Expert answers: Alcohol use after bariatric surgery

Written by Rachel E. Goetze, Ph.D., Medical Psychology Fellow

Alcohol use after bariatric surgery has become a hot topic, and researchers and clinicians have learned a lot in the past 10 years. We now believe that long-term abstinence from alcohol following bariatric surgery may be best for your health, safety and maintained weight loss success.

Alcohol absorption after bariatric surgery

Alcohol impacts us differently following bariatric surgery. We think this is in part because of changes to anatomy and how the body absorbs alcohol. For individuals who have not had bariatric surgery, peak blood alcohol level after having an alcoholic beverage takes about 25 minutes. However, those who have had a sleeve gastrectomy experience peak blood alcohol level in nine minutes, and those who have had the Roux-en-Y Gastric Bypass reach peak levels in a little as five minutes!

Here’s what else we know:

• Alcohol is much more intoxicating after bariatric surgery; one glass of wine can lead to blood alcohol levels over the legal driving limit.
• It takes longer for alcohol to leave our system after bariatric surgery, so individuals stay intoxicated for longer periods of time.
• Individuals may be at greater risk for developing problematic use and reliance on alcohol due to the highly intoxicating properties of alcohol following bariatric surgery.

Physical impacts of alcohol after bariatric surgery

Eliminating alcohol use after bariatric surgery may help avoid the following dietary and health complications:

• Dehydration – Staying hydrated after bariatric surgery is very important, and alcohol can act as a diuretic, countering all that hydrating you’ve done throughout the day.
• Excess calories – Alcohol is full of “empty calories,” meaning the calories from these beverages are largely non-nutritious and do not provide the protein and vitamins necessary after bariatric surgery.
• Impact on judgement – When intoxicated, it may be difficult to stick to post-bariatric surgery dietary and physical activity recommendations.
• Weight regain – Alcohol and the beverages we mix with it are often full of sugar, caffeine and carbonation. These are all important to avoid following bariatric surgery to reduce the possibility of medical complications.
• Dumping syndrome – For some people, the sugar in alcohol can cause dumping syndrome, a very uncomfortable experience when food moves from your stomach into your small bowel too quickly.
• Ulcer risk – The acidity in alcohol can increase the risk of developing stomach ulcers following bariatric surgery.
• Liver risk – After bariatric surgery, alcohol has more direct impacts on the liver and can increase the risk of damage.

Risk factors for problematic alcohol use after bariatric surgery

Who is at risk for problematic alcohol use after bariatric surgery? Everyone.

We often see difficulties with alcohol developing two to three years after bariatric surgery; a time when people have returned to solid foods and routine eating patterns. Some factors have been associated with increased risk of problematic alcohol use after bariatric surgery, such as younger age, being male and a history of tobacco and other substance use. However, approximately 1 in 5 individuals develop problematic alcohol use following bariatric surgery, and a percentage of these people has no history of past use.

These risks have led to the recommendation that individuals interested in bariatric surgery reduce and eliminate alcohol prior to surgery, and maintain lifelong abstinence. Your bariatric team may ask you questions about alcohol use and will support any changes they recommend. If you find that your alcohol use has increased following bariatric surgery, reach out to your care team.