Probiotic Supplement Reduces Alcohol Absorption in Small Intestine

Probiotic supplements with ethanol-metabolizing activity may help reduce the disease burden of excessive alcohol consumption.
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What is already known
Heavy alcohol consumption is associated with diseases of the heart, pancreas, and liver, and endotoxin derived from gut bacteria likely creates the environment conducive to organ damage. Probiotics containing Lactobacillus strains have successfully treated alcohol-induced liver disease in rats.

What this research adds
Swedish biotech company, de Faire Medical AB, developed a probiotic supplement containing two Bacillus strains that preferentially metabolize ethyl alcohol. Researchers conducted a pilot study in human subjects to determine whether the supplement could reduce absorption of ingested alcohol.

When taken daily for one week prior to consuming an alcoholic beverage, the probiotic supplement significantly reduced blood alcohol levels by 70% compared to placebo. Probiotic supplements with ethanol-metabolizing activity may help reduce the disease burden and associated economic costs of excessive alcohol consumption.

Heavy alcohol consumption can contribute to chronic diseases of the liver, heart, pancreas, and digestive tract, yet there is wide individual variation in tolerable alcohol intake. While ethyl alcohol and its primary metabolite, acetaldehyde, can cause direct oxidative stress and inflammation, it is thought that bacterial endotoxin and impaired gut barrier function promote susceptibility to alcohol-induced organ damage. Previous studies conducted in rats showed that Lactobacillus rhamnosus, taxonomically found in the Bacilli class, significantly reduced the severity of alcoholic steatohepatitis, commonly known as fatty liver disease. This bacterial strain also significantly reduced alcohol-induced oxidative stress and inflammation in both the liver and intestine and preserved gut barrier function. These results warranted further testing in humans as potential therapy or prevention of alcoholic liver disease. 

Now, de Faire Medical AB, a Life Sciences company based in Stockholm, has developed a functional dietary supplement (“AB001”) with two bacterial species that metabolize ethyl alcohol into carbon dioxide and water. AB001 is comprised primarily of fermented rice bran as the substrate, two microbes in the Bacilli class—Bacillus subtilis and Bacillus coagulans, the amino acid L-cysteine, and dextrin. L-cysteine is a sulfur-containing, rate-limiting precursor in the synthesis of glutathione, a potent antioxidant.  Delivered in an acid-resistant capsule, the microbes pass through the stomach and temporarily colonize the upper gastrointestinal tract where they can metabolize ingested ethyl alcohol thus inhibiting absorption into the bloodstream.  A small-scale human trial conducted in Germany evaluated the extent to which a small dose of alcohol entered the bloodstream following treatment for one week each of AB001 versus placebo. The researchers also measured the effect of the supplement on breath alcohol levels and cognitive function. The study was a randomized double blind crossover design so that each subject alternately participated in experimental and control groups. 

On the day of the study, subjects were given a dose of vodka to yield 0.3 g alcohol/kg body weight. This dosage was restricted by ethical guidelines of the institutional review board granting study approval. Blood and breath alcohol measurements were taken at regular intervals following alcohol consumption. Cognitive function was evaluated using a timed number connection test, and all subjects were monitored for adverse reactions. 

The results, published in Nutrition and Metabolic Insights, showed that treatment with AB001 significantly reduced blood alcohol concentration by up to 70% compared to placebo sixty minutes following alcohol ingestion. Breath alcohol concentration was approximately 30% lower with the supplement, and there was no difference in cognitive function between the two groups. No adverse events were reported. 

Mitochondrial Toxicity

Alcohol is slowly absorbed in the stomach and rapidly absorbed by intestinal epithelial cells. It enters the bloodstream where it is metabolized predominantly by alcohol dehydrogenase, an enzyme found in the liver. Acetaldehyde, a toxic product of that reaction, has been previously shown to impair mitochondrial function and induces production of reactive oxygen species (ROS). The result is an inhibition of mitochondrial respiration, reduced cellular energy production, and sensitization of the cell to further damage. It is this vicious cycle of oxidative stress that can ultimately lead to alcoholic liver disease.  

Microbial Therapy

When taken for one week prior to ingestion, AB001 was shown to curtail absorption of alcohol in the bloodstream via direct breakdown of alcohol in the intestinal lumen. Another possible mechanism is the reduction in oxidative stress which preserves barrier function in the intestinal mucosa. The reduction in breath alcohol at 30% was significant but less considerable than in blood alcohol concentration. Absorption of ethyl alcohol by the oral mucosal may account for this difference. The study authors reported additional unpublished results of a subsequent study comparing the effects of double the dose of alcohol following a single pre-treatment dose of AB001 vs. placebo. The results showed that the single dose of AB001 still conferred significant protection against alcohol absorption, though to a lesser extent. Blood alcohol concentration was 10% lower and breath alcohol was 7% lower with AB001 vs. placebo. The authors concluded that the bacteria in the dietary supplement exert optimal effect with sufficient time and dosing to enable intestinal colonization.

The authors disclosed that the study was funded by DeFaire Medical AB, Stockholm, Sweden, and one of the listed authors, Johan de Faire, is founder and shareholder of de Faire Medical, AB.