December 6th, 2012

Diabetes and bypass surgery: for some, a sort-of cure?

This Discover article lays out a fascinating state of affairs: for many diabetes patients, gastric bypass surgery offers what was once thought a pipe dream—a cure.

When I first saw this, I figured it was because they lost weight. False. The results occur almost immediately, before any weight loss. It’s thought that it has something to do with the bypass mechanism, which avoids the upper part of the small intestine:

Three days after surgery, one-third of his diabetic bypass patients leave the hospital needing no insulin, or on lower doses, before ever losing a pound…

Bypass surgery may be so good at curing diabetes because malfunctions in the duodenum, the first part of the small intestine, cause the disease. That still-controversial hypothesis comes from another pioneer of diabetes surgery, Francesco Rubino, chief of gastrointestinal metabolic surgery at Weill Cornell Medical College in New York. When exposed to nutrients en route from the stomach, chemical secretions from the duodenum block insulin production or cause insulin resistance, he believes. Either way, bypass surgery that circumvents the duodenum may prevent this malfunction.

Fascinating stuff.

But here’s a caution from a different study:

For two thirds of the participants in the study, their diabetes initially disappeared after gastric surgery – however, symptoms returned within five years among one third of them. They added the proportion of patients whose diabetes never went away after surgery, and found that 56% had no long-lasting diabetes remission.

That’s still an awful lot of patients benefiting, considering how devastating a disease diabetes can be in terms of its complications, and how difficult to control with conventional treatment.

One thing that’s clear to me is that the human body and its functions are amazingly complex, and that we’ve barely scratched the surface of understanding them. I’ve long thought that the reality of weight maintenance, gain, and loss is quite different from the simple idea that fat people are greedy and just can’t control themselves. That’s not been my observation at all, although I suppose some obese people (including those featured on some of those reality TV shows) fit that description. Some thin people do, too.

From the Discover article:

“There are over 200 hormones in the GI tract,” Teixeira explains as we chat in his office at St. Luke’s. All of those hormones are vying to control your eating behavior. Ghrelin drives the urge to eat. Stretch receptors in the stomach signal when to stop. This hardwired system worked well for our hunter-gatherer ancestors constantly struggling to find enough food for survival. In the modern world—where cheap, high-calorie food is available all around—taste, smell, emotion, learning, memory, and food addiction tend to override our biological cues and entice us to eat even when there is no need. “We are living in a time of overabundance, and we are engineered to hold on to these calories. It’s like a trap,” Teixeira says.

A wonderful, delicious, almost irresistible trap. Especially during the holiday season. Who would want to do away with that abundance? Certainly not me. But going to the grocery store these days can sometimes feel like an exercise in saying “no, no, no, no, no, and no” to the wondrous goodies around us.

7 Responses to “Diabetes and bypass surgery: for some, a sort-of cure?”

  1. BigFire Says:

    I had gastric by-pass surgery 2 years ago precisely for this side-effect. The fact that I lost 1/2 of my weight to me is just a nice side benefit. 2.5 years ago, my type 2 diabetes was spiraling out of control, and I have to do something dramatic to get it in control.

    Mind you, just having the surgery is not the solution. I’ve been exercising daily, and had a change in my diet. But the first step really did help. At least for me.

  2. sergey Says:

    Five years without diabetes adds yet another five to your healthy lifespan.

  3. Teri Pittman Says:

    this is one of the reasons why low carb diets are successful. Yes, you cut back on carbs and that helps you lose weight. The other big advantage is that you artificially restrict what you eat.

    I do a Paleo diet and I find it interesting to go to the grocery store and see what others buy. I am usually the only person with a significant amount of vegetables and fruit. I ignore a lot of the store. It’s more work (as there aren’t a lot of ready made Paleo foods) and I have to put more thought into what I buy.

    There is so much that we don’t understand about the digestive system, especially when it comes to how it acts as part of the immune system. So much of what we thought was correct about diet turns out to be badly wrong. I really hate it when I see those stories about weight loss, the ones that say it’s just a matter of what you eat. In my case, I can eat clean, stay under 50g of carbs and still not lose weight. I have to add thyroid meds to burn calories. It’s much more complicated that a lot of people realize.

  4. roc scssrs Says:

    Has all this been approved by the HHS Secretary? We can’t have people experimenting willy-nilly. This is Obamacare, after all.

  5. neo-neocon Says:

    Teri Pittman: please don’t take this personally, because it is not aimed at you at all.

    But let me just say I’ve completely had it with assertions about how great low carb diets are and why they work so well. They may indeed work for some people, but there are a lot of people for whom they do not work, and I am one of them.

    I’ve explored the subject at some length in this post, but especially in this comment and this one, as well as others.

  6. J.J. formerly Jimmy J. Says:

    neo and Teri,
    “Jack Spratt could eat no fat,
    his wife could eat no lean.
    Betwixt the two of them,
    they licked the platter clean.”

    Or- “Different strokes for different folks.”

    It’s one of the major problems with the “science” of health care. The doctors and dieticians would like to be able to treat us like duplicates of one another. The problem is that we are very different from one another. And that makes their jobs far more difficult with the present state of knowledge.

    We all have to be mindful of our own situations and willing to recognize what works and what doesn’t.
    A lot of the official government line about diet is a bit like the warmist’s line on AGW. They think they understand what’s happening, but they really don’t. The human body and global climate change are far more complex than they want to admit.

  7. sergey Says:

    This is a general problem with contemporary medicine: all people are different, but they are treated all alike, as if their only differences are their diseases. Wrong: their health is different too. When medicine was an art, not a science, their inherent differences were the first thing for doctors to recognize. Medical doctors 200 years ago were also astrologists, alchemists and physiognomists, and had different treatments for different patients. Now only homeopaths understand these differences and use them in their practical work. When I read that homeopathy is not efficient in clinical trials, I can only sigh. It can not be efficient in such setting when all individual differences are nixed – and this is the first requirement for clinical trials! Our “scientific” approach to medicine simply negates all huge body of knowledge accrued by individualized medicine of past thousand years, and this is not good.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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