this is a great reminder that just because something is sold over-the-counter does not make it safe to use…much less use regularly or liberally.  We help our clients to find specific, natural anti-inflammatory alternatives to these kind of drugs depending on their unique body and specific symptoms (yes, ones that work!).

If you want to know more about specific ways to minimize “hangover” after a night of celebration, check out this related article.

If you’d like to learn more about clinical research into hangover relief, check this out.  It’s a Scientific American article that both clinical and lay readers will appreciate.