Saturday, July 10, 2010

New push for gastric bypass for diabetes

I have noticed a new media campaign hawking gastric bypass for diabetes. And not only that but also they are suggesting this surgery (which Rudy Leibel called "draconian") for those folks who are not especially overweight.

The articles are misleading like this one on MSNBC. For example this article states that:

Scientists in recent years have discovered that diabetes all but disappears in some obese patients soon after the operation.

No scientist ever wrote that "diabetes disappears". No scientist ever used the word "CURE" either. What they stated was that after any weight loss surgery including the less invasive gastric band, the sugar levels seem to go down in 72 percent of diabetics at the two year post op point.

(And some of the surgeons admitted that they didn't know if the after surgery fasting caused the sugar levels to go down or the surgery itself!)

Additionally, the one study which did a follow up at the 10 year point after surgery found that only 36 percent of the diabetics still had sugar levels in the so called "normal" range.[New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al]

What continues to amaze me is that they are still doing a surgery, which is a more invasive version of one invented in 1888 (for the treatment of duodenal ulcers) and about which the inventer, Dr Edward Mason, stated in 1980, after extensive patient follow up, that it was too risky even for those patients who were clinically obese. Mason wrote:

"For the vast majority of patients today, there is no operation that will control weight to a "normal" level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity."

Dr Mason advocated a less invasive surgery which did not interfere with the digestion of vitamins.

The gastric bypass, says Kaiser Permanante's release form, causes vitamin deficiencies in nearly 100 percent of patients.

Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium.

Some of these vitamins and nutrients can only be supplemented intravenously. Others cannot be supplemented and the deficiencies can be either disabling or life threatening in the long run.

The surgeons I have asked about lifespan after a gastric bypass have been evasive, implying that a gastric bypass patient might live longer than a clinically obese person but again, science has not proven this at all.

Dr Mason, in 1965, thought this surgery would work for the clinically obese because his normal weight patients who had this surgery, had a difficult time keeping their weight at a normal level.

However, followup suggested it was too riddled with complications and even as late as 2006, Dr Mason wrote that since the mid 1990s scientists have learned a great deal about "the biochemical mechanisms that influence food intake and weight".

" I would like to see greater use of simple restriction procedures that do not rearrange these finely balanced mechanisms," Mason added in an article he wrote for the U of I healthletter.

And in July 2010, 30 years after Dr Mason first advocated not doing the gastric bypass even for clinically obese people, the media is campaigning for diabetics to have this surgery?

The worst thing is that

  1. Blood sugar levels can be controlled in diabetics through lifestyle changes - often without medication for several years after diagnosis (my hubby kept his sugar levels at normal without meds for the first 15 years after diagnosis

  2. Medication works well without invasive surgery especially if combined with a few lifestyle changes

  3. As stated before, the few long term studies we have, suggest that the gastric bypass isn't very effective in the long run for many patients, at either keeping weight off or controlling diabetes

Not only does the recommendation of gastric bypass to control diabetes make no sense to me - it seems, more than somewhat ethically challenged.


vesta44 said...

The main thing they are basing their "cure" on is fasting BGs and A1c numbers. What they aren't looking at is the BG numbers that diabetics should be taking 2 hours after eating a meal (are those numbers above 140) and are diabetics having an unusual number of low readings (below 70). Just because fasting BGs are good, and A1c is good doesn't mean the diabetic who had the bypass has good control of hir BG. If zie isn't still testing before and after meals like zie did before the bypass, zie has no idea what hir BG numbers are. And just as much damage can be done from having too many highs and lows as from having consistently high BG numbers.
Just because you've been told your diabetes is "cured" doesn't mean it has been.........

Anonymous said...

If you follow Your doctors orders you will be successful after RNY.
Self discipline is the key to success.
All of my health issues associated with metabolic syndrome are in remission.
I follow all recommendations by my Medical team that includes vitamin supplementation.

SueW said...

Lisa, first of all, 2 years after surgery 28 percent did not have their diabetes go into remission regardless of whether following doctors orders or not. Secondly, researchers admit they do not know whether the sugar levels go down in post op gastric bypass patients due to the starvation happening in the first year or two (many patients consume less than 700 calories a day) or the surgery itself. Third, most diabetics can get their sugar levels down through dietary changes and exercise without having invasive surgery. Fourth, the new medications work well in bringing sugar levels down and finally, the Swedish Obesity study found that after 10 years, most WLSer diabetics again were suffering with the disease i.e. 64 percent. It is true that it's mostly the patient's work whether any success happens with the gastric bypass... "Success with WLS is 10 percent the surgery and 90 percent the patient" says Dr Terry Simpson a WLS surgeon. This of course, suggests that the patient could do the work without surgical alterations which can cause long term vitamin deficiencies etc.. And it should be noted that some patients are totally 100 percent compliant and not only suffer devastating repercussions (hypoglycemia, erratic sugar levels, epilepsy) but also regain their weight. Each body is different. If the surgery is working well for you, that's wonderful. My best wishes that your good fortune continues but be aware that the RNY doesn't work for many people even if they do follow "all the rules". I've known folks who have had several WLS and still got ill and regained the weight.

SueW said...

comment from Mintradz:

>>The key ingredients for us not to suffer from minor side effects of gastric bypass surgery is through thorough monitoring of our daily intake, determined discipline, and a lot of courage to face and embrace the coming days. Follow your doctor's advice.<<

Min, unfortunately, many patients do everything right and still get more than "minor side effects". As the inventor of the gastricbypass stated (he stopped doing them in 1980 due to side effects in follow up patients), the stomach is probably the size it is for a reason and surgically altering it and the surrounding bowel can have devastating side effects. In the early 2000's, he wrote that since we know so much more about the digestive system now than we did when he started doing gastric bypass, he felt it could be a bad idea to interfere with the natural arrangement.