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Auto-Brewery Syndrome (ABS): Causes, Symptoms, Risk Factors, Diagnosis And Treatment

Auto-brewery syndrome (ABS), also known as 'gut fermentation syndrome' is a rare disease in which a special type of yeast called Saccharomyces cerevisiae and others outgrow in the gut and converts carbohydrates into ethanol, giving symptoms of alcohol intoxication to an individual without even its consumption. This disease was first diagnosed in the 1970s in Japan. Only a few cases of ABS have been reported in the past three decades [1] .

According to a report published on 5 August 2019 in the journal BMJ Open Gastroenterology, a 46-year-old man was diagnosed with this uncommon medical condition. Medical experts say that the patient was a healthy and active man and had no previous medical condition. In the year 2011, he got an antibiotic therapy due to his thumb injury. Later, he started experiencing episodes of depression, personality change and drunkenness (without having alcohol).

Then on one morning, he was arrested for 'drunk and drive' and the police refused to believe him. After proper investigation and diagnosis, it was found that he had a rare auto-brewery syndrome in which his intestine itself was producing alcohol after fermenting the carbohydrates he was consuming [4] .

Causes Of Auto-Brewery Syndrome

Yeasts like Saccharomyces cerevisiae (also known as brewer's yeast), Candida albicans, Torulopsis glabrata, Candida kefyr and Candida glabrata are responsible for causing ABS. Usually, Saccharomyces cerevisiae is the leading cause of the condition. They are found normally in the gut but when their number outgrows in the GI tract in conditions like diabetes, Crohn's disease and liver cirrhosis, they become pathogenic and ferments carbohydrates into ethanol (alcohol) [2] . This lead to a rise of blood alcohol concentration level in the body resulting in ABS. In the aforementioned case of a 46-year-old man, doctors found out that a colony of fungi was present in his gut and they were continuously consuming carbohydrates for energy, instead of oxygen, and producing ethanol as a byproduct.

Symptoms Of Auto-Brewery Syndrome

People with ABS may not present the symptoms at the initial stage but some neurological effects can be seen due to increased level of alcohol in the blood. Common symptoms of ABS are as follows [7] :

  • Bad breath [1]
  • Chronic fatigue
  • Irritable bowel changes [3]
  • Diarrhoea
  • Brain fog [4]
  • Veisalgia (hangover) [1]
  • Poor productivity
  • Loss of coordination
  • Anxiety and depression [4]
  • Stomach pain
  • Food cravings

Risk Factors Of Auto-Brewery Syndrome

ABS is either present at birth or develops later. People with the below-mentioned medical conditions are likely to get ABS. They are as follows:

  • Diabetes
  • Chronic intestinal obstruction
  • Liver dysfunction
  • Gastroparesis

Poor health, reduced immunity and use of antibiotics for a long time can also increase the risk of ABS [5] .

Complications Of Auto-Brewery Syndrome

Complications due to ABS can affect an individual's professional and personal life. As the syndrome gives symptoms similar to drunkenness, it is often misunderstood that the particular person is a heavy drinker. Also, the loss of coordination in people with ABS make others believe it strongly. If a person with ABS does a breathalyser test, their alcohol level turns out to be four times higher than the normal reading.

Diagnosis Of Auto-Brewery Syndrome

Diagnosing ABS is quite confusing as the condition can occur in people who have never taken a sip of alcohol before. Symptoms like moodiness, memory problems and loss of concentration are similar to other neurological conditions which may lead to a confusion between ABS and other similar conditions. Also, diabetes type 2 and liver cirrhosis can tamper the diagnosis of ABS as in both cases, the concentration of endogenous ethanol is higher.

Though there are no specific tests to diagnose ABS, it is typically carried out by the following methods:

Medical history: This helps the medical expert to identify the cause leading to an increase of yeast in the intestine.

Breathalyser test: To find out the level of alcohol in the body by a breath sample [6] .

Stool test: To find out the quantity of yeast in the intestine [8] .

Glucose challenge test: In this test, a glucose tablet is given to the patient and their blood alcohol level is checked for any fluctuation in the level. If the blood alcohol level remains the same, ABS rules out but if it ranges from 1.0 - 7.0 mg per decilitre, the person has drunkenness disease [9] .

Treatment Of Auto-Brewery Syndrome

Treatment methods of ABS are as follows:

Drug therapy: In the drug therapy, antifungal medications like nystatin, fluconazole and acidophilus are given to the patient to kill fungi present in their intestine and causing fermentation. These drugs contain antifungal agents like azoles, echinocandin or any antibiotic [10] .

Multi strain probiotic supplements: These supplements are used to balance bacteria in the gut. However, this treatment method needs more scientific evidence.

How To Manage Auto-Brewery Syndrome

  • Diet modification (low carb and high protein)
  • Avoiding alcohol
  • Avoid dietary antibiotics [11]
  • Consult a nutritionist to know about foods responsible to trigger the condition.

Foods That People With ABS Should Avoid

  • Fruit juices
  • Rice
  • Pasta
  • Crackers
  • Beverages or sugary drinks
  • Starchy vegetables like potato
  • Dairy products like milk and ice cream
  • Beer
  • Legumes
View Article References
  1. [1] Painter K, Cordell B, Sticco KL. Auto-brewery Syndrome (Gut Fermentation) [Updated 2019 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  2. [2] Garcia, G., Dogi, C., De Moreno de LeBlanc, A., Greco, C., & Cavaglieri, L. (2016). Gut-borne Saccharomyces cerevisiae, a promising candidate for the formulation of feed additives, modulates immune system and gut microbiota. Beneficial microbes, 7(5), 659-668.
  3. [3] West, C., Stanisz, A. M., Wong, A., & Kunze, W. A. (2016). Effects of Saccharomyces cerevisiae or boulardii yeasts on acute stress induced intestinal dysmotility. World journal of gastroenterology, 22(48), 10532–10544. doi:10.3748/wjg.v22.i48.10532
  4. [4] Malik, F., Wickremesinghe, P., & Saverimuttu, J. (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
  5. [5] Hafez, E. M., Hamad, M. A., Fouad, M., & Abdel-Lateff, A. (2017). Auto-brewery syndrome: Ethanol pseudo-toxicity in diabetic and hepatic patients. Human & experimental toxicology, 36(5), 445-450.
  6. [6] Berger A. (2002). Alcohol breath testing. BMJ (Clinical research ed.), 325(7377), 1403. doi:10.1136/bmj.325.7377.1403
  7. [7] Akhavan, B. J., Ostrosky-Zeichner, L., & Thomas, E. J. (2019). Drunk Without Drinking: A Case of Auto-Brewery Syndrome. ACG Case Reports Journal, 6(9), e00208.
  8. [8] Auchtung, T. A., Fofanova, T. Y., Stewart, C. J., Nash, A. K., Wong, M. C., Gesell, J. R., … Petrosino, J. F. (2018). Investigating Colonization of the Healthy Adult Gastrointestinal Tract by Fungi. mSphere, 3(2), e00092-18. doi:10.1128/mSphere.00092-18
  9. [9] Eyth E, Basit H, Smith CJ. Glucose Tolerance Test. [Updated 2019 Jun 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  10. [10] Šimová, Z., Poloncová, K., Tahotná, D., Holič, R., Hapala, I., Smith, A. R., ... & Griač, P. (2013). The yeast Saccharomyces cerevisiae Pdr16p restricts changes in ergosterol biosynthesis caused by the presence of azole antifungals. Yeast, 30(6), 229-241.
  11. [11] Welch, B. T., Coelho Prabhu, N., Walkoff, L., & Trenkner, S. W. (2016). Auto-brewery Syndrome in the Setting of Long-standing Crohn’s Disease: A Case Report and Review of the Literature. Journal of Crohn's and Colitis, 10(12), 1448-1450.

Read more about: yeast bacteria
Story first published: Tuesday, October 29, 2019, 16:30 [IST]
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