68 hot dogs in one sitting?

Q: This past July 4th, I watched Nathan's hot dog eating contest on TV where the winner (for the sixth time), Joey Chestnut, ate an incredible 68 hot dogs in 10 minutes! How can someone eat that much? He's not even that big a guy. Can't someone's stomach explode from doing that? Does he need to vomit afterward?

A: The stomach is a muscular sac, and like the urinary bladder, it can be stretched way beyond its normal capacity with a lot of willpower and determination. Normally, there's a sense of fullness where you "just can't eat another bite." People who eat huge quantities of food for "sport" have learned to ignore the signals that prevent engorgement, stretching their stomach to the limits of its capacity. That capacity for most people is about 32 ounces, but these "super gurgitators" can stretch their stomachs to more than a gallon (128 ounces). One's size does not predict eating ability.

Once the true upper limit of consumption for an individual has been reached, there's nowhere for more food to go but up — as in regurgitation. The stomach won't burst. Among competitive food eaters, induced vomiting after an event is frowned upon and considered unsportsmanlike, much like athletes who take anabolic steroids.

By the way, Chestnut consumed more than 21,000 calories, more than 1,300 grams of fat, and 46,512 milligrams of sodium (not including buns) in his gastronomic feat.

Alcohol abuse and bariatric surgery

Question: I am seriously considering having gastric bypass surgery. I have diabetes, high blood pressure, arthritis, and high cholesterol. So I know it'll help improve my life. But I just read a story about gastric bypass patients being at increased risk of becoming alcoholics. I don't drink very much, so how worried should I be about it?

Answer: While you should be aware of it, your risk is very low since you're not much of a drinker. A slightly higher rate of alcoholism observed in gastric bypass patients was reported in a University of Pittsburgh Graduate School of Public Health study just published in the Journal of the American Medical Association. One aspect of the patient sample that may have overstated the higher risk is that only 7.6 percent of the study subjects reported a prior history of alcohol abuse. That baseline rate was far below the nearly 30 percent found in a 2007 study of nearly 45,000 people interviewed in a general population sampling. After surgery, the percentage of the bariatric surgery patients in the Pittsburgh study who had an alcohol problem appeared to rise to 9.6 percent, still well below the rate in the population at large.

There is a plausible reason for the slightly higher rate of alcoholism found in the Pittsburgh study. Gastric bypass increases the sensitivity to alcohol because the alcohol mostly bypasses the stomach and gets rapidly absorbed by the intestines into the bloodstream. The faster a drug hits the brain receptors, the greater the addiction risk.

That said, bariatric surgery is the most successful treatment for achieving substantial weight loss in obese folks. It's been shown to reverse risk factors for heart disease, reverse adult-onset diabetes, correct cholesterol disorders and normalize blood pressure.