Can You Get Drunk Without Drinking? The Mystery of Auto-Brewery Syndrome

A Belgian man was recently charged with a DUI but later acquitted after claiming he hadn't consumed any alcohol, despite his blood alcohol content (BAC) suggesting otherwise. This raises an intriguing question: is it possible to become intoxicated without drinking alcohol?

While this doesn't happen to most people, those diagnosed with auto-brewery syndrome experience exactly this phenomenon. To understand how this condition can be dangerous whether you drink alcohol or not, let's explore what auto-brewery syndrome actually is.

What Is Auto-Brewery Syndrome?

Auto-brewery syndrome, also known as gut fermentation syndrome, is a rare condition where certain bacteria and fungi in the gut overgrow and convert carbohydrates into alcohol. While everyone has healthy microorganisms in their gut microbiome, an overgrowth can lead to this unusual syndrome.

The excess yeast feeds on consumed sugars and converts them into energy, producing carbon dioxide and ethanol as byproducts. Ethanol—the intoxicating component of alcohol—enters the bloodstream and travels throughout the body, causing symptoms of intoxication. This means blood alcohol concentration can rise without any alcohol consumption and can become significantly elevated with even minimal alcohol intake.

The History of Gut Fermentation Syndrome

One of the earliest documented cases dates back to 1948, involving a five-year-old African boy who died after swelling in his gastrointestinal tract caused his stomach to rupture. During the postmortem examination, the gas and liquid in his abdominal cavity smelled distinctly like alcohol.

Other early cases were recorded in Japan during the 1950s. In 1976, researchers documented a 24-year-old woman who became intoxicated after eating carbohydrates. Her condition resulted from fungal overgrowth, and she was successfully treated with antifungal medication and carbohydrate restriction, paving the way for our current understanding of auto-brewery syndrome.

Fewer than 100 cases have been reported worldwide, but researchers believe the condition is underdiagnosed.

What Causes Auto-Brewery Syndrome?

Since auto-brewery syndrome stems from an imbalance in the gut microbiome, several underlying conditions and habits can contribute to its development. A specific type of yeast, Saccharomyces cerevisiae, is often found at abnormal levels in affected individuals.

Conditions that may increase the risk include:

• Crohn's disease
• Irritable bowel syndrome
• Small intestinal bacterial overgrowth
• Diabetes
• Obesity
• Weakened immune system

Habits that harm the gut microbiome can also raise the risk. Excessive antibiotic use destroys healthy gut bacteria, disrupting the microbiome and encouraging fungal overgrowth. A diet high in carbohydrates or processed foods can cause gastrointestinal distress and further imbalance.

Auto-Brewery Syndrome Symptoms

As the name implies, auto-brewery syndrome causes the body to produce alcohol internally, leading to symptoms that mirror alcohol intoxication and hangovers.

Initial symptoms resemble being drunk:

• Loss of coordination
• Brain fog
• Dizziness
• Slurred speech
• Mood changes
• Delirium

After the body metabolizes the alcohol, hangover-like symptoms may appear:

• Headaches
• Fatigue
• Bloating
• Burping
• Nausea and vomiting
• Difficulty concentrating
• Memory issues

Symptoms may fade once the body detoxifies, but they can return with carbohydrate and sugar consumption if the condition isn't addressed.

How To Diagnose Auto-Brewery Syndrome

Diagnosis involves a combination of laboratory tests and clinical observation. Because the condition is rare, doctors typically rule out other illnesses first.

Preliminary steps include reviewing medical history, documenting symptoms, and performing a physical exam. Blood and urine tests help exclude other conditions, while stool samples and endoscopies can detect bacterial or fungal overgrowth.

If other causes are eliminated, a carbohydrate challenge test may be conducted. This involves consuming a carbohydrate-rich meal or glucose pills on an empty stomach, followed by BAC measurement. An elevated BAC without alcohol consumption indicates auto-brewery syndrome.

Can You Drink With Auto-Brewery Syndrome?

Drinking alcohol can be extremely dangerous for individuals with auto-brewery syndrome. Since their bodies already produce alcohol from carbohydrates, additional alcohol consumption can lead to dangerously high BAC levels, increasing the risk of severe intoxication and long-term health damage.

Even after treatment with antifungals, symptoms can recur. Alcohol disrupts the gut microbiome and weakens the immune system, raising the likelihood of yeast overgrowth returning.

Dangers of Auto-Brewery Syndrome

Auto-brewery syndrome poses significant risks, particularly when undiagnosed or misunderstood. Unlike typical alcohol consumption, intoxication can occur unexpectedly after a carbohydrate-rich meal.

Risks include:

• Increased accident risk
• Alcohol poisoning
• Risky behavior
• Decreased motor control
• Impaired judgment

Long-term health effects mirror those of chronic alcohol use:

• Liver damage or disease
• Cardiovascular disease
• Certain cancers
• Diabetes
• GI issues

The condition can also lead to alcohol cravings and dependence, legal problems such as DUI charges, and negative impacts on employment or academic performance.

Treating Auto-Brewery Syndrome

Treatment typically combines lifestyle changes and medication. Dietary adjustments include:

• Avoiding carbohydrates
• Avoiding processed foods
• Avoiding added sugars
• Eating a higher-protein diet for satiety

Antifungal medications target the yeast overgrowth:

• Fluconazole
• Itraconazole
• Nystatin
• Echinocandins

Probiotic supplements may be recommended to restore gut balance. Since the condition isn't fully understood, treatment plans are tailored to the individual. Recurrence is possible, requiring long-term management for some.

Managing Auto-Brewery Syndrome

Long-term lifestyle changes can help prevent recurrence:

• Treat underlying conditions: Managing related health issues reduces gut microbiome imbalance.
• Exercise regularly: Physical activity supports a healthy gut microbiome and strengthens the immune system.
• Limit added sugars: Reducing sugar intake helps maintain gut balance and lowers obesity and diabetes risk.
• Choose complex carbohydrates: Opt for whole grains and vegetables over simple carbs to prevent blood sugar spikes.
• Quit or cut back on alcohol: Alcohol feeds yeast overgrowth and disrupts gut health, increasing recurrence risk.

Key Takeaways

Auto-brewery syndrome, though extremely rare, mimics the effects of drinking alcohol without actual consumption. Similar to how alcohol is produced through fermentation, an overgrowth of gut yeast replicates this process inside the body. This can be dangerous if untreated, and drinking alcohol can exacerbate the risks. For those with the condition, and indeed for everyone, reducing or eliminating alcohol consumption can offer significant health benefits. Tools like Quitemate can support those looking to make positive changes to their drinking habits.