Credit score: Journal of Scientific Investigation (2024). DOI: 10.1172/JCI180157
Postprandial hypoglycemia is without doubt one of the principal issues of bariatric surgical procedure and may have an effect on as much as 30% of sufferers. Not like odd hypoglycemia, wherein low blood sugar is normally related to little meals, postprandial hypoglycemia happens after meals and causes signs corresponding to sweating, tremors, weak spot and even psychological confusion.
A examine carried out at Harvard College in the US has recognized the central position of serotonin (a hormone concerned in temper regulation) within the improvement of post-bariatric hypoglycemia. The outcomes have been printed within the Journal of Scientific Investigation and, in line with the authors, level the way in which to attainable therapies.
“We identified that this type of hypoglycemia is associated with the dysregulation of serotonin levels in the blood, a hormone that, in addition to controlling mood, is also capable of stimulating the secretion of the hormones insulin [in the pancreas] and GLP-1 [an acronym for glucagon-like peptide-1, produced in the small intestine in response to food intake] in the body,” says Rafael Ferraz-Bannitz, who carried out the analysis throughout an internship overseas.
“We observed that in individuals with post-bariatric hypoglycemia, serotonin levels are low when they’re fasting. However, after a meal, they increase significantly, unlike patients without symptoms or people who’ve not had bariatric surgery, whose serotonin levels decrease after a meal,” provides Ferraz-Bannitz, who’s presently a postdoctoral fellow at Joslin Diabetes Middle and Harvard Medical College.
In line with the researcher, though the issue is widespread—in the US, the nation with the best variety of bariatric surgical procedures on the earth, it’s estimated to have an effect on as much as 30% of those that endure surgical procedure—little was recognized in regards to the mechanisms that set off postprandial hypoglycemia.
“It’s extremely debilitating. Patients even concentrate their food in just one meal a day because they know they’re going to be very sick. Many are unable to work, drive or have even the slightest quality of life. And it’s a problem that can affect up to 83,000 people every year in the United States alone. In Brazil, the number is likely to be high as well, since it’s the country that performs the second most bariatric surgeries in the world,” the researcher emphasizes.
The way it was performed
The researchers analyzed 189 metabolites (compounds produced by the enzymatic reactions of the metabolism) within the blood of three teams of people: 13 sufferers with post-bariatric hypoglycemia; 10 who had undergone surgical procedure however had no signs; and eight people who had neither undergone surgical procedure nor had hypoglycemia.
Blood was taken whereas the contributors have been fasting, half-hour after taking a shake (made up of proteins, carbohydrates, and lipids), and two hours after ingesting the drink (the time when sufferers with postprandial hypoglycemia normally present indicators).
The evaluation confirmed adjustments primarily within the serotonin sample. “For a lot of metabolites, we seen vital variations between the group that developed hypoglycemia and those that have been asymptomatic.
“However, the difference in the serotonin pattern was what most caught our attention. Individuals with post-bariatric hypoglycemia had very low fasting serotonin levels. Curiously, in response to the meal, there was a fivefold increase in the levels of this hormone in these individuals,” Ferraz-Bannitz advised Agência FAPESP.
The researchers additionally discovered different vital metabolic alterations. “In the fasting state, these individuals showed a decrease in the levels of ten amino acids, including tryptophan [a precursor of serotonin], as well as biomarkers related to diabetes. On the other hand, we noticed an increase in the levels of ketones, bile acids, and some metabolites from the Krebs cycle [which is part of the energy production process in cells],” he studies.
There’s a relationship between serotonin and the secretion of insulin and GLP-1. In line with Ferraz-Bannitz, earlier in vitro research had already proven that serotonin is ready to stimulate the secretion of insulin in pancreatic beta cells and GLP-1 in intestinal neuroendocrine cells.
It’s value noting that insulin is accountable for transporting sugar from the blood to the physique’s cells, the place it’s used as a supply of power. GLP-1, however, is a hormone that’s launched within the presence of glucose and offers a way of satiety by signaling to the mind that the person is full.
“In this study, we’ve demonstrated in vivo that serotonin administration in mice was able to induce hypoglycemia by increasing the endogenous secretion of insulin and GLP-1,” feedback the researcher.
Thus, the outcomes counsel that the post-meal enhance in serotonin noticed in people with post-bariatric hypoglycemia might contribute to the rise in insulin secretion and, consequently, the event of hypoglycemia and signs corresponding to dizziness, tremors, and psychological confusion.
Serotonin blocker
To raised perceive the position of serotonin within the improvement of post-bariatric hypoglycemia, checks have been carried out on mice. “When serotonin was injected into the animals, they suffered a dizzying drop in blood glucose, inducing hypoglycemia—a situation similar to that of sufferers.
“When we evaluated the plasma of the mice, we observed that the injection of serotonin increased the secretion of insulin and GLP-1, the same hormones that are elevated in individuals who’ve developed postprandial hypoglycemia,” he says.
The researchers then determined to check using serotonin antagonists as a therapy technique in mice. “The use of ketanserin, a well-known serotonin receptor 2 blocking drug, proved to be very effective in the experiments. It was able to block serotonin-induced hypoglycemia in the animals and promote a reduction in insulin and GLP-1 secretion. This is a promising result that suggests a potential therapeutic target for individuals with post-bariatric hypoglycemia,” he concludes.
With the outcomes, the group, coordinated by Mary-Elizabeth Patti, professor at Harvard Medical College and senior investigator on the Joslin Diabetes Middle, plans to conduct new scientific trials to show the effectiveness of this potential therapy for individuals affected by postprandial hypoglycemia.
Though they’ve proven that serotonin could also be accountable for triggering your entire hypoglycemia course of in individuals who have had bariatric surgical procedure, the researchers nonetheless have no idea what causes this distinction within the sample of the hormone.
“This is one of the acknowledged limitations of the study, as we didn’t have access to biopsies of the intestines of these individuals to assess the amount and activity of serotonin-producing cells. However, one of the hypotheses we raised is that hypoglycemia may be associated with some alteration in the microbiota, bile acids, or other factors in the intestine—the organ that produces 90% of the body’s serotonin. Future studies in Professor Patti’s laboratory could answer this question,” says Ferraz-Bannitz.
Extra info:
Rafael Ferraz-Bannitz et al, Postprandial metabolomics evaluation reveals disordered serotonin metabolism in post-bariatric hypoglycemia, Journal of Scientific Investigation (2024). DOI: 10.1172/JCI180157
Quotation:
Analysis uncovers key bariatric surgical procedure complication trigger (2024, December 10)
retrieved 10 December 2024
from https://medicalxpress.com/information/2024-12-uncovers-key-bariatric-surgery-complication.html
This doc is topic to copyright. Other than any truthful dealing for the aim of personal examine or analysis, no
half could also be reproduced with out the written permission. The content material is supplied for info functions solely.
