Almost three per mille without alcohol – can that be true or is the woman lying?

Seven times within two years – that’s how often a mother of two children had to go to hospital with alcohol poisoning. A sad case of alcoholism? You might think. But the woman hadn’t touched a drop for years. Could that be true? The doctors who examined the woman again and again asked themselves the same question. They have now presented her story to us.

The 50-year-old woman from Canada used to enjoy a glass of wine on holidays, but in recent years she had completely given up on alcohol due to her religious beliefs. Or so she thought. For the past two years, she had been repeatedly overcome by excessive sleepiness. Sometimes she fell asleep – whether at work or when she was preparing food for her family. She fell, sometimes could no longer speak clearly and smelled of alcohol. When she then presented herself in the emergency room, the diagnosis was alcohol poisoning. How could that be? After all, she always said that she had not drunk any alcohol. Her family also confirmed her abstinence.

A computer tomography (CT) scan of her head, which doctors had taken during one of her hospital stays, showed no abnormalities. Psychiatrists from addiction medicine examined her three times. But the woman scored zero on a standard questionnaire about her own alcohol consumption. According to this, alcohol abuse would be unlikely – at least if she had answered truthfully to questions such as “Have you ever felt guilty about your drinking?”

Is there a rare diagnosis behind your alcohol levels?

During her seventh visit to the emergency room, the doctors measured an alcohol level of around 2.8 per mille, which for some people is close to unconsciousness. If this woman really hadn’t drunk any alcohol, there could only be one explanation for this value. And so the emergency doctor finally made a suspected diagnosis: autobrewery syndrome.

This rare disease is caused by the digestive tract being overpopulated by certain alcohol-producing yeasts or bacteria. If the microbiome is weakened by a weak immune system or after taking antibiotics, the microbes can multiply excessively and become a kind of brewery in the body. Due to their strong fermentation processes, they sometimes produce so much alcohol, especially when processing carbohydrates, that those affected begin to slur their words or stagger.

Possible cause: antibiotics

The doctor prescribed the woman medication for a fungal infection and referred her to gastroenterology, where she was also recommended a low-carbohydrate diet. Her symptoms did indeed disappear soon afterward. However, when she started eating more carbohydrates again after a few weeks, the old symptoms returned and she fell again. She was again prescribed antifungal medication, her diet was changed to a low-carbohydrate diet and the symptoms disappeared again. After a few weeks, the woman was also given special probiotics to restore balance to her intestinal flora.

This time the success lasted. After six months, she was given a type of glucose syrup as a test to check how her body reacted to it. Even hours later, her blood alcohol level had barely increased measurably. In retrospect, it is not possible to say for sure why the woman developed the syndrome. However, her doctors suspect that repeated use of antibiotics for urinary tract infections may have led to the incorrect colonization of the intestine. Genetic factors may also have played a role, according to the authors of the case report.

Patient wins in court

A systematic review in 2020 identified just 20 patients reported in the English-language medical literature since 1974. The condition was first described in Japan in 1952 under the term Meitei-sho, which means “alcohol autointoxication syndrome.”

The last case that became public, however, was not long ago: a 40-year-old from Bruges, Belgium, was repeatedly pulled over with an elevated blood alcohol level. After the police again found him to have excessive blood alcohol levels in April 2022, he was charged. The man defended himself. His illness had led to the elevated alcohol levels through no fault of his own. A few weeks ago, the court ruled in his favor.