Mechanisms maintaining reduced appetite and normoglycaemia after metabolic surgery. The role of bile acids
Author(s)
Pournaras, Dimitrios
Type
Thesis
Abstract
Obesity is becoming the healthcare epidemic of this century. Weight loss surgery is
the only effective treatment for morbid obesity. Furthermore glycaemic control in
type 2 diabetic patients is improved after metabolic surgery.
Here I observed that with gastric bypass, type 2 diabetes can be improved and even
rapidly put into a state of remission irrespective of weight loss. This is achieved via
an improvement of both insulin resistance and insulin production. Reduced insulin
resistance within the first week after surgery remains unexplained, but increased
insulin production in the first week after surgery may be explained by the enhanced
postprandial GLP-1 response.
In addition, I demonstrate that bile flow changes lead to increased gut hormone
response in animal models. Roux-en-Y gastric bypass in humans causes changes
in bile flow leading to increased plasma bile acid concentrations. This phenomenon
may explain the improved glycaemic control following gastric bypass.
In conclusion I investigated the mechanism of diabetes remission after metabolic
surgery and explored the role of gut hormones and bile acids in the changes in
glucose homeostasis following metabolic surgery.
the only effective treatment for morbid obesity. Furthermore glycaemic control in
type 2 diabetic patients is improved after metabolic surgery.
Here I observed that with gastric bypass, type 2 diabetes can be improved and even
rapidly put into a state of remission irrespective of weight loss. This is achieved via
an improvement of both insulin resistance and insulin production. Reduced insulin
resistance within the first week after surgery remains unexplained, but increased
insulin production in the first week after surgery may be explained by the enhanced
postprandial GLP-1 response.
In addition, I demonstrate that bile flow changes lead to increased gut hormone
response in animal models. Roux-en-Y gastric bypass in humans causes changes
in bile flow leading to increased plasma bile acid concentrations. This phenomenon
may explain the improved glycaemic control following gastric bypass.
In conclusion I investigated the mechanism of diabetes remission after metabolic
surgery and explored the role of gut hormones and bile acids in the changes in
glucose homeostasis following metabolic surgery.
Date Issued
2012-05
Date Awarded
2012-10
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Bloom, Steve
Le Roux, Carel
Publisher Department
Medicine
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)