A week into his course of cephalexin, a common antibiotic prescribed to ward off infection in an injured thumb, a man checked into the emergency room with some strange symptoms.

They included memory loss, brain fog, and episodes of depression, along with personality changes and uncharacteristic aggression.

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Among my sleep studies research there are numerous notes about how alcohol disrupts sleep. Because it causes the brain to be simultaneously in alpha and delta activity patterns (one’s for being wide awake, the other for being in deep sleep), and blocks REM sleep, and messes with adenosine production interrupting your circadian rhythm, and aggravating breathing problems such as snoring and sleep apnea. . This has me thinking about a recently-discovered, seemingly-rare condition known as auto brewery/gut fermentation syndrome. It’s a condition in which the naturally-occurring yeast in your gut causes the sugars you consume to ferment into alcohol. Known cases lead to folks becoming drunk as a result of drinking fruit juice (for example), but — as with any condition — there should be cases that run the gambit between in-your-face (drunkenness) and subtle-enough-to-be-misdiagnosed-as-a-dozen-other-things-if-at-all. . With this in mind: What if an individual’s daily sugar intake, daily energy use, and overall gut yeast levels are balanced in such a way that their gut doesn’t automatically create alcohol during the day, but then at night (with some sugars still in the system and physical activity coming to a halt) the gut then creates alcohol? That person would have no trouble falling asleep, but would regularly have trouble staying asleep. . It’s just a theory. But it’s a theory that can be checked (at least on the individual level) via stool test and or glucose challenge test. And for those struggling to get a proper diagnosis for sleep issues, those are tests worth taking. . If it turns out a person has secondary insomnia resulting from auto brewery syndrome, that means there’s only a handful of underlying conditions that could be causing the whole kit-n-kaboodle. Because no one’s born with auto brewery syndrome, it arises as a result of some other condition creating too much yeast in your gut. And that really helps to narrow down the possibilities. . And as someone whose OCD was misdiagnosed and punished in equal measure for about 25 years before we finally knew what was what, if even one random-ass theory can help someone get to the right diagnosis a little fast

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Doctors were unable to get to the root of the cause, and he suffered those same symptoms for some time. Three years later, a psychiatrist treated him with antidepressants, but his issues persisted.

Things came to a head when he was pulled over on suspicion of drink driving, and was found to have a blood-alcohol level of 200mg/dL (about the equivalent of 7-10 drinks, depending on your weight). He was nauseous, vomiting, impaired, had no memory of the event, and passed out in the hospital.

The patient, however, insisted he had not had one single drink.

It was his aunt who brought him a breathalyzer, and as he tracked his measurements over time, he received similar readings.

A doctor in Ohio administered a carbohydrate test, where the patient consumes carbohydrates and then has their blood-alcohol levels monitored over the course of several hours, and found elevated alcohol levels in his blood. They also found brewer’s yeast in his stool, and eventually diagnosed him with auto-brewery syndrome (ABS).

The syndrome, also known as gut fermentation syndrome, is extremely rare. It causes the digestive system to produce ethanol that makes you intoxicated. Several cases have been reported over the years, usually discovered under similar circumstances (people arrested for drunk driving without having a drink).

This man, however, is the first documented case of ABS stemming from a course of antibiotics.

“We postulate that the antibiotic altered his gut microbiome, allowing fungal growth. This diagnosis should be considered in any patient with positive manifestations of alcohol toxicity who denies alcohol ingestion.”

He was given antifungal medications and, despite a relapse after a night of pizza and soda, is doing well.

I’m not saying this will work if you ever find yourself on the wrong end of a traffic stop, but I mean. It could be your guts making beer, and you just don’t know it.