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Gastric bypass surgery lowers women's alcohol tolerance

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A small study indicates that changes in how  is metabolized after surgery can speed its delivery into the bloodstream, resulting in earlier and higher peaks in blood-alcohol levels. Studying  who had undergone surgery, the researchers found that those who had consumed the equivalent of two drinks in a short period of time had blood-alcohol contents similar to women who had consumed four drinks but had not had the operation.

The research is published Aug. 5 in the journal JAMA Surgery.

"The findings tell us we need to warn patients who have  that they will experience changes in the way their bodies metabolize alcohol," said first author M. Yanina Pepino, PhD, an assistant professor of medicine in the Division of Geriatrics and Nutritional Science. "Consuming alcohol after surgery could put patients at risk for potentially serious problems, even if they consume only moderate amounts of alcohol."

Although this study included only women, it is likely that men who have gastric bypass surgery experience similar changes in how their bodies metabolize alcohol.

The researchers studied alcohol's effects in 17 obese women. Eight of the women had undergone Roux-en-Y gastric bypass surgery—the most common bariatric surgical procedure worldwide—one to five years before the study began. The other nine participants had not yet had the operation.

As part of the study, the women spent two days, about one week apart, at Washington University's Clinical Research Center. On one visit, each woman randomly consumed either the equivalent of two  or two nonalcoholic beverages during a 10-minute period. At the second visit, each was given the beverages not received during the first visit. At both visits, the researchers measured the women's blood-alcohol contents and used a survey to assess their feelings of drunkenness.

The women in the gastric bypass group had an average body mass index (BMI) of 30, which is considered obese, but it compared with an average BMI of 44 for the women who had not yet had the surgery. Among those who had not undergone surgery, blood-alcohol content peaked about 25 minutes after they finished consuming the alcohol and measured 0.60. In women who had the surgery, blood-alcohol content peaked at 5 minutes after drinking and reached 1.10, significantly above the legal driving limit of 0.80.

"These findings have important public safety and clinical implications," said senior investigator Samuel Klein, MD, the William H. Danforth Professor of Medicine and director of the Center for Human Nutrition. "After just two drinks, the blood-alcohol content in the surgery group exceeded the legal driving limit for 30 minutes, but the levels in the other group never reached the legal limit.

"The peak blood-alcohol content in the surgery group also met the criteria that the National Institute on Alcohol Abuse and Alcoholism uses to define an episode of binge drinking, which is a risk factor for developing alcohol problems."

Women who had undergone gastric bypass also reported feeling the effects of alcohol earlier and for longer periods of time than women who had not had the surgery.

The study is not the first to find that gastric  can alter alcohol metabolism, but Pepino said it is significant because earlier studies had measured blood alcohol less vigorously and were less clear about the extent of the changes in alcohol metabolism.

"The women who had the surgery only received the equivalent of two drinks, but it was as if they had consumed twice that amount," she said. "Consuming alcohol after surgery the way one did before the operation could put patients at risk for potentially serious consequences, even when they drink only moderate amounts of alcohol."

More information: Pepino MY, Okunade AL, Eagon JC, Bartholow BD, Bucholz K, Klein S. Effect of Roux-ex-Y gastric bypass surgery: converting 2 alcoholic drinks to 4. JAMA Surgery, published online Aug. 5, 2015. DOI: 10.1001/jamasurg.2015.1884 


Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

Something I feel like we already knew?  Sigh.  Please read.

PR from The Obesity Society -

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

First study of its kind ties hypothalamus, in addition to the gut, to the aperitif phenomenon

SILVER SPRING, MD – The first study of its kind measuring the brain's role in mediating caloric intake following alcohol consumption among women shows that alcohol exposure sensitizes the brain's response to food aromas and increases caloric intake. The research, led by William J. A. Eiler II, PhD, of the Indiana University School of Medicine's Departments of Medicine and Neurology, adds to the current body of knowledge that alcohol increases food intake, also known as the "aperitif effect," but shows this increased intake does not rely entirely on the oral ingestion of alcohol and its absorption through the gut. The study is published in the July issue of the journal Obesity published by The Obesity Society (TOS).

"The brain, absent contributions from the gut, can play a vital role in regulating food intake. Our study found that alcohol exposure can both increase the brain's sensitivity to external food cues, like aromas, and result in greater food consumption," said Dr. Eiler. "Many alcoholic beverages already include empty calories, and when you combine those calories with the aperitif effect, it can lead to energy imbalance and possibly weight gain."

Researchers conducted the study in 35 non-vegetarian, non-smoking women at a healthy weight. To test the direct effects of alcohol on the brain, researchers circumvented the digestive system by exposing each participant to intravenously administered alcohol at one study visit and then to a placebo (saline) on another study visit, prior to eating. Participants were observed, and brain responses to food and non-food aromas were measured using blood oxygenation level dependent (BOLD) response via fMRI scans. After imaging, participants were offered a lunch choice between pasta with Italian meat sauce and beef and noodles. 

When participants received intravenous alcohol, they ate more food at lunch, on average, compared to when they were given the placebo. However, there were individual differences, with one-third of participants eating less after alcohol exposure when compared to the placebo exposure. In addition to changes in consumption, the area of the brain responsible for certain metabolic processes, thehypothalamus, also responded more to food odors, compared to non-food odors, after alcohol infusion vs. saline. The researchers concluded that the hypothalamus may therefore play a role in mediating the impact of alcohol exposure on our sensitivity to food cues, contributing to the aperitif phenomenon.

 "This research helps us to further understand the neural pathways involved in the relationship between food consumption and alcohol," said Martin Binks, PhD, FTOS, TOS Secretary Treasurer and Associate Professor of Nutrition Sciences at Texas Tech University. "Often, the relationship between alcohol on eating is oversimplified; this study unveils a potentially more complex process in need of further study."

Study authors agree and call for further research into the mechanism by which the hypothalamus affects food reward.

"Today, nearly two-thirds of adults in the U.S. consume alcohol, with wine consumption rising, which reinforces the need to better understand how alcohol can contribute to overeating," continued Dr. Binks.

Read the full article in Obesity here.


Nobody wants to hear it.

"There is no risk-free level of alcohol consumption," says Dr. Rehm. "There is always some risk, and the risk increases in accordance with the level of consumption."

Having said that, Dr. Rehm believes that it would be helpful to have low-risk drinking guidelines, written for the public, so that people who are going to drink anyway would know how much alcohol would increase their risk substantially. Such guidelines should recognize lower drinking limits for women and advise against episodes of heavy drinking.


Katie Jay Keynote Speaking at Southcoast Center for Weight Loss - Video

Katie Jay of www.nawls.com was the keynote speaker at an event at Southcoast Center for Weight Loss in Wareham, MA yesterday.

She is amazing.  

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Thank you, Katie.  

Here we are -

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150 patients returned to the Southcoast Center for Weight Loss Saturday for a reunion as the group marked its own milestone: 3,500 patients since Dr. Rayford Kruger launched the unit nine years ago.It is now the largest and busiest bariatric surgery program in New England, with three surgeons who perform about 650 procedures at Wareham's Tobey Hospital a year.

 


Weight-Loss Surgery's Weird Alcoholism Risk (It's not weird.)

Weight-Loss Surgery's Weird Alcoholism Risk | The Fix.

Copied entire article from Weight-Loss Surgery's Weird Alcoholism Risk | The Fix. - because - BECAUSE -

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Gastric bypass surgery is something of a medical marvel. In Roux-en-Y surgery, a small pouch is made from part of your stomach, building a new, smaller one. The pouch is then connected to the middle portion of the small intestine (the jejunum), bypassing the upper part (the duodenum). Because your new stomach is about 90% smaller than your old one, you feel full with much smaller amounts of food and take in many fewer calories. Another popular smaller-stomach operation is adjustable gastric band surgery, in which an inflatable silicone device is placed around the top of the stomach.

In all, the American Society for Metabolic and Bariatric Surgery estimates that approximately 200,000 people have bariatric surgery every year. The Roux-en-Y operation generally costs between $15,000 and $30,000; the band is cheaper by about $10,000. Many private insurance policies offer no coverage for what they consider an elective procedure.

There have been previous reports of bariatric surgery patients having serious trouble with alcohol use after their surgeries. A 2012 Archives of Surgery study by the New York Obesity Nutrition Research Center looked at 100 people who had Roux-en-Y and 55 who had the adjustable band. The post-op patients were significantly more likely than the general population to use addictive substances, especially two years after the procedures. The Roux-en-Y cohort seemed particularly susceptible to alcohol use.

If food has always been your drug, and surgery abruptly denies you your fix, you turn to other drugs.

A much larger 2012 study in the Journal of the American Medical Association came to a similar conclusion. University of Pittsburgh researchers followed almost 2,000 people who had Roux-en-Y, adjustable band or another weight-loss surgery. Before their operations, 7.6% of the group abused alcohol; after the knife, 9.6% did so. And, the patients who had the Roux-en-Y surgery were twice as likely to abuse alcohol as those who had the gastric band.

Health experts have long known that obesity and depression often go hand-in-hand. Depression can lead to becoming obese, and the opposite is also true. Many obese people are depressed before they have surgery and are therefore at high risk of depression afterward. For one thing, recovery is a slow process, and health complications of the surgery are very common; 40% of patients suffer from infection and post-operative bleeding. Perhaps more important, bariatric surgery is no magic bullet, and some patients become disillusioned as they realize that in order to "solve" their serious weight problems, they have to maintain good eating and exercise habits—lifestyle changes that likely proved elusive in the past. 

Addiction experts see the problem as one of switching addictions. People become obese because they use eating as a drug. Excessive eating is a form of self-medication for painful feelings associated with depression, anxiety and deeper personality disorders. Like most drugs, food, especially carbs and sugars, trigger the brain's reward pathways, causing a feeling of pleasure. But sustained excessive eating causes the brain to lose its capacity to produce these feel-good chemicals. That's whenaddiction starts.

Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.

Hogwash, says John Morton, MD, a bariatric surgeon at the Stanford School of Medicine and member of the executive council of the American Society for Metabolic and Bariatric Surgery. Like many other surgeons who specialize in this procedure, he favors a physical rather than a psychological or switching-addiction explanation for the high risk of alcohol abuse. "[There is a] heightened sensitivity to alcohol [and it is] purely physiologic," Morton says. Along with the liver, the stomach produces alcohol dehydrogenase, an enzyme that breaks down alcohol into other, less toxic molecules. Because gastric bypass patients have much less stomach, and therefore less of that enzyme, more alcohol enters their bloodstream.

"As a result," Morton says, "you get drunker faster and stay drunker longer." The same phenomenon occurs with people who have their stomachs removed because of cancer. If alcohol abuse in bariatric patients were due to psychological issues, you wouldn't expect cancer patients to have greater alcohol sensitivity, Morton argues.

Mitch Roslin, MD, a specialist in bariatric medicine at New York's Lenox Hill Hospital, agrees. He calls the switching-addictions theory "BS.” Drinking alcohol in your post-Roux-en-Y life is "the epitome of drinking on an empty stomach"—after all, your stomach is almost nonexistent. "Essentially," Roslin says, "drinking alcohol after Roux-en-Y is like having an alcohol IV."

"Essentially, drinking alcohol after Roux-en-Y is like having an alcohol IV," Roslin says.

But why does alcohol sensitivity show up more in the second year after the surgery? Roslin suggests that the second year is when you realize that your surgery will not, by itself, keep you healthy, that you do indeed have to "fix the inside." At that point, you might feel depressed, use alcohol to escape and comply less with your post-op instructions. 

Morton’s and Roslin’s explanations may account for why people who have had gastric bypasses can get a buzz by drinking a small amount of alcohol, but they don't quite explain why some people who never abused booze before end up becoming post-op alcoholics. Nor do they account for another, even more serious, health risk for people who have had gastric bypasses: suicide.

Two recent studies—in Pennsylvania and Utah—reinforce the link between obesity and emotional distress by focusing on suicide rates. A study of 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 showed a surprisingly high incidence of suicide. Of the 440 deaths that occurred, 16 resulted from suicide or drug overdose; by comparison, the rate for the general population is only three. And this August, a study published in The New England Journal of Medicineshowed that a group of almost 10,000 bariatric patients had a 58% higher than average risk of dying in an accident or suicide. When the bariatric patients' suicide rate was compared to that of obese people who had not had surgery, it was close to double, 11.1 per 10,000 compared to 6.4 per 10,000.

When the high risk of suicide is coupled with the high risk of alcohol abuse, a psychological, if not a switching-addiction, explanation is almost inescapable. Patients may be aware of these risks, but the need for the surgery overrides such concerns. While prospective patients often undergo psychological evaluations before the procedure, doctors often do not follow up with the patients and patients often do not participate in post-surgery counseling. The addiction to food is typically viewed as more or less having been "treated" by the gastric bypass. The danger of developing a new addiction remains low on the list of health priorities.

There is no denying the benefits of bariatric surgery. Without it, many people struggling with obesity would be doomed to lives burdened with diabetes, heart disease, mobility problems and high risk of stroke and early death. At the same time, it's clear that the surgery's benefits would be increased by improved screening of patients for mental health problems—and addiction—before surgery as well as deeper, longer counseling afterward. This may mean fewer people will be eligible for the surgery—a prospect that neither doctors nor patients would embrace. At the very least, reframing how patients understand the surgery is in order: It is not a magic bullet but one in a serious of interventions that are, like it or not, lifelong.


25% Drink 16% Calories Via Alcohol Daily.

About 25% of you drink alcohol every day -- given the normal non-weight loss surgical population according to a new CDC study.  And about 16% of your daily calories come from alcohol.  

PS.  Give this study to bariatric patients -- I would say from my very non-professional standpoint that results would be higher vs. calorie intake given our higher rates of addictions to All The Things.  

That is some scary daily nutrition math.

No-Light-Beers

Cheers.

CDC -

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The U.S. population consumes an average of 100 calories a day from alcoholic beverages. Men, 150 calories; women, 53.

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“If you are drinking an extra 150 calories more than you need a day, those extra calories could end up on your waist or your hips,” said Joan Salge Blake, a clinical associate professor in the nutrition program at Boston University and a spokeswoman for the Academy of Nutrition and Dietetics. “Those excess daily calories could cause you to put on a pound monthly and would add up to over 10 pounds in a year,” Blake said.

Specifically for a gastric bypass patient -- it can lead to all sorts of damage.  Play in the Google.  


The Link between Acute Liver Failure and Bariatric Surgery

Tylenol, a no-no after gastric bypass?  Maybe.  Down the road, if confirmed in future large study -

Continue reading "The Link between Acute Liver Failure and Bariatric Surgery " »


Does your proximity to a bar increase your RISK for alcoholism?

Does a person's proximity to a bar trigger over-indulgence?  

A recent study suggests (Duh?!) perhaps it ACTUALLY DOES!  To bring the weight loss surgery community into it -- consider locality of bariatric-themed community events.  Where Do The Food Addicts Gather At These Events? Which events get the most attendance?  

Continue reading "Does your proximity to a bar increase your RISK for alcoholism?" »


A highlight from the OH Conference in Atlanta - Living Thin Within!

Recently the Obesity Help Conference I met this great woman, Jill.  Jill was to speak during the event, but I did not know that, nor did she introduce herself as anyone of importance.  

And we just TALKED AS PEERS.

Let me tell you something --

Continue reading "A highlight from the OH Conference in Atlanta - Living Thin Within!" »


Substance Use Following Bariatric Weight Loss Surgery - Alcohol Is a PROBLEM.

Reuters

More (albeit just a little...) evidence points to WHAT WE AS PATIENTS HAVE BEEN TRYING TO TELL YOU, over and over and over and over.

People who had weight loss surgery reported greater alcohol use two years after their procedures than in the weeks beforehand, in a new study.

"This is perhaps a risk. I don't think it should deter people from having surgery, but you should be cautious to monitor (alcohol use) after surgery," Alexis Conason, who worked on the study at the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital Center, told Reuters Health.

Continue reading "Substance Use Following Bariatric Weight Loss Surgery - Alcohol Is a PROBLEM." »


Oh. Yes. She. Did.

Hold the Press Releases, Suz!  

How do you go from not paying your taxes, failure to ship orders since 2011, closing your store, foreclosure, shutting down all communication to... THIS?

Continue reading "Oh. Yes. She. Did." »


Alcohol abuse after weight loss surgery? | Harvard Gazette

Alcohol abuse after weight loss surgery? | Harvard Gazette.

 

Experts on the use of bariatric surgery for the treatment of obesity gathered at the Radcliffe Institute for Advanced Study earlier this month for a two-day seminar examining new evidence that stomach surgery for the treatment of obesity has unexpected side effects, including an increased incidence of alcohol abuse among patients.

 

 


Alcoholism and the family - are you affected by someone else?

How do you know if you are affected by someone else's problem drinking?  Are you?

Via Al-Anon -

Millions of people are affected by the excessive drinking of someone close. The following questions are designed to help you decide whether or not you need Al-Anon:

 1. Do you worry about how much someone drinks?

 2. Do you have money problems because of someone else’s drinking?

 3. Do you tell lies to cover up for someone else’s drinking?

 4. Do you feel that if the drinker cared about you, he or she would stop drinking to please you?

 5. Do you blame the drinker’s behavior on his or her companions?

 6. Are plans frequently upset or canceled or meals delayed because of the drinker?

 7. Do you make threats, such as, “If you don’t stop drinking, I’ll leave you”?

 8. Do you secretly try to smell the drinker’s breath?

 9. Are you afraid to upset someone for fear it will set off a drinking bout?

 10. Have you been hurt or embarrassed by a drinker’s behavior?

 11. Are holidays and gatherings spoiled because of drinking?

 12. Have you considered calling the police for help in fear of abuse?

 13. Do you search for hidden alcohol?

 14. Do you ever ride in a car with a driver who has been drinking?

 15. Have you refused social invitations out of fear or anxiety?

 16. Do you feel like a failure because you can’t control the drinking?

 17. Do you think that if the drinker stopped drinking, your other problems would be solved?

 18. Do you ever threaten to hurt yourself to scare the drinker?

 19. Do you feel angry, confused, or depressed most of the time?

 20. Do you feel there is no one who understands your problems?

If you have checked any of these questions, Al-Anon or Alateen may be able to help. Find a meeting now.