RNY and hunger pains...

Well,…. I don’t know spit, but…. (I hope my editor shows up or I could type for a week, sorry) When the poster said- "He said when he did the surgery, he cuts the nerve that runs from our old stomach to our brain that regulates hunger and satiety impulses…. This nerve delivers the hormone gherlin to our brains. And since the nerve connection no longer works, we no longer feel that extreme hunger." She actually meant- "I thought I heard my surgeon Say….." It’s a bit like saying- "My mechanic told me that the wire to my headlights are cut, and the gas, that normally flows through those wires, is diverted to run through the radiator and that causes the engine to run cooler." There’s a lot of facts and ideas woven into a knot going on there. I’ll attempt some "untying." The "Medical Profession Jury" is still "Out" on gherlin’s role in How it effects Bariatric Surgery, If it effects Bariatric Surgery outcomes, Why it might effect Bariatric Surgery outcomes, even Where it comes from… and that "Vagal Nerve" is more tangentially connected than actually responsible… Gherlin is a fairly new discovery when it comes to Hormones. The discovery of ghrelin was reported by Masayasu Kojima in 1999. The name is based on its role as a Growth Hormone-Releasing peptide. There are more conclusive "long-range studies" on the long-term effects of internet use on Cancer patients, Than there is on Gherlin. Gherlin is carried in the blood, and signals the pituitary, thyroid and other glands of the endocrine system (Primarily the hypothalamus) to Send chemical signals to the brain to induce hunger when the body Is lacking food. People who don’t eat for over 5 hours Begin showing increased Ghrelin hormone levels in their blood. After they eat? The Ghrelin levels drop and the endocrine system Signals the brain- "We’re not hungry now." Shortly after Ghrelin was discovered, A bunch of mice were made hungry or full in hundreds of ghrelin studies. By 2000, they had tested out some humans and found- "Subjects receiving ghrelin (IV) reported a 46% increase in the perception of hunger and ate an average of 28% more calories at a subsequent buffet meal compared with another occasion when they received none." So, the presence of ghrelin does "Make us Hungry." But Where exactly that ghrelin came from was still not defined… The studies that most folk refer to are from 2001- and some from 2002 The standard "Line from ASBS (Bariatric Surgeons) WAS- Gastric Bypass Reduces Appetite Hormone: "Dr. Walter Pories, ….president-elect of the society for bariatric surgery, said he and other doctors had long suspected that the gastric bypass operation might be decreasing the levels of some hormone made in the gut – they had no idea which hormone – that was affecting appetite, blood sugar and weight." (that’s from 2001) See, told you it was new… & working from- Roles for Ghrelin in the Regulation of Appetite and Body Weight, David E. *******s, JAMA Dec., 2002 Ghrelin Levels Fall After Weight Loss Surgery: "Ghrelin might be the mystery hormone. When *******s and his colleagues measured it in people who had had the surgery from nine months to 31 months earlier, they found ghrelin levels to be one-third or less of the lowest levels found in normal weight or overweight people who had not had the surgery. And the surgical patients did not have the spikes seen before and after meals in the other people." Blood ghrelin concentration is at its lowest right after eating a meal, but rises during the fast right before the next meal. (this from 2001 *******s, study on Diabetes -- It shows this pattern and is based on plasma ghrelin level fluctuations from in ten people over the course of a day (non-ops indicated by the blue line, post-ops- red). *******s presented his findings that- "Human plasma ghrelin levels sharply increase before and decrease after every meal… Because most ghrelin production occurs in the anatomical region affected by RYGB, (Roux-N-Y Gastric Bypass) we investigated the effect of this operation on circulating ghrelin levels….The mechanism by which RYGB may decrease circulating ghrelin levels is unknown." After a lot of study on the levels of gherlin and the muscle contractions of Different portions of the Stomach and small intestines, *******s concluded that "….roughly two thirds of circulating human ghrelin comes from the stomach and one third from the small intestine." And went on with- "The gastric fundus contains 10 to 20 times more ghrelin per gram of tissue than the duodenum, the next richest source." ("fundus" is that bottom part of the stomach, separated off by gastric by-pass. The part removed in the DS procedure.) *******s speculated that the majority of the ghrelin-producing cells were isolated from food and stimulation by gastric bypass and thus accounted for the drop in ghrelin levels seen in Post-Ops who did not have peaks between meals as "Non-Ops" do. He went on to state- " the position of the staple-line partitioning the stomach may be a critical determinant for the effect. The fundus, … lies immediately adjacent to the staple line ...in gastric bypass. Positioning this line even slightly too far to the left might … fail to suppress ghrelin levels." So, depending just where a doc cuts, can determine "Hunger Hormone" levels Later down the line for post-ops. An interesting "twist." (the first of a few) At first (and by this I mean- 2002 findings) the drops in hunger and long-range satiety and success Of DS patients was attributed to drops in ghrelin levels. But, 2006 studies indicate- "…biliopancreatic diversion (with DS) exhibits increased levels of ghrelin" But also the increased level of leptin and a Glucagon-like peptide. (GLP-1) "GLP-1 is increased more after BPDS than after gastric bypass…. This finding might explain why BPDS tends to ameliorate non-insulin-dependent diabetes mellitus more than does gastric bypass." So it’s not just- "Less ghrelin is a good thing," But also a whole host of digestive chemistry at play. I expect to see a lot of buzz about GLP-1 and leptin leading to more DS’s being performed specifically for Diabetes treatment.

So? About that Vagal nerve? For everything I know about the Vagal Nerve, checkout- VagalNerve&WLS

But, as to this connection? Well… -in ’02, an alternate hypothesis as to why the drop in ghrelin looked at the production of it over the whole of the stomach and small intestine. From the Journal of Biological Chemistry, 2002 The hypotheses was that the "interruption" Or differing degrees of damage to the Vagal nerve seen in bariatric surgery Was responsible for reducing the stimulation to the ghrelin producing cells. Oddly enough, the same year, 6 different studies were published And 3 fell on the side of- "Yes, this effects the ghrelin produce levels!" and 3 concluded- "No, no significant effect on ghrelin production!" "The Expert" by 02, was already *******s, And he concluded- "Treatment of the vagus nerve in RYGB is not consistent among bariatric surgeons. Although many practitioners strive to preserve vagal fibers, some projections innervating the fundus, especially from the left vagal branch, are almost certainly severed in modern procedures that completely transect the stoma*****reasingly popular laparoscopic approaches often sacrifice the entire vagal input to the majority of ghrelin-producing tissue. …We have found that vagotomy in rats disrupts ….but does not affect the response" as of 2006, the ASBS Position on "the findings" so far are- "The effect of gastric bypass surgery (GBP) on plasma concentrations of ghrelin is controversial. Dietary weight loss increases plasma levels of ghrelin, so one would expect plasma ghrelin to increase after GBP, but results are inconsistent. Some studies have demonstrated increased plasma levels and some no change, but the majority have shown a decrease. The reasons for these discrepancies are not clear. Surgical procedures differ in the amount of conserved fundus, with its higher density of ghrelin-producing cells included in the upper stomach pouch. Furthermore, vagal nerve fibers are cut during the procedure, interfering with the release of ghrelin mediated by vagal stimulation." And all of that may be- "Neither Here nor There" as they say in the South. A more recent study of ghrelin levels seen in those with Anorexia Nervosa, published 2006 by the American Association for Clinical Chemistry, Looked at how increased or constant levels of Ghrelin is produced by those With atrophied digestive system damage. It seems that the body adapts quite well. "Although ghrelin was first isolated and purified from gastric mucosa, (the stomach/ guts) recent studies have demonstrated additional production sites for this peptide." In the reduction of active "gastric motility," researchers found an increase of – "the significant production and distribution of ghrelin … in the major human salivary glands." Yep, spit. As the battle of the studie****s 10 years of research We may find that the decreased levels of Ghrelin found in By-Pass patients May well be the result of swallowing less saliva due to eating less. Eat less, or at least swallow less spit, And hunger levels drop. That’s my present hypothesis concerning it. But I don’t know spit. Best Wishes- Dx