geoffrey modest medical blogs

  there has been a major increase in prescribing gabapentinoids (gabapentin and pregabalin) for chronic pain and neuropathic pain, despite many studies finding no or minimal effect. there is an impressive list of associated adverse events including very serious ones, however.     -- a study done on gabapentinoid utilization in 72 countries from 2012 o 2023 found annual sale increase by 114.5% from 2012 to 2022, with a 180.9% increase in developing countries and a 110.0% increase in developed countries: see graph below from gabapentinoid and opiate utilization 2012 to 2023 Pharmicoepidem2025 in dropbox, or doi.org/10.1002/pds.70149     -- gabapentinoids, however, have substantial side effects like dizziness, somnolence, and gait disturbance, with the number of patients needed to take gabapentinoids in order for one of them to experience adverse effects ranging from 3 to 11 depending on the adverse effect, with approximately 33% of patients experiencing somnolen...

  the auto-brewery syndrome (ABS) has hit the popular press https://www.nytimes.com/2026/04/03/well/autobrewery-syndrome.html ); this syndrome results from the gut microbiome producing excess ethanol and exceeding the hepatic ability to metabolize it. at times it results in individuals being accused of DUI (driving under the influence of alcohol) despite no alcohol consumption, having the breathalyzer test at high a level as 0.18% (see NatMicrobiology2026 in dropbox or https://doi.org/10.1038/s41564-025-02225-y and https://www.ncbi.nlm.nih.gov/books/NBK513346/ ). In addition, per the NY Times, an individual left his job after being stigmatized for smelling of alcohol, some individuals had frank alcohol intoxication and were felt to be liars by their doctors and spouses, and some even having alcohol withdrawal symptoms when not eating sufficient carbohydrates to stimulate the gut to produce ethanol Background (largely from the review article: auto-brewery syndrome review NatRe...