Morbid Obesity: Eliminating the G Spot

December 26, 2019

We owe our existence to food. Food is our God, our daily muse, our reason for chasing dreams and for some of us, our only source of joy and happiness at the end of a long and hard day. If it had not been this way, for us to be hungry, physically and metaphorically, perhaps we would never even get out of bed.

And yet it is food again, too much of it, that drags us down, hold us back, and almost paralyzes us to the point where life-altering decisions need to be made. Now you know why we are here, to talk about and know more about obesity. To realize what it feeds on and how it leads us down paths of self-destruction, to the brink till sanity returns and we call for help.

Obesity is now a pandemic. It involves all countries, all races, and people of all social strata. To understand what makes us susceptible to obesity, to realize how we to make a difference to ourselves and benefit long term, understanding hunger and genesis is the key.

Our body is uniquely wired. Our brain signals the body and the body, in turn, has a bio-feedback mechanism for the brain. We know a lot about Low Carb Diet, Keto Diet, Fat-Free Butter, Low Cholesterol food, good cholesterol, and bad cholesterol. We also know about food, what should be eaten and what not, through the internet and elsewhere. But for those of us who are overweight, who dread what the latest BMI (Body Mass Index) calculations will show up, who have now realized what the dead-end of diet control, exercises, weight loss sharing tips, the daily restrictions of physical capabilities, the occasional sense of doom, the unending darkness at the end of this tunnel looks like it is now time to realize where it all begins and hopefully put an end to this vicious cycle.

Pause. Think. Reflect.

We are what we eat and drink. A good seventy percent of it is just water. The habits that we grow as kids blossoms into adulthood and multiplies. The food we eat makes it through the esophagus and into the stomach. The stomach is the biggest receptacle or reservoir for the food that we eat. Complex molecules of digestion, that we call the Gastrointestinal Hormones or G-hormones, have an intuitive role in hunger, satiety, food digestion & absorption, all controlled through a biofeedback mechanism that we call the Gut-Brain Axis. Changes in levels of G-hormones in blood as detected by the brain has a direct implication on what we feel like eating, how much we eat and how we process what we eat.

The G Hormones

The most important of these is Ghrelin, produced by the endocrine cells of the stomach in an area known as the fundus, which is the only known appetite-stimulating gastrointestinal hormone. Its levels are increased after overnight fasting; they rise approximately two-fold immediately before a meal and decrease to their lowest values 1 hour after each meal. The decrease of ghrelin levels is also dependent on meal calorie value and composition; for example, the decrease is lower after fat-based meals compared with carbohydrate- or protein-based meals. It is also interesting to note that the ghrelin levels decrease less in people who are obese. Thus the increase in this hormone level which directly stimulates your hunger via the gut-brain axis results in hunger as well as increased deposition of fat in the fat cells or adipocytes in your body.

There are two more interesting hormones collectively called Incretins. One is the Glucagon-like Peptide-1 (GLP-1), and the other is Glucose-dependent Insulinotropic Polypeptide (GIP). Both are secreted in the stomach and small intestine. Once released from the gastrointestinal tract they affect the activity of the hypothalamus and brain stem, both involved in food intake regulation and food habit modulation. They are also critical regulators of Insulin secretion from the pancreas, digestion & metabolism of a meal high in carbohydrate content and simultaneously suppressing appetite as well as reducing the rate of food absorption into the blood by lowering the rate of gastric emptying. This, in turn, has a direct implication on our satiety and sense of fullness after meals.

What Obesity Surgery Does

When we decide to undertake surgery for obesity there are two components by which weight loss is facilitated. One is the Restrictive component and the other the Malabsorptive component. The two most common ways in which these are done are Sleeve Gastrectomy and Gastric By-Pass Surgery. Sleeve Gastrectomy makes a small tube fashioned out of your stomach, restricting the passage of food, so basically, for the first few days after surgery, you sustain yourself on liquids and then gradually progress on to a soft blended diet along with fluids. The Gastric By-Pass Surgery, on the other hand, does a major structural change within your stomach and intestine where the food you take in initially is not only restricted in quality and quantity but also the digestion process starts a good 150 to 200 meters of gut away from where it normally starts. As a result, critical macro and micronutrients absorption is reduced, resulting in a calorie deficit. And thus over a period of time, there is a loss of weight.

It has been observed through research that there are changes in the blood levels of the G- Hormones immediately after obesity surgery, more so after gastric bypass surgery. These changes along with the physical alteration in the capacity for food intake drive down hunger. The reduction in the size of the stomach, such as after sleeve gastrostomy, also decreases your natural appetite through the G-hormones. The markedly suppressed level of ghrelin, the principal hunger stimulator, has been hypothesized to be contributing to the weight-reducing effect of the procedure. Patients who undergo gastric bypass have been shown to feel hungry less often after the operation, eat fewer meals and snacks per day, and voluntarily reduce their intake of calorie-dense foods such as fats, high-calorie carbohydrates, high-calorie beverages, red meat, and ice cream.

What is best for you?

We work as a team. You are the most important member of the team and also the team leader. It is based on decisions you make that we tailor out the best treatment for you. The team has the Bariatric Surgeon, along with the Dietician, the Medical Specialist, the Cardiologist, the Endocrinologist, the Psychology Counselor, the Nurses, and the Operating room technicians. We discuss each and every detail of your weight loss program and help you achieve better health, better personal and social well-being.

Blog By

Dr. Daipayan Ghosh

Consultant – Obesity & Diabetes

Apollo Spectra Hospitals, Gurugram