Alcohol and Alcoholism Advance Access originally published online on January 18, 2008
Alcohol and Alcoholism 2008 43(2):171-173; doi:10.1093/alcalc/agm162
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Illicit alcohol consumption and neuropathy – a preliminary study in Sri Lanka
1 Department of Physiology
2 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
* Author to whom correspondence should be addressed at: Department of Physiology, Faculty of Medicine, Thalagolla Road, Ragama, Sri Lanka. Tel: +0094–11-2953410, +0094–11–2961128; E-mail: himanif{at}mfac.kln.ac.lk
Received 11 July 2007; first review notified 2 August 2007; in revised form 5 October 2007; accepted 9 October 2007
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ABSTRACT |
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Aims: To compare the effects on peripheral and autonomic nerve functions of Sri Lankan illicitly distilled alcohol consumption versus legal spirit consumption. Methods: Peripheral nerve conduction and autonomic nerve functions were assessed in 40 healthy control subjects and two groups of chronic heavy drinkers: 41 illicit spirit drinkers and 17 legal spirit drinkers. Results: Lower-limb motor and sensory nerve conduction parameters were affected in both groups of alcoholics. When compared with controls, in illicit spirit drinkers the mean heart rate indexes of all parasympathetic tests were lower while in legal spirit drinkers the heart rate response to standing was affected. There were no differences in the results of the above tests when the two groups of heavy drinkers were compared. Conclusions: Though chronic alcoholism results in peripheral and autonomic nerve damage, the damage caused by consumption of illicitly distilled spirit is not worse than the damage caused by consumption of legal spirits.
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Introduction |
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Long-term excessive alcohol consumption affects the peripheral and autonomic nervous systems (Barter and Tanner, 1987
; Johnson and Robinson, 1988; Charness et al., 1989; Villalta et al., 1989; Monforte et al., 1995; Lindgren et al., 1996; Peters and Preedy, 1999; Zambelis et al., 2005).
In Sri Lanka a large though unknown number of people consume illicitly distilled alcohol (Ramachandran et al., 1986; Pathmeshwaran, 1997). In a study (Pathmeshwaran, 1997) conducted in a suburban district with a population of 2.2 million, it was shown that 65% of the ethanol consumed by men was produced outside state regulations.
Due to lack of proper quality control in the production process, illicit alcohol seems likely to be more toxic, particularly to the nervous system, than legal spirits. Yet no systematic study has been done to compare the effects of illicit alcohol consumption with legal spirit consumption on the peripheral and autonomic nervous systems.
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Methodology |
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Chronic heavy drinkers were recruited to volunteer for the study from among employees of the North Colombo Teaching Hospital and University of Kelaniya.
They were defined as: individuals with average daily ethanol consumption 
75 g in the previous 2 years with a score of 8 in the AUDIT questionnaire (Division of Mental Health, WHO, Geneva). Those with a history of major organ damage or illness, which might have any effect on the nervous system, were excluded from the study.
The control group consisted of age- and sex-matched healthy volunteers who did not consume ethanol or who consumed ethanol occasionally (calculated daily intake <10 g/day).
Informed consent was obtained from all the subjects prior to the study. The study was approved by the Ethics Committee, Faculty of Medicine, University of Kelaniya.
Clinical and laboratory methods used
A detailed history of alcohol intake and dietary habits was obtained from each subject.
After history taking and clinical examination, biochemical and haematological investigations were carried out in alcoholics to preclude major organ damage and illnesses/clinical conditions, which might have any effects on the nervous system.
Assessment of the quantity of ethanol taken. The amount of ethanol in legal spirits was worked out based on the capacity of the bottle and the concentration of ethanol indicated on bottle labels. For illicit alcohol, six random alcohol samples were obtained from different parts of the country, and sent for analysis in order to get their mean ethanol content. These samples were also tested for the presence of methanol and other impurities such as lead and arsenic, which are known to be neurotoxic.
Based on the above figures and a subject's alcohol history, the total amount of ethanol consumed per week was calculated. It was divided by seven to get a daily ethanol intake. This method was used since almost all the alcoholics had the same pattern of drinking during the 2 years prior to the test.
Assessment of the peripheral nervous system. Peripheral nerve conduction studies were performed in all the subjects using standard techniques and equipment (Sapphire ll, Medilec Limited, UK, and TECA Corporation, USA).
Conduction velocity was measured in the following motor nerves in both upper and lower limbs: median nerve (elbow to wrist), ulnar nerve (below elbow to wrist), and peroneal nerve (below fibular head to ankle). Orthodromic sensory nerve conduction was recorded from the ulnar and the median nerves in both upper limbs. Antidromic sensory responses were recorded from the sural nerves in both lower limbs. The amplitude and the distal latency of sensory responses were recorded.
Assessment of the autonomic nervous system. The following clinical tests of autonomic nerve function were carried out on all alcoholics and controls, on the same day, using standard techniques (Monforte et al., 1995; Keshavarzian et al., 1987):
- Heart rate response to deep breathing
- Heart rate response to Valsalva manoeuvre
- Heart rate response to standing
- Blood pressure response to standing.
Alcoholics were not studied when features of alcohol withdrawl were present.
Statistical analysis
Test results were expressed as mean (standard deviation). The statistical package EpiInfo (version 6.04C) was used for data analysis. Differences between groups were analysed using tests of analysis of variance (ANOVA). Values of P 
0.05 were required for significance.
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Results |
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Fifty-eight chronic heavy drinkers and 40 control subjects completed the study. All were males. The mean age of illicit liquor consumers was 44 ± 14 years, legal spirit consumers 41 ± 12 years and 40 ± 8 years for the controls (P > 0.05).
Forty-one (71%) of the heavy drinkers had consumed illicit alcohol while 17 (29%) had consumed only legal spirits (the number of legal spirit drinkers volunteered for the study was low). The legal spirit consumed by them was ‘Arrack’ (the government-licensed locally produced liquor; ethanol content 36% v/v, methanol 0.001%, arsenic and lead – not detected). The mean ethanol content of the illicit alcohol samples was 20.9 ± 0.03% and the mean methanol content was 0.04 ± 0.037%. All the samples had trace amounts of arsenic (mean 0.003 ppm) and <0.10 ppm of lead.
The mean total lifetime dose was 17 ± 10.2 kg ethanol per kg bodyweight for illicit alcohol drinkers and 15 ± 7.4 kg ethanol per kg bodyweight for legal spirit drinkers (P > 0.05).
Physical examination revealed no overt features of malnutrition in any of the subjects. None of the chronic heavy drinkers had a history suggestive of chronic liver cell disease or clinical features suggestive of chronic liver disease such as jaundice, oedema, ascites, splenomegaly or hepatic encephalopathy at the time of the test. However, 22 of 41 (54%) illicit alcohol consumers and 11 of 17 (65%) legal spirit drinkers had mild to moderate hepatomegaly (P > 0.05).
The serum vitamin B12 concentrations were within the defined normal range in all heavy drinkers and were not significantly different between illicit alcohol drinkers and legal spirit drinkers (P > 0.05). Results of the other haematological and biochemical investigations also showed no significant difference between the two groups of heavy drinkers.
Peripheral nervous system assessment
When compared with the control group, abnormalities were detected in some peripheral nerve conduction parameters both in illicit alcohol drinkers and legal spirit drinkers. However, when the two heavy drinker groups were compared there were no statistically significant differences in these parameters (Table 1).
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Autonomic nervous system assessment
Mean heart rate indexes of all parasympathetic tests were significantly lower in illicit alcohol drinkers when compared with those of the control group. The heart rate response to standing was significantly less, even in legal spirit drinkers. However, when the two chronic heavy drinker groups were compared there were no statistically significant differences between their test results (Table 1).
We were unable to find a correlation of the total lifetime dose of ethanol with the results of autonomic function tests and peripheral nerve conduction studies (P>0.05).
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Discussion |
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TOPABSTRACTIntroductionMethodologyResultsDiscussionReferences |
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Long-term alcohol consumption is known to affect the functions of the peripheral and the autonomic nerves in the body (Barter and Tanner, 1987
; Johnson and Robinson, 1988; Charness et al., 1989; Villalta et al., 1989; Monforte et al., 1995; Lindgren et al., 1996; Peters and Preedy, 1999; Zambelis et al., 2005). What the results of our study have demonstrated is that autonomic and peripheral nerve functions are involved irrespective of the type of the alcoholic drink they consume. From the available data we are unable to give the exact reason for the impairment of peripheral and autonomic nerve functions in the two groups of alcoholics. Since abnormalities were present in both groups of alcoholics, this could be attributed to a direct toxic effect of ethanol or its metabolites on the peripheral and autonomic nerves. However, we were unable to find a correlation between the total lifetime dose of ethanol and nerve function parameters in both groups of alcoholics. The reliability of alcoholics’ reports on their drinking behaviour is questionable and the lack of correlation could be attributed to that.
Deficiency of thiamine and other B vitamins was thought to have a contributory role in the pathogenesis of alcoholic peripheral neuropathy (Victor, 1975; Barter and Tanner, 1987; Charness et al., 1989; D’Amour et al., 1991). Alcoholics in our study showed no overt features of malnutrition and none had low serum vitamin B12 levels. However, we could not rule out sub-clinical thiamine deficiency as an etiological factor since we did not have facilities to assess their red cell transketolase activity.
There were trace amounts of methanol and impurities such as arsenic in the illicit alcohol samples we analysed. Chronic arsenic poisoning has been identified as a causative factor of polyneuropathy (Ratnaike, 2003; Hafeman et al., 2005). However, in contrast to our hypothesis, peripheral and autonomic nerve function tests showed no significant differences between illicit alcohol users and legal spirit drinkers. Nevertheless, the long-term effects of such impurities on the peripheral and autonomic nervous system probably merit further study.
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References |
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