E-mail updates
Follow on Twitter
Subscribe to RSSIn a last ditch effort to lose weight, roughly 113,000 people subject themselves to bariatric surgeries such as stomach banding and gastric bypass every year in the United States. But some of those patients may be trading pounds for an alcohol problem, according to a new study presented today at the annual meeting of the American Society for Metabolic and Bariatric Surgery in San Diego, and published by the Journal of the American Medical Association.
Hints that bariatric operations could lead to subsequent alcohol abuse have been collecting over the past few years, as case reports and doctor anecdotes have filtered into discussions and scientific publications. But the new study, headed by Wendy C. King, assistant professor of epidemiology at University of Pittsburgh’s graduate school of public health, is the first to follow many patients treated at a number of institutions from pre-op through two years post-surgery.
In all, 1,945 adults were assessed from 2006 to 2011. Alcohol use disorder (AUD), meaning abuse and dependence, “significantly increased in the second post-operative year compared with the year prior to surgery or the first post-operative year,” the study says.
The percentage seems small: At pre-operative assessment, 7.6 percent of study participants showed AUD. Two years after the operations, 9.6 percent did. Symptoms (without AUD) of alcohol dependence rose from 2.8 percent to 5.5 percent.
But that translates into about 2,000 more people with an alcohol use disorder, as King pointed out in the study, and in an interview. And even if a patient does not have AUD, she said, “one in eight patients in the second post-operative year reported typically drinking at least three drinks” when they drank. “That level can have implications for their weight loss, liver function, vitamin and mineral status so that is concerning….We don’t know the safe amount of booze after a [gastric] bypass.”
Almost the entire increase in AUD among bariatric surgery patients occurred in those receiving a type called Roux-en-Y gastric bypass. The biological mechanism at work has not yet been firmly established, but it likely rests in the differences between surgeries. In the Roux-en-Y procedure, doctors create a stomach pouch out of a small portion of the stomach and attach it directly to the small intestine.
Banding surgeries are restrictive -- they shrink the available space in the stomach so a person feels full after a small amount of food. Gastric bypass surgeries are both restrictive and malabsorptive, meaning they shrink space for food and change how its nutrients are absorbed in the small intestine.
As a result, gastric bypass patients feel alcohol’s effects faster, and for longer.
So the study’s findings, while important, aren’t surprising, explained Leslie Heinberg, the director of behavioral services for the Bariatric and Metabolic Institute of the Cleveland Clinic. Previous research has shown that male brains receive a more powerful reward from alcohol and among the study participants, the greatest risk for post-op alcohol abuse was in men.
Heinberg also pointed out one more prosaic possibility for an increase in AUD after surgery, one King acknowledged, too: When formerly obese people lose a lot of weight, they gain confidence, feel attractive, and may have more opportunity to socialize and drink.
That could explain why drinking and AUD was actually lower during the first year after surgery while patients were losing weight, then spiked during the second year. “It may be an unintended consequence of doing a heck of a lot better,” Heinberg, who was not associated with the study, suggested.
The findings should not dissuade anybody from a gastric bypass, Heinberg said, though both patients and doctors should weigh this information when considering risks and benefits of various surgeries.
Anita Courcoulas, professor of surgery and chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center, who was a co-author of the study, stressed that “surgeons need to counsel patients” about the possibility of AUD. Importantly, she said in an email to msnbc.com, bariatric surgery patients should be monitored closely for long periods of time “for signs and symptoms of alcohol use disorders and should consider counseling after bariatric surgery.”
Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com) to be published Sept. 13.
More from Vitals:
Leave a Comment:
Did these scientists consider that someone that has a problem with food might also transfer that problem to another substance? Duh. They need to go back to the books and learn about addictions.
Boomers,
My thought exactly...remove or inhibit the ability to "self-medicate" with food and the person merely wanders off in search of a different "fix"
I also think that it's the right interpretation. It wold be interesting to look for signs of other types of addiction.
Did you read the study?! You honestly believe these scientists, whose IQs are probably twice your own, didn't recognize that? You think they aren't aware of all of the scientific studies showing generalization between addictive behaviors and the overlapping neural circuitry??
My god, these comments... it seems to be that MSNBC attracts the dumbest people on the web.
We read it. These scientists' IQs are not twice ours. And it is almost axiomatic that physicians and medical researchers outside of the substance abuse field dismiss alcoholism/addiction as a primary disorder and instead classify it as a symptom (of depression, anxiety, bariatric surgery, etc.).
Instead of your overlapping neural circuitry observation, these "brilliant" scientists infer that the prevalence of drinking is because the patients "gain confidence, feel attractive, and may have more opportunity to socialize and drink."
So, we disagree with the esteemed researchers and infer that they drink because they have a pre-existing impulse control/addiction problem, not because they can now go out to bars more frequently. But, maybe we're not smart enough to point that out.
This is all to do with publications of papers, basically a nerd/scientist/doctor trying to make a name for themselves, and too many "news" companies trying to break a story.
Stuff may cause "whatever" in a lab rat at one part per billion or whatever, but what will it do for me? Your guessing right.
Just bugger off & leave me to live & die the way I want to, and stop trying to create links to illnesses that are at best untenable.
Really, you went to the journal and found the article and read the study?
I call shenanigans.
Fair enough DD140. I recognize my error and will clarify. We read the article (not the study) and disagree with Heinberg's inference concerning the findings. As the director of behavioral services for the Bariatric and Metabolic Institute of the Cleveland Clinic, she's probably smarter than us and the study's authors. I, therefore, retract any criticism of the study's authors and reserve same for Heinberg. Otherwise my comment still stands.
Exactly right, trading one addiction for another. They need counseling for at least a couple of years after the bypass. I already know someone who had a gastric bypass and two years later she is as big as she was before the GB.
Absolutely right. I had mine done March 11th, 2009. I have lost over 200lbs since and I still have another 100-150 to go. Its not a fixall medical miracle. You still need to change the head and thats the hard part.
They are using alcohol to self-comfort. Once you take the food out of their lives, they need to replace it with something else that will provide comfort. I have read that it is not unusual for a gastric bypass patient to become a shopaholic, alcoholic, etc. This should tell you something. That people are not fat because they like to eat. They are fat because they HAVE to eat to keep from going crazy. I would bet that obese people lack the feel good hormones that thin people have.
I quit smoking and took up eating. It took about 6 months for that new habit to kick in. It started to occur when my taste buds reawakened and began to crave sweets. I never ate sweets, nor craved or even thought about them when I smoked. I have gained 85 pounds in the nine years since I quit. There are other factors- like lack of exercise, and stress, too.
Perhaps I could skip the bariatric surgery and take up drinking heavily to solve the excess weight problem.
You lucky person, I quit 4 years, nearly 5 now ago, I am still trying to find a coffee that tastes reasonable, everything tastes god awful, my breathing has not improved, I have lost an "edge" mentally I used to have, I have become a miserable SOB and gained 40 lbs.
Since quitting My blood pressure has increased & I have been diagnosed with diabetes. I am taking drugs by the handful to control these.
4 years ago I smoked & had no health issues.
Join the dots
PS no bariatric surgery for me, motorcycle accident & a navel surgeon ruled that out 30 years ago
The psychological issues are going to be present and a good bariatric surgeon has programs and support systems in place to help you. Dr. Carson Liu in Los Angeles is the best at this.
My surgeon has done well with this as well here in Massachusetts. he even runs a "get back on track" program for displaced patients (I had my surgery done in VT but had to move soon after when I got laid off. had to go where the work is.) He took me in and we got me into group meetings and got my support network going again. He truely cares for the people he works with.
So now we can add alcoholism to the LONG list of side effects associated with mutilating the stomach in an effort to lose weight in order to conform to the standards of society and keep money flowing into Big Diet and Big Pharma.
The people who are turning to alcohol are merely trading addictions.
I had gastric by pass 5 years ago and had to undergo psychological testing before I was approved for the surgery. My surgeon made it very clear that he would not operate on anyone who drank alcohol or smoked. I did neither.
I lost my weight along with my type 2 diabetes; I have adhered strictly to my post-op diet and exercise. I have not regained my weight.
If you have an addiction to food before the surgery and if you do not treat the root cause of the addiction you will find another means to "self-medicate" whether it be alcohol, drugs, whatever.....
I had mine done March 11th, 2009. I relapsed for a short period when I injured my knee and couldn't walk more than 10 minutes at a time without severe pain. I am back on track and losing. I do drink once every few months (by drink, I have one drink and I am done) but yeah, getting past the mental part of it is the hard part.
Everyone loves a fat-assed drunk...
As I had my surgery over 8 years ago, maybe things have changed. In my first orientation of issues related to gastric-bypass one of the key items discussed was what I would not be part of my life style after surgery. 1. No Alcohol 2. No carbonated beverages; No caffeine; No Chocolate; At 8 years out a have lost over 100 lbs, have not gained any weight back. Don't drink, Have had maybe 3 carbonated beverages (Can't handle the feeling I experience, unless I take very small sips; Caffeine only occasionally and again I don't like the side effect I experience; No chocolate, for me it is too sweat and does not agree with me.
Was it worth it? Would do it again with out a moments hesitation. I have never in my entire life been able to maintain my weight with in 5 lbs until I had my surgery.
If a person is not willing to follow the expectations laid out, then they should be held responsible for not following the program. Let them reimburse the insurance or program that paid for the surgery.
My husband had gastric bypass surgery nearly a decade ago. Many insurance companies at that time, including his, would not cover the cost of surgery so he paid for it out of pocket. He was a heavy drinker before the surgery, so having the procedure performed did not, at least in his case, cause him to trade one addiction for another. He has regained a significant amount of weight back due to not only his alcohol consumption, but also due to the fact that he did not form consistent changes in his dietary or exercise habits. I've been trying to work with him on all three fronts. I love him and don't want to lose him before his time.
You would think these doctors would check people like myself. Something in my genes prevents me from gaining much weight. I've been within my weight limit since my high school days. I'm 72 now.
Gastric bypass is a surgical intervention for a psychological problem. Period!
Another study that 99.99999999% of the planet does not give a siht about.
My sister-in-law got it and now she drinks like a fish and she hadn't really drunk that much before. Never really thought there was a connection though. I just thought it was her four kids driving her to drink.
The problem is there was a lack of any long term studies
before Bariatric surgery was declared the magic solution. The few credible studies from places like
Johns Hopkins or Mayo Clinic indicate a higher than normal complication and
death rate. Many in the medical
profession believe this surgery which is roughly the same cost as Open Heart
Surgery is being pushed to replace the revenue decline in Open Heart Surgery
which is being replaced more and more by cath and stint procedures that cost
far less. Just as it is in most health
issues, it is all about the money.
Pharmacy companies, Hospitals, Surgeons and Insurance companies.
I had gastric bypass surgery about 4 ½ years ago. I have lost almost 100 pounds, am a size 6/8, exercise often, met & married my husband, and pretty much had a 180’ on quality of my life. Not everyone gets this surgery because they are too stupid/lazy to put down the cheeseburger. I had 4 dislocated ribs and hypothyroid…this kept me from being able to lose weight with exercise or diet. I was unable to so much as carry my groceries up the stairs to my apt and other mild chores like laundry or my ribs would rip out of place and I was immobile for days.
As for drinking, I drank more before my surgery because my body tolerated it. When you get a major surgery like this you have to re-learn your limits. A glass of wine with dinner or going out for drinks with friends is something I have no problem doing… but you can’t be downing shots and being stupid (surgery or not, this type of behavior is a bad idea). It doesn’t matter the size of the person or the surgeries they have when it comes to alcohol abuse…this is a problem that spans every size, gender, and culture.
]It’s awful the way that this surgery has been portrayed by the people who thought they could lose weight without hard work…because it IS hard work and a life changing ordeal. The people who gain the weight back because they refuse to use common sense can’t blame the surgery for ‘not working’ or think that the surgery is just a ‘quick fix’. It works when done for the right reasons and with the right mind set. This isn’t always a psychological problem, people can and do have physical reasons for this surgery.
From comments I read about fat people, seems like a skinny alcoholic is certainly much better that a fat healthy person.
What did they think was going to happen when they took away these patients' main method of stress relief?
Hi I have spent many hours researching the web but must say with great pleasure that your site ranks in my top 5 for layout and content, the posts have great detail and are very helpful.
Regards
Stephen
Hi I have spent many hours researching the web but must say with great pleasure that your site ranks in my top 5 for layout and content, the posts have great detail and are very helpful.
Regards
Stephen