Can you imagine yourself getting drunk without having had a single drop of alcohol? It might sound ridiculous, but such a situation can actually exist. Individuals who suffer from this have a condition called Auto brewery syndrome (ABS), also called gut fermentation syndrome.
It is a rare condition that causes endogenous alcohol production within the body. This is due to an overgrowth of certain strains of yeast in the gastrointestinal tract, leading to the intestinal fermentation of carbohydrates into alcohol.
The auto-brewery condition has been used as a defense in DUI trials throughout the years, but not to worry! It is unlikely that this condition would produce enough ethanol to cause elevated blood alcohol levels.
This article digs deep into Auto Brewery Syndrome, examining its causes, symptoms, diagnosis, therapy, and the difficulties experienced by those who are affected.
Understanding Auto Brewery Syndrome
The gastrointestinal system is a plethora of a wide variety of bacteria, with fungi making up less than 0.1% of the microorganisms found in the typical human stomach. The most prevalent fungus in the gut is Candida albicans, a form of yeast.
The sugars and starches in food are consumed by yeasts and other fungi, which they then use to produce energy. Additionally, waste from this process also includes carbon dioxide. As a result of microbial fermentation, ethanol is created, which circulates throughout the body.
The earliest known case of ABS was first discovered in 1946, during an emergency laparotomy of a 5-year-old South African kid. Blood ethanol content was not found at that time; hence, the examiner initially hypothesized that this was caused by gram-negative gut flora fermenting sweet potatoes. Later, throughout the 1970s in Japan, more cases of ABS were reported.
Those who suffer from auto-brewery syndrome may have an elevated blood alcohol level even after little to no alcohol consumption. ABS can also cause similar physical and mental symptoms to those of alcohol intoxication or hangover.
What Causes Auto Brewery Syndrome?
While the exact cause of ABS is still unknown, a number of events have been linked to its emergence. It is believed that the overgrowth of yeast, especially a causative organism like Saccharomyces cerevisiae, in the gut has a substantial impact.
This could happen as a result of an imbalance in the gut microbiome, which long-term antibiotic usage, a high-carbohydrate diet, or a compromised immune system can bring on. Additionally, some drugs like antibiotics or immunosuppressants may hasten the onset of the syndrome by upsetting the usual bacteria in the gut.
Specific medical disorders can raise the risk of getting auto-brewery syndrome; these include:
- Crohn’s disease
- IBS, or irritable bowel syndrome
- Short bowel syndrome
- Small intestinal bacterial overgrowth
- Diabetes mellitus
Risk Factors Associated with Auto Brewery Syndrome
Recognizing those who may be more vulnerable to Auto Brewery Syndrome and putting preventative measures or focused interventions in place requires an understanding of these risk factors:
1. Imbalance in the gut Microbiome
Candida albicans, which is frequently linked to Auto Brewery Syndrome, can grow out of control in conditions when the gut microbiome is disturbed or unbalanced.
The normal balance of helpful bacteria can be upset by factors like the use of antibiotics, a high-sugar diet, and ongoing stress. These imbalances are associated with gastrointestinal and systemic diseases and could create the ideal environment for the fermentation of ingested carbohydrates and the subsequent generation of ethanol.
2. Diet High in Carbs
A diet rich in carbohydrates, especially simple sugars and refined carbs, is like adding fuel to the fire of endogenous fermentation. Since yeast depends on sugars for growth, an abundance of carbohydrates may facilitate yeast overgrowth. The increased yeast population raises the possibility that the body will produce alcohol.
3. Using Antibiotics
The delicate balance of gut microbes can be disturbed by taking antibiotics often or for an extended period. In addition to killing off hazardous bacteria, antibiotics can also get rid of good bacteria that control the number of yeast. Interruption of this equilibrium might result in an overgrowth of yeast, raising the possibility of Auto Brewery Syndrome.
4. Underlying Health Issues
Some underlying medical problems may raise the Auto Brewery Syndrome risk. For instance, people with diabetes, obesity, or compromised immune systems can be more prone to yeast overgrowth. Because of the high blood sugar levels associated with diabetes, yeast can grow in certain conditions.
5. Persistent Stress
The gut flora and general health may suffer as a result of persistent stress. The immune system can be compromised by stress hormones like cortisol, which can upset the equilibrium of gut flora. Auto Brewery Syndrome can be exacerbated by a compromised immune system that finds it difficult to regulate yeast overgrowth.
6. Medical Conditions
Endogenous ethanol levels have been found to be higher in some situations, including type 2 diabetes mellitus and liver cirrhosis. Additionally, studies have demonstrated that Klebsiella bacteria can similarly ferment carbohydrates to alcohol in the stomach, which can hasten the progression of non-alcoholic fatty liver disease.
Because of the fermentation of improperly absorbed carbohydrates, small bowel syndrome individuals who have had surgical resection are susceptible to developing gut fermentation.
Symptoms of Auto Brewery Syndrome
The symptoms of ABS can mimic those that have ingested high amounts of alcohol, which include:
- chronic fatigue syndrome
- mood swings
- brain fog
- poor coordination
People who experience this disease, however, might not have had any serious alcohol consumption. Others may not believe them since their symptoms seem unjustified or self-inflicted, which may cause skepticism. According to a survey, patients with chronic intestinal obstruction, gastroparesis, diabetes, or liver dysfunction such as nonalcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) are more prone to experience the auto-brewery syndrome.
In addition, a weak immune system, diabetes mellitus, poor diet, and antibiotic use can all contribute to the overproduction of yeast in the body.
Diagnosis of Auto Brewery Syndrome
Due to its rarity and the lack of defined diagnostic criteria, ABS might be difficult to diagnose. In most cases, medical experts base their decisions on a combination of the patient’s symptoms, alcohol breath tests, and blood alcohol content.
Examining a patient’s medical history, getting a current list of symptoms, and conducting a physical examination are the usual steps doctors use to start the diagnostic procedure.
A tiny stool sample may be taken by the doctor, who will then submit it to a lab for evaluation. Checking for unusual bacteria and fungal concentrations is typically part of this analysis.
In order to check for auto-brewery syndrome, some physicians may do a carbohydrate challenge test. They will instruct the person to consume a meal high in carbohydrates or to take a glucose pill on an empty stomach.
Doctors can also use a long, thin tube known as an endoscope to collect fluid from various areas of the digestive system. These samples will be examined in a laboratory for bacterial or other fungal growth or overgrowth.
Treatments for Auto Brewery Syndrome
Addressing the underlying cause and restoring the gut flora is the key to managing Auto Brewery Syndrome. Some methods include:
1. Dietary adjustments
Dietary changes are one of the main methods of treatment for Auto Brewery Syndrome. The endogenous alcohol fermentation process in the gut can be decreased by reducing carbohydrate intake or adopting a low carbohydrate diet, particularly of simple sugars and refined carbs.
It might be advised to follow a ketogenic or low-carb diet that is a low carbohydrate diet high in wholesome fats, proteins, and fiber. Dietary adjustments are intended to make the digestive system’s environment less favorable for yeast overgrowth and the subsequent synthesis of alcohol.
Avoid refined foods with added sugars and simple carbohydrates if you have the auto-brewery syndrome, like pasta made with white rice flour, white bread, desserts, sugar, high fructose corn syrup, and sweet drinks like soda and fruit juice.
2. Antifungal Drugs and Probiotics
The gut microbiota can be restored by using probiotics, which are healthy microorganisms. By preventing the proliferation of Candida albicans and other yeast strains, they aid in normal stool bacterial flora by restoring a healthy balance between bacteria and yeast.
To support a healthy gut environment, doctors may prescribe probiotic supplements that contain Lactobacillus and Bifidobacterium species, which competitively inhibit fungal growth. Moreover, yeast overgrowth may be targeted and reduced with antibiotic therapy with the help of antifungal drugs like fluconazole or nystatin.
3. Changes in Lifestyle
Changing your way of life for the better can help with managing Auto Brewery Syndrome. The body’s immune system can be strengthened by using stress reduction strategies, engaging in regular exercise, and getting enough sleep. To avoid symptoms worsening, it’s imperative to avoid drinking alcohol completely.
4. Treating Underlying Medical Conditions
There may be a connection between Auto Brewery Syndrome and specific underlying illnesses that fuel yeast overgrowth. In order to better manage auto-brewery syndrome itself, several disorders can be treated to help with symptom relief.
One way to do this is to minimize the amount of blood glucose levels made available for yeast fermentation by controlling diabetes with proper blood sugar control. Similarly, addressing obesity, immune system issues, or hormone imbalances can aid in gut health restoration and reduce alcohol production.
5. Psychological Support
Because of possible skepticism and misinterpretations from others, living with Auto Brewery Syndrome can be emotionally difficult. Individuals can find a secure environment to express their experiences, deal with the psychological consequences, and get validation and understanding by seeking psychological care, such as therapy or support groups.
6. Fecal Microbiota Transplantation
Another weird but effective way to treat ABS is fecal microbiota transplantation, or in simpler words- a poop transplant! While there’s no actual poop exchange happening, the good bacteria from one body is transplanted into another. Antibiotics tend to kill an excessive number of “good” bacteria, and fecal microbiota transplants, also known as bacteriotherapy, help restore the balance of bacteria in the body.
The treatment is most usually carried out via colonoscopy. This is not really a recent development, as fecal transplants have been used in Traditional Chinese Medicine for at least 1,700 years. However, there are a number of tests required before doctors may do bacteriotherapy.
Although Auto Brewery Syndrome is a rare ailment, a few case studies have been published that offer insight into the struggles and experiences endured by those who have this disorder.
Here are a few noteworthy examples:
Case 1: A 61-year-old man who frequently experienced episodes of unexplained intoxication was the subject of this case report, which was written in the International Journal of Clinical Medicine. The patient denies drinking alcohol but had symptoms, including drowsiness, confusion, and slurred speech, that were consistent with being drunk.
Different alcohol breath tests and blood alcohol concentration checks regularly revealed excessive blood alcohol levels in his system. The diagnosis of Auto Brewery Syndrome was made after other potential explanations, including liver disease and alcohol use, were ruled out. A low carbohydrate diet was used as part of the treatment,
Case 2: A 46-year-old man with no substantial medical or mental history sought assistance for the diagnosis and treatment of ABS. He had previously been active and healthy. He did not use any prescription, over-the-counter, or herbal treatments.
Beginning in January 2011, he claimed to have experienced memory loss, mental changes, and depressive episodes for more than six years. He started experiencing these changes after receiving antibiotic treatment for a complicated traumatic thumb injury.
One week after his antibiotic therapy was finished, it became evident that his demeanor had changed, and he had started acting aggressively and experiencing depressive episodes. He underwent his primary care physician’s (PCP) initial evaluation in January 2014 and was then referred to a psychiatrist who treated him with fluoxetine and lorazepam.
Auto Brewery Syndrome is such a condition that necessitates a thorough approach to treatment. Probiotics, antifungal drugs, lifestyle adjustments, dietary changes, and psychological support are all essential in managing this syndrome.
Living with ABS can take a huge toll on the physical and mental state of the person. Isolation, anxiety, and despair may result from the struggle, along with the urge to distance themselves from society due to the fear of scrutiny. In order to support and empathize with those affected by this condition, it is essential to increase knowledge and understanding among medical professionals and society at large.