What is Auto-Brewery Syndrome?
Auto-brewery syndrome, also known as gut fermentation syndrome, is a condition where the body produces alcohol on its own. This can happen through fermentation by certain forms of fungi or bacteria found in the stomach, mouth, or urinary system. People affected by this syndrome often show signs similar to being drunk, even though they haven’t consumed any alcohol. Many of them also report consuming diets high in sugar and carbohydrates.
Production of alcohol within the body is a regular part of digestion and usually happens in very small amounts. However, when certain yeast or bacteria start fermenting uncontrollably, it can lead to much higher alcohol levels in the blood. This syndrome is more commonly noticed in people suffering from other conditions such as diabetes, obesity, and Crohn’s disease, but it can also happen to otherwise healthy people. A number of different yeast strains and rare bacteria types are known to cause this condition.
Although auto-brewery syndrome is not often diagnosed, it’s likely that it goes unnoticed or misdiagnosed more often than we realize. In very rare cases, the condition has also been found in the mouth and the urinary bladder.
What Causes Auto-Brewery Syndrome?
Auto-brewery syndrome is a condition where your body brews its own alcohol. This happens because of various yeasts from the Candida and Saccharomyces families and some strains of bacteria. They live inside our bodies naturally but sometimes turn harmful and start to produce ethanol, a type of alcohol.
The yeasts that cause this condition include Saccharomyces cerevisiae, S. boulardii, and a few strains of Candida, such as C. glabrata, C. albicans, C. kefyr, and C. parapsilosis. Also, some bacteria linked to this condition are Klebsiella pneumonia, Enterococcus faecium, E. faecalis, and Citrobacter freundii.
Existing health issues, like diabetes or liver problems, can impact if you’re diagnosed with auto-brewery syndrome. For example, people with type 2 diabetes or liver cirrhosis had higher levels of alcohol made by their bodies than a group of healthy people. The highest level was found in people who had both type 2 diabetes and liver cirrhosis. Their blood alcohol concentration reached 22.3 mg/dL.
In an experiment, four common yeasts were mixed with infant formulas. After 24 and 48 hours, alcohol production was measured. The amount of alcohol produced provides a possible explanation for patients showing auto-brewery syndrome.
Body-made alcohol can contribute to the development of non-alcoholic fatty liver disease (NAFLD). It’s also found in higher levels in obese patients and those with non-alcoholic steatohepatitis (NASH), an inflammation and damage of the liver.
Risk Factors and Frequency for Auto-Brewery Syndrome
Auto-brewery syndrome is an uncommon condition that can affect both men and women, including adults and children, across the globe. It’s likely that many instances of this syndrome are not properly identified and diagnosed.
Signs and Symptoms of Auto-Brewery Syndrome
Auto-brewery syndrome is a rare condition that can greatly impact someone’s life. This happens when the body produces its own alcohol, leading to a series of unwanted effects. These can include vomiting, belching, chronic fatigue, dizziness, loss of coordination, confusion, hangover-like symptoms, and digestive issues. The chronic fatigue can lead to additional problems, such as anxiety, depression, and reduced productivity.
One of the bizarre outcomes of this syndrome is that patients can end up with alcohol levels above the driving limit even though they haven’t consumed any alcoholic beverages. The unpredictability of these high-alcohol episodes can cause a range of problems, such as injuries from falls, legal issues due to drink driving charges, and strains on personal relationships.
- Vomiting
- Belching
- Chronic fatigue
- Dizziness
- Loss of coordination
- Confusion
- Hangover-like symptoms
- Digestive issues
Due to the rarity and unusual nature of Auto-brewery syndrome, it can be challenging for medical professionals to diagnose and manage. A thorough medical and dietary history is essential, and it can be helpful to involve family members. This can provide valuable insights, especially if there are gaps in the patient’s memory around their intoxication episodes or their meals.
Testing for Auto-Brewery Syndrome
Auto-brewery syndrome may be something a doctor considers when a patient shows high blood alcohol levels but hasn’t been drinking alcohol. This condition could be a possibility if someone is stopped for drunk driving, yet claims not to have had any alcohol. Symptoms may include problems with mental functions, clumsiness, and mood swings. Patients may not exhibit these symptoms right away.
People with chronic issues in their gut, slow stomach emptying, diabetes, or a specific type of liver disease called non-alcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) are more likely to have auto-brewery syndrome. A team of different healthcare professionals, including a mental health expert, should be involved in the evaluation process.
To diagnose this condition, doctors will typically start with a thorough examination and medical history, asking the patient and their family about diet, alcohol use, and any strange instances where the person seemed drunk without drinking alcohol. Several lab tests may be ordered, including a full blood count, blood chemistry panel, blood alcohol level, drug screening, and stool tests to check for bacteria and fungi.
Doctors will also want to rule out any other conditions that may cause the symptoms, such as a head injury, secret drinking, or mental health disorders. To confirm the diagnosis of auto-brewery syndrome, doctors may monitor the patient for 24 hours while they consume a high-carbohydrate diet. Their blood and breath alcohol levels will be checked several times during this period. If levels go up during the test, it confirms the diagnosis of auto-brewery syndrome.
An upper and lower endoscopy may also be performed. This involves using a thin, flexible tube with a camera and light to look inside the digestive tract. During this procedure, samples will be taken to check for bacteria and fungi.
It’s important to note that not everyone with auto-brewery syndrome will have symptoms within 24 hours. This can depend on how quickly food moves through their system and where the microbes that cause the condition are located.
Treatment Options for Auto-Brewery Syndrome
It’s important for patients to have a say in their treatment plan to ensure they stick to it. When dealing with a patient with a dangerously high level of alcohol in their blood, they should immediately receive treatment for severe alcohol poisoning.
Medication is provided based on the specific yeast or bacteria causing the problem, as determined by lab tests. This usually involves one or more drugs from the azole or polyene group. In rare cases, resistant strains might necessitate the use of echinocandins or antibiotics.
A key part of treating auto-brewery syndrome involves a dietary change. This usually means a high protein and low carbohydrate diet until symptoms improve. This is critical because sugar turns into alcohol, so taking out both simple and complex sugars from the diet can help decrease the amount of alcohol produced within the digestive and urinary systems.
The use of probiotics, supplements that promote a healthy balance of bacteria in the gut, might also be beneficial. This could potentially aid in treating auto-brewery syndrome, but further studies are required to confirm this.
To reduce the chance of auto-brewery syndrome coming back, it’s recommended to minimize the intake of carbohydrates. A nutritionist can be of significant help in planning and managing the patient’s diet.
Anything that disrupts the balance between harmful and beneficial bacteria can potentially lead to increased fermentation in the gut. As a result, the use of antibiotics should be limited. If they are necessary, there should be a plan to retest and treat fermenting pathogens after the course of antibiotics is completed.
Certain treatment strategies have shown success, like controlling carbohydrate intake, taking antifungal/antibiotic medication, and using probiotics. Here, it’s best to avoid using antibiotics generally. In prolonged cases of the syndrome that experience repetitive relapses, fecal microbiota transplants might be required.
What else can Auto-Brewery Syndrome be?
When trying to diagnose D-lactic acidosis, doctors have to first eliminate other causes. Some of these potential causes may include things like head injuries, mental disorders, or even concealed alcohol drinking. It’s also important to consider auto-brewery syndrome as another possible reason for someone’s symptoms.
People with auto-brewery syndrome can exhibit signs of being drunk, such as poor coordination or slurred speech, even though they haven’t had any alcoholic beverages. This situation can especially occur if the individual consumes a lot of carbs or has previously taken antibiotics. That’s why it’s crucial for doctors to consider this condition in their list of possible diagnoses.
What to expect with Auto-Brewery Syndrome
The symptoms of auto-brewery syndrome in some individuals can be improved by discontinuing antibiotics and adopting a diet free of sugar and low in carbohydrates. Others might need to take antibiotics or antifungal drugs, alongside dietary changes. Taking probiotics, eating a diet low in carbohydrates, and steering clear of antibiotics could help to prevent the syndrome from coming back.
There are, however, some patients who continue to struggle with recurrent episodes of the syndrome. These individuals have difficulty finding a balance in their gut bacteria and continue to experience episodes of feeling drunk without consuming alcohol.
Possible Complications When Diagnosed with Auto-Brewery Syndrome
Most people can return to their usual eating habits and way of life after one round of treatment. Some might experience a relapse one or more times, particularly if they are treated with antibiotics that interfere with the bacteria in their gut. Auto-brewery syndrome, when the body produces alcohol inside its own digestive system, can have a significant impact on both patients and their loved ones. This condition often gets confused for regular alcohol consumption, which can lead to social problems and legal consequences. It disrupts lives, relationships and puts a strain on everyone involved.
Even when symptoms disappear, having alcohol produced in your body for a long time can lead to a desire for alcohol and can even result in alcohol addiction. Alcohol use disorder may come up during or after treatment.
Recovery from Auto-Brewery Syndrome
Usually, symptoms can be relieved through a combination of changes to the diet, medication, and probiotics. Both patients and healthcare providers should be alert to the chance of symptoms returning. In some instances, stomach and intestinal (GI) tests may show a type of yeast that did not respond to the first medication. For those having frequent relapses, a fecal microbiota transplant might be considered. An alcohol treatment program may also be needed for some patients.
Preventing Auto-Brewery Syndrome
Patients undergoing treatment should limit their intake of sugars and carbohydrates, choosing instead a diet rich in proteins. In the long run, they should learn how to stick to a diet low in carbohydrates, stay away from antibiotics in their food, and avoid consuming alcohol.
Patients should also be informed about the microbiome and discouraged from using antibiotics unless absolutely necessary. If patients do need to take antibiotics, they should discuss with their healthcare provider about a plan to avoid any setbacks.
It’s important for patients to be aware of the potential risk of alcohol use disorder both during their treatment and after their symptoms clear. If required, they should be given contact information for alcohol treatment facilities.
