Kasia Dietz
Updated on: October 13, 2024 10:14 am GMT
It sounds almost surreal: a man in Singapore, stopped by police for suspected drunk driving, reveals he has never touched alcohol. Surprisingly, his blood alcohol level was measured at 200 milligrams per 100ml of blood—more than double the legal limit. This bizarre situation, however, can be better understood through the lens of a rare medical condition known as auto-brewery syndrome (ABS).
The Rare and Baffling Auto-Brewery Syndrome (ABS)
Auto-brewery syndrome, also referred to as gut fermentation syndrome, is an uncommon metabolic condition affecting less than 100 individuals worldwide, according to a 2021 report. It causes the gastrointestinal tract to ferment carbohydrates into alcohol, leading to elevated blood alcohol levels without any alcohol consumption.
Dr. Jonathan Lee, a senior consultant from the National University Hospital (NUH) in Singapore, explained how this occurs. “When there are excessive carbohydrates ingested, the gut of someone with ABS can convert these into alcohol,” he stated. If the liver cannot metabolize all the carbohydrates, the excess gets converted into alcohol, mimicking the effects of drinking alcoholic beverages.
The man, now in his 50s, first experienced symptoms of ABS in 2011 after taking antibiotics for a thumb injury. These symptoms included dizziness, memory loss, and brain fog. Despite visits to several doctors over the years, he remained undiagnosed, eventually being referred to a psychiatrist.
Symptoms and Diagnosis
The symptoms typical of ABS were startlingly similar to those exhibited by chronic alcoholics. The patient suffered from:
- Brain fog
- Dizziness
- Aggression
- Memory loss
As the symptoms persisted, he underwent countless tests without obtaining a clear diagnosis. a stool sample revealed the presence of Saccharomyces cerevisiae, or brewer’s yeast—an essential component in beer fermentation. Simply advising him to stop eating carbohydrates did not resolve his issues.
After months of uncertainty, he sought help from Associate Professor Dan Yock Young, a senior gastroenterologist at NUH. “We screened him for metabolic causes and found that blood alcohol levels were raised, despite no history of alcohol intake,” stated Prof. Dan. In total, it took approximately three to six months before the team identified and diagnosed him with ABS.
The Role of Gut Microbiome
ABS results from an imbalance in the gut microbiome, which includes bacteria, fungi, and viruses. Each patient’s triggers may vary significantly. In this case, the antibiotics prescribed for his thumb injury were believed to have upset the man’s gut balance, paving the way for the unwanted fermentation of carbohydrates.
“Science has changed this,” Dr. Lee said regarding advancements in understanding the condition. “Today, we sequence samples to look for the DNA of pathogens, leading to more precise diagnoses.”
Treatment Approaches
Once diagnosed, the man received a comprehensive treatment plan that included:
- Antibiotics and antifungal medications: These were tailored based on test results.
- Dietary changes: He was advised to follow a strict low-carbohydrate diet while avoiding sugars and refined foods.
Many commonly perceived “healthy” options, such as juices, fruit, fermented foods like yogurt, and even certain drinks like kombucha, were to be eliminated. These foods were avoided because the yeast and bacteria in the gut would thrive on them.
Dr. Lee emphasized the importance of meal timing and composition: “By consuming high-fiber foods first, the digestion of sugars could be reduced, since the microbes and enzymes would be focused on the fiber.”
After two weeks of adhering to this new diet and medication regimen, his symptoms began to improve significantly.
Prognosis and Life Changes
While the prognosis is generally good with treatment, the long-term outcome for patients with ABS can be unpredictable. The Singaporean man continues to manage his condition, although he has experienced occasional relapses. Prof. Dan noted, “Despite these challenges, he feels vindicated by his diagnosis, realizing that his symptoms were not merely psychological.”
Due to ongoing concerns surrounding his condition, he has since made the decision to stop driving. The combination of elevated blood alcohol levels and debilitating symptoms led him to recognize the necessity of prioritizing his health.
As researchers continue to learn about ABS and its impacts on quality of life, the case serves as a reminder of how elusive some medical diagnoses can be. The man’s journey from misdiagnosed to acknowledged reflects the broader challenges many face in understanding complex bodily conditions.
the story of this man sheds light on just how intricate our bodies can be. Understanding conditions like auto-brewery syndrome not only enhances awareness but also guides effective treatment, which can help those affected regain control over their lives.
Every day can bring new challenges, but with the right help and support, people living with ABS can find ways to feel better and improve their health.
