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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.

My treatment recommendation was that Sam should completely change his diet to eliminate foods that break down to simple sugar, such as highly processed “white foods” including breads, pasta, rice, and his daily breakfast doughnuts. I also prescribed the anti-fungal Difulcan.

After just six weeks, Sam’s symptoms had vanished. I ordered another gastric culture and when it was negative decided it was safe to stop the antifungal medication.

Sam’s wife was thrilled. “I felt kind of bad that I had been accusing Sam of lying about his drinking,” Elaine said. “But he totally understands and he forgives me. And guess what? I’m eating better now that I’m helping him cut out the white carbs so I’ve lost six pounds!”

“She looks great and we both feel fantastic,” Sam chimed in. “Now I can have my two beers in the evening and eat a healthy meal without feeling drunk at all. Who would have thought that your own stomach could put you on a constant bender? Now I’ve heard everything!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Pleas visit DrSavard.com.