Man acquitted of drink-driving after he proves his body creates its own alcohol: What is auto-brewery syndrome?

ABS, explained

Auto-brewery syndrome, also known as gut fermentation, is a mysterious condition that raises the levels of alcohol in the blood and produces the symptoms of alcohol intoxication in patients, even when they have had minimal or no alcohol intake.

The condition was first described in Japan in 1952 and was only formally named as such in 1990.

According to experts, this condition occurs when an overgrowth of certain types of fungus in the gut convert carbohydrates into alcohol. They explain that ABS occurs as a result of an underlying condition, such as gastrointestinal disease and microbiome imbalances. Other conditions such as Crohn's disease, diabetes , irritable bowel syndrome (IBS) could also increase the risk of developing ABS.

Dr Payal Kohli, ABC10 health expert, said: "We've seen it in adults and in children, both men and women, but what we tend to see is its people who have kind of chronic illness, particularly chronic GI illness such as Crohn's disease or SIBO, which is small intestinal bacterial overgrowth syndrome, short gut syndrome. We've also seen higher risk in patients with diabetes and obesity because again, those types of conditions can throw your gut flora out of whack. But really, it can also happen in healthy people as well."

Experts note that besides the levels of intoxication, ABS patients will complain of symptoms such as headaches, nausea, belching, loss of coordination, memory problems and difficulty in concentrating.

Prevalence of ABS

ABS is a rare condition with medical experts stating only 20 people have been diagnosed with it officially. Authors of a 2019 case report in BMJ Open Gastroenterology also noted ABS was an underdiagnosed medical condition.

In fact, before the case of the Belgium man, there was another Belgian who had been diagnosed with ABS.

There have also been other cases, including that of Mark Mongiardo, a 40-year-old resident of Florida. Recounting his struggles to Today.com, he said that he had begun his teaching and coaching career. When someone complained of him smelling like alcohol, he recalls being called into the principal's office — something that happened off and on for the next several years. It escalated, and from 2012 and 2016, he often found himself in the principal or athletic director's office answering questions about alcohol consumption.

But it was only in 2019 that he finally found the existence of ABS online and came to the conclusion that he struggled from it too.

A woman in New York also had a drink-driving charge dismissed in 2015 after her lawyers argued she had ABS, too, CNN reported.

Doctors state that in many cases, diagnosing ABS becomes difficult as the patients don't struggle with intoxication. Panola College Dean of Nursing Barbara Cordell was quoted as telling USAToday, "I have seen in a few cases where they function at alcohol levels such as 0.30 and 0.40 when the average person would be comatose or dying. Part of the mystery of this syndrome is how they can have these extremely high levels and still be walking around and talking."

Treatment for ABS

While ABS may sound unreal, doctors have come up with ways to treat it. One of the main treatment methods is to change diets. Doctors note that those with ABS should avoid carbohydrates and processed foods.

A doctor will likely recommend that people follow a low sugar diet until their symptoms resolve. People who no longer experience symptoms can try gradually reintroducing carbohydrates to their diet.

Doctors can also treat auto-brewery syndrome with antifungals and, in some cases, antibiotics. Antifungals can help reduce the amount of fungus in the gut. In some cases, probiotic supplements may help balance the microbes in the gut by introducing beneficial bacteria and inhibiting fungal growth. However, the efficacy of probiotic supplements as a treatment for auto-brewery syndrome remains unclear.

With inputs from agencies