-Milanckona Das, Amity University Kolkata
Drinking alcohol to get rid of our “thoughts” is a method that we pick up very often. But what if you generate your alcohol within your body and then you don’t have to drink to get tipsy! It happens very seldom within the body when there’s an overgrowth of yeast in the intestine, contributing to ethanol fermentation. This ends up in a sensation somewhat similar to alcohol intoxication without a medical history of intake of alcohol. This sort of symptom results in Auto-Brewery Syndrome.
The condition is characterized by fermentation of the carbohydrates consumed in the body’s gastrointestinal tract triggered by bacteria or fungi. ABS is an unusual medical disorder where the endogenous fermentation inside the digestive system creates intoxicating amounts of ethanol. One may have signs of alcohol consumption somewhat close to slurred speech, stumbling, loss of muscle control, dizziness, and blenching. Organisms that are chargeable for this condition may include- Candida albicans, Saccharomyces cerevisiae, Enterococcus faecium. To get an ethanol end product, these species use lactic acid fermentation or mixed acid fermentation pathways.
In the small intestine, the ethanol formed from these pathways is consumed, causing a rise in the concentration of blood alcohol that causes the symptoms of intoxication without the intake of alcohol. Researchers suspect that the root causes of ABS are associated with excessive use of antibiotics, inadequate nutrition, and/or carbohydrate-rich diets. Other pre-existing conditions such as diabetes and genetic abnormalities that lead to inappropriate liver enzyme activity are also responsible. Later, decreased aldehyde dehydrogenase activity may lead to ethanol accumulation within the bowel, which causes fermentation. Any of these conditions can cause Auto-Brewery Syndrome alone or together and lead to microbiome dysbiosis.
Fermentation is a biochemical mechanism in which yeast and some bacteria convert sugars into ethanol, carbon dioxide, and other metabolic by-products. The fermentation pathway involves pyruvate produced in the EMP (Embden-Meyerhof-Parnas) pathway from yeast. On the other hand, some bacteria acquire pyruvate through the ED (Entner-Doudoroff) pathway. During a reaction that involves the enzyme pyruvate decarboxylase, pyruvate is then decarboxylated into acetaldehyde. NAD+ which is caused by alcohol dehydrogenase (ADH), produces the reduction of acetaldehyde to ethanol. Via a mechanism called the first-pass metabolism, ADH rids the body of alcohol.
However, if the ethanol breakdown rate is lower than the output rate, intoxication occurs. Alcohol levels can be estimated by blood collected from an individual. A more simultaneous method is to check the breath alcohol concentration. Bloodstream endogenous ethanol is best detected by gas chromatography. Gas chromatography is where the inhaled air or blood is heated to isolate the assorted components of the vapour or blood. Then the volatiles moves through a chromatograph that isolates ethanol so it can be quantified from the smaller volatiles. More convenient approaches, particularly during an acute attack at home, include serum measurements and breathalyzers.
As we’ve got some idea of ABS, so next time when we see an individual with signs of alcohol use, we should not assume that the person is intoxicated by drinking. It can also be something else, and we know what it is!
Also read: A Comparative Insight- MIS-C, Kawasaki Disease and Covid-19!
Reference-
1.Malik F, Wickremesinghe P, Saverimuttu J; Case report and literature review of auto-brewery syndrome: probably an under-diagnosed medical condition; 2019; BMJ Open Gastroenterology; Vol: 6; DOI: http://10.1136/bmjgast-2019-000325
2.Murat Akbaba; A medicolegal approach to the very rare Auto-Brewery (endogenous alcohol fermentation) syndrome; 2020; Traffic Injury Prevention; Vol: 21; DOI: https://doi.org/10.1080/15389588.2020.1740688
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