Surgery for obesity is being done more frequently to combat the pandemic of obesity globally. A lot of these subjects are food lovers (read ‘addicted’). Many among them smoke and drink.
It has been pointed out by the detractors of bariatric surgery that once these food lovers lose their hunger for food a direct result of surgery, they tend to take up addictions for other things such as alcohol, drugs, gambling, etc. (termed as addiction transfer by psychologists). Food is a great emotional filler and once that is lost from life after bariatric surgery, the patients tend to find alternatives in these substances. Hence, a great potential for alcohol addiction is a possibility after bariatric surgery. A counter argument to this may still be that an obese subject with less willpower may get addicted to alcohol anyways anytime of his or her life, bariatric or no bariatric surgery.
Bariatric surgery alters the way the body metabolizes alcohol. Postoperatively these patients become more sensitive to alcohol intake. The mechanism of this is really very simple: As bariatric surgery reduces the size of the stomach and reduces its transit time (the stomach empties faster), there is decreased alcohol breakdown by the enzyme alcohol dehydrogenase. The absorption by the intestine therefore is higher and more rapid, which effectively translates into higher blood levels of alcohol 1.
This implies that you need less alcohol to become intoxicated. In fact, even one glass of wine at dinner can mean that your blood alcohol level is over the legal limit, and can have serious implications as far as your ability to concentrate is concerned (now that should perk you up). Or you may rejoice that much less alcohol (moolah saved!) will be required to make one tipsy. Experts are of the view that even one glass of wine (and if you are a whisky drinker, remember that sodas are a big no after bariatric surgery) may be too much for post bariatric surgery patients, with two being the outer limit. It will also take a bariatric surgery patient longer to return to a sober level after drinking alcohol than normal. 1-2.
Moreover, alcohol is a source of empty calories and defeats the very purpose of bariatric surgery of caloric restriction and weight loss. Very frequently alcohol consumption is associated with fried food, long sedentary hours all of which are going to lead to weight gain.
Alcohol and obesity in unison are detrimental to liver function, can cause reflux disease (heartburns) and ulcer disease. Alcohol impairs the absorption of some vitamins from the stomach too.
For all the reasons stated above patients are strongly discouraged to consume alcohol after bariatric surgery. So, although alcohol in normal subjects have not been proven to relate convincingly to obesity, alcohol is a big no-no after bariatric surgery. An occasional drink will not harm you, but bariatric surgeons are willing to err on the side of safety rather than allow their patients to drink.
1. Hagedorn, J., Encarnancion, B., Brat, G., & Morton, J., “Does gastric bypass alter alcohol metabolism?”. Surgery for Obesity and Related Disease 3: 543–548.
2. Maluenda F, Csendes A, De Aretxabala X, Poniachik J, Salvo K, Delgado I, Rodriguez P. Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity. Obes Surg. 2010 Jun; 20(6): 744-8.