Ryan et al. reported that the improvement in T2DM end points correlated with increases in Roseburia species of microbiota, while in other papers from the same group, weight lost was linked to the level of serum bile acid elevation post VSG14, while NASH improvement post VSG was dependent on an intact FXR–SHP (small heterodimer partner) signaling pathway15. The gene discussed is NR1H4; the disease is metabolic dysfunction-associated steatohepatitis.