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How Does Bariatric Surgery Cure Diabetes

The Role Of Bariatric Surgery To Treat Diabetes: Current Challenges And Perspectives

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: [email protected] . 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 >>

Curing Diabetes: The Only Confirmed (pseudo) Cure

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 >>

How Does Gastric Bypass Surgery Cure Type 2 Diabetes?

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 >>

The Solution For Obesity And Diabetes Already Exists. So Why Do So Few People Know About It?

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 >>

Is Weight Loss Surgery The Answer For Diabetes?

Is Weight Loss Surgery The Answer For Diabetes?

With commentary by Anita P. Courcoulas MD, MPH, FACS, professor of surgery and director of minimally invasive bariatric & general surgery at the University of Pittsburgh Medical Center Is weight-loss surgery better than nutrition and physical activity alone for reversing type 2 diabetes? That controversial question has occupied researchers, doctors, insurers and people with diabetes for more than a decade. Now, a small yet well-designed study seems to have the answer: Surgery. University of Pittsburgh researchers randomly assigned 61 obese women and men with type 2 diabetes to receive gastric bypass surgery, an adjustable gastric band or an intensive lifestyle change program. Study volunteers were tracked closely for three years, as scientists monitored their weight, fasting blood sugar, A1c levels (a test of long-term blood sugar control) and use of insulin and other diabetes medications. The results: More weight (and fat) lost: Gastric bypass recipients lost an average of 25% of their body weight (and nearly 11% of their body fat), gastric band wearers dropped 15% of their weight (and 5.6% of their body fat) and lifestyle group members lost 5.7% of their weight and 3% of their body fat. People in the gastric bypass also saw their waist size shrink the most, an indicator that they’d lost the most visceral fat – the kind that packs around internal organs and contributes to blood sugar processing problems. Lower blood sugar: People in the gastric bypass group saw fasting blood sugar drop 66 mg/dL and their A1c levels fall 1.4%. In comparison, gastric band recipients got a 35-point reduction in fasting blood sugar and a 0.8% reduction in A1c levels. For the lifestyle-only group, fasting blood sugar fell an average of about 28 mg/dL but A1c levels rose slightly. Less d Continue reading >>

Can Bariatric Surgery Cure Type 2 Diabetes?

Can Bariatric Surgery Cure Type 2 Diabetes?

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 dont 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 Continue reading >>

New Study: Weight-loss Surgery May Cure Diabetes

New Study: Weight-loss Surgery May Cure Diabetes

New study: Weight-loss surgery may cure diabetes It seemed too good to be true when 60 Minutes reported it in 2008, but a new study confirms that weight-loss surgery can put type 2 diabetes in remission Could weight-loss surgery be a cure for type 2 diabetes? That's exactly what a new study, published today by the New England Journal of Medicine, suggests. The study showed that weight-loss surgery is dramatically more effective in the treatment of type 2 diabetes than a conventional treatment of diet changes and medication. Patients in the study suffered from severe type 2 diabetes, and most went into remission after undergoing one of two bariatric surgeries. "It's an unprecedented effect that we've never seen in diabetes before," says surgeon Dr. Francesco Rubino, senior author of the NEJM study and director of The Diabetes Surgery Center at New York-Presbyterian Hospital/Weill Cornell Medical Center. "Remission hasn't even been a word in the textbooks about diabetes." Doctors have been performing bariatric (or weight-loss) surgeries since the 1950s. Until now, the procedures have been considered just a treatment for morbid obesity. "The name 'bariatric' comes from a Greek term 'baros,' which means weight," explained Dr. Rubino. "In the 1950s, there were anecdotal reports that diabetes disappeared after these surgeries, but it was considered a side-effect of weight loss." Four years ago, Dr. Rubino was interviewed by Lesley Stahl for a 60 Minutes report on gastric bypass surgery as a potential cure for diabetes. "At the time it was little more than an exciting pie-in-the-sky theory," says 60 Minutes producer Shachar Bar-On, who worked with Stahl on story. Back then, Dr. Rubino had been performing the surgeries on diabetic rats, effectively reversing the animals' diabe Continue reading >>

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

Gastric bypass seems to help diabetic patients by changing the way their body regulates gut hormones . This may be because theres no more stomach cavity, or perhaps because a small section of the intestines where these hormones might be stimulated is removed no one is quite sure . But we do know that around two thirds of patients who get gastric bypass dont require any medication to treat their diabetes, and they stay that way for years ( follow-up studies have only gone out five years so far). The weight loss itself also helps, since shedding body fat improves diabetes generally, but patients on traditional medication and weight loss interventions dont see nearly the same improvement. In fact, many of them are in exactly the same position at the five-year mark as they were on day one, while their surgically-enhanced counterparts have often put their diabetes into remission. Some other bariatric surgeries are just as good for diabetics As we said earlier, gastric bypass is only the best-known of the bariatric surgeries. Theres also an adjustable gastric band, which is exactly what it sounds like: a band that creates a smaller stomach pouch over time as its tightened. Its not the most effective method for either weight loss or diabetes improvement, but it is (relatively) easy and fast, and has the lowest rate of surgical complications. Another method is the sleeve gastrectomy, which doesnt so much put a sleeve on the stomach as it does make the stomach look like a sleeve. By removing part of the organ, surgeons can make it smaller and more tubular. This method seems to be just as effective as full gastric bypass in terms of both weight loss and diabetes remissionpeople lose about 50 percent of their body mass and a majority of patients see improvement in their gut hormo Continue reading >>

How Weight Loss Surgery Helps Type 2 Diabetes

How Weight Loss Surgery Helps Type 2 Diabetes

Weight loss surgery can make a big difference for people with type 2 diabetes. For some people, blood sugar levels get back to normal after surgery. Diabetes can be cured.That could mean you need less medication or none at all. Research shows improvements in type 2 diabetes after weight loss surgery. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, only 6% to 8% of people who took medicine, but didn’t have surgery, showed similar results. If you’re thinking about it, and you’re ready to make big changes to keep up the results, you’ll want to know if it’s right for you. First, your doctor will consider two things: Is your BMI 35 or higher? Have you tried to lose weight and keep it off without success? If so, he will give you a detailed checkup and ask you questions to see if you are physically and emotionally ready for the operation and the major changes you'll need to make. (You'll need to eat a lot less and make a healthy diet and exercise part of your life forever.) Depending on your particular case, other doctors may also get involved. For instance, if you have heart disease, your cardiologist would need to approve you for surgery. There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both. Get to know what’s involved with each of these: 1. Gastric bypass (also called Roux-en-Y gastric bypass) The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to Continue reading >>

Bariatric Surgery And Diabetes

Bariatric Surgery And Diabetes

Can Bariatric Surgery Cure My Diabetes? Weight loss surgery can absolutely help you handle or even cure your type II diabetes. More than 90% of our patients who undergo the gastric bypass, and more than 95% or our patients that receive the duodenal switch, experience remission of their diabetes. That means no more diabetic medications. No more symptoms like dizziness or frequently having to run to the bathroom. No more looming risk of something worse happening. It means relief. Imagine how that would feel. How Does Bariatric Surgery Cure Diabetes? Weight loss surgery has a powerful effect on many peoples’ diabetes. Here’s why: First, weight loss itself can often cause remission. Type II diabetes is partly caused by the metabolic effect of too many hormonally active fat cells, which causes insulin resistance in the body. And, if you’re suffering from obesity, this issue alone can often lead to type II diabetes. But this part of the problem is tied to your weight, and when you lose weight, the diabetes can vanish. Our weight loss surgery patients often lose 100 to 200 pounds or even more, which has a powerful effect on their diabetes. However, interestingly bariatric surgery can even help cure diabetes right after surgery, before any significant weight loss happens. In fact, many patients experience normalization of their insulin, glycosated hemoglobin, and glucose levels within a couple of days after surgery. How can this happen? While we are still teasing out some of the details in answer to this question, we do know that a class of intestinal hormones known as incretins may be a large part of this answer. Incretins, such as GLP-1 and GIP, are produced by our intestines in response to eating dietary sugars and help to increase insulin production. However, in diabe Continue reading >>

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric bypass surgery for patients with type two diabetes, in most cases, is either remitted or relapses within five years, researchers from the Group Health Research Institute reported in the journal Obesity Surgery. The authors explained that after gastric bypass surgery, diabetes symptoms may disappear for some patients - in many cases before they lose a lot of weight. Does this mean, therefore, that gastric bypass surgery is a "cure" for diabetes? Not necessarily, they wrote, after gathering and analyzing data from the largest community-based study that looked at the long-term outcomes after bariatric surgery among diabetes patients. 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. When diabetes did go away, it stayed away for several years - an important benefit. Experts know that bariatric surgery (weight loss surgery) is much more effective in reducing heart disease and stroke risk than medications, researchers from the Cleveland Clinic recently explained. They reported their findings in the journal Heart (October 2012 issue). Their study involved very obese patients, including those with and without diabetes. Who receives the most benefit from gastric surgery? Lead researcher, David E. Arterburn, MD, MPH, explained that those with less severe diabetes symptoms tended to benefit the most from gastric surgery - they were the ones most likely to experience remission after the operation, and for longer. Dr. Arterburn said: "Gastric surgery isn't for everyone. But this evidence suggests that, once Continue reading >>

Why Weight-loss Surgery Cures Diabetes: New Clues

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 >>

A New Look At How Gastric Bypass

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 >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

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 >>

Why The New Surgical Cure For Diabetes Will Fail!

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 >>

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