Gastric Bypass Surgery: A Fountain of Youth?
During the recent Obesity Week conference between the Obesity Society and the American Society for Metabolic and Bariatric Surgery (ASMBS), Dr. John Morton, a bariatric surgeon at Stanford University and President Elect of ASMBS, presented some surprising data. He found that the telomere, an important marker of cell aging, increased in length after weight loss surgery:
“The study included 51 bariatric surgery patients (77 percent female, averaging 48.6 years old) with a mean baseline BMI of 44.3 kg/m2. One year after surgery, patients showed a 71 percent decrease in excess body weight, as well as reductions in CRP and fasting insulin. Changes in mean telomere length were not significantly different from baseline. However, significant increases in telomere length were observed in individuals with high baseline CRP or LDL cholesterol levels.”
The telomere protects the ends of chromosomes. The classic analogy is that of the shoelace aglet, keeping chromosomes intact during cell divisions. Telomeres are intimately associated with cellular aging at the molecular level. Preserving telomere structure or even lengthening them, is thought to “add life” to cells by extending the number of available cell divisions. Sound like the Fountain of Youth? Maybe.
Telomeres have received a lot of press recently. Studies have shown decreased telomere length in men unemployed for more than two years. Depression has also been associated with shorter telomeres. Meditation and yoga, through decreasing stress, have been linked to longer telomeres. The telomere is even being studied as a target in cancer treatment. Certainly, the telomere is an important structure. It’s no surprise that significant weight loss would have an effect.
“The biggest thing I notice is the psychosocial impact. People have more time to spend on healthy pursuits as a result of the life changes associated with weight loss,” says Dr. Sheila Partridge, medical director of the Center for Weight Loss Surgery at Newton-Wellesley Hospital.
Dr. Morton’s study showed a decrease in many of the markers associated with inflammation. Insulin levels also dropped after surgery. Until these findings are published in the peer-reviewed literature, they are just preliminary. However, the implications are certainly eye catching. Reversing the effects of aging is not all that far-fetched.
Dr. Partridge, however, urges caution when making these assumptions. “Because obesity is a metabolic disease with multiple effects on the body, there are many confounders that must be evaluated,” she says. “What the study does illustrate though, is that more basic science research is needed in the field.”
Obesity a Disease
This summer the American Medical Association declared obesity a disease. “This was a true watershed moment,” Partridge says. “Obesity is an epidemic and its recognition as a disease will force the medical community to treat it as such. Weight loss surgery causes significant weight loss, decreases BMI and actually reverses diabetes.”
Obesity has wide ranging health consequences. It has been linked to increased risk of death, heart disease, multiple cancers, stroke, diabetes, hypertension, elevated lipids, lung disease, arthritis, and sleep apnea. Weight loss is associated with significant health improvement, adding years to one’s life. In other words, a Fountain of Youth.
Risks and Benefits of Bypass Surgery
Bypass surgery is safer than a gallbladder or hip replacement surgery with low risks of infection and other major complications. Long term nutritional issues can be avoided with adherence to lifelong follow up and taking vitamins and supplements as prescribed. Three types of procedures are offered: laparoscopic gastric bypass; sleeve gastrectomy; and laparoscopic adjustable gastric band.
The benefits of surgery appear to be long lasting. “Patients for the most part keep the weight off,” Partridge says. Bariatric surgery provides more significant weight loss than counseling or drug treatment. There is improvement in physiology, decrease in systemic inflammation and correction of the metabolic syndrome of obesity. Patients experience an overall better sense of well being. Following bariatric surgery, most patient show improvement or resolution of diabetes, hypertension, sleep apnea, hyperlipidemia and more than 40 other obesity related diseases. As a result, there is an overall decrease in mortality among patients.
Bariatric surgery with the associated weight loss, improved metabolic status and other health benefit is a life changer for patients. Are these benefits a direct result of telomere length or is there another pathway involved? It is likely a multi-factorial and complex process. More research is needed. The Fountain of Youth claim may be premature but not unreasonable. Only time will tell.