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How does what we've learned from surgery (specifically Roux-en-Y) factor into how we think about Obesity and Type 2 Diabetes?

by (25)
Updated September 16, 2014 at 7:34 PM
Created November 30, 2011 at 12:29 AM

I've read Taubes work on the carbohydrate hypothesis, Guyenet on food reward, and Becker on the Hypothalmic Hypothesis. My background is organic chemistry, not endocrinology or biochemistry, so much of the deep theory is a bit much for me.

Recent work in rats and humans has shown that Roux-en-Y Gastric Bypass rapidly resolves type 2 diabetes much faster than the corresponding drop in weight, proving that it's not caused by solely weight loss.

How does this factor in to how we think about T2D and obesity?

TNJ

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15003 · November 30, 2011 at 1:04 PM

Yeah, sorry bout that. What I like about it is that it makes the point that some of this diabetes "reversal" unrelated to weight loss is really related to the post-WLS VLC diet.

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8879 · November 30, 2011 at 12:07 PM

While I'm in no way encouraging these WLS surgeries, the mangling of the description of diabetes and insulin in that HAES piece is painful! In the second one, there's an interesting thing. If this one case had high ppBG but normal HbA1c, this would seem to support that pp glucose spikes don't lead to the dreaded glycation, it's the elevated chronic glucose. Is his diabetes "masked"? Perhaps he's a 1.5.

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18635 · November 30, 2011 at 2:13 AM

Yupper my wife rotates on the bariatric floor of her hospital. Lots of return customers there. Tons of poor results that need multiple surgery and extended stays to try to rectify.

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25467 · November 30, 2011 at 1:12 AM

It should be called the, "Ruined n you want to Y now? Horrible operation only suited for those who are on deaths door from obesity.

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3 Answers

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8879 · November 30, 2011 at 12:00 PM

I think there's something about the incretins -- like GLP-1 -- that play a role in insulin signaling and may mimic insulin. The theory goes something like: more rapid delivery/more "bolus" delivery of nutrients to the ileum restores GLP-1 secretion that is impaired in diabetics.

I had just found a paper where GBP reversed diabetes in a non-obese animal model: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356425/

A non-surgical option there would be Byetta or Victoza -- both GLP-1 mimetics. Byetta produces weight loss, especially in the most obese. I would think this would be worth a shot before GBP for sure.

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15003 · November 30, 2011 at 12:45 AM

Here are a couple of papers that suggest weight loss surgery is not necessarily the panacea wrt diabetes:

Roux-en-Y is a pretty drastic surgery. It may or may not resolve obesity and/or diabetes. But it is a good bet to set someone up down the road for critical nutritional deficiencies. It makes me sad that it's something people feel compelled to do.

7dc950fc76a046048e683d2a27dced37
15003 · November 30, 2011 at 1:04 PM

Yeah, sorry bout that. What I like about it is that it makes the point that some of this diabetes "reversal" unrelated to weight loss is really related to the post-WLS VLC diet.

24df4e0d0e7ce98963d4641fae1a60e5
8879 · November 30, 2011 at 12:07 PM

While I'm in no way encouraging these WLS surgeries, the mangling of the description of diabetes and insulin in that HAES piece is painful! In the second one, there's an interesting thing. If this one case had high ppBG but normal HbA1c, this would seem to support that pp glucose spikes don't lead to the dreaded glycation, it's the elevated chronic glucose. Is his diabetes "masked"? Perhaps he's a 1.5.

3846a3b61bc9051e4baebdef62e58c52
18635 · November 30, 2011 at 2:13 AM

Yupper my wife rotates on the bariatric floor of her hospital. Lots of return customers there. Tons of poor results that need multiple surgery and extended stays to try to rectify.

Ed71ab1c75c6a9bd217a599db0a3e117
25467 · November 30, 2011 at 1:12 AM

It should be called the, "Ruined n you want to Y now? Horrible operation only suited for those who are on deaths door from obesity.

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37177 · November 30, 2011 at 12:35 AM

Based on overall reading, it seems that weight loss--regardless of the foods eaten--will improve health numbers at least temporarily. There are definitely a number of ways to lose, with varying possibilities of sustainability for the longer term.

In my opinion, it's more a question of how the individual will maintain the lowered weight or continue the weight loss without deterioration in health: losing muscle vs. fat, suffering a return of binge eating, etc.

Starvation diets, extreme diets that limit the food list too much risk a kickback reaction at some point or an inability to stick with the plan long enough to achieve your goals.

The above comments pertain mostly to people trying to lose weight. For those already at a good weight but seeking improved or continued good health, the question remains, what are you willing to eat for the rest of your life to maximize your health?

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