When Her Body Brewed Alcohol: Unraveling the Mystery
After being misdiagnosed as an alcoholic for two years, a unique medical condition known as auto-brewery syndrome was discovered. Her gut was fermenting alcohol from carbohydrates, leading to a surprising revelation by doctors.
Her breath smelled strongly of alcohol, but she hadn't been drinking. One day, she fainted and hit her head while preparing lunch for her kids. Despite her dizziness and weakness, doctors didn't believe her and her husband for two years.
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"Despite visiting her family doctor repeatedly and making seven trips to the emergency room in two years," explained Dr. Rahel Zewude, an infectious disease specialist at the University of Toronto.
Doctors discovered that the woman's alcohol levels were between 30 and 62 millimoles per liter, whereas a normal range is below 2 millimoles per liter, according to Zewude.
Barbara Cordell, president of Auto-Brewery Syndrome Information and Research, highlighted that alcohol levels exceeding 62 millimoles per liter are extremely dangerous and could potentially be life-threatening.
While no one she knows has reached such high levels of alcohol in their blood, Cordell mentioned in an email that many individuals can still function at levels of up to 30 or 40 millimoles per liter.
Cordell, who was not part of the new case, stated that she is aware of more than 300 individuals with auto-brewery syndrome and their private Facebook support group consists of over 800 patients and caregivers.
It is puzzling how individuals with remarkably high levels of this syndrome can function normally.
When the Toronto woman visited the emergency room, all doctors were curious about her drinking habits. She underwent evaluations by three hospital psychiatrists, who all agreed that she did not exhibit signs of alcohol use disorder.
Zewude, who treated the woman and coauthored a report on the anonymous case that published Monday in the Canadian Medical Association Journal, shared that the woman informed doctors about her religious beliefs that prohibit drinking. Her husband also confirmed that she did not consume alcohol.
However, it was only during her seventh visit that an emergency room doctor suggested the possibility of auto-brewery syndrome and referred her to a specialist for further evaluation.
Dr. Fahad Malik, a gastroenterologist at United Heath Services in Binghamton, New York, shared that he currently has 30 patients with the disorder. He mentioned that patients often face disbelief and ridicule during their treatment. Malik was not part of the new case study.
According to Malik, many patients have been wrongly labeled as 'closet drinkers' or diagnosed with behavioral conditions before receiving the correct diagnosis. Malik, who also serves as a clinical assistant instructor at the State University of New York Upstate Medical University, highlighted this common issue among patients.
Auto-brewery syndrome, also called gut fermentation syndrome, is a very uncommon condition where bacteria and fungus in the gut change the carbs in food into ethanol. The first case was in 1946 in Africa, when a 5-year-old boy's stomach ruptured mysteriously. During an autopsy, his belly was filled with a "frothy" fluid that smelled like alcohol.
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Replacing alcohol with weed is becoming increasingly popular in the US. According to a review in April 2021, there have been 20 reported cases of auto-brewery syndrome in English medical literature since 1974. In Japan, this condition is known as meitei-sho, or “alcohol auto-intoxication syndrome,” and there have been additional reports of similar symptoms there.
Auto brewery syndrome happens when specific types of bacteria and fungi multiply too much in a person's gut microbiome, essentially turning the gut into a mini alcohol distillery.
Researchers think this occurs in the small intestine and is quite different from the usual fermentation process in the large intestine that provides energy for our bodies.
Most cases of pathogens are due to an overgrowth of two species of fungi: Saccharomyces and Candida. Candida can be found on the body, in the mouth, digestive tract, and vagina. It often becomes dominant when beneficial bacteria are reduced by antibiotics.
A 61-year-old man experienced frequent bouts of unexplained drunkenness before being diagnosed with an intestinal overabundance of Saccharomyces cerevisiae, also known as brewer’s yeast, which is used to make beer, as reported in July 2013.
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Some individuals with the syndrome may have a high level of alcohol in their body due to their metabolism, which they may not be aware of until they face legal issues.
A man in North Carolina in his late 40s was stopped by police who suspected him of driving under the influence. Even though his blood alcohol level was at 0.2%, which is like having 10 drinks in an hour and way above the legal limit, he insisted that he had not been drinking.
According to Cordell, incidents like this are more common than we realize, but often go unnoticed. Many individuals could be going about their day feeling sluggish and attributing it to fatigue, when in reality they might be unknowingly metabolizing alcohol.
Risk factors for auto-brewery syndrome include diabetes, liver disease, gastrointestinal diseases like inflammatory bowel disease, and short gut syndrome. Zewude also mentioned that there could be a genetic predisposition that affects how well a person metabolizes alcohol.
"It's not just one thing that causes this syndrome," she explained. "It's a combination of different risk factors coming together at the right moment to create a metabolic storm in the body."
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For Zewude's patient in Toronto, the metabolic storm started in her mid-40s. She began experiencing urinary tract infections one after the other, each requiring antibiotics for treatment. As a result, the beneficial bacteria in her gut started to decrease, creating an opportunity for harmful fungi to thrive.
When the woman was 48 years old, her body was converting almost all the carbohydrates she ate into alcohol. This process required fuel for the yeast in her body, which came from the carbohydrates in her diet.
According to Zewude, the symptoms were less severe when she consumed fewer carbs. However, if she had a slice of cake or a large carbohydrate meal, her alcohol levels would rapidly increase. During these times, she could be preparing lunch for her children and suddenly fall asleep.
Treatment for auto-brewery syndrome typically begins with a course of fungicides. These are prescribed after a biopsy or colonoscopy has identified the specific pathogens that have colonized the gut, according to Zewude. It is important to avoid starting with a broad spectrum fungicide, as this approach can have negative consequences.
Zewude explains that antimicrobial resistance plays a significant role in the syndrome. This is often a result of frequent antibiotic use, which can disrupt the balance of bacteria in the gut and contribute to the development of auto-brewery syndrome. To address this issue, it is recommended to start with a narrow approach when prescribing fungicides. If a patient becomes resistant to a particular fungicide, then other options can be explored.
Auto-brewery syndrome is an extremely rare condition in which bacteria and fungus in the gastrointestinal tract turn the carbohydrates in everyday food into ethanol.
Auto-brewery syndrome is an extremely rare condition in which bacteria and fungus in the gastrointestinal tract turn the carbohydrates in everyday food into ethanol.
Patients are advised to follow a very strict low-carb diet in addition to getting rid of the yeast. It is recommended to avoid carbs completely, although it can be challenging to do so. Probiotics are also suggested to restore beneficial bacteria.
The woman is now off antifungal medications but continues to follow a very low-carb diet to prevent another relapse. It's crucial for patients to keep in close contact with their doctors since everyone's experience with the condition can be different, according to Zewude.
Zewude highlighted the importance of having a supportive partner, like the woman's husband, who alerted him as soon as he detected alcohol on her breath once more. It's essential for anyone dealing with the syndrome to ensure that their spouse, friend, roommate, or anyone close to them is aware of the signs and symptoms and knows to seek medical help promptly in such situations.
Editor's P/S:
The article highlights the complexities of auto-brewery syndrome, a rare condition where gut bacteria convert food into alcohol, leading to intoxication despite abstention from drinking. The woman's case illustrates the challenges faced by patients, who often encounter disbelief and misdiagnosis. It also underscores the importance of recognizing the condition and seeking prompt medical attention to avoid potential health risks.
Moreover, the article discusses risk factors associated with auto-brewery syndrome, such as diabetes, liver disease, and certain medications that disrupt the gut microbiome. Understanding these risk factors and implementing preventive measures, like maintaining a balanced diet and limiting antibiotic use, can help reduce the likelihood of developing the condition.
