Hypothesis that alpha-amylase evokes regulatory mechanisms originating in the pancreas, gut and circulation, which govern glucose/insulin homeostasis

Figure 1 Main types of bariatric surgery, from left to right. A: Sleeve gastrectomy; B: Roux-en-Y gastric bypass; C: One-anastomosis gastric bypass. Citation: IFSO. Sleeve Gastrectomy. [cited 20 December 2022]. Available from: https://www.ifso.com/sleeve-gastrectomy/[19]; IFSO. Roux-en-Y Gastric Bypass. [cited 20 December 2022]. Available from: https://www.ifso.com/roux-en-y-gastric-bypass/[20]; IFSO. One Anastomosis Gastric Bypass. [cited 20 December 2022]. Available from: https://www.ifso.com/alternative-intestinal-procedures/[21]. Copyright© Dr. Levent Efe, courtesy of IFSO, 2022.

Figure 2 Forms of biliopancreatic diversions, from left to right. A: Biliopancreatic diversion (BPD); B: BPD with duodenal switch. Citation: IFSO. Biliopancreatic Diversion (BPD). [cited 20 December 2022]. Available from: https://www.ifso.com/bilio-pancreatic-diversion/[25]; IFSO. Biliopancreatic Diversion with Duodenal Switch. [cited 20 December 2022]. Available from: https://www.ifso.com/bilio-pancreatic-diversion-with-duodenal-switch/[26]. Copyright© Dr. Levent Efe, courtesy of IFSO, 2022.

Figure 3 A schematic view of acini-islet-acinar- and alpha-amylase-dependent inhibitory pathway involved in the regulation of glucose metabolism before and after Biliopancreatic diversion surgery. A: Before biliopancreatic diversion surgery; B: After biliopancreatic diversion surgery. Incretin-dependent, quick stimulatory pathways (black) and acini-islet-acinar–dependent intrapancreatic inhibitory pathway and downregulating alpha-amylase dependent pathways, originating in the duodenum, of insulin secretion (orange and green respectively). AIA: Acini-islet-acinar.