It’s no secret that obesity is a major health hazard. However, many fad weight-loss methods—self-starvation, substituting vitamin pills for real food, smoking or taking unprescribed amphetamines to suppress the appetite—are just as unhealthy or more so. For the vast majority of people, the best way to lose weight is simply to stay physically active, eat a healthy diet with limits on empty-calorie foods—and keep these as long-term habits so unnecessary weight stays off.
It does happen, though, that someone is dangerously overweight and, for one reason or another, the standard weight-loss approach is impractical. In which case, the doctor may prescribe a weight-loss drug or recommend bariatric surgery (an operation to make the stomach smaller, so a person feels full sooner and takes in fewer calories).
The Basics of Gastric Surgery
The four most common forms of bariatric (“gastric”) surgery are:
- Gastric bypass surgery, which involves removing and/or stapling off a portion of the stomach, then repositioning the small intestine to direct food through the resulting “pouch.” Besides providing a smaller stomach and a faster sensation of “fullness,” this has a “malabsorptive” effect on gut bacteria, keeping some potentially fattening nutrients from entering the body tissues. The operation is reversible, but only through another complicated surgical procedure (typically undertaken only under extreme circumstances), and side effects such as reflux disease or chronic diarrhea may be permanent.
- Gastric sleeve, which accounts for roughly 60 percent of weight-loss surgeries performed since 2016, completely removes up to 85 percent of the stomach and staples the remainder shut. It involves fewer organs than gastric bypass and does not cause malabsorption. However, it is not a reversible operation. (Gastric sleeve surgery is sometimes the “opening act” for the considerably more complicated BPD/DS operation—biliopancreatic diversion with duodenal switch—which follows the sleeve surgery with a malabsorptive bypass around the small intestine.)
- Gastric banding uses an inflatable band to seal off the lower part of the stomach, leaving a small channel that slows the passage of food. It is relatively easy to adjust the band’s size and to reverse the operation. However, the “feeling full” advantages are limited, many people find the band painful, and it is less effective than other methods for inducing lasting weight loss. Banding accounts for only a tiny percentage of gastric surgeries: it works best for people who need extra incentive to practice slower eating.
- Intragastric balloon surgery involves implanting a saline-filled silicone balloon in the stomach by way of the esophagus, to provide “feeling full” benefits without the risks of more invasive surgery or the discomforts of gastric banding. Unlike the other options on this list, an intragastric balloon is deliberately designed to be temporary—removed after about six months, at which time it may or may not be replaced.
Obviously, all types of gastric surgery have advantages and disadvantages. Gastric bypass, in particular, carries a danger many people are unaware of: it places the patient in a high-risk category for developing alcohol abuse disorder.
Why Gastric Bypass Surgery Increases Alcoholism Risk
Twenty percent of people who have undergone gastric bypass surgery show strong symptoms of alcoholism at some point within five years. Three times as many former gastric bypass patients die of alcohol-related causes (or the effects of other drugs) than do their counterparts in the general population. It’s not simple coincidence nor the stress of surgery-related lifestyle changes: research has established that the physical changes of gastric bypass do, in fact, make many people more susceptible to alcoholism.
- The reduced calorie intake associated with gastric bypass is also associated with faster rise in blood alcohol level, and with longer retention of alcohol in the blood. (A substantial percentage of bariatric patients report getting drunk faster after surgery, and objective research has confirmed that they really do.)
- Removing or blocking off part of the stomach means losing access to the alcohol-metabolism hormones that reside there—and with them, the first line of defense against drunkenness.
- People who have had recent gastric bypass will be on a largely liquid diet (the stomach is still healing, and unable to manage solid chunks of food). For some, this may lead to temptation to compensate for “deprived” feelings with a wide variety of liquids, perhaps including alcohol.
- Some patients (and lab animals) have been observed to develop a taste for alcohol after gastric bypass—although there are also reports of longtime drinkers losing their taste for alcohol. (Note that the appetite-inhibiting hormone leptin has chemical links to dopamine, the pleasure chemical associated with drug highs.)
Although pre-surgery drug use (including smoking) increases risk somewhat, many patients who develop alcoholism after gastric bypass never had a drinking problem previous to surgery.
It’s worth noting that doctors routinely advise gastric-bypass and gastric-sleeve patients to avoid alcohol for 6–12 months after the surgery and to limit consumption to an occasional small glass (preferably without added sugar) thereafter. This is not only due to the increased risk of drunkenness and addiction, but because alcohol is a known stomach irritant—just what a stomach recovering from surgery doesn’t need.
What to Do: If You’re Considering Gastric Surgery
It should be obvious by now that gastric bypass and similar surgeries are not to be undertaken lightly—particularly if your desire to lose weight is tied to any form of self-esteem issue, which is also a frequent factor in alcoholism. Before committing to any form of weight-loss surgery, have a long consultation with your regular doctor—and perhaps a therapist as well—regarding your personal reasons as well as the general pros and cons.
- Ask your doctor(s) about each of the following:
- Whether you are actually overweight, and, if so, what specific risks are associated with your degree of overweight/obesity
- Whether a less drastic method—standard diet and exercise, prescription drugs combined with diet and exercise, digestion-slowing stomach injections—might be a better option
- How your body would likely respond to gastric surgery—how well you will tolerate the actual operation, what post-surgery side effects are likely, how much weight you will actually lose and keep off
- What screening tests you will need to qualify for surgery
- Whether any personal or family history of chemical addiction puts you at extra risk for post-gastric-bypass alcoholism
- Whether, if you decide to opt for gastric surgery, you should give up or drastically reduce social drinking.
Finally, remember what your doctors will no doubt emphasize: this is not a matter of “one quick fix and I can go back to eating whatever I please.” Even with the less permanent forms of surgery, you will need major and lasting lifestyle changes—beyond cutting down or abstaining from alcohol—if the weight is to stay lost and your health is to stay good for the long haul. Invariably, there will be exercise and diet “prescriptions.” If you’ve had gastric bypass or another form of malabsorptive surgery, you may also need a permanent regimen of dietary supplements to ensure adequate vitamins and minerals.
What to Do: If Someone Shows Symptoms of Post-Surgery Alcoholism
Simply being aware of the risk for alcoholism after gastric bypass can help reduce it. The surest bet, of course, is to avoid alcohol altogether. However, if you or someone you know has resumed drinking post-surgery, stay alert for possible signs of alcoholism developing:
- Wanting and planning to drink less, but finding that impossible to accomplish
- Spending disproportionate amounts of one’s income on alcohol
- Neglecting work, hobbies, or personal care because of drinking or its aftereffects
- Lying/rationalizing to others (or to oneself) about the amount of alcohol consumed
- Becoming irrationally defensive if anyone says anything negative about the alcohol use.
Note that these symptoms indicate possible alcoholism in anyone, whether or not they have ever had weight-loss surgery. Anyone with a possible problem should seek medical help immediately, before things get worse.
But if you and your doctor agree that gastric surgery is best for you, you don’t have to reject it for fear of developing alcoholism. Just stay aware of the risks, monitor yourself carefully—and remember that, whatever health problems you have or don’t have, the best thing you can do is take overall good care of yourself.
Help and Hope for Alcoholism
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