Gastric Bypass Surgery

     A 36-year old female gastric bypass patient left a party after having only two alcoholic beverages, drove her car into oncoming traffic, causing the death of a 12-year old child. Her blood alcohol level was above the legal limit for the operation of a motor vehicle and was far higher than would have been expected from the two alcoholic beverages she claimed to have consumed. Was the patient telling the truth about the amount of alcohol she drank at the party or did her surgery affect the way her body absorbed or metabolized the alcohol?

     A recent study reported in the British Journal of Clinical Pharmacology found that the gastric bypass procedure significantly affects alcohol absorption and its inebriating influence. According to the study protocol, a group of gastric bypass patients, three years post-surgery, and their non-surgical controls consumed an alcoholic drink containing 20% v/v alcohol (95% ethanol), and blood alcohol levels were examined over a period of time. The data showed that blood alcohol levels of the gastric bypass patients were far higher and required much less time to peak than those of the non-surgical controls.

     The more rapid absorption of alcohol and heightened blood alcohol levels would cause the bariatric patient to have a more pronounced feeling of inebriation during and shortly after drinking. And, such effects could have serious ramifications with regard to driving an automobile or performing other skilled tasks such as operating heavy machinery, piloting a plane or any other task that may influence the safety of the individual or that of others.

     Why would alcohol absorption be higher for someone who has had gastric bypass (or any other surgical procedure that reduces the size of the stomach and bypasses the upper portion of the gut)? With the gastric bypass procedure, 95% of the stomach and the upper gut (duodenum and a portion of the jejunum) are bypassed. Alcohol passes directly from the stomach pouch, usually without restriction, into the second portion of the gut, known as the jejunum. This portion of the gut has a large surface area and readily and rapidly absorbs the alcohol.

     In addition to anatomical changes in the GI tract that influence alcohol absorption, the gastric bypass patient (or any bariatric patient) may also be more sensitive to the intoxicating effects of alcohol because of the reduced calorie intake that occurs after surgery. A number of studies have found that alcohol absorption is far higher if fasting or when consumed on an empty stomach than if provided with a meal or drank soon thereafter.

     During the first several months following gastric bypass or any other bariatric surgical procedure, total daily calorie intake is quite low. Drinking alcohol, even small amounts, at this time, would increase significantly an individuals risk for intoxication.

     In the rapid weight loss period following bariatric surgery, alcohol consumption could have far more serious consequences than inebriation, namely brain damage, coma and death. How is this possible?

     Muscle, heart, liver and other tissues use fat and sugar (glucose) for fuel. The brain, however, requires sugar (glucose) to function. To avoid low sugar, the body stores sugar in the form of glycogen. However, glycogen stores can be depleted in a short period of time with prolonged work or exercise, starvation or a diet low in carbohydrate. When this happens, the body has two back-ups mechanisms that help to provide the brain and nervous system the sugar required to function.

     One of the mechanisms whereby sugar is produced is a process called gluconeogenesis, a chemical pathway that converts certain components of protein, lactic acid and other substances into sugar. Fat cannot be converted into sugar. However, the production of sugar by gluconeogenesis is run by energy produced by the incomplete breakdown of fat into ketone bodies via a process known as ketosis.

     Ketone bodies can be used by all tissues, including the brain, for fuel. And, ketones can also be converted into sugar via gluconeogenesis. In this way, the brain and nervous system can function normally, even during times of low calorie intake, such as during the rapid weight loss period following bariatric surgery.

     The production of ketones is what causes the sweet or distinct smell in the urine and on the breaths of bariatric patients during the rapid weight loss period after surgery. And, during this time, it is extremely important that alcohol NOT be consumed. Why?

     Alcohol inhibits gluconeogenesis and ketosis. This means the brain and nerves are depleted of the fuel needed to function. The consequences of such fuel depletion initially are disorientation, confusion, semi-consciousness, coma and, ultimately, death. The detrimental effects of alcohol on the brains fuel supply can also cause accidents, such as the hypothetical situation described below.

     A bariatric patient, four weeks after surgery, had a couple of drinks and drove to the post office. But, instead of walking into the post office to get her mail, she drove her car through the front window. She claimed to have “blacked out” before the accident and had no memory of the event. People standing by said she was disoriented and, presumably, intoxicated. Fortunately, someone provided her a beverage containing sugar that helped her to regain full consciousness, preventing coma or even death, as well as an evening in jail.

     Drinking alcohol in the early postoperative period may have other adverse effects on health. Frequent vomiting, low calorie intake, not taking multivitamins and malabsorption may cause a number of vitamin and mineral deficits, including thiamin. Alcohol further reduces the absorption of thiamin, causing severe deficits and a condition known as Beriberi (see May 2003 issue of Beyond Change). Beriberi, in turn, may cause congestive heart failure, nerve damage, muscle cramping and pain, crippling, brain damage, a loss of memory and inability to learn, confusion, disorientation, coma and death.

     Addiction transfer is yet another precaution to be considered with regard to alcohol. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity. With bariatric surgery, the addictive tendencies for food and aberrant eating behavior are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of one study, addiction transfer may occur in up to 25% of bariatric patients.

     Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. One 12-ounce can of beer, for instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5 ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and 1.5 ounces of liquer contains 160 calories.

     Based on all the information provided above, should the bariatric patient abstain from alcohol totally? The bariatric patient should absolutely NOT drink alcohol during the rapid weight loss period and definitely not if consuming no or low carbohydrates, not taking vitamin and mineral supplements, vomiting frequently, or not able to keep their food down. However, with time, there is no reason an individual should not be able to enjoy an occasional drink, provided they are aware that it only takes a small amount of alcohol to produce an inebriating effect. With such knowledge, appropriate precautions should be taken, such as waiting a sufficient length of time after drinking to drive or perform other skilled tasks.

Written by Allen Trapp who is board certified by the National College for DUI Defense and the author of Georgia DUI Survival Guide Visit Website

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18 Responses to “Gastric Bypass Surgery”

  1. I had gastric bypass (Roux-n-Y) November, 2004. I started to social drink wine and sometimes a Cosmo a few times a week (in the past 3 months). I noticed the drink(s) definately went to my head very quickly. That is why I did this research. I find it interesting, that a patient could transfer an addiction (food to alcohol). I try to limit my carbs in my diet. I still take my multiple vitamin and calcium tablet daily. However I will be aware of the problem of sugar needed for the brain; as well as monitoring my intake of alcoholic beverages closer.

  2. Thanks Allen & Rob. Great article!

  3. Debbie Andresky Says:

    Very interesting article. I had my surgery in October 2001 and had always been a social drinker my entire life. I did so much research before hand, I was totally scared to death throughout the first two years after to even think about having a drink. As time has passed I find myself wanting to be a social drinker again but because it “hits me” so fast now and even at times I have blacked out, I now am doing research to see if I am an alcoholic. This makes me wonder if I have indeed transferred the addiction of food to alcohol. I am now limiting myself to drinking nonalcoholic wine which usually satisfies my desire for the taste and does not cause the negative effects I want to avoid. I never had the desire for sweets, I prefer salt. I guess I will keep the sugar info in my mind in the future.

  4. My sister had a gastric bypass about 7 years ago, she was not given any information regarding the changes her body would go through and has suffered for many years with health problems including dental problems. Last Year in November she had excruiciating pain from her teeth while going through a root canal and tried using over the counter medications and gums which did not help so she tried to self medicate by swishing tequila in her mouth and drinking the shot of tequila 1800. She later went shopping and then proceeded to get on the freeway at an intersection that had no sinage to prevent her from turning left and when she turned left, a man doing a wheelie came out of nowhere and they collided, he later died of his injuries and my sister volunteered her blood, wasn’t read her rights, and later booked for felony dui manslaughter. Her breath test read .16 and .15 then the blood test which was given hours later read .19. When her trial came to court the judge DENIED her the right to talk about her having a gastric bypass and she was found guilty! In the sentencing she was told by the judge that she finds it very hard to believe that she only had 1 drink because she had to have had atleast 9-11 drinks per the expert and since my sister has not come to terms with her having drank so much and that she feels that she’s unremorseful that she sentenced her to 2 years in prison!

    My sister has never even had a speeding ticket let alone hurt anyone! I feel that there isn’t enough documented literature for gastric patients about their bodies. I feel that my sister was given a very harsh sentence for a first time offender and that her civil rights were violated. All she’s ever wanted was to fit in and feel like she existed, she was 385 lbs and weighs now 145. If anyone has proof that could help overturn her conviction we’re tyring to appeal, they say by the time the appeal process is initiated she’ll most likely be out of prison! But with documented proof, maybe she’ll get her life back and clear her name for this horrible accident! The judge also refused to allow into the trial that fact that the man she hit was high on marijuana per his toxicology report, had no license to drive a motorcycle, nor did he have auto insurance. She was also ordered to pay $17K restitution!

  5. I am a 50 yr old male 9 months out of a gastric bypass surgery and weighing appx 240 lbs. I have been drinking socially for the past 2 months. I recently went through a roadblock and blew a .095 after one drink, resulting in a DUI. My first offense ever. I question the accuracy of the breathalizer test on gastric bypass patients. Any comments to help me research this topic would be appreciated. Local attorneys don’t have a clue and show no desire to be educated with research.

  6. I RECENTLY WAS ARRESSTED FOR A DUI BECAUSE OF A BREATH RESULT OF .06 WHICH THE LEGAL LIMIT IS .08 BUT WAS WONDERING IF ANYONE HAS ANY CASES WHERE THEY WERE DISMISSED DUE TO GASTRIC BYPASS SURGEY?

  7. I drank a few beers and had a brain wave come over me to take a handfull of pills. Just on a whim my life almost ended because booze goes right to my head because of my gastric bypass surgery. I started drinking vodka and orange juice instead of eating after 6 months and became addicted to alcohol, then quit it but periodically get the desire to have it and this is what it can do

  8. I also came am fighting my first DUI, I was told to do some research on this..I didn’t blow even though I had 2 drinks. IS there any good info that I can print out to help my case…

  9. Hi,
    I just got a DUI I had 1 shot and blew a .19, I know it was my gastric bypass that made my levels higher.ANyone out there know of anybody that has been able to prove this in court? and win?
    Let me know

  10. I had gastric bypass 4 years ago. Just recently left a party where I had 4 drinks in 5 hours. Was stopped and processed for DUI .18 was my BAC! I don’t understand how this could be so high! I am certainly within the legal limit with my weight and the 5 hours. Obviously gastric bypass plays a big part in this reading. I have never been stopped in my 23 years of driving, for anything! The states attorneys first “deal” was way beyond what any other first timer gets, obviously due to the high BAC. They of course believe I must “need help” because no normal person would think of driving after so much alcohol. I have not broached the subject of gastric bypass yet. But have told my laywer, who also doesn’t seem to even want to pursue that avenue. At the very least, I believe my “sentence” should be much less because I am not, nor have never been, an irresponsible person and would never “intend” to drive with such a high level of alcohol in me. Anyone with suggestions out there would be helpful…Someone out there must be pursuing the BAC testing for gastric bypass….

  11. Hi there. I jut want to share my experience in this particular site. Its related in gastric bypass surgery. This gives a full and great details about weight loss. It is a report made by Julianne Kennedy. Her site is: http://www.weight-loss-surgery-secrets.com/controversial/free_wls_report.htm

  12. What this says is that people who have had gastric bypass surgery get intoxicated faster and stay intoxicated longer. I think some folks think that this makes them less succeptible to a DUI, because they are less blameworthy. Perhaps that is true at sentencing, but that would be wrong. People who are impaired by presription drugs prescribed by their doctors and who are taking the prescription drugs as they were told by their doctors get DUIs all the time. The fact that they were taking their prescription drugs properly means nothing (at least in the guilt phase). So just because people with Gastric Bypass surgery get drunk faster and stay drunk longer does not help regarding whether someone is guilty of a DUI or not. What it does mean is that people who have the surgery need to not drink as much and wait much longer before driving.

  13. heartlandrose Says:

    Or is this a possibility of gut fermentation (dysbiosis) of which this person new nothing about? This is happening across the country and people do not know how to defend against this craziness! Doctors love to cut away at the colon and not really treat what is truly going on. Gut fermentation needs to be screened at the time of the DUI arrest. For some reason DOT seems to think they are really getting a justified arrest by doing this. Furthermore, most people even the ones on medication should be evaluated at the time of the accident for there lack in metabolizing alcohol! This is discusting. The reason I say this is because dysbiosis nearly shuts down your metabolism unknowingly! The US government is trying there damndest to keep people from getting this to go through! They are covering it all up! It is a very hard thing to defend against in the court! This is a case of guilt by innocence according to the law. Now, isn’t DUI suppose to be about the intent of the individual and knowing that they had too much to drink. My son had the same thing happen when he was tested 5 hours later and he had a high blood alcohol level due to dysbiosis. You tell me that this is normal!!!!!!!!!!!!!!!

  14. heartlandrose Says:

    Too add to this dysbiosis thing further, over use of antibiotics contributes to this greatly. This is what has happened to my son. Because of his heart condition he has to take antibiotics every time he gets touched in his mouth or any blood will be worked with. Another factor to look at is mercury poisoning in the body or at least heavy metals. I seen the remark about the dental pain. This person obsviously has some major things going on in there body and I truly believe what she says to be true. There is innocent people getting arrested for this reason all the time. We need to find an attorney that can help with this matter.

  15. heartlandrose Says:

    Is this really due to what they cut away or is it possibly due to the overuse of antibiotics? What if there is an infection at the time of the accident? Isn’t OWI due to intent? What if you did not know this was going on in your body due to the dysbiosis in your colon? My guess is there is some more health issues. People do not understand that one person can metabolize way more than someone that is not aware that they may have a medical condition in there body that can possibly cause them to constantly carry a blood alcohol level even though they do not drink at all. The court system does not care!!! They just call you a lier. They are putting inocent people all the time. This is what my son is in the middle of right now. We need to get these people together and change some laws that these people get screened when they have accidents!

  16. heartlandrose Says:

    Is this really due to what they cut away or is it possibly due to the overuse of antibiotics? What if there is an infection at the time of the accident? Isn’t OWI due to intent? What if you did not know this was going on in your body due to the dysbiosis in your colon? My guess is there is some more health issues. People do not understand that one person can metabolize way more than someone that is not aware that they may have a medical condition in there body that can possibly cause them to constantly carry a blood alcohol level even though they do not drink at all. The court system does not care!!! They just call you a lier. They are putting away inocent people all the time. This is what my son is in the middle of right now. We need to get these people together and change some laws that these people get screened when they have accidents!

  17. Gastric bypass surgery raising alcohol levels in the blood was talked about on the Oprah Winfrey show. For those weight loss surgery patients out there that take a drink every now and then, it is important that you know about this. It could save your life.

    – Chris
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  18. dNetworkID’…

    Georgia DUI Blog » Blog Archive » Gastric Bypass Surgery…

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