Imagine feeling drunk after a meal — without touching a single drop of alcohol. It may sound unbelievable, but for people living with Auto-Brewery Syndrome (ABS), also known as gut fermentation syndrome, this isn’t fiction. It’s a rare, disorienting, and life-altering condition. Experts break down what ABS really is and how to manage it.
“Auto-Brewery Syndrome (ABS) is a rare condition in which the body produces ethanol internally due to the fermentation of ingested carbohydrates by certain fungi or bacteria in the gut,” explains Dr Naveen Polavarapu, senior consultant gastroenterologist, liver specialist, and advanced therapeutic endoscopist at Yashoda Hospitals. He adds, “This endogenous ethanol production can lead to elevated blood alcohol levels, causing symptoms of intoxication — even in the absence of alcohol consumption.”
ABS is often triggered by an imbalance in the gut microbiome. “The condition is typically caused by an overgrowth of yeast, such as Candida albicans and Saccharomyces cerevisiae, or specific gut bacteria. These microbes ferment sugars and starches from food, producing ethanol in the process,” Dr Naveen elaborates.
The symptoms can be as baffling as they are concerning. “Individuals may experience slurred speech, dizziness, impaired coordination, and hangover-like effects — all without having consumed alcohol,” he says. A key indicator is an elevated blood alcohol concentration (BAC) despite abstinence.
Diet plays a crucial role in both triggering and managing ABS. “Foods high in sugar and refined carbohydrates provide fermentable substrates for gut microbes, exacerbating the condition,” notes Dr Sugra Fathima, consultant dietitian and nutritionist at Olive Hospital, adding, “This includes items like bread, pasta, sweets, and sugary drinks. Natural sugars in fruit can generally be included in moderation, but individual responses vary, so it’s best to consult a doctor.”
Diagnosing ABS isn’t always straightforward. “Physicians use a combination of tests, including blood or breath alcohol assessments after carbohydrate consumption — but without alcohol intake,” explains Dr Naveen, adding, “Stool analysis can reveal microbial overgrowth, and a glucose challenge test may confirm ethanol production.”
Managing ABS begins with dietary changes aimed at minimising alcohol production in the gut. “A diet rich in lean protein — such as chicken, turkey, fish, or tofu — and non-starchy vegetables like leafy greens, cucumbers, bell peppers, and broccoli can help,” says Dr Fathima. “Whole grains like quinoa, brown rice, and oats offer fibre and nutrients without worsening symptoms. Healthy fats from avocados, olive oil, nuts, and seeds are also beneficial,” she adds.
Treatment usually involves antifungal or antibacterial medication, probiotics, and dietary management. “Probiotics help restore the natural balance of gut flora, suppressing the ethanol-producing microbes,” Dr Naveen points out.
However, not all fermented foods are helpful. “Curd might offer beneficial probiotics, but fermented foods like pickles or idli — which contain yeasts or molds — can worsen the condition,” cautions Dr Fathima.
ABS can affect more than just physical health. “The biochemical effects of ethanol on the brain can cause mood swings, irritability, anxiety, or even depression,” says Dr Naveen.
Moreover, the condition can impair nutrient absorption. “It often leads to deficiencies in vitamins and minerals like B6, zinc, and magnesium,” Dr Fathima states, adding, “Supplements, as advised by your doctor, can help meet nutritional needs.”
Recovery varies from person to person. “Some may recover after one round of treatment and return to a normal diet, while others may need long-term carbohydrate restriction to avoid relapse. Ongoing monitoring with a healthcare provider is essential,” she notes.
It may be bizarre to think your gut could turn food into alcohol — but with proper diagnosis, expert guidance, and thoughtful dietary choices, this rare syndrome can be managed. Sometimes, all it takes is a little help for your gut to find its balance again — and stop fermenting your life into chaos.