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Gastric bypass, Lap-Band and hot sauce. One of these things is not like the others, or is it? The first two are weight-loss surgeries, but hot sauce? The ingredient that gives the peppery liquid its heat could play a role in the future of weight loss, according to BWH researchers. Ali Tavakkoli, MD, of the Department of Surgery, and his team are attempting to identify less invasive surgical alternatives for weight loss. One of these approaches uses capsaicin—the component responsible for the chili pepper’s burning sensation.
Tavakkoli is investigating whether two surgeries called vagal de-afferentation—which uses capsaicin—and vagotomy can achieve weight loss and reduce the risk of obesity-related diseases, such as diabetes, with fewer side effects when compared to today’s surgical options.
Vagotomy involves removing the vagus nerve, which sends information between the gut and the brain. Vagotomy, typically used to treat ulcers, was promoted by surgeons in the 1980s as a weight-loss procedure, since it led to the feeling of fullness in patients who had the surgery.
However, it eventually lost its appeal due to undesirable side effects and the growing popularity of other weight-loss surgeries. But with today’s high prevalence of obesity and diabetes, researchers are revisiting vagotomy as a possible alternative.
Vagal de-afferentation, like vagotomy, also involves the vagus nerve. But rather than removing the nerve completely, surgeons use capsaicin to destroy only certain nerve fibers. Capsaicin destroys the nerve fibers that take signals from the gut to the brain, leaving intact the nerve fibers that send signals in the opposite direction, from the brain to the gut.
“By selectively destroying and preserving certain fibers, we believe the metabolic benefits of the procedure can be achieved without affecting gut motility, thus eliminating some of the side effects associated with a complete vagotomy,” said Tavakkoli.
After testing the two surgeries in his lab, Tavakkoli found that vagotomy significantly reduced total body fat, as well as visceral abdominal fat—the “beer belly” fat that pads the spaces between abdominal organs. Vagal de-afferentation also reduced these fats, but to a lesser degree. Tavakkoli believes, however, that the reduction was still remarkable.
“The reduction in visceral fat is particularly important,” said Tavakkoli. “High visceral fat volume is a marker of obesity and obesity-related diseases. Preferentially lost visceral fat after vagal de-afferentation highlights the potential for this procedure.”
Tavakkoli notes that there is still a lot of work to be done before determining whether vagal de-afferentation or vagotomy can actually be used on humans, and whether capsaicin could be applied directly to human vagal fibers. The study results, however, provide some promise of what the future can hold.
“As demand for surgeries that reduce weight and obesity-related diseases increases, procedures that can achieve success in a less invasive fashion will become increasingly important,” said Tavakkoli. “This is an important and developing surgical discipline, especially as diabetes rates soar worldwide, and people try to find effective therapies to fight this epidemic.”
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