This week’s New England Journal of Medicine has one report about the success of weight loss surgery for the treatment of type 2 diabetes (1) and this week’s Journal of the American Medical Association has clinical guidelines about that (2) and 2 other articles about the relationship of the weight-to-hip ratio to type 2 diabetes, that will have to wait for next week’s article from me; I’m a busy man. But the news of the day is an overview called “Unveiling the “magic” of diabetes remission after weight-loss surgery.” (3)
Everybody with obesity and type 2 diabetes, which is more that 10% of us, would like to know how this surgery works so they could maybe skip the drastic surgery and “bypass by the bypass”.(4)
People who have gastric bypass improve their insulin production and need fewer or no diabetes medications, immediately, before they’ve lost any weight. They also eat much less in the first few days after this drastic assault on their intestines. So someone tried a drastic calorie restriction like that on type 2 diabetics and they had the same immediate effect on their insulin sensitivity and blood sugar levels as the surgery. That’s it! But non surgery subjects got hungry and miserable and had to go back to eating until they caught back up but gastric surgery patients stay happy and keep on losing 30% of they’re weight and stay cured of their diabetes. Also just putting in a tube that forms a barrier between the food and the lining of the first part of your intestines after the stomach, or burning and scarring the inner surface lining of that segment that more simply mimics part of bypass surgery might work just as well. So the real magic is not totally solved.
Gut hormones like GLP-1 and grelin are changed by this surgery but studies of those hormones don’t yield anywhere near the same success. This surgery also changes the intestinal bacteria populations and must have influences on you brain. Maybe it is the combination of column A and columns B,C etc.. as well as things we still don’t know. Or maybe what we still don’t know is the big magic.
Until we figure out how to bypass bypass surgery, the joint statement by International Diabetes Organizations recommends this surgery as an option for treatment of type 2 diabetics who have any degree of obesity.
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.