Benefits of the Sleeve Linked with Changes in Bile Acid

When you hear that a procedure removes 80% of a person’s stomach, it makes sense to think their weight loss is because the size of their stomach forces them to eat smaller meals. But that may be an serious oversimplification. New research has debunked a common misunderstanding of how vertical sleeve gastrectomy (the sleeve) helps patients to lose weight: It may not be the size of the stomach, according to the study, but rather changes in gut metabolism that cause weight loss after the procedure.

In short, researchers discovered that with the sleeve there is a change in bile acids that bind to a nuclear receptor called FXR. Without FXR, both weight loss and improvement in diabetes was not as great. The findings are noteworthy because conventional thought is when you make the stomach smaller, patients lose more weight because they have less room to put food and thus, take-in fewer calories. This research shows, however, that a reason the sleeve works is that it increases circulating bile acids that are known to bind to the nuclear receptor FXR.

Additionally, the researchers observed changes in several key gut bacterial groups that have been previously linked to risk of type 2 diabetes, and the changes were also related to FXR and bile acids. Scientists believe that manipulating gut bacteria may be a way to mimic how bariatric surgery works—an important breakthrough as surgery is not an accessible option for many people who need it. “The article is very interesting,” said Oklahoma weight loss surgeon, Dr. Toby Broussard.  “More research should should be done to determine the effect of bile acids and gut bacteria on weight loss and diabetes–which could lead to enhancement in treatment,” he said. You can read more about the link between gut bacteria and obesity here.

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