Re: DS and alcohol

June 22, 2008

In a message dated 6/22/2008 10:14:24 P.M. Central Daylight Time,

sonofmosiah@... writes:

I seem to recall that the binder said no alcohol until after the first year,

and only occasionally thereafter.

Anyone remember or have any comment?

____________________________

Jim,

I occasionally have a margarita on special occasions, And of course I

sleep through most of my meal if I drink more than 1/2...LOL. I do recall Dee

talking about people dying who drank before the first year because of the

liver. Usually in excess..... One woman in particular she told about. It is

like

all else in life.... moderation. Alcohol is a rough chemical on the liver and

I agree that with moderation it should be Ok occasionally after the first

year, But as with all things your mileage may vary and what might be perfectly

acceptable for most might cause problems with other. I have a friend with a

fatty liver(Not a ds pt) and a few drinks causes her liver enzymes to go sky

high, so she doesn't drink at all. I wouldn't suggest an alcoholic have a DS

because they would be stressed enough with body changes and the emotional

aspect and added the increased stressor of trying to stay off the booze for a

year would not likely happen.

So that is my comment......

Mel

**************Gas prices getting you down? Search AOL Autos for

fuel-efficient used cars.

(http://autos.aol.com/used?ncid=aolaut00050000000007)

June 22, 2008

In a message dated 6/22/2008 11:05:12 P.M. Central Daylight Time,

soarthruwind@... writes:

Dr. K told me that our bodies no longer absorb the alcohol. I tried to get

drunk once after the surgery (3 years post-op). I had 5 beers. I could only

manage to get slightly drunk, sobered up real quick and ended up with alcohol

poisoning. I make it a point to stay clear of alcohol completely.

--

_____________________

That is weird because I understood that we absorbed it faster and my

experiences with small amounts of alcohol making me woozy seemed to support

that. It

did tend to leave my system VERY fast. I do get a head ache from Alcohol

which I never did pre op. I found this online at Beyond change(Bariatric site)

Interesting and kind of scary .....

A 32-year old male 5 months out from gastric bypass surgery was issued a DUI

after attending his brotherâ€™s wedding reception. According to the patient, he

had only consumed 2 glasses of champagne, although his blood alcohol levels

were above the legal limits to operate a motor vehicle.

A female patient, 50 years of age and one-year post-gastric bypass hit and

killed a pedestrian with her automobile after having less than 2 glasses of

wine. When police arrived she had difficulty with her coordination, slurred her

words and seemed somewhat confused, although her alcohol test suggested that

her blood alcohol levels were shy of the legal limit.

Were these patients telling the truth about the amount of alcohol they had

consumed or did their surgery affect the way the body absorbs or metabolizes

alcohol?

A recent study reported in the British Journal of Clinical Pharmacology (1)

found that the gastric bypass procedure significantly affects alcohol

absorption and its inebriating influence. According to the study protocol, a

group

of gastric bypass patients, three years post-surgery, and their non-surgical

controls consumed an alcoholic drink after an overnight fast, and blood

alcohol levels were examined over a period of time. The data showed that blood

alcohol levels of the gastric bypass patients were higher and required much

less

time to peak than those of the non-surgical controls.

The more rapid absorption of alcohol and heightened blood alcohol levels

would cause the bariatric patient to have a more pronounced feeling of

inebriation during and shortly after drinking. And, such effects could have

serious

ramifications with regard to driving an automobile or performing other skilled

tasks such as operating heavy machinery, piloting a plane or any other task

that may influence the safety of the individual or that of others.

Why would alcohol absorption be higher for someone who has had a gastric

bypass (or other surgical procedure that reduces the size of the stomach, i.e.

biliopancreatic diversion with or without the duodenal switch, gastrectomy)?

With the gastric bypass procedure, more than 95% of the stomach is bypassed.

Alcohol passes directly from the stomach pouch, usually without restriction,

into the intestines where, due to the large surface area of the intestines,

alcohol is rapidly absorbed.

In addition to anatomical changes that influence alcohol absorption, the

bariatric surgical patient may be more sensitive to the effects of alcohol

because of low calorie intake. Several studies found that alcohol absorption is

more rapid and blood levels higher if alcohol is consumed on an empty stomach

than if provided with a meal or drank soon thereafter (2-3). During the first

several months following bariatric surgery, total daily calorie intake is

quite low. Drinking alcohol, even small amounts, at this time, would increase

significantly an individualâ€™s risk for intoxication.

Metabolic changes that occur with rapid weight loss, as well as the morbidly

obese condition, can also alter the rate that the liver is capable of

clearing alcohol from the body by the liverâ€™s primary pathway for alcohol

metabolism. Reduced clearance of alcohol by this pathway may further increase

blood

alcohol levels and the risk for intoxication and alcohol toxicity (4-6).

Metabolic changes that occur with massive and rapid weight loss may also

increase

the clearance of alcohol by a secondary pathway of alcohol metabolism that

substantially increases the risk for liver damage while, at the same time,

makes

an individual more sensitive to the toxic and cancer-promoting effects of

pollutants in the air, industrial solvents (such as those in household

cleaners), and certain drugs (4-6).

Alcohol use can also cause brain damage, a loss of consciousness or even

death by reducing the supply of sugar (glucose) to the brain. Muscle, heart,

liver and other tissues use fat and sugar (glucose) for fuel. The brain,

however, needs sugar to function. To avoid a depletion of sugar, the body stores

sugar in the form of glycogen. Glycogen stores, however, can be depleted in a

short period of time with prolonged work or exercise, fasting or a diet low in

carbohydrate. Furthermore, alcohol reduces the process that allows sugar to be

stored as glycogen (7).

The bariatric patient, particularly in the rapid weight loss period and if on

a low carbohydrate diet, may have low amounts of stored sugar (glycogen).

Drinking alcohol could deplete those stores and cause blood sugar levels to

decline. The body, however, has another mechanism to maintain appropriate

amounts of sugar in the body. This process is known as gluconeogenesis and is a

chemical pathway that converts certain components of protein, lactic acid and

other substances into sugar. However, alcohol reduces the production of sugar

by this process (4-7) and can, thereby, cause hypoglycemia (low blood sugar).

Usually when blood sugar levels fall, there are certain hormones produced

that restore blood sugar levels to normal. However, when someone drinks

alcohol, the response of these hormones to low blood sugar is blunted. To make

matters worse, hormone responses to low blood sugar are also blunted or

depressed

in postoperative bariatric patients (8). The bariatric patient, therefore,

would have a much higher risk of becoming hypoglycemic (having low blood sugar)

than someone who drinks that has not had the surgery, particularly if the

patient drinks alcohol during the rapid weight loss period.

Since the brain and nervous system need sugar for fuel, low blood levels

could adversely affect neuromuscular and cognitive functions, causing a loss of

coordination and balance, slurred speech, poor vision, and confusion. These

are all conditions that mimic those associated with intoxication. The patient

described earlier, who appeared extremely intoxicated even though her blood

alcohol levels were not high, may have been hypoglycemic. Low blood sugar, over

a period of time, can result in a â€˜black outâ€™ or loss of consciousness,

brain and nerve damage, and even death.

The use of alcohol after surgery could also cause irreversible brain and

nerve damage, coma and possible death by inhibiting the absorption of important

vitamins, including B-complex vitamins such as thiamin (B1) or vitamin B12.

Alcohol inhibits the absorption of thiamin and other B-complex vitamins,

reduces activation of certain vitamins, and stimulates the breakdown of vitamin

A,

pyridoxine, and folate (4-6). These vitamins may already be deficient in

bariatric patients because of nutrient restriction, malabsorption or impartial

digestion of foods produced by the prospective surgery. Alcohol use, then,

would compound the negative effects that bariatric surgery has on

vitamin/mineral

status and increase the risk for associated health problems, including nerve

and brain damage, defects in metabolism, a decrease in the ability of the

body to heal, low immunity, fatigue and more.

Alcohol has numerous other toxic effects in the body. Not only does alcohol

cause liver disease but also negatively affects other tissues. Alcoholâ€™s

influence on the heart inflammation (myocarditis), a loss of heart tissue

(cardiomyopathy), and irregular heart beats (arrthymias) that can lead to sudden

death. Skeletal muscle is particularly susceptible to alcohol with loss of

skeletal muscle fibers and strength. Alcohol also causes inflammation of the

intestinal tract, gastritis, pancreatic, acid reflux disease and increased risk

for gastric and esophageal cancer. And, alcohol causes damage, often

irreversible, to the brain and nervous system.

In addition to the numerous health problems that drinking alcohol after

surgery may cause, the bariatric patient should also be cautious of alcohol

addiction. The prevalence of food addiction and associated eating

abnormalities,

i.e. binge eating, carbohydrate cravings, are high among individuals with

morbid obesity. With bariatric surgery, the addictive tendency for food and

aberrant eating behavior are considerably improved. However, individuals with

addictions often transfer their addiction to yet another substance, such as

alcohol. According to the findings of Austrian psychologist, Dr. beth

Ardelt,

addiction transfer may occur in as many as 25% to 30% of bariatric patients.

Drinking alcohol after surgery may also reduce maximal weight loss success.

Alcohol has no nutrient benefits and contains high numbers of calories that

may cause weight gain or prevent weight loss. One 12-ounce can of beer, for

instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5

ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and

1.5 ounces of liquer contains 160 calories.

Are there guidelines for using alcohol after surgery? Presently, there are no

official guidelines that have been established pertaining to the use of

alcohol after having bariatric surgery. However, based upon knowledge of

changes

in the absorption and metabolism of alcohol, coupled with the metabolic state

of the bariatric patient at various stages postoperatively (4), the

following suggestions are recommended

* Do NOT drink alcohol during the rapid weight loss period.

* When drinking, remember that small amounts of alcohol can cause

intoxication or can result in low blood glucose with serious consequences.

* Do not drive or operate heavy equipment after drinking alcohol, even

small amounts.

* Eat if you plan to have a drink.

* Make certain to take your bariatric vitamin and mineral supplements.

Buffington, Ph.D. Buffington, Ph.D., is the Director of

Research for The Obesity Wellness Center

References:

Klockhoff et al. Br J Clin Parmacol 54:587-91, 2002.

et al. J Forens Sci 36:376-85, 1991,

Hahn et al. Alc Alcohol 32:501-5, 1997.

Buffington CK. www.BariMD.com (A review of alcohol

absorption and metabolism in the bariatric patient), 2005.

Lieber et al. Mt Sinae J Med 67:84-94, 2000.

Lieber et al. Am J Clin Nutr 58:430-42, 1993.

Mokuda et al. l Nutr and Metabolism 48:276-280, 2004.

Guldstrand et al. Metabolism 52:900-7, 2003.