"Didn't Drink Alcohol but Smelled Like It": Rare Disease Discovered in Canada

'Auto-Brewery Syndrome' Where the Body Produces Alcohol Itself
First Reported in Africa... No Suitable Treatment Available

A case of 'Auto-brewery syndrome,' in which gut microbes ferment carbohydrates to produce alcohol despite no alcohol consumption, has been confirmed in Canada.

Dr. Rahel Zeoud's team at the University of Toronto recently reported a case of a woman in her 50s diagnosed with auto-brewery syndrome in the Canadian Medical Association Journal (CMAJ).

A liquor sales counter at a large supermarket in downtown Seoul.
[Photo by Yonhap News]

The woman constantly had the smell of alcohol on her breath and experienced persistent dizziness and fatigue. One day, while preparing lunch for her children, she even hit her head on the kitchen sink. She had little appetite and barely ate, and had to take a 1-2 week leave due to drowsiness and lethargy. The same symptoms recurred every 1-2 months.

Doctors who had previously treated the woman noted that she did not drink alcohol for religious reasons, and her husband also confirmed that she did not consume alcohol.

It was only after her seventh visit to the emergency room that a diagnosis of auto-brewery syndrome was made through evaluations by emergency medicine, gastroenterology, infectious disease, and psychiatry specialists.

Auto-brewery syndrome is a rare disease in which gut microbes ferment carbohydrates into alcohol. It has been confirmed that budding yeast used in beer fermentation, Candida species, and Klebsiella pneumoniae are involved in this process, but the exact cause remains unknown.

In 1948, a 5-year-old boy living in Uganda, Africa, suffered a bowel rupture for unknown reasons, and an autopsy revealed that his intestines were filled with contents smelling of alcohol, marking the first known report of the condition.

Later, it was first diagnosed in Japan in 1952, and the first case in the United States was confirmed in the 1980s. Worldwide, fewer than 100 cases have been reported to date, and rare instances of people who have never consumed alcohol being caught for drunk driving have been discovered.

There is no standard diagnostic method or definitive treatment for auto-brewery syndrome. The research team stated that only limited treatments such as antifungal prescriptions and low-carbohydrate diets are available.

The team administered probiotics to supplement the patient's gut microbiota, restricted antibiotic use to reduce abnormal microbial overgrowth, and is currently monitoring her progress.

The patient has been symptom-free for six months. Tests conducted between 30 minutes and 48 hours after oral glucose intake showed no ethanol detected, and her carbohydrate intake is currently being gradually increased.

Dr. Zeoud explained, "Auto-brewery syndrome causes significant social, legal, and medical problems for patients and their families," adding, "This patient case demonstrates that awareness of this syndrome is very necessary for clinical diagnosis and management."