Gastric bypass often cures type 2 diabetes, but other problems may arise

Pass on the Bypass?

A New York doctor believes he can cure type 2 diabetes with gastric bypass surgery.

No doubt, remission of type 2 diabetes is one of the benefits of gastric bypass, but the exact reason why remission follows the surgery isn’t clear. But it is controversial.

Most doctors believe that weight-loss prompts the diabetes turnaround. But Dr. Francesco Rubino, Chief of Gastrointestinal Metabolic Surgery at Weill Cornell Medical College in New York, has devoted considerable research to his theory that diabetes is caused by a digestive tract malfunction, which can be repaired with gastric bypass. In fact, Dr. Rubino hopes to test this theory by performing gastric bypass on type 2 diabetes patients who are not overweight.

The outcome of that trial could revolutionize the way we treat type 2 diabetes. And successful results would probably also make gastric bypass surgery even more popular than it already is.

But before we cross that threshold, this is a good time to stop and assess gastric bypass dangers.

Beyond digestion

Three years ago, a government report showed that about four in 10 gastric bypass patients experience complications. Abdominal hernias, infections, and digestive problems such as acid reflux, vomiting, and diarrhea are typical setbacks.

A study from the University of Arkansas shows that neurological difficulties may also arise after gastric bypass.

Researchers examined 150 patients with neurological problems and found that 26 were potentially linked to bariatric surgery. The most frequent and disabling condition was myelopathy, a spinal column disorder that causes loss of sensation and even mobility. Symptoms of myelopathy generally began about 10 years after surgery.

Other neurological conditions the UA team linked to bariatric surgery:

• Encephalopathy – progressive cognitive decline, memory loss, inability to concentrate, and loss of consciousness
• Optic neuropathy – progressive vision loss
• Polyneuropathy – movement loss due to inflammation

In the May 22, 2007, issue of the journal Neurology, the authors note that the common denominator among the 26 patients was multiple nutritional deficiencies. Correction of these deficiencies usually did not correct the problems. Copper and vitamin B-12 deficiencies were linked to myelopathy, but specific deficiencies could not be pinpointed for the other complications.

On the periphery

The Arkansas study is not the first to recognize that gastric bypass can prompt health challenges beyond the digestive tract.

A 2004 study, which also appeared in Neurology, found that 16 percent of 435 bariatric surgery patients experienced peripheral neuropathy, characterized by numbness or prickly, burning sensations in the feet, legs, hands, and arms. Extended peripheral neuropathy often results in impaired coordination, urinary urgency, erectile dysfunction, and lightheadedness.

Most sobering of all, however, is a study I told you about in the e-Alert “A Refreshing Blink” (11/2/05). As reported in the Journal of the American Medical Association, researchers from the University of Washington examined medical records for more than 16,000 gastric bypass patients.

Results showed that five percent of men and three percent of women in the 35-44 age group died within one year of surgery. These rates were slightly higher in the 45-54 age group, and in patients aged 65 to 74, about six percent of the women died within one year, and almost 13 percent of the men.

You can find more information about the pros and cons of bariatric surgery at the web site for Bariatric Edge: bariatricedge.com. Although this site essentially promotes this type of surgery, other gastric bypass complications are discussed, including the possibility of increased bone calcium loss and metabolic bone disease.

Sources:
“Neurologic Complications of Gastric Bypass Surgery for Morbid Obesity” Neurology, Vol. 68, No. 21, 5/22/07, neurology.org
“A Controlled Study of Peripheral Neuropathy After Bariatric Surgery” Neurology, Vol. 63, No. 8, 10/26/07, neurology.org