The Cure For Diabetes?

Have you seen the news that surgery can cure diabetes?  If not, take a look.

Video: Surgery can reverse diabetes. NBC reports.

Researchers from Australia say that patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.

Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.  “It’s the best therapy for diabetes that we have today, and it’s very low risk,” said the study’s lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia.

Obesity is a major risk factor for diabetes and currently more than one-third of U.S. adults (35.7%) are obese and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.[Data from the National Health and Nutrition Examination Survey (NHANES)]                       

According to the Centers for Disease Control and Prevention (CDC) during the past 20 years, there has been a dramatic increase in obesity in the United States and rates are remaining high. In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more.  Experts are now projecting that over the next forty years, the prevalence of type 2 diabetes in the USA would rise from one in ten to one in three! 

Returning to this latest study, all the patients were obese and had been diagnosed with type 2 diabetes during the past two years. Their average age was 47. Half the patients underwent a type of surgery called laparoscopic gastric banding, where an adjustable silicone cuff is installed around the upper stomach, limiting how much a person can eat.

Both groups lost weight over two years; the surgery patients lost 46 pounds on average, while the standard-care patients lost an average of 3 pounds.

Blood tests showed diabetes remission in 22 of the 29 surgery patients after two years. In the standard-care group, only four of the 26 patients achieved that goal. The patients who lost the most weight were the most likely to eliminate their diabetes.

Both patient groups learned about low-fat, high-fiber diets and were encouraged to exercise. Both groups could meet with a health professional every six weeks for two years.
All of this is very exciting, right?  Perhaps it is less exciting than the media would like you to believe.  You may have noticed that I have been underlining the phrase "standard-care".  What exactly is the standard care for diabetes patients?  To understand that we first have to understand what diabetes is and what causes it.

Diabetes is a lifelong (chronic) disease in which there are high levels of sugar in the blood.  Diabetes can be caused by too little insulin, resistance to insulin, or both.  Insulin is a hormone produced by the pancreas to control blood sugar.  During digestion food is broken down into a simple form of sugar called glucose.  At the same time, our pancreas makes insulin to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either their pancreas does not make enough insulin, their cells do not respond to insulin normally, or at times both things happen.

Anyone can get type 2 diabetes. However, those at highest risk for the disease are those who are obese or overweight, women who have had gestational diabetes, people with family members who have type 2 diabetes and people who have cardiovascular disease (a cluster of problems that include high cholesterol, high triglycerides, low good 'HDL' cholesterol and a high bad 'LDL' cholesterol, and high blood pressure).  Older people are more susceptible to developing the disease since aging makes the body less tolerant of sugars.  Also, people who smoke, have inactive lifestyles, or have certain dietary patterns have an increased risk of developing type 2 diabetes. 

Now that we know what diabetes is, how is it treated?  What is the "standard-care" that the Australian study compared the surgery to?  It is a combination of monitoring blood sugar levels at home, medication, and wight loss.  Current recommendations are for most people with type 2 diabetes to be treated with an anti diabetic drug called metformin plus insulin, as necessary.  Using a combination of treatments (oral medication plus insulin) generally means that the person can take a lower dose of insulin, compared to if insulin treatment is used alone. There may also be a reduced risk of weight gain if combination therapy is used. 

Now I'll repeat something.  Anyone can get type 2 diabetes.  But those that are obese, have cardiovascular disease, or are inactive are at the highest risk.  So what leads to diabetes?  Lifestyle leads to diabetes.  You are not born with type 2 diabetes.  Your lifestyle leads to it. 

That being said, why are doctors looking for invasive surgeries to "cure" diabetes when we know that healthy lifestyle choices will do the same thing?  I have a theory. 

It is hard to eat well and exercise.  It requires more than just a desire to be healthy.  You have to do the work every day to monitor what you are eating, how much exercise you are getting, whether or not you want to smoke, etc.  Americans over the last two decades have been proving that they would rather eat large amounts of unhealthy foods and become increasingly more sedentary.  My theory is that people would rather try the path of least resistance to lose weight and reverse their diabetes than change their habits and lifestyle choices.

For many people surgery may seem the "easier" way to lose weight.  In fact, in the United States, surgeons perform more than 100,000 obesity surgeries each year.  These surgeries are relatively safe, the death rate for stomach band surgery, which can cost $17,000 to $20,000, is about 1 in 1,000. There were only minor complications in the Australian study. Stomach stapling has a 2 percent death rate and costs $20,000 to $30,000.  While there may be only minor complications associated with the surgeries, a Belgian study recently published in the Archives of Surgery reported that more than a decade after having stomach-banding surgery, nearly half of the patients needed to have the bands removed. More than half of them had to have additional surgery, including a gastric bypass, and most lost less than half their weight goal.  Not quite as exciting when we look at the long term outcomes rather than just the immediate results, is it? 

Why are we looking at surgery when countless studies have shown that nutrition is not adequately taught or modeled in schools, where children are less likely to have opportunities to exercise during the day? And why aren't more doctors trained to counsel patients about their dietary and exercise needs? In fact, studies show they're less likely to bring it up if they are more overweight than their patients or dealing with a parent who won't accept that their child is obese.

I would argue that we need a new "standard-care" for diabetes treatment.  I would argue that it is not invasive surgery that will probably need to be repeated to maintain the reversal of diabetes.  There was another study recently about reversing diabetes that did not garner as much attention.  This study in Diabetologia proved that, indeed, Type 2 diabetes can be reversed through diet changes, and, the study showed, this can happen quickly. It took one to eight weeks!

So shouldn't doctors be implementing this program rather than surgery or medications that obviously are not working very well? Unfortunately despite this research the findings are ignored in favor of surgery because behavior and lifestyle change is "hard." In fact, with the right conditions and support, lifestyle diet and lifestyle change is very achievable.

Lets look at what the research showed.  The study, Reversal of Type 2 diabetes: normalization of beta cell function in association with decrease pancreas and liver triglycerides  showed that a dramatic diet change (protein shake, low glycemic load, plant-based low-calorie diet) without exercise reversed most features of diabetes within one week and all features by eight weeks. 

They studied 11 people with diabetes and compared them to a control group. Through blood testing and MRI imaging they measured their blood sugar and insulin responses, cholesterol levels and fat in the pancreas and liver before and after diet changes at one, four and eight weeks.

The pancreas' insulin producing cells were revitalised and the fat deposits in the pancreas and liver went away. Blood sugars normalized in just one week, triglycerides dropped in half in one week and reduced 10-fold in eight weeks. The body's cells became more insulin sensitive and essentially, in just eight weeks, all evidence of diabetes was gone and the diabetic patients looked just like the normal controls on all the testing.  All without exercise, medications, or surgery!

What should the standard-care for diabetes be?  I guess that is a question for each person suffering from the disease.  We know that medication can work but that surgery seems to have more immediate results.  Those results make surgeons lots of money but are not long term for the patients.  We also know that dietary changes work extremely well and do not have to partnered with exercise, although it is recommended to do so.  The choice is yours.  I personally think that viewing yourself as a participant in the disease rather than a victim of it will probably change your perception of how to treat it.  Diabetes is a product of lifestyle choices and therefore can be reversed by different lifestyle choices.  Choose well and be well.