Auto-brewery Research Articles

Evidence for an early onset of endogenous alcohol production in bodies recovered from the water: implications for studying alcohol and drowning

Endogenous alcohol production can increase the blood alcohol concentration (BAC) of drowning victims following submersion and confound epidemiological studies of the role of alcohol. This study seeks to determine how soon after a drowning death a victim’s BAC is influenced by post-mortem alcohol production. The drop in mean lung weight that occurs over time in the water was hypothesized to serve as a proxy for the time course of decomposition, and thus provide an empirical measure to determine how soon after death to first suspect endogenous alcohol. The autopsy lung weights of 562 previously healthy males who drowned were compared across six submersion time groups (0–11.9, 12–23.9, 24–47.9, 48–95.9, 96–167.9 and ≥168 h) and two times of year (winter and non-winter). The hypothesis that a drop in lung weight is sensitive to the time course of decomposition was supported by (1) a statistically significant drop in mean lung weight that occurred 12–23.9 h post-submersion in the non-winter months, but not until 96–167.9 h in the colder winter months; and (2) a significant drop in lung weight was not observed in the group of cases with zero BAC. With a parallel finding that an increase in the proportion of cases with a positive BAC first occurred at the 12–23.9 h submersion group during the warmer non-winter months, we concluded that production of alcohol can occur in bodies recovered from the water as early as 12 h after death. Because excluding drownings with submersion durations greater than 12 h would exclude almost half of our cases from epidemiological studies of alcohol and drowning, additional evidence from the forensic literature was used to develop an adjustment procedure to account for endogenous alcohol production for submersion times of up to 1 week.

Endogenous ethanol 'auto-brewery syndrome' as a drunk-driving defence challenge.

The concentration of ethanol in blood, breath or urine constitutes important evidence for prosecuting drunk drivers. For various reasons, the reliability of the results of forensic alcohol analysis are often challenged by the defence. One such argument for acquittal concerns the notion that alcohol could be produced naturally in the body, hence the term 'auto-brewery' syndrome. Although yeasts such as Candida albicans readily produce ethanol in-vitro, whether this happens to any measurable extent in healthy ambulatory subjects is an open question. Over the years, many determinations of endogenous ethanol have been made, and in a few rare instances (Japanese subjects with very serious yeast infections) an abnormally high ethanol concentration (> 80 mg/dl) has been reported. In these atypical individuals, endogenous ethanol appeared to have been produced after they had eaten carbohydrate-rich foods. A particular genetic polymorphism resulting in reduced activity of enzymes involved in hepatic metabolism of ethanol and a negligible first-pass metabolism might explain ethnic differences in rates of endogenous ethanol production and clearance. Other reports of finding abnormally high concentrations of ethanol in body fluids from ostensibly healthy subjects suffer from deficiencies in study design and lack suitable control experiments or used non-specific analytical methods. With reliable gas chromatographic methods of analysis, the concentrations of endogenous ethanol in peripheral venous blood of healthy individuals, as well as those suffering from various metabolic disorders (diabetes, hepatitis, cirrhosis) ranged from 0-0.08 mg/dl. These concentrations are far too low to have any forensic or medical significance. The notion that a motorist's state of intoxication was caused by endogenously produced ethanol lacks merit.

Regulation of Candida albicans populations in the gastrointestinal tract: mechanisms and significance in GI and systemic candidiasis.

Colonization of the gastrointestinal (GI) tract by Candida species, and C. albicans in particular, may play an important role in human health and disease, as the GI tract has been implicated as an important source of infection in cases of recurrent vaginitis (104) and systemic candidiasis (94,112,149–151,164). The overgrowth of C. albicans in the intestinal tract and its subsequent passage through the gut mucosa into the host bloodstream, for instance, is believed to be the proximate mechanism leading to systemic candidiasis (151), particularly in patients with acute leukemia (103,112,129). Similarly, colonization of the GI tract by C. albicans and other Candida spp. may lead to involvement in a number of other disease syndromes that include esophageal, gastric and intestinal thrush, gastric and intestinal ulceration, GI bleeding, diarrhea, peritonitis, perianal itch, napkin dermatitis, chronic “irritable bowel” syndrome, and auto-brewery syndrome (12,59,60,80,81,94,102,106,112,117,118,130,131,149–151,156, 164,165,171). The importance of GI colonization by C. albicans therefore should not be underestimated, especially in view of the suggestion that “the most important source of Candida species in human disease is endogenous” (118). On the other hand, GI colonization by C. albicans may also have important beneficial effects on the host in that it apparently results in stimulation of the immune system, leading to a protective response to systemic Candida infection in the noncompromised host (31,32).

Production of ethanol from infant food formulas by common yeasts.

Four common yeasts (Candida albicans, Candida tropicalis, Torulopsis glabrata and Saccharomyces cerevisiae) were combined with five infant food formulas and/or supplements (Isomil, Nutramigen, 5% glucose, Coca Cola and Similac) and incubated at 37 degrees C. Gas chromatography was used to measure ethanol production after 24 and 48 h incubation. The quantities of ethanol produced suggest a possible explanation for patients exhibiting the 'Auto-Brewery Syndrome' and raises interest in the role auto-produced ethanol could have in explaining the etiology of Sudden Infant Death.

Endogenous alcohol production by intestinal fermentation in sudden infant death.

In some cases of sudden infant death syndrome (SIDS) the intestinal flora was found to be dominated by Candida albicans. Microbiologic investigations of the various organs showed the occasional presence of different Candida species, but not in the form of massive growth as in sepsis. There is no basis to assume that the activity of yeasts, first of all of Candida albicans, is a contributory factor in the occurrence of SIDS. Candida albicans was shown to produce alcohol from glucose at a rate of maximally 1 mg of alcohol per gram of intestinal content per hour. It is concluded that the intestinal production of alcohol in vivo from cases showing a Candida albicans dominated intestinal flora will not be able to surpass the normal alcohol metabolizing capacity of the liver. Thus, measurable concentrations of alcohol in the blood from such cases cannot be expected.