In a recent post, we looked at how anxiety can put you at a higher risk of developing alcoholism, or alcohol use disorder (AUD). This time, we’re looking at the risk of alcohol abuse after gastric bypass surgery, a phenomenon that afflicts thousands of people every year.
What is gastric bypass surgery?
It’s a type of weight loss surgery, also known as bariatric surgery, used to treat severe obesity in people who haven’t had success with diet and exercise. About 228,000 people in the U.S. had bariatric surgery last year—a record high as the obesity rate continues to rise.
The most common type of gastric bypass surgery is “Roux-en-Y.” Here’s how it works: The surgeon staples off an upper section of the stomach, and then reroutes the small intestine to connect to this upper pouch. Therefore, food bypasses the rest of the stomach and the first section of the small intestine. This significantly reduces the amount of food you can eat, and also reduces the amount of fat, protein, calories, vitamins, and minerals you absorb from food. So postoperative patients can more easily lose a lot of weight, but they also have to take vitamin supplements for the rest of their lives.
How can gastric bypass lead to AUD?
Multiple studies have shown that people who have had gastric bypass surgery metabolize alcohol differently. They get drunker faster and take longer to sober up.
In 2007, a team of Stanford University researchers gave a glass of wine to 19 postoperative gastric bypass patients and 17 people who hadn’t had the surgery. They then measured their alcohol levels using a breathalyzer. The gastric bypass group had a peak alcohol level of .08 percent—the legal limit for driving under the influence—versus .05 percent for the control group. And it took the postoperative patients 108 minutes on average to reach an alcohol breath level of zero, while it took the control group an average of 72 minutes. So gastric bypass patients’ alcohol levels were more than 50 percent higher than normal, and it took them 50 percent longer to fully digest it. A 2015 study found similar results: Gastric bypass patients converted two drinks into four drinks, getting twice as drunk as those who hadn’t had surgery.
So we know gastric bypass makes you metabolize alcohol differently after surgery. But does that translate to developing AUD?
“In many cases this occurs months to years after surgery”
“At Ria, we’ve seen many patients who develop AUD after bariatric surgery,” says John Mendelson, Ria Health’s chief medical officer. “In many cases this occurs months to years after surgery.”
The first comprehensive study of the connection between gastric bypass and alcohol abuse came out in 2012. Researchers found that, two years after surgery, patients showed a higher rate of AUD that, in many of them, could be attributed to having had gastric bypass. Just last year, a team at the University of Pittsburgh released a study with clearer results. They followed up with more than 2,000 patients for five years after undergoing bariatric surgery. Of those who had gastric bypass, more than 20 percent exhibited AUD symptoms at some point.
According to the National Institute of Alcohol Abuse and Alcoholism, 6.2 percent of American adults have AUD. That means gastric bypass patients may be more than three times as likely to develop AUD than the average person.
Could there be a non-physiological reason for post-gastric bypass AUD?
Some scientists have tossed around the theory of “addiction transfer”—that when someone can’t satisfy their food addiction anymore, they’ll become addicted to something else, like alcohol. But that doesn’t quite square with the science: The 2012 study found a higher prevalence of AUD among postoperative gastric bypass patients, but not among those who underwent a different kind of weight-loss surgery called “banding.” The 2017 study found similar results: Gastric bypass patients were twice as likely to have AUD than banding patients. Apparently, not all weight loss surgeries pose the same risk of increasing alcohol dependence; gastric bypass is the riskiest.
What does this mean for gastric bypass patients?
Drinking alcohol after surgery can be dangerous. If you’re considering gastric bypass surgery or have already had it, it’s recommended that you steer clear of alcohol altogether or drink with extra caution.
If you’ve had the surgery and have found yourself abusing or depending on alcohol, know that you’re not alone and that there are resources to help you. At Ria Health, we use the latest scientific approaches—including FDA-approved medications—to help our members reduce or stop drinking. And thankfully, according to Mendelson, “the response to treatment is similar in post-bariatric surgery patients to patients who haven’t had surgery”—and response to treatment has been very good overall.
Our program is tailored to your goals, and one-on-one meetings with our medical team are done on your time from your smartphone—so you don’t have to go to the doctor’s office. Learn more about how our program works here, and go here to get started.
Joanna Nix is a writer in the San Francisco Bay Area. Her work has appeared in Mother Jones and Sierra magazines.