Beer : Health and Nutrition

The Impact of Alcohol on Health 153
the plausible direct impact of alcohol in reducing risks of athero sclerosis and for the
bene cial impact on the mind and spirit. The presence of antioxidants, phytoestrogens,
etc. is less well understood but offers promise.
Allergy
Allergic and asthmatic reactions to alcoholic drinks were recently reviewed by Vally and
Thompson (2003). They say that most reported cases of intolerance to alcoholic beverages
occur with wine. However, beer can contain biogenic amines, notably tyramine
(Izquierdo-Pulido et al. 2000), which presents a risk to those taking monoamine oxidase
inhibitors to counter stress and depression (Shulman et al. 1997) and can cause
migraines and hypertensive crises (Crook, 1981; Zee et al. 1981). Tyramine is a ‘pressor
amine’ which can cause a rise in blood pressure by constricting the vascular system and
increasing the heart rate (Gloria 2003). Histamine acts as a neural transmitter and thus
has a psychoactive in uence. However, it can directly stimulate the heart, impact on
smooth muscle and control gastric secretion. Gorinstein et al. (1999) measured levels
of tyramine in the range 3.6–7.4 mg/L and histamine in the range 3–3.2 mg/L in beers.
Other amines are also present (Table 6.4). However, it will be seen that other foodstuffs,
notably cheese, are even richer sources. Not listed here is chocolate, which contains
high levels of 2-phenylethylamine. There is a belief that these various amines are a
signi cant source of migraines in those partaking of foodstuffs such as chocolate, red
wine and larger quantities of beer. The suggested upper limit for alcoholic beverages
(per litre) is 2–8 mg histamine and 8 mg tyramine.
Ehlers et al. (2002) report a direct allergic reaction of individuals to ethanol itself.
Some beers may contain added sulphite, which may trigger reactions in people sensitive
to this agent, which is commonly used in sodas and other non-alcoholic drinks
as a preservative. However, sulphite is sparingly used in beer, also when compared to
wine, and in many markets (e.g. the US) beers will contain much less than 10 mg/L SO 2 .
Nonetheless Gall et al. (1996) indicate that one patient was sensitive to just 3–4 mg/L
SO 2 .
One of the most prevalent sensitivities to products based on cereals is coeliac disease
(Campbell 1992), a reaction to gluten and related proteins. Ellis et al. (1994) demonstrated
the presence in barley malt of coeliac-activating material, seemingly derived from
the hordein storage proteins. Of course, the amounts of such material might be expected
to vary considerably between beers, depending on the extent to which the protein is
hydrolysed and denatured in the malting and brewing processes, the levels of protein in
the grist, and so on. It has been suggested that other proteins in beer may also have an
allergic impact. One such protein is a lipid transfer protein (Asero et al. 2001), which
is believed to be important for the foaming of beer. The claims were made on the basis