Two articles about inserting foreign substances into our intestines to achieve better health both happened to arrive in my email inbox today. We’ll start with the one that won’t make you lose your appetite.
Improved glucose parameters, substantial weight loss, and increased incretin hormone levels can be achieved by the insertion of a novel, minimally invasive, intestinal device in obese patients with type 2 diabetes.
Hmmm … must be something that vaporizes refined carbohydrates as they come down the tube.
The use of a duodenal-jejunal bypass liner (DJBL) not only improves hemoglobin A1c and aids weight loss, but also appears to increase levels of glucagon-like peptide (GLP)-1 and peptide YY while in place, according to the findings of a small study presented at the annual meeting of the European Society for the Study of Diabetes.
Although the effects may be temporary, they could offer patients a reversible alternative to bariatric surgery that helps to kick-start weight loss and self-management of diabetes, said study author Dr. Charlotte de Jonge of Maastricht University Medical Centre in the Netherlands. “Not all patients want [bariatric] surgery, as it is permanent.”
I’d rather see someone with diabetes choose a reversible alternative over gastric bypass any ol’ day. But if the goal is weight loss and management of diabetes, why not try a reversible low-carbohydrate diet first?
The DJBL (EndoBarrier) is a 60-cm impermeable sleeve that is inserted and removed endoscopically, and which effectively blocks the duodenum and proximal jejunum in a manner similar to the Roux-en-Y-gastric bypass procedure. It is thought to work by creating a physical barrier between ingested food and the intestinal wall, and perhaps alters the activation of incretin hormones in the gut.
Good lord … so the key to treating diabetes is apparently to eat what you’ve been eating, but prevent your body from absorbing it. Right. And the key to avoiding headaches is to keep pounding your head on your desk, but put a pillow on the desk first.
Within 1 week after implantation, fasting and area under the curve (AUC) glucose concentrations were improved (11.4±0.5 mmol/L vs. 8.9±0.4 mmol/L and 1,999±88 vs. 1,535±53), respectively. In addition, AUC concentrations of GLP-1 increased from 2,584 at baseline to 4,112 at removal and PYY from 4,440 to 6,448 (P less than .01 for all comparisons with baseline).
When the device was removed at 6 months, a significant mean weight loss of 13 kg (P less than .001) had been recorded, with a mean loss of excess weight of 30% (P less than .001), said Dr. de Jonge. Importantly, mean HbA1c decreased from 8.4% at baseline to 7.0% at removal (P less than .001) and there was a reduction in the use of antidiabetic medication in all but one of the study participants.
Well, when you prevent much of what people eat from being absorbed, I’d expect their glucose levels to drop and their need for medication to drop with it. But Dr. Eric Westman and others have achieved the same result with diet. In one of his studies, 95% percent of the subjects who adopted a low-carb diet reduced or eliminated their need for diabetes medications.
If this procedure mimics the effects of gastric bypass, then I’d be worried that the people who have it done will become vitamin deficient and end up with brittle bones and other negative health effects. That’s what often happens with gastric bypass, as I wrote about in a previous post.
And now for the second article about intestinal invasion – if you haven’t eaten dinner yet, you may want to read this later. (To read the full article online, you need to register with MedPage Today.)
Obese patients with a constellation of symptoms known as the metabolic syndrome improved insulin sensitivity with a fecal transplant from healthy thin donors, researchers here reported.
Recruiting those healthy thin donors must’ve required a clever sales pitch. I don’t even like to pee in a cup.
After six weeks, peripheral insulin sensitivity significantly improved in 18 patients who received feces from lean donors compared with those who received an autologous transplant (P<0.05), said Anne Vrieze, MD, of the Academic Medical Center in Amsterdam, and colleagues. There was also a trend toward improvement in hepatic insulin sensitivity but it wasn’t significant, they reported at the European Association for the Study of Diabetes Meeting.
“This confirms the potential role of gut microbiota in the disturbance of glucose and lipid metabolism in obesity,” Vrieze said during the presentation. “The challenge is to use this knowledge to develop therapies.”
Yes, it’ll be interesting to see how much Merck and Pfizer end up charging for skinny-guy poop. On a positive note, this could provide a whole new career for naturally-thin unemployed guys. As it is now, most of the people paid to create s@#$ are in government.
John Buse, MD, PhD, of the University of North Carolina at Chapel Hill, cautioned that the researchers didn’t yet present data on actual differences in gut bacteria after transplantation, but the idea was promising.
“It’s interesting,” he told MedPage Today. “There’s little data, so it’s hard to tell. But it’s a cool idea.”
Um … cool idea? No, a Victoria’s Secret model using coconut oil as an all-over moisturizer is a cool idea.
Animal studies affirmed an association between obesity and gut microbiota, as animals given bacteria from the feces of obese mice had a significantly greater increase in total body fat than those colonized with a “lean” microbiota, Vrieze said. But data on a clinical roll for gut microbiota are scarce.
I’m not sure what a clinical roll means. Perhaps they’re referring to those little round bread-like things you get in the hospital if they’ve put you on a heart-healthy low-fat diet.
Vrieze and colleagues enrolled 18 obese men ages 21 to 65 with metabolic syndrome who weren’t taking medication for their condition and who hadn’t used antibiotics in the last three months. All of them kept a food and exercise diary over the study period.
All patients had jejunum biopsies and a bowel lavage to clear their own native bacteria. They were then randomized to either allogenic transplant of feces from lean male donors or autologous transplantation.
I’m guessing the original proposal called for 500 patients, but only 18 didn’t run screaming from the room when the investigators explained, “Well, what we’re going to do is clear all the poop out of your bowels, then we’ll either insert some skinny guy’s poop in your bowels, or we’ll re-insert your own poop. No, sorry, we can’t tell you whose poop you’ll get. That would violate the double-blind protocol. What? No, you can’t ask the skinny guys to avoid spicy foods.”
Fecal transplantation programs — while far from common — actually are already in place at a few centers in the U.S. based on some evidence suggesting efficacy in tough-to-treat gastrointestinal infections with the bacteria Clostridium difficile.
Since the gut plays an active role in regulating hormones that impact both obesity and diabetes associated with obesity, the focus has expanded to bacteria in the gut.
If the procedure turns out to produce significant weight loss, I’m guessing fecal transplantation will become much more common. I’m also guessing that pretty much everyone who loses weight that way will lie about it.
“Oh, thank you. Yes, I’ve lost 60 pounds. Excuse me? Uh … well … I started doing Pilates every day.”