Wednesday, June 4, 2008

Is gastric bypass surgery a cure for Type 2 diabetes?

Greensboro, NC
When Dr. Enrico Jones became so overweight he could no longer work in his yard, he underwent bariatric surgery.

He expected to lose weight, and he has — 70 pounds. But he also has gotten other benefits.

In particular, combined with a diet he began before surgery, the procedure has left his Type 2 diabetes in remission. He no longer needs to take medicine to control it.

That's important because Type 2 diabetes, the most common type, can lead to blindness, kidney disease, heart disease, nerve damage and other problems. In North Carolina, the incidence of diabetes more than doubled in the past decade; more than 9 percent of the state's population now has the disease.

Researchers are now looking at whether a particular type of bariatric surgery, the gastric bypass, can be used as a direct cure for Type 2 diabetes in people who are not overweight. That's because some patients who have undergone gastric bypass surgery have seen their Type 2 diabetes disappear almost overnight.

Cris Clark of Greensboro had the procedure in December 2006. At the time, she weighed 298 pounds and suffered from Type 2 diabetes and high cholesterol, itself a risk factor for heart disease. She was taking medications for both conditions.

Her weight gradually receded to its present 180 pounds. But she was able to stop taking her diabetes and cholesterol medicines immediately.

"The day right after the surgery, I wasn't on (them) anymore," she said.

Other bariatric patients who have undergone a different procedure, in which a silicone band is wrapped around the stomach to reduce hunger — "lap band" surgery — have found that their diabetes comes under control more gradually as they lose weight. That's what happened with Jones.

How does gastric bypass affect diabetes? Researchers suspect that the answer has to do with hormones. Research with rats in which their upper small intestines were bypassed — also bypassing the pancreas, which produces insulin — found that the procedure eliminated Type 2 diabetes almost immediately. When the procedure was reversed, the rats developed diabetes again.

It is not clear whether the procedure could be used as a direct cure for Type 2 diabetes in people. The United States currently does not allow bariatric surgery on people who are not overweight. But clinical trials in Brazil are beginning to see whether such surgery can eliminate Type 2 diabetes in people who are not overweight.

"This requires much more research, which all the (medical) societies are doing," said Dr. Kristen Earle, a Greensboro bariatric surgeon. "It's an interesting finding, but it's very early. … Whenever you put a first study out there, you have to say, 'OK, what's your five-year data? What's your 10-year data?'"

Lisa White is a believer. The Gibsonville woman had lap-band surgery in 2007.

Although she did not have diabetes, both her parents did, and before the surgery, her own blood-sugar levels were approaching diabetes level. Now, they're normal.

But weight loss and diabetes control weren't the only benefits, she found.

Before surgery, her blood pressure had been 140 over 90 even with medication. Now, she says, it is 120 over 75, within the normal range.

"I'd do it again tomorrow," she said about her surgery.

Jones still has to take medication, but now his blood pressure is under control. Before the surgery, it wasn't.

He also no longer experiences the joint problems that led to his needing a hip replacement when he was still in medical school.

The painful bone spurs he used to develop in his feet are a thing of the past.

The benefits of bariatric surgery go well beyond simple weight loss, medical researchers have found. And that's good because obesity has become so common and the risks associated with obesity are so great.

About 15 percent of adult Americans were obese in the late 1970s, the U.S. Centers for Disease Control and Prevention found, but that figure had more than doubled by 2004.

In addition to high blood pressure, Type 2 diabetes and high cholesterol, obesity can increase the risk of heart disease, stroke, gall-bladder disease, sleep apnea and some cancers.

Researchers also believe that if obese people lose a significant amount of weight, they are at reduced risk of cancers of the kidney, breast, colon, liver, pancreas, ovaries, esophagus and gall bladder.

Weight loss from bariatric surgery also can eliminate sleep apnea, a condition in which a person stops breathing in his sleep multiple times during the night.

Sleep apnea doesn't just cause poor sleep. It also puts people at increased risk for heart attacks, strokes, high blood pressure, obesity and diabetes.

Weight loss from bariatric surgery can even reduce the incidence of erectile dysfunction and other sexual problems in obese men, new research suggests.

The benefits of bariatric surgery are not widely spread so far because only about 1 percent of Americans who are eligible for bariatric surgery have had it, CBS' "60 Minutes" has reported. It can cost $25,000 or more, and insurance doesn't always cover it.

But Jones found his procedure worthwhile, in part because he's back working in his yard. He has always loved doing that, but in the summer of 2006 he realized he had grown so heavy he no longer had the energy.

Now, since losing those 70 pounds, "my feet don't hurt anymore, and I'm back to cutting my grass."

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