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.
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The American Cancer Society (ACS) has updated its guidelines for colorectal cancer screening.
The organization released the update in its flagship journal on Wednesday, noting that the new recommendations “re-affirm” that adults at average risk should be screened for colorectal cancer at age 45 and continue through 75, for those with a life expectancy greater than 10 years.
In addition to the standard colonoscopy, the ACS also recommends that patients receive a blood-based screening test in a doctor’s office, which is designed to detect tumor DNA in the blood.
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The ACS also suggested an at-home screening option that looks for hidden blood and molecular markers in stool samples.
These new guidelines reflect recent advancements in disease detection, as well as a “critical shift in public health strategy to expand screening options and lower barriers to access,” the ACS stated in a press release.
The ACS recommends blood-based testing and at-home stool sampling as options for colorectal cancer screening. (iStock)
Dr. Robert Smith, senior vice president of early cancer detection science at the American Cancer Society and senior author of the report, wrote in a statement that colorectal cancer should be emphasized as a “highly preventable disease as much as a treatable one.”
“By offering more screening tools in our guideline update, more eligible adults will be able to participate in lifesaving colorectal cancer testing, helping to close the screening gap and catch more cancers at an earlier, treatable stage,” he added.
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According to the ACS, colorectal screening “dramatically improves survival,” as studies show early-stage detection yields a five-year survival rate of more than 90% in the U.S.
About one in three American adults are eligible for colorectal cancer screening but have not been tested, although ACS research marks colorectal cancer as the top cancer killer of adults under 50.
Colorectal cancer is the top cancer killer of adults under the age of 50, according to the ACS. (iStock)
People at a high risk of colorectal cancer may need to begin screening before age 45 or be screened more often, the ACS added. Those over 85 years old should no longer be screened for colorectal cancer, per the guidelines.
Dr. William Dahut, chief scientific officer at the ACS, commented that “no matter which test you choose, what’s most important is to get screened, and that includes underserved, rural and minority populations.”
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These guideline changes follow a surge in colorectal cancer diagnoses in younger individuals. Recent ACS research revealed a 50% relative increase in diagnoses in adults aged 45 to 49 from 2021 to 2022.
Dr. Aparna Parikh, medical director of the Center for Young Adult Colorectal Cancer at the Mass General Cancer Center, who is not affiliated with the ACS, shared that experts don’t “entirely understand why” cases are on the rise.
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“But it seems to be an interplay of a person’s risk factors, overall makeup and early exposures,” she previously told Fox News Digital. “[Those] include dietary exposures, environmental exposures and possible antibiotic exposures, as well as lifestyle factors in the right host.”
Changes in bowel habits are the primary red flag that should raise the suspicion of colorectal cancer. (iStock)
Another recent ACS study found that drinking heavily and consistently over an adult’s lifetime could lead to a higher risk of colorectal cancer.
Other known risk factors include family history, obesity, smoking, a diet high in red and processed meats, inflammatory bowel disease, and a personal history or family history of polyps.
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While there may be no symptoms of colorectal cancer before diagnosis, especially in the early stages, certain symptoms should not be overlooked, experts say.
Dr. Eitan Friedman, PhD, an oncologist and founder of The Suzanne Levy-Gertner Oncogenetics Unit at the Sheba Medical Center in Israel, confirmed to Fox News Digital that changes in bowel habits are the primary red flag that should raise the suspicion of colorectal cancer.
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Other symptoms include fatigue as a result of anemia, stomach pain or abdominal discomfort, rectal bleeding or blood in the stool, weakness and unexplained weight loss.
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The sudden death of Kyle Busch has drawn attention to a rare but devastating medical progression: when pneumonia escalates into fatal sepsis.
An ER doctor spoke with Fox News Digital about how sepsis can trigger a rapid health decline.
“Sepsis is actually not a specific disease or diagnosis, but rather the syndrome that occurs when the body has certain abnormal findings and a presumed infection,” said Dr. Kenneth J. Perry, a South Carolina-based emergency medicine physician.
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The markers of sepsis include elevated white blood cell counts, a high or low temperature, and elevated heart and respiratory rates, according to Perry. Because of this, a patient with pneumonia is often already technically septic by definition.
In the wake of Kyle Busch’s sudden passing, there is a focus on the rapid decline from pneumonia to fatal sepsis. (Getty; iStock)
While many people assume a worsening infection means bacteria are multiplying uncontrollably, it often has more to do with the body’s internal environment.
“It is often not the bacteria itself that is causing the specific decline,” Perry said. “In most cases, it is a cascade of inflammatory processes that are set in motion by the infection.”
When this inflammation spirals out of control, the body moves from having a manageable infection into severe sepsis. This is when otherwise healthy people can rapidly deteriorate.
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“The concerning thing that can happen with any individual … is that sepsis can then lead to low blood pressure, worsening vital signs and organ damage,” Perry said.
“As multiple organs fail, it becomes very difficult for the medical team to treat and can sometimes lead ultimately to death.”
“The medical evaluation provided to the Busch Family concluded that severe pneumonia progressed into sepsis, resulting in rapid and overwhelming associated complications,” the family shared in a statement. (James Gilbert/Getty Images)
It is very unlikely to have pneumonia and not have any symptoms, according to Perry. Early signs can mimic a severe flu, including fevers, chills, a productive cough, and chest or back pain in cases where the lung is infected.
When sepsis begins to take hold, time becomes the most critical factor. “We have known for a number of years that early antibiotic therapy is beneficial in the treatment of sepsis,” Perry said.
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If you or a loved one are managing an infection at home, the doctor says the following red flags mean you should bypass the clinic and head straight to the emergency room.
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- Shortness of breath or difficulty breathing
- A racing heart rate or fever that continues to worsen even after starting treatment
- Severe chest pain associated with a productive cough
The slide into sepsis is, in most cases, a cascade of inflammatory processes that are set in motion by the infection, the doctor said. (iStock)
While cases like Busch’s are tragic, Perry stressed that this shouldn’t cause widespread panic. Most patients with pneumonia do very well with standard oral antibiotics.
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The NASCAR star’s rapid decline underscores the importance of medical vigilance and “having a primary care physician with whom you have a good relationship,” according to the ER doctor.
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“Monitoring symptoms while having easy access to primary care is a very beneficial and appropriate plan for most patients,” he added.
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