Woman who visited A&E seven times was drunk on her gut bacteria

Auto-brewery syndrome is a rare condition thought to develop when the array of microbes in the gut goes awry

A woman who visited A&E seven times feeling sleepy and dizzy was drunk on alcohol that was brewed in her stomach, doctors have found.
The 50-year-old was eventually diagnosed with auto-brewery syndrome, a rare condition which has only ever been recorded in around 20 people.
This unusual medical phenomenon is thought to develop when the array of microbes in the gut which help digest food goes awry.
Fermenting funghi becomes dominant and converts carbohydrates into ethanol, much as happens between barley and yeast in a brewer’s tank, which then seeps into the bloodstream and gets the person drunk.
It is believed the woman, who had a history of chronic urinary tract infections (UTI), had a warped microbiome (the collection of all microbes, such as bacteria, fungi, viruses, and their genes, that naturally live inside us) caused by repeated antibiotic prescriptions.
This meant fermenting fungi were more common than they should be and her carb-rich diet saw her get drunk even though she had not consumed any alcoholic drinks.
The anonymous Canadian patient went to hospital seven times with symptoms of sleepiness, clumsiness, falls, and slurred words. Tests showed there was alcohol in her system, but the woman, who lived with her husband and children, was teetotal due to religious beliefs.
“Auto-brewery syndrome carries substantial social, legal and medical consequences for patients and their loved ones,” says Dr Rahel Zewude, study co-author from the University of Toronto.
“Our patient had several [emergency department] visits, was assessed by internists and psychiatrists, and was certified under the Mental Health Act before receiving a diagnosis of auto-brewery syndrome, reinforcing how awareness of this syndrome is essential for clinical diagnosis and management.”
During the seventh visit to the hospital, the doctors could smell alcohol on her breath, but the patient and her family were adamant she had not consumed a drink. Tests showed her blood alcohol level was around 285mg per 100 ml, around 3.5 times the UK’s legal drink-drive limit.
Doctors then suspected this may be a rare case of auto-brewery syndrome and prescribed antifungal medication to address the imbalance in the gut and also installed a strict no-carb diet.
To avoid bread and pasta, the diet was focused on meals such as omelettes and vegetables for breakfast; barbeque chicken or lentil soup for lunch; chicken, salmon or lamb with a small amount of rice or dahl for dinner; and no sugary drinks.
This fixed the issue for four months before the patient then began eating carbs once more and experienced symptoms again, slurring words and having a fall.
A prescription of so-called good bacteria, Lactobacillus acidophilus, was given to replenish the gut microbiota and the patient now only has very specific antibiotics if she develops another UTI.
“Auto-brewery syndrome is thought to result when microorganisms capable of fermenting alcohol from carbohydrates outgrow normal gut flora,” the scientists write in the Canadian Medical Association Journal.
“Auto-brewery syndrome is uncommon because it requires several host factors to interact with substantial overpopulation of fermenting microorganisms and high carbohydrate consumption.”