Drunkenness without a drop of alcohol - the story of a Canadian woman with autofermentation syndrome

Her breath smells of alcohol. She is dizzy, disoriented, and weak to the point that one day she faints and hits her head on the kitchen counter while preparing lunch for her school-aged children. And in fact, she didn't drink a drop of alcohol.
This is the strange story of a 50-year-old woman from Toronto who suffered from autofermentation syndrome. She and her husband told doctors their problems for two years before anyone believed them.

"She went to her family doctor over and over again. She went to the emergency room seven times over two years," said Dr. Rachel Zeud, an infectious disease specialist at the University of Toronto.

"Doctors determined that the woman's blood alcohol levels were abnormally high, even life-threatening," said Barbara Cordell, president of the Autofermentation Syndrome Information and Research Association, which provides patient education and research into the unusual condition.

All of the doctors in the emergency room expressed doubt about the Toronto woman's drinking habits and repeatedly diagnosed her with "alcohol intoxication," reports CNN.

The woman underwent several courses of antibiotics for urinary tract infections, along with a proton pump inhibitor, to reduce the amount of acid in her stomach.

The patient stated that her religion does not allow the consumption of alcohol, and her husband confirmed. It wasn't until the seventh visit that an emergency room doctor finally said, "I think this looks like autofermentation syndrome," and sent her to a specialist.

Problem treatment

A nutritionist prescribes a low-carbohydrate diet to the woman. She also undergoes a one-month course of treatment with an antifungal drug. Gradually the symptoms disappeared, but temporarily. The woman started taking carbohydrates again, but a month later, the same symptoms reappeared - slurred speech and drowsiness. She was advised to restart the low-carbohydrate diet and her symptoms completely resolved.

Dr. Fahad Malik, a gastroenterologist at United Heath Services in Binghamton, New York, who currently has 30 patients with the disease, pointed out that treating these patients with distrust and ridicule is common.

The disease, also known as intestinal fermentation syndrome, is an extremely rare condition in which bacteria and fungi in the gastrointestinal tract convert carbohydrates into ethanol. The first known case was recorded in 1946 in Africa, when a 5-year-old boy's stomach ruptured for no known reason. An autopsy revealed that his abdomen was filled with a "foamy" liquid that smelled of alcohol.

Since 1974, 20 diagnosed cases of autofermentation syndrome have been described in the English medical literature, according to an April 2021 review. Cases have also been reported in Japan, where the condition is known as meitei-sho, or "alcohol autointoxication syndrome."

Scientists believe that the process takes place in the small intestine and is significantly different from the normal intestinal fermentation in the large intestine, which gives energy to our body.

Although a number of pathogens can contribute to this, most cases are due to overgrowth of two types of fungi: Saccharomyces and Candida. Candida lives on the body, in the mouth, digestive tract and vagina, often taking over when more beneficial bacteria are killed off by taking antibiotics.

A July 2013 report described a case of a 61-year-old man who had frequent bouts of unexplained drunkenness for years before being diagnosed with an excess of Saccharomyces cerevisiae, or brewer's yeast, the same yeast used to beer production.

Many people with the syndrome can function with large amounts of metabolically generated alcohol in their bodies, sometimes only realizing it when they are in trouble with the law.

A North Carolina man in his late 40s has been pulled over for what police believe is a DUI. He denied drinking, although his blood alcohol level was high. | BGNES