Bariatric Realities – Medical Professionals’ Guidelines about Alcohol Use & WLS


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I know I said my next article was going to be on causes of obesity, but I got carried away tonight doing some investigating about the professional medical guidelines for alcohol use after weight loss surgery. In summary, the gist of the recommendations are: “Patients undergoing bariatric surgery should be screened and educated regarding alcohol intake both before and after surgery… patients should be made aware that alcohol use disorders (AUD) can occur in the long term after bariatric surgery.” (From: http://asmbs.org/res...riatric-surgery.)

Bariatric Realities – Medical Professionals’ Guidelines about Alcohol Use & WLS

I know I said my next article was going to be on causes of obesity, but I got carried away tonight doing some investigating about the professional medical guidelines for alcohol use after weight loss surgery. In summary, the gist of the recommendations are: “Patients undergoing bariatric surgery should be screened and educated regarding alcohol intake both before and after surgery… patients should be made aware that alcohol use disorders (AUD) can occur in the long term after bariatric surgery.” (From: http://asmbs.org/res...riatric-surgery.)

Well, now. Those are some non-specific medical recommendations by medical professionals who are the predominant leaders and caregivers of the surgical weight loss population. Education and awareness. Hey – I am all about education and awareness. Great things, education and awareness.

And yet, I’m gonna say that as a recommendation, that is a very “PC” non-recommendation recommendation, when one considers that we are talking about 1) ALCOHOL and 2) WEIGHT LOSS SURGERY patients.

Consider these educational nuggets and facts I found that WLS patients really ought to be aware of:

Psychologist Stanton Peele, writes, “readers now know that scientifically, it's not alcohol that causes people to live longer, but it is simply being with others and that they are less socially isolated when they drink that prolongs their lives. After all, alcohol is a toxin.” (italics and bold added) (From https://www.psycholo...alcohols-poison.

My comments: Yes – alcohol is a toxin, and that means POISON. Those of us in the medical field really ought to know that people are not supposed to ingest poison. But the recommendations do not say, “Do NOT ingest the toxin, alcohol.” No, no, no… they say be educated and aware.

Dr. Charles S. Lieber, M.D., M.A.C.P., in a publication for the National Institute on Alcohol Abuse and Alcoholism, writes, “A complex interplay exists between a person’s alcohol consumption and nutritional status,” and … alcohol and its metabolism prevent the body from properly absorbing, digesting, and using essential nutrients” (italics added.) Dr. Lieber does indeed, educate us about the nutritional value of alcohol: Alcohol would not fall under the category of an essential nutrient because not having it in your diet does not lead to any sort of deficiency. Alcoholic beverages primarily consist of Water, pure alcohol (chemically known as ethanol), and variable amounts of sugars (i.e., carbohydrates); their content of other nutrients (e.g., Proteins, Vitamins, or minerals) is usually negligible. Because they provide almost no nutrients, alcoholic beverages are considered ‘empty calories.’ Therefore, any calories provided by alcoholic beverages are derived from the carbohydrates and alcohol they contain.” (italics added)

My comments: People who have weight loss surgery (other than the band) experience absorption issues to one degree or another. Nutritional deficiency is one of the concerns the medical professionals monitor in the months and years following WLS. We stress to patients the importance of taking Vitamin supplements for the rest of their lives to help ensure proper nutritional balance.

And yet, rather than saying, “Alcohol use is unwise after WLS,” or “Don’t drink alcohol after WLS,” the governing body of health professionals for bariatric surgery recommends being “educated” and “aware.”

Is that happening? Are the physicians and surgeons and nutritionists and mental health professionals educating patients and making patients aware that ALCOHOL IS A TOXIN THAT CAN INTERFERE WITH Vitamin ABSORPTION – and it should not be consumed after weight loss surgery? I can’t answer that, although I know we do this at the programs I work with. If it’s not happening, why not?

Having a background in direct sales, which, ironically, was incredible education for my later career as a psychologist, I was taught to “anticipate the objections.” Many health care professionals may be pooh-pooh’ing the vitamin deficiency issue associated with alcohol, stating it’s only those who drink heavily who are at risk for this type of vitamin deficiency. That information, to the best of my knowledge, is relevant for persons who have not had weight loss surgery. What’s more, we don’t know the extent to which people are drinking many years after WLS. Most of the research, as noted in the ASMBS Guidelines/Statements entitled ASMBS position statement on alcohol use before and after bariatric surgery, states, “The existing studies do not present a uniform picture regarding the overall prevalence of lifetime or current alcohol use disorders (AUD) in patients seeking bariatric surgery. The vast majority of the existing literature is retrospective, with small sample sizes, lack of control groups, and low response rates. There are also varying definitions of alcohol disorders (“high-risk” versus “misuse” versus “abuse/dependence”) in the bariatric surgery literature.” In other words, this research does provide some information, but remember, we don’t really know that much because there isn’t enough research on enough people over a long enough period of time. We don’t then, know the actual affect that alcohol use has on vitamin absorption for WLS patients. We DO know that vitamin deficiency is a concern, so WHY aren’t we telling people not to drink?

Not only is alcohol a toxin for our bodies, “Alcohol is actually classified as a drug and is a known depressant. Under this category, it is the most widely used drug in the world. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA)” (italics and underling added). http://www.medicinen...ion/article.htm

My comments: I am literally chuckling now at the absurdity of this situation. The situation being the medical professionals, all having a code of ethics that reflects the “do no harm” sentiment, ignoring potential harm for their patients. Please note that we would all consider alcohol as being “empty calories” and having sugar/carbohydrates and certainly no Protein.

PLEASE let it be the case that the mental health practitioners around the world who deal with surgical weight loss patients are telling them, “Don’t eat empty calories. Eat a lot of Protein. Limit the simple carbs and sugar. And refrain from consuming your calories from liquids. NO STARBUCKS. BUT, HEY - GO AHEAD AND DRINK THOSE SUGAR/CARB LADEN, EMPTY, NUTRITION-ROBBING TOXIC CALORIES IN ALCOHOL, THAT ARE, BY THE WAY, THE MOST WIDELY ABUSED DRUG IN THE WORLD.”

Honestly, that sentence should be the entire article.

But WAIT! There’s MORE!

I really love this last tidbit I’ll share with you. It’s so much nicer for me when I can find it online so it’s not that mean, alcohol-hating Dr. Stapleton being the one to blame!

“The truth is that no one needs alcohol to live, so regardless of what you've heard or want to believe, alcohol is not essential in our diets. Did you know that a glass of wine can have the same calories as four Cookies? How about a pint of lager – surprised to hear it’s often the caloric equivalent of a slice of pizza? You do not need to be an alcoholic for alcohol to interfere with your health and life.”

https://www.drinkawa...ries-in-alcohol

Do you hear this, people in the medical profession? Are you giving the OK for your patients to eat four Cookies “now and then,” or “in moderation,” or “not for the first six months, or year after surgery?” Do you realize that you may be DOING HARM by giving your patients “permission” to drink alcohol?

“But our job is not to be the watchdog or decision-maker for people.” Another potential objection to my dismay about the recommendations being for “education” and “awareness,” rather than a direct, “SAY NO TO ALCOHOL” stance. I agree that no one can make the decisions about what people can or cannot do, or what they will or will not do. People in the medical field do tell people things like, “Don’t get that wet or you could get an infection,” “Keep the splint on for the next six weeks if you want to heal properly.” There ARE dos and don’ts that are educational and increase awareness. What’s the real issue that medical professionals don’t take a hard stance on alcohol after WLS? I don’t know. I do know that I did my dissertation on medical doctor’s attitudes toward addiction. Turns out it is much like that of their attitudes toward obesity: many don’t know that much about it, very many do not feel comfortable working with it, and most don’t care about/understand it.

To top it all off, HERE’s the real kicker… Not only do the medical AND some of the WLS organizations not tell people, “Don’t drink alcohol,” THEY PROVIDE ALCOHOL AT THEIR EVENTS!

I can’t say any more.

Connie Stapleton, PhD

connie@conniestapletonphd.com

Facebook: Connie Stapleton

Twitter: @cstapletonphd

LinkedIn: Connie Stapleton, Ph.D.

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The endocrinologist, psychologist, nutritionist, and surgeon all told me not to drink alcohol. They said that this would be a "forever" lifestyle change (and their program requires you not drink during the pre op phase or they won't approve you for surgery). They very explicit that "moderation" isn't an option and noted that there is evidence that WLS patients have higher rates of alcoholism post op. They all had a lot of research and statistics and related the issues with Vitamin absorption, dumping, weight regain, and told me about a couple of patients that had not heeded the warning and spiraled out of control with alcohol (DUIs, losing their jobs, etc.). I would consider myself to have been a social drinker- a glass of wine at dinner maybe twice a month but after what the WLS team told me I wouldn't even consider touching it now.

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Speaking only for myself, I'd prefer an occasional glass of wine to an occasional four Cookies, hands down.

I'm an adult. I'm educated and capable of educating myself about the pros and cons of alcohol intake now that I'm sleeved.

I neither want or need anything beyond education on the matter from my bariatric team. Like every bite I put in my mouth and every step I take toward improved fitness, these are my responsibilities for my life, and my lifetime. I neither want nor need draconian edicts in an attempt to scare me into adherence into what anyone thinks I "must" do, or not. It's paternalistic, patronizing, and unwelcome.

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I am not denying that alcohol can be a problem - it hits you much harder post WLS. At 4 years out though, I consider social drinking as one of my lifestyle balancing acts. I don't need the empty calories, very true, but I am maintaining at goal, have healthy blood work, healthy liver (had scan done due to stones so could see my liver looked good per the doctors) and as mentioned above, much prefer my few times a month happy hour with the girls or wine on a dinner date over dessert etc.

It is a balancing act and we all need to take responsibility for how we choose to "balance" and seek help when it becomes a problem... or if health, lifestyle, family, friends etc are impacted. Honestly, I am more likely to binge on ice cream so THAT is something I need to have pretty much abstince on.

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So you're anti-alcohol of any kinds for WLS patients and think all WLS patients should be or become tee-totalers ... right?

Do you feel the same way about alcohol for patients a year out (and in maintenance) as during the weight-losing phases?

Do you also recommend no-Cookies for WLS patients? Ever? Even in maintenance?

What about cake?

Barbeque (and all the sugar in those BBQ sauces)? Chili?

Breads? If not all breads, which kinds / brands?

What about coffee? Tea? Marijuana?

What about sweet potatoes? White potatoes?

Fruits -- with or without sugar?

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@@VSGAnn2014

Thank you for your response! I'm not a nutritionist, or a physician, but I'll answer each of your questions from my perspective and having worked in a bariatric center for the last 12 years. But please consult your physician and nutritionist.

So you're anti-alcohol of any kinds for WLS patients and think all WLS patients should be or become tee-totalers ... right? Personally, I am against alcohol for all WLS patients for the reasons mentioned in the article, including: alcohol is a toxin, it is empty calories, it is empty liquid calories, and there are potential nutritional absorption issues that could be made worse by drinking alcohol.

Do you feel the same way about alcohol for patients a year out (and in maintenance) as during the weight-losing phases?

Yes, for the same reasons as stated above.

Do you also recommend no-Cookies for WLS patients? Ever? Even in maintenance?

Recommend? Yes, I would recommend no Cookies, although I wouldn't expect in reality that a person may never have a cookie again. Four cookies at a time? I would never recommend that. Unlike alcohol, however, a cookie is not a toxin that interferes with absorption of essential nutrients.

What about cake?

Recommend? Yes, I would recommend no cake, although I wouldn't expect in reality that a person may never have cake again. Unlike alcohol, however, cake is not a toxin that interferes with absorption of essential nutrients.

Barbeque (and all the sugar in those BBQ sauces)? Chili?

There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free.

Breads? If not all breads, which kinds / brands?

There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free. Always the healthier the better.

What about coffee? Tea? Marijuana?

I would ask your doctor and nutritionist about coffee and tea. I believe there are other reasons they suggest to limit these. Marijuana? No, I would not ever RECOMMEND that someone use marijuana (unless POSSIBLY in the case of medical illness).

What about sweet potatoes? White potatoes?

There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free.

Fruits -- with or without sugar?

There are no toxins that interfere with absorption of essential nutrients in these foods. There are carbs in all foods other than lean meat, so people will eat some carbs. I do not recommend going carb-free.

So - those are my thoughts. Again - please consult your physician and nutritionist as those are not my areas of expertise.

Be well!

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@@CowgirlJane

I respect your position. Many people make the choice to consume alcohol in a social manner. I have no issues with people drinking alcohol. I believe each individual needs to consider their circumstances (medical and others) and make their own choice. I believe that the medical community, however, needs to make it clear that alcohol is a toxin, can interfere with the absorption of essential nutrients, and that it is definitely nothing but empty calories.

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I think you bring up some very good points.

One thing I have observed just on BariatricPal is that for those of us who are not really drinkers to begin with, the idea of possibly never drinking again is not a big deal.

But, for those who are drinkers (from regular social drinkers all the way to full-blown practicing alcoholics), just the idea of never drinking again will often lead to very strong negative reactions,

I would guess that the "medical community" recognizes that if these people are going to be helped and will even listen to health advice, they will be more effective with a less restrictive message.

Alcohol use is a HUGE hit button issue on this forum. I encourage you to read some of the alcohol-related threads.

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