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The original theory behind restrictive bariatric surgery was simple and anatomically plausible: Create a smaller, more easily filled stomach, and satiety will lead to decreased caloric intake. However, some beneficial metabolic changes (e.g., glucose tolerance) occur within days after bariatric surgery, before weight loss ensues. A new study confirms that biochemistry might be more important than anatomy.
An international team postulated that binding of bile acids to a nuclear receptor called FXR — which is expressed in metabolically active organs such as liver, adipose tissue, and intestine — was key to many of the benefits realized after vertical sleeve gastrectomy (VSG; resection of about 80% of the greater curvature of the stomach). To t…