Being drunk without drinking a drop of alcohol is possible. People affected by auto-brewery syndrome, or intestinal fermentation syndrome, exhibit all the hallmarks of drunkenness and suffer from the day-to-day medical and social consequences ofalcoholism. How to explain this phenomenon? What solutions can be contemplated? Responses from Pr. Jean-Claude Alvarez, head of the Department of Toxicological Pharmacy at Raymond-Poincaré AP-HP Hospital (Garches) and Dr. Pascal Menecier, adicologist at the Mâcon Hospital Center.
What is auto-brewery syndrome?
Gut fermentation syndrome (auto-brewery Syndrome, In english is a rare and poorly documented phenomenon in the scientific literature. It results in “the endogenous production of ethanol during the fermentation of carbohydrates by the yeasts of the gastrointestinal tract”, explains Professor Álvarez, co-author of an analysis published on the subject in December 2020 in the journal Analytical and Clinical Toxicology (source 1).
In concrete terms, interested persons can reach a blood alcohol level of 4 grams per liter of blood (4 g/L), without having drunk a single drop of alcohol. “But given current knowledge, it’s more of a medical curiosity,” said Dr. Menecier. We can think that this syndrome is underdiagnosed, because it is controversial and still unknown, “but it is still anecdotal, it is not necessary to make a wildfire”, continues the doctor.
Note: The first case of autofermentation was reported in 1948 in a 5-year-old African boy. Since then several dozen have been reported worldwide, but none have yet been described in France – which does not mean that some people do not suffer from it in France.
What symptoms should alert?
Ethanol concentrations found in the blood of affected patients may be responsible for the same symptoms as those seen in cases of acute alcohol intoxication (hangover):
“Certain concentrations of alcohol can certainly lead to ethyl coma“, assumes Dr. Menecier. And his colleague underlines the obstacle course of patients: “a person who constantly shows signs of alcoholism, does not go unnoticed. But often patients have to fight to prove that they are not secretly drinking, go through different tests, etc.”
In question, a rare phenomenon of intestinal fermentation
How can you be drunk without having drunk alcohol? Very often, this syndrome is favored by a digestive pathology or an imbalance of the digestive flora. The main causes of this imbalance:
- massive carbohydrate intake, that is, the sugar present in bread, pasta, soft drinks, ready meals, chips, etc. In some cases, they are not tolerated by the body, they ferment and turn into ethanol (alcohol).
- the natural presence of yeasts (mainly candida Where saccharomyces cerevisiae) or certain bacteria (Klebsiella pneumonia Where Enterococcus faecium) in the intestine.
- taking antibioticswhich can also alter the gut microbiota killing the good bacteria and promoting the proliferation of yeasts responsible for alcoholic fermentation.
Self-fermentation syndrome: what consequences on a day-to-day basis?
The health consequences of this pathology can be extremely disabling in the private and public spheres.
From a physical point of view, the symptoms of alcohol intoxication (described above) complicate interactions and limit common quests, such as picking up the children from school, going shopping, etc. Especially since this syndrome lends itself rather to a smile.
Symptoms such as chronic fatigue, disorientation, irritable bowel syndrome, chronic fatigue syndrome, can also Lead to depressive symptoms and fuel anxiety. Not to mention the risk of addiction.
We can describe a phenomenon of habituation and tolerance: the amounts of alcohol in the blood are so important that the effects are less and less perceptible, specifies Dr. Menecier.
A problem that is all the more worrying since many diseases can be caused by excessive alcohol consumption: mainly liver ailments (steatosis, alcoholic hepatitis, cirrhosisetc), and cancer (esophageal cancer, liver cancer, mouth cancer, throat cancer, colorectal cancer, etc.). high blood pressure can also be favored by regular consumption of alcohol, as well as Alterations in attention, concentration or memory.
“Beyond the health and social consequences, the self-brewery syndrome can have medical and legal implications, underlines Professor Álvarez, in particular in the case of driving while intoxicated, despite the absence of alcohol consumption”. If they test positive, without having consumed alcohol, patients are exposed to large fines, including prison arrest temporary.
Treatment: what management to limit this syndrome?
Management of auto-brewery syndrome is based on avoiding certain foods too rich in carbohydrates or industrial yeasts.
the taking of antifungal medications It is also essential to regulate the populations of yeasts present in the intestine and responsible for fermentation. Since probiotics can be associated with it to reintroduce good bacteria in the intestinal flora. Objective: to eliminate the feeling of drunkenness and especially the production of alcohol, which is harmful to the body.
Addiction treatment may be necessary in patients who have developed a long-term addiction to ethanol. “A sudden rebalancing can lead to symptoms similar to those of alcoholic withdrawal : sweating, tremors, excessive sweating, nausea/vomiting, significant fatigue, possible dizziness, headaches, tachycardia, etc.