Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Auto-Brewery Syndrome

Episode Date: November 3, 2019

On Sawbones, we take pride in our ability to detangle medical myth from fact and give you the truth about the human body. This week on Sawbones ... things aren't so clear. You may need a stiff drink for this one ... unless your body is making them already? Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, tour of Missguided medicine. I'm your co-host Justin McRoy.

And I'm Cindy McRoy. Justin, this was a tough one for me this week. What's that buddy? Well, a lot of what we cover on this show. We're married by the way. We never mentioned that. In the intro, we never say like, we're married doctors and we... Well, no, you're not a doctor.

And it is called a marital tour of misguided medicine. I didn't know if I needed a clarify. We're not like brother and sister anything like, we're married. And I'm rounding up on the doctor's thing. Is that not? That's not how that works. Okay.

So, some of us are doctors on the show and some of us aren't. And sorry, I said I didn't mean to interrupt you, bud. You can continue now. I'm very sorry. Thank you. Justin, usually when we go into topics on the show, I have a pretty clear picture of the truth of the, of like what the evidence is, what the science is, because we're covering something old, and it's something that has either been figured out or proven or disproven or whatever by now, right? Or it's something that, while it's new, it is pretty clear that it's fake or not,

or it's evolving in a direction that's very obvious. This topic this week really has me scratch on my head because it's a strange one and I, I am, I went into it thinking one thing and now I'm kind of starting to think another. Okay. But I could be wrong. This is very stressful.

This has been a very stressful research week. I've been seeing a lot of this conflict play out in our home, and I'm happy that it can now spill over into the listener's daily lives. I like to know the answer. And I'm not sure. I know. Like today, we had to hang a bunch of pictures on the wall.

And I said, said, I gotta be honest, I have no idea how to do this well. And Sidney and I, as Sidney then said, oh, honey, me neither. And then literal moments after I hung the first picture, Sidney suddenly got very concrete ideas about how picture hanging should be conducted vis-à-vis placement, height, eye lines, very concrete ideas that apparently were not there moments before.

Well, it wasn't until you started doing so bad. Sure. Then you started doing so bad. Sure. And you decided to have concrete. Here's what I don't understand. Maybe we didn't know going in, but once you did the stuff you did, and then looked at it, how did you not go? Okay, well, not that scratch that option out. Let's go to plan B.

I said, it looks, I said, I think it looks nice. Like an art gallery in Sydney said that is the opposite of what we want. It's like a really whack art gallery where the pictures are hung at strange sort of equal, like spacing and sort of the same height, but not quite. It looks like you just, like didn't measure as opposed to like haphazard intentionally.

It looks like you didn't measure. That's what I didn't want. So what's the topics? Anyway, thank you to Holly and Elizabeth and Katie and Greg, Andy Meredith, Mary, Oliver and Brandon for all suggesting auto-brewery syndrome. Have you heard of this? I mean, is this the part where I lie and pretend like you haven't been talking about it? It's been in the media. Have you heard about this one folks? It had you heard about it before I told you. No, but your dad had and that's something, but your dad watched

is a lot of oddball stuff. He keeps track of like weird things in the news. You wouldn't have to watch oddball stuff to find this. This is this is infiltrated the what what people like to use the MSM. Yes mainstream media, the lame stream media in my book. Oh, you call them I see I don't I love the mainstream media love the media love it love journalists. Thank you I'm on the pro side, but I used to be a job. I know so I married it. Well, no I'm married a guy who worked at Best Buy. Yes. He became a journalist. I prefer games editorialists I really was more about bringing my own fun, funky take to things than I was like real hard news, you know

I uh, so there have been a ton of articles in Various news outlets on the internet. I think this has made some like news stories on TV and then newspapers and stuff because it's a really interesting idea. And it's all based on an article that was published this past summer and this is not the first case of this ever or the first article that was ever published on this.

It just seems to be the first one that has kind of captured the attention of the public. So this past summer, the BMJ Open Gastroenterology Journal. So that's a, it's an online open access journal. So this has captured a ton of media attention. It was a case report and a literature review that tells the story of a 46-year-old pretty healthy guy who started having issues. He traces it back to a finger injury in 2011. He had some sort of wound on his finger and some sort of complicated injury that required a course of an antibiotic called cephalectin or you may have heard the brand name Keflex. So he took the whole course of the antibiotics and after he completed it, he started having these strange episodes and he described them as kind of a brain fog.

And you'll hear that term throughout this diagnosis and this syndrome. And I always think that I always get nervous when I hear the term brain fog because you find it attached to a lot of other diagnoses that are more questionable. Things like chronic Lyme, you'll hear brain fog tied to a lot. I prefer to go with having a senior moment. That's what I go with. Brain fog is more like I just feel, the way people tend to describe it is like I can't, you know, you feel fuzzy.

I would think about it like the times in my life where I've taken cold medicine. I feel like that if I had the mental capacity in state, I do now, if I just woke up one morning in my like late teens or early 20s with this mental state, I would think that I suddenly have brain fog. I can feel my cognitive abilities like dwindling as I age into to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to to sometimes first it progressed until he was having some actual like mood changes, like depressive symptoms and libilt, like his mood was very labile, some personality changes even.

And he finally sought care for this in 2014. So this went on for quite a while before he went and saw a doctor and discussed these issues and the physician he saw felt it was largely a psychiatric issue. And so treated him with some antidepressant and antanxiety medications for what appeared to be some sort of depressive or anxiety or both kind of diagnosis. This didn't really help. And everything kind of culminates in this story in an early morning arrest for a DUI. So he's pulled over. He appears intoxicated. He refuses a breathalyzer.

He's sent to the emergency room. And his blood alcohol level is found to be 200 in the ER. Yikes. So it seems pretty straightforward at this point, right? You find a lot of times if you can find substance use disorders and things like depression or other mood disorders or other psychiatric diagnoses can be comorbidities they can run together.

You might find a slightly higher rate of one with the other or vice versa, especially when one is being, is not being managed. The medications we're not working for his symptoms. So on the surface, it seems pretty straightforward. He is, you know, trying to get a hold of these medical conditions. He's trying to get treatment.

He's still in the process. It's not successful yet. He has had some alcohol to try and get on top of it. Yes. Self-medicating. He got caught in a DUI as a result. Now, what's interesting is that he insisted he had not had a single alcoholic beverage. Even prior to this episode, he says, I was never much of a drinker, occasionally on social situations, but very rarely. And in the last couple of years, he hadn't been drinking at all because

of all these symptoms he'd been having. He didn't want any more brain fog than he was already experiencing. So he is adamant. I did not drink. So as people that have been doing sawdust for many years, we would at this point default to something, if not skepticism, maybe something approaching a realistic practicality. And a lot of the physicians who encountered him agreed with what might probably initial skepticism would be. Well, a lot of people deny that they have a problem at first. It would not be unusual to be embarrassed or feel guilty, realize that, you know, this, if you had been

drinking, I shouldn't have done that. I could have hurt myself or someone else. I wish I hadn't. I need help. This is becoming an issue. All of those are huge things to be able to say out loud and seek help for. And so those are huge things to be able to say out loud and seek help for. And so it's very natural to think, well, he's just not telling the truth. Sort of like when I come home and I'm like, Sid, I don't know how that oatmeal cream pie,

double-decker wrapper got into the car. It doesn't make sense to me. If you have any ideas, please let me know, because I'm freaked out too. I'm freaking out with you about this oatmeal cream pie, double-decker bar bar right after I went to dollar general. We're in this together. Yeah, we're in this together. Solve this puzzle. Yeah, help me crack this

one. Well, even though the the physicians he saw the healthcare professionals he saw, which he he saw several did not really believe him. His aunt did. And his aunt got him a breathalyzer and said, I heard about something like this over in Ohio. I want you to check on this breathalyzer every once in a while and see if even if you're not drinking, you know, it looks like you're drinking on this breathalyzer. See, if you've still got alcohol in your bloodstream, even if you hadn't been drinking alcohol.

in your bloodstream even if you hadn't been drinking alcohol. So he did that and he, you know, sensibly found that he was blowing positives on the breathalyzer, even though he wasn't drinking. And he located this clinic in Ohio and he went there. And the doctors there had seen a patient with a similar situation before, like I said, this wasn't the first case, just kind of the first one that seems to have caught media attention. And they felt like they knew what was going on. So they checked his stool and they found Saccharomyces Sarvasia and another yeast species. And that one specifically is better known as brewer's yeast.

And from here they diagnosed him with auto-brew recendrum. So what this basically means is that some people get filled up with a kind of yeast. It's mainly been yeast that have been implicated, although a couple bacteria have been thought to possibly cause this as well. But mainly yeast that have filled up the intestines. And we want yeast when we're brewing to turn sugar into alcohol, right? That's the whole idea.

That's how you brew beer or whatever, any kind of alcohol. But in this case, the carbohydrates and sugars and everything that this patient is eating will go into the stomach, into the intestines, the yeast will gobble it up, turn it into alcohol, that alcohol will get into your bloodstream, and you get drunk. Okay. So that is the basic theory behind auto brewery syndrome, and the idea that we could find

elevated levels of this yeast in the stool was thought to be proof, right? Because you might have a little of this in your GI tract, but you shouldn't have as much as a lot of these patients are, you know, are finding. So that was the, that was what this man was diagnosed with. And like I said, the docs at this office in Ohio felt like this was the likely cause because this wasn't the first time that they had seen a case like this. Where else have they seen a case? Well Justin, I'm going to tell you about that right after we go to the billing department.

Let's go. The medicines, the medicines that I've killed in my car before the mouth. We are so thrilled that your interest in attending Hieronymous Wiganstaff's School for Heroism and Villainy. Wiganstaff's beautiful campus, both state-of-the-art facilities and instructors with real-world experience. We are also proud to say that our alumni have gone on to be professional heroes and villains in the most renowned kingdoms in the world. But of course, you are not applying to the main school, are you? You're applying for our sidekick and henchperson annex.

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You gotta do more exercises before I record. Like the vocal ones. Sure, the one. The actors do. Sure. So this is a rubber baby bug. This is a relatively new diagnosis in the Sabo and Schema of Things. But there have been case reports dating back to the 70s, mainly from Japan.

There was one case series in 1972, a water reported on 12 people with what has been called throughout the years drunkenness disease, endogenous ethanol fermentation, gut fermentation syndrome, and then of course auto brewery syndrome, which it's no surprise to me if you look at these different choices. But auto brewery syndrome is you've become a brewery, which is an evocative. Yeah, I mean it really makes you sound like you're both you're something between brewery and man. You are half brewery, half man. This is the future that the terminator was warning us.

Right. A lot of the early cases were tied to some sort of pre-existing gastrointestinal. They're gonna be pre-existing beer. Like yes, that would make sense. A lot of the early cases were people who were drink-gated, didn't want you to know. No.

No, they were people who already had some sort of, um, maybe motility problem in their bowels or they had, for instance, something called short gut syndrome. So this would happen if some of your intestine had been removed. It's literally what it sounds like. Your gut's too short. Your small intestine is shorter than it should be. Short gut syndrome. Short gut syndrome. That's the, that You're a small intestine is shorter than it should be. Short gut syndrome. That's the, that's a good name too.

Well, we're on name quality. It's a good one. Short gut syndrome. It's exactly what it sounds like. And it could have either been because you weren't, you, there was just a genetic difference at birth or because some of it has been removed or, or some of it is there, but it's not functional. So much intestine is actually functional. Either way, there was a case report of a 13-year-old girl

who had short gut syndrome. And after eating a lot of carbs would appear to be intoxicated. And she actually was sent to like a detox and rehabilitation center for substance use disorder related to alcohol. How do you ask me? How short do we be talking? So do you know how long the small intestine is? See, again, you guys start asking about this stuff beforehand,

because I will tell you with confidence it's 20 feet. That's right, Justin. I'm so impressed. You mean you did tell me? Yeah, well, it's an impressive fact. It's impressive that I retained it. And I listened. That's impressive. And you, a lot of that, I don't want to say it's redundant, because I mean, it's good that you have all that,

but you can get by until you have about 6.6 feet or less. And that's when things start getting kind of dicey. But it's best, if possible, to keep as much small in testin' as you share. I'm home on all of it. There were also cases where people with things like Crohn's disease or other inflammatory bowel diseases could also have these, have this auto brewery syndrome because the idea was that if you have inflammation in your intestines, there are places where you can form

strictures like tightening due to like scar tissue and damage tissue and that kind of thing. Strictures can form and you can also have sort of partial blockages where stuff can't get through for a little bit and then it can. And that can result in like pooling of like fecal material. So basically things aren't going through the old gullyworks as as quickly or efficiently as they should. And as stuff sits there. It turns into beer. Yes, that is the thought, because a bunch of yeast will grow. And these are also-

Not beer, right? Alcohol. Alcohol. Yeah, we're just talking about alcohol, ethanol, production. In addition, in some of these other conditions we're talking about, you may as a result have to take more courses of antibiotics in your life than the average person without one of those conditions would have to. And there has been a lot of thought that these are tied to people who have taken courses

of antibiotics, especially multiple courses, because we've said this on the show before. When you take an antibiotic, it's going to kill bacteria. It doesn't know to just focus on your sinuses or your ear or that foot wound you have or whatever, right? It's just killing bacteria. And in that process, it can kill some good bacteria that you have in your gut that you need to help you digest stuff. The other reason that you have that good bacteria

is that it helps keep things like yeast at bay. It outcompeats the yeast. If you wipe out... Outcompeats the yeast is catching. You should try to make more of that. You know, you gotta outcompeat the yeast. If you have antibiotics that wipe out too much of that good bacteria,

the yeast can just flourish, right? Like it's a yeast party because the bacteria is not there to keep it at bay. And then it's thought that can also lead to this because these grow and then they ferment and then you got alcohol and then you seem drunk, but you never drink. Otoburri syndrome. There have been scattered cases throughout the year since then, throughout the 70s, when this was first kind of recognized. And some of these people do have one of these underlying diagnoses. Other people appear to be

totally healthy before being diagnosed with this. Sometimes you can trace it to like the patient we mentioned in the beginning with like a course of antibiotics that was thought to maybe possibly trigger it. Other times you can't. They're all different in terms of like their age and what their health status is and what they do and where they live with the exception of, they appear drunk, they have an elevated blood alcohol level.

They deny it for drinking. That it's weird, but that variety of things... Okay, let's keep going... Let's finish this, because I want to talk to you generally about this. But keep going on the specifics for the moment if we can. There are some characteristics that can put you at risk. Some things that I already mentioned. There are some characteristics that can put you at risk. Some things that I already mentioned, but they did find some specific, like, people who

have outer brewery syndrome documented generally, not all, but generally they felt they were in poorer overall health prior to this diagnosis, even before the symptoms started. They had more food sensitivities, they tended to drink more water, less tea, coffee, dairy, candy, that kind of thing. They cook at home more, they don't eat out as much, they don't have as much starch and they have a lot of GI problems already. I don't know if these were all things they found put you more likely to maybe be diagnosed with this later. There's been some thought that diabetes or liver disease like cirrhosis could be linked to it.

And I found some research that was kind of equivocal on that. There was one study that suggested that patients with diabetes naturally produce more endogenous alcohol, more ethanol than patients without diabetes, but it never rises to a level that it matters You know what I mean like there might be more alcohol in your gut But it doesn't it's not enough to make a difference. It's just suggesting that like maybe it does sometimes like it it

That maybe for some diabetic. It is maybe it is that that would be the thought although there was another city from 2017 that said there is no correlation between would be the thought, although there was another city from 2017 that said there is no correlation between diabetes or glucose, blood glucose level and blood alcohol level at all. So I think that's still something we're trying to figure out. Like I said, antibiotics are a common theme. Exposure to antibiotics. Is this something that's like a, I don't know the right terminology, but like a symptom versus a condition, like a symptom of something else happening or its own thing.

Well, I mean, these patients report a lot of other symptoms in addition to like the drunkenness. So I mean, if the idea is that yeast has overgrown in your intestine, it's going to produce, I mean, that is the problem. And this is one symptom of it. But there are a lot of other, you know, GI issues and general wellness issues, general health issues. I should say that that you can suffer from, I think, in addition to the intoxication from the alcohol. There was some thought that there was a genetic component and that's why we saw so many cases early on in Japan because that's really where a lot of the first cases were documented

and that was the question, is this just, is it a genetic thing? It's interesting because the thought is that it isn't, it isn't, auto-brewery syndrome isn't genetic, but your ability to break down alcohol, how fast you can break it down, varies from person to person, and that is genetic. So, here's susceptibility. Well, so there's an enzyme that turns alcohol into something called acetaldehyde, which is toxic. And acetaldehyde, the more that it accumulates in your body,

you get nauseous, you get flushed, you get, I mean, you just feel terrible. And you have another enzyme that breaks that down further into acetate, and then into water and crumb dioxide, and it's harmless. The more you have of that second enzyme, the faster you get through that toxic part. And for most of us, you don't even notice it, right? Right. You drink and you don't feel bad.

For some people, if they have less of that enzyme, that toxic metabolite will build up pretty quickly, and after just a drink or so, they can feel really sick, really bad. So the thought was, if you're one of those people and your body's making alcohol, you're going to notice a lot faster than somebody who has more of that enzyme and I mean, they just feel off. You know, because you wouldn't think if you hadn't been drinking and you just felt kind of foggy and off, you wouldn't assume, oh, I must be drunk. Right.

Because you hadn't been drinking. Right. So that is, maybe we just noticed it in Japan first, because the symptoms were a lot more pronounced and a lot more uncomfortable than for patients elsewhere in the world. I don't know. The diagnosis right now is a lot to do with history.

Like ask. And the big thing that a lot of the authors stress is you have to allow in your head the possibility that someone Appears drunk has an elevator blood alcohol level and did not drink alcohol and just like allowing your brain to accept that as a Possibility is kind of the first step Because I mean one I mean a lot of healthcare professionals would just say come on come on just be honest with me My belly so your belly is making the bear, because I'm just telling you this.

And there's, I mean, it's good in a sense that there has been a lot of media interest in this, because there's not a lot of awareness of it, I think. You can, if you really wanna know for sure, you basically can put somebody in the hospital. This is been kind of a diagnostic test that had been proposed, but this is also pretty early, so I'm not gonna say it's in the hospital. This has been kind of a diagnostic test that has been proposed, but this is also pretty early. So I'm not going to say it's like the standard. You would put them in the hospital, give them some glucose, and then check their blood

alcohol level at certain intervals every few hours, right? And if after a big glucose load, their blood alcohol level starts going up and they're being monitored so you know they're not drinking alcohol. Yeah, well they're... You got a diet. Do they have a dentist or they haven't done a lot of this kind of thing? Well, all of the cases have been case reports. Meaning. So, there are different kinds of journal articles of research studies of papers that are published.

And the best when it comes to something like this, or if you have a large group of patients who have a condition or are thought to have a condition, and you can do some sort of randomized control trial of a test or a treatment or something where some people get one thing, some people get another, you don't know who gets what. Right?

That kind of thing. So a clinical trial kind of deal. Yeah, similar idea. These are not big cohort studies. These are not big giant studies of a cross-section of the population, some of which have auto brewery syndrome, some of which don't, and comparing that. But have we demonstrated that?

These are individual stories of singular or maybe a handful of patients. Have we demonstrated that phenomenon happens, though? I mean, like, you know that? Yes, this has been done. This happens. But it's been done so few times. It's not scientifically robust.

Okay. But the case reports are powerful and that they are telling stories of patients that we don't see a lot, very detailed accounts, and then exactly what was done to try to figure out what was wrong. So they are interesting and certainly important to science, but you don't derive a gold standard diagnostic test or a gold standard treatment from a case report, right? Because that's very individualized. So they've done things like scopes, upper scopes and lower scopes and checked intestinal contents or checked stool for yeast.

That's been another way that they've tried to figure this out. The treatment of it, again, it's varied from patient to patient. Everybody who's been diagnosed with this, they've tried a different approach. Can you wait them out? I mean, does it go away? I guess is what I'm saying. Because you're talking about your body processing the alcohol, right? If you processed it, like, I mean, wouldn't,

do you know what I'm saying? That episode would go away, but the geese are still in there. And the next time you eat a big car blow, it'll happen again. Weird. So the treatments have reflected that. One, antifungals to try to kill the yeast. So that's been tried a variety of different

antifungal medications have been given to patients. Restrictive diets. Lowering the carbohydrates. Yeah, just don't eat carbs. That's been a big, that's been part of the treatment. If folks it's great for you to do it. Probiotics have been thrown in there. So put the good bacteria back in there to try to keep the yeast at bay, to try to outcompete

the yeast again. These have all been... I've heard that, I've got bacteria can change so much, right? It can, and like you said, replace it, but what if you... Yeah, I mean, right now, what most of the case studies seem to indicate is that the low carbohydrate diet and then a course of some sort of antifungal is the big mainstay of treatment and then probiotics have been proposed as a kind of a junk of treatment. But it's been different for every patient.

If you read through these different cases, I read through a case report of three different patients and for each one, it was a totally different clinical course and a totally different treatment regimen with variable levels of success from each one. So like the first patient, of course, of antifungals, and they were great. Six weeks later, they're great. The next one was put on a low carb diet and had extreme difficulty sticking to that and had multiple episodes even after being able to stick to the low carb diet.

Some of the patients were put on three or four different courses of different antifungals. Some of them were hospitalized and put on like strong IV antifungals. So it's been different. So it's hard to say which treatment worked the best because it seems very individualized for each patient so far. The case we first talked about had a very rocky course. He was seen by countless specialists in gastroenterology, psychiatry, neurology, all kinds of different sub-specialties and general practice.

He continued to have episodes one which landed him in the hospital with a bleed in his brain from falling and hitting his head while he was intoxicated. He was treated with a couple different antifungals. He was put on a low carb diet. It took him a while. The authors mentioned specifically that they had a huge setback because he ate pizza. And that had a he had an extreme relapse of otter brewery syndrome after eating pizza.

I don't want my blood to turn to beer, but I do want to crush that in the side. So the scientists in there, every tower, well, just have to get used to it. Just gonna, I'm just eating this pizza. I'm eating this pizza. And I know that there are carbs in pizza. I'm sorry, dark. It was cauliflower crust.

It was cauliflower. I thought it wasn't. I know that. It folks don't let them sing you with the cauliflower crust. Ask for the ingredients because it's probably got flour in there somewhere. It don't, I mean, a lot of them do. Anyway, if it tastes edible, it's got something else in there. Hey, I love cauliflower.

Don't. Yeah. Don't hate on cauliflower in my brain. Okay. That's fine. So anyway, it took him a while. He did a manate. He did eventually manage to it seems clear the east and he is able to I think

eat a more normal diet and he is symptom free at this time or so the author's report. There's been some thought, you know, breweries is now a supplement people take. So is that something we might see more if people are taking it? I don't know. When I first, there was a, there was an article published about this in the year 2000, which basically said, listen, we don't know, all the science behind this is shaky. It's all case reports. They're still not as far as like the mechanism, like the actual like on a molecular level,

how everything is happening. It's still a lot of hypothetical stuff. We haven't actually proven a lot of it in a lab or in a human body. We're still guessing. So based on all that, there was this big medical legal article that was published in the year 2000 that said, this cannot be a defense against drunk driving. If you are arrested and charged with driving under the influence, driving while intoxicated, you cannot use this as a

defense because right now we don't have a strong enough scientific basis for its existence and we think you might be lying basically was the implication of this article. Yeah, you could also love you know this and you're like I'm feeling drunk. I know what this is this is my auto brewery syndrome that I have. I'm not going to drive like This argument has been made as well if you know you have this Yes, you should refrain from driving Is that even if you even if we accept well, maybe the science isn't all there But it is a real thing and the science will come we're just we just haven't you know figured it all out yet

Even if we accept that premise should you be driving if you know you have this? Maybe when you eat pizza, you should stay at home, just like you would if you'd drink some beer. Delivery, order, order, it doesn't matter. Stay at your house. It's hard when I heard about it, I'd heard about this years ago in passing. And I was vaguely familiar. And the impression I got from other physicians was, this isn't real. This is, this is people who don't, who are in extreme denial about their drinking.

Well, let's break this down for a second. And, and we're using like, I mean, we have all the research, the facts you have, right? The facts we have presented. And so a lot of it comes down to interpretation. But let me tell you, and my after doing solvents for a very long time, I'll tell you my sort of read on it. And you can tell me where, where, what I'm missing or what, what else. Basically, when you first hear about it, there's an Occam's razor thing of, well, you're trying to cover up your drinking. That's what drinking is shameful. In some parts of the culture, some people are just trying not to, whatever, then there's an accident

or what I fill in in my head to use that example. So, Akka's a razor would say, you're trying to cover up your drinking. That would be the obvious thing. And the other thing that I would put in the negative column is when you're talking about the treatment for it, differs person to person.

That sets off alarm bells for me too of like, well, why? You know, like if this is a real phenomenon, like we should be able to, whatever, but then but it's happened so broadly and then you talk about like kids having it and stuff like that, like then it starts to make you wonder like, well maybe it's just something that we don't understand very well that our bodies can do. Our bodies make weird smells when we eat asparagus for no reason. Our bodies do dumb stuff.

It's, I mean, the thing is, it makes a sort of sense on the surface. Now that is not always enough justification to believe something. There are lots of things that you think makes sense, and that's not how the human body works at all. It might be the opposite. That being said, if you read some of the, and I've read a lot of the case reports of this, some of them are very compelling and the, it seems like from the, the way the diagnostic test was administered, they were being monitored, blood alcohol levels that went up while the patient was in the hospital, which doesn't make any sense at all unless somebody was bringing

them alcohol. And I mean, it says they were being monitored. Obviously, we're not there in the room with these people, but I have no reason to think they're lying. I have no reason to think that people who published these articles, you know, who took care of these patients, why would they be lying about it? So, there's a lot of compelling argument to be made that this is just an underdiagnosed, unrecognized, real clinical entity that we don't understand, all of the pathophysiology behind yet.

There's still a lot of questions. And I think because I read some some companion case reports from people who had tried to use this defense to hide that they they were they were in fact drinking. And I think because of that. And then because of I have found in some of the articles, it starts to brush up against some pseudoscience and pseudomedicine that is adjacent to this that I find concerning. Because I'll start to read this and I'll think this all makes sense. Yes, and this must be a real thing that we just haven't learned enough about yet.

And then they'll start to talk about on the side of that the idea that were overrun with yeast and the idea that chronic yeast causes these problems. And there is a whole pseudo-diagnosis around systemic chronic yeast. I don't think we've ever covered that on the show that has been used to explain a number of ills and is not in any way evidence-based or scientific or accepted by medicine as a whole. So, right. So, it's hard because I have found that it has brushed up against some of that. Some of the authors have dabbled in both roles.

That's very human, though. It makes sense that people who are trying to get you to believe they're dumb thing would glom onto any sort of daylight, they could find regarding the unknown or things that, oh, we're not sure about this. Well, if we can open up the idea that maybe this is real, maybe my dumb thing is real too. You never know. I'm serious. The doubt that this shows, because it is not well understood, it seems like it would

be a breeding ground for like, hey, maybe it might think that this is not real. Could slide in there. Well, I do think, I think that's why we've said on the show before. Well, it is very important to follow the evidence, follow the science, do things in a, we have a systematic way of approaching questions. In order to do that, you have to first ask the question, is it possible that in the intestines of some humans, there is enough yeast that it is fermenting enough sugar to create enough ethanol that it can get into your bloodstream and make you intoxicated. Is that actually happening?

And it seems like right now that that is, at least in some of these case reports, that has happened. Why and how and exactly what we do about it? I think we still have tons of questions. I had been concerned initially that this was the new spontaneous human combustion. And you were just going to do like a straight face history of it? Well, well, no, I'm, I'm, I've got to be honest, I'm picturing solbons 100 years from now and what they're going to say about me because there's the chance they're saying, can you believe we didn't, we didn't accept that this was real.

Obviously, it was real. Obviously, this happens. Obviously, and now we know the exact treatment and why it happened and all that. I also think that there's a chance that in a hundred years, maybe they're gonna laugh at me. But right now, I would say that what the authors said is true. Obviously, there are going to be patients who come in and they appear intoxicated

and their blood alcohol level is elevated, and it is because they have indeed been imbibing some sort of alcohol of beverage. However, if a patient insists they haven't, keep your mind open. Give them the benefit of the doubt and do a little more digging, do a little more workup, do a little more investigating. Don't just tell them they're lying and move on. That would be my and that's a good general rule for medicine. Assume that your patients are telling you the truth and let them prove you wrong.

Don't assume that they're lying to you and make them prove the opposite. So I would say in this case, I am going to leave my mind open to the possibility that auto-brewery syndrome is something I'm going to see and take care of and manage and help patients with. And I would rather time prove me wrong. Well, city that is not what I sort of expected with this when you went into this topic, but I'm very happy. Me neither. Me neither. I'd read that article from 2000 and I thought, well, okay, but I mean, I have some exciting news.

If you wanna see me in Sydney live and celebrate this most joys of Cannell Knights for 2019, you can come see us on December 21st at 4 p.m. at the Keith Albey Theater in Huntington, West Virginia. Tickets for that show are going to go on sale Friday November 8th, they are general admission. Friday November 8th at 12pm, Eastern time. On your birthday.

On my birthday. The Travis's birthday. All proceeds from that show are going to go to Harmony House, which is, it provides shelter and resources to people who are experiencing homelessness. So, local organization that is run by really wonderful heartfelt caring people and does a great service in our community and could really use some help. You could also, though, if you would like, celebrate candle lights from afar with our new line of candle lights ornaments.

There's a beautiful new solbona ornament. Have you seen this one said? It's very festive. Oh, it is very festive. I love it. The little snakes, but they've got winter hats on. It's delightful. But you can head over to mackelroymerch.com,

MCELROYmerch.com. And you can head over to mackelroymerch.com, M-C-E-L-R-O-Y, merch.com. And you can see that ornament. We've also got a special candidates ornament that is benefiting Harmony House on there as well. So you can buy as many of those as your home can hold. Thank you to the taxpayers for the use of some medicines at the intro and outro of our program. Thanks to you for listening.

Thanks to Max for listening. Thanks to Max Fun for having us as part of their extended podcasting family. And we're so thrilled that you decided joyous this week. And that is going to do it for us. So until next time, my name is Justin McRod. I'm Sydney McRod. And as always, don't, go a hole in your head.

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