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.
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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.
Weight-loss medications known as glucagon-like peptide-1 (GLP-1) agonists, which have gained popularity for treating type 2 diabetes and obesity, have been shown to have the surprising secondary benefit of reducing alcohol intake.
A team of international researchers from Ireland and Saudi Arabia followed 262 adult patients with obesity who started taking two GLP-1 medications: liraglutide or semaglutide.
Among the regular drinkers, weekly alcohol intake decreased by 68%, from approximately 23 units of alcohol to around 8 units.
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The findings were recently published in the journal Diabetes, Obesity and Metabolism and were also presented last week at the European Congress on Obesity in Spain.
GLP-1 agonists mimic a hormone called GLP-1, which is released from the gastrointestinal system after eating, according to study co-author Carel Le Roux, a professor at University College Dublin.
Weight-loss medications known as glucagon-like peptide-1 (GLP-1) agonists have been shown to have the surprising secondary benefit of reducing alcohol intake. (iStock)
These medications activate GLP-1 receptors in the brain, decreasing the sense of “reward” people feel after eating or drinking, eventually leading to reduced cravings for both food and alcohol, he told Fox News Digital.
“It is this commonality of function that suggests the GLP-1 receptors in the brain may be a therapeutic target for not just the disease of obesity, but also for alcohol use disorder,” the professor said.
Study findings
Before the participants started the weight-loss drugs, they self-reported their weekly alcohol intake, then were categorized as non-drinkers, rare drinkers or regular drinkers.
Approximately 72% had at least two follow-up visits and 68% reported regular alcohol consumption.
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After starting the weight-loss medications, the participants’ weekly average alcohol intake decreased by almost two-thirds overall — from approximately 11 units of alcohol to four units after four months of treatment with the GLP-1 agonists.
The reduction in alcohol use was comparable to the decrease that can be achieved by nalmefene, a drug that decreases the “buzz” feeling in people with alcohol use disorder in Europe, according to the researchers.
Among the regular drinkers, weekly alcohol intake decreased by 68%, from approximately 23 units of alcohol to around 8 units. (iStock)
For the 188 patients who were followed over an average of four months, none had increased their alcohol intake after starting the weight-loss medications.
Patients reported that after an evening meal, they were too full to have their usual drink — and when they did drink, they reported becoming full extremely quickly and drinking at a slower pace, Le Roux noted.
“The findings in this study suggest that we may have just found a therapeutic target for alcohol use disorder.”
This suggests that the experience was less enjoyable, partly due to the reduced rate of alcohol absorption.
Some patients also reported that they didn’t enjoy the flavor of the alcoholic beverages as much, and also that hangovers were much worse.
All of these experiences showed that the weight-loss medications create “guard rails” that prevent most patients from drinking excessively, giving them a degree of control over their alcohol intake, according to Le Roux.
After starting the weight-loss medications, the participants’ weekly average alcohol intake decreased by almost two-thirds overall. (iStock)
“The findings in this study suggest that we may have just found a therapeutic target for alcohol use disorder — the GLP-1 receptor,” the professor told Fox News Digital.
“This finding potentially opens the possibility of an entirely new pharmacological treatment paradigm, which could be used in conjunction with conventional methods, such as behavior therapy and group support.”
Potential limitations
The study was limited by its relatively small number of patients, the researchers acknowledged.
Also, the researchers were not able to verify the participants’ self-reported alcohol intake, and roughly one-third of them were not available for follow-up.
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There was also no control group, which means the researchers couldn’t prove that taking weight-loss medication reduces alcohol intake.
The main advantage of GLP-1 agonists is that they only need to be taken once a week and continue to work for the entire week. (iStock)
“Randomized, controlled trials with diverse patient populations — including patients diagnosed with alcohol use disorder — are needed to provide the quality and quantity of data that could be used to support an application for licensing the medication for the treatment of alcohol use disorder,” Le Roux said.
(One such trial is currently underway in Denmark.)
Study implications
With the current medications available to treat alcohol use disorder, the “major problem” is compliance, Le Roux said — “because the cravings for alcohol tend to come in waves.”
“This means a patient might be fully committed to treatment at one point in the week, but then stop taking the medication later in the week when a craving comes,” the professor added.
“This research suggests a promising ancillary benefit of GLP-1 analogs, potentially influencing cravings for alcohol and offering a new avenue for managing alcohol use disorder,” a physician said. (iStock)
There are currently three FDA-approved medications to treat alcohol use disorder: naltrexone (which helps decrease cravings by reducing the “buzz” feeling that comes with drinking alcohol); disulfiram (which helps some people avoid alcohol by making them feel sick when they drink), and acamprosate (which restores the balance of hormones in the brain to reduce cravings), according to the National Institute on Alcohol Abuse and Alcoholism.
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But less than 10% of people with alcohol use disorder get the proper treatment, with many resuming use within the first year of treatment, past research shows.
The main advantage of the GLP-1 agonists is that they only need to be taken once a week and continue to work for the entire week.
For the 188 patients who were followed over an average of four months, none had increased their alcohol intake after starting the weight-loss medications. (iStock)
Outside experts say the study’s findings highlight the potential of weight-loss medications to help treat alcohol use disorder.
“This research suggests a promising ancillary benefit of GLP-1 analogs, potentially influencing cravings for alcohol and offering a new avenue for managing alcohol use disorder,” Dr. Fatima Cody Stanford, obesity medicine physician at Massachusetts General Hospital and Harvard Medical School, who was not part of the study, told Fox News Digital.
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“While the exact mechanisms are still being explored, the findings contribute to our understanding of the broader benefits of GLP-1 analogs beyond obesity treatment,” Stanford added.
Surgeons in Southern California have performed the first human bladder transplant, introducing a new, potentially life-changing procedure for people with debilitating bladder conditions.
The operation was performed earlier this month by a pair of surgeons from the University of California, Los Angeles, and the University of Southern California on a 41-year-old man who had lost much of his bladder capacity from treatments for a rare form of bladder cancer.
“I was a ticking time bomb,” the patient, Oscar Larrainzar, said on Thursday during a follow-up appointment with his doctors. “But now I have hope.”
The doctors plan to perform bladder transplants in four more patients as part of a clinical trial to get a sense of outcomes like bladder capacity and graft complications before pursuing a larger trial to expand its use.
Dr. Inderbir Gill, who performed the surgery along with Dr. Nima Nassiri, called it “the realization of a dream” for treating thousands of patients with crippling pelvic pain, inflammation and recurrent infections.
“There is no question: A potential door has been opened for these people that did not exist earlier,” said Dr. Gill, the chairman of the urology department at U.S.C.
Pushing the Envelope
Until now, most patients who undergo a bladder removal have a portion of their intestine repurposed to help them pass urine. Some receive an ileal conduit, which empties urine into a bag outside the abdomen, while others are given a so-called neobladder, or a pouch tucked inside the body that attaches to the urethra and allows patients to urinate more traditionally.
But bowel tissue, riddled with bacteria, is “inherently contaminated,” Dr. Gill said, and introducing it to the “inherently sterile” urinary tract leads to complications in up to 80 percent of patients, ranging from electrolyte imbalances to a slow reduction in kidney function. The loss of the intestinal segment can also cause new digestive issues.
Dr. Despoina Daskalaki, a transplant surgeon at Tufts Medical Center who was not involved in the new procedure, said advances in transplant medicine (from critical life-sustaining organs, like hearts and livers, to other body parts, like faces, hands, uteri and penises) had led doctors to start “pushing the envelope.”
“They’re asking: ‘Why do we have to put up with all the complications? Why don’t we try and give this person a new bladder?’” Dr. Daskalaki said.
In late 2020, Dr. Nassiri was in his fourth year of residency at the University of Southern California when he and Dr. Gill sat down in the hospital cafeteria to begin brainstorming approaches. After Dr. Nassiri began a fellowship on kidney transplantation at U.C.L.A., the two surgeons continued working together across institutions to test both robotic and manual techniques, practicing first on pigs, then human cadavers, and finally, human research donors who no longer had brain activity but maintained a heartbeat.
One of the challenges of transplanting a bladder was the complex vascular infrastructure. The surgeons needed to operate deep inside the pelvis of the donor to capture and preserve a rich supply of blood vessels so the organ could thrive inside the recipient.
“When we’re removing a bladder because of cancer, we basically just cut them. We do it in less than an hour on a near-daily basis,” Dr. Gill said. “For a bladder donation, that is a significantly higher order of technical intensity.”
The surgeons also chose to conjoin the right and left arteries — as well as the right and left veins — while the organ was on ice, so that only two connections were needed in the recipient, rather than four.
When their strategy was perfected in 2023, the two drew up plans for a clinical trial, which eventually would bring the world’s first recipient: Oscar.
An Ideal First Candidate
When Mr. Larrainzar walked into Dr. Nassiri’s clinic in April 2024, Dr. Nassiri recognized him. Almost four years earlier, Mr. Larrainzar, a husband and father of four, had been navigating end-stage kidney disease and renal cancer, and Dr. Nassiri helped remove both of his kidneys.
But Mr. Larrainzar had also survived urachal adenocarcinoma, a rare type of bladder cancer, and a surgery to resect the bladder tumor had left him “without much of a bladder at all,” Dr. Nassiri said. A normal bladder can hold more than 300 cubic centimeters of fluid; Mr. Larrainzar’s could hold 30.
Now, years of dialysis had begun to fail; fluid was building up inside his body. And with so much scarring in the abdominal region, it would have been difficult to find enough usable length of bowel to pursue another option.
“He showed up serendipitously,” Dr. Nassiri said, “but he was kind of an ideal first candidate for this.”
On a Saturday night earlier this month, Dr. Nassiri received a call about a potential bladder match for Mr. Larrainzar. He and Dr. Gill drove straight to the headquarters of OneLegacy, an organ procurement organization, in Azusa, Calif., and joined a team of seven surgeons working overnight to recover an array of organs from a donor.
The two brought the kidney and bladder to U.C.L.A., then stopped home for a shower, breakfast and a short nap. They completed the eight-hour surgery to give Mr. Larrainzar a new bladder and kidney later that day.
Dr. Nassiri said that kidney transplants can sometimes take up to a week to process urine, but when the kidney and bladder were connected inside Mr. Larrainzar, there was a great connection — “immediate output” — and his creatinine level, which measures kidney function, started to improve immediately. Mr. Larrainzar has already lost 20 pounds of fluid weight since the surgery.
The biggest risks of organ transplantation are the body’s potential rejection of the organ and the side effects caused by the mandatory immune-suppressing drugs given to prevent organ rejection. That is why, for Dr. Rachel Forbes, a transplant surgeon at Vanderbilt University Medical Center who was not involved in the procedure, the excitement is more tempered.
“It’s obviously a technical advance,” she said, but “we already have existing options for people without bladders, and without the downside of requiring immunosuppression.” Unless a patient is — like Mr. Larrainzar — going to be on those medications anyway, “I would be a little bit nervous that you would be exchanging some complications for others,” she said.
A new bladder transplant also does not have nerve connections in the recipient, so while it works well as a storage organ, doctors did not know whether Mr. Larrainzar would ever be able to sense a full bladder, let alone hold and empty it naturally. They spoke about catheters, abdomen maneuvers and eventually developing an on-demand bladder stimulator to help with the release.
But at a follow-up appointment on Thursday morning — just two days after Mr. Larrainzar was discharged from the hospital — Dr. Nassiri removed the catheter and gave him fluids, and Mr. Larrainzar immediately felt that he could urinate.
Dr. Nassiri called it a miracle, then phoned Dr. Gill, who was in a U.S.C. operating room, and exclaimed two words: “He peed!”
“No way! What the hell?” Dr. Gill said. “My jaw is on the floor.”
After finishing the surgery, Dr. Gill drove straight to U.C.L.A. and watched Mr. Larrainzar do it again.
“Of course, this is very, very early. Let’s see how everything goes,” Dr. Gill cautioned. “But it’s the first time he has been able to pee in seven years. For all of us, this is huge.”
Mr. Larrainzar, exhausted, smiled, and Dr. Nassiri brought him a bottle of mineral water to celebrate.
Health
Biden battling 'most aggressive type' of prostate cancer with bone metastasis, medical expert says
Former President Joe Biden was diagnosed with an “aggressive form” of prostate cancer that has a five-year survival rate of between 30% and 40%.
The former president’s prostate cancer is characterized by a Gleason score of 9 and Grade Group 5 with bone metastasis, indicating that it is “pretty far advanced,” Fox News senior medical analyst Dr. Marc Siegel said on ‘Fox Report.’
“It’s the most aggressive type,” Siegel said. “That means it has the highest risk of spread — which obviously he has had.”
Biden is also presenting with urinary symptoms, which is another sign that the cancer is advanced. Prostate cancer often presents as asymptomatic in its early stages, he said.
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President Biden’s cancer is “pretty far advanced,” according to Dr. Marc Siegel. (SAUL LOEB/AFP via Getty Images)
“This was found by physical examination by a prostate exam,” Siegel said. “A lot of times we find an elevation in prostate-specific antigen, PSA, and then we go after it… I mean, he must have had the best possible care here. I’m a little taken aback that it’s this far advanced.”
Siegel said he conducts a prostate-specific antigen, or PSA, test on every male over the age of 45 years old. The test measures how much PSA is in the blood and is primarily used to screen for prostate cancer, according to Mayo Clinic.
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While the PSA test is not always a perfect indicator of prostate cancer, someone who has a rise in PSA automatically gets an MRI, Siegel said. After the MRI, a decision is made about whether to conduct a biopsy.
More than 80% of men over the age of 80 years old have some prostate cancer cells in their body, according to Siegel.
“It would be really surprising if they weren’t doing a very close screening on this because everybody knows in the medical community that this is the one cancer in men you really look out for,” he said. “… He doesn’t seem to have a lot of risk factors that I would think about other than age, but age is enough and he’s 82, so that’s a big risk factor.”
Doctors will likely treat Biden with hormone therapy, Siegel said. They may also attempt to radiate the lesion found on the bone or remove the prostate altogether.
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“Sometimes they decide to do more than one therapy,” Siegel said. “They might try to take the prostate out, do radiation and the hormone therapy altogether. That’s not uncommon.”
There are two types of medications used to treat this type of advanced prostate cancer — Lupron, which stops testosterone production, and Casodex, which stops testosterone from binding. Side effects of the medication can leave people feeling “fatigued and listless,” according to Siegel.
The PSA test measures how much PSA is in the blood and is primarily used to screen for prostate cancer. (iStock)
“The other thing I’m concerned about is bone pain, because those metastases to the bone can be pretty painful,” he said.
If the cancer is caught early while its still localized to the prostate gland, it’s curable “most of the time,” Siegel said.
“The goal is to get it before it leaves the prostate,” Siegel said. “When it’s left the prostate, it becomes much more difficult to cure.”
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