Metabolic bariatric surgery (MBS), also known as weight loss surgery, involves procedures that remove or alter portions of the stomach and/or digestive tract. While these surgeries can offer significant health improvements for individuals struggling with obesity, they also bring about changes in how the body processes substances like alcohol. Understanding these changes is crucial for individuals considering or who have undergone bariatric surgery.
Altered Alcohol Absorption
One of the most significant changes after weight loss surgery is the altered way the body absorbs alcohol. Alcohol is absorbed much faster, leading to quicker intoxication and potentially higher blood alcohol concentration (BAC) levels for a longer duration. This increased BAC elevates the risk of impaired judgment and coordination, posing dangers such as driving under the influence, even when feeling seemingly "okay."
A study presented at the annual meeting of the American Society for Bariatric Surgery demonstrated this effect. Researchers found that gastric bypass patients reached a breath-alcohol peak of 0.08 percent after consuming 5 ounces of red wine, compared to a peak of 0.05 percent in the control group. Furthermore, it took the bypass patients significantly longer to return to a zero BAC, averaging 108 minutes versus 72 minutes for the control group.
The Role of Alcohol Dehydrogenase
The lining of the stomach contains an enzyme called alcohol dehydrogenase, which breaks down alcohol. After procedures like gastric bypass, the amount of this enzyme available is reduced. Consequently, alcohol is not metabolized as effectively in the stomach and heads into the small intestine, and then into the bloodstream, leading to a quicker and more intense buzz.
Individualized Guidance and Choices
Ultimately, the decision of whether or not to consume alcohol after bariatric surgery rests with the individual. However, it is essential to consult with a surgeon or healthcare provider to gain a comprehensive understanding of the risks and implications.
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Potential Risks of Alcohol Consumption After Bariatric Surgery
Weight Gain and Poor Sleep
Alcohol consumption can disrupt sleep patterns, leading to increased hunger and potentially hindering weight loss or even causing weight gain.
Gastric Irritation and Ulcer Formation
Alcohol is a mild gastric irritant, and its consumption may lead to the development of gastric ulcers in some individuals. Following bariatric surgery, the stomach may be more vulnerable to ulcer formation, making it crucial to avoid gastric irritants like alcohol.
Liver Health
Alcohol can have a negative impact on liver health post-surgery. Studies have indicated an increased risk of alcohol-related cirrhosis (scarring of the liver) in weight loss surgery patients, particularly among women. This heightened risk is attributed to elevated blood alcohol levels and the fact that pre-surgery liver fat, while problematic, sometimes offers a degree of protection against alcohol-related damage.
Calorie Content and Nutrient Absorption
Alcoholic beverages are often high in calories, especially when mixed with sugary sodas or juices. These "empty calories" provide little to no nutritional value and can interfere with vitamin and nutrient absorption, potentially leading to deficiencies.
Alcohol Use Disorder (AUD)
There is a potential risk of developing an alcohol use disorder (AUD) after bariatric surgery. Individuals with a history of addiction may be more susceptible to substituting food with other substances like alcohol.
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Recommendations and Guidelines
Abstinence
Many healthcare professionals recommend complete abstinence from alcohol after bariatric surgery to mitigate the risks outlined above.
Gradual Reintroduction (If Chosen)
If an individual chooses to reintroduce alcohol after surgery, it should be done gradually and in very small amounts, only after full recovery and the initial period of rapid weight loss has ended.
Mindful Consumption
It's crucial to stay attuned to how the body reacts to alcohol and avoid overconsumption.
Avoidance of Certain Beverages
Carbonated beverages and sugary drink mixers should be avoided.
Awareness of Calorie Content
Individuals should be mindful of the calorie content of alcoholic drinks and work with their bariatric surgery team to develop a plan to prevent slowed weight loss or weight regain.
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Food Consumption
Alcohol should never be consumed on an empty stomach. Eating food while drinking alcohol is important.
Slow Pace
Alcohol should be consumed slowly and in small amounts.
Know Your Limit
It is important to know when to stop drinking and opt for non-alcoholic beverages instead.
Addressing Misconceptions
Misconceptions surrounding alcohol consumption after weight loss procedures are common. While bariatric patients may process alcohol differently, it doesn't necessarily mean alcohol must be completely avoided. However, increased sensitivity to alcohol's effects is typical.
Research Findings
Research indicates that patients who undergo Roux-en-Y gastric bypass (RYGB) are at an increased risk for an alcohol use disorder (AUD). Studies have found increases in alcohol intake, AUD, and treatment for problematic alcohol intake following surgery, particularly RYGB. One study demonstrated that RYGB patients had significantly more AUDs than patients who received laparoscopic adjustable gastric banding surgery.
A study examining reward and pharmacokinetic (PK) changes in RYGB patients found that after surgery, patients experienced greater reward from alcohol, achieved higher maximum BAC, and reached their peak BAC more quickly. This suggests that the faster a substance enters the central nervous system, the more rewarding and potentially addictive it becomes.
The Importance of Understanding Mechanisms
Gaining a better understanding of how and why bariatric surgery patients are at greater risk for AUDs is crucial. Bariatric surgery patients are approximately three times more likely to die of a drug- or alcohol-related cause than the general public.
Limitations and Considerations
It's important to note that research findings may be limited by sample size and the artificiality of laboratory assessments. The reinforcing value of alcohol may depend on drink type, dose, and the social/environmental context in which the patient is drinking. Additionally, data may be limited to RYGB patients, and results may not be generalizable to other bariatric procedures.
Changed Anatomy and Breathalyzer Results
Changed anatomy after weight loss surgery can affect breathalyzer results administered by police.