I get the following question quite a bit “How do you think that malabsorption causes alcoholism/addiction?”, so I thought I’d make that the topic of today’s blog.
The malabsorptive component of many types of gastric bypass surgery can cause nutrient deficiency and as a recent study has shown, amino acid deficiency (caused by malabsorption of proteins).
This deficiency or deficiencies can lead to some very uncomfortable feelings including anxiety, rapid heartbeat, restlessness, fatigue, confusion, irritability (and others – see list below). Often our first instinct, when these feeling comes is to assuage them with food – our “old friend”. In the past, we may have found this to be a reliable method of providing immediate relief – albeit with a weighty side effect. We would often get a boost in serotonin or glucose or whatever and temporarily feel better. Now, post-gastric bypass surgery, we may find our old friend may or may not provide the relief that it used to.
Now we come to what I call the “double whammy” component – the way alcohol is now metabolized by the gastric bypass patient. A normal stomach has an enzyme called alcohol dehydrogenase that is responsible for metabolizing alcohol. After surgery, the new “little” stomach no longer has access to very much of this enzyme. The result is you get drunk faster and stay drunker longer.
A study by John Morton showed gastric bypass patients having progressively increased blood alcohol content as well as length of time to sober. For example, Pre-operatively Blood alcohol was 0.024, at 3 months 0.059 and at 6 months 0.088. Respectively, time to sober up was 49 minutes, 61 minutes and 88 minutes. No explanation was offered as to the progessive nature of the findings.
So, let’s just say you are experiencing this uncomfortable feeling, and you decide to have a drink to “take the edge off”. It’s never been a problem before so it never occurs to you it will now. All of a sudden you get swift and immediate relief (dopamine floods your pleasure centers), unlike anything you ever got with snacking. Your brain puts two and two together and very quickly starts telling you, you “need” this.
However, many gastric bypass patients weren’t drinkers at all and never turn to alcohol. Some decide to go to their doctor – makes sense right? Some medications that are often prescribed for these “uncomfortable feelings” are anti-depressants (Prozac, Zoloft, Effexor, Cymbalta, LexaPro, Celexa, Paxil …), anti-anxiety medications or benzodiazapenes (Xanax, Ativan, Valium, Klonipin), and/or sleep medications (Ambien, Lunesta, Sonata, Rozerem). Benzodiazapenes are very addictive and in this situation, if you are masking a nutritional deficiency that will only get worse if uncorrected, it is easy to see how someone could quickly become addicted. Like alcohol, this drug will also supply quick and immediate (though temporary relief) and again the brain will realize this drug makes you feel better and want more.
Prescription pain medications are also something that may be readily available to the gastric bypass patient. In addition to the original gastric bypass surgery, the patient may have had other revision type surgeries such as hernia repair or a tummy tuck or gall bladder or something unrelated. For whatever reason, if experiencing this “dis-ease” (I call it), and then the patient takes an opiate pain medication (LorTab, Vicodin, Oxycontin, Percocet, Hydrocodone) and gets immediate relief, the brain puts it together and decides that “this is a really good thing” – it doesn’t think about the side effects – it just knows how much relief is being provided.
So the way this sets the gastric bypass patient up for addiction is by creating a scenario where the malabsorption changes the brain/body chemistry such that the person feels so “wrong” – that when whatever drug that person chooses provides that “right” feeling (be it alcohol “the double whammy”, prescription medication, gambling, shopping, sex), the brain re-wires itself to want more and more of whatever made it feel so “right”. So, I don’t think you can say this surgery makes you an addict, but perhaps, you can say it is conducive to optimizing the ideal circumstances where addiction can occur.
I think it’s important to avoid the nutritional deficiency in the first place, for many, many reasons – this being merely one. If you do notice those first “inklings” realize that is your body/brain telling you something. Try to find out if you have any nutrient deficiencies if possible and nourish your body with the appropriate food and/or supplements. If you have already developed an addiction, seek help and professional assistance.
Website with list of nutrients and associated symptoms