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A flood of news stories and medical journal reports tell us that gastric bypass and gastric sleeve surgery for weight can also cure diabetes. But the fine print in the data analysis tells us that this approach may leave a great deal to be desired.

There are type 2 diabetics who have achieved 6% HbA1C (glycosylated hemoglobin), 100 mg/dl fasting blood sugar levels, and freedom from medication by diet, and not necessarily by eating only itty bitty portions of food and never straying from their diet plan.

The diabetics who achieve remission and partial remission by eating right are those who successfully follow low-carb diets.

But the objective of low-carb diets in type 2 diabetes is to avoid eating foods that the body changes into sugar, and to make sure the body makes less sugar, rather than to label food itself as "bad."

There are just some foods that type 2 diabetics can't eat. There are other foods that type 2 diabetics can eat, although "hog wild" is never a description that can be applied to healthy diabetic eating.

Diabetics Just Can't Have Carbohydrates

Yummy as carb-rich foods, diabetics just cannot have them, or at least they need to limit themselves to the kind of carb intake that would be possible after a gastric bypass procedure.

Diabetes guru Dr. Richard Bernstein tells his patients to limit their consumption of carbs to a mere 12 grams per meal (and sometimes not that much). That means eliminating all starches and sugars, but allows for filling up with salad and low-carb veggies. 

Other diet experts say that eating up to 50 grams of carbohydrate with a meal is OK.

That can be operationalized as 1 slice of bread, with no other carbohydrate foods, or 1 carefully measured half-cup serving of rice or potatoes, with no other carbohydrate foods, or the occasional cookie, but just one, and only when it has been "earned" with exercise.

 This approach seems to work about as well. But it is OK on these plans to fill up with real foods, if not favorite foods, and there can be allowances for eating more when diabetics exercise more, say, when they spend an afternoon skiing, or walk through the park, or paint the house. Those adjustments are not possible for diabetics who have had weight loss reduction surgery. After surgery, diet limitations are locked in.

Still Want the Surgery?

Of course, the advantage of weight loss reduction surgery is that is effortless. What the advertisements for the surgery leave out is that it is also dangerous. How dangerous?

  • About 3.5% of people who have any form of weight loss reduction surgery have to the surgery redone before the incision heals.
  • About 16% of people who have any form of weight loss reduction surgery die within 5 years.
When the stomach is removed or the small intestine bypassed, the digestive tract simply cannot absorb certain B vitamins, especially vitamin B12.

Sometimes the deficiency of vitamin B12 results in dementia that leads to suicide. Or the inability to absorb the fat-soluble vitamin K leads to osteoporosis. Or feeling full all the time leads to fatal anorexia.

There may be some type 2 diabetics who can only control their disease with the help of weight loss reduction surgery. (Weight loss reduction surgery is not, for a variety of reasons, performed on completely insulin-dependent, type 1 diabetics.) But for many the best plan is to find a diet that helps them feel full with their original stomachs intact.

  • Brethauer SA, Aminian A, Romero-Talamás H, Batayyah E, Mackey J, Kennedy L, Kashyap SR, Kirwan JP, Rogula T, Kroh M, Chand B, Schauer PR. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus.Ann Surg. 2013 Oct. 258(4):628-36. discussion 636-7. doi: 10.1097/SLA.0b013e3182a5034b. PMID: 24018646.
  • Malin SK, Samat A, Wolski K, Abood B, Pothier CE, Bhatt DL, Nissen S, Brethauer SA, Schauer PR, Kirwan JP, Kashyap SR.Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: effects of bariatric surgery versus standard medical therapy.Int J Obes (Lond). 2013 Oct 29. doi: 10.1038/ijo.2013.196. [Epub ahead of print] PMID: 24166065.
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