Suppression of enteroendocrine cell glucagon-like peptide (GLP)-1 release by fat-induced small intestinal ketogenesis: a mechanism targeted by Roux-en-Y gastric bypass surgery but not by preoperative very-low-calorie diet

What is it about?

Aside its many other beneficial health effects, Roux-en-Gastric Bypass surgery has rapid, non-weight-dependent effects on type-2 diabetes that are obvious already days after the operation before any substantial weight loss has taken place. One reason for this is an immediate improvement of the intestinal hormonal response to food intake which stimulates insulin release after meals. This effect has been attributed to food entering the small intestine more rapidly after the surgical rerouting of the alimentary tract, by almost entirely bypassing the stomach. We have now found that Gastric Bypass may promote this effect also by inhibiting the production of upper small intestinal ketone bodies, that are induced in response to prolonged intake of high-fat content foods. These small intestinal ketones seem to inhibit the hormone-producing cells that normally release the insulin-stimulating intestinal hormones in response to food intake. Thus, by inhibition of small intestinal ketone body production, Gastric Bypass can improve type-2 diabetes independent of weight decrease.

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