I've been following the weight loss obsession at the supermarket checkouts for years, and not a month goes by without headlines on the subject in almost all of the "Soccer Mom" magazines.
In a desperate attempt to solve the fat problem, doctors have now turned to the Court of Last Resort-the surgeons, who proceeded to follow their old mantra, "when in doubt, cut it out" with the now well-known gastric bypass procedure. For those who don't know, gastric bypass involves cutting out all but a tiny portion of the top of the stomach. The rationale behind this was to make the stomach small enough that the patient would feel "full" sooner-and he IS full sooner, literally, because his stomach is smaller.
Everyone was delighted when this drastic remedy turned out to work. Not only did the patients lose weight, but they were also able to maintain the weight loss indefinitely.
To understand why gastric bypass works, you've got to go back a couple of years to a study published in the New England Journal of Medicine regarding a hormone called ghrelin (pronounced GRELL-in), which is located primarily in the stomach.
In the study, a team of Seattle scientists, headed by Dr. David E. Cummings of the University of Washington, measured daily fluctuations of ghrelin in 13 obese subjects before and after a six-month weight-reduction program. The subjects, who weighed an average of 220 pounds before the study began, lost an average of 38 pounds in three months with a combination of diet and exercise, and kept it off for three more months.
But the researchers found that ghrelin rose sharply before meals and fell shortly after meals, confirming earlier studies showing that it triggers the desire to eat. After the subjects lost an average of 17 percent of their body weight, ghrelin output rose roughly 25 percent. This will, it appears, virtually FORCE the subject to eat-and, in turn, re-gain much (if not all) of the weight he lost. Or, as the researchers put it, "weight reduction brought about by caloric restriction caused ghrelin levels to increase, suggesting that ghrelin might contribute to the drive to eat that makes long-term success with dieting so rare."
An end to yo-yo dieting
"It's well known that your body works against you when you try to lose weight," Dr. Cummings reported to Time magazine. "What's new is the possibility that a rise in ghrelin is the way it's done." Unfortunately, the researchers didn't follow the subjects after the study ended, but they "expect" that most of them regained the lost weight. But one participant did tell the Wall Street Journal that he regained everything he lost plus 15 more pounds. That's the usual story with all diets. The corpulent seem doomed to corpulence. At least they did until the advent of gastric bypass surgery.
Researchers also measured ghrelin levels in five subjects who had stomach bypass surgery. "Despite a 36 percent weight loss the ghrelin profile in the gastric-bypass group was 77 percent lower than in normal-weight controls," the researchers reported. In other words, people who lost weight following stomach bypass surgery had very low ghrelin levels compared to obese subjects who had lost the same amount of weight and compared to people of normal weight. What's more, ghrelin levels in people who had the surgery didn't even rise before meals as it does in most people.
This may explain why people who undergo gastric bypass surgery are remarkably successful in losing weight-and keeping it off.
Some patients have lost as much as 300 pounds and kept the weight off for a decade or more, according to the Washington Post. "It's nowhere near like dieting and exercise, where almost universal weight regain is seen," Dr. Cummings told the Post. "We propose that the loss of ghrelinmay be the explainer," Cummings added.
Ghrelin's better half
But that's not the end of the story. If ghrelin is the appetite-stimulating bad guy in the weight-loss scenario, leptin, which is the body's natural appetite suppressor, is the good guy. Leptin is located in the fat cells of the body, and they react to the hunger induced by ghrelin.
The Post reporter expounds on the wonder of it: "When we've stored enough fat, leptin tells us to stop eating. Ghrelin, on the other hand, tells us to eat and store fat. In ancient times, ghrelin helped us prepare for the next famine. In modern times, however, it acts as the evil twin of leptin. When we go on a diet and lose weight, ghrelin makes us hungry. The body thinks we are starving and encourages us to eat and regain the weight."
Do you get the Darwinian mindset here, the subtle evolutionary pitch? "In ancient times, ghrelin helped us prepare for the next famine." It's usually the reporters who feel the urge to explain to you the "evolutionary significance" of every new scientific discovery. This is so you will not stray from the state religion--science--and its prophet, Darwin. Sorry for the tangent, but I just can't stand these evolution-loving religiosos messing with my brain.
Anyway, back to ghrelin, leptin, and gastric bypass. In gastric bypass, surgeons cut out all but a tiny pocket at the top of the stomach. This, of course, limits food intake. It also shuts down the production of ghrelin to a barely detectable level, since most of the ghrelin-producing cells are removed by the surgery. So if the body isn't being stimulated by ghrelin, Mr. Leptin, presumably, thinks he doesn't have to suppress the appetite any more and just waits quietly, going along for the ride. Anyway, that's my explanation. It seems plausible if you consider the first-hand accounts of some patients who have undergone this procedure. One person who had the surgery told the Wall Street Journal that he often doesn't notice he's hungry until his blood sugar is so low that he feels faint. He actually has to remind himself to eat.
So it looks like the surgeons may have gotten it right for once-albeit by accident. (Too bad it didn't work out that way for heart bypass surgery, tonsillectomy, thymectomy, hysterectomy, and lobotomy.)
Still no easy answers
Dr. Gabe Markin reported: "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."
Dr. Markin seems a bit dogmatic, but I find it hard to argue with him in the case of malignantly obese people (i.e., those more than 100 pounds overweight).
But what about everyone else? I wonder if we might create another problem if this surgery becomes wildly popular. Many women are obsessed with their weight and many who are not really fat at all think they are. If a surgeon is a little knife-happy and thinks more of the bottom line of his bank account than the patient's anatomical bottom line, might we not be setting these weight-obsessed women up for unnecessary surgery?
Hopefully, researchers can figure out how to juggle these two appetite regulators, ghrelin and leptin, in a safe, effective way without putting people at risk for the complications that accompany major surgery.
Actions to take:
(1) In the meantime, if you're overweight by less than that 100-lb. marker, you owe it to yourself and your body to try eliminating carbohydrates, sugar, and processed food from your diet. While ghrelin seems to be a proven factor in weight gain, so are these unhealthy foods. Cutting them out will be one of the best things you'll ever do for yourself.
(2) There are also some natural, but safe, substances that can work together with an ongoing dietary plan low in carbohydrates and high in protein to help you lose weight. Nutrients like lecithin, pantothenic acid, chromium, L-carnitine, and bioflavonoids can help support metabolism, boost energy levels, regulate sugar and cravings, and support the immune system. Safe herbal extracts include garcinia cambogia and fenugreek. Most of these should be available in health-food stores, or even your local drug store. They are also available, along with a few other nutrients, in my Ultimate Weight Support formulation from Real Advantage Nutrients. For more information go to www.realadvantagevitamins.com or call (800)723-7318 or (203)699-3615 and ask for order code DIETRA. (Unfortunately, the Real Advantage products are not available to Australia or Germany at this time.)
(3) Something else to consider, too: People always seem to gain weight when they quit smoking. I think it's possible that the nicotine (or some other factor in the smoke) depresses ghrelin production, or stimulates leptin production, or both. I doubt there will ever be any research on the topic, but if you want to perform your own at-home experiment by smoking a good cigar or a couple of cigarettes a day, more power to you.
"Stomach hormone foils weight loss efforts," Clarence Bass' Ripped Enterprises (www.ripped.com), accessed 6/2/04
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"Early onset of reproductive function in normal female mice treated with leptin," Science 1997; 275(5,296): 88-90
"Weight-reducing effects of the plasma protein encoded by the obese gene," Science 1995; 269(5,223): 543
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"Stomach hormone linked to weight," The Washington Post, 5/23/02