Monday, January 6, 2014

Auto-Brewery Syndrome


The yeast Saccharomyces cerevisiae
As 2014 gets into full gear, I am thinking about one of the most intriguing science/medicine news stories that we saw in 2013: auto-brewery syndrome.  This is one of the weirdest diseases I've heard of in quite a long time.  In auto-brewery syndrome, yeast that live inside your gastrointestinal tract ferment carbohydrates like sugar and starches into alcohol that can actually make you drunk.  

This sounds like a made-up disease, but a few cases of this happening have really been reported in medical literature.

It seems like, while very rare and still controversial, it might be possible for yeast inside your body to make enough alcohol to actually intoxicate you.
 




In July of 2013, a study was published in the International Journal of Clinical Medicine about a man who had a five-year long history of "unexplained intoxictation."  He would often seem intoxicated without ever having had a drop to drink, reaching blood alcohol levels of up to 0.4 % (five times the legal limit for driving in most states).

What the authors of the study believe was happening was that the man had high levels of Saccharomyces cerevisiae in his intestinal tract, based on positive stool cultures for this organism that came from the patient.  Sacchariomyces cerevisiae is the budding yeast (a single-celled type of fungus) that is responsible for producing alcohol when beer, wine, and other alcoholic beverages are made (as we previously discussed).  The authors think that every time he had some food or beverage that contained a lot of carbohydrates, the yeast inside his body were fermenting it into alcohol.  They treated him with antifungals to kill the yeast, a low-carb diet to prevent more fermentation, and probiotics to repopulate his gut with good bacteria.  He appeared to return to normal.             

Several cases of auto-brewery syndrome have been described in Japan, sometimes attributed to other yeast species such as Candida albicans and Candida krusei.  Yeast from the Candida genus, particularly Candida albicans, can often cause yeast infections in humans.  Other cases of auto-brewery syndrome have been reported in children with short bowel syndrome.  These cases were also successfully treated with anti-fungal drugs.  Short bowel syndrome is a disease where nutrients are not absorbed properly due to genetic or acquired disfunction or absence of part of the intestinal tract, sometimes caused by Crohn's disease or intestinal tumors, infections, or injury.

However, before anyone starts to think that auto-brewery syndrome might be a good defense for a drunk driving charge, note that the idea that alcohol is produced endogenously is a defense that has been tried many times, unsuccessfully.  The rarity of this disease and remaining controversy over whether endogenous gut yeast or bacteria can really make enough alcohol to get you drunk means that nobody is going to take this a legitimate defense.  All of the studies that have been reported on auto-brewery syndrome have been case studies of just one person.  There has been no controlled clinical trial with multiple patients.  The better solution is to just not drink and drive, and probably not to drive at all if you do have auto-brewery syndrome.

Many recent studies have begun to reveal the complex role that the bacteria living in our gut play in our own physiology (function under normal conditions) and pathophysiology (function during disease).  Humans are full of bacteria that live in and on us.  We call these bacteria and other microorganisms the microbiome.  This may just be another way that a metabolic product produced by members of our internal microbial community can affect the way we feel and act.        

© 2014 TheMadScienceBlog


Sources and Further Reading
  • B. Cordell and J. McCarthy.  "A Case Study of Gut Fermentation Syndrome (Auto-Brewery) with Saccharomyces cerevisiae as the Causative Organism."  International Journal of Clinical Medicine.  2013.  Available here.
  • M. Doucleff.  "Auto-Brewery Syndrome: Apparently You Can Make Beer In Your Gut."  NPR The Salt blog.  17 September 2013.  Available here.  
  • A.J. Montiel-Castro, R.M. Gonzalez-Cervantes, G. Bravo-Ruiseco, and G. Pacheco-Lopez.  "The Microbiota-Gut-Brain Axis: Neurobehavioral Correlates, Health, and Sociality.  Frontiers in Integrative Neuroscience.  2013.  7:70.  Available here.
  • B.-S. Kim, Y.-S. Jeon, and J. Chun.  "Current Status and Future Promise of the Human Microbiome."  Pediatr. Gastroenterol. Hepatol. Nutr.  2013. 16:71-79.  Available here.
  • E.A. Eloe-Fadrosh. and D.A. Rasko.  "The Human Microbiome: From Symbiosis to Pathogenesis.  Annual Reviews in Medicine.  2013.  64:145-163.  Available here.  

Other Sources

  • BK Logan and AW Jones.  "Endogenous Ethanol 'Auto-Brewery Syndrome' as a Drunk-Driving Defence Challenge."  Med Sci Law.  2000.  40:206-215.  
  • E Jansson-Nettelbladt, S Meurling, B Petrini, and J Sjolin.  "Endogenous Ethanol Fermentation in a Child with Short Bowel Syndrome."  Acta Paediatr.  2006.  95:502-504.  
  • A. Dahshan and K. Donovan.  "Auto-Brewery Syndrome in a Child with Short Gut Syndrome: Case Report and Review of the Literature."  J Pediatr Gastroenterol Nutr.  2001.  33:214-215.



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