Instead of approving her for a liver transplant, doctors pushed this woman to enter a substance abuse program after detecting the presence of alcohol in her body. The problem? She hadn’t had anything to drink...

Life or Death

For Christine Leland, the stakes were high. The Pennsylvania resident had traveled to the University of Pittsburgh Medical Center seeking a liver transplant, which she needed in order to survive. At first, the UPMC transplant team said no—and it wasn’t the first time that Leland had been denied.

Signs of a Problem

Leland had been rejected by a different hospital’s transplant program. UMPC was her only hope, but they wouldn’t even add her to the waitlist. Instead, the transplant team referred her to an alcohol addiction treatment program. Leland was sober, but nobody seemed to believe her. Finally, they took another look at the lab results…

Desperate for a Transplant

Christine Leland had never been a big drinker, so learning that she suffered from cirrhosis was a shock on its own. Leland’s liver was scarred beyond repair, and her diabetes was out of control. When she first attempted to seek a liver transplant, the hospital took one look at her lab results and began pointing fingers.

Bad Luck

The doctors informed her that she would be unable to receive a liver transplant because she was an alcoholic, which had caused cirrhosis of the liver. They found alcohol in her urine. Leland was flabbergasted. She tried to assure the transplant team that she hadn’t had anything to drink that day, but they wouldn’t believe her.

Trying Again

Despite Leland’s protests, the hospital sent her on her way. Leland began to panic. How was it possible that alcohol was in her urine when she hadn’t consumed any alcohol? Desperate for answers, she went to the University of Pittsburgh School of Medicine and Medical Center, hoping they might be able to help.

Time Was Running Out

Leland knew the clock was ticking. It was only a matter of time before her liver would fail. She needed to be considered for a transplant or else her life would be in jeopardy. Unfortunately, the transplant team at UPMC was about to kick her to the curb…

Suspected Alcoholic

Once again, Leland had tested positive for alcohol on a urine drug test, leading the team to believe that she was hiding an alcohol abuse disorder. Suspecting that Leland’s alleged addiction may have led to her failing liver, they insisted that she seek professional help elsewhere.

Something Strange

Leland was once again denied a spot on the waitlist and kicked to the curb. Soon afterward, in early 2019, a psychiatrist with the transplant center approached the medical director of the UPMC Clinical Toxicology Laboratory, Kenichi Tamama. She had noticed an anomaly in Leland’s lab results and wanted a second opinion…

She Didn’t Seem Drunk

During her interaction with the transplant team, Leland had not seemed impaired and vehemently denied drinking. The concentration of alcohol found in her urine was surely high enough to result in drunkenness. Not only that, but Leland’s blood tests returned negative for ethanol, the main ingredient in alcoholic drinks.

Bizarre Discovery

Tamama saw that Leland’s urine contained high levels of glucose due to her uncontrolled diabetes, as well as high levels of yeast. He wondered if the microbes in her bladder were fermenting that sugar into alcohol… but how?

Feeling Guilty

“As I went over the medical record of the patient and learned the situation of the patient, I started feeling obliged to do something for this patient,” Tamama said, “because she might have been falsely mislabeled as an alcohol abuser.” He decided to conduct an experiment…

Running Tests

Tamama and his team took Leland’s urine sample and put it on ice. After incubating the sample at 98.6 degrees to mimic the environment of the body, the researchers saw that Leland’s urine had “remarkably high levels of ethanol production.”

New Diagnosis

They found that Leland’s urine was missing two essential metabolites that would have been present had she been drinking. After doing some research, his team determined that Leland suffered from a previously unknown medical condition: auto-brewery syndrome, or “bladder fermentation syndrome.”

Back on the List

As a result of the experiment, the UPMC transplant team decided to reconsider Leland for a life-saving transplant. Surprisingly, Leland’s experience wasn’t the only recorded instance of the auto-brewery syndrome. When one 46-year-old man was pulled over for drunk driving, no one believed his insistence that he hadn’t had anything to drink...

Drunk Driving

Tom Abramowicz, 46, was driving home from work when the police pulled him over for driving erratically. He refused to take a breathalyzer test, asserting that he hadn’t consumed alcohol that day. Despite his clearly drunken demeanor, Tom wasn’t lying...

Technically Drunk

When Tom was sent to the hospital, doctors discovered that his blood-alcohol level was 0.2—over twice the legal limit for operating a vehicle. Tom’s family, doctors, and the police believed that Tom was a closet alcoholic, but this was far from the case.

Was There A Secret Addiction?

Over the years, Tom had become prone to falls. He exhibited “brain fog and aggressive behavior.” Once Tom was arrested on suspicion of drunk driving, the hospital finally gave him some answers. No one could have anticipated how strange the truth would be.

Something Brewing...

It turns out the 46-year-old man’s body had begun to produce alcohol on its own. Whenever Tom consumed carbohydrates, his body brewed alcohol in his gut. It may sound funny, but for people like Tom, auto-brewery syndrome is no laughing matter.

The Cause

In Tom’s case, the issue began in 2011 after he started to take antibiotics for a thumb injury. Tom had always been an active, healthy person, but after taking the antibiotics, his demeanor shifted. He started to develop “very uncharacteristic” personality changes and depression…

No One Listened

“He was able to function and it was mainly after meals,” said Dr. Fahad Malik, who co-authored the case study on Tom’s rare syndrome. “No one believed him.” Tom started seeing a psychiatrist to deal with the mental side effects of what he was experiencing.

Professional Help

The psychiatrist prescribed Tom antidepressants and anti-anxiety medication to mitigate the shift in his thoughts and behavior. Not long afterward, Tom was arrested for a DUI when his blood alcohol concentration appeared to be twice the legal limit—high enough for most people to blackout from drinking.

Growing Hopeless

The case report noted that hospital staff and police both refused to believe him when he repeatedly denied consuming alcohol. It makes sense; his blood alcohol level indicated otherwise. However, things took a turn when Tom learned about a similar situation happening to someone in Ohio...

He Wasn’t Alone

Tom’s aunt was watching the news and heard that someone else was living Tom’s nightmare. She picked up the phone and called him right away, advising her nephew to get a breathalyzer in order to monitor his alcohol levels. She urged him to go to the lab to be tested…

High-Carb Experiment

Tom went to the same doctors that treated the person in Ohio with his disorder. To confirm that Tom was suffering from auto-brewery syndrome, they asked that he eat a carb-heavy meal in order to check whether his blood alcohol levels spiked. Eight hours later, Tom was technically drunk, all from eating carbohydrates.

Complications

Tom was prescribed antifungal medication and adhered to a strict carb-free diet, but the change in lifestyle was hard for him. He relapsed, and his blood alcohol levels caused him to fall and injure himself. He then went to Richmond University Medical Center, hoping they could give him a permanent solution…

He Couldn’t Quit Carbs

Once again, Tom underwent rigorous antifungal therapy. For several weeks, it was successful—but he couldn’t help himself. “Unbeknownst to us, he ate pizza and drank soda while on this treatment, resulting in a severe ABS relapse,” the doctors stated in their case study.

Cured

Finally, the fungal growth went away, and Tom began taking probiotics to help regulate his gut flora. His symptoms vanished. Over a year after Tom’s treatment finished, he resumed eating carbohydrates as part of a normal diet.

Odd Phenomenon

The syndrome flares up when “gut disturbances” like antibiotic use allow fermenting fungi or bacteria in the gastrointestinal tract to grow uncontrollably. When a person with this type of auto-brewery syndrome consumes carbs like bread, pasta, pizza, or sugary drinks, the fermenting microbes turn into ethanol—leading to “extreme blood alcohol levels.”

Leading to Trouble

The syndrome even made it to the mainstream, having been featured in an episode of Grey’s Anatomy. Still, the occurrence of unexplained, seemingly random intoxication can profoundly disturb patients’ lives, often leading to issues at home and in the workplace...

Rare Condition

In 2014, the driver of a truck that spilled 11,000 salmon onto a highway claimed to have auto-brewery syndrome. A year later, a woman in New York was received a DUI after registering a blood alcohol level over four times the legal limit, but the case was thrown out after it was proven that she had auto-brewery syndrome.

Ongoing Illness

Auto-brewery syndrome may cause people to smell like alcohol or be too exhausted to work or be social. Others may be unemployed due to the effects of the condition; some skip meals to maintain sobriety.

Living in a State of Misery

39-year-old Nick Hess has persistent symptoms that interfere with his quality of life. If he’s not intoxicated, he’s hungover. He had to drop out of college due to his symptoms and is in the process of appealing a DUI conviction. On a daily basis, Nick suffers from vomiting, headaches, and other symptoms.

Trying to Catch Him in the Act

Hess’ wife originally didn’t believe that her husband wasn’t drinking. She even recorded him to make sure that he wasn’t sneaking alcohol. When she realized that he was just playing video games all day, she knew there was something deeper going on.

Long-Term Solutions

“She would watch me wake up and sit on that couch from the moment I woke up to the moment I went to sleep and progressively get more and more drunk,” he said. According to research, the only way to treat the condition is through antifungal medications, probiotics, and a low-carb diet.