Weight Loss Surgery May Increase Alcoholism
June 19, 2012

Weight Loss Surgery May Increase Alcoholism

Connie K. Ho for redOrbit.com

A recent study by the National Institutes of Health (NIH) has found that adults who underwent common bariatric surgery to lose weight had a higher risk of developing alcohol use disorder (AUD) two years after having the surgery.

With 1,945 participants in the study, researchers looked at alcohol consumption and alcohol disorder systems from the Longitudinal Assessment of bariatric Surgery (LABS). LABS, a NIH-funded project, examined patients who had weight-loss surgery at one of 10 hospitals throughout the U.S. Study participants completed the Alcohol Use Disorders Identification (AUDIT) test approximately 30 days after the surgery as well as one and two years after the surgery. The test was created by the World Health Organization and aimed to identify symptoms of alcohol use disorder, otherwise known as alcoholism. Symptoms of the disorder include alcohol use and dependence.

"Given a standardized quantity of alcohol, patients reach a higher peak alcohol level [in the bloodstream] after surgery compared with case-controls or their pre-operative levels," the group of researchers wrote in the report.

If the patients demonstrated at least one symptom of alcohol dependence or had a total AUDIT score of 8 out of 40, they would be categorized as having AUD. Around 70 percent of the study participants had Roux-en-Y (RYGB) gastric bypass surgery that could reduce the size of the stomach, shorten the intestine, as well as limit food intake and body consumption of calories. Another 25 percent of patients had laparoscopic adjustable gastric banding surgery that could make the stomach smaller with an adjustable band. Lastly, 5 percent of the patients had other, but less commonly known weight-loss surgeries.

7 percent of those who underwent the RYGB procedure reported symptoms of alcohol use disorder before having the surgery. One year after the surgery, there was no major increase in AUD. However, two years after having surgery, 10.7 percent of patients stated that they had symptoms of AUD; this was an increase of over 50 percent as compared to the pre-surgical rate. As such, one in eight LABS study participants reported that, after the weight loss surgery, they had a minimum of three drinks per day the second year after having the surgery. Even though having AUD before the surgery is a strong predictor of having it after the surgery, many of the participants reported that they did not have the illness before the surgery.

"This is concerning, given the negative impact heavy drinking may have on vitamin and mineral status, liver function and weight loss," commented lead author Dr. Wendy King, an assistant professor in the Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health, in a prepared statement.

There were other factors involved as well. For those patients who had less social support or who reported recreational drug use and smoking before the surgery, they were more likely to show symptoms of AUD after the surgery. As well, men and younger adults also had a higher change of developing AUD. Binge eating, depressive symptoms and mental health treatment were also not independently related to an increased rate of AUD after surgery.

"The study results suggest that clinicians should be aware of the importance of monitoring for signs and symptoms of AUD and consider counseling after bariatric surgery," remarked Dr. Mary Horlick, project scientist for LABS at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), in the statement.

The results from past studies also show that bariatric surgery could possibly increase the change of alcohol use disorders in a small, retrospective way.

"This first prospective study of AUD symptoms before and after surgery was done in a large number of people from 10 hospitals across the United States, using a validated and reliable alcohol use screening method," continued Horlick.

Some physicians believe that, as a result of the bypass surgeries, alcohol is metabolized in a different way.

"I tell people they should absolutely not drink alcohol at all if they have the gastric bypass," Dr. Robin Blackstone, president of the American Society for Metabolic & Bariatric Surgery who reviewed the study for WebMD, recommended specifically about the Roux-en-Y procedure.

Overall, the research is valuable and gives new insights into the effects of the weight-loss surgeries.

"It not only confirms the fact that there are some people affected by this alcohol sensitivity, but it also tells us who those people are who are most at risk," concluded Blackstone in the WebMD article.

The study´s results were included in the website of the Journal of the American Medical Association recently. They were presented at the American Society for Metabolic and Bariatric Surgery. They highlight the increasing popularity of bariatric surgery to treat obesity. Currently, more than one-third of U.S. adults are obese, identified as having a body mass index (BMI) of 30 or higher, and around six percent are very obese, identified as having a BMI of 40 or more; BMI looks at weight in regards to height.

"These findings show that there is much more to learn about bariatric surgery and how it influences a patient's health and well-being,” noted NIDDK Director Dr. Griffin P. Rodgers in the statement. "It is important that patients and their doctors be fully aware of short- and long-term benefits and risks of bariatric surgery. We hope the LABS results will help researchers identify clinical questions that require further research, including better understanding of the risk of AUD."