Sometimes when I read health and medical articles in the newspaper, I don’t know whether to laugh, cry, scream, or just bang my head against the wall. If memory serves, a recent article about the wonders of gastric-bypass surgery prompted a full round of each, followed by a string of expletives that made me grateful my daughters were in school. (If my memory is fuzzy, it’s probably because of the head-banging.)
The article, which appeared in our local newspaper but originated with the Los Angeles Times, was headlined: Gastric bypass: Is it a diabetes fix? Here is a link to the online version so you can read the full story in all its glorious stupidity. In the meantime, I’ve pasted several snippets below, with my comments interspersed.
The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvements in the control of Type 2 diabetes, often before patients had even left the hospital.
Wow, that’s amazing! I wonder what it is about having surgery that reduces a patient’s runaway blood sugar so quickly. Perhaps by the time most of us reach adulthood, we have a big wad of undigested cotton candy sitting in our small intestines, left over from childhood trips to the state fair. Remove the intestines, remove the cotton candy. Makes sense.
Or perhaps it has something to do with the post-surgery diet, which consists of two to three ounces of sugar-free liquids or sugar-free gelatin. Newsflash: if you stop dumping sugar and starch into your digestive system, your blood sugar goes down.
Today, evidence of the connection is so solid that some doctors say surgery should be considered as a treatment for diabetes, regardless of a person’s weight or desire to lose weight.
Yes, more surgery is clearly the answer. Granted, a couple of generations ago we had only a fraction of the Type 2 diabetes rate we see today, and that was long before surgeons were comfortable ripping people’s guts out. But what the skeptics forget is that safety standards were lax in those days, and lots of people used to accidentally rip their own guts out in day-to-day activities like chopping wood, tossing lawn darts, and going fishing with really big hooks. It’s much safer and far less painful to let a surgeon remove your intestines.
“We thought diabetes was an incurable, progressive disease,” says Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery.
Well, of course you did, Doctor Doofenshmirtz. That’s because people in your profession have been trying to cure diabetes with low-fat diets, then scratching their heads in amazement when the diets don’t work. By the way, if you’re ever quizzed on the topic of alcoholism, the answer is: No, you can’t cure it by switching from bourbon to scotch. I thought you should know.
“This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It’s unbelievable.”
No, I believe it. They’re able to go off their medication because the surgery also forces them to go off sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream. In fact, about all they can eat are tiny portions of meat and vegetables.
But experts still aren’t sure why obesity surgery helps resolve Type 2 diabetes or how long the effect might last.
It’ll last as long as the newly-mangled patients avoid sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream
This much is clear: Patients who have weight-loss surgery begin to lose weight rapidly, which by itself improves Type 2 diabetes, allowing diabetics to more easily control their blood glucose levels. But something else appears to be occurring as well.
The “something else” is what’s not occurring: consuming sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream
There is strong evidence that surgery — especially gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine — causes chemical changes in the intestine, says Dr. Jonathan Q. Purnell, director of the Bionutrition Unit at Oregon Health & Science University.
Yes, all kinds of wonderful changes occur in the digestive system when you rip out several feet of it. Here are just a few:
- Reduced ability to absorb fat-soluble vitamins, leading to chronic deficiencies in vitamins A, B12, D, E and K – even if you take a lot of supplements.
- Dumping of poorly-digested food into the large intestine, causing dizziness, bloating, diarrhea and fatigue.
- Nausea and vomiting
But researchers now suspect it has other functions related to metabolism.
Of course it does, you @#$%ing idiots! When you’re limited to a few ounces of protein and vegetables per day and have to give up sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream, your metabolism changes.
Surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.
No, making a drastic change in your diet alters the secretion of hormones. When you give up sugar and starch, you don’t need nearly as much insulin anymore. Ask Dr. Jay Wortman. He gave up sugar and starch after becoming a Type 2 diabetic, and he doesn’t need medication either. (But of course, the Canadian government is convinced his new diet causes heart disease.)
But diabetes also tends to resolve or improve in 50% to 80% of people who have lap-band surgery, in which a band is placed around the top of the stomach to make it smaller, he says. And there is some evidence that the effect occurs in a newer type of weight-loss surgery called gastric sleeve, in which a portion of the stomach is removed so that it takes the shape of a tube or sleeve.
Uh, what a minute … I thought you were just telling us that removing several feet of the intestines creates magical hormonal changes. The lap band and the lap sleeve just force you to eat less — which for most people means focusing on protein foods and giving up sugar and starch. Do you see the contradiction here?
Evidence suggests the effect on diabetes can last for an extended period or even indefinitely, particularly if people don’t regain a lot of weight.
It’s not regaining the weight that causes diabetes to return. The weight gain and the diabetes are both caused by people deciding they can fill their itty-bitty stomachs with itty-bitty servings of sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream. Then they get insulin spikes that make them ravenously hungry, so they eat more than they’re supposed to. Some even manage to stretch their itty-bitty stomachs back to a nearly-normal size.
“There is durability, but we also know that some people do get the disease back again,” Purnell says… It’s not clear yet why people have different responses.
Well, let me take a shot at explaining this mystery, Dr. Frankenstein: some people stick to the recommended post-surgery diet of meat and vegetables. Some people go back to eating the sugar and starch that made them fat and diabetic in the first place.
Studies from several other countries show that surgery also results in remission of diabetes for people who are not morbidly obese.
So let me get this straight: obesity causes diabetes, yet we can cure people who aren’t obese but still have diabetes by ripping their guts out and forcing them to stop filling up on sodas, corn chips, bread, Cocoa Puffs, mashed potatoes, pancakes, cookies, bagels, french fries, snickerdoodles, Little Debbie Snack Cakes, Twinkies, and Chunky Monkey ice cream. Call me crazy, but it’s starting to sound like diet might have something to do with developing Type 2 diabetes. (No, wait … it’s a progressive, incurable disease that nobody can really explain …)
There is even discussion, particularly in other countries, of performing weight-loss surgery for people with Type 2 diabetes who are not overweight.
Of course there is. Other countries don’t have our obesity rate. How the heck are the bariatric surgeons in France and Spain supposed to make a living if they’re only allowed to operate on fat people?
“Doctors say, ‘If I can lower glucose by medications, why send patients to surgery?'” Purnell says. “Surgery, however, allows people to have meaningful and sustained weight loss and their diabetes is better. There are risks involved with surgery, obviously, but it makes sense, to me, to do surgery.”
Spot-on, Dr. Frankenstein. As you know from your advanced medical training, there are only two types of treatments that can make sick people well: drugs and surgery.
Now if you’ll excuse me, I need to go bang my head against the wall.