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Alcohol and Gastric Bypass Surgery: Risks and Dangers

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Weight loss surgery can be a life-changing procedure for individuals struggling with obesity. It can help reverse or greatly improve many serious health issues, such as diabetes, high blood pressure, and pain. However, these procedures also change how the body metabolizes alcohol, making people more likely to develop an alcohol use disorder.

According to a recent study, gastric bypass surgery, one type of weight loss surgery, may increase the dangers of drinking much more than other weight-loss strategies. In this article, we will explore the findings of this study and provide a detailed understanding of how weight loss surgery affects alcohol absorption and increases the risks of alcohol use disorder.

How does weight loss surgery affect alcohol absorption?

Weight loss surgeries dramatically reduce the size of the stomach. During a sleeve gastrectomy, the surgeon removes about 80% of the stomach, leaving a banana-shaped tube. Alternatively, in a gastric bypass, a surgeon converts the upper stomach into an egg-sized pouch, bypassing most of the stomach, the valve that separates the stomach from the small intestine, and the first part of the small intestine.

The stomach lining contains alcohol dehydrogenase, an enzyme that breaks down alcohol. After weight loss surgery, people have less of this enzyme available, which means drinking wine, beer, or liquor will expose them to a higher dose of unmetabolized alcohol. While some alcohol is absorbed directly from the stomach, most moves into the small intestine before being absorbed into the bloodstream.

After a sleeve gastrectomy, the pyloric valve continues to slow down the passage of alcohol from the downsized stomach to the small intestine. However, 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, which makes people feel intoxicated more quickly and may put them at a higher risk of alcohol use disorders.

Understanding the Risks of Alcohol and Weight Loss Surgery

A study published in JAMA Surgery found that gastric bypass surgery increased the risk of alcohol-related hospitalizations. The study included nearly 7,700 people (mostly men) from 127 Veterans Health Administration centers who were treated for obesity between 2008 and 2021. About half received a sleeve gastrectomy, nearly a quarter underwent gastric bypass, and 18% were referred to MOVE!, a program that encourages increased physical activity and healthy eating.

After adjusting for participants' body mass index and alcohol use, researchers found that participants who had gastric bypass were 98% more likely to be hospitalized for alcohol-related reasons than those who had sleeve gastrectomy, and 70% more likely than those who did the MOVE! program. The rate of alcohol-related hospitalizations did not differ between people who had sleeve gastrectomy and those who did the MOVE! program.

These findings emphasize the importance of understanding the risks associated with alcohol consumption after weight loss surgery, particularly after gastric bypass surgery. The changes in alcohol absorption and metabolism make it easier for individuals to develop an alcohol use disorder, which can have serious health consequences.

Dr. Chika Anekwe, an obesity medicine specialist at the Harvard-affiliated Massachusetts General Hospital Weight Center, emphasizes the importance of understanding the risks associated with alcohol consumption after weight loss surgery. She states:

Alcohol-related problems after weight-loss surgery are a known risk. That's one reason we require people to abstain from alcohol for at least six months - and preferably a full year - before any weight-loss surgery. We recommend that people avoid alcohol completely after any type of weight-loss surgery. A year after the surgery, an occasional drink is acceptable, but patients should always consult with their healthcare providers and take steps to prevent the development of an alcohol use disorder.

The Health Harms of Alcohol Use Disorder

Alcohol use disorder can lead to numerous health problems, including liver disease, cancer, heart disease, and stroke. Some of these conditions require hospitalization, including alcoholic gastritis, alcohol-related hepatitis, alcohol-induced pancreatitis, and alcoholic cardiomyopathy.

As the study authors note, people who had gastric bypass surgery had a higher risk of being hospitalized for an alcohol use disorder, even though they drank the least amount of alcohol compared with the other study participants. This suggests that changes in alcohol metabolism resulting from the surgery likely explain the findings.

Advice on Alcohol If You've Had Weight-Loss Surgery or Are Considering It

"We recommend that people avoid alcohol completely after any type of weight-loss surgery," says Dr. Chika Anekwe, an obesity medicine specialist at the Harvard-affiliated Massachusetts General Hospital Weight Center. A year after the surgery, an occasional drink is acceptable, she adds, noting that most patients she sees don't have a problem with this restriction.

People who undergo weight-loss surgeries have to be careful about everything they consume to ensure they get adequate amounts of important nutrients. Like sugary drinks, alcohol is devoid of nutrients, which is yet another reason to steer clear of it.

Individuals who have had weight loss surgery may need to adjust their drinking habits to prevent the development of an alcohol use disorder. This may include avoiding alcohol altogether, limiting alcohol consumption to special occasions, and seeking support if they feel that they are at risk of developing a problem with alcohol.

Conclusion

Weight loss surgery can be a life-changing procedure for individuals struggling with obesity, but it also comes with risks. Alcohol consumption after weight loss surgery, particularly after gastric bypass surgery, can lead to serious health consequences, including alcohol use disorder and hospitalization.

Understanding the risks associated with weight loss surgery and alcohol consumption is crucial to maintaining good health after the procedure. Individuals who have had weight loss surgery should consult with their healthcare providers and take steps to prevent the development of an alcohol use disorder. With the right care and support, individuals can achieve long-term success and improve their overall health and well-being.

Wynne Lee, MD

Dr. Wynne Lee is a physician at Massachusetts General Hospital (MGH), where she provides primary care.

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