Life-saving potential in effort to explain Roux-en-Y’s powerful side benefits

NimaSaeidi, an assistant professor of surgery at Harvard Medical School and Massachusetts General Hospital and a member of the Center for Engineering in Medicine, had started down one career path when a lecture on Roux-en-Y gastric bypass surgery redirected him.

The MGH lecture outlined not just the procedure’s striking effectiveness for weight loss — averaging 40 percent — but also its promise against diabetes, high blood pressure, cholesterol, and fatty-food cravings. Saeidi, an assistant in bioengineering at MGH, halted his work in tissue engineering and began to study gastric bypass.

“To me, it’s really a mystery,” said Saeidi, “and it seems to be like a miracle.”

The idea of a compound that mimics the positives of Roux-en-Y is particularly enticing amid twin national epidemics of obesity and diabetes. A therapy that conferred the surgery’s benefits while avoiding its less healthy side effects — brittle bones, vitamin deficiency, anemia, and increased rates of alcoholism — would likely add significantly to the 45,000 morbidly obese patients the procedure helps annually.

The problem is scientists still don’t know how it works.

In Roux-en-Y, physicians make a small pouch out of the upper portion of the stomach and then cut and reattach the small intestine to the pouch, bypassing the entire lower stomach and the first few feet of the small intestine. This transformation of the stomach into a pouch makes patients feel full quickly, while food’s rapid passage into the intestine alters digestion and absorption of calories — as well as of minerals and vitamins, the cause of some of the surgery’s negative side effects.

The surgery was developed decades ago as a treatment for stomach ulcers, and was first used as a correction for morbid obesity by University of Iowa physicians in 1967. Follow-up research uncovered dramatic benefits independent of weight loss.

For example, though Type 2 diabetes risk is tied to obesity, post-Roux-en-Y resolution of the disease — more than 80 percent of patients are cured — is not solely a weight-loss phenomenon.

“We see effects happening within two to three days,” Saeidi said. “Patients get surgery and they’re completely diabetic, they need insulin or metformin medication. And many of them leave the hospital without any medication. It is just puzzling how this is happening and what is causing it.”

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