Ethanol exposure in children: Food as a by far more relevant source than phytomedicines

Ethanol is widely used as a solvent during the manufacturing of herbal medicinal products and is also frequently present as a constituent in finished herbal medicinal products for the use in patients of all ages, including children. Furthermore, alcohol is a constituent of a large number of food items including those not labelled as alcohol-containing. These include fermented foods such as bread, yoghurt etc. but also food marketed as non-fermented such as fruit juices etc. At the same time, exposure even to very low levels of ethanol, especially in children, has been supposed to have possible adverse effects on psychomotoric functions.

In this study we have analysed the alcohol levels in a range of different food products purchased from the German retail market. It was found that orange juice, apple juice and grape juice contain substantial amounts of ethanol of up to 0.77 g/L. Between several brands of apple juice, however, the levels can differ by more than ten-fold. Furthermore, packed bakery products such as Burger rolls or sweet milk rolls were found to contain more than 1.2 g ethanol/100 g. Based on these findings, we designed a scenario for average ethanol exposure by a 6 years-old child of 20 kg b.w. Consumption data for three food 'categories', i.e. bananas, bread and bakery products, and apple juice were derived from data in U.S. and German surveys.

Under these assumptions an average daily exposure of 10.3 mg ethanol/kg b.w. was estimated. If one of the three 'categories' was assumed to be consumed at a high (acute) level, the daily exposure rose to 12.5 – 23.3 mg/kg b.w. This amount is almost twofold (average) or up to fourfold (high) higher than the lowest exposure level from herbal medicines (6 mg/kg b.w.) which has been suggested to lead to a precautionary but mandatory list of warning hints with respect to the use in children.

It is noteworthy, that regulatory attempts obviously increasingly tend to regulate medicinal drugs in a way more narrow as compared to food, so that the benefit of such regulatory interventions for the consumer/patient becomes questionable.