Auto-Brewery Syndrome: Also Known as Drunkenness Disease
Introduction
In 2019, a 46-year-old man was arrested by police under the suspicion of driving under the influence of alcohol, with a blood alcohol concentration of 0.2, after he was insistent that he had not consumed alcohol that night.1 Researchers discovered that fungi in his digestive system were converting digested carbohydrates into alcohol; a very rare disease known as auto-brewery syndrome.
Summary of Disease
Auto-brewery syndrome (ABS) is a remarkably rare condition that can occur when certain gut fungi excessively convert carbohydrates into alcohol, making one inebriated despite having zero alcohol intake.2 The alcohol generated in the gut is eventually absorbed in the small intestine, causing an overall increase in blood alcohol concentration and producing symptoms comparable to the feeling of being intoxicated. It can be difficult to diagnose ABS, as it could be mistaken for other conditions due to its non-specific symptoms.2 As expected, these episodes of random intoxication can significantly disrupt a person’s life, making it difficult to complete daily tasks.
Etiology and Pathophysiology
ABS can be caused by an overabundance of yeast, a type of fungi, in the gut; specifically, certain yeasts from the Candida and Saccharomyces families.3 Yeasts feed on starches and sugars from the food to convert them into energy. Through this process, ethanol is released as a by-product into the bloodstream, travelling throughout the entire body and ultimately causing ABS.4
ABS may also result from long-term antibiotic use, which can alter the gut microbiome and eventually result in overgrowth of fungus and certain bacteria, such as the strains Klebsiella pneumonia and Enterococcus faecium.5 On top of that, certain medical conditions such as diabetes, obesity, a weakened immune system, and Crohn’s can further increase a person’s risk of getting ABS.2
Symptoms
Symptoms of ABS are comparable to the feeling of being drunk, and are very broad; often being mistaken as symptoms of other diseases. These symptoms include fatigue, dry mouth, headache, dehydration, dizziness, nausea and vomiting, red or flushed skin, and mood changes.5 ABS can also lead to other serious health conditions, like chronic fatigue syndrome, irritable bowel syndrome and depression.5 Like any illness, symptoms may differ between person-to-person.
“Auto-brewery syndrome (ABS) is a remarkably rare condition that can occur when certain gut fungi excessively convert carbohydrates into alcohol, making one inebriated despite having zero alcohol intake”
Diagnosis
Currently, there are no definite tests to concretely diagnose ABS. Due to the rarity of the disease, doctors often do not consider ABS when assessing patients with altered mental status, and will often perform testing for more common illnesses first.5 An individual’s medical history will first be reviewed by a doctor, and a physical examination will be performed.
A doctor can diagnose ABS by performing a stool test to determine if there is an excessive amount of yeast present in the gut. This is executed by sending a stool sample to a specimen testing or pathology lab in order to be examined for abnormal concentrations of bacteria and fungi.2 Alternatively, doctors may insert an endoscope, a long thin tube, into the gastrointestinal tract to collect fluid. This fluid will then be examined in the lab for overgrowth of bacteria or fungi.2
A less invasive method used to diagnose ABS is the glucose challenge test. This test involves consuming a sugar capsule on an empty stomach, with no food or fluid intake for a couple of hours prior to the test. Blood alcohol level will then be checked an hour after consuming the capsule. A negative test result signifies a blood alcohol level of zero. Conversely, if an increase in blood alcohol content is observed, a diagnosis of ABS could be made.5
Additionally, doctors may run additional blood and urine tests to rule out any possible underlying conditions that could be responsible for their symptoms.2
Prognosis
There are several different treatment options for ABS patients, including dietary and nutritional changes, and medication.
Dietary changes to treat ABS involve avoiding carbohydrates and sugary foods. Lowering the intake of these foods may aid in balancing fungus in the gut and relieving symptoms, and overall results in less alcohol production. ABS can also be treated with the use of antifungal medication. Examples of antifungal drugs include Diflucan, Sporanox, Mycostatin and Cancidas. While taking antifungal medications, it is recommended that patients follow a strict diet; low sugar, carbohydrates or alcohol.5 It is important to note some of the negative side effects of antifungals, some of which include abdominal pain, diarrhea, headache, indigestion and loss of appetite.6 Multistrain probiotic supplements can also help to balance the amount of bacteria present in the gastrointestinal tract.5
Children vs. Adults
Adults and children can both get ABS, displaying similar signs and symptoms. ABS is not congenital, but one may be born with another condition that can eventually lead to it. For example in children, short bowel syndrome, a condition where the body is incapable of absorbing enough nutrients from consumed foods due to a shortened small intestine,6 can put them at a significantly higher risk of getting ABS.5
Gayathiri Rajkumar
Works Cited:
Iftikhar N. Auto Brewery Syndrome: Symptoms, Diagnosis, Treatment, and Diet. Healthline. https://www.healthline.com/health/auto-brewery-syndrome. Published November 2, 2018. Accessed November 30, 2020.
Eske J. Auto-brewery syndrome: Definition, symptoms, and more. Medical News Today. https://www.medicalnewstoday.com/articles/auto-brewery-syndrome. Published 2020. Accessed November 30, 2020.
Short bowel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/short-bowel-syndrome/symptoms-causes/syc-20355091. Published December 31, 2019. Accessed November 30, 2020
Iati M. He was acting drunk but swore he was sober. Turns out his stomach was brewing its own beer. The Washington Post. https://www.washingtonpost.com/health/2019/10/24/he-was-acting-drunk-swore-he-was-sober-turns-out-his-stomach-was-brewing-its-own-beer/. Published October 31, 2019. Accessed November 30, 2020.
Painter K, Cordell BJ, Sticco KL. Auto-brewery Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513346/
HSE.ie. 2021. Side Effects Of Antifungal Medicines - HSE.Ie. [online] Available at: https://www.hse.ie/eng/health/az/a/antifungal-medicines/side-effects-of-antifungal-medicines-.html. Accessed 23 January 2021.
Cite This Article:
Rajkumar G., Chen L., Chowdhury F., Nakhoul R., Chharawala, V., Lombo, L. Auto Brewery Syndrome: Also Known as Drunkenness Disease. Illustrated by A. So. Rare Disease Review. February 2021. DOI:10.13140/RG.2.2.26611.86565
