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Diabetes May Be Disorder Of Upper Intestine: (Obesity)Surgery May Correct It
Science Daily ^ | March 6, 2008

Posted on 05/05/2008 10:41:51 PM PDT by 2ndDivisionVet

Growing evidence shows that surgery may effectively cure Type 2 diabetes — an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes.

A new article — published in a special supplement to the February issue of Diabetes Care by a leading expert in the emerging field of diabetes surgery — points to the small bowel as the possible site of critical mechanisms for the development of diabetes.

The study's author, Dr. Francesco Rubino of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, presents scientific evidence on the mechanisms of diabetes control after surgery. Clinical studies have shown that procedures that simply restrict the stomach's size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese.

"By answering the question of how diabetes surgery works, we may be answering the question of how diabetes itself works," says Dr. Rubino, who is a professor in the Department of Surgery at Weill Cornell Medical College and chief of gastrointestinal metabolic surgery at NewYork-Presbyterian/Weill Cornell.

Dr. Rubino's prior research has shown that the primary mechanisms by which gastrointestinal bypass procedures control diabetes specifically rely on the bypass of the upper small intestine — the duodenum and jejunum. This is a key finding that may point to the origins of diabetes.

"When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem," says Dr. Rubino, who is heading up NewYork-Presbyterian/Weill Cornell's Diabetes Surgery Center.

In fact, it has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism. "It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes," Dr. Rubino says.

While other gastrointestinal operations may cure diabetes as an effect of changes that improve blood sugar levels, Dr. Rubino's research findings in animals show that procedures based on a bypass of the upper intestine may work instead by reversing abnormalities of blood glucose regulation.

In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels. "When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose," says Dr. Rubino. In striking contrast, when nutrients' passage is diverted from the upper intestine of diabetic patients, diabetes resolves.

This, he explains, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.

How exactly the upper intestine is dysfunctional remains to be seen. Dr. Rubino proposes an original explanation known in the scientific community as the "anti-incretin theory."

Incretins are gastrointestinal hormones, produced in response to the transit of nutrients, that boost insulin production. Because an excess of insulin can determine hypoglycemia (extremely low levels of blood sugar) — a life-threatening condition — Dr. Rubino speculates that the body has a counter-regulatory mechanism (or "anti-incretin" mechanism), activated by the same passage of nutrients through the upper intestine. The latter mechanism would act to decrease both the secretion and the action of insulin.

"In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream," he explains. "In some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in Type 2 diabetes."

Indeed, in Type 2 diabetes, cells are resistant to the action of insulin ("insulin resistance"), while the pancreas is unable to produce enough insulin to overcome the resistance.

After gastrointestinal bypass procedures, the exclusion of the upper small intestine from the transit of nutrients may offset the abnormal production of anti-incretin, thereby resulting in remission of diabetes.

In order to better understand these mechanisms, and help make the potential benefits of diabetes surgery more widely available, Dr. Rubino calls for prioritizing research in diabetes surgery. "Further research on the exact molecular mechanisms of diabetes, surgical control of diabetes and the role played by the bowel in the disease may bring us closer to the cause of diabetes."

Today, most patients with diabetes are not offered a surgical option, and bariatric surgery is recommended only for those with severe obesity (a body mass index, or BMI, of greater than 35kg).

"It has become clear, however, that BMI cut-offs can no longer be used to determine who is an ideal candidate for surgical treatment of diabetes," says Dr. Rubino.

"There is, in fact, growing evidence that diabetes surgery can be effective even for patients who are only slightly obese or just overweight. Clinical trials in this field are therefore a priority as they allow us to compare diabetes surgery to other treatment options in the attempt to understand when the benefits of surgery outweigh its risks. Clinical guidelines for diabetes surgery will certainly be different from those for bariatric surgery, and should not be based only on BMI levels," he notes.

"The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease," adds Dr. Rubino.

Type 2 diabetes, which accounts for 90 to 95 percent of all cases of diabetes, is a growing epidemic that afflicts more than 200 million people worldwide.

At a time when diabetes is growing epidemically worldwide, Dr. Rubino says that finding new treatment strategies is a race against time. "At this point, missing the opportunity that surgery offers is not an option."

In addition to having performed landmark studies in the field of diabetes surgery, Dr. Rubino was the principal organizer of an influential Diabetes Surgery Summit, held in Rome in March 2007. This international consensus conference helped establish the field, making international recommendations for the use of surgery and creating an International Diabetes Surgery Task Force. Dr. Rubino serves as a founding member.


TOPICS: Culture/Society; Extended News; News/Current Events
KEYWORDS: cure; diabetes; gastricbypass; obesity
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I had heard something about this on TV the other day. Wow!
1 posted on 05/05/2008 10:44:06 PM PDT by 2ndDivisionVet
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To: 2ndDivisionVet

Tag for later reading...


2 posted on 05/05/2008 10:53:56 PM PDT by Uriah_lost (This space reserved for a decent candidate,,,lemme know when we get one.)
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To: Uriah_lost

There will be a cure for type two diabetes in the next 20-30 years.


3 posted on 05/05/2008 10:55:41 PM PDT by TheConservator ("I spent my life trying not to be careless. Women and children can be careless, but not men.")
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To: 2ndDivisionVet
"It has become clear, however, that BMI cut-offs can no longer be used to determine who is an ideal candidate for surgical treatment of diabetes," says Dr. Rubino.

Translation: "It has become clear I can make much more money doing this surgery on more than just the obese."

Surgery is not the best answer to diabetes, or even one that will work long term. Exercise and diet are the best answers.

4 posted on 05/05/2008 10:57:34 PM PDT by apt4truth
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To: TheConservator
"There will be a cure for type two diabetes in the next 20-30 years."

I'm sure someone said that 20-30 years ago.

5 posted on 05/05/2008 10:58:29 PM PDT by apt4truth
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To: 2ndDivisionVet
The dudodenum is where the majority of absorbtion of nutirents takes place. The surgery might "cure" diabetes but you will need to be on pills and shots for the rest of your ife.

I can cure athlete's foot by cutting off your feet, but there is a sollution outside of surgery.

6 posted on 05/05/2008 11:02:52 PM PDT by LukeL (Yasser Arafat: "I'd kill for a Nobel Peace Prize")
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To: apt4truth

Now, if we could only cure illiteracy.


7 posted on 05/05/2008 11:08:08 PM PDT by Gondring (I'll give up my right to die when hell freezes over my dead body!)
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To: apt4truth

How can you say that? Long term outcome with management is about the same as ignoring it, from what I have read.


8 posted on 05/05/2008 11:12:16 PM PDT by patton (cuiquam in sua arte credendum)
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To: LukeL

>”The dudodenum is where the majority of absorbtion of nutirents takes place”< ——
Really, what’s the other 20 odd feet there for? My understanding of its function is a little more like this:

The duodenum is largely responsible for the breakdown of food in the small intestine. Brunner’s glands, which secrete mucus, are found in the duodenum. The duodenum wall is composed of a very thin layer of cells that form the muscularis mucosae.
The duodenum also regulates the rate of emptying of the stomach via hormonal pathways. Secretin and cholecystokinin are released from cells in the duodenal epithelium in response to acidic and fatty stimuli present there when the pyloris opens and releases gastric chyme into the duodenum for further digestion. These cause the liver and gall bladder to release bile, and the pancreas to release bicarbonate and digestive enzymes such as trypsin, lipase and amylase into the duodenum as they are needed.


9 posted on 05/05/2008 11:12:22 PM PDT by Uriah_lost (This space reserved for a decent candidate,,,lemme know when we get one.)
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To: apt4truth

...and if you travel faster than 20mph all the air will be forced from the vehicle and you will suffocate. Its scientific fact (or was).


10 posted on 05/05/2008 11:14:48 PM PDT by Uriah_lost (This space reserved for a decent candidate,,,lemme know when we get one.)
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To: Uriah_lost
I had a gut feeling about this!
11 posted on 05/05/2008 11:24:11 PM PDT by ME-262 (Nancy Pelosi is known to the state of CA to render Viagra ineffective causing reproductive harm.)
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To: ME-262

BTTT


12 posted on 05/05/2008 11:30:49 PM PDT by snowtigger (It ain't what you shoot, it's what you hit...)
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To: ME-262

Judging by your screen name, perhaps you “Swallowed” something.


13 posted on 05/05/2008 11:33:43 PM PDT by Uriah_lost (This space reserved for a decent candidate,,,lemme know when we get one.)
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To: Uriah_lost
Perhaps there is kraut in my craw.
14 posted on 05/05/2008 11:39:29 PM PDT by ME-262 (Nancy Pelosi is known to the state of CA to render Viagra ineffective causing reproductive harm.)
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To: apt4truth

I’ve noticed how people tend to stress on the main functions of body organs, while ignoring minute, hitherto-unknown ones. Doctors are ready to lop off parts of the intestine, looking at them as if they are some sort of plumbing inside the body, and just that.

For long, they said the appendix was a useless vestigal organ, until it was found recently that it provides a reserve for probiotic agents.


15 posted on 05/05/2008 11:45:08 PM PDT by CarrotAndStick (The articles posted by me needn't necessarily reflect my opinion.)
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To: CarrotAndStick
Those vestigial organs aren't what they're not cracked up to be!

The Reasoning of Fools:

If I don't know the purpose of a thing, it must not have one.

If I don't know the answer, it must be unknowable.

If I can't do it, it must be impossible.

All of the scientific theories we believe today are correct.

16 posted on 05/05/2008 11:58:11 PM PDT by ME-262 (Nancy Pelosi is known to the state of CA to render Viagra ineffective causing reproductive harm.)
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To: Uriah_lost
In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels. "When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose," says Dr. Rubino. In striking contrast, when nutrients' passage is diverted from the upper intestine of diabetic patients, diabetes resolves.

My Dad had a variation of this surgery. Actually, he had a bile duct bypass done 40 years ago for a choledochal cyst, by a competent surgeon at Mayo.

A few years ago, a new surgeon convinced him that they could "further reduce his risk of cancer with this great new surgery." At the time of this surgery, he was perfectly healthy; his problems from childhood with the cysts had been cured for years...but the surgeon terrified him with the prospect that he might be at risk for cancer. They performed a roux en y hepaticojejunostomy.

He nearly immediately developed diabetes (he did not have it prior to the surgery) as mentioned in the paragraph above...that theory appears to be correct.

Several years later, he developed adenocarcinoma of the bile ducts in his liver; and died three months after diagnosis.

I'm just saying: you had better have a VERY extreme case of Type II Diabetes, that has demonstrated itself completely uncontrollable with the normal treatment, before this type of drastic measure is recommended for a patient. The infection rate is rather high, I believe. I know that my Dad had back-up into his liver after surgery, and ended up spending three weeks in the hospital with a liver abscess.

The surgery itself is brutal...even when performed on a healthy person. I realize it is not exactly the same situation or procedure...but for goodness sake...it seems like total overkill; with a bunch of unknown future risks.

I do find it interesting that they may have found some "cause" in that area of the body for diabetes. Perhaps they can devise a less invasive treatment.

17 posted on 05/06/2008 12:06:30 AM PDT by garandgal
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To: garandgal

family friend had a daughter die from gastric bypass few months ago


18 posted on 05/06/2008 1:00:16 AM PDT by Mount Athos (if water boarding was a sexual preference, they'd be teaching it in public schools)
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To: BossLady

Zing for later


19 posted on 05/06/2008 1:19:58 AM PDT by BossLady ("People will do anything, no matter how absurd, in order to avoid facing their own soul" - Carl Jung)
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To: LukeL

I can cure athlete’s foot by cutting off your feet, but there is a sollution outside of surgery.


I’ll take the non-surgical approach for my headache please.


20 posted on 05/06/2008 1:41:45 AM PDT by kenth (I have a apolitical blues)
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To: 2ndDivisionVet

Had gastric bypass surgery. Been diabetes free for five years now.


21 posted on 05/06/2008 2:38:37 AM PDT by Southerngl
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To: 2ndDivisionVet

Wasn’t this on 60 Minutes or some other program? I think I saw a panel of about 9 people who had diabetes before gastric bypass and then were diabetes free immediately after, within days, I think. It seemed remarkable.


22 posted on 05/06/2008 3:58:37 AM PDT by GOP_Proud (Disgruntled about it all. None of the above.)
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To: 2ndDivisionVet

So how come we have a Obesity and Diabetic epidemic

All of a sudden we have been giving birth to people with screwed up small intestines


23 posted on 05/06/2008 4:46:51 AM PDT by uncbob
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To: uncbob
I think it has something to do with the chemicals and junk in our food. If you read the ingredients, there's a lot of stuff in the grocery store that you would stop buying.

Carolyn

24 posted on 05/06/2008 4:58:51 AM PDT by CDHart ("It's too late to work within the system and too early to shoot the b@#$%^&s."--Claire Wolfe)
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To: TheConservator

“There will be a cure for type two diabetes in the next 20-30 years.”

Sounds great. But before we start celebrating, can you name a few diseases that have been cured in the last 20-30 years? Don’t include any prevented by vaccination or cured with antibiotics or thru surgery - these approaches are old and obvious and won’t work on many of our remaining diseases.

Have you noticed that most older medical charities no longer promise cures? They just promise incremental improvements or that they’ll do more research.

If you do a google search you’ll be hard pressed to find any recent cures. There is a list of 12 diseases cured in the 20th century - but these are due to antibiotics and vaccinations. An, oh yes, all of them were cured by 1950.


25 posted on 05/06/2008 5:21:08 AM PDT by trenton1776
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To: 2ndDivisionVet

Bump for later read.


26 posted on 05/06/2008 5:30:16 AM PDT by Zippo44 (Liberal: another word for poltroon.)
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To: TheConservator
There already is a cure for type 2.

It's called lose your obesity and EAT RIGHT.

Once you do that, your insulin resistance problem fades away.

But most people would rather do anything - go through traumatic possibly fatal surgery, pay any amount, take any drug - than actually CHANGE their lifestyle.

27 posted on 05/06/2008 5:38:20 AM PDT by Lizavetta
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To: LukeL

My sister had the gastric bypass and she’s off all of her medications that she had to take before. She no longer has diabetes, no heart problems, no high blood pressure and only has to take a few dietary supplements. Nothing like all of the maintenance meds she was on before.


28 posted on 05/06/2008 5:59:22 AM PDT by CajunConservative (They can either go quietly or they can go loudly but either way they will go. Bobby Jindal)
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To: apt4truth; LukeL

“Surgery is not the best answer to diabetes, or even one that will work long term. Exercise and diet are the best answers.”

There are many patients that can’t or won’t do the common sense things. And there are patients that do lose weight, watch their diet and exercise religiously and still have poorly controlled NIDDM.

“The dudodenum is where the majority of absorbtion of nutirents takes place. The surgery might “cure” diabetes but you will need to be on pills and shots for the rest of your ife. “

Shots and pills for what? Vitamins may be needed but for someone that cannot keep their sugars below 200, that might be a good trade off.

“I can cure athlete’s foot by cutting off your feet, but there is a sollution outside of surgery”

Unfortunately, the long term treatment for diabetes often includes cutting off your feet. Other common outcomes are renal failure, blindness, heart attack and stroke.


29 posted on 05/06/2008 6:55:47 AM PDT by dangerdoc (dangerdoc (not actually dangerous any more))
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To: Lizavetta

It’s not that easy.

I’ve seen people that once they have developed NIDDM, they have gotten down to healthy body weight, eat a healthy diet, excercise daily and their blood sugars still won’t come down to normal.

The question is what do you do for them?

Or the 60 year old man with bilateral knee replacements that weighs 500 lbs? He can’t exercise, you know he won’t loose wieght. Do you just wait and start cutting off limbs and put them on dialysis when the kidneys quit, treat the strokes and heart attacks and eventually put them in the nursing home?

I’m not arguing for surgery but there has to be more options.


30 posted on 05/06/2008 7:03:27 AM PDT by dangerdoc (dangerdoc (not actually dangerous any more))
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To: LambChop_NY
Sweetie Ping! Interesting article.

Garde la Foi, mes amis! Nous nous sommes les sauveurs de la République! Maintenant et Toujours!
(Keep the Faith, my friends! We are the saviors of the Republic! Now and Forever!)

LonePalm, le Républicain du verre cassé (The Broken Glass Republican)

31 posted on 05/06/2008 7:05:16 AM PDT by LonePalm (Commander and Chef)
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To: 2ndDivisionVet

bookmarked


32 posted on 05/06/2008 7:28:35 AM PDT by adm5 (Roger That. - MA2 Michael A. Monsoor, USN - Medal of Honor Recipient Posthumously)
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To: apt4truth

Surgery is not the best answer, you are correct. HOWEVER, for those of us who are severely insulin resistant, exercise and diet and NOT the ONLY answer. I wish it were so.

I’ve lost around 80 pounds, by doing a rather severe version of Atkins. Almost no carbs...and yes, my doctor knew about it. But one can only keep that up for so long before they must live in the real world. It’s rough. So to finish the weight loss I’ll be starting on medication provided by doc after much thought and planning. My lifestyle is becoming increasingly active, but asthma complicates the mix.

Perhaps this will be an answer for folks like me.


33 posted on 05/06/2008 7:34:46 AM PDT by kimmie7 (<<<---- Too surly for the hoarde.)
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To: Gondring
"Now, if we could only cure illiteracy."

We could wipe it and ignorance out by eliminating the Democrat party.

34 posted on 05/06/2008 7:36:23 AM PDT by mass55th
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To: dangerdoc
I’ve seen people that once they have developed NIDDM, they have gotten down to healthy body weight, eat a healthy diet, excercise daily and their blood sugars still won’t come down to normal.

That's me.

More options would certainly be nice.

35 posted on 05/06/2008 7:39:23 AM PDT by kimmie7 (<<<---- Too surly for the hoarde.)
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To: Lizavetta
There already is a cure for type 2. It's called lose your obesity and EAT RIGHT.

Once you do that, your insulin resistance problem fades away.

But most people would rather do anything - go through traumatic possibly fatal surgery, pay any amount, take any drug - than actually CHANGE their lifestyle.

You have a lot to learn about Type 2 diabetes. I'm slim, I eat an extremely low carb diet, I exercise over an hour a day and I still need a bunch of pills to control my Type 2 diabetes.

My insulin resistance did not "fade away" over the past 4 years. Many of us did NOT develop diabetes from lifestyle related causes.

36 posted on 05/06/2008 7:41:15 AM PDT by Senator_Blutarski (No good deed goes unpunished.)
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To: 2ndDivisionVet

When I was massively overweight, I was pre-diabetic. Losing 100 pounds corrected it.


37 posted on 05/06/2008 7:43:32 AM PDT by mysterio
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To: Senator_Blutarski

Viruses are also associated with some forms of diabetes. (not sexually transmitted viruses)


38 posted on 05/06/2008 7:48:52 AM PDT by hepatoma
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To: apt4truth
“Surgery is not the best answer to diabetes, or even one that will work long term. Exercise and diet are the best answers.”

...and we should just take your word for this because you are an all knowing God? lol

39 posted on 05/06/2008 8:14:56 AM PDT by monday
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To: 2ndDivisionVet; neverdem
The Bypass Effect On Diabetes, Cancer
Surgery Can Send Diabetes Into Remission, And May Reduce Risk Of Certain Cancers
 
It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.  Surgeons have been performing bariatric, or weight loss operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.  Despite the increase in obesity, only a small number of people have had the gastric bypass operation.

Correspondent Lesley Stahl met some people who were once morbidly obese.  There was Tony Sideman, who underwent surgery in April 2007 and has lost 140 pounds; there was Janet Rovak, who lost 90 pounds in the eight months since her surgery; and there was Travis Goodbou, who lost 260 pounds in the seven months since he underwent the operation.  Dr. Neil Hutcher from Richmond, Va. has performed more than 3,000 bypass surgeries. Asked how many people gain the weight back, Dr. Hutcher tells Stahl, "You know I think when you’re dealing with an incurable disease that kills many people, if you have an 85 to 90 percent success rate, that’s pretty darn good."

"Is that what you have?" Stahl asks.  "Yeah," Hutcher says.  There's no diet, no exercise regimen, and no pill with a success rate like that. These patients lose a ton of weight and keep it off.  Here's how Hutcher does the surgery: first, he sections off a small pouch of the upper part of the stomach, which is then attached to a lower part of the small intestine, bypassing most of the stomach, so that there's not a lot of room for food.   It used to be that roughly one in 100 people died from this operation. Hutcher says it's now about one in 1,000, which makes it less deadly than most major surgeries.  "It's less than gall bladder surgery. It's about one-tenth of cardiac surgery," he explains.  It's safer because of new surgical techniques which have also made it more effective. For instance, they can make the stomach pouch smaller than they used to.  "Even if I wanted to eat a whole cheesecake, my stomach is very tiny. It holds four ounces max, stretched to the max. And that's not even one piece of cheesecake," a female patient explained.

A big reason the operation works is because it seems to suppress appetite. "If you listen to your patients, they come back and they say, 'Doctor, you put the fire out,'" Hutcher says.  "When you see a sign for fast food or…she's already shaking her head at me," Stahl asked a patient.  "Don't want it," the female patient replied. "I used to crave sweets all the time. I couldn't go past the gift shop at work without getting a candy bar. Now I go past it and I never give it a thought."  Paul Delios of Saugus, Mass. has lost 90 pounds. He owns a doughnut shop with his siblings, but he's able to resist the cravings. "Before I'd have cravings for everything. Now I really don't," he told Stahl.

For most patients the cravings really do disappear. One theory is that's because the operation suppresses the levels of a stomach hormone called "grelin" that activates the sensation of hunger.  Yet most people who have this operation do not get skinny. Dr. David Cummings, an expert on appetite at the University of Washington, says as a rule these patients end up just one third lighter.  "Most people with severe obesity who undergo gastric bypass do not become fully normal, in terms of body weight. They go from severely obese to mildly obese, or from obese to overweight. But nevertheless it’s an enormous change," Dr. Cummings explains.

And not just in terms of weight loss. Dr. Hutcher says the operation itself can take type 2 diabetes - which has ballooned in this country - and throw it into complete remission.  The group of patients Stahl met say they all had diabetes before the operation; post-surgery, none have diabetes.   That means they no longer need sugar-control medication, like insulin injections.  One patient, Vicki, told Stahl she went from having eight or nine insulin shots a day to none, and that she's diabetes free - "cured" as she put it.  "Would you use the term 'cure diabetes?'" Stahl asks Dr. Hutcher.  "I think my patients are cured," he says.  "Cured?" Stahl asks.  "Well, they go home on no medication," he says. "And I've followed them now for 10 and 15 years, and see no evidence of recurrence. So, it's pretty darn close."

Studies confirm that about 80 percent of diabetics go into complete remission following the operation. Obesity is considered one of the major causes of type 2 diabetes, but here's something odd: when you have the gastric bypass operation, your diabetes goes away long before you lose the weight.  For Travis, the man who lost 260 pounds in seven months, it took "about a week and a half" before he was rid of diabetes and off all his medication.  Another male patient named Bill said it took him four days. "I went into the hospital on Friday, came home on Monday and dumped my pills," he told Stahl.

This spontaneous remission puzzled Italian surgeon Francesco Rubino, now at New York Presbyterian Weill Cornell Medical Center. "We wanted to know what is making diabetes remit. We thought it could have been something to do with the small bowel," Dr. Rubino says.  So he began performing the bypass on diabetic rats, and realized that when he disconnected the top of the small intestine, an area called the duodenum, the diabetes disappeared. Then, he reversed the operation.   When he reattached it, the diabetes came back.

This was a pivotal discovery. By merely blocking food from traveling through the duodenum, Rubino sent diabetes into remission, proving the effect was independent from weight loss. This meant diabetes could essentially be removed with a scalpel.  Dr. Rubino says this operation has been performed on humans.  60 Minutes joined him in Sao Paulo, Brazil, where clinical trials have begun on diabetics who are not obese, to determine if the "diabetes surgery" is safe and effective.

As of now, if you have diabetes and are not obese you can't have the bypass surgery. Under guidelines written by the National Institutes of Health 17 years ago in 1991, only the severely or morbidly obese are eligible for any bariatric operation. If you're just mildly obese, you can't get it.  "And a lot has changed since 1991," Dr. Hutcher remarks. "I would like to see them change their guidelines, especially for the diabetics. I think we have clear cut evidence that we can do terrific things for diabetes."   The NIH told 60 Minutes there's no plan to revise the guidelines, but they are currently studying the benefits and risks of bypass surgery.

Several existing studies point to one risk. "I've seen some studies that say that suicide rates go up among patients who have this operation. Now why would that be?" Stahl asks Dr. Hutcher.  "We're not sure," he says. "A lot of our patients are very depressed. When you lose weight, there's a period of euphoria and then there's a period of realization that maybe my depression wasn't related to pounds."  But in the meantime, the positive side effects continue to accumulate, like for sleep apnea disorder.  "Sleep apnea is one of the silent killers. That's where, at night, you literally suffocate. You stop breathing," Hutcher says.

Of the patients Stahl met, about half had had sleep apnea; after the surgery, none of them did.  That's because of the weight loss. Dr. Bruce Miller, a family doctor from Hopewell Va., has lost 120 pounds in three months.  "I've seen all my other problems improve as well," he says. "I don't take any blood pressure pills anymore. I don't take any cholesterol pills anymore as well as my diabetic medicine. I'm off all medicine."  In addition to the operation reducing hypertension and coronary artery disease, there appears to be an affect on cancer as well.  "Does being fat give you cancer?" Stahl asks Dr. Eugenia Calle, an epidemiologist at the American Cancer Society.  "Being overweight or obese increases the likelihood that you'll get several different types of cancer," Calle says.

Dr. Calle has been studying the link between cancer and obesity.  Asked what kinds of cancer, Calle gives Stahl a long list: "Breast cancer, colon cancer, endometrial cancer, kidney cancer, cancer of the esophagus, pancreatic cancer, liver cancer."   "I should have said what cancers don't, aren't affected by obesity," Stahl remarks.  "There are very few that aren't affected, yes," Calle says.  "Have you been able to calculate how many people die every year of obesity-related cancers?" Stahl asks.  "We have. And our estimate is that about 100,000 individuals in the U.S…,every year die of cancer, because of their weight," Calle says.  "So if you lose weight, you're fending off cancer?" Stahl asks.  "Well, that is and has been, up until now, sort of the piece of evidence that hasn't been in place. People don’t really lose weight in this country," Calle says. "They lose it and they gain it back."   But now researchers are studying people who've had bypass surgery, because they tend to keep the weight off. "And in those populations, very interestingly, the cancer, overall cancer risk, is greatly reduced, cut in half," Calle explains.

The number of people having weight loss operations grows every year. But it's still a small number compared to the millions who are eligible for the surgery and the many more who could benefit.  "So, what percent of the people who are eligible for this operation, actually eligible, get it?" Stahl asks.  "Actually, less than one per cent," Dr. Hutcher says.  "And how many had the operation this year," Stahl asks.  "About 200,000. So it's one percent," he says.  The bypass operation costs an average of $25,000 and insurance companies don't always cover it; and despite the gains in safety, most doctors still consider the operation an option of last resort. That is no longer the case for Dr. Miller’s patients.  "I look at 'em now and I'm handing out my surgeon's card right when I see 'em. I'm not waiting for the last resort now," Dr. Miller says, who lost 120 pounds after the surgery.  "Do you think most doctors are where you are?" Stahl asks.  "Probably not," he says. "They haven’t walked the walk."

"If you're used to a lifestyle of eating, you know, eating makes you comfortable. You're sad, you're mad, whatever the case may be: you eat," Travis Goodbou told Stahl.  Goodbou is just 26 years old. Heavy his hold life, he got the operation in July to change his weight. It ended up changing his health, and the way he lives his life. "For me I think I was addicted to food. I loved to eat, I loved to cook; I loved everything about food. Now, I love movin'. I'm kind of addicted to life out there. You don't catch me home," he says.
 
 

40 posted on 07/12/2008 8:10:34 PM PDT by Coleus (Abortion and Physician-assisted Murder (aka-Euthanasia), Don't Democrats just kill ya?)
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To: Lizavetta

My dad has always been thin. He has always eaten right. He was recently diagnosed with type 2 diabetes.


41 posted on 07/12/2008 8:24:06 PM PDT by keepitreal ("I'm Barack Obama and I approve this message. . . until I don't.")
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To: keepitreal

I’m obese now and taking 7 shots a day of insulin but when I was first diagnosed I was 6’1” and 225 lbs and in very good shape. 15 years later and it’s a different story. I still exercise daily but even with over 400 IU’s a day I can’t get my blood sugar out of the 400’s and keep it down. I tried to get approved for bariatric surgery last year but my insurance sain no. Plan to try again this year.


42 posted on 07/14/2008 12:34:31 PM PDT by pgkdan (Tolerance is the virtue of the man without convictions - G.K. Chesterton)
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To: pgkdan

God bless you! I hope that you can get the surgery this year.


43 posted on 07/14/2008 12:37:56 PM PDT by keepitreal ("I'm Barack Obama and I approve this message. . . until I don't.")
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To: Mrs. Don-o

ping


44 posted on 07/14/2008 12:44:11 PM PDT by don-o (Have you donated to FR? If not, why not?)
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To: keepitreal

Thanks! My GP and my Endocrinologist are both in my quarter and are writing letters for me. Don’t know if it will help but it can’t hurt.


45 posted on 07/14/2008 12:48:51 PM PDT by pgkdan (Tolerance is the virtue of the man without convictions - G.K. Chesterton)
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To: Lizavetta; TheConservator
"But most people would rather do anything - go through traumatic possibly fatal surgery, pay any amount, take any drug - than actually CHANGE their lifestyle."

What you seem to have overlooked here, Lizavetta, is that Gastric Bypass Surgery REQUIRES a lifelong change of lifestyle. I had the surgery on May 8. Because of the permanent, radical changes in my enteric anatomy, I will never again eat the types of foods or the amounts of foods I ate prior to my surgery.

Gastric bypass is not a one-shot deal. It is a tool --- "a" tool --- which facilitates the ongoing change of lifestyle you're talking about.

46 posted on 07/14/2008 1:10:00 PM PDT by Mrs. Don-o ("Make things as simple as possible, but not simpler."--- Einstein)
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To: TheConservator
There is a cure for Type 2 Diabetes right now. I had type 2 Diabetes for 20 years, until May 8, 2008 (the date of my RNY gastric bypass). By my discharge date (2 days later) I have not had Diabetes and --- I know this from repeated blood glucose testing --- I have had no abnormal glucose levels, neither high nor low --- since the date of surgery.

Some 80% of post-gastric-bypass people never have another abnormal glucose reading for the rest of their lives.

47 posted on 07/14/2008 1:13:44 PM PDT by Mrs. Don-o ("Make things as simple as possible, but not simpler."--- Einstein)
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To: apt4truth
"Surgery is not the best answer to diabetes, or even one that will work long term."

This is not what post-gastric bypass clinical data shows. Evidence? Links?

48 posted on 07/14/2008 1:15:23 PM PDT by Mrs. Don-o ("Make things as simple as possible, but not simpler."--- Einstein)
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To: LukeL

I am a postmenopausal woman and a post-op GBS. I take a daily multivitamin, extra calcium and a sublingual B-12. I did that even before surgery. It’s not a big deal.


49 posted on 07/14/2008 1:17:16 PM PDT by Mrs. Don-o ("Make things as simple as possible, but not simpler."--- Einstein)
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To: Mount Athos
My surgeon has had 5 deaths in the 3-months post-op period for 1,800 RNY gastric bypasses. (The deaths were all from pulmonary embolism.) That's 0.28% (zero-point-two-eight) percent. That's far outweighed by the incidence of death of similarly circumstanced, matched obese people who have not had the surgery, in EVERY category of disease, inluding the various complications of diabetes, strokes, heart attacks, and even cancer.
50 posted on 07/14/2008 1:25:10 PM PDT by Mrs. Don-o ("Make things as simple as possible, but not simpler."--- Einstein)
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