Weight-loss surgery is a strong option for those who qualify, scientists are still learning about some of the potential side effects of bariatric surgery like whether or not it can lead to an increased risk of alcohol use disorder.
Typically, patients can expect to lose up to two-thirds of their body weight within the first two years after surgery. But a growing number of RYGB patients began reporting more than weight loss at the two-year mark.
These findings suggest that gastric bypass alters the absorption and/or metabolism of alcohol in such fashion as to increase alcohol sensitivity. In order to determine how gastric bypass may affect the body’s response to alcohol, we reviewed the process of alcohol absorption and metabolism in the non-surgical and gastric bypass patient. This article includes the findings and, based upon such, provides the healthcare professional suggested guidelines for patient use of alcohol post-surgery.
Many patients could feel the effects of alcohol after having only a few sips of one drink. Such enhanced alcohol sensitivity following gastric bypass is likely due, in part, to a more rapid increase in the rate of alcohol absorption
Alcohol absorption pre- and post-surgery
Why would alcohol absorption be more rapid and alcohol levels higher for someone who has had a gastric bypass? When alcohol enters the stomach of someone with normal gut anatomy, some of it is metabolized in the stomach by the enzyme alcohol dehydrogenase in a process known as first pass gastric alcohol metabolism. Conditions that reduce gastric metabolism of alcohol increase blood alcohol levels and its effects. Such conditions include female gender, aging, and various medications.
The length of time alcohol stays in the stomach also regulates blood alcohol levels by controlling the rate of absorption. Although a small amount of alcohol is absorbed in the stomach, most is absorbed into the circulation via the small intestines. Alcohol absorption is primarily regulated by the rate that alcohol empties into the intestines from the stomach. The longer alcohol remains in the stomach, the less is absorbed and the lower the blood alcohol content is and risk for intoxication and toxicity. Food slows gastric emptying and, consequently, reduces the rate of alcohol absorption by the intestines. Conversely, alcohol consumed on an empty stomach substantially enhances absorption and increases blood alcohol content and risk for intoxication.
How to Mitigate Your Risk for Alcohol Addiction
Tell your doctor about your family history of alcohol use disorder. Talk openly and honestly about past addictions in your family, and be vigilant if symptoms begin to develop. Seek treatment if you become reliant on alcohol.
If you suffer from binge eating disorder, treat the underlying causes. Therapy is a good way to ensure you’ve dealt with dormant stressors and triggers that can lead to addiction transfer.Under these conditions, first pass alcohol metabolism is negligible because alcohol passes directly from the stomach pouch, via gravity, into the intestines where, due to the large surface area of the intestines, it is rapidly absorbed. To make matters worse, when drinking alcohol, many patients obey the postoperative dietary rule of no eating while drinking, causing alcohol to be absorbed at an even faster rate.
Alcohol metabolism and toxicity
In the non-surgical patient, 60 to 90 percent of alcohol that enters the body is metabolized in the liver by the alcohol dehydrogenase pathway. ADH is maximally activated by small amounts of alcohol but activity along the pathway can be reduced by an accumulation of end-products. Fasting and low calorie intake—such as occurs in the early postoperative period—as well as defects in hepatic mitochondrial function with obesity, may reduce the metabolism of products of the ADH pathway, decreasing hepatic clearance of alcohol. Furthermore, activities along the ADH pathway may be impaired by steatosis or fatty liver disease, conditions that are relatively common among individuals with morbid obesity. The gastric bypass patient, therefore, may not only have higher rates of alcohol absorption, but at least in the early postoperative period, possible defects in alcohol clearance as well.
Metabolic changes that occur with massive and rapid weight loss may also affect the amount of alcohol cleared by the liver via the microsomal ethanol metabolizing system. Activities along this pathway are increased in association with obesity and are induced both by alcohol intake, free fatty acids and, possibly, ketone bodies. Alcohol metabolism by the microsomal ethanol metabolizing system substantially increases the risk for liver damage, while at the same time making an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents, and certain drugs, including acetaminophen.
Alcohol use may cause hypoglycemia and, through reduction in the supply of glucose to neural tissue, cause possible neuromuscular and cognitive dysfunction, loss of consciousness, or even death. To maintain appropriate glucose levels, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with fasting or a diet low in carbohydrates. Furthermore, alcohol reduces the process, glycogenesis that allows sugar to be stored as glycogen.
How RYGB may lead to alcohol use disorder
This is one of the largest and longest studies to date of people who undergo weight loss procedures.
The study being observational, it cannot explain the reason why RYGB may increase the risk so much more than other surgical procedures. However, the authors cite previous studies that have suggested that RYGB may raise alcohol levels in the bloodstream quicker and higher compared with other procedures.
Another possibility is that RYGB increases tolerance by altering the genetic expression of the hormones that deal with reward circuits in the brain.
For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse.
In a gastric bypass procedure, a surgeon uses staples to create a small pouch in the stomach. This essentially separates the pouch from the rest of the stomach. The pouch is then connected to a loop of the small intestine that is beyond its first section. The smaller stomach pouch makes a person feel full after eating a small amount of food. Bypassing the first section of the intestine also makes it more difficult for the body to absorb calories.
A less invasive approach is laparoscopic adjustable gastric banding. Working through small holes in the abdomen, a surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. Like gastric bypass, it makes a person feel full after eating only a small meal or snack. But it does not bypass the stomach.
Alcohol and the stomach
The researchers could not pinpoint why gastric bypass may lead to problems with alcohol. But there are some possible explanations.
The stomach lining contains an enzyme called alcohol dehydrogenase that breaks down alcohol. When alcohol enters only a small stomach pouch, it comes in contact with less alcohol dehydrogenase, and so more of it enters the bloodstream.
In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities are high in association with obesity. With bariatric surgery, aberrant eating behaviors are considerably improved. However, individuals with addictions often transfer those addictions to yet another substance, such as alcohol.
Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss.
If you are a candidate for obesity surgery and are thinking about having the procedure, talk with your doctor about all of the benefits and risks. If you have a gastric bypass, perhaps the safest thing to do is avoid alcohol completely for the first year. If you’d find that difficult to do, limit your alcohol use to one drink a few times per week. Be aware of how much alcohol you consume, and whether you feel it is causing problems in your life.