Grape or grain but never the twain? A randomized controlled multiarm matched-triplet crossover trial of beer and wine

Abstract

Background: Alcohol-induced hangover constitutes a significant, yet understudied, global hazard and a large socio-economic burden. Old folk wisdoms such as "Beer before wine and you'll feel fine; wine before beer and you'll feel queer" exist in many languages. However, whether these concepts in fact reduce hangover severity is unclear.

Objectives: The aim of this study was to investigate the influence of the combination and order of beer and wine consumption on hangover intensity.

Methods: In this multiarm, parallel randomized controlled matched-triplet crossover open-label interventional trial, participants were matched into triplets and randomly assigned according to age, gender, body composition, alcohol drinking habits, and hangover frequency. Study group 1 consumed beer up to a breath alcohol concentration (BrAC) ≥0.05% and then wine to BrAC ≥0.11% (vice versa for study group 2). Control group subjects consumed either only beer or only wine. On a second intervention day (crossover) ≥1 wk later, study-group subjects were switched to the opposite drinking order. Control-group subjects who drank only beer on the first intervention received only wine on the second study day (and vice versa). Primary endpoint was hangover severity assessed by Acute Hangover Scale rating on the day following each intervention. Secondary endpoints were factors associated with hangover intensity.

Results: Ninety participants aged 19-40 y (mean age 23.9), 50% female, were included (study group 1 n = 31, study group 2 n = 31, controls n = 28). Neither type nor order of consumed alcoholic beverages significantly affected hangover intensity (P > 0.05). Multivariate regression analyses revealed perceived drunkenness and vomiting as the strongest predictors for hangover intensity.

Conclusions: Our findings dispel the traditional myths "Grape or grain but never the twain" and "Beer before wine and you'll feel fine; wine before beer and you'll feel queer" regarding moderate-to-severe alcohol intoxication, whereas subjective signs of progressive intoxication were confirmed as accurate predictors of hangover severity. This trial was prospectively registered at the Witten/Herdecke University Ethics Committee as 140/2016 and retrospectively registered at the German Clinical Trials Register as DRKS00015285.

FIGURE 1

Study design. On the first day, group 1 consumed beer until a breath alcohol concentration (BrAC) ≥0.05% was reached and afterwards wine until a BrAC ≥0.11% was reached. On day 2, they crossed over. Group 2 completed the opposite drinking regimen. Control-group subjects drank either only beer or only wine on day 1, with only the other drink on day 2. AHS ratings were recorded after the BrAC had returned to zero, on the day after each intervention. AHS, Acute Hangover Scale; BrAC, breath alcohol concentration.

FIGURE 2

Enrollment and randomization.

FIGURE 3

Hangover severity in relation to alcohol consumption. (A) “Grape or grain but never the twain?”—AHS ratings (0 representing the absence of symptoms and 56 corresponding to the maximal hangover intensity) of all participants demonstrated for both intervention days according to type/order of consumed alcoholic beverages. (B) “Beer before wine and you'll feel fine; wine before beer and you'll feel queer?”—comparison of intraindividual differences of AHS ratings, according to the order in which beer and wine were consumed, depicted for the 2 study groups. Data are presented as medians and quartiles using Tukey box plots; to compare intraindividual differences of AHS ratings (B) Welch's two-sample t-test was used at a 5% significance level. AHS, Acute Hangover Scale.

FIGURE 4

Gender-specific comparison of relative AHS ratings (45 women, 45 men). Data are presented as medians and quartiles using Tukey box plots. AHS, Acute Hangover Scale; BrAC, breath alcohol concentration.

FIGURE 5

Multiple linear regression analysis. Analyses were performed separately for study day 1 (n = 89) and study day 2 (n = 88). The target variable was the subjects’ Acute Hangover Scale ratings reported on the day following each intervention. Data are presented as regression coefficients and 95% CIs. BrAC, breath alcohol concentration.