Auto-brewery Research Articles

Auto-brewery Syndrome: A Comprehensive Review of an Endogenous Ethanol Production Disorder

Auto-brewery Syndrome: A Comprehensive Review of an Endogenous Ethanol Production Disorder

S4477 A Case of Auto Brewery Syndrome (ABS) Complicating Cirrhosis and Leading to Liver Transplant

S4477 A Case of Auto Brewery Syndrome (ABS) Complicating Cirrhosis and Leading to Liver Transplant

S3958 Brewed from Within: A Case of Phosphatidylethanol Positive Auto-Brewery Syndrome in a Patient with Crohn’s Disease

S3958 Brewed from Within: A Case of Phosphatidylethanol Positive Auto-Brewery Syndrome in a Patient with Crohn’s Disease

The Intersection of Ultra-Processed Foods, Neuropsychiatric Disorders, and Neurolaw: Implications for Criminal Justice.

Over the last decade there has been increasing interest in the links between the consumption of ultra-processed foods and various neuropsychiatric disorders, aggression, and antisocial behavior. Neurolaw is an interdisciplinary field that seeks to translate the rapid and voluminous advances in brain science into legal decisions and policy. An enhanced understanding of biophysiological mechanisms by which ultra-processed foods influence brain and behavior allows for a historical reexamination of one of forensic neuropsychiatry's most famous cases-The People v. White and its associated 'Twinkie Defense'. Here in this Viewpoint article, we pair original court transcripts with emergent research in neurolaw, including nutritional neuroscience, microbiome sciences (legalome), pre-clinical mechanistic research, and clinical intervention trials. Advances in neuroscience, and related fields such as the microbiome, are challenging basic assumptions in the criminal justice system, including notions of universal free will. Recent dismissals of criminal charges related to auto-brewery syndrome demonstrate that courts are open to advances at the intersection of neuromicrobiology and nutritional neuroscience, including those that relate to criminal intent and diminished capacity. As such, it is our contention that experts in the neurosciences will play an increasing role in shaping research that underpins 21st-century courtroom discourse, policy, and decision-making.

Correction to "Auto-brewery syndrome in a 50-year-old woman".

Correction to "Auto-brewery syndrome in a 50-year-old woman".

Endogenous ethanol production in health and disease.

The gut microbiome exerts metabolic actions on distal tissues and organs outside the intestine, partly through microbial metabolites that diffuse into the circulation. The disruption of gut homeostasis results in changes to microbial metabolites, and more than half of the variance in the plasma metabolome can be explained by the gut microbiome. Ethanol is a major microbial metabolite that is produced in the intestine of nearly all individuals; however, elevated ethanol production is associated with pathological conditions such as metabolic dysfunction-associated steatotic liver disease and auto-brewery syndrome, in which the liver's capacity to metabolize ethanol is surpassed. In this Review, we describe the mechanisms underlying excessive ethanol production in the gut and the role of ethanol catabolism in mediating pathogenic effects of ethanol on the liver and host metabolism. We conclude by discussing approaches to target excessive ethanol production by gut bacteria.

Auto-brewery syndrome in a 50-year-old woman.

Auto-brewery syndrome in a 50-year-old woman.

A catalog of ethanol-producing microbes in humans.

Aim: Endogenous ethanol production emerges as a mechanism of nonalcoholic steatohepatitis, obesity, diabetes and auto-brewery syndrome. Methods: To identify ethanol-producing microbes in humans, we used the NCBI taxonomy browser and the PubMed database with an automatic query and manual verification. Results: 85 ethanol-producing microbes in human were identified. Saccharomyces cerevisiae, Candida and Pichia were the most represented fungi. Enterobacteriaceae was the most represented bacterial family with mainly Escherichia coli and Klebsiellapneumoniae. Species of the Lachnospiraceae and Clostridiaceae family, of the Lactobacillales order and of the Bifidobacterium genus were also identified. Conclusion: This catalog will help the study of ethanol-producing microbes in human in the pathophysiology, diagnosis, prevention and management of human diseases associated with endogenous ethanol production.

S2895 A Complex Conundrum: Investigating Auto-Brewery Syndrome as a Rare and Misdiagnosed Condition

S2895 A Complex Conundrum: Investigating Auto-Brewery Syndrome as a Rare and Misdiagnosed Condition

The Human Body as an Ethanol-Producing Bioreactor—The Forensic Impacts

Auto-brewery syndrome (ABS), also called gut fermentation syndrome, is an extremely infrequent but also underrecognized disorder where ethanol is produced endogenously, similar to a typical bioreactor. The reliability of forensic alcohol analysis results is frequently challenged as the ethanol concentration in the breath, blood, and/or urine constitutes important evidence for prosecuting drivers under the influence of the alcohol. This further emphasizes the need to understand ABS, as in legal proceedings it is often presented as grounds for acquittal due to the concept that the findings could have corresponded to endogenously produced ethanol. However, this rare and underdiagnosed medical condition should not be considered as purely a lawyer’s favorite argument. Manifestations of ABS can have a severe impact on a patient’s life and pose social consequences as well. Unfortunately, barely anything has been unearthed, and aspects such as genetic susceptibility, gut-mucus-eating microorganisms, and fecal microbiome transplantation were reviewed for the first time in this context. The framework of this review was not limited to the gut microbiota exclusively; moreover, the overgrowth of microorganisms is linked to the use of antibiotics. Studies have indicated that carbohydrate fermentation occurs in locations other than in intra-intestinal flora. Accordingly, the literature was searched for cases of patients with ABS with yeast infections in their genitourinary or oral systems.

The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective.

Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords.In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.

The Influence of the Oral Microbiome on Oral Cancer: A Literature Review and a New Approach.

In our recent article (Smędra et al.: Oral form of auto-brewery syndrome. J Forensic Leg Med. 2022; 87: 102333), we showed that alcohol production can occur in the oral cavity (oral auto-brewery syndrome) due to a disruption in the microbiota (dysbiosis). An intermediate step on the path leading to the formation of alcohol is acetaldehyde. Typically, acetic aldehyde is transformed into acetate particles inside the human body via acetaldehyde dehydrogenase. Unfortunately, acetaldehyde dehydrogenase activity is low in the oral cavity, and acetaldehyde remains there for a long time. Since acetaldehyde is a recognised risk factor for squamous cell carcinoma arising from the oral cavity, we decided to analyse the relationship linking the oral microbiome, alcohol, and oral cancer using the narrative review method, based on browsing articles in the PubMed database. In conclusion, enough evidence supports the speculation that oral alcohol metabolism must be assessed as an independent carcinogenic risk. We also hypothesise that dysbiosis and the production of acetaldehyde from non-alcoholic food and drinks should be treated as a new factor for the development of cancer.

Changes in the mRNA expression of glycolysis-related enzymes of Candida albicans during inhibition of intramitochondrial catabolism under anaerobic condition.

Candida albicans can cause two major types of infections: superficial infection and systemic candidiasis. C. albicans infects diverse host niches, owing to a wide range of virulence factors and attributes, such as morphological transitions and phenotypic switching. C. albicans uses glycolysis, followed by alcoholic fermentation or mitochondrial respiration to rapidly generate ATP under aerobic conditions. In this study, we quantified the mRNA expression of several glycolysis-related enzymes associated with the initial phase of environmental changes using two strains: a type strain, NBRC 1385, and a strain from a patient with auto-brewery syndrome, LSEM 550. Additionally, we analyzed the regulation of a rate-limiting enzyme in glycolysis, phosphofructokinase 1 (PFK1). Our results showed that the mRNA expression of enzymes in the middle and last stages of glycolysis and alcoholic fermentation increased, and that of mitochondrial respiration enzymes decreased under short-term anaerobic conditions. Carbonyl cyanide-p-trifluoromethoxyphenylhydrazone (FCCP) administration showed similar results under anaerobic conditions. Moreover, PFK1 maintained its regulatory effect under different conditions; no significant change was observed in its mRNA expression. Our results suggest that C. albicans obtains energy via carbohydrate catabolism in the early phase of environmental change and survives in various parts of the host.

Understanding Auto-Brewery Syndrome in 2023: A Clinical and Comprehensive Review of a Rare Medical Condition.

Auto-brewery syndrome (ABS) occurs when the gastrointestinal tract produces excessive endogenous ethanol. This article examines various aspects of ABSsuch as its epidemiology, underlying etiology, diagnostic difficulties, management strategies, and social implications. By synthesizing the existing medical literature, we hope to identify understanding gaps, pave the way for further research, and ultimately improve detection, treatment, and awareness. The databases we used are PubMed, PubMed Central, and Google Scholar. We carefully screened all published articles from inception till date and narrowed down 24 relevant articles. We at Richmond University Medical Center and Mount Sinai are one of the leading medical centers for diagnosing and treating this rare condition in the United States.

Three Klebsiella species as potential pathobionts generating endogenous ethanol in a clinical cohort of patients with auto-brewery syndrome: a case control study

Patients with auto-brewery syndrome (ABS) become inebriated after the ingestion of an alcohol-free, high-carbohydrate diet. Our previous work has shown that high-alcohol-producing (HiAlc) Klebsiella pneumoniae can generate excessive endogenous ethanol and cause non-alcoholic fatty liver disease (NAFLD). Therefore, it is reasonable to speculate that such bacteria might play an important role in the pathogenesis of ABS. The characteristics and metabolites of the intestinal flora from a clinical cohort of patients with ABS were analysed during different stages of disease and compared to a group of healthy controls. An invitro culture system of relevant samples was used for screening drug sensitivity and ABS-inducing factors. Rabbit intestinal and murine models were established to verify if the isolated strains could induce ABS invivo. We observed intestinal dysbiosis with decreased abundance of Firmicutes and increased of Proteobacteria in patients with ABS compared with healthy controls. The abundance of the genus Klebsiella in Enterobacteriaceae was strongly associated with fluctuations of patient's blood alcohol concentration. We isolated three species of HiAlc Klebsiella from ABS patients, which were able to induce ABS in mice. Monosaccharide content was identified as a potential food-related inducing factor for alcohol production. Treatments with antibiotics, a complex probiotic preparation and a low-carbohydrate diet not only alleviated ABS, but also erased ABS relapse during the follow-up observation of one of the patients. Excessive endogenous alcohol produced by HiAlc Klebsiella species was an underlying cause of bacterial ABS. Combined prescription of appropriate antibiotics, complex probiotic preparation and a controlled diet could be sufficient for treatment of bacteria-caused ABS. The funders are listed in the acknowledgement.

“Believe Me, I Don't Drink”: A Case of Auto-Brewery Syndrome in Psychiatric Practice

This is the first case report of auto-brewery syndrome (ABS) in a psychiatric setting. ABS, also known as gut fermentation disorder or endogenous ethanol fermentation, is a rare disorder where microbe overgrowth in the gut leads to alcohol fermentation, causing symptoms similar to alcohol intoxication without ingestion of alcohol. In this case report, we discuss possible etiology, clinical presentation, diagnosis, and management of ABS. This case will help practicing psychiatrists add ABS to their differential when seeing a patient in an emergency setting who appears intoxicated but denies any alcohol intake. [ Psychiatr Ann . 2023;53(4):184–187.]

(162) Intoxicated Without a Drop to Drink: A Case Report Of Auto-Brewery Syndrome

(162) Intoxicated Without a Drop to Drink: A Case Report Of Auto-Brewery Syndrome

S3412 Functional Medicine Approach to Care Improves Quality of Life and Blood Alcohol Levels in a Patient With Autobrewery Syndrome

Introduction: Autobrewery syndrome, or gut fermentation syndrome (GFS), is a rare condition characterized by elevated blood alcohol concentration (BAC) in the absence of alcohol consumption. Treatment involves antifungals and a low carb diet, which are often ineffective. In this case, we describe a patient with GFS who failed traditional therapy, was unable to complete activities of daily living due to high BAC, and responded well to a functional medicine approach to care with sustained improvement in BAC. Case Description/Methods: In 7/2020, a 58-year-old man with T2D, obesity, HTN and gout developed recurrent episodes of dysarthria, behavioral changes, and somnolence. On multiple occasions in the ER, his BAC level was found to be elevated. The patient and family denied alcohol use. He was ultimately diagnosed with GFS. He self-initiated a strict low-carb diet with initial success in controlling his BAC from 11/2020 to 12/2020. From 10/2020 to 10/2021, he underwent multiple courses of antifungal medications (nystatin, fluconazole, micafungin, and oral amphotericin). The longest period of remission (BAC 0) was 41 days while on micafungin. After 41 days on micafungin and a restricted diet, his BAC increased. Over this time, he lost 80 lbs. In 11/2021, he established with a functional medicine GI and dietitian. Stool metabolomics showed no obvious abnormalities. The 5 R protocol (remove, replace, repair, reinoculate, rebalance) was introduced. He started with an aggressive bowel regimen with prucalopride and lactulose. He completed 15 days of high-potency Bacillus subtilis probiotic, followed by a transition to a more diverse probiotic. He added daily intake of a medical food to his restricted diet. New foods were then introduced, one at a time, in the evening, with subsequent monitoring of BAC. In 2/2022, he started Undecylenic acid (10-Undecenoic Acid) as fatty acid support. Lifestyle modifications were added to emphasize more exercise, daily outdoor walks, optimal sleep, and decreasing stress. He did well until BAC levels spiked in 3/2022 due to consumption of alcohol, triggered by cravings that developed when the gut production of alcohol decreased. After alcohol cessation, BAC levels have remained undetectable for 60+ days with continued diet modifications and supplements (Figure). Discussion: GFS is difficult to treat with minimal traditional treatment options. This case is a patient with GFS that failed all medical options and is now thriving after a functional medicine approach to care.Figure 1.: BAC levels continued to spike with medical therapies and have sustained improvement with functional medicine care.

S3013 Home Brew Gone Wrong: A Case Report on Potential Auto-Brewery Syndrome Sequelae

Introduction: Auto-Brewery Syndrome (ABS) is a condition not often seen in medical practice. It involves the conversion of carbohydrates to alcohol by the intestinal microbiome in a subset of patients. However, when these patients deny any consumption of alcohol, they are often brushed off or worked up for other etiologies, including stroke or hypoglycemia. There are also many possible medical sequelae that are not as widely reviewed due to the rarity of this disease. These include symptoms of chronic alcohol consumption such as increased alcohol cravings addiction, possible neuropathy, and liver disease such as fatty liver disease or cirrhosis. Case Description/Methods: In this case, we present a 26-year-old male with a history of auto-brewery syndrome presenting with bilateral lower extremity paralysis, sensation loss, and neuropathy. These symptoms were similar to an episode which was inconclusive. He consumed alcohol occasionally but was sober at that time. During that stay, he was diagnosed with auto-brewery syndrome. In ED, his blood alcohol was 493mg/dL, although he was sober for 1 year, and his liver function tests were significantly elevated with AST twice the level of ALT, consistent with findings of alcoholic liver injury. There was some return of neurological and hepatic function over the hospital stay with supportive care. He was placed on a consistent carbohydrate diet and his LFTs subsequently improved. Discussion: While there is data on potential causes and causative organisms for this condition, there is little in the literature on the potential sequelae associated with auto-brewery syndrome. Chronic alcoholism and its effects are widely seen and studied. From alcohol neuropathy to cirrhosis, the effects of consistent alcohol consumption are deleterious to one’s health. The question that needs to be asked is: are patients with chronic exposure to endogenous alcohol at risk for the same complications seen in chronic alcoholism? Cirrhosis, which is seen as a risk factor for ABS, may actually be a consequence of ABS. In this patient, his AST and ALT were mildly elevated, even during previous admission. Therefore, the patient may have been experiencing chronic liver injury from alcohol use while sober, placing him at increased risk for NASH and eventually cirrhosis at a much earlier onset than expected. It would be imperative in this case to ensure that the patient is on a limited intake of carbohydrates, or antifungals if necessary.

Auto brewery syndrome

Auto brewery syndrome is also known as intestinal fermentation syndrome in which ethanol is produced through engogenous fermentation of fungi or bacteria in gastro-intestinal system, oral cavity or into urinary tract system. It is a rare medical condition which intoxicating quantities of ethanol are produced by endogenous fermentation in the digestive system. The organism responsible for auto brewery syndrome and it includes various organisms yeast and bacteria including including Saccharomyces Cerevisiae, Saccharamyces Boulardii, Candida Albicans, Candida tropical is, Candida Krusei, Candida Glabrata, Candida KEFYR, Candida Parapsilosis, Klebsiella pneumonia and Enterococcus fascism. These organisms use lactic acid fermentation or mixed acid fermentation pathways.