“No, I didn’t drink a single drop of alcohol, I promise! » This sentence, thrown around at the police checking the alcohol levels of drivers, often smacks of myth. But not with this 40-year-old Belgian. Prosecuted for repeated drunken driving, he was released on Monday after proving that he suffered from an extremely rare pathology: alcoholic self-fermentation syndrome.
Known as intestinal fermentation or auto-brewery syndrome, it is thought to affect only a handful of people worldwide. In these patients, the digestive system endogenously produces ethanol when they ingest foods high in carbohydrates such as bread, pasta or potatoes. How to explain this syndrome? What are its consequences and above all, can it be treated? We tell you everything.
How to explain this syndrome?
“Three things must be present for alcohol to occur,” explains Laurent Beaugerie, professor of gastroenterology at Saint-Antoine hospital. You need too much sugar, too much yeast and a pre-existing condition. » The fermentation of sugar into alcohol takes place using yeast. If everyone has them in their intestinal microbiota, in people with auto-brewery, two yeasts are present in too large a number. “The yeasts involved are candida albicans and the saccharomyces cerevisiae, also called baker’s yeast. » The cause is certain digestive diseases or an imbalance in the intestinal flora.
The right part of the large intestine in which alcoholic fermentation occurs normally receives very little sugar. But in people with auto-brewery syndrome, the sugars which are normally digested in the small intestine arrive in large numbers in this famous right part of the colon. “This happens either because people have eaten enormous quantities of sugar, or because there is a short circuit because they have had intestinal surgery, for example. »
Too much sugar and too much yeast in the right part of the large intestine can therefore exceptionally produce alcohol. “A person with a normal intestine will not self-brew,” explains Laurent Beaugerie. You either need a shortened intestine or one that doesn’t contract well enough. » This is particularly the case for patients suffering from Crohn’s disease and certain severe forms of diabetes.
What are its consequences?
Although the person suffering from auto-brewery syndrome has not ingested a single drop of alcohol, their condition is still similar to that of a drunk person. When the alcohol level remains low, a slight feeling of inebriation, headaches, nausea and fatigue may be felt. But depending on the amount of carbohydrates consumed, this level can rise and cause speech problems, confusion, or even a hangover the next day. A regularly high level could even lead, in the long term, to a risk of cirrhosis, high blood pressure, cancer or hepatitis. It can also lead to significant social and behavioral problems, such as violence or car accidents.
Can we treat it?
If we cannot play on a shortened small intestine or a bypass in obese people, we can, however, reduce our sugar intake. “We can put these patients on a diet enriched in protein and depleted in slow carbohydrates, the fast carbohydrates being very quickly absorbed and not remaining long in the intestine,” emphasizes the professor.
People affected by intestinal fermentation syndrome can try to reduce the number of offending yeasts present in their microbiota. “Taking antifungals can help but you can’t take them for months. » According to the professor, the theoretically most promising approach would be to take smart probiotics. “Prescribing good probiotics, such as lactobacilli, to reduce the number of pathological yeasts in the microbiota could help correct auto-brewery syndrome,” concludes the doctor.