Health
Can you become drunk without drinking alcohol? Here’s how it could happen
While some people might have experienced the feeling of “being drunk” the morning after they consumed excessive amounts of alcohol, is it possible to feel intoxicated without ever drinking an alcoholic beverage?
Although it’s extremely rare, experts say it can happen.
The phenomenon is called auto-brewery syndrome, or ABS, according to Dr. Douglas Dieterich, M.D., director of the Institute for Liver Medicine at the Mount Sinai Health System in New York City.
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The syndrome occurs when a patient’s gut gets colonized by a fungus that metabolizes carbohydrates and sugar into alcohol through fermentation, the doctor told Fox News Digital.
Before diagnosing a patient with ABS, Dieterich said that doctors “should always rule out other causes and make sure the patient is not drinking surreptitiously.”
Auto-brewery syndrome occurs when a patient’s gut gets colonized by a fungus that metabolizes carbohydrates and sugar into alcohol through fermentation, a doctor told Fox News Digital. (iStock)
Here’s a deeper dive.
A real-life case of auto-brewery syndrome
In one recent case study published in the Canadian Medical Association Journal, a 50-year-old woman had not consumed alcohol. Yet she continually had symptoms associated with intoxication, including the smell of alcohol on her breath, slurred speech and elevated blood alcohol levels during several emergency department visits.
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The woman had a history of recurrent urinary tract infections that were treated with several courses of antibiotics, along with medications to reduce stomach acid.
Eventually the patient was diagnosed with auto-brewery syndrome, according to the published report.
In a recent case study, a woman (not pictured) continually showed symptoms associated with intoxication, including having the smell of alcohol on her breath, slurred speech and elevated blood alcohol levels — even though she had not consumed alcohol. (iStock)
“ABS carries paramount medical, legal, social and financial consequences for patients and their loved ones,” Dr. Rahel Zewude, lead author of the study and an infectious diseases and microbiology fellow at University of Toronto in Canada, told Fox News Digital.
“Therefore, awareness of this rare syndrome in the medical community, as well as in the general public, can be instrumental in reducing delays in diagnosis.”
“ABS carries paramount medical, legal, social and financial consequences for patients and their loved ones.”
The woman in the case study saw her physician and visited the emergency department at least seven times over a two-year period. She complained of excessive sleepiness, slurred speech, falls and alcohol smells on her breath.
During her first ED visit, she was diagnosed with alcohol intoxication after having an elevated blood alcohol limit at 39 mmol/L (normal is 2 mmol/L or less) — despite her reports of not consuming alcoholic drinks, which family members verified.
The woman’s liver enzymes were normal and a computed tomography (CT) scan of her head revealed no acute findings, the study said.
The woman was diagnosed with alcohol intoxication after having an elevated blood alcohol limit at 39 mmol/L (normal is 2 mmol/L or less) — despite not consuming alcoholic drinks. (iStock)
Throughout the woman’s various visits to the emergency department, three psychiatrists provided addiction-related care, even though she scored a zero on the CAGE (Cut, Annoyed, Guilty and Eye) screening test, which assesses patients for alcohol use disorder.
(A total score of 2 or higher is considered clinically significant, according to the American Addiction Centers website.)
After experiencing episodes every one to two months, the woman was diagnosed — upon her seventh visit to the ED — with possible auto-brewery syndrome. She was prescribed an antifungal medication called fluconazole and referred to a gastroenterologist.
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She completed a one-month course of fluconazole and adhered to a low-carb diet — and her symptoms began to resolve.
After four months, though, symptoms began to come back when she ramped up her carbohydrate intake, the study said.
“A sugar-free, low-carb diet has been shown to be effective in managing symptoms — the fewer carbohydrates ingested, the less chance that carbohydrate fermentation will occur in the gut,” an expert advised. (iStock)
After another course of fluconazole and a return to a low-carb diet, the symptoms resolved.
A course of probiotics was also prescribed to help foster better gut health.
What makes a person susceptible to ABS?
Several factors contribute to ABS, according to Zewude.
“The disease likely presents when these factors emerge simultaneously alongside a high-carbohydrate diet,” she told Fox News Digital.
One of the main factors is disruption of the gut microbiome, which is the population of microorganisms in the gut.
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“In ABS, the fungi that ferment alcohol overpopulate our gut ahead of other non-fermenting bacteria,” Zewude said.
“This gut microbiome disruption can occur due to frequent or prolonged courses of antibiotics.”
One of the main factors in ABS is disruption of the gut microbiome, which is the population of microorganisms in the gut. “In ABS, the fungi that ferment alcohol overpopulate our gut ahead of other non-fermenting bacteria,” the study author said. (iStock)
Diabetes as well as gastrointestinal illnesses such as Crohn’s, liver disease and ulcerative colitis can also be risk factors for ABS, Zewude said.
Genetic predispositions that affect how the body metabolizes and clears ethanol can also play a role.
Testing for and treating ABS
One way to test for ABS is to perform an oral glucose challenge in a supervised setting, where a patient first measures their fasting blood alcohol level.
This baseline level should be undetectable if the person had fasted for eight hours and did not consume any alcohol, according to Zewude.
“Diet modification is an extremely important part of reducing or resolving symptoms of auto-brewery disease.”
The patient then ingests a high load of glucose, and their alcohol level is measured in 30-minute, one-hour, two-hour, four-hour, eight-hour and 24-hour increments.
“If their alcohol level begins to rise after ingestion of glucose, that can help confirm gut fermentation of alcohol from carbohydrates, which is ABS,” Zewude told Fox News Digital.
Although ABS has been described in medical literature for over 50 years, the condition still remains misunderstood, with limited information regarding diagnosis and treatment, according to health experts. (iStock)
The test should be conducted in a monitored clinic to ensure that the patient is not consuming alcohol, and to ensure safety in the event that the patient does become intoxicated, the expert advised.
The rare condition requires a multidisciplinary approach that may include a liver specialist or gastroenterologist, primary care physician, infectious diseases specialist and registered dietitian, health experts told Fox News Digital.
It is typically treated with antifungal medications and a low-carb diet, as noted in the case study mentioned earlier.
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“Diet modification is an extremely important part of reducing or resolving symptoms of auto-brewery disease,” Simone Gmuca, a registered dietitian who works with patients in Douglaston, New York, told Fox News Digital.
Patients with ABS should also incorporate plenty of lean meats, fish, avocados, olive oil, nuts, seeds and leafy green vegetables into their diet, experts recommended. (iStock)
“A sugar-free, low-carb diet has been shown to be effective in managing symptoms — the fewer carbohydrates ingested, the less chance that carbohydrate fermentation will occur in the gut,” added Gmuca, who was not affiliated with the study.
Patients should avoid simple carbohydrates like breads, pastas, crackers, sugary beverages, potato chips and fruit juices during treatment, the doctor said.
“Increasing lean protein, heart-healthy fats and low-starch vegetables can help promote satiation and reduce the risk of nutrient deficiencies,” Gmuca added.
The condition known as ABS requires a multidisciplinary approach that may include a liver specialist or gastroenterologist, primary care physician, infectious diseases specialist and registered dietitian, said health experts. (iStock)
Patients with ABS should also incorporate plenty of lean meats, fish, avocados, olive oil, nuts, seeds and leafy green vegetables into their diet, she recommended.
For more Health articles, visit www.foxnews/health
Although ABS has been described in medical literature for over 50 years, the condition still remains misunderstood — with limited information regarding diagnosis and treatment, according to health experts.
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A new solution may be on the horizon for the 30 million people in the U.S. who suffer from sleep apnea.
In a Finland study, a new breathing device showed promising results in reducing symptoms of the disorder, according to researchers.
The device, called WellO2, uses resistance training to strengthen throat muscles and steam breathing to humidify airways.
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In the small study conducted by University of Turku’s Sleep Research Center, 25 participants with mild to moderate sleep apnea used the device at home twice a day for three months, breathing in and out 30 times per session.
At the end of the study period, the participants reported increased respiratory muscle strength, reduced nighttime breathing interruptions, improved sleep quality and decreased insomnia, according to a press release.
In a Finland study, a new breathing device, shown at right, has shown promising results in reducing symptoms of the disorder, according to researchers. (iStock/WellO)
Snoring occurrences were also reduced.
The findings were presented on June 5 at the Nordic Lung Congress 2024 in Helsinki, Finland.
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The study will now be peer-reviewed by the scientific congress, then will be published later this year, according to the researchers.
The device, called WellO2, uses resistance training to strengthen throat muscles, plus steam breathing to humidify airways. (WellO2)
“Currently, there are no available technologies or medications to treat sleep apnea,” lead author Dr. Usame Al-Rammahi, a doctoral researcher of pulmonary diseases and clinical allergology at the University of Turku, told Fox News Digital.
“Our first data suggest that respiratory muscle training may be the answer that not only alleviates symptoms, but also addresses the underlying cause of OSA by strengthening muscles.”
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CPAP (continuous positive airway pressure) is currently the most common treatment for sleep apnea — but about a third of patients struggle to adapt to it, Al-Rammahi noted.
WellO2 is designed to be used as an add-on therapy with CPAP.
CPAP (continuous positive airway pressure) is right now the most common treatment for sleep apnea, yet about a third of patients struggle to adapt to it. (iStock)
“Even though CPAP should be used as needed, WellO2 training can be used as an additional therapy, since it addresses underlying reasons and may lessen CPAP adverse effects by moistening the airways,” Al-Rammahi told Fox News Digital.
Limitations of the study
This is a preliminary report and research is currently ongoing, Al-Rammahi said.
The study also did not include a control group.
“There is no quick fix for respiratory rehabilitation.”
“Nonetheless, given that the study compared their results to each participant’s personal findings, those persons were the controls,” Al-Rammahi said.
“Despite the lack of a control group, the findings remain important. Qualified questionnaires were used, and polysomnography (PSG) was a thorough and trustworthy procedure that provided substantial results.”
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Dr. Chelsie Rohrscheib, a neuroscientist and sleep specialist at Wesper in New York, was not involved in the study but commented on the device’s potential.
“Sleep apnea is primarily caused by obstructions in the upper airway that block the flow of oxygen into the lungs,” she said.
Approximately 30 million people in the U.S. suffer from sleep apnea. (iStock)
“This device is designed to strengthen the muscles of the upper airway and reduce these obstructions from occurring,” she also told Fox News Digital.
While the device was shown to offer “some improvement” when tested in a small population of patients, Rohrscheib noted that use of the device was only correlated with “moderate improvement” in the number of respiratory events.
For more Health articles, visit www.foxnews/health
“That means it’s not guaranteed to work for every patient or to completely eliminate your sleep apnea symptoms,” she said.
“Further, the device was not tested in patients with severe sleep apnea — thus, patients should not rely on this device alone for treatment for their sleep apnea without the guidance of a sleep physician.”
“Patients should not rely on this device alone for treatment for their sleep apnea without the guidance of a sleep physician,” a sleep expert said. (WellO2 )
Katri Lindberg, a respiratory specialist nurse in Finland who works with WellO2 as a breathing expert, said she recommends WellO2 training regularly for individuals who want to stop snoring or for whom CPAP devices are not suitable for treating sleep apnea.
“The research results are only preliminary findings from a small study, but they provide strong indications that we have found a rehabilitation tool that can now rehabilitate the symptoms of a large group of people worldwide, rather than merely alleviating them,” Lindberg told Fox News Digital.
“The study also indicates that there is no quick fix for respiratory rehabilitation. To remove symptoms and keep them at bay, regular, although relatively small, amounts of respiratory training are needed.”
Kidney transplants are not uncommon — the kidney is actually the most frequently transplanted organ in the U.S. — but a Chicago man recently received his in a highly unusual way.
John Nicholas, 28, was awake during the entire procedure, which was performed on May 24 at Northwestern Medicine Hospital. He was discharged the very next day.
Doctors administered a spinal anesthesia shot — similar to what is used for a Cesarean section — instead of general anesthesia, according to a press release from the hospital.
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“This is the first case at Northwestern Medicine where a patient was awake during an entire kidney transplant procedure and went home the next day, basically making this an outpatient procedure,” said Satish Nadig, M.D., PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, in the release.
“Inside the operating room, it was an incredible experience being able to show a patient what their new kidney looked like before placing it inside the body,” he added.
John Nicholas, the patient, is pictured with his surgeons in the operating room after completion of the kidney transplant. (Northwestern Medicine)
“It was incredibly simple and uneventful.”
This type of “awake transplant” could reduce surgical risks and shorten the length of the patient’s hospitalization, doctors say.
“It was an incredible experience, being able to show a patient what their new kidney looked like before placing it inside the body.”
It could also increase access to care for patients who are considered high-risk or have phobias surrounding general anesthesia.
Ideal candidate
Nicholas’ surgery took about two hours, according to the hospital.
He was considered an ideal patient for awake surgery due to his young age, his otherwise good health and his “eagerness to participate,” per the release.
John Nicholas is pictured awake during his kidney transplant in late May. (Northwestern Medicine)
“It was a pretty cool experience to know what was happening in real time and be aware of the magnitude of what they were doing,” said Nicholas in a statement to Northwestern.
“At one point during surgery, I recall asking, ‘Should I be expecting the spinal anesthesia to kick in?’ They had already been doing a lot of work and I had been completely oblivious to that fact. Truly, no sensation whatsoever.”
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Although Nicholas did receive sedation for comfort, he said he was still aware of what was going on.
“Especially when they called out my name and told me about certain milestones they had reached,” he noted.
Nicholas, center, is pictured after surgery with Dr. Vicente Garcia Tomas, his anesthesiologist, at left, and Dr. Nadig, transplant surgeon, at right. (Northwestern Medicine)
Nicholas walked out of the hospital on May 25, the day after surgery.
With typical kidney transplants, the recipient remains in the hospital for two to three days.
Saved by a friend
Nicholas’ kidney issues began at age 16 when he was diagnosed with Crohn’s disease, the release stated.
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After a few years of managing the condition with medication, his kidney function worsened and he required a transplant.
Nicholas’ mother originally planned to donate her kidney, but a breast cancer diagnosis prevented her from doing so, the hospital relayed.
Nicholas, at left, is pictured with his donor and best friend, Pat Wise, after surgery. (Northwestern Medicine)
It was Nicholas’ best friend from elementary school, 29-year-old Pat Wise in Alexandria, Virginia, who ultimately donated the life-saving kidney.
‘Another tool in our toolbelt’
Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, was not involved in the surgery but shared his input.
“My opinion is that in most cases, spinal anesthesia presents a reasonable alternative for those at high risk of general anesthesia complications,” Siegel told Fox News Digital.
Nicholas is pictured awake with his care team during his kidney transplant surgery. (Northwestern Medicine)
“Having said that, general anesthesia would be preferred whenever possible for major surgery like this,” said Dr. Siegel, “because control of the airway and breathing is essential, and is much easier if the patient is asleep and on the ventilator.”
The doctors at Northwestern credit the patient for helping to advance the field of transplant medicine.
Nicholas, left, and donor Wise are pictured at a press conference after the surgery. (Northwestern Medicine)
“When John agreed to be the first known patient at Northwestern Medicine to undergo an awake kidney transplant and be discharged home the next day, he knew the benefits outweighed the risks, and … he’s now helping to move the field of transplantation forward,” said Vinayak Rohan, M.D., transplant surgeon at Northwestern Memorial Hospital, in the release.
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“He is an extremely compliant patient who was in tune with his body and willing to push the envelope,” stressing that the patient had faith in the doctors and they, in turn, had faith in him.
Nicholas, center, is pictured with his entire care team. “He’s now helping to move the field of transplantation forward,” a surgeon said about the patient. (Northwestern Medicine)
The hospital now plans to establish the AWAKE Program (Accelerated Surgery Without General Anesthesia in Kidney Transplantation) for patients who want or need to pursue surgery without general anesthesia.
For more Health articles, visit www.foxnews/health
“It really opens up a whole new door and is another tool in our toolbelt for the field of transplantation,” Nadig added.
Fox News Digital reached out to Northwestern Medical for additional input.
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