Open Discussion: Weight Loss Surgery & Diabetes
By: Seth MargoliesCategory: Weight Loss Surgery
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For the last several years, I would go around to different support groups for weight-loss surgery patients and speak about fitness. I would often ask the groups what physical activity on a regular basis could help to better their overall fitness. Inevitably the topic of diabetes would come up. Many of the patients suffered from this insidious disease and would relay stories of their affliction and post-surgery remission. Many who had the disease would not know what ailments came along with the disease. I would then rattle off facts about the disease that I usually found on the American Diabetes Association’s (ADA) website in the hopes of educating some pre-ops with facts about the disease, and the need to stay fit and lose weight. It never even dawned on me, that although I was dealing with a population that was claiming to be in remission post-operatively, the ADA did not even mention Weight Loss Surgery on their extensive website. I understand the need for meticulous research and that published studies need to be presented before a large organization like the ADA, before the ADA will endorse it, but to not have any information on Weight Loss Surgery I found curious. After all, the Diabetes epidemic was rampant in this country and the world, and many were suffering.
Recently, I became very interested in the disease because my best friend’s father died from complications of the disease. This was a man I had known and loved for nearly forty years. His kidneys failed as a result of his illness, and he needed to go on dialysis. He found that his quality of life was slipping due to the dialysis, and thus he decided to have a kidney transplant. The kidney he received was sleepy, which meant it did not function, and as a result of the anti-rejection medications he was receiving, he developed C-Diff or Clostridium Difficile Colitis. This is a “bad” bacterium in the intestines. “Good” bacteria usually fight it off, but because the anti-rejection medications killed off many of the “good” bacteria, he developed this ailment, which resulted in more surgery to have a good portion of his colon removed. He then received a colonoscopy bag. He then needed even more surgery on his colon, because not all of the infected tissue was removed the first time. He was in the hospital for the last twelve weeks of his life. By the time I saw him, he was not conscious, needed dialysis, was ridden with bedsores, his muscles atrophied, because of inactivity, and wounds on his body were not healing. He lost nearly forty pounds in the hospital and was wasting away. It was horrific to see someone I had known for my entire life afflicted like this. No one should ever have to experience that. And it seems that we are closer to finding better treatments for this disease than farther away.
When talking about Diabetes, I am for the most part speaking of type II diabetes, which, according to the ADA, is the most common form accounting for over ninety percent of the cases. There are about 21 million people in the United States suffering from the disease with over 200 million worldwide, or about seven percent of the population in the U.S., and a million new cases are diagnosed annually. There is no way of determining how many undiagnosed new cases are developing per annum. Ninety percent of the patients newly diagnosed with the disease, according to the ADA, are overweight so obesity is definitely a risk factor. But, still we do not have all the answers to what causes the disease just certain risk factors. Diabetes basically is a disease where the body does not utilize insulin sufficiently or produce the hormone. Insulin helps in the conversion of glucose into energy in the body. Basically it causes the cells in the body to become starved. As a result, there are serious complications which can include kidney failure making dialysis necessary or worse, kidney transplants, strokes, heart attacks, wounds that do not heal which can lead to amputations, depression and blindness among other things. The ADA recently dropped the bombshell that we, as Americans, spend approximately 174 billion dollars a year on diabetes and the complications that come from the disease. They suggested that it is more money than is spent on the war on terrorism being fought now on two fronts Afghanistan and Iraq.
Recently, a study was conducted by John B. Dixon, MBBS, Ph.D. from Monash University in Melbourne, Australia, and published in JAMA comparing Weight Loss Surgery, and conventional medicinal treatments that now exist for Diabetes. Sixty patients were selected who were diagnosed with the disease within two years of the study. The patients, who had a Body Mass Index (BMI) of 30 to 40, were then randomly assigned either WLS or conventional medicinal treatment. The type of WLS used was gastric banding which is more common in Australia. According to the study, 73 percent of the patients whom had WLS showed no signs of the disease two years out, while only 13 percent of the people treated non-surgically. The patients that had the surgical procedure lost 62 percent of excess weight compared to 4.3 percent excess amongst the non-surgical. This was the first study of its type and there are others to follow.
The hope is that this will open a dialogue and seriously study how WLS may be an effective, or the most effective treatment for type II diabetes to date. Naturally, more studies need to be done. Since Dr. Dixon’s study only included the gastric band, which is generally a restrictive procedure. Dr. Francesco Rubino of New York Presbyterian Hospital recently completed a study involving Gastric Bypass Surgery. His findings were printed in Diabetes Care a publication of the ADA. Dr. Rubino presents scientific evidence on the mechanisms of diabetes control after surgery. Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese.1
It seems that we are entering a very interesting time in the treatment of Diabetes. According to the ADA, they are taking a strong interest in the recent developments and studies that have been coming out, and even went so far as to endorse the discussion about the positive effects of surgery at the Rome Diabetes Surgery Summit. Of course, being as well respected as they are, they need answers to questions including the efficacy of the procedures over time, which procedure is most effective and complication rates of surgery compared to side effects of drugs before they can give their endorsement. Unfortunately, with the number of cases diagnosed annually, and the money spent this epidemic, it has become a race against time, and the need for studies and discussions about WLS as a treatment for Diabetes escalated.
Seth Margolies, MFA is a bariatric patient. Since his surgery in September of 2003 he has become an advocate for fitness in the bariatric world. Seth is an actor, writer and motivational speaker. He has completed a cross-country bike tour across America to promote healthy living. He is also the producer of Weigh2Win a bariatric fitness support video and a regular contributor to WLS Lifestyles magazine.
RESOURCES: American Diabetes Association, The New York Times, WebMD, MSNBC.com
REFERENCES:
- New York- Presbyterian Hospital/Weill Cornell Medical Center 2008, March 6. Diabetes May Be Disorder Of Upper Intestine: Surgery May Correct It. Science- Daily. www.sciencedaily.com/ releases/2008/03/080305113659.htm
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