How does Bariatric Surgery Like Gastric Bypass or Sleeve Surgery Affect Alcohol Metabolism?
Bariatric Surgery like gastric sleeve and gastric bypass surgery potentiate the intoxicating effects of alcohol due to its faster rate of absorption into the blood and slower metabolism.
- After bariatric surgery the consumed alcohol rapidly reaches the small intestine which in turn absorbs it at a rapid rate. This results in high blood alcohol concentrations (BAC) occurring with much lesser amounts of alcohol intake than would have happened prior to surgery.
- Due to gastric size getting reduced post weight loss surgery, the amounts of an enzyme alcohol dehydrogenase needed to metabolize alcohol during its first pass metabolism is also greatly reduced resulting in higher levels of alcohol in the blood for a longer period of time.
- The end result is that patients with weight loss surgery had faster and higher peak levels with lesser amounts of alcohol, and the blood levels also took much longer to reach zero levels.
- Another effect of alcohol is the relaxing effect it produces, both on the inside as well as the outside. It causes relaxation of the stomach and esophagus allowing the person to eat or drink more.
These effects have been substantiated by scientific research which have shown that alcohol metabolism is markedly different in people who have undergone bariatric surgery. The differences in peak alcohol levels were significantly higher compared to persons who did not have the surgery.
According to a study, for a given amount of alcohol, when the gastric bypass surgery patients showed peak levels of .08 percent, or enough to be termed drunk to drive a vehicle, the control group who did not have the surgery showed a BAC of just 0.05 percent. This translates into a nearly 40% difference!
This difference in the rates of alcohol absorption and metabolism could affect the ‘social’ drinker. For instance, the average person who consumes two beers maybe well below the legal limit, while the same amount in a post-gastric surgery patient will cause blood alcohol levels way above the legal limit.
The study concluded with the advice cum warning that persons who have undergone weight loss surgery should be careful about how much they drink and to avoid driving under the influence as the results could be catastrophic.
Another interesting but unsettling observation was the increased incidence of alcohol use disorder (AUD) following weight loss surgery. Patients who underwent the Roux-en-Y bypass were more likely to abuse alcohol in comparison to those who had undergone the gastric band or sleeve surgery.
Various theories for the increased risk of AUD after bariatric surgery have been put forth by experts namely
- Depression is common in patients who undergo bariatric surgery and they continue to be depressed afterwards and turn to alcohol.
- Disillusionment post-surgery if the expected weight loss does not occur
- Addiction specialists suggest that this could be a switching of addictions from food before weight loss surgery to alcohol and a variety of other substances to maintain their ‘fix’. Basically surgery does not cure the addictive tendencies that were present in the person.
Many studies have been published on the high incidence of AUD in weight loss surgery patients.
- A recent study published in Revue Medicale Suisse. 2016 Mar 23;12(511):602-5, titled Increased risk of alcohol use disorders after bariatric surgery has concluded that the risk of alcohol abuse is increased post weight loss surgery, especially after the Roux-en-Y operation, and has recommended that these patients have to be followed up regularly with alcoholism treatment specialists after surgery.
- Another study conducted by Spadola CE et al which appeared in, Substance Abuse2016 Nov 22:1-6, titled Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients. doi: 10.1080/08897077.2016.1262305 has found that young adults after weight loss surgery show a tendency to binge drinking and drinking until highly intoxicated.
- A study titled The gut in the brain: the effects of bariatric surgery on alcohol consumption,which appeared in Addict Biology2016 Aug 31. doi: 10.1111/adb.12436. has suggested an alteration in the brain reward processing to play a major role in the development of AUD and increased alcohol use following weight loss surgery.
In conclusion, it might be stated that bariatric surgery offers a myriad of benefits in obese patients. However more attention needs to be paid both pre surgery in the form of counselling and explaining the risks regarding AUD post weight loss surgery, as well as regular follow-up of patients by addiction specialists following bariatric surgery.
More research may be necessary to delineate and understand the mechanisms of how weight loss surgery increases the risk of alcohol abuse.
Bariatric or weight loss surgery is performed in persons with severe obesity or even in moderately obese persons with severe comorbidities such as diabetes, hypertension, hyperlipidemia, obstructive sleep apnea depression and low self-image to name a few.
The procedure can be a gastric bypass procedure where a small stomach pouch created surgically is connected further down to the small intestine bypassing a large part of the stomach and upper part of the small intestine to minimize the amount of food the stomach can hold and to reduce the absorptive surface area of the small intestine.
In a gastric sleeve operation, a large portion of the stomach is resected leaving behind only a vertical banana shaped portion, once again to markedly reduce the quantum of food the stomach can hold.
The end result of both procedures is the markedly reduced food quantities the person can consume, and this promotes weight loss. Though the bariatric surgery is beneficial to promote weight loss and improve general health and well being, there are some side effects that have to be borne in mind.
Following weight loss surgery, the food from the stomach is emptied into the small intestine rapidly, which absorbs the food rapidly within a short time. This is referred to as the dumping syndrome, one of the side effects of weight loss surgery.
We shall see how the effects of gastric weight loss surgery affects a person’s ability to tolerate the effects of alcohol and why it is so.
- Alcohol Intake after Bariatric Surgery - (https://www.pennmedicine.org/updates/blogs/metabolic-and-bariatric-surgery-blog/2015/august/alcohol-intake-after-bariatric-surgery)
- Alcohol Metabolism Changes Considerably After Gastric Bypass Surgery - (http://www.sado.org/articles/Article/134)
- Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive bariatric surgery. - (https://www.ncbi.nlm.nih.gov/pubmed/23716012)
- Increased risk of alcohol use disorders after bariatric surgery. - (https://www.ncbi.nlm.nih.gov/pubmed/27188054)
- Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients. - (https://www.ncbi.nlm.nih.gov/pubmed/27874326)
- The gut in the brain: the effects of bariatric surgery on alcohol consumption. - (https://www.ncbi.nlm.nih.gov/pubmed/27578259)
Latest Publications and Research on Alcohol Effects After Bariatric SurgerySerum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition. - Published by PubMed
Brown Bowel Syndrome: A Multi-institutional Case Series. - Published by PubMed
Diagnoses related to abuse of alcohol and addictive substances after gastric bypass and sleeve gastrectomy: a nation-wide registry study from Norway. - Published by PubMed
Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition. - Published by PubMed
Brown Bowel Syndrome: A Multi-institutional Case Series. - Published by PubMed