Этанол и суррогаты алкоголя

Int J Environ Res Public Health. 2009 Aug;6(8):2090-101. doi:10.3390/ijerph6082090. Epub 2009 Jul 27.

The quality of alcohol products in Vietnam and its implications for public health.

Lachenmeier DW(1), Anh PT, Popova S, Rehm J.

Author information:

(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger

Strasse 3, 76187 Karlsruhe, Germany. lachenmeier@web.de

Four homemade (artisanally manufactured and unrecorded) and seven commercial(industrially manufactured and taxed) alcohol products from Vietnam were collected and chemically analyzed for toxicologically relevant substances. The majority of both types had alcohol contents between 30 and 40% vol. Two homemade samples contained significantly higher concentrations of 45 and 50% vol. In one of these homemade samples the labeled alcoholic strength was exceeded by nearly 20% vol. All other analyzed constituents of the samples (e.g., methanol, acetaldehyde, higher alcohols, esters, metals, anions) were found in concentrations that did not pose a threat to public health. A peculiarity was a homemade sample of alcohol with pickled snakes and scorpions that contained 77% vol of alcohol, allegedly used as traditional Chinese medicine. Based on this small sample, there is insufficient evidence to conclude that alcohol quality, beyond the effects of ethanol, has an influence on health in Vietnam. However,future research with larger samples is needed.

DOI: 10.3390/ijerph6082090

PMCID: PMC2738875

PMID: 19742208 [Indexed for MEDLINE]

Drug Alcohol Rev. 2019 May 16. doi: 10.1111/dar.12937. [Epub ahead of print]
Methanol content in homemade alcohol from a province in North Vietnam.
Lao Y(1), Pham BD(2), Le HT(2), Nguyen Van H(2), Hovda KE(1).
Author information: 
(1)Norwegian National Unit for CBRNE Medicine, Department of Acute Medicine, Oslo
University Hospital, Oslo, Norway.
(2)Institute for Preventive medicine and Public health, Hanoi Medical University,
Hanoi, Vietnam.
INTRODUCTION AND AIMS: Methanol poisonings pose a major risk especially where
illegal alcohol is consumed. The source of the methanol in the drinks are
debated. We aimed to evaluate whether home distillation of alcohol made from rice
was capable of producing toxic amounts of methanol.
DESIGN AND METHODS: Twenty households with homemade alcohol production in Phu Tho
province in Vietnam were included in this pilot study. We followed the whole
production process and an alcohol sample from each household was analysed for
methanol content.
RESULTS: 17 (85%) of the samples contained detectable levels of methanol. The
median concentration was 9 mg/L (range 2-37 mg/L). To develop clinical symptoms
of methanol poisoning from the sample with the highest concentration would
require drinking more than 424 L.
DISCUSSION AND CONCLUSIONS: Homemade alcohol from rice did not contain sufficient
amount of methanol to cause toxicity in our study. This supports the theory of
methanol being added to ethanol post production for economical purposes as the
main source of mass poisonings.
DOI: 10.1111/dar.12937 
PMID: 31095796 

Analysis of methanol and its derivatives in illegally produced alcoholic
Arslan MM(1), Zeren C(1), Aydin Z(2), Akcan R(3), Dokuyucu R(4), Keten A(5),
Cekin N(6).
Author information: 
(1)Department of Forensic Medicine, Mustafa Kemal University Faculty of Medicine,
Hatay, Turkey.
(2)Department of Chemistry, Mustafa Kemal University Faculty of Arts and
Sciences, Hatay, Turkey.
(3)Department of Forensic Medicine, Hacettepe University Faculty of Medicine,
Ankara, Turkey.
(4)Department of Physiology, School of Medicine, University of Mustafa Kemal,
Hatay, Turkey. Electronic address: drecepfatih@gmail.com.
(5)Kahramanmaraş Branch of the Council of Forensic Medicine, Kahramanmaraş,
(6)Department of Forensic Medicine, Çukurova University Faculty of Medicine,
Adana, Turkey.
INTRODUCTION: Illegal alcohol production remains as a common issue worldwide.
Methanol poisoning mostly occurs because of the methanol used in production of
counterfeit alcohol instead of ethyl alcohol due to its low price or by drinking 
the liquids containing methyl alcohol. Pectolytic enzymes results in an increase 
of methanol levels in many fermentation products such as ciders or wines.
Methanol poisonings are infrequently encountered in forensic medicine practice.
However, sporadic cases due to methanol intoxication as well as epidemic cases
have been reported. In this study, we aimed to identify existence of methanol and
its metabolites in illegally produced alcoholic beverages used in Antakya region.
MATERIAL AND METHODS: Twelve legally produced alcohol samples and Fifty-six
different illegally produced alcohol samples were collected from the markets and 
local producers. Existence of methanol, formic acid, methyl amine, methyl formate
and trioxan were determined using GC-MS method in these samples.
RESULTS: Fifty-six different illegal alcohol samples were analyzed in this study 
and methanol was detected in 39 (75%) of samples. Formic acid was detected in 3, 
formamide in 1, methyl amine in 6, methyl formate in 10 and trioxan in 2 samples.
CONCLUSION: Overwhelming majority of illegal alcoholic beverages was detected to 
contain methanol. Interestingly this study also revealed the presence of
trioxane, which has not previously reported among toxic agents in illegal alcohol
DOI: 10.1016/j.jflm.2015.04.005 
PMID: 26048498  [Indexed for MEDLINE]

J Forensic Leg Med. 2016 Oct;43:85-89. doi: 10.1016/j.jflm.2016.07.014. Epub 2016
Jul 29.
Hepatotoxicity of illegal home-made alcohols.
Gökce H(1), Akcan R(2), Celikel A(3), Zeren C(3), Ortanca I(3), Demirkiran S(3).
Author information: 
(1)Mustafa Kemal University Medical Faculty, Department of Pathology, Hatay,
(2)Hacettepe University Medical Faculty, Department of Forensic Medicine, Ankara,
06100, Turkey. Electronic address: akcanmd@hotmail.com.
(3)Mustafa Kemal University Medical Faculty, Department of Forensic Medicine,
Hatay, Turkey.
OBJECTIVE AND AIM: Alcohol-related hepatotoxicity is not only caused by excessive
alcohol consumption but also caused and even accelerated by hepatotoxic
ingredients other than ethanol. Concentrations of hepatotoxic substances might be
significantly high, particularly in illegally produced home-made alcohols. In
this study we aim to analyze the hepatotoxic effects of a home-made alcohol
traditionally called "bogma raki" in Turkey.
MATERIALS AND METHOD: Fifty Wistar albino male rats were used. Five groups were
randomly formed with ten animals in each. Besides laboratory diets, groups were
fed as follows: Group 1 (control group) distilled water; Group 2 bogma raki with 
distilled water (%44 (v/v), 9.2 ml/kg/day); Group 3 bogma raki with distilled
water (%44 (v/v), 9.2 ml/kg/day)+walnut (10 g/kg/day); Group 4 whisky with
distilled water (%40 (v/v), 9.2 ml/kg/day); Group 5 distilled water + walnut
(10 g/kg/day), for 28 days. The toxicological analysis of The spirits were
analyzed using Hewlett-Packard (Palo Alto, CA) GC/MS system with HP 6890 gas
chromatograph, an HP 5972 mass selective detector (MSD) and an HP 6890 automatic 
liquid sampler GC/MS; the pressure of the carrier gas helium was 6.0 bar and the 
split value with a ratio of 1:100. The injection unit temperature set to 250 °C
and MS quadrupole temperature set to 280 °C. The MS quadrupole detector
ionization energy set to 70 eV. The initial column temperature was 60 °C (for
4 min) programmed by 6 °C/min to final temperature 160 °C and kept for 8 min at
160 °C. Utilized whisky and bogma raki samples were analyzed for the amounts of
trans-anethole, ethanol, methanol, 1-propanolol, butanol, 2-butanol,
2-methyl-1-propanolol (isobutanol) and 3-methylbutanol (isoamyl alcohol).
Histopathological changes in liver tissues were graded as follows; normal = 0
(<10%), mild = 1 (10%-40%), moderate = 2 (40%-70%), severe = 3 (above 70%).
RESULTS: Chemical composition of illegally produced raki sample (%v/v) was as
follows: trans-anethole %1.93, ethanol %95.70, 2-methyl-1-propanolol (isobutanol)
%0.19, asetic acid %0.25, 3-methylbutanol (isoamyl alcohol) %0.77, and others
%1.16. Chemical composition of commercial whisky sample (%v/v) was as follows:
ethanol %97.72, 2-methyl-1-propanolol (isobutanol) %0.57, asetic acid %0.23,
3-methylbutanol (isoamyl alcohol) %1.28, and others %0.2. No traces of
trans-anethole were detected in whisky. Normal liver morphology was recorded in
control and walnut groups. However, bogma raki caused significant congestion and 
inflammatory cell infiltration compared to control and walnut group. On the other
hand, whisky administration caused mild degeneration including inflammation in a 
limited area.
CONCLUSION: Obtained findings suggest that trans-anethole containing alcoholic
beverages are more hepatotoxic compared to commercial alcoholic beverages.
DOI: 10.1016/j.jflm.2016.07.014 
PMID: 27497237  [Indexed for MEDLINE]
Alcohol Alcohol. 2006 Jul-Aug;41(4):446-50. Epub 2006 May 10.
The composition of surrogate and illegal alcohol products in Estonia.
Lang K(1), Väli M, Szucs S, Adány R, McKee M.
Author information: 
(1)Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu,
AIM: To identify the composition of illegal and surrogate alcohol products
consumed in Estonia.
METHODS: The initial source of information was a series of visits made in August 
2005 to a soup kitchen in central Tartu, Estonia. Individuals were asked for
brief details of their personal circumstances, what they normally drank, and in
addition they were asked to bring samples of the substances they usually
consumed. In other cases, the substances identified were purchased by the
investigators or from informal contacts in north-eastern part of Estonia, an area
that is well known for illegal alcohol consumption. Samples were tested for
chemical contents.
RESULTS: We identified a range of alcohol-containing substances that are
consumed, although, not intended for consumption. These comprised medicinal
products, aftershaves, illegally produced spirits, and fire-lighting fuel. The
medicinal compounds contained, on average, 67% ethanol by volume; the aftershaves
contained slightly less. Both were typically pure, with a few containing
detectable quantities of isoamyl alcohol. The illegally produced alcohol
contained, on average, 43% ethanol by volume, ranging from 32 to 53%. However,
many also contained detectable quantities of long chain alcohols. These
substances are half the price or less of commercial vodka, with fire lighting
fuels especially inexpensive.
CONCLUSIONS: There is in Estonia a range of alcohol-containing substances easily 
available at low cost. Some contain substantially higher concentrations of
ethanol than commercial spirits and others also contain toxic long chain
DOI: 10.1093/alcalc/agl038 
PMID: 16687467  [Indexed for MEDLINE]
Alcohol Clin Exp Res. 2005 Oct;29(10):1884-8.
The composition of surrogate alcohols consumed in Russia.
McKee M(1), Suzcs S, Sárváry A, Adany R, Kiryanov N, Saburova L, Tomkins S,
Andreev E, Leon DA.
Author information: 
(1)European Centre on Health of Societies in Transition, London School of Hygiene
and Tropical Medicine, London, United Kingdom. martin.mckee@lshtm.ac.uk
BACKGROUND: In the course of a case-control study examining determinants of
premature death among working age men, it became clear that a significant
percentage of the population (7.3%) were drinking a variety of surrogate alcohol 
products (products not legally sold for consumption). In this population, where
there is a high death rate from alcohol-related causes, including acute alcohol
poisoning, it was important to know what these products contained.
METHODS: The identity of products being consumed was identified from the survey
of controls. Representative samples were obtained and subjected to analysis using
gas chromatography and mass spectrometry to determine their composition.
RESULTS: Three broad groups of product were identified: samogon (home-produced
spirits); medicinal compounds; and other spirits (mainly sold as aftershaves).
Commercially produced vodkas were used for comparison. Samogon contained lower
quantities of ethanol than vodka [mean, 39 vs. 44 volumetric percentage (v/v%),
respectively] but in addition contained certain toxic long-chain alcohols.
Medicinal compounds contained only ethanol, at a higher concentration that vodka 
(mean, 66 v/v%), while the other spirits, which were also essentially pure
ethanol, contained a mean of 94 v/v%.
CONCLUSIONS: A significant number of Russian men are drinking products that have 
either very high concentrations of ethanol or contaminants known to be toxic.
These products are untaxed and thus much less expensive than vodka. There is an
urgent need for policy responses that target their production and consumption.
PMID: 16269919  [Indexed for MEDLINE]
Alcohol Clin Exp Res. 2007 Oct;31(10):1613-24. Epub 2007 Aug 6.
Surrogate alcohol: what do we know and where do we go?
Lachenmeier DW(1), Rehm J, Gmel G.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany.
BACKGROUND: Consumption of surrogate alcohols (i.e., nonbeverage alcohols and
illegally produced alcohols) was shown to impact on different causes of death,
not only poisoning or liver disease, and appears to be a major public health
problem in Russia and elsewhere.
METHODS: A computer-assisted literature review on chemical composition and health
consequences of "surrogate alcohol" was conducted and more than 70 references
were identified. A wider definition of the term "surrogate alcohol" was derived, 
including both nonbeverage alcohols and illegally produced alcohols that contain 
nonbeverage alcohols.
RESULTS: Surrogate alcohol may contain substances that cause severe health
consequences including death. Known toxic constituents include lead, which may
lead to chronic toxicity, and methanol, which leads to acute poisoning. On the
other hand, the role of higher alcohols (e.g., propanol, isobutanol, and isoamyl 
alcohol) in the etiology of surrogate-associated diseases is currently unclear.
Whether other constituents of surrogates have contributed to the high all-cause
mortality over and above the effect of ethanol in recent studies also remains
CONCLUSIONS: Given the high public health importance associated with the
consumption of surrogate alcohols, further knowledge on its chemical composition 
is required as well as research on its links to various disease endpoints should 
be undertaken with priority. Some interventions to reduce the harm resulting from
surrogate alcohol could be undertaken already at this point. For example, the use
of methanol or methanol-containing wood alcohol should be abolished in denatured 
alcohol. Other possible surrogates (e.g., automobile products) should be treated 
with bittering agents to avoid consumption.
DOI: 10.1111/j.1530-0277.2007.00474.x 
PMID: 17681034  [Indexed for MEDLINE]
Alcohol Clin Exp Res. 2009 Oct;33(10):1757-69. doi: 10.1111/j.1530-0277.2009.01013.x. Epub 2009 Jul 1.
Association between quality of cheap and unrecorded alcohol products and public
health consequences in Poland.
Lachenmeier DW(1), Ganss S, Rychlak B, Rehm J, Sulkowska U, Skiba M, Zatonski W.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt Karlsruhe, Germany.
BACKGROUND: The research aimed to study the quality of cheap alcohol products in 
Poland. These included unrecorded alcohols (i.e., home-produced or illegally
imported), estimated to constitute more than 25% of total consumption and fruit
METHODS: A sample of alcohol products (n = 52) was collected from local markets
and chemical analyses were conducted. The parameters studied were alcoholic
strength, volatiles (methanol, acetaldehyde, and higher alcohols), ethyl
carbamate, inorganic elements, and food additives including preservatives,
colors, and sweeteners. The compositions of the beverages were then
toxicologically evaluated using international standards.
RESULTS: With the exception of 1 fortified wine, the unrecorded alcohols were
home-produced fruit-derived spirits (moonshine) and spirits imported from other
countries. We did not detect any nonbeverage surrogate alcohol. The unrecorded
spirits contained, on average, 45% vol of alcohol. However, some products with
considerably higher alcoholic strengths were found (up to 85% vol) with no
labeling of the content on the bottles. These products may cause more pronounced 
detrimental health effects (e.g., liver cirrhosis, injuries, some forms of
malignant neoplasms, alcohol use disorders, and cardiovascular disease) than will
commercial beverages, especially as the consumer may be unaware of the alcohol
content consumed. Fruit wines containing between 9.5 and 12.2% vol alcohol showed
problems in terms of their additive content and their labeling (e.g., sulfites,
sorbic acid, saccharin, and artificial colors) and should be subjected to
stricter control. Regarding the other components investigated, the suspected
human carcinogens, acetaldehyde and ethyl carbamate, were found at levels
relevant to public health concerns. While acetaldehyde is a typical constituent
of fermented beverages, ethyl carbamate was found only in home-produced
unrecorded alcohols derived from stone fruits with levels significantly above
international guidelines.
CONCLUSIONS: The contamination of unrecorded alcohols with ethyl carbamate should
be analyzed in a larger sample that also should include legal alcoholic
beverages. Furthermore, the impacts of unrecorded alcohol on the health of people
with lower socioeconomic status should be studied in detail. Overall, given the
extent of the alcohol-attributable disease burden in Poland, the highest priority
should be given to the problem of ethanol and its very high content in unrecorded
alcohol products.
DOI: 10.1111/j.1530-0277.2009.01013.x 
PMID: 19572980  [Indexed for MEDLINE]
Alcohol Alcohol. 2009 Jan-Feb;44(1):93-102. doi: 10.1093/alcalc/agn095. Epub 2008
Nov 25.
The composition of alcohol products from markets in Lithuania and Hungary, and
potential health consequences: a pilot study.
Lachenmeier DW(1), Sarsh B, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Germany.
AIMS: The rates of alcohol-attributable mortality in Lithuania and Hungary have
been shown to be higher than those in most other European countries. Quality of
alcohol products is investigated as a possible explanation.
METHODS: In a descriptive pilot study, a convenience sample of alcohol products
was collected from local city markets in both countries (Lithuania n = 10,
Hungary n = 15) and chemical analyses, including some that have not been done in 
prior studies, were conducted. The parameters studied were alcoholic strength,
volatiles (methanol, acetaldehyde, higher alcohols), ethyl carbamate, anions
(including nitrate) and inorganic elements (including lead). Additionally, a
multi-target screening analysis for toxicologically relevant substances was
RESULTS: The majority of samples (64%) had an alcohol content between 35% vol.
and 40% vol., being in accordance with the typical strength of legal spirits in
Europe. Three samples containing significantly higher concentrations of alcohol
above 60% vol. were found to be unrecorded alcohol products, defined as any
alcohol that is outside of legal and taxed production. Screening analysis showed 
that those samples contained various flavourings, including the hepatotoxic
substance coumarin, at concentrations above the legal limit for foods. All other 
substance classes under study were found to be at levels of no toxicological
CONCLUSIONS: Although some problems with the quality of the alcohol samples were 
found, there is insufficient evidence from this pilot study to conclude that
alcohol quality has an influence on health as reflected in alcohol-attributable
mortality rates. Given the extent of alcohol-attributable disease burden in
central and eastern European countries, future research should focus on
collection of large, representative samples, particularly of unrecorded sources, 
which was the most problematic product group in our study.
DOI: 10.1093/alcalc/agn095 
PMID: 19033379  [Indexed for MEDLINE]
Foods. 2017 Oct 17;6(10). pii: E89. doi: 10.3390/foods6100089.
High Ethanol Contents of Spirit Drinks in Kibera Slums, Kenya: Implications for
Public Health.
Okaru AO(1), Abuga KO(2), Kibwage IO(3), Lachenmeier DW(4).
Author information: 
(1)Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O.
Box 19676-00202, Kenya. alex.okaru@gmail.com.
(2)Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O.
Box 19676-00202, Kenya. koabuga@uonbi.ac.ke.
(3)Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O.
Box 19676-00202, Kenya. okibwage@uonbi.ac.ke.
(4)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Straße 3, 76187 Karlsruhe, Germany. lachenmeier@web.de.
Cheap licit and artisanal illicit spirit drinks have been associated with
numerous outbreaks of alcohol poisoning especially with methanol. This study
aimed to evaluate the quality of cheap spirit drinks in Kibera slums in Nairobi
County, Kenya. The samples consisted of cheap licit spirits (n = 11) and the
artisanal spirit drink, 'chang'aa', (n = 28). The parameters of alcoholic
strength and volatile composition were used as indicators of quality and were
determined using gas chromatography with flame ionization detection (GC-FID) and 
gas chromatography-mass spectrometry (GC-MS) respectively. The ranges for
alcoholic strength were 42.8-85.8% vol and 28.3-56.7% vol for chang'aa and licit 
spirit drinks respectively, while the pH ranges were 3.3-4.2 and 4.4-4.8 for
chang'aa and licit spirit drinks respectively. The majority of volatiles were
found in artisanal spirits and they included higher alcohols, ethyl esters and
carbonyl compounds. The alcoholic strength of all the artisanal spirits (100%)
and 91% of the licit spirits was above the 40% vol of standard spirits such as
vodka. The high ethanol content of the alcohol products was the only element of
public health significance in this study.
DOI: 10.3390/foods6100089 
PMCID: PMC5664028
PMID: 29039800 
Food Chem Toxicol. 2010 Oct;48(10):2842-7. doi: 10.1016/j.fct.2010.07.016. Epub
2010 Jul 16.
The composition of unrecorded alcohol from eastern Ukraine: is there a
toxicological concern beyond ethanol alone?
Lachenmeier DW(1), Samokhvalov AV, Leitz J, Schoeberl K, Kuballa T, Linskiy IV,
Minko OI, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt Karlsruhe, Weissenburger Strasse 3,
D-76187 Karlsruhe, Germany. Lachenmeier@web.de
In 2005, approximately half of all alcohol consumption in Ukraine was unrecorded.
This paper investigates the chemical composition of unrecorded and low-cost
alcohol, including a toxicological evaluation. A sample of alcohol products
(n=78) from both recorded and unrecorded sources was obtained mainly from eastern
Ukraine, and chemically analyzed. Analysis entailed alcoholic strength, levels of
volatile compounds (methanol, acetaldehyde, higher alcohols), ethyl carbamate,
anions, and inorganic elements. The majority of unrecorded alcohol was homemade
samohon with alcoholic strength averaging close to 40% vol. A limited number of
samples, advertised for medicinal purposes, were identified with high alcoholic
strengths (above 60% vol.). Single samples showed contamination with acetaldehyde
and ethyl carbamate above the levels of toxicological concern. Metal
contamination was frequent, with copper levels above 2mg/l in 33 samples, and
zinc above 5mg/l in 10 samples. Overall, however, the composition of unrecorded
samples did not raise major public health concerns other those for ethanol. The
priority of alcohol policy in Ukraine should be the general reduction of alcohol 
consumption with a specific focus on that from small-scale home production.
Further research is needed on potential mitigative measures and the origin of the
metal contamination in particular alcoholic beverages.
DOI: 10.1016/j.fct.2010.07.016 
PMID: 20638436  [Indexed for MEDLINE]
Addiction. 2011 Mar;106 Suppl 1:20-30. doi: 10.1111/j.1360-0443.2010.03322.x.
Is contaminated unrecorded alcohol a health problem in the European Union? A
review of existing and methodological outline for future studies.
Lachenmeier DW(1), Schoeberl K, Kanteres F, Kuballa T, Sohnius EM, Rehm J;
Alcohol Measures for Public Health Research Alliance (AMPHORA).
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany.
AIMS: Some European countries with high levels of unrecorded alcohol consumption 
have anomalously high rates of death attributable to liver cirrhosis. Hepatotoxic
compounds in illegally produced spirits may be partly responsible. Based on a
review of the evidence on the chemical composition and potential harm from
unrecorded alcohol, the Alcohol Measures for Public Health Research Alliance
(AMPHORA) project's methodology for identifying, analysing and toxicologically
evaluating such alcohols is provided.
METHODS: A computer-assisted literature review concentrated on unrecorded
alcohol. Additionally, we refer to our work in the capacity of governmental
alcohol control authority and a number of pilot studies.
RESULTS: The risk-oriented identification of substances resulted in the following
compounds probably posing a public health risk in unrecorded alcohol: ethanol,
methanol, acetaldehyde, higher alcohols, heavy metals, ethyl carbamate,
biologically active flavourings (e.g. coumarin) and diethyl phthalate.
Suggestions on a sampling strategy for identifying unrecorded alcohol that may be
most prone to contamination include using probable distribution points such as
local farmers and flea markets for selling surrogate alcohol (including denatured
alcohol) to focusing on lower socio-economic status or alcohol-dependent
individuals, and selecting home-produced fruit spirits prone to ethyl carbamate
CONCLUSIONS: Standardized guidelines for the chemical and toxicological
evaluation of unrecorded alcohol that will be used in a European-wide sampling
and are applicable globally are provided. These toxicological guidelines may also
be used by alcohol control laboratories for recorded alcohol products, and form a
scientific foundation for establishing legislative limits.
DOI: 10.1111/j.1360-0443.2010.03322.x 
PMID: 21324018  [Indexed for MEDLINE]
World J Gastroenterol. 2014 Jun 21;20(23):7217-22. doi: 10.3748/wjg.v20.i23.7217.
Influence of unrecorded alcohol consumption on liver cirrhosis mortality.
Lachenmeier DW(1), Monakhova YB(1), Rehm J(1).
Author information: 
(1)Dirk W Lachenmeier, Jürgen Rehm, Epidemiological Research Unit, Institute for 
Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187
Dresden, Germany.
Unrecorded alcohol includes illegally distributed alcohol as well as homemade or 
surrogate alcohol which is unintended for consumption by humans (e.g., cosmetics 
containing alcohol). The highest unrecorded alcohol consumption occurs in Eastern
Europe and some of these countries have an over proportional liver cirrhosis
mortality. Compounds besides ethanol have been hypothesized as being responsible 
for this observation. On the other hand, chemical investigations were unable to
prove that unrecorded alcohol regularly contains contaminants above toxicological
thresholds. However, illegally produced spirits regularly contain higher
percentages of alcohol (above 45% by volume), but for considerably less costs
compared with licit beverages, potentially causing more problematic patterns of
drinking. In this review, it is investigated whether patterns of drinking rather 
than product composition can explain the liver cirrhosis mortality rates.
Statistical examination of World Health Organization country data shows that the 
originally detected correlation of the percentage of unrecorded alcohol
consumption and liver cirrhosis mortality rates disappears when the data is
adjusted for the prevalence of heavy episodic drinking. It may be concluded that 
there is currently a lack of data to demonstrate causality between the
composition of illicit spirits (e.g., higher levels of certain contaminants in
home-produced products) and liver toxicity on a population scale. Exceptions may 
be cases of poisoning with antiseptic liquids containing compounds such as
polyhexamethyleneguanidine, which were reported to be consumed as surrogate
alcohol in Russia, leading to an outbreak of acute cholestatic liver injury,
histologically different from conventional alcoholic liver disease.
DOI: 10.3748/wjg.v20.i23.7217 
PMCID: PMC4064067
PMID: 24966592  [Indexed for MEDLINE]
Addiction. 2000 Mar;95(3):339-46.
Beverage-specific alcohol consumption and cirrhosis mortality in a group of
English-speaking beer-drinking countries.
Kerr WC(1), Fillmore KM, Marvy P.
Author information: 
(1)University of California-San Francisco, Laurel Heights 94143-0612, USA.
Comment in
    Addiction. 2000 Aug;95(8):1267-70; author reply 1271-2.
    Addiction. 2000 Mar;95(3):350-1; discussion 355-8.
    Addiction. 2000 Mar;95(3):347-50; discussion 355-8.
    Addiction. 2000 Mar;95(3):352-3; discussion 355-8.
    Addiction. 2000 Mar;95(3):354-5; discussion 355-8.
AIMS: To compare beverage-specific per capita consumption and total alcohol
consumption's associations with cirrhosis mortality rates in multiple countries.
DESIGN: Pooled cross-sectional time-series analysis.
SETTING: Australia, Canada, New Zealand, the United Kingdom and the United States
during the years 1953-1993.
MEASUREMENTS: National level data on per capita total alcohol, beer, wine and
spirits consumption and standardized all-cause cirrhosis mortality rates.
FINDINGS: Significant associations with cirrhosis mortality are found for both
total ethanol and spirits. Spirits consumption is found to make up the majority
of the effect of alcoholic beverage consumption on cirrhosis mortality and the
model including only spirits is found to fit the data at least as well as the
model including only total ethanol consumption. The lag relationship between all 
alcohol types and cirrhosis is found to be short with only present and 1 year's
lagged consumption having significant associations.
CONCLUSIONS: Spirits consumption rather than beer or wine is associated with
cirrhosis mortality in this group of primarily beer-drinking countries. This
finding offers important clues to understanding the drinking behaviors associated
with cirrhosis mortality on the individual level.
PMID: 10795350  [Indexed for MEDLINE]
J Stud Alcohol. 1996 Jan;57(1):77-84.
Behavioral and social consequences related to the consumption of different
beverage types.
Smart RG(1).
Author information: 
(1)Social Science Consulting, Toronto, Canada.
OBJECTIVE: The purpose of this article is to review the literature on the effects
of beer, wine and spirits on the behavioral consequences of alcohol consumption.
METHOD: The methods involve library research and analysis of the various
published articles relating to experimental and survey studies of different
RESULTS: The major results indicate that (1) after spirits consumption blood
alcohol concentrations rise more quickly than after beer; (2) for most behavioral
tasks beer creates less impairment than brandy at the same dose levels; (3)
brandy also leads to more emotional and aggressive responses; (4) those who drink
beer or beer and spirits have more alcohol-related problems than others; and (5) 
beer drinkers are more likely than others to drink and drive, to be arrested for 
drinking-driving and to be in alcohol-related accidents.
CONCLUSIONS: It appears that beer and spirits lead to greater problems than does 
wine consumption. However, there is a need for more studies of women and
confirmed drinkers of various beverages. There is also a need to study the
effects of wine consumption on behavioral impairment. Lastly, there is a need to 
determine if there is a beer-drinking culture which supports heavy drinking and
driving after drinking.
PMID: 8747505  [Indexed for MEDLINE]
Clin Geriatr Med. 1992 Feb;8(1):127-41.
Alcohol and the elderly.
Dufour MC(1), Archer L, Gordis E.
Author information: 
(1)National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland.
Moderate drinking for the elderly of both genders is no more than one drink per
day, where a drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of
spirits. Age does not affect the rate of absorption or elimination of alcohol.
Lean body mass decreases and adipose tissue increases with age, however,
resulting in a corresponding decrease in the volume of total body water. With a
smaller volume of distribution, an alcohol dose identical to that administered to
a younger individual of the same size and gender will produce a higher blood
alcohol concentration in the elderly. Low-dose alcohol stimulates appetite and
promoters regular bowel function. In the well-nourished nonalcoholic elderly, the
negative impact of alcohol consumption on nutrition is minimal. Alcohol
consumption improves mood by increasing feelings of happiness and freedom from
care while lessening inhibitions, stress, tension, and depression. Although in
the laboratory low-dose alcohol improves certain types of cognitive function in
young men, in other types of task performance, alcohol induces impairment, which 
worsens with age. The effects of alcohol on sleep are primarily detrimental,
worsening both insomnia and breathing disturbances during sleep. Although the
role of alcohol consumption in mortality from heart disease has not been
investigated in the elderly, moderate drinking appears safe. Under some
circumstances low-dose alcohol may produce analgesia whereas in others it may
worsen pain. The elderly use a significant proportion of both prescription and
over-the-counter medication, a large variety of which interact with alcohol.
Alcoholic beverage consumption may exacerbate cognitive impairment and dementias 
of other etiology. Although some studies suggest that moderate use of alcohol by 
institutionalized senior citizens appears to produce benefits including improved 
socialization, separation of the effects of the social situation from those
specifically attributable to alcohol remains to be accomplished. Older
individuals who want to drink, have no medical contraindications, and take no
drugs (prescription or over-the-counter) that interact with alcohol, may consider
one drink a day to be a prudent level of alcohol consumption. Patients should be 
counseled to avoid alcohol consumption immediately prior to going to bed in order
to avoid sleep disturbances. They also should be cautioned against potential
drug-alcohol interactions and told to avoid alcohol ingestion prior to activities
such as driving. The decision to recommend a particular level of alcohol
consumption in any given patient must, however, be carefully tailored not only to
that individual's specific medical needs but to his or her social and
environmental circumstances as well.
PMID: 1576571  [Indexed for MEDLINE]
Sleep. 2003 Mar 15;26(2):185-91.
Ingestion of ethanol just prior to sleep onset impairs memory for procedural but 
not declarative tasks.
Smith C(1), Smith D.
Author information: 
(1)Dept. of Psychology, Trent University, Peterborough, Ontario, Canada.
STUDY OBJECTIVES: The aim of Experiment 1 was to determine if moderate ethanol
consumption at bedtime would result in memory loss for recently learned cognitive
procedural and declarative tasks. The aim of Experiment 2 was to establish that
the memory loss due to alcohol consumption at bedtime was due to the effect of
alcohol on sleep states.
DESIGN: In Experiment 1, participants were asked to learn a cognitive procedural 
task and a declarative task in the evening. Then, either the same evening or 2
nights later, they were asked to drink ethanol (0.7g/kg). Sleep was monitored for
3 days and re-testing of the tasks was done on the eighth day after training at
the same time of day. In Experiment 2, subjects were asked to learn a cognitive
procedural task (Tower of Hanoi) and a motor procedural task (Pursuit Rotor) in
the late afternoon. Then one group was asked to drink ethanol (0.9 g/kg) right
after task acquisition (5 hours before bed), while the other was asked to drink
the same dose of ethanol just prior to bedtime. Re-testing was done 8 days later 
at the same time of day.
PARTICIPANTS: Subjects in Experiment 1 were 15 college students between the ages 
of 19 and 24 that appeared to be in good health and were relatively naive in
terms of drinking alcohol. Subjects in Experiment 2 were 13 college students in
the same age range. These subjects were considered to be more experienced
drinkers than subjects in Experiment 1 but were not judged to be heavy drinkers.
MEASUREMENTS AND RESULTS: In Experiment 1, the alcohol ingestion resulted in
memory loss for the cognitive procedural task but not the declarative task.
Further, the effect was seen when alcohol ingestion occurred the same day or 2
days after the end of acquisition. In Experiment 2, alcohol ingestion at bedtime 
impaired memory for the cognitive procedural and motor procedural tasks. By
contrast, alcohol ingestion in the afternoon, immediately after the acquisition
of these two tasks, did not impair memory. There were clear changes in the nature
of rapid eye movement (REM) sleep as a result of evening alcohol ingestion. In
Experiment 1, the number of REMs and number of minutes of REM in the first half
of the night were reduced. In Experiment 2, the reduction was in REM densities in
the first half of the night.
CONCLUSIONS: Moderate doses of ethanol can modify the REM sleep architecture by
reducing the number of REMs and/or REM densities as well as minutes of REM sleep,
particularly in the first half of the night. These modifications result in memory
impairment for recently learned cognitive procedural material. Alcohol may also
have a subtle effect on Stage 2 sleep as well, since memory for a Stage 2
sensitive motor procedural task was also impaired.
PMID: 12683478  [Indexed for MEDLINE]
Addiction. 2014 Jun;109(6):880-93. doi: 10.1111/add.12498. Epub 2014 Mar 3.
A systematic review of the epidemiology of unrecorded alcohol consumption and the
chemical composition of unrecorded alcohol.
Rehm J(1), Kailasapillai S, Larsen E, Rehm MX, Samokhvalov AV, Shield KD,
Roerecke M, Lachenmeier DW.
Author information: 
(1)Social and Epidemiological Research (SER) Department, Centre for Addiction and
Mental Health (CAMH), Toronto, Canada; Institute of Medical Sciences, University 
of Toronto (UofT), Toronto, Canada; Dalla Lana School of Public Health, UofT,
Toronto, Canada; Dept. of Psychiatry, Faculty of Medicine, UofT, Toronto, Canada;
PAHO/WHO Collaborating Centre for Mental Health & Addiction, Toronto, Canada;
Epidemiological Research Unit, Technische Universität Dresden, Klinische
Psychologie & Psychotherapie, Dresden, Germany.
BACKGROUND AND AIMS: Unrecorded alcohol constitutes about 30% of all alcohol
consumed globally. The aims of this systematic review were to determine the
epidemiology (occurrence, types, prevalence) of unrecorded alcohol consumption in
different countries/regions, analyse the chemical composition of unrecorded
alcohol and examine health outcomes caused by the consumption of unrecorded
alcohol, based on either epidemiology or toxicology.
METHODS: A systematic search for, and qualitative analysis of, papers with
empirical results on the different categories of unrecorded alcohol, based on
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
RESULTS: Unrecorded alcohol was widespread in all regions of the world. Artisanal
fermented beverages and spirits were the most common categories of unrecorded
alcohol globally, and were available on all continents. In India, industrially
produced spirits (country spirits) were most prevalent. In Russia and countries
of the former Soviet Union, surrogate alcohols complemented artisanal spirits.
Cross-border shopping was the most prevalent method of obtaining unrecorded
alcohol in parts of Europe. Ethanol was the most harmful ingredient of unrecorded
alcohol, and health consequences due to other ingredients found in unrecorded
alcohol were scarce. However, as unrecorded alcohol is usually the least
expensive form of alcohol available in many countries, it may contribute to
higher rates of chronic and irregular heavy drinking.
CONCLUSIONS: Very large amounts of alcohol are produced globally that go
unrecorded. The primary harm from this kind of alcohol arises from the fact that 
it is typically much cheaper than licit alcohol.
DOI: 10.1111/add.12498 
PMID: 24467748  [Indexed for MEDLINE]
Int J Drug Policy. 2011 Mar;22(2):153-60. doi: 10.1016/j.drugpo.2010.11.002. Epub
2011 Jan 15.
Alcohol under the radar: do we have policy options regarding unrecorded alcohol?
Lachenmeier DW(1), Taylor BJ, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Strasse 3, D-76187 Karlsruhe, Germany. Lachenmeier@web.de
BACKGROUND: According to the World Health Organization, the public health impact 
of illicit alcohol and informally produced alcohol should be reduced. This paper 
summarizes and evaluates the evidence base about policy and intervention options 
regarding unrecorded alcohol consumption.
METHODS: A systematic review of the literature using electronic databases.
RESULTS: The literature on unrecorded consumption was sparse with less than 30
articles about policy options, mostly based on observational studies. The most
simplistic option to reduce unrecorded consumption would be to lower recorded
alcohol prices to remove the economic incentive of buying unrecorded alcohol.
However, this may increase the net total alcohol consumption, making it an
unappealing public health policy option. Other policy options largely depend on
the specific sub-group of unrecorded alcohol. The prohibition of toxic compounds 
used to denature alcohol (e.g. methanol) can improve health outcomes associated
with surrogate alcohol consumption. Cross-border shopping can be reduced by
either narrowing the tax differences, or stricter control. Actions limiting
illegal trade and counterfeiting include introduction of tax stamps and
electronic surveillance systems of alcohol trade. Education campaigns might
increase the awareness about the risks associated with illegal alcohol. The most 
problematic category appears to be the home and small-scale artisanal production,
for which the most promising option is to offer financial incentives to the
producers for registration and quality control.
CONCLUSION: Even though there are suggestions and theories on how to reduce
unrecorded alcohol consumption, there is currently no clear evidence base on the 
effectiveness or cost effectiveness of available policy options. In addition, the
differences in consumption levels, types of unrecorded alcohol, culture and
tradition point to different measures in different parts of the world. Thus, the 
recommendation of a framework for moving forward in decision making currently
seems premature. Instead, there is a need for systematic research.
DOI: 10.1016/j.drugpo.2010.11.002 
PMID: 21242085  [Indexed for MEDLINE]
Adicciones. 2011;23(2):133-40.
Quality of illegally and informally produced alcohol in Europe: Results from the 
AMPHORA project.
[Article in English, Spanish]
Lachenmeier DW(1), Leitz J, Schoeberl K, Kuballa T, Straub I, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt, Karlsruhe, Germany.
BACKGROUND: In the WHO region Europe, the average unrecorded adult per capita
alcohol consumption was 2.67 L pure ethanol in 2005, which is 22% of the total
consumption of 12.20 L. Despite concerns about potential health harms from the
chemical composition of unrecorded alcohol, there are surprisingly few data on
the problem in the European Region. This study reports the results from the
Alcohol Measures for Public Health Research Alliance (AMPHORA) project, which
assessed the quality of unrecorded alcohol in a Europe-wide study.
METHODS: Samples of unrecorded alcohol were collected in 16 European countries
and chemically analyzed for potentially health-relevant parameters. Thresholds
for parameters were defined based on potential health hazards of daily drinking.
RESULTS: The average alcoholic strength of unrecorded wine products was 14.9%
vol, and 47.8% vol in unrecorded spirits. One half of the samples (n=57) showed
acceptable alcohol quality. The other half (n=58) showed one or several deficits 
with the most prevalent problem being ethyl carbamate contamination (n=29). Other
problems included copper (n=20), manganese (n=16) and acetaldehyde (n=12). All
other parameters (including methanol, higher alcohols, phthalates) were only
seldom problematic (limit exceedance in less than 10 samples). The price of
unrecorded alcohol was approximately 45% of the price of recorded alcohol.
CONCLUSIONS: The major problem regarding unrecorded alcohol appears to be ethanol
itself, as it is often higher in strength and its lower price may further
contribute to higher drinking amounts. Compared to the health effects of ethanol,
the contamination problems detected may be of minor importance as exposure will
only in worst-case scenarios reach tolerable daily intakes of these substances.
PMID: 21647540  [Indexed for MEDLINE]
Addiction. 2009 Apr;104(4):533-50. doi: 10.1111/j.1360-0443.2009.02516.x.
Carcinogenicity of acetaldehyde in alcoholic beverages: risk assessment outside
ethanol metabolism.
Lachenmeier DW(1), Kanteres F, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany.
Comment in
    Addiction. 2009 Apr;104(4):551-3.
AIMS: In addition to being produced in ethanol metabolism, acetaldehyde occurs
naturally in alcoholic beverages. Limited epidemiological evidence points to
acetaldehyde as an independent risk factor for cancer during alcohol consumption,
in addition to the effects of ethanol. This study aims to estimate human exposure
to acetaldehyde from alcoholic beverages and provide a quantitative risk
METHODS: The human dietary intake of acetaldehyde via alcoholic beverages was
estimated based on World Health Organization (WHO) consumption data and
literature on the acetaldehyde contents of different beverage groups (beer, wine,
spirits and unrecorded alcohol). The risk assessment was conducted using the
European Food Safety Authority's margin of exposure (MOE) approach with benchmark
doses obtained from dose-response modelling of animal experiments. Life-time
cancer risk was calculated using the T25 dose descriptor.
RESULTS: The average exposure to acetaldehyde from alcoholic beverages was
estimated at 0.112 mg/kg body weight/day. The MOE was calculated to be 498, and
the life-time cancer risk at 7.6 in 10,000. Higher risk may exist for people
exposed to high acetaldehyde contaminations, as we have found in certain
unrecorded alcohol beverages in Guatemala and Russia, for which we have
demonstrated possible exposure scenarios, with risks in the range of 1 in 1000.
CONCLUSIONS: The life-time cancer risks for acetaldehyde from alcoholic beverages
greatly exceed the usual limits for cancer risks from the environment set between
1 : 10,000 and 1 : 1,000,000. Alcohol consumption has thus been identified as a
direct source of acetaldehyde exposure, which in conjunction with other sources
(food flavourings, tobacco) results in a magnitude of risk requiring
intervention. An initial public health measure could be to reduce the
acetaldehyde content in alcoholic beverages as low as technologically possible,
and to restrict its use as a food flavour additive.
DOI: 10.1111/j.1360-0443.2009.02516.x 
PMID: 19335652  [Indexed for MEDLINE]
Interdiscip Toxicol. 2011 Dec;4(4):198-205. doi: 10.2478/v10102-011-0030-x.
Unrecorded alcohol consumption in Russia: toxic denaturants and disinfectants
pose additional risks.
Solodun YV(1), Monakhova YB, Kuballa T, Samokhvalov AV, Rehm J, Lachenmeier DW.
Author information: 
(1)Irkutsk Forensic Institute, Prosecutor General's Office, Shevzov Street 1,
664035 Irkutsk, Russia.
In 2005, 30% of all alcohol consumption in Russia was unrecorded. This paper
describes the chemical composition of unrecorded and low cost alcohol, including 
a toxicological evaluation. Alcohol products (n=22) from both recorded and
unrecorded sources were obtained from three Russian cities (Saratov, Lipetsk and 
Irkutsk) and were chemically analyzed. Unrecorded alcohols included homemade
samogons, medicinal alcohols and surrogate alcohols. Analysis included alcoholic 
strength, levels of volatile compounds (methanol, acetaldehyde, higher alcohols),
ethyl carbamate, diethyl phthalate (DEP) and polyhexamethyleneguanidine
hydrochloride (PHMG). Single samples showed contamination with DEP (275-1269
mg/l) and PHMG (515 mg/l) above levels of toxicological concern. Our detailed
chemical analysis of Russian alcohols showed that the composition of vodka,
samogon and medicinal alcohols generally did not raise major public health
concerns other than for ethanol. It was shown, however, that concentration levels
of DEP and PHMG in some surrogate alcohols make these samples unfit for human
consumption as even moderate drinking would exceed acceptable daily intakes.
DOI: 10.2478/v10102-011-0030-x 
PMCID: PMC3274728
PMID: 22319254 Alcohol Clin Exp Res. 2017 Jan;41(1):207-215. doi: 10.1111/acer.13280. Epub 2016 
Dec 16.
Composition of Unrecorded Distilled Alcohol (bai jiu) Produced in Small Rural
Factories in Central China.
Newman I(1), Qian L(2), Tamrakar N(1), Feng Y(1), Xu G(3).
Author information: 
(1)Department of Educational Psychology, Nebraska Prevention Center for Alcohol
and Drug Abuse, University of Nebraska-Lincoln, Lincoln, Nebraska.
(2)Department of Guidance & Training, Chinese Center for Health Education,
Beijing, China.
(3)Key Laboratory of Industrial Biotechnology, School of Biotechnology, Jiangnan 
University, Wuxi, China.
BACKGROUND: Unrecorded traditional distilled spirits (bai jiu, ) are made and
used throughout rural China for everyday use and special occasions. Nearly every 
town or village has a distiller to supply the demand. In rural China, distilling 
bai jiu is legal and regulated lightly or not at all. The World Health
Organization estimates that as much as 25% of all alcohol consumed in China is
unrecorded alcohol, of which an unknown portion is unrecorded bai jiu. Little is 
known about the composition of unrecorded Chinese spirits from rural parts of the
country. This study focused on white spirits because the high ethanol (EtOH)
concentration makes them more likely to contribute to health risks compared to
other types of lower alcohol by volume (ABV) Chinese unrecorded alcohol.
METHODS: Researchers purchased samples of Chinese white spirits from
small-factory distillers in central China. An independent laboratory conducted
the analysis. Alcohol strength (ABV) was determined by hydrometer. Gas
chromatography was used to determine the concentration of volatile organic
compounds: EtOH, methanol, acetaldehyde, ethyl acetate, and higher alcohols.
Samples were tested for 3 heavy metals-arsenic, cadmium, and lead. We used the
guidelines developed by the Alcohol Measures for Public Health Research Alliance 
(AMPHORA) of the European Commission to assess risk.
RESULTS: ABV ranged from 35.7 to 61.4%, and 58 of the 61 samples exceeded 40%
ABV. The concentration of methanol, ethyl acetate, lead, arsenic, and cadmium was
below AMPHORA guideline. The sum of higher alcohols exceeded the AMPHORA maximum 
in just 1 sample. Forty of the 61 samples had acetaldehyde levels beyond the
AMPHORA guideline.
CONCLUSIONS: The unrecorded Chinese alcohols we analyzed had a high EtOH
concentration-a public health concern that is also presented by recorded
alcohols. The high percentage of samples (65.5%) that had elevated acetaldehyde
suggests the need to investigate the causes for this result and the need for
steps to reduce acetaldehyde levels. The cumulative long-term risks of using high
EtOH and high acetaldehyde Chinese spirits are heightened by the percentage of
people in China who have a genetic trait for impaired acetaldehyde metabolism.
DOI: 10.1111/acer.13280 
PMID: 27984849  [Indexed for MEDLINE]
Food Chem Toxicol. 2008 Aug;46(8):2903-11. doi: 10.1016/j.fct.2008.05.034. Epub
2008 Jun 6.
The role of acetaldehyde outside ethanol metabolism in the carcinogenicity of
alcoholic beverages: evidence from a large chemical survey.
Lachenmeier DW(1), Sohnius EM.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Str. 
3, D-76187 Karlsruhe, Germany. Lachenmeier@web.de
Acetaldehyde is a volatile compound naturally found in alcoholic beverages, and
it is regarded as possibly being carcinogenic to humans (IARC Group 2B).
Acetaldehyde formed during ethanol metabolism is generally considered as a source
of carcinogenicity in alcoholic beverages. However, no systematic data is
available about its occurrence in alcoholic beverages and the carcinogenic
potential of human exposure to this directly ingested form of acetaldehyde
outside ethanol metabolism. In this study, we have analysed and evaluated a large
sample collective of different alcoholic beverages (n=1,555). Beer (9+/-7 mg/l,
range 0-63 mg/l) had significantly lower acetaldehyde contents than wine (34+/-34
mg/l, range 0-211 mg/l), or spirits (66+/-101 mg/l, range 0-1,159 mg/l). The
highest acetaldehyde concentrations were generally found in fortified wines
(118+/-120 mg/l, range 12-800 mg/l). Assuming an equal distribution between the
beverage and saliva, the residual acetaldehyde concentrations in the saliva after
swallowing could be on average 195 microM for beer, 734 microM for wine, 1,387
microM for spirits, or 2,417 microM for fortified wine, which are above levels
previously regarded as potentially carcinogenic. Further research is needed to
confirm the carcinogenic potential of directly ingested acetaldehyde. Until then,
some possible preliminary interventions include the reduction of acetaldehyde in 
the beverages by improvement in production technology or the use of acetaldehyde 
binding additives. A re-evaluation of the 'generally recognized as safe' status
of acetaldehyde is also required, which does not appear to be in agreement with
its toxicity and carcinogenicity.
DOI: 10.1016/j.fct.2008.05.034 
PMID: 18577414  [Indexed for MEDLINE]
Pancreas. 2010 Nov;39(8):1199-204. doi: 10.1097/MPA.0b013e3181dd65b5.
Can by-products in country-made alcohols induce acute pancreatitis?
Barreto SG(1), Jardine D, Phillips P, Bhatia M, Saccone GT.
Author information: 
(1)Department of General and Digestive Surgery, Faculty of Science and
Engineering, Flinders Medical Centre and Flinders University, Adelaide, South
Australia, Australia. barr0264@flinders.edu.au
Comment in
    Pancreas. 2011 Oct;40(7):1143-4; author reply 1144-5.
OBJECTIVES: We previously reported a high incidence of alcohol-related acute
pancreatitis (AP) in Goa, India, where country-made alcoholic products are
consumed in addition to the commercially available alcoholic products. We aimed
to analyze the composition of these country-made alcoholic products consumed by a
population with a high incidence of alcohol-related AP.
METHODS: Three locally distilled alcoholic products (ethanol content, >20%)
regularly consumed by patients developing AP, as determined by responses in a
patient questionnaire, were selected. Three commercially available products with 
comparable ethanol content (rum, whiskey, and brandy) were used for comparison.
Representative samples were analyzed using gas chromatography/mass spectrometry. 
Compound assignments used mass spectral searches of the NIST library (2008).
RESULTS: Commercially available rum, whiskey, and brandy used for comparison
contained the 2 major constituents, ethanol and water. In addition, the
country-made alcoholic products contained a higher level of by-products including
long-chain alcohols (eg, butanol, propanol), aldehydes (eg, acetaldehyde), acids 
(eg, acetic acid), and even traces of methanol.
CONCLUSIONS: Country-made alcoholic products contain many compounds in addition
to ethanol. Given the high incidence of alcohol-related AP in the population
where these products are consumed, further evaluation of their constituents in
relation to the induction of pancreatic damage is warranted.
DOI: 10.1097/MPA.0b013e3181dd65b5 
PMID: 20531242  [Indexed for MEDLINE]
Arch Toxicol. 2016 Oct;90(10):2349-67. doi: 10.1007/s00204-016-1770-3. Epub 2016 
Jun 29.
Carcinogenic compounds in alcoholic beverages: an update.
Pflaum T(1), Hausler T(1), Baumung C(1), Ackermann S(1), Kuballa T(1), Rehm
J(2)(3)(4)(5)(6)(7), Lachenmeier DW(8)(9).
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Strasse 3, 76187, Karlsruhe, Germany.
(2)Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON,
M5S 2S1, Canada.
(3)Campbell Family Mental Health Research Institute, CAMH, 250 College Street,
Toronto, ON, M5T 1R8, Canada.
(4)Institute of Medical Science (IMS), University of Toronto, Medical Sciences
Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada.
(5)Department of Psychiatry, University of Toronto, 250 College Street, 8th
Floor, Toronto, ON, M5T 1R8, Canada.
(6)Dalla Lana School of Public Health, University of Toronto, 155 College Street,
6th Floor, Toronto, ON, M5T 3M7, Canada.
(7)Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer
Str. 46, 01187, Dresden, Germany.
(8)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Strasse 3, 76187, Karlsruhe, Germany. Lachenmeier@web.de.
(9)Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer
Str. 46, 01187, Dresden, Germany. Lachenmeier@web.de.
The consumption of alcoholic beverages has been classified as carcinogenic to
humans by the International Agency for Research on Cancer (IARC) since 1988. More
recently, in 2010, ethanol as the major constituent of alcoholic beverages and
its metabolite acetaldehyde were also classified as carcinogenic to humans.
Alcoholic beverages as multi-component mixtures may additionally contain further 
known or suspected human carcinogens as constituent or contaminant. This review
will discuss the occurrence and toxicology of eighteen carcinogenic compounds
(acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethanol, ethyl 
carbamate, formaldehyde, furan, glyphosate, lead, 3-MCPD, 4-methylimidazole,
N-nitrosodimethylamine, pulegone, ochratoxin A, safrole) occurring in alcoholic
beverages as identified based on monograph reviews by the IARC. For most of the
compounds of alcoholic beverages, quantitative risk assessment provided evidence 
for only a very low risk (such as margins of exposure above 10,000). The highest 
risk was found for ethanol, which may reach exposures in ranges known to increase
the cancer risk even at moderate drinking (margin of exposure around 1). Other
constituents that could pose a risk to the drinker were inorganic lead, arsenic, 
acetaldehyde, cadmium and ethyl carbamate, for most of which mitigation by good
manufacturing practices is possible. Nevertheless, due to the major effect of
ethanol, the cancer burden due to alcohol consumption can only be reduced by
reducing alcohol consumption in general or by lowering the alcoholic strength of 
DOI: 10.1007/s00204-016-1770-3 
PMID: 27353523  [Indexed for MEDLINE]

eCollection 2016 Jun.
Chemical Components of Noncommercial Alcohol Beverage Samples: A Study With the
Viewpoint of Toxic Components in Mashhad, Iran.
Dadpour B(1), Hedjazi A(2), Ghorbani H(2), Khosrojerdi H(1), Vaziri SM(3), Malek 
Zadeh H(4), Habibi Tamijani A(2).
Author information: 
(1)Faculty of Medicine, Addiction Research Center, Mashhad University of Medical 
Sciences, Mashhad, IR Iran.
(2)Legal Medicine Research Center, Legal Medicine Organization, Tehran, IR Iran.
(3)Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences,
Mashhad, IR Iran.
(4)Medical Toxicology Research Center, Mashhad University of Medical Sciences,
Mashhad, IR Iran.
BACKGROUND: Iran has one of the lowest alcoholic beverage use rates in comparison
with other countries, because it is legally forbidden and because of religious
beliefs. Even so, unrecorded and noncommercial alcohol remains a considerable
concern, which needs special attention.
OBJECTIVES: In the current research, we have studied the general composition of
noncommercial alcohol samples to identify potentially toxic components in the
context of the city of Mashhad in IR Iran.
PATIENTS AND METHODS: Using a descriptive study, chemical composition records of 
alcohol samples obtained from Mashhad and its suburbs (from March 2013 to March
2014) were evaluated in terms of ethanol percentage and methanol percentage using
gas chromatography. Likewise, the pH of the alcohol and the location of the
sample were also considered. Some substances, such as inorganic elements, were
not included because there was no information about these substances in the
RESULTS: Of 877 reports of alcohol samples, more than 50% were obtained from
Mashhad and the rest were from the suburbs. Of the reports, 57.5% were in the
spring and summer, followed by 42.5% in the fall and winter. The mean (min-max)
of ethanol percentage was 30.04% (0 - 98.4). In four cases, methanol was
detected. The mean (min-max) of methanol percentage was 23% (4 - 95).The majority
of the samples had an acidic pH.
CONCLUSIONS: The composition of unrecorded samples did not raise major
toxicological concern beyond ethanol in alcohol products. However, concentration 
levels of methanol in some unrecorded alcohol samples made these samples
detrimental for human consumption.
DOI: 10.5812/ijhrba.27831 
PMCID: PMC5002315
PMID: 27622171 
J Agric Food Chem. 2006 Dec 27;54(26):9992-7.
Production and composition of cider spirits distilled in "alquitara".
Madrera RR(1), Valles BS, Hevia AG, Fernandez OG, Tascón NF, Alonso JJ.
Author information: 
(1)Area de Tecnología de los Alimentos, Servicio Regional de Investigación y
Desarrollo Agroalimentario (SERIDA), E-33300 Villaviciosa (Asturias), Spain.
The capacity of alquitara (a traditional distillation system) to produce cider
brandies is evaluated. To do so, the chemical composition of 12 fractions
obtained during the distillation process and the cider brandies obtained from
five ciders were analyzed (alcohol strength, methanol, volatile substances,
furfural, and metals), taking into account European and Spanish legislation.
During the course of distillation, an important increase in methanol, furfural,
2-phenylethanol, and metals in the last fractions was observed, while fusel oils 
were more abundant in the first fractions collected. Only acetaldehyde behaved
differently, showing a minimum concentration in the middle fractions that might
be explained by its formation on the surface of alquitara. On the other hand, the
final distillates obtained by means of this method complied with the considered
regulations. Worth highlighting in this regard are the low levels of a potential 
toxin such as methanol, as well as the detection of a constant ratio for
methanol, ethanol, and fusel oil for the pairs of cider/spirits analyzed, which
could be interpreted as an indication of good uniformity in the distillation
system and method, thus guaranteeing product quality.
DOI: 10.1021/jf062316h 
PMID: 17177532  [Indexed for MEDLINE]
Int J Environ Res Public Health. 2009 Jan;6(1):349-60. doi:10.3390/ijerph6010349. Epub 2009 Jan 20.
Ethyl carbamate in alcoholic beverages from Mexico (tequila, mezcal, bacanora,
sotol) and Guatemala (cuxa): market survey and risk assessment.
Lachenmeier DW(1), Kanteres F, Kuballa T, López MG, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany.
Ethyl carbamate (EC) is a recognized genotoxic carcinogen, with widespread
occurrence in fermented foods and beverages. No data on its occurrence in
alcoholic beverages from Mexico or Central America is available. Samples of agave
spirits including tequila, mezcal, bacanora and sotol (n=110), and of the
sugarcane spirit cuxa (n=16) were purchased in Mexico and Guatemala,
respectively, and analyzed for EC. The incidence of EC contamination was higher
in Mexico than in Guatemala, however, concentrations were below international
guideline levels (<0.15 mg/L). Risk assessment found the Margin of Exposure (MOE)
in line with that of European spirits. It is therefore unlikely that EC plays a
role in high rates of liver cirrhosis reported in Mexico.
DOI: 10.3390/ijerph6010349 
PMCID: PMC2672322
PMID: 19440288  [Indexed for MEDLINE]
Can J Clin Pharmacol. 2010 Winter;17(1):e47-50. Epub 2010 Jan 4.
Alcohol content in declared non-to low alcoholic beverages: implications to
Goh YI(1), Verjee Z, Koren G.
Author information: 
(1)Motherisk Program, Division of Clinical Pharmacology & Toxicology, The
Hospital for Sick Children, Toronto, Canada.
BACKGROUND: Alcohol consumption in pregnancy may result in serious adverse fetal 
outcome. Non- or low alcoholic wines and beers may be a risk-reduction strategy
to help alcohol-dependent individuals to prevent or limit ethanol consumption.
The objective of this study was to quantify ethanol concentrations in Canadian
beverages claiming to contain no or low alcohol content.
METHODS: Forty-five different beverages claiming to contain no or low alcohol
content in the Canadian market were tested for ethanol concentration using gas
RESULTS: Thirteen (29%) of the beverages contained ethanol levels higher than the
declared concentration on their label. Six beverages claiming to contain no
alcohol were found to contain greater than 1% ethanol.
CONCLUSION: Pregnant women seeking replacement to alcoholic beverages may be
misled by these labels, unknowingly exposing themselves and their unborn babies
to ethanol.
PMID: 20051610  [Indexed for MEDLINE]
Sci Total Environ. 2009 Nov 1;407(22):5861-8. doi:10.1016/j.scitotenv.2009.08.012. Epub 2009 Sep 3.
Artisanal alcohol production in Mayan Guatemala: chemical safety evaluation with 
special regard to acetaldehyde contamination.
Kanteres F(1), Rehm J, Lachenmeier DW.
Author information: 
(1)Centre for Addiction and Mental Health (CAMH), 33 Russell Street, ARF 2035,
Toronto, ON, Canada.
There is a lack of knowledge regarding the composition, production, distribution,
and consumption of artisanal alcohol, particularly in the developing world. In
Nahualá, an indigenous Mayan municipality located in highland Guatemala, heavy
alcohol consumption appears to have had a significant negative impact on health, 
a major role in cases of violence and domestic abuse, and a link to street
habitation. Cuxa, an artisanally, as well as commercially produced sugarcane
alcohol, is widely consumed by heavy drinkers in this community. Cuxa samples
from all distribution points in the community were obtained and chemically
analyzed for health-relevant constituents and contaminants including methanol,
acetaldehyde, higher alcohols, and metals. From those, only acetaldehyde was
confirmed to be present in unusually high levels (up to 126 g/hl of pure
alcohol), particularly in samples that were produced clandestinely. Acetaldehyde 
has been evaluated as "possibly carcinogenic" and has also been identified as
having significant human exposure in a recent risk assessment. This study
explores the reasons for the elevated levels of acetaldehyde, through both
sampling and analyses of raw and intermediary products of cuxa production, as
well as interviews from producers of the clandestine alcohol. For further
insight, we experimentally produced this alcohol in our laboratory, based on the 
directions provided by the producers, as well as materials from the town itself. 
Based on these data, the origin of the acetaldehyde contamination appears to be
due to chemical changes induced during processing, with the major causative
factors consisting of poor hygiene, aerobic working conditions, and inadequate
yeast strains, compounded by flawed distillation methodology that neglects
separation of the first fractions of the distillate. These results indicate a
preventable public health concern for consumers, which can be overcome through
education about good manufacturing practices, as well as financial incentives to 
separate the acetaldehyde-rich fractions during distillation.
DOI: 10.1016/j.scitotenv.2009.08.012 
PMID: 19729189  [Indexed for MEDLINE]
Eur J Cancer Prev. 2011 Nov;20(6):526-9. doi: 10.1097/CEJ.0b013e328348fbe4.
Acetaldehyde level in spirits from central European countries.
Boffetta P(1), Kaihovaara P, Rudnai P, Znaor A, Lissowska J, Swiatkowska B, Mates
D, Pandics T, Salaspuro M.
Author information: 
(1)International Prevention Research Institute, Lyon, France.
Intake of acetaldehyde in alcoholic beverages, in central Europe, might explain
the high rate of alcohol-related diseases in these countries. We measured the
acetaldehyde level in 30 samples of home-made spirits and 12 samples of
industry-made spirits from four central European countries, including 35
fruit-based and five grain-based spirits. Acetaldehyde was detected in all
fruit-based spirits and in none of the grain-based spirits. Acetaldehyde levels
were above 2000 µmol/l in 12 samples, 11 of which were home-made. In a
multivariate analysis restricted to fruit-based spirits, however, the difference 
between home-made and industry-based spirits was not statistically significant.
These results add evidence to the hypothesis that intake of acetaldehyde in
alcoholic beverages, in central Europe, contributes to the burden of
alcohol-related disease, especially that of upper digestive tract cancers. The
acetaldehyde level should be monitored and high-level exposure should be avoided.
DOI: 10.1097/CEJ.0b013e328348fbe4 
PMID: 21811156  [Indexed for MEDLINE]
J Toxicol Clin Toxicol. 2004;42(5):597-601.
Analysis of moonshine for contaminants.
Holstege CP(1), Ferguson JD, Wolf CE, Baer AB, Poklis A.
Author information: 
(1)Blue Ridge Poison Center, Division of Medical Toxicology, Department of
Emergency Medicine, University of Virginia, P.O. Box 800699, Charlottesville, VA 
22908-0699, USA. ch2xf@virginia.edu
OBJECTIVES: In the past, some moonshine products contained potentially toxic
contaminants. Although moonshine production continues in the United States, no
studies have analyzed the content of moonshine since the early 1960s. We
hypothesize that moonshine continues to contain potentially toxic concentrations 
of contaminants.
METHODS: Forty-eight samples of illicitly distilled moonshine were obtained from 
law enforcement agencies. An independent laboratory, blinded to both the
moonshine source and a control sample of ethanol, conducted the analysis. Lead
content was determined using atomic absorption spectrophotometry with a graphite 
tube atomizer. Alcohol content, including ethanol, acetone, isopropanol,
methanol, and ethylene glycol, was determined using gas liquid chromatography
with flame ionization detection.
RESULTS: Ethanol content ranged from 10.5% to 66.0% with a mean value of 41.2%.
Lead was found in measurable quantities in 43 of 48 samples with values ranging
from 5 to 599 parts per billion (ppb) with a mean value of 80.7 ppb. A total of
29 of 48 (60%) of samples contained lead concentrations above or equal to the EPA
water guideline of 15 ppb. Methanol was found in only one sample at a
concentration of 0.11%. No samples contained detectable concentrations of
acetone, isopropanol, or ethylene glycol.
CONCLUSIONS: Many moonshine samples contain detectable concentrations of lead.
Extrapolations based on the described moonshine lead content suggest that chronic
consumers of moonshine may develop elevated lead concentrations. Physicians
should consider lead toxicity in the differential diagnosis when evaluating
patients consuming moonshine.
PMID: 15462151  [Indexed for MEDLINE]
Food Chem Toxicol. 2008 Feb;46(2):476-9. Epub 2007 Aug 23.
Potential mechanism for Calvados-related oesophageal cancer.
Linderborg K(1), Joly JP, Visapää JP, Salaspuro M.
Author information: 
(1)University of Helsinki, Research Unit of Substance Abuse Medicine, Helsinki
00014, Finland. klas.linderborg@helsinki.fi
The old Normandian habit of consumption of hot Calvados is associated with an
increased risk of oesophageal cancer compared to other alcoholic beverages. The
role of alcohol consumption in the risk of oesophageal cancer is well
established. The first metabolite of alcohol, acetaldehyde is a potential local
carcinogen in humans. Accordingly, different acetaldehyde concentrations in
different beverages could account for some of the variations in cancer risk with 
regard to the type of alcoholic beverage. Eighteen samples of farm-made Calvados 
were collected in Normandy. Samples of commercially available beverages were
purchased, including factory-made Calvados, other spirits, wines, beer and cider.
The samples were analysed gas-chromatically for acetaldehyde and ethanol
concentrations. All results are expressed as mean+/-SD. The mean acetaldehyde
concentration of all Calvados samples (1781+/-861 microM, n =25) differed highly 
significantly (p<0.001) from that of all wine samples (275+/-236 microM), from
all other spirits samples (1251+/-1155 microM, p<0.05), and from all beer and
cider samples (233+/-281 microM, p<0.001). Farm-made Calvados and farm-made
cognac had the highest mean acetaldehyde concentration of the measured beverages.
The high concentration of acetaldehyde combined with possible effects of the high
temperature at which Calvados is consumed could account for the increased risk of
Calvados-related oesophageal cancer.
DOI: 10.1016/j.fct.2007.08.019 
PMID: 17892909  [Indexed for MEDLINE]
Int J Environ Res Public Health. 2018 Dec 1;15(12). pii: E2710. doi:10.3390/ijerph15122710.
Chemical Composition and Safety of Unrecorded Grain Alcohol (Bai Jiu) Samples from Three Provinces in China.
Newman IM(1), Qian L(2), Tamrakar N(3), Zhang BB(4).
Author information: 
(1)Nebraska Prevention Center for Alcohol and Drug Abuse, Department of
Educational Psychology, University of Nebraska-Lincoln, P.O. Box 880345, Lincoln,
NE 68588, USA. inewman1@unl.edu.
(2)National Center for Health Education, Beijing 100011, China.
(3)Nebraska Prevention Center for Alcohol and Drug Abuse, Department of
Educational Psychology, University of Nebraska-Lincoln, P.O. Box 880345, Lincoln,
NE 68588, USA. ntamrakar1987@gmail.com.
(4)School of Biotechnology, Jiangnan University, Wuxi 214122, China.
About 20% of spirits consumed in China are "unrecorded", where these spirits are 
produced in small-scale distilleries and sold outside the systems of taxation and
quality control. Researchers visited small distilleries in rural Yunnan, Hubei
and Anhui and purchased 56 samples of unrecorded bai jiu. Seven samples of the
recorded bai jiu were purchased as reference samples. An independent laboratory
conducted a blind analysis of the samples. Results were compared to the standards
for unrecorded alcohol adopted by the European Commission's Alcohol Measures for 
Public Health Research Alliance (AMPHORA). No samples exceeded the AMPHORA
guidelines for methanol, ethyl acetate, lead and cadmium; one sample exceeded
1000 g/hL of combined higher alcohols; one sample exceeded 100 mg/L of arsenic;
and three samples exceeded 50g/hL of acetaldehyde, but only by relatively small
amounts. Low-priced unrecorded bai jiu averaged 9.8 RMB/jin (500 mL), compared to
10.7 RMB/jin for inexpensive recorded bai jiu. The low-priced unrecorded bai jiu 
samples had a mean alcohol-by-volume of 51.8%, compared to 50.1% for the recorded
bai jiu samples. The results did not raise any critical safety issues with
unrecorded bai jiu, but there may be long-term health risks related to ethanol,
acetaldehyde and arsenic. The social ties between the bai jiu makers and the
people who consume their product are a deterrent to adulteration; but when bai
jiu is sold outside of the social circle, the deterrent disappears.
DOI: 10.3390/ijerph15122710 
PMID: 30513745  [Indexed for MEDLINE]
Food Addit Contam. 1989 Jul-Sep;6(3):383-9.
Investigation of ethyl carbamate levels in some fermented foods and alcoholic beverages.
Dennis MJ(1), Howarth N, Key PE, Pointer M, Massey RC.
Author information: 
(1)Ministry of Agriculture, Fisheries and Food, Food Science Division, Norwich,
An analytical procedure has been developed for the determination of trace amounts
of ethyl carbamate in fermented foodstuffs and alcoholic beverages.
Concentrations were generally below the 1-5 micrograms/kg detection limit in
bread, cheese, yoghurt, beer, gin and vodka. Higher concentrations were found in 
the other alcoholic beverages examined, which included whisky, fruit brandy,
liqueur, wine, sherry and port.
DOI: 10.1080/02652038909373794 
PMID: 2721787  [Indexed for MEDLINE]
Forensic Sci Int. 2008 Oct 25;181(1-3):40-6. doi:10.1016/j.forsciint.2008.08.010. Epub 2008 Oct 15.
Occurrence of ethanol and other drugs in blood and urine specimens from female
victims of alleged sexual assault.
Jones AW(1), Kugelberg FC, Holmgren A, Ahlner J.
Author information: 
(1)Department of Forensic Genetics and Forensic Toxicology, National Board of
Forensic Medicine, Artillerigatan 12, SE-587 58 Linköping, Sweden.
Results of toxicological analysis of blood and urine specimens from 1806 female
victims of alleged non-consensual sexual activity are reported. After making
contact with the police authorities, the victims were examined by a physician for
injuries and biological specimens were taken for forensic toxicology and other
purposes (e.g. DNA). Urine if available or otherwise on an aliquot of blood after
protein precipitation was screened for the presence of drugs by enzyme
immunoassay methods (EMIT/CEDIA). All positive results from screening were
verified by more specific methods, involving isotope dilution gas
chromatography-mass spectrometry (GC-MS) for illicit drugs. A large number of
prescription drugs were analyzed in blood by capillary column gas chromatography 
with a nitrogen-phosphorous (N-P) detector. Ethanol was determined in blood and
urine by headspace gas chromatography and concentrations less than 0.1g/L were
reported as negative. The number of reported cases of alleged sexual assault was 
highest during the warmer summer months and the mean age of victims was 24 years 
(median 20 years), with approximately 60% being between 15 and 25 years. In 559
cases (31%) ethanol and drugs were negative. In 772 cases (43% of total) ethanol 
was the only drug identified in blood or urine. In 215 cases (12%) ethanol
occurred together with at least one other drug. The mean, median and highest
concentrations of ethanol in blood (N=806) were 1.24 g/L, 1.19 g/L and 3.7 g/L,
respectively. The age of victims and their blood-alcohol concentration (BAC) were
positively correlated (r=0.365, p<0.001). Because BAC decreases at a rate of
0.10-0.25 g/(Lh), owing to metabolism the concentration in blood at time of
sampling is often appreciably less than when the crime was committed several
hours earlier. Licit or illicit drugs were identified in blood or urine in N=262 
cases (15%). Amphetamine and tetrahydrocannabinol were the most common illicit
drugs at mean (median) concentrations in blood of 0.22 mg/L (0.1mg/L) and 0.0012 
mg/L (0.0006 mg/L), respectively. Among prescription drugs, sedative-hypnotics
such as diazepam and zopiclone were common findings along with SSRI
antidepressants and various opiate analgesics. Interpreting the analytical
results in terms of voluntary vs. surreptitious administration of drugs and the
degree of incapacitation in the victim as well as ability to give informed
consent for sexual activity is fraught with difficulties.
DOI: 10.1016/j.forsciint.2008.08.010 
PMID: 18922656  [Indexed for MEDLINE]
West Afr J Med. 2009 Sep-Oct;28(5):291-4.
Sweet little Gabonese palm wine: a neglected alcohol.
[Article in English, French]
Mavioga EM(1), Mullot JU, Frederic C, Huart B, Burnat P.
Author information: 
(1)Hopital d'Instruction des armees BEGIN, Service de Biochimie, Toxicologie et
Pharmacologie Cliniques, Saint-Mandé, France. menack28@yahoo.fr
BACKGROUND: During the last ten years, consumption of palm wine, a popular
traditional alcoholic beverage, seriously increases in Gabon. This sweet beverage
seems to be the main alcohol and the most drunken in low socioeconomic
OBJECTIVE: To have an idea of its composition and toxicity, 21 samples of palm
wine were collected in the country and analysed.
METHODS: Twenty-one palm wine samples were randomly selected from all over Gabon.
Methanol and ethanol concentrations in the samples were measured by gas
chromatography. Aromatic hydrocarbons were measured by selected ion monitoring
mode in mass spectrometry. Delection of heavy metals was by standard techniques.
RESULTS: Gabonese palm wine contained ethanol at a mean concentration of about 60
g*L-1, i.e. 7.5 degrees (volume %), volatile components such as alcohols,
aldehydes, carboxylic acids and esters and trace metals. Trace metals were
present at low concentrations below internationally recognized maximal limits for
alcoholic beverages with less than 2 microg*L-1 for cadmium, less than 10
microg*L-1 for arsenic and for lead 15 samples with concentrations under 10
microg*L-1 and the last six samples with concentrations between 11 and 61
microg*L-1. None of the searched aromatic or chlorinated solvents, indicative of 
refined fuel or industrial contamination, was detected.
CONCLUSION: For the parameters analyzed here, there seems to be no significant
difference in constitution between Gabonese wine palm and others kind of palm
wine produced in West Africa. This alcohol needs to be more considered by public 
health authorities and medical teams because of its health and economic
PMID: 20383831  [Indexed for MEDLINE]
Regul Toxicol Pharmacol. 2008 Apr;50(3):313-21. doi: 10.1016/j.yrtph.2007.12.008.
Epub 2008 Jan 16.
Defining maximum levels of higher alcohols in alcoholic beverages and surrogate
alcohol products.
Lachenmeier DW(1), Haupt S, Schulz K.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Strasse 3, D-76187 Karlsruhe, Germany. Lachenmeier@web.de
Higher alcohols occur naturally in alcoholic beverages as by-products of
alcoholic fermentation. Recently, concerns have been raised about the levels of
higher alcohols in surrogate alcohol (i.e., illicit or home-produced alcoholic
beverages) that might lead to an increased incidence of liver diseases in regions
where there is a high consumption of such beverages. In contrast, higher alcohols
are generally regarded as important flavour compounds, so that European
legislation even demands minimum contents in certain spirits. In the current
study we review the scientific literature on the toxicity of higher alcohols and 
estimate tolerable concentrations in alcoholic beverages. On the assumption that 
an adult consumes 4 x 25 ml of a drink containing 40% vol alcohol, the maximum
tolerable concentrations of 1-propanol, 1-butanol, 2-butanol, isobutanol, isoamyl
alcohol and 1-hexanol in such a drink would range between 228 and 3325 g/hl of
pure alcohol. A reasonable preliminary guideline level would be 1000 g/hl of pure
alcohol for the sum of all higher alcohols. This level is higher than the
concentrations usually found in both legal alcoholic beverages and surrogate
alcohols, so that we conclude that scientific data are lacking so far to consider
higher alcohols as a likely cause for the adverse effects of surrogate alcohol.
The limitations of our study include the inadequate toxicological data base
leading to uncertainties during the extrapolation of toxicological data between
the different alcohols, as well as unknown interactions between the different
higher alcohols and ethanol.
DOI: 10.1016/j.yrtph.2007.12.008 
PMID: 18295386  [Indexed for MEDLINE]
Addiction. 2005 Apr;100(4):536-42.
Could the high level of cirrhosis in central and eastern Europe be due partly to 
the quality of alcohol consumed? An exploratory investigation.
Szucs S(1), Sárváry A, McKee M, Adány R.
Author information: 
(1)Department of Preventive Medicine, School of Public Health, Medical and Health
Science Centre, University of Debrecen, H-4012 Debrecen, Hungary.
BACKGROUND: The burden of alcohol-related diseases differs widely among
countries. Since the 1980s, a band of countries in Central and Eastern Europe
have experienced a steep rise in deaths from chronic liver diseases and
cirrhosis. A possible risk factor is the consumption of illegally produced
home-made spirits in these countries containing varying amounts of aliphatic
alcohols and which may be hepatotoxic. However, little is known about the
composition of such beverages.
AIMS: To compare the concentration of short-chain aliphatic alcohols in spirits
from illegal and legal sources in Hungary.
DESIGN: Samples taken from commercial retailers and illegal sources were
collected and their aliphatic patterns and alcohol concentrations were determined
by gas chromatographic/mass spectrometric (GC/MS) analysis.
FINDINGS: The concentrations of methanol, isobutanol, 1-propanol, 1-butanol,
2-butanol and isoamyl alcohol were significantly higher in home-made spirits than
those of from commercial sources.
CONCLUSIONS: The results suggest that the consumption of home-made spirits is an 
additional risk factor for the development of alcohol-induced cirrhosis and may
have contributed to high level of liver cirrhosis mortality in Central and
Eastern Europe. Restrictions on supply and sale of alcohol from illicit sources
are needed urgently to reduce significantly the mortality from chronic liver
DOI: 10.1111/j.1360-0443.2005.01009.x 
PMID: 15784068  [Indexed for MEDLINE]
Food Chem Toxicol. 2015 Sep;83:210-4. doi: 10.1016/j.fct.2015.05.006. Epub 2015
Jun 25.
The total margin of exposure of ethanol and acetaldehyde for heavy drinkers
consuming cider or vodka.
Lachenmeier DW(1), Gill JS(2), Chick J(3), Rehm J(4).
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger
Strasse 3, D-76187 Karlsruhe, Germany; Epidemiological Research Unit, Institute
for Clinical Psychology and Psychotherapy, Technische Universität Dresden,
Dresden, Germany. Electronic address: Lachenmeier@web.de.
(2)School of Nursing, Midwifery and Social Care, Edinburgh Napier University,
Sighthill Campus, Edinburgh EH11 4BN, Scotland, UK.
(3)School of Nursing, Midwifery and Social Care, Edinburgh Napier University,
Sighthill Campus, Edinburgh EH11 4BN, Scotland, UK; Castle Craig Hospital, Blyth 
Bridge, West Linton, EH46 7DH Scotland, UK.
(4)Epidemiological Research Unit, Institute for Clinical Psychology and
Psychotherapy, Technische Universität Dresden, Dresden, Germany; Social and
Epidemiological Research (SER) Department, Centre for Addiction and Mental
Health, Toronto, Canada; Addiction Policy, Dalla Lana School of Public Health,
University of Toronto (UofT), Canada; PAHO/WHO Collaborating Centre for Mental
Health & Addiction, Toronto, Canada; Institute of Medical Science, UofT, Canada.
Heavy drinkers in Scotland may consume 1600 g ethanol per week. Due to its low
price, cider may be preferred over other beverages. Anecdotal evidence has linked
cider to specific health hazards beyond other alcoholic beverages. To examine
this hypothesis, nine apple and pear cider samples were chemically analysed for
constituents and contaminants. None of the products exceeded regulatory or
toxicological thresholds, but the regular occurrence of acetaldehyde in cider was
detected. To provide a quantitative risk assessment, two collectives of exclusive
drinkers of cider and vodka were compared and the intake of acetaldehyde was
estimated using probabilistic Monte-Carlo type analysis. The cider consumers were
found to ingest more than 200-times the amount of acetaldehyde consumed by vodka 
consumers. The margins of exposure (MOE) of acetaldehyde were 224 for the cider
and over 220,000 for vodka consumers. However, if the effects of ethanol were
considered in a cumulative assessment of the combined MOE, the effect of
acetaldehyde was minor and the combined MOE for both groups was 0.3. We suggest
that alcohol policy priority should be given on reducing ethanol intake by
measures such as minimum pricing, rather than to focus on acetaldehyde.
DOI: 10.1016/j.fct.2015.05.006 
PMID: 26116882  [Indexed for MEDLINE]
Alcohol Clin Exp Res. 2014 Sep;38(9):2460-7. doi: 10.1111/acer.12511.
Alcoholic beverage strength discrimination by taste may have an upper threshold.
Lachenmeier DW(1), Kanteres F, Rehm J.
Author information: 
(1)Chemisches und Veterinäruntersuchungsamt (CVUA), Karlsruhe, Germany; Ministry 
of Rural Affairs and Consumer Protection, Stuttgart, Germany; Epidemiological
Research Unit, Institute for Clinical Psychology and Psychotherapy, Technische
Universität Dresden, Dresden, Germany.
BACKGROUND: Given the association between alcohol consumption and negative health
consequences, there is a need for individuals to be aware of their consumption of
ethanol, which requires knowledge of serving sizes and alcoholic strength. This
study is one of the first to systematically investigate the ability to
discriminate alcoholic strength by taste.
METHODS: Nine discrimination tests (total n = 413) according to International
Standardization Organization (ISO) 4120 sensory analysis methodology "triangle
test" were performed.
RESULTS: A perceptible difference was found for vodka in orange juice (0.0 vs.
0.5% vol; 0 vs. 1% vol), pilsner and wheat beer (0.5 vs. 5% vol), and vodka in
orange juice (5 vs. 10% vol, 20 vs. 30% vol, and 30 vs. 40% vol). The percentage 
of the population perceiving a difference between the beverages varied between 36
and 73%. Alcoholic strength (higher vs. lower) was correctly assigned in only 4
of the 7 trials at a significant level, with 30 to 66% of the trial groups
assigning the correct strength. For the trials that included beverages above 40% 
vol (vodka unmixed, 40 vs. 50% vol and vodka in orange juice, 40 vs. 50% vol),
testers could neither perceive a difference between the samples nor assign
correct alcoholic strength.
CONCLUSIONS: Discrimination of alcoholic strength by taste was possible to a
limited degree in a window of intermediate alcoholic strengths, but not at higher
concentrations. This result is especially relevant for drinkers of unlabeled,
over-proof unrecorded alcoholic beverages who would potentially ingest more
alcohol than if they were to ingest commercial alcohol. Our study provides strong
evidence for the strict implementation and enforcement of labeling requirements
for all alcoholic beverages to allow informed decision making by consumers.
DOI: 10.1111/acer.12511 
PMID: 25257295  [Indexed for MEDLINE]
Rev Assoc Med Bras (1992). 1993 Oct-Dec;39(4):234-6.
[Hepatotoxic substances in Brazilian rum].
[Article in Portuguese]
Mincis M(1), Mizuta K, Bulhões E, Andriolo M, Khouri S, Doin P.
Author information: 
(1)Disciplina de Gastroenterologia Clínica, Escola Paulista de Medicina, Istituto
de Pesquisas Technológicas de São Paulo S.A.--IPT.
The purpose of this study was to investigate whether Brazilian "pingas" (liquor
distilled from sugar cane) contain toxic agents other than ethanol at levels
which might risk consumers health, especially regarding liver damage. We have
studied 8 different "pingas" in which the levels of iron, copper and zinc were
measured through an atomic absorption method, and the levels of ethanol,
acetaldehyde, n-propanol, ethyl acetate, isobutane, and isoamylic alcohol were
measured through gas chromatography and mass spectrometry. Iron levels were
higher than those allowed in two liquors, samples 1 and 8 (respectively 0.57 mg/L
and 0.38 mg/L). Such levels may be considered deleterious to health if these
liquors are consumed in great amounts and during large periods, especially if a
synergistic interaction between alcohol and iron exists, as accepted by some
authors. Our findings warrant that further studies be performed.
PMID: 8162089  [Indexed for MEDLINE]
Food Addit Contam. 1993 Sep-Oct;10(5):585-92.
A survey of ethyl carbamate in beverages, bread and acidified milks sold in
Vahl M(1).
Author information: 
(1)National Food Agency of Denmark, Central Laboratory, Søborg.
A sensitive gas-chromatographic method of analysis using mass specific detection 
has been applied to a study of ethyl carbamate in the Danish diet. Beverages and 
foods which were assumed to give a major contribution to the exposure of the
Danish population to this potentially carcinogenic compound were investigated.
Average values, ranges obtained for concentrations of ethyl carbamate and the
number of analyses were 534 micrograms/l (< 5-5000 micrograms/l, n = 22) in
spirits, 30 micrograms/l (7-61 micrograms/l, n = 14) in fortified wines, 7
micrograms/l (< 3-29 micrograms/l, n = 57) in wine, 3 micrograms/l (0.2-6.6
micrograms/l, n = 50) in beer, 3.5 micrograms/kg (0.8-12 micrograms/kg, n = 33)
in bread and 0.2 microgram/kg (< 0.1-0.3 microgram/kg, n = 19) in yogurts and
other acidified milk products. It is estimated that the average daily intake of
ethyl carbamate is approximately 2 micrograms per person. The 5% of Danish males 
who have the highest alcohol intake probably consume more than 7 micrograms of
ethyl carbamate per day.
DOI: 10.1080/02652039309374182 
PMID: 8224327  [Indexed for MEDLINE]
Trans R Soc Trop Med Hyg. 1991 Jan-Feb;85(1):133-5.
Ingredients and contaminants of traditional alcoholic beverages in Tanzania.
Nikander P(1), Seppälä T, Kilonzo GP, Huttunen P, Saarinen L, Kilima E, Pitkänen 
Author information: 
(1)Institute of Development Studies, University of Helsinki, Finland.
Home-made but commercially available alcoholic beverages were collected in Dar es
Salaam, Tanzania and analysed for their congener alcohol, additive, aflatoxin and
heavy metal contents. Ethanol concentrations of the 15 brewed samples ranged from
2.2 to 8.5% w/v whilst the 2 distilled samples contained ethanol 24.2 and 29.3%
w/v. Aflatoxin B1 was found in 9 brewed beverages, suggesting the use of
contaminated grain or fruit for their production. The amount of zinc in 4 samples
was double the World Health Organization recommended maximum for drinking water
(5 mg/litre). One brewed beverage contained toxic amount of manganese (12.8
mg/litre). Both distilled spirits were rich in fusel alcohols and one was
fortified by caffeine. The results suggested that impurities and contaminants
possibly associated with severe health risks, including carcinogens, are often
found in traditional alcoholic beverages. Continuous daily drinking of these
beverages is certain to increase health risks. Contaminated grain or fruit
rejected from foodstuff production should not be used for the production of
alcoholic beverages.
DOI: 10.1016/0035-9203(91)90187-4 
PMID: 2068743  [Indexed for MEDLINE]
J Forensic Sci. 1999 Nov;44(6):1292-5.
Alcohol content of beer and malt beverages: forensic consideration.
Logan BK(1), Case GA, Distefano S.
Author information: 
(1)Washington State Toxicology Laboratory, Bureau of Forensic Laboratory
Services, Washington State Patrol, 2203 Airport Way South, Seattle, WA, USA.
Beer consumption is commonly an issue in a medico-legal setting, requiring
estimates either of a likely blood alcohol concentration (BAC) for a given
pattern of consumption or vice versa. Four hundred and four beers and malt
beverages available for sale in the State of Washington were tested by gas
chromatography for their alcohol content. Considerable variability in the
alcoholic strength was found, even within the same class. Overall the range of
concentrations was 2.92%v/v to 15.66%v/v. The mean alcohol concentration for ales
was 5.51%v/v (SD 1.23%v/v), and for lagers, 5.32% (SD 1.43%v/v). Some specialty
brews had characteristically higher or lower mean concentrations: ice beers
6.07%v/v, malt liquor 7.23%v/v, light beer 4.13%v/v, seasonal ales 6.30%v/v. Six 
brands of lager and four light beers account for the majority of all beer sales
in the United States, and the mean alcohol concentration for these products was
measured as 4.73%v/v and 4.10%v/v respectively. Few of the beers (17%) were
labeled with respect to alcohol content, and in some cases, there was a
significant disparity between the concentration listed on the label, and the
measured alcohol concentration. Toxicologists need to exercise caution when
performing Widmark type calculations, using all available information to select
the most appropriate estimate for alcoholic strength of a beer or malt beverage.
PMID: 10744486  [Indexed for MEDLINE]
Leg Med. 1985:34-61.
Blood alcohol concentrations: factors affecting predictions.
Winek CL, Esposito FM.
As a result of extensive alcohol research conducted on both humans and animals,
it is possible to predict a BAC, given pertinent data. In addition, it is
possible to estimate from a given BAC the quantity of alcohol consumed. Caution
must be used in these predictions, for certain factors will affect the final
estimation. Absorption of alcohol is influenced by gastrointestinal contents and 
motility, and also the composition and quantity of the alcoholic beverage. The
vascularity of tissues influences the distribution of alcohol, and their water
content will determine the amount of alcohol present after equilibrium.
Elimination of alcohol begins immediately after absorption. The elimination rate 
varies for individuals but falls between .015 percent to .020 percent per hour,
with an average of .018 percent per hour. In addition to these factors, a BAC
will depend on the subject's weight, percentage of alcohol in the beverage, and
the rate of drinking. The principal effect of alcohol in the body is on the
central nervous system. Its depressant effect consists of impairment to sensory, 
motor and learned functions. When combined with some other drugs, a more
intoxicated state occurs. Although tolerance to alcohol at low blood
concentrations is possible, the tolerance most noted is a learned tolerance among
chronic drinkers. contamination of antemortem blood samples collected for alcohol
analysis is minimal when swabbing with an ethanolic antiseptic is performed with 
routine clinical technique; sloppy swabbing has been shown to increase the BAC
determination significantly. The alcoholic content of blood used for transfusion 
does not contribute significantly to the BAC of the recipient, since extensive
dilution occurs; nor does the alcohol present in injectable medication contribute
significantly. Although many factors may alter the concentration of alcohol
present in autopsy specimens, postmortem synthesis of alcohol receives the most
attention. The microorganisms that cause postmortem ethanol production can be
inhibited by adding a preservative to the samples and storing them under
refrigeration. Should putrefaction be present, it is recommended that, in
addition to blood, several different specimens be collected and analyzed for the 
presence of alcohol. Antemortem blood samples containing ethanol, collected using
sterile tubes and techniques, may be analyzed up to 14 days later with reasonable
certainty that the ethanol level reflects that which was present at the time of
PMID: 3835425  [Indexed for MEDLINE]
Z Lebensm Unters Forsch. 1984 May;178(5):393-6.
Metals in Finnish liqueurs.
Harju K, Ronkainen P.
The metal content of some representative Finnish berry liqueurs was determined by
atomic absorption spectrometry. The berry liqueurs were prepared from cloudberry 
(Rubus chamaemorus), arctic bramble (Rubus arcticus), cranberry (Vaccinum
oxycoccus), lingonberry (Vaccinum vitis-idaea) and sea buckthorn (Hippophae
rhamnoides). In addition some other Finnish berry, fruit and herbal liqueurs were
analyzed. The trace elements studied were Al, As, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, 
Na, Ni, Pb, Rb, and Zn. The level of poisonous metals in all the samples was very
low: As less than 0.1, Cd less than 0.005 and Pb less than or equal to 0.1 mg/l.
PMID: 6464557  [Indexed for MEDLINE]