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Auto-brewery syndrome

The concentration of ethanol in blood or breath is key evidence in cases of driving under the influence of alcohol. For various reasons, the reliability of blood and breath tests is often questioned by the defense. One argument that is sometimes raised is the hypothesis that alcohol can be produced naturally in the body (endogenous origin), and hence the term ‘auto-brewery syndrome’ has been used.1

Auto-brewery syndrome (ABS, intestinal fermentation syndrome, Meitei-Sho syndrome) is a very rare condition, occurring in both men and women, as well as in children, in whom ethanol is produced in the gastrointestinal tract as a result of endogenous fermentation by certain fungi, or sometimes by certain bacteria.
In addition to denying consuming ethyl alcohol, patients with auto-brewery syndrome frequently exhibit numerous symptoms of ethyl alcohol poisoning and report eating a diet high in carbohydrates (white bread, pastries, potatoes, rice, pasta).2, 3 Small amounts of endogenous ethanol are produced during normal digestion, and these levels are typically undetectable using current techniques. However, when fermenting yeast or bacteria become pathogenic, it can even lead to the generation of extreme levels of ethyl alcohol in the blood.
bacteria like Klebsiella spp. and Enterococcus fecium, as well as other strains of Candida, including Candida glabrata, Candida albicans, Candida kefyr, and Candida parapsilosis, as well as Saccharomyces cerevisiae and Saccharomyces boulardii and Intestinal microbiome diseases, such as intestinal dysbiosis, usually of the fungal variety, are followed by excessive colonization by fermenting bacteria. As a result, a patient with ABS may exhibit symptoms that are similar to those of a food allergy or intolerance.
Glycolysis, the initial step of fermentation, follows the Embden-Meyerhof-Parnas pathway that is common in eukaryotes.19. Glucose will be the primary organic substrate for yeast. When fermentation is carried out during distillation, hydrolytic enzymes such as α-amylase and glucoamylase are used to saccharify starch and produce glucose. There is continuing research to abbreviate the saccharification stage in order to enhance fermentation on an industrial scale. Certain strains of fungus belonging to the genera Saccharomyces and Candida develop the capacity to degrade sucrose and generate the enzyme glucoamylase as a result of the induced mutation.
The glycolysis reaction subsequently transforms glucose into glyceraldehyde 3-phosphate and pyruvate:2Pyruvate + 2ATP + 2NADH++ 2H+ → glucose + 2ADP + 2Pi + 2NAD+
Pyruvate decarboxylase catalyzes the subsequent step of fermentation, which is the decarboxylation of pyruvate into acetaldehyde. Acetaldehyde alcoholic dehydrogenase converts acetaldehyde to ethanol in the last step:2NAD+ + 2Ethanol + 2CO2 → 2Pyruvate + 2NADH + 2H+
Antibacterial (antibiotics) and antifungal medications (such as azoles, polyenes, and echinocandins) should be used orally if bacteria or fungus are the source of unfavorable gastrointestinal symptoms. Following a suitable low-carb, high-protein diet until symptoms go away is the main treatment for ABS. Supplementing with probiotics is also advised. Long-term exposure to endogenous ethanol can lead to addiction and desires for alcohol in subsequent drinks, even when symptoms have subsided.
In everyday practice, GFS is an uncommon but underdiagnosed illness. The Saccharomyces and Candida genera are the ones that report the sickness the most, and antibiotics have been used in the past to treat some cases. Research on nonalcoholic fatty liver disease indicates that endogenous alcohol synthesis has a bacterial origin; these microorganisms may also be the cause of GFS. Antibiotics, antifungal drugs, low-carb diets, and probiotics are currently used to treat GFS. Fecal microbiota transplantation may have a part in the management of GFS.

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