LIVING WITH AUTO BREWERY SYNDROME: TIPS FOR DIET, LIFESTYLE, AND SUPPORT
Medically Reviewed by Dr. Rosmy Barrios
Have you ever felt intoxicated without having a single drop of alcohol?
If so, you may be experiencing a rare condition known as Auto Brewery Syndrome (ABS). This condition, also known as drunkenness disease or gut fermentation syndrome, is a real medical disorder where the body produces ethanol in the digestive system, causing a person to display signs of intoxication without consuming any alcohol.[1]
This article will explore what auto-brewery syndrome is, its types and causes, symptoms, risks, and complications, how to diagnose and treat it, and tips for managing this condition.
What is Auto Brewery Syndrome?
Under usual circumstances, gut bacteria influence overall health and well-being by producing beneficial by-products. Those with ABS have fewer beneficial bacteria and an overgrowth of alcohol-producing organisms, such as yeast.
These yeasts ferment carbohydrates and produce ethanol, the type of alcohol found in alcoholic beverages. These organisms may also colonize the urinary tract or the mouth, causing the smell of alcohol on the breath.
Intoxicated by Carbs
Individuals with ABS frequently report symptoms synonymous with alcoholism, such as occasionally staggering, chronic digestive upset, memory problems, and mood swings.
They commonly crave consuming a diet high in carbohydrates and sugars. Despite cravings, sugars and glycemic carbohydrates cause their symptoms to intensify. Studies suggest these individuals lead less healthy lifestyles, consume water more often, and avoid starchy carbs.[2]
Blood Alcohol Levels in ABS
ABS is not easily detectable and there is no standard definition of blood alcohol levels to define the condition.
Patients tend to run into trouble for "driving while intoxicated" or due to concerns raised in their households before seeking medical attention for their symptoms. It is difficult to ascertain the blood alcohol levels that occur in those with ABS.[3]
For drivers, the legally permissible blood alcohol concentration (BAC) most prevalent across countries is 0.05% (or 0.05g per 100mL blood), with many allowing up to 0.08%.[4] However, BAC levels in ABS patients may exceed this by 3-4 times, ranging from mild (0.02%) to severe intoxication (0.3%). While rare, ABS can lead to potentially life-threatening complications if alcohol levels exceed 0.3%, risking coma and fatality if the levels rise above 0.4%.[5]
Causes of Auto Brewery Syndrome
Several organisms alter the microbiome in those with ABS, leading to cravings for sugary foods to support their fermentation and their alcohol-producing metabolism.
The strains of yeast that produce the high alcohol levels seen in those with ABS usually belong to the Saccharomyces and Candida families. The most frequent yeast strains found in patients are Candida Albicans and Saccharomyces Cerevisiae (or brewer's yeast used commercially to make beer).
ABS patients frequently have co-occurring bacterial infections that contribute to the condition, stemming from the bacteria Enterococcus faecium, E. faecalis, Klebsiella pneumonia, and Citrobacter freundii.
Those with ABS often have digestive, metabolic, or liver-related comorbidities that contribute towards increasing alcohol absorption and gut fermentation or decreasing alcohol elimination.
Some known risk factors of secondary ABS include:
- Antibiotic use: Antibiotics can disturb the balance of good bacteria in the gut, contributing to an overgrowth of yeast.
- Diabetes: People with Diabetes have a higher risk of developing ABS due to erratic blood glucose levels and their body's inability to metabolize carbohydrates properly.
- Obesity: Obesity can lead to an overgrowth of yeast in the gut, causing ABS.
- Digestive Disorders: Several digestive disorders are associated with ABS, including Crohn's disease, celiac disease, short bowel syndrome, pseudoobstruction, and small intestinal bacterial overgrowth (SIBO). In each case, microbial disturbances may contribute to higher alcohol production and difficulties in clearing alcohol from the system.
- Liver disease: Liver damage can affect the body's ability to metabolize alcohol, leading to lowered blood alcohol metabolism and symptoms of ABS.
Auto Brewery Syndrome Symptoms
The most common symptom of ABS is feeling intoxicated without consuming any alcohol.
As seen with chronic alcoholism, studies suggest that the intoxication of those with ABS manifests in several symptoms that affect multiple systems of the body:[6]
- Neurologic symptoms: staggered gait, slurred speech, poor coordination, a higher number of falls, headaches and migraines, blurred vision or light sensitivity, faintness, brain fog, and memory problems.
- Digestive symptoms: nausea, vomiting, diarrhea, and generalized abdominal discomfort.
- Psychological and behavioral symptoms: depression or mood swings, strange behavior, sleepiness, fatigue, disorientation, and confusion.
- Other symptoms include craving sweet foods, frequent runny nose and cough, and frequent thirst or dehydration.
- It is vital to rule out other causes of these signs and symptoms, like head injuries, secret drinking, lactic acidosis, and mental health issues.
Risks and Complications: Living with Auto Brewery Syndrome
While ABS may seem like a harmless condition, it can pose serious risks and complications if left untreated for too long. These include:
- Accidents: Feeling intoxicated without consuming alcohol can lead to accidents, primarily when operating heavy machinery or driving.
- Nutritional deficiencies: The continuous strain of eliminating alcohol from the body can lead to multiple nutritional deficiencies.[7] The most prominent deficiencies include thiamine, folate, Vitamin B6, Vitamin A, magnesium, calcium, zinc, and iron.[8]
- Liver damage: The constant production of alcohol in the body can put a strain on the liver, leading to liver damage.
- Disease risk: Long-term exposure to excessive ethanol produced in the body can elevate the risk of comorbid diseases associated with alcohol use disorder, including diabetes, liver disease, depression, and inflammatory bowel disease. [9][10]
- SIDS Risk: Few studies suggest that infants are vulnerable to ABS and that it may contribute to sudden infantile death syndrome.[11]
Those with ABS can find life challenging until they receive a diagnosis and treatment. The condition can interfere with their relationships, leading to strain, mistrust, and misunderstandings. Many people with ABS get accused of being closet alcoholics by their friends and family when, in fact, they are entirely intolerant to drinking alcohol.
When symptoms flare, they run the risk of arrest or receiving a fine for "driving under the influence”.
When seeking medical treatment, misdiagnosis and harmful prescriptions may occur, particularly with psychiatric medications prescribed for altered mental state and strange behavior. Mixing these medications with alcohol that is produced in the body can further worsen their effects.
How to Diagnose Auto Brewery Syndrome
The diagnosis of ABS can be challenging as it is rare, and the symptoms can mimic other health conditions. It is often easier if the patient is tested positive for "drinking under the influence".
A complete case history can help a doctor assess the symptoms and any comorbidities that might increase the odds of having ABS. They will likely also make use of the following diagnostic tests:[12]
- Blood alcohol test: This test measures the level of alcohol in the blood, showing elevated levels in people with ABS.
- Breathalyzer test: A breathalyzer test can detect the presence of alcohol in the breath, even if gut yeasts are the cause.
- Fecal test: This test looks for yeast in the stool, which can indicate an overgrowth in the gut.
- Glucose tolerance test: This test measures how the body responds to glucose, which can help determine if there is an overgrowth of yeast in the gut.
Auto Brewery Syndrome Treatment
There is no cure for ABS, and treatment depends on the patient's symptoms.[13]
Patients who get admitted to the hospital for severe alcohol intoxication need stabilization and intravenous rehydration. Following a diagnosis, treatment consists of antifungal medications, diet and lifestyle changes, and possibly FMT.
Those who receive antifungal medications followed by probiotics and dietary changes often experience little to no symptoms after treatment.
Counseling can help people with ABS cope with the psychological effects of the condition.
Antifungal medications can help eliminate excess yeast in the gut.
In some cases, antibiotics can treat comorbid infections.
Diet and Lifestyle Changes
Steer clear of carb-rich foods, particularly those high in starch, as this can help lower the amount of alcohol produced in the stomach.[14] Foods high in yeast and molds should also be avoided.[15]
Those with ABS may benefit from a diet lacking in:
- Dairy
- Alcohol
- Coffee
- Peanuts
- Corn and corn syrup
- Refined sugars, including glucose, dextrose, maltodextrin, and fructose
- Wheat bread and pasta
- White rice
- High-glycemic beverages, such as soda and fruit juice
A diet higher in proteins and low glycemic carbohydrates with a high fiber content can help encourage the right bacteria in some ABS cases. Some studies show that multi-strain probiotics may restore the ratio of healthy bacteria in the gut for ABS patients, reducing the overgrowth of yeast. More evidence is required.
In other cases, these foods and probiotics may promote digestive symptoms, especially in those with SIBO.[16]
A qualified nutritionist can further help recommend dietary modifications that reduce ethanol fermentation and relapse.
Decreasing stress, getting enough sleep, and exercising daily can also help manage ABS symptoms. Eliminating environmental exposure to molds and yeast can also benefit those with ABS.
FMT
Fecal microbiota transplantation (FMT) has shown promise as a treatment option for Auto Brewery Syndrome (ABS), according to a study published in the Annals of Internal Medicine. A man aged 47 who received FMT treatment after ABS remained without symptoms for 34 months following the treatment.
FMT can help restore the balance of gut bacteria and reduce the overgrowth of alcohol-producing yeasts, providing a potential avenue for managing ABS symptoms.
More research is required to confirm the safety and efficacy of FMT for ABS.
Tips for Managing Auto Brewery Syndrome
While there is no cure for ABS, some tips can help prevent ABS recurrence, manage the symptoms, and reduce the risk of complications:
- Do not drink alcohol: If you have ABS, it is best to avoid alcohol, as drinking any amount can worsen your symptoms.
- Consume fewer carbs: Eating foods with fewer carbs can lower the amount of alcohol produced in your gut.
- Drink lots of water: Drinking water can help to flush out extra alcohol and toxins from your body.
- Get plenty of sleep: Getting enough rest can help you handle the symptoms of ABS.
- Stay active: Exercising regularly can help you relax and improve your overall health.
- Get help: Support groups or therapy can help you deal with ABS.
Conclusion
Auto Brewery Syndrome is an unusual medical condition that leads to alcohol production in the digestive tract when carbohydrates are consumed, leading to a feeling of being intoxicated without drinking alcohol. While it may seem like a harmless condition, it can have severe risks and complications if left untreated, even leading to hospitalization, coma, and death. If you experience symptoms of ABS, seeking medical help and following the recommended treatment plan to manage the condition effectively is essential. People with ABS can lead healthy lives with proper management.
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