Intestinal Insight

Bile component appears to help lower high blood sugar after bariatric surgery

By STEPHANIE DUTCHEN   August 6, 2020 

Black and white microscope image shows dozens or hundreds of tube-like projections aligned in different directions

Magnified under a microscope, differentiated human intestinal cells in a dish show tight junctions between cells and waves of tentacle-like microvilli on cell surfaces. Image: Devlin lab

Every year, about 250,000 people in the U.S. with severe obesity and related health conditions undergo bariatric surgeries. These procedures can help people lose excess weight and rapidly improve high blood sugar, high blood pressure and heart disease.

Some of these changes result from restricting the amount of food the stomach can hold. Others arise from post-surgical changes in hormone levels and other aspects of metabolism that researchers are still trying to fully grasp.

A new study from Harvard Medical School and Brigham and Women's Hospital reveals the latest piece of the puzzle of how bariatric surgery can lead to healthier blood sugar levels.

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The researchers report in Nature Chemical Biology that a specific bile acid—a component of bile produced in the liver—rises in the guts of mice and humans after bariatric surgery and sets off a chain of biochemical events that lowers high blood sugar.

The findings point to a potential new drug candidate for treating disorders of blood sugar regulation, such as type 2 diabetes.

"These findings are exciting because, to our knowledge, it’s the first time someone has identified an anti-diabetic small molecule whose levels are increased by bariatric surgery," said A. Sloan Devlin, assistant professor of biological chemistry and molecular pharmacology in the Blavatnik Institute at HMS.

Devlin is co-senior author of the study with Eric Sheu, HMS assistant professor of surgery at Brigham and Women's.

"It's exciting to find that this bile acid, previously believed to be a waste product, has glucose-regulating effects in mice," said Sheu. "It will be important to further explore our findings to determine whether it can be turned into a drug that helps patients as well."

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