Some people can get drunk without consuming alcohol. While that might sound like the ultimate life hack to some, it’s actually a rare medical condition called auto-brewery syndrome (ABS) that’s difficult to diagnose.
In a study published Thursday in the journal Nature Microbiology, researchers pinpointed gut bacteria and biological pathways that trigger alcohol production in ABS, shedding light on an often misunderstood syndrome. A biological pathway is a series of biochemical processes that carry out functions in a cell or organism.
“By determining the specific bacteria and microbial pathways responsible, our findings may lead the way toward easier diagnosis, better treatments, and an improved quality of life for individuals living with this rare condition,” Elizabeth Hohmann, co-senior author of the study from the Infectious Disease Division in the Mass General Brigham Department of Medicine, said in a statement by Mass General Brigham.
Poop samples
ABS occurs when particular gut microbes convert carbohydrates into ethanol—an alcohol that then enters the bloodstream. Anyone’s digestion can produce small amounts of alcohol; ABS can make a person noticeably drunk. Diagnostic issues, social stigma, and limited awareness often leave the condition undiagnosed, according to the researchers. Diagnosis is complicated because the standard method requires closely monitored blood alcohol testing, which is often hard to get.
In fact, many patients go undiagnosed for years, often facing medical complications, social stress, and legal problems. Imagine being charged with drunk driving without having consumed alcohol!
Hohmann and her colleagues investigated the gut microbes of 22 people with ABS, 21 household partners without ABS, and 22 healthy control individuals. They found that stool (poop) samples from patients during ABS flare-ups produced ethanol to a significantly greater extent than the samples from the other two groups. This points to the potential for creating a stool test that could lead to more reliable diagnoses.
Bacteria involved in ABS
Stool analysis indicated that several bacteria, such as Escherichia coli and Klebsiella pneumoniae, play major roles in ABS. Furthermore, when symptoms flared, some participants revealed significantly greater amounts of enzymes related to pathways of fermentation than members of the control group. However, the team reports that finding the specific microbes that cause ABS in individual people is still a long and complicated endeavor.
The scientists also worked with a patient whose symptoms improved after a fecal transplant (putting someone else’s medically processed sample of feces into the gut) and had ameliorated symptoms. Other previous approaches had not been successful. Shifts in particular bacterial strains and metabolic activity in the individual’s gut aligned with their relapse and recovery, further supporting the biological basis of the syndrome. A second transplant with a differing antibiotic pretreatment saw the patient remain without symptoms for over 16 months.
“Auto-brewery syndrome is a misunderstood condition with few tests and treatments. Our study demonstrates the potential for fecal transplantation,” explained Hohmann, who is participating in another study investigating fecal transplantation in ABS patients.
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