By Marika Sboros
What next! Doctors across the globe are now pushing bariatric surgery as a breakthrough new treatment for diabetes, and the closest modern medicine has come yet to a cure.
If you don’t know what bariatric surgery is, count yourself lucky. It’s an invasive surgery to reduce the size of the stomach or intestines. It is used to treat morbid obesity that is sometimes a close companion of diabetes – which is why doctors often refer to it as diabesity.
So far, most obesity specialists have recommended it as last resort for people who can’t lose weight by much less riskier means, such as: dietary change away from the foods that contributed to the obesity in the first place.
Now global diabetes experts say some diabetics should have bariatric surgery, even if they are only mildly obese.
That recommendation is in a consensus statement with corresponding guidelines by a group of 45 international organisations, diabetes specialists, and researchers, including the International Diabetes Federation, the American Diabetes Association, the Chinese Diabetes Society and Diabetes India. The new guidelines followed the Second Diabetes Surgery Summit, an international consensus conference held in September 2015 at King’s College London.
The statement authors are hailing it as “probably the most radical change ever since the discovery of insulin”. They say it is the closest yet to that holy grail of modern medicine: a cure for diabetes.
They say there’s a large body of evidence demonstrating that bariatric surgery – several gastrointestinal (GI) operations initially designed to promote weight loss in morbidly obese patients – can improve glucose homeostasis (blood sugar control) “more effectively than any known pharmaceutical or behavioral approach), causing durable remission in many patients with Type 2 diabetes”.
Report author and UK professor of metabolic and bariatric surgery at King’s College London Dr Francesco Rubino has said the surgery represents “a radical departure from conventional approaches to diabetes” – that much certainly is true. Rubino says the new guidelines “effectively introduce one of the biggest changes for diabetes care in modern times”.
He is also quoted as saying it is “the closest we have ever been to a cure for diabetes” and “the most powerful treatment to date”.
Diabetes UK director of Health Intelligence and Professional Liaison Simon O’Neill has come out in strong support for obesity surgery fo diabetes. He is quoted in a media report saying it should be “fully recognised as an active treatment option for Type 2 diabetes alongside established forms of Type 2 diabetes treatments, such as lifestyle changes, and blood glucose lowering medications”.
O’Neill wants “needless barriers to obesity surgery services” knocked down so that more can benefit from this “potentially lifesaving treatment”.
That can seem somewhat excessive. It can seem heavily laced with irony, coming from organisations that give dietary advice based on low-fat, high-carb official dietary guidelines. These shown in a report in the BMJ by US science journalist Nina Teichloz last year to be influenced by the food industry.
Teicholz and others have fingered the guidelines as possible also fueling global epidemic of obesity and type 2 diabetes.
There are different forms of bariatric surgery. The names are enough to give pause for thought even as they can sound relatively benign: adjustable gastric band, Roux-en-Y gastric bypass, biliopancreatic diversion with a duodenal switch, and vertical sleeve gastrectomy.
And of course, it’s putting it mildly to say that like all surgical procedures, all bariatric surgery carries inbuilt risks. One of those risks is premature death. Even Britain’s normally super-conservative National Health Service on its website, says complications of weight loss surgery that could lead to death include pulmonary embolism that causes serious breathing difficulties; internal bleeding; infection; heart attack; stroke.
Another common complication in people with a gastric bypass is that the hole (stoma) connecting their stomach pouch to their small intestine becomes narrowed and may get blocked by a piece of food, the NHS says. This is known as “stomal stenosis” and is thought to occur in one-fifth of people with a gastric bypass.
Harvard University nutrition professor Dr David Ludwig has a deserved reputation as an “obesity warrior”. He is already out and about with a sharpened scalpel cutting away at what looks like unadulterated scientific nonsense.
In a Facebook post, Ludwig notes that the consensus statement of major international diabetes organizations recommends at least considering weight loss surgery for all people with type 2 diabetes and obesity.
“True, surgery works better than ‘conventional’ diet/lifestyle),” says Ludwig.
“But is it fair to compare a $50,000 procedure with a treatment typically less than 1/10th the cost? Could we reverse type 2 diabetes with a state-of-the-art, intensive approach to diet – without the surgical risks and complications? Why hasn’t this possibility been properly studied? “
Ludwig cuts straight to the heart of this controversial debate.
One of the problems with bariatric surgery as a solution is the growing body of evidence to show that low-carb, high-fat (LCHF) diets work not just better than conventional diets for diabetes, but to reverse the condition completely.
If you doubt it, speak to two of Canada’s top diabetes experts: nephrologist Dr Jason Fung, and physician Dr Jay Wortman. Wortman has told me in detail how he reversed his own diabetes more than 12 years ago, just by adopting LCHF. His symptoms vanished faster than he ever thought possible, never to return to this day.
South African University of Cape Town emeritus professor Dr Tim Noakes is another who can attest to the power of diet to treat type 2 diabetes. Noakes is a type 2 diabetic. He has reversed all his symptoms with LCHF diet alone, but still take metformin (a drug used to treat diabetes), because he says, he wants “perfect blood sugar control”.
Fung, who is also an internal medicine specialist, treated his diabetic patients conventionally for more than 10 years before he realised that all he was doing was mostly making them fatter and sicker. He had an epiphany, did his own research and advised his patients to change to LCHF.
Lo and behold what happened next: within days, many of their symptoms vanished never to return; many were able to come off all medication for diabetes.
Fung and Wortman don’t claim that as a cure in strictly medical terms. It is true that if the patients reverted to the dietary and lifestyle habits that made them diabetic in the first place, the condition would recur. But I’d say that’s as close as dammit to a cure, and who cares if the establishment refuses to call it such.
Neither Fung nor Wortman is claiming that LCHF is the right path for everyone or that its magic will work every time. For people who don’t like eating the LCHF way, or who want even better results on it, Fung has devised innovative intermittent fasting regimens which he says have added to the success rate.
To them and growing numbers of experts globally it just makes more sense to try changing your diet before letting a surgeon loose on your innards.
I’d say it’s a no-brainer.