Abstract
ABSTRACT Introduction:The wide net of physiological issues involved in metabolic surgery is extremely complex. Nonetheless, compared anatomy and phisiology can provide good clues of how digestive tracts are shaped for more or less caloric food, for more or less fiber, for abundance and for scarcity. Objective:To review data from Compared Anatomy and Physiology, and in the Evolutionary Sciences that could help in the better comprehension of the metabolic surgery. Method:A focused review of the literature selecting information from these three fields of knowledge in databases: Cochrane Library, Medline and SciELO, articles and book chapters in English and Portuguese, between 1955 and 2019, using the headings “GIP, GLP-1, PYY, type 2 diabetes, vertebrates digestive system, hominid evolution, obesity, bariatric surgery “. Results:The digestive tract of superior animals shows highly specialized organs to digest and absorb specific diets. In spite of the wide variations of digestive systems, some general rules are observed. The proximal part of the digestive tract, facing the scarcity of sugars, is basically dedicated to generate sugar from different substrates (gluconeogenesis). Basic proximal gut tasks are to proportionally input free sugars, insulin, other fuels and to generate anabolic elements to the blood, some of them obesogenic. To limit the ingestion by satiety, by gastric emptying diminution and to limit the excessive elevation of major fuels (sugar and fat) in the blood are mostly the metabolict asks of the distal gut. A rapid and profound change in human diet composition added large amounts of high glycemic index foods. They seem to have caused an enhancement in the endocrine and metabolic activities of the proximal gut and a reduction in these activities of the distal gut. The most efficient models of metabolic surgery indeed make adjustments in this proximal/distal balance in the gut metabolic activities. Conclusion:Metabolic surgery works basically by making adjustments to the proximal and distal gut metabolic activities that resemble the action of natural selection in the development the digestive systems of superior animals.
Highlights
If you want to build an efficient wing, you may go deep into aeronautical engineering and into physics, or you can copy it from a bird
As some tissues have the capacity to consume glucose even in the absence of insulin, endogenous glucose production is basically devoted to insulin-independent tissues, mainly the central nervous system
In this period of starvation, the muscles and other body tissues that have no access to glucose consume mostly fat
Summary
If you want to build an efficient wing, you may go deep into aeronautical engineering and into physics, or you can copy it from a bird. After the adaptation that follows extensive proximal bowel resectioning (almost the whole jejunum, in these few cases), no significant malabsorption was present; the individuals were healthy and, surprisingly, not obese, not hypertensive and with normal blood sugar and lipids. How did it happen, if malabsorption were not present? The occurrence of random changes in living beings may, in certain circumstances, be beneficial This is the cornerstone of evolutionary sciences. Based on the Compared Anatomy and Physiology, and in the Evolutionary Sciences the objective of this review was to find links with these issues and the metabolic surgery
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