One woman's controversial diagnosis of 'auto-brewery' syndrome got her out of a DUI.

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After a woman was arrested for driving while intoxicated in upstate New York, her lawyer (of all people) discovered that she might have auto-brewery syndrome. In other words, her gut was making its own alcohol, rendering her legally intoxicated hours after she’d had her last drink. Her defense sounds about as phony as "affluenza" or "my dog ate it." But it's actually valid.

Auto-brewery syndrome, also known as gut fermentation syndrome, is not well known or well understood (or common). But a few cases have been reported in scientific journals, and at least two specialists in the United States have diagnosed and treated it in recent years. Here’s what we know about this woman’s strange case, and what seems to have been going on in her body.

Driving while auto-brewing

Back in October 2014, a resident of Hamburg, New York met her husband at a restaurant for lunch. According to her lawyer, Joseph Marusak, who spoke with CNN, she had four drinks between noon and 6 p.m.—less than one drink an hour, and not enough to make a woman her size legally drunk when it was time to drive home, a pharmacologist later testified on her behalf.

But on that drive home, the 35-year-old (who has not been named by the media) got a flat tire, and another driver reported it as an accident. The police arrived to find the woman who “exhibited glassy-bloodshot eyes and slurred speech,” and had trouble with several sobriety tests, police reported, according to The Buffalo News. Her blood-alcohol level was measured at .33% by a Breathalyzer device, which is well over the legal limit and could even be life-threatening.

After the woman was charged with driving while intoxicated—and continued to have a high blood-alcohol level later at the hospital, even when she seemed sober—her lawyer did some research and came across auto-brewery syndrome on the Internet. He contacted Barbara Cordell, PhD, Dean of Nursing and Health Services at Panola College, who first encountered auto-brewery syndrome in 2010 and published a case report about it in a 2013 issue of the International Journal of Clinical Medicine.

Cordell referred the lawyer and his client to Anup Kanodia, MD, a doctor in private practice in Westerville, Ohio, who has treated auto-brewery patients. The woman underwent tests in New York and in Ohio, which confirmed that her body did indeed seem to be making its own alcohol, even when she’d had nothing to drink.

What’s going on in there?

Doctors don’t know a lot about auto-brewery syndrome, but they do know that it’s caused by an excess of yeast in the gut. Humans don’t naturally have yeast in their body, but because of our diets and lifestyle—we eat bread, drink alcohol, take antibiotics—it is often found in very small amounts, says Dr. Kanodia, who’s also a clinical assistant professor at Wexner Medical Center at The Ohio State University.

For most people, that yeast is metabolized with few effects on the body. But in some people, this yeast proliferates, like an infection, and begins to turn glucose from foods (specifically carbohydrates) into alcohol.

Dr. Kanodia says genetics may play a role in why some people develop auto-brewery syndrome. A high-carbohydrate or high-yeast diet, lack of sleep, stressful situations, or taking antibiotics may also raise a person’s risk. “And part of it is probably just luck,” he says.

People with auto-brewery syndrome can build up a tolerance for alcohol, which is why they can register such high BAC levels—sometimes without showing signs of intoxication. “You and I may feel drunk at .15%, but these people live and function every day at .15%,” he says. “But then when they get too much stress or not enough sleep or eat the wrong foods, they’ll go up to a .3 or .4, which is when they may start to feel or act a little different.”

Driving while intoxicated isn’t the only danger people with auto-brewery syndrome face. The condition comes with all the risks of alcohol abuse, says Dr. Kanodia, both long-term and short-term. “We’ve seen patients who pass out and hit their heads, who have neurologic issues, who have elevated liver enzymes,” he says. “It can have an effect on your heart disease risk, cancer risk, sleep, depression, anxiety, you name it.”

Fortunately, Dr. Kanodia has had success in treating this condition with a high-protein, high-fat, low-carbohydrate diet, along with strategies to reduce stress and improve sleep. Some patients are also treated with an anti-fungal medication. He says it’s too soon to tell if auto-brewery is a chronic condition that will keep coming back, but says that most of his patients have remained symptom-free after treatment.

So, is this for real?

Dr. Kanodia estimates that he’s diagnosed about 10 patients with auto-brewery syndrome since he first learned about it in 2012. He also says that, to his knowledge, he and Cordell are two of the only medical professionals in the United States with experience treating the condition.

Elena Barengolts, MD, an endocrinologist at the University of Illinois who studies bacteria in the gut, says that the condition does seem legit. “Only a few cases have been reported, but they are very well documented,” she says. “So while it is extremely, extremely rare, yes, it does seem plausible.”

To make alcohol, Dr. Barengolts says, you need an anaerobic (or oxygen-free) environment. “This exists in the gut, so it makes sense that fermentation could happen there,” she says. In fact, the most common type of yeast associated with this condition—Saccharomyces cerevisiae—is the same type that’s used to make wine and beer. “It was found in jugs in China from 7,000 years ago,” she says, “and it’s been used by people in all sorts of food and alcohol production since those times.”

Auto-brewery syndrome was first described in 1912. Several cases have been reported in Japanese people with severe yeast infections, as well as in children who have had gastrointestinal surgery and have shortened bowels. (The latter makes sense, says Barengolts, since their ability to properly digest sugars could be compromised.)

Last year, the BBC reported on a man who “gets drunk on chips,” and went undiagnosed for years until he learned about auto-brewery syndrome. As of May 2015, he was also trying to appeal a drunk driving charge. While the condition isn’t frequently cited in legal cases, it was discussed (and largely dismissed) as a potential defense in a 2000 article in the journal Medicine, Science and the Law.

While he admits the condition is rare, Dr. Kanodia estimates that 95% of people who have it go undiagnosed. “Most health-care practitioners don’t know about it or don’t know how to test for it or treat it, since this is such a new diagnosis,” he says. “We need to continue researching it and educating doctors about it, so we can develop consensus in the medical community.”

As for the New York woman, Dr. Kanodia says she’s doing well. “At her last appointment, she did not have any auto-brewery symptoms,” he says. In light of her diagnosis, the charges against her were dropped in December, but the Erie County District Attorney’s Office said it plans to appeal the ruling.