The fact is that intragastric injection of botulin A has been reported in the top endoscopy (GI Endoscopy) journal to be effective for weight loss in a meta-analysis of 8 studies which included 115 study subjects (http://bit.ly/1ynV6fc).
Overweight individuals have been found to have problems with satiation that can trick the brain into overeating. One reason is that the stomach-derived, appetite-stimulating hormone ghrelin is telling the brain, “Heck I need more food. I’m not satisfied yet!” The stomach has a “failure to communicate” properly with the brain. So you eat more. This, in conjunction with the fact that in obesity the stomach is less accommodating to food and empties quicker which can cause surges in blood sugar and insulin-driving fat accumulation, is a recipe for weight gain.
As I discuss in The Gut Balance Revolution individuals who are overweight or obese have impairments in satiation along with rapid gastric emptying of food. Botulinum toxin A (Botox-A) is a bacterial-derived neurotoxin which blocks acetylcholine A release at the neuromuscular junction causing a temporary muscular paralysis. Botox-A injection into the stomach of animals has been shown toincrease the amount of time food is in the stomach, causing increased stretching, which signals the brain to slow down the intake of food. The doctors inject Botox-A into the deep muscular layers of the stomach to weaken its contractions, delay the gastric transit of food and improve satiation so one feels full earlier after a meal.
There was variation in the stomach region injected, amount used, whether there was adjunctive dietary restrictions, and whether randomization of a control (saline) material was utilized. Those studies that were non-randomized showed the best weight loss, raising the question of an inherent bias.
However, overall the analysis gave a thumbs up affirming that this technique is effective for weight loss, but it does raise some intrigue and other questions as well. Patients who engaged in dietary modification coupled with Botox-A injections into the stomach wall did better than injection therapy alone. The overall net mean weight loss per patient who received Botox-A was not elucidated.
The use of Botulinum toxin A for this purpose is “off-label” and is not approved by the Food and Drug Administration for this purpose. This means that you will need to pay $$$$$$$ out of pocket for this technique. Doctors who use this technique report that over a 6 month period patients can anticipate an additional 20 pound weight loss as part of a comprehensive lifestyle program (see video ).
But that doesn’t sound natural. It’s short term and expensive!
Yes, I understand all of those points, but I see many people who are struggling with their weight and they need all the help they can get. Sometimes the early success of losing a few pounds encourages more sustained dietary and lifestyle efforts.
Other Applications of Botox-A Injections into the Stomach
In my practice I use the technique of intragastric injection of Botox-A to relax the pyloric sphincter Injecting Botox-A into the valve (pyloric sphincter) which regulates the emptying of the stomach into the small intestine promotes an easier and faster passage of food out of the stomach. It is the complete opposite of the situation that is seen in obesity as described above.
Individuals with gastroparesis struggle to keep from being underweight. Unfortunately, gastroparesis is a condition having very few FDA sanctioned therapeutic options, and I have seen gratifying results using this technique to improve the flow of food into the small intestine. The literature is emerging but there is research to support is this application in selected patients with gastroparesis.
Safety of Intragastric Botox-A
Botox-A wears off in a few months and there is a paucity of adverse effects.
Take Home Message
Intragastric injection of Botox-A may be useful to jump-start the induction phase of weight loss when coupled with diet and lifestyle modification to balance your gut physiology and ecology to facilitate weight loss. Ultimately, in order to effectively lose excess body fat and reset your metabolism you will need to restore good gut balance and promote biodiversity of the intestinal microbiome. Botox-A is helping to temporarily normalize gut physiology by slowing down a hurried gut to process food at a more natural pace and improve satiation.
Food for Thought
Looking for a more natural way to slow down the stomach? Try some cinnamon in your cereal, smoothie, and coffee. Cinnamon is a spice that sugar in part by impeding the transfer of carbs into the small intestine for their absorption into the bloodstream.
Stay tuned for more weight loss tips to come.
To your good health.
Dr. Gerry Mullin
The Food MD