Though she exhibited all the signs of intoxication, including a foul odour on her breath, the 50-year-old Toronto woman insisted she hadn't touched a drop of alcohol. This went on for two years of doctor visits with her husband, pleading her case, until finally, someone believed her. Her dizziness, disorientation, and weakness even led to a fainting incident where she struck her head while making lunch for her children.
"She visited her family doctor again and again and went to the emergency room seven times over two years," Dr Rahel Zewude, an infectious disease specialist at the University of Toronto told CNN.
Doctors were baffled to find the woman's alcohol levels fluctuating between a dangerously high 30 to 62 millimoles per litre. For reference, normal levels are below 2 millimoles per litre. Barbara Cordell, an expert on a rare condition called Auto-Brewery Syndrome, explained that while levels of 62 are life-threatening, some individuals with this syndrome can function at levels as high as 30-40 millimoles per litre.
"I know of over 300 people diagnosed with auto-brewery syndrome and we have over 800 patients and caregivers in our private Facebook support group," said Cordell, who was not involved in the new case.
"Part of the mystery of this syndrome is how these people can have these extremely high levels and still be walking around and talking."
Despite the woman's concerning symptoms, emergency room doctors remained unconvinced by her claims of sobriety. Further scrutiny came from three separate hospital psychiatrists who ultimately ruled out alcohol dependence (alcohol use disorder) as a cause.
"She told doctors her religion does not allow drinking, and her husband verified she did not drink," said Zewude, who treated the woman and coauthored a report on the anonymous case that was published Monday in the Canadian Medical Association Journal.
"But it wasn't until the seventh visit that an emergency room doctor finally said, 'I think this sounds like auto-brewery syndrome,' and sent her to a specialist," Zewude said.
Dr. Fahad Malik, a gastroenterologist specializing in Auto-Brewery Syndrome, understands the woman's struggle. With 30 patients under his care (though not involved in this specific case), he's seen firsthand how common disbelief and even ridicule are for those with this condition.
"Most patients have been disregarded as 'closet drinkers' or with behaviour conditions before diagnosis," said Malik, who is also a clinical assistant instructor at the State University of New York Upstate Medical University.
A very uncommon condition called Auto-brewery Syndrome, also known as gut fermentation syndrome, causes the body to turn everyday carbohydrates into alcohol through the action of bacteria and fungus in the gut. This surprising condition first came to light in 1946, when an autopsy of a 5-year-old African boy who died from a ruptured stomach revealed a surprising finding: his abdomen was filled with a frothy liquid that smelled strongly of alcohol.
Despite the first documented case in 1946, Auto-brewery Syndrome remains rare. An April 2021 review found only 20 diagnosed cases reported in English medical literature since 1974. Interestingly, Japan has documented additional cases under the name "meitei-sho" or "alcohol auto-intoxication syndrome." This suggests the condition might be more widespread than diagnosed rates currently reflect.
Auto-brewery syndrome disrupts the delicate balance of our gut microbiome. When certain fungi and bacteria overgrow, they essentially turn the digestive tract into a fermentation vat, similar to a brewing still. This internal fermentation, unlike the healthy gut processes in the large intestine, produces alcohol.
Scientists believe this abnormal fermentation occurs primarily in the small intestine. While various pathogens can be culprits, the most common offenders are fungal overgrowths, particularly of Saccharomyces and Candida. Candida, a fungus naturally present in the body, can take advantage of situations where beneficial bacteria are depleted, often after antibiotic use.
A striking case documented in 2013 involved a 61-year-old man who experienced unexplained intoxication for years. The culprit? An overabundance of Saccharomyces cerevisiae, or brewer's yeast - the very yeast used in beer production!
