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Bariatric surgery and alcohol

Surgery may increase sensitivity to and absorption of alcohol

After consuming an alcoholic beverage that was equivalent to having two standard drinks, women who had gastric bypass or sleeve gastrectomy surgery experienced blood alcohol-concentration peaks sooner and about twice as high

Both Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) may dramatically change patients' sensitivity to and absorption of alcohol, according to researchers at the University of Illinois at Urbana-Champaign. They reported that some women's sensitivity to alcohol increased so much after bariatric surgery that the amount they could consume before feeling the effects was reduced by half, compared with their pre-surgery drinking habits.

After consuming an alcoholic beverage that was equivalent to having two standard drinks, women who had gastric bypass or sleeve gastrectomy surgery experienced blood alcohol-concentration peaks sooner and about twice as high - 50% above the 0.08% blood alcohol content that is the legal threshold for drunk driving in many US states, compared with gastric band patients. The findings were in line with previous studies that showed Roux-en-Y gastric bypass and sleeve gastrectomy cause a twofold increase in peak blood alcohol levels.

M Yanina Pepino (left) and Maria Belen Acevedo (Credit: L Brian Stauffer)

"About a third of women in the study felt almost no sedative effects, even when they reached peak blood alcohol concentrations that were comparable to those of women in the general population consuming four standard drinks," said Dr M Yanina Pepino, a professor of food science and human nutrition who led the study. "People who have not had bariatric surgery and are less sensitive to the sedative or impairing effects of alcohol, and those who are more sensitive to its stimulant effects, are generally at greater risks for developing alcohol problems, even decades later."

The study, ‘Alcohol sensitivity in women after undergoing bariatric surgery: a cross-sectional study’, published in the Surgery for Obesity and Related Diseases journal, assessed whether the alcohol sensitivity questionnaire (ASQ), a simple self-report measure, could pinpoint reduced alcohol sensitivity in the bariatric population.

Women who had RYGB (n=16), SG (n = 28) or laparoscopic adjustable gastric banding surgery (n=11) within the last five years completed the ASQ for both pre- and post-surgical timeframes, and 45 of them participated in oral alcohol challenge testing post-surgery. The researchers recorded blood alcohol concentration (BAC) and subjective stimulation and sedation were also measured before and for 3.5 hours after drinking.

The smell and flavour of the alcohol was masked so that participants could not tell if the drink contained it on their first sip. Before drinking either beverage and at several time points afterward, the participants completed surveys about any effects they were feeling, while the researchers collected multiple blood samples.

In line with faster and higher peak BACs after RYGB and SG than laparoscopic adjustable gastric banding surgery (p<0.001), post-surgery ASQ scores were more reduced from pre-surgery scores after RYGB/SG than after laparoscopic adjustable gastric banding surgery (−2.3±0.3 versus −1.2±0.2; p<0.05). However, despite the dramatic changes in BAC observed when ingesting alcohol after RYGB/SG surgeries, which resulted in peak BAC that were approximately 50% above the legal driving limit, a third of these women felt almost no alcohol-related sedative effects.

"These and other effects such as feeling sedated can be signals to stop drinking, and being insensitive to them increases one's chances of consuming greater amounts of alcohol and the risk for an alcohol-use disorder," said Dr Maria Belen Acevedo, a postdoctoral research associate at the U of I and the study's first author.

Screening post-bariatric surgery patients with the Alcohol Sensitivity Questionnaire could help identify people who might be at increased risk of alcohol problems after the surgery and enable clinicians to deliver more effective prevention programs for these patients, according to the researchers. The findings may help shed light on why postoperative gastric bypass and sleeve gastrectomy patients may be at increased risks of developing alcohol problems after having weight-loss surgery.

The study was supported by grants from the National Institutes of Health and the U.S. Department of Agriculture National Institute of Food and Agriculture's Hatch Project.

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