March 25, 2010

Before You Choose Weight Loss Surgery Read This

A new study confirms what quite a few other studies suggest. The reason that weight loss appears to "cure" diabetes has nothing to do with weight loss. It is because the surgery changes the way that gastric hormones, most notably GLP-1 are secreted.

The study is discussed here:

Science Daily: How weight loss surgery reverses Type 2 diabetes.

I've blogged before about the irresponsible way that stomach amputation is being promoted as a "cure" for diabetes when the promoters' own data show that it doesn't cure it, but merely slows it down for a few years. If you haven't read that post, I'd urge you to read it. You'll find it HERE.

But I bring up the topic again because this latest study--a rodent study--both confirms the temporary nature of the fix and suggests that many people could achieve the same effect without risking a surgery whose kill rate is so high that if it were associated with a drug, that drug would never have made it through the FDA approval process. (Surgery doesn't need to go through any approval process.)

The doctors who profit mightily from selling obesity surgery are NOT going to tell you that there is a drug which is far safer than the surgery and which controls blood sugar and provides dramatic weight loss to one third of those who take it: BYETTA.

Byetta is a synthetic form of GLP-1. It dramatically slows stomach emptying, making it very hard to overeat. For many people it changes the brain's way of processing hunger, making them not feel like eating. It may stimulate insulin release, too.

An FDA report found fewer than 100 cases of pancreatitis in the hundreds of thousands of people who had taken Byetta, which sparked a panic among doctors who stopped prescribing it. For some reason, the fact that 25 people out of every 10,000 who have weight loss surgery die shortly after having the surgery went unnoticed by these same doctors. That same statistic is rarely mentioned by the gastric surgeons they refer their patients to, either.

Further review has not conclusively linked Byetta with pancreatitis--the rate of pancreatitis in obese people who don't take Byetta is pretty much the same as the rate in obese people who do, and that rate is extremely low.

So before you amputate a big part of your stomach, rearrange your intestinal tract or have a band inserted that may cause severe scarring or infection, ask your doctor about Byetta. If he tries to scare you away from trying it, ask why he's not concerned about the far higher death rate from WLS. If he doesn't know the death rate from WLS, find a new doctor.

One huge advantage of Byetta is that if it doesn't work for you, you just stop taking it and any side effects go away. The surgery permanently modifies your digestive tract in a way that cannot be reversed.

It produces a shockingly high rate of complications, and those who have it often require subsequent surgeries when infections occur, stitches tear, and bands become embedded in tissue, These surgeries may also cause permanent malnutrition which puts you in danger of starving to death.

WARNING! There is a new drug similar to Byetta that is much less effective and more dangerous, VICTOZA. Your doctor may suggest you try it instead of Byetta because doctors inevitably put patients on new drugs in response to drug company marketing efforts which often include subtle bribes to the doctor. Don't let a doctor try to talk you into trying Victoza instead.

You can read about why Victoza is a bad substitute for Byetta HERE.

One last thing: If you're desperate enough to be considering weight loss surgery to "reverse" your diabetes, before you do something irreversible, spend a month trying out the drug-free technique that lowers blood sugars to the normal level for a very high proportion of people with Type 2 diabetes of those who try it--including those A1cs as high as 12%.

You'll find this extremely simple and dramatically effective technique described here:

How to Get Your Blood Sugar Under Control

The American Diabetes Association admits in its treatment guidelines that the approach sketched out here is both safe and effective.

It just doesn't pour profits into the pockets of surgeons and drug companies. Give it a try. If it doesn't work, you probably have something else going on besides garden variety Type 2 and need to see an endocrinologist not a gastric surgeon to find out what and get help with it.

The study referenced HERE makes it crystal clear that if your problem is insulin insufficiency or a serious endocrinological problem rather than high carb intake weight loss surgery will have no effect on your blood sugar.



ItsTheWooo said...

I love byetta. I'm not diabetic but when I first heard of this drug several years ago I did research on it for a school project, and my thought was that this incretin mimetic is a very good therapy, in the same class as metformin (i.e. drugs that help resolve the underlying defects). Most traditional diabetic therapies seem to make things worse, or lower blood sugar at the cost of overall health (like the TZD drugs, which work partly by making the fat tissue reproduce like a tumor, offering insulin-sensitive vesciles for excess blood sugar production, not to mention risk of hypoglycemia).

Byetta seems to be hittin all the bases.
*Makes insulin release, but ONLY when glucose elevates (normal physiology, to make insulin when glucose rises - byetta is the only diabetic drug that does this)
*Helps preserve and nurture the beta cells (an underlying defect in type 2 pathology - beta cells rot away, GLP-1 is related to maintaining beta cell health)
*Regulates APPETITE (another underlying defect contributing to both obesity and hyperglycemia due to hyperphagia)

The fact that it is a consistent finding that diabetes type 2 features reduces GLP-1 release, and this is also often found in obesity (a warning sign of future diabetes) suggests that perhaps replacing the GLP-1 is a good idea. Replacing hormones the body should make but doesn't is usually a good idea. Leptin, for me, for example, has been fantastic.

When you replace hormones that should be made, you don't run into the same problems you get when you try to create a designer molecule that targets one or two effects. "OH it will lower your blood sugar but you'll grow tumors on your pancreas, WOOPS". The body, our genetics, expect this GLP-1, and much diabetic pathology relates to it being chronically low.

... another good way to raise GLP-1: EAT LESS CARB, MORE FAT.

Studies suggests that in obese and diabetic people, GLP-1 secretion is diminished only in response to carbohydrate, but response to dietary fat is in tact.

Teh reason fat people and diabetic people do so well on low carb diets may not be entirely because of lower glucose intake, but partly because our bodies metabolize fat correctly and thus we don't run into the abnormal hormonal/endocrine conditions that attempting to utilize gluocse will cause. Studies seem to show if you eat dietary fat, GLP-1 release matches lean/healthy controls... eat dietary carb, GLP-1 release is abnormally low.

Denny Barnes said...

Why do you think the small intestine in Type 2 diabetics has an impaired ability to release incretins to control insulin signaling? Interestingly, I wrote on lessons from gastric bypass surgery at today. I postulate that gut inflammation is the underlying issue. Your thoughts?

Jenny said...


If the problem were inflammation, surgery wouldn't reverse it so quickly. Inflammation once established is very tough to reverse.

I don't know the mechanism. One would hope researchers would look for it, but because of the focus on fixes rather than prevention, it's not likely they will.

Denny Barnes said...

I have not seen any studies that measure inflammation after gastric bypass surgery. To test the inflammation theory, we would just need to see if C-reactive protein dropped after WLS surgery before there was significant weight-loss. Generally, CRP is highly correlated with insulin resistance.

Jenny said...

The CRP test reference in research is actually the "cardiac specific CRP" and wouldn't be a good index to inflammation in the gut.

nyh gi said...

You are incorrectly describing the surgery proposed for non obese type 2 diabetics. There is no amputation of the stomach or any other organ (of course the "A" word is inflammatory to any diabetic). The surgery involves the bypassing of the duodenum and first part of the jejunum - nothing is amputated. The surgery is relatively simple and low risk and can be done laparoscopically.

Denny Barnes said...

C-reactive protein (CRP) is also a market for inflammatory bowel disease. In Crohn's disease it is too high to be measured on the hsCRP used to asses cardiac risk, but I have read that low-grade chronic inflammation of the intestinal lining which might result in undetected leaky gut syndrome often yields an hsCRP in the 5-10 range. I am postulating that the inflamed lining of the small intestine (where the incretins are produced) would interfere with insulin signaling. What do you think the best marker would be to test for the presence or absence of inflammation in the small intestine?

Jenny said...


The experimental surgery done on rodents might be lower risk (no surgery done under anesthetic is 100% safe) and it has no significant track record yet in human to show the real risks. Very small studies such a have been done on it so far tend to paint too optimistic a picture and to be done on cherry picked patients.

But most obese people with diabetes are not being offered that surgery to "reverse" their diabetes, they're being offered banding or Roux-en Y. These surgeries produce a dramatic drop in blood sugar in most people within 6 weeks--mostly because they force them to cut out almost all carbs. You can get the same "reversal" of diabetes by just cutting out the carbs and leaving the stomach alone.

Boz said...

I had a good experience with Byetta until I had a cortisone shot, which after I had to go on insulin. After starting Byetta (and getting used to its side effects,) I lost some weight, but my a1c dropped to around 5.4. I would recommend Byetta over any other of the drugs I take or have taken. I'm not happy on insulin, but I have no other options and have considered lap-band. Since I'm not a big surgery fan, so IO probably won't unless things get desperate, and diet and exercise aren't effective anymore.