New research released this week from University of Pittsburgh Graduate School of Public Health is showing that people who have undergone the increasingly popular gastric bypass surgery appear to be at an increased risk of developing alcohol disorders, abuse and dependence, better known as alcoholism.
The findings of Wendy King, Ph.D., assistant professor in GSPH’s Department of Epidemiology, and her colleagues are published in Journal of the American Medical Association and are the first to find a clear link between Roux-en-Y gastric bypass (RYGB) surgery and symptoms of alcohol abuse.
The information is important and useful because it presents the possibility of both better screening patients before surgery, while providing more complete aftercare and counseling.
Alerting the patients to the problem should also give them time to consider other options, as well as help them avoid future issues should they go ahead with the procedure.
Dr. King who presented the results Monday at the American Society for Metabolic & Bariatric Surgery’s annual meeting in San Diego, continues:
“Patients should be educated about the potential effect of bariatric surgery, in particular RYGB surgery, to increase the risk of alcohol use disorders … Alcohol screening should be included in routine pre- and post-operative care.”
Dr. King and her colleagues looked at nearly 2,000 patients across 10 different hospitals in the United States, asking them to complete the Alcohol Use Disorders Identification Test 30 days before surgery, as well as one and two years after the surgery. The questionnaire was developed by the World Health Organization to better identify symptoms of possible alcohol abuse.
Nearly three quarters of the patients had RYGB surgery, that reduces the size of the stomach and shortens the intestines to both limit food intake and reduce the body’s ability to digest the calories consumed. Another 25 percent had laparoscopic adjustable gastric banding. This is a different procedure to RYGB using an adjustable band around the patient’s stomach, mechanically reducing the amount of food the stomach can hold. The other 5 percent of patients had one of three different less-popular weight-loss surgeries.
Some 7 percent of subjects reported symptoms related to alcohol abuse prior to surgery. This number seems somewhat low when compared to general statistics relating to alcohol abuse, a 2007 study published in the Archives of General Psychiatry pegged nearly 30% of subjects in a study of nearly 45,000 people has showing signs of abuse. None the less, Dr. King’s figures are important because although there was a reduction in alcohol symptoms during the first year, the number increased by more than 50% to 10.7% in the second year.
Dr. King concludes:
“Among RYGB patients, there was a significant decrease in alcohol consumption in the first year after surgery, compared to the year before surgery, but not in the second year. Thus, the increase in alcohol use disorder symptoms following RYGB surgery was likely a result of an increase in alcohol sensitivity following surgery combined with resumption of higher levels of alcohol consumption in the second post-operative year … This is concerning, given the negative impact heavy drinking may have on vitamin and mineral status, liver function and weight loss.”
Gastric banding did not appear to increase alcohol problems, but King’s study had one in eight participants drinking three or more drinks per day in the second post operative year. The safe level for alcohol consumption in people who have undergone RYGB has not been established, but studies have shown that in general RYGB patients feel more intoxicated for longer, after drinking less.
King’s report goes on to identify possible markers for people who will have a tendency to experience alcohol problems after the surgery, including:
- A lower sense of interpersonal support (i.e., having people to do things with)
- Recreational drug use
- Consumption of alcohol at least two times per week
- Prior alcohol use disorders
It is known from previous surveys that men and younger adults are in general more likely to develop alcohol problems and Dr. King’s work showed the same findings held true in association with RYGB. Surprisingly, more than half the patients who had symptoms of alcohol problems in the second year post surgery, did not show signs prior to surgery. Dr. King’s report found that depressive symptoms, mental health and binge eating were not independently related to post operative alcohol disorders.
Despite a small negative finding in relation to alcohol, bariatric surgery remains the best treatment for achieving substantial weight loss in obese patients. Losing weight has been shown to reverse risk factors for heart disease and in some cases reverse type II diabetes. It is therefore an important treatment and Dr. King’s work serves as a useful guidance to doctors, patients and surgeons who can better consider the risk factors and counsel their patients accordingly.
Written by Rupert Shepherd