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Shahid Karim
Shahid Karim, Board Certified MD
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My wife has not drunk a drop of alcohol in weeks, but feels

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My wife has not drunk a drop of alcohol in weeks, but feels drunk all the time. I've bought a breathalyser and she was twice the legal driving limit at 11am in morning and I'd been with her all night and morning. Any ideas on causes or treatment?
JA: Has your wife discussed the treatment with a doctor?
Customer: Yes, we are getting more blood tests tomorrow. But what can cause alcohol to be present?
JA: The Doctor will be able to answer that. Has she used any medication for this?
Customer: Not yet. The doctors don't know what the problem is. She also has nausea from time to time, but I know there are loads of things which can cause that.
JA: Thank you so much for your time. Finally, is there anything else in her medical history you think the Doctor should know?
Customer: No. She is not on any medication, apart from the pill and is 51 yrs old.

Hi, thank you for getting in touch. I'm sorry to hear about what's been going on. Firstly in terms of the breathalyser there are some things that can make them falsely positive if no alcohol has been ingested such as cigarette fumes, diabetics' breath, hair sprays and some mouthwashes for example. I'll give you a link to a site that goes into more detail. The second thing is the symptoms of feeling drunk. Really there are two main possibilities. One is that alcohol has been ingested of course but I understand you're certain that's not the case. Second is diabetes and the presence of something called ketones in the breath. I do think it's important that this be tested for by your GP when you see them. I hope that helps.

https://www.alcolizer.com/wp-content/uploads/2017/01/12660_WhitePaper_Substances-that-Can-Affect-A-Breath-test_LR.pdf

Shahid Karim and 2 other Medical Specialists are ready to help you
Customer: replied 12 days ago.
I understand that the felling of being drunk has some subjectivity about it. However, I can assure you that she does not smoke, never uses mouthwash or hair spray and was recently tested for diabetes and was normal (4.2%). P.S. I am Diabetes II myself in remission, so I understand about that. I have tested my wife 4 times now over 7 hours (and her level has gone down slightly from 40 micro g per 100 ml and is 34 now). I also used the breathalyser and it recorded 0.00. So, assuming the breathalyser is not a false positive - why does she have alcohol in her blood, given I am with her 24 x 7 and know she is not drinking (I have removed all alcohol from the house as a precaution - and she doesn't go out of the house on her own, so she can't be buying a secret stash).
Customer: replied 12 days ago.
I understand that the feeling of being drunk has some subjectivity about it. However, I can assure you that she does not smoke, never uses mouthwash or hair spray and was recently tested for diabetes and was normal (4.2%). P.S. I have Diabetes II myself, but am in remission, so I understand all about that. I have tested my wife 4 times now over 7 hours (and her level has gone down slightly from 40 micro g per 100 ml and is 34 now). I also used the breathalyser myself and it recorded 0.00. So, assuming the breathalyser is not a false positive - why does she have alcohol in her blood, given I am with her 24 x 7 and know she is not drinking? I have removed all alcohol from the house as a precaution - and she doesn't go out of the house on her own, so she can't be buying a secret stash.

I see. Tough one really. One of the other options then would also be auto-brewery syndrome which is fairly rare and essentially is due to bugs within the gut, yeasts in particular, fermenting what we've eaten and producing ethanol as a byproduct which enters the bloodstream and would explain the symptoms and the device results. I've included a link to a medical article on it for more information. I hope you manage to get to the bottom of it soon and would advise you to try some of the steps mentioned in the article. All the very best.

https://www.ncbi.nlm.nih.gov/books/NBK513346/

Customer: replied 12 days ago.
Sorry about sending the previous reply twice. Anyway, I understand your point about ketones in the breath and the possibility of hyperglycemia. She is having a blood test that includes testing for diabetes again (HbA1c) tomorrow and the results will be available on Monday (when we see the doctor). Thank you for your help.
Customer: replied 12 days ago.
Just seen your second post - yes, that would fit the symptoms, but I guess we'll see what the diabetes test tells us. Many thanks.

Sure thing, you're very welcome. Come back if you've further questions. All the very best to you both.

Customer: replied 9 days ago.
Hi. I am fairly certain she had auto-brewery syndrome (ABS), at least in part because her breath did not smell of nail polish, so I don't believe the breathalyser was being triggered by ketones. Her blood test confirmed she is not diabetic and was ok apart from, unsurprisingly, it indicated liver damage (SGPT / ALT =159 U/L). I put her on a strict ultra low carb diet from Friday morning and her alcohol levels started to drop (from 41 micro-g/l - twice the Scottish drink/drive limit) and by Sunday morning her alcohol levels reached 0.0. and have stayed that way. However, the problem is her short term memory has not been good recently (which I put down to being drunk). During the low carb diet it deteriorated down to "goldfish" level (asking the same questions every 2 minutes). On Sunday morning, I realised this was probably Hypoglycemia and, despite the risk that it may make the ABS start again, then put her on a high sugar/carb diet (eg sugary fruit juice etc). The ABS has not (yet) returned (alcohol =0.0), but her memory problems have not noticeably improved. So, I am now wondering if either the sudden lack of alcohol in her blood is somehow causing this - or whether this is liver or pancreas related?
Customer: replied 8 days ago.
Currently, she has no nausea, is on a normal (alcohol-free) diet, doesn't feel drunk (breathalyser = 0.00) and has no other symptoms apart from a headache and the memory problems. She can accumulate new memories to a certain extent, but if she takes a nap or goes to sleep, many of her recent memories disappear and I have to explain everything again.
Customer: replied 8 days ago.
I should also say there are absolutely no symptoms of dementia, she is perfectly normal and can talk, problem solve, no anxiety or confusion etc.

Hi, thanks for the update. I can see what you mean and it may well be ABS, it's quite a rare condition and it is possible that the pancreas may be involved. I'd suggest you seek referral to a specialist with an interest in ABS (usually a gastroenterologist) so that she can get the personalized care she needs. Glad she's on track to getting better though. All the best again.

Customer: replied 8 days ago.
Thank you - and, yes, the GP has referred us to a gastroenterologist. Many thanks.

Oh that's good to hear, I'm glad I could have helped. Take care.

Customer: replied 8 days ago.
P.S. My view - Occam's razor applies, no matter how rare it is. 1) She was drinking no alcohol. 2) Alcohol was in her blood (having ruled out ketones fooling the breathalyser). 3) Yeast makes alcohol. Ergo: she has yeast making alcohol in her system. I starved the yeast with an ultra low carb diet for 42 hours and then 6 hours later (48hrs in total) she was alcohol free. This condition has not come back, despite me pumping sugar and carbs in her system, so the bad yeast is dead. This yeast had been "stealing" loads of sugar from her gut for weeks, during all of which time she has been struggling with low sugar levels. This is clearly a very nasty & insidious disease, not the least for the liver damage caused by the constant generation of alcohol. I suspect that this condition may be significantly underdiagnosed.

You may well be right and I completely agree, a single unifying diagnosis is usually the way to go. Worth keeping a log of intake vs. response for the gastroenterologist too. All the best.

Customer: replied 6 days ago.
Since Tuesday, she has felt well and her ability to retain short term memories slowly improved and now seems normal (although it has varied during each day and I was worrying about whether it would ever completely heal).She had a headache for 3 days, presumably as her liver was detoxing, now that it was finally free of the continuous alcohol poisoning.However, after hoovering, she has just told me she feels drunk again and I breathalysed her and got a non-zero result for the first time since last Sunday (0.320 mg/l, ie at the England drink dirving limit). Because of her short term memory problems, I have had her on a high sugar/carb diet and had no signs of ABS returning, until now.So, I am putting her back on to a very low carb diet, but I am wondering how I can cure her of this (ie kill the yeast), whilst not brining about Hypoglycemia?We chose not to give her a CanesOral Oral tablet (fluconazole) before, because of the risk of liver damage – and that her alcohol level was zero. But now the ABS has returned, I am reconsidering.Is there a more “liver-friendly” anti-yeast treatment?Thanks, Neil.