Could Weight Reduction Surgery Be The Key To Diabetic Control?

Hey there Guys,

In the past week the medical blogsphere has been very excited about a recent study that shows that gastric bypass surgery to dramatically reduce weight was not only able to help treat diabetes but in a great number of cases diabetes is considered “cured”.

Obesity and diabetes are often found hand in hand. Unfortunately many of the medicines used to treat diabetes can cause weight gain which can make diabetes worse and the cycle continues.

As noted in the New England Journal Of Medicine:

At 2 years, diabetes remission had occurred in no patients in the medical-therapy group versus 75% in the gastric-bypass group and 95% in the biliopancreatic-diversion group (P<0.001 for both comparisons). Age, sex, baseline BMI, duration of diabetes, and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months. At 2 years, the average baseline glycated hemoglobin level (8.65±1.45%) had decreased in all groups, but patients in the two surgical groups had the greatest degree of improvement (average glycated hemoglobin levels, 7.69±0.57% in the medical-therapy group, 6.35±1.42% in the gastric-bypass group, and 4.95±0.49% in the biliopancreatic-diversion group).

Now to translate.

What this study shows is that three groups were studied. One group was conventional medical treatment for diabetes – exercise, diet and medications. The other two groups studied were two different forms of weight loss surgery. Both operations are dramatic as they both bypass significant sections of the gut which leads to less opportunity for food to be eaten and absorbed.

Two years into the study those on conventional medical treatments were still diabetic. Those who had the operations had greatly reduced blood sugar levels, and were considered no longer diabetic.

While gastric bypass surgery might be hailed as a miracle cure here, it’s important to note that it’s a very dramatic surgery that significantly changes the way that the digestive tract works.

Nutritionist and fellow blogger Timi Gustafson has noted on his blog:

As a dietitian, my greatest concern is how the anatomical changes affect the metabolism of patients. Because bariatric surgery limits food intake so dramatically and also diminishes the absorption of nutrients, there is a great risk of malnutrition. Especially a sufficient supply of protein, which is extremely important during rapid weight loss for overall health and to allow for proper healing from the surgery, can become hard to obtain. Part of the reason for this is that the initial digestion of proteins takes place in the stomach, which after surgery is not only reduced in size but also in capacity. Even more problematic is the hindered absorption of essential nutrients in the small intestine because some or much of it is bypassed.

Absorption of different elements of food happen at different stages of the gut. If a large portion of the gut is either removed or bypassed there is a significant risk of various deficiencies that can lead to other complications such as osteoporosis and even malnutrition.

While this study is very promising, showing both weight loss and improvement in diabetes, I had to wonder if there were other options available.

One other option is the use of gastric banding. The advantages of this procedure is that it does not remove any of the digestive tract and is able to be reversed if needed.  This way no part of the digestive tract is bypassed, allowing all vitamins and minerals to be absorbed. The main function of the band is to reduce the ability to over-eat by making the functional portion of the stomach about the size of an egg.

Looking at the journals it is clear that it too is also a useful tool to help reduce diabetes. An Australian study from my home town of Melbourne has been able to demonstrate that 2 years after gastric banding 90% of diabetic patients had significantly improved blood sugars with 64% essentially cured.

It is very reassuring that use of a less dramatic, reversible surgery can make a significant improvement in health for those that are very overweight and living with its complications such as diabetes.

Sadly all weight loss surgeries are expensive, however with medical insurance the out-of-pocket cost can come down to as low as $3000. When weighed against medical expenses the “return of investment” is often seen in as little as three years after surgery.

If you have struggled with weight loss this surgery may be an option available to you. Be sure to talk with your doctor about all your options.

Have you had gastric surgery? I’d love if you are able to share your thoughts. Feel free to drop a comment in the boxes below.  If you have a friend that may benefit from this information please help spread the word. One good way can be to hit the Facebook “like” button.

Yours in good health.

Dr George


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