The Truth About Bariatric/Gastric Bypass Surgery

Surgeons were happy to read in the New England Journal of Medicine recently that some of their colleagues now believe gastric bypass surgery can “cure” Type 2 diabetes. Two separate studies [1] reported that the surgery was “more effective than the standard drug treatment” in obese and overweight diabetics.

 

This apparent breakthrough was heralded without a dissenting voice on the TV networks and major newspapers.

 

But considering that current drug treatment for Type 2 is practically worthless (and this isn’t just my opinion), how much of a real leap forward is this new discovery? Let’s look…

 

Doctors finally admit Type 2 drugs are “ineffective”

Now that Big Medicine seems to have something better to offer diabetes patients, it isn’t being shy about dissing the effectiveness of diabetes drugs.

 

“Traditional treatments for diabetes do not work,” bluntly declared Dr. Neil E. Hutcher, MD.

 

“Even people with good medical control still go on dialysis, lose limbs, and have significant heart attacks, drug reactions and other complications,” he goes on to explain.

 

By “good medical control,” he means Type 2 patients who follow their doctor’s orders to a “T.” This requires testing their blood several times a day, while taking a battery of drugs to control their blood sugar, cholesterol, blood pressure, and other risk factors for diabetic complications.

 

But we’ve known since 2008 (thanks to the ACCORD study [2]), that people on these medications do very poorly — and actually experience more deaths and complications because of these meds.

 

Now they want to offer you “diabetes surgery”

One reason Dr. Hutcher isn’t shy about bashing diabetes drugs is because he’s a bariatric surgeon — and the past president of the American Society for Metabolic and Bariatric Surgery (ASMBS).

 

As one of his industry’s chief “salesmen,” he recently touted the gastric bypass as the new diabetes cure in front of millions on TV’s 60 Minutes (which should get these surgeons loads of new business).

 

Joining the push was Dr. Francesco Rubino, one of the study’s leaders, who claimed the procedure is such an excellent treatment that it should be called “diabetes surgery.”

 

These surgeons want the operation offered much sooner to people with Type 2 — not just as a last resort.

 

This is a significant shift in mindset for the general public — and there’s a well-intentioned marketing reason for it.

 

From “weight-loss surgery” to “diabetes surgery”

Gastric bypass and Lap-Band surgeries are currently recommended as weight loss procedures for patients with a body mass index (BMI) between 35-40 — especially if they have diabetes. (This would mean a 5′ 10″ man who weighs 245-280 lbs., considered to be obese.)

 

Bariatric surgeons, including the entire ASMBS, are pushing for lower thresholds for the obvious reason: so they can perform more of these surgeries.

 

“We need trials that look at these surgeries in people with diabetes who have a BMI of 30 to 35,” he says current ASMBS president Dr. John W. Baker, MD. (That same 5′ 10″ man weighing just 210-245 lbs. currently labeled overweight.) If the studies are positive, bariatric surgeons will be able to perform this procedure on people with diabetes who have a lower BMI — with health insurance paying for them.

 

And it’s an attractive deal for insurance companies. The surgery costs less than one year’s worth of drug treatment for Type 2 diabetes (about $33,000).

 

But, in reality, the surgery isn’t the miracle cure surgeons are making it out to be. There are serious flaws in these studies, which I’ll point out in a moment. But first, let’s look at how they were conducted…

 

The study results “seem” impressive

The two studies are the first to compare stomach-reducing surgery to current drug therapy for obesity-related Type 2 diabetes, which some people are referring to as “diabesity.”

 

The Cleveland Clinic study involved 150 Type 2 diabetics who were given one of two types of surgery, plus a third group given medicines alone. At the start, their A1C levels — a key measure of blood sugar levels — were 9 or higher, on average. (A healthy, non-diabetic A1C is 6 or below.)

 

One year later, only 12% of the drug-only group had healthy blood sugar, compared to 42% and 37% in the two surgery groups.

 

The second study, which Dr. Rubino co-led, involved 60 patients given either surgery or drugs alone. Two years later, 95% and 75% of the two surgery groups maintained a sub-6% A1C without any diabetes drugs. None of those in the drug-only group achieved this.

 

The surgery produced immediate improvements

According to the press releases, the results were “dramatic.” And there are signs that the surgery itself, not any resulting weight loss, reversed the diabetes.

The researchers claim that the surgery immediately normalizes blood glucose levels and reduces or eliminates the need for medications.

 

Some patients were able to stop taking insulin as early as three days after their surgery because their bodies started producing more of the hormone. Insulin resistance was also reduced, so that the body’s insulin is no longer ignored by the cells.

 

In one study, most surgery patients were able to stop all diabetes drugs immediately after their procedure.

 

The researchers admit they don’t understand why this occurs.

 

Some theorized that re-directing food to the lower intestine stimulates a substance called glucagon-like peptide 1, which can increase insulin production.

 

Another explanation suggests that hormones which trigger hunger may be dulled by rearranging the anatomy, resulting in fewer cravings for sugar and carbs, which means better blood sugar levels.

 

But both of these “explanations” ignore the obvious.

 

Could this be the real reason the surgery works?

What the surgeons are failing to mention is that post-surgical patients are put on a very strict low-calorie, low-carb diet that forbids sugar … fat … fried or breaded food … soda … sweetened drinks … syrups … candy … and any meat other than the leanest pork and chicken.

 

As I reported earlier [3], a diet like this has the power to reverse insulin resistance and Type 2 diabetes almost immediately all by itself.

 

According to the original UK study [4], a drastically reduced-carb and calorie diet, just like the one that bariatric surgery patients are placed on, allowed Type 2 diabetics to eliminate their medications in one week or less by reversing most features of their diabetes.

 

All signs of Type 2 completely vanished by 8 weeks — and pancreatic function was restored to normal.

 

And this reversal lasted for as long as the study participants remained on the diet — which is exactly what happens with the post-surgery patients!

 

It’s the diet, stupid

Gastric bypass is grossly misunderstood by most lay people. You still have to eat right and exercise regularly to manage your weight and your diabetes. If you don’t, your weight and your diabetes will return, which they do in the vast majority of patients.

 

And, yes, you must exercise.

 

The main benefit I see is that compliance isn’t voluntary — it’s mandatory. If patients binge on any of the forbidden foods, they can get violently ill with vomiting and diarrhea.

 

This is why, far from representing the first line treatment for Type 2, as the surgery lobby is suggesting, I believe bariatric surgery should be reserved for morbidly obese patients who have failed repeatedly at diet-and-lifestyle modification.

 

For these Type 2s who can’t stop consuming the high-carb foods and beverages that trigger insulin (and thus drive fat storage), surgery may be a life-saving option.

 

But I feel that every effort must first be made to educate these patients about the foods and beverages that lead directly to obesity and insulin resistance. And doctors simply aren’t doing this.

 

One can’t help but wonder why.

 

In addition, the downside and dangers of the bariatric surgery should be thoroughly explained to these candidates.

 

The dark side of gastric bypass surgery

The first point that needs to be made to them is that the surgery is risky and dangerous.

 

The “one-in-a-hundred mortality rate” that the surgeons are boasting about may sound low, but compared to other procedures, this is a very high death rate indeed.

 

In fact, the one-year mortality rate [5] for gastric bypass is actually 1.2% fatality rate in the first 30 days.

 

“My very first patient death was a 20-year-old woman who had just undergone gastric bypass surgery,” Dr. Stefan Ripich (my co-author of The 30-Day Diabetes Cure [6]), told me recently.

 

“At the time, I was a young nurse working on a medical/surgical floor. She was being transferred from the surgical gurney back into her bed when she suddenly dropped dead from a blood clot that moved from her leg into her heart. She died in a second. There was no saving her.”

 

This occurs more frequently than we realize.

 

There are other risks, too [7] — including hospital-bred infections, internal bleeding, anesthesia complications, ulcers, pulmonary problems, or the possible removal of the spleen.

 

Long-term success is rare

While the two-year success rate the researchers cite appears impressive, longer-term analysis shows that diabetes-reversal and weight-loss results are pretty dismal.

 

In reality, a majority of patients eventually revert to their old eating habits, thus regaining the weight and their Type 2.

 

A 2010 study published in Eating Disorders Review [8] (Aarts, et al.) stated that “significant deterioration of diabetes control and hypertension became evident over time.”

 

Using weight loss of 25% of the patient’s pre-surgery body weight to define treatment success, the Dutch researchers found that about 80% of the patients retained their weight loss during the first three years. After this, there was a steady decline to 64% of patients at five years, and only 20% at 10 years.

 

Similarly, control of diabetes, hypertension, and gastro-esophageal reflux (GERD) all deteriorated significantly over time.

 

Besides regaining their weight and their Type 2, many patients experienced medical complications, some of which required multiple surgeries to correct the damage.

 

It’s also quite common for post-surgical patients to develop vitamin deficiencies and/or anemia because the surgery left the patients unable to absorb certain vitamins and nutrients

 

Patients also have had great difficulty obtaining adequate nutrition from the small portion of food they are able to eat. And many can’t even take vitamin and supplement pills without grinding them to a powder.

 

Is “diabesity” a true medical condition?

We hear much about the condition called “diabesity” these days. But is this a real medical condition — or a term fabricated by medical opportunists?

 

“The relationship between diabetes and obesity should be screamed from the rooftops,” says Christine Ren Fielding, MD, FACS, an associate professor of surgery at the New York University Program for Surgical Weight Loss.

 

“Many people don’t understand just how closely diabetes and obesity are related,” she says.

 

Well, let’s look…

 

Two-thirds of the US population is estimated to be either overweight or obese. Yet, less than 10% of the population has Type 2 diabetes.

 

In other words, there are more obese people walking around who do have diabetes than who don’t. Just as there are plenty of normal-weight people who have Type 2.

 

This doesn’t add up, does it?

 

If being obese were the cause of diabetes, every obese person in the country would have the disease. And that’s clearly not the case.

 

And if weight-loss is the reason bariatric surgery should be recommended for obese diabetics, how do the researchers explain the turnaround of Type 2 before the patients ever had a chance to lose weight?

 

Co-existence isn’t causality

As Dr. Ripich and I have demonstrated with people who have succeeded on The 30-Day Diabetes Cure plan, reversing Type 2 diabetes does not require weight loss.

 

In his excellent book, Good Calories, Bad Calories, author Gary Taubes explains that people don’t have Type 2 because they are overweight. Rather, he argues, they are overweight because they have some metabolic dysfunction.

 

If you want to understand exactly how this happens, please read my explanation here [7].

 

While it’s often true that losing significant weight can reverse Type 2, most people attempt weight-loss in very unproductive ways (exercise, diets, calorie-restriction, etc.).

 

They try, they fail, they get frustrated, and they give up.

 

But reversing insulin-resistance (by avoiding the foods and beverages that trigger insulin) will always result in significant weight loss — without ever “trying” to lose weight.

 

If you want to see how easily this can be achieved, I invite you to examine The 30-Day Diabetes Cure [9].

 

The real takeaway from these new studies

While these studies fail to prove (at least to me) that gastric bypass surgery is the solution to the current diabetes epidemic — or our obesity crisis — they did make a couple of things obvious.

 

One, is how miserably current drug treatments are failing people with Type 2 diabetes.

 

The second is how unwilling Big Medicine is to get behind the most effective treatment and “cure” we have for Type 2: a good diet and an active lifestyle.

 

Could it be that the researchers weren’t willing to add diet-and-lifestyle to this study because it might have beaten both the surgery and the drug therapy?

 

How would surgeons possibly make money by merely educating their patients?

 

As we’ve demonstrated with The 30-Day Diabetes Cure — plus numerous clinical trials that have proven the efficacy of diet-and-lifestyle — eating better and becoming more active work faster, better, and are more affordable than any other diabetes treatment we have today.

 

If physicians truly cared more about their patients than their profits, they’d heed the science and act to really help people.

 

Unfortunately, this is not going to happen in the near future. So it’s up to you to help yourself.

 

 

 

 

URLs in this post:

[1] Two separate studies: http://www.nejm.org/doi/full/10.1056/NEJMoa1200225

[2] the ACCORD study: http://www.nytimes.com/2008/02/07/health/07diabetes.html?r=1/

[3] As I reported earlier: http://myhealingkitchen.com/jim-healthy/british-doctors-cure-type-2-diabetes/

[4] original UK study: http://www.diabetologia-journal.org/Lim.pdf

[5] one-year mortality rate: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852384/

[6] The 30-Day Diabetes Cure: https://30daydiabetescure.com

[7] There are other risks, too: http://myhealingkitchen.com/featured-articles/can-bariatric-surgery-cure-diabetes/

[8] Eating Disorders Review: http://www.eatingdisordersreview.com/

[9] The 30-Day Diabetes Cure: https://30daydiabetescure.com/products/the-book

About Jim Healthy

Jim Healthy™ is a prolific health writer with a life-long dedication to researching and publishing the most important health discoveries of our time -- and creating practical “action plans” that help readers incorporate these new medical findings in their daily lives. He is the co-author of The Healthy Body Book, Arthritis Interrupted, The 30 Day Diabetes Cure, and The Healing Kitchen.
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