Can one be drunk without drinking any alcohol?

Auto-Brewery Syndrome Made Simple

Auto-Brewery syndrome, also known as gut fermentation syndrome, is when your body makes alcohol inside your stomach, mouth, or bladder, not from drinking. People with this condition act drunk, but they don’t drink any alcohol. They often eat a lot of sugary and starchy foods.

What Causes It?

Certain yeasts and bacteria in your body can turn bad and produce alcohol. Some yeasts like Candida and Saccharomyces families are usually good but can become bad in this syndrome. Bacteria like Klebsiella pneumonia and others can do this too. Conditions like diabetes and liver issues can make it worse.

How Common Is It?

This condition is rare but can happen to anyone, even kids, in different countries.

Why Does It Happen?

It’s mainly because of an upset in your gut, mouth, or urinary system. This can come from eating too many carbs and using antibiotics too much.

Symptoms

People with this syndrome might throw up, feel tired all the time, get dizzy, lose balance, feel confused, have a bad stomach, and even have problems with mood, like feeling anxious or sad. They can also seem drunk when they don’t drink.

How to Find It

Doctors need to ask questions and do some tests to figure out if someone has this syndrome. They might check the person’s blood and stool and even do an alcohol test.

Treatment

If someone’s alcohol level is very high, they should be treated like they drank too much. Medicines can help if yeast or bacteria are causing the problem. Changing the diet to have less sugar and starch is a big part of the treatment. Taking probiotics (good bacteria) can also help. It’s important to avoid antibiotics unless really needed, and if taken, watch out for yeast and bacteria again.

What to Remember

This condition can affect people’s lives a lot, causing problems in legal matters and relationships. It can also lead to wanting more alcohol. Doctors and patients need to work together to treat it. An interprofessional team of healthcare providers is the best way to manage this condition. This team includes primary doctors, specialists, nurses, nutritionists, and pharmacists. They should make sure the patient follows the treatment plan and gets any help needed.

References

1.: Tameez Ud Din A, Alam F, Tameez-Ud-Din A, Chaudhary FMD. Auto-Brewery Syndrome: A Clinical Dilemma. Cureus. 2020 Oct 16;12(10):e10983. [PMC free article] [PubMed]
2.: Hafez EM, Hamad MA, Fouad M, Abdel-Lateff A. Auto-brewery syndrome: Ethanol pseudo-toxicity in diabetic and hepatic patients. Hum Exp Toxicol. 2017 May;36(5):445-450. [PubMed]
3.: Welch BT, Coelho Prabhu N, Walkoff L, Trenkner SW. Auto-brewery Syndrome in the Setting of Long-standing Crohn’s Disease: A Case Report and Review of the Literature. J Crohns Colitis. 2016 Dec;10(12):1448-1450. [PubMed]
4.: Cordell BJ, Kanodia A, Miller GK. Case-Control Research Study of Auto-Brewery Syndrome. Glob Adv Health Med. 2019;8:2164956119837566. [PMC free article] [PubMed]
5.: Malik F, Wickremesinghe P, Saverimuttu J. Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition. BMJ Open Gastroenterol. 2019;6(1):e000325. [PMC free article] [PubMed]
6.: Takahashi G, Hoshikawa K, Kan S, Akimaru R, Kodama Y, Sato T, Kakisaka K, Yamada Y. Auto-brewery syndrome caused by oral fungi and periodontal disease bacteria. Acute Med Surg. 2021 Jan-Dec;8(1):e652. [PMC free article] [PubMed]
7.: Kruckenberg KM, DiMartini AF, Rymer JA, Pasculle AW, Tamama K. Urinary Auto-brewery Syndrome: A Case Report. Ann Intern Med. 2020 May 19;172(10):702-704. [PubMed]
8.: Bayoumy AB, Mulder CJJ, Mol JJ, Tushuizen ME. Gut fermentation syndrome: A systematic review of case reports. United European Gastroenterol J. 2021 Apr;9(3):332-342. [PMC free article] [PubMed]
9.: Green AD, Antonson DL, Simonsen KA. Twelve-year-old female with short bowel syndrome presents with dizziness and confusion. Pediatr Infect Dis J. 2012 Apr;31(4):425. [PubMed]
10.: Yuan J, Chen C, Cui J, Lu J, Yan C, Wei X, Zhao X, Li N, Li S, Xue G, Cheng W, Li B, Li H, Lin W, Tian C, Zhao J, Han J, An D, Zhang Q, Wei H, Zheng M, Ma X, Li W, Chen X, Zhang Z, Zeng H, Ying S, Wu J, Yang R, Liu D. Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae. Cell Metab. 2019 Dec 03;30(6):1172. [PubMed]
11.: Saverimuttu J, Malik F, Arulthasan M, Wickremesinghe P. A Case of Auto-brewery Syndrome Treated with Micafungin. Cureus. 2019 Oct 14;11(10):e5904. [PMC free article] [PubMed]
12.: Simic M, Ajdukovic N, Veselinovic I, Mitrovic M, Djurendic-Brenesel M. Endogenous ethanol production in patients with diabetes mellitus as a medicolegal problem. Forensic Sci Int. 2012 Mar 10;216(1-3):97-100. [PubMed]
13.: Bivin WS, Heinen BN. Production of ethanol from infant food formulas by common yeasts. J Appl Bacteriol. 1985 Apr;58(4):355-7. [PubMed]
14.: Li NN, Li W, Feng JX, Zhang WW, Zhang R, Du SH, Liu SY, Xue GH, Yan C, Cui JH, Zhao HQ, Feng YL, Gan L, Zhang Q, Chen C, Liu D, Yuan J. High alcohol-producing Klebsiella pneumoniae causes fatty liver disease through 2,3-butanediol fermentation pathway in vivo. Gut Microbes. 2021 Jan-Dec;13(1):1979883. [PMC free article] [PubMed]
15.: Yuan J, Chen C, Cui J, Lu J, Yan C, Wei X, Zhao X, Li N, Li S, Xue G, Cheng W, Li B, Li H, Lin W, Tian C, Zhao J, Han J, An D, Zhang Q, Wei H, Zheng M, Ma X, Li W, Chen X, Zhang Z, Zeng H, Ying S, Wu J, Yang R, Liu D. Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae. Cell Metab. 2019 Oct 01;30(4):675-688.e7. [PubMed]
16.: Aragonès G, González-García S, Aguilar C, Richart C, Auguet T. Gut Microbiota-Derived Mediators as Potential Markers in Nonalcoholic Fatty Liver Disease. Biomed Res Int. 2019;2019:8507583. [PMC free article] [PubMed]
17.: Nair S, Cope K, Risby TH, Diehl AM. Obesity and female gender increase breath ethanol concentration: potential implications for the pathogenesis of nonalcoholic steatohepatitis. Am J Gastroenterol. 2001 Apr;96(4):1200-4. [PubMed]
18.: Baker SS, Baker RD, Liu W, Nowak NJ, Zhu L. Role of alcohol metabolism in non-alcoholic steatohepatitis. PLoS One. 2010 Mar 08;5(3):e9570. [PMC free article] [PubMed]
19.: Zhu L, Baker RD, Zhu R, Baker SS. Gut microbiota produce alcohol and contribute to NAFLD. Gut. 2016 Jul;65(7):1232. [PubMed]
20.: Iizumi T, Battaglia T, Ruiz V, Perez Perez GI. Gut Microbiome and Antibiotics. Arch Med Res. 2017 Nov;48(8):727-734. [PubMed]
21.: Maier L, Pruteanu M, Kuhn M, Zeller G, Telzerow A, Anderson EE, Brochado AR, Fernandez KC, Dose H, Mori H, Patil KR, Bork P, Typas A. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature. 2018 Mar 29;555(7698):623-628. [PMC free article] [PubMed]
22.: Spinucci G, Guidetti M, Lanzoni E, Pironi L. Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Eur J Gastroenterol Hepatol. 2006 Jul;18(7):799-802. [PubMed]
23.: Jansson-Nettelbladt E, Meurling S, Petrini B, Sjölin J. Endogenous ethanol fermentation in a child with short bowel syndrome. Acta Paediatr. 2006 Apr;95(4):502-4. [PubMed]
24.: Dahshan A, Donovan K. Auto-brewery syndrome in a child with short gut syndrome: case report and review of the literature. J Pediatr Gastroenterol Nutr. 2001 Aug;33(2):214-5. [PubMed]
25.: Cordell B, Kanodia A, Miller GK. Factors in an Auto-Brewery Syndrome group compared to an American Gut Project group: a case-control study. F1000Res. 2021;10:457. [PMC free article] [PubMed]
26.: Ushida Y, Talalay P. Sulforaphane accelerates acetaldehyde metabolism by inducing aldehyde dehydrogenases: relevance to ethanol intolerance. Alcohol Alcohol. 2013 Sep-Oct;48(5):526-34. [PubMed]
27.: Dinis-Oliveira RJ. The Auto-Brewery Syndrome: A Perfect Metabolic “Storm” with Clinical and Forensic Implications. J Clin Med. 2021 Oct 10;10(20) [PMC free article] [PubMed]
28.: Vandekerckhove E, Janssens F, Tate D, De Looze D. Treatment of Gut Fermentation Syndrome With Fecal Microbiota Transplantation. Ann Intern Med. 2020 Nov 17;173(10):855. [PubMed]
29.: Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215. [PMC free article] [PubMed]