your poor liver

Very few things you learn about in medical school are worthy of "normal people" conversations. No one, including me, cares about gluconeogenesis. Who, other than a med student, will appreciate an electon micrograph of a podocyte. When it comes to our insides, people grimace when you talk about bile caniculi and want no more detail than the knowledge that our liver exists and is somewhere in the middle-ish area of our body.

electron micrograph of a podocyte

One of the rare exceptions is pedialyte and the theorized physiology behind the hangover. I have found that normal people LOVE to talk about pedialyte. Seriously.

My take on the hangover comes from an amalgamation of sources. The most fresh in my head is the recent New Yorker article.

The alcohol that we drink is ethanol. Our body breaks this down with the help of a number of liver enzymes. One theory states that the hell of the hangover begins when our body is finished breaking down ethanol, and moves on to methanol, an additional ingredient in alcoholic beverages. In the process of breaking down methanol, the body releases materials that are toxic, and basically these are (some of) the materials that make you feel like crap. With this theory in mind, the hair-of-the-dog hangover remedy makes perfect sense. By having that morning-after bloody mary you are re-introducing ethanol into your body. This causes your body to shift focus and re-direct its attention to the digestion of ethanol. The methanol does not disappear, it is for the moment forgotten about, and you begin to see the light at the end of the tunnel. Similarly, this is why spicy foods, or other foods that the body either sees as toxins or needs to spend time and energy on to digest, relieve our suffering. The liver re-prioritizes and is temporarily distracted from dealing with the methanol. It’ll save your punishment for a later date. At which time, hopefully you will be asleep and unaware of the agony.

There are a number of other components to the hangover. Nausea is probably caused by an irritation and activation of certain receptors that line your stomach. Fatigue might be caused by a release of cytokines, signalling compounds usually released by immune cells that enable communication between different parts of the body. Also, alcohol is a diuretic which increases one’s need to pee, and there you get dehydration.

This is where med school, physiology, and pedialyte enter the picture. When you wake up in the morning feeling kind of crummy and very thirsty, Gatorade is often a first choice drink. What I learned is that Gatorade is not the best idea. It may actually cause you to have diahrrea. In general, from compartment to compartment the body likes to keep thinks balanced and in the appropriate proportions. Gatorade has a high glucose content. When you drink Gatorade you are introducing high levels of solute into the lumen of your intestine, way more than your intestine can absorb. So now you have more molecules in the lumen than in the cells that line the lumen of the intenstine. In order to keep concentrations balanced and lower the luminal solute concentration, water will flow out of the cell into the lumen of your intestine, causing watery poop, aka diahrrea.

The solution: pedialyte. Yes, that stuff (that I thought was supposed to be nasty until I actually tried it last weekend) for babies. It has the perfect concentration of glucose and other electrolytes, your body can absorb what it needs. This was discussed for maybe 11 seconds of one small group session, and it is the equivalent of about 1/677,837,286 th of what was covered over the entire semester of physiology. But is one of the, ohhh let’s say, FOUR things that actually stuck.




Filed under med school

6 responses to “your poor liver

  1. Pingback: I need Pedialyte «

  2. G-Max

    Actually, alcoholic drinks do not contain methanol unless it’s some poorly made illegal moonshine. However, the body does metabolize ethanol into acetaldehyde, which is pretty damn toxic and part of the reason why you feel like shit. Another reason is that ethanol is involved in the conversion of glucose into glycogen and back; too much alcohol causes blood sugar levels to drop. Alcohol can also mess up your electrolyte levels, which might contribute to the fatigue and confusion. And, of course, there’s plain old dehydration, which causes the headache. Although Pedialyte does nothing about the acetaldehyde, it does a pretty good job with the hydration, glucose, and electrolytes (note that although the bottle might say “dextrose” rather than “glucose”, dextrose is just the biologically active isomer of glucose). Also, if you’re coming down from a particularly nasty binge, you might have diarrhea, which is exactly what Pedialyte was designed to counteract.

  3. Good Job on the articles you have here, thank you for putting your time into it!

  4. Mike

    Looking into what G-Max said, it seems unless we figure out a way to deliver an enzyme cocktail, we’re not getting around the bottlenecks of alcohol metabolism.

    So real food. If tolerable, would real food be better than Pedialyte/Gatorade or is the idea fast and easy absorption?

    If the drinks are the better choice.. electrolytes in drinks are usually forms of sodium and potassium, right? Both Pedialyte and Gatorade have those two. Is Pedialyte far more helpful than a [glucose] proportionate serving of Gatorade; are the ingredients substantially different?

    I second the comment above – thanks for taking the time to write this!

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