Doctors repeatedly told the Toronto woman she was drunk, but she never took a sip of alcohol. What is auto-brewery syndrome?

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A Toronto woman was taken to the emergency room seven times over a two-year period with signs of alcohol poisoning. The problem? She had never had a single sip of alcohol.

According to a new article published in the Journal of the Canadian Medical Association, a 50-year-old woman visited her family doctor and the emergency room, complaining of drowsiness and suddenly falling asleep while preparing meals for her children or getting ready to go to work. The woman, who had slurred speech and the smell of alcohol on her breath, said she would become so sleepy she would fall, but insisted she was not drinking alcohol.

After each visit, the woman was diagnosed with alcohol poisoning. Her symptoms persisted: The woman and her husband assured health care providers that although she had once had a glass of wine while on vacation, in recent years she had stopped drinking alcohol due to her symptoms. religious beliefs.

On her seventh emergency room visit, the woman had a blood alcohol level of 62 mmol/L (alcohol-related deaths typically occur when levels are above 86.8 mmol/L). Her emergency room doctor believed the woman and her husband when they said she didn’t drink alcohol and suspected she might have auto-brewery syndromea condition that causes the body to convert carbohydrates into ethanol.

Dr. Rahel Zewude, an infectious disease specialist and medical microbiology fellow at the University of Toronto, who conceptualized the CMAJ study, says Yahoo Canada that the condition is “very rare”.

“The broader medical community is not very familiar with this syndrome,” she said. “That was the main reason we wanted to ensure this report was released. »

What is auto-brewery syndrome?

According to the report, autobrewery syndrome occurs when “microorganisms capable of fermenting alcohol exceed the normal intestinal flora.” People with the syndrome would become intoxicated and appear drunk without actually consuming alcohol.

A “painful” journey to diagnosis

Before being referred to a gastroenterologist who confirmed the diagnosis of autobrewery, the journey was difficult for the Canadian. She was evaluated by three separate psychiatrists who “provided care related to addiction medicine.” According to the study, during her third emergency room visit, she received certification under the Mental Health Act, which allows doctors to provide care for mental health disorders against a person’s wishes. The woman’s doctors reportedly had concerns of “self-neglect” when the woman attempted to leave the hospital without a psychiatric evaluation.

“It was very distressing for her to keep going to the emergency room seven times before being diagnosed and to be so adamant and clear that she wasn’t drinking anything – but she was behaving exactly like someone who was drinking…” Zewude said. “It’s a testament to the constant support of her partner and the emergency room physician, Dr. Goldman, who believed her and gave her this diagnosis.”

Why do some people develop auto-brewery syndrome and others don’t?

According to Zewude, who treated the woman, it takes a perfect storm of conditions for a person to develop auto-brewery syndrome.

“Our hypothesis is that there are several factors that must interact at the same time for the syndrome to occur,” Zewude said. Yahoo Canada. “There are comorbidities that patients with auto-brewery syndrome have more than others, such as diabetes, inflammatory bowel disease and liver disease. All of these can contribute to the urgency of the syndrome because they affect our intestinal motility and our ability to properly eliminate and metabolize alcohol.

In the Toronto woman’s case, there was no evidence of diabetes or inflammatory bowel disease. However, the woman had a history of recurrent urinary tract infections (UTIs) for several years that required antibiotics which Zewude believes contributed to the destruction of the gut microbiome, but it is speculated that there may also be a genetic predisposition to disease.

How to treat auto-brewery syndrome?

The woman’s emergency room doctor prescribed fluconazole, an oral medication used to treat fungal and yeast infections. As part of the referral to the gastroenterology clinic, a dietitian advised her to follow a low-carbohydrate diet, which resulted in improvement in her symptoms for 4 months. Once she began increasing her carbohydrate intake, she experienced symptoms again and suffered a crash, prompting her to return to Fluconazole, follow a low-carb diet, and prescribe probiotics to restore gut health.

“This is a rare syndrome and what we do has to be absolutely tailored to the interests and lifestyle of the patient,” Zewude said. “Some patients are so upset by the episodes they’ve experienced that they’ll say, ‘I’d rather follow this low-carb diet for the rest of my life if it means I’ll never have that again.'”

Zewude continues to monitor the woman, who is “doing well” on a low-carb diet. However, this will be an “ongoing conversation” with the patient.

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