Does it make you angry that you have such a difficult time losing weight? A report in the New England Journal of Medicine touts a breakthrough that may lead to a cure for obesity. Researchers at the University of Washington have shown that a hormone, called ghrelin, produced primarily by the stomach, makes you hungry, and that eating drops blood levels of ghrelin to shut off hunger.
The researchers showed that blood levels of ghrelin rise just before you eat and drop after you eat. This is what you would expect from a hormone that makes you hungry.
They showed that people who lose weight have higher blood levels of ghrelin, than they did when they were fat. This also supports the theory because the body tends to maintain its ideal weight and when you lose weight, your body should produce more ghrelin to stimulate you to regain the lost weight. Therefore ghrelin makes you fat by causing hunger to make you eat more and slowing your metabolism to make you burn fewer calories.
Previous studies showed that ghrelin is produced primarily by cells in the stomach and a little bit by cells in the upper intestines. Using this information, researchers then studied obese people who had had gastric bypass surgery. In this surgery, a hole in made in the upper stomach, a piece of the intestine is sewn against the stomach hole, and the lower stomach is sewn shut. Therefore, after a person eats, food passes into the uppermost portion of the stomach and then out through a hole, so that the food doesn't even get into the stomach. In gastric bypass patients, food never enters the stomach or upper intestines, the areas that produce ghrelin.
People who have had bypass surgery do not have a rise in ghrelin before they eat and do not have a drop after they eat. Their levels of ghrelin remain low all the time. This shows that ghrelin is produced by stomach cells only when food passes into the stomach. How can ghrelin cause hunger and make you fat, and be called out by food entering the stomach? At first this doesn't make any sense whatever. However, the authors feel that an empty stomach cause stomach cells to produce ghrelin. Food in the stomach stops production of ghrelin. However, when no food enters the stomach for a long time, stomach cells stop making ghrelin and a person stops being hungry.
These studies show that today the only really effective way for permanent weight loss for people who are more than 100 pounds overweight is to have gastric bypass surgery. In the near future, a drug company will probably develop a drug that blocks ghrelin, and that company will sell that more than a trillion dollars a year of that drug. As of now, any doctor who tells grossly obese people that they are too fat because they eat too much or exercise too little is callous toward the obese person. Being more than 100 pounds overweight appears to be a disease caused by stomach cells that make too much ghrelin, and the only effective treatment we have at this time is bypass surgery.
NEJM. May 23, 2002
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