明明没有喝酒却能酩酊大醉？

When a man in North Carolina was pulled over on suspicion of driving drunk, police didn't believe him when he said he hadn't had any alcohol. 

一名北卡罗莱纳州的男子因涉嫌酒后驾驶被警察拦下时声称自己没有喝酒，然而警察并不相信他。

The man, in his late 40's at the time, refused to take a breathalyzer test and was taken to a hospital, where his initial blood alcohol level was found to be 0.2% — about 2.5 times the legal limit and the equivalent of consuming 10 drinks an hour. Despite the man swearing up and down that he hadn't had anything to drink, doctors didn't believe him either. 

这名年近50的男子拒绝接受酒精测试，因此被带去了医院。检查结果显示，他血液中最初酒精含量为0.2%，约为法定上限的2.5倍，相当于每小时喝10杯酒。尽管这名男子不停地发誓说他没有喝任何东西，医生们还是不相信他。

But researchers at the Richmond University Medical Center in New York eventually discovered that the man was telling the truth. He wasn't downing beers or cocktails — instead, there was yeast in his gut that was likely converting carbohydrates in the food he ate to alcohol. 

但纽约里士满大学医学中心的研究人员最终发现，这名男子说的是实话。他并没有喝啤酒或鸡尾酒，事实是他的肠道里有一种酵母，这种酵母可能会把他吃的食物中的碳水化合物转化成酒精。

In other words, his body was brewing beer. The man's intestinal tract was acting like his own internal brewery.

换句话说，他的身体在自动酿酒。这个男子的肠道就像是他自己身体里的啤酒厂。

The findings were reported in a study in BMJ Open Gastroenterology. The man, whose identity has not been revealed, had a rarely diagnosed medical condition called auto-brewery syndrome (ABS), also known as gut fermentation syndrome.

这一发现发表在《BMJ开放胃肠病学》杂志上。这名未透露身份的男子患有一种名为“自动酿酒综合症”(ABS) 的罕见的疾病。这种病也被称为肠道发酵综合症。

Gut fermentation syndrome occurs when yeast in the gastrointestinal tract causes the body to convert carbohydrates ingested through food into alcohol. The process typically takes place in the upper GI tract, which includes the stomach and the first part of the small intestine. 

肠道发酵综合症的发生是由于胃肠道内的酵母把人体将通过食物摄取的碳水化合物转化成了酒精。这个过程通常发生在上消化道，包括胃和小肠的第一部分。

when he ate or drank a bunch of starch — a bagel, pasta or even a soda — the yeast fermented the sugars into ethanol, and he would get drunk. Essentially, he was brewing beer in his own gut.

当他摄入一些淀粉时，比如说吃一个百吉饼，吃一碗意大利面，甚至是喝一杯苏打水，酵母菌就会把糖分发酵成乙醇，于是他就醉酒了。从本质上来讲，他其实是在自己的肠子里酿造啤酒。

"These patients have the exact same implications of alcoholism: the smell, the breath, drowsiness, gait changes," Fahad Malik, the study's lead author and the chief internal medicine resident at the University of Alabama at Birmingham, told CNN. "They will present as someone who's intoxicated by alcohol, but the only difference here is that these patients can be treated by antifungal medications."

该研究的主要作者，阿拉巴马大学伯明翰分校的首席内科住院医师Fahad Malik告诉CNN:“这些患者会表现出和酗酒完全相同的症状:他们身上的味道、他们的呼吸、他们的倦意以及他们走路姿态的变化都很像酗酒的人。”“他们会表现得像喝醉了酒的人，但唯一的区别是这些病人可以用抗真菌药物治疗。”

Things weren't the same for the man after he completed a course of antibiotics to treat a thumb injury. His personality started to change, researchers wrote in the study, and he experienced episodes of depression, 'brain fog,' memory loss and aggressive behavior that was out of character for him.

这名男子结束了一个治疗拇指损伤的抗生素疗程后，变化就发生了。研究人员在研究报告中写道，他的性格开始发生变化，他经历了抑郁、“脑雾”、失忆以及与他性格不符的攻击行为。（脑雾是指压力，睡眠不足，药物或疾病等因素引起的包括失神，健忘，迟钝，倦怠，头晕在内的一系列症状）

Three years later, after his suspected drunk driving arrest, the man's aunt bought a breathalyzer to record his alcohol levels. She had heard about a similar case that had been successfully treated by a doctor in Ohio and convinced her nephew to seek treatment there too.

三年后，他涉嫌酒后驾车被捕。随后，他的阿姨买了一个酒精测试仪来记录他的酒精含量。她听说在俄亥俄州的一位医生成功医治了一个类似的病例，因此她说服了自己的侄子也去那里接受治疗。

His basic lab tests turned out normal. But doctors found two strains of yeast in his stool: Saccharomyces cerevisiae, a yeast commonly used in beer brewing, winemaking and baking, as well as another fungus.

他的初步检验结果是正常的。但是医生在他的排泄物中发现了两种酵母：酿酒酵母（Saccharomycescerevisiae），一种被普遍用于酿造啤酒、葡萄酒或用于烘培的酵母；除此以外，还有另一种真菌。

The man was successfully treated at the Ohio clinic and told to stick to a strict carbohydrate-free diet along with some special supplements. But after a few weeks, his symptoms started to flare up again. This time, no treatment seemed to work despite visits to numerous medical professionals.

男子的病在俄亥俄州的诊所被成功治好了。并且，他被告知要严格坚持无碳水化合物的饮食和一些特殊补充剂。但几周后，他的症状复发了。这次，尽管他拜访了很多医学专家，但没有任何一种治疗起效。

At one point, the man became so inebriated that he fell and experienced bleeding in his brain. He was taken to a neurosurgical center where he spontaneously recovered in 10 days, researchers said.

有一次，这名男子“醉酒”太严重，他摔倒了，导致脑部出血。研究人员说，他被带到一家神经外科中心，在10天内自行康复了。

"In this institution, his blood alcohol levels ranged from 50 to 400 mg/dL," the researchers wrote. "Here too, the medical staff refused to believe that he did not drink alcohol despite his persistent denials."

“在这个机构里，他血液中的酒精含量在50到400毫克/立升之间浮动。”研究人员写到。“这里也一样，尽管他一再否认，医护人员就是不相信他没有喝酒。”

Finally, the man sought help from an online support group and got in touch with the researchers at the Richmond University Medical Center, who said in the study that they believed the antibiotics he took years ago altered his gut microbiome and allowed fungi to grow in his gastrointestinal tract. 

最后，男子向一个线上支援小组寻求帮助并联系到了里士满大学医学中心的研究人员。在这次研究中，他们认为之前的抗生素改变了他的肠道微生物,并允许真菌在胃肠道生长。

The researchers then used antifungal therapies and probiotics to help normalize the bacteria in his gut, a treatment that he has continued. And aside from one relapse that occurred after he binged on pizza and soda without telling the researchers, it seems to be working. And he can eat pizza again.

然后，研究人员使用抗真菌疗法和益生菌来帮助他肠道内的细菌恢复正常水平。除了他在没有告诉研究人员的情况下暴饮暴食披萨和苏打水后出现的一次复发外，这种疗法似乎已经起到了一定的作用。而且他之后又能吃披萨了。

"Approximately 1.5 years later, he remains asymptomatic and has resumed his previous lifestyle, including eating a normal diet while still checking his breath alcohol levels sporadically," the authors wrote in the study.

这项研究的作者写道，“大约1年半后，他没有再没有出现过醉酒症状，恢复了他以前的常规生活方式，包括正常饮食。但他仍然时不时地检查他呼出的酒精量。”

There have only been a few studies documenting cases of gut fermentation syndrome and the condition is rarely diagnosed, Malik said. In the past, it's even been regarded as a myth. Gut fermentation syndrome was described in1912 as "germ carbohydrate fermentation," and was studied in the 1930s and 1940s as a contributing factor to vitamin deficiencies and irritable bowel syndrome. A group of 20 to 30 cases popped up in Japan in the 1970s and the first US cases were reported about 10 years later. 

Malik说，目前只有少数研究记录了肠道发酵综合症的病例，而且这种情况很少被诊断出来。在过去，这种症状甚至被视为一个神话。肠道发酵综合症在1912年被描述为“细菌碳水化合物发酵”，并在20世纪30年代和40年代被认为是导致维生素缺乏和肠易激综合症的一个影响因素。20世纪70年代，日本出现了20至30例肠道发酵综合征的病例，大约10年后，美国出现了首例肠道发酵综合征病例。

In most instances, the infections occurred after a person took antibiotics — which can wipe out the bacteria in the gut, making room for fungi like yeast to flourish — or had another illness that suppresses their immune system.

在大多数情况下，在人们摄入抗生素之后，才会发生酵母菌感染或患上其他压制免疫系统的疾病，因为抗生素可以消灭肠道中的细菌，为酵母菌这类真菌的生长腾出空间。

We dug around the scant literature on auto-brewery syndrome and uncovered a handful of cases similar to the one in Texas. A 2013 study described a case of a 61-year-old man who for years seemed to be drunk all the time before he was diagnosed with gut fermentation syndrome. In 2015, a woman in upstate New York had a DUI dismissed after presenting evidence that she had the condition.

我们找到了少量的关于自动酿酒综合症的文献，并发现了一些与这个发生在德克萨斯州情况类似的实例。在2013年一项案例的研究中，一位常年来一直被视为处于醉酒状态的老人在61岁时才被查出来是患了肠道发酵综合征；在2015年，一位来自纽约北部的女子在出示患有该病的证据后才被解除酒后驾驶的判定。

Although in rare cases, the yeasty beasts can indeed take up long-term residency in the gut and possibly cause problems The authors of the Richmond University Medical Center study recommend that doctors investigate for the condition especially when a patient shows elevated blood alcohol levels despite denying that they consumed alcohol.

虽然只有在少数情况下酵母菌才会在肠道内长期驻留并有可能引发问题，但里士满大学医疗中心的一项研究的作者建议医生们：当遇到查出来血液中酒精浓度高，却又一直否认喝过酒的患者，应该调查一下他们是否患有该病。

Early signs of gut fermentation syndrome can include mood changes, delirium and brain fog, the researchers wrote, even before a patient starts exhibiting symptoms of alcohol inebriation.

研究者写道，肠道发酵综合征的早期迹象包括心情的转变，神志失常以及脑雾现象，这些迹象甚至在开始显现出醉酒的一些症状前就会出现。

The study says more research should be done on the use of probiotics as a treatment for the condition. "This is a condition that is treatable with dietary modifications, appropriate antifungal therapy, and possibly probiotics," the researchers wrote. "The use of probiotics and faecalmicrobiota transplantation could be considered for future studies."

研究还指出，关于或许能治疗该病的益生菌的使用还有待更多的实验。“这种病可以通过饮食调整、适当的抗真菌治疗等方式医治，益生菌治疗也很有潜力，”研究者写道，“未来的研究可以考虑使用益生菌和粪便微生物移植的治疗方式。”