Is Weight Loss Surgery a Risk for Alcoholism?

Weight Loss Surgery and your Risk of Alcoholism

Some people who are very overweight undergo a radical surgery for weight loss. Gastric Bypass Surgery is done to either make the stomach smaller or bypass most of it all together. One of the most successful surgeries that can cure diabetes can also mean a life of misery and even death.

Why so dangerous?

An overwhelming number of people who get this type of surgery develop Alcoholism. One in Five people according to this report. I have met several people like this in my career as an Addiction Doctor. What was once an incredible feeling of losing weight and regaining their confidence in life was quickly shattered by alcohol.

Why does this happen?

Let’s look at it a little more closely.

When you get enrolled for a surgery like this you will receive counseling on diet, mental health and what to expect. The patients I have treated say that they remember the doctors mentioning briefly that they shouldn’t drink alcohol. That’s it, that is the only warning they get. They all regret not taking this warning very seriously but at the same time blame their surgical team for not emphasizing this risk.

A quick google search reveal that about 20% of people develop alcoholism after this surgery.

There are two main types of gastric bypass surgery, one in which they cut the stomach and resew it to make it smaller or they simply bypass most of the stomach, the other to constrict the opening to the stomach with a tight band wrapped around the upper part.

According to this study the latter surgery is associated with less risk of developing an alcohol use disorder.

What Causes the Alcoholism?

The first theory has to do with the drug itself. Due to the surgery more alcohol enters the person’s brain. Alcohol passes through the stomach faster therefore gets metabolized less and enters the small intestine where it is absorbed more than usual.

My one patient was an elderly lady and stated that after her surgery she would get black-out drunk off just one big glass of wine.

Does a stronger effect of the alcohol cause the addiction? Unfortunately this argument falls prey to the age old argument of how addiction develops i.e. the drug itself causes the addiction. Is it the drug or could it be something else?

“Alcohol is the Problem or the Drug is the problem.” This has been the premise to prohibition, the war on drugs and the stigma of addiction which is now generally accepted as false doctrine.

So what is a better explanation?

Another theory alludes to the person who was once obese, starts losing weight and feeling good. As a result they become more social and engage in more activities that involves alcohol. They naturally consume more alcohol in their new found social confidence and slowly become dependent and eventually alcoholic.

The next argument is closer to the truth in my opinion.

Transference of Addictions. This is based on the premise that the obese person was once using food to resolve some form of internal stress. In this case the brain learns that food is a solution to psychological stress and reinforces the behavior of engaging in food intake in response to stress. Since the effect of the food on the stress is fleeting, the person has engage in more food intake to continue masking the stress. See here for more on how Addiction works in the Brain.

Once the gastric bypass surgery has been performed, the person is greatly limited to the amount of food they can consume therefore self-treat their psychological stress. Their brain then tries to find an alternative to stress relief. The same process is initiated as the brain learns to associate alcohol with stress relief and the addiction ensues.

How to Prevent Alcoholism after a Gastric Bypass Surgery

A crucial step in the treatment for the alcohol use disorder after a gastric bypass surgery is to figure out the root cause of the addiction to food in the first place and attempt to manage or resolve this issue. The food addiction likely started during a time of stress in the past and the food became the solution to the stress.

It will be very important to get counseling on the issues that led to the food addiction in the first place.

Advice for weight loss before you get surgery

Your relationship to food will have to change.

Do you see food as a fix for stress?

How to help stop emotional eating.

Change how you see food… Yes it nourishes your body and provides energy but let me ask you this, when you eat or drink, do you normally finish your food before everyone else at the table? Do you always get a second helping? Do you eat when you feel stressed?

Try this next time: A technique called Grounding.

While you eat, consider each bite of food, as you chew, try to analyze each individual flavor. Also, try to envision where each of these flavors have come from. Believe it or not but the average meal today contains more flavor from around the world than even the greatest Kings had on their dinner table less than 100 years ago. We are very fortunate to live in a time such as this to be exposed to so many flavors from around the world. The point of this exercise is to slow down your eating, to appreciate all the work that went into your meal and to consider the fact that food is not just nourishment to your body but a tiny sample of the ingenuity of the human race. The advancement in technology alone is apparent when you look at the contents of the average grocery store. The fact that you can buy an orange out of season in your immediate area that has been transported from the other side of the world in less than a few days to preserve it is simply miraculous.

Instead of Emotional eating

Try emotional HEALTHY eating. Instead of a soda, drink water, instead of carbs eat a carrot. Try emotional exercising or meditating.

Weight loss is contingent on your calorie bank. Your bank balance depends on how much money you put in versus how much you spend. The more you put in and the less you spend the fatter your bank account. Your weight is the same, the more calories you put in and the less you expend the fatter you get.

The problem with trying to lose weight is that you have to choose discomfort. The discomfort of being hungry and the discomfort of exercise. This is the hardest part for most. If your food addiction is predicated on trying to relieve stress it will add a third component of discomfort.

The answer, if you do have to eat, eat healthy, drink a big glass of water and then it a small sugar snack. Try exercising first and if you have sweat enough you may reward yourself with a small treat.

Easy to say, hard to do, I know, but if your wish to lose weight and avoid surgery is strong enough you may be able to succeed.

List of 29 Healthy Snacks to soothe your stress.

Good luck.

Dr. Z.