By SHEILA REDDY, MD, and LARA SALAHI
Andrew Kahn was only a social drinker before his weight-loss surgery. He never imagined he would develop problems with alcohol because he had bariatric surgery. But he did.
The 61-year-old from Fort Lauderdale, Fla., who had his gastric bypass surgery in 2003, eventually developed alcoholism and was treated at a rehabilitation facility for his addiction.
"I never had any guidance or education about that," said Kahn. "If I was given the choice between being obese and becoming an alcoholic, I would have thought about [my decision] more."
The American Society for Metabolic and Bariatric surgery estimates that approximately 72 million people are obese in the United States and 200,000 people have bariatric surgery each year.
Kahn's alcohol addiction may not be a unique result of gastric bypass surgery. New research suggests that having Roux-en-Y gastric bypass surgery, where the size of the stomach is reduced and the intestine is shortened, thus limiting how much a person can eat, can increase the risk of alcohol-use disorders.
The study, conducted by researchers at the University of Pittsburgh Medical Center, adds to mounting evidence of a link between have the popular gastric bypass surgery and the symptoms of alcohol-use disorders.
Before the surgery, the nearly 2000 study participants completed a survey developed by the World Health Organization that is used to identify symptoms of alcohol abuse.
The patients then completed the survey one and two years after their weight-loss surgery. The study found 7 percent of patients who had gastric bypass reported symptoms of alcohol use disorders prior to surgery. The second year after surgery, 10.7 percent of patients were reporting symptoms.
The findings were published Monday in the Journal of the American Medical Association.
"There have been previous studies that show there is a change in alcohol sensitivity in gastric bypass," Wendy King, a research assistant professor in the department of epidemiology at the University of Pittsburgh Medical Center, and the study's lead author.
King's study is the first to show that with this increased sensitivity there is also an increased risk of alcohol use disorders (AUD), the term used to describe alcohol abuse and dependence.
Dr. Mitchell Roslin, a bariatric surgeon at Lenox Hill Hospital in New York City, said the link between gastric bypass surgery and increased alcohol use has been attributed before to the shifting addiction theory and that this is false. The shifting addiction theory is that if a person has an impulsive drive to eat and the ability to eat large amounts of food is taken away, then he will shift his addiction to another addictive substance, like drugs or alcohol.
"A gastric bypass patient has a small pouch [for a stomach] so alcohol goes straight into the intestine and is absorbed rapidly," said Roslin. "When it is absorbed rapidly, there is a high peak and rapid fall."
The higher absorption rate makes alcohol more addictive, he added.
Indeed, before his surgery, Kahn would have two drinks, then feel sleepy and go to bed. After the surgery, he said he felt the alcohol would go through his system faster, which allowed him to drink more.
"It wears off so quickly so you can keep going and going," said Kahn.
Gastric bypass is the most commonly performed bariatric surgery in the United States and represents 70 percent of all surgeries performed during the study. Laparoscopic gastric banding, where an adjustable band in placed around a patient's stomach and limits how much food the stomach can hold, did not have an associated risk with increases in alcohol problems.
King said this is to be expected as gastric banding does not change the anatomy and thus the metabolism of alcohol like gastric bypass does.
The study also found that the increase in alcohol-use disorders was not seen until the second post-operative year as opposed to the first year after surgery.
"This emphasizes that continuing education about alcohol use is needed until the second year after surgery. With follow up [patients] need to hear about consumption and what is appropriate," said King.
Dr. Leslie Heinberg, the Director of Behavioral Services for the Bariatric and Metabolic Institute of the Cleveland Clinic, thinks these increases are causes for caution more so than concern. Patients should be educated before their surgery about the changes that will occur in how they will absorb and metabolize alcohol.
"Given that the increased rates of alcohol use disorders post-operatively are equivalent to what is seen in the general population, it shouldn't be a reason to avoid a life-saving procedure," said Heinberg. "Rather, it points to the importance of education, informed consent and continued monitoring."
King said her study highlights one of the risks of the surgery but it is important for patients to take in context all of benefits and risks and work with doctors to determine what is the best option for them.
"Bariatric surgery is the most effective treatment we have for obesity. It would be shame if people walked away thinking gastric bypass was a bad procedure based on this [study]," said King.
Andrew Kahn said that he did not have the opportunity to know that alcohol addiction may occur after his surgery and he wants other patients to be informed about these risks. He initially lost over 70 pounds after his surgery, but in the six months he was heavily drinking, he gained 35 of those pounds back and became depressed. He eventually attended a detoxification program and has been sober since 2010.
Kahn said he would not have had an alcohol problem if he did not have gastric bypass. Still, he wouldn't have traded in the surgery if given a second chance.
"Gastric bypass saved my life," he said.