Wednesday, March 28, 2012

A Surgeon's Solution to Diabetes

While Type II, or Adult-Onset, Diabetes has tripled in the U.S. over the last three decade, its treatment has lagged sorrily behind. The most proven 'cure' of the disease is weight loss - certainly not an easy task. However, it did not pass unnoticed that weight loss due to surgery was enough to alter the level of gut hormones and in some cases send the disease into remission. Now the AAMC recommends gastric bypass for those with Type II Diabetes and a B.M.I. over 35. Recent research suggests an even broader recommendation.
A study conducted at Catholic University of Rome found a 75 percent remission rate of the disease after gastric bypass and an astounding 95 percent rate following biliopancreatic diversion - a surgery not performed in the United States. Both surgeries effectively shrink the stomach, altering the transition into the small intestine and the digestion of food. A similar study in Cleveland showed 42 percent rate for gastric bypass. The results may lie heavily in the hands of the surgeon, as these surgeries were all performed by those at the top of their field and it is yet to be seen if it the same result is found by a larger sample. However, 200,000 bariatric surgeries are performed each year so even modest results could have a resounding positive influence over the control of diabetes.

Posted by James Fargnoli (A)

10 comments:

  1. It doesn't make much sense to me that taking the easy way out like that would work so well. To me, it seems that the body would not have time to adjust and fix its problems if surgery was preformed, and that natural weight loss would leave them better off. I guess that's why I'm not a doctor though.

    Rhys Ursuliak

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    1. I don't really understand this blog. I get that their are two way to treat diabetes other than natural weight loss. I don't understand the procedure for the two surgeries. Is it like liposuction? Like Rhys said above, the natural weight loss does seem like the safer choice. Obesity is a growing problem in society today-doctors are looking to make money by creating these alternate treatment to diabetes other than just prescribing a healthier lifestyle.


      Posted by Jen Silva(3)

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    2. This study deals with very extreme BMIs (over two standard deviations from the mean). In most of these cases, realistic natural weight loss even when wildly successful is still unlikely to bring them into a healthy range.
      The surgeries, however, actually shrink the stomach changing the digestive process and reducing the number of certain gastrointestinal proteins effecting diabetes.

      Posted by James Fargnoli

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  2. I think the reason Adult Onset diabetes has tripled over the last three decades is because our society has learned horrible eating and exercise habits. I recently heard someone say we are the "Shake Weight" generation (for any of you who haven't see this ridiculous product, you shake a plastic dumbbell) and we expect to see results without putting in any effort. I think that's great that they found a surgery that works, but I see it as somewhat of an easy way out. Healthy eating habits and exercise regiments will always be the best way to fighting disease.

    Taylor Pirog (2)

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    1. I agree with you about our habits. However, culture is much more difficult to change than medicine. Also, there is a strong genetic component to obesity. There was a great study done involving the Dutch Famine in which epigenetic factors contributed to the way that children of the famine stored more fat and, in turn, their children were not adjusted for excess food availability and suffered from high obesity rates.

      Posted by James Fargnoli

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  3. Yeah we are eating just too much junk these days. Diabetes can be prevented, at least in the type 1 variety. A lot of the time people bring in upon themselves. Type 2 however is a real issue worth curing. This procedure is a little confusing, shrinking the digestive track is all good in all, but whats the end result?

    posted by Dorian Pillari(c)

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    1. Type II is the adult-onset disease, effected drastically by nutrition and exercise. Type I is congenital.


      Posted by James Fargnoli

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  4. our society promoting fast food and minimal exercise is the main cause of many diseases like type 2 diabetes. The two surgeries as mentioned above, are the easy way out. As successful as they might be, I believe they infact promote unhealthy diet and lack of exercise as they are the quick fix. I believe one should diet and exercise to rid of this disase rather than taking the easy way out with surgery.

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    1. I agree with this, we really shouldn't be touting surgery as a solution to a problem that we can cut to at the root. Our culture is the real cause of diabetes, and we can fix it by changing the way we eat. Less meat, less fast food, less grease and sugar, more fruit, etc.

      Mike Selden (C)

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  5. I agree with Jen that the blog is a little bit hard to understand, but not because of the content. I think some extra editing and rearranging of sentences could have gone a long way and I don't think as a blogger one should always be responsible for defining terms as blogging is really geared towards a community of people interested in a specific topic.

    I know 4 people who have had gastric bypass surgery, and it's really sad how it is used and how unhealthy these individuals are today.

    Gastric bypass surgery initially shrinks the stomach to 2 ounces (about the size of a shot glass). The stomach is still prone to stretching post surgery, and if poor habits aren't discontinued, the surgery's goals will fail and result in obesity again.

    In order to be considered for gastric bypass, the person needs to be considerably over weight (certain BMI (height to weight ratio) criteria need to be met), and interestingly, many doctors require patients to attempt to lose at least 10 pounds pre-surgery. In the case of one of my cousins, when she didn't lose 10 pounds, her surgery was postponed. She recently had the surgery 2 weeks ago, and part of the reason she elected the surgery was because she claimed to be severely depressed about her weight. Of course, she is still depressed. The root of overeating and neglect on a psychological level needs to be addressed.

    In the case of the three other people I know, one is the mom of my cousin who had the surgery 2 weeks ago, and one of the others is also my cousin on the same side of the family, they did not alter their lifestyle, don't exercise regularly and frequently eat traditional Puerto Rican cuisine, which consists of fatty cuts of meat, lots of frying and carbo-rich diets, extremely unfriendly to pre-diabetics and diabetics. My aunt has adult onset diabetes and my cousin has already ballooned back to a size 14 from a size 0 post operation.

    The other person, a male friend, was about 400 pounds pre surgery. He lost significant weight, but drank and partied. His feelings towards his post operation body were poor. He is left with Frankenstein like scars and loose, stretched flaps of skin. He was lucky enough that his insurance company covered removal of excess skin from his arms, legs and stomach, but he endured immense pain and ended up in the hospital for 2 weeks with an infection and unable to urinate for almost 24 hours.

    My cousin as a result of the surgery and stress ended up having to go into surgery again because her intestines became twisted and she was unable to digest food.

    The surgery simply seems like a quickfix, and the people opting for the surgery often don't have the psychological motivation to be healthy afterwards. They drink, eat foods they should avoid and to be honest, look really awful and unhealthy post surgery. Their skin is stretched and their bodies don't absorb nutrients and vitamins as well, and taking multivitamins appears futile.

    It is no surprise that without nutrition guidance and possible therapy post surgery that post-op patients haven't really decreased their odds of preventing Type II diabetes.

    Also, reducing the stomach size doesn't reset one's metabolic pathways, it simply makes it smaller so less food can be consumed. If diet especially isn't changed, why would the surgery help?


    Karen-Maria Melendez (C)

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