Surgery for diabetes used to mean things like foot amputation for the ravages of the disease rather than for the treatment of the underlying causes. In the July issue of Scientific American, that also has an article about why primordial black holes could solve the enigma of dark matter in the universe, Dr. Francesco Rubino has a review article about the primary treatment and total cure of type 2 diabetes with intestinal bypass surgery that was used until recently only for the treatment of obesity.(1) Francesco Rubino an Italian surgeon, now with King’s College Hospital in London, is a well known dean of obesity surgery and the effort to try to discover how it works.
According to Dr. Rubino’s review he was struck early on that this intestinal surgery cured or vastly improved type 2 diabetes, apparently independently from the weight loss incurred. Although weight loss with or without this surgery does help type 2 diabetes and this was originally thought to be the mechanism of this particular beneficial result, he noted that type 2 diabetics were cured before they lost weight. Also studies in rats and humans show that diabetes can be cured even if they regain the weight or never lose any or had type 2 diabetes but were not obese.
How it works is not completely understood. Obesity surgery does a lot of things. It alters nerve circuitry between the gut and brain, it alters the bacterial populations that live in you intestines, it changes the mechanics of bile acids delivered by your liver and gall bladder, in changes the secretion of hormones by your guts and it changes the digestion and absorption of sugar into the blood stream. Even though these surgical procedures have been labeled “restrictive” and “malabsorptive” it is known that they do not work by keeping you from eating or absorbing the calories from what you do eat. (2) This kind of surgery does so many things and has so many beneficial effects not just on weight and type 2 diabetes but also on fatty liver disease and blood pressure and heart attacks and strokes and even cancer and overall longevity.
Still, this kind of surgery, while it is safe compared to most kinds of surgery and probably cost effective in the long run, is drastic and invasive. But if we were to come up with a pill that could duplicate just the things we understand so far about the effects of this surgery and for which we already have developed medicines, it would have to contain a dozen component chemicals. (2)
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.