“One in five patients who undergo Roux-en-Y gastric bypass (RYGB) are likely to develop problems with alcohol”.  Fascinating evidence coming out of one of the largest, longest-running studies of adults who have undergone bariatric surgery in the States.

Although weight loss surgery is an effective management tool for obesity, it requires major lifestyle change which patients may be inadequately prepared for. When we look at the studies in a bit more detail, we can see that it is primarily patients who have undergone the Roux-en-Y gastric bypass who experience an increase in alcohol frequency and alcohol use disorders 2 years post-surgery.

 

This is thought to be the result of a phenomenon known as “symptom substitution”. The successful elimination of one symptom without treating the underlying cause which will result in the appearance of a substitute symptom. Symptom substitution theory would predict an increase in alcohol intake as the result of the elimination of excessive eating without addressing the underlying reasons for over eating. Interestingly, studies have shown that drugs, alcohol and food all trigger similar responses by the brain.

 

Following surgery, patients are advised to refrain from alcohol for reasons associated with excessive energy intake and changes in the metabolism of alcohol when consumed. Patients are often compliant with these recommendations immediately following surgery however less so the further away from their surgery date they become. We know that patients become intoxicated far more quickly with a smaller amount of alcohol following bypass surgery and take longer to return to sobriety than before surgery.

 

 

Do these patients drink more as they have a reduced tolerance for alcohol after bypass surgery? Do they drink so they can experience the effects of alcohol use sooner and more frequently? I’m not sure we have the answers yet, but it’s certainly a space we need to keep our eyes on.