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What is Auto-Brewery Syndrome (ABS)?

Auto-brewery syndrome (ABS) is also known as gut fermentation syndrome or the 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 endogenous fermentation of fungi. Bacteria in the gastrointestinal (GI) tract can also cause ABS.

Certain fungi from common yeasts and some bacteria in the body are normal. But some 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. People can test over the legal limit without drinking alcohol.

Auto-brewery syndrome not only has physical health effects, but it can also get you in legal trouble.

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

Since then, researchers have been looking into auto-brewery syndrome. However, more research needs to be done to understand its risks.

What are the Symptoms of ABS? 

The symptoms of auto-brewery syndrome are often the same as alcohol intoxication. These include:6

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

How Does ABS Affect Health? 

Gut fermentation syndrome is more likely to be found in patients with comorbidities like Crohn 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 who have auto-brewery syndrome experience episodes of the above symptoms, some of which can cause other health issues.

For example, chronic fatigue syndrome can also lead to problems like anxiety and depression and cause poor productivity and performances at work and school.6

Further, depression is linked to a whole host of physical health complications, including heart problems.

People with auto-brewery syndrome typically have to follow strict low-sugar diets that can also affect their lifestyles.

Exposure to endogenous ethanol over the long term even has the potential to cause alcohol cravings and alcohol addiction.6 In other words: Even if you did not drink before, 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. That said, it is also more than likely underdiagnosed.

Doctors still know very little about auto-brewery syndrome patients’ backgrounds — their health histories, lifestyles, diets, etc.

However, what they do know is that these patients have significant lifestyle differences compared to people who don’t have auto-brewery syndrome. Still, more research needs to be done.3

Someone who is suspected to have auto-brewery syndrome should undergo testing.

While they may not immediately show symptoms of intoxication, they may have some early neurological symptoms like loss of coordination.

If someone has an elevated blood alcohol level but denies drinking alcohol, they should be tested for endogenous ethanol production.6

Diagnosis may start with a psychiatric evaluation because symptoms include mental health disorders like anxiety and depression.

The doctor should also conduct a complete physical examination and obtain family history information regarding diet and alcohol intake, as well as episodes of unexplained intoxication symptoms.6 

Then the doctor should take lab tests and bacterial and fungal cultures. 

These include:

  • A complete blood count (CBC) test
  • A blood alcohol level test
  • A metabolic panel
  • Drug screenings
  • A stool culture to detect potentially high yeast levels in the stomach
  • A glucose challenge test
  • A carbohydrate test, and more. 

The doctor may take an upper and lower endoscopy, as well.1

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

It is important to eliminate other possible causes of the above symptoms like head injuries or actual alcohol ingestion that could explain blood alcohol concentration. 

How Is Auto-Brewery Syndrome Treated? 

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

Stabilization

Stabilization includes getting the right intravenous fluids to get and stay hydrated, keeping a clear airway to maintain proper breathing, and correcting any nutritional deficiencies that may arise with intoxication.2

Medications

Your doctor may also prescribe drugs for yeast or bacteria to control alcohol levels in your body. 

For example, antifungal medications to treat auto-brewery syndrome include Fluconazole (Diflucan) and Itraconazole (Sporanox).1 If you have rare or resistant microbes in your body, 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 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 is a rare condition. However, it is also a difficult one to deal with if you do develop it. That’s why prevention is key. This is especially true because there are currently no clear risk factors for auto-brewery syndrome.5

Preventing auto-brewery syndrome requires sticking to a clean diet that’s low in sugar and carbohydrates.6 If you take antifungal agents, they do allow for carbohydrate intake without auto-brewery syndrome symptoms.4

Regularly taking a multistrain bacterial probiotic can help to inhibit fungi and better balance the bacteria in your body, as well.4

You should also limit your alcohol intake, which is linked to diabetes and liver cirrhosis. Again, people with these health issues are more likely to develop auto-brewery syndrome.6

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

Resources

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Auto-Brewery Syndrome.” SBV Journals

Auto-Brewery Syndrome: A Schematic for Diagnosis and Appropriate Treatment.” Nutrition Issues in Gastroenterology.

Barbara Jean Cordell, Anup Kanodia. “Case–Control Research Study of Auto-Brewery Syndrome - Barbara Jean Cordell, Anup Kanodia, Gregory K Miller, 2019.” SAGE Journals.

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.

Medicine, 1Division of General Internal. “Drunk without Drinking: A Case of Auto-Brewery Syndrome : ACG Case Reports Journal.” LWW.

Painter, Kelly. “Auto-Brewery Syndrome.” StatPearls [Internet]., U.S. National Library of Medicine, 20 July 2021.

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