Surgery For Diabetes?

      108 Comments on Surgery For Diabetes?

One of the times I interviewed Dr. Mike Eades for Fat Head, he told me (after we were done shooting) that the usual treatment pattern for type 2 diabetes and other diet-related ailments goes something like this:

  • Doctor puts patient on a low-fat diet
  • Patient’s condition doesn’t get any better or gets even worse
  • Doctor declares that diet won’t fix the problem and prescribes a drug

I’m afraid we’ll soon be seeing more and more of an alternate version of that treatment pattern:

  • Doctor puts patient on a low-fat diet
  • Patient’s condition doesn’t get any better or gets even worse
  • Doctor declares that diet won’t fix the problem and recommends surgery

There were some dramatic headlines this week about a new study showing that weight-loss surgery works even better than diet or drugs (wow!) for reversing type 2 diabetes. Here are some quotes from a news story in the New York Times:

Two studies have found that weight-loss operations worked much better than the standard therapies for Type 2 diabetes in obese and overweight people whose blood sugar was out of control. Those who had surgery, which stapled the stomach and rerouted the small intestine, were much more likely to have a complete remission of diabetes, or to need less medicine, than people who were given the typical regimen of drugs, diet and exercise.

Hmm, I wonder what the typical regimen of drugs, diet and exercise would be? We’ll come back to that.

The new studies, published on Monday by The New England Journal of Medicine, are the first to rigorously compare medical treatment with these particular stomach and intestinal operations as ways to control diabetes. Doctors had been noticing for years that weight-loss operations, also called bariatric surgery, could sometimes get rid of Type 2 diabetes. But they had no hard data.

Experts say better treatments are desperately needed for the disease.

“Type 2 diabetes is one of the fastest growing epidemics in human history,” according to an editorial published with the two studies.

Yes indeed, rates of type 2 diabetes have been skyrocketing in the past few decades. Now … what’s changed in the population since, say, 1980? Have we been suffering from a shortage of bariatric surgery, whereas our grandparents all had their stomachs stapled as part of their high-school graduation ceremonies? I don’t think so.

One of the studies, conducted at the Catholic University in Rome, compared two types of surgery with usual medical treatment. After two years, the surgical groups had complete remission rates of 75 percent and 95 percent; there were no remissions in patients who received medical treatment.

The second study, at the Cleveland Clinic, compared two types of surgery with an intensive medical regimen. The remission rates one year after surgery were lower than in the Italian study — 42 percent and 37 percent — at least in part because the American study used a stricter definition of remission.

Sounds as if those Italians need to tighten up their definitions a bit. Otherwise we’ll have diabetics moving to Italy so they can become non-diabetics. The Italian Tourism Board may even start a new campaign.

Come to Italy! The scenery is a-lovely, the people are a-nice, and your fasting glucose will-a drop by 30 points!

I looked up the study conducted in the U.S. to see what “typical” regimen produced such lousy results compared to hacking up the digestive system. Can’t say I was surprised:

All patients received intensive medical therapy, as defined by American Diabetes Association (ADA) guidelines, including lifestyle counseling, weight management, frequent home glucose monitoring, and the use of newer drug therapies (e.g., incretin analogues) approved by the Food and Drug Administration.

Fabulous. The non-surgical patients were told to follow the ADA guidelines … you know, the guidelines that explain how carbohydrates drive up your blood sugar and therefore you should base your diet on them. Talk about rigging the game in your favor. That’s like spiking one team’s Gatorade with vodka before the Super Bowl.

Tom Brady is having a rough day out there. He’s been sacked six times, he’s been knocked down three times, and he’s fallen down 22 times for no apparent reason. I guess the Giants are just a better team, folks.

Every 3 months for the first 12 months, patients returned for study visits with a diabetes specialist at the Cleveland Clinic. Patients were counseled by a diabetes educator and evaluated for bariatric surgery by a psychologist and encouraged to participate in the Weight Watchers program.

Double fabulous. The patients were counseled by a diabetes educator. Here’s all you need to know about that: Hope Warshaw is a diabetes educator.

Then they were encouraged to follow the Weight Watchers diet – another low-fat diet. The researchers not only spiked the opposing team’s Gatorade with vodka, they added a few sleeping pills as well.

Folks, Brady just went down again despite not being touched, and I don’t think he’s getting up. This Giants defense is on fire today!

So we had one group of patients who were encouraged to follow a low-fat, high-carb diet and another group of patients who underwent surgery and – surprise! – the surgery group had higher rates of remission. Boy, mangling the digestive system Mother Nature gave us must perform some biological miracles.

It’s been nearly three years since I wrote about gastric bypass and lap-band surgery, so here’s a review of what patients are told to eat afterwards:

The second phase of the Lap-Band diet consists of 5 to 6 weeks of a modified full liquid diet; the key component of this phase is consuming two ounces of a protein shake every hour for ten to twelve hours a day with two ounces of other liquids such as soup, baby food, or sugar-free gelatin three times a day.

During the second six weeks following Lap-Band surgery patients may eat food that is shredded in a food processor prior to eating. The basic foods on the Lap-Band diet include meats or other forms of protein, vegetables, and salads.

After Lap-Band surgery the stomach will never hold more than 4 to 6 ounces per meal, so making every bite count is essential for healthy and nutritionally rounded weight loss success. Protein is especially important following Lap-Band surgery. The Lap-Band diet does not include most bread, potatoes and other starchy vegetables.

Surgeons reduce your stomach to an itty-bitty pouch, so you’re encouraged to base your itty-bitty meals on protein foods and vegetables while skipping the bread, potatoes and other starchy vegetables. In other words, it’s a low-carb diet … the itty-bitty version. Even if you ignored the advice and wanted to eat a big bowl of Kellogg’s Krave, you couldn’t. The itty-bitty pouch wouldn’t hold more than few ounces.

So we’re supposed to be impressed that people who undergo surgery and are limited afterwards to a few ounces of protein and vegetables end up reversing diabetes? Based on this rigged result, we’re perhaps going to start treating more diabetics with surgery – without first comparing surgery to a simple low-carb diet? What kind of doctors would promote that idea? Perhaps we should look at the disclosures in this (ahem) study:

Dr. Schauer reports receiving payment for board membership from Ethicon Endo-Surgery, Surgiquest, Barosense, RemedyMD, and Stryker, consulting fees from Ethicon Endo-Surgery, Stryker, Gore, and Carefusion, payment for expert testimony from Physicians Review of Surgery, and lecture fees from Ethicon Endo-Surgery, Allergan, Cinemed, and Quadrant Healthcare, holding a patent for a medical device to enhance weight loss in codevelopment with the Cleveland Clinic, royalties from Springer, having an equity interest in Intuitive Surgical, Barosense, Surgiquest, and RemedyMD, and receiving institutional grant support (to the Cleveland Clinic) from Ethicon Endo-Surgery and Bard Davol; Dr. Kashyap, receiving consulting fees from Ethicon; Dr. Brethauer, receiving consulting fees, lecture fees, and payment for board membership from Ethicon Endo-Surgery and lecture fees from Covidien; Dr. Kirwan, receiving grant support from Nestle and ScottCare.

Ah, I see. The study was conducted by a bunch of doctors who are paid by firms in the weight-loss surgery industry.

No other potential conflict of interest relevant to this article was reported.

Oh, that’s okay. I think the conflicts already reported were quite enough.

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108 thoughts on “Surgery For Diabetes?

  1. Sarah

    Please take it easy on us WLS people, Tom. I, for one, didn’t discover, or connect the dots, or phrase it how you will the low-carb, high-protein Fathead/Paleo style diet until years after I had an RNY gastric bypass. Do I sometimes wish I could have gone back and done it differently? Of course. But I don’t regret. My altered digestive system gave me a jumpstart on loss and lifestyle change and to this day presents few, in any problems (and I am SCRUPULOUS about checking my vitamin levels, bone density, etc.). Sometimes it’s not ignorance, or stupidity, or laziness. Sometimes it’s being on a diet since you were three years old (low-fat, high carb, of course) and needing more help than most people will ever need. There is also a huge hormonal component in the surgery that most people never hear about because the medical profession doesn’t understand it and therefore can’t report on it. But the surgery hugely reduces ghrelin production for anywhere from three to twelve months (sometimes longer, if you’re lucky) which makes making those high-protein, low-carb choices a piece of proverbial cake.

    It’s not that I don’t agree with you completely. And I cracked up at the football analogies. But demonize the conventional wisdom, not its unwitting victims.

    I don’t blame the surgery patients at all. They’ve been given bad information.

    Reply
  2. Cor Aquilonis

    Reading posts like this makes my heart break It’s got to be awful: you get fat even though you try to cut calories and fat, just like your doctor told you to, but you just get hungrier and hungrier… What a nightmare – it’s like you body fat turns against you and destroys your vivacity, then health, then your life.

    You know, progress wasn’t made in the treatment of mental illness until doctors realized that mental illness isn’t the patients fault, it’s something that happened to them. I doubt there will be significant advances in obesity treatment until the abandon the “lazy glutton” paradigm and realize that it’s something that’s happening to the patient, not a flaw in their character – a biochemical problem that needs biochemical treatment (i.e. low carb/leptin.) Right now, the treatment for obesity is akin to telling a schizophrenic to “just pay no mind to the voices.” It’s also just about as effective.

    Exactly. That’s why most diets fail. This isn’t about character, it’s about biochemistry.

    Reply
  3. Claude

    I think that this would qualify as the most hilarious post of the year. Too bad I ended up crying since the joke is on all of us.

    Reply
  4. johnny

    It’s deplorable to see how low can these doctors go in their pursuit of the almighty dollar.

    Whatever happened to the Hippocratic Oath? Has it become a “living document”?

    Sure, it’s a living, breathing document … which, like a “living, breathing” Constitution, means people feel free to ignore it.

    Reply
  5. Rhonda Cowsert

    I know so many people who have had some form of weight loss surgery and every single one of them experienced horrific complications that continue to affect their every day lives. I admit that there was a time (before my low carb education) that I seriously considered weight loss surgery but always came to the conclusion that the risk just wasn’t worth it. Now that I know the same results can be achieved without maiming the body I wonder why doctors ever think it’s a good idea.

    My doctor has mentioned both surgery and diet pills to get my weight under control. When I began losing weight doing low carb? He was reluctantly pleased but was sure to let me know that I needed to be sure and maintain a low FAT diet with plenty of low fat skinless chicken, egg WHITES (no yolks because those are BAD for you) or – well, I stopped listening to him at that point but I’m sure that something BAD was going to happen like toe fungus and zombies – or maybe zombie toe fungus?

    When I got my last cholesterol test results they weren’t perfect (total: 219, trigs: 126, LDL: 140, HDL: 54, VLDL: 25) but they were a damn site better than they were when I was toeing the party line on the low fat – high whole grain diet (total: 222, trigs: 174, LDL 139, HDL: 48, VLDL: 35) so I just nod, smile and I keep my butter, my whole eggs and my steaks!

    Keep it up. Your lipid profile may continue to improve.

    Reply
  6. Peter

    The NY Times headline “Surgery for Diabetes May Be Better Than Standard Treatment” says it all. Awesome job in digging out the background information, missed by the vaunted and objective NYT reporter. Most importantly, each barbaric (oops, I mean bariatric) surgery runs between $11.6K to $26K. That’s a lot of loot.
    Now it makes more sense that the latest American Diabetic Assocaition magazine includes a healthy banana bread recipe w/ banana, flour and 1/2 cup brown sugar. The more T22D folks eat this means more business for surgeons.

    The ADA membership consists of doctors who depend on a stream of diabetic patients for their livelihoods.

    Reply
  7. LeeAnn

    Tom,

    I actually had a gastric bypass 10 years ago for reasons other than diabetes. I remember clear as day what I was to eat post-surgery….1 ounce diced chicken 4x a day. Talk about low cal protien diets! Since the surgery, I got pregnant, and had to ‘bypass the bypass’. I had to eat to gain weight to sustain the pregnancy (i.e. high carb foods), and ended up stretching out my ‘pouch’ in the process. When my son was 2, I was on my way back to where I was before. I did the low fat diet, and lost weight, but was ALWAYS hungry. I saw your movie, and have gone back to the high protein, high fat, low carb, no processed food eating… I feel great.

    My brother is a surgeon who does lap bands, and agrees with you 100%; unfortunately, he is up against other doctors who tout the USDA…so he tries to advise patients the best he can when he can (i.e. after removing diverticula, hernia repair, etc) …..and then scrubs for another surgery….

    I agree with Sarah…be gentle with us…we have seen the error of our ways, and are now enjoying a different lifestyle…….. with cream on top 🙂

    I don’t blame the patients. I would guess most of them tried diets promoted by the supposed experts before giving up and going for surgery. That’s what happened to my friend who had the procedure. It was only after seeing Fat Head that she realized she was trying the wrong diets.

    Reply
  8. Katy

    “After Lap-Band surgery the stomach will never hold more than 4 to 6 ounces per meal…”

    Unless the patient continues to overeat and stretches the stomach out again, as many do. Sadly, people are so desperate that they’ll try anything, but not having the flexibility to consume different amounts of food when one wishes can be most disturbing to one’s well-being.

    I’ve heard of people managing to stretch their itty-bitty pouches over time, then eating more junk and gaining back the weight.

    Reply
  9. Jenny

    Frustrating. My mom is a t2 diabetic. She went untreated for years and ended up in ICU for over a week with diabetic ketoacidosis. I was asking her about her diet over the weekend and she says she’s following the doctor’s guidelines to eat 15 carbs. I was shocked and pleased, but then she told me what “a carb” is. About 20 grams of carbs = “a carb.” Sigh. She’s on insulin twice a day and eating bread and other crap. She thinks that “sweets” are the only problem. And she’s getting fatter. And her a1c is well into the 7s. Not cool. I do realize that she probably wouldn’t follow a low carb approach, but let’s put the information out there as a recommendation and trust that some patients would make the right call.

    20 carbs = a carb? What kind of new math is that?

    Reply
  10. The Older Brother

    Don’t forget the “dumping!”

    That’s the term for how what remains of your digestive tract responds when you eat a meal of more than about a half of a cup or cup of food. It’s pretty much exactly what it sounds like. And that’s the name people who promote gastric bypass give it.

    The amazing part is the MSM articles pretty much tell you that the whole thing is done by doctors on the take to the surgery equipment and supply manufactures, but they print it anyway.

    Oy.

    Do “No Dumping” signs help at all?

    Reply
  11. Lynnanne

    In our pre-Paleo days, The Fiance and I went to a seminar given by a local hospital on weight loss surgery. I expected diagrams of the affected organs, maybe a video of the surgery, but what we got was two hours of how to ensure that your insurance company would pay for it. Helpful hospital billing people were on hand to look up your insurance policy and let you know if you qualified. For my insurance company, you had to work with a dietitian for six months to “prove you can lose weight” before they would pay for the surgery. I think that was when I started backing out of the room. If could have FREAKING lost weight on my low fat, high carb, exercise six-days-a-week lifestyle, I wouldn’t have been sitting in the audience in a room full of double-sized chairs!

    By the way, at 310 lbs and 225 lbs respectively, we were the tiniest people in the room, apart from the surgeons and the obligatory formerly obese and now skinny ex-patient holding up her giant pants. Actually she wasn’t an ex-patient, as she still had to show up regularly to have her lap band adjusted, which the doctor didn’t mention cost money, but I’ve since read costs about $250 a pop.

    Thank goodness The Fiance and I found Paleo and have since lost over 160 lbs between us, without the surgery. Though I think people like us make Ethicon Endosurgery sad.

    By the way, I’m not a sports fan but I would TOTALLY pay to watch two drunken football teams play each other. Throw in a drunken marching band and drunk halftime performers, and you’ve got a sure-fire winner.

    Personally, I’d pay to see drunken figure skating.

    Reply
  12. Phil

    Having spent 4 years caring for people who have had Adjustable Gastric Band and Vertical Sleeve Gastrectomy Surgery, I can appreciate the sentiments on many sides of the argument. My experience leads me to believe:
    1. Avoiding sugars and simple starches are VERY effective
    2. Eating “real foods” (avoiding processed foods) is VERY effective
    3. People don’t always eat because they are hungry (stressed, bored, depressed, prompted to eat by an external stimulus)
    4. Bands and ‘sleeves” are safer than bypass
    5. Most surgeons truly believe they are doing the right thing for their patients (even though most still believe in low-fat, low-calorie diet and that a-calorie-is-a-calorie because that has been what they have been taught since medical school)
    6. There is a very strong, well financed, special-interest which insists on making as much money as possible (in congress, the food/restaurant industry, business community and media).
    7. The combination of fat/sugar/salt (as in most processed and restaurant foods) have the addictive properties of any controlled dangerous substance.

    I wish that my patients could just eat right, be active, get a good night’s sleep, deal with their demons and get healthy. However, this is incredibly hard for people who are extremely overweight. What the surgical procedure does is take “hunger” out of the equation. It is a “tool” in addition to all of the above.

    Surgery does have its risks and some people do die (bypass is riskier than “sleeve” which is riskier than bands, IMO). People also die (statistically more often) when they are unable to consistently eat right, be active, get a good night’s sleep and deal with their demons. It is still incredibly hard for people to believe that success is within their reach (they have failed on so many previous occasions). Until they achieve and maintain their weight loss, it just seems to be one more attempt doomed to failure. Hopefully, 5-10 years from now, the public will be more enlightened.

    The people I for sorry for are those who tried to lose weight on some crappy low-fat diet, gave up, and had the surgery. Certainly they wouldn’t all stick to a low-carb diet — many people don’t — but some would find it solves their problems without resorting to surgery.

    Reply
  13. Mirva Pennamo

    I read that in Norway they have gastric-bypass-operated children in ages 13, and the study will go on till 100 children has been operated because they are fat. I think this is frightening if this is the future. To take away normally working organ only because people (children) eat wrong foods. And what does this operation to these children and to their growth.

    That’s horrible. I can’t imagine the health problems they’ll have as adults.

    Reply
  14. Joshua

    My wife had been considering the surgery years back and I had researched it and I seem to remember reading that something like 70% of people who had surgery will gain back all the weight lost after 7 years. Craziness!

    Glad you did your research first.

    Reply
  15. Claude

    I think that this would qualify as the most hilarious post of the year. Too bad I ended up crying since the joke is on all of us.

    Reply
  16. johnny

    It’s deplorable to see how low can these doctors go in their pursuit of the almighty dollar.

    Whatever happened to the Hippocratic Oath? Has it become a “living document”?

    Sure, it’s a living, breathing document … which, like a “living, breathing” Constitution, means people feel free to ignore it.

    Reply
  17. Erik

    Bariatric surgery patients also have a 58% higher rate of suicide and accidents, and only 10% of patients ever achieve a normal BMI. Most simply go from very obese to slightly less obese. According to Wikipedia, the Number Needed To Treat is an astonishingly high 77.

    I was reading a book on mindful eating and the author indicated that she had treated many bariatric patients. The majority of them would declare “if I learned how to eat this way before, I wouldn’t have needed the surgery.”

    I was even more surprised when I found out the surgery isn’t even 100% effective for weight loss. Many of the patients find workarounds, like eating every waking minute instead of every third waking minute.

    I wonder what the Number Needed To Treat is for “eat less sugar and get some exercise”.

    I hope it’s somewhere south of 77.

    Reply
  18. emi11n

    KD, you should check out this site: http://junkfoodscience.blogspot.com/
    There is a whole series of posts about bariatric surgery. Warning, it will scare you, but there may be info you can use to help your friend.

    The thing that hacks me off about these studies is they make it sound as if surgery should become the go-to treatment for diabetes. But they didn’t compare actual OUTCOMES for their subjects– overall health, number and severity of health issues, etc. We don’t know if any of these study groups had a better survival rate, or a better quality of life. Hell, this was a short-term study, two years is within the “honeymoon phase” for many surgical patients. Diabetes symptoms do reemerge in some patients years later; and the surgery may also cause severe hypoglycemia that can only be treated with a pancreatectomy, leaving them as insulin-dependent diabetics for life. And they may simply exchange their diabetes meds for drugs to treat their new digestive issues, anemia and vitamin deficiency. These studies don’t tell patients what they really need to know. Just propaganda for bariatric “medicine”.

    Reply
  19. Lori

    Probably, part of the “cure” of the surgery is in the small and liquid meals. Dr. Berstein’s Diabetes Solution talks about the Chinese Restaurant Effect–that big meals stretch cells in the intestine, causing a rise in blood sugar and insulin.

    I’m sure that’s a big part of the (ahem) cure.

    Reply
  20. Katy

    “After Lap-Band surgery the stomach will never hold more than 4 to 6 ounces per meal…”

    Unless the patient continues to overeat and stretches the stomach out again, as many do. Sadly, people are so desperate that they’ll try anything, but not having the flexibility to consume different amounts of food when one wishes can be most disturbing to one’s well-being.

    I’ve heard of people managing to stretch their itty-bitty pouches over time, then eating more junk and gaining back the weight.

    Reply
  21. Jenny

    Frustrating. My mom is a t2 diabetic. She went untreated for years and ended up in ICU for over a week with diabetic ketoacidosis. I was asking her about her diet over the weekend and she says she’s following the doctor’s guidelines to eat 15 carbs. I was shocked and pleased, but then she told me what “a carb” is. About 20 grams of carbs = “a carb.” Sigh. She’s on insulin twice a day and eating bread and other crap. She thinks that “sweets” are the only problem. And she’s getting fatter. And her a1c is well into the 7s. Not cool. I do realize that she probably wouldn’t follow a low carb approach, but let’s put the information out there as a recommendation and trust that some patients would make the right call.

    20 carbs = a carb? What kind of new math is that?

    Reply
  22. Phil

    Having spent 4 years caring for people who have had Adjustable Gastric Band and Vertical Sleeve Gastrectomy Surgery, I can appreciate the sentiments on many sides of the argument. My experience leads me to believe:
    1. Avoiding sugars and simple starches are VERY effective
    2. Eating “real foods” (avoiding processed foods) is VERY effective
    3. People don’t always eat because they are hungry (stressed, bored, depressed, prompted to eat by an external stimulus)
    4. Bands and ‘sleeves” are safer than bypass
    5. Most surgeons truly believe they are doing the right thing for their patients (even though most still believe in low-fat, low-calorie diet and that a-calorie-is-a-calorie because that has been what they have been taught since medical school)
    6. There is a very strong, well financed, special-interest which insists on making as much money as possible (in congress, the food/restaurant industry, business community and media).
    7. The combination of fat/sugar/salt (as in most processed and restaurant foods) have the addictive properties of any controlled dangerous substance.

    I wish that my patients could just eat right, be active, get a good night’s sleep, deal with their demons and get healthy. However, this is incredibly hard for people who are extremely overweight. What the surgical procedure does is take “hunger” out of the equation. It is a “tool” in addition to all of the above.

    Surgery does have its risks and some people do die (bypass is riskier than “sleeve” which is riskier than bands, IMO). People also die (statistically more often) when they are unable to consistently eat right, be active, get a good night’s sleep and deal with their demons. It is still incredibly hard for people to believe that success is within their reach (they have failed on so many previous occasions). Until they achieve and maintain their weight loss, it just seems to be one more attempt doomed to failure. Hopefully, 5-10 years from now, the public will be more enlightened.

    The people I for sorry for are those who tried to lose weight on some crappy low-fat diet, gave up, and had the surgery. Certainly they wouldn’t all stick to a low-carb diet — many people don’t — but some would find it solves their problems without resorting to surgery.

    Reply
  23. Mirva Pennamo

    I read that in Norway they have gastric-bypass-operated children in ages 13, and the study will go on till 100 children has been operated because they are fat. I think this is frightening if this is the future. To take away normally working organ only because people (children) eat wrong foods. And what does this operation to these children and to their growth.

    That’s horrible. I can’t imagine the health problems they’ll have as adults.

    Reply
  24. AndreaLynnette

    This is just plain awful. I feel sick for all these people who get duped into surgery, and then go through all those horrid complications. I know a man who went through it, is still a good 100lbs overweight, and frankly, he smells terrible. Something about the surgery’s side effects causes constant, nasty gas. It just leaks out of him all the time. He smells like week-old boiled cabbage, and I can barely stand to be around him. He’s a friend, but it’s HARD to be near him. And he has to take mountains of medicine to control the worst of the vitamin deficiencies and other complications.

    Consenting to evisceration cannot possibly be a better idea than setting aside grains and sugar! How can we possibly live in a culture where the LCHF diet is considered more dangerous, more radical, than eating the kinds of food we were built to eat?

    That’s where bad dietary advice has taken us.

    Reply
  25. Erik

    Bariatric surgery patients also have a 58% higher rate of suicide and accidents, and only 10% of patients ever achieve a normal BMI. Most simply go from very obese to slightly less obese. According to Wikipedia, the Number Needed To Treat is an astonishingly high 77.

    I was reading a book on mindful eating and the author indicated that she had treated many bariatric patients. The majority of them would declare “if I learned how to eat this way before, I wouldn’t have needed the surgery.”

    I was even more surprised when I found out the surgery isn’t even 100% effective for weight loss. Many of the patients find workarounds, like eating every waking minute instead of every third waking minute.

    I wonder what the Number Needed To Treat is for “eat less sugar and get some exercise”.

    I hope it’s somewhere south of 77.

    Reply
  26. emi11n

    KD, you should check out this site: http://junkfoodscience.blogspot.com/
    There is a whole series of posts about bariatric surgery. Warning, it will scare you, but there may be info you can use to help your friend.

    The thing that hacks me off about these studies is they make it sound as if surgery should become the go-to treatment for diabetes. But they didn’t compare actual OUTCOMES for their subjects– overall health, number and severity of health issues, etc. We don’t know if any of these study groups had a better survival rate, or a better quality of life. Hell, this was a short-term study, two years is within the “honeymoon phase” for many surgical patients. Diabetes symptoms do reemerge in some patients years later; and the surgery may also cause severe hypoglycemia that can only be treated with a pancreatectomy, leaving them as insulin-dependent diabetics for life. And they may simply exchange their diabetes meds for drugs to treat their new digestive issues, anemia and vitamin deficiency. These studies don’t tell patients what they really need to know. Just propaganda for bariatric “medicine”.

    Reply
  27. Lori

    Probably, part of the “cure” of the surgery is in the small and liquid meals. Dr. Berstein’s Diabetes Solution talks about the Chinese Restaurant Effect–that big meals stretch cells in the intestine, causing a rise in blood sugar and insulin.

    I’m sure that’s a big part of the (ahem) cure.

    Reply
  28. AndreaLynnette

    This is just plain awful. I feel sick for all these people who get duped into surgery, and then go through all those horrid complications. I know a man who went through it, is still a good 100lbs overweight, and frankly, he smells terrible. Something about the surgery’s side effects causes constant, nasty gas. It just leaks out of him all the time. He smells like week-old boiled cabbage, and I can barely stand to be around him. He’s a friend, but it’s HARD to be near him. And he has to take mountains of medicine to control the worst of the vitamin deficiencies and other complications.

    Consenting to evisceration cannot possibly be a better idea than setting aside grains and sugar! How can we possibly live in a culture where the LCHF diet is considered more dangerous, more radical, than eating the kinds of food we were built to eat?

    That’s where bad dietary advice has taken us.

    Reply
  29. Firebird7478

    Sooner or later, the cure for depression will be decapitation.

    Don’t give them any ideas.

    Of course, they’ll report the incidence of side effects is low.

    Reply
  30. Firebird7478

    Sooner or later, the cure for depression will be decapitation.

    Don’t give them any ideas.

    Of course, they’ll report the incidence of side effects is low.

    Reply
  31. Janknitz

    It seems to me the logical solution would be to require the patient to try the post op diet (perhaps with more calories and fat to adjust for hunger) for 6 or 8 weeks (or more) BEFORE being accepted for surgery ( the low carb diet, not the low fat diet which is a fake-out, as Phillipa states).

    If the individual is successful with the same diet that will have to be followed post-operatively, he or she can consider:
    1. If it’s possible to do well on just the diet, do I really need the surgery?
    2. Do I really want to be on this type of diet for the rest of my life–there will be no choice if I have the surgery?
    3. Is it worth risking the surgery to “keep me honest” on this diet? (For some people, this may be the real issue–they may welcome the physiological consequences as a mechanism to keep them on the diet ).

    At that point, the patient is making a truly informed decision if he or she chooses to go forward with the surgery.

    If the individual fails at the diet, then he or she should not be permitted to undergo the surgery because he or she has demonstrated that he/she cannot comply with the post operative plan.

    I see the point, but part of their reasoning is that people who can’t stick a diet will so if they have no choice. Also from what I’ve been told, the smaller stomach means less hunger even with the tiny meals.

    None of that means I think the surgery is a good idea.

    Reply
  32. Peter

    Bariatric is an invasive surgery. A NY Times graphics:
    http://www.nytimes.com/interactive/2012/03/27/science/bariatric-surgery.html?ref=science
    Experts like Hope Warshaw, Ornish, Campbell, Esselyn and Oz, remind me of the defenders the 60’s who proclaimed tobacco was quite safe and didn’t cause cancer. I saw a debate between Warshaw and Dr. Berstein. In the vid, Dr. Berstein chewed a bit of little bit of supposedly wholesome whole-grain bread, tested his saliva with a glucose strip and made it turned blue. Warshaw simply ignored it and kept on mouthing high-carb (45-65% daily calories) eating as healthful for T2D. Really?
    But then, she must ignore the evidence in order to keep her paying clients (ENOVA oil, SPLENDA Brand Sweeteners, Hi-maize resistant starch, Blue Bunny Frozen Desserts, as listed at her site) happy.

    I think Hope Warshaw is a classic case of the phenomenon described in “Mistakes Were Made (but not by me).” She’s been parroting the same old nonsense for so long, she can’t bring herself to admit she’s been wrong all this time.

    Reply
  33. Judy

    Barbaric doesn’t even come close to this surgery.

    A friend of mine had gastric bypass 8 or so years ago – to lose weight, get off heart meds, diabetic meds, etc., and he wasn’t that overweight.

    After two! surgeries, complications (which I blame on the idiot surgeon – hence the second surgery), and 4 months on a feeding tube, he’s still vomiting 3-4 times a week. Sure, he’s lost weight and kept it off. He’s also lost all his teeth. He’s on so many meds they’re a meal in themselves – blood pressure, sleeping pills, antipsychotics (lithium, etc.), and more. He has episodes where he can’t remember anything for 6-8 weeks at a time. He can’t work and is on full disability.

    The best part? I asked him a few years ago (before the psychotic episodes got so bad) if he knew then what he knows now, would he still go through with the surgery? The answer? YES! No hesitation whatsoever.

    Forget banging my head on the desk. Shoot me now.

    That’s horrible. I can’t believe he’d do it again if given the chance. Wow.

    Reply
  34. Janknitz

    It seems to me the logical solution would be to require the patient to try the post op diet (perhaps with more calories and fat to adjust for hunger) for 6 or 8 weeks (or more) BEFORE being accepted for surgery ( the low carb diet, not the low fat diet which is a fake-out, as Phillipa states).

    If the individual is successful with the same diet that will have to be followed post-operatively, he or she can consider:
    1. If it’s possible to do well on just the diet, do I really need the surgery?
    2. Do I really want to be on this type of diet for the rest of my life–there will be no choice if I have the surgery?
    3. Is it worth risking the surgery to “keep me honest” on this diet? (For some people, this may be the real issue–they may welcome the physiological consequences as a mechanism to keep them on the diet ).

    At that point, the patient is making a truly informed decision if he or she chooses to go forward with the surgery.

    If the individual fails at the diet, then he or she should not be permitted to undergo the surgery because he or she has demonstrated that he/she cannot comply with the post operative plan.

    I see the point, but part of their reasoning is that people who can’t stick a diet will so if they have no choice. Also from what I’ve been told, the smaller stomach means less hunger even with the tiny meals.

    None of that means I think the surgery is a good idea.

    Reply
  35. Peter

    Bariatric is an invasive surgery. A NY Times graphics:
    http://www.nytimes.com/interactive/2012/03/27/science/bariatric-surgery.html?ref=science
    Experts like Hope Warshaw, Ornish, Campbell, Esselyn and Oz, remind me of the defenders the 60’s who proclaimed tobacco was quite safe and didn’t cause cancer. I saw a debate between Warshaw and Dr. Berstein. In the vid, Dr. Berstein chewed a bit of little bit of supposedly wholesome whole-grain bread, tested his saliva with a glucose strip and made it turned blue. Warshaw simply ignored it and kept on mouthing high-carb (45-65% daily calories) eating as healthful for T2D. Really?
    But then, she must ignore the evidence in order to keep her paying clients (ENOVA oil, SPLENDA Brand Sweeteners, Hi-maize resistant starch, Blue Bunny Frozen Desserts, as listed at her site) happy.

    I think Hope Warshaw is a classic case of the phenomenon described in “Mistakes Were Made (but not by me).” She’s been parroting the same old nonsense for so long, she can’t bring herself to admit she’s been wrong all this time.

    Reply
  36. Judy

    Barbaric doesn’t even come close to this surgery.

    A friend of mine had gastric bypass 8 or so years ago – to lose weight, get off heart meds, diabetic meds, etc., and he wasn’t that overweight.

    After two! surgeries, complications (which I blame on the idiot surgeon – hence the second surgery), and 4 months on a feeding tube, he’s still vomiting 3-4 times a week. Sure, he’s lost weight and kept it off. He’s also lost all his teeth. He’s on so many meds they’re a meal in themselves – blood pressure, sleeping pills, antipsychotics (lithium, etc.), and more. He has episodes where he can’t remember anything for 6-8 weeks at a time. He can’t work and is on full disability.

    The best part? I asked him a few years ago (before the psychotic episodes got so bad) if he knew then what he knows now, would he still go through with the surgery? The answer? YES! No hesitation whatsoever.

    Forget banging my head on the desk. Shoot me now.

    That’s horrible. I can’t believe he’d do it again if given the chance. Wow.

    Reply
  37. northern_sky

    This article resonates with me quite strongly. Many years ago, my mom became afflicted with constant migraine headaches. After trying all of the usual drugs for migraine that were available in the early 90’s, our family doctor insisted that the headaches were due to the extra weight that she had, and referred her to a bariatric surgeon. She underwent the surgery in 1993, long before laparoscopic surgery was the norm.

    The end result was a multitude of health problems many orders of magnitude greater than the headaches she suffered. She had to take vast quantities of painkillers to manage her headaches, as her digestive system could no longer absorb more than 10-15% of the pills before being passed though her system. She suffered constant digestive distress. She had multiple instances where vitamin deficiencies and anemia put her in the hospital, often near death.

    We lost her in 2007. Her bowel became blocked and perforated, causing sepsis. All due to the problems she had suffered from the surgery 14 years before.

    I watched your movie late last year, and started on a low-carb diet on Ash Wednesday of this year. I have already lost 20 pounds, my blood pressure has dropped dramatically, and I no longer suffer from depression as I once did. When I think about all the doctors over the years that wanted me to walk the same path as my mom, I almost get too angry to speak. If the advice my mom had gotten hadn’t been so bad, she very likely would still be with us, lighting our lives with her smiles and her kind words. It makes me sad and furious that so many others are suffering similar fates.

    Thank you for your continues work in this. I also hope and pray for the day that bariatric surgery will be thrown onto the junkpile of history.

    I hope so too. I’m sorry to hear about your mom.

    Reply
  38. northern_sky

    This article resonates with me quite strongly. Many years ago, my mom became afflicted with constant migraine headaches. After trying all of the usual drugs for migraine that were available in the early 90’s, our family doctor insisted that the headaches were due to the extra weight that she had, and referred her to a bariatric surgeon. She underwent the surgery in 1993, long before laparoscopic surgery was the norm.

    The end result was a multitude of health problems many orders of magnitude greater than the headaches she suffered. She had to take vast quantities of painkillers to manage her headaches, as her digestive system could no longer absorb more than 10-15% of the pills before being passed though her system. She suffered constant digestive distress. She had multiple instances where vitamin deficiencies and anemia put her in the hospital, often near death.

    We lost her in 2007. Her bowel became blocked and perforated, causing sepsis. All due to the problems she had suffered from the surgery 14 years before.

    I watched your movie late last year, and started on a low-carb diet on Ash Wednesday of this year. I have already lost 20 pounds, my blood pressure has dropped dramatically, and I no longer suffer from depression as I once did. When I think about all the doctors over the years that wanted me to walk the same path as my mom, I almost get too angry to speak. If the advice my mom had gotten hadn’t been so bad, she very likely would still be with us, lighting our lives with her smiles and her kind words. It makes me sad and furious that so many others are suffering similar fates.

    Thank you for your continues work in this. I also hope and pray for the day that bariatric surgery will be thrown onto the junkpile of history.

    I hope so too. I’m sorry to hear about your mom.

    Reply
  39. Susan

    Many years ago, I worked on a hospital surgical floor. A patient came in for a revision to her previous bariatric surgery. This was pre Lapband when they actually removed part of the stomach. She had eaten enough to stretch her remaining stomach so it wasn’t working for her anymore. She almost died from the second surgery and the post op complications. I was glad to see her finally go home after weeks in the hospital, but I knew she would probably be back again the day she came in to give the nurses a plate of Pecan Tassies (basically, little bite sized pecan pies). You just know she couldn’t get away without a least a few samples.

    Yikes. She’ll probably stretch it again.

    Reply
  40. ZergGirl

    I wish I could go back in time and tell my friends who have had this surgery to eat Paleo/Primal/LCHF for just two months and then make their decision.

    The “after surgery” diet is completely in tune with my needs after having switched to LCHF. A four-ounce rare filet mignon, a few mushrooms sauteed in butter, maybe a bite or two of kale or, if I’m feeling like a bit of sweet, a slice of canteloupe…..that is a perfect lunch right there!

    I do have the benefit of getting to shred my meat with my teeth, which is a lot more convenient and pleasurable than using a food processor… (to quote my 3-y/o niece, “that’s just ewwwwwww!”)

    Ewwww is right.

    Reply
  41. Susan

    Many years ago, I worked on a hospital surgical floor. A patient came in for a revision to her previous bariatric surgery. This was pre Lapband when they actually removed part of the stomach. She had eaten enough to stretch her remaining stomach so it wasn’t working for her anymore. She almost died from the second surgery and the post op complications. I was glad to see her finally go home after weeks in the hospital, but I knew she would probably be back again the day she came in to give the nurses a plate of Pecan Tassies (basically, little bite sized pecan pies). You just know she couldn’t get away without a least a few samples.

    Yikes. She’ll probably stretch it again.

    Reply
  42. ZergGirl

    I wish I could go back in time and tell my friends who have had this surgery to eat Paleo/Primal/LCHF for just two months and then make their decision.

    The “after surgery” diet is completely in tune with my needs after having switched to LCHF. A four-ounce rare filet mignon, a few mushrooms sauteed in butter, maybe a bite or two of kale or, if I’m feeling like a bit of sweet, a slice of canteloupe…..that is a perfect lunch right there!

    I do have the benefit of getting to shred my meat with my teeth, which is a lot more convenient and pleasurable than using a food processor… (to quote my 3-y/o niece, “that’s just ewwwwwww!”)

    Ewwww is right.

    Reply
  43. Marilyn

    Judy, did you have a chance to look at the Junkfood Science link in Emilln’s post? There are other stories there similar to yours.

    Reply
  44. Marilyn

    Judy, did you have a chance to look at the Junkfood Science link in Emilln’s post? There are other stories there similar to yours.

    Reply
  45. LaurieLM

    I observed a delivery many years ago. It was fascinating. The Mom was delivering her second child. She was almost there, but she was anxious and in pain and she was pleading, loudly and persistently for pain relief . Her body was clearly giving her signals to push. I swear on a stack of bibles that this is what the Doc said to her. “Stop pushing or the baby will be born before I can give you your spinal.”

    I don’t fault the Doc really, it is what he was trained to do. I read the article about bariatric surgery supposedly curing diabetes. My Doc friend sent it to me (ironically my Doc friend is an OB GYN). This insanity will stop at some point. Re-plumbing the body and hacking out body parts will go the way of the DODO eventually and it cannot happen soon enough.

    We can hope.

    Reply
  46. LaurieLM

    I observed a delivery many years ago. It was fascinating. The Mom was delivering her second child. She was almost there, but she was anxious and in pain and she was pleading, loudly and persistently for pain relief . Her body was clearly giving her signals to push. I swear on a stack of bibles that this is what the Doc said to her. “Stop pushing or the baby will be born before I can give you your spinal.”

    I don’t fault the Doc really, it is what he was trained to do. I read the article about bariatric surgery supposedly curing diabetes. My Doc friend sent it to me (ironically my Doc friend is an OB GYN). This insanity will stop at some point. Re-plumbing the body and hacking out body parts will go the way of the DODO eventually and it cannot happen soon enough.

    We can hope.

    Reply
  47. Judy

    Thanks Marilyn. I’ll check it out. He has a tendency to believe his doctors even when he dislikes what they say. sigh. Yeah, he’s got all these problems, but hey! he’s lost weight and he’s not diabetic. See? Proof the surgery works. I’d bang my head on the desk, but my supper is in the way.

    Speaking of supper: For all you bacon lovers out there…I just read about a restaurant in Minneapolis that makes a special bacon burger – 50/50 ground bacon and ground beef. Thought I’d try making it myself at home tonight. I just chopped up the (uncured) bacon really small and added it to some pasture-raised ground beef. Topped it with a bit of Swiss cheese. YUM!! Of course, it has bacon. What’s not to love?

    Too bad I already had dinner. I may have to try that tomorrow.

    Reply
  48. Judy

    Thanks Marilyn. I’ll check it out. He has a tendency to believe his doctors even when he dislikes what they say. sigh. Yeah, he’s got all these problems, but hey! he’s lost weight and he’s not diabetic. See? Proof the surgery works. I’d bang my head on the desk, but my supper is in the way.

    Speaking of supper: For all you bacon lovers out there…I just read about a restaurant in Minneapolis that makes a special bacon burger – 50/50 ground bacon and ground beef. Thought I’d try making it myself at home tonight. I just chopped up the (uncured) bacon really small and added it to some pasture-raised ground beef. Topped it with a bit of Swiss cheese. YUM!! Of course, it has bacon. What’s not to love?

    Too bad I already had dinner. I may have to try that tomorrow.

    Reply
  49. Sandy

    I am one of those poor people who was “duped” into bariatric surgery 12 years ago. Changed my life for the better. No longer diabetic. Some of you have no clue what you’re talking about. I work in bariatric medicine and I see 9 good story to every 1 bad story. Often those bad stories are people who do not do what they are told to do. So sorry for all of the ignorance that I am reading on here. It’s sad because this surgery saves many more lives than you would like to believe. Some of you are so busy bashing something that you have no idea about. Do a little research…how about that?? (SMH)

    I have done a little research. More than a little. I’ve also heard from plenty of people who regret the surgery, including a close friend who hasn’t had normal digestion ever since.

    “I work in bariatric medicine …” Yeah, I could’ve figured as much.

    Reply
  50. Sandy

    I am one of those poor people who was “duped” into bariatric surgery 12 years ago. Changed my life for the better. No longer diabetic. Some of you have no clue what you’re talking about. I work in bariatric medicine and I see 9 good story to every 1 bad story. Often those bad stories are people who do not do what they are told to do. So sorry for all of the ignorance that I am reading on here. It’s sad because this surgery saves many more lives than you would like to believe. Some of you are so busy bashing something that you have no idea about. Do a little research…how about that?? (SMH)

    I have done a little research. More than a little. I’ve also heard from plenty of people who regret the surgery, including a close friend who hasn’t had normal digestion ever since.

    “I work in bariatric medicine …” Yeah, I could’ve figured as much.

    Reply

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