Alcohol and Gastric Bypass

The information below is a repost from two outstanding resources in the WLS world. The words below are from Beth - Melting Mama - as she wrote on her blog a couple weeks ago and again on Obesity Help the other day. I actually missed the original discussion thread but found the reposting on Rob's blog - Former Fat Dudes - when he published it here.

Drinking alcohol after gastric bypass surgery is very serious and being educated about the biological, medical and emotional risks is essential. I love that this heavy topic with very deep scientific information is still so "Melting Mama" in the way she presents it. Having met Beth in person, I can tell you that she speaks the same way she writes ... with passion!

This post is very long with many outbound links to medical reviews, articles and research. But please read it all.

Melting Mama Wrote:

A few month gastric bypass post op writes 

“Can I have a glass or two of wine? I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?”

No. 

(Bold for impact here. You DO NOT NEED ALCOHOL AT TWO MONTHS POST GASTRIC BYPASS.)

I won’t pussy foot around and say, “You’re going to do what you want, but always listen to your surgeon! How about a sugar free cocktail?”

Can I drink alcohol after weight loss surgery? – Dr. Garth Davis

We recommend waiting one year after surgery before consuming alcohol. Then, with your surgeon’s approval, you can enjoy a glass of wine or a small cocktail. Remember to be careful because even the smallest amounts of alcohol will affect you differently after obesity surgery.

That is obviously not working for us.

*Disclaimer - “But, MM! You’ve been photographed with The Drink! How dare you preach about the drink! I’m going to drink it anyway! Nanananana!” Yes. I have. There are lots of photos, mostly Facebook-style, one time taking one sip and having a seizure! The others? Totally product placement. I did not drink. Do as you please, but here is my truth. I am nearly seven years post gastric bypass, and I choose to have a sip or three on social occasions. This includes: weddings, uh, once a year, and perhaps a drink at an event. I typically regret imbibing even a sip or three quite immediately. But, just like food: I have selective memory. I get the “just a taste won’t make me sick” idea and it fails me, my gut, my brain. Are we clear? And, to be clear as mud, the more I learn, the more I know, and opinions change. Also, I will sip. I am SEVEN YEARS post gastric bypass. 

Absurdity, n.: A statement or belief manifestly inconsistent with one’s own opinion. (Ambrose Bierce)

“Why can’t I have a drink, MM?”

Because I said so.

Imagine if curing addiction were that easy? I’d like to see it done this way -

Early post op, you absolutely, positively do not need alcohol coursing through your new, altered guts. There is NO excuse for it. Zero. None. Zip. NADA. (I left out Zilch, ’cause that’s a product for mixing sugar-free alcoholic drinks.)

This should be common sense.

You just had your intestines surgically re-arranged. You have a fresh stomach pouch that needs to heal. Do you really want to send alcohol through your raw piping? You wouldn’t send certain foods through there, why would you consider something so caustic as alcohol?

Seriously, “OMG! I totally swallowed a piece of gum, will I die?” But, “Tequila is low carb!”

The months pass, and you’re no longer a newbie, and make you feel like you can handle a little drinkie-poo.

“I am an adult! I deserve it! Damn it I am going to drink if I want to, I had this surgery to be normal!”

You might start researching drinks, you might hit up the Google for “sugar-free alcoholic drinks” wondering what’s good.

You may ask your pouched peers when they had their first drink, and what it was, and did they “get sick?” You might consider, “What if it makes me dump? What should I drink so I won’t dump? How much should I have?” completely ignoring the actual nutrition of most alcoholic beverages.

You decide it’s time.

Because, it’s “Christmas! And, I just saw this great recipe/idea on a WLS website so it must be okay for Bariatric patients.”

This is where MM has the DUH realization (again) that people do take advice from the internet. BLINDLY. EVEN. “So and so said it’s good for me, so I will do it!” It doesn’t even MATTER if the information sucks.

Please do not take advice or suggestions from non-professionals on the internet. We are typically only patients, peers, bloggers or sales people with zero medical expertise. You are a big girl, you can make your own decisions. People on the internet with big mouths can only offer suggestions, but you must make solid, rational decisions based on what is GOOD FOR YOU. What is good for you must include input from your doctors, nutritionists, and your COMMON SENSE.

You’re feeling a bit powerful, ’cause you have a TOOL. And since you had WLS, you HAVE POWERTOOLSMM! This means you are magically cured from any and all prior addictive personality traits! You may feel that you “never had a problem with food anyway,” so you will maintain FULL control of yourself when tempted. You might tell folks you were never an addict, and you were just an over-indulgent eater. Super.

Your pouch and you head to a holiday party and you are at least, partially successful in avoiding the 12 foot buffet table filled with pastries, and then you see the libations.

You are socializing and talking, and fill your little cup up with some wine, maybe even half of what you might have drank pre-op, you sip. The first sip hits you like a bomb, it burns all the way down into your pouch. You feel like you swallowed a Brillo Pad, if even for a second.

Then, maybe your ears get hot, maybe your face flushes. In the average non-WLS person, alcohol takes ONE MINUTE to hit the brain. You have a straight shot from MOUTH > SMALL INTESTINE, guess how fast it hits your brain?

INSTANEOUSLY.

Whee. “I think I already feel it. Holy shit, two sips and the room feels a little, whoa….”

“When consumed by the gastric bypass patient, alcohol readily passes through the stomach pouch largely unimpeded and into the jejunum where, due to its large surface area, it is rapidly absorbed. Research has shown that gastric bypass patients—even those that are three or more years postoperative—have a more rapid absorption of alcohol and a peak in blood alcohol content that is considerably higher than that of someone with normal gastrointestinal anatomy. (Bariatric Times)

You might “like” this. This might be tipsy, tipsy might be good. It might feel really good.

For some people it doesn’t feel good at all, and they are quite turned off by alcohol post WLS. (Ironically, this feeling now bothers me, because it feels like an oncoming seizure.)

Perhaps you enjoy it and soon, you’ve finished that glass and “Maybe just a little more?”

The buzz you had a short time ago, feels like it’s gone, even if the alcohol is still coursing through your blood. You are still drunk. You might drink more to reach tipsy again.

Patients should be warned about drinking alcohol too quickly because even relatively small amounts of alcohol, such as two small glasses of wine (0.3 g kg−1) might produce unexpectedly high BAC shortly after the end of drinking. Also when other surgical procedures are performed on the gut such as gastric resection and gastrectomy, a more rapid absorption of ethanol can be expected. The present experiment with alcohol as a model substance might have implications for the absorption and pharmacological effects of other drugs or when prescription drugs are taken together with alcohol. (Wiley Online Library)

This effect of alcohol on our post bypass systems is dangerous. We may not have ANY IDEA how DRUNK WE ARE, until we are passed out, in a coma, or driving home and crashing.

“You’re too dramatic, Beth, that won’t happen to me.”

Sure it won’t.

We aren’t talking about binge drinking here (although it happens), this can occur with relatively SMALL amounts of alcohol. I am pointing to the casual drink or two that hits too hard. I could potentally kill myself with one martini. There is NO WAY that I can drink hard liquor in one sitting. MM + Martini = Fun Down The Escalator! BOOM!

...Gastric bypass surgery may enhance alcohol sensitivity by altering the rate that alcohol is absorbed or metabolized. Such changes in alcohol sensitivity and clearance significantly increase the risk for alcohol toxicity and its deleterious consequences (i.e., liver disease, cardiomyopathy, loss of muscle mass and strength, neuromuscular and cognitive defects, gastritis, pancreatitis, acid reflux, and specific vitamin deficiencies) (Bariatric Times)

You’ve stopped drinking, either because you’re toasted, or you are AWARE you have had enough and made a choice to stop. Make sure to give a warm welcome to hypoglycemia!

Alcohol use may also adversely affect the health of the bariatric patient by increasing the risk for hypoglycemia and its potentially negative influence on cognitive function and neuromuscular control. (Bariatric Times)

Recognizing and treating hypoglycemia with a gastric bypass is hard enough, and it is a known side effect of the surgery. However, recognizing a low blood sugar and treating it effectively while you aren’t AWARE of it? That is “fun.”

Drinking, especially binge drinking, can cause hypoglycemia because your body’s breakdown of alcohol interferes with your liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal. (Islets of Hope)

Those of us with diagnosed reactive hypoglycemia post roux-en-y gastric bypass probably shouldn’t drink at all. The risk of dropping our glucose levels so low, and not being aware enough to fix it? Sure a couple glucose tabs and crackers will help you, but again, NOT IF YOU AREN’T AWAKE, dear.

Another problem with hypoglycemia due to the excessive consumption of alcohol? HYPOGLYCEMIA LOOKS LIKE DRUNK. I live with this, I know this.

Generally, symptoms of hypoglycemia include:

Mild Hypoglycemia

• Increased or sudden hunger
• Feeling shaky, dizzy or nervous
• Pounding heartbeat
• Drowsiness, feeling tired
• Sweating (cold and clammy)
• Numbness or tingling around the mouth
• Headache or stomachache

Moderate Hypoglycemia

• Any of the above mild symptoms, plus:
• Headache
• Personality change
• Irritability
• Confusion and/or difficulty concentrating
• Headache or stomachache
• Slurred or slow speech
• Poor coordination

Severe Hypoglycemia

• Any of the above mild or moderate symptoms, plus:
• Loss of consciousness
• Seizures and/or convulsions
• Death

You make it through the holiday season, and navigated your way through a few drinks, and you seem to be okay with handling yourself and alcohol. But, maybe you find a new craving for that “glass of wine with dinner,” and it becomes a pattern. Two or three nights a week, you’re having a glass of wine (other libation…) and soon you’re having it nightly.

Maybe then, you feel that a little “mommies’ sleeping pill” might help in addition to dinner, and you’re sipping wine to help you fall asleep. But, remember, you are still a gastric bypass patient, and maybe you feel normal, look normal.. but… this behavior may quickly NOT be normal. 

BIG RED FLASHING WARNING SIGNAL HERE.

Bariatric patients with pre-existing addictive behavior toward food could, with food restriction, transfer such addiction to alcohol. All of these observations point to the likelihood of alcohol use having a more negative influence on health status postoperatively than was previously recognized. (Bariatric Times)

Research is limited, but I implore you to ask around and find peers you can trust to discuss this issue with. Your friends are addicts. Old statistics, one via an old episode of Oprah stated 30% of us “find a new drug” post operatively, but I would bet my $15Kworkneededteeth that it is vastly understated.

Weighty Secrets -

I drink because it keeps me from eating. I look forward to eating and it has become the high point of my day. I know exactly how much to eat now before I get sick. I’m gaining weight and just keep telling myself that all I have to do is quit drinking to lose it. I'm lying to myself and I know it. Hate myself. Go figure. Life just sucks ass huh?

I would say that this issue, of alcoholism (and the whole myriad of addictions… drugs, shopping, gambling…etc.) in the post op community is not discussed, nor researched enough at this time.

“…lifetime rates of substance use disorders among candidates for bariatric surgery are substantial, but rates of current substance use disorders prior to surgery are low.” (American Journal of Psychiatry)

There isn’t much research to say, either, but what is seen in our communities is enough to warrant a larger scale look. For instance – studies show that WLS patients are less likely to die from the co-morbid diseases of obesity, BUT, have a higher rate of death from accidental deaths and suicide.

“Reports reveal that a substantial number of severely obese persons have unrecognized presurgical mood disorders or post-traumatic stress disorder or have been victims of childhood sexual abuse. Data on the association between presurgical psychological status and postsurgical outcome are limited. Some centers for bariatric surgery recommend that all patients undergo psychological evaluation and, if necessary, treatment before surgery and psychologically related surveillance postoperatively. Although research has shown an improved quality of life after gastric bypass surgery, certain unrecognized presurgical conditions may reappear after surgery. The results of our study suggest that further research is warranted to explore the optimal approach to evaluating candidates for surgery, including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery. (NEJM)

Transfer addictions are real after weight loss surgery, and can stem from the innocent (Hello internet!) to illegal drugs.

What Causes Addiction Transfer and Cross Addiction?

Psychologists originally developed the phrase “addiction transfer” because of a trend they observed: Drug addicts and alcoholics in treatment recovered from an addiction to one form of drug only to swap it for another type of drug or other compulsive behavior. Because these patients still feel a void or haven’t fully addressed the underlying reasons for their addiction, they find new ways to escape or numb their emotions. For those who thought life would be perfect if only they could overcome an addiction, the reality sets in that life is still at times difficult, boring and hard to manage. 

Addiction transfer also has a neurological basis. Research suggests that the same biochemical processes are at work in multiple types of impulse-control disorders, such as compulsive eating, alcoholism, smoking, compulsive gambling and drug addiction. Each of these behaviors triggers the same reward sites in the brain, resulting in cravings that are difficult to resist.

Addiction is a brain disease, and the brain is immensely complex. “The brain may be the most difficult puzzle in the universe,” says Graham. “The brain is hard to study, and it gives up its secrets slowly. This is the main reason that neurology and psychiatry have not necessarily kept pace with the progress of other areas of medicine.” (Drug Addiction Center.com)

Everyone has an opinion on how much is too much alcohol after weight loss surgery. But, only you know what you’re really doing. All the explaining in the world does not discount the fact that alcohol is dangerous for you with your new anatomy. Trying to validate WHY you have to have it doesn’t change anything.

Ask yourself why you have to have alcohol. Do you really require a cocktail at dinner every single night — or to bed — and on the weekends — and? Are you prepared to pay the consequences of your actions? Are you aware that the consequences might involve you, blacked out, on the floor with no help? Yeah. That’s sexy. You did this for your health, right?

RESOURCES:

• Weighty Secrets - Addictions, Alcoholism
• Weighty Secrets - Video Posts from 20/20 Moms and Alcoholism
• Intervention - Amber, Eating Disorder and Alcoholism
• Is Alcoholics Anonymous for You? 12 Questions Only You Can Answer:Alcoholics Anonymous asks drinkers to honestly answer 12 questions about their drinking habits. If you answer “yes” to four or more questions, alcoholics recommend seeking help. 
• Rethinking Drinking is an outpost of the NIAAA where drinkers can assess their drinking habits and learn to spot warning signs.
• What’s Your Drinking Pattern? Find out how your drinking habits compare to those of other adults in the United States at the institute’s website.
• NIAAA’s Cocktail Content Calculator can help you keep track of how much alcohol is in your drink. How strong is your mixed drink or cocktail?

RESOURCES - GETTING HELP:
More than 1 million people submit to detox and rehab programs for alcohol addiction every year in this country.

• National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), where you can find information on treatment options and facilities.
• For local information on treatment available in your city and state, check out the Substance Abuse Treatment Facility Locator through SAMSA.gov.