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Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric Bypass Procedure: A Review

Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric Bypass Procedure: A Review. Lauren M. Beckman, MS, RD: University of Minnesota (UM) Tiffany R. Beckman, MD, MPH: UM Carrie P. Earthman, PhD, RD, LD: UM. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION.

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Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric Bypass Procedure: A Review

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  1. Changes in Gastrointestinal Hormones after the Roux-en-Y Gastric Bypass Procedure: A Review Lauren M. Beckman, MS, RD: University of Minnesota (UM) Tiffany R. Beckman, MD, MPH: UM Carrie P. Earthman, PhD, RD, LD: UM JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  2. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Gastrointestinal (GI) Hormones and Leptin Characteristics JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  3. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Effect of Weight Loss on Gastrointestinal Hormones and Leptin Concentrations JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  4. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Gastrointestinal Hormones and Leptin Response after Roux-en Y Gastric Bypass (RYGB) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  5. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Glucagon-Like Peptide-1 (GLP-1) after Roux-en Y Gastric Bypass (RYGB) • When post-RYGB patients were still considered obese, GLP-1 levels were significantly higher compared to lean • Suggests that a component of the RYGB procedure alters the GLP-1 profile • GLP-1 is secreted from the distal ileum in response to nutrient intake • Increased GLP-1 levels post-RYGB hypothesized to occur due to surgical component that promotes more rapid delivery of nutrients to the distal gut JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  6. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Peptide YY (PYY) after Roux-en Y Gastric Bypass (RYGB) • PYY response to a test meal or an oral glucose tolerance test was exaggerated, occurred earlier, and remained elevated above baseline levels for the remainder of the sampling time period • Occurs as early as 2 days post-RYGB, prior to any weight loss • In some studies the effect was seen as long as 6 months post-RYGB JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  7. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Leptin after Roux-en Y Gastric Bypass (RYGB) • Studies that examined the correlation between anthropometric measurements and leptin levels found: • Change in leptin concentration significantly correlated with change in BMI, body weight, and fat mass JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  8. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Ghrelin after Roux-en Y Gastric Bypass (RYGB) • Ghrelin reduction post-RYGB first reported by Cummings et al. in 2002, who also found that ghrelin levels were significantly increased following weight loss due to caloric restriction • This suggests that RYGB had a positive effect on the “hunger hormone” while other methods of weight loss did not JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  9. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Ghrelin after Roux-en Y Gastric Bypass (RYGB) • Ghrelin significantly decreases immediately post-RYGB • One study reported reduction 30 minutes post-RYGB • Evidence documents decreasedghrelin is maintained for more than one year post-RYGB • Consistent finding of decreased ghrelin levels post-RYGB offers a partial explanation for the success of the procedure • Low ghrelin levels would not contribute to feelings of hunger and thereby weight gain JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  10. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Ghrelin after Roux-en Y Gastric Bypass (RYGB) • Possible component of RYGB that promotes altered ghrelin: • Distal stomach (site of ghrelin release) is bypassed  ghrelin secretion is suppressed  hunger is reduced JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  11. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Ghrelin after Roux-en Y Gastric Bypass (RYGB) • To determine what component of the RYGB is responsible for the changes in ghrelin, one study collected plasma immediately before, during, and after the procedure and found the greatest decline after dividing the stomach • BLOOD COLLECTION TIME POINTS JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

  12. Changes in Gastrointestinal Hormones After the Roux-en-Y Gastric Bypass Procedure: A Review Summary • Glucagon-Like Peptide-1 (GLP-1), Peptide YY (PYY), leptin, and ghrelin change favorably after Roux-en Y Gastric Bypass (RYGB) • Compared to those undergoing other surgical procedures, those who are normal weight, overweight, or obese, or who lost weight by conventional methods, post-RYGB patients have: • Increased GLP-1 and PYY • Decreased ghrelin • Decreased leptin in proportion to body weight JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Beckman et al.J Am Diet Assoc. 2010; Volume 110 (April).

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