4 ms·

how does this start?

jMyles 2y ago
Second 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
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adderthorn 2y ago
In her case, I would guess a lot of antibiotics since the article mentioned frequent ciprofloaxin treatments for UTIs.
- nerdponx 2y ago
  It's wild that probiotics aren't considered medically necessary and prescribed alongside antibiotics at this point.
  - Auracle 2y ago
    Probiotics are really limited in scope compared to what bacteria you naturally have, unfortunately. They’re far from a silver bullet. That’s why things like fecal transplants exist.
    - nerdponx 2y ago
      Yeah but obliterating your gut flora without even making an attempt at remediation is madness to me. It's like saying that people who quit smoking shouldn't bother going to the gym because their lungs are already busted. I haven't looked at the literature in a while, but several years ago I saw some research which concluded that probiotics generally do not directly recolonize the gut; instead, they temporarily prevent colonization by "bad" things and help maintain a healthy environment until diverse recolonization happens gradually over time. I also saw some evidence (backed by personal experience) that "complex" naturally fermented foods (sauerkraut, kimchi, etc) were more effective than single-culture probiotics.
  - simiones 2y ago
    I was prescribed probiotics every time I was prescribed an antibiotic in the last few years, even by a dentist. This may vary a lot by country, though.
  - jakubmazanec 2y ago
    It probably depends on a country or a doctor. Here in Czechia I never got prescription for antibiotics without both doctor and pharmacist advising me to also take probiotics.
  - belorn 2y ago
    The metabolic system is like a ecosystem, where every intervention has a fairly large spectrum of unknowns. Probiotics can do harm, just like antibiotics, or it may do nothing, or it may improve health or reduce symptoms. Generally it doesn't have long term negative effect so it fairly safe, but I can see how doctors would be careful throwing in additional unknowns, especially initially when testing if the antibiotics themselves has the intended effect without major side effects. We live in symbiosis with the gut flora, and the tools we have to fix problems are crude and based on trial and error.
- metadaemon 2y ago
  A very notorious antibiotic for its plethora of side-effects.
im3w1l 2y ago
The article seems to hint at her previous gut flora being wiped out by broad-spectrum anti-biotics taken for her recurrent urinary tract infections, thus allowing the fungi in.

Second 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 ago

In her case, I would guess a lot of antibiotics since the article mentioned frequent ciprofloaxin treatments for UTIs.

nerdponx 2y ago
It's wild that probiotics aren't considered medically necessary and prescribed alongside antibiotics at this point.
- Auracle 2y ago
  Probiotics are really limited in scope compared to what bacteria you naturally have, unfortunately. They’re far from a silver bullet. That’s why things like fecal transplants exist.
  - nerdponx 2y ago
    Yeah but obliterating your gut flora without even making an attempt at remediation is madness to me. It's like saying that people who quit smoking shouldn't bother going to the gym because their lungs are already busted. I haven't looked at the literature in a while, but several years ago I saw some research which concluded that probiotics generally do not directly recolonize the gut; instead, they temporarily prevent colonization by "bad" things and help maintain a healthy environment until diverse recolonization happens gradually over time. I also saw some evidence (backed by personal experience) that "complex" naturally fermented foods (sauerkraut, kimchi, etc) were more effective than single-culture probiotics.
- simiones 2y ago
  I was prescribed probiotics every time I was prescribed an antibiotic in the last few years, even by a dentist. This may vary a lot by country, though.
- jakubmazanec 2y ago
  It probably depends on a country or a doctor. Here in Czechia I never got prescription for antibiotics without both doctor and pharmacist advising me to also take probiotics.
- belorn 2y ago
  The metabolic system is like a ecosystem, where every intervention has a fairly large spectrum of unknowns. Probiotics can do harm, just like antibiotics, or it may do nothing, or it may improve health or reduce symptoms. Generally it doesn't have long term negative effect so it fairly safe, but I can see how doctors would be careful throwing in additional unknowns, especially initially when testing if the antibiotics themselves has the intended effect without major side effects. We live in symbiosis with the gut flora, and the tools we have to fix problems are crude and based on trial and error.
metadaemon 2y ago
A very notorious antibiotic for its plethora of side-effects.

im3w1l 2y ago

The article seems to hint at her previous gut flora being wiped out by broad-spectrum anti-biotics taken for her recurrent urinary tract infections, thus allowing the fungi in.