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Auto-Brewery Syndrome (ABS) – The "Drunkenness Disease"

Auto-Brewery Syndrome (ABS), also known as gut fermentation syndrome, is a rare medical condition in which the digestive system produces alcohol (ethanol) internally. This occurs due to an overgrowth of yeast (commonly Saccharomyces cerevisiae or Candida species) in the gut, which ferments carbohydrates into alcohol.



Symptoms of ABS: Unexplained drunkenness without consuming alcohol

Dizziness, confusion, and slurred speech

Mood swings and depression

Fatigue and brain fog

Headaches

Digestive issues (bloating, diarrhea)

Causes and Risk Factors: 

A diet high in carbohydrates, which fuels the fermentation of yeast

Overuse of antibiotics (kills good bacteria, allowing yeast to thrive)

underlying illnesses such as liver failure, Crohn's disease, or diabetes

Unbalances in the immune system

Diagnosis and Treatment: Although no alcohol was consumed, the breathalyzer test revealed the presence of alcohol.

Tests for blood alcohol content (BAC)

Analysis of the gut microbiota

Options for treatment include:

The ketogenic or low-carb diet lowers fermentable glucose.

Antifungal drugs: nystatin or fluconazole to eradicate yeast

Probiotics: Use good microorganisms to restore gut balance

Changes in lifestyle: Steer clear of alcohol and refined sweeteners

Famous Cases: ABS has falsely accused certain persons of DUI, putting them in legal hot water.

A man in Texas with a BAC of 0.37 without drinking was the subject of a well-known case in 2013.



Saccharomyces cerevisieae

The significance of gut microbiota, especially fungi like Saccharomyces cerevisiae, in the body's production of alcohol is highlighted by recent findings on fungi in auto-brewery syndrome (ABS). Researchers have found instances where patients become intoxicated without drinking alcohol due to fungal proliferation in the intestines.

S. cerevisiae was identified from the feces of a patient with an ABS diagnosis, according to a 2024 study. Even though the fungus was initially eradicated by antifungal medications like fluconazole, the patient continued to produce ethanol, suggesting that other microbes may be at play. Doctors tried a fecal microbiota transplant (FMT) to address this, and after two procedures, the gut flora was successfully restored and the generation of ethanol was stopped.

The medical and social difficulties that ABS patients encounter were highlighted in another study. After several ER trips for inexplicable intoxication symptoms, a 50-year-old lady was eventually diagnosed with ABS. The study emphasizes that low-carb diets and antifungal medications continue to be the main therapies. and emphasizes the need for clinicians to be more alert.

By focusing on gut microbiota rather than just removing particular fungi, these findings create new avenues for treating ABS. 

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