Alcoholics and other problem drinkers can be highly creative in inventing excuses and explanations for the presence of high amounts of alcohol in their system, when they insist they never drank a drop.
I recall a woman admitted to our clinic in London who was reported by our staff to be staggering around with slurred speech and reeking of alcohol, while she insisted she had long since stopped drinking.
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We told her that urine and blood samples showed the presence of significant quantities of alcohol in her body. After only a brief pause, she suggested that this was explained by her habit of generously splashing Eau de Cologne over herself after her bath and at regular intervals through the day. When we pointed out that alcohol cannot be absorbed through the skin to this degree, even if she bathed in the stuff, she paused again.
As an alternative, she insisted that her bladder was full of diverticuli (small, bulging pouches in the lining of the colon), containing alcohol from her drinking days. We pointed out that this, too, was not possible, and offered to do bladder X-rays to prove it. Short of invoking UFOs and alien probes, she still swore that she was not drinking, and that it was our job to explain this “miraculous” presence of alcohol in her urine, not hers.
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It was at that point that a visitor reported three large bottles of vodka dangling from string outside the window of her room – which seemed altogether like a more convincing explanation.
The 'auto-brewery syndrome'
A recent news story reported that a woman in America was absolved of a charge of drunken driving after her lawyer managed to persuade the court that she was suffering from what has been called the “auto-brewery syndrome”. It is a condition which is claimed to cause some people to create alcohol in their intestines at certain times.
The judge in this case found this claim to be “highly compelling” and dismissed all charges against the woman, though the prosecutor plans to appeal.
She’d spent thousands of dollars on the services of a doctor, claiming to be an expert on this syndrome, who insisted that during a flare-up of this condition, her body might produce enough alcohol to meet the legal definition of drunkenness without having consumed alcohol. According to him this is “a brand new disease, and we’re still trying to understand it”. There seems to be no appropriate antibiotic therapy, but he did advise her to “eat differently”.
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The “expert’s” name is Dr Anup Kanodia, a GP with an interest in alternative medicine, but I haven’t managed to find reports of him having treated any other case of this syndrome. I find peculiar his comment to a reporter that “it’s likely that upward of 95 percent of sufferers don’t know they have the condition”. It’s just logical that if they don’t know they have it, they wouldn’t contact any doctor about it, so nobody would know whether or not they have it. The claim that he has been able to count people with this unrecognized and undiagnosed condition – to find that 95% of them are unaware of their condition – is baffling.
The woman is a teacher, who was arrested with “glassy bloodshot eyes and slurred speech”. She admitted to having drunk three cocktails, and a breathalyzer found her blood alcohol level to be .33 %. The judge should have insisted on further evidence before accepting this theory. Courts must not be naïve. The existence of a syndrome does not mean that a person has it.
Valid defence or handy excuse?
If this unprecedented decision survives appeal, it could become a popular legal defence. When prosecuting drunk drivers, the level of ethanol/alcohol in the breath, blood or urine is very important evidence. The defence almost always challenges the results of forensic tests, either for convincing reasons, or just because this can create enough useful confusion.
This has been called the “auto-brewery syndrome” or “gut fermentation syndrome”, where alcohol may be produced within the body without the actual consumption of alcohol. We know that yeasts like Candida albicans can produce ethanol in test tubes, but it’s far from certain whether this happens significantly in people.
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There have been a few reports of cases, mostly scientifically flawed, and with alcohol levels too low to be forensically or medically significant. It’s a scientific fact that we do produce some alcohol within our bodies, but only in tiny amounts, not nearly enough to get us arrested for drunken driving. Most of the alcohol produced in our guts is absorbed and broken down in the liver.
An excess of brewer’s yeast
A case that lends some credence to the gut fermentation syndrome was recently reported in Texas. A man (ironically his hobby was home-brewing) lurched into a casualty ward, complaining of dizziness, and a breathalyzer showed a blood alcohol level way over the legal limit for driving, though he swore he hadn’t drunk alcohol all day.
He described getting drunk at odd times. A doctor isolated him in hospital for 24 hours, where, after eating high carbohydrate foods, it was found that he indeed produced low levels of alcohol. He had an excess of brewer’s yeast in his intestines, as well as a gut infection with Saccharomyces cerevisiae which fermented any starch he ate to ethanol. Some people take this yeast as a probiotic supplement, and it’s found in many foods including breads, wine and beer.
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The Japanese proof
Since the 1950s the Japanese have reported dozens of the most convincing cases of what they call meitei-sho, a condition with similar features. Rice (a high carb food) was consumed in the presence of high yeast levels in the intestines, and cases were often related to intestinal surgery or low stomach acidity. Some cases seem to begin after taking antibiotics that kill off the usual friendly bacteria in the gut, enabling yeast to flourish.
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So, why are particularly the Japanese affected? It’s interesting. In dealing with alcohol, the liver uses an enzyme, alcohol dehydrogenase, to convert it to acetaldehyde. Usually, a second enzyme, aldehyde dehydrogenase (ALDH) quickly changes that to harmless elements. But around 50% of people in Japan and other parts of East Asia have an anomalous gene that produces faulty ALDH. In them, even small amounts of alcohol cause a build-up of aldehyde, causing palpitations, flushed face, headache, nausea, confusion and dizziness. Other enzymes eventually clean up the aldehyde, and the symptoms disappear.
This disorder is worth considering in cases where, apart from typical signs of drunkenness and hangovers, there can be dizziness, irritable bowel symptoms, and fatigue. The yeast infection can be cleared up by e.g. fluconazole, an anti-fungal drug and following a low carb diet.
In short, this condition is rare, and although it may sound like a cheap way to get drunk, it is actually inconvenient and unpleasant rather than enjoyable. It cannot be compared to the enjoyment of a good beer or a single malt Scotch.
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Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.