Cardiomyopathy

One of the first reports on cobalt intoxication was in 1967, it was later called Quebec beer drinkers ‘cardiomyopathy. Doctors first believed that it was viral, but they could not isolate the virus. The presence of an anti-influenza a complement fixing antibody, was repeatedly found in the bodies of the men. They described that it was prevalent in men in their 40s to 60s who were heavy drinkers who died unexpectedly. It was then thought that the patients were suffering from beriberi heart disease, however a high cardiac output is expected in the acute stage of this heart disease. We do not think chronic beriberi heart disease, hypokinetic and unresponsive to thiamine, is a common entity; the presence of abnormal erythrocyte transketolase activity found in these patients may simply reflect recent nutritional deficiency secondary to heart failure.

            It turned out that the men had all drank beer made at the Dox brewery in Quebec City. The brewery had added cobalt to stabilize the beer’s foam. This company accounts for approximately 80% of the local market in Quebec. A beer of the same name is manufactured in Montreal and, as far as could be ascertained approximately the Quebec Dox brewery beer contained approximately 10 times more cobalt sulfate. This chemical had been added to come 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 insufficient rinsing with plain water. For this reason, in larger breweries, cobalt sulphate has been added only to draught beer. However, since the Quebec Dox brewery was a smaller brewery separate batches were not brewed for bottle and for draught beer, and cobalt sulphate was therefore added to all the beer processed in the brewery. Thus, causing the intake levels to be significantly higher than those in Montreal. The same problem occurred in Omaha, the syndrome in both Omaha and Quebec appeared a month after the addition of cobalt sulphate to beer and no new cases developed a month after this procedure was discontinued.

            Cobalt has been used extensively as an antianemic agent and it is remarkable that the patients in the Quebec cases were polycythemic. Also, in the Quebec cases thyroid lesions typical of the cobalt-induced goiters were described. It was found that other factors have increased these patients’ susceptibility to cobalt. The absorption of cobalt is known to be extremely variable: it is diminished after a meal, it varies with the quantity and the type of dietary protein, it varies with the pH of the stomach and upper duodenum, and it is increased if iron deficiency exists. Cobalt has been shown to have a biological action of great complexity. It has been used in vitro to stimulate certain enzymes systems and inhibit others. Webb have discovered that the inhibition of ketoacid oxidation is the point at which cobalt acts on cell metabolism, blocks the Krebs cycle and aerobic cellular respiration. The type of biological activity of cobalt is dependent on the concentration of the metal. It was found that in various species diffuse myocardial degeneration with interstitial edema as the result of cobalt. It would appear that cobalt was the essential factor in the production of the Quebec beer-drinkers’ cardiomyopathy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1923410/pdf/canmedaj01236-0048.pdf

http://www.cbc.ca/news/health/how-quebec-beer-and-tv-s-dr-house-solved-a-medical-mystery-1.2526403