New Information on Ghrelin, the Hunger Hormone

Getting started

empty plate in-between fork and knife

If you’re reading this article, you have likely spent a good amount of time researching bariatric surgery, and we commend you for that. Bariatric surgery is not a one-and-done solution to excess weight and obesity. It requires a lot of careful thought, introspection, and research into the best procedure for you. Having done at least some of that, you will have undoubtedly come across a hormone known as ghrelin. This is one of the few hormones that promote hunger rather than satiety, which is leptin‘s job. Ghrelin sprang to the forefront of bariatric surgery in the late 1990s because of the experiences we, as surgeons, saw in our patients after gastric sleeves. Amazingly, gastric sleeve patients were losing a great deal of excess body weight. However, it seemed disproportionate to the simplicity of the procedure. It turned out that the restriction-only mechanism of the gastric sleeve was not the only mechanism that worked to help patients. Soon, we realized that by removing the fundus of the stomach, the outer, curved end, and creating the sleeved shape pouch, we were also removing the primary production center of the hunger hormone in our bodies. It stands to reason that by doing this, patients lost even more weight because they had a hormonal mechanism of weight loss in addition to physical restriction.

With this new understanding of the metabolism, the gastric sleeve soon became the most popular procedure in the United States. However, patients must be aware that while ghrelin has shown reduced hunger after a gastric sleeve, the small intestine begins to pick up where the stomach left off. To be sure, these levels are nowhere near what the stomach used to secrete. However, it does mean the patients will feel progressively hungrier, starting right around a year and a half or two after surgery.

What Does This Mean for Gastric Sleeve Patients?

If you have recently had gastric sleeve surgery, you should know that hunger suppression may not last forever. As such, you must focus on modifying your diet and lifestyle to ensure that you won’t derail, even when the hunger pangs return. Essentially, you have a two-year head start to change your life permanently. This is not to say that you will undoubtedly be in trouble once the hunger pangs return. It only means you must be aware of the realities of your metabolism and give yourself the best opportunity to remain successful.

Does This Mean I Will Regain Weight?

The primary reason patients regain weight several years after bariatric surgery is simply a liberalization of their diet and exercise program. This is normal as the excitement of the surgery wears off, and social commitments often increase with newfound confidence. Studies have shown, at least in animals, that ghrelin is only one part of the more significant weight loss picture related to the gastric sleeve and bariatric surgery, more generally. If you follow your postoperative directions and focus on your diet and exercise habits, there’s no reason why you can’t be very successful now and long into the future.

With that said, consistently lax dietary and exercise habits can allow your pouch to stretch in the future, causing weight regain. If, after a thorough evaluation, there is no reversible cause for this weight gain, you may need to consider a second, revisional procedure. With that said, ultimately, prevention is better than treatment, so sticking to your diet and exercise program, as delineated in your postoperative packet, is the best way to ensure long-term success.

Feel free to call us any time if you need advice or guidance.