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Updated on July 31, 2023
5 min read

What You Should Know About Auto-Brewery Syndrome

What is Auto-Brewery Syndrome (ABS)?

Auto-brewery syndrome (ABS) is also known as gut fermentation syndrome or drunkenness disease. It causes you to be highly intoxicated without ever taking a sip of alcohol.1 

It is a rare condition in which the body produces ethanol (alcohol) through the endogenous fermentation of fungi. Bacteria in the gastrointestinal (GI) tract can also cause ABS.

Gut fermentation syndrome can happen to anyone, including children. The first reported case in the medical community was in the 1950s.

How Dangerous is ABS?

Certain fungi from common yeasts and some bacteria in the body are normal, but others can be dangerous. For example, the body may produce strains of fermenting yeasts and rare bacteria known as pathogens.6 These can take a toll on your physical and mental health.

Auto-brewery syndrome often presents in episodes. Some episodes of endogenous alcohol production can be serious.

You can also get into legal trouble because ABS can cause you to fail an alcohol test even if you didn't drink.Despite these potential side effects, more research is required to understand the risks of ABS.

How Does Auto-Brewery Syndrome Develop?

With auto-brewery syndrome, your body converts sugars and carbohydrates into alcohol.1 It does this in the gastrointestinal tract.6

People with auto-brewery syndrome usually have a high-sugar and high-carbohydrate diet.6 Because of this, they typically have to follow strict low-sugar diets that can also affect their lifestyles.

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What are the Symptoms of ABS? 

The symptoms of ABS are often the same as alcohol intoxication. These symptoms include:6

  • Nausea with or without vomiting
  • Irritable bowel syndrome (IBS)
  • Dizziness
  • Veisalgia
  • Belching
  • Chronic fatigue
  • Mood changes
  • Neurological symptoms
  • Poor coordination
  • Disorientation
  • Feeling intoxicated without alcohol consumption

How Does ABS Affect Health? 

Gut fermentation syndrome is more likely found in people with comorbidities like Crohn's disease, diabetes, and obesity.2 People with type 2 diabetes mellitus and liver cirrhosis tend to have more endogenous ethanol levels than those without.6

People with auto-brewery syndrome experience episodes of the above symptoms, some of which can cause other health issues. For example, chronic fatigue syndrome (CFS) can also lead to problems like:6

  • Anxiety
  • Depression
  • Poor work or school productivity and performance
  • Depression-related health complications like heart problems

Long-term exposure to endogenous ethanol also has the potential to cause alcohol cravings and alcohol addiction.6 In other words, you may start to drink and misuse alcohol due to intense cravings produced by auto-brewery syndrome over time. 

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How is Auto-Brewery Syndrome Diagnosed? 

Auto-brewery syndrome is rarely diagnosed and may be under-diagnosed. Doctors know very little about people with ABS. However, they do know these people have significant lifestyle differences compared to those who don't have ABS.3

If you think you have auto-brewery syndrome, consider getting tested. If you have an elevated blood alcohol level but haven't been drinking, you should be tested for endogenous alcohol production.6

While you may not show symptoms of intoxication, you may have some early neurological symptoms like loss of coordination. Diagnosis may start with a psychiatric evaluation. This is because symptoms include mental health disorders like anxiety and depression.

How is Auto-Brewery Syndrome Tested?

A doctor should also conduct a complete physical examination and obtain family history information. This may include diet and alcohol intake and episodes of unexplained intoxication symptoms.6 You'll also have to take lab tests and bacterial and fungal cultures. 

This includes a:1

  • Complete blood count (CBC) test
  • Blood alcohol level test
  • Metabolic panel
  • Drug screening(s)
  • Stool culture to detect potentially high yeast levels in the stomach
  • Glucose challenge test
  • Carbohydrate test
  • Series of an upper and lower endoscopy

Tests should occur in specific orders. For example, the carbohydrate challenge test needs to happen when the person’s breath and blood alcohol levels are at zero.

It is important to eliminate other possible causes of a positive alcohol test. These include head injuries or alcohol ingestion that could explain blood alcohol concentration (BAC). 

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How Is Auto-Brewery Syndrome Treated? 

Auto-brewery syndrome requires treatment. If a person has a dangerously high blood alcohol level, they will need treatment for alcohol intoxication, even if they did not drink alcohol. They will likely need to visit the hospital to be stabilized.6

Stabilization

Stabilization includes getting the right intravenous (IV) fluids to get and stay hydrated. They'll also maintain a clear airway for proper breathing and correct any nutritional deficiencies due to intoxication.2

Medications

Your doctor may also prescribe drugs for yeast or bacteria to control alcohol levels in your body. For example, anti-fungal medications to treat auto-brewery syndrome include Fluconazole (Diflucan) and Itraconazole (Sporanox).1 If you have rare or resistant microbes, you may also need an antibiotic.6

Dietary Modification

You may be asked to follow a high-protein,low-sugar, and low-carbohydrate diet. Diet therapy may also involve taking certain supplements like a multistrain probiotic to balance out the bacteria in your gastrointestinal (GI) tract.6 Weight loss or treatment for other underlying health conditions may also be necessary.1

Tips for Preventing Auto-Brewery Syndrome

Auto-brewery syndrome can be difficult to deal with, which is why prevention is key. This is especially true because there are no clear risk factors for ABS.5

Preventing auto-brewery syndrome requires:4,6

  • Sticking to a clean diet low in sugar and carbohydrates
  • Taking anti-fungal agents
  • Regularly taking a multi-strain bacterial probiotic to balance the bacteria in your body
  • Limiting your alcohol intake

If you or someone you know suspects auto-brewery syndrome, immediately consult a medical professional for testing. Treatment is available to help you cope with symptoms and live healthier without unexplained alcohol intoxication.

Updated on July 31, 2023
6 sources cited
Updated on July 31, 2023
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. Auto-Brewery Syndrome.” SBV Journals
  2. Auto-Brewery Syndrome: A Schematic for Diagnosis and Appropriate Treatment.” Nutrition Issues in Gastroenterology.
  3. Barbara Jean Cordell, Anup Kanodia. “Case–Control Research Study of Auto-Brewery Syndrome - Barbara Jean Cordell, Anup Kanodia, Gregory K Miller, 2019.” SAGE Journals.
  4. Malik, Fahad, et al. “Case Report and Literature Review of Auto-Brewery Syndrome: Probably an Underdiagnosed Medical Condition.” BMJ Open Gastroenterology, BMJ Specialist Journals, 1 Aug. 2019.
  5. Medicine, 1Division of General Internal. “Drunk without Drinking: A Case of Auto-Brewery Syndrome : ACG Case Reports Journal.” LWW.
  6. Painter, Kelly. “Auto-Brewery Syndrome.” StatPearls [Internet]., U.S. National Library of Medicine, 20 July 2021.
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