Hormonal
Metabolic surgery (RYGB/VSG) improves glycemic control and induces T2DM remission through weight-loss-independent mechanisms, specifically by altering bile acid metabolism (FXR/TGR5 pathways), increasing incretin hormones (GLP-1/PYY), and modulating the gut microbiome, in addition to caloric restriction.
Metabolic surgery works by changing how your body processes food signals (hormones and bile acids), not just by making you eat less. This reset can lead to diabetes remission even before significant weight loss occurs, suggesting that the procedure alters the underlying biology of insulin resistance.
While historically believed to be related to weight loss and caloric restriction, multiple weight loss independent mechanisms have been identified to contribute to the long-term glycemic effects induced by metabolic surgery. There are changes in bile acid metabolism, the gut microbiome, incretins, and other gut hormones after surgery that are implicated.
Why this rating
The paper is a comprehensive review citing numerous human and animal studies, though it acknowledges some debate regarding microbiome consistency.
Source
Mechanism of metabolic surgery for the treatment of Type 2 Diabetes Mellitus (T2DM)
David J. Leishman et al. · Mini-invasive Surgery · 2023
DOI 10.20517/2574-1225.2023.29
More from this paper
- Metabolic surgery increases circulating levels of bile acids (BAs), which activate FXR and TGR5 receptors to suppress gluconeogenesis, improve insulin resistance, and stimulate GLP-1 secretion, thereby improving glucose homeostasis.Good
- Metabolic surgery (VSG/RYGB) alters gut hormone profiles by increasing GLP-1 and PYY while decreasing ghrelin, leading to reduced hunger and improved satiety, which aids in sustained weight loss and glucose control.Good
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