The mysterious case of auto-brewery syndrome

A rare condition called auto-brewery syndrome (ABS) turns the carbohydrates a person consumes into alcohol, making them intoxicated without drinking. So, for example, if you develop ABS, your breath will smell of alcohol, you will feel dizzy, and you may say things that you later regret even though you haven’t been drinking.

What makes this rare syndrome particularly dangerous is that it is not widely known to the general public or even the medical community. As a result, a patient may experience a lot of physical and mental distress at the time the illness is diagnosed. Imagine you show up to work drunk. Will your boss believe you when you tell him you only had lunch?

Researchers at the University of Toronto recently published a case study of a 50-year-old woman suffering from ABS. The study reveals valuable information about this rare disease, including treatment methods and the challenges patients face.

“Patients with ABS have suffered devastating medical and non-medical consequences. There are previous reports of a patient who suffered a cerebral hemorrhage following a fall during ABS poisoning. Additionally, including our patients, several patients had to miss work and some of them lost their jobs due to this syndrome,” said Dr. Rahel Zewude, lead author of the study and expert in infectious diseases at the University of Toronto. ZME Science.

The root cause of auto-brewery syndrome

Auto-brewery syndrome (ABS) was first described in a 1948 report, in a five-year-old Ugandan boy. The child underwent emergency abdominal surgery and the surgeon noticed an odor of alcohol emanating from his stomach contents.

Since the child did not consume alcohol, doctors suspected that his body had probably converted the sweet potato meal he had eaten earlier in the day into alcohol. Cases that arose in the following years confirmed this theory.

Scientists have discovered that ABS develops when microorganisms, including fungi that inhabit our intestines (such as Saccharomyces cerevisiae and Candida species, including C. albicans And C. glabrata) start fermenting alcohol from the carbohydrates we ingest in our meals.

“ABS is thought to be caused in part by a disruption in the gut microbiome, where alcohol-fermenting fungi become the predominant organism in the gut, ahead of other non-fermenting bacteria. This disruption of the gut microbiome can occur as a result of frequent or prolonged antibiotic treatments,” Zewude said.

However, several other factors could be at play, and the syndrome likely occurs when these factors appear simultaneously with high-carbohydrate meals.

For example, gastrointestinal diseases such as Crohn’s disease and ulcerative colitis, as well as liver diseases, have also been identified as risk factors for ABS. Additionally, genetic predispositions may also affect ethanol metabolism and contribute to the occurrence of this rare syndrome.

The case study and ABS treatment

The unnamed woman was 48 years old when she began experiencing symptoms of ABS. She felt lethargic, had slurred speech and the smell of alcohol on her breath. When she went to her family doctor’s emergency department, she was diagnosed with alcohol poisoning.

But the woman had not consumed alcohol in recent years. Over the next two years, she visited the emergency department several times. Doctors performed brain scans and prescribed medication to treat his alcohol addiction. During this time, three psychiatrists also separately evaluated her for alcohol use disorders.

“She scored zero on the CAGE (Cut, Annoyed, Guilty, and Eye) screening questionnaire for alcohol use disorder,” the study authors note.

Finally, after two years and on her seventh emergency room visit, a doctor suggested a diagnosis of ABS for the woman. She tested positive, was given antifungal medication, fluconazole (100 mg, twice daily), and started on a low-carb diet. Two weeks after treatment, her symptoms completely disappeared.

After a month, she stopped taking fluconazole but followed a low-carb diet. However, after four months, when she started increasing her carbohydrate intake, she had a relapse of ABS with similar symptoms. This episode was also treated with the same antifungal medication and a low-carb diet.

After six weeks, the treatment was stopped. However, doctors performed certain diagnostic endoscopic procedures and, based on the results, administered probiotics to the woman to restore normal activity of the intestinal microbiome. The patient has not had any symptoms of ABS in the past six months.

“We advised her to gradually increase her carbohydrate intake and she will continue follow-up with our infectious disease clinic, gastroenterologist and dietitian,” the study authors said.

ABS is a rare disease but awareness is crucial

The woman was two years late in her diagnosis. Unfortunately, this is quite common in patients with ABS due to limited knowledge of this disease, even among doctors. This delay is the cause of the many devastating medical and social problems that ABS patients face.

However, knowledge of ABS and its early diagnosis can save patients from many of these problems and the resulting distress.

“By releasing this report to our colleagues and the general public, I hope it will help raise awareness of this underappreciated syndrome and help patients who may go undiagnosed,” Zewude said. ZME Science.

The study is published in the journal CMAJ.