We all have vices. This is not necessarily bad; A vice can be something as positive as studying or reading, or as harmless as watching movies. Unfortunately, it is true that many incur in more harmful addictions, such as psychotropic drugs, cigarettes, pineapple pizza, or alcohol. The latter in particular is especially frequent and socially accepted, and come on, let's admit that the vast majority of us occasionally enjoy a few drinks with friends, and that feeling of light drunkenness that removes our social inhibitions and makes us feel capable of anything. Some studies even claim that drinking a small amount of alcohol daily helps prevent a number of diseases _(and many others say otherwise, but we all have to die of something, right?)_, so its consumption is not too dangerous with moderation _(physically, at least. It's not very emotionally healthy to call your ex in the early morning after half a bottle of rum)_. But what if we can't control our blood alcohol level? And even worse, what if we get drunk without even having to drink liquor? This is the complex reality of those who must live with **Auto-brewery Syndrome**:
# <center>Rare Diseases: Auto-brewery Syndrome</center>
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<center>https://p0.pikrepo.com/preview/105/517/clear-drinking-glass-with-beer.jpg</center><div class="pull-left">[*Source: Pikrepo*](https://www.pikrepo.com/fjrtf/clear-drinking-glass-with-beer)</div><div class="pull-right">*License: Public Domain*</div>

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Alcoholic beverages have been part of our culture practically since the beginning of civilization itself; Wine is believed to have been born in the Middle East in 9000 B.C., and there is evidence of its consumption in 7000 B.C. in what is now China. Alcohol has been present in our greatest successes and celebrations, in toasts during ceremonies after conquests in wars or in celebrating more mundane achievements such as birthdays or promotions at work, and has been there to drown our sorrows throughout our history, after our hardest defeats, making our worst losses slightly more bearable and dulling the inner cries in our hardest moments. It has been given as an offering to all kinds of gods, and poured on the ground in the name of the dearly departed. If we analyze it, its importance throughout our history cannot be overstated; it's something that has always been with us and probably always is. Of course, before it seems that I’m romanticizing things too much, it goes without saying that throughout this period of time it has also caused countless deaths and tragedies _(and let’s not even mention the number of vomit-filled objects it has left in its wake)_, and of course my medical advice is to stay away from it, within reason. But what if this alcohol is created within our own bodies?
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Before delving into the subject in depth, I would like to talk a little about how exactly alcoholic beverages are made, and why they cause a state of drunkenness. There are two types of liqueurs: those created by **fermentation**, such as wine or beer, and those product of a **distillation** process, such as vodka or rum. Fermentation is the result of a mixture of carbohydrates in the form of sugars and starch together with yeast, or some other catalyst, which converts carbohydrates into carbon dioxide and **ethyl alcohol** _(or ethanol)_, which is the type alcohol that is used for the production of spirits. In distillation, a fermented liquid based on cereals, tubers or plant waste is used, and the pure alcohol is separated from the water, to then add flavor and smell with various ingredients or through aging processes.
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 After ingestion, alcohol is absorbed by the mucosa of the stomach and small intestine, and from there it is distributed throughout the body along with body water, especially affecting the central nervous system, depressing it and inhibiting the activity of the neurons, and at the same time causing release of dopamine _(the main neurotransmitter of the brain's reward system, responsible for feelings of euphoria and happiness)_, thus causing its already known effects: loss of motor coordination and social inhibitions, sleepiness, sedation, and a pleasant feeling that makes its consumption so addictive and can create dependency. After a couple of hours, ethanol is metabolized in the liver, mainly due to the action of the enzyme **alcohol dehydrogenase** or ADH, and eventually it is transformed into water and carbon dioxide, and eliminated through urine, sweat, and breath _(making breath BAC tests possible)_.
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<center>https://cdn.pixabay.com/photo/2014/02/12/03/23/liquor-264470_960_720.jpg</center><div class="pull-left">[*Source: Pixabay*](https://pixabay.com/es/photos/licor-alcohol-bar-club-beber-264470/)</div><div class="pull-right">*License: Public Domain*</div>

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Now, we already know that to produce alcohol, only two basic ingredients are needed: yeasts and sugars or starches, extremely common elements, even present within our own body, although generally in very small amounts, not enough as to cause a fermentation reaction. But this changes in a few individuals, those who suffer from **Auto-brewery Syndrome** or Auto-fermentation syndrome, who have within their digestive system an ecosystem that would be the envy of any European vineyard, capable of producing significant amounts of alcohol without requiring any effort _(although being unable to extract and market it, it is not possible to hire several affected by this condition and create your own humanitarian brewery, I know you were thinking about it)_.
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This rare condition is **caused** by an abnormal accumulation within the intestinal tract of yeasts _(fungi, specifically)_, such as Candida albicans or even Sacharomyses cerevisiae, the same that ferments beer, wine, and bread dough. These yeasts are normally present in small quantities and under normal conditions they are eliminated by the liver and intestine from time to time, but on rare occasions when the intestinal flora is greatly altered, such as after massive consumption of oral antibiotics, these can multiply until reaching a quantity capable of initiating a fermentation process, converting sugars and starches, such as potatoes, wheat or rice, into alcohol, making the patient drunk from the inside and making it extremely difficult to explain to that traffic officer why you have high levels of blood alcohol after eating a bag of chips. Other possible predisposing causes are diseases such as diabetes, Crohn's disease, intestinal pseudo-obstructions, or short bowel syndrome, along with a high carbohydrate diet.
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Its main **symptoms** are basically the same as in any alcohol poisoning _(or drunkenness, to put it colloquially)_; loss of fine motor coordination, disorientation, dysarthria _(difficulty in articulating words)_, lethargy, dehydration, mood swings, headache, nausea, vomiting, and frequent belching. Now, I know my audience and I know that most of you have lived through all of this, but I still describe them for academy’s sake. For its **diagnosis**, although there is no specific test for this disease, an adequate medical evaluation is useful to rule out alcohol consumption and demonstrate the presence of the previously mentioned predisposing factors, laboratory studies to assess the level of blood alcohol, a stool test to measure the amount of yeast present in the intestine, an oral glucose tolerance test to assess whether the body converts it to alcohol, and an intestinal endoscopy.
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<center>https://p0.pikist.com/photos/514/530/beer-brewery-metal-tanks-brewing-steam-machine-engine-cultural-industrial.jpg</center><div class="pull-left">[*Source: Pikist*](https://www.pikist.com/free-photo-voywq)</div><div class="pull-right">*License: Public Domain*</div>
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### <center>*All this? Unnecessary; all you need is an abnormal intestinal flora and a tube of Pringles*</center>

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Its **management and treatment** fortunately is not very complex; If the patient has high blood alcohol levels, he is treated for acute alcohol poisoning, just as it would be done with anyone who drinks it orally, after stabilization, antifungal medications such as fluconazole are indicated, sometimes together with antibiotics, to eliminate the overpopulation of intestinal yeasts, the patient's diet is modified by changing it to one low in sugars and carbohydrates and high in proteins, and probiotic supplements are administered to balance the intestinal flora. In addition, predisposing conditions such as Crohn's disease or diabetes also need to be treated or controlled. Although the disease in its acute state can cause complications, most are of a social or legal nature; it rarely leaves physical sequelae, and if the patient changes his diet, relapses are rare.
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We can use this condition as an example to teach the lesson that not everything is always as it seems; Due to its extreme rarity, the auto-brewery syndrome is practically unknown even within the medical world, and it is common for the few individuals around the world who suffer from it to be labeled as alcoholics and ostracized. For this reason, although it is true that many times the simplest explanation is generally the correct one, sometimes it is necessary to investigate further in order to arrive at the truth. But then again, this syndrome is _incredibly rare_, so no, you probably won't be able to use it as a defense the next time you're fined for driving under the influence, just be more responsible.
## References:
* [Painter, Kelly et al. Auto-brewery Syndrome (Gut Fermentation), 2020](https://www.ncbi.nlm.nih.gov/books/NBK513346/)
* [Healthline – Auto Brewery Syndrome: Can You Really Make Beer in Your Gut?]( https://www.healthline.com/health/auto-brewery-syndrome)
* [Wikipedia – Auto-brewery syndrome](https://en.wikipedia.org/wiki/Auto-brewery_syndrome) 
* [Medical News Today – Auto-brewery syndrome: Everything you need to know](https://www.medicalnewstoday.com/articles/auto-brewery-syndrome) 
* [Drinkiq – How is alcohol made?](https://www.drinkiq.com/en-ie/facts-about-alcohol/how-is-alcohol-made/#:~:text=Alcohol%20is%20made%20by%20fermenting,basis%20for%20all%20alcohol%20drinks.)
* [Wikipedia – Alcoholic drink](https://en.wikipedia.org/wiki/Alcoholic_drink)
* [Mayoclinic – Alcohol poisoning](https://www.mayoclinic.org/diseases-conditions/alcohol-poisoning/symptoms-causes/syc-20354386)