Solve the Medical Riddle: She Suspected That Her Husband Was a Closet Drinker, Fourth Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported his symptoms. The doctor  referred him to a gastroenterologist, a specialist in digestive disorders. The second week, the GI specialist proceeded with the examination. Both physicians used the components the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendation

Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Reveals the Diagnosis

Lorna G. made a good point when she said that Sam might have a brain tumor that was causing his erratic behavior, but the reason I didn’t have him tested for that was because the breakfast doughnuts led me straight to my diagnosis: Auto-Brewery Syndrome, also called Gut Fermentation Syndrome. The results of the gastric culture confirmed that.

Marilyn N. came very close when she suggested Candida overgrowth form Candida albicans. The problem is similar in that a “commensal” or “good” member of the gut microbiome goes haywire, whether because of diet choices such as carbohydrates, or because of certain illnesses or long-term use of antibiotics. In the case of Auto-Brewery Syndrome, the yeast that’s the perpetrator is Saccharomyces cerivisiae, or Brewer’s yeast.

Brewer’s yeast is in a whole host of foods including breads, wine and, of course, beer – hence the name. The yeast most often doesn’t do any harm and usually doesn’t even colonize or set up house in the intestines. However, in rare cases the yeast can take up long-term residency in the gut and possibly cause problems as it morphs into a fungus.

In other words, Sam was not lying. He had not been drinking excessively. His condition is rare but real. The scant literature on Auto-Brewery Syndrome includes a handful of cases similar to one in Texas that was published online in July 2013 in the International Journal of Clinical Medicine. However, some reports in Japan date back to the 1970s. In most instances, the infections occurred after a person took antibiotics, which can wipe out the bacteria in the gut and make room for fungi to flourish. In other cases, the cause was an illness that suppressed the immune system.   

In Sam’s case though, Auto-Brewery Syndrome was causing his stomach to use excess yeast in the intestine to ferment carbohydrates and other sugary foods into alcohol.