Messing with Your Mind – in Your Gut

Every day is a day to learn something new. So yesterday we learned that our gut has a mind of its own – the enteric nervous system. Randy Seeley presented his work on this at the Columbia Cornell Obesity Medicine course. It seems that much of the progress in obesity treatment over the last few decades comes from understanding this brain in our gut. It interacts with the brain that is our central nervous system to regulate diverse metabolic functions. In a 2020 review article Seeley and colleagues explained it:

“25 years ago, the future of treating obesity and diabetes focused on end organs known to be involved in energy balance and glucose regulation, including the brain, muscle, adipose tissue, and pancreas. Today, the most effective therapies are focused around the gut. This includes surgical options, such as vertical sleeve gastrectomy and Roux-en-Y gastric bypass, that can produce sustained weight loss and diabetes remission but also extends to pharmacological treatments that simulate or amplify various signals that come from the gut.”

The New Understanding of Metabolic Surgery

Seeley explained how thinking about bariatric surgery as merely restrictive or malabsorptive became obsolete as he and others came to understand better how gastric bypass and sleeve surgeries work so well. The fact is that they alter the signaling between the mind of our gut and our central brain. Not all of the mechanisms are 100% clear. But what is clear is that the changes in signaling are a source of profound metabolic changes that occur.

This is why you will see the label of “bariatric” surgery fade away in favor of the more apt “metabolic” label that is gaining traction.

A Cornucopia of Metabolic Targets

Seeley went on to describe a cornucopia of metabolic targets that arise from understanding how metabolic surgery alters gut function. It produces changes in secretion of gut hormones and gastric emptying. Because of surgery, the gut handles nutrients differently and produces different signals about their presence in the gut. Handling of bile acids changes, as does absorption of micronutrients. The barrier function of the gut undergoes changes and of course, the microbiome of the gut changes.

All of these changes are simply clues – for understanding how diet and other environmental pressures lead our guts to dysfunction and produce metabolic changes which in turn produce further changes in our guts. The result is a deeper understanding of diseases like diabetes and obesity, more questions to answer, and abundant targets for interventions.

Judging by the progress these insights are yielding in the clinic, prospects for further progress are bright.

Click here for more from Seeley and his colleagues about using insights into gut function for progress in treating metabolic disease.

Oedipus Rex, painting by Max Ernst / WikiArt

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May 4, 2024