Message in a Bottle: Beware of Post-Operative Alcohol Use

Alcohol use disorders are a common and especially dangerous form of transfer addiction following gastric bypass surgery. In a web-based survey of more-than 300 bariatric surgery patients, it was found that 83 percent of patients who responded consumed alcohol either occasionally or regularly, and 28 percent of these individuals said they felt they had a problem controlling their intake.

Roughly 8 percent of bariatric patients will experience transfer addiction that is serious enough to require inpatient treatment for alcohol abuse, and treatment centers are seeing a rise in patients who have had bariatric surgery.

It should be noted that more than half of people who develop serious alcohol use problems following bariatric surgery did not have issues with alcohol use prior to surgery. Therefore, it is ill advised for any post-operative patient, whether or not they were previous drinkers, to have an easy-going attitude about alcohol intake afterwards. Patients who have been post-operative for a longer period of time are more vulnerable to developing alcohol problems, with most problematic drinking starting at around two years post-surgery.

Gastric bypass surgery in particular changes the way the body metabolizes alcohol. In fact, all of the factors involved in alcohol metabolism, including weight, liver function, food intake and production of an enzyme that breaks down alcohol in the body are altered by gastric bypass surgery. This makes drinking a more risky activity.

It is important for patients to be informed that alcohol has a much more intoxicating effect after surgery, with a single glass of wine potentially putting a gastric bypass patient’s blood alcohol level over the legal driving limit. I personally had a patient pulled over for a DUI following just one glass of wine with a full dinner.

Post-RNY, patients’ blood alcohol levels rise more quickly and take longer to return to zero. This is highlighted in a study of blood alcohol concentration (BAC) levels conducted at Stanford University.

On pre and post-gastric bypass surgery patients, after drinking just 5 ounces of red wine:

  • Their BAC pre-operative was 0.024 percent, and it took 49 minutes to reach a zero BAC.
  • Their BAC after 3 months post-operative was 0.059, and it took 61 minutes to reach a zero BAC.
  • Their BAC after 6 months post-operative was 0.088 (over the legal limit), and it took 88 minutes to reach a zero BAC.

There is conflicting evidence regarding the impact of alcohol on gastric sleeve patients, and more studies are needed to draw a clear conclusion. One study conducted found that similar to gastric bypass patients, BAC levels rose more quickly and took longer to return to zero. However, other researchers have concluded that sleeve patients do not share the same alterations in alcohol metabolism as gastric bypass patients.

There is a laundry list of complications related to transfer addiction in the form of excessive alcohol use. These complications include:

  • —  Weight regain
  • —  Malnutrition
  • —  Dehydration
  • —  Vitamin deficiencies (especially thiamin)
  • —  Ulcers
  • —  Elevated liver enzymes
  • —  Pancreatitis
  • —  Hypoglycemic episodes
  • —  Poor sleep
  • —  Mood changes and development of depression
  • —  High blood pressure
  • —  Seizures
  • —  Negative interactions with other medications
  • —  Death

In one study, bariatric patients admitted to a comprehensive substance abuse facility were significantly more likely to have a diagnosis of alcohol withdrawal when compared to non-bariatric patients. Alcohol withdrawal can be deadly, so it is very important for a patient not to try to detox on their own. Professional medical evaluation and assistance is required.

Conclusion

“Safe” levels of alcohol consumption have yet to be established for patients after having bariatric surgery. It should not be assumed that medical complications won’t occur until someone is drinking to an alcoholic level. In my clinical experience, I’ve seen patients who were regular drinkers but not heavy drinkers (i.e. 1 glass of wine per night) experience ulcers and pancreatitis.

My practice recommends that patients abstain from drinking following surgery in the same way we recommend they eliminate high sugar and high fat foods. The goal of bariatric surgery is to improve one’s health and quality of life, and regular consumption of alcohol does neither.

Kelly Broadwater, LPA, LPC, CEDS

Kelly Broadwater, LPA, LPC, CEDS

About the Author:

Kelly Broadwater, LPA, LPC, CEDS, is the founding co-executive director of The Chrysalis Center for Counseling & Eating Disorder Treatment. As a psychologist and certified eating disorders specialist who is an expert in bariatric psychology, Ms. Broadwater developed the comprehensive aftercare program for bariatric surgery patients offered at her outpatient practice. Her clinical experience includes conducting pre-operative psychological evaluations, providing pre- and post-operative individual counseling and facilitating group therapy for post-surgery patients. Ms. Broadwater frequently speaks on topics related to bariatrics, including co-presenting at the 2015 International Association of Eating Disorder Professionals conference on effective bariatric aftercare. She is an integrated health associate member of the American Society for Metabolic & Bariatric Surgery.



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