Abstract
The pandemic spread of obesity and type 2 diabetes is a serious health problem that cannot be contained with common therapies. At present, the most effective therapeutic tool is metabolic surgery, which substantially modifies the gastrointestinal anatomical structure. This review reflects the state of the art research in obesity and type 2 diabetes, describing the probable reason for their spread, how the various brain sectors are involved (with particular emphasis on the role of the vagal system controlling different digestive functions), and the possible mechanisms for the effectiveness of bariatric surgery. According to the writer’s interpretation, the identification of drugs that can modulate the activity of some receptor subunits of the vagal neurons and energy-controlling structures of the central nervous system (CNS), and/or specific physical treatment of cortical areas, could reproduce, non-surgically, the positive effects of metabolic surgery.
Highlights
Diabetes and obesity have been classified as the third and fourth leading health risk factors, respectively, in the world [1]
More than 90% of the body’s 5-hydroxytryptamine (5-HT) and 50% of its dopamine are produced in the gastrointestinal tract, predominantly by the endocrine cells (EC) and, to a lesser extent, by myenteric neurons and mast cells that transmit their impulses to populations of neurons mainly in the nucleus tractus solitarius (NTS) of the brainstem [44]
Most fMRI studies evaluating appetitive or anticipatory responses to visual food stimuli have shown that the brain of normal-weight subjects compared to that of subjects with obesity reacts differently in the regions associated with reward, executive control, and energy homeostasis [63]
Summary
Diabetes and obesity have been classified as the third and fourth leading health risk factors, respectively, in the world [1]. Their growing prevalence cannot be countered or even limited, and they are considered to be epidemics. Beta cells increase insulin secretion, but, over time, compensation becomes insufficient, gradually leading to hyperglycemia [4]. It is well-known that hyperglycemia involves a series of harmful consequences affecting, in particular, the cardio-circulatory system (endothelial damage) and the peripheral nervous system
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