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

[Connie Stapleton PhD 342]

@@OKCPirate

Thank for the reading by John Grisham! Indeed, a very good narrative! As I have said, I don't have a problem with people drinking alcohol - if it's not contraindicated for them for whatever reason. I stand firm in my belief that for those who have WLS, alcohol has no place in their "diet." Very much enjoyed the video!

Connie

[VSGAnn2014 12,992]

I'm 19.5 months post-op (sleeve surgery). I am a woman and a social drinker, defined (for women) as having no more than one alcoholic drink (1.5 ounces of spirits or 5 ounces of wine) a day and no more than 7 drinks in a week. I have one drink most days, but not every day.

Earlier this week, I brought up the subject of social drinking to my psychologist whom I've been seeing for the last 24 months. Like the OP, he has a Ph.D. in psychology. Although he has a general practice, his practice includes many bariatric patients and others who have medical conditions and need to improve their self-care. He also delivers day-long pre-op bariatric surgery orientation and educational classes, so he's very well versed in the latest research re WLS patients' nutritional challenges (which vary considerably according to the specific WLS they undergo), emotional challenges, medical complications, the potential for transfer addictions and pre-conditions and correlates related to those transfer addictions, and anything else you'd expect someone who teaches that class and consults with bariatric patients to know.

I raised the subject of social drinking with my psychologist to invite his perspective about my current use of alcohol because a few months ago my husband's cancer reappeared after being in remission for less than a year. In addition to being my husband's primary care giver, I don't want to do anything to jeopardize my own self-care as a recovering obese person.

Specifically, I asked him if he thought I should be drinking at this time, if he thought I was drinking too much, and what red flags around alcohol could appear in circumstances like mine. We had a great discussion. He repeated several things which I had learned from studying research studies available online as well, including:

1. Transfer addictions with alcohol do happen, but not to the extent that this topic is discussed in the lay literature. He said that most people who have trouble with alcohol post-op had trouble with alcohol pre-op.

2. He said that there is a smaller percentage (5% or 6%) of WLS patients who did NOT have alcohol issues pre-op who do develop problems with alcohol post-op.

3. He said that my continuing social drinking is something I should keep a mindful awareness of -- about not only how much I'm drinking but why I'm drinking and what benefits I derive from it. He asked why I drink, and I answered that I enjoy the ritual of it and the tastes of it -- either a scotch before dinner or a glass of wine paired with the meal. He asked if I ever drank to inebriation, and I said no, that's not why I drink.

4. He said he would be concerned if I were to use alcohol to medicate or manage my emotions in times of stress. I'm not doing that -- even now. Alcohol has never been my go-to drug to medicate my feelings.

I'm in the camp of @@CowgirlJane and others here in that of all the things I worry about wasting calories on, the 100-135 calories spent on a pre-dinner single malt scotch or a glass of wine with dinner is the least of my worries. (My current maintenance calorie budget is 1,800/day.)

However, the substance I do struggle with in terms of portion-creep that challenges my discipline is chocolate -- specifically, dark chocolate with sea salt. About six weeks ago I had to declare a moratorium on that stuff. Over a period of three months, I'd edged up from one square of chocolate after dinner to two squares to four squares to (gulp!) six squares ... every damn night! I seriously doubt that dark chocolate is a toxin, but it was sure about to make me its b***h!

So for me, mindfulness, moderation and common sense will be the keys to my maintenance success. But total abstinence and perfection -- not so much.

EDIT: P.S. I've lost 100 pounds and now weigh 135 pounds. I reached my initial weight loss goal (150 pounds) 8.5 months post-op. I've weighed at or below that weight for the last year.

[Connie Stapleton PhD 342]

@@VSGAnn2014

Very nicely stated. Thank you for adding your experience! I agree with your psychologist on several points but not on others. I have also had certification as an alcohol and drug therapist for 25 years, so in addition to my 12 years specifically in the field of bariatrics, I have an extensive background in substance abuse. The data is limited about alcohol and WLS. I happen to think the problem is much more extensive than the literature suggests regarding transfer addiction. No matter what, alcohol is and always will be a drug, a toxin and has an effect on the absorption of nutrients. You, and all persons, are free to choose what to eat and drink! I'm very sad to hear about your husband. Please take care of yourself while you are caring for him. Thank you.

Connie

[Tssiemer1 549]

I'm still pre op but I'm partial to vodka with lime. Or just straight up Woodford reserve.

[RickM 1,747]

My doc's perspective on the subject is that ideally alcohol should be a never again thing, but realistically, people being human, his real absolute is for none at all during the weight loss phase (something we sign up for during the psych evaluation). His biggest concern, beyond the long term transfer addiction issue that is the centerpiece of this article, is liver health. Or livers are usually in marginal, at best, condition from our obesity, and it is further taxed by its role in metabolizing all the fat that we are rapidly losing; it doesn't need any more stress from metabolizing alcohol (which beyond being a toxic as noted, is specifically a liver toxin.

His perspective is somewhat colored by his background as a biliopancreactic (liver/pancreas) transplant surgeon before he got into bariatrics and continuing along side that practice. Addressing the obesity problem can significantly reduce the demand for transplants; alcoholism is another significant source of such demand. He does not want to see any of his bariatric patients coming back on his transplant table.

[Connie Stapleton PhD 342]

@@SweetPeas So glad to hear that the medical professionals on your team said no alcohol! Where did you have your surgery?

@@SweetPeas So glad to hear that the medical professionals on your team said no alcohol! Where did you have your surgery?

[Connie Stapleton PhD 342]

@@Tssiemer1

You CAN drink wine... it's just not a very good idea!

[Connie Stapleton PhD 342]

@@2goldengirl

Please remember that I am only talking about RECOMMENDATIONS. And recommendations from those who are the governing body of WLS. It's not about saying ALL or NOTHING, nor does where I am coming from having anything to do with WLS patients being able to make good decisions - or not. What I am saying is that BECAUSE alcohol is a toxin and may interfere with absorption of essential nutrients, the governing body's RECOMMENDATION, not MANDATE, be that it is not a wise decision to consume alcohol after weight loss surgery.

I totally agree that each and every person is responsible for their own health.

Thank you!

[Christinamo7 4,041]

so my question for the OP, do you think no one WLS or not, should ever consume alcohol? it is a toxin for everyone, afterall.

I do enjoy an occasional drink - and hope I will tolerate that again once I get to my maintenance level, however if I no longer care for it that will not be the end of the world for me either, but some of my friends will get lovely presents.

[Connie Stapleton PhD 342]

@@CowgirlJane

I love your comparison between alcohol and ice cream and how one calls your name and one doesn't. I also completely agree that WLS is not a "one size fits all" kind of thing. People definitely need to know the things that may need to be "off limits" for them and make healthy decisions accordingly. That will be different for every person.

Please remember that I am only talking about RECOMMENDATIONS. And recommendations from those who are the governing body of WLS. It's not about saying ALL or NOTHING, nor does where I am coming from having anything to do with WLS patients being able to make good decisions - or not. What I am saying is that BECAUSE alcohol is a toxin and may interfere with absorption of essential nutrients, the governing body's RECOMMENDATION, not MANDATE, be that it is not a wise decision to consume alcohol after weight loss surgery.

Thank you!

[Connie Stapleton PhD 342]

@@OKCPirate

I agree very much with the minister's quote: "very little good comes form the absolute shall."

Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects.

A recommendation is different than a "thou shalt not."

Thanks for the website referral. I'll definitely look at it! I definitely agree that people are different and also agree with Dee Hock. I am suggesting that there are simple, clear recommendations with the medical reasons as to why alcohol is contraindicated for WLS patients. I'm not saying to set rules.

I'm so glad hearing that you and your kids have great communication. Very awesome.

Thank you so much for sharing your thoughts!

[Connie Stapleton PhD 342]

@@Christinamo7

Given that alcohol is a toxin, then it's not a "wise" thing for anyone to do, really! But I'm not saying anything about no one, WLS patient or not, EVER having alcohol. Every person is individually responsible for whatever they put into their bodies.

My message is not about judging those who drink or smoke or whatever... My message is about a governing body taking a more clear stance in their RECOMMENDATION. Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects.

A recommendation is different than a "thou shalt not."

Thank you for sharing your thoughts.

[Connie Stapleton PhD 342]

@@CowgirlJane

I'm with you on the cigarettes! We could certainly rant about that! Please remember that my comments are specifically related to the bariatric professionals who are the "leaders of the pack." My position is that this governing body needs to have a more definite RECOMMENDATION, based on the fact that alcohol is a toxin that can have deleterious effects on the absorption of essential nutrients, in addition to other possible negative effects.

A recommendation is different than a "thou shalt not."

Thanks.

[VSGAnn2014 12,992]

There's a "governing body of WLS"?

A governing body?

Really?

You do realize, don't you, that bariatric surgeons don't even agree about whether a sleeve stretches post-op.

This business about "alcohol is a toxin" is such a broad-brush assertion -- since toxicity of a substance (including drugs) is dependent on dosage.

[SweetPeas 117]

I had my surgery at mayo Clinic. They weren't overbearing about it but open and honest (and had a consistent message from provider to provider, regardless of the specialty) and put forth a lot of their first hand observations from their own practice. It's their job to give me the best possible recommendation to increase my changes of being successful with WLS and healthy. I appreciated the information, and like I said I wasn't drinking enough for giving it up to be a big deal. For me, a close personal relationship with pizza is the real struggle.