When Mark Mongiardo was in his second year of teaching, someone commented that he smelled of alcohol. He felt surprised because he hadn’t had any alcoholic beverages and wouldn’t risk his career by imbibing at work. Over the years, the teacher and basketball coach often heard he smelled like alcohol.
“I thought that there was something wrong with me. I wasn’t exactly sure what,” Mongiardo, 40, of Florida, tells TODAY.com. “I just thought I was tired all the time. My wife has on numerous occasions said I wasn’t acting right.” Mongiardo often worked more than 12 hours a day and attributed his exhaustion and behavior changes to that. Then he was arrested twice within six months for driving while intoxicated, even though he hadn’t been drinking. An internet search revealed a possible diagnosis.
“We started searching, ‘Can your body create alcohol?' And we found this auto-brewery syndrome,” he says.
Smells like alcohol, exhaustion
In 2005, Mongiardo began his teaching and coaching career. When someone complained of him smelling like alcohol, he recalls being called into the principal’s office — something that happened off and on for the next several years. It escalated, and from 2012 and 2016, he often found himself in the principal or athletic director’s office answering questions about alcohol consumption.
“Those were tough years,” he says.
He eventually switched jobs to become an athletic director. Three weeks into his new gig, police pulled him over, and he failed a field sobriety test. His new boss gave him a chance.
“The superintendent said, ‘You’ve done such a great job within the first three weeks of being an athletic director that we actually are willing to move past it,’” Mongiardo recalls. “When I got pulled over six months later, that’s when I knew something was wrong. ... Two DWIs within six months, I was facing felony charges. So, they had no choice. The district put me on administrative leave.”
Mongiardo felt puzzled. He had not been drinking before being charged with a DWI. His wife worried that he was drinking in secret.
“I had all the signs and symptoms of drinking even before she smelled me. So, for years, she thought I was hiding drinking and I would come home each day and I would basically be drunk,” he says. “I had symptoms of being intoxicated from slurring speech to balance issues. And this happened even at social events where I had not been drinking.”
Finally, in 2019, he searched online, wondering if the body could produce alcohol, and he found auto-brewery syndrome. By this time, he had to sell his house in New Jersey and move in with his wife’s family in Long Island, New York.
“I tried to get a job, but I had pending felony charges,” Mongiardo says. “With pending felony charges, with the department of education, my fingerprints are on hold, so I couldn’t get a teaching position. I tried getting a job at Aldi supermarket but my background check, I didn’t pass.”
Mongiardo found a doctor in Staten Island who was familiar with auto-brewery syndrome. The doctor ran a glucose challenge test to see if Mongiardo had the condition. While fasting, Mongiardo’s blood-alcohol concentration (BAC) was zero, considered completely sober. As he consumed a sugary beverage for the test, his BAC steadily increased.
“Within the first hour, I was at 0.14,” he says. “Once I saw that, (the doctor) was just shaking his head. He said, ‘You have auto-brewery syndrome absolutely. Your BAC level went through the roof.’ We were crying. Honestly, it was just so emotional.”
According to the Cleveland Clinic, a BAC of 0.15% can cause people to feel drowsy and confused, and they would be more likely to vomit.
Auto brewery syndrome occurs when the gastrointesintal tract converts food into alcohol.
“Auto-brewery syndrome is a rare problem,” Dr. Rohit Loomba, a professor in the division of gastroenterology in the department of medicine at University of California at San Diego Medical School, who didn’t treat Mongiardo, tells TODAY.com. “Certain bacteria, particularly in the GI tract, can metabolize or format the food that we eat and make that into ethanol, and then it can cross the intestinal epithelium and come inside the blood.”
Basically, the gut microbiome begins fermenting carbohydrates and sugars into alcohol. When it gets to the blood, it can be detected like it would if someone had been drinking.
“There are patients who don’t drink alcohol, and we will detect ethanol in their blood,” he says. “There’ll be small amounts that will … have pathogenic effects on the liver and other organs.”
Many times, patient learn they have it because they have liver disease, and it’s an accidental finding. Loomba says, in some cases, E. coli present in the gut microbiome (which is different from the E. coli that causes an acute infection with gastrointestinal symptoms) contributes to a person developing auto-brewery syndrome. Doctors often use antibiotics to treat the condition. A low-carb and low-sugar diet can also prevent the body from producing alcohol.
“We know based on studies that they type of food that we eat is also food for the bacteria living in the gut,” Loomba, a member of the American Gastroenterological Association, says. “Depending on what types of food we eat, we may accentuate certain bacteria.”
According to the National Library of Medicine, symptoms could include:
- Balance problems
- Feeling confused
- Bowel problems
- Feeling tired
- Feeling dizzy
- Acting intoxicated
Diagnosis can be difficult, as it takes time to monitor the blood alcohol levels of people who are not drinking to make sure “there is alcohol in the blood, and (alcohol is) not orally consumed," Loomba says.
Life after diagnosis
After finding a doctor and receiving a diagnosis, Mongiardo started eating a low carb and sugar diet.
“I come from an Italian-American family. I haven’t had pasta or pizza or anything like that since I was diagnosed in May 2019,” he says. “It was extremely challenging in the beginning.”
When Mongiardo was struggling to find work, he became licensed as a real estate agent in New York. He wanted to take advantage of people moving from New York to Florida, so he moved south right before the pandemic hit. For about two years, his family was in New York while he was in Florida, where he ended up getting a job at Target.
Mongiardo monitors his BAC at home because he worried about driving with his children. He hopes that his story helps others who might feel alone if they experience auto brewery syndrome.
“This disorder is out there because I was going through these issues, and I had no idea what it was,” he says. “It’s devastating for someone to live with this, and if I could help others understand that this is out there, maybe someone won’t have to go through the same thing I went through.”