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Jewish World Review
Ask the Harvard Experts: Risk of alcohol abuse increases after weight-loss surgery
Howard LeWine, M.D.
What to know before considering gastric bypass surgery
Q: I'm considering gastric bypass surgery. I really enjoy my nightly glass of wine. Will I still be able to drink after the surgery?
A: It might be best to avoid alcohol for a while right after the surgery. A recent study highlighted why you need to be cautious about drinking after a gastric bypass procedure.
Researchers reported that almost 11 percent of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7 percent drank too much before the operation, representing a 50 percent increase.
In a gastric bypass procedure, the surgeon uses staples to create a small pouch in the stomach. This bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.
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The smaller stomach pouch makes the person feel full after eating a small amount of food. Because the first section of the intestine is bypassed, fewer calories are absorbed.
Gastric banding is done through small holes in the abdomen using a laparoscope. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach.
The risk of alcohol use disorder was twice as high for people who had gastric bypass than for those who had placement of an adjustable stomach band. Although the researchers were not sure why there was such a difference, it does make sense.
The stomach lining contains an enzyme called alcohol dehydrogenase that breaks down alcohol. With a much smaller stomach after gastric bypass, less of this enzyme is available and more alcohol gets directly into the blood stream. Also, alcohol remains at higher concentrations for longer periods after gastric bypass.
Perhaps this is why excess alcohol use did not show up until the second year after surgery. During the first year after the operation, some casual drinkers might not have realized they were feeling twice as much effect from the same amount of alcohol they were used to drinking. So they may not have realized that they were developing alcohol dependence.
If you do decide to have gastric bypass, perhaps the safest thing to do is avoid alcohol completely for the first year. If you'd find that difficult to do, limit your alcohol use to one small glass of wine a few times per week. Be aware of how much alcohol you consume, and whether you feel it is causing problems in your life.
(Howard LeWine, M.D., is a practicing internist at Brigham and Women's Hospital, Boston, Mass., and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)
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