DrBill -

I read an interesting article on the sensitivity of EtG tests, but the article was published in 2007 and apparently the study was conducted in 2005 or 2006. Are you aware of how these tests have changed since then? The claim is that the EtG test will confirm within an 80 hour window... however I have seen information that this window only catches the most extreme cases and likely someone with a slow metabolism.

Generally, for the EtG test to be most effective it would have to be conducted every 24 hours or within about a 48 hour window. Do you have any further insight?

Thanks,

There has been no change in the test, per se. It is conducted with gas chromatography/mass spectrometry (GC/MS) and High-performance Liquid Chromatography (HPLC) both of which isolate specific molecules, in this case Ethylglucuronide (EtG).

There have been a couple of additions to the test. Some laboratories are now expanding the technology to detect Ethylsulfate (EtS) in addition to EtG. Another addition, beginning in 2008 some laboratories now claim to be able to apply the process to hair testing. Tri-mega, London, was the first in 2008 and that has now spread to the US although I don't know how many labs currently use the hair test. Greg Skipper, the doctor that first promoted EtG testing in the US, in 2004, takes a dim view of the hair testing claims. See EtG, Skipper

The 80 hour claim is more of a promotional theme than scientifically reliable fact. In fairness it was lifted from a Study by F. Wurst, the Swedish doctor that first established the validity of EtG as a bio-marker. His statement was "upto 80 hours."

The fact that 80 hrs is not a constant is easy to calculate: EtG is a by-product of metabolism. Clearly metabolizing one drink creates less metabolites than 2 drinks. EtG is eliminated (rate unknown) therefore the greater the amount of EtG present the longer it takes to eliminate it. There are some studies that tracked how long EtG remained in the system from various quantities but the interindidual variation was so great as to render the results meaningless. (Ex: 1 drink showed no EtG at 3 hrs in one individual and in another it was detectable at 30 hr)

Your information as to the window of detection is pretty close. Depending on the amount of alcohol consumed 24-48 hours is as good as any for an estimate.

Another confounding variable is that the amount of EtG produced from the alcohol metabolic process probably varies from individual to individual (just as basic metabolic rates vary), although that is currently an unknown factor.

The science behind the test seems to be sound and the techology used (GC/MS) is reliable and highly sensitive. The massive problems that have emerged are related to unregulated use, lack of standardized cut off levels and improper interpretation of low level findings.

Thank you for your response, you seem to be the most informed of the blog posters on this issue. I have read a number of the scholarly articles that I could find and it seemed to me that if the labs were consistently catching people at the 80 hour marker and were catching somewhat less at the 100 hr marker, they would be advertising it as an "up to 100 hr test"...

It seems to me also that a credible monitoring program that would not want to deal with arguing false positives would more than likely set the threshold at 500 ng/ml?

In your view, how does size, weight and exercise affect the results? i.e. how does a bigger individual with a higher % of fat fare compared to a smaller individual with a lower % of fat.

Establishing a cut off level at any threshold would bring some uniformity to the field. However, incidental exposure to environmental ethanol creates readings in the 300-800 range (average), according to the court testimony of Greg Skipper, MD (see FindACase™ | Johnson v. State Medical Board of Ohio) That means that total abstainers can test in that range. As example I have been advised that Arizona sets a threshold of 2000, although I've been unable to substantiate, to date.

All of the factors you mention contribute to absorption, distribution and elimination of systemic alcohol, the metabolic cycle for ethanol. Any condition or activity that influences metabolism necessarily influences metabolites.

Unfortunately the scientific literature is under-developed and the advertising claims overblown in relation to EtG testing. Much of the information you read on the subject is simply wrong, particularly the propaganda generated by the testing industry. Stick with the peer reviewed studies, court cases where you can find them, and question even the studies as some of the researchers have a financial interest (check the required disclosures at the top or end of the study).

Also, are you by chance familiar with the lab affinity?

There is a process typed lab affinity, there is a laboratory called Affinity, and a program known as Affinity Lab---clarify that for me.

Is there a way to have an offboard discussion? Could you email me at my board name at Yahoo?

There is a way to private message me with confidential info and I think you click on my user name. Think so. If not let me know.

It does not seem to be activated...

I am -91 when it comes to websites and computers. I get private messages and I checked and it seems to be working. I don't know how to transmit confidential info otherwise.

For some reason I cannot currently get the message function to work... thank you for the information. The sources of information were very valuable for my research.

DrBill you gave the following example earlier: (Ex: 1 drink showed no EtG at 3 hrs in one individual and in another it was detectable at 30 hr) -

Do you know what the physical makeup of each individual was?

Not that particular. In that study I do recall that the drinks were measured in proportion to body weight and it involved social drinkers as opposed to detoxing alcoholics. I can look back through some info and try to find a list of the research to date. It strikes me there are only 9 studies, some are case reports (1 individual) and some are as few as 3. It is really sparse research.

It'll probably be tomorrow before I get to it.

No worries, thank you. I am trying to make comparisons between overweight inviduals that don't really exercise and skinny individuals that exercise on a regular basis and would have ostensibly a high metabolism. I know there is not enough data, but I would assume that the outliers that typically test positive at 80 hrs out would be those that are overweight, do not exercise and have a relatively slow metabolism.

Don't think so. First there is a difference in male v female alcohol metabolism due to an intestinal enzyme called ADH, (alcohol dehydrogenase). Men have it, women don't (or very little). Second, women eliminate alcohol at a faster rate then men despite the fact that they have higher body fat. Third, frequency and amount of consumption play a significant role in metabolism due to a liver function called MEOS (Microsomal Ethanol Oxidizing System). This is like an overdrive system that is operative in regular drinkers but not in occasional drinkers. Some studies indicate it is also activated by the amount of alcohol in the system as well (overload/intoxication).

In addition, none of the studies to date have controlled for liver function (or pathology) despite being performed on chronic alcoholics. While the factors you mention play an indirect role in EtG production via metabolism there is no way to correlate that information without a fixed ratio for EtG production in relation to quantity of systemic alcohol.

Contrary to your theory, my experience would indicate that those who test highest would be thin, under-nourished, suffering from vitamin deficiency, fatty liver and gastrointestinal problems. My profile fits chronic Type II alcoholism but may not hold true for EtG.

So your theory is equal to mine. I'm certainly interested in anything you find.

Let me see if I am folloiwng you here - you say - Third, frequency and amount of consumption play a significant role in metabolism due to a liver function called MEOS (Microsomal Ethanol Oxidizing System). This is like an overdrive system that is operative in regular drinkers but not in occasional drinkers. Some studies indicate it is also activated by the amount of alcohol in the system as well (overload/intoxication). --

So are you thereby saying that occasional drinkers don't have the ability to metabolize as quickly as regular drinkers?

But your next statement would seem to indicate that skinny stage II alcoholics that are enaging in regular active drinking would test the highest?

Yes. Regular drinkers do metabolize at a faster rate than occasional drinkers.

Yes skinny alcoholics who drink to excess constantly would probably test higher for EtG, certainly their metabolism often slows down. This has nothing to do with morphology but a lot to do with pathology. The liver is overworked and damaged. That is where 80+ of metabolism occurs. The gastrointestinal tract is stripped of enzymes where maybe 15-20% of alcohol metabolism occurs via ADH. Over utilization of the MEOS system is believed to contribute to liver disease. To further clarify, Type II alcoholism is advanced long-term chronic drunkenness (some refer to this as skid row type). The extreme end of the alcoholic typologies.

I am also interested in this 80 hour claim and how it affects differently situated classes of people. If you were to make a generic observation from your studies - for occasional drinkers who would be the prototypical individual that would fail at the outer 80 hour band given either a moderate or heavy drinking episode ending at hour 1 in the 80 hour band?

It is relatively safe to say that consumption of up to 5 drinks will not be detectable after 48 hours regardless of the drinking history or physical characteristics of the imbiber (excepting pathology). That isn't based on my knowledge of the physiological mechanisms involved. It is an observation derived from various studies and reported elimination times. It is a guess based on the fact that the more alcohol consumed the higher the level of EtG.

Few of the research projects have involved females (1, 2 at most) which is unusual as the male v female variance in metabolism is well established as are gender enzyme discrepancies. So that leaves a black hole in the EtG literature.

To the best of my knowledge there has been no attempt to correlate EtG production or elimination with individual metabolic rates. Another big question mark.

The only mention of physical characteristics has been the administration of ethanol based on body weight. Even there the body weight is not stated.

Therefore I have nothing to go on. It would be my thinking that the system of a regular but healthy drinker would eliminate faster than a healthy infrequent drinker, holding constant basic metabolic rate, gender and pattern of consumption. That is based on the assumption that one reaches "0" BAC faster than the other and therefore shifts the time to first drink rather than point of elimination of ethanol (0 BAC). When you start the process at 0 BAC then there is another question mark. If they each had the same amount of EtG in their system would one eliminate at a faster rate than the other? The question that overshadows that is would they have the same amount of EtG in their system? Probably not, I think, but don't know for sure.

You are correct in relation to exercise in that anything increasing the BMR will speed up all metabolic processes and should eliminate EtG at a correspondingly faster rate. There is no research on that and isn't likely to be.

In order to reach the 80+ limit requires extreme intoxication in an otherwise healthy individual. A BAC of from .25 and up.

Now, how many people do you know that can use up a full page while not answering your question?

Thank you for indulging me, the intellectual banter kept my day interesting.