Alcohol Use in the Bariatric Patient

Cynthia Buffington, Ph.D.

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Excessive alcohol intake resulting in inebriation could lower sexual inhibitions and impair good judgment, increasing the risk for pregnancy and sexually transmitted disease.  Gastric bypass may not only cause emotional and hormonal changes that raise sexual desires but also increases the risk of inebriation when drinking alcohol. 

Even years after surgery, the gastric bypass patient has higher blood alcohol levels after consuming an alcoholic beverage than does someone who has not had the surgery.   This is because the procedure bypasses most of the stomach (where some alcohol is normally broken down) and the first part of the gut.  Alcohol consumed rapidly passes through the stomach pouch and dumps directly into the portion of the gut (jejunum) that has the largest surface area available for absorption. 

The heightened absorption of alcohol increases the risk of intoxication, which could have serious ramifications when operating an automobile, performing a skilled task, or using clear judgment in making decisions, including the decision to engage in sex.

During the early postoperative period or any time while on a protein-only diet, use of alcohol may have far more detrimental consequences than intoxication, including memory loss, brain damage, coma and even death.  How is this possible?

The brain and nervous tissue require sugar as fuel to function.  To avoid low levels, the body stores sugar in the form of glycogen.  However, glycogen stores can be depleted in a short period of time with starvation or when consuming a diet low in carbohydrate.  When sugar supply declines, the body has two back-up mechanisms that help to provide the brain and nervous system the fuel required to function.

One of these mechanisms involves a chemical pathway that produces sugar, a process known as gluconeogenesis.  With a protein-only diet, energy needed to run this pathway is supplied by incomplete breakdown of fat into ketones, a process known as ketosis.  Ketones can be used by all tissue (including the brain) for fuel, and can also be converted into sugar by gluconeogenesis. 

The production of ketones is what causes the sweet or distinct smell in the urine and on the breath during the rapid weight loss period following gastric bypass.  And, during this period, it is extremely important that alcohol NOT be consumed.  Why?

Alcohol inhibits ketosis and, thereby, gluconeogenesis.   This means the brain and nerves are depleted of the fuel needed to function.  The effects of fuel depletion include disorientation, confusion, semi-consciousness, coma and even death.  Drinking alcohol after surgery, therefore, could have far more serious consequences than a loss of sexual inhibition.

Based on this information, should the gastric bypass patient totally refrain from drinking alcohol?  Alcohol should NOT be consumed during the rapid weight loss period or while on an all-protein diet.  After this time, however, there is no reason an occasional drink should not be enjoyed, provided the consumer is aware that a small amount of alcohol can produce an inebriating effect and, having such knowledge, takes the appropriate steps to assure their safety, including having available protection in the event of heightened sexual desire.