Auto-brewery syndrome
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Auto-brewery syndrome (ABS) is a rare medical condition in which intoxicating quantities of ethanol are produced through endogenous fermentation within the digestive system.[1][2][3] Normally ethanol is produced with different concentrations in the mammalian cells, where as endogenous alcohol is classified as unprompted ethanol production via different metabolic channels.[4] Saccharomyces cerevisiae, a type of yeast best known for its uses in producing bread and alcoholic beverages, has been identified as a pathogen for this condition. Recent research has also shown that Klebsiella bacteria can similarly ferment carbohydrates to alcohol in the gut, which can accelerate non-alcoholic fatty liver disease.[5] Another example is seen in some Japanese people, who have an ability to produce significant amounts of endogenous alcohol due to the fermentation of carbohydrates by Candida albicans, which is a normal gut flora. [4] While the exact cause of ABS is still being studied, it is believed that the pathology of the disease does come from an overgrowth of yeast in the intestines known as "fungal-type-dysbiosis of the gut which ferments carbohydrates into alcohol as well as mimics food intolerance or allergies. [6]
The earliest cases were reported in Japan between 1950-1970, however can now be found all over the world. [6]
It can occur in patients of short bowel syndrome after surgical resection because of fermentation of malabsorbed carbohydrates.[7] In one instance where a man was diagnosed with auto-brewery syndrome, it had been noted that he was previously on a prolonged course of antibiotics. It is theorized that this led to alteration of his gut microbiome, which allowed fungal growth, which in turn allowed fungal yeast to form and that yeast fermented carbohydrates into alcohol.[8] Subsequently the gentleman was treated with anti-fungal agents which helped dissipate his symptoms. [8] Endogenous alcohol production has been shown to be increased in patients with diabetes mellitus and cirrhosis. [9]
Claims of endogenous fermentation of this type have been used as a defense against drunk driving charges.[10][11] But since some judges reject this defense and have issued prison terms,[12] doctors caution that "these patients have to be very careful about driving a motor vehicle" since in those jurisdictions, these patients would be arrested for being over the legally defined blood alcohol content limit (which varies vastly by state and local jurisdiction) even if the patients were not actually impaired at the time of arrest.[13]
One case went undetected for 20 years.[14]
It has also been investigated, but eliminated, as a possible cause of sudden infant death syndrome.[15]
A variant occurs in persons with liver abnormalities that prevent them from excreting or breaking down alcohol normally. Ethanol is normally metabolized mostly in the liver by the class I isozymes of alcohol dehydrogenase (ADH). [4]Patients with this condition can develop symptoms of auto-brewery syndrome even when the gut yeast produces a quantity of alcohol that is too small to intoxicate a healthy individual.[16] One of the normal roles of ADH is to rid the body of ethanol that is produced by fermentation of sugars in the stomach by a process called first-pass metabolism. [4]
Another variant, urinary auto-brewery syndrome, is when the fermentation occurs in the urinary bladder rather than the gut. This single reported case is associated with diabetes due to the presence of sugar in the urine for the yeast to ferment. The person did not develop symptoms of intoxication, but did test positive in the urine for alcohol. Fermentation may continue after the urine is expressed, resulting in it developing an odor resembling wine.
Symptoms[edit]
This disease can have profound effects on everyday life. As well as the recurring side effects of excessive belching, dizziness, dry mouth, hangovers, disorientation, irritable bowel syndrome, and chronic fatigue syndrome, it can lead to other health problems such as depression, anxiety and poor productivity in employment. The random state of intoxication can lead to personal difficulties, and the relative obscurity of the condition can also make it hard to seek treatment.[17] [18][unreliable medical source?]
A case of urinary fermentation of carbohydrates by endogenous microorganisms leading to urinary ethanol has been reported.[19]
Diagnosis[edit]
Alcohol can be detected by testing blood or the breath. This may have to be repeated at multiple times of the day to account for naturally occurring fluctuations. ABS is difficult to diagnose unless the patient is in a completely monitored environment, and unfortunately in some cases every other diagnosis is ruled out first. [9] Diagnosis should be confirmed using a carbohydrate challenge test in a closely monitored setting. [20] There are no current universal tests, but many protocols have been formed and some include obtaining samples of gastric, jejunal, and stool to test for fungal cultures prior to testing. [20]
Treatment[edit]
There are different treatments that can be used by themselves or in combination. Current recommendations are a multidisciplinary approach which also include early psychiatrist involvement. [8] Dietary carbohydrate control, antifungal or antibiotic therapy, general antibiotic avoidance, and probiotics have all shown positive effects as treatments.[21] The role of probiotics in ABS is vastly understudied at this time.[8]
- ↑ Doucleff, Michaeleen (September 17, 2013). "Auto-Brewery Syndrome: Apparently, You Can Make Beer In Your Gut". The Salt. NPR.
- ↑ "A one-woman brewery: Patient's bladder causes her to urinate alcohol".
- ↑ Kaji, H.; Asanuma, Y.; Yahara, O.; Shibue, H.; Hisamura, M.; Saito, N.; Kawakami, Y.; Murao, M. (1984). "Intragastrointestinal Alcohol Fermentation Syndrome: Report of Two Cases and Review of the Literature". Journal of the Forensic Science Society. 24 (5): 461–71. doi:10.1016/S0015-7368(84)72325-5. PMID 6520589.
- ↑ 4.0 4.1 4.2 4.3 Hafez, Em; Hamad, Ma; Fouad, M; Abdel-Lateff, A (May 2017). "Auto-brewery syndrome: Ethanol pseudo-toxicity in diabetic and hepatic patients". Human & Experimental Toxicology. 36 (5): 445–450. doi:10.1177/0960327116661400. ISSN 0960-3271.
- ↑ Yuan, J.; et al. (2019-09-19). "Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae". Cell Metabolism. 30 (4): 675–688.e7. doi:10.1016/j.cmet.2019.08.018. PMID 31543403.
- ↑ 6.0 6.1 Cordell, Barbara Jean; Kanodia, Anup; Miller, Gregory K (January 2019). "Case–Control Research Study of Auto-Brewery Syndrome". Global Advances in Health and Medicine. 8: 216495611983756. doi:10.1177/2164956119837566. ISSN 2164-9561. PMC 6475837. PMID 31037230.
- ↑ Painter, Kelly; Cordell, Barbara; Sticco, Kristin L. (2019). "Auto-brewery Syndrome (Gut Fermentation)". StatPearls. PMID 30020718.
- ↑ 8.0 8.1 8.2 8.3 Malik, Fahad; Wickremesinghe, Prasanna; Saverimuttu, Jessie (August 2019). "Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition". BMJ Open Gastroenterology. 6 (1): e000325. doi:10.1136/bmjgast-2019-000325. ISSN 2054-4774. PMC 6688673 Check
|pmc=value (help). PMID 31423320. - ↑ 9.0 9.1 Saverimuttu, Jessie; Malik, Fahad; Arulthasan, Marutha; Wickremesinghe, Prasanna (2019-10-14). "A Case of Auto-brewery Syndrome Treated with Micafungin". Cureus. doi:10.7759/cureus.5904. ISSN 2168-8184. PMC 6853272 Check
|pmc=value (help). PMID 31777691. - ↑ Logan, BK; Jones, AW (July 2000). "Endogenous ethanol 'auto-brewery syndrome' as a drunk-driving defence challenge". Medicine, Science and the Law. 40 (3): 206–15. doi:10.1177/002580240004000304. PMID 10976182.
- ↑ "New York drink driver says her body is a brewery". BBC News. 2015-12-31. Retrieved 3 January 2016.
- ↑ Castrodale, Jelisa (April 26, 2019). "Man Imprisoned for Drunk Driving Says His Body Actually Turns Food into Alcohol: Surprisingly, there's legitimate science to back it up". Vice.
- ↑ "Auto-brewery syndrome occurs when a disturbance to the gut microbiome results in the fermentation of sugars". Quirks & Quarks. October 25, 2019. CBC Radio One.
- ↑ "Auto-brewery syndrome: Teetotal Teesville man can't stay sober as everything he eats turns to alcohol". Teesside Gazette. Teesside, England. October 7, 2013. Retrieved April 22, 2014.
- ↑ Geertinger, P.; Bodenhoff, J.; Helweg-Larsen, K.; Lund, A. (1982-09-01). "Endogenous alcohol production by intestinal fermentation in sudden infant death". Zeitschrift für Rechtsmedizin. 89 (3): 167–172. doi:10.1007/BF01873798. PMID 6760604.
- ↑ Thomson, Helen (March 5, 2015). "The Man Who Gets Drunk on Chips". BBC News.
- ↑ Chester, Nick (February 11, 2014). "The Man Who Is Drunk All the Time Because His Body Produces Its Own Alcohol". VICE. Retrieved 19 November 2014.
- ↑ Boyter, Scott (April 10, 2017). "Auto Brewery Syndrome – What It Is, and How to Deal With It". GundryMD.com. Retrieved 13 April 2017.
- ↑ Kruckenberg, Katherine M.; DiMartini, Andrea F.; Rymer, Jacqueline A.; Pasculle, A. William; Tamama, Kenichi (25 February 2020). "Urinary Auto-brewery Syndrome: A Case Report". Annals of Internal Medicine. doi:10.7326/L19-0661.
- ↑ 20.0 20.1 Saverimuttu, Jessie; Malik, Fahad; Arulthasan, Marutha; Wickremesinghe, Prasanna (2019-10-14). "A Case of Auto-brewery Syndrome Treated with Micafungin". Cureus. doi:10.7759/cureus.5904. ISSN 2168-8184. PMC 6853272 Check
|pmc=value (help). PMID 31777691. - ↑ Painter, Kelly; Cordell, Barbara; Sticco, Kristin L. (October 9, 2019). "Auto-brewery Syndrome (Gut Fermentation)". NCBI - National Center for Biotechnology Information. Retrieved 5 November 2019.
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