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This Strange Fungal Condition Makes You Drunk without Drinking

This strange fungal condition makes you drunk without drinking

Greater awareness is needed about self-brewery syndrome, which can cause dangerous accidents and trigger social ostracism if not correctly diagnosed

Close-up photo of a sign with an alcohol prohibition symbol hanging in an outdoor park

The woman had visited several emergency departments in Toronto six times over the past two years, always complaining of the same symptoms. She was at home, getting ready to go to work or preparing food for her family when, seemingly out of nowhere, she suddenly felt excessively tired and groggy. Her words began to fail and she lost motor coordination, which sometimes caused her to fall. Her breath would start to smell like alcohol and her blood alcohol level would increase. In other words, she was drunk.

But the woman had not consumed alcoholic beverages. In fact, years before she had stopped drinking due to religious beliefs. She repeatedly told doctors that she was teetotal, as was her husband. However, every time she ended up in the hospital, she was diagnosed with alcohol poisoning. On one visit, an emergency room doctor even certified that, under the Ontario Mental Health Act, she would remain involuntarily in hospital until a psychiatric evaluation could be performed.

The woman’s seventh visit to the emergency department finally broke this pattern. Brian Goldman, an emergency room doctor at Mount Sinai Hospital in Toronto, heard her story. Then he did something strange: He prescribed an antifungal medication and referred her to a gastroenterologist. Goldman suspected the woman had self-brewery syndrome, a rare condition in which a person’s intestine ferments alcohol from carbohydrate-rich foods and causes them to become intoxicated without ever having consumed alcohol.

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As the woman’s emergency department odyssey demonstrated, knowledge about this syndrome is lacking, even in the medical community. In an effort to raise awareness, Goldman and several others decided to try to give the syndrome a broader profile using the woman’s story as a case study, which they published last week in the Journal of the Canadian Medical Association.

“It was very distressing for our patient and her husband to keep repeating the same story for two years,” says the study’s lead author, Rahel Zewude, a physician and fellow in medical microbiology and infectious diseases at the University of Toronto. “We thought sharing her story would be a great way to spread awareness about this syndrome and hopefully shorten the time to diagnosis in the future.”

Brewery syndrome was first reported in 1948 by doctors in Uganda who had noticed a strong odor of alcohol while performing abdominal surgery on a five-year-old boy. There is no indication that the child consumed alcohol that same day. But he had eaten a sweet potato and doctors wondered if his digestive tract had fermented it somehow. The syndrome was officially described in 1952 in Japan. Dozens of cases have since been reported in Japan, and an additional 20 cases were described in English-language medical literature between 1974 and 2020. Cases have occurred in countries around the world and in people ranging in age from children to older adults.

From those rare cases, doctors and scientists have hypothesized that homebrewing syndrome occurs when fungi ferment alcohol, usually brewer’s yeast (Saccharomyces cerevisiae) either candid species, which occur naturally in the human body, overpopulate in a person’s intestine. Certain bacteria can also ferment alcohol, and in extremely rare cases, homebrewery syndrome has been linked to an overpopulation of bacteria. Klebsiella pneumoniae.

The currently understood mechanism for how this happens involves a number of factors that may contribute to a greater likelihood of the syndrome developing. These include having taken frequent or prolonged courses of antibiotics; have diabetes, inflammatory bowel disease, or liver disease; and have a possible genetic predisposition through mutations that affect specific enzymes that help metabolize and eliminate alcohol. “These factors must collide to create the perfect storm,” says Zewude.

That said, he adds, some people who suffer from the syndrome don’t appear to have any risk factors.

Brewery syndrome poisoning is triggered when someone eats a carbohydrate-rich meal, and the episodes typically last the same amount of time as someone who was intoxicated from drinking alcohol would experience. People may also experience intense hangover-like symptoms in the following days. After returning from the hospital, the woman in the current case study would spend up to a week recovering in bed.

The syndrome has not been reported to cause death from lethal blood alcohol levels. But there have been people who have suffered significant medical consequences, including one person who fell drunk and suffered a brain hemorrhage and another who broke his ribs and nose. There have also been several cases of people suddenly getting drunk while driving, Zewude says. “You can imagine how devastating those consequences could be.”

People’s performance at work may also suffer and relationships with family members may become strained. Mental health may suffer as a result. “Everyone smells alcohol on your breath and you act like you’re drunk, but you deny that you’re drinking and no one believes you, not even your doctors,” says Zewude. “That’s very distressing.”

“It was important to publish this study,” says Michael Silverman, assistant professor of medicine and infectious diseases at Western University in Ontario, who was not involved in the work. “Missing diagnosis may be associated with serious outcomes.”

Fortunately, when properly diagnosed, autobrewery syndrome can be treated with antifungal treatment. Typically, people with this condition must also follow a low-carbohydrate diet, potentially long-term. “Every patient is a little different, so treatment approaches need to be tailored to each patient,” says Zewude. “Our patient hasn’t had a relapse in months and we hope that continues to be her trajectory.”



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