Two seemingly groundbreaking studies, published this week in the New England Journal of Medicine found that Type 2 diabetes, or "diabesity," could be cured with gastric bypass surgery. The flurry of media attention and medical commentary hail this as a great advance in the fight against diabetes. The cure was finally discovered for what was always thought to be a progressive incurable disease. But is this really a step backwards? Yes, and here's why.
No one is asking the most obvious question. How did the surgery cure the diabetes? Did the surgeons simply cut out the diabetes like a cancerous tumor?
No. The patients in the studies changed their diet. They changed what they put in their stomach and that's something that doesn't require surgery to change. If they had surgery and they didn't stop bingeing on donuts and soda they would get violently ill and vomit and have diarrhea. That's enough to scare anyone skinny. If I designed a study that gave someone an electric shock every time they ate too much or the wrong thing, I could reverse diabetes in a few weeks. But you can get the benefits of a gastric bypass without the pain of surgery, vomiting and malnutrition.
Most don't realize that after gastric bypass, diabetes can disappear within a week or two while people are still morbidly obese. How does that happen? It is because food is the most powerful drug on the planet and real, whole, fresh food can turn on thousands of healing genes and hundreds of healing hormones and molecules that create health within days or weeks. In fact, what you put on your fork is more powerful than anything you can find in a prescription bottle.
The researchers asked the wrong question. It should not have been, "Does surgery work better than medication?" but "Does surgery work better than intensive lifestyle and diet change?"
Astonishingly, the researchers just compared surgery to medication, which has been proven over and over not to reverse diabetes, and often promotes progressive worsening of the diabetes. Patients who go on insulin gain weight, and their blood pressure and cholesterol go up. And in recent studies, those who had the most aggressive medical therapy to lower blood sugar had higher rates of heart attack and death.
These two new studies on gastric bypass should have included a treatment group that had intensive lifestyle therapy as well as medical therapy or surgery.
Lifestyle change and changes in diet work faster, better and more cheaply than any medication and are as effective or more effective than gastric bypass without any side effects or long-term complications. These changes are not easy, but then neither is gastric bypass.
A recent study entitled Reversal of Type 2 diabetes: normalization of beta cell function in association with decrease pancreas and liver triglycerides proved that diet alone could reverse Type 2 diabetes. The bottom line: A dramatic diet change (protein shake, low glycemic load, plant-based low-calorie diet but no exercise) in diabetics reversed most features of diabetes within one week and all features by eight weeks. That's right, diabetes was reversed in one week. That's more powerful than any drug known to modern science, and is as or more effective than gastric bypass. But since it was a diet study, it got no press or attention. Other research proves that intensive lifestyle therapy can achieve the same results.
We don't have to heal with steel, we can heal with meals.
As I write this, new guidelines and insurance coverage for this new surgical diabetes cure are in motion. But this is a grave mistake. One in four people over 65 years old, nearly one in five African Americans and almost one out of 10 of our whole population have Type 2 diabetes. By 2050, there will be one in three Americans with Type 2 diabetes.
Recommending gastric bypass as a national solution for our diabetes epidemic is bad medicine and bad economics. If the nearly 30 million diabetics in America took advantage of this new miracle cure at $25,000 a pop, it would cost three-quarters of a trillion dollars ($750,000,000,000). If we paid people $100 a pound to lose weight, we would still be better off. To treat the nearly 400 million diabetics around the globe, would cost $10 trillion. Does this make any sense?
Shrinking someone's stomach to the size of a walnut with surgery is one way to battle obesity and diabetes and may be lifesaving for a few, but it doesn't address the underlying causes. And many will regain the weight because they didn't change their understanding of their bodies or relationship to food.
Clearly, weight loss is critical and important for obtaining optimal health. However, what we are finding in patients who have gastric bypass surgery is that even a dramatic change in diet in a short period of time creates dramatic metabolic changes.
All the parameters that we thought were related to obesity, such as high blood sugar, high cholesterol, high blood pressure, inflammation and clotting, are dramatically reduced even without significant weight loss because of the rapid effects of dietary changes that control which genes get turned on or off. This is called nutrigenomics -- the way food talks to your genes. While weight loss is important, what's more important is the quality of food you put in your body -- food is information that quickly changes your metabolism and genes.
Unless we address the root causes -- what we eat, our sedentary lifestyle and the social and environmental conditions that drive obesity and disease -- we will have tens of millions more diabetics lining up for stomach stapling! The only ones to benefit would be the bariatric surgeons, the makers of the surgical instruments and the hospitals who are paid handsomely.
To paraphrase President Clinton, "It's the food, stupid!"
My book, The Blood Sugar Solution, is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society. Obesity and diabetes are social diseases and we need a social cure, not a surgical one.
My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment and reversal of our diabesity epidemic.
To learn more and to get a free sneak preview of the book go to www.drhyman.com.
Now I'd like to hear from you...
Do you think we should promote a gastric bypass as a national strategy to deal with the diabetes epidemic?
How have you reversed diabetes with food?
Have you had gastric bypass and did you maintain the weight loss? Or gain it back?
Please leave your thoughts by adding a comment below.
To your good health,
Mark Hyman, MD
For more by Mark Hyman, M.D., click here.
For more on diabetes, click here.
For more on personal health, click here.
Follow Mark Hyman, MD on Twitter: www.twitter.com/markhymanmd
David Katz, M.D.: The Calorie: Excess Heat, Too Little Light
Surgery in two weeks.
You say "Everybody already knows that a healthy diet will improve type 2 diabetes" well improving, managing, maintaining diabetes is unnecessary if it is cured. I don't want to be diabetic anymore. Sure I could suffer other maladies if I choose not to eat right - but diabetes is killing me whether I eat right or not, end of story.
A big problem here is that the diet most doctors are still recommending is not what people need. Doctors telling people that the way to deal with type II diabetes is to limit their meat consumption and up their consumption of "good carbs" like fruit and whole grains.
Rather, they should be pointing people to something that more closely resembles a ketogenic diet.
As you state in your article, it didn't take long to see a measurable change for the better. As I am regaining my mobility, I'll be out walking and doing light cardio exercising in addition to the strategy we have thus far employed.
My plan is to be completely free from this disease by the end of the year. At the pace we're going, I am very confident we'll make it.
When I tried to give him my thanks, I found his post had been *removed*! What on earth could be so bad about what he said? Sheesh.
1) I have seen similar reversals in the same time frame when people completely restrict carbs
2) a bariatric surgeon told me that he routinely puts his patients on a pre-op diet that is very low carb in order to shrink the fatty liver so it doesn't get in the way of the laparoscopic instruments
3) another bariatric surgeon told me that the post-op diet is very low in carbs
Let's do an RCT where one arm gets the pre-op low carb diet, the surgery and the post-op low carb diet and the other arm gets everything but the surgery. I think you would see similar results.
~Rachel Anne Manning