From Wikipedia, the free encyclopedia
Methanol toxicity | |
---|---|
Other names | Methanol poisoning, methanol overdose |
Molecular structure of methanol | |
Specialty | Emergency medicine |
Symptoms | Decreased level of consciousness, poor coordination, vomiting, abdominal pain, specific smell on the breath |
Complications | Blindness, kidney failure |
Causes | Methanol (such as found in windshield washer fluid ) |
Diagnostic method | Blood acidosis, increased osmol gap, methanol blood level |
Differential diagnosis | Infections, exposure to other toxic alcohols, serotonin syndrome, diabetic ketoacidosis |
Prevention | Consuming safe alcoholic beverages |
Treatment | Antidote, hemodialysis |
Medication | Fomepizole, ethanol |
Prognosis | Good with early treatment |
Frequency | 1,700 cases per year (US) |
Methanol toxicity (also methanol poisoning ) is poisoning from methanol, characteristically via ingestion. Symptoms may include a decreased level of consciousness, poor or no coordination, vomiting, abdominal pain, and a specific smell on the breath.
Decreased vision may start as early as twelve hours after exposure. Long-term outcomes may include blindness and kidney failure, Blindness may occur after drinking as little as 10 mL; death may occur after drinking quantities over 15 mL (median 100 mL, varies depending on body weight). Methanol poisoning most commonly occurs following the drinking of windshield washer fluid,
This may be accidental or as part of an attempted suicide, Toxicity may also rarely occur through extensive skin exposure or breathing in fumes. When methanol is broken down by the body it results in formaldehyde, formic acid, and formate which cause much of the toxicity.
The diagnosis may be suspected when there is acidosis or an increased osmol gap and confirmed by directly measuring blood levels. Other conditions that can produce similar symptoms include infections, exposure to other toxic alcohols, serotonin syndrome, and diabetic ketoacidosis, Early treatment increases the chance of a good outcome.
Treatment consists of stabilizing the person, followed by the use of an antidote, The preferred antidote is fomepizole, with ethanol used if this is not available. Hemodialysis may also be used in those where there is organ damage or a high degree of acidosis,
- Other treatments may include sodium bicarbonate, folate, and thiamine,
- Outbreaks of methanol ingestion have occurred due to contamination of drinking alcohol,
- This is more common in the developing world,
- In 2013 more than 1700 cases occurred in the United States.
- Those affected are usually adult and male.
Toxicity to methanol has been described as early as 1856.
Contents
Why did alcohol cause blindness?
Alcohol Addiction Increases the Risk of Blindness The type of alcohol that has the potential to cause blindness is methanol. These substances can immediately damage the nervous system, including the eye nerves. Initially, it causes inflammation, followed by the death of nervous system tissue, which can cause blindness and lead to death.
The alcohol content of alcoholic beverages varies. Most types of alcoholic beverages that are drunk are types of ethanol compounds with the molecular formula C2H5OH. This type of alcohol can affect the central nervous system, so when it is drunk, it will certainly cause the person consuming it to lose consciousness, and in severe conditions, it can cause death.
In the manufacture of adulterated alcohol (self-mixed), it is often mixed with methanol (CH3OH) or benzene (C6H6). These materials can also cause poisoning and cause permanent nerve damage (blindness or death). The mixed material has been fused with alcohol and cannot be separated or decomposed.
- Methanol is a type of chemical substance that can cause blindness and paralysis when it enters the body.
- In mild cases, benzene causes a deficiency of erythrocytes (a condition when the level of red blood cells in the body falls below the normal range) and leukocytes (a condition when the number of white blood cells in the body falls below normal).
Meanwhile, in severe cases, benzene will cause nausea and even death due to heart and respiratory system failure. For cases of sudden blurry vision, an ophthalmologist will provide maximum therapy in the form of high-dose drug injections. The therapy given aims to reduce swelling of the optic nerve due to methanol or alcohol intoxication.
Individual responses vary from therapy given; if it is not too late, sometimes visual acuity can improve, but if there has been total tissue damage, it will be difficult to return to normal so that blindness occurs. We cannot predict the occurrence of death. However, alcohol that has been mixed with methanol is very dangerous when consumed.
Consumption of 70% alcohol that has been mixed with methanol can cause blindness and paralysis. In severe cases, it can cause cardiac arrest and death, and the cases are quite common in our society. Of course, many types of cancer are also triggered by alcohol consumption.
Alcohol consumption can trigger cancer in several areas of the body, including the mouth, esophagus, throat, larynx (part of the respiratory system), and liver. In the human body, alcohol will activate several types of enzymes that trigger the development of cancer cells. Alcohol will also damage the DNA in the body so that some parts of the cells will grow and multiply uncontrollably.
Given the dangers that can cause everything from blindness to death, it is appropriate for all of us to stay away from alcohol and start living a healthy life without it. : Alcohol Addiction Increases the Risk of Blindness
What’s in moonshine?
How is Moonshine Made? – The traditional ingredients for moonshine are corn and sugar, and during fermentation, the sugar produces ethanol, which makes hooch or moonshine. During distillation, alcohol separates from the mash. Unlike other liquors such as whiskey or bourbon, moonshine is unaged, which produces a distilled spirit with high alcohol content.
The stereotype of moonshiners centers around how “country folk” distill and transport their potables in jugs marked “XXX” during the night to avoid being detected. But having access to commercially produced all-copper moonshine stills on the internet has made moonshine distillation less risky in the modern era.
But for a great drink, here is the recipe:
Does moonshine have methanol?
Methanol: The Toxic Side Of Moonshine – You may have heard stories about the dangers of moonshine, or any illegally distilled liquor. The real culprit of these true stories, however, is methanol. Methanol, or methyl alcohol, is a byproduct of the distilling process.
Can smoking cause blindness?
Vision Loss, Blindness, and Smoking Smoking is as bad for your eyes as it is for the rest of your body. If you smoke, you can develop serious eye conditions that can cause vision loss or blindness. Two of the greatest threats to your eyesight are: 1,2
- Macular degeneration
- Cataracts
Macular degeneration, also called, is an eye disease that affects central vision. You need central vision to see objects clearly and for common tasks such as reading, recognizing faces, and driving. There are two forms of AMD: dry AMD and wet AMD. Macular degeneration always begins in the dry form, and sometimes progresses to the more advanced wet form, where vision loss can be very rapid if untreated.3 cause blurry vision that worsens over time.
Without surgery, cataracts can lead to serious vision loss. The best way to protect your sight from damage linked to smoking is to quit or never start smoking.4 You may think your eyes are fine, but the only way to know for sure is by getting a full eye exam. AMD often has no early symptoms, so an eye exam is the best way to spot this eye disease early.
An eye specialist will place special drops in your eyes to widen your pupils. This offers a better view of the back of your eye, where a thin layer of tissue (the retina) changes light into signals that go to the brain. The macula is a small part of the retina that you need for sharp, central vision.
- Blurred vision or a blurry spot in your central vision
- The need for more light to read or do other tasks
- Straight lines that look wavy
- Trouble recognizing faces
Eye injections are often the preferred treatment for wet AMD. Your doctor can inject a drug to stop the growth of these blood vessels and stop further damage to your eyes. You may need injections on a regular basis to save your vision. Smoking causes changes in the eyes that can lead to vision loss. If you smoke:
- You are twice as likely to develop AMD compared with a people who do not smoke.2,8
- You are two to three times more likely to develop cataracts compared with a people who do not smoke.4
If you smoke, stop. Quitting may lower your risk for both AMD and cataracts.2,9 If you already have AMD, quitting smoking may slow the disease.2 AMD tends to get worse over time. Quitting smoking is something within your control that may help save your sight. Other healthy habits may also help protect your eyes from cataracts and AMD: 3,4
- Exercise regularly.
- Maintain normal blood pressure and cholesterol levels.
- Eat a healthy diet rich in green, leafy vegetables and fish.
- Wear sunglasses and a hat with a brim to protect your eyes from sunlight.
smoked and started losing her vision at age 56. She’s had dozens of shots in each eye to avoid further vision loss. “Nothing at all—food, drink, cigarettes, nothing—is worth going through what I’m going through.” smoked and started losing her vision at age 56. She’s had dozens of shots in each eye to avoid further vision loss. “Nothing at all—food, drink, cigarettes, nothing—is worth going through what I’m going through.” The symptoms of an early cataract may improve with new eyeglasses, brighter lighting, antiglare sunglasses, or magnifying lenses.4 When glasses and brighter lighting don’t help, you may need surgery.
- A doctor will remove the cloudy lens and replace it with an artificial lens.
- This clear, plastic lens becomes a permanent part of your eye.4 Coping with vision loss can be frightening, but there is help to make the most of the vision you have left and to continue enjoying your friends, family, and special interests.
If you’ve already lost some sight, ask your healthcare professional about low-vision counseling and devices such as high-powered lenses, magnifiers, and talking computers.
- For facts about age-related macular degeneration, visit the AMD Web page.
- For additional information on AMD prevention and treatment, visit the National Institute of Health’s web page.
- For eye health information from the American Academy of Ophthalmology, visit the web site.
The is the national membership association of Eye doctors. Eye doctors are ophthalmologists, medical and osteopathic doctors who provide comprehensive eye care, including medical, surgical, and optical care. The (ASRS) web site offers the following resources for consumers:
- Information for patients who have been diagnosed with retina conditions
- Additional resources for patients who need assistance
- Information on the importance of care by a retina specialist
- National Eye Institute.,
- American Macular Degeneration Foundation.,
- National Eye Institute.,
- National Eye Institute.,
- National Eye Institute.,
- National Eye Institute.,
- Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP., Eye (Lond) 2005; Sep 19(9):935–44,
- U.S. Department of Health and Human Services., Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004,
- Lindblad B, Håkansson N, Wolk A., JAMA Ophthalmology 2014;132(3):253–7,
Can you reverse methanol poisoning?
Methanol poisoning can be treated successfully if diagnosed within 10-30 hours of ingestion. If you suspect someone might have methanol poisoning, get them to a hospital which has dialysis equipment as soon as possible.
Can I get drunk on methanol?
What are the signs of methanol poisoning? – The earliest signs of methanol poisoning can be hard to distinguish from the normal effects of alcohol. You can develop mild symptoms similar to alcohol intoxication within an hour, along with nausea, vomiting and abdominal pain.
After 12 to 24 hours, the more significant symptoms can develop, such as headache, dizziness, vertigo and blurred vision. “The bad thing is that it takes 12 to 24 hours, and often people have been solidly drunk and sleeping,” says Gordian Fulde. Ignorance of the issue can also lead to misdiagnosis or critical delays in diagnosis.
If eye symptoms such as blurred vision or difficulty looking a bright light develop, then “they really are in trouble,” says Fulde. “That’s when they really need to do something.”
Can alcohol cause temporary or permanent blindness?
Stroke is one of the major causes that lead to blindness, temporary or permanent.
Why do alcoholics often have trouble with night blindness?
Alcohol and Nutrition – Alcohol Alert No.22- 1993 National Institute on Alcohol Abuse and Alcoholism No.22 PH 346 October 1993 Alcohol and Nutrition Nutrition is a process that serves two purposes: to provide energy and to maintain body structure and function.
Food supplies energy and provides the building blocks needed to replace worn or damaged cells and the nutritional components needed for body function. Alcoholics often eat poorly, limiting their supply of essential nutrients and affecting both energy supply and structure maintenance. Furthermore, alcohol interferes with the nutritional process by affecting digestion, storage, utilization, and excretion of nutrients (1).
Impairment of Nutrient Digestion and Utilization Once ingested, food must be digested (broken down into small components) so it is available for energy and maintenance of body structure and function. Digestion begins in the mouth and continues in the stomach and intestines, with help from the pancreas.
- The nutrients from digested food are absorbed from the intestines into the blood and carried to the liver.
- The liver prepares nutrients either for immediate use or for storage and future use.
- Alcohol inhibits the breakdown of nutrients into usable molecules by decreasing secretion of digestive enzymes from the pancreas (2).
Alcohol impairs nutrient absorption by damaging the cells lining the stomach and intestines and disabling transport of some nutrients into the blood (3). In addition, nutritional deficiencies themselves may lead to further absorption problems. For example, folate deficiency alters the cells lining the small intestine, which in turn impairs absorption of water and nutrients including glucose, sodium, and additional folate (3).
- Even if nutrients are digested and absorbed, alcohol can prevent them from being fully utilized by altering their transport, storage, and excretion (4).
- Decreased liver stores of vitamins such as vitamin A (5), and increased excretion of nutrients such as fat, indicate impaired utilization of nutrients by alcoholics (3).
Alcohol and Energy Supply The three basic nutritional components found in food-carbohydrates, proteins, and fats-are used as energy after being converted to simpler products. Some alcoholics ingest as much as 50 percent of their total daily calories from alcohol, often neglecting important foods (3,6).
Even when food intake is adequate, alcohol can impair the mechanisms by which the body controls blood glucose levels, resulting in either increased or decreased blood glucose (glucose is the body’s principal sugar) (7). In nondiabetic alcoholics, increased blood sugar, or hyperglycemia-caused by impaired insulin secretion-is usually temporary and without consequence.
Decreased blood sugar, or hypoglycemia, can cause serious injury even if this condition is short lived. Hypoglycemia can occur when a fasting or malnourished person consumes alcohol. When there is no food to supply energy, stored sugar is depleted, and the products of alcohol metabolism inhibit the formation of glucose from other compounds such as amino acids (7).
- As a result, alcohol causes the brain and other body tissue to be deprived of glucose needed for energy and function.
- Although alcohol is an energy source, how the body processes and uses the energy from alcohol is more complex than can be explained by a simple calorie conversion value (8).
- For example, alcohol provides an average of 20 percent of the calories in the diet of the upper third of drinking Americans, and we might expect many drinkers who consume such amounts to be obese.
Instead, national data indicate that, despite higher caloric intake, drinkers are no more obese than nondrinkers (9,10). Also, wh en alcohol is substituted for carbohydrates, calorie for calorie, subjects tend to lose weight, indicating that they derive less energy from alcohol than from food (summarized in 8).
The mechanisms accounting for the apparent inefficiency in converting alcohol to energy are complex and incompletely understood (11), but several mechanisms have been proposed. For example, chronic drinking triggers an inefficient system of alcohol metabolism, the microsomal ethanol-oxidizing system (MEOS) (1).
Much of the energy from MEOS-driven alcohol metabolism is lost as heat rather than used to supply the body with energy. Alcohol and the Maintenance of Cell Structure and Function Structure Because cells are made mostly of protein, an adequate protein diet is important for maintaining cell structure, especially if cells are being damaged.
Research indicates that alcohol affects protein nutrition by causing impaired digestion of proteins to amino acids, impaired processing of amino acids by the small intestine and liver, impaired synthesis of proteins from amino acids, and impaired protein secretion by the liver (3). Function Nutrients are essential for proper body function; proteins, vitamins, and minerals provide the tools that the body needs to perform properly.
Alcohol can disrupt body function by causing nutrient deficiencies and by usurping the machinery needed to metabolize nutrients. Vitamins. Vitamins are essential to maintaining growth and normal metabolism because they regulate many physiological processes.
- Chronic heavy drinking is associated with deficiencies in many vitamins because of decreased food ingestion and, in some cases, impaired absorption, metabolism, and utilization (1,12).
- For example, alcohol inhibits fat absorption and thereby impairs absorption of the vitamins A, E, and D that are normally absorbed along with dietary fats (12,13).
Vitamin A deficiency can be associated with night blindness, and vitamin D deficiency is associated with softening of the bones (6). Vitamins A, C, D, E, K, and the B vitamins, also deficient in some alcoholics, are all involved in wound healing and cell maintenance (14).
In particular, because vitamin K is necessary for blood clotting, deficiencies of that vitamin can cause delayed clotting and result in excess bleeding. Deficiencies of other vitamins involved in brain function can cause severe neurological damage. Minerals. Deficiencies of minerals such as calcium, magnesium, iron, and zinc are common in alcoholics, although alcohol itself does not seem to affect the absorption of these minerals (15).
Rather, deficiencies seem to occur secondary to other alcohol-related problems: decreased calcium absorption due to fat malabsorption; magnesium deficiency due to decreased intake, increased urinary excretion, vomiting, and diarrhea (16); iron deficiency related to gastrointestinal bleeding (3,15); and zinc malabsorption or losses related to other nutrient deficiencies (17).
Mineral deficiencies can cause a variety of medical consequences from calcium-related bone disease to zinc-related night blindness and skin lesions. Alcohol, Malnutrition, and Medical Complications Liver Disease Although alcoholic liver damage is caused primarily by alcohol itself, poor nutrition may increase the risk of alcohol-related liver damage.
For example, nutrients normally found in the liver, such as carotenoids, which are the major sources of vitamin A, and vitamin E compounds, are known to be affected by alcohol consumption (18,19). Decreases in such nutrients may play some role in alcohol-related liver damage.
- Pancreatitis Research suggests that malnutrition may increase the risk of developing alcoholic pancreatitis (20,21), but some research performed outside the United States links pancreatitis more closely with overeating (21).
- Preliminary research suggests that alcohol’s damaging effect on the pancreas may be exacerbated by a protein-deficient diet (22).
Brain Nutritional deficiencies can have severe and permanent effects on brain function. Specifically, thiamine deficiencies, often seen in alcoholics, can cause severe neurological problems such as impaired movement and memory loss seen in Wernicke/Korsakoff syndrome (23).
- Pregnancy Alcohol has direct toxic effects on fetal development, causing alcohol-related birth defects, including fetal alcohol syndrome.
- Alcohol itself is toxic to the fetus, but accompanying nutritional deficiency can affect fetal development, perhaps compounding the risk of developmental damage (24,25).
The nutritional needs during pregnancy are 10 to 30 percent greater than normal; food intake can increase by as much as 140 percent to cover the needs of both mother and fetus (24). Not only can nutritional deficiencies of an alcoholic mother adversely affect the nutrition of the fetus, but alcohol itself can also restrict nutrition flow to the fetus (24,25).
- Nutritional Status of Alcoholics Techniques for assessing nutritional status include taking body measurements such as weight, height, mass, and skin fold thickness to estimate fat reserves, and performing blood analysis to provide measurements of circulating proteins, vitamins, and minerals.
- These techniques tend to be imprecise, and for many nutrients, there is no clear “cut-off” point that would allow an accurate definition of deficiency (4).
As such, assessing the nutritional status of alcoholics is hindered by the limitations of the techniques. Dietary status may provide inferential information about the risk of developing nutritional deficiencies. Dietary status is assessed by taking patients’ dietary histories and evaluating the amount and types of food they are eating.
A threshold dose above which alcohol begins to have detrimental effects on nutrition is difficult to determine. In general, moderate drinkers (two drinks or less per day) seem to be at little risk for nutritional deficiencies. Various medical disorders begin to appear at greater levels. Research indicates that the majority of even the heaviest drinkers have few detectable nutritional deficiencies but that many alcoholics who are hospitalized for medical complications of alcoholism do experience severe malnutrition (1,12).
Because alcoholics tend to eat poorly-often eating less than the amounts of food necessary to provide sufficient carbohydrates, protein, fat, vitamins A and C, the B vitamins, and minerals such as calcium and iron (6,9,26)-a major concern is that alcohol’s effects on the digestion of food and utilization of nutrients may shift a mildly malnourished person toward severe malnutrition.
Alcohol and Nutrition-A Commentary by NIAAA Director Enoch Gordis, M.D. The combination of an adequate diet and abstention from alcohol is the best way to treat malnourished alcoholic patients. Nutritional supplements have been used to replace nutrients deficient in malnourished alcoholics in an attempt to improve their overall health.
Dosages of nutritional supplements such as vitamin A that exceed normally prescribed levels may result in overdose. Although various nutritional approaches have been touted as “cures” for alcoholism, there is little evidence to support such claims. However, renewed research attention to the nutritional aspects of alcohol leaves open the possibility that a role for nutritional therapy in alcoholism treatment may yet be defined.
- References (1) Lieber, C.S.
- The influence of alcohol on nutritional status.
- Nutrition Reviews 46(7):241-254, 1988.
- 2) Korsten, M.A.
- Alcoholism and pancreatitis: Does nutrition play a role? Alcohol Health & Research World 13(3):232-237, 1989.
- 3) Feinman, L.
- Absorption and utilization of nutrients in alcoholism.
Alcohol Health & Research World 13(3):207-210, 1989. (4) Thomson, A.D., and Pratt, O.E. Interaction of nutrients and alcohol: Absorption, transport, utilization, and metabolism. In: Watson, R.R., and Watzl, B., eds. Nutrition and Alcohol, Boca Raton, FL: CRC Press, 1992.
Pp.75-99. (5) Sato, M., and Lieber, C.S. Hepatic vitamin A depletion after chronic ethanol consumption in baboons and rats. Journal of Nutrition 111:2015-2023, 1981. (6) Feinman, L., and Lieber, C.S. Nutrition: Medical problems of alcoholism. In: Lieber, C.S., ed. Medical and Nutritional Complications of Alcoholism: Mechanisms in Management,
New York: Plenum Publishing Corp., 1992. pp.515-530. (7) Patel, D.G. Effects of ethanol on carbohydrate metabolism and implications for the aging alcoholic. Alcohol Health & Research World 13(3):240-246, 1989. (8) U.S. Department of Health and Human Services.
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- Alcohol consumption, nutrient intake and relative body weight among U.S. adults.
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(10) Colditz, G.A. ; Giovannucci, E.; Rimm, E.B.; Stampfer, M.J.; Rosner, B.; Speizer, F.E.; Gordis, E.; and Willett, W.C. Alcohol intake in relation to diet and obesity in women and men. American Journal of Clinical Nutrition 54(1):49-55, 1991. (11) World, M.J.
; Ryle, P.R.; Pratt, O.E.; and Thomson, A.D. Alcohol and body weight. Alcohol and Alcoholism 19(1):1-6, 1984. (12) Lieber, C.S. Alcohol and nutrition: An overview. Alcohol Health & Research World 13(3):197-205, 1989. (13) Leo, M.A., and Lieber, C.S. Alcohol and vitamin A. Alcohol Health & Research World 13(3):250-254, 1989.
(14) Tortora, G.J., and Anagnostakos, N.P., eds. Principles of Anatomy and Physiology,5th ed. New York: Harper & Row Publishers, 1987. (15) Marsano, L., and McClain, C.J. Effects of alcohol on electrolytes and minerals. Alcohol Health & Research World 13(3):255-260, 1989.
(16) Flink, E.B. Magnesium deficiency in alcoholism. Alcoholism: Clinical and Experimental Research 10(6):590-594, 1986. (17) McClain, C.J. ; Antonow, D.R.; Cohen, D.A.; and Shedlofsky, S.I. Zinc metabolism in alcoholic liver disease. Alcoholism: Clinical and Experimental Research 10(6):582-589, 1986. (18) Leo, M.A.
; Kim, C.-I.; Lowe, N.; and Lieber, C.S. Interaction of ethanol with *-carotene: Delayed blood clearance and enhanced hepatotoxicity. Hepatology 15(5):883-891, 1992. (19) Leo, M.A. ; Rosman, A.S.; and Lieber, C.S. Differential depletion of carotenoids and tocopherol in liver disease.
Hepatology 17(6):977-986, 1993. (20) Mezey, E. ; Kolman, C.J.; Diehl, A.M.; Mitchell, M.C.; and Herlong, H.F. Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism. American Journal of Clinical Nutrition 48(1):148-151, 1988. (21) Korsten, M.A. ; Pirola, R.C.; and Lieber, C.S.
Alcohol and the pancreas. In: Lieber, C.S., ed. Medical and Nutritional Complications of Alcoholism: Mechanisms in Management, New York: Plenum Publishing Corp., 1992. pp.341-358. (22) Korsten, M.A. ; Wilson, J.S.; and Lieber, C.S. Interactive effects of dietary protein and ethanol on rat pancreas: Protein synthesis and enzyme secretion.
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- 23) Victor, M.
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Nutritional issues in perinatal alcohol exposure. Neurobehavioral Toxicology and Teratology 6(4):261-269, 1984. (25) Phillips, D.K.; Henderson, G.I.; and Schenker, S. Pathogenesis of fetal alcohol syndrome: Overview with emphasis on the possible role of nutrition.
Alcohol Health & Research World 13(3):219-227, 1989. (26) Hillers, V.N., and Massey, L.K. Interrelationships of moderate and high alcohol consumption with diet and health status. American Journal of Clinical Nutrition 41(2):356-362, 1985. All material contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NIAAA.
Citation of the source is appreciated. Copies of the Alcohol Alert are available free of charge from the Scientific Communications Branch, Office of Scientific Affairs, NIAAA, 5600 Fishers Lane, Room 16C-14, Rockville, MD 20857. Telephone: 301-443-3860.U.S.