TENGOODRULES.ORG
​
Six Goals for Auto Brewery Syndrome (ABS) Recovery
​
Successful recovery from Auto Brewery Syndrome (ABS), also known as Gut Fermentation Syndrome, can require major lifestyle changes. This document outlines important therapeutic goals which can be achieved by a healthy lifestyle and describes the role of an optimal low-carbohydrate diet, self monitoring, and eliminating substances that disrupt healthy gut function.
Disclaimer
​
ABS is a relatively new diagnosis and the therapeutic goals and strategies described here are based on limited data. This is a "living document" which will be updated as more information becomes available. It has not been peer reviewed. Please ensure you are accessing the most recent version of this document.
​
Management of Auto Brewery Syndrome should be diagnosed and supervised by a qualified healthcare provider. Due to its rarity and overlapping symptoms with other conditions, ABS requires a careful diagnosis. ABS is not the only cause for unexplained symptoms of intoxication. We have much to learn about the best treatment for ABS, and a skilled clinician who conducts a detailed examination is best able to direct therapy, which may include modalities such as antifungal medications, fecal transplant, or medications that reduce craving for alcohol. Most interventions are at least partly experimental, each person requires individualized treatment, and good clinicians may not agree about the best course of action.
​
This information is intended for educational purposes only and is not intended to diagnose or treat any illness. The author is not responsible or liable for the use or misuse of the information provided. No guarantees of benefit or the absence of harm can be offered, and use of the information provided is solely at your own risk.
Dr. John C. Umhau MD MPH CPE FASAM CDR (ret)
October 2, 2025
Recent ABS References:
​
1) Goal: Minimize carbohydrate availability
​
Auto-Brewery Syndrome (ABS) typical occurs when microorganisms in the gut microbiome ferment carbohydrates into alcohol. Therefore, minimizing carbohydrate availability is key to avoiding an episode of ABS and a very low-carbohydrate diet is essential. Consuming less then 5 grams of carbohydrates daily can drastically limit alcohol production, and following this strict diet for a year or more is often required for the gut microbiome to return to a balanced state. This diet eliminates all foods that contain sugar or starch, including bread, pasta, rice, potatoes, fruit, fruit juice, sweet drinks, candy, and pastry. It also requires avoiding all vegetables, although some individuals with ABS may eventually be found to tolerate small amounts of low starch, high fiber vegetables without developing a flare of ABS. Carbohydrates are hidden in many processed foods, so it is important to read every food label. Counting carbohydrates can be a burden, but achieving a goal of consuming less than five grams may help prevent a flare of ABS and restore health.
​
A diet rich in fat and protein can help individuals with Auto-Brewery Syndrome (ABS) completely avoid episodes. Because fat cannot be fermented into alcohol, it is a safe and reliable food energy source for people with ABS. Healthy fat should be an important part of everyone’s diet, and people are mistaken to considering all fat the same. The following list of foods exemplify healthy choices for people with ABS:
​
-
Unrefined, organic healthy fats: grass fed lard, coconut oil, avocado oil, walnut oil, olive oil.
-
Fish and seafood: Especially fatty fish like mackerel, trout, sardines, and salmon which provide important omega-3 fat
-
Meats: grass-fed beef, organs, game meat, lamb, bison, pork, pastured chicken, turkey, duck
-
Eggs: pastured or omega-3 whole eggs
-
Dairy: grass-fed butter, unprocessed, non-mold containing cheeses - hard cheese, cream cheese, feta
-
Fermented foods containing only a minimal carbohydrate
​
Note: Some of these foods contain small amounts of carbohydrate which, for some people, could be sufficient to cause problems.
Supplying the body with fat while reducing carbohydrate intake allows the body to shift its primary energy source from glucose to small fat molecules called ketones: beta-hydroxybutyrate (BHB), acetoacetate and acetone. Following a low carbohydrate diet allows the body to increase the blood concentrations of these ketones so that they can supply almost all of the energy needs of the body and brain, a metabolic state called ketosis.
​
Fasting, as well as physical activity, helps use up glucose stored as glycogen in muscles and liver, and helps push metabolism towards ketosis. The adaptation from carbohydrates to ketones typically takes a few weeks. Early in the adaption process people may feel tired, irritable, or dizzy, but these effects are temporary. Drinking water throughout the day is very important especially with fasting or exercise and can help minimize these symptoms.
When someone has adapted to being in a state of ketosis, they often notice improved mental clarity, reduced appetite, more stable energy throughout the day They may also notice a mild fruity odor to the breath and urine due to acetone. An important benefit of being in ketosis is that ketones often minimize craving for sweets and alcohol. Ketones may also reduce symptoms of alcohol withdrawal.
​
Even individuals not following a low carbohydrate diet can provide a supply of ketones to the brain by consuming fat in the form of medium-chain triglycerides (MCTs). MCTs are saturated fats of a size allowing the body to absorb and metabolize them efficiently into ketones. MCTs occur naturally in many whole foods. Coconut oil contains about 15% MCTs and is great for stir-frying veggies, eggs and meats or adding to foods. Certain cheeses, grass fed butter and full fat milk contains about 7% MCTs.
​
An efficient way to get MCTs is from refined MCT oil, which contains 100% MCTs. Refined MCT oil is flavorless and odorless, making it easy to add to smoothies, coffee, or foods. MCT oil provides about 15 grams of MCTs per tablespoon while the same amount of coconut oil provides about 2 grams of MCTs. Consuming MCTs, perhaps 15 grams every four to six hours, can help maintain a blood level of ketones even if you are not fully in ketosis or following a low carbohydrate diet. Many people with ABS find that being in ketosis dramatically reduces their craving for sweets and alcohol as well as symptoms of alcohol withdrawal. Starting with low amounts before gradually increasing to 15 grams every six hours will often minimize stomach upset.
​
Sometimes people eliminate virtually all carbohydrates from their diet, but episodes of alcohol production continue. It is often unclear why this happens - people can have very different situations. Following a low carbohydrate, keto diet which incorporates a spoonful of coconut oil every few hours may minimize this problem, but in some cases, ABS episodes continue. Sugar is also manufactured by the body, particularly during stress, and this sugar may be converted to alcohol. Blood or mucous can contain glucose and this sugar can be fermented by various organisms in places other than their gut. Protein is essential for health, but too much can interfere with ketosis. That’s because the body is able convert excess protein into glucose through a process called gluconeogenesis. As a result, eating a high protein but low fat diet may raise blood glucose sugar and lead to an episode of ABS.
2) Goal: Learn what works best for the individual
​
The individual with ABS can become an expert on preventing their symptoms. Monitoring and recording breath alcohol levels frequently every day can help them know when their body is making alcohol - even if they don't notice anything. maintaining this practice for the long term can prevent problems and help maintain recovery. Keeping a detailed record of food, drink, sunlight exposure, medication use, emotional state, and physical activity can be informative for the individual and their health care provider and can lead to the best treatment advice. This will help develop the optimal unique plan for their unique situation.
​
Some individuals notice that if they become dehydrated, they are much more likely to experience severe symptoms of ABS. If someone is dehydrated and they begin to make alcohol, the alcohol concentration in their blood will be greater, and they will be more likely to experience intoxication. The solution to this problem is to drink plenty of water throughout the day, especially on hot days when dehydration is more likely. Adding electrolytes, (i.e., sodium and potassium) to the diet can also help prevent dehydration.
​
An abundant and steady level of ketones in the body will often help people with ABS feel healthy, reduce craving for alcohol, moderate stress, and minimize the bodies need to manufacture glucose. Measuring ketone levels frequently - after different activities and consuming different foods can help them learn how to insure they are in a healthy state of ketosis. A breath test meter measures ketones excreted through the breath and is convenient to use throughout the day. Blood test meters may give the most accurate and useful measure of ketosis, but some people find that obtaining the required drop of blood to place on a test strip is excessively difficult. Urine can be also tested for ketones inexpensively using test strips designed for this purpose.
3) Goal: Restore healthy gut function and microbiome diversity
​
A diverse gut microbiome, one with many kinds of living organisms, can help prevent unhealthy organisms that make alcohol from dominating the microbiome and causing ABS. Consuming a variety of fermented, probiotic foods, including small amounts of Greek yogurt, kefir, sauerkraut, tempeh, kvass, pickles, olives, natto, and miso help restore a diverse microbiome naturally, and with probiotics, will minimize the risk of an ABS flare. Many people benefit from consuming a spoonful of low carbohydrate, live, fermented foods at every meal, but are aware that consuming too much might lead to an episode of ABS. Other people find that probiotic supplements are key to creating diversity in the microbiome and a healthy gut that does not ferment alcohol.
​
People with ABS also find that spices are very helpful. They report that garlic, pepper, turmeric, cinnamon, and oregano oil reduce their risk of ABS. Importantly, new research suggests that consuming liquid fish oil throughout the day promotes healthy gut bacterium and can protect the brain from the damage caused by alcohol. Drinking coffee, even if decaffeinated, is also healthy for the gut.
​
Some foods can reduce the diversity of the microbiome and damage the gut. Processed foods typically contain preservatives, stabilizers and chemical additives which disrupt normal gut function - these ingredients should be completely avoided. Artificial colors and sweeteners are often harmful to the gut and should be avoided. Organic food is often expensive, but it is safest. Be aware that mold in foods such as coffee and peanuts or in the environment may also contribute to ABS episodes. As people with ABS try various probiotics and foods, they will learn what helps ... and what makes their situation worse.
4) Goal: Strengthen the brain
​
Alcohol can damage the brain, and this damage can make recovery from ABS the shrinkage or atrophy that accompanies excessive alcohol exposure. Exercise, sleep, and sun exposure can all help protect the brain. However, a nutritious diet is critical to ensure that the mind stays clear and the willpower strong. Alcohol exposure will deplete vitamins, minerals, and essential fats from the body but this effect is minimized by nutrients that can protect liver, gut and brain from damage.
​
The essential omega-3 fat, DHA, is arguably the most critical nutrient for a healthy brain. The brain needs more DHA than than any vitamin or mineral - and even more DHA is needed by people exposed to alcohol. However, omega-3 fat such as DHA can only be obtained from the diet. DHA, naturally produced by algae in the sea, is concentrated in seafood, especially deep-sea oily fish. There is also some DHA in grass fed animals and wild game. However, DHA and other omega-3 fats are often lacking in modern diets, causing many people to suffer from preventable mental disorders.
​
Restoring the brain by consuming DHA is a key strategy to overcome alcoholism and to help people with ABS recover. Fish or cod liver oil supplements abundant in DHA can promote a healthy gut and often produce dramatic benefits. Doses greater than 9,000 milligrams of EPA+DHA per day have successfully treated severe mental illness. Fish oil has been used as medicine for thousands of years, attesting to its safety. Sometimes, however, it causes stomach upset.
​
Many people feel better and think more clearly when they optimize their diet with nutritional supplements, especially B vitamins. Vitamin B3, (niacin) is especially helpful. Vitamin B1, (thiamine) is critical to prevent permanent alcohol related brain damage. Minerals, including lithium, zinc, magnesium can be extremely important. In addition, supplements such as NAC, glutathione, and milk thistle are sometimes suggested to help support liver health in people with ABS.
Critical Vitamins and Minerals For ABS
​
-
Lithium orotate 120 mg (5 mg of elemental lithium) daily
-
Magnesium 300 - 500 mg daily
-
Zinc 20 mg daily
-
Calcium carbonate 800 mg daily
-
Vitamin D 4000 -10,000 IU daily
-
Vitamin C 1000 mg daily
-
Vitamin B1 (thiamine) 100 mg daily
-
Vitamin B2 (riboflavin)
-
Vitamin B3 (niacin) When supervised by a physician, this has been used at doses of 500 to 2000 mg three times daily to reduce alcohol consumption.
-
Vitamin B5, (Pantothenic acid) 100-200 mg/day
-
Vitamin B6 (pyridoxine) 5-20 mg/day [or pyridoxal 5'-phosphate, P5P, 25-50 mg/day]
-
Vitamin B7 (biotin)
-
Vitamin B9, (folate) 0.8 to 5.0 mg/day (This should be L-5-Methyltetrahydrofolate or L-Methyltetrahydrofolate)
-
Vitamin B12 (cobalamin) more than 400 mcg/day [or methylcobalamin, more than 1 mg/day]
5) Goal: Prevent or eliminate addiction to alcohol
​
Anyone repeatedly exposed to alcohol is at risk for addiction. A genetic predisposition to drink may make a person more susceptible, but everyone is at risk. Many forms of trauma as well as underlying emotional problems can also increase the danger of addiction, and such problems often require special ongoing attention and care. Drinking concentrated alcohol on an empty stomach or with carbonated beverages, can also increase the risk of addiction. Gastric surgery or medications such as serotonin reuptake inhibitor (SSRI) antidepressants can also aggravate the problem.
​
If someone has ABS, they are at very high risk for developing addiction, so the best choice is not to drink. However, if someone with ABS does drink, drinking can lead to an alcohol addiction that will persist even after ABS has been successfully treated. Before this happens, a knowledgeable physician can prescribe medications which help with people with alcohol problems, especially a medication called naltrexone.
​
Naltrexone is a pill or injection which can reduce the craving for alcohol. Naltrexone works specifically to block endorphins - the opiate reward signals generated by alcohol ... or even subconscious thoughts about alcohol. When people take naltrexone, the pleasure or "buzz" associated with alcohol can be eliminated. When naltrexone blocks endorphins in the brain, the brain changes that occur with repeated alcohol exposure are not reinforced, and this can eradicate addiction. In many people, taking naltrexone an hour before they drink will eventually extinguish alcohol addiction by eliminating the subconscious craving that often drives drinking. This is the principle which explains why targeted naltrexone, sometimes called The Sinclair Method, is effective at overcoming addiction. Some people who take naltrexone even when they don't plan to drink find that thoughts about alcohol are gradually diminished as well.
​
Sweets, like alcohol, can also stimulate the brain to make endorphins, which helps explain why naltrexone may help people with ABS by preventing or reducing sweet craving. People with ABS have used naltrexone as needed whenever they find themselves thinking about sweets or carbohydrate, and over time, these thoughts and cravings have been eliminated.
​​
Clinical experience shows that naltrexone not only helps people alcoholism, but also those with ABS. In the case of ABS, as in drinking alcohol, using naltrexone will not reduce symptoms of intoxication. However, regular naltrexone use by someone with active ABS may prevent addiction to beverage alcohol from developing.
​
The effect of a naltrexone pill lasts perhaps 6 or 8 hours but varies depending on dose and an individual's unique metabolism. Long-acting injectable naltrexone lasts 4 weeks and may be especially helpful in ABS. People sometimes experience nausea, headache, or other symptoms when they start to take naltrexone, but these symptoms typically resolve. Naltrexone is relatively safe but should not be used if someone is regularly taking opiates as it will cause them to experience acute withdrawal symptoms. Other medications for alcoholism, such baclofen, topiramate or acamprosate, may also help people with ABS.
​
This information is presented for educational purposes only and cannot substitute for the individualized advice from a physician or other experienced clinician.
6) Goal: Never give up
​
To keep inspired and encouraged, people struggling to overcome ABS will often write themselves a letter or record a video that will remind them of their goal to recover. They often benefit from becoming active in a mutual support group that provides encouragement when they need it. When they find themselves craving alcohol and / or sweets, they learn to become honest and open about these thoughts - they are an expected feature of ABS. The often share their story with other people who struggle with addiction to food or alcohol and learn from people who have been successful. They are open to suggestions. Many people afflicted with ABS make lifelong friends and discover profound benefits for themselves in the process of "working" a recovery program such as Alcoholics Anonymous. Many find a deeper relationship with God in the process.
​
Everyone is different, and the path to overcoming ABS is not the same for everyone. Keeping their physician and other care givers informed about they are doing enables them to get the best care possible. ABS can recur, so once they find what works, they can learn to keep doing that without fail - because recovery is a lifelong process, and it can be different for everyone.