You should feel no sympathy for the erratic driver who’s pulled over by a police officer, given a breathalyzer test, and blows a 0.08 or even more. What you probably should feel is outrage.

After all, drunk driving costs the United States approximately $44 billion each year. Far worse, it causes 28 deaths each day.

There is a time, however, when you should save your outrage for the next impaired motorist and take pity on this one. It’s when the person judged to be under the influence of alcohol has in actuality consumed none.

For years, DUI defense attorneys have stressed the more accurate way to measure blood alcohol concentration is by drawing blood from a vein. The Wilson Law Firm based in Manassas, Virginia notes on their website, for instance, that studies have shown breathalyzer readings can vary up to 15 percent from a standard blood test with about a quarter of those variances resulting in a higher reading.

Asthma medications, over-the-counter medications, oral gels for toothaches and mouth sores, mouthwash and breath sprays, fermented foods and energy drinks, medical conditions like diabetes and acid reflux, and even exposure to fumes from chemicals, paints, and adhesives can all skew the accuracy of a breathalyzer test.

The same is true for a phenomenon called auto-brewery syndrome (ABS).

In an article published less than two weeks ago in Nature Microbiology, ABS is defined as “a rarely diagnosed disorder of alcohol intoxication due to microbial ethanol production.” In other words, the intoxication doesn’t occur from the drinking of alcohol, but from a perfect stomach storm of food, gut microbes, and physiology.

The syndrome certainly is rare. Jasmohan Bajaj, a hepatologist and gut-liver axis researcher at the Virginia Commonwealth University, tells Jennie Erin Smith for a Science article about ABS that he’s only ever diagnosed one case of it in his career.

For years, the explanation for ABS was that fungi gone wrong were somehow fermenting carbohydrates in the gut. In 2019, however, a landmark study detected a bacteria capable of creating ethanol.

That led to further investigation, including the aforementioned one recently published in Nature Microbiology. In it, researchers had 22 people diagnosed with ABS along with members of their households (who served as the control group) submit stool samples.

As Smith explains in the Science article, the expected was detected. While stool from the control group didn’t contain alcohol, stool from those with ABS did. Moreover, the researchers found more strains of Klebsiella pneumoniae, a common bacteria, in the ABS stool samples than in the control samples.

It’s this bacteria that takes us back to the landmark 2019 study.

For when those researchers transplanted Klebsiella from an extreme ABS sufferer into mice, the mice developed the disease. While Klebsiella is normally harmless, a surfeit of it has been linked to what the medical community used to call non-alcoholic fatty liver disease, what they now call metabolic dysfunction-associated steatotic liver disease, and what you probably call fatty liver disease.

No matter how you name it, though, it’s become a big problem.

The American Liver Foundation estimates up to 100 million Americans now have fatty liver disease, but many are unaware of it. The disease is often asymptomatic until it reaches an advanced stage.

Nevertheless, research indicates fatty liver disease is both a predictor and producer of type 2 diabetes, although the link between the two is complicated.

Here’s what’s not. You decide what goes into your gut, and thereby what gets digested by your gut bacteria. So in the vast majority of cases, you determine whether or not you get either disease.

Which, by logical extension, means you’re also responsible for the byproducts gut bacteria produce during digestion. One of which could reduce the risk of colorectal cancer.

According to the Cancer Research Institute, colorectal cancer’s the third most diagnosed cancer, the third leading cause of cancer death in both men and women — and the cancer that’s suddenly “skyrocketing” in young adults. But a study published in the January 2025 issue of Nature Metabolism found that when bacteria digest plant fiber, a few types of short-chain fatty acids result. One is butyrate.

Prior research has shown butyrate affects a number of enzymes in a way that causes them to slow colon cancer cell growth or even cause the cells to die. All the while, butyrate causes colonocytes — the epithelial cells in the colon that absorb water, electrolytes, and metabolites from digested food; protect the gut from disease; and support good gut bacteria — to thrive.

That this short-chain fatty acid is capable of both helping and hurting cells depending on their type has come to be called the butyrate paradox. It’s just one more example of something that’s been mentioned in this column a few times before.

That what goes on in your gut affects your health far more than we ever thought. Therefore, if you seek optimal health, you need to stay abreast of the latest research and be willing to experiment with your diet.