Imagine feeling drunk without having consumed any alcohol. For individuals with autobrewery syndrome (ABS), this is an unsettling reality. Also known as gut fermentation syndrome, ABS is a rare medical condition where the gut microbiome converts ingested carbohydrates into ethanol through fermentation within the digestive system. This unusual process is mediated by an overgrowth of certain yeast (Candida species) or bacteria Saccharomyces cerevisiae (brewer's yeast) that are typically harmless in small amounts. When these microorganisms proliferate excessively, they can produce significant quantities of alcohol, leading to elevated blood alcohol levels (BAL) and symptoms of intoxication, including dizziness, fatigue, nausea, confusion, and mood changes.
While the primary focus of ABS research has been on gut microbiota and dietary influences, genetic predispositions might also play a crucial role:
Research into alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes highlights their critical roles in ethanol metabolism, where ADH converts ethanol to acetaldehyde and ALDH further breaks down acetaldehyde into harmless acetate. Genetic variations in these enzymes can complicate ethanol metabolism, worsening alcohol intoxication symptoms and contributing to the development of ABS.
Antibiotic use has been associated with ABS in multiple case reports. For instance, a 2006 case described a patient with chronic intestinal issues who showed elevated blood ethanol levels despite no alcohol consumption, linked to Candida albicans and S. cerevisiae overgrowth triggered by amoxicillin and clavulanic acid alongside a high-sugar diet. Another study by Malik et al. demonstrated ABS symptoms developing after three weeks of cephalexin treatment, suggesting antibiotics disrupt gut microbiota (gut dysbiosis). Additionally, prolonged antibiotic use like amoxicillin/clavulanic acid and metronidazole can lead to bacterial overgrowth in the small intestine, promoting conditions favorable for yeast like S. cerevisiae to ferment carbohydrates into alcohol.
Autoimmune Disorders: Individuals with genetic predispositions to autoimmune disorders might have an altered immune environment that favors the proliferation of yeast and bacteria capable of ethanol production. Bayoumy et al. discovered through a comprehensive review of ABS case reports that yeast overgrowth, particularly by species such as S. cerevisiae, Saccharomyces boulardii, C. glabrata, C. albicans, C. kefyr, and C. parapsilosis, is the primary culprit behind ABS. This microbiome imbalance, notably C. albicans prevalent in immunocompromised individuals, underscores its significant role in ABS development.
Numerous approaches like Genome-Wide Association Studies (GWAS), Candidate Gene Studies, Family Studies, and Microbiome & Metagenomic Studies can be undertaken to understand the genetic aspects contributing to this rare disorder and identify the genetic variants that contribute to it, which can help in uncovering novel genetic loci linked to immune function, metabolism, and host-microbe interactions.
The Psychological Impact of Autobrewery Syndrome
Beyond the physical symptoms, ABS can have significant psychological and social impacts. Individuals may struggle with feelings of embarrassment, frustration, and isolation due to the unpredictable nature of their symptoms. Misunderstanding from family, friends, and even healthcare providers when looking for a diagnosis can exacerbate these challenges. Mental health support and patient education are crucial components of comprehensive care for those living with ABS.
References:
Painter K, Cordell BJ, Sticco KL. Auto-Brewery Syndrome. [Updated 2023 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513346/
Paramsothy J, Gutlapalli SD, Ganipineni VDP, Okorie IJ, Ugwendum D, Piccione G, Ducey J, Kouyate G, Onana A, Emmer L, Arulthasan V, Otterbeck P, Nfonoyim J. Understanding Auto-Brewery Syndrome in 2023: A Clinical and Comprehensive Review of a Rare Medical Condition. Cureus. 2023 Apr 17;15(4):e37678. doi: 10.7759/cureus.37678. PMID: 37206535; PMCID: PMC10189828.
Tameez Ud Din A, Alam F, Tameez-Ud-Din A, Chaudhary FMD. Auto-Brewery Syndrome: A Clinical Dilemma. Cureus. 2020 Oct 16;12(10):e10983. doi: 10.7759/cureus.10983. PMID: 33209539; PMCID: PMC7667719.
-Written by Sohni Tagore
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