Can surgery cure diabetes?

Can surgery cure diabetes?

It can, according to a new study that appeared late last month in the Journal of the American Medical Association (JAMA).

But there’s a catch. And there’s another way.

Opportunity doubled

You might call laparoscopic adjustable gastric banding (LAGB) the less invasive cousin of gastric bypass surgery.

Gastric bypass requires open surgery and permanent alteration of the GI tract. Laparoscopic surgery requires only small incisions to allow a viewing instrument and other surgical tools.

With LAGB, a band is secured around the stomach to create a small pouch. This results in less food intake and a feeling of satiety – which may make an obese patient feel like his body is suddenly on his side, rather than constantly dragging him down.

STUDY PROFILE Researchers at Monash University in Australia compared LAGB to conventional care in controlling diabetes and reducing weight

Sixty obese subjects with recently diagnosed type 2 diabetes were divided into two groups, to receive either LAGB surgery or lifestyle counseling to modify diet and encourage exercise

Subjects in the conventional care group were also given diabetes drugs, such as metformin, as needed

After two years, 22 subjects in the LAGB group achieved remission of their diabetes, while only four subjects in the conventional care group achieved remission

LAGB subjects lost an average of nearly 21 percent of their body weight, while conventional care subjects lost an average of about 2 percent of body weight

High praise for sale

Now for the caveats

At face value, the Monash study is a success for LAGB – especially when you consider that more than 70 percent of the surgery patients achieved diabetes remission without using prescription drugs.

But what about subjects who have had type 2 diabetes for several years? As studies go, two years is a long time – but theaverage age of the subjects was 47. Will they still be in remission at age 57? 67? 77? That’s a key unanswered question – especially important given that LAGB is an expensive procedure that’s still not covered by many insurance plans.

The Monash team also reports that there were no serious complications from LAGB, but what does “serious” mean? Are nausea and vomiting serious? Is band infection serious? Is band erosion into the stomach serious? These are all potential adverse reactions to LAGB.

But the most unsettling part of this study is the connection to industry. According to the New York Times, Allergan Health (the maker of the gastric bands used in the study) paid for the research with a grant to Monash University. The lead author of the study also received speakers’ fees and research grants from Allergan.

And to ice the cake, an editorial that appears in the same issue of JAMA states that the insights from the study of surgical interventions for diabetes “may be the most profound since the discovery of insulin.” Wow! That’s high praise! And it would be really impressive if the Times had not mentioned that the authors of the editorial received travel grants from Allergan to attend a diabetes surgery conference.

In Rome!

Do you get the feeling the fix is in?

A modest proposal

The main point that’s missed by the glowing reports about this study is the fact that patients have to make some basic behaviorial changes in order for LAGB to be successful. They have to exercise daily, stick to a strict diet, and they can’t snack between meals. So the primary benefit of LAGB would seem to be hunger reduction. With satiety on your side, all those other things are easier. Not automatic – but certainly easier.

So before opting for surgery, a type 2 diabetic could start working on those behaviorial changes. And to help the effort, he could think about using a couple of non-surgical, non- drug techniques to promote satiety.

In the e-Alert “Loud and Clear” (9/13/07), I told you about a study in which unfiltered apple cider vinegar, taken at mealtimes, significantly lowered blood sugar and insulin responses while increasing satiety. And in the e-Alert “Beef ‘n’ Butter” (4/20/04), I told you how a fatty acid supplement called CLA has been shown to increase satiety while also helping obese subjects reduce body fat mass. You can find these e-Alerts at the links below.

http://www.hsionline.com/ealerts/ea200709/ea20070913a.html

http://www.hsionline.com/ealerts/ea200404/ea20040420.html

Talk to your doctor before adding CLA or apple cider vinegar to your supplement regimen.