Hi Dr Jossart

Some of the medical literature seems unclear on this point; does ghrelin return 3-5 years after surgery? Is that a possible reason for weight gain? I understand that this procedure is still considered experimental by some and there is paltry information on long term effects, but when can we expect to see studies that aren't just anecdotal, that include quantitative information?

Ghrelin and Sleeve Gastrectomy

LSG is a relatively new bariatric operation which was designed as a restrictive procedure. Recent studies challenge this classification showing accelerated gastric emptying after LSG [58]. However, another study of patients undergoing LSG showed no difference in gastric emptying compared to preoperatively and therefore the controversy remains [59]. The fact that the fundus of the stomach, the main location of ghrelin-producing cells, is excluded in this procedure led to speculation that ghrelin could play a role in the mechanism of action. Three studies confirmed a decrease in fasting ghrelin levels after LSG [54, 57, 60]. A prospective, double-blind study comparing RYGB and LSG confirmed a significant postprandial suppression of ghrelin postoperatively, while there was no change in the RYGB group [30]. In the same study, the marked suppression of ghrelin levels after LSG was associated with greater appetite reduction and excess weight loss during the first postoperative year compared to RYGB [30]. An even more recent prospective randomised comparison of LSG and RYGB confirms that both operations reduce fasting and meal stimulated ghrelin levels, significantly more so after LSG, so resection of the fundus has more impact on the ghrelin levels compared to just bypassing it [61].

Conclusion

The role of ghrelin in the success of bariatric and metabolic surgery remains to be further elucidated. Some of the findings of the initial studies have not been confirmed in more recent investigations. Different gut hormones as well as having an incretin effect have been implicated to be key players in appetite control. However, the hypothesis that ghrelin might play a role in the mode of action of metabolic surgery has been crucial in the development of the field. The weight loss as well as the remission of type 2 diabetes experienced after metabolic surgery is not exclusively attributed to pure restriction or malabsorption any more. A lot of research is focused on exploring the hormonal and metabolic changes after metabolic surgery as well as the mechanism of action.

From this article:

Ghrelin and Metabolic Surgery

I really never lost my gherlin. . maybe some but not all. I still get hungry and have ever since surgery (I'm 5 months out), but I've learned to ignore it or drink water. Can't have everything I guess.

That's too bad Thineoneday, it's one of the perks of this type surgery. I went on to read more articles about Ghrelin. They didn't know much about it, until 1999. And that some people have much more than others, which they think has a lot to do with obesity. The hormone works on an eating cycle where is slows if you eat, and grows when you don't. They also go on to say that they do not know yet if it will return to those who no longer have it.

And, don't forget that the stomach is not the only place that Ghrelin is produced. From my super geeky readings, I recall it's also produced in the pancreas, just in smaller amounts.

Thanks Tiff, yes i forgot to add the pancreas. And I was curious when I read that, if that's why some people feel hunger still.

There is still very limited information on ghrelin levels after the VSG. It appears to increase some after one year and patients tend to have more cravings by the third year but not necessarily weight regain. The reason for this is that there may be a slight increase in ghrelin and pouch size that leads to cravings and increased food intake but not enough to regain significant weight. The key is to make the VSG pouch small enough the day of surgery to allow for just the right calorie intake to maintain weight loss 2-3 years later.