There’s an extremely rare condition that afflicts at least 100 people around the world called auto-brewery syndrome, or ABS. Scientists aren’t sure how many people have ABS largely because of the stigma associated with the disease, “as patients may be mislabeled as drinkers who hide their habits,” writes Nautilus’s Molly Glick.
To family, friends, and anyone who comes into contact with someone with ABS, it appears that the individual is drunk. ABS sufferers are known to have been arrested for intoxication, experienced family problems, and suffered from isolation.
There has been only one peer-reviewed study performed on people with ABS, and it was extremely limited. Just five patients were studied in a 2023 survey.
“Auto-brewery syndrome is a misunderstood condition with few tests and treatments,” explained Elizabeth Hohmann, a physician at the Mass General Brigham Department of Medicine, in a statement.
The condition can also lead to medical issues such as cognitive impairment, liver damage, and withdrawal symptoms. However, scientists believe they may be on track to identify the cause of the disease, which could eventually lead to treatment.
Researchers suspect that imbalanced gut microbes are to blame, and the condition might be linked to gastrointestinal illnesses like Crohn’s disease and short-gut syndrome. Some case reports have identified types of ethanol-producing bacteria called Klebsiella in samples from ABS patients, who recovered with antibiotics. But the precise causes behind this mysterious condition remain elusive.
To learn more about ABS triggers and treatments, Hohmann and her colleagues examined the makeup of gut microbes from 22 people diagnosed with the condition, along with 21 unaffected people from their households to see whether their environments and diets play a role. The study, which was published today in Nature Microbiology, also included 22 healthy control participants.
Finding the culprit is only part of the solution. Some form of treatment needs to be developed as well.
Stool samples and blood tests revealed that, during a flare, median ethanol concentrations in ABS patients were significantly higher—nearly three times more—than those seen in the household partners. This hints that ABS could be diagnosed with a stool test, which may prove a far more convenient and accessible option than the other testing methods outlined above.
“The authors note that rather than focusing on specific bacteria species, treatments that target microbial enzymes involved in ethanol production may be a more effective strategy,” according to the statement. “That’s because during ‘flare-ups’ of ABS, patients had ‘elevated levels of certain enzymes that are known to be involved in fermentation,'” Glick writes.
Stool samples from “individuals with ABS during a flare produced more ethanol in vitro, which could be reduced by antibiotic treatment,” according to the abstract of a study of 23 patients published in January by Nature Microbiology. Finding the right antibiotic may be difficult since the enzymes might respond to different antibiotics.
Those with ABS also had higher amounts of bacteria such as Escherichia coli and Klebsiella pneumoniae in their stool. These microbes are known to turn sugars into alcohol. Previously, research had suggested that certain fungi were to blame. But overall, the precise types of tiny perps behind ABS are still unclear, and it’s tough to tease out all the species involved.
Why study a disease that afflicts so few people? The chances are very good that studying this disease will lead another microbiologist to have an “Eureka!” moment and help solve a puzzle they are working on, leading to a breakthrough in research for another, unrelated disease. It happens a lot more than most people realize and is one of the cornerstones of scientific progress.
That’s how basic research works. It always pays off in ways that can’t be easily seen.
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