It sounds like a far-fetched excuse to get out of trouble with the law: someone with a shockingly high blood alcohol level claims that it's due to a rare medical condition, rather than having some drinks and getting behind the wheel of a car.
But that’s exactly what happened to a 40-year-old man in Belgium in 2022. Twice in that year, he was pulled over by police, who found that his blood alcohol level was three or four times above the legal limit. Both times, however, he asserted that he hadn’t drunk any alcohol, despite the unfortunate coincidence that he also worked at a brewery. He was eventually acquitted of the charges after being examined by multiple doctors, who agreed that he had a rare condition called auto-brewery syndrome (ABS). The judge noted that, despite his high blood alcohol level, he had not shown symptoms of intoxication in either incident.
Individuals with ABS experience the process of fermentation in their gut, caused by gut bacteria and fungi turning the carbohydrates from their diet into carbon dioxide and alcohol, which then passes into the blood. A small amount of fermentation is normal during digestion, but the gut microbes of someone with ABS take it to extreme levels, sometimes leading to intoxication. However, the internal production of alcohol appears to affect individuals with ABS in various ways. Some ABS sufferers can have a sky-high blood alcohol concentration (BAC) of 0.30 or even 0.40 while still functioning relatively normally.
Living with a brewery inside:
- Auto-brewery syndrome typically develops as a result of other health issues that affect the gut, including obesity, diabetes, and Crohn’s disease. Antibiotics may also play a role by disrupting the gut flora balance in the microbiome.
- Unfortunately, cases of ABS often come to light when a patient's intoxicated behavior causes them to get in trouble of some kind—either getting hurt, crashing a vehicle, or appearing to be drunk at work.
- Though having ABS can be devastating on many aspects of daily life, there are treatments available for this underdiagnosed condition. By monitoring their own BAC, individuals can judge when their behavior may be affected by their gut activity. Limiting one's intake of sugar and carbohydrates can be effective in controlling extreme fermentation, while probiotics can be used to help rebalance the microbiome. In severe, chronic cases, a fecal transplant may be helpful.