TEDx Talk

I found out this summer that I would presenting at a TEDx event in Wooster Ohio. When I submitted my proposal, I thought this would be the perfect opportunity to dive into some research about a curiosity of mine. Ever since I started my internship hours, I have always been curious about all the post-gastric bypass patients that were sitting in treatment for alcoholism. I had planned to do an independent study on the topic, but I became too burnt out from school and opted to take a different class. 

Since announcing that I was going, I have had people contacting me frequently wanting to know more. So, I thought, now that I am finally done with the talk, I would share some of the information that I learned. 

I start out with a little "about me" segment. I proudly declared my past history of alcoholism and moved right on! There were some weird faces out in that audience :) I explained what addiction is. Addiction as a disease of the brain reward system. I threw up some stats from the National Institute of Health to bring home another quick message - addiction affects 40 million people and only 1 in 10 will receive treatment.

I moved on to talk about gastric bypass - in particular the Roux-en-Y procedure. The patients after this particular intervention seem to be the ones who are now developing the struggles with alcohol. Obesity in America in rampant and this procedure is very effective in the management of weight loss - rapid weight loss at that. It's dramatic but so is life at a BMI of 40 or larger. It's hard to be hopeful when someone tells you, you need to lose 100 pounds. This surgery provides consistent and rapid weight loss which in theory, I can imagine, keeps motivation up to continue to make lifestyle  changes. 

In the procedure a new smaller stomach is created. The gastric juices and enzymes are still active in the main stomach so that is reconnected at a lower spot in the intestinal tract. The intestine at a higher point is then connect back to the new smaller stomach. This reconfiguration prevents an individual from eating large quantities at one time and also limits the absorption of calories. 

I presented about 2 major studies completed in 2012 and 2013 that clearly showed that there is something going on in the gastric bypass population. The rate appeared to double at year 2 post-op for some patients. The number of reports of alcoholism reported prior to the surgery and the first year after the surgery, appeared to stay stagnant. It wasn't until the 2nd year post op the problems started up.

Thought #1 - the psychosocial profile of an obese individual - high rates of depression, higher rates of PTSD, agoraphobia and bulimia nervosa. Also, there were higher rates of issues with body image and self-confidence. Also high rates of social isolation and societal rejection. These issues are very much seen in the general addiction population and people much more susceptible to developing addiction especially with issues of undertreated mental health.

Additionally in this psychosocial profile - I discussed the issue of having unmet expectations and new life stressors because of the surgery. Regardless of the education and the information out there, when people get set on and idea and think it can do something life-changing for them, we build expectations. While individuals may clearly  be losing weight, the weight loss and surgery are not going to change the other issues list above. Additionally, up to 40% of gastric bypass patients have some form of complications. That can also let someone down as well. With these particular issues, a gastric bypass patient may not have the proper coping mechanisms to deal with all of this and end up turning to alcohol to cope. 


Thought #2 - altered alcohol metabolism. The enzyme alcohol dehydrogenase which starts to immediately breakdown alcohol in the stomach is no longer accessible. So this leads to the system to start the absorption in the intestine instead. This leads people to become intoxicated quicker and for longer period of time. I presented a small study that showed this phenomenon and subsequent studies have been showing the same result. This could lead to a quicker physical dependence on alcohol. Not to mention, it might look pretty enticing to the psychosocial model - get drunker, faster and for longer to deal with my problems that didn't go away after surgery.

Thought #3 - Cross addiction - This thought assumes that there is such a thing as food addiction. I believe there is such a thing and I buy into this thought more than all others. If there is addiction prior to surgery to food and this is not adequately treated, the addiction is likely to pop up somewhere else. The surgery limits this amount of food that a person can take in. They are no longer able to eat the way they used to and are no longer able to get that addiction satisfied. Here comes alcohol - high calorie, fast high......a new addiction emerges. 

All in all, I think it is a combination of these three factors. There is also other research that is talking about the 
gut-brain" communication. Our GI system and brains are linked hormonally and physiologically in such a way that if we take out the communication path between the two of them, we are setting up people for trouble. I can't explain it very well just yet and couldn't find all the needed research to throw into my presentation, but I will keep you posted as I learn more. My advisor in grad school mentioned to me that after gastric bypass people report personality changes because this communication path have been altered. 

There is so much more I could talk about here. I had to keep my speech to 18 minutes! I hope to write more about this soon on a more professional level. Again, I will keep you posted!

Thanks to all

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