Should one avoid consuming durians when drinking alcohol?

Question

I read on {1} that one may want to avoid consuming durians when consuming alcohol, as durians were shown to inhibit aldehyde dehydrogenase (ALDH) in their in vitro study. Has this hypothesis been confirmed or rejected when tested in vivo?

Excerpt from {1}:

This study provides evidence that some component(s) of durian fruit inhibit(s) yALDH in vitro. Inhibitory action of the non-polar sulfury constituents of the fruit like diethyl disulfide on yALDH, with further investigation, offers a novel rationale to the etiology of the durian-alcohol anecdote. As such, work on this theme is currently undertaken to confirm the bioactive component(s) in the durian fruit, and validate the consistency of the findings hereby reported in mammalian models in vivo.

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References:

• {1} Maninang, John & Lizada, Connie & Gemma, Hiroshi & 弦間, 洋. (2009). Inhibition of aldehyde dehydrogenase enzyme by Durian (Durio zibethinus Murray) fruit extract. Food Chemistry. 117. 10.1016/j.foodchem.2009.03.106. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Maninang%2C+John+%26+Lizada%2C+Connie+%26+Gemma%2C+Hiroshi+%26+%E5%BC%A6%E9%96%93%2C+%E6%B4%8B.+%282009%29.+Inhibition+of+aldehyde+dehydrogenase+enzyme+by+Durian+%28Durio+zibethinus+Murray%29+fruit+extract.+Food+Chemistry.+117.+10.1016%2Fj.foodchem.2009.03.106.+&btnG=

Answer 1

The answer is very probably yes, these findings were confirmed and one should avoid consuming durian fruit and alcohol. But interestingly, anyone tempted to try probably will avoid it anyway.

The fruit contains "components" that interfere with alcholo metabolism, leading to increased toxicity and a quick learning experience.

A combination of consuming durian fruit and alcohol drinks is reported to lead adverse effects in humans (Maninang, Lizada, & Gemma, 2009). Earlier, Croft (1981) reported on patients consuming durian and drinking alcohol simultaneously, which included deaths as well as cardiac arrest episodes. The symptoms included clinical manifestations such as: palpitation, vomiting, facial flushing, nausea, and drowsiness. In addition, physiological effects of drinking alcohol might also have major contribution on health effects. According to Kitson and Weiner (1996), component derived from ethanol is oxidised in liver by the action of aldehyde dehydrogenase (ALDH) enzyme. Disulfiram can retard ALDH activity resulting in the accumulation of alcohol-derived acetaldehyde. According to some researchers (Brien & Loomis, 1985), acetaldehyde contributes to the adverse reactions known as the disulfiram-ethanol reaction (DER). The inhibitory activities of sulphur-containing compounds obtained from natural resources on ALDH are well known (Kitson & Weiner, 1996). Several studies have shown durian to be abundant in sulphur compounds (Baldry et al., 1972; Moser et al., 1980; Voon et al., 2007b; Weenen et al., 1996; Wong & Tie, 1995).

Sub-chronic and acute toxicity examinations (through oral feeding) in rats and mice fed diets containing polysaccharide gel isolated from durian rind showed no toxic effects (Pongsamart, Sukrong, & Tawatsin, 2001; Pongsamart, Tawatsin, & Sukrong, 2002). Maninang et al. (2009) evaluated the effects of durian fruit extract on the inhibition of ALDH. The enzymatic assay demonstrated that yeast aldehyde dehydrogenase (yALDH) significantly lost enzymatic activity in the presence of durian fruit extract at all the tested concentrations (0.03, 0.07, 0.16, 0.33, 0.65, and 1.63 ppm). The intensity of inhibition increased with increase in the fruit extract concentration and was up to a maximum of 70% at 0.33 ppm extract. However, the inhibitory effect was observed to be low at the highest concentration (1.63 ppm) of the tested fruit extract. The non-polar organic constituents of the durian fruit extract gave positive results in the sulphur-test elicited significant inhibitory effects on yALDH. In addition, several studies reported that the diethyl disulphide to be the most abundant sulphur com- pound which contains a disulphide bridge in durian (Laohakunjit, Kerdchoechuen, Matta, Silva, & Holmes, 2007; Voon et al., 2007a). As the sulphur content of durian is reported to have inhibitory characteristic on ALDH activity and can be mortal in person who consume durian and drink alcohol simultaneously, further in vivo studies are warranted to provide more scientific evidence for better understanding to the consumers.

Lee-Hoon Ho & Rajeev Bhat: "Exploring the potential nutraceutical values of durian (Durio zibethinus L.) – An exotic tropical fruit", Food Chemistry 168 (2015) 80–89. (DOI)

The learning in vivo:

We hereby present empirical proof that concurrent administra- tion of ethanol and durian elicits DER-like interactions in vivo. Although work is currently undertaken to identify the bioactive component(s) in durian causing the ill interaction with ethanol, the clinical manifestations appear to be similar to those observed in rats given cabbage, a known source of the ALDH-inhibiting PEI- TC. Consistently, blood acetaldehyde levels were elevated in rats that exhibited CTA and hypothermia, which further supports the role of acetaldehyde, rather than ethanol, in the severity of the DER. Ethanol is the most available psychoactive drug in many parts of the world. With advocacies on increased consumption of fruits and vegetables, and moderate alcohol drinking, the likelihood of unsafe food-alcohol interactions observed in the present study is not remote. These findings provide a basis for a caveat on the choice of food items that precede ethanol.

John S. Maninang et al.: "The influence of durian (Durio zibethinus Murray cv. Monthong) on conditioned taste aversion to ethanol", Food Chemistry Volume 131, Issue 2, 15 March 2012, Pages 705-712. (DOI)