Prospective Study Of Gut Hormone And Metabolic Changes After Laparoscopic Sleeve Gastrectomy And Roux
- Rachel Arakawa,
Roles Data curation, Investigation, Project administration, Writing original draft, Writing review & editing
Affiliation Division of Endocrinology & Metabolism, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Gerardo Febres,
Roles Data curation, Investigation, Project administration
Affiliation Division of Endocrinology & Metabolism, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Bin Cheng,
Roles Formal analysis
Affiliation Department of Biostatistics, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Abraham Krikhely,
Roles Investigation
Affiliation Division of Minimal Access/Bariatric Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
-
Roles Investigation
Affiliation Division of Minimal Access/Bariatric Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
Bonnies Before And After Gastric Bypass Experience
Bonnie before and after gastirc bypass surgery.
A few short months after gastric bypass surgery, Bonnie experienced menopause. After talking to her doctor she found out, while rare, sudden weight loss can trigger menopause in older women. Bonnie admits she wasnt happy nor prepared for this after surgery. However, she would definitely do it again if she had the choice.
Why Do Hunger And Satiety Change After Bariatric Surgery
The main reason is that while the size of your new stomach plays a role in how hungry and full you feel, its not the star of the show. Instead, just like mood, sleep, heart rate, reproduction, and more, hormones take the lead in determining how full and hungry you feel. Changes in these hormones after surgery differ from person to person, as we talked about in our article about factors other than behaviors that influence your weight after WLS. The hormonal changes are a bit complex, so well touch on the basics here and point you to where you can find out more.
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The Hunger Hormone Ghrelin
Ghrelin is the hormone that our bodies make to tell our brains that were hungry, and its often the one that gets talked about the most as a mechanism for weight loss after WLS. Ghrelin is produced in the stomach and stimulates hunger, fat deposition, and the release of growth hormone, among other things. With both the gastric bypass and gastric sleeve, reducing the size of the stomach also reduces the amount of ghrelin thus reducing hunger. During weight loss without surgery, the body produces more ghrelin to try to prevent weight loss. By reducing ghrelin, the surgery overrides the bodys desire to keep weight on. Much like before surgery, ghrelin levels and hunger will still vary from person to person after surgery. This is also true for the factors that lead to satiety.
What Kind Of Personality Change After Bariatric Surgery Are We Talking About
About a year after the surgery, research tells us that some spouses may become less accommodating and selfless.
They may advocate for themselves in rather direct ways that are not at all in keeping with their former selves.
This new pattern of assertiveness can sometimes seem abrupt, blunt, and somewhat confrontational.
Perception is everything. Personality change after bariatric surgery can also be positive.
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Why Do Hormonal Changes Occur After Bariatric Surgery
Bariatric surgery is the collective name for the procedures that help individuals dealing with severe obesity lose weight. This is accomplished by restricting food intake, limiting the absorption of nutrients, or a combination of both.
Due to this, many endocrine-related organs are affected. Many associated hormones may also be affected.
The most common hormones that are discussed in relation to bariatric surgery are Ghrelin , GLP-1 , and leptin .
These changes are mostly related to diet and lifestyle changes. Alterations to the intestinal tract can affect endocrine functioning and hormonal composition.
However, it should be noted that a lot of research has also studied the effects of bariatric surgery on sexual hormones, such as testosterone and estrogen amongst others.
Bariatric surgery has helped many people achieve their weight-loss goals but like any surgery, it is not without risk. There are also varying risks depending on the type of bariatric surgery you want to have.
In most cases, three main types of bariatric surgeries are identified. This would include Adjustable Gastric Band Surgery, Roux-En-Y Gastric Bypass Surgery, and Gastric Sleeve Surgery.
Gastric Band Surgery involves the placement of a band around the top portion of the stomach that can be adjusted to allow a small amount of food into the stomach at a time.
Gastric Sleeve Surgery reduces stomach size and slows the digestive process.
Which Hormones Affect Weight Gain/loss
The act of gaining or losing weight involves the same three factors. Energy in, energy out, and the way your body uses energy .
When you eat food, your body receives energy. Your body then uses that energy to operate. Your metabolism dictates how much of the energy you consume gets used. The leftover is stored as fat. At least thats the way your metabolism is supposed to work.
When you suffer from obesity, your metabolism slows. You might feel extremely hungry even though you recently ate.
What makes it so frustrating is that you might try everything to lose weight. Struggling in the gym does little and depriving yourself of your favorite foods only makes you hangry. The weight, sadly, stays put.
This is not your fault. And it has nothing to do with willpower.
Its all about your hormones.
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How Does Bariatric Surgery Can Help In Regulating The Gastrointestinal Hormones Leptin And Ghrelin
In bariatric surgery, the size of the stomach is reduce and the hormone ghrelin is secreted by stomach mainly due to the reduction in size, the secretion and release of hunger hormones decline gradually resulting in a healthy weight loss creating a satiety effect.
Eventually, the energy homeostasis will be maintained.
Medically reviewed by Dr. Manish Motwani, Bariatric & Metabolic Laparoscopic Bariatric Surgeon Curated by Deep Kaur
Managing Hormone Changes After Weight Loss Surgery
Rerouting your intestinal tract is going to change some of your hormonesincluding reducing your hunger. Bariatric surgery, such as gastric sleeve and gastric bypass, reconfigure the anatomy of your gastrointestinal tract which recalibrates your energy balance and fat metabolism.
The most pronounced change is the reduction of the intestinal hormone called ghrelin, also called the hunger hormone. As a result, hunger and appetite are diminished, increasing prolonged feelings of fullness . As a result, you feel less interest or desire to eat.
Interestingly, this and how other surgically-induced hormone changes function is in sharp contrast to those changes produced by traditional weight loss.
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D Bariatric Surgery And Sex Hormone Levels In Obese Men
Forest plot of the mean difference in TT levels in men before and after bariatric surgery. Forest plot of the mean difference in FT levels in men before and after bariatric surgery. Forest plot of the mean difference in E2 levels in men before and after bariatric surgery. Forest plot of the mean difference in LH levels in men before and after bariatric surgery. Forest plot of the mean difference in FSH levels in men before and after bariatric surgery. Forest plot of the mean difference in SHBG levels in men before and after bariatric surgery. Forest plot of the mean difference in insulin levels in men before and after bariatric surgery.
Gut Hormone Levels In Poor And Good Responders After Bariatric Surgery
As discussed, multiple satiety gut hormones are elevated after RYGB and SG, but is there a difference in gut hormone levels between good responders and poor responders to bariatric surgery? Almost all the studies which have addressed this question have been performed after RYGB. Despite the different definitions for good and poor responders between the studies, people with poor postoperative weight loss after RYGB have elevated ghrelin levels and reduced secretion of satiety gut hormones compared to good responders to the operation . Moreover, suppression of hunger was more pronounced in good responders to RYGB after a standardized meal compared to poor responders .
Poor responders to bariatric surgery can be further categorized as primary poor responders and secondary poor responders . There is a lack of standardisation in definitions for primary and secondary poor responders and good responders . The majority of people who are poor responders to bariatric surgery are secondary poor responders, with a 5% of bariatric surgery population being primary poor responders . There may be a number of differences in physiology between primary and secondary poor responders compared to good responders to bariatric surgery.
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What Type Of Personality Changes Should I Expect After Bariatric Surgery
With the variety of hormonal changes that are happening in the body after surgery, mood and emotional changes can happen. Hormones will fluctuate after surgery as a result of nutrient and sugar intake being limited and insulin production being altered. Post-surgery, your diet will change drastically.
No matter the type of bariatric surgery sleeve gastrectomy, duodenal switch, or gastric bypass surgery they all require a specialized diet for a short time before the surgery, post-op, and for the rest of your life. It will require restricting or even fully eliminating certain foods and drinks that you once enjoyed regularly. No more binge eating, much less sugar intake, and overall smaller portions will be the new norm.
Because of this, insulin production is changed, and this causes the levels of amino acids that are released in order to release healthy serotonin amounts to enter the brain. Decreased serotonin levels can lead to mental health issues, such as depression and anxiety.
Once you start seeing the weight come off, you will likely feel encouraged. But for some people, their obesity has been imprinted into their whole being and it may be difficult to not stress about maintaining your new weight. This often becomes a source of anxiety for weight loss patients.
Improved Sex Drive And Function After Bariatric Surgery
An important quality of life component that is often overlooked in obesity and bariatric medicine is sexual health. People with obesity frequently report decreased sexual desire and overall satisfaction.
The Journal of the American Medicine Association performed a clinical trial with women who had undergone surgical weight loss and reported they experienced significant improvements in overall sexual functioning, in most reproductive hormones of interest, and in overall psychosocial status.
Weight loss can stabilize your hormones. Studies have shown as little as a 10 percent weight reduction can be effective in improving ovulation and menses. Doing so can help reduce the level of androgens in your body and reduce negative symptoms and boost fertility.
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Gut Hormones And Their Role In Appetite And Food Intake After Bariatric Surgery
The increased levels of postprandial secretion of gut hormones and their known role in food intake and appetite have predictably led to the hypothesis that changes in gut hormones are contributed to the observed changes in appetite and food intake after RYGB and SG. To demonstrate causality for the effect of gut hormones on satiety and food intake after bariatric surgery, a somatostatin analogue has been used to non-specifically attenuate the response of postprandial gut hormones . The first evidence to strongly suggest a role for the exaggerated response of gut hormones was provided when increased food intake and reduced satiety was shown in patients after RYGB who received octreotide compared to saline within a randomized controlled trial . In contrast, patients who had undergone AGB , did not exhibit changes in appetite or food intake with octreotide administration .
Sex Drive And Function Improved After Bariatric Surgery
An important quality of life component often overlooked in obesity and bariatric medicine is sexual health. People with obesity frequently report decreased sexual desire and overall satisfaction. The Journal of the American Medicine Association performed a clinical trial with women who had undergone surgical weight loss and reported they experienced significant improvements in overall sexual functioning, in most reproductive hormones of interest, and in overall psychosocial status.
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New Research Emergingthe Special Problem Of Addiction Transfer After Surgery
New Research has expressed concerns that Addiction Transfer or cross addiction is a personal risk for some patients after bariatric surgery. The definition ofAddiction Transfer specifically refers to trading compulsive eating for a new and different compulsive behavior, often another process addiction, such as sex or love.
There is also strong evidence of a biological reason for cross-addiction. New research reveals various forms of transfer addiction in almost 30% of patients who have had bariatric surgery. Another research project puts the rate even higher.
These patients, post-surgery, can no longer turn to food as a source of comfort. An intra-psychic pressure builds and a replacement addiction presents itself.
One of the challenges of process addictions such as food and sex is that they can serve many emotional purposes reward, and many levels of distraction.
Risks Associated With Hormonal Changes After Bariatric Surgery
In some cases, hormonal changes have been found to lead to gastric bypass long-term side effects.
These are not very common, but have been identified as risks patients should be aware of before they undergo surgery.
Some of these risks can also be mitigated by choosing the right type of surgery for you. This is because each type of surgery presents its own risks and hormonal changes.
There are also some preventative measures that can lower the risks presented below.
Depression
A lot of research has been conducted on the link between bariatric surgery and depression.
Naturally, one would think that the weight loss effects post-surgery contribute to positive mental health changes.
Unfortunately, a restrictive diet can lead to negative changes in mental health in many cases.
Interestingly, some research suggests that the diet can directly affect changes in serotonin levels in the body, which in turn, alters neurotransmitter activity that can cause depression and anxious moods.
Serotonin is the hormone that ensures stability in mood and also general feelings of well-being and happiness.
Women have lower overall levels of serotonin, therefore they may be more prone to depression than men.
Other factors and lifestyle changes post-surgery may contribute to feelings of despondency, including the fact that activities that were previously enjoyed may now be off-limits .
Nutrient Deficiency
This can take the form of a lack of macronutrients and/or micronutrients .
Weakened Bones
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Bariatric Surgery : A Treatment For Obesity
From the point of view of therapeutics, proper dietary re-education, together with lifestyle modification and physical exercise as well as psychological specialized support for obesity treatment are needed. However, studies such as Look AHEAD showed that weight loss and glycemic control is difficult to maintain in the long term, even with intensive lifestyle intervention . Thus, bariatric surgery is the most effective therapy in the long term for severely obese patients with associated metabolic diseases and for morbidly and super morbidly obese patients . In addition, there is increasing literature that supports the inclusion of BS for the treatment of T2DM and obese patients . In this context, a global approach developed by a multidisciplinary unit, which allows a personalized and comprehensive treatment for obese patients as well as the selection of those patients who can be benefit from surgical treatment is extremely relevant.
After BS, many aspects are modified and imply a reduction in the risk of obesity-associated disorders as well as of all-cause mortality . Some of the beneficial effects of BS are improved physical function , sustained weight loss, reduction of comorbidities such as osteoarthritis and respiratory dysfunction , a more favorable metabolic profile, which implies an improvement in quality of life, and the resolution of cardiovascular risk factors with lower triglyceride levels and higher HDL-C levels in most patients 1 year after surgery .
Sexy And Beautiful For The First Time
Research also tells us that the most significant pitfall for marriage after bariatric surgery is that the patient may suddenly, perhaps for the first time, find themselves seen as an attractive other.
In an unhappy marriage, sexual acting-out can be a significant marital stressor, particularly in cases where the patient was obese during their teenage years. They may feel that they are making up for lost time.
This acting out behavior can be particularly problematic if the patient was also overweight for the duration of the marriage as well while a teenager.
For these patients, who may be experiencing the sexual attention of attractive others on a consistent basis for the first time.
Patient Expert Cheryl Ann Borne reports that the odds of these marriages collapsing within two years after the surgery is an incredible 80 to 85 percent.
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What Is Obesity And How It Occurs
Excessive consumption of carbohydrates and fats will lead to fat deposition.
When an excess of carbohydrate is consumed, it gets converted into glycogen and will later get deposited as fat.
When we consume carbohydrate it mainly get utilize by our cells for their cellular process and functions.
With excess consumption of carbohydrates and its conversion, it results in Obesity.
50% of our daily energy intake should be from Carbohydrate.
In obesity, there is excess fat of 10-20% greater than standard body weight.
Leptin is a hormone responsible for suppressing hunger which is secreted by our brain.
In obese conditions with the presence of excess fat insensitivity to hormone leptin can occur which will result in uncontrolled hunger.
The prime reason for obese condition is when excessive amount of calorie is consumed in comparison to total energy expenditure.
Any individual with the BMI of 30 kg/m2 and above is considered as obese and require therapeutic weight loss surgery intervention.
Eating disorder, emotional eating, genetic inheritance, stress, low physical activity are all supporting factors that can lead to obesity.
With constant calorie restrict diet, plateau effect is experience where further weight loss is difficult after certain period, yo-yo effect is also experience where weight comes back immediately once diet is stopped.
When an individual has BMI of 30kg/m2 or Above, Bariatric intervention is necessary and is the solution.