Alcohol and Its Biomarkers

Clinical Aspects and Laboratory Determination

Amitava Dasgupta

• Publisher: Elsevier
• Year: 2015
• ISBN:
  9780128004098
• Topic: Biological Sciences
• Subtopic: Genetics & Genomics
• Index: Biological Sciences

Alcohol and Its Biomarkers: Clinical Aspects and Laboratory Determination is a concise guide to all currently known alcohol biomarkers, their clinical application, and the laboratory methods used to detect them. Pathologists can use this resource to understand the limitations and cost factors associated with each method for determining certain alcohol biomarkers. In addition, interferences in these determinations are discussed, so that clinicians can understand the causes of falsely elevated biomarkers and pathologists and laboratory scientists can potentially eliminate them. The book focuses on the analytical methods used to detect alcohol in blood and urine, the limitations of alcohol determination using enzymatic methods, and the differences between clinical and forensic alcohol measurement. Chapters also cover cutting-edge alcohol biomarkers for potential use.

• Focuses on the analytical methods used for detecting alcohol in blood and urine along with the pitfalls and limitations of alcohol determination using enzymatic methods
• Explains the difference between clinical and forensic alcohol measurement
• Includes a brief overview of the benefits of consuming alcohol in moderation and the hazards of heavy drinking

Chapter 1

Alcohol

Use, Abuse, and Issues with Blood Alcohol Level

This chapter provides an overview of U.S. Department of Agriculture guidelines on drinking in moderation versus hazardous drinking. Moderate alcohol consumption can reduce the risk of various diseases, including cardiovascular diseases, stroke, certain cancers, age-related dementia, and neurodegenerative diseases. Red wine may reduce the risk of developing Alzheimer’s disease. However, such benefits are lost with alcohol abuse—the risks of all these diseases are markedly higher in heavy drinkers and alcoholics in comparison with nondrinkers and moderate drinkers. This chapter also discusses how the number of drinks consumed on one occasion is translated into blood alcohol level (Widmark formula) and how much alcohol can be consumed by individuals who want to drive home safely (blood alcohol <0.08%).

Keywords

Alcohol consumption; health benefits of moderate drinking; French paradox; alcohol determination

Contents

1.1 Introduction 1

1.2 Alcohol Consumption: Historical Perspective 2

1.3 Alcohol Content of Various Alcoholic Beverages 3

1.4 Guidelines for Alcohol Consumption 4

1.5 Benefits of Drinking in Moderation 6

1.5.1 Moderate Alcohol Consumption and Reduced Risk of Cardiovascular Disease 7

1.5.2 Is Red Wine More Effective than other Alcoholic Beverages for Protecting the Heart? 10

1.5.3 Moderate Consumption of Alcohol and Reduced Risk of Stroke 10

1.5.4 Moderate Consumption of Alcohol and Reduced Risk of Developing Metabolic Syndrome and Type 2 Diabetes 11

1.5.5 Moderate Alcohol Consumption and Reduced Risk of Dementia/Alzheimer’s Disease 13

1.5.6 Association between Moderate Alcohol Consumption and Reduced Cancer Risk 13

1.5.7 Can Moderate Alcohol Consumption Prolong Life? 14

1.5.8 Moderate Alcohol Consumption and Reduced Risk of Arthritis 15

1.5.9 Moderate Alcohol Consumption and Reduced Chance of Getting the Common Cold 15

1.6 Adverse Heath Effects Related to Alcohol Dependence 16

1.6.1 Liver Diseases and Cirrhosis of the Liver Associated with Alcohol Abuse 16

1.6.2 Alcohol Abuse and Neurological Damage 18

1.6.3 Alcohol Abuse and Increased Risk of Cardiovascular Disease and Stroke 21

1.6.4 Alcohol Abuse and Damage to the Immune System 21

1.6.5 Alcohol Abuse and Damage to the Endocrine System and Bone 22

1.6.6 Alcohol Abuse Increases the Risk of Certain Cancers 22

1.6.7 Fetal Alcohol Syndrome 23

1.6.8 Alcohol Abuse and Reduced Life Span 24

1.6.9 Alcohol Abuse and Violent Behavior/Homicide 25

1.6.10 Alcohol Poisoning 26

1.7 Blood Alcohol Level 27

1.7.1 Alcohol Odor on Breath and Endogenous Alcohol Production 29

1.8 Conclusions 30

References 30

1.1 Introduction

Alcohol use can be traced back to 10,000 BC. The “drunken monkey hypothesis,” originally proposed by Professor Robert Dudley of the University of California at Berkeley, speculates that the human attraction to alcohol may have a genetic basis due to the high dependence of primate ancestors of Homo sapiens on fruit as a major source of food. Ethanol produced by yeast from fructose diffused out of the fruit and the alcoholic smell helped primates identify fruits as ripe and ready to consume. In tropical forests where monkeys lived, competition for ripe fruits was intense, and hungry monkeys capable of identifying ripe foods and eating them rapidly survived better than others. Eventually, “natural selection” favored monkeys with a keen appreciation for the smell and taste of alcohol. By the time humans evolved from apes approximately 1 to 2 million years ago, fruit consumption was mostly replaced by the consumption of roots, tubers, and meat. Although human ancestors stopped relying mainly on fruits as diet, it is possible that humans’ taste for alcohol arose during our long-shared ancestry with other primates. Anecdotally, humans often consume alcohol with food, suggesting that this is a natural instinct. For millions of years, the amount of alcohol consumed by our ancestors was strictly limited, and the situation did not change even 10,000 years ago when humans had knowledge of agriculture and could produce plenty of barley and malt, the raw material for fermentation. The ancient beers and wines probably contained only 5% alcohol. After alcohol distillation was invented in Central Asia in approximately AD 700, drinks with higher alcoholic content became available, and the history of alcohol abuse by humans began. Alcohol abuse can also be considered as a disease of nutritional excess [1].

1.2 Alcohol Consumption: Historical Perspective

The first historical evidence of alcoholic beverages was the archeological discovery of Stone Age beer jugs from approximately 10,000 years ago. Egyptians probably consumed wine approximately 6000 years ago. The first beer was probably brewed in ancient Egypt, and Egyptians used alcoholic beverages (both beer and wine) for pleasure, rituals, and medical and nutritional purposes. The earliest evidence of alcohol use in China dates back to 5000 BC, when alcohol was produced mainly from rice, honey, and fruits. A Chinese imperial edict from approximately 1116 BC made it clear that the use of alcohol in moderation was the key and was prescribed from the heavens. In ancient India, alcohol beverages were known as “sura,” a favorite drink of Indra, the king of all gods and goddesses. Use of such drinks was known in 3000–2000 BC, and ancient Ayurvedic texts concluded that alcohol was a medicine if consumed in moderation but a poison if consumed in excess. Beer was known to Babylonians as early as 2700 BC. In ancient Greece, wine making was common in 1700 BC. Hippocrates identified numerous medicinal properties of wine but was critical of drunkenness [2].

In ancient civilization, alcohol was used primarily to quench thirst because water was contaminated with bacteria. Hippocrates specifically cited that water from only springs and deep wells and from rainfall was safe for human consumption. Beer was a drink for common people, whereas wine was the preferred drink of elites. Drinking alcoholic beverages for thirst quenching was less common in ancient Eastern civilizations than in Western civilizations because drinking tea was very popular in Asian countries. During boiling of water to prepare tea, all pathogens die, thus making tea drinking a safe and healthy practice [3].

Yeast can be used to produce alcoholic beverages with up to 15% alcohol content. To prepare alcoholic beverages with higher alcohol content, distillation was needed, which probably originated in Asia. The distillation process became common in Europe only during the 11th century and later. During early American history, colonialists showed little concern about drunkenness, and the production of alcoholic beverages was a major source of commerce. In 1791, however, the “whiskey tax” was introduced, which was a tax on both privately and publicly brewed distilled whiskey. The whiskey tax was repealed by President Thomas Jefferson in 1802, but a new alcohol tax was temporarily imposed between 1814 and 1817 to pay for the War of 1812. In 1862, President Abraham Lincoln introduced an alcohol tax to pay for Civil War expenses. The act also created the office of Commissioner of Internal Revenue. In 1920, alcohol was prohibited in the United States, but Congress repealed the law in 1933. In 1978, President Jimmy Carter signed a bill legalizing home brewing of beer for personal use—the first time since prohibition [4].

1.3 Alcohol Content of Various Alcoholic Beverages

Alcohol content of alcoholic beverages varies widely; for example, beer contains approximately 4–7% alcohol, whereas the average alcohol content of vodka is 40–50%. However, due to wide differences in serving sizes of various alcoholic beverages, one drink (often called one standard drink) is considered to contain approximately 0.6 oz of alcohol, which is equivalent to 14 g. In the United States, a standard drink is defined as a bottle of beer (12 oz) containing 5% alcohol; 8.5 oz of malt liquor containing 7% alcohol; a 5-oz glass of wine containing 12% alcohol; 3.5 oz of fortified wine such as sherry or port containing approximately 17% alcohol; 2.5 oz of cordial or liqueur containing 24% alcohol; or one shot of distilled spirits such as gin, rum, vodka, or whiskey (1.5 oz). In general, the average bottle of beer contains 0.56 oz of alcohol, whereas a standard wine drink may contain 0.66 oz and distilled spirits may contain up to 0.89 oz of alcohol [5]. The alcohol content of various popular beverages is given in Table 1.1.

Table 1.1

Alcohol Content of Various Drinks

Beverage	Alcohol Content (%)
Standard U.S. beer	4–7
Table wine	7–14
Sparkling wine	8–14
Fortified wine	14–24
Whiskey	40–75
Vodka	40–50
Gin	40–49
Rum	40–80
Tequila	45–50
Brandies	40–44

Historically, the alcohol content of various drinks was expressed as “proof,” a term that originated in the 18th century when British sailors were paid with money as well as rum. To ensure that the rum was not diluted with water, it was “proofed” by dousing gunpowder with it and setting it on fire. If the gunpowder failed to ignite, this indicated that the rum was diluted with excess water. A sample of rum that was 100 proof contained approximately 57% alcohol by volume. In the United States, proof to alcohol by volume is defined as a ratio of 1:2. Therefore, a beer that has 4% alcohol by volume is defined as 8 proof. In the United Kingdom, alcohol by volume to proof is a ratio of 4:7. Therefore, multiplying alcohol by volume content by a factor of 1.75 will provide the “proof” of the drink.

Currently in the United States, the alcohol content of a drink is measured by the percentage of alcohol by the volume. The Code of Federal Regulations requires that alcoholic beverage labels must state the alcohol content by volume. The regulation permits but does not require the “proof” of the drink to be printed. In the United Kingdom and in European countries, the alcohol content of a beverage is expressed also as the percentage of alcohol in the drink. Alcoholic drinks primarily consist of water, alcohol, and variable amounts of sugars and carbohydrates (residual sugar and starch left after fermentation); there are negligible amounts of other nutrients, such as proteins, vitamins, and minerals. However, distilled liquors such as cognac, vodka, whiskey, an...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Preface
• Chapter 1. Alcohol: Use, Abuse, and Issues with Blood Alcohol Level
• Chapter 2. Genetic Aspects of Alcohol Metabolism and Drinking Behavior
• Chapter 3. Measurement of Alcohol Levels in Body Fluids and Transdermal Alcohol Sensors
• Chapter 4. Alcohol Biomarkers: An Overview
• Chapter 5. Liver Enzymes as Alcohol Biomarkers
• Chapter 6. Mean Corpuscular Volume and Carbohydrate-Deficient Transferrin as Alcohol Biomarkers
• Chapter 7. β-Hexosaminidase, Acetaldehyde–Protein Adducts, and Dolichol as Alcohol Biomarkers
• Chapter 8. Direct Alcohol Biomarkers Ethyl Glucuronide, Ethyl Sulfate, Fatty Acid Ethyl Esters, and Phosphatidylethanol
• Chapter 9. Less Commonly Used Alcohol Biomarkers and Proteomics in Alcohol Biomarker Discovery
• Chapter 10. Genetic Markers of Alcohol Use Disorder
• Index