Quebec beer-drinkers' cardiomyopathy

Quebec beer-drinkers' cardiomyopathy

Soms zie je in je blog een zoekwoord dat je niet herkent. Zo zag ik soms "Quebec beer-drinkers' cardiomyopathy" terugkomen. Geen idee wat het is. Wat is het?

Cardiomyopathie is een aandoening van de hartspier. Het hart kan minder goed samentrekken of ontspannen. Dan pompt het bloed minder goed rond. Cardiomyopathie is een chronische ziekte. Ongeveer 40.000 mensen in Nederland hebben cardiomyopathie. (https://www.hartstichting.nl/hart-en-vaatziekten/cardiomyopathie)

De aanleg voor cardiomyopathie is soms al bij de geboorte aanwezig. Het is dan een erfelijke afwijking. Erfelijkheid kan onderzocht worden met bijvoorbeeld DNA-onderzoek. Een hartspierziekte kan ook ontstaan als het hart lang achter elkaar belast wordt. Dit gebeurt bijvoorbeeld bij: ontsteking van de hartspier (myocarditis), lange tijd last hebben van hoge bloeddruk of hartritmestoornissen, vernauwde kransslagaders, hartklepziekte, diabetes, problemen met de schildklier of stofwisseling, lang gebruik van alcohol of drugs, bestraling of chemotherapie (https://www.hartstichting.nl/hart-en-vaatziekten/cardiomyopathie)

beer-drinkers' cardiomyopathy cardiac dilatation and hypertrophy due to excessive beer consumption; in at least some cases it has been caused by addition of cobalt to the beer during manufacturing.... Dow Breweries — was a brewing company based in Quebec, Canada. It was formed in 1952 in the facilities formerly used by the Boswell Brewery (1843–1952) in Quebec City.[1] It was acquired by Carling O Keefe and stopped its activities on March 31, 1966.[2] After… …   Wikipedia cobalt poisoning — poisoning from long term excessive exposure to cobalt, seen in those who work with cobalt and formerly in beer drinkers because for years cobalt was added to beer as a foam stabilizer. Symptoms include nausea, vomiting, tinnitus, nerve deafness, (https://medicine.en-academic.com/109508/beer-drinkers%27_cardiomyopathy)

Quebec beer-drinkers' cardiomyopathy: forty-eight cases Y L Morin, A R Foley, G Martineau, J Roussel PMID: 6051256 PMCID: PMC1923396 Free PMC article No abstract available (https://pubmed.ncbi.nlm.nih.gov/6051256/)

Can Med Assoc J. 1967 Oct 7;97(15):926-8. Quebec beer-drinkers' cardiomyopathy: etiological considerations Y Morin, P Daniel PMID: 6051264 PMCID: PMC1923410 Free PMC article No abstract available (https://pubmed.ncbi.nlm.nih.gov/6051264/)

Can Med Assoc J. 1967 Oct 7; 97(15): 926–928. PMCID: PMC1923410 PMID: 6051264 Quebec beer-drinkers' cardiomyopathy: etiological considerations. Y. Morin and P. Daniel (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/)

Quebec beer-drinkers' cardiomyopathy Summary is felt to be multicausal in origin. While it is probable that excessive alcohol ingestion and various nutritional deficiencies played an important part, it is believed that the addition of cobalt to beer was the essential factor in the production of this type of cardiomyopathy. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf)`

Cobalt-beer cardiomyopathy is described in twenty-eight patients admitted to the Veterans Administration Hospital in Minneapolis from 1964 to 1967. Clinically, the syndrome differed from alcoholic cardiomyopathy and beriberi by its rather abrupt onset of left ventricular failure, cardiogenic shock and acidosis. Pericardial effusion and polycythemia were present in the majority and suggested cobalt intoxication. It is difficult to explain the cardiotoxic effect of cobalt because the amount ingested in the beer (up to 10 mg/day) is far less than the amount used in the treatment of refractory anemia (up to 50 mg/day).  (https://www.sciencedirect.com/science/article/abs/pii/0002934372901362)

BETWEEN August 1965 and April 1966, a syndrome was encountered in the Quebec City area, with definite clinical, hemodynamic and pathological features. Similar cases were not seen in other parts of the country in spite of a comprehensive search by clinicians and patho¬ logists of major Canadian centres. However, we had the opportunity to examine similar cases in Omaha, Neb., where more than 50 patients were studied and reported by Sullivan and his group.1 In addition, a similar series of 17 cases was re¬cently described in Belgium by Kesteloot et al.2 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf)

The relationship between alcoholism and heart disease has been recognized for more than 100 years. For instance, Bollinger4 felt that the heavy beer drinking occurring in Munich 80 years ago was responsible for cardiac dilatation. However, he also believed that "apoplexy" and "nephritis" were secondary to the "plethora" in¬duced by beer consumption.  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf)

Most published series of chronic idiopathic cardiomyopathies have a high proportion of alcoholics (about 60%),10 and it is generally believed that excessive alcohol ingestion can lead to myocardial degeneration and fibrosis,11 especially as alcohol has been shown to have a deleterious effect on myocardial function.12  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf)

A parallel can be drawn between this episode and the 2000 cases of "beer" poisoning which occured in Manchester in 1900.13 A Royal Com¬mission, after an open and thorough investiga¬tion, came to the conclusion that this syndrome was due to the contamination of beer by arsenic.14 Certain aspects of the Manchester beer drinkers' disease are remarkable: (1) the "un¬usual amount of heart failure and edema"15 as compared to that in the average non-alcoholic case of arsenic intoxication; (2) the "peculiar idiosyncrasy which people seemed to have",16 in that many similarly exposed heavy beer drinkers were symptom-free; (3) the "amount of arsenic found in the beer and actually con¬sumed [daily] by the patient was . . . not suffi¬cient to explain the poisoning";17 (4) eminent physicians, such as Sir William Gowers,18 pointed out that they prescribed 10 times this amount of arsenic to epileptics for long periods of time without side effects; (5) it was therefore concluded that "the alcoholic vehicle in the form of beer accentuated the toxic effect of arsenic".19 The similarities between the Manchester and Quebec episodes led us to investigate the con¬stituents of the beer itself. All surviving patients and those who could be questioned, drank preferably (but not exclusively) brand XXX. The XXX brewery is in an unusual position in Quebec City, having been established on the site of the oldest brewery in North America built by Jean Talon in 1668 to help combat alcoholism amongst French settlers. Its excellent tasting brew was (and still is) very popular in Quebec and accounts for approximately 80% of the local market. A beer of the same name is manufactured in Montreal and, as far as could be ascertained, the only difference in both products at that time was that the Quebec XXX Brand beer contained approximately 10 times more cobalt sulphate. This chemical had been added to some Canadian beers since July 1965 to improve the stability of the foam. The absence of satisfactory foam in spite of adequate carbon dioxide content has been a recent problem and is due to the washing of glasses in taverns with detergents and to insufBcient rinsing with plain water. For this reason, in larger breweries, cobalt sulphate has been added only to draught beer. However, in smaller breweries, such as in Quebec City, separate batches were not brewed for bottle and for draught beer, and cobalt sulphate was therefore added to all the beer processed in the XXX brewery. Thus, the intake of this additive was increased to much higher levels than in Montreal. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf)

“Quebec beer drinkers’ cardiomyopathy” appeared as an epidemic among heavy beer drinkers in Canada in the mid-1960’s [1]. The cardiomyopathy resembled typical dilated cardiomyopathy, except for purplish skin coloration and a high early mortality rate (42%). It was associated with development of a large pericardial effusion and low output heart failure. Quebec beer drinkers’ cardiomyopathy disappeared when Canadian brewers discontinued their new practice of adding minute quantities of cobalt to beer to stabilize the foam head. Since the Quebec outbreak, studies on experimental animals have been carried out in collaboration with Dr. С.I. Chappel to reproduce the characteristic vacuolar and dystrophic “myocardosis” of humans and to gain an insight into the pathogenesis of this condition, using cobalt administration alone or in combination with hormonal and nutritional factors [2, 3]. It is well known that cobalt (Co) is a silvery grey solid at room temperature. It is the 33rd most abundant element and has been found in a variety of media, including air, surface water, and leachate from hazardous waste sites, groundwater, soil, and sediment. Sources of exposure to cobalt and inorganic cobalt compounds are both natural and anthropogenic. Natural sources include wind-blown dust, seawater spray, volcanoes, forest fires, and continental and marine biogenic emissions. Anthropogenic sources include the burning of fossil fuels, sewage sludge, phosphate fertilizers, mining and smelting of cobalt ores, processing of cobalt alloys, and industries that use or process cobalt compounds [2]. The largest source of exposure to cobalt for the general population is the food supply. The estimated intake from food is 5–40 µg/day, most of which is inorganic cobalt. Occupational exposure to cobalt occurs in several industries. (https://romj.org/2017-0103)

Cobalt can cause a distinctive, rapidly progressive and reversible depression of cardiac systolic function, which is readily distinguished from other causes of cardiomyopathy. Patients present with the subacute onset of severe heart failure, which is accompanied by hypotension and cyanosis, pericardial effusion, low voltage on the electrocardiogram, marked elevation of serum enzymes, and lactic acidosis. They typically have a history of lethargy, anorexia, and weight loss in the months preceding the illness and exhibit other evidence of cobalt’s effects on the body (eg, polycythemia and goiter). The course of cobalt-related cardiomyopathy may be progressive and fatal, but those who survive and cease exposure generally demonstrate complete resolution of symptoms and recovery of cardiac function. Patients presenting with rapid onset of cardiomyopathy, who also exhibit polycythemia, pericardial effusion, or goiter should be evaluated for cobalt exposure. (https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.116.003604)

A patient with a mysterious set of heart symptoms left doctors in Germany stumped until they noticed some striking similarities to a case on the TV medical drama House —  a mystery first solved by Canadian doctors nearly 50 years ago by looking at beer. A 55-year-old man with severe heart failure was referred to a hospital in Marburg, Germany, to rule out coronary artery disease, a common cause of heart failure. He was almost deaf and almost blind, with fever of unknown cause, hypothyroidism, enlarged lymph nodes and several other symptoms. Both his hips had been replaced but otherwise his medical history was uneventful. Hugh Laurie starred as Dr. House in a medical drama that gave doctors in Germany clues to a case of mysterious cobalt poisoning. (Adam Taylor/Fox/Associated Press) "Searching for the cause combining these symptoms — and remembering an episode of the TV series House, which we used for teaching medical students  — we suspected cobalt intoxication as the most likely reason," wrote Dr. Juergen Schaefer of Marburg University Clinic Center for Undiagnosed Diseases and his co-authors in Thursday's online issue of the medical journal The Lancet. Schaefer's team took X-rays of the hip and found high levels of two heavy metals, cobalt and chromium, in his urine. The diagnosis? Cobalt intoxication from metal hip replacements. One of the first published reports on cobalt intoxication was in 1967. Called "Quebec beer drinkers' cardiomyopathy," doctors described 44 men in their 40s to 60s who were heavy drinkers who died unexpectedly. "There was a suspense element to the story," recalled cardiologist Dr. Yves Morin of Quebec City. "It took a lot of time and effort to find a cause of the disease." It turned out the men all drank beer made at the Dow brewery in Quebec City. The brewery had added cobalt to stabilize the beer's foam. Morin said autopsies were carefully conducted but pathologists in Canada and the U.S. weren't familiar with the lesions. Investigations of similar outbreaks in other beer-brewing towns led to diagnoses of cobalt poisoning. "At that point, the addition of cobalt was suspended throughout the world but you can't imagine the number of patients everywhere who died from that disease because it was 40 per cent mortality," Morin said. (https://www.cbc.ca/news/health/how-quebec-beer-and-tv-s-dr-house-solved-a-medical-mystery-1.2526403)

Kobalt is een scheikundig element met symbool Co en atoomnummer 27. Het is een zilverkleurig overgangsmetaal.... Het woord kobalt komt van het Duitse kobold (kabouter). Kobalterts werd vaak verward met ertsen van de metalen die men wilde delven, waardoor de teleurstelling groot was als men het ongewenste kobalt verkreeg. Kobalt trekt het giftige arseen aan en joeg daarom angst aan bij de mijnwerkers. Men geloofde dus dat kobolden uit kwaadaardigheid dit metaal in de mijnen legden.... Samen met nikkel en ijzer wordt het vaak in grote hoeveelheden aangetroffen in meteorieten. Het komt ook voor in het menselijk lichaam als bestanddeel van vitamine B12, in het lichaam van een volwassene komt 1 à 2 gram kobalt voor. In de aardkorst komt kobalt voor als cobaltiet, erythriet, skutterudiet en andere mineralen.... Met uitzondering van de productie in Marokko en artisanaal gedolven kobalt in Congo (Kinshasa), wordt het meeste kobalt gedolven als bijproduct van koper of nikkel. ... Als schuimstabilisator voor het schuim van bier werden kobaltzouten (kobalt(II)chloride of -sulfaat) gebruikt. De stabiliserende werking van kobalt op de schuimkraag van bier werd in 1957 in Kopenhagen ontdekt en door de Denen gepatenteerd.[3] Sommige bierfabrikanten voegden te veel kobaltverbindingen aan het bier toe om steviger schuim te verkrijgen, maar dit procedé werd gestopt toen bleek dat kobalt slechter voor de lever was dan alcohol.[3][4] (https://nl.wikipedia.org/wiki/Kobalt)

Schuim komt in diverse levensmiddelen voor. Naast geklopt eiwit, allerlei soorten koekjes en ijs, is bierschuim een van de meest bekende.  De verschillende soorten schuim hebben met elkaar gemeen dat ze bestaan uit een vloeibare fase en een gasfase. Bij geklopt eiwit en ijs is de gasfase meestal lucht. Bij bierschuim bestaat het gas uit koolstofdioxide. De samenstelling van de vloeibare fase varieert al naargelang de soort schuim. De wand van de gasbellen bestaat uit water met daarin opgelost diverse eiwitten en koolhydraten. Deze stoffen verlagen de oppervlaktespanning van het water en voorkomen daardoor dat het water de druppelvorm aanneemt. In bierschuim komen dextrines (koolhydraten), hopbestanddelen en eiwitten voor. De hop geeft de karakteristieke smaak aan de schuimkraag. De wanden van de gasbellen zijn niet overal even dik. Door capillaire werking en door de zwaartekracht worden de dikke gedeelten steeds dikker en knappen de dunnere delen uiteindelijk. Het schuim zakt in elkaar. Met hulpmiddelen is het mogelijk de stabiliteit van het schuim te verhogen. Daartoe worden onder andere schuimstabilisatoren gebruikt, zoals gemodificeerde alginaten en soms ook kobaltzouten (kobalt(II)chloride of -sulfaat). De stabiliserende werking van kobalt op de schuimkraag van bier werd in 1957 in Kopenhagen ontdekt en door de Denen gepatenteerd. In het Canadese Montreal werd deze stabilisator wat te uitbundig toegevoegd aan het gerstenat. De vaste klanten van de cafés, met name de zware drinkers, kregen hartklachten. Enkele tientallen lieten het leven. Dat kobalt de enige oorzaak van de verhoogde sterfte was kon, gezien de drink- en voedingsgewoonten, niet worden bewezen. Kleine hoeveelheden kobalt in het dagelijkse voedsel zijn niet giftig, maar zelfs noodzakelijk. Dit metaal is onder andere een wezenlijk bestanddeel van vitamine B12. In het lichaam van een volwassene komt 1 - 2 gram kobalt voor.  (ALOChemie 2005-2006 – Leentje Bastiaens en Marc Kwanten , https://wet.kuleuven.be/wetenschapinbreedbeeld/lesmateriaal_biochemie/bier_schuim/waarom-staat-er-schuim-op-biermjj.pdf)

Dow Ale was a legend in Quebec brewing until a strange event in the late 1960s spelled the end of the brand as a force. Quebec City, the old capital of the Province of Quebec, was a stronghold of the Dow brand. William Dow had started brewing in the 1800s in the Province. By the 1960s and after various mergers and takeovers, Dow, formerly named National Breweries, had four main brands: Dow Ale, Kingsbeer (a lager), Champlain Porter, and Dow Porter. Dow Ale was the big seller. (https://www.beeretseq.com/dow-ale-a-great-beer-name-with-a-sad-ending/)

In 1966, hospitals in Quebec City started to notice that a spate of men in their 40s-60s, known to be heavy beer drinkers, were suffering from cardiomyopathy. It’s an ailment often manifested by irregularity of heart rhythm. Many died, something like 20-25 persons. Not all these men consumed the Dow brand but most did. Dow in Quebec City – it had a brewery there and in Montreal –  made the fateful decision to dump its inventory of Dow Ale, a good faith gesture meant to reassure people. However, the population viewed the action as an admission of culpability. The beer forever became known as “la bière qui tue“, or the beer which kills. (https://www.beeretseq.com/dow-ale-a-great-beer-name-with-a-sad-ending/)

Metallo-surfactanten zijn moleculen die zich gedragen als zeepmoleculen, maar ze bevatten een metaal in de structuur (figuur 1). Deze nieuwe zeepsoorten hebben geheel nieuwe toepassingen: zeep met metalen zoals palladium en rhodium is katalytisch actief, met rutheen en zink krijgen we fotoactieve materialen en met nikkel en koper, geleiders. Metallo-surfactanten hebben ook een grotere “waskracht” dan gewone zeepsoorten. Dit was reeds een halve eeuw geleden bekend bij sommige bierfabrikanten die kobaltverbinding aan het bier toevoegden om steviger schuim te verkrijgen. Dit procédé werd gestopt toen bleek dat kobalt nog slechter voor de lever was dan alcohol. (https://web.archive.org/web/20071208204912/http://www.science.uva.nl/hims/object.cfm/04BB9E28-AD44-4C9A-B0CD682E0226BF75/80B62750-BF5A-4714-B6893600672C72C6)

Medical studies conducted by Quebec authorities never established a direct link between Dow’s beer and the deaths. Nevertheless, many experts felt that cobalt sulphate, then used in some brewing to improve head or foam retention, probably caused or exacerbated the medical issue. To be sure, these men were heavy drinkers, they consumed a dozen beers each day or more. Also, the malady seemed to be concentrated in Quebec City, yet Montreal was a large market too for the brand. But while many breweries in Quebec added cobalt sulphate to their beer at the time, Dow apparently used an unusually large amount, some accounts state ten times the normal quantity. Hence the feeling on the part of many doctors that cobalt was probably responsible, but it was never conclusively proved. Still, Dow stopped using the chemical after the debâcle and the deaths did not recur, at least not in the concentrations that had been noticed. Needless to say Dow beer fell sharply in sales after the disaster. In 1972 the brand was sold to another brewery, Molson Breweries in Montreal, which continued to brew the beer until the early 1990s. In 1987 Molson merged with Carling O’Keefe, the final successor to National Breweries (itself a combination of 14 breweries formed after WW I of which Dow was a key component). Online there are numerous examinations of this unique incident in both Canadian and international brewing history. Here is a good place to start, for those interested in more information. (https://www.beeretseq.com/dow-ale-a-great-beer-name-with-a-sad-ending/)

Dow Breweries was a brewery based in the province of Quebec, Canada. The company was founded by William Dow (1800–1868).[1] The Dow Brewery eventually came under the control of National Breweries of Quebec in the 1920s, which itself was bought out in 1952 by Canadian Breweries. After Canadian Breweries became Carling O'Keefe and merged with Molson Breweries, its brands were discontinued in 1997.... Dow had started as an apprentice at the Montreal brewery of Thomas Dunn, established in La Prairie in 1790. Dow eventually became a partner in Dunn's brewery and took over the company upon Dunn's death, establishing William Dow & Co., later known as Dow Breweries.[2] Dow Breweries was purchased in the 1920s by National Breweries of Quebec, which itself was acquired by Canadian Breweries (CBL) in 1952.[3] Under CBL ownership, it took over the Quebec City brewery of the Boswell Brewery (1843–1952).[4] CBL was one of the "Big Three" of Canadian brewing and Dow became a national brand. The Quebec City brewery stopped its activities on March 31, 1966,[5] and production of the Dow brands moved to other plants. At the urging of Board chair and academic Pierre Gendron, Dow Breweries supported the construction of the Montreal Planetarium, originally calling it "Dow Planetarium". It was completed in 1966 as one of many projects for the Canadian Centennial. In August 1965, a patient presented to a hospital in Quebec City with symptoms suggestive of alcoholic cardiomyopathy. Over the next eight months, 50 more cases with similar findings appeared in the same area with 20 of these being fatal. It was noted that all patients were heavy drinkers who mostly drank beer and preferred the Dow brand, 30 out of those consuming more than six litres (12 pints) of beer per day.[6] Epidemiological studies found that Dow had been adding cobalt sulfate to the beer for foam stability since July 1965 and that the concentration added in the Quebec city brewery was 10 times that of the same beer brewed in Montreal where there were no reported cases.[7][8] Although Dow denied any responsibility, the Dow Brewery in Quebec City temporarily shut down and the remaining beer was dumped into the Saint Lawrence River. At the time of the incident, Dow Ale was the number one selling beer in Quebec; however, as a result of the "tainted beer scandal" sales of the brand soon dropped dramatically never to recover.[9] Canadian Breweries became Carling O'Keefe in 1973, which eventually merged with the Molson Brewery in 1989. The Dow brands were discontinued in the spring of 1997. Brands brewed by Dow included Dow Ale, Kingsbeer Lager and Black Horse Ale. The Molson Black Horse Ale sold today in Newfoundland is a different product. (https://en.wikipedia.org/wiki/Dow_Breweries)

Although this building was built around 1861, the history of the Dow brewery began nearly 60 years earlier, in 1790, when a farmer named Thomas Dunn started in the beer industry in La Prairie, who was an important stopover for travelers who went to New York from Montreal. At the time, travelers had to navigate from Montreal to Sorel on the St. Lawrence River and then, navigate the Richelieu River from Sorel to St-Jean-sur-Richelieu (formerly known as Dorchester, taking them a whole day. That might explain why many travelers preferred to go through La Prairie and then traveled on horseback to St-Jean-sur-Richelieu, where they boarded on boats to go to New York City. This shortcut cut at least half-a-day from their trip. Anyway, let’s go back to the beer industry. In 1809, the brewery moves to Montreal on Notre-Dame street and then on St. Joseph street in 1818. The name "Dow Brewery" comes from James Dunn's business partner, son of Thomas: William Dow, a Scottish master brewer who takes the reins of the company in 1834. ... While Molson was the beer everyone was drinking in Montreal, Quebec City was a real fortress for Dow brewery. 85% of all beer drank in Quebec City, and 51% of the beer consumed in the rest of the province came from the Dow brewery. Known as a pioneer in promotion and marketing, they said at the time that Dow innovated and then the others followed. ... Between August 1965 and April 1966, more than 48 hospital patients in the Quebec region were diagnosed with an unusual cardiac disease. Fifteen of them will die. While fingers were quickly pointed at their alcoholism, the Dow brewery was put under the spotlight when journalists found an enzyme in the beer, the cobalt salt, who was added to increase foam production. This enzyme was suspected as the cause of these men's death. Although no link was found between Dow beer and the death of these men, the brewery tried to show their credentials by pouring the remaining stocks in the St-Lawrence River and also stopped the beer production in its Quebec City’s brewery. This operation was a real mess and, on the contrary, people saw these acts as a recognition of guilt. And thus, in only one year, Dow brewery lost nearly all its market share in Quebec. The following year, in 1967, the brewery was sold to O'Keefe, its competitor. It was then sold to Molson in 1989. Although the Dow beer will be brewed until 1998, Dow won’t ever recover from this dark history. (https://www.urbexplayground.com/urbex/curse-dow-brewery)

Oja, dat was het. Met toevoeging van kobalt heeft het bier mooi schuim. Nu zit kobalt in voeding en is zelfs onderdeel van vitamine B12, dus dat is niet vreemd. Maar als je te veel toevoegt kunnen consumenten wat (te) veel binnenkrijgen. Bij een overdosis kobalt kun je hartproblemen krijgen.