Out of closet, drinking problem :(
Here is the text to the Medscape article in case you can't log in.
Gastric Bypass Increases Risk for New-Onset Alcohol Abuse
October 10, 2011 (Orlando, Florida) — Roux-en-Y gastric bypass (RYGB) surgery is associated with an increased risk of developing new-onset alcohol abuse, according to findings presented here from a study of 340 patients who underwent the procedure in Boston, Massachusetts.
The poster was presented at Obesity 2011: The Obesity Society's 29th Annual Scientific Meeting.
"Our data underscore the need for asking patients during their preop evaluation about their use of alcohol, and again when following up after surgery," presenter Stephanie Sogg, PhD, told Medscape Medical News. Dr. Sogg is a clinical staff psychologist at the Massachusetts General Hospital Weight Center in Boston.
Dr. Sogg said that several years ago she began hearing from patients that not only was alcohol having a far greater effect on them after surgery than before, but also that some were developing full-blown alcoholism after surgery — even if they had never had a previous problem with drinking.
And what was most intriguing, Dr. Sogg said, was that many of the people who were becoming alcoholics were middle-aged. That is long after most people begin to have alcohol-related problems. Data from the National Institute on Alcohol Abuse and Alcoholism indicate that the mean age of onset of alcohol abuse is 22 years.
"Although there's not much in the literature on the subject of alcohol abuse following Roux-en-Y surgery, there's quite a lot of discussion among weight loss specialists — anecdotal evidence — that this is a problem," she said.
To find out more about a possible link, Dr. Sogg and her colleagues conducted telephone interviews with 340 patients who had undergone RYGB surgery at Massachusetts General Hospital in Boston. All procedures had been carried out at least 18 months before the survey.
About three quarters of the patients were female, and 91% were white. Mean age at the time of surgery was 46 years, and the mean time since surgery was 57 months.
Surveyors asked patients to quantify their preoperative and postoperative alcohol intake. Patients were also asked about how alcohol affected them both before and after surgery.
"We decided to ask about quantity and frequency rather than specific symptoms of alcohol abuse," Dr. Sogg said. "That’s because we felt patients would be more comfortable reporting quantitative data rather than answering more subjective questions about their drinking."
More than two thirds of participants said they were affected more by alcohol after surgery than before, she said.
Problem drinking was defined as consuming at least 3 drinks per day on at least 4 days per week, or having 5 or more drinks on at least 2 days per month.
"We found a significant increase in risk of new-onset postsurgical alcohol abuse among these patients," Dr. Sogg said.
They defined "remote" problem drinking as problem drinking that had ceased more than 6 months before surgery. If patients were having drinking problems within the 6 months before surgery, that was defined as "immediate" problem drinking, Dr. Sogg explained.
About 21% of participants reported having drinking problems at some point before surgery. In all, 15% reported a remote history and 6.5% reported having an immediate problem.
Approximately 9% of participants reported a period of problem drinking after their surgery. Problem drinking after surgery was associated with younger age (P = .040), longer time since surgery (P = .001), and a higher baseline body mass index (P = .049).
"Drinking problems within 6 months prior to surgery strongly predicted problem drinking after surgery," Dr. Sogg said. The odds ratio was 6.59 (P = .0005).
However, a remote history of problem drinking was not associated with having drinking problems after surgery (odds ratio, 1.01; P = .99), she noted.
Of particular note, Dr. Sogg said, was that 7% of patients surveyed reported new-onset problem drinking after RYGB.
However, no clinical or demographic variables were identified as predictors of new-onset drinking problems.
"In the population as a whole about 90% of alcohol problems develop before the mid-30s," Dr. Sogg said. "The mean age of our sample was 46. So it's troubling to find how relatively common new-onset alcohol problems were in this population of patients."
Another observation Dr. Sogg said she has made over the years — but didn’t include in the present study — is how quickly drinking problems seem to progress in post-surgery patients. "Alcohol abuse is usually a gradual-onset problem, but in many of our patients who develop drinking problems, it seems to rapidly ramp up, escalating very quickly."
On the basis of her study results, Dr. Sogg said clinicians need to increase their focus on the potential of alcohol-related RYGB complications. "That means better patient education, better screening, and better efforts at prevention, both before and after surgery," she said.
"I think what this study clearly tells us is that alcohol can be a problem after surgery for some of these patients. And we especially need to watch people who had problems with drinking up to the time of surgery," said Leslie Heinberg, PhD, director of behavioral sciences at the Bariatric and Metabolic Institute, Cleveland Clinic, Ohio, in an interview with Medscape Medical News.
She emphasized, however, that patients in the study *****ported a remote history of alcohol problems before surgery were not at increased risk for postoperative drinking problems.
Dr. Heinberg, who is also associate professor at the Cleveland Clinic Lerner College of Medicine, said that in their program she and her colleagues are very careful to counsel all their patients about the physiologic changes that take place during surgery and how those changes will make patients permanently more susceptible to alcohol.
"We make sure they understand that if increased susceptibility is something that’s likely to create problems for them, they might want to reconsider having the surgery," she said.
Dr. Sogg and Dr. Heinberg have disclosed no relevant financial relationships.
Obesity 2011: The Obesity Society 29th Annual Scientific Meeting; Abstract #21-OR. Presented October 5, 2011.
This is day 2. I did drink a small amount yesterday to stop the shakes. I read on line cold Turkey can cause coma, stroke or heart attack. But nothing today. :) Heart rate at 107, down from the 135 it was yesterday though. :) BP a little high but not too bad today. So the poison is leaving me.
Strange that its hard. What the heck! But, I can do this. Thanks MM.
Dangers of Drinking Alcohol for Gastric By-Pass Patients
Alcohol can be deadly for gastric bypass patients. Recent studies suggest that people who have had a gastric bypass have problems with alcohol absorption and experience an increase in the rate of alcohol intoxication.
A group of gastric bypass patients was studied three years after surgery and exhibited increased blood alcohol levels after drinking than those who did not have the surgery. Further, the bypass patients also got drunker more quickly. The culprit? Alcohol is absorbed into the blood stream more quickly post-bypass.
During a gastric bypass, approximately ninety-five percent of the stomach and duodenum is bypassed. When alcohol is ingested, it passes directly from the stomach into the jejunum. Because the jejunum has a large surface area, the alcohol is absorbed into the system much more quickly than if had be required to first pass into the duodenum.
In addition to biological changes in the gastrointestinal track, gastric bypass surgery limits the amount of calories a patient is able to eat. As food in the stomach helps limit the rate of absorption of alcohol, this reduced diet causes quicker, and more intense, intoxication. This phenomenon is also seen in normal people who drink alcohol on an empty stomach.
Because the rate of absorption of alcohol is adversely affected after gastric bypass surgery, some post-op patients will be more susceptible to alcohol addiction than they were prior to the bypass. Mental health professionals call this phenomenon “addiction transfer." In order to reduce the chances that a gastric bypass patient will become addicted to alcohol, researchers suggest that extensive counseling should be conducted prior to surgery in order to address the underlying emotional issues that cause the patient to over eat. Successful treatment of the addictive food behaviors may stave off an addiction transfer to alcohol.
Given that most gastric bypass patients already experience addiction to food and have abnormal eating habits, there is a very real danger that, given the inability to satisfy food cravings, the patient will transfer the addictive behavior to alcohol. Studies have shown that up to one-quarter of gastric bypass patients develop alcohol addiction once unlimited ingestion of food is no longer possible.
As a consequence of this increased susceptibility to the intoxicating effects of alcohol, gastric bypass patients must be particularly vigilant when getting behind the wheel. For instance, a patient who was able to drive safely after three or four drinks pre-surgery may now be too drunk to drive after just one. This was the case for a 36-year-old woman who left a party after having only two drinks; she drove her car into oncoming traffic and killed a twelve-year-old girl. After just two drinks her blood alcohol level was much higher than a normal person of her height and weight would have experienced.
Bypass patients who drink alcohol are also at increased risk for malnutrition. Given that only a limited amount of calories can be ingested and absorbed by the body, the empty, non-nutritious calories found in alcoholic beverages take up the space that would otherwise be used by proteins and healthy carbohydrates. Patients who drink heavily often experience vitamin and mineral deficiencies.
Studies have further shown that post bypass patients can suffer brain damage, coma or death if they consume alcohol during the rapid weight loss period that follows the surgery. Although most organ muscles (heart and liver) use glucose for fuel, the brain needs it to function. The body stores sugar as glycogen, which can be depleted in a short period of time when dieting. If the stores are depleted, the body will produce sugar during ketosis. However, during ketosis, it is important that alcohol not be consumed. Since alcohol inhibits ketosis, the brain will not be able to get the fuel it needs to survive.
http://www.treatmentcenters.net/addiction/alcoholism/alcohol -dangers-gastric-bypass/
Sharyn, RN
RIP, MOM ~ 5/31/1944 - 5/11/2010
RIP, DADDY ~ 9/2/1934 - 1/25/2012
