Whether it is a reunion, wedding, or a ball game, alcohol usually plays a vital role in our daily lives. For some, it is a staple in their daily dietary routine. For others, alcohol is consumed only socially. Unfortunately, patients need to understand that the body will respond to alcohol differently after weight loss surgery. Although there is not a definitive rule saying “you cannot have alcohol after bariatric surgery,” we need to understand how the body used to react to alcohol prior to surgery and re-assess how we should drink post-surgery.

What is the Sleeve?

Life after any weight loss surgery can face some challenges since a large portion of the digestive tract has been modified. The gastric sleeve surgery, also known as a sleeve gastrectomy or “the sleeve”, is a common irreversible weight loss surgery that removes 80 percent of the stomach while leaving the small intestine as is. The remaining portion looks like a vertical sleeve or a banana-shaped stomach.  Food empties out into the small intestine as it did prior to surgery. The excised portion of the stomach contains a hormone (ghrelin) that stimulates hunger.

Therefore, with significantly restricted food intake, less hunger hormone and increased satiety, rapid weight loss is expected.

Patients can expect 60 to 80 percent loss of excess weight if the body is taken care of properly with wholesome nutrition and lifestyle changes.  Because the small intestine is left intact and unaltered, absorption is not affected which can be a double-edged sword. Whether you are eating a lean piece of chicken with steam broccoli or drinking 5 oz glass of white wine with every dinner, the body will absorb and metabolize everything.

Alcohol absorption increases after Gastric Sleeve

Gastric sleeve surgery, along with other weight loss surgeries, can change how our body absorbs and breaks down alcohol. With the small stomach pouch, alcohol will enter the small intestine a lot quicker and most of the absorption will take place in the small intestine. Therefore, the body will be more sensitive to the effects of alcohol. Just imagine what it used to feel like drinking on an empty stomach before surgery, but now it is much worse.

You will realize the effects from a glass of wine will feel like as if you drank four glasses which will cause blood alcohol level to quickly raise just after one drink. Pay close attention how your body reacts after each drink. You will soon learn your limit to how much of what beverage will make you feel “buzzed.”

One study suggests alcohol consumption may enhance blood alcohol concentration (BAC) after sleeve gastrectomy and maintain at the higher levels for a longer period of time compared to pre-surgery patients. It also suggests that since patients peak BAC much sooner after the last drink, the commonly used breathalyzer may underestimate one’s true blood level. Therefore, increased self-awareness is crucial for avoiding poor decision such as getting behind the wheel after any drink.

Avoid Alcohol in The Beginning

It is recommended to avoid alcohol during the rapid weight loss phase (approximately the first six months) and hold off until weight stabilizes which can take up to 18 months post-surgery. You want the body to readjust to its new settings as your metabolism is changing just as much as your weight loss. Learning the amount of certain foods and beverages your new system can tolerate takes time and patience. This includes alcohol intake.

Alcohol Has Empty Calories

If your goal is to lose weight, the last thing you want to do is eat and drink empty calories. Alcohol, like any other caloric beverages, provides very minimal nutritional value and only hinders weight loss. Patients need to realize that alcohol can have almost double the calories per ounce compared to soda or juice - this is especially true of hard liquor.

Alcohol is not considered a carbohydrate, protein, or fat. It has about 7 calories per gram (vs 4 calories per gram for carbohydrates and protein). Most people drink more than the standard serving sizes which can lead to overindulging and possible alcohol addiction. Below is a breakdown to show the difference in calories with various caloric beverages.

Gastric Sleeve and Alcohol Use Disorder

If you find yourself drinking more than usual despite how you may feel, you may be at risk of developing an alcohol use disorder, also known as AUD. This issue needs to be addressed immediately before any onset of further complications. Check with your insurance company for professional therapists or programs that specialize in substance abuse treatment with bariatric patients. Also joining a support network can increase the chance of rebounding and achieving a healthier weight and lifestyle. There are many bariatric support groups that use different platforms (ie. online forums or in-person group meetings) to address a wide spectrum of needs.

Tips on Drinking and How to Stay on Track After Surgery

It is crucial to find ways to avoid sabotaging all the hard work it took to reach your goals. Although you may feel comfortable, the urge to introduce alcohol might be strong. It is important to follow a structured guideline to promote a healthier lifestyle post- surgery. You determine the degree of your success and a good portion in that process depends on what you put in your body including alcohol. Here are some recommendations:

• Avoid any alcohol at least for the first six months after bariatric surgery
• Do not drink on an empty stomach: eat protein with whole-grain carbohydrates first
• Be mindful on how your body reacts to alcohol
  • A small amount may lead to intoxication
• Do not get behind the wheel after ANY alcohol consumption
• Be mindful of your mental state when drinking
• Seek professional help
• Find a support network to keep you stay on track