Bariatric surgery offers a transformative path for individuals grappling with severe obesity, but it's crucial to understand the potential complications that may arise post-surgery. Among these, an increased risk of alcohol use disorder (AUD) has emerged as a significant concern. This article delves into the complex relationship between weight loss surgery, particularly gastric bypass, and the development of alcohol-related problems, providing insights into the underlying mechanisms, risk factors, and preventative measures.
The Link Between Bariatric Surgery and Alcohol Use Disorder
Research indicates a potential connection between severe obesity and addictive disorders. Bariatric surgery (BS), a procedure that modifies the gastrointestinal tract to aid weight loss, can inadvertently affect how the body processes alcohol. When alcohol is consumed after bariatric surgery, it is absorbed more rapidly, leading to higher peak concentrations in the blood and a prolonged elimination time. This altered metabolism increases the risk of addiction and alcohol-related harm.
Data suggests that patients undergoing BS are subsequently at increased risk of developing substance use disorders, particularly AUDs but also abuse of other drugs. Up to 43% of all patients with post-surgical AUDs did not show any signs of pre-surgical AUDs.
A study using health claims data with a follow-up time of more than 8 years and more than 400,000 patients with bariatric interventions, the authors reported an increased post-surgical risk for AUDs according to coded ICD-diagnoses.
How Bariatric Surgery Alters Alcohol Metabolism
Gastric Bypass vs. Sleeve Gastrectomy
The type of bariatric surgery performed can influence the risk of developing AUD. Gastric bypass, which involves creating a small stomach pouch and connecting it directly to the small intestine, bypassing a significant portion of the digestive tract, is particularly associated with increased alcohol sensitivity.
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After a sleeve gastrectomy, the pyloric valve continues to slow down the passage of alcohol from the downsized stomach to the small intestine. But with a gastric bypass, the surgeon reroutes the small intestine and attaches it to the small stomach pouch, bypassing the pyloric valve entirely. As a result, drinking alcohol after a gastric bypass can lead to extra-high blood alcohol levels. That makes people feel intoxicated more quickly and may put them at a higher risk of alcohol use disorders, says Dr.
The Role of Alcohol Dehydrogenase
The lining of the stomach contains alcohol dehydrogenase, an enzyme that breaks down alcohol. After weight-loss surgery, people have less of this enzyme available. So drinking wine, beer, or liquor will expose them to a higher dose of unmetabolized alcohol.
Impact on the Brain
The surgery may change mechanisms in the brain driven by genes, as well as hormones that affect consumption. After scientists performed bypass surgery on rats that don’t like alcohol, the rodents developed a taste for the intoxicant.
Risks Associated with Alcohol Consumption After Weight Loss Surgery
Dumping Syndrome
Most drinks with alcohol have a lot of sugar that could cause dumping syndrome. Alcohol may lead to dumping syndrome.
Liver Damage
The liver breaks down alcohol so it can be removed from the body. After surgery, alcohol makes your liver work harder. Alcohol can damage your liver. Alcohol might affect your liver.
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Dehydration
Alcohol can make you urinate (pee) more. Alcohol can contribute to dehydration.
Impaired Judgment
People may make poor choices after drinking. This includes driving but also food choices. Alcohol impairs judgment.
Increased Risk of Ulcers
Drinking alcohol increases the risk of stomach ulcers. Alcohol can increase risk of ulcers.
Addiction
People who have bariatric surgery are at greater risk for alcohol problems. Even if you have never had any problems with alcohol. Alcohol is addictive.
Identifying and Addressing Alcohol Use Disorder After Bariatric Surgery
Screening and Assessment
The Alcohol Use Disorders Identification Test (AUDIT), which consists of 10 items addressing aspects of alcohol consumption (e.g. frequency of consumption, loss of control). The value of each item ranges from 0 ( = unproblematic) to 4 ( = severe), thus constituting a possible total score between 0 and 40.
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Study Results
Based on health claims data, a study found a proportion of 2-3% who had been diagnosed with AUDs at least once during the observation period. According to AUDIT, one in ten patients reported risky drinking, with almost six percent meeting the criteria for hazardous alcohol consumption and almost four percent meeting the criteria for alcohol dependence.
A higher likelihood for at least hazardous alcohol consumption was found for males as compared to females, a longer time since surgery and dissatisfaction with post-surgical weight loss. Post-surgical care of any duration and higher TWLs were associated with a lower likelihood of hazardous drinking.
Factors Influencing Risk
How much weight participants lost, or whether they were binge eaters before surgery didn’t affect the risk of developing the alcohol-related symptoms, the study found.
The Myth of Addiction Transfer
It’s not correct to say obese people are addicted to food, or that they’ll transfer one addiction for another,” Parikh said. Also, people who quit smoking after bypass surgery were not more likely to develop alcohol issues.
Recommendations for Patients Considering or Undergoing Bariatric Surgery
Pre-Surgical Evaluation and Counseling
At Bellevue, candidates who have a current drinking problem are asked to “get it under control first,” Parikh said, and be abstinent before the surgery.
Post-Surgical Abstinence and Moderation
“We tell patients to abstain from drinking during the first six weeks [after surgery], and then minimize it for one to two years,” he said. “We’d be OK with one or two glasses of wine a week.”
Complete Avoidance
"We recommend that people avoid alcohol completely after any type of weight-loss surgery," says Dr. Anekwe.
Awareness and Monitoring
Given the results, people who’ve had bypass surgery might want to stay away from alcohol altogether, King suggested.“Some had symptoms even if they drank less than twice a week. Maybe you don’t drink for a month, but when you do one night you can’t stop,” King said.
Focus on Overall Health
People who undergo weight-loss surgeries have to be careful about everything they consume to ensure they get adequate amounts of important nutrients.