Effect of Nicotine Consumption in Auto-Brewery Syndrome

Purpose: Auto-Brewery Syndrome (ABS) is a rare condition defined by a proliferation of yeast species in the gut, where they enter the bloodstream. Patients typically show signs of intoxication upon carbohydrate ingestion as a result of yeast fermentation. A literature review reveals several cases of patients with diagnosed ABS who were admitted to the hospital for psychosis and agitation. In addition to ABS, patients often present with several comorbidities, including Chronic Traumatic Encephalopathy (CTE) and a history of e-cigarette or tobacco consumption. Given the temporal relationship between nicotine consumption and the onset of psychotic episodes in these patients, there may be a link between nicotine consumption and worsening psychosis in patients with CTE and ABS. Question/hypothesis: Could nicotine consumption exacerbate Auto-Brewery Syndrome to induce psychotic episodes in the setting of Chronic Traumatic Encephalopathy? Methods: An English literature review of case reports involving patients who are smokers with concurrent ABS and CTE and an English literature review on the effects of nicotine in the body Results: The literature suggests a connection between nicotine consumption and increased catecholamine levels, which can increase glucose production and blood glucose levels. The proposed mechanism involves activation of the nicotinic acetylcholine receptors in the adrenal medulla, which increase the production and release of catecholamines, namely epinephrine. Epinephrine then binds B2 receptors on the liver and skeletal muscles, upregulating glucose production and release. The glucose may then be fermented by yeast in the bloodstream, resulting in alcohol toxicity and/or psychotic episodes. Conclusion: Our review shows that patients experienced an increase in psychotic episodes while staying at a psychiatric hospital where they were provided with cigarettes and produced elevated BAC measurements during these events. The mechanism by which nicotine increases glucose production in the body led us to believe that these patients were experiencing ABS exacerbations secondary to nicotine consumption, inducing psychotic events in the CTE setting.