Is alcohol and weight loss surgery a risky combination?

Gastric bypass contributes to higher rates of alcohol-related hospitalizations, study finds.

For obese people, weight loss surgery can reverse or significantly improve many serious health problems, such as diabetes, high blood pressure, and pain. But these procedures also change the way the body metabolizes alcohol, leaving people more likely to develop an alcohol use disorder. A new study finds that one type of surgery, gastric bypass surgery, may increase the dangers of drinking far more than other weight-loss strategies.

“Alcohol-related problems after weight loss surgery are a known risk. This is one of the reasons why we require people to abstain from alcohol for at least six months – and preferably a full year – before any weight loss surgery,” says Dr. Chika Anekwe, a specialist in obesity medicine at the Associated Harvard Massachusetts Center for Severity. The new findings are interesting and make sense from a biological perspective given the differences in operations, she adds.

How does weight loss surgery affect alcohol absorption?

Weight loss surgeries dramatically reduce the size of the stomach.

  • In a sleeve gastrectomy, the most common procedure, the surgeon removes about 80% of the stomach, leaving a banana-shaped tube.
  • For a gastric bypass, the surgeon turns the upper part of the stomach into a pouch the size of an egg. This procedure is called a bypass because most of the stomach, the valve that separates the stomach from the small intestine (pylorus), and the first part of the small intestine are bypassed.

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

After a sleeve gastrectomy, the pyloric valve continues to slow the passage of alcohol from the reduced 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 gastric bypass surgery can lead to extremely high blood alcohol levels. This makes people feel intoxicated more quickly and can put them at higher risk for alcohol use disorders, says Dr. Anekwe.

Findings from a study on weight loss surgery and alcohol

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 sleeve gastrectomy. Nearly a quarter had gastric bypass surgery. Another 18% were referred to MOVE!, a program that promotes increased physical activity and healthy eating.

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

The health effects of alcohol use disorder

Alcohol use disorder can lead to many health problems. Some 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 hospitalization for an alcohol use disorder, even though they drank the least amount of alcohol compared to other study participants. This suggests that a change in alcohol metabolism as a result of surgery likely accounts for the findings.

Advice on alcohol if you have had or are considering weight loss surgery

“We recommend that people avoid alcohol completely after any type of weight loss surgery,” says Dr. Anekwe. One year after surgery, occasional drinking is acceptable, she adds, noting that most patients she sees have no problem with this restriction.

People undergoing weight loss surgery must be careful about everything they consume to ensure they are getting adequate amounts of important nutrients. Like sugary drinks, alcohol is devoid of nutrients—another reason to stay away from it.

Gastric bypass has become less popular than sleeve gastrectomy over the past decade, mostly because it’s more invasive and a bit more risky. Although the new study suggests another downside to gastric bypass, Dr Anekwe says it may still be a viable option for people with severe obesity, as the bypass leads to more weight loss and better blood sugar control , than the sleeve procedure.

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