Herbal cures for hangover

*Blend of sweet lime, pear, mango, ginger, thyme, coconut water could be used to overcome the alcohol-induced condition

The Yuletide is here again! It is a period associated with overindulgence in ‘drinks’ and unhealthy foods with the attendant hangover and pilling up of kilogrammes.

Hangover or veisalgia is the term that refers to the psychological and physiological effects following alcohol consumption. It is characterised by an unpleasant and uneasy feeling that includes, but is not limited to, headache, fatigue, drowsiness, nausea, and in some cases, vomiting.

Overconsumption of alcoholic beverages is a well-recognised contributor to a variety of health problems and may cause function disorders of major organs such as the liver, brain, heart, lung, and prostate.

To address the menace, several natural products have shown effective protection against alcohol-induced injuries and significant attenuation of hangover symptoms in several animal models and limited human tests. Alcohol levels in the blood were reduced, the hangover symptoms scores were lowered and the biochemical marks of liver injury were restored with natural plant treatments, and the mechanisms of action are mainly anti-oxidative and anti-inflammation.

In addition, several natural products could be effective in reducing voluntary alcohol intake, improving alcohol-drinking behaviors, and attenuating withdrawal syndromes of alcohol use disorder. Natural products have shown wide prospects for the prevention and treatment of hangover and alcohol use disorder.

Top on the list of herbal cures for alcohol hangover is Phyllanthus amarus. Scientists have validated a local plant, Phyllanthus amarus, to provide relief to hangover symptoms.

Also, a beverage made from a blend of sweet lime, pear, mango peel, ginger, thyme, dates, and coconut water could be used to overcome hangover, and the consumption of this beverage with cheese, cucumber, and tomatoes may further alleviate the hangover symptoms.

Phyllanthus amarus belongs to the plant family Euphorbiaceae. To the Efik it is called oyomokeso amanke edem; geeron-tsuntsaayee (birds millet) in Hausa; Ibo (Asaba) buchi oro, Ibo (Umuahia) ngwu; iyeke in Urhobo; and ehin olobe or eyin olobe in Yoruba.

The study titled “Effects of Phyllanthus amarus PHYLLPRO TM leaves on hangover symptoms: a randomized, double-blind, placebo-controlled crossover study’ was published in the journal Pharmaceutical Biology.

The researchers from the Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Biotropics Malaysia Berhad, Selangor, Malaysia; Medicus Research LLC, Northridge, CA, USA; and Centre for Sports and Exercise Sciences, Exercise Science, University of Malaya, Kuala Lumpur, Malaysia concluded: “The results of this study suggest that this product may be of interest to generally healthy adults for the treatment of hangover symptoms and for protection against oxidative stress induced by various assaults. Further research is still needed to confirm the mechanism of action of PHYLLPRO TM, however, and to study its effects in older individuals and in individuals drinking varying amounts of alcohol.”

Until now, Phyllanthus amarus is traditionally known to improve general liver health. However, its effect on a hangover is unknown. This study evaluated PHYLLPRO™, a standardised ethanol extract of P. amarus leaves for protection against oxidative stress and recovery from hangover symptoms.

Ten days daily oral supplementation of 750 mg/day followed by intoxication was evaluated in a randomized placebo-controlled (containing the only excipient), crossover study in 15 subjects (21–50 years old), for oxidative stress, liver damage, alleviating hangover symptoms (Hangover Severity Score: HSS) and mood improvement (Profile-of-Mood-Scores: POMS).

The results showed PHYLLPRO™ was able to remove blood alcohol in the active group while the placebo group still had 0.05 per cent at 12 hour post-intoxication. For HSS, the active group showed reduced hangover symptoms while there were higher levels of nausea, headache, anorexia, tremulousness, diarrhoea and dizziness in the placebo group at hour 10 post-intoxication.

Increased fatigue at hour two and tension from baseline to hour 22 was reported in the placebo group using POMS. Significant anti-inflammatory group effect favouring the active group, by the upregulation of cytokines IL-8 and IL-10 and immune-modulatory effects via IL-12p70 were observed. The incidence of adverse events was similar between groups indicating the safety of PHYLLPRO™.

Phyllanthus amarus is traditionally used for the treatment of hepatitis and jaundice, and for general liver health, among other uses. Constituents of P. amarus include lignans, phyllanthin, hypophyllanthin phyltetralin and niranthin.

In patients with chronic viral hepatitis B, P. amarus normalised alanine aminotransferase (ALT) and the albumin: globulin ratio, and the effective rate was not significantly different from patients treated with interferon. In addition, P. amarus treated group showed a decrease in ALT and bilirubin, while an increase in haemoglobin.

Meanwhile, in animals, P. amarus exhibited protective effect against carbon tetrachloride-induced liver toxicity. This hepatoprotective effects of P. amarus is proposed to be due to its antioxidant activities and/or its ability to normalise liver enzymes as shown in animal models. While in ethanol treated rats, aqueous extract of P. amarus is able to reduce the AST and ALT to normal values, while methanol extract of P. amarus is able to restore glutathione (GSH) levels, reduce lipid peroxidation and protect against hepatic fibrosis.

However, the role of P. amarus in hepatoprotection against hangover symptoms and alcohol-induced injury has not been studied clinically. In the current study, the researchers tested the hypothesis that an ethanol extract preparation of P. amarus leaves, PHYLLPRO TM, previously associated with antioxidant and free radical scavenging activity, would protect the liver against oxidative stress induced by alcohol consumption, thus reducing hangover symptoms.

This clinical study provided evidence of the ability of PHYLLPRO TM to remove blood alcohol more efficiently compared with placebo, resulting in reduced hangover symptoms and improved mood.

Another study published in the journal Current Research in Food Science demonstrated the influence of food commodities on hangover based on alcohol dehydrogenase and aldehyde dehydrogenase activities.

According to the researchers, hangover may be alleviated by altering the rate of alcohol metabolism and facilitating elimination of acetaldehyde by affecting the activity of alcohol dehydrogenase (ADH) and/or aldehyde dehydrogenase (ALDH) enzymes.

In the present study, several food commodities like fruits, vegetables, cereals, pulses, dairy products, spices and other miscellaneous products (ascorbic acid, cocoa sample, tea, coffee, egg yolk and date samples) were investigated for their effect on the in vitro activities of the enzymes and their antioxidant properties.

Of the many screened food commodities, few showed an increase in the activity of either one or both the enzymes, ADH and ALDH. Studies showed no correlation between ADH and ALDH enzyme activities and antioxidant property of the selected food commodities for anti-hangover effect. Further, an anti-hangover (AHO) product was developed using pear (65 per cent), sweet lime (25 per cent), and coconut water (10 per cent) and, validated for in vitro ADH and ALDH enzyme activities. AHO product was found to enhance ADH and ALDH activities by 23.31 per cent and 70.02 per cent, respectively.

Several natural compounds like 6-gingerol (in ginger), dehydroevodiamine, ginsenosides, linolenic acids among many others, have been recommended as a cure for a hangover. Researchers have investigated and identified natural components (such as polyphenols) from various food sources such as fruits, mushrooms, and herbs to alleviate hangover symptoms. These natural food sources are reported to function effectively by exhibiting positive effects on the hepatic enzymes, that is by either enhancing the activity of ALDH and/or ADH and thereby assisting in aldehyde and alcohol clearance from the system, respectively. A herbal mixture “DTS 20” containing Viscum album L. (40 per cent), Lycium chinense L. (30 per cent), Inonotus obliquus (20 per cent), and Acanthopanax senticosus H. (10 per cent) has also been studied and found to reduce the oxidative stress and plasma alcohol concentrations.

According to the researchers, pear showed the highest positive effect on ALDH activity at 90.98 per cent. Orange, starfruit, and sweet lime also enhanced the ALDH activity significantly by 15.48 per cent, 22.76 per cent and 33.47 per cent, respectively. The potential use of pear to alleviate hangover has been reported in previous studies based on their effect on the activity of the enzyme. Enhanced ALDH activity of pear facilitates in faster elimination of acetaldehyde and thus it serves as a suitable AHO. Zhang et al. (2016) reported that orange and starfruit showed a decrease in the activity of ALDH (by 11.81 per cent and 61.95 per cent, respectively) while dragon fruit did not significantly affect the ALDH activity. Wang et al. (2016b) also reported fresh orange juice to decrease the ALDH activity. This variation could be due to the differences in the sample nature and sample preparation methods. The presence of polyphenols in the fruits has been reported to enhance the activity of ADH and ALDH. However, the exact mechanism is yet to be elucidated.

Among the vegetable samples analysed, bitter gourd and carrot showed an increase in ADH activities and a decrease in ALDH activities. Tomato and cucumber samples showed an increase in the activity of ALDH (41.19 per cent and 87.25 per cent). Investigators have reported that heat-treated cucumber had the ability to enhance the activity of ALDH and ADH. The researchers said contrary to this result, their work showed a significant decrease of ADH activity by cucumber. This could be due to differences in the variety as well sample preparation method.

Recently, a variety of anti-hangover (AHO) products has been launched into the market. “PartySmart” is a formulation containing grapes, gooseberry, date palm, Phyllanthus amarus, green chiretta (Andrographis paniculata), and chicory, which is reported to significantly reduce several of the hangover symptoms, and prevent the formation of acetaldehyde adducts.

Similarly, a product named “Oh!K” containing turmeric, ginger, black pepper, green tea extracts has also been formulated. Studies have shown that this drink is an effective remedy to treat alcoholic hangovers by replenishing the body with the vital nutrients that are lost as a result of hangovers.

Another product, “DotShot” containing curcumin as the principal component and other vital electrolytes, has also been reported to enhance the ALDH activity and thereby assist in the breakdown of acetaldehyde. “LIVitup” is an AHO tablet containing kalmegh ghan, a mixture of kalmegh (Andrographis paniculata) and neem (Azadirachta indica) leaves, which prevents hangover symptoms by reducing the acetaldehyde build-up in the body after alcohol consumption. The fruit juice blend developed, as AHO formulation in the present study is a simple, effective, economical, and ready-to-prepare alternative to these formulations with good sensory appeal.

The researchers concluded: “This study analysed the effect of certain common food commodities on hangover through in vitro studies by enhancing either alcohol dehydrogenase and aldehyde dehydrogenase activities, or at least the aldehyde dehydrogenase activity, to formulate an anti-hangover product. A beverage made from a blend of sweet lime, pear, and coconut water could be used to overcome a hangover. No correlation between the antioxidant activity and the activity of alcohol dehydrogenase and aldehyde dehydrogenase was seen. This dispels the common belief that an antioxidant could serve as an anti-hangover product. The consumption of this beverage with cheese, cucumber, and tomatoes may further alleviate the hangover symptoms.”

Meanwhile, previous studies had shown that having bitter kola as a companion and working out regularly can ameliorate the negative impacts and even lower blood pressure, ulcer, and boost sperm count. In fact, they say bitter kola can detoxify and protect the liver from any alcohol and food poisoning effects.

Another study published in the journal Molecules and titled “Natural Products for the Prevention and Treatment of Hangover and Alcohol Use Disorder” confirmed that mango flesh and peel had ameliorating effects on plasma alcohol levels and increased the activities of ADH and ALDH in mice.

Mango (Mangifera indica) is a widely consumed tropical fruit. It is rich in polyphenolic compounds, which could protect from several diseases. Mango fruit intake provides antioxidants that may act in a synergistic way with other foods to offer protection. Kim et al. confirmed that mango flesh and peel had ameliorating effects on plasma alcohol levels and increased the activities of ADH and ALDH in mice. A loading plot indicated that several compounds in mango fruit, such as fructose and aspartate, might enhance alcohol metabolism. As a result, mango flesh and peel could be the source of functional foods with the intention of decreasing plasma alcohol levels after excessive alcohol intake.

Also, the extracts of thyme (Thymus vulgaris) have detoxifying and antioxidant effects. The leafy parts of thyme and its essential oil have been widely used in food for flavor, aroma and preservation and also in traditional medicines. The essential oil of thyme has showed free radical scavenging and antibacterial activity, and it could detoxify alcohol toxicity. Thymol was the major component (44.4 per cent–58.1 per cent), followed by p-cymene (9.1 per cent–18.5 per cent), γ-terpinene (6.9 per cent–18.9 per cent), and carvacrol (2.4 per cent–4.2 per cent) in the tested oil samples. The water extract of thyme possessed the ability of detoxifying the injuries of alcohol on liver and brain in mice. It could decrease nitric oxide and Malondialdehyde (MDA) level in liver and brain, and increase the total antioxidant capacity and Glutathione Peroxidase (GPx) activity. MDA occurs naturally and is a marker for oxidative stress. Therefore, Thymus vulgaris was recommended to treat alcohol toxicity through its potent antioxidant properties.

The study also identified ginger. Ginger (Zingiber officinale) has been used as an important ingredient in cooking and traditional herbal medicine for a long time. It exhibits antioxidant potential and hepatoprotective activity. 6-Gingerol as the major bioactive constituent of ginger could efficiently scavenge various free radicals. The antioxidant compounds of ginger may modulate the oxidative stress induced by alcohol. Superoxide dismutase (SOD), ascorbic acid, and Glutathione (gamma-glutamyl-cysteinyl-glycine; GSH) levels were decreased, and Glutathione S-transferases activity was increased in alcohol-treated rats. However, after treatment with the extract of ginger, these parameters came to normal.

Owing to the antioxidant effect of ginger, Zingiber officinale is recommended to be used as a natural product to treat alcohol toxicity. The water extract of ginger could decrease the levels of both l-γ-glutamyl transpeptidase and butyryl cholinesterase. A formula (KSS formula) consisting of a pith of citrus tangerine, the rhizome of Zingiber officinale, and brown sugar has been traditionally used in China for the treatment of discomfort after excessive alcohol ingestion. In a clinical effectiveness evaluation study, the hangover symptoms such as nausea, vomiting, and diarrhea were alleviated after administration of formula in scheduled prophylactic doses.

Excessive alcohol consumption caused alcoholic fatty liver disease (AFLD). The ginger essential oil and citral exhibited hepatoprotective activity against AFLD in mice. The amounts of metabolites in serum such as d-glucurono-6,3-lactone, glycerol-3-phosphate, pyruvic acid, lithocholic acid, 2-pyrocatechuic acid, and prostaglandin El increased after alcohol administration, but the levels were recovered in treatment groups. Therefore, ginger could be used as a candidate for the prevention and treatment of hangover and organ damages induced by overconsumption of alcohol through its antioxidant action.

Also, another study published in Clinical Phytoscience, International Journal of Phytomedicine and Phytotherapy, has investigated the impact of date palm pollen (Phoenix dactylifera) treatment on paracetamol-induced hepatorenal toxicity in rats.

According to the study, consumption of plant-derived nutraceuticals and crude drugs in Arab traditional medicine is widely believed to confer beneficial effects in liver and kidney diseases. Fruits from the date palm Phoenix dactylifera L. are a rich source of nutrients and bioactive phytochemicals, which possess a myriad of pharmacological effects. The study examined the impact of Date Palm Pollen (DPP) aqueous suspension treatment on paracetamol (APAP) [Acetaminophen (APAP)] triggered hepatorenal damage in rats and further explored the underlying putative mechanism.

The researchers concluded: “The present observations point to a hepatorenal protective effect of acute DPP treatment in APAP-intoxicated rats which is underpinned by its robust antioxidant properties.”