Obesity Surgery

, Volume 22, Issue 1, pp 140–151 | Cite as

Carbohydrate Content of Post-operative Diet Influences the Effect of Vertical Sleeve Gastrectomy on Body Weight Reduction in Obese Rats

  • Maximilian Bielohuby
  • Kerstin Stemmer
  • José Berger
  • Juliane Ramisch
  • Kathleen Smith
  • Jenna Holland
  • Kenneth Parks
  • Paul T. Pfluger
  • Kirk M. Habegger
  • Matthias H. Tschöp
  • Randy J. Seeley
  • Martin BidlingmaierEmail author
Animal Research



Vertical sleeve gastrectomy (VSG) effectively reduces body weight (BW) in obese rats and humans. However, post-surgical weight regain is frequently observed in subjects after VSG, but the underlying reasons remain poorly understood. We therefore investigated if post-surgical consumption of different diets can affect the outcome of VSG.


VSG or sham operation was performed in Long–Evans rats with diet-induced obesity (n = 37). After post-surgical recovery, rats were fed ad libitum either with standard chow (CH), high-fat (HF) or low-carbohydrate, high-fat (LCHF) diets. BW and food intake were measured every second day; serum leptin, cholesterol, HDL cholesterol, and triglycerides were analyzed 4 weeks after surgery. Energy expenditure and locomotor activity were determined by a combined indirect calorimetry system, lean and fat mass by nuclear magnetic resonance.


After 4 weeks, BW gain, fat mass, and leptin were lower in VSG rats when compared to sham controls (p < 0.05). Energy expenditure and locomotor activity were not affected by VSG indicating that weight reduction derives from the significantly lower cumulative 4-week energy intake in VSG compared to sham. Sham rats fed LCHF consumed the most energy, followed by rats fed HF. In contrast, after VSG cumulative energy intake was highest in rats fed HF, but not different between CH and LCHF. Consistently, post-surgical BW and fat mass regain were highest in the HF-VSG group. Lipid profiles were improved by VSG but not differentially affected by diets.


In conclusion, consumption of a HF diet but not the more energy-dense LCHF diet reduced the effectiveness of VSG in rats.


Bariatric surgery Obesity Low-carbohydrate/high fat diet Western-style diet Food preference Energy expenditure Cholesterol 


Authors’ Disclosure

All authors have nothing to disclose. RJS serves as a paid consultant and speaker on the behalf of Ethicon Endo-Surgery.


This work was supported by Ethicon Endo-Surgery and the “Deutsche Forschungsgemeinschaft” [DFG (Ste1466/4-1)].


  1. 1.
    Bielohuby M, Matsuura M, Herbach N, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats. J Bone Miner Res. 2010;25:275–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Bielohuby M, Menhofer D, Kirchner H, et al. Induction of ketosis in rats fed low-carbohydrate, high-fat diets depends on the relative abundance of dietary fat and protein. Am J Physiol Endocrinol Metab. 2011;300:E65–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Bielohuby M, Sawitzky M, Stoehr BJ, et al. Lack of dietary carbohydrates induces hepatic growth hormone (GH) resistance in rats. Endocrinology 2011.Google Scholar
  4. 4.
    Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA. 2003;289:1837–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Brehm BJ, Seeley RJ, Daniels SR, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003;88:1617–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Day JW, Ottaway N, Patterson JT, et al. A new glucagon and GLP-1 co-agonist eliminates obesity in rodents. Nat Chem Biol. 2009;5:749–57.PubMedCrossRefGoogle Scholar
  8. 8.
    Delling L, Karason K, Olbers T, et al. Feasibility of bariatric surgery as a strategy for secondary prevention in cardiovascular disease: a report from the Swedish obese subjects trial. J Obes 2010: 2010.Google Scholar
  9. 9.
    Foster GD, Wyatt HR, Hill JO, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153:147–57.PubMedGoogle Scholar
  10. 10.
    Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Gannon MC, Nuttall FQ. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004;53:2375–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Haufe S, Engeli S, Kast P, et al. Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology. 2011.Google Scholar
  13. 13.
    Hofmann SM, Zhou L, Perez-Tilve D, et al. Adipocyte LDL receptor-related protein-1 expression modulates postprandial lipid transport and glucose homeostasis in mice. J Clin Invest. 2007;117:3271–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Hofso D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163:735–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Jacobs M, Gomez E, Romero R, et al. Failed restrictive surgery: is sleeve gastrectomy a good revisional procedure? Obes Surg. 2011;21:157–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Jornayvaz FR, Jurczak MJ, Lee HY, et al. A high-fat, ketogenic diet causes hepatic insulin resistance in mice, despite increasing energy expenditure and preventing weight gain. Am J Physiol Endocrinol Metab. 2010;299:E808–15.PubMedCrossRefGoogle Scholar
  17. 17.
    Karra E, Yousseif A, Batterham RL. Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends Endocrinol Metab. 2010;21:337–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy AR, Pissios P, Otu H, et al. A high-fat, ketogenic diet induces a unique metabolic state in mice. Am J Physiol Endocrinol Metab. 2007;292:E1724–39.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim JY, Yang YH, Kim CN, et al. Effects of very-low-carbohydrate (horsemeat- or beef-based) diets and restricted feeding on weight gain, feed and energy efficiency, as well as serum levels of cholesterol, triacylglycerol, glucose, insulin and ketone bodies in adult rats. Ann Nutr Metab. 2008;53:260–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Kohli R, Stefater MA, Inge TH. Molecular insights from bariatric surgery. Rev Endocr Metab Disord. 2011.Google Scholar
  21. 21.
    Lobley GE, Bremner DM, Holtrop G, et al. Impact of high-protein diets with either moderate or low carbohydrate on weight loss, body composition, blood pressure and glucose tolerance in rats. Br J Nutr. 2007;97:1099–108.PubMedCrossRefGoogle Scholar
  22. 22.
    Miras AD, le Roux CW. Bariatric surgery and taste: novel mechanisms of weight loss. Curr Opin Gastroenterol. 2010;26:140–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy (LSG): review of a new bariatric procedure and initial results. Surg Technol Int. 2006;15:47–52.PubMedGoogle Scholar
  24. 24.
    Noakes M, Foster PR, Keogh JB, et al. Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk. Nutr Metab (Lond). 2006;3:7.CrossRefGoogle Scholar
  25. 25.
    Nordmann AJ, Nordmann A, Briel M, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:285–93.PubMedCrossRefGoogle Scholar
  26. 26.
    Ochner CN, Kwok Y, Conceicao E, et al. Selective reduction in neural responses to high calorie foods following gastric bypass surgery. Ann Surg. 2011;253:502–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Perez-Tilve D, Hofmann SM, Basford J, et al. Melanocortin signaling in the CNS directly regulates circulating cholesterol. Nat Neurosci. 2010;13:877–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Schultes B, Ernst B, Wilms B, et al. Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery. Am J Clin Nutr. 2010;92:277–83.PubMedCrossRefGoogle Scholar
  29. 29.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Stefater MA, Perez-Tilve D, Chambers AP, et al. Sleeve gastrectomy induces loss of weight and fat mass in obese rats, but does not affect leptin sensitivity. Gastroenterology 138: 2426–2436, 2436 e2421-2423, 2010.Google Scholar
  31. 31.
    Thomson CA, Stopeck AT, Bea JW, et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer. 2010;62:1142–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Tirosh A, Shai I, Afek A, et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011;364:1315–25.PubMedCrossRefGoogle Scholar
  33. 33.
    Vianna CR, Coppari R. A treasure trove of hypothalamic neurocircuitries governing body weight homeostasis. Endocrinology. 2011;152:11–8.PubMedCrossRefGoogle Scholar
  34. 34.
    West GB, Brown JH, Enquist BJ. The fourth dimension of life: fractal geometry and allometric scaling of organisms. Science. 1999;284:1677–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Westman EC, Vernon MC. Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design. Nutr Metab (Lond). 2008;5:10.CrossRefGoogle Scholar
  36. 36.
    Westman EC, Yancy Jr WS, Olsen MK, et al. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. Int J Cardiol. 2006;110:212–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Zhang F, Strain GW, Lei W, et al. Changes in lipid profiles in morbidly obese patients after laparoscopic sleeve gastrectomy (LSG). Obes Surg. 2011;21:305–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Zheng H, Shin AC, Lenard NR, et al. Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery. Am J Physiol Regul Integr Comp Physiol. 2009;297:R1273–82.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Maximilian Bielohuby
    • 1
  • Kerstin Stemmer
    • 2
  • José Berger
    • 2
  • Juliane Ramisch
    • 1
  • Kathleen Smith
    • 2
  • Jenna Holland
    • 2
  • Kenneth Parks
    • 2
  • Paul T. Pfluger
    • 2
  • Kirk M. Habegger
    • 2
  • Matthias H. Tschöp
    • 2
  • Randy J. Seeley
    • 2
  • Martin Bidlingmaier
    • 1
    Email author
  1. 1.Endocrine Research UnitMedizinische Klinik Innenstadt, LMUMunichGermany
  2. 2.Metabolic Diseases Institute, College of MedicineUniversity of CincinnatiCincinnatiUSA

Personalised recommendations