Auto-Brewery Syndrome: Causes, Symptoms, and Treatment

Introduction

• Auto-Brewery Syndrome (ABS): A rare condition where food in the stomach ferments into ethanol, causing drunken-like behavior without alcohol consumption.
• Other Name: Gut fermentation syndrome.
• Prevalence: Less than 100 cases reported worldwide as of 2021.
• Main Concern: Underdiagnosed and can lead to serious consequences, especially if operating vehicles.

Symptoms

• Symptoms mimic alcohol intoxication:
  • Unexplained intoxication
  • Dizziness, disorientation, uncoordination
  • Chronic fatigue, bloating, irritable bowel syndrome
  • Slurred speech, GI distress, confusion
  • Memory loss, seizures, coma
  • Nausea, vomiting, glassy eyes, falling down

Causes

• Microorganisms like yeast (Saccharomyces cerevisiae, Candida albicans) break down carbohydrates into ethanol.
• Risk factors include:
  • High carbohydrate intake, diabetes, alcoholism
  • Antibiotics or proton pump inhibitors usage
  • Gastrointestinal tract pathologies
  • Genetic factors
• Can occur in healthy individuals as well.

Diagnosis

• Blood tests for metabolism and blood alcohol levels.
• Fecal testing for yeast growth.
• Carbohydrate challenge test to confirm diagnosis.
• Rule out other conditions with similar symptoms.

Treatment

• Multidisciplinary Approach: Involves primary care, gastroenterologist, infectious disease specialist, nutritionist, and possibly endocrinologist or hepatologist.
• Immediate Care: Treatment for alcohol poisoning if needed.
• Medications: Antifungal drugs (fluconazole, micafungin, etc.) or antibiotics if bacterial.
• Dietary Management:
  • Low-carbohydrate, high-protein diet to prevent relapse.
  • Consultation with a nutritionist recommended.
• Supplements: Probiotics to balance gut bacteria.
• Advanced Treatment: Possible fecal microbiota transplant for chronic relapses.

Complications

• Long-term Risks: Potential cravings for alcohol, development of alcohol use disorder.
• Linked Conditions: Nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH).
• Social and Legal Issues: Misunderstanding of condition can lead to social isolation and legal troubles.

Living with Auto-Brewery Syndrome

• Maintain a low-carbohydrate diet.
• Communicate with family and friends about the condition.
• Monitor symptoms and avoid triggering foods.

FAQs

• Triggers: Underlying health conditions and certain diets.
• Testing: Blood alcohol levels, glucose challenge test, fecal sample tests.
• Foods to Avoid: Carbohydrates that convert to alcohol.
• Driving Precautions: Diagnosis helps manage dietary choices and avoid legal issues.

Takeaways

• Serious condition with potential life-altering effects.
• Requires careful management of diet and lifestyle.
• Diagnosed individuals should educate themselves and others for better management and understanding.