Gastric Bypass and Alcohol: What is the Relationship?

What is the relationship between gastric bypass and alcohol use disorder? This question is increasingly being asked — no surprise, considering the number of people undergoing bariatric or weight loss surgery.

The American Society for Metabolic and Bariatric Surgery report that the number of weight-loss surgeries in the U.S. increased from 158,000 in 2011 to almost 200,000 in 2015.  Given the ongoing obesity trend, this number will likely continue to rise.

So, what happens after weight loss surgery? There is quite a significant change to your system after this procedure. As a result, there are differences in the way your body absorbs what you ingest. This absorption is also the case for alcohol.

Research shows that gastric bypass surgery increases the risk of alcohol use disorder. Why is this so? There are quite a few reasons, and we will talk about them.

After bariatric surgery, you may want to know if it is possible to drink alcohol safely. There is no definitive answer to this, but the short answer is “yes.” However, this will have to be done gradually and with some modifications too.

Alcohol and The Gastric Bypass Patient

To shed more light on the relationship between gastric bypass and alcohol, let us give case examples. These real-life scenarios are from the Bariatric Times.

Case 1

• 32-year-old man
• Four months out from gastric bypass surgery
• He got a citation for driving under the influence (DUI) of alcohol
• This DUI was shortly after leaving his brother’s wedding reception
• According to the patient, he only had one glass of champagne
• His blood alcohol content  was above the legal driving limit of 0.08%

Case 2

• 50-year-old woman
• One year post-gastric bypass
• She hit and killed a pedestrian with her vehicle after less than two glasses of wine
• At the scene of the accident, she was staggering and slurring her words
• She was taken into custody and, two hours later, she was still intoxicated
• The officers suspected she might have had one to two bottles of wine, rather than two glasses

Is it possible both patients may not have been telling the truth? Possibly. But what if they were? Did bariatric surgery affect the way their bodies absorb alcohol?

Many studies have been done to ascertain the relationship between gastric bypass and alcohol addiction. A survey done shows the following:

1. 90% of people who took the survey claimed they were more sensitive to alcohol after gastric bypass.
2. Most patients reported that they could feel the effects of alcohol after taking only a few sips of their drink.
3. Over 25% experienced loss in motor coordination after having only one or two drinks.
4. Many of them were unable to regain control of their balance and coordination for up to two hours.
5. About 5% of them received a DUI
6. Most of the DUIs occurred a few months after gastric bypass and usually after having only one drink.

Alcohol Absorption Before Gastric Bypass

Let us talk a little bit about the normal process in someone who has not had weight loss surgery. A few interesting facts to know are:

• Some alcohol is broken down in the stomach.
• Conditions that decrease the breakdown of alcohol in the stomach can increase blood alcohol levels.
• Female gender, aging, and some medications are examples of such conditions that can cause an increase in blood alcohol content.
• The length of time alcohol stays in the stomach also controls blood alcohol levels by controlling the rate of absorption.
• Although a small amount of alcohol is absorbed in the stomach, most of the absorption is via the small intestines.
• Alcohol absorption is primarily regulated by the rate that alcohol empties into the intestine from the stomach.
• The longer alcohol stays in the stomach, the less absorption occurs, and the lower the blood alcohol level.
• Food slows the emptying of the stomach and, consequently, decreases the rate of alcohol absorption in the intestines.
• On the other hand, drinking alcohol on an empty stomach increases absorption. Hence, an increase in blood alcohol content and risk for intoxication.

Gastric Bypass and Alcohol Absorption

So, as we can see, the stomach has a huge role to play when you drink alcohol. Following gastric bypass, however, a large portion of the stomach is bypassed. A few facts to keep in mind are:

• More than 95% of the stomach is left out during gastric bypass surgery.
• This procedure means alcohol passes straight from the small portion left of the stomach into the intestines.
• As a result of this, alcohol absorption occurs very quickly.
• To make matters worse, not eating while drinking causes an even faster rate of alcohol absorption.
• These cause a rapid increase in blood alcohol content and, as a result, intoxication.
• Alcohol consumption can cause low blood glucose with severe consequences. This condition is known as hypoglycemia.

To further highlight the relationship of gastric bypass and alcohol, a study reports the following:

• Gastric bypass patients have a higher rate of alcohol absorption and blood alcohol content.
• Blood alcohol levels of gastric bypass patients are higher (about 50%) than in people who have not done this surgery.
• Gastric bypass patients require much less time for the blood alcohol level to reach a maximum. It was about ten vs. thirty minutes.
• These reasons likely explain why weight loss surgery patients say they feel the effects of their drink much sooner.

In summary, research shows interesting changes with gastric bypass and alcohol. The blood alcohol levels peak higher and faster after bariatric surgery. Also, blood alcohol content takes longer to return to normal. Furthermore, many weight loss surgery patients ingest less food when drinking. As a result, there is an increase in alcohol absorption into the blood.

For some gastric bypass patients, a single drink may be enough to increase blood alcohol levels to the point of legal intoxication!

Guidelines for Alcohol after Gastric Bypass Surgery

There are no official guidelines for using alcohol after weight loss surgery.

Drinking alcohol is generally not recommended immediately after gastric bypass surgery. Alcohol absorption into the blood is much faster and higher. As a result, intoxication is more likely. Also, alcohol contains many calories but with little nutritional value. Hence, alcohol intake can work against your goal of losing weight.

Having said this, we do know, however, that some people still drink after weight loss surgery. It is important to remember that this comes with certain risks.

As much as possible, avoid alcohol within the first six to twelve months after your bariatric surgery. It is to your benefit to avoid drinking alcohol during the rapid weight loss period.

Eventually, when cleared by your surgeon to safely consume some alcohol, it is crucial to be with someone you trust, if you plan on drinking in public. The reason for this is because you can get dangerously drunk very quickly due to the changes from surgery. Also, it is strongly advisable to avoid shots if you must have a drink. Furthermore, only drink after a meal or during meals. Food helps slow down the absorption of alcohol. Another essential thing to remember is taking your vitamin and mineral supplements.

For those who drink, a recommendation is to limit alcohol to one standard drink every two hours. In addition, consider a maximum of two drinks to avoid problems due to the rapid absorption of alcohol. As a reminder, one standard drink is one 12-oz beer, 5-oz wine, or 2-oz liquor.

To stay safe, you must never drive or operate heavy machinery after drinking alcohol. Consumption of even small amounts of alcohol can quickly lead to intoxication.

Addiction Transfer

People who have a history of addiction may be at a higher risk of developing a new addiction. Weight loss surgery leads to a decrease in food intake. Because of this, you may find yourself trading your food addiction for other addictive behaviors. Such new addictions may include alcohol, drugs, sex, shopping, or gambling addiction.

A study shows that approximately 14% of gastric bypass patients increase their alcohol intake after surgery. Consequently, they may continue to struggle with weight loss, considering the number of empty calories in alcohol. To put things into perspective, let us look at the average amount of calories in alcohol:

• One 12-oz can of beer: 150 calories
• 5-oz of wine: 123 calories
• 1.5-oz of whiskey: 105 calories

Treatment of Alcohol Addiction in Gastric Bypass Patients

Following gastric bypass, alcohol addiction remains a possibility even after many years. A study shows that the number of weight loss surgery patients who develop alcohol problems continues to grow throughout seven years of follow-up.

Because alcohol issues may not appear for many years, doctors need to consider this. Healthcare professionals should routinely take an alcohol history from patients with a history of gastric bypass. They should also refer them to treatment if there are suspicions of drinking problems.

The recommendation is to have alcohol dependence screening before and after gastric bypass. Alcohol use disorder affects not just the person who drinks, but also those around them. This secondary effect on other people is known as secondhand drinking.

The treatment for alcohol addiction is the same as for people who have not had gastric bypass. There are many helpful inpatient and outpatient treatment programs. Medication-Assisted Treatment is a great option. Non-medication treatment involving support groups like Alcoholics Anonymous have been around for a very long time. The importance of counseling cannot be over-emphasized. Support from friends and family also goes a very long way.

Conclusion

There is a relationship between gastric bypass and alcohol addiction. The recent increase in bariatric surgeries makes it more critical to address this.

Gastric bypass surgery involves bypassing most of the stomach. What this means is that alcohol goes more quickly into the intestines – where most of the absorption takes place. As a result of this, the blood alcohol level rises faster than in someone who has not had bariatric surgery.

For some gastric bypass patients, a single drink may be enough to increase blood alcohol levels to the point of legal intoxication! There are no official guidelines for drinking after weight loss surgery. Some surgeons recommend abstaining from alcohol during the rapid weight loss period. On the other hand, some others suggest not drinking for about six to twelve months after surgery.

For those who drink, it is advisable to drink during or after meals. The reason for this is because food slows down the absorption of alcohol into the bloodstream. nIn addition, the recommendation is to drink slowly. This advice is due to the rapid absorption of alcohol following weight loss surgery. Drinking alcohol slowly gives the body enough time to break it down in the liver.

To stay safe, do not drive or operate heavy machinery. Even small quantities of alcohol can rapidly lead to intoxication.

Treatment for alcohol use disorder in people with gastric bypass surgery is the same as for those who have not had the surgery. Inpatient and outpatient treatments are readily available. Medication-Assisted Treatment, counseling, and support groups are essential components of treatment.

What have your experiences been? Please leave your comments below. Also, share this article with others who may benefit from this write-up.

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The entire content of AddictionBlueprint, including content on drugs and alcohol, medications, therapies, facilities, spotlights, recommendations, and other features is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. This does not constitute a physician-patient relationship. Please seek the advice of your physician or other qualified health providers regarding your addiction, mental and medical issues.