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Auto-brewery syndrome
Auto-brewery syndrome (ABS), also known as gut fermentation syndrome, is a rare metabolic condition in which endogenous fermentation of carbohydrates by yeast or bacteria in the gastrointestinal tract produces ethanol, leading to symptoms of alcohol intoxication without alcohol consumption
Prevalence
Unknown
N/A
US Estimated
N/A
Europe Estimated
Age of Onset
All ages
ICD-10
K90.49
F10.129
Inheritance Pattern
Autosomal dominant
Autosomal recessive
Mitochondrial/Multigenic
X-linked dominant
X-linked recessive
Rare View
Auto-Brewery Syndrome, also known as Gut Fermentation Syndrome, is a rare condition in which the body produces alcohol (ethanol) internally. This occurs when certain microorganisms, such as yeast (Saccharomyces cerevisiae) or bacteria, ferment carbohydrates in the gastrointestinal tract.
5 Facts you should know
FACT
A condition characterized by the fermentation of ingested carbohydrates in the gastrointestinal tract of the body caused by bacteria or fungi
FACT
Symptoms that usually accompany auto-brewery syndrome include elevated blood alcohol levels as well as symptoms consistent with alcohol intoxication—such as slurred speech, stumbling, loss of motor functions, dizziness, and belching
FACT
Organisms use lactic acid fermentation or mixed acid fermentation pathways to produce an ethanol end product
FACT
The ethanol generated from these pathways is absorbed in the small intestine, causing an increase in blood alcohol concentrations that produce the effects of intoxication without the consumption of alcohol
FACT
Auto-brewery syndrome is more prevalent in patients with co-morbidities such as diabetes, obesity, and Crohn’s disease
Interest over time
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Common signs & symptoms
Episodes of apparent alcohol intoxication
Dizziness or lightheadedness
Slurred speech
Fatigue
Confusion or brain fog
Headaches
Mood changes
Elevated blood or breath alcohol levels without alcohol intake
Current treatments
Dietary modification
- Low-carbohydrate or ketogenic-style diets
Pharmacologic Therapy
- Antifungal agents (e.g., fluconazole, nystatin)
- Antibiotics in select bacterial overgrowth cases
Adjunctive strategies
- Probiotics to restore microbial balance
- Management of underlying gastrointestinal conditions
References:
Painter KL, Cordell BJ, Sticco KL. Auto-brewery syndrome (gut fermentation syndrome). StatPearls Publishing; 2020. ABS is rare and involves endogenous ethanol production by fermenting gut microbes. Malik F, Wickremesinghe P, Saverimuttu J. Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition. BMJ Open Gastroenterol. 2019;6(1):e000325. doi:10.1136/bmjgast-2019-000325 — Describes clinical presentation, microbiome involvement, and treatment response. Tameez Ud Din et al. Auto-brewery syndrome: a clinical dilemma. PubMed 2020 — Summarizes etiology, diagnosis (including glucose challenge), and management. The Auto-Brewery Syndrome: A Perfect Metabolic “Storm” with Clinical and Forensic Implications. J Clin Med. 2021;10(20):4637. doi:10.3390/jcm10204637 — Reviews microbial fermentation of carbohydrates to ethanol and clinical implications. Cleveland Clinic. Auto-Brewery Syndrome: Symptoms, Causes & Treatment. Cleveland Clinic Health System. Reviewed 04/21/2025 — Overview of pathophysiology, symptoms, risk factors, and treatment approaches