Small Intestine To The Rescue
Heres how it works: After gastric bypass, which is a common weight loss solution for the severely obese, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. The quite amazing thing is that this is not present normally in the small intestine of adults, but only in the fetus, said Dr. Erini Nestoridi, a research fellow in Stylopoulos lab, in an interview with Healthline. This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of dumping the food directly to the intestine, since the stomach is bypassed, contributes to these changes.
Although weight loss and improved diabetes symptoms go hand in hand, previous research has shown that gastric bypass surgery helps resolve the disease even before weight loss occurs.
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Types Of Weight Loss Surgery
There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both.
Get to know whatâs involved with each of these:
The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to the small pouch and bypasses the top of the small intestine. The result: You get full faster and absorb fewer calories and nutrients.
Pros: Up to 80% of people show no signs of diabetes after surgery. Plus, people usually lose 60% to 80% of their extra weight.
Cons: Your body canât absorb as many vitamins and minerals as before, which could lead to health problems, including a condition called dumping syndrome. Also, the surgery is not reversible.
The surgeon removes a large part of your stomach. With less room for food, you feel full faster. This operation also lowers ghrelin, the hormone that makes you feel hungry.
Pros: More than 60% of people show no signs of diabetes after surgery. Plus, people usually lose 50% of their extra weight. It is also done laparoscopically.
Cons: You can’t get this surgery reversed later on. Also, your body canât absorb as many vitamins and minerals as before, which could lead to health problems.
3. Adjustable gastric band
4. Biliopancreatic diversion with a duodenal switch
5. Electric Implant Device
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Bariatric Procedures And Their Effect On Diabetes Control
After bariatric surgery, patients lose more weight than with traditional weight-loss methodsâup to 25% of their total body weight. Furthermore, of those with type 2 diabetes, 87% achieve at least better glucose control and need fewer antidiabetic medications,12 and an average of 78% achieve normal glycemic control without taking any antidiabetic medications at all.12,13
But not all bariatric procedures have the same effect on weight and diabetes: certain procedures have a greater effect.
The two major types are classified as gastric restrictive procedures and intestinal bypass procedures. The classification was initially based on the presumed mechanism of weight loss.
Gastric restrictive procedures limit gastric volume and, hence, restrict the intake of calories by inducing satiety. Afterward, patients lose approximately 10% to 20% of their total body weight.
Furthermore, multiple studies, including a randomized controlled trial14 , have shown remission of type 2 diabetes with laparoscopic adjustable gastric banding but not with conventional medical therapy. The effect is primarily mediated by weight loss and improved insulin sensitivity, both of which occur several months following surgery. Of note, however: in this trial,14 all the patients had diabetes of short duration, less than 2 years.
What Is Type 2 Diabetes
Type 2 diabetes is a condition that occurs when the sugar levels in our blood become too high. Why is there sugar in our blood? You might ask. When we consume food, our digestive system starts to break it down. It takes carbohydrates and turns them into glucose a sugar that gives the cells in our body energy and is critical to our lives.
Next, the glucose goes into our bloodstream to be delivered to our cells to provide us with energy. Glucose cannot get into the cells without the presence of insulin which in a sense opens them up to receive the glucose. Once the insulin works for its magic and hands over the glucose to the cells, the sugar level in the bloodstream lowers and the process starts again.
The body is designed to keep itself healthy so it will store glucose, in the form of glycogen, in the liver and the muscles just in case it needs it before we eat again. When our blood sugar starts to get low, our bodies start reminding us to eat. A healthy body keeps this cycle going but when something goes wrong, it can cause the sugar in our blood to reach unsafely high levels.
In type 2 diabetes the body becomes resistant to insulin and causes chronic high sugar levels. An individual with type 2 diabetes is required to monitor their blood sugar level regularly, watch their diet, and may require insulin or some other type of medication to control their sugar levels.
Doesnt Weight Loss Surgery Have Risks
While all surgeries have risks, the dangers involved with gastric sleeve and related surgeries are no different than standard procedures like gallbladder surgery. The procedures are minimally invasive. They have been deemed both safe and effective, not only for obesity but also for the treatment of type 2 diabetes.
You can lower your chances of experiencing complications by choosing the best gastric sleeve surgeon you can find, such as Dr. Babak Moeinolmolki of Healthy Life Bariatrics in Los Angeles, California.
Indications For Bariatric Surgery In Patients With Diabetes
According to guidelines from the National Institutes of Health,23 the current indications for bariatric surgery include a BMI of 40 kg/m2 or higher, or a BMI between 35 and 40 kg/m2 with at least two obesity-related comorbidities. Diabetes is considered a key comorbidity that justifies the risk of surgery. The guidelines suggest that bariatric surgery be discussed with all severely obese patients with type 2 diabetes who have not been able to lose weight with other weight-control approaches.
Since type 2 diabetes mellitus is a progressive disease characterized by relentless deterioration of beta-cell function, many endocrinologists favor aggressive weight-loss approaches early in the course of the disease. We believe that bariatric surgery should be considered early, as it may help preserve pancreatic beta-cell function and slow the progression of microvascular and macrovascular complications.
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How Exactly Does Bariatric Surgery Help Type 2 Diabetes
Type 2 diabetes occurs when a person’s body becomes resistant to insulin, the hormone that controls blood sugar levels. When the body becomes resistant to insulin, it can be harder to keep blood sugar levels from getting too high, which can lead to a higher risk for heart disease, stroke, kidney failure, and even blindness.
Weight-loss surgery treats type 2 diabetes in two important ways:
- Helps people achieve a healthier body mass index by reducing their food intake and decreasing the number of calories their body can absorb. This alone can decrease a person’s insulin resistance and make blood sugar easier to control.
- Triggers changes to gut hormones that encourage healthier metabolism and more stable blood sugar levels.
Weight-loss surgery has been shown to reduce the body’s production of ghrelin, the hormone that stimulates appetite. At the same time, the surgery increases the production of hormones such as GLP-1, which has a positive effect on insulin production. With more insulin available, the body is better able to move blood sugar into the cells to be used for energy, rather than letting it build up in the bloodstream.
These changes can begin to take place soon after surgery, to the point where many of my patients have been able to lower their dosage of diabetes medication right away. Within 2 years, the majority of them experience remission of their diabetes and no longer need to take any medication at all. As you could imagine, they are thrilled with that result!
Is Bariatric Surgery A Cure For Diabetes
Weight loss surgery may cure diabetes, suggest widespread media reports. But can surgery really reverse this disease?
To find out what is known and what we still need to learn about the relationship between diabetes, obesity and weight loss surgery, Consumer Guide to Bariatric Surgery asked members of its advisory board to weigh in on the research.
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Obesity Promotes Diabetes Weight Loss Counteracts It
Obesity, a potent risk factor for type 2 diabetes, contributes to its development by inducing insulin resistance and inflammation, which in turn impair glucose regulation.3,4 Fat deposits in the abdomen, muscles, and liver contribute to elevations of circulating free fatty acids and adipocyte-derived cytokines that mediate insulin resistance and inflammatory pathways.5
In the Diabetes Prevention Program,6 modest weight loss through diet and exercise reduced the incidence of type 2 diabetes, and in the ongoing Action for Health in Diabetes study of the National Institutes of Health, it improved glucose homeostasis.7,8
The current medical approach to type 2 diabetes includes advising the patient to lose weight through lifestyle modification, and prescribing drugs that restore glycemic control by reducing insulin resistance and improving insulin secretion .9,10
When Is Surgery Recommended
Bariatric surgery is available on the NHS for people who meet certain criteria. These include:
- you have a BMI of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight
- you’ve tried all other weight-loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off
- you agree to long-term follow-up after surgery such as making healthy lifestyle changes and attending regular check-ups
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Laparoscopic Adjustable Gastric Band
In this procedure, which has largely fallen out of favor, the surgeon inserts a ring with an inner inflatable band and places it around the top of the stomach to create a small pouch. The band has a circular balloon inside thats filled with saline . A doctor can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing saline through a small port placed in your skin.
After the initial surgery, the doctor adjusts the size of the band opening during several follow-up visits. If the band causes problems or is not effective enough for weight loss, a surgeon may remove it.
Unlike with the other procedures, the body digests and absorbs food in a normal manner. Still, lap band procedures can help reduce high blood sugar, past research has shown.
How Can People With Type 2 Diabetes Prepare For Bariatric Surgery
If you do opt to have bariatric surgery, you will have to be on a medically supervised diet and diet education program for six consecutive months before undergoing the procedure, says Jordana Turkel, RD, CDE, at Park Avenue Endocrinology & Nutrition in New York City. Patients are advised to discontinue any carbonated beverages and caloric beverages, as well as eliminate and reduce high-fat, high-sugar foods. Lastly, patients should practice separating foods and beverages, and not consuming them together.
After surgery, continue these habits to help reduce the risk for complications, such as dumping syndrome, in which too-rapid movement of food into the small intestine can cause nausea, vomiting, abdominal cramping, and low blood sugar, according to the Cleveland Clinic.
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Determining Your Candidacy For Gastric Sleeve Surgery
In order to qualify for gastric sleeve surgery, you should be in otherwise good health and able to tolerate surgery. Dr. Reilly reviews your medical history, your existing health, and your expectations for weight loss before determining if surgery is right for you.
Candidates for gastric sleeve surgery typically need to have abody mass index over 40. You may benefit from the surgery even if you have Type 2 diabetes thats well-controlled with medications.
Dr. Reilly may also recommend a gastric sleeve if your BMI is between 35 and 39, but youre not able to manage Type 2 diabetes with other therapies.
To find out if gastric sleeve surgery is an option for managing your Type 2 diabetes, or book an appointment online today.
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How Does Gastric Bypass Help Diabetes
Gastric bypass is known to have a strong effect on type 2 diabetes. The American Society for Metabolic and Bariatric Surgery estimates that 80 percent of people who have gastric bypass will achieve complete type 2 diabetes remission. Other estimates are similar.
In fact, bariatric surgery is so promising for diabetes improvement that in 2016, an international group of diabetes authorities voted to include surgery as standard treatment for type 2 diabetes in clinical guidelines.
This change is supported by documented clinical efficacy and by the evidence of an important role of the gut in metabolic regulation, which makes it an appropriate target for anti-diabetes interventions, wrote Dr. Francesco Rubino, one of the authors of the consensus statement on clinical guidelines.
Dr. Rubino, a bariatric surgeon who practices in the U.K., was featured in a fascinating 6-minute video by The Economist, which you can view below.
In the video, Dr. Rubino stated that he believes that the section of the intestines that is bypassed in a gastric bypass procedure figure heavily into the development of diabetes. Bypassing this section of the intestines can change a large number of factors independent of weight loss, such as:
- Bile metabolism
Dr. Rubino and others believe these changes can combine to permanently send diabetes into remission.
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Here Are A Few Other Facts About Type 2 Diabetes
- Diabetes is one of the top 10 leading causes of death in the United States.
- Living with diabetes puts a person at a higher risk for heart disease, stroke, kidney failure and blindness.
- About 10 percent of Americans live with type 2 diabetes.
- Type 2 diabetes is caused by overweight and obesity about 90 percent of the time.
- One out of every ten dollars spent on health care is spent on diabetes care.
- Diabetes surgery is the most effective treatment for type 2 diabetes and may result in remission or improvement in nearly all cases.
- For patients with type 2 diabetes and even milder degrees of obesity, bariatric surgery should be recommended. It is the single most effective way to resolve the condition and stop the need for medication.
- Diabetes surgery is very safe with complication rates as low as common procedures such as knee replacement and gallbladder surgery
How Does Bariatric Surgery Impact Your Risk Of Diabetes
The global prevalence of diabetes and obesity in adults indicates that it has reached epidemic proportions. Obesity is a chronic disease affecting more than 100 million adults. The prevalence of class III obesity BMI 40 has quadrupled, BMI 30 has tripled, and super obesity hasincreased fivefold. The alarming and major concern is the increasing prevalence of obesity in children which is suggesting the endemic is going to get worse. The percentage of diabetes among adults increased from 4.7% in 1980 to 8.5% in 2014. The estimation of death directly caused by diabetes as reported by the World Health Organization is 1.6 million deaths in 2016. Healthy diet, regular physical activity, and maintaining a normal body weight are crucial ways to prevent or delay the onset of Type 2 diabetes. Weight loss in general, surgically or non-surgically, results in better glycemic control, complete resolution of diabetes, and prevention of diabetes. Weight loss and diabetes control go hand in hand although studies have shown that gastric bypasses help to resolve diabetes even before weight loss occurs.
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How To Treat Diabetes From The Inside Out
Each intervention contact focused on a behavioral topic related to weight loss. After three years, 40 percent of the bypass subjects were in remission from type 2 diabetes or had prediabetes, as were 29 percent of the lap band participants. None of the people who lost weight from intensive lifestyle changes were in remission or had prediabetes.
After three years, participants who underwent surgery were less reliant on medication, while medication use did not change among the lifestyleweight loss group. Of those who were using meds at baseline, 65 percent of the bypass group and 33 percent of the lap band group had ceased using diabetes medication.