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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.

Diabetics never get a day off.

They don't get permission to eat sweets on holidays. There is never a time that eating too much is allowed without a penalty to health. And they can't stop taking their medications without serious consequences to health unless, we are increasingly told, they have weight loss reduction surgery, such as the radical Roux-en-Y gastric bypass procedure which permanently reroutes food through the stomach and small intestine, or maybe a potentially reversible procedure called the gastric sleeve which reduces the size of the stomach, or a form of "stomach amputation" called gastrectomy.

If your stomach simply is not there to hold food, you will eat less. But does that cure type II diabetes?

That is the question that a group of surgeons at the Bariatric and Metabolic Institute and Endocrinology and Metabolism Institutes of the Cleveland Clinic in Ohio set to answer.

Does Weight Loss Surgery Result in Diabetes Reversal?

The Cleveland Clinic physicians followed 217 people who had type 2 diabetes and who were given weight loss surgery for periods of 5 to 9 years. They wanted to see how would achieve "complete remission" from diabetes, which they defined as:

  • HbA1C of 6.0% or less,
  • Fasting blood sugar level of 100 mg/dl or less, and
  • No medications.

Some type 2 diabetics, it is fair to note, reach these goals by dieting, but their successes are relatively rare.

The doctors found out that over the long term:

  • 24% of type 2 diabetics who had weight loss surgery achieved "complete remission."
  • 26% of type 2 diabetics who had weight loss surgery achieved "partial remission," which the doctors defined as a reduction in HbA1C of 1% or more.
  • 34% of type 2 diabetics who had weight loss surgery were "improved," that is, their HbA1C levels went down, but less than 1%.
  • 16% of type 2 diabetics who had weight loss surgery experienced no change at all in the blood sugar levels.
  • About 80% of diabetics whose blood sugar levels normalized right after surgery stayed in the normal range.

In press releases for the study, the surgeons announced "Bariatric surgery can induce a significant and sustainable remission" from type 2 diabetes. But does it really?

Looking at the Numbers a Different Way

People who don't have a financial interest in promoting weight loss reduction surgery for diabetics might look at the results of the study differently. The same numbers may be interpreted as:

  • 76% of type 2 diabetics who had weight loss reduction surgery still had the disease
  • Since the average starting HbA1C in the study was 8.5%, half of diabetics who had dangerously high blood sugar levels before surgery continued to have dangerously high blood sugar levels after it.
  • Any improvement in diabetes after weight loss reduction surgery was due to eating less.

So it is a fair to ask, why let a surgeon hook up organs that don't naturally belong together or cut out part of your stomach when any benefit from surgery could also be achieved by eating less, specifically by eating fewer carbohydrates? Isn't diet easier than drastic, dangerous abdominal surgery?

Unfortunately, many type 2 diabetics are still told that diabetes dieting only means eating less.

Diabetes Reversal Without Surgery?

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.

Read full article

  • 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.
  • Photo courtesy of MilitaryHealth by Flickr : www.flickr.com/photos/militaryhealth/6883594846/
  • Photo courtesy of Alan Levine by Flickr : www.flickr.com/photos/cogdog/5188432051/

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