When I started to research this topic that was the first question that came to my mind. Apparently, bariatric surgery has an extraordinary effect on type 2 diabetes. It completely reverses the metabolic condition in roughly two-thirds of patients.
I first heard of this about two years ago but apparently it’s been observed as an outcome in these surgeries for over ten years. This warrants the question: Is the bariatric surgery cure for type 2 diabetes legit? Read on.
Kinds of Bariatric Surgery
There are generally four types of these surgeries today. If you’d like to learn more, you can click on each surgery name to take you to its Wikipedia article. They are:
- Roux-en-Y Gastric Bypass – Alters the gastrointestinal tract causing ingested food to bypass the most of the stomach and the upper portion of the small intestine.
- Adjustable Gastric Band – Places a band around the upper portion of the stomach to reduce its size and the amount of food a person can ingest safely.
- Duodenal Switch – also known as biliopancreatic diversion with duodenal switch. Two-thirds of the stomach is removed. What is left of the stomach is rerouted to the lower part of the small intestine. This causes only a fraction of nutrients to be absorbed, leading to weight loss.
- Sleeve Gastrectomy – Reduces the stomach to about 25% of its original size that results in a tube like structure. Naturally, you’re only able eat a fraction of food after the surgery.
Effects of Bariatric Surgery Cure for Type 2 Diabetes
I’m going to provide general data concerning these results in this section but at the end of this post, I will list references to studies where you can find much more detail if you wish to do so. My goal here is to provide an overall picture of documented results seen with these surgeries.
Overall and undoubtedly, diabetes related morbidity and mortality decline after bariatric surgery. The effects of this are generally, long lasting, it appears. In fact, there is evidence that type 2 diabetes is completely reversed.
This reversal or remission is defined as an elimination of diabetes medications and normalized blood glucose levels and is roughly seen in about two-thirds of patients post-operatively. The average weight loss is 85 lbs. or 38.5 kg.
Specifically, two large-scale studies (346 patients) analyzed the outcome of Roux-en-Y gastric bypass. Normal fasting blood glucose and A1c levels were normalized and an average 97 lbs. of weight lost. Medications taken were also significantly reduced when not completely eliminated.
In another cross study review and analysis, 621 studies from 1990-2006 were analyzed. A total of 135,246 patients participated in these studies. Overall, 78% of patients achieved complete resolution of type 2 diabetes. Also, overall, 86.6% of patients had their diabetes improved or resolved.
On a personal note, my wife’s co-worker had bariatric surgery (don’t know which) and within the year had her type 2 diabetes completely disappear. She works diligently to keep T2D and her weight away. Yes, it appears you need to continue working at it.
Metabolic disorders like obesity and T2D are lifestyle diseases with genetics thrown in. These genetics we influence with our…? (Lifestyle – this is epigenetics). My wife’s co-worker lost weight really slowly at first and ended up having the procedure redone. It was on the 2nd time around that her type 2 diabetes reversed.
I bring this up because one of the biggest characteristics of these T2D reversals resulting from bariatric surgery is that it happens right away even before weight loss occurs. Interesting to say the least! But why does it happen so fast or even happen at all in the first place.
Mechanisms of The Bariatric Surgery Cure for Type 2 Diabetes
From everything that I’ve read, I get the impression that the reasons type 2 diabetes goes into remission following bariatric surgery are not quite fully understood much less set in stone. But there is emerging data that identifies key players in this process.
I’ll briefly explain this and follow that up with the requirements for these surgeries and how non-candidates can emulate these results so keep reading.
The most obvious reason is that bariatric surgery involves re-configuring or reshaping the stomach and bypassing portions of the small intestine. This leads to a big reduction in the amount of food a person can ingest and obviously the amount of nutrients (calories) absorbed. This stimulates anti-diabetic effects, starting in the gut of course.
What’s been noted, specifically but not exclusively, is potent hormonal activity. Incretin metabolic hormones stimulate the most impactful of this hormonal activity. Their primary function is to increase insulin secretion in response to food but not all food. It appears that specifically they do their handiwork in response to glucose obtained through carbohydrates. This is why they’re referred to as being glucose-dependent.
There are two incretins: GLP-1 and GIP. Endocrine cells in the epithelium of the small intestine secrete both.
- Glucagon-like Peptide 1 or GLP-1 anticipates the rising tide in glucose levels from the presence from carbohydrates in the small intestine.
- GLP-1 slows down gastric emptying which slows down the rate of food nutrient absorption into the bloodstream; think low-glycemic.
- GLP-1 inhibits glucagon, a hormone also secreted by the pancreas that stimulates the liver to produce glucose. This is one of the main sources of the dawn phenomenon effect seen in type 2 diabetics.
- Glucose-dependent insulinotropic polypeptide or GIP is another incretin that works much in the same way as GLP-1 with some differences.
- GIP appears to not play a role in gastric emptying.
- It appears to stimulate the central nervous system acting on the vagal nerve, which stimulates nerve firings in the liver and pancreas.
- Both GLP-1 and GIP has been shown to stimulate growth in the pancreatic islet B-cells; the ones that produce insulin. Not only that, GIP appears to have anti-aging effects and works against programmed cell death on these B-cells.
- Once secreted in the small intestine both incretins travel in blood circulation to the pancreas where they reach the islet B-cells to bind to receptors on those cells. This in turn stimulates insulin release and the subsequent lowering of blood glucose levels.
Here’s the bottom line to all the bullet points above: In type 2 diabetics, incretin hormone activity is impaired to varying degrees. Sure there are unanswered questions but what I have outlined above has been concluded from the available research and observable evidence after bariatric surgery.
In fact, there are medications referred to as incretin mimetics that mimic the action of incretin hormones on the body. They are said to be GLP-1 and GIP agonists because they activate a pharmacological response on their respective receptors on the pancreas. You may have heard of these injectable drugs by their common names:
Incretin Mimetics Bariatric Cure For Type 2 Dibetes
Now for the big question…
Is The Bariatric Surgery Cure For Type 2 Diabetes Real?
Like many questions in life, it depends! Don’t you just love that response? It exists for a reason since there are so many variables to the answer.
Start with how you define the word cure. I tend to think of it as something permanent; that once you took or received this cure, you’d be rid of the illness forever. In terms of type 2 diabetes, I like the words reverse or remission because like cancer, it can and does come back.
It’s all just semantics, however. Dictionary.com in a nutshell defines the word cure as a restoration to health. Based on that definition then yes, bariatric surgery certainly is a potential cure for type 2 diabetes.
Just reread the first half of this article and you can understand why. It’s not effective in 100% of cases but with an overall success rate of 78% amongst 135,000+ patients in terms of complete remission of type 2 diabetes symptoms and elimination of medications, I’d say you have a winner!
Sorry, I don’t mean to rain on your parade but there is a BUT…
Who Is a Candidate for Bariatric Surgery?
To me at least the next obvious question is who can get bariatric surgery. I’ve always known it’s not for everyone. According to the American Society for Metabolic & Bariatric Surgery, to qualify, a person must meet one of these criteria:
- Body mass index or BMI > 40, or 100 pounds overweight
- BMI> 35 and at least two obesity-related illnesses such as: T2 diabetes, sleep apnea, high blood pressure, heart disease, etc.
- Unable to sustain weight loss despite repeated efforts.
As you see, our BMI is probably the biggest factor in who can get bariatric surgery. Let’s focus on BMI for a bit. I’m currently at 200 pounds or 90 kg and am 5’8” or 173 cm in height.
According to the BMI charts, I’m classified obese although you wouldn’t know it by my picture; at least that’s what I believe. That excludes me as a candidate right away. Yet I’m certainly very diabetic, albeit controlled through natural means.
The 5 Rs of Type 2 Diabetes Reversal: Remove-Replace-Recondition-Repeat-Restore CLICK ON IMAGE TO LEARN MORE
It wouldn’t’ be a stretch to conclude that many diabetics would not be ideal candidates either after all there are 387 million of us globally. So now what? Are we left out?
An Alternative For The Rest of Us
Obviously, we can’t go and reconfigure our gastric anatomy! That aside, we want to mimic other factors that I have already noted playing a role in reversing type 2 diabetes in bariatric patients.
- Drastically limit the amount of nutrients that we ingest and absorb. Specifically, carbohydrates should be your first focus as they are the ones that trigger the release of in-cretin hormones. Recall, this biochemical reaction is impaired in type 2 diabetics and needs to be reignited.
- Another reason for drastically cutting carbs is because of the three macro-nutrients, carbs convert to glucose immediately, starting when they enter your mouth after which they travel down further in digestion and ultimately hit the bloodstream. Protein also can convert to glucose but under very specific conditions. The same with fat but only once it’s been deposited in adipose tissue and is later converted to a form of energy. Again, focus on carbs!
- As you limit carbs, naturally you want to replace them with healthy fats and protein. From plenty of experience with this, I can assure you over time you get fewer cravings, eat less overall, and go longer between meals. A ketogenic diet is perfect for this and is what I follow.
- Another way to mimic factors of bariatric surgery is to practice intermittent fasting. This has positive effects on diabetics not just for lowering blood sugar but on restoring insulin sensitivity; the holy grail of type 2 diabetes. I encourage you to read my article on this very subject by clicking here.
Folks, although there is certainly a lot more involved in conquering type 2 diabetes, the listed factors above provide a one-two punch in tackling this silent (at first) and slow killer. They provide an immediate and actionable starting point. I practice them daily, not always perfectly but always with an eye on the prize.
I’ve been tracking my food, blood sugar, and physical activities on and off for over two years now and it’s evident that when I follow the plan, I achieve dramatic results. I get and keep my blood sugar within normal ranges. Of course, when I get sloppy and “indulge” in prohibited foods, it goes the other way but this is also the case with non-diabetics.
I say that to remind myself to not fret over the infractions and to just get back on track. Start by counting the amount of carbohydrate grams you’re eating daily by reading labels and looking up foods online for their nutritional profile.
Limit the total daily grams of carbohydrates to 20-30 grams in the beginning and watch those blood sugar levels go down. I guarantee it!
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