It can be incredibly frustrating being constantly told that you have a drinking problem when you've never had a drop but for this 61-year-old Pennsylvania woman, each and every effort to become eligible for a life-saving liver transplant was thwarted by an insurmountable hurdle—she kept testing positive for alcohol. No matter how many times she asserted that she had not been drinking, her urine drug screens read otherwise. Accordingly, she was refused entry on the liver transplant waiting list numerous times, the doctors presuming she was struggling with alcohol addiction.

But the reality was much stranger than anyone might have dreamed. In what seems to be a first in medical history, physicians found that her own bladder was secreting alcohol—a process so unusual that it had not been given an official name yet. Her case sheds new light on how the human body, under abnormal circumstances, can simulate effects of alcohol use without ingestion.

The patient had severe liver cirrhosis, a scarring and liver function loss that requires a transplant to save her life. She also had diabetes that was uncontrolled, leading to high levels of glucose (sugar) in her urine.

Initially, physicians at one hospital brushed off her assertion that she was sober, believing that she was denying alcohol addiction. When she subsequently reported for assistance at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital, the same problem persisted. Her urine samples consistently registered the presence of ethanol, the beverage type of alcohol, further increasing the medical staff's suspicion. Yet there was a critical discrepancy: whereas her urine tested positive for ethanol, it was free of the usual metabolic byproducts—ethyl glucuronide and ethyl sulfate—seen days after drinking.

This contradiction interested Dr. Kenichi Tamama, a senior researcher on the study and an associate professor of pathology and medical director of UPMC's Clinical Toxicology Laboratory. If the woman was consuming alcohol, the metabolites should have been found in her urine. Also, her blood alcohol tests were negative, and she never showed any symptoms of being intoxicated.

Following more research, the doctors discovered a surprising cause: yeast in the woman's bladder was fermenting sugar into alcohol. The process, normally related to making beer or wine, was occurring within her body. Consequently, they suggested calling her condition "urinary auto-brewery syndrome" or "bladder fermentation syndrome."

This condition is similar to, but different from, a rare disorder called auto-brewery syndrome (ABS), also referred to as gut fermentation syndrome. ABS happens when some microbes in the gut ferment carbohydrates into alcohol, leading to people with the condition becoming intoxicated without consuming alcohol. In the case of the Pennsylvania woman, however, her condition was confined to her bladder, so the alcohol did not reach her bloodstream. She therefore never seemed drunk, although her urine was ethanol-positive.

To be sure about their suspicion, scientists performed an experiment. The researchers took a fresh urine specimen from the patient and incubated it at a temperature of the human body (98.6°F or 37°C). Ethanol in the sample zoomed within no time. The sample did not yield any alcohol, however, if it were incubated below normal temperature (39°F or 4°C) or after the addition of a chemical for stopping fermentation. This test conclusively established that the yeast in her bladder was the cause of the alcohol production.

Additional lab tests determined the offender—Candida glabrata, a yeast that is normally present in the human microbiome. Candida glabrata is closely related to brewer's yeast, which is employed in alcoholic fermentation. Under conditions of excess sugar, as in the case of the woman with uncontrolled diabetes, Candida glabrata metabolized the glucose in her bladder to ethanol.

Due to these observations, the woman was finally reevaluated for liver transplant, a move that could turn around her condition and save her life. Her case highlights the need to cast aside standard assumptions of diagnosis and to explore infrequent metabolic phenomena.

Although sporadic reports of such cases have appeared, they were usually considered postmortem changes or laboratory artifacts due to the improper storage of urine samples. This case presents tangible evidence that bladder fermentation is possible in living patients and serves to increase awareness among medical professionals regarding distinguishing between true alcohol intake and endogenously produced alcohol.

What Is Auto-Brewery Syndrome?

Auto-brewery syndrome, or gut fermentation syndrome, is a rare condition where carbohydrates ferment to alcohol within the gastrointestinal tract. Patients can present with signs of intoxication, such as dizziness, slurred speech, and coordination impairment, without alcohol consumption. This results from an imbalance in gut microbiota, typically yeasts such as Candida.

The syndrome is well-documented in medical literature for more than 50 years, yet it remains significantly underdiagnosed. A study published in 2021 estimated that fewer than 100 cases had been reported globally. Experts, however, estimate that numerous other people might be suffering from the condition unknowingly, as the symptoms might be confused with alcohol intake, metabolic conditions, or psychiatric issues. In severe instances, people with ABS have been charged with DUI, even though they consumed no alcohol.

How Is Urinary Auto-Brewery Syndrome Different From Typical Auto-Brewery Syndrome?

Urinary auto-brewery syndrome (bladder fermentation syndrome) and conventional auto-brewery syndrome (gut fermentation syndrome) are similar but differ significantly.

In urinary auto-brewery syndrome, alcohol is synthesized in the bladder because of microbial fermentation of sugar. It may also happen in an open sample of urine outside the refrigerator. But as the alcohol is contained within the bladder and does not get into the bloodstream, individuals who have it do not have symptoms of being intoxicated.

In contrast, classical auto-brewery syndrome happens within the gastrointestinal tract, where fermentative microbes metabolize carbohydrates into alcohol. This alcohol is absorbed into the bloodstream, resulting in a positive plasma ethanol reading and creating symptoms of intoxication similar to that following alcohol intake.

Today, Delhi again woke up to a thick layer of smog, and the adjoining cities like Noida, Ghaziabad, Gurugram, and Faridabad too woke up to zero-visibility fog on Monday. The air quality too dipped down to 'severe' category, with AQI registered at 400 plus on the index. While on Sunday, the AQI did show some improvement, as the city registered 'very poor' AQI, however, by the end of the day, the capital city was trapped under fog and pollution.

Delhi Struggling With Pollution And Cold Wave

The Indian Meteorological Department (IMD) has also issued an orange alert for Delhi on 29 December, Monday. The maximum temperature is expected to be around 22 degree Celsius, while the minimum will be at 7 degree Celsius. Mornings would encounter heavily dense fog, while there is an expectation of marginal relief on December 30. Most of North India is also said to be worst hit, including states like Uttar Pradesh, where thick fog is predicted till December 31, Punjab and Haryana is expected to face cold wave through December 30, and Himachal and Uttarakhand could see rain and snowfall from December 30 onwards.

As per IMD, cold wave is a condition of air temperature which becomes fatal to human body when exposed. This happens during the winter seasons and the cold wave impact gets aggravated due to wind speed. Cold Wave is considered when minimum temperature of a station drops to 10 degree Celsius or less for plains and 0 degree Celsius for Hilly regions.

Read: Delhi Sees Some Relief From Toxic Air; GRAP IV Removed, 'Will Bring Down Pollution In 5 Years,' Says Nitin Gadkari

How Can Cold Waves Impact Your Health?

IMD says that cold wave could cause mild to severe hypothermia. The common symptoms include shivering, dizziness, drowsiness, irritability, confusion, slowed, slurred speech, and altered vision. This happens when body experiences a lowered core temperature below 34.4 degree Celsius.

Frostbite is another health hazard that can happen due to cold waves. It is freezing of body tissue, accompanied with hypothermia. When ice crystal form between the cells of the skin and grow by extracting fluid from the cells, the circulation is obstructed, causing additional damage to the tissue affected. It commonly affects hands, feet, ears, nose and cheeks. The common symptoms are redness in skin, or skin turning grey. Some may also experience tingling sensations, fingers turning numb yellowish, waxy, or grey color.

Chilblains could be caused due to exposure to cold, wet, and humid conditions. Repeated prolonged exposure of bare skin could lead to this development in just few hours. It could impact your ears, nose, cheeks, fingers, and toes. Common symptoms include skin turning pale and colorless, prickly sensations, red, swollen, hot, and itchy skin and blisters.

Dehydration could also happen due to lack of fluid intakes, which is common during extreme cold. This could lead to headaches, dizziness, dry mouth, stomach cramps, and increased heartbeat. IMD notes carbon monoxide poisoning or CMP, snow blindness, and trench foot are also common during cold seasons, and provides ways to prevent these from happening.

What Do These Alerts Mean?

Delhi is currently under Orange Alert for cold wave. What do these different alerts mean?

Green Alert: This means no action will be taken, as this is a normal day during winter season

Yellow Alert: This means 'be updated' and refers to cold wave alert where the conditions in isolated areas may persist for two days

Orange Alert: This means 'be prepared' and refers to severe cold wave conditions that could persist for two days. This could also mean that though the condition is not severe, but the conditions could persist for four days or more

Red Alert: This means 'take action' and refers to severe cold wave conditions that persists for more than two days, or total number of cold wave days exceeding six days

BBC Countryfile presenter Julia Bradbury, who was diagnosed with breast cancer during the lockdown, in 2021, underwent a single mastectomy back to remove her tumor. Now, 55, she has recently opened up about a big lifestyle change that she has made to ensure that her cancer does not come back.

She said that she has given up alcohol completely, which some people also find "infuriating". In an interview with The Times, she said that doctors had warned her that every drink she consumes which is above a certain limit could increase the chance of her cancer returning. She said "death looked me in the eyes".

Speaking to The Times, she said, "I get a lot of pushback on social media about this. People go, ‘I was healthy, I go to the gym, I got cancer, and now it’s metastasized, and I’ve got secondary cancer. So, are you blaming me for my illness? No. All I’m saying is, this is what I went through. It was a wake-up call, and it made me look at life differently. It made me prioritize my sleep, emotional health, and gave me more time for my loved ones. If I drink more than four units of alcohol a week, my risk of recurrence goes up by 28 per cent. But people find me giving up drinking infuriating.”

What Does Data Say About Alcohol And Cancer?

The National Cancer Institute, US, notes that there s strong scientific evidence that alcohol drinking can cause cancer. The International Agency for Research on Cancer (IARC) classified alcohol as a Group 1 carcinogen (cancer-causing substance) in 1987 due to sufficient evidence that it causes cancers of the oral cavity, pharynx, larynx, esophagus, and liver in people. The National Toxicology Program has listed consumption of alcoholic beverages as a known human carcinogen in its Report on Carcinogens since the ninth edition, in 2000.

Epidemiologic studies have shown that people who drink alcohol are at higher risk of certain cancers than those who do not drink alcohol and that the more someone drinks, the higher the risk of these cancers. Even light drinkers can be at increased risk of some cancers.

In the US in 2019, alcohol consumption was responsible for about 5% or nearly 100,000—of the 1.8 million cancer cases. It also led to 4% or nearly 25,000 of the 600,000 US cancer deaths that year.

Read: Can Drinking Beer Cause Cancer? A New Study Says There Is No Safe Limits

Julia also notes that her poor health took a hit on her confidence as well as her bank balance. This is why she has taken a new approach to life, as reported by the Express. She said, "I am very, very fortunate, and overall, I am having a wonderful life."

“But I’ve had a cancer diagnosis, both my parents have had cancer, I’ve lost people along the way, I’ve had financial worries, I’ve had to reinvent myself, and I’m not 100 per cent happy all of the time - of course not. But you can get through things, you can overcome hardships, and I like to think that’s what I do," she said.

While she is now healthy, she continues to go on her routine check-ups every year. "I wasn’t close to death, but death looked me in the eyes. So I am more focused on my health than I ever have been. I don’t drink, I eat a healthy diet, and exercise every day. When I came home from my mastectomy, I promised I would spend time outside every day, and that is my mantra, however poor it might be in this winter.”

Melanie Watson, Diff'rent Strokes actress and disability advocate dies at 57 on Friday, December 26. The news was confirmed by her brother Robert, and told that she was hospitalized prior to her death. While her cause of death has not been revealed yet, her brother said that she was in hospital due to some bleeding issue.

What Is Osteogenesis Imperfecta?

Melanie was born with osteogenesis imperfecta or OI, which the Johns Hopkins Medicine notes is an inherited (genetic) bone disorder that is present at birth. It is also known as brittle bone disease. A child born with OI may have soft bones that break or fracture easily, bones that are not formed normally and other problems Signs and symptoms may range from mild to severe.

OI also have eight different forms and the types vary greatly both within and between types. As per the Johns Hopkins Medicine, here are the eight types of OI:

Type I. Mildest and most common type. About 50% of all affected children have this type. There are few fractures and deformities

Type II. Most severe type. A baby has very short arms and legs, a small chest, and soft skull. He or she may be born with fractured bones. He or she may also have a low birth weight and lungs that are not well developed. A baby with type II OI usually dies within weeks of birth

Type III. Most severe type in babies who don’t die as newborns. At birth, a baby may have slightly shorter arms and legs than normal and arm, leg, and rib fractures. A baby may also have a larger than normal head, a triangle-shaped face, a deformed chest and spine, and breathing and swallowing problems. These symptoms are different in each baby.

Type IV. Symptoms are between mild and severe. A baby with type IV may be diagnosed at birth. He or she may not have any fractures until crawling or walking. The bones of the arms and legs may not be straight. He or she may not grow normally.

Type V. Similar to type IV. Symptoms may be medium to severe. It is common to have enlarged thickened areas (hypertrophic calluses) in the areas where large bones are fractured

Type VI. Very rare. Symptoms are medium. Similar to type IV.

Type VII. May be like type IV or type II. It is common to have shorter than normal height. Also common to have shorter than normal upper arm and thighbones.

Type VIII. Similar to types II and III. Very soft bones and severe growth problems.

What Causes OI?

This is a disease that could be passed on through genes and there are different types that could be passed on in different ways. These genes could be inherited from one or both parents, or could be passed on from an unexplained change or a mutation of the gene.

Most babies who have OI have a defect of one of two genes. These genes help in collagen forming, which is a main part of connective tissue that connects and supports the whole body, including bones. Because of a certain defect, there is no enough collages, or the collagen is abnormal, which causes this disease.

The main aim of treatment for this disease lies in prevention of deformities and fractures.