Autobrewery

Autobrewery (pronounced aw-tuh-broor-ee (U) or aw-tuh-broo-uh-ree (non-U))

In the slang of clinical medicine, a clipping of “auto-brewery syndrome”, a condition in which the contents of the sufferer’s stomach ferment, creating alcohol (known also as “gut fermentation syndrome” (GFS), “endogenous ethanol fermentation” (EEF) or the more pleasing “drunkenness disease”).  The standard initialism is ABS).

1940s: The construct was auto- (used here as a prefix to mean “reflexive, regarding or to oneself”) + brewery (historically a building or establishment for brewing beer or other malt liquors, especially the building where the brewing is done.  The auto- prefix was a learned borrowing from Ancient Greek αὐτο- (auto-) (self-) (reflexive, regarding or to oneself (and most familiar in forms like autobiography)), from αὐτός (autós) (himself/herself/oneself), from either a construct of (1) the primitive Indo-European hew (again) + to- (that) or (2) the Ancient Greek reflexes of those words, αὖ (aû) (back, again, other) +‎ τόν (tón) (the) and related to Phrygian αυτος (autos), the existence of alternatives suggesting there may have been a common innovation.  Brewery was from the Dutch brouwerij (brewery), the construct being brew +‎ -ery.  Brew was from the Middle English brewen, from the Old English brēowan, from the Proto-West Germanic breuwan, from the Proto-Germanic brewwaną, from the primitive Indo-European bhrewh-.   It was cognate with the Dutch brouwen, the German brauen, the Swedish brygga, the Norwegian Bokmål brygge, the Ancient Greek φρέαρ (phréar) (well), the Latin fervēre (to be hot; to burn; to boil), the Old Irish bruth (violent, boiling heat) and the Sanskrit भुर्वन् (bhurván) (motion of water).  Etymologists suspect brew may be related to English “barley”.  The suffix -ery was from the Middle English -erie, from the Anglo-Norman and Old French -erie, a suffix forming abstract nouns.  The suffix first occurs in loans from the Old French into the Middle English, but became productive in English by the sixteenth century, sometimes as a proper combination of -er with “y” (as in bakery or brewery) but also as a single suffix (such as slavery or machinery).  Auto-brewery syndrome is a noun.

In medicine, a syndrome is a collection of symptoms (some of which clinicians sometimes classify variously as “definitive” & “indicative”) which often manifest simultaneously and characterize a particular abnormality or condition.  The term is commonly used in medicine and psychology and syndromes can either be codified as diagnosable conditions or just part of casual language to describe aspects of the human condition (such as “Paris Hilton Syndrome”).  A syndrome describes patterns of observable symptoms but does not of necessity indicate a condition’s cause or causes.  A syndrome does not need to be widespread or even suffered by more than one patient and a single case is all that is required for a syndrome to be defined; the symptoms need only to be specific.  Diagnosing a syndrome typically involves clinicians identifying the common symptoms and ruling out other possible conditions, something often complicated by the variability in severity and presentation among different individuals, many syndromes being classic examples of “spectrum conditions”.  Like any condition, the course of the treatment regime for a syndrome will focus on (1) managing the symptoms and (2) dealing with the underlying causes when known.

Researchgate’s illustration of the patho-physiological mechanisms of ABS.

Auto-brewery syndrome (known also as “gut fermentation syndrome” (GFS), “endogenous ethanol fermentation” (EEF) or the more pleasing “drunkenness disease”) is a rare and still not widely understood condition, first described in the medical literature during the 1940s.  The condition manifests in patients who exhibit all or some of the symptoms associated with alcohol-induced of intoxication despite not having consumed alcohol.  The early cases highlighted cases where patients had yeast in the gastrointestinal tract, this fermenting carbohydrates (turns sugary and starchy foods) into ethanol, leading to elevated blood alcohol levels.  Because of the rarity of the condition and the effectiveness of treatment regimes, study has been intermittent.

To certain groups (students in university engineering faculties come to mind), auto-brewery syndrome may sound a desirable (time & money saving) condition but for sufferers it can be debilitating and, if untreated, is potentially fatal.  There are legal implications too because those with ABS can appear intoxicated and if breath or blood-tested, can be “over-the-limit for various purposes.  The rarity of presentations (clinicians can in an entire career never see a case) also can mean a patient in somewhere like a hospital’s emergency ward will be assumed to be drunk, their protests of sobriety not believed.  Notably, many of the cases in the literature are those arrested for DUI (driving under influence), one woman in New York found to be have a blood alcohol concentration (BAC) some four times above the legal limit.  She wasn’t charged (despite an elevated BAC while in charge of a vehicle (which included bicycles, horses, donkeys, elephants and such) being an offence of absolute liability) because of the medical evidence.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

However, a potential legal issue for sufferers is that ABS is also an “accelerant condition” in that one can become very drunk even if one’s consumption of alcohol has been minimal (less than one standard drink).  It would in such circumstances still be possible to mount an ABS-based defense to a charge of intoxication but a defendant’s evidential onus of proof would be higher (and technically often more difficult).  Symptoms and side effects are essentially similar to being drunk or having a hangover and include red or flushed skin, dizziness, disorientation, headache, nausea & vomiting, dehydration, dryness in the mouth, burping or belching, fatigue, problems with memory or concentration and mood changes.  Additionally, ABS can induce or worsen other conditions including chronic fatigue syndrome (CFS or ME) and irritable bowel syndrome (IBS) as well as general issues such as anxiety and depression.  The cause is an excess of yeast (a type of fungus) in the gut, the most common being Candida albicans, Candida glabrata, Torulopsis glabrata, Candida krusei, Candida kefyr and Saccharomyces cerevisiae (brewer’s yeast) and although most have concluded ABS is likely usually to be complication of another disease, imbalance, or infection in the body, the exact mechanism(s) have never been determined.  For other it could be simply a product of their specific genetic mix and both adults and children can be afflicted.  More recent research has revealed that in some cases problems with the liver may cause ABS; this happens when the liver is too slow to process alcohol and even small quantities of alcohol produced by gut yeast can produce symptoms.  An excess of yeast in the body can also be a consequence of the use of certain antibiotics, inadequate nutrition, diabetes and deficiencies in the immune system.

An engineering student, studying.

Although doctors tend to disapprove of “Dr Google” and other forms of self-diagnosis, a defensibly scientific approach for those who suspect they may suffer ABS is (1) abstain from the consumption of alcohol for 24 hours, (2) on an empty stomach eat some food high in carbohydrates and (3) after an hour use a home-breathalyzer to record one’s BAC.  Record the findings and repeat the test several times with different levels of carbohydrate consumption.  Such a test obviously is a challenge for engineering students, few of who abstain from alcohol for 24 hours but it can be done.  If a pattern emerges of an elevated BAC without any preceding consumption of alcohol, take the findings to a physician and seek a diagnosis and treatment.  Treatments can be as simple as reducing the consumption of carbohydrates or the use of antifungal medications.