How The Small Intestine Can Start Producing Ghrelin and What To Do

Several bariatric surgeries, especially the gastric sleeve, offer benefits in addition to the mechanical shrinking of the gastric pouch/stomach. These secondary benefits often excite patients the most and represent an additional layer of weight loss potential. In the case of the gastric sleeve, when the outer portion of the stomach is removed from the body, the central hunger hormone production center, known as the fundus, comes out with it. The lack of ghrelin reduces appetite and cravings, which helps patients feel less hungry and ultimately lose weight.

However, any gastric sleeve patient will tell you that, slowly but surely, hunger starts to return. This usually begins around the second year after surgery. But how can hunger pangs start again if the fundus has been removed? Well, the body is very complex and adaptable. To that end, cells in the small intestine may adapt to secrete ghrelin to compensate for the lack of production in the stomach. It’s truly a remarkable adaptation, but it creates a real concern for gastric sleeve patients and their weight maintenance.

Note: The amount of ghrelin produced and secreted by the small intestine is significantly lower than that of the stomach. However, this can catch some patients off-guard, especially those still relying on their lack of hunger to maintain their significant weight loss.

So, What Should Patients Do?

As mentioned above, the rebound of ghrelin production is not so significant that patients will immediately start eating what they did before. As such, we don’t want you to worry about it or consider it a downside to having gastric sleeve surgery. However, this reminds us that the fight against obesity is ongoing. Patients must be aware of their bodies and stage of weight loss and ensure that they have permanently changed their lifestyle habits, including diet and exercise, by this point.

Remember that this new production of ghrelin is one of many challenges you will experience at about two years post surgically. This is also where most patients hit their target goal weight and tend to liberalize their diet and exercise programs. Doing so can introduce more calories into the body, leading to weight regain. By far though, the most common causes of weight regain are snacking and high calorie liquids like sodas and sugary drinks.

The Bottom Line

Patients must be mindful that the two-year mark is a possible inflection point in post-operative success. Keeping your motivation and focus is key. Once over the hump, the maintenance phase can continue, and most patients find that they can more easily maintain their new lifestyle over the longer term.

Of course, if you have any questions about the progression of postoperative life, we encourage you to contact our office or bring it up at your follow-up appointment with Dr. Chang. In the meantime, if you’re considering any bariatric surgery or the gastric sleeve specifically, we encourage you to contact our office to schedule a consultation after watching our online bariatric surgery seminar.