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Comment by stevemk14ebr | Hacker News Reader

how does this start?

Second and third paragraphs under "discussion":

> Auto-brewery syndrome is thought to result when microorganisms capable of fermenting alcohol from carbohydrates outgrow normal gut flora.6 Although population-based studies have shown that gut alcohol fermentation with low levels of endogenous ethanol can occur even among healthy people, blood ethanol levels rarely reach concentrations high enough to cause intoxication.7 Auto-brewery syndrome is uncommon because it requires several host factors to interact with substantial overpopulation of fermenting microorganisms, and high carbohydrate consumption.6 Comorbidities such as diabetes, liver disease, gut dysmotility disorders, and inflammatory bowel disease are associated with auto-brewery syndrome through mechanisms contributing to increased levels of blood glucose and decreased ethanol metabolism.6,7 Genetic predisposition for inactive aldehyde dehydrogenase enzyme and subsequent inefficient alcohol metabolism, may also play a role.6 In our patient, we suspect her recurrent antibiotics for UTI and dexlansoprazole use led to gut dysbiosis with potential contribution of genetics, resulting in auto-brewery syndrome.

> Commonly implicated fungi responsible for outgrowing normal gut flora in auto-brewery syndrome are Saccharomyces cerevisiae and Candida species including C. albicans, C. tropicalis, and C. glabrata.2 Bacteria have also been cultured from patients with auto-brewery syndrome. Although the role of bacteria remains unclear, a recent case–control study proposed Klebsiella pneumoniae as an important culprit.7–9

In her case, I would guess a lot of antibiotics since the article mentioned frequent ciprofloaxin treatments for UTIs.

It's wild that probiotics aren't considered medically necessary and prescribed alongside antibiotics at this point.

Probiotics are really limited in scope compared to what bacteria you naturally have, unfortunately. They’re far from a silver bullet. That’s why things like fecal transplants exist.

Yeah but obliterating your gut flora without even making an attempt at remediation is madness to me. It's like saying that people who quit smoking shouldn't bother going to the gym because their lungs are already busted.

I haven't looked at the literature in a while, but several years ago I saw some research which concluded that probiotics generally do not directly recolonize the gut; instead, they temporarily prevent colonization by "bad" things and help maintain a healthy environment until diverse recolonization happens gradually over time.

I also saw some evidence (backed by personal experience) that "complex" naturally fermented foods (sauerkraut, kimchi, etc) were more effective than single-culture probiotics.

I was prescribed probiotics every time I was prescribed an antibiotic in the last few years, even by a dentist. This may vary a lot by country, though.

It probably depends on a country or a doctor. Here in Czechia I never got prescription for antibiotics without both doctor and pharmacist advising me to also take probiotics.

The metabolic system is like a ecosystem, where every intervention has a fairly large spectrum of unknowns. Probiotics can do harm, just like antibiotics, or it may do nothing, or it may improve health or reduce symptoms. Generally it doesn't have long term negative effect so it fairly safe, but I can see how doctors would be careful throwing in additional unknowns, especially initially when testing if the antibiotics themselves has the intended effect without major side effects.

We live in symbiosis with the gut flora, and the tools we have to fix problems are crude and based on trial and error.

That is true of literally anything ever.

It's becoming clear that the risks of probiotic supplementation to counteract the damage caused by antibiotics are substantially lower than the benefit of actually counteracting the damage caused by antibiotics.

Yes, you can get cramps or diarrhea or brain fog or even SIBO, but that all sounds a lot better to me than intractable c-diff or the growing number of "peripheral" health problems that we now know are at least somewhat related to gut health.

It seems like this is starting to get better here in the midwest US. I think the last 3/4 times I've been prescribed antibiotics (different doctors, different states) I was given a speech and take home sheet about needing to take probiotics with them. The 4th just gave the sheet and skipped most all the talking in general. No prescription for it on any count but that's no different than being told to take any standard dosage of an OTC (in lieu of making you feel better about going if nothing else was prescribed already that visit).

I think it also depends on the antibiotic how much you get recommended a probiotic. There was one I was given for a stubborn tooth infection and the endodontist was militantly clear that I needed to take a probiotic and spent about 5 minutes going over the signs of cdiff as it was a common result and can be so problematic. Still ended up getting cdiff anyways but at least I knew what to expect :).

It really sucks that you ended up with c. diff even with the probiotics.

But it's a relief that the doctors seem to care.

Here in the northeast at best they offhandedly suggest trying a probiotic, but give no advice beyond that. If you mention probiotic foods you get a shrug and a "sure that's good", but they never volunteer it.

Probiotics aren't one single thing. We generally lack evidence-based medicine guidelines for prescribing probiotics outside of a few limited situations, although this is an active area of research. Most of the OTC probiotics available to consumers are basically junk placebos.

https://blogs.bcm.edu/2023/08/11/reluctant-to-prescribe-prob...

A very notorious antibiotic for its plethora of side-effects.

The article seems to hint at her previous gut flora being wiped out by broad-spectrum anti-biotics taken for her recurrent urinary tract infections, thus allowing the fungi in.

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