Recently, I attended a convention of the American Diabetes Association in New York City where the main booth heralded a breakthrough "cure" for diabetes. Excited to think I might learn something new, I hustled right over. Imagine my dismay when all the information at the booth was about weight loss surgery!
Do we need a cure? Absolutely!
Is surgery a one-size-fits-all solution for diabetes? No way.
I understand the desire to find a solution. After all, Type 2 diabetes is looming as the biggest epidemic and public health issue in human history. Close to 300 million people are affected worldwide and another 150 million forecast to be diagnosed by 2030. The reason? Obesity.
Yes, obesity is a tenacious problem, but surgery is only a Band-Aid solution, albeit one that is growing in popularity. In the last decade alone, the rate of weight loss surgeries performed each year in the U.S. has increased from 10,000 to 230,000. But how many of the 1.7 billion overweight citizens of the world can afford gastric bypass? And how many of those will regain the weight?
I have seen many patients go under the knife for these procedures only to gain back the weight they lost, plus some. Weight loss surgery may seem like a panacea, but it won't solve the underlying hormonal and metabolic imbalances that are driving the diabetes and obesity.
My patient Alan is a prime example. Alan has been overweight since he was 6 years old and never experienced a day without ravenous hunger. At age 40, he had gastric bypass surgery and shrunk from 450 pounds to 250 pounds. The size of his stomach changed, but his overall lifestyle did not. Eventually, he gained back 100 pounds. Even with a stomach the size of a walnut, he managed to gain weight one tiny, fattening bite at a time. By the time he landed in my office, he was 60 years old and tired of juggling all the complications of weight loss surgery.
The Reality of Gastric Bypass: What Doctors Don't Tell You
Alan is hardly an anomaly. A report on the effectiveness of weight loss surgery published by the Agency for Healthcare Research and Quality found that within 3 to 5 years after laparoscopic gastric banding, as many as one-third of patients are not able to maintain weight loss due to noncompliance with a prescribed diet and other issues. Plus, the complications stemming from lap band surgery were as high as 30 percent.
We also know that weight loss surgery is not without risks. Altering the gastrointestinal tract can lead to nutritional deficiencies that require lifelong monitoring and supplementation of calcium, vitamin B12, folate, multivitamins, iron, and thiamine. And the psychological risks of these surgeries are often underplayed. In 2010, a study published in the American Journal of Medicine showed a dramatic increase in suicide among patients who had bariatric surgery, most occurring within three years following the surgery (1).
Even more disturbing is the rise in overweight teens choosing weight loss surgery. Since the late '90s, the number of weight loss procedures performed on teenagers has skyrocketed (2). Some studies show the mean age of these young patients is just 16 years old, with some as young as 12! (3) Very few studies have looked at the long-term ramifications of these surgeries. What kind of problems are we passing on to our youth?
A Better Solution
Instead of glorifying the ability of weight loss surgery to stem the tide of Type 2 diabetes in this country, we need to remember that Type 2 diabetes is an entirely preventable and reversible lifestyle disease. Let me repeat: There is clear evidence from the scientific literature that diabetes is reversible, especially if it is caught early and treated aggressively through lifestyle intervention and nutritional support, and occasionally with medications (4). In many cases even later stage diabetes can be reversed with very intensive lifestyle changes, medications and supplements.
A groundbreaking new study from England showed unequivocally that people with advanced Type 2 diabetes, when the pancreas has lost its oomph and the insulin-producing (beta) cells are damaged, can reverse the course of the disease in just one week by optimizing dietary strategies, such as eating low-glycemic foods and staying on a low-calorie diet (5). One week!
The best news is that dietary changes alone can help your body heal. Studies of patients who have weight loss surgery show that even a dramatic change in diet in a short period of time creates beneficial metabolic changes (6). All the metrics we thought were related to obesity, such as high blood sugar, high cholesterol, high blood pressure, inflammation, and clotting, are drastically reduced even without significant weight loss due to the rapid effects of dietary changes on the body. (For more information on how to reverse diabetes with diet, see The Blood Sugar Solution.)
Let me be clear: Maintaining a healthy weight is ideal for optimal health. But we shouldn't be signing up for surgery without exhausting every other avenue. Curing diabetes with surgery relies on outdated ideas about the origins of disease and overlooks the complex web of biology as well as the social, political, and economic conditions at the root of our current epidemic.
We can do better.
To learn more please see The Blood Sugar Solution. Get one book or get two and give one to someone you love -- you might be saving their life. When you purchase the book from this link you will automatically receive access to the following special bonuses:
Now I'd like to hear from you...
Have you considered bypass surgery?
Do you experience nutritional deficiencies due to bypass surgery?
Have you battled with weight loss?
Please leave your thoughts by adding a comment below.
To your good health,
Mark Hyman, MD
References:
(1) Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long-term follow-up from bariatric surgery, Am J Med. 2010 Nov;123(11):1036-42
(2) Nguyen NT, Karipineni F, Masoomi H, Laugenour K, Reavis K, Hohmann S, Varela E. Increasing utilization of laparoscopic gastric banding in the adolescent: data from academic medical centers, 2002-2009. Am Surg. 2011 Nov;77(11):1510-4.
(3)Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J. National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J AM Coll Surg. 2008 Sep;207(3):458
(4) Diabetes Prevention Program Research Group, Knowler WC, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
(5) Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011 Jun 9.
(6) Saliba J, Wattacheril J, Abumrad NN. Endocrine and metabolic response to gastric bypass. Curr Opin Clin Nutr Metab Care. 2009 Sep;12(5):515-21. Review.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
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Could you please touch on the subject of why the pancreas would stop producing ideal levels of insulin in the case of postprandial hypoglycemia (often found in menopausal and post menopausal women and the speculation that the loss of estrogen has triggered it ) which can lead to diabetes in people eat well, exercise and do have good body weight, blood work, BP etc.
However....
Vitamin D in healthy amounts- the ideal range endorsed by the ES is 30-60 ng/ml, 25 OH, appears to prevent insulin resistance.
Vitamin D deficiency is at the core of diabetes. Look at the research and take heed!
Are you kidding me??????????????????
Raise, and maintain, circualting vitamin D to th healthy range of 30-60 ng/ml.
For life!!!!!!!!!!!!!!!!!!!!!!!
The Endocrine Society has endorsed this fact (after trying everything else) and it works.
Calorie (noun) Tiny creatures that live in your closet and sew your clothes a little bit tighter every night.
http://www.pcrm.org/shop/byNealBarnard/dr-barnards-program-for-reversing-diabetes
If you think it isn't edible unless it is fried, changing your diet is practically impossible. The answer does not lie with the present generation of home cooks, but the next one. If children can be enticed to eat nutritious foods they might not experience at home and actually prefer them, perhaps they will pass on those new food choices to their progeny.
The solution is neither quick nor easy.
You're kidding, right? Self-indulgent over-eating is driving the diabetes and obesity epidemic...PERIOD! And don't go claiming that you're a victim of the fast-food industry or corn syrup sweeteners. YOU EAT TOO MUCH!
The solution to obesity/diabetes SHOULD have been included in the health care reform bill. That bill should have mandated that those who deliberately damage their health through compulsive over-eating, drug/alcohol abuse, smoking and other lifestyle habits must pay higher health care premiums than responsible insureds. Not only would that have more fairly reduced insurance premiums for responsible citizens but it would have provided a strong motivator to the health abusers to clean up their acts, thereby achieving a more healthy lifestyle in the process.
However, I am a fallible one. Give me one sniff of a french fry, and I'm a goner. I absolutely love hard cider. Candy? Can't resist it. Pizza is an entire food group as far as I am concerned. But I KNOW this is wrong, which is why I spend an hour on the treadmill from 5 to 6 every morning atoning for my sins.
If it is this hard for me, and I am a 64 year old MBA who owns her own business, what must it be for those who were not taught self-reliance and self-denial from birth? I am guilted onto the treadmill. What is going to get everyone else there?
My post offered one suggestion, i.e., the financial incentive of a lower health care premium if you eliminate unhealthy lifestyles. This approach has already been adopted by employee health plans at some companies and the results have been interesting. While there were strong negative reactions from smokers, et al in the beginning, many openly changed their tune after a year, crediting the higher premiums with nudging them toward quitting smoking, losing weight, etc. Pretty cool result for something that actually makes premiums fairer AND improves people's habits!
As for me, I'm 66, also an MBA (UCLA), a junk-food junky and a former smoker (quit at age 28). But at 6'2" and 165#, I'm hardly overweight. I walk three miles a day, work out with weights and keep my junk food cravings under tight control.
Undoubtedly many kids fail to learn self-discipline early on but with the right incentives, adults can develop the control necessary to turn things around. Too bad that the HCR missed such a great opportunity...although few pols would've supported something that jacked up rates on overweight, smoking, drinking VOTERS!
Mom did, once my dad died, loosened up on her diet. She didn't have so much sugary stuff, but liked to eat salty, crunchy stuff with her one cocktail before dinner. I think she was less controlled then.
I learned in my 30's that I was sensitive to sugar, wheat and several other foods. Bad news: eating out is a bit difficult, some restaurants have little I can eat. Good news: I never encounter foods like corn syrup, etc., since prepared or boxed foods have ingredients I can't tolerate. So I eat really healthy and my blood sugar stays normal.
At first, it seems like a person is giving up so much. It can seem so daunting to just get one meal prepared when a person is used to grabbing a frozen prepared meal or opening a box to make a quick meal. But when you start FEELING better, and seeing the results that you're after, it's all worth it. After awhile, it's just the normal routine.