It has traditionally been thought that bariatric surgery works because of the diminished size of the stomach. The operation is performed on people who have lost the ability to control their own eating habits. The surgery makes decisions for them, imposing upon them eating habits that are radically different than those they were employing before the surgery: Smaller meals, more frequent meals, less junk and fried foods. (Sweets, for instance, in any volume, make many post-surgery patients sick.)
Recent research, however, suggests that the reason for the effectiveness of the surgery in weight loss is NOT because of the smaller stomach. Rather, it is now suggested that weight loss occurs because of the change in the gut flora that the operation induces. According to a Harvard University study, it appears that the gut ecosystem of obese people changes after gastric bypass to more closely resemble that of normal-weight people. The scientists weren't sure whether the changed microbe population was a cause or effect of weight loss. Thus, they did an experiment with mice. They gave gastric bypass surgery to a group of mice that had been specially bred to carry no gut bacteria at all. They then implanted new gut flora into the mice. The mice quickly lost weight. The suggestion is that the adjustment of the intestinal flora was the effect that was responsible for the weight loss, not the gastric bypass surgery.
The question begs to be asked: Might solely adjusting the gut flora of humans have the same effect of weight loss? The scientists who conducted the study believe there is a good possibility for this. Author of the study, Lee Kaplan, says that: "Adjusting people's microbe levels, without surgery, might one day give doctors an entirely new way to treat the critical problem of obesity." He further states: "We're learning that the story is more complicated than just how much you exercise and how much you eat."
There is, too, an additional factor in weight loss that has been studied in relation to bariatric surgery. It is the 1999 discovery of the the hormone ghrelin, commonly referred to as the "hunger hormone." Ghrelin is released primarily from cells in the stomach, and then it travels to the brain. There, it interacts with both the hypothalamus (the brain's physiological eating center) and the brain's pleasure centers to arouse hunger. What is seen in the bariatric surgery is that the production of ghrelin decreases, and this, too, contributes to a decrease in appetite.
Thus, the next question: Might there be a way to diminish this hormone short of the radical step of surgery? Again, research suggests yes. In experiments, people who got injections of ghrelin before a buffet meal ate 30% more than a group of eaters not given extra ghrelin.
It would be useful to find a more natural alternative than bariatric surgery for severe weight loss, as there are considerable downsides to the surgery: Fewer nutrients are absorbed; vomiting and nausea are common post-surgical effects; subsequent infections can occur. Roughly 30% of patients develop conditions due to malnutrition, such as anemia and osteoporosis. And, most importantly, bariatric surgery is usually only the first of many surgeries, as the new trimmed-down body is "flabby, baggy and saggy," as one of the recipients described his post-bariatric body. As Lawrence Reed, MD, a New York City plastic surgeon says, "Post-bariatric surgery is a very important part of rehabilitation."
Readers of past Musings will remember that I covered the issue of gut flora in a newsletter posted on May 6th, 2013, entitled The Two Best Brains You Have (after the one in your head). Here is a quote from that:
"We are born 90% human, 10% microbes. By the time most of us die, we will have reversed the proportion of human to microbes, and we will have become 90% microbial. One might be tempted to say that at the time of our death, we are more microbial than human."
And, there is recent very exciting news about gut health, microbes, and a major illness. A new study reports that the lack of diversity among friendly microbes in the gut may be a contributing factor in autism. This study is the first comprehensive bacterial analysis of the intestinal environments of autistic children. Researchers have already established that gut microflora plays a critical role in a long list of essential biological processes--not just weight maintenance and digestion, as suggested in this Musings, but also in: Immune defense, mood regulation, heart health, and more. Authors of this autism study note that three bacterial groups have been identified as lacking in ASD patients: Prevotella, Coprococcus, and Veillonellaceae. This research fits in nicely with the observation that many children on the autism spectrum have GI problems, including reports of feeling better on a gluten-free, casein-free diet. A growing body of evidence suggests that when these problems are adequately addressed, when the gut flora is improved, autistic behaviors among these children improve dramatically.
ABOUT THE COLON (And Weight...)
The ideal pH in the colon is between 6.7 and 6.9. This is a slightly acidic environment, as 7 is neutral. The colon needs to be slightly acidic, as this both inhibits the growth of undesirable bacteria, such as E coli and S almonella, and also promotes the growth of beneficial bacteria, such as Lactobacillus. One of the acids produced by Lactobacillus is butyrate. Butyrate is the primary energy source for the cells that line the intestinal wall. Butyrate functions as an anti-inflammatory, anti-oxidant, and there is, as well, some evidence that it inhibits cancer cells. Related to its effect on weight, it promotes a feeling of satiety. You feel full and satisfied, and thus are less inclined to over-eat.
Butyrate can be found in most health food stores. Dr. David Williams, who has written on this topic, especially recommends the brand Nutricology.
Colonics are always good to cleanse the colon, which in turn, allows for the production of good bacteria.
ABOUT WATER (And Weight...)
Being overweight is a major health hazard -- potentially the greatest one facing the country today (in spite of the U.S. recently moving to second place behind Mexico, down a notch from our former esteemed first place position on the planet, in the race to having the largest per capita number of overweight people). According to the Centers for Disease Control, being overweight or obese increases risks for coronary heart disease, Type 2 diabetes, uterine, breast and colon cancers, high blood pressure, high cholesterol, stroke, liver and gallbladder disease, sleep apnea, osteoarthritis, and infertility.
A couple of years ago, I interviewed an Indian Swami for my first show on MNN TV. He had some interesting things to say about water and hunger. He suggested that if you want to lose weight, the easiest and most effective policy to institute in your eating habits is to drink a glass of water 20 minutes before eating. Here is the interview:
In 37% of Americans, the thirst mechanism is so weak that it is often mistaken for hunger.
Even mild dehydration will slow down one's metabolism as much as 30%.
One glass of water will shut down midnight hunger pangs for almost 100% of the dieters.
Lack of water is the #1 trigger of daytime fatigue.
Research indicates that 8-10 glasses of water a day could ease back and joint pain for up to 80% of sufferers
A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing
on the computer screen or on a printed page.
Drinking five glasses of water daily decreases your risk of colon cancer by 45%; breast cancer risk is reduced by 79%;
bladder cancer goes down by 50%.
Water has been shown to improve cognitive functioning in school children. When they drink water, they think better. Most children arrive at school in a state of mild dehydration. Think about this: we could give all children a placebo pill which they could take with a glass of WATER, and their grades would improve, with or without the placebo effect. OK. Leave out the sugar pill. Just give them water.
UPDATE ON FECAL TRANSPLANTS
I have talked in a past Musings about the unusual procedure of fecal transplants wherein gut infections and other gut disturbances are treated by implanting the intestines with healthy bacteria from healthy family member-donors' fecal matter. As a result of several physicians becoming interested in performing this procedure, the ever-watchful FDA has tried to claim human excrement as a drug. The FDA said the stools were unregulated drugs, and would require investigational new drug applications, and thus, would have to be taken through the extraordinarily expensive approval process before doctors could continue to perform the procedure. In June, as a result of embarrassing publicity, the FDA said they won't enforce the regulation after all.