Evenson’s blood alcohol reading in May 2016 was baffling. But a lot about his health was baffling back then. 

Two and a half years earlier, in December 2013, Evenson was struck by a car one Sunday morning while heading into church. He suffered an array of injuries, including a broken leg, a fractured cheekbone, a torn eardrum and a traumatic brain injury, which triggered a mysterious seizure condition that perplexed doctors for more than seven years.

Eventually, in March 2021, Zhiyi Sha, M.D., a neurologist at the MINCEP Epilepsy Care clinic at the University of Minnesota, discovered that Evenson was having pseudo-seizures, caused by psychological trauma rather than abnormal electrical brain signals. A few months of cognitive therapy to treat Evenson’s post-traumatic stress disorder caused the seizures to subside.

But while Evenson was in the throes of those undiagnosed seizures, he landed in the ER with his 0.314 percent blood alcohol level. His sky-high reading was inexplicable, but so were the dizzy spells, blackouts and memory loss he was experiencing frequently. Overwhelmed with his medical issues at the time, the Evensons overlooked the strange blood alcohol reading, assuming it was a side effect of something else. “We thought it could be part of the head injury,” Karen says. 

A part of Evenson felt ashamed about that night. Though he knew he hadn’t drunk excessively, he found the alcohol reading — and the insinuation that he had a drinking problem — “super embarrassing” and “very upsetting,” he says. He wanted to forget all about it, and the incident quickly faded into the background. 

In 2022, though, the couple’s focus turned back to that episode. With Evenson’s seizures out of the way, Karen began noticing him exhibiting other strange behaviors. “Not normal Scott stuff,” she says.

Typically kind and attentive, Evenson seemed more agitated and stubborn. He sometimes stumbled over furniture and ran into doorways. He often slurred his words. “He would act like he was drunk,” Karen says. She insisted that her husband visit his primary care doctor to get tested for stroke, diabetes or another cause, but nothing showed up. 

Karen started to wonder if her husband was secretly drinking. After all, alcohol abuse is not uncommon: Almost 30 million people in the United States, or roughly 10 percent of the population, have an alcohol use disorder, according to the 2023 National Survey on Drug Use and Health. White men, like Evenson, have higher rates of these disorders than other demographics. And many hide it. 

When Karen confronted Evenson, he denied drinking. She had always trusted her husband’s word — his steadfast integrity was one reason she fell in love with him back in 2009. But with no other explanations, that trust started to fracture. She began checking the cupboards for hidden stashes of liquor. Meanwhile, Evenson himself began doubting his sobriety and sanity amid growing memory lapses. Maybe I am drinking, he thought. Maybe I am going crazy.  

One night in May 2022, as Karen witnessed her husband slip into incoherence despite his abstinence, she became convinced something else was going on. Once she put Evenson to bed, she turned to the internet for answers, typing into Google’s search bar “slurred speech, no alcohol, drunk without drinking.” An article popped up about a Texas nurse whose husband had suffered those exact symptoms and was eventually diagnosed with a condition called auto-brewery syndrome (ABS). 

The next morning, Karen turned to her husband, article in hand, and said, “I bet you have this.” 

A handful of similar encounters with other medical professionals followed. In March 2024, Evenson was prescribed a course of antibiotics to treat a bout of strep throat. Then, on the eve of Easter’s Good Friday, he ate a high-carb pasta lunch. He ended up in the ER of Mercy Hospital in Coon Rapids, Minnesota, that night with a blood alcohol concentration of 0.345 percent, the equivalent of drinking more than 15 standard drinks in an hour. The ER’s attending doctor seemed receptive to the couple’s ABS hypothesis, noting on Evenson’s discharge papers: Possible auto-brewery syndrome. Please evaluate.

The next day, however, when Evenson returned to the same hospital with pain in his back and side, different medical staffers attended to him and, despite the note in his chart, “totally treated him like a drunk,” Karen says. While Evenson was getting a scan to identify the source of his pain, Karen says, “the nurse came out and said to me, ‘So how much really did he drink?’”

A few weeks later, Evenson’s gastroenterologist diagnosed him with exocrine pancreatic insufficiency, often caused by long-term alcohol consumption. The doctor prescribed medication to treat the condition, then told him to stop drinking.

Finally, one doctor chose to take the couple’s suspicion seriously. In early July, Evenson returned to the office of neurologist Sha — who had diagnosed his pseudo-seizures in 2021 — to discuss his recurring memory lapses. He told Sha he believed ABS flares were the cause, then presented him with months’ worth of Breathalyzer readings the couple had taken at home. Intrigued, Sha explored the literature. “I’d never seen this,” he admits, “but it seemed like a real entity.”  

A glucose tolerance test, also called a carbohydrate challenge, is required to diagnose ABS. The test must be performed while the patient is under surveillance to ensure the person is not sneaking alcohol. As a brain, not gut, specialist, Sha couldn’t administer the test himself, but he could get Evenson into the hospital — the perfect testing environment — under the guise of a neurological observation. Sha could then suggest that the hospital’s gastroenterology department test for ABS while Evenson was under watch.

The plan worked. In late July, Evenson was admitted to the University of Minnesota Medical Center. On day four of his stay, the internal medicine team delivered a bright-orange liquid containing 200 grams of glucose to Evenson’s room for his carbohydrate challenge. An initial blood draw confirmed his blood alcohol concentration was at 0 percent. Then he drank the glucose. 

Several blood draws over the course of the day revealed his blood alcohol concentration was rising: It peaked at 0.08 percent — the equivalent of drinking roughly five standard drinks in an hour — at 10:30 a.m. and 11:30 a.m., then fell over the course of the afternoon and evening. 

The next day, Evenson was discharged from the hospital, drowsy and nauseated, but with “a gift,” he says: a diagnosis of auto-brewery syndrome. 

The most common treatments for ABS are diet changes and antimicrobial therapies. Some patients stop flares by eliminating most carbohydrates from their diet, which removes the fuel feeding the alcohol-producing bacteria. Most patients, however, also require stool testing to pinpoint the exact alcohol-producing bacteria, and then an antimicrobial drug is used to rebalance the gut microbiome. 

Finding a doctor willing to perform the tests has proved to be another colossal task, Evenson says. Following his diagnosis, local doctors kept referring him to Minnesota's Mayo Clinic, where a research fellow is treating people with gut microbiome disorders, including ABS. But the program was at capacity for months. “I was told I’d just have to wait it out,” he says. 

That wait has been dreadful, Evenson says. While there have been stretches when he has been flare-free — eight days is his longest — those stretches are rare and hard to enjoy because of the fear that a flare is imminent. “I’m on guard all the time,” he says. He still can’t babysit his grandchildren unsupervised, or ride his bike, and quality time with his wife continues to dwindle. “If we have to function as a couple, it has to be in the mornings, because by night I’m just not myself anymore,” he says.    

But there is some hope. In April, Evenson underwent a fecal microbiota transplant (FMT) as part of a clinical trial by Massachusetts General Hospital and the University of California, San Diego. An FMT involves transferring bacteria and other microorganisms from a healthy donor’s stool into a patient’s digestive tract. The goal is to have the donor’s microbiome makeup take over, eradicating the ABS. 

For Evenson, the first FMT transplant didn’t work. But the trial team is committed to researching his case further and plans to attempt another FMT after Evenson has taken a mix of antimicrobial drugs to help kill the offending bacteria, he says.

Evenson is praying for a complete cure, but at this stage, he says, he’ll happily settle for something less. “If we can stop these daily flares and just make them every once in a while,” he says, “I’ll take it.”