Pathophysiological Processes: Auto-Brewery Syndrome
In late December 2014, Ray Lewis, a former truck driver for the Oregon Department of Fish and Wildlife, was seriously injured and lost his job when he crashed and overturned his truck and spilled its cargo of 11,000 salmon on the McKenzie River Highway outside of Eugene, Oregon. Lewis was charged with Driving Under the Influence (DUI) – having a. 29 blood alcohol level, which is three times above the legal limit (Medrano, 2017). In 2015, after medical tests, Lewis was diagnosed with auto-brewery syndrome. Auto-brewery syndrome, also known as gut fermentation syndrome or endogenous ethanol fermentation, occurs when abnormal amounts of gastrointestinal yeast convert common food carbohydrates into ethanol (LaMotte, 2016). A person with this digestive disorder experiences alcohol (ethanol) intoxication without consuming any alcohol.
Instead, a person becomes naturally intoxicated by the ingestion of carbohydrate-rich foods such as bread, potatoes or rice. Alcohol is produced inside the body from sugars and other carbohydrates by a process called fermentation, which is the chemical breakdown of bacteria or yeast. The earliest case of auto-brewery syndrome was recognized in Japan in 1972. Since then, only a few cases of this disorder have been reported in the last three decades (Cordell & McCarthy, 2013). Through stool cultures, it was found that the causative organism of auto-brewery syndrome is a yeast called saccharomyces cerevisiae. (Cordell & McCarthy, 2013). This form of yeast is used as an ingredient in bread, as well as alcoholic products. People who suffer from auto-brewery syndrome will have an overgrowth of saccharomyces cerevisiae in their body (specifically in the small intestine) and begin to convert sugars from foods, usually carbohydrates, into alcohol (MacMillan, 2016).
Although auto-brewery syndrome is a rare medical condition, Kelly Painter and Richard Whitten from the National Center for Biotechnology Information (2018), state that this condition has been identified in both adults (males and females) and children -- of any age. Contributing risk factors that accompany auto-brewery syndrome is the excessive consumption of carbohydrate-rich food, gastrointestinal surgery, and antibiotic medications. These factors are known to eliminate the bacteria in the stomach and allow for the production of Brewer’s yeast.
Auto-brewery syndrome must be recognized because of the social implications such as physical harm or death (both self and others), incarceration, and loss of employment. Modifiable factors, such as diet alone, can help decrease the symptoms of this disorder. Some of the signs and symptoms that manifest in diagnosing this condition are: dizziness, dry mouth, sugar cravings, stomach pain, bloating, gas, belching, changes in bowel movement, hangovers, generalized aches and pains, discharge from the nose, a productive cough, and sinusitis. Chronic fatigue syndrome is also associated with this disease so feelings of anxiety, depression, problems with concentration, memory, and thought processes can also be affected. There are several complications that pertain with this disorder, with the random state of intoxication it can result in difficulties to focus and function throughout the day like performing daily tasks or even while being at work. The obscurity of this condition may also make it difficult to diagnose and find a successful treatment (Painter & Whitten, 2018). The person may often be mistaken for being a heavy drinker, and denial is common among people who drink too much. Some people have also gotten in trouble for drunk driving and showed significant results with a breathalyzer test even without the consumption of alcohol. Another complication is some people might dread of even having breakfast, like having a bagel, for fear of becoming drunk and may cause a potential life-threatening accident. This can lead to malnourishment and may not eat enough food to supply the body with essential nutrients. Some of the physical problems in the body that can arise is that the small intestine may become more permeable, resulting in deficiencies of important vitamins and minerals, like B vitamins, zinc, and magnesium (Hartney, PhD. , 2018). These vitamins and minerals are important for the body to function optimally.
For example, a deficiency in magnesium can cause loss of appetite, nausea and vomiting, fatigue, and weakness. In more severe cases, it can lead to numbness, muscle cramps, seizures, abnormal heart rhythms, personality changes, or low potassium or calcium levels (Bowers, 2018). Becoming deficient in important vitamins and minerals can lead to a serious cascade of events. Candida is a common yeast found in the environment, on our bodies and in our bodies. It competes for space with the normal flora on the skin and in warm and moist environments, especially in the digestive tract. Candida can overgrow almost anywhere in the body and cause an infection. Candida species are the most common cause of invasive fungal infections in humans, producing infections that range from nonlife threatening mucocutaneous disorders to invasive disease that can involve any organ (Fayemiwo & Adegboro, 2014). Candida yeast that normally lives in the small intestine and in the sides of the mouth that help with nutrient absorption cause no problems, but when there is an overgrowth of yeast it can affect the body. Signs and symptoms of overgrowth could be fatigue, toenail fungus, athlete’s foot, mood swing, irritability which are more of the minor issues. The more major issues can cause an autoimmune disease such as: ulcerative colitis, scleroderma, psoriasis, and lupus. The endocrine and immune system become compromised making it hard for the adrenal glands to produce cortisol.
As mentioned, auto-brewery syndrome can be determined through a positive stool sample that presents the causative organism, Saccharomyces cerevisiae. Saccharomyces cerevisiae is also known as brewer’s yeast, with a very well-known history and life cycle because of the brewing industry (Fayemiwo & Adegboro, 2014). Cultures of gastric fluids are taken from someone who comes into the hospital who appears drunk but, has not been drinking. Cultures of the gastric fluids can determine a high concentration of carbohydrate-rich foods which produces candida within the small intestine. The yeast ferments within the body turning it into ethanol, causing a person to seem drunk. A blood test is performed to determine the levels of IgG, IgA, IgM antibodies. However, this test can sometime show up negative when a urine analysis or stool sample test have been administered. A Urine Organix Diagnostic test can also be conducted. The urine test will determine if there is an abundance over growth of yeast, and if it is located in the small intestine or upper gut.
The stool testing and gastric fluid cultures are done more often as they are found to be the most accurate. Gut Fermentation Syndrome warrants additional investigation to determine which organisms induce symptoms and what definitive tests should be conducted to confirm diagnosis. In addition, research would be important to determine how overgrowth occurs with S. cerevisiae when it is normally found as a commensal in the gut of humans (Cordell & McCarthy, 2013). In conclusion, there is no apparent cure for this condition and researchers aren’t entirely sure as to how Saccharomyces cerevisiae makes its way into someone’s gut, as further research has yet to be conducted.
Although, there has been reports of successful treatments with the use of antibiotics, antifungal therapy, and carbohydrate control (Painter & Whitten, 2018). Certain modifications in the diet must also be addressed like a diet high in protein, low in sugars and carbohydrates, and free of alcohol and yeast. In addition, taking probiotics that increase normal bacteria in the gastrointestinal tract is also said to lower the risk of gut fermentation.
