1. So What is Ghrelin? Going for the 3 Increases: Increase in Health, Increase in Happiness & Increase in Energy Strategies for Success in Weight Management By: James J. Messina, Ph.D.

2. What is Ghrelin Hormone secreted by the stomach Novel-hormone-releasing peptide found in hypothalamus & Stomach Appetite-stimulating hormone Sends feed me messages to brain Part of the bodys built-in defense mechanism to protect against famine & starvation

3. Human Ghrelin

4. What causes increase in Ghrelin Dieting Other forms of weight loss Normal adaptive function of body to maintain itself When lose weight-body senses this as famine Triggers survival mechanism to keep body weight constant SEE A PICTURE OF THIS NEXT SLIDE

6. What happens when Ghrelin Increases? Metabolism drops Person feels hungry Person east more Will power can only forestall the urge to eat more for only a limited time

7. Why Gastric-bypass Surgery Short- circuits Normal Body Response Disables the ghrelin producing cells in stomach Cells in stomach that produce ghrelin become inactive This happens when these cells are no longer exposed to food in stomach The ghrelin cells go to sleep when deprived contact with ingested nutrients

8. Research reported in New England Journal of Medicine – May 23, 2002 Conducted by VA Puget Sound Health Center & University of Washington – led by Dr. David Cummings -Endocrinologist Compared blood samples after six month period of time of two groups of obese patients 13 dieters & 5 gastric-bypass patients Dieters were on low-fat, low-calorie diet

9. Findings of Study Dieters lost 17% of their body weight but their ghrelin level increased 24% Gastic-bypass patients lost 36% of their body weight & their ghrelin levels fell 72% lower than those in diet group

10. Explanation for Difference in Ghrelin Level with Gastric-bypass Objective of Gastric-bypass is to shrink stomach to only 5% of original size by rewiring course of food through digestive system Tiny new stomach pouch can only hold 2 teaspoons of food-which travels into first part of small intestines Permanent absence of food in rest of stomach ultimately suppresses ghrelin production

11. Future of Weight Loss Efforts Development of ghrelin antagonist-to block production of ghrelin However, such a drug will never be enough since we know that Binges are often unrelated to hunger or sensation of stomach emptiness but rather to environmental cues soooooooo Will always need in addition: Healthy eating & physical activity

12. More Information on Ghrelin Check out the links on Ghrelin under Hot Topics on our links section at: http://www.coping.org/balanced/strategies/r esource.htm#Ghrelin