Asked by Rick Shetron, Troy, New York
"60 Minutes" had a story several months ago about a type of weight-loss surgery that seemed to also cure type 2 diabetes in many people. Has more research been done on this? Do you need the full bypass of about one-third of the small intestine or just the duodenum and jejunum? My weight problem came about with/after diabetes, not before.
Diet and Fitness Expert
Dr. Melina Jampolis
Physician Nutrition Specialist
Hi, Rick. I'm not a surgeon, so to answer your question more thoroughly, I consulted with a very well-respected bariatric surgeon in San Francisco, John Rabkin, M.D. He explained that the roux-en-Y gastric bypass (RGB) improves type 2 diabetes via at least three different mechanisms:
1. The surgery decreases caloric intake immediately after the procedure because food intake is restricted by the small volume of the created stomach pouch, which holds only 1 ounce. The decrease in food intake, particularly refined carbohydrates, which are not well-tolerated after this procedure, can help stabilize blood sugar levels and immediately improves control of diabetes.
2. The significant amount of weight loss that results from the surgery improves insulin resistance over time.
3. There are changes in hormones and caloric processing because the food ingested bypasses the segment of the small intestine closest to where it attaches to the stomach (the duodenum and proximal jejunum), but not quite as much as you mentioned (not one-third of the small intestine). Because of the anatomical changes resulting from the surgery, it appears that these hormonal changes are greater than would be seen with weight loss via diet and exercise, but no research has yet to compare the two directly and evaluate hormonal changes.
The overall outcome is complete resolution of type 2 diabetes in greater than 70 percent of patients with diabetes before the procedure.
Unfortunately, as many RGB patients regain weight over time, the durability of the cure isn't as high as with a newer procedure called the duodenal switch.
In this procedure, there is a much larger pouch created (4 to 5 ounces), and the complete stomach anatomy is preserved, which helps preserve more normal stomach function. In this procedure, the rearrangement of the intestines leads not only to some restriction of food, but also causes your body to absorb significantly fewer calories, which has a more lasting effect.
Rabkin, a leader in this procedure, reports that he has had a 96 percent cure of type 2 diabetes at one year after surgery, which has persisted for five and 10 years post -op and seems to be similarly durable out past 15 years post-op.
Hope this helps. I strongly recommend spending a considerable amount of time with your surgeon if you are considering either of these procedures, as both have important lifestyle-related issues that should be discussed to determine the best procedure for you for the long term.
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