Tonic or bitter lemon drinks carry the note "quinine-containing". The reason for this is known to very few consumers: Even if the consumption of quinine-containing beverages is unproblematic for the majority of the population, the consumption of large quantities for individual persons can be a health concern. "Pregnant women, in particular, should refrain from consuming them as a precautionary measure, " says Professor Dr. med. Dr. Andreas Hensel.
Risk of hypersensitivity to quinine
Even people who are advised by the doctor because of a certain clinical picture or a hypersensitivity to cinchona alkaloids of quinine should avoid drinks containing quinine. In order to better inform consumers about possible risks, the BfR (Federal Institute for Risk Assessment) recommends extending the previous labeling with specific information for pregnant women and certain other risk groups.
Application of quinine
Quinine is a bitter-tasting, crystalline powder extracted from the bark of the cinchona tree, Cinchona pubescens. In medicine, the alkaloid is used to treat malaria and nocturnal leg cramps. Quinine is also used as a flavoring, especially in beverages such as Tonics and bitter lemonades. In Germany, non-alcoholic soft drinks may contain a maximum of 85 milligrams quinine per liter (mg / L).
Risk for pregnant women
Consumed in larger amounts, quinine can be a health problem. The BfR sees potential risks for pregnant women in particular: the scientific literature reports "withdrawal symptoms" in a newborn whose mother had drunk over one liter of tonic water a day during pregnancy. 24 hours after birth it was found that the infant was shaking nervously. Quinine was detected in his urine. Two months later, these symptoms could no longer be observed.
Because of their slightly bitter taste, quinine-containing drinks are popular thirst quenchers, which are consumed in large quantities especially in the summer months - even by pregnant women. Moreover, there are recommendations on the Internet that pregnant women are strongly advised to consume quinine-containing beverages in order to combat nocturnal calf cramps or to counteract morning sickness. The advice of the BfR to pregnant women, however, as a precaution to dispense quinine-containing drinks, is based on the use of quinine as a drug - here is a pregnancy as a contraindication.
Other risk groups
Also, people who are advised by the doctor due to certain diseases such as tinnitus, pre-damage of the optic nerve, certain forms of hemolytic anemia or hypersensitivity to cinchona alkaloids from the intake of quinine should abstain from quinine-containing foods. Anyone who has cardiac arrhythmias or is taking drugs that interact with quinine, such as anticoagulant drugs, should drink quinine-containing sodas only after consulting a doctor. With these recommendations, health protection in the food sector will be adapted to measures for risk reduction in the area of pharmaceuticals, according to the BfR.
Better labeling required
Even today quinine-containing drinks must be labeled. However, the BfR considers that further indications for risk groups are just as necessary as comprehensive information for consumers about possible undesirable effects of quinine. The signs of an intolerance to quinine, which can already occur after the consumption of small amounts of quinine in the case of existing hypersensitivity, are too little known in the population, according to the BfR. Tinnitus, visual disturbances, confusion or bleeding from the skin and bruising may be mentioned as undesirable effects as a result of quinine intake. In these cases, no more quinine should be consumed and a doctor should be consulted.