Auto-brewery syndrome or gut fermentation syndrome is an uncommon condition that has a significant effect on the daily lives of those who have it. The disease causes symptoms of alcohol intoxication after an individual eats or drinks food or beverages containing carbohydrates. Age and sex are not factors for developing the condition — men, women, and children can all get auto-brewery syndrome.
What is Auto-Brewery Syndrome?
During normal digestion, the gut breaks down foods with fermentation, aided by bacteria that reside in the colon. In people with auto-brewery syndrome, the fermentation occurs in the small intestine instead, causing increased levels of ethanol. Although the liver usually detoxifies the small amounts of alcohol left behind from the yeast fermentation process, those with the condition create too much alcohol for the liver to process and the individual becomes intoxicated.
The Pathogens
Researchers have identified certain gastrointestinal fungi as the pathogens that produce alcohol and are responsible for gut fermentation syndrome. Two of these intestinal yeasts are Saccharomyces cerevisiae and Candida glabrata. Auto-brewery syndrome causes an overgrowth of these yeast pathogens inside the intestines. When carbohydrates are ingested–even small amounts, in some cases–they metabolize with the produced ethanol, which triggers symptoms of intoxication. Brewer’s yeast is made from Saccharomyces cerevisiae and is collected during the process of brewing beer. Essentially, when a person has auto-brewery syndrome, the gut becomes its own brewery.
Symptoms
Auto-brewery syndrome often mimics food allergies or intolerance to certain foods, masking the symptoms needed for an accurate diagnosis. Chronic fatigue is an early symptom. People with gut fermentation syndrome describe symptoms such as frequent lightheadedness, dizziness, and disorientation any time they consume carbohydrates. People are often described as being in a state of drunkenness after eating or drinking foods or beverages containing carbohydrates. The assumption that individuals are intoxicated can cause additional psychological distress.
Additional Symptoms of Auto-Brewery Syndrome
The feeling of overwhelming tiredness and consistent lack of energy may also cause anxiety, depression, and problems with daily productivity. Additional physical symptoms of auto-brewery syndrome include bloating, abdominal distension, pain, and discomfort. Individuals usually report low-quality or frequent stools and recurring bouts of diarrhea. Others complain of frequent nausea and vomiting. Headaches, dehydration, cold sweats, shaky hands, and other symptoms associated with hangovers are common symptoms as well.
Conditions Leading to Auto-Brewery Syndrome
Doctors are hesitant to diagnose auto-brewery syndrome due to its rarity and the lack of research available. There are those in the medical community who believe that auto-brewery syndrome only occurs in immunocompromised individuals. Research indicates the condition could be a complication of Crohn’s disease and other inflammatory bowel disorders in adults and children diagnosed with short bowel syndrome. Additional research suggests that people with gut fermentation syndrome also experience a deficiency of B vitamins, zinc, and magnesium. Some studies find a connection between people diagnosed with auto-brewery syndrome and those with eczema and chronic vaginal yeast infections.
Diet and Auto-Brewery Syndrome
Limited research shows that those with auto-brewery syndrome tend to crave sugar and carbohydrates and may indulge in sugary food binges. One study found that people diagnosed with the condition also reported a higher prevalence of food sensitivities than the control group. Many individuals with the syndrome say they consumed a diet high in carbohydrates and sugars throughout their lives. Additional research indicates that people with auto-brewery syndrome also tend to eat out less once they become aware of their condition, to better control what is in their meals.
Onset and the Role of Antibiotics
One theory is that people who take antibiotics for extended periods may be more susceptible to auto-brewery syndrome. Antibiotics cause an imbalance of microbiota, the harmless bacteria in the gut that may be a factor in the onset of the syndrome. Some patients diagnosed with a sudden onset of gut fermentation syndrome reported taking antibiotics following a surgery or an illness. Physicians believe that the antibiotics may destroy bacteria in the lower intestine to the extent that the yeast pathogens significantly increase, causing the condition. Other studies discovered a higher number of diagnoses among those who reported a long-term use of acne medication, versus those who took the medication for shorter periods.
Evaluation and Diagnosis
Physicians may suspect that an individual has auto-brewery syndrome if they report feeling intoxicated after consuming carbohydrates, even in small amounts. Others say they feel drunk after consuming small amounts of alcohol. In some cases, people seek medical attention after an arrest for driving under the influence, even though they have not consumed any alcoholic beverages. There are reports of guardians sending their teens to rehabilitation centers after their child exhibits frequent symptoms of drunkenness. A doctor will usually perform an alcohol blood screen, a drug screen, a glucose challenge, and a stool test to diagnose auto-brewery syndrome. They may also prescribe hospitalization to rule out any alcohol consumption. Additional testing could identify the microbes and enzymes present in the patient’s gut before making a diagnosis.
Treatment for Auto-Brewery Syndrome
A diet high in carbohydrates and sugars may lead to or exacerbate the condition, so a high-protein, low-carbohydrate diet is crucial for people with auto-brewery syndrome. This allows the body to lower the amount of alcohol fermented from the gastrointestinal tract. Any imbalance between the harmful and beneficial bacteria in the gut can increase the amount of fermentation. Therefore, doctors are cautious when prescribing antibiotics for the condition, because antibiotics may also kill off beneficial types of bacteria and cause the condition to worsen. Some physicians report success using antifungal therapy to help balance the fungus levels in the gut, along with vitamin and mineral supplements.
Prognosis
Once the diagnosis is confirmed and the individual has completed a course of antibiotic or antifungal medications and modified their diet as prescribed, the symptoms of auto-brewery syndrome usually improve. Those who adhere to a low-carbohydrate diet report having fewer symptoms than before their diagnosis. Although these treatments are not a full cure, most report an overall improvement in their health. Regular medical follow-ups are important. Research into the causes of auto-brewery syndrome is ongoing.