I ran across this article the other day describing a case worthy of an episode of House.  It details the story of a gentleman who got drunk out of the blue without consuming any alcohol at all.  He went to the ER one day complaining of feeling dizzy and was found to have a blood alcohol level of 0.37 percent (the legal limit for driving while intoxicated in our state is 0.08.)  Suspicious that he was a closet drinker, doctors kept him isolation for 24 hours to ensure he was not sneaking any alcohol and monitored his blood alcohol concentration.  It still remained at 0.12 percent long after it should have returned to zero.

An overgrowth of a yeast called saccharomyces cerevisiae within this man’s intestines caused his bizarre condition.  Saccharomyces cerevisiae is used in the brewing industry to make alcohol and is commonly known as brewer’s yeast.  Doctors treated him with a restricted carbohydrate diet and antifungal medication and his ailment resolved.

The story is an extreme example of a much broader condition called intestinal dysbiosis.  While this particular case has its own specific term, auto-brewery syndrome, it is very rare. Intestinal dysbiosis, a more inclusive term, is very common and I see it quite frequently in my practice.

Intestinal dysbiosis is an imbalance in the bacteria in your intestines.  Certain species of bacteria belong in your gastrointestinal tract.  They have a symbiotic relationship with you.  They help you by keeping other, less optimal bacteria out or in check. They also aid in the production of some vitamins and keep your intestinal lining healthy.  In turn, you give them a place to live.  When these bacteria are disrupted, other opportunistic bacteria and yeast can take up residence in your intestines.  Supposedly, if you take your intestines and scrape all of the bacteria out of them and place it on a scale, it would weigh between two to five pounds.  (I don’t know how they know this, and am not sure I want to.)

Anything that can disrupt your usual intestinal bacteria can cause intestinal dysbiosis.  Antibiotics are a frequent trigger since they kill off some healthy intestinal bacteria along with whatever other bug they are supposed to kill.  Symptoms vary but often include abdominal bloating and discomfort (particularly with eating); constipation and/or diarrhea; excessive flatulence, and worsening of symptoms with ingestion of alcohol and/or a large amount of carbohydrates, especially simple sugars.  Dysbiosis can cause a number of symptoms outside of the gastrointestinal tract as well: decreased mental clarity, fatigue, malaise, generalized muscle and joint aches, and food intolerances.  Sometimes the only symptoms may be those outside of the gastrointestinal tract.

What can be done about this common but frequently unrecognized condition?  Just as the poor gentleman with auto-brewery syndrome was treated, a two-part approach exists.  One of the most critical components is following a carbohydrate restricted diet.  Utilizing probiotics (capsules containing normal, healthy bacteria that should be in your gut) and antifungal, antibacterial, and/or antiparasitic medications or supplements as appropriate constitutes the other part.  Sometimes, if symptoms are mild, they may respond to the addition of an over-the-counter probiotic to a nutrient-dense, whole food diet.  If you ever have to take an antibiotic, it’s reasonable to take a probiotic capsule at least 2 hours apart from any antibiotic dose (so the antibiotic doesn’t kill the probiotic on the way down) and to continue the probiotic for a week or two after finishing the last dose of antibiotic to help maintain your healthy bacteria.

If you think you may have intestinal dysbiosis, I recommend seeing a functional medicine practitioner.  You can find one here.  If you have any blood in your stools or severe abdominal pain, you should see your doctor right away.  

This article in no way constitutes medical advice and if you are having physical symptoms, these should be addressed by an appropriate health care practitioner.  Live long and live well.

©2013 by Luc Readinger, MD

Beer Belly: Man Becomes Drunk When Stomach Turns Into a Brewery

A Case Study of Gut Fermentation (Auto-Brewery) with Saccharomyces cerevisiae as the Causative Organism
Please take time to read the guest post I wrote on prescription medications and the Whole30 diet for the Whole9 blog as part of their "Talk to your Doc" series.  Part 2 will be posted there in the near future.
When you work in an industry, you become privy to its dirty little secrets.  What I want to share with you are reviews of several articles I’ve read over the course of my career that have formed my view of medical literature, from editorials to randomized controlled trials.  Though you may come to conclude that I'm jaded, I would argue that by treating the literature with skepticism, I am able to better serve my patients.  

Thyroid Storm

This editorial appeared in Journal of the American Medical Association in 1997.

In the late 80’s, Synthroid, the dominant drug for thyroid hormone replacement, contracted Betty Dong, PharmD at UCSF to do research that would determine bioequivalence amongst different thyroid hormone replacement medications.  This research had not been done previously.  Bioequivalence is the property whereby two drugs with the same active ingredient produce the same physiological effect.  Hypothyroidism is a condition where the body does not produce enough thyroid hormone to properly regulate the body’s metabolism leading to symptoms such as fatigue, feeling cold, and others.  Synthroid, the first synthetic thyroid replacement medication, had been the favorite medication for treating hypothyroidism since it came on the market in 1958.  Prior to this, animal extracts were used.  The makers of Synthroid wanted the study done to prove the superiority of their product because the state of Massachusetts was considering adding a competitor’s formulation to the state formulary.  

Betty Dong had written favorably on Synthroid in the past.  She signed a contract with Synthroid’s manufacturers to conduct the new research comparing the bioequivalence of multiple thyroid replacement preparations.  The contract specified all of the research parameters and statistical methods to be used.  The company maintained a close eye on her work, visiting her several times a year to oversee the research.  Except for a few minor adjustments, the work proceeded as anticipated.  And then the results came in.  All of the thyroid preparations being tested turned out to be equivalent to one another.  It was calculated that using generic preparations instead of Synthroid would save $356 million per year.

Synthroid’s manufacturers immediately began a campaign to discredit the research and Dong.  They met with the university.  Lawyers got involved.  Dong stood by her results and the statistical analysis (done using the exact methods as agreed upon in the contract.)  The study and Dong’s conclusions were sound.  The university supported her.  This was important information that the medical community would benefit from knowing as no other study had rigorously tested the bioequivalence of various thyroid replacement preparations before.  When Dong and her team went to publish, they were blocked by the makers of Synthroid.  A clause in the contract required Synthroid’s written permission to publish the study and its results.  Synthroid’s executives threatened to sue Dong and the other researchers if they published the paper.  They withdrew the article from publication at the last minute.  

Synthroid then published the data using different statistical methods to show that it was superior to other preparations.  They did this with their own physician listed as the lead author in a journal of which he was the editor.  Credit was not given to Dong or any of her colleagues who worked on the study.  

Eventually Dong’s original research paper was published with the consent of Synthroid after they decided the negative press they were receiving was more egregious to them than having the actual study published.

The editorial gives a behind-the-scenes look at what can happen in the world of medical research.  The conflict of interest between academic researchers and the commercial interests that fund them highlights the struggle to control the dissemination of medical knowledge.  In this case, a commercial interest attempted to suppress information beneficial to the medical community (and public) to protect its investments and profit margins.  

Realizing that behind every study lies interests beyond those of medical knowledge helped me to read the medical literature more critically.  While you can’t read the backstory of every paper published, you can learn to read between the lines.  I now look to see who funded a study before I even consider reading it.  Protecting patients from commercial interests that go against their own is part of my duty to them as a physician.

I encourage you to read the entire editorial originally published in JAMA that can be found here.  There is also a write up of the full story from the Wall Street Journal that can be found here.  Both of these recount the story in more detail.  Remember Thyroid Storm whenever you read about a new medical study reported in the press.

©2013 by Luc Readinger, MD