A glass of wine with dinner, a cold beer after mowing the yard…alcohol is woven into the fabric of life for many of us. But if you’ve had bariatric surgery such as gastric sleeve—or are considering it—you need to understand how alcohol can affect you, both mentally and physically.

Issue #1: Drunker, Faster

Bear with me on some science-y stuff here.

Many bariatric procedures, including gastric sleeve surgery, result in a change to the way your body processes alcohol. Because alcohol metabolism happens with help from the stomach, and gastric sleeve patients have a much smaller stomach than before, more pure alcohol enters their bloodstream. It’s like drinking on an empty stomach—multiplied by a lot. The liver also plays a big part in metabolizing alcohol, and sleeve patients’ livers are busy processing all the fatty acids they’re burning with that new sleeve. Which means alcohol gets processed last, and alcohol levels in the blood soar in the meantime. So you’ll get drunker more quickly, with those effects lasting much longer than what you’re used to.

In essence, the very processes helping you lose weight to improve your health are working againstalcohol consumption.

Issue #2: Empty Calories

Speaking of losing weight, alcohol is nothing but empty calories. And those are the enemy of significant, lasting weight loss. Many sleevers would never dream of drinking regular soda again, but wine contains twice the calories per ounce that soda does. And hard liquor is even worse in terms of calories. When you’re working so hard to get healthy foods into your body, why would you sabotage those efforts by guzzling calories with basically no nutrition?

Issue #3: The Risk of Dependence

Unfortunately, alcohol abuse after bariatric surgery has become a hot topic in the weight loss world. There are multiple studies that find an increased usage of alcohol in people who’ve undergone bariatric surgery. The kind of bariatric surgery does seem to affect this risk, however, with bypass patients being the most vulnerable.

A 2012 study in JAMA Surgery found a significant increase in alcohol use disorders in patients after Roux-en-Y gastric bypass, and CBS News reported nearly 21 percent of bypass patients develop a drinking problem. The same study cited in the CBS report said that the problem may lie in the fact that procedures like Roux-en-Y gastric bypass and the duodenal switch change the anatomy so that alcohol no longer travels through the initial part of the small intestine. But procedures like sleeve gastrectomy and Lap Band don’t seem to lead to the same outcome (increased alcohol use) because the small intestines aren’t altered.

The Bottom Line

While gastric sleeve might not have the same links to increased alcohol use in its post-op patients, we do know that the procedure affects the way patients’ bodies process alcohol. My advice: Just skip the alcohol. I strongly urge my patients to lay off the stuff during the first 12 to 18 months after surgery because their bodies are working very hard during this period to shed a lot of weight. After they’ve reached their goal weight, a small amount once in a while probably won’t have adverse effects.

Nothing is off limits completely when you undergo gastric sleeve surgery, which is both a good thing and a bad thing. It means you’re in charge of your success. And part of your decision-making process will be whether to consume alcohol. We here at Endobariatric are always happy to talk with you about this issue—or any other—at any time.