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I didn't have alcohol until 6 months out. Warning - it will hit you faster than before!

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.

I wasn't allowed alcohol until 3 months post-op.

my doctor and nut said alcohol would not hurt me once I am fully healed. I like whiskey, and I like wine, especially red. but these early months are when I am loosing weight the best and I am not going to waste the carbs in the first 6 months. I tended to have a drink oh, 2-3 a month - and I cook with wine. Once I am down in my weight it will just have to be factored in to my "carb allowance" and, practice at home - I sure won't have my first drink in public. I think this will also be my only exception to not drinking while eating. Because it will be a special occasion, I think it's better to have a little food in my tummy. Talk to your team, see what they recommend based on your personal medical history, medications, and surgery type.

It's been a month, when can I do a shot of whiskey? Sent from my SM-N910V using the BariatricPal App

@@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

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.

@@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

But if you are going to talk about alcohol, you have to include the best political speech of all time and the best on the subject: Read it here: http://www.rdrop.com/users/jimka/whisky.html John Grisham reads it for you here:

I keep thinking about a quote from a minister when the temperance movement began in the US in the 19th Century: "very little good comes from the absolute shall." I've always taken the approach of explaining the pluses and minuses of recreational drugs. Why the positives? Because people are getting something out of it if they are using it, and to ignore that would be less than honest with my kids. It's in the honest cost/benefit analysis that helps guide them so they can make the positive decisions that I do hope they will make. Alcohol has been an on again, off again struggle with me (before and after WLS). Some WLS patients have a sip of wine and feel intoxicated, and I have a tough time feeling it at all unless I drink a great deal. So to change and relearn my relationship with alcohol, I used some techniques from this site: https://hamsnetwork.wordpress.com/. I also found me keeping my eye focused on bigger goals makes it much easier to say "not now" than scare tactics. But everyone is different. Some need hard fast rules, others need general guidelines. Personally I agree with Dee Hock: "Simple, clear purpose and principles give rise to complex intelligent behavior. Rules and regulations give rise to simple stupid behavior." Understanding addiction, substance use and abuse is incredibly complex. It has never been aided by alarmist media treatment. There are no simple solutions. I am always amazed at the dismal success rate of "rehab." I am also amazed that the vast majority of drug/alcohol users go through life with scant few problems. I have felt that my kids stayed out of trouble because there was always clear communication, acceptance, tolerance, encouragement and lack of judgement in the family. "Absolute Shall's" just don't work for me.

Actually, for me it isn't about the alcohol at all. It's more the all-or-nothing, "WLS patients can't be trusted to make good decisions" attitude that fries me. I'm a grownup. This is my life, my sleeve, and my health. I accept full responsibility for them.

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.

@@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.

@@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!

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?

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.

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.

So my grief counselor has suggested I try Wellbutrin. Things have been especially bad for me lately because its coming up on the 1 year anniversary of my friend's suicide. We've also been exploring some buried emotions from my brother's death that I never really got over (apparently drowning them in alcohol didn't make them go away ;(. ). At this point I'm having difficulties experiencing any sort of emotion besides sadness.....most of my days are spent going through the motions and putting on a show for others and quite frankly I'm exhausted. She thinks the Wellbutrin will help me with the biochemical issues I may be having that are hindering my healing process. So I'm going in to see my PCP on Friday to get his OK for the Rx. So anyone else taking it for depression? How's it working for you? Just wondering if there are any weight loss/weight gain/appetite issues I could expect by taking this medication. Any other weird side effects? I've taken Prozac and other SSRIs in the past for anxiety and stress, but the main problem was I could not sleep while on them. Not sleeping was worse than the reasons I was taking them in the first place so I had to stop.

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.

I am 8 mos out and I eat everything. Popcorn and nuts. I eat beans, pasta and bread sparingly. It fills me up too quickly. I've posted before and I've received negative comments about my eating habits. But it works for me. I started at 200 and I now weigh 133...and I don't fluctuate much. I eat many times a day, but 4 or 5 bites. I don't log my food or count anything. Maybe I'm being naive or getting cocky...but I've done that my whole life and I feel free now. I can definitely eat more now. I don't think I've stretched out my stomach. I can eat very little in the morning, but as the day goes on I can eat more. I never drink alcohol, carbonated drinks, or juice. I eat chips, tacos, English muffins and peanut butter, turkey jerky, nuts, cheese, pizza, etc. Sweets aren't my thing, and if I do eat them, it's a few bites. Don't eat ice cream. I love cheeseburgers (half with one bun). A taquito. Half a piece of chicken and four bites of salad with ranch. A few fries. Sweet potato. No fruit really. I eat what I want when I want...just four or five bites. I would really have to work at it all day and make myself uncomfortable to gain weight. I don't know if this is bad advice, but it works for me. I never took PPI's. You'll do what works for you. To be honest, I will always be a food addict. My bad cravings really never went away, but I can't indulge now. If I had to eat chicken and veggies the rest of my life I'd be very unhappy. I want to eat healthy now to feel good...not just be skinny. I'm only 8 months out. I might be changing my tune if I put on weight in the years to come. ????

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/resources/alcohol-use-before-and-after-bariatric-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/resources/alcohol-use-before-and-after-bariatric-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.psychologytoday.com/blog/addiction-in-society/201011/science-is-what-society-says-it-is-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.medicinenet.com/alcohol_and_nutrition/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.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/appearance/calories-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.

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/resources/alcohol-use-before-and-after-bariatric-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.psychologytoday.com/blog/addiction-in-society/201011/science-is-what-society-says-it-is-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.medicinenet.com/alcohol_and_nutrition/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.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/appearance/calories-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.

I'm in a similar situation, although I have about 45 more pounds to lose. I think I prompted mine by traveling for almost a solid month, not eating an optimal selection and also consuming some alcohol during that period. Since that time I've only been able to drop a pound or two, and my weight has been fluctuating around the same point. I'm having a hard time getting the weight loss restarted. Thinking this coming week I will kick up the exercise routine and also maybe do a '5 day pouch reset' program to see if I can get the weight loss rolling again.

No rush ElChris was curious, I think it's awesome that you don't stress over the scale. I'm sure being in Vegas was hard, but you made it, how did your body handle the drinks? I'm so afraid of alcohol right now but would love a glass of red wine [emoji57]

Hi Everyone! I had my quarterly with my GP and my labs were awesome. I sleep better and just generally feel much better. I know I still don't get enough Protein but I'm trying. I'm down 38 lbs. I can feel it only one person at work mentioned it. I relocated for work 2.5 years ago and I'm back at the weight I was when I arrived.... I think now anything I do lose will be more noticeable to coworkers. I still haven't told anyone at work but my boss. I made it through another client dinner last week. Nibble here, nibble there... no alcohol. I lost all interest for food. My GP told me that that I have to be careful since at 6 months my hunger will be back and most people gain the weight back. A bit discouraging... but has me wondering what percentage of people actually gain the weight back.