Alcohol Metabolism after Bariatric Surgery

wine wlsAt the Minimally Invasive Surgery Symposium (MISS) 2012, Dr. John Morton, Director of Bariatric Surgery at Stanford, gave a presentation on his research about alcohol metabolism and addiction following weight loss surgery. His research was in response to some recent headlines about the possibility of addiction transfer after surgery. One of the headlines that he pointed out was “Trading Twinkies for Tequila”, published several years ago, about a young woman who after receiving a gastric bypass, said that she began binging on alcohol to feel the familiar buzz of food-binging.  Morton’s research group set out to first determine if there are changes in alcohol metabolism following surgery, and also determine if there is potential for addiction-transfer; that is, if as described by the woman in the story, binge eating can shift to alcohol abuse after surgery.

Morton’s first study, conducted a few years ago, addressed the issue of alcohol metabolism following weight loss surgery. The study looked at 19 patients who had received a Roux-en Y gastric bypass (RYGB) and 17 control patients, matched for factors such as age and BMI. Alcohol metabolism tests were performed on the patients before their RYGB operation and then measured again at three and six months post-operation. Patients also reported the symptoms that they experienced when drinking and completed a questionnaire about their drinking habits. The participants were given 5 ounces of red wine and then tested with a breathalyzer every 5 minutes until their blood alcohol content (BAC) reached zero. The peak for gastric bypass group was .08, while the control was .05. The results showed that a single glass of wine was enough for the weight loss surgery patients to reach the legal driving limit of .08 percent. The time it took for the participants’ BAC to reach zero was 108 minutes for the surgery group and 72 minutes for the control group. He concluded that for the surgery patients, their BAC peaked higher and took longer to return to zero, but there were no difference in reported symptoms of between the two groups. Additional research found that when looking at the same patient at three stages: pre-op, 3 months post-op, and 6 months post-op, their peak blood alcohol level went from 0.02 to 0.09 from the same amount of alcohol. The average pre-op alcohol metabolism was 49 minutes to BAC of zero. Post-op, alcohol metabolism took significantly longer. Six months post-op was more dramatic than 3 months, so the trends continued as time went on. Some intoxication symptoms changed, but some did not. Most patients had some different symptoms of intoxication after surgery, so they were able to be taught to be aware of those, and better recognize the effect alcohol was having.

Next, Dr. Morton talked about his study designed to examine the issue of addiction transfer after bariatric surgery. The study included patients who were surveyed both before and after weight loss surgery. He found that their drinking habits changed significantly: they consumed fewer drinks at one time after surgery, and also reported drinking fewer times per week. Their alcohol preference didn’t change in terms of beer vs. wine vs. hard alcohol. Additionally, Dr. Morton found that 40 percent fewer patients drank at all post-operation. The researchers found that whether a person was a drinker or not did not seem to affect the amount of weight lost after bariatric surgery.

The final study that Dr. Morton presented about looked at 121 post-op patients and found that there was no statistically significant difference in alcohol abuse. There was actually less post-op alcohol abuse reported (from 21 percent to 17 percent). The end result and key finding was that the studies did not find evidence for post-operative addiction transfer to alcohol abuse.

Also of note, Morton conducted a similar longitudinal (pre-op, 3-month and 6-month post-op) study with gastric band and gastric sleeve patients, and, in contrast to the gastric bypass patients, changes in their alcohol metabolism were not seen, in terms of higher peak and longer to BAC of zero. Dr. Morton concluded his presentation by explaining that he warns patients to be careful of behaviors associated with alcohol like being more relaxed, letting guard down, and being around friends who are likely eating.

You can read more about Dr. Morton’s study on alcohol metabolism in RYGB patients here.

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