Hunger Hormones May Be Dieters' Worst Enemy

Hunger Hormones May Be Dieters' Worst Enemy

There could be a REASON why we fail diets. Or -- diets fail us.

One year after initial weight reduction, levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss. Long-term strategies to counteract this change may be needed to prevent obesity relapse.

Ghrelin.  You may have heard of this evil little hormone.

Nature -

Do you follow?

*blink blink* 

Wikipedia tells me --

Ghrelin  is a 28 amino acid peptide and hormone that is produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates hunger.^[1] Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone leptin, produced by adipose tissue, which induces satiation when present at higher levels.

In some bariatric procedures, the level of ghrelin is reduced in patients, thus causing satiation before it would normally occur.

Medical News: Hunger Hormones May Be Dieters' Worst Enemy - in Primary Care, Obesity from MedPage Today.

Hormones regulating when a person feels hungry or sated do not rapidly adjust to weight loss, which may be a factor in the yo-yo effect observed among dieters, researchers found.

One year after losing weight, levels of appetite-regulating hormones didn't revert to baseline levels, Joseph Proietto, PhD, of Heidelberg Repatriation Hospital in Australia, and colleagues reported in the Oct. 27 issue of the New England Journal of Medicine.

The findings suggest that the "high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits," Proietto and colleagues wrote.

It's well established that heavy patients who lose weight dieting often fail to keep the pounds off, the researchers explained.

Studies have shown that restricting calories can lower levels of the hormones leptin -- which tells the brain that the body is full -- and ghrelin -- which stimulates hunger.

Doesn't this also help explain why some forms of weight loss surgery ... work better overall in the long term?  In certain types of WLS -- most of ghrelin producing factor -- is removed. 

Go DS.  Or not. It's up to you.  Surgery flame wars!

DSFacts.com -

Approximately 70% of the stomach is removed along the greater curvature, also called a vertical sleeve gastrectomy (VSG). The remaining stomach is fully functioning, banana shaped and about 3 - 5 oz in size which restricts the amount you can consume. The pylorus continues to control the stomach emptying into the small intestine; as a result patients do not experience "dumping". The upper portion of the duodenum remains in use; food digests to an absorbable consistency in the stomach before moving into the small intestine. This allows for better absorption of nutrients like vitamin B12, calcium, iron and protein when compared to gastric bypass procedures.

A benefit of removing a portion of the stomach is that it also greatly reduces the amount of ghrelin producing tissue and amount of acid in the stomach.

Ghrelin is the "hunger hormone" and by reducing the amount of the hormone produced the appetite is suppressed.

Study -

Sumithran P, et al "Long-term persistence of hormonal adaptations to weight loss" N Engl J Med 2011; 365:1597-1604.

Wow.   Makes me even more grateful for my "mutant" RnY - I actually had a near total gastrectomy due to constant hospitalization from bleeding ulcers that refused to heal.  So most of my stomach, even more than a DS'rs or a VSG's, is completely gone.  The small amount left was put into the RnY formation and my intestines also follow the RnY formation.   I feel so fortunate.

I had been told about the ghrelin thing and how fortunate I was but I never really understood it until I read all this.  Thanks Beth.

Neither did I --

In fact -- I remember being told that my ghrelin would chill with RNY -- years ago.

Fail.

It does chill a little. 

Our homeostatic systems are very complex and we don't understand everything they do and how it all interacts. But WLS definitely changes it for the better and that's why we can lose weight and mostly keep it off.

Of course we don't -- otherwise we'd all be thin.

No, because WLS makes it better but better doesn't mean perfect.

If WLS didn't fix our homeostatic system, we'd all of us always regain all our weight lost plus a bit extra just like we did when we went on diets. Some people do do that, but it's pretty rare.

What's more common is to lose 60-80% of our excess weight over the long haul. So that's a big improvement for someone who was SMO and is now only obese or overweight and it wouldn't be possible of all WLS did was restrict our calories for a while.

We all know what happens to people who lose weight by restricting their calories without WLS... they eventually gain it all back with friends. That's because just restricting calories doesn't do things like change our ghrelin levels. In fact, it actually raises them!

wow, i had bleeding ulcers early after RNY. god did they suck. luckily for me they did eventually heal. i'm glad this turned out well for you and that you're now healthy!

Thanks Chris.  sorry I'm so ridiculously late replying - don't get on  OH much anymore.

I find it interesting that these articles that discuss hunger/obesity always focus on just the stomach as if obesity is just a stomach issue.

Obesity is a disease with biological, psychological, and I suppose sociological factors. Biologically, obesity is both a gastric and intestinal condition. So just addressing the stomach issues (i.e. remove much of the ghrelin hormone) is rather incomplete. While the sleeve part of the ds removes much of "the hunger" hormone it is the metabolic affect that the intestinal component of the ds surgery provides that truly gives satiety. I suppose you could say the sleeve removes the hunger hormone, but the switch corrects the broken satiety hormones. It takes the combination of the sleeve and the switch to do the trick.

I'd add environmental --