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Most South Africans enjoy a life of sunshine, braai ( BBQ) and the odd tipple of our favorite alcoholic beverage.  Well ,it seems that, the odd tipple may have serious consequences for those of us that have had Bariatric Surgery.

 According to a recent American Study researchers have concluded that some people who undergo weight-loss surgery end up trading their struggle with food for one with alcohol – but perhaps not for the reason you think.

The largest prospective study to examine the connection found that 10.7% of patients who underwent a bariatric operation called roux-en-Y gastric bypass got in trouble with drinking by the second year after the surgery.  That compared with about 7% of patients who drank too much before they had the same operation, reflecting a 50% increase in relative risk.

The results, presented Monday at a meeting of the American Society for Metabolic & Bariatric Surgery in San Diego, are based on 1,945 patients, 70% of whom had the roux-en-Y operation. They are consistent with smaller studies and anecdotal reports suggesting a link between weight-loss surgery and alcohol abuse.

The earlier reports led some experts to speculate that patients were swapping one addiction for another – a phenomenon psychiatrists call addiction transfer.

But “the [new] study doesn’t support that,” Wendy King, lead author and an epidemiologist at University of Pittsburgh’s Graduate School of Public Health, tells the Health Blog.

For one thing, King says, most of the patients who didn’t have the roux-en-Y operation had a less-invasive lap band procedure, which wasn’t associated with an increase in alcohol problems after the operation. Indeed, having the roux-en-Y doubled a patient’s risk of alcohol dependence or abuse after the operation.

“If it was shifting addictions, it seems like you would expect to find it in both procedures,” King says.

For another, 16% of the patients were classified as binge eaters, an indicator of food addiction, and they weren’t any more likely than other bariatric-surgery patients to develop new alcohol problems after the procedure.

So what might account for the increased risk associated with roux-en-Y?  By shrinking the stomach and bypassing the upper portion of the small intestine, the operation changes the way people digest alcohol, King suggests.

“Alcohol spends less time in the stomach and gets absorbed in the intestine more rapidly,” King says. And “it takes longer to return to a sober state.” (The lap band makes the stomach smaller but doesn’t alter the intestinal track.)

The study, sponsored by the National Institutes of Health and also published online by the Journal of the American Medical Association, found that patients consumed less alcohol during the first year after surgery than prior to the operation.

But by the second year, patients drank more frequently than they did before surgery and consumed as much alcohol on a typical day as when they drank prior to their operations.

“It may be that the changes in alcohol sensitivity from the surgery coupled with the increase in alcohol consumption explain why we found an increase” in alcohol dependence and abuse, King says.

Interestingly, it is the same gastric bypass that other researchers believe results in the roux-en Y’s biggest benefit beyond weight loss itself:  For many such patients the procedure appears to cure diabetes or substantially improve their blood sugar levels.

King says the implications of the new study aren’t to steer people who need it away from the surgery, but to prompt clinicians and patients alike to be aware of the potential associated risks of alcohol abuse.

She noted that high-calorie consumption associated with excessive drinking can offset the weight-loss benefits of bariatric surgery and that alcohol can have deleterious effects on the liver and overall nutrition.

There’s a need to “educate patients not just on the risk of alcohol use disorders,” King says, but on how the “negative effects” of high alcohol consumption “might sabotage some of the goals of bariatric surgery.”

Bariatric Surgery Support Newsletter August 2012


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