Thursday, October 4, 2007

Obesity Surgery as a California DUI defefnse

California DUI criminal defense lawyer news

Bariatric surgery and alcohol consumptio: A doctor in California hurriedly put together an experiment. The following story summarizes his findings.

California DUI story

People who had obesity surgery got drunk after just one glass of red wine, researchers reported in a small study that was inspired by an episode on “The Oprah Winfrey Show.”

“A lot of people think they can have one glass of wine and be OK,” said Dr. John Morton, assistant professor of surgery at Stanford University Medical Center, who is the study’s lead author. “The concern here is they really can’t.”

Morton has performed more than 1,000 gastric bypass, or stomach stapling, surgeries. He said he routinely warns his patients about drinking alcohol, but it wasn’t until Winfrey discussed the issue on her show last October that the public really took notice. He said questions poured in. “I didn’t find a whole lot in the literature, so that prompted the study,” he said.

The research team gave 36 men and women - 19 who had obesity surgery and 17 who did not - five ounces of red wine each to drink in 15 minutes. Using a breathalyzer, their alcohol levels were measured every five minutes until it returned to zero. More than 70 percent of the surgery patients hit a blood-alcohol level of 0.08 percent, which qualifies as legally intoxicated in California, and two reached levels above .15, Morton said. By contrast, most of the control group had levels below 0.05 percent, the study reported.

Researchers also found that obesity patients took longer to sober up. After matching the control group with the patient group for age, gender and weight, they found the patients took 108 minutes on average to return to a zero blood-alcohol level versus 72 minutes for the control group. Morton said the obesity surgery patients don’t produce as much of an enzyme that breaks down alcohol because their stomachs are smaller. Also, the alcohol passes to their small intestine faster, speeding up absorption, he said.

Dr. Madelyn Fernstrom, director of the weight management center at the University of Pittsburgh Medical Center, said Morton’s results support alcohol warnings normally given to gastric bypass patients. However, she called drinking five ounces of wine in 15 minutes an “artificial” test. No one - let alone bariatric surgery patients - would be advised to drink that amount of alcohol so quickly, she said.

There are more serious issues involved. Yes, alcohol will be absorbed quicker. Alcohol may even be eliminated slower because of decreased first pass metabolism in the stomach. BUT... a 200 pound man cannot get to a .15 on a single glass of wine. (Standard size drink of wine is typically 4 oz., although Dr. Morton's group ingested 5 oz.)

What's interesting about that study was that the bypass group reached an average of .08 on that single glass of wine, but the control group reached a BrAC of .05. For most weight classes, even including woman, the amount consumed should have been .02 to .03... .04 for a very small woman.

So, irrespective of whether the breath test subject was part of the gastric surgery group or the control group, everyone was blowing much higher than their BAC would have reflected with blood testing.

One could conclude BAC is higher in gastric bypass cases because:

1. There is much less alcohol dehydrogenase in the gut to process alcohol before reaching the duodenum;

2. The more rapid transfer to the duodenum results in a faster alcohol absorption yielding more alcohol in at one time which equals higher BAC’s

But, during absorption the positive differential between arterial and venous blood should be greater yielding a greater absorptive phase overstatement of actual blood alcohol by breath testing.

This effect should be shorter in duration due to the shorter absorptive phase.

So, if the person blows within a very short time of last consumption the breath test should be even more inaccurate than usual, but this effect will last a much shorter time.