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.
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.