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 >>
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 >>
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 >>
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 >>
Is Gastric Bypass Surgery Your Best Choice For Reversing Diabetes?
Home / Type 2 Diabetes / Is Gastric Bypass Surgery Your Best Choice For Reversing Diabetes? Is Gastric Bypass Surgery Your Best Choice For Reversing Diabetes? If you are diabetic, you must have heard that losing weight is crucial for diabetes management and can even make blood sugar levelsget back to normal. And lets be honest here who doesnt like shortcuts, right? To some of us, gastric bypass surgery seems like a good option to cure or reverse diabetes. Its true that weight loss is good for diabetes, and a surgery that guarantees weight loss can make a big difference for people withType 2 Diabetes. Gastric bypass reduces size of stomach which leads to weight loss and eventually reverses diabetes. Some patients find thatblood sugar levelsreturn to normal within days after surgery. That means you could lead the rest of your life taking less or no medication at all for diabetes. However, gastric bypass surgery will severely restrict your life. Not only will you have to seriously limit how much food you eat, you also have to eat from a very restricted food list. So the question is is gastric bypass the right method to cure diabetes for most of us? OR is it a rather extreme course of action, one that is only suitable for the morbidly obese? Lets explore bariatric surgery as a method to reverse diabetes in detail. Gastric Bypass or Bariatric Surgery is a weight-loss surgery that changes the digestive system. Commonly, the surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. As a result, you can only eat or drink small quantities at a time, as you feel full sooner and hence absorb fewer calories. The food you eat goes to the small pouch and bypasses the top of the small intestine. There are other kind of bariatric surgeries too that ma Continue reading >>
Surgery Reverses Diabetes
Home / Diabetes , Insulin /Surgery Reverses Diabetes T2D3 Could Type 2 Diabetes really be a disease that reverses? Weve outlined in our previous post how most specialists, doctors and researchers view T2D as a progressive chronic disease. That means that once you have it, it will eventually progress no matter what you do. However, in truth, T2D is actually a reversible, curable dietary disease.And I can quite easily prove it to you. Let me show you several examples. One of the most well studied examples comes from the literature surrounding bariatric surgery. This is commonly called stomach stapling surgery, and there are many kinds. The earliest surgery was called the Roux-en-Y surgery where the stomach would be cut to the size of a walnut and the small intestines rewired in order for the remaining food to be not properly absorbed into the body. This is an example of a combined restrictive (causing restriction on how much can be eaten) and malabsorptive (food is not properly absorbed) surgery. This surgery has multiple complications, but does tend to work, as you may well imagine. Another form of surgery is the sleeve gastrectomy, where only the stomach is cut to the size of a walnut. This is a purely restrictive form of surgery and also works quite well. With the stomach so small, it is often impossible to eat very much food at all. Often people will need to resort to a liquid diet. Any attempt to eat more than a thimbleful will result in severe gastric distention (ballooning of the miniature stomach) and results in persistent nausea and vomitting. A third type of bariatric surgery is the lap band. This involves the surgical implantation of a band that wraps around your stomach, thereby reducing the size to that of a walnut, without actually cutting anything out. It 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 >>
Obesity Action Coalition Dear Doctor Can Bariatric Surgery Treat Type 2 Diabetes?
Dear Doctor -Can Bariatric Surgery Treat Type 2 Diabetes? Answer provided by Lloyd Stegemann, MD, FASMBS To view a PDF version of this article, click here . Diabetes is a devastating problem worldwide. It has been estimated that as much as 8.3 percent of the worlds population has diabetes and this number is on the rise. As your weight goes up, so does your risk of developing type 2 diabetes (T2D). In fact, almost 25 percent of individuals who are affected by severe obesity (body mass index greater than 35) will carry a diagnosis of T2D. Uncontrolled diabetes leads to a host of long-term problems including heart attacks, strokes, kidney failure, blindness and the need for amputations. For many years, bariatric surgeons have known that bariatric surgery has a profound effect on T2D. It is not uncommon for our T2D patients to come off of all of their diabetic medications after bariatric surgery. Many primary care physicians (PCP), however, have been reluctant to advise bariatric surgery as the first line of treatment for their patients affected by severe obesity with T2D because of the lack of quality studies comparing the effectiveness of medical therapy versus surgical therapy for the treatment of T2D. Two recent studies that appeared in the New England Journal of Medicine were designed to help answer this question. In the first study, known as the STAMPEDE trial, 150 poorly controlled diabetic patients were divided randomly and equally into three groups. All of the patients in the study received intensive medical therapy including lifestyle counseling, weight management, frequent blood sugar monitoring, and diabetic medications. Fifty of the patients then continued with this intense medical therapy, 50 underwent a roux-en-y gastric bypass surgery, and the other 50 pati 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 >>
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?
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 >>
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 >>
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 >>
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 Diabetes
New guidelines last week recommended surgery as Type 2 diabetes treatment for people who are obese, including some who are mildly obese. Is “metabolic surgery” something you should consider? The guidelines were approved by the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups around the world. They were published in the June issue of the journal Diabetes Care. If you are heavy and have an HbA1c of 7.0 or above, your doctor may soon advise you to have one of these surgeries. You will be told the surgery will lower your blood sugar and your weight, which usually happens. You may not be told the negative effects. How do you decide? When performed to manage diabetes, bariatric or weight-loss surgery is known as “metabolic surgery.” The term covers Roux-en-Y “gastric bypass” surgeries, which reduce your stomach to a small pouch and plug it into the middle of the small intestine. It also includes “sleeve gastrectomy,” in which the deep part of the stomach is removed and the rest stapled together into a sleeve shape. Wrapping a band around the stomach to shrink it (“gastric banding“) is also now considered metabolic surgery. There are other surgeries that restructure the bowel in different ways, which I’ll write about next week. Surgeons have been pleased to learn that their weight-loss operations also lower blood sugars, though they are working to fully understand how that happens. It’s probably not the weight loss. Often, the improvements in diabetes numbers come long before significant weight loss occurs. A conference in Rome in 2007 reported that people were getting off their diabetes medications and lowering their HbA1c scores after surgery. Eight years later, a follow-up conference in London decided Continue reading >>