Alcohol & RNY

Whew! Big question! Let me see if I can clear the water a little.

OK let’s start with your "new stomach"

It has been a long held belief that the stomach is responsible for alcohol absorption. Our bodies are well adapted to alcohol metabolism. Alcohol is absorbed through the mucosa (lining) of the entire GI tract. In studies looking at location of absorption of alcohol, usually the stomach is responsible for 10-20% of the absorption of whatever alcohol is consumed. The intestine absorbs the rest. The intestines connect directly to a blood stream network that travels to the liver (portal circulation). Now, if your stomach is full of food, the alcohol absorption can be slowed slightly. With restrictive procedures such as RNY, a full stomach is much smaller – and a person will probably sip their alcoholic drink to keep from getting uncomfortable.

As far as your "new stomach" having enough enzyme to break down the alcohol – most body tissues contain the enzyme to break down alcohol. Your stomach usually doesn’t have to bother because the alcohol isn’t there long enough for it to be troubled with metabolism – the liver does the job.

The bottom line: your stomach is a site of some absorption of alcohol, but only minimally does the stomach metabolize alcohol.

Now on to your liver: The metabolic pathway of alcohol does not result in formaldehyde production, it results in acetylaldehyde formation. The names may sound familiar, but these are very different chemicals! I could go into the specifics of the metabolic pathway (but you aren’t here for a chemistry lesson, are you?) but suffice it to say that your liver requires the nutrients Zinc, B-1, and Vit C to turn alcohol into energy, carbon dioxide and water. Note that these 3 nutrients are commonly malabsorbed with WLS. Here’s some of the danger with alcohol – if you don’t have enough of the nutrients needed for alcohol metabolism, you can have a build-up of acetylaldehyde, which is a potent "oxidant" and can cause tissue damage in your body.

I would also point out that many obese or formerly obese people have a condition known as "fatty liver". This is a chronic condition, though your body can repair some of the damage over time. Any time your liver is damaged – from injury, fatty infiltrates, hepatitis, or other causes, your metabolism of certain things can be impaired. This is another reason why alcohol is discouraged with WLS. People don’t come with a label that tells us all of the things going on inside your body. If you have liver disease, your liver can be 90% destroyed before you start to show significant clinical symptoms. The liver is an amazing organ, with 400+ functions – when it’s gone, you’re dead! Medical professionals tend to over-do it a little when it comes to this organ, because it is so vital for your life.

Now what about the occasional drink: I’m not going to follow people around & tell them what to do. I’ll give you a few facts to help you make your own decision. The main enzyme for alcohol metabolism is called "alcohol dehydrogenase" or ADH for short. This enzyme requires zinc to be produced by your body. Different people produce this enzyme in different quantities. Its production is affected by age, gender (men have more), and race. If you drink in excess of the amount of enzyme that you have, your body will rush to make more. In the meantime, the alcohol that is un-metabolized can injure tissue and generally wreck havoc on your body. Perhaps this is why people get a wicked headache/hangover when they over-drink? So word for the wise – if you don’t drink regularly, you will be more likely to have the negative effects of alcohol when you do.

2 sips – I don’t know. You are welcome to be your own test subject!

Let me know if this clears things up!