Abstract
The gut hormones peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) play an integral role in appetite control and energy homeostasis. GLP-1 is an incretin that stimulates insulin secretion thereby improving glycemic control. Both nutrients and bile acids (BAs) are known stimulators of PYY and GLP-1 secretion from endocrine L-cells of the distal small intestine. Recent evidence implicates PYY and GLP-1 as contributing to the improvement in glycemic control and weight loss following gastric bypass (GBP) surgery for the treatment of obesity. The mechanisms for the increased levels of PYY and GLP-1 seen after GBP are not entirely understood and several hypotheses have been put forward. This chapter focuses on the role that altered gastrointestinal (GI) anatomy following GBP plays on BA and nutrient delivery to the distal small intestine. It is proposed that quicker transit and greater exposure of both nutrients and BAs to the distal terminal ileum results in increased PYY and GLP-1 secretion after GBP which contributes to the weight loss and improvement in type 2 diabetes seen after this procedure. Following GBP hunger is suppressed and there is a well-described change in feeding behavior whereby patients tend to eat fewer meals and snacks per day with a selective reduction of calorically dense high-carbohydrate foods.
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Abbreviations
- ARC:
-
Arcuate nucleus
- AUC:
-
Area under the curve
- BND:
-
Gastric banding
- BPD:
-
Biliopancreatic diversion
- D2:
-
Type 2 iodothyronine deiodinase
- FGF-19:
-
Fibroblast growth factor-19
- FXRα:
-
Farnesoid X receptor α
- GBP:
-
Gastric bypass
- GI:
-
Gastrointestinal
- GK:
-
Goto Kakizaki rats
- GLP-1:
-
Glucagon-like peptide 1
- HbA1C:
-
Hemoglobin A1C
- HOMA-IR:
-
Homeostasis model assessment for insulin resistance
- MAPK:
-
Mitogen-activated protein kinase
- mM:
-
Millimolar
- OGTT:
-
Oral glucose tolerance test
- PI3K:
-
Phosphoinositide 3-kinase
- PYY:
-
Peptide YY
- RYGBP:
-
Roux-en-Y gastric bypass
- T2DM:
-
Type 2 diabetes mellitus
- TGR5:
-
G-protein-coupled receptor TGR5
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Roberts, R.E., Alaghband-Zadeh, J., Le Roux, C.W. (2011). The Role of Bile Acids in Gut-Hormone-Induced Weight Loss After Bariatric Surgery: Implications for Appetite Control and Diabetes. In: Preedy, V., Watson, R., Martin, C. (eds) Handbook of Behavior, Food and Nutrition. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92271-3_85
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