Posted on 03/06/2008 2:52:56 PM PST by blam
Diabetes May Be Disorder Of Upper Intestine: Surgery May Correct It
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. (Credit: iStockphoto/Jacob Wackerhausen)
ScienceDaily (Mar. 6, 2008) — 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.
Adapted from materials provided by New York- Presbyterian Hospital/Weill Cornell Medical Center.
ping
OK. Millet contains NO GLUTEN.
Of course, this means it will not rise like wheat, for breads, but traditional flatbreads can be made.
I would suggest that a millet based flat bread would probably be suitable for many Pizza style dishes.
Objections or Allergic to dairy? Lactose intolerant?
For various reasons, I make pizza without cheese on many occasions. ( Yes, I actually have a sister that has a dairy Allergy. )
Well...THAT’S interesting....and I will be the perfect “petrie dish.” Middle aged woman who had a dexa scan last year showing I have the bones of a 28 year old....so, next time I have a dexa....it should be less...according to the study....but, somehow I doubt it. I think exercise has a LOT to do with bone density....and I power walk about 17-20 miles a week. I NEED cod liver oil, as I also have a genetic pre-disposition to small, dense, non bouyant LDL....
But some people are allergic, and considering the direction of this thread, they are a carb, and high in starch, which may be what some are trying to avoid.
They are in the same family as carrots though, so may be OK.
ping
Have you tried oatmeal? I mean the real cooked kind, not instant. It has some carbs but it has a low glycemic index, which means that is digested very slowly. I have type II and I have found oatmeal to be a big help in keeping my blood sugar down.
ping for later read.
Trying to find pasture fed cows, and bug fed chickens/eggs is near impossible anymore unless you live in some nicely gifted agricultural zones, or you raise them yourself. As one of the articles you linked to states, animals fed a PUFA diet aren’t going to produce saturated fats.
I found the articles very interesting despite the fact that most of what I read used the same sources so it was like reading the same articles over and over, but I also noticed that at least one was produced by the ailing coconut oil industry!
Personally, I’ve never been fond of commerciallu produced anemic eggs, and some of the expensive ‘uncaged organic’ (commercially produced) eggs are even worse! I love grasshopper fed orange yolks that stand tall in the pan.
I have refused to submit to the margarine fad because it tastes like rancid oil to me, and once you melt it the water boils off leaving a burned mess in the bottom of the pan, unfit to pour over dog food even! I like BUTTER! And I know how to make my own.]
Pasture beef is sooo much more tender, and flavorful than the fat free, tight muscled mess on the grocer’s shelf today. I made the meat manager at Safeway replace the fat he took off my roast leaving it to be a dry tough mess after cooking, and for not leaving ME the choice of what I want to eat! He didn’t charge me for the fat. But, I would prefer to have access to grassfed beef. I can’t find any, and am not in a position to raise it myself.
Grass fed beef tends to have a ‘gamier’ flavor than it’s corn fed brother. It’s a little closer to Elk in it’s flavor and texture, and has a yellow tallow rather than a hard fat in the fatty places. It’s connective tissue is more flexible so it’s not tough, the meat is lean, but flavorful.
I am diabetic so I found the entire thread an interesting read, as well as having learned something from the outside links.
But, I don’t want to have my bowels removed to resolve the diabetis issue. I just eat what I want...as much truly organic (homegrown) as I can access, and am on the continual hunt for good homegrown eggs (I love eggs to the tune of a couple dozen a week). I do have access now and then to some nice lard which I render myself from pigs who ate the supper left overs, and fresh garden produce. The quality of the lard is so good, that it actually does my skin good in just the handling of it.
Someday, I hope to be in a position to grow my own again. I was healthier and had more energy before i began including all this poly unsaturated garbage into my diet.
Just lay off excess breads (especially store bought)& empty starches like pasta. If I get a hankering for pasta, i make my own and I do use eggs in it. Everything in moderation. I tend to manage quite well as long as I don’t over eat, and remember to take my insulin. Wish I didn’t have to, and would like to reverse it. But fruit and eggs and nuts...GOOD STUFF! Specially with a nice fresh cold glass of whole milk!
If you can tolerate some carbs, there is a pretty good cheese pizza made by "Amy's" with a gluten free rice crust. My local store has a large shelf of gluten free items. I don't eat much of that stuff because it caters to people who want to stuff baked grains down the hatch. I'm pretty happy without that stuff.
Wheat, barley and rye. All contain the gliaden antigen. Corn has its own gluten that can interfere with insulin in some people.
Beer typically has gluten antigens from the wheat and/or barley, estrogens from the hops and of course the alcohol. My wife handed me the last two ounces of some Killian's Red to go with kielbasa sausage and sauerkraut a couple night's ago. Big mistake. There is no room for mistakes. A few pleasurable moments drinking Killian's was followed by a rather noisy gastric rodeo. :-(
Oats are often cross contaminated with wheat. I'm sure it's fine for folks who aren't gluten intolerant, but it does carry a finite risk for those who are.
Its odd,we check glucose levels before meals and bedtimes on all gastric bypass patients.
We have a patient now that before surgery had elevated numbers. When he went home something went wrong and he developed problems that has now kept him in the hospital but his sugar levels are constantly normal. And it ticks me because we are charging him 4 times a day for a service he does’nt need.
In the long run you can’t fool Mother Nature!
People can cure themselves there are plenty of site on the net of how to detox the body and to let it heal its self, than choose edibles highter up on the food chain.
Avoid process foods, certain preservative and Chemical and no antibiotics in food, trans fats or hydrogenated oils, go for frozen vegs that are flash freeze, as much organic meats, dairy, and real whole grains and no HFCS.
Death to Diabetes is just one of many programs to detox and heal.
For the past 5 or so years, he's also had a diabetic-like fluctuations in his blood sugars. They won't officially call it diabetes, but he has to follow a strict dietary pattern or his numbers go all wacky.
ping
Long forgotten is their prior uses as paint binders and pesticides, all of which petroleum products did better and cheaper(at the time).
Hence the need to find some other uses for them. Ironically, one of the first such uses was medical for kidney transplant recipients. Unfortunately, while successful at suppressing the immune system so the kidney wasn't rejected, they did the job too well and most, if not all of the early kidney transplant reciepients developed cancer and died. So, they moved on to get them in our food. NUTS!
No thanks, I'll cook my food in and with non-hydrogenated, cold expeller-pressed, organic, coconut oil, and ingest anti-oxidents to counter what happened to the food while not in my control. If enough folks would do the same, perhaps now that oil is $100+/barrel, the highly altered for human consumtion oils could return to their proir uses in paint and pesticides.
I think it is wrong to charge him for something, but on another note, it is documentation of what I say.
People said for years that the reason my sugar was down was because I couldn’t eat. It’s been five years, I can eat with the best of them now!! But my sugar still seems ok.
I think they stumbled on something with this. I really do.
Another thing to watch for ~ those steak sauces made by whiskey companies ~ they pump 'em full of stuff derived from MALT BARLEY.
Oh, yes, explosive stuff!
Parsnips are so high in sugar that no diabetic should ever eat them.
Then the surplus is stashed away in fat cells.
There's no real difference between starches and sugars from any source ~
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