The Role Of Bariatric Surgery To Treat Diabetes: Current Challenges And Perspectives
The role of bariatric surgery to treat diabetes: current challenges and perspectives 1 Carel W. le Roux ,2,3 and Alexander Kokkinos 1 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK Chrysi Koliaki, Email: moc.oohay@ikailokc . Received 2017 May 27; Accepted 2017 Aug 6. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. Bariatric surgery is emerging as a powerful weapon against severe Continue reading >>
Diabetes Reversal After Bypass Surgery Linked To Changes In Gut Microorganisms
Studies have shown that bariatric surgery can lead to remission of type 2 diabetes mellitus (T2DM) in rodents and humans, but this beneficial effect cannot be explained solely by weight loss. In a new study, researchers investigating gastric bypass in a mouse model of T2DM confirmed that bypass surgery improves glucose tolerance and insulin sensitivity. Interestingly, the improved metabolism occurred in conjunction with changes in gut microorganisms, suggesting a potential role for gut microbiota in diabetes remission. Studies have shown that bariatric surgery can lead to remission of type 2 diabetes mellitus (T2DM) in rodents and humans, but this beneficial effect cannot be explained solely by weight loss. In a new study published in The American Journal of Pathology, researchers investigating gastric bypass in a mouse model of T2DM confirmed that bypass surgery improves glucose tolerance and insulin sensitivity. Interestingly, the improved metabolism occurred in conjunction with changes in gut microorganisms, suggesting a potential role for gut microbiota in diabetes remission. "Our research showed that duodenum-jejunum gastric bypass (DJB) surgery may be applied to cure diabetes of both genetic (mutation) and environmental (diet-induced) origin," explained lead investigator Xiang Gao, PhD, of State Key Laboratory of Pharmaceutical Biotechnology and MOE Key Laboratory of Model Animal for Disease Study, Model Animal Research Center, Nanjing Biomedical Research Institute and the Collaborative Innovation Center of Genetics and Development, Nanjing University. "We found that DJB surgery induced gut microbiota alterations, which may be the key reason for diabetes remission after bariatric surgery. Our data indicate that suppressed inflammation is the result, not the cause Continue reading >>
The Solution For Obesity And Diabetes Already Exists. So Why Do So Few People Know About It?
If your appendix fails, surgery is your best option. Blocked arteries? Surgery. Obesity and diabetes? Until recently, the most obvious solutions were diet, exercise, and drugs as needed; however a growing body of research suggests the optimal way to manage these conditions is with—that's right—surgery. "Why isn't every type 2 diabetic referred for an operation?" says Mitchell Roslin, MD, chief of bariatric and metabolic surgery at Lenox Hill Hospital in New York City. "I ask myself this every day." His puzzlement stems from a raft of recent reports about the stunning long-term effects of bariatric surgery on diabetes, as well as weight loss. The Cleveland Clinic's groundbreaking STAMPEDE (a charming acronym for the clunkily named Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) study, published in 2012, was the first to show that bariatric surgery is more effective than medicine in controlling diabetes in obese people. The Cleveland Clinic has since published a follow-up study showing that gastric bypass surgery significantly improves and, in fully 50% of the cases they looked at, even reverses diabetes. There are several types of bariatric surgery, but the most common reduce the size of the stomach with a gastric band or through removal of a portion of the stomach (called sleeve gastrectomy), or resect and re-route the small intestine to a small stomach pouch (gastric bypass surgery). "It's amazing, honestly," says lead investigator Philip Schauer, MD, director of the Cleveland Clinic Bariatric and Metabolic Institute of the results his team compiled. "We hesitate to use the word 'cure' because that means no more diabetes for the rest of one's life. Remission is more accurate; it means blood sugar is normal without medication. But it is Continue reading >>
Can Bariatric Surgery Cure Type 2 Diabetes?
More and more studies claim that the answer may be "yes"; in many cases, bariatric surgery is an effective cure for those suffering from type 2 diabetes. To be clear, diabetes is not well understood and medical science cannot claim a permanent “cure”. The goal is to put diabetes in remission. Remission means a return to normal blood sugar levels and no need for diabetes medications. With glucose at normal levels, the progression of diabetic complications is halted, thus giving the body a chance to repair the damage. In other words, remission means that you are presently "cured" and will remain so, unless the factors causing the disease return to a degree sufficient to cause a relapse. So, the correct question is, does bariatric surgery cause type 2 diabetes to go into remission? And, in many cases, the answer is a resounding yes. How does bariatric surgery “cure” Type 2 diabetes? We know that bariatric surgery puts type 2 diabetes into remission; what we don’t know is how it does it. It's clear that healthy weight loss plays a significant role in reducing blood sugar levels in Type 2 diabetics, and bariatric surgery has been proven to be the most effective way for obese patients to lose significant body weight. But, there are additional factors at work. Many see an instant reversal of their diabetes immediately after gastric bypass surgery or gastric sleeve surgery – before they lose any weight. This is what science doesn't fully understand. One theory suggests that bypassing or removing part of the stomach immediately impacts the way glucose is processed in the digestive system. Another claims that by shunting food directly to the lower intestine, a substance called glucagon-like peptide 1 (GLP-1) is stimulated, which can increase insulin production. Scient Continue reading >>
Bariatric Surgery And Diabetes
Yes, it'strue. Not only does bariatric surgery curetype IIdiabetes; it is the only cure. Before we talk about that,a word should be saidabout diabetes in general: Type 2 diabetes is often lumped with other metabolic diseases that overweight adults tend to have, like high blood pressure and high cholesterol, but in truth, diabetes is quitea bit worse. If you are someone who has had diabetes for a while, then you understand the difference: Unlike those other metabolic diseases, diabetes always progresses. Its relentlessly progressive. You can slow the damage suffered by your organs the feet, eyes, heart, kidneys, and brain but you cannot completely stop it. Its different with high blood pressure and high cholesterol. With those diseases, as long as you take the right medication, you have a very good chance of avoiding organ damage altogether. Not true with diabetes. Even if you are downright saintly with your medications and blood sugar checks, the disease will worsen with time. Your diet-controlled diabetes will one day require oral medication. That one pill will eventually turn into two, and later it will become three. With time, your sugar will become impossible to control without insulin;and further on it will be hard even with insulin the end-stage diabetic. With proper, meticulous care, this progression could be slowed, perhaps even by decades, but it can never really be turned off that is until it was learned that bariatric surgery had a curative effect on Type 2 diabetes. The finding that bariatric surgery and diabetes are related was first publicized in the nineties by an insightful gastric-bypass surgeon, Dr. Walter Pories, whose cartoon is shown (with permission). Early in his career, Dr. Pories performed bariatric surgery because his patients needed the weigh Continue reading >>
How Does Gastric Bypass Surgery Cure Type 2 Diabetes?
Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight. Why? “What we found is that the secret for the cure of diabetes after gastric bypass lies in the intestine,” said Dr. Nicholas Stylopoulos, principal investigator at the Division of Endocrinology at Children's Hospital Boston and Boston Medical School, in an interview with Healthline. “The key message is that after gastric bypass the intestine becomes the most important tissue for glucose use and this decreases blood sugar levels.” His research was published last week in the journal Science. Doctors are hopeful they can find a way to mimic the processes that lead to improvements for type 2 diabetics after gastric bypass without actually doing the surgery. Small Intestine to the Rescue Here's how it works: After gastric bypass, which is a common weight loss solution for the severely obese, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. “The quite amazing thing is that this is not present normally in the small intestine of adults, but only in the fetus,” said Dr. Erini Nestoridi, a research fellow in Stylopoulos' lab, in an interview with Healthline. “This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.” Although weight loss and improved diabetes symptoms go hand in hand, previous research has shown that gastric bypass surgery helps resolve the disease even before weight loss occurs. According to the U.S. Centers for Disease Control and Pr Continue reading >>
Curing Diabetes: The Only Confirmed (pseudo) Cure
Curing diabetes has been a goal of physicians and diabetic patients since it was first discovered by the Ancient Greeks in the 1st century (1). Almost 2,000 years later, it seems that we have finally learned how to cure diabetes, or at least provide a “pseudo-cure” that puts diabetes into potentially permanent remission: bariatric surgery. Review and click the sections below to learn more about the only known cure for diabetes. Continue reading >>
Bariatric Surgery For Type 2 Diabetes Reversal: The Risks
The twin epidemics of obesity and type 2 diabetes are on the rise. From 1986 to 2000, the prevalence of BMI 30 kg/m2 doubled, whereas that of BMI >40 kg/m2 quadrupled, and even extreme obesity of BMI 50 kg/m2 increased fivefold (1). Of particular concern is the alarming increasing prevalence of obesity among children, suggesting that the epidemic will worsen (2). The impact of obesity on longevity has been well documented. In the world, over 2.5 million deaths annually can be attributed to obesity; in the U.S. alone over 400,000 deaths attributable to obesity occur per year—second only to those attributable to cigarette smoking. There is a direct relationship between increasing BMI and relative risk of dying prematurely, as evidenced in the Nurses’ Health Study with a 100% increase in relative risk as BMI increased from 19 to 32 kg/m2. Annual risk of death can be as high as 40-fold that of an age- and sex-matched nonobese cohort (3,4). The Framingham data revealed that for each pound gained between ages 30 and 42 years there was a 1% increased mortality within 26 years, and for each pound gained thereafter there was a 2% increased mortality. Only one in seven obese individuals will reach the U.S. life expectancy of 76.9 years. In the morbidly obese population, average life expectancy is reduced by 9 years in women and by 12 years in men. It has been over 10 years since the resolution of type 2 diabetes was observed as an additional outcome of surgical treatment of morbid obesity. Moreover, it has been shown unequivocally that diabetes-related morbidity and mortality have declined significantly postoperatively, and this improvement in diabetes control is long lasting. Bypass procedures, the Roux-en-Y gastric bypass (RYGBP) and the biliopancreatic diversion (BPD), are Continue reading >>
Why Weight-loss Surgery Cures Diabetes: New Clues
Scientists are a step closer to understanding why diabetes is cured in the majority of patients that undergo gastric bypass surgery."Our research centered on enteroendocrine cells that 'taste' what we eat and in response release a cocktail of hormones that communicate with the pancreas, to control insulin release to the brain, to convey the sense of being full and to optimize and maximize digestion and absorption of nutrients," said the study's team leader. Scientists at The University of Manchester are a step closer to understanding why diabetes is cured in the majority of patients that undergo gastric bypass surgery. The research, published in the journal Endocrinology, shows the cure is likely to be explained by the actions of specialized cells in the intestine that secrete a cocktail of powerful hormones when we eat. During the research, the team showed that gut hormone cells previously thought to contain just one hormone, had up to six hormones including the hunger hormone ghrelin. Study team leader, Dr Craig Smith, a Senior Lecturer in Molecular Cell Physiology, said: "Our research centred on enteroendocrine cells that 'taste' what we eat and in response release a cocktail of hormones that communicate with the pancreas, to control insulin release to the brain, to convey the sense of being full and to optimize and maximize digestion and absorption of nutrients." "Under normal circumstances these are all important factors in keeping us healthy and nourished. But these cells may malfunction and result in under or over eating." 75% of people suffering from obesity who also have diabetes are cured of diabetes after receiving a gastric bypass and Dr Smith says that understanding how bypass surgery cures diabetes is the crux of his team's research. Dr Smith: "This is wh Continue reading >>
Metabolic And Bariatric Surgery And Type 2 Diabetes
Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>
Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery
An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. Continue reading >>
Life After Weight Loss Surgery: Can It Cure Type 2 Diabetes?
Three years ago, diabetes was just one of Carole Means' many health problems. At age 48, she weighed 515 pounds, and her heart was three times its normal size. Her blood glucose was in the 400s, she was on insulin and glucose-lowering pills, and her kidneys were failing. Yet her physical agony wasn't as painful as the emotional toll the weight took. In four years, she never saw her son play high school football, and she didn't attend his graduation. She rarely left her Des Moines home. Today, Carole spends two hours a day at a gym and loves to chase after her grandchildren. "I missed out on so much," she says wistfully. "But I'm making up for it now. My husband can barely keep me at home." Carole lost the bulk of her weight after undergoing surgery that reduced her stomach to the size of a golf ball. She had to make drastic, permanent changes in what and how she eats, but she says it's been worth it. She weighs about 130 pounds now and takes no diabetes medications. "My doctor says I no longer have diabetes," she says. "I know why I didn't die: I needed to stick around to share my story and inspire others to transition from hopeless to hopeful." Is Diabetes Remission Possible? While Carole's experience is not the norm, weight loss and the plummeting glucose levels that often follow bariatric surgery can be dramatic. Most people lose about 56 percent of their excess weight, with the range being 45-65 percent (66-110 pounds) based on data from the various surgeries during one to 10 years of follow-up. "The heavier you are, the longer it takes," says Margaret Furtado, RD, bariatric nutrition specialist at the University of Maryland Medical Center in Baltimore and author of The Complete Idiot's Guide to Eating Well After Weight Loss Surgery (Alpha, 2009). Men lose weight fa Continue reading >>
A New Look At How Gastric Bypass "cures" Type 2
A New Look at How Gastric Bypass "Cures" Type 2 David Bernlohr (left) and his research partner, surgeon Sayeed Ikramuddin. Biochemist, University of MinnesotaTwin Cities College of Biological Sciences and Medical School For years, scientists have marveled at the effects of gastric bypass surgery. The operation, which involves surgically removing part of the stomach and small intestine, physically restricts the amount of food people are able to consume and digest, leading to dramatic weight loss. Even more remarkable, the procedure puts type 2 diabetes in remission for some people. The surgery restores the body's sensitivity to insulin and revives the pancreatic cells that produce it, even before any weight loss occurs. Biologists studying the phenomenon say it has something to do with inflammation, caused by overactive immune cells that build up in fatty tissue. "One of the key observations in human biology is that when an individual transitions from lean to obese, there's an increase in inflammation," says David Bernlohr, PhD, a researcher at the University of MinnesotaTwin Cities. That inflammation leads to things such as insulin resistance, which means the body needs to produce more and more insulin to control blood glucose levels. Eventually, the insulin-producing cells in the pancreas begin to give out, causing type 2 diabetes. After gastric bypass surgery, though, inflammation seems to decrease or disappear almost immediately. Tiny engines inside the cells called mitochondria that shut down as a result of inflammation grind to life again, increasing the body's sensitivity to insulin in the process. The surgery seems to reverse the course of type 2 diabetes in "just a couple of days," Bernlohr says. Help support diabetes science: Join the Summit Circle, ADA's soci Continue reading >>
Why The New Surgical Cure For Diabetes Will Fail!
Two seemingly groundbreaking studies, published this week in the New England Journal of Medicine found that type 2 diabetes, or “diabesity”, could be cured with gastric bypass surgery. The flurry of media attention and medical commentary hail this as a great advance in the fight against diabetes. The cure was finally discovered for what was always thought to be a progressive incurable disease. But is this really a step backwards? Yes, and here’s why. No one is asking the most obvious question. How did the surgery cure the diabetes? Did the surgeons simply cut out the diabetes like a cancerous tumor? No. The patients in the studies changed their diet. They changed what they put in their stomach and that’s something that doesn’t require surgery to change. If they had surgery and they didn’t stop binging on donuts and soda they would get violently ill and vomit and have diarrhea. That’s enough to scare anyone skinny. If I designed a study that gave someone an electric shock every time they ate too much or the wrong thing, I could reverse diabetes in a few weeks. But you can get the benefits of a gastric bypass without the pain of surgery, vomiting, and malnutrition. Most don’t realize that after gastric bypass diabetes can disappear within a week or two while people are still morbidly obese. How does this happen? It is because food is the most powerful drug on the planet and real whole fresh food and can turn on thousands of healing genes and hundreds of healing hormones and molecules that create health within days or weeks. In fact, what you put on your fork is more powerful than anything you can find in a prescription bottle. The researchers asked the wrong question. It should not have been does surgery work better than medication, but does surgery work b Continue reading >>
Bariatric Surgery For People With Type 2 Diabetes And Prediabetes
Q: What is type 2 diabetes? What is prediabetes? Type 2 diabetes is a chronic, degenerative disease that develops when the body cannot make enough, or properly use, insulin – a hormone that helps regulate sugar (glucose) in the body. Prediabetes is a precursor to type 2 diabetes, defined by above-average glucose levels. Q: Do bariatric surgeries (Roux-en-Y gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy) cure type 2 diabetes? A: Patients are often told weight loss surgeries will cure diabetes. That’s simply not true. However, individuals with type 2 diabetes or prediabetes and obesity may benefit from the modest weight loss achieved through surgery. After a gastric bypass or a sleeve gastrectomy, patients experience weight loss and changes in their gastrointestinal tract. Weight loss surgery causes profound changes in the incretins -- hormones in the gastrointestinal tract that cause insulin to be released. These changes lead to significant improvement in type 2 diabetes and can cause long-term changes in the pancreas that causes diabetes to go away. These changes may help individuals: Achieve remission for type 2 diabetes Decrease the amount of medications they need on a daily basis Postpone the onset of diabetes (for individuals with prediabetes) Q: How can weight loss surgery affect diabetes treatment? A: Modest weight loss can postpone the onset of diabetes for people with prediabetes. If diabetes is in the early stages, the individual might be able to stop taking diabetes medications (such as metfromin or insulin) for many years. For people with longstanding diabetes, taking oral medications, the effects of surgery may allow sugar levels to be controlled with food restrictions only. If the diabetes has been present for more than 10 ye Continue reading >>
