The human body is a marvel when it works.
It’s… interesting when it fucks up a bit.
It’s super holyshitballs terrifyingly amazing when it fucks up in unusual ways.
Because anybody can feel out of it from the sniffles, but it takes quite the trick of nature to get hammered on a cookie.
Today’s Moment of Science… Auto-Brewery Syndrome.
Everything that’s thrown down the ol’ gullet is stripped for parts by a soup of acids and enzymes. Sugars, proteins, and vitamins are torn molecule from molecule, converted into shit the body can use, and whatever shit it can’t is turned into, well, shit. Given the choreography involved in metabolizing everything from cauliflower to Flamin’ Hot Cheetos, it’s amazing that this dance ever goes off a hitch. It’s somehow less surprising when it fucks up catastrophically.
So, getting drunk on your own supply.
Sounding every bit like something one of my brilliant idiot friends would claim in a moment of desperation, the internet assures me that auto-brewery syndrome (ABS) is a real and potentially serious disorder. The first known description of ABS in the medical literature was likely a 1948 write-up in the BMJ, Rupture of Stomach in African Child. It appeared the digestion of a sweet potato yielded both alcohol and a build-up of gas, leading to a fatal three inch tear in the young patient’s stomach wall.
How exactly does the digestive system go into auto-Friday mode? A group of pathogenic yeast and bacteria that produce alcohol via one of a few types of fermentation are typically the cause. Growing a gut full of Candida and homebrew is a messy business that involves– technical term– throwing the digestive ecosystem into utter chaos. Popping antibiotics like sexy sexy m&m’s along with an imbalanced diet, particularly one high in carbs and sugar, are known risk factors. This can unalive good bacteria while fueling the more disruptive microbeasts. Other risk factors include short bowel disorder, type 2 diabetes, liver cirrhosis, and decreased levels of enzymes like aldehyde dehydrogenase.
It’s hit or miss which risk factors show up in case reports on the drunken pathogenic candida experience (my band name). They typically have one thing in common though; people thought they were just drunks.
A 45 year old man with type 2 diabetes was put on a long course of antibiotics after nasal septal surgery. He had been a non-drinker for twenty years. Two months after completing his antibiotics, he was back at the hospital, apparently inebriated and having seizures. He’d been arrested for drunk driving multiple times and was admitted with a blood alcohol content (BAC) of 0.41% (the legal limit is 0.08%). Doctors suspected the seizures were due to alcohol withdrawal. It took extensive testing under supervision at multiple facilities over the course of 14 months to prove his gut flora was the culprit. When standard treatment with oral fluconazole failed, he needed a two month course of intravenous antifungal medication.
A 25 year old man with no apparent risk factors went to the ER because, a few times a week after dinner, he felt drunk. Which wouldn’t have been cause for alarm except that he hadn’t been drinking. He’d recently tried keto to lose weight, which… is another discussion for another day, but it was the only change to his diet, and not one typically associated with ABS. In the emergency room, he was found to have a BAC of 0.3%. They couldn’t do much except let him sober up, give him a referral, and send this obvious lush home. Testing by specialists showed that he was a perfectly healthy human distillery. Treatment with three weeks of oral fluconazole resolved his symptoms entirely. He also stopped doing fucking keto.
A 13 year old girl with short bowel disorder presented with ‘bizarre’ behavior, a lack of coordination, drowsiness, fruity smelling breath, and of course, parental suspicion that she was acting like a teenager. She denied the drinking of course, but her BAC was as high as 0.35%. She was admitted to a rehab facility where, somehow, she continued getting wasted. They started putting together that this could be ABS, with symptoms appearing after having a higher carb meal or snack. After a couple courses of antibiotics didn’t work, they tried testing and found that, fucking yikes, this was a fungal issue. Fluconazole and done, baby.
To prove that someone’s body is producing alcohol, typically a carbohydrate challenge test is used. TL;DR, eat sugar on an empty stomach and see if drunkenness ensues. Which is not dissuading me from wrecking my gut bacteria just out of curiosity.
ABS is suspected to be under-diagnosed, but it’s rare like a sincere person on twitter, so it’s just not particularly easy to recognize. It also must take some fucking audacity to suggest “I think this person’s stomach got them drunk.” But even if diagnosed correctly every time, the number of cases annually likely wouldn’t be that high. With every known risk factor, odds are you’ll still need to go through the trouble of drinking to drink away your trouble.
This has been your Moment of Science, waiting for the day when auto-cannabis syndrome is finally diagnosed.
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