What is auto-brewing, this syndrome that naturally produces alcohol in the body ?

Auto-brewery syndrome: when the body makes alcohol itself

People who suffer from it can find themselves accused of drunk driving. However, they did not drink a drop of alcohol. This is what a 40-year-old motorist who suffers from auto-brewery syndrome or auto-fermentation syndrome managed to make the judges understand. What is it ?

The Belgian media reported the unusual story of a Belgian motorist. This forty-year-old appeared on Monday April 22 in Bruges after being tested for excessively high blood alcohol levels on two occasions in 2022. However, he was acquitted by the court. The reason ? The man managed to prove that he suffered from auto-brewery syndrome, also called auto-fermentation.

What is this syndrome ?

Auto-brewery syndrome is a rare syndrome in which the ingestion of carbohydrate-rich foods causes the yeast in the tube to produce ethanol digestive. "The blood concentrations of ethanol found in these patients are significant, up to 4g/L, and may be responsible for symptoms similar to those observed in acute ethanol poisoning, underlines an article published in August 2020 in the journal Analytical and Clinical Toxicology. The patient then finds himself intoxicated. 4 g/L corresponds to values ​​which can lead to alcoholic coma, and, in the most serious cases, to death. In the medium term, symptoms of chronic alcoholism may appear.

What are the causes of auto-brewery syndrome ?

According to the journal Analytical and Clinical Toxicology, this syndrome is most often caused by a digestive pathology or an imbalance in the intestinal flora. The French Association of Dietitians-Nutritionists cites cases of diabetes, obesity and associated Crohn's disease. "The latter may be primary or secondary to treatment with an antibacterial promoting the proliferation of fungal germs which will be responsible for the fermentation of sugars."

The first case of self-fermentation was reported in 1948 in a 5-year-old child in Uganda. The article in Analytical and Clinical Toxicology puts forward several risk factors based on a review of the rare known cases:

Excessive consumption of carbohydrates Repeated antibiotic therapy, causing a disruption of the intestinal microbiota Abdominal surgery The proliferation of germs from the Candida or Saccharomyces family A metabolic, gastrointestinal or hepatic pathology

What support ?

The diagnosis is based on "the search for personal and family history, biological analyses, a detailed interview, an endoscopy and a carbohydrate challenge test after absorption of 200 g of glucose and measurement of ethanolemia at different times& ;quot;.

The treatment is based on stopping antibiotic therapy, an antifungal treatment, aimed at restoring the intestinal flora and limiting the fermentation of sugars. Treatment is associated with a diet low in sugars and/or taking probiotics. Sometimes, follow-up by an addictologist is necessary because the patient can develop an alcohol dependence.

How for the Belgian motorist judged on Monday, auto-brewery syndrome poses medico-judicial problems. From a simple fine to incarceration, the consequences can be serious for the patient. "Due to its social and legal implications, self-fermentation syndrome should can be considered in any patient regularly presenting with a high ethanol concentration who insistently denies having ingested alcohol, even if this is a very rare phenomenon and still controversial", we read in an article published in December 2020 in the journal Analytical and clinical toxicology.