Auto-Brewery Syndrome

The rare syndrome making yeast into alcohol - in the patient's body.
Jenny Ewen, BA, NREMT
Editor-In-Chief
The signs of being intoxicated are typically pretty obvious – flushed cheeks, dizziness, disorientation, slurred speech, memory problems. While it usually requires actually drinking alcohol to reach this state, a rare disease actually creates these symptoms, making someone very drunk without consuming any alcohol at all. This is Auto-Brewery Syndrome (ABS).

For those who suffer from this syndrome, their gut fungi (which is yeast) ferments ingested carbohydrates (similar to the way beer is made through fermentation), resulting in production of ethanol. The ethanol production causes the person to become inebriated with all the same symptoms of actual alcohol intoxication, including the possibility of drunk driving.

Who Can Get ABS?

ABS was first described in 1946 in a child in South Africa. In the 1970s, multiple cases were noted in Japan. Early symptoms include changes in mood and brain fog.

ABS is mostly seen in patients who also have chronic conditions such as diabetes, IBS, or immunosuppression. It can be diagnosed in adults or children, and symptoms are similar, but as far as it’s understood, ABS is most often triggered by another condition, including liver disease. Some research suggests patients who get ABS have been previously exposed to antibiotics, suggesting that antibiotics disrupted the gut microbiota resulting in an overgrowth of yeast.

Patients with ABS may have the scent of alcohol on their breath (without consuming any alcohol) and can have blood alcohol readings of three times the typical legal limit (0.08%).

Diagnosis

Diagnosing ABS is typically based on concerns of alcoholism or being arrested for a DUI/DWI. The patient themselves might have poor recall of previous events, so sometimes it’s helpful to gather more information from friends and family as part of a full history of the patient. It’s important to find out when and if the patient actually does consume alcohol to work through this tricky diagnosis.

Other medical conditions should be ruled out via lab tests such as blood and stool testing, along with testing how much yeast is in the gut. Patients may be advised to purchase a breathalyzer and log the results.

The best way to diagnose ABS is the glucose challenge test, which involves the patient taking a glucose capsule without any other food or drink, then after an hour, a healthcare provider will check the patient’s blood alcohol level. Someone without ABS will have a zero blood alcohol level – someone with ABS will have a level ranging from 1-7 milligrams per deciliter (mg/dL).

It is suspected that ABS is actually an underdiagnosed condition, and still might not be fully understood.

Treatment

Treatment is possible for ABS. Initially, treatment is the same as for alcohol intoxication including hydrating the patient with IV fluids and maintaining the airway. Alcohol withdrawal symptoms may need to be managed.

After initial symptoms are resolved, the patient should go on a low carb or carb-free diet, with only consuming small amounts of carbohydrates found in fruits and vegetables. Antifungal treatment can be started, along with a probiotic.

After completing the antifungal treatment, the patient could consume some carbohydrates and have their blood alcohol level tested. If it’s positive, then further antifungal treatment may be required.

As research into the gut microbiome continues, more information about this rare disease may be uncovered.

Sources & More Information

BMJ Journals, Open Gastroenterology. “Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition” by Fahad Malik, Prasanna Wickremesinghe, and Jesse Saverimuttu. https://bmjopengastro.bmj.com/content/6/1/e000325

Healthline, “Auto Brewery Syndrome: Can You Really Make Beer in Your Gut?” https://www.healthline.com/health/auto-brewery-syndrome

NIH National Library of Medicine – National Center for Biotechnology Information. “Auto-Brewery Syndrome: A Clinical Dilemma” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667719/#:~:text=Auto%2d Brewery%20syndrome%20(ABS),distress%2C%20and%20state%20of%20confusion.

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