When type 2 diabetes is reversed after gastric bypass surgery, is it due to the actual operation or just the severely restrictive diet required for recovery?
Reversing Diabetes with Surgery
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Roux-en-Y gastric bypass surgery (RYGB) is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported. These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. And just severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery? We didn’t know… until this study. They put diabetics on the exact same post-surgery diet, with and without the actual surgery.
They found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery. Blood sugar control improved better in the absence of surgery, suggesting that the whole surgical-diabetes-reversal is not due to the surgery at all, but just the diet people have to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have as much potential to resolve diabetes as does major surgery.
If you remember my video, Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Type II diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intra-organ fat. Too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating like 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels can normalize, thanks to a fall in liver fat. Here’s a CT scan showing a 35% reduction in liver volume as all the fat is cleared out. Then, the body starts pulling fat out of the pancreas, and when the cause of diabetes goes away, the diabetes goes away.
The insulin-producing beta-cells of the pancreas have woken up! Clearly, the b-cells are not permanently damaged in type 2 diabetes, but are merely inhibited. They report reversal of diabetes up to 28 years after diagnosis.
So, diabetics motivated enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. For many people, this may prove too high a price to pay. It’s hard to voluntarily restrict food intake that much. Ok, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.
Of course, major surgery carries major risks, both during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There’s got to be a better way, and, in fact, there is. Instead of changing the quantity of food eaten, either voluntarily or involuntarily, is it possible to reverse diabetes by changing the quality of the food? We’ll find out how, next.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- D M Dunaief, J Fuhrman, J L Dunaief, G Ying. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Open Journal of Preventive Medicine Vol.2, No.3, 364-371 (2012).
- I Lingvay, E Guth, A Islam, E Livingston. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013 Sep;36(9):2741-7.
- R Taylor. Type 2 diabetes: etiology and reversibility. Diabetes Care. 2013 Apr;36(4):1047-55.
- S L Colles, J B Dixon, P Marks, B J Strauss, P E O’Brien. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006 Aug;84(2):304-11.
- S Steven, E L Lim, R Taylor. Population response to information on reversibility of Type 2 diabetes. Diabet Med. 2013 Apr;30(4):e135-8.
- J E Varela. Bariatric surgery: a cure for diabetes? Curr Opin Clin Nutr Metab Care. 2011 Jul;14(4):396-401.
- R Taylor. Reversing the twin cycles of Type 2 diabetes. Diabet Med. 2013 Mar;30(3): 267-75.
Images thanks to Dennis Skley via Flickr and Ivan Kmit and Ivonne Wierink via 123rf.
Roux-en-Y gastric bypass surgery (RYGB) is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported. These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. And just severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery? We didn’t know… until this study. They put diabetics on the exact same post-surgery diet, with and without the actual surgery.
They found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery. Blood sugar control improved better in the absence of surgery, suggesting that the whole surgical-diabetes-reversal is not due to the surgery at all, but just the diet people have to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have as much potential to resolve diabetes as does major surgery.
If you remember my video, Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Type II diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intra-organ fat. Too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating like 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels can normalize, thanks to a fall in liver fat. Here’s a CT scan showing a 35% reduction in liver volume as all the fat is cleared out. Then, the body starts pulling fat out of the pancreas, and when the cause of diabetes goes away, the diabetes goes away.
The insulin-producing beta-cells of the pancreas have woken up! Clearly, the b-cells are not permanently damaged in type 2 diabetes, but are merely inhibited. They report reversal of diabetes up to 28 years after diagnosis.
So, diabetics motivated enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. For many people, this may prove too high a price to pay. It’s hard to voluntarily restrict food intake that much. Ok, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.
Of course, major surgery carries major risks, both during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There’s got to be a better way, and, in fact, there is. Instead of changing the quantity of food eaten, either voluntarily or involuntarily, is it possible to reverse diabetes by changing the quality of the food? We’ll find out how, next.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- D M Dunaief, J Fuhrman, J L Dunaief, G Ying. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Open Journal of Preventive Medicine Vol.2, No.3, 364-371 (2012).
- I Lingvay, E Guth, A Islam, E Livingston. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013 Sep;36(9):2741-7.
- R Taylor. Type 2 diabetes: etiology and reversibility. Diabetes Care. 2013 Apr;36(4):1047-55.
- S L Colles, J B Dixon, P Marks, B J Strauss, P E O’Brien. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006 Aug;84(2):304-11.
- S Steven, E L Lim, R Taylor. Population response to information on reversibility of Type 2 diabetes. Diabet Med. 2013 Apr;30(4):e135-8.
- J E Varela. Bariatric surgery: a cure for diabetes? Curr Opin Clin Nutr Metab Care. 2011 Jul;14(4):396-401.
- R Taylor. Reversing the twin cycles of Type 2 diabetes. Diabet Med. 2013 Mar;30(3): 267-75.
Images thanks to Dennis Skley via Flickr and Ivan Kmit and Ivonne Wierink via 123rf.
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Title
Reversing Diabetes with Surgery
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
You guessed it! The title of the next video is Reversing Diabetes with Food, followed by one of my favorites to date: Diabetes Reversal: Is It the Calories or the Food?.
Here’s a link to the Diabetes as a Disease of Fat Toxicity video I referenced. What kind of fat? See Lipotoxicity: How Saturated Fat Raises Blood Sugar.
For more videos in my series diving deep into underlying causes of type 2 diabetes:
- What Causes Insulin Resistance?
- The Spillover Effect Links Obesity to Diabetes
- What Causes Diabetes?
- Curing Painful Diabetic Neuropathy
- Can Vinegar Help with Blood Sugar Control?
And, for an overview, see How Not to Die from Diabetes.
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