On a different note, we've been talking about whether or not babies
sense *hunger* the first few days of life.  Well, I wish I knew the
answer. Catherine posited that at least some babies do -- they seem
RAVENOUS.  And then there are the babies that everyone says -- "Well,
they SHOULD be hungry -- it's been 3/4/5 hours since they ate."  My
question to all of you is one I've asked before -- what mechanism causes
the sensation of hunger in humans.  It's not just an empty stomach.
It's not just a drop in blood sugar.  What is it?  Why is it that we can
eat dinner at 6:00 pm and be STARVED at 9:00 pm?  Or, conversely, eat
dinner at 6:00, and not *feel* hungry until 9:00 the next morning?  Why
is it that some babies do not seem to sense hunger -- and don't seem to
be interested in eating....they might suck, but the type of sucking is
the "hanging out" variety, not the breastFEEDING variety?

Jan Barger, RN, MA, IBCLC -- Wheaton IL

----------------------------------------------------------------------
A recent news story talked about the discovery of Ghrelin, (often
misspelled gherlin) a hunger hormone.  People secreting abnormally lots
of it, like Prader-Willy Syndrome kids and adults, are ravenously hungry
all the time.  It is produced to varying degrees in different people and
does not secrete when on a fast or by the part of a stapled stomach
receiving no food.  See below:

http://www.medscape.com/viewarticle/434543

The New England Journal of Medicine
May 23, 2002 (Volume 346, Number 21)
Plasma Ghrelin Levels After Diet-Induced Weight Loss or Gastric Bypass
Surgery
Cummings DE, Weigle DS, Frayo RS, et al.
The New England Journal of Medicine. 2002;346(21):1623-1630 
Obesity has become a widespread problem throughout the world. Moreover,
overweight individuals suffer tremendously in efforts of weight
maintenance after the initial loss. Gastric bypass, however, a surgical
procedure in which the stomach and duodenum are bypassed with a
gastrojejunal anastomosis, appears successful in the long-term
regulation of weight loss postoperatively. 
Ghrelin is a circulating hormone that appears to be involved with hunger
as well as long-term body weight regulation. The authors of this study
have proposed that ghrelin secretion is interrupted as a result of
gastric bypass, leading to the successful long-term maintenance of
weight loss. 
Two groups of patients were evaluated in this study. Thirteen obese
subjects were recruited from a Nutrition Research Unit and received a
low-fat, high-protein, liquid formula diet of 1000 kcal per day for 3
months. After the 3 months, patients were transitioned into solid food
containing 30% fat, 15% protein and 55% carbohydrate, and were
maintained at a target weight. Five patients who had undergone gastric
bypass in the last 9-31 months were also recruited. Two groups of
controls were used for comparison to the gastric bypass patients: normal
weight individuals as well as obese subjects matched for age and sex who
had undergone diet-induced weight loss. In all participants, 24-hour
blood samples were collected to assay ghrelin levels. 
In the diet-induced group, subjects lost a mean of 17.4% ± 1.5% of their
initial body weight. Ghrelin patterns in the blood were similar before
and after weight loss: rising before meals and falling after. As was
seen in previous studies, ghrelin secretion in between meals shows a
diurnal pattern. After weight loss, the area under the curve increased
by 24%, P = .006. Additionally, a positive correlation (R = .67) was
seen between the percentage decrease in weight loss and percentage
increase in area under the curve. 
Three different groups were compared with each other in the other arm of
the study: patients who had gastric bypass, normal-weight adults, and
normal-weight patients who had lost weight through diet. In the gastric
bypass group, plasma ghrelin levels were significantly lower compared
with both the normal-weight controls and diet controls (P < .001 and P =
.01, respectively). Of note, insulin and leptin patterns in the gastric
bypass patients did not differ from the other control groups. 
These data suggest that gastric bypass surgery interferes with the
body's secretion of ghrelin. The authors have extrapolated that the
significantly low levels of ghrelin lead to better long-term weight
control. The study is limited by its small sample sizes as well as lack
of randomization. However, it does provide a new route for further
translational research which could lead to better weight control
regimens for patients in the future.

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