Imagine you are a police officer. You see a car swerving all over the road. You pull over the driver, and they are plainly inebriated. They insist, with slurred speech, that they haven't consumed any alcohol all day. Do you believe them?
In 2024, a Belgian man was acquitted after being arrested three times for DUI in four years. Though his position at a brewery raised suspicions, he asserted that he had not been drinking. Three doctors confirmed that he had auto-brewery syndrome and was ignorant. People with this illness have microorganisms in their intestines that produce abnormally high levels of alcohol when they break down sugars and carbs.
Though it is an uncommon condition, a lady was acquitted of a DUI conviction in 2016 after being diagnosed with the same syndrome. Her blood alcohol level was four times the legal limit.
I am a microbiologist who is fascinated by how the gut microbiome influences human health. As the author of the book "Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are," I have conducted significant study on how your microbiome influences your health, mood, and behaviour. It turns out that the specific bacteria in your intestines that cause auto-brewery syndrome may also induce fatty liver disease by creating excessive amounts of alcohol.
diseased liver, without drinking
Excess fat in the liver can lead to major health issues, such as inflammation. This can result in cirrhosis, scarring, and liver cancer. Most individuals link fatty liver disease to drunkenness. However, metabolic dysfunction-associated steatotic liver disease, or MASLD, develops without excessive alcohol consumption. This disorder, previously known as nonalcoholic fatty liver disease, affects between 80 and 100 million Americans.
Obesity, insulin resistance, elevated cholesterol, and hepatitis C infection all appear to be contributing factors to MASLD. Microbes could be another.
Liver illnesses. Stages of Liver Damage
Liver illnesses. The stages of liver damage range from healthy to fatty, fibrotic, and cirrhosis. (© Designua, stock.adobe.com)
In a 2019 investigation, doctors discovered a patient suffering from both auto-brewery syndrome and severe MASLD. When researchers examined stool samples from the patient, they discovered a type of bacteria called Klebsiella pneumoniae. This strain of K. pneumoniae produced four to six times more alcohol than strains of the same bacterium in healthy persons. After examining a cohort of 43 other individuals with MASLD, they revealed that 61% of them had K. pneumoniae excreting extremely high quantities of alcohol. Only 6% of the 48 healthy adults who served as controls carried such germs.
The researchers discovered that K. pneumoniae bacteria were just marginally more prevalent in the intestines of MASLD patients. The bacteria produced different amounts of alcohol. But may the bacteria's high alcohol production actually lead to fatty liver?
A microbrewery in your belly
To determine whether microorganisms were truly to blame for fatty liver, the researchers fed high-alcohol-producing K. pneumoniae bacteria to healthy mice. Within a month, these mice showed quantifiable signs of fatty liver, which advanced to cirrhosis within two months. The bacteria-induced liver damage followed the same timetable as when the researchers fed the mice pure alcohol.
Transferring intestinal material from mice or humans with MASLD into healthy animals resulted in fatty liver damage, lending support to their concept.
Finally, researchers used a virus that solely kills Klebsiella to treat MASLD mice's intestinal material. When intestinal material free of Klebsiella was transplanted into healthy mice, they developed no illness.
Futuristic gut-brain axis
The microorganisms in your gut can produce compounds that affect your emotions and health, for better or worse. (© Inna, stock.adobe.com)
Their findings indicate that certain K. pneumoniae bacteria produce excessive alcohol, which can contribute to fatty liver. This also suggests that some K. pneumoniae-induced cases of fatty liver may be treated with antibiotics. Indeed, feeding imipenem to animals with K. pneumoniae-induced fatty liver reversed disease development.
Because K. pneumoniae turns sugar to alcohol, doctors may be able to detect this type of fatty liver using a simple blood test that measures blood alcohol levels in reaction to sugar. The researchers discovered that mice harbouring the alcohol-producing Klebsiella bacteria became drunk and had higher blood alcohol levels after consuming sugar.
It's unclear whether this phenomenon is prevalent. Klebsiella bacteria is widespread in human intestines, however it is unclear why certain persons harbour strains that produce high levels of alcohol.
In a broader sense, the study highlights the role of the microbiome in regulating mood and behavior. Some people, like the woman charged with DUI, may have intestinal microorganisms that secrete enough alcohol to make them appear drunk when they simply ate a sugary dessert. The Belgian man is also attempting to reduce the quantity of alcohol produced by his gut microorganisms through diet and medicine. It's unclear whether these people have a higher tolerance for alcohol as a result of their regular exposure.
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