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Auto-brewery syndrome in a 50-year-old woman
- donatj 2y agoThis poor woman. I feel like auto-brewery syndrome is well known enough in pop culture that I am somewhat stunned it went so long before anyone considered the possibility.
- lenerdenator 2y agoIt's known in pop culture because it's so strange to actually see in a doctor's office.
- sed3 2y ago[flagged]
- master-lincoln 2y agobecause believing is for religious people...
- sed3 2y agoBelieving something with 4000 years of tradition in different cultures, was validated in several studies is "religious". Versus believing something that came out last year, and has only single study sponsored by manufacturer...
- joseda-hg 2y agoI'd say you're misinterpreting what belief implies here Tradition isn't proof, but also it doesn't harm credibility, at least to coherent people, and that's how it should be* Eventually if there's enough proof, the consensus shifts, regardless of how much initially people try to deny it Fasting goes against recent consensus, yet it's becoming both more researched and more recommended (At the very least at the layman level, I'm no dietician) * Something working doesn't tell you why it works, so it's important to be rigorous and always check, else you risk cargo-culting unnecesary or even risky things
- notarobot123 2y ago...and rational people when combined with justification and evidence.
- schmidtleonard 2y ago(X) Doubt Last time I was in a medical space, intermittent fasting was all the buzz. The idea that it somehow has opposition from mainstream medicine seems like the kind of thing that an internet community would invent to pretend at being brave rebels (and run defense if case they were caught getting frisky with unsubstantiated health claims.) If you search "intermittent fasting" on google, the results are full of very positive articles from all the big names in medicine: Johns Hopkins: Intermittent Fasting: What is it, and how does it work? Mayo Clinic: Intermittent fasting: What are the benefits? Harvard Health: Intermittent fasting: The positive news continues So no, I don't buy for one second that "most doctors do not believe something like fasting can improve health."
- sed3 2y agoIntermittent fasting is pretty much American invention with all the usual marketing.
- Cthulhu_ 2y agoThere's a lot of vagueness in your last statement and I'm not sure what you're trying to imply. "Most doctors" is an unspecific appeal to authority; which doctors can you cite that do not believe something like fasting can improve health? "believe" was already mentioned by another commenter. An authority will make an assertion based on facts, not a belief based on ??? "something like" is it fasting or is it something else? Be specific. "fasting" What kind of fasting do you mean? Between sunup and sundown like ramadan? Intermittent fasting? 30 day juice diet fasting? "improve health" Improve how? And what aspect of health? "Health" is such a broad term that saying "this is good for your health" or "this food is healthy" are empty statements.
- sed3 2y agoMy point is that "auto brewery syndrome" is pretty well known at some type of community.
- failrate 2y agoIt took me several years to get a SIBO diagnosis even though the "breath test" fir it is cheap and easy. Similar symptoms and treatment to autobrewery syndrome, and a lot of the feedback I got from doctors prior to diagnosis was that I was either a hypochondriac or "just more sensitive to pain".
- nerdponx 2y agoIt's ridiculous what doctors will put people through instead of doing a basic test that's cheap and easy to administer and (in the USA) should be covered by health insurance. I know someone who went through a similar experience with H. pylori.
- jrockway 2y agoTests are not 100% accurate, so running a test without a good reason can lead to a lot of unnecessary medical intervention. A false positive can lead to thousands of dollars of expense and not getting better.
- failrate 2y agoIn my particular case, I had numerous other more expensive and invasive tests before my gastro finally decided to even offer the breath test. The treatment is a course of antibiotics for a week.
- solveit 2y agoThis reasoning only makes sense in the context of a dysfunctional system. "We can't gather information because we will react in stupid ways". Surely the correct response for noninvasive tests is to run the test, and raise the threshold for intervention?
- andrewflnr 2y agoOr if it's cheap, run the test twice. And you're presumably going to have other symptoms that corroborate the results. Maybe the symptoms of X are ambiguous alone, but what are the odds you have a positive test for X and matching symptoms but not X itself? Not zero, but lower.
- Workaccount2 2y agoThe core issue is that the system is just not good at catching outliers, and the only conceivable way to do so would be incredibly wasteful and expensive. For every case of "It took 8 doctors over the course of 3 years to get a diagnosis" there are 5000 cases of "It took 1 doctor on one visit to get a diagnosis"
- belmarca 2y agoAnd "outliers" aren't necessarily exotic. Idiopathic disease isn't rare and difficult to diagnose.
- Gibbon1 2y agoThe problem is the fat tail of rare conditions is really wide because their are thousands of them. Say there are 500 rare conditions with a rate of 2 per 100k per year. That means one out of 100 patients will develop one of those 500 in a given year.
- tivert 2y ago> The core issue is that the system is just not good at catching outliers, and the only conceivable way to do so would be incredibly wasteful and expensive. But in this case, I don't think it would be "incredibly wasteful and expensive." The case study stated, "On her ED visits, she was discharged with the diagnosis of alcohol intoxication, despite her reports of no alcohol intake, corroborated by her family." She didn't need some expensive diagnostic test for a diagnosis, she needed a doctor to pay attention to what she and her family were saying.
- shermantanktop 2y agoAnd to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this. As someone with a relatively obscure condition, I’ve gotten used to being the pachinko ball that falls straight down the diagnostic chart to the wrong conclusion. But I understand the numbers are against me.
- MisterTea 2y ago> I feel like auto-brewery syndrome is well known enough in pop culture Never heard of it until now.
- s1mon 2y agoIt may depend on what TV shows you watch. It's been on Grey's Anatomy, the Good Doctor and House MD. I thought it was on Chicago Med once or twice too.
- eadler 2y agoI don't think it's ever been on House. Don't recall it from memory or find it on a quick Google search. Posisble I'm wrong though.
- stevemk14ebr 2y agohow does this start?
- jMyles 2y agoSecond and third paragraphs under "discussion": > Auto-brewery syndrome is thought to result when microorganisms capable of fermenting alcohol from carbohydrates outgrow normal gut flora.6 Although population-based studies have shown that gut alcohol fermentation with low levels of endogenous ethanol can occur even among healthy people, blood ethanol levels rarely reach concentrations high enough to cause intoxication.7 Auto-brewery syndrome is uncommon because it requires several host factors to interact with substantial overpopulation of fermenting microorganisms, and high carbohydrate consumption.6 Comorbidities such as diabetes, liver disease, gut dysmotility disorders, and inflammatory bowel disease are associated with auto-brewery syndrome through mechanisms contributing to increased levels of blood glucose and decreased ethanol metabolism.6,7 Genetic predisposition for inactive aldehyde dehydrogenase enzyme and subsequent inefficient alcohol metabolism, may also play a role.6 In our patient, we suspect her recurrent antibiotics for UTI and dexlansoprazole use led to gut dysbiosis with potential contribution of genetics, resulting in auto-brewery syndrome. > Commonly implicated fungi responsible for outgrowing normal gut flora in auto-brewery syndrome are Saccharomyces cerevisiae and Candida species including C. albicans, C. tropicalis, and C. glabrata.2 Bacteria have also been cultured from patients with auto-brewery syndrome. Although the role of bacteria remains unclear, a recent case–control study proposed Klebsiella pneumoniae as an important culprit.7–9
- deleted 2y ago[deleted]
- adderthorn 2y agoIn her case, I would guess a lot of antibiotics since the article mentioned frequent ciprofloaxin treatments for UTIs.
- nerdponx 2y agoIt's wild that probiotics aren't considered medically necessary and prescribed alongside antibiotics at this point.
- teeray 2y agoYou have to wonder how much damage to this poor woman’s liver was caused by the ED’s constant diagnosis of “go home, you’re drunk.”
- aaron695 2y agoThere's talk of people trying to give themselves auto-brewery syndrome - https://www.reddit.com/r/BrandNewSentence/comments/bn5e57/my_roommate_succeeded_in_giving_himself/ https://www.reddit.com/r/BrandNewSentence/comments/bn5e57/my... I haven't pinned down a proper account of someone who's tried and if it works, proper testing and stuff. This is what bio-hackers should be working on. Word of the day: Boofing is a slang term used to describe the process of ingesting a drug through the anus.
- giantg2 2y agoI wonder if autobrewery syndrome is less common in cultures that eat fermented foods, such as sauerkraut and kimchi.
- freitzkriesler2 2y agoProbably, it's why I eat a lot of Greek yogurt. Fermented foods keep the gut bacteria in check. This sounds like an awful disease to have. As someone who suffers from fungal problems, f*ck em. I hate fungi so much .
- Carrok 2y agoYeast (the things responsible for fermenting foods) are fungus. So if you like fermented foods, you shouldn’t hate fungi.
- nerdponx 2y agoMost fermented foods are not yeast-fermented. Alcoholic beverages are.
- zdragnar 2y agoGreek yogurt is full of lactobacillus bacteria, not fungi.
- _nalply 2y agoKefir, a food similar to yoghurt, is fungus-based fermented food. The Kefir grain contains a symbiotic culture of yeasts and lactic and acetic acid bacteria.
- vitiral 2y agohating fungi is a bit like hating your own liver or stomach. They are an absolutely fundamental component to the web of life on earth, including your own.
- s1artibartfast 2y ago
- dav_Oz 2y ago>On her seventh ED visit, the patient presented with slurred speech, alcohol odour on her breath, and an elevated ethanol level of 62 mmol/L. About 0.285% or 2.85‰ (!). For a 200lbs (90kg) person about 14 drinks[0] for a 120lbs (55kg) person about 11 drinks. TL;DR: The issue was resolved with a low carb diet (about 6 months) and putting her on courses of fluconazole. [0]1 drink = a 12-ounce (350 ml) beer or 5 ounces of wine (140 ml) http://www.clinlabnavigator.com/alcohol-ethanol-ethyl-alcohol.html http://www.clinlabnavigator.com/alcohol-ethanol-ethyl-alcoho...
- HankB99 2y ago> About 0.285% That's pretty high and aligns with the description of slurred speech and other signs of inebriation. I wonder if those afflicted ever connect diet with severity of symptoms as it seems that high carbs increase ETOH production. I also wonder if the constant exposure leads to addiction and if withdrawal complicates treatment.
- adamomada 2y agoAs someone who was a home brewer, the amount of fermentable sugar this woman must have consumed over the Days of fermentation to cause a BAC at that level at one point in time is astounding to the point where I’m suspicious she wasn’t drinking I’m talking about the equivalent of consuming a pound of honey for multiple days straight, and more likely something like multiple pounds somehow turbo fermented to hit that alc%. If she didn’t have this medical problem, she would have had five others soon. For those who don’t know, there is an upper limit of natural fermentation where if you try hard, maybe you hit 20% alc/vol. Four pints of it to hit those numbers at the low end (120 lb / 55 kg person)
- Jensson 2y ago> there is an upper limit of natural fermentation where if you try hard, maybe you hit 20% alc/vol In a drink. In your stomach your blood will absorb that, meaning the yeast will just continue to make alcohol forever until you die since the yeast tolerates much higher alcohol percentages than you do. Yeast makes sugar into about half alcohol, so 200g carbs would be enough for about 2% blood alcohol at 5l blood. 200g carbs isn't that much, you'd get it from some cake and soda at a party.
- im3w1l 2y agoI'm a little surprised there is no mention of flatulence in that article. The reddit post in aaron695's comment does bring it up, and intuitively I think it should be present. I self-diagnosed (so yeah make of it what you will) auto-brewery syndrome in myself, after I had ingested unusually large amounts of live yeast - I had been making cider and drinking it a bit earlier then recommended - while the yeast was still very active, as I was playing around. Only symptom I noticed was flatulence after carb-heavy meals (didn't notice becoming tipsy, but I'm not very good at noticing that either ig). Like I literally farted once a minute for a day one time. However this only lasted a very short time, maybe a few days. I still had a very mild version of that like a month or two later (from memory so idk) and like a year or two later it was completely gone.
- steezeburger 2y agoHow can you self diagnose yourself from a symptom that's not even included as a symptom for what you're self diagnosing for?
- im3w1l 2y agoWell I didn't think of it in terms of the label auto-brewery syndrome. Rather I was just thinking "I guess the yeast has colonized my gut". How, well because I have seen and listened to fermentation and admired the bubbling process - it's very satisfying btw. And so it seemed very natural to assume that the same thing was happening inside me. https://www.youtube.com/watch?v=DV_9tfFyY00 https://www.youtube.com/watch?v=DV_9tfFyY00
- MisterTea 2y agoBrooklyn Lager + 24 month aged Canadian cheddar + rosemary & olive oil Triscuits = flatulence so bad it will keep you awake or you will fart yourself awake multiple times. Also, bad gas pains.
- datadrivenangel 2y agoA delicious combo though
- davidthewatson 2y agoThe problem of "how doctors think" was well-documented over 15 years ago by Jerome Groopman. As a result, I think the problem is well understood, at least by those who are aware of books like Groopman's. Unfortunately, his message hasn't traveled far despite his reputation and book sales. http://jeromegroopman.com/ http://jeromegroopman.com/
- ASalazarMX 2y agoYearly checkup, new lab doctor asks how many hours have you fasted. You reply "Zero, but I've only consumed my own alcohol". Still not worth it.
- tacitusarc 2y agoThere was a Scott Alexander post about how the point of expertise is the ability to out predict the statistical odds. I’m struggling to find that post. Edit: Found it. https://www.astralcodexten.com/p/heuristics-that-almost-always-work https://www.astralcodexten.com/p/heuristics-that-almost-alwa...
- ta988 2y agoThis shows the absolute lack of humanity from those doctors, that refuse to listen to patients. Now that was a resolved case, what about all the other cases? I am living with someone that was told for decades that it was all in their head and that they had psychiatric issues before finally they decided to listen and map the symptoms and realize it was a simpler endocrine problem. This is how patients are treated and especially if they are women and/or racialized.
- thinkingtoilet 2y agoIt goes both ways. How many alcoholics had this doctor treated that lied about their drinking? We can expect our doctor's to be perfect but addicts lie, and it's normal to expect addicts to lie. I think a little empathy would have gone a long way here, don't get me wrong, but saying they have no humanity is a bit much.
- escape_goat 2y agoI do not think it true that it goes "both ways." Patients do not have a collective responsibility to doctors. Patients should not go untreated because other patients lie about their addictions. Being a doctor means exactly watching dozens of horses go in and out the door each day and saying "that's a zebra" before the zebra makes it to the exit. There's a fundamental responsibility to perform differential rather than normative diagnosis.
- s1artibartfast 2y agoPatients do not have a collective responsibility to doctors, but I dont think doctors have the responsibility to provide a diagnosis at all. I think people have strange and exaggerated expectations. You don't go to a car mechanic and expect them to have all the answers and perfect accuracy. The expectation is that they will take a look and provide their fallible opinion.
- TillE 2y agoIf a particular doctor is clueless, that's what referrals are for. You don't just shrug and move on.
- jxramos 2y ago> with a strategy of antifungal therapy and a low-carbohydrate diet. I wonder if she ultimately switched to a meat only diet or at least tried it.
- tpoacher 2y agoThe term "rare" disease should be replaced by "rarely diagnosed" disease. The difference is subtle but hugely important.
- s1artibartfast 2y agoIs it not a rare disease? It has been recorded around 100 times worldwide, and is notable enough to publish a paper when it is observed. It is probably more common than diagnosed, but still incredibly rare!
- tpoacher 2y ago> Is it not a rare disease? We don't know. Possibly. > It has been recorded around 100 times worldwide, and is notable enough to publish a paper when it is observed. Indeed. Had it been recorded more often, it wouldn't be as notable. > It is probably more common than diagnosed, but still incredibly rare! Hence rarely diagnosed. :)
- s1artibartfast 2y agoNonsense. It could be 1,000X more common and still be considered a very rare disease. It is safe to say it is rare. A disease is considered "rare" in the US if less than 200k people have it. If there 200k Americans suffering from spontaneous drunkenness, we would know it.