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Ghrelin is a hormone produced in our bodies that primarily regulates the sensation of hunger. Think of it as your body’s internal “empty tank” indicator. As the stomach empties, ghrelin levels rise, signaling the brain that it’s time to eat. Once we are full, the secretion slows and eventually stops.
The highest concentration of ghrelin is secreted from the fundus of the stomach—the rounded, upper-outer portion of the gastric pouch.
The Gastric Sleeve Advantage
During a Gastric Sleeve (VSG) procedure, the fundus—along with about 80% of the stomach—is physically removed from the body. This significantly reduces the body’s ability to produce ghrelin. Logically, removing the primary source of the “hunger hormone” leads to the notable hunger suppression many sleeve patients experience. The same goes for the Duodenal Switch and SADI, which both involve a gastric sleeve as the first part of the procedure.
Interestingly, the Gastric Bypass (RNY) doesn’t always offer the same immediate hormonal suppression. While the bypass creates a smaller pouch, the “old” stomach remains in the abdomen. Because that tissue is still there (even if food isn’t passing through it), it can still produce ghrelin, though the signaling pathways are often altered in other complex ways.
Why It’s Not a “Magic Bullet”
While the reduction of ghrelin is a powerful tool, it isn’t a universal “off switch” for hunger for several reasons:
Bio-Individuality: Every body reacts uniquely. Some patients see a massive drop in hunger, while others may still feel those familiar pangs.
Head Hunger vs. Physical Hunger: Ghrelin controls physical hunger. It doesn’t control “head hunger”—the emotional or habitual urge to eat triggered by stress, boredom, or smelling something delicious.
The Regulatory Buffet: Ghrelin is just one player in a complex system of hormones (like Leptin and GLP-1) that manage your metabolism.
It’s important we also discuss the likelihood of some hunger returning in the future. About 2 years after the gastric sleeve, the small intestine begins to adapt and pick up the slack, creating its own ghrelin. This ghrelin production is nowhere near the amount the stomach once produced, but returning hunger pains can catch some patients off guard.
To stay ahead of it, we encourage our patients to use those couple of years of reduced hunger as a time to develop important nutritional and behavioral habits. If you are not diligent about changing your lifestyle, and not “just” going on a diet, you may return to your former eating habits and regain some weight.
What This Means for You
Losing weight and maintaining that loss requires more than just removing the fundus. The surgery provides a “metabolic window” of reduced hunger, but long-term success depends on a commitment to lifestyle changes.
Think of the reduction in ghrelin as a helpful gust of wind at your back—it makes the journey easier, but you still have to do the walking. As research into these hormones continues, we gain a better understanding of how to work with our bodies rather than against them.
Where We Come In
By now, you’ve understood that you can’t go at it alone. Weight loss, especially significant weight loss after bariatric surgery or even with medication, requires a strong support group around you to understand when you’re down and need help, and to be part of the celebration when you hit milestones. That includes our practice. It’s important that if you are beginning to feel hunger pangs, and are unsure how to proceed, or if you are beginning to regain some weight, more than just a few pounds here or there once in a while, call us.
Many patients are embarrassed that they have not kept all the weight off. Others don’t want to bother us. But remember, we are all in it together, and we look forward to helping you through the inevitable struggles of this amazing journey.
