Can I Drink Alcohol After Gastric Sleeve Surgery?

Surgeon Response to "Can I Drink Alcohol After Gastric Sleeve Surgery?"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear Pete in Los Angeles,

Alcohol use after Bariatric Surgery (WLS) is an important question that you are correct in addressing prior to undergoing the WLS procedure. Although there is no absolute prohibition against drinking alcohol after WLS, several significant issues should be considered.

First, alcohol is a liquid carbohydrate which has a very high caloric content. Consequently, with any of the standard WLS procedures, increased caloric intake of carbohydrates will blunt the desired weight loss afforded by the WLS. Furthermore, liquid calories are more likely to pass quickly from your stomach (and/or gastric pouch) and are, therefore, less likely to provide any sense of satiety which is, in part, how the WLS procedures curb your desire to eat. In general, after the initial recovery from any of the WLS procedures, avoidance of ANY liquid calories (including alcohol) is a mainstay of achieving and maintaining the desired weight loss.

Second, more than 90% of patients undergoing WLS will demonstrate abnormal liver pathology on liver biopsy at the time of the WLS procedure. Most of these biopsies demonstrate simple hepatic steatosis (fat in the liver) which can be expected to resolve as you lose weight. However, about a third of these biopsies demonstrate more significant liver injury which may not resolve with weight loss and places you at increased risk of liver failure should it progress. In fact, it’s predicted that within the next 10 years the most common cause of liver failure resulting in the need for liver transplantation in the United States will be from Non-alcoholic Fatty Liver Disease (NAFLD). Alcohol is a known hepatotoxin (liver-damaging substance) which has the potential to further damage a ‘compromised’ liver.

Third, as WLS patients rapidly lose weight, there is added ‘stress’ to the liver which has to work ‘overtime’ to keep up. As you consume fewer calories, the liver serves as the energy supplier to the body and, therefore, has to work harder. If the liver is already ‘compromised,’ consuming a known hepatotoxin while challenging the liver is a recipe for liver failure. Routinely, the toxic effects of alcohol are somewhat reduced by the simultaneous consumption of food calories, something that is less likely to occur after WLS as you deliberately are consuming fewer food calories.

Finally, the effects of the alcohol on your mental state are usually amplified after WLS, likely due both to your lower body mass as you are losing/have lost excess weight as well as the lower simultaneous consumption of food calories. The metabolism of the ingested alcohol may also be altered should you undergo either a Roux-en-Y Gastric Bypass (RNY) or a Duodenal Switch (DS) due to the fact that with these two WLS procedures the ingested alcohol no longer travels through the initial part of the small intestine, unlike with the Verticle Sleeve Gastrectomy (VSG) and the Adjustable Gastric Band (“Lap- Band” and “Realize Band”) procedures where there isn’t an alteration of the small intestinal anatomy. WLS patients routinely report feeling much more susceptible to the central nervous system (CNS) effects of alcohol (‘cheap date’ syndrome.) Also, due consideration is the potential issue of “addiction transfer” (abuse of one substance or activity in excess in lieu of another formerly abused substance or activity no longer being abused) sometimes implicated in the excessive use of alcohol post WLS.

In conclusion, there is no scientific evidence that one WLS procedure would be better than another in terms of alcohol use post WLS. Alcohol can be used judiciously in moderation after WLS recognizing the changes in your body from the WLS and the risks involved: risks to your goal of weight loss and weight loss maintenance, the health of your liver, and to your mental status/behavior while subjected to the effects of the alcohol.

Best regards,
John Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:

• Gastric Sleeve Diet - Pre-op, Post-op, & Long-term
• Life After Bariatric Surgery - All You Need to Know

Surgeon Response to "Burning sensation after tequila with gastric sleeve"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear Mary,

The burning sensation that you experienced after drinking a shot of Tequila may be a manifestation of 'dumping' which some patients experience after the Roux-en-Y Gastric Bypass (RGB) procedure. When nutrients, most commonly simple carbohydrates but also complex carbohydrates (including alcohol) and fats, pass from the gastric pouch into the small intestine unobstructed/uncontrolled (ie: pyloric valve no longer in continuity with the food stream) many patients experience abnormal hormonal release that elicits many deleterious symptoms ranging from mild abdominal discomfort to frank syncope (fainting.)

One risk of the RGB is ulceration of the gastric-intestinal anastomosis. This can lead to bleeding and/or perforation if it is severe. For this reason, patients who have had an RGB shouldn't use aspirin, NSAIDS (such as ibuprofen, etc.) or any other medications or substances that are 'ulceregenic' (prone to ulcer formation.) Alcohol may be included in this group of substances. Furthermore, as previously outlined, alcohol use after Weight Loss Surgery (WLS) has myriad other potential adverse effects that should be carefully considered before resuming alcohol use after WLS.

In your situation, after suffering such a complicated course after a Verticle Sleeve Gastrectomy (VSG) staple line leak necessitating conversion to an RGB, I recommend that you adhere to a very careful dietary regimen including minimal distilled alcohol use.

Best regards,

John M. Rabkin
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:

• Gastric Sleeve Complications & Side Effects - The 5 Most Common Issues
• Gastric Sleeve Revision Surgery - All You Need to Know

Surgeon Response to "Mother Drinking Beer After Bariatric Surgery"

by: Dr. Vafa Shayani

Dear Dan:

Thank you for your communication.

What you are describing is unfortunately very common among bariatric patients who suffer from substance abuse disorder: replacing one substance for another. Your mother, for most of her life, abused food (not necessarily intentionally). When she was no longer able to do that, she turned to alcohol as a replacement. The most important step for your mother's well-being is long-term mental health intervention to address her substance abuse tendencies.

In the mean time, if indeed she underwent placement of an implantable device for weight loss, it is very easy to remove the device and eliminate that variable from the picture. And if that device happens to be an adjustable gastric band (became available in the United States in June of 2001), then she doesn't necessarily need an operation; she simply needs to have the band emptied so she no longer feels food-deprived.

Dr. Vafa Shayani
Bariatric Institute of Greater Chicago

(click here for Dr. Shayani's full bio & contact info)

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DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:

• Lap Band Removal - All You Need to Know
• Lap Band Revision Surgery: Your 4 Options