Auto-brewery syndrome - Wikipedia

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Auto-brewery syndrome

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Medical condition in which the gut produces excess alcohol

Medical condition<br>Auto-brewery syndromeOther namesGut fermentation syndrome, endogenous ethanol fermentationDigestive systemSpecialtyGastroenterology, toxicology<br>Auto-brewery syndrome (ABS ) (also known as gut fermentation syndrome or endogenous ethanol fermentation ) is an extremely rare and underdiagnosed medical condition characterized by the fermentation of ingested carbohydrates in the gastrointestinal tract caused by bacteria or fungi.[1]

Intoxicating amounts of ethanol are produced through endogenous fermentation within the digestive system.[2] The organisms responsible for ABS include various yeasts and bacteria, including Saccharomyces cerevisiae, S. boulardii, Candida albicans, C. tropicalis, C. krusei, C. glabrata, C. parapsilosis, Kluyveromyces marxianus, Klebsiella pneumoniae, and Enterococcus faecium.[1][3] These organisms undergo lactic acid fermentation or mixed acid fermentation pathways to produce an ethanol end product.[4][5] The ethanol generated from these pathways is absorbed in the small intestine and stomach, raising blood alcohol concentrations and causing the effects of intoxication without the ingestion of alcohol.[6]

Researchers suggest the underlying causes of ABS are related to prolonged antibiotic use,[7] poor nutrition, and/or diets high in carbohydrates,[8] and to pre-existing conditions such as diabetes and genetic variations that result in improper liver enzyme activity.[7] Any of these conditions, alone or in combination, could cause ABS, and result in dysbiosis of the microbiome.[9]

Other variants include urinary ABS and oral ABS, when fermentation occurs in the urinary bladder and mouth, rather than the gut.[7] Urinary ABS is asymptomatic and does not produce intoxicating effects because it occurs outside the digestive tract, therefore individuals who may have it are less likely to seek medical advice.[10] This condition still presents legal challenges, since urinary tests are often used to confirm sobriety in cases of suspected drunk driving.[11]

Claims of endogenous fermentation have been attempted as a defense against drunk driving charges, some of which have been successful,[12] though the condition is so rare and under-researched they are currently not substantiated by available studies.[13]

Signs and symptoms<br>[edit]

People with this condition typically experience signs of ethanol intoxication, including slurring of speech, incoordination, memory loss, and cognitive disturbances unusual for them.[14] Some report a fruity or foul smell from their breath.[15]

Acute symptoms associated with ABS may include blood alcohol content of 200 to 500 mg/dL. Mood changes and other neurological problems, including memory loss or brain fog have also been reported.[15]

Chronic symptoms may include fatigue,[15] liver cirrhosis, fatty-liver disease, and symptoms similar to irritable bowel syndrome.[7] Secondary symptoms may include anxiety, depression, or relationship troubles.[7]

Risk factors<br>[edit]

Certain clinical conditions such as type 2 diabetes mellitus and liver cirrhosis have been identified as producing higher levels of endogenous ethanol.[11] Patients with short bowel syndrome, diabetes mellitus, Crohn's disease, liver cirrhosis, small intestinal bacterial overgrowth, gastroparesis, and immunocompromised individuals may be at greater risk of developing ABS.[11]

An extensive history of a diet high in ultra-processed food and use of antibiotics has been significantly associated with the disease.[7] Processed food is typically high in sugar, a type of carbohydrate, allowing the fermenting organisms to flourish.[16] Diet composition more broadly may influence ethanol production by altering the availability of fermentable substrate in the gut. Carbohydrate-rich diets provide fermentable sugars that can increase gut ethanol production by microorganisms, such as Saccharomyces cerevisiae. In contrast, ketogenic diets may limit ethanol production due to reduced substrate availability, while high-protein diets support more moderate levels of fermentation. These patterns are consistent with metabolic modeling of certain fermentative organisms, which predict increased ethanol production in high-glucose environments. It is believed antibiotics disrupt bacterial populations, allowing yeast species to proliferate and produce ethanol.[16]

Metabolic action<br>[edit]

Further information: Pharmacology of ethanol

Ethanol fermentation cycle<br>Fermentation is a biochemical process during which yeast and certain...