Surgery, Extreme Low-calorie Diet Reverse Type 2 Diabetes

New hope for type 2 diabetes sufferers?

A new review of previous studies on bariatric surgery and its metabolic effects suggests that more than 60 percent of obese diabetics can be cured of the blood sugar disease ““ at least in the short term ““ by undergoing weight-loss surgery.  Meanwhile, a separate British study published on Friday reveals that people with obesity-related type 2 diabetes were cured of the condition by consuming an extreme, low-calorie diet for two months.

Weight Loss Surgery

Although previous studies had suggested that weight-loss surgery could reverse diabetes, researchers from the Netherlands formalized the evidence through their analysis of nine previous studies, finding that more than 60 percent of obese diabetics could be cured of the disease, and 80 percent could stop taking their diabetes medications altogether after undergoing weight loss surgery.

Type 2 diabetes has been traditionally been considered a progressive condition that is initially controlled by diet, then medications and finally, with insulin injections.  The condition is caused by too much glucose in the blood due to the pancreas not producing enough insulin – a hormone which breaks down glucose into energy in the cells ““ or due to the body not reacting to it, known as insulin sensitivity.

The Dutch researchers sifted through the data from nine previous studies of diabetics who had either undergone gastric bypass or gastric banding surgery.   Eight of the nine studies included between 23 and 177 patients, while one study monitored the outcomes of 82,000 patients.  Each study tracked the patients for at least one year after their weight loss surgery.

In a gastric banding procedure, the surgeon places a ring over the top of the stomach, which limits the amount of food the patient can consume.  In gastric bypass, food is redirected around the stomach into a small pouch, which reduces the amount of food a person can eat and hampers absorption of the food.  More than 220,000 Americans had some type of weight loss surgery in 2009, according to the American Society for Metabolic and Bariatric Surgery.  The average price per patient was about $20,000.

After conducting their analysis, the researchers found that 83 percent of diabetics who underwent gastric bypass were able to stop taking diabetes medications, some within days of the surgery. Meanwhile, 62 percent of diabetics who had the gastric banding procedure could stop taking diabetes medication while maintaining good control of their blood sugar, wrote the researchers in their report published in the June issue of Archives of Surgery.

Those outcomes surpass what can be achieved with conventional diabetes treatments, said Dr. Rick Meijer at the Institute for Cardiovascular Research at Vrije Universiteit in Amsterdam, lead author of the report.

“In standard practice, only a very minor group of individuals with an iron-will can lose enough weight to be cured from type 2 diabetes mellitus,” he told Reuters.

“The rest of patients have a chronic disease with the need of daily medication-regimens.”

Meijer said roughly 90 percent of the 18 million U.S. diabetes cases are due to excessive weight. 

However, not all obese diabetics are eligible for weight loss surgery, and it is not yet clear how long the surgery’s effect on diabetes can last.

Indeed, one study included in the analysis found that, just one third of patients whose diabetes had ended continued to have good control of their blood sugar 10 years after surgery.

Surgery also includes additional, but still low, potential for complications. For instance, one recent study that followed patients up to a month after surgery found that seven percent experienced some type of problem, ranging from minor wound infections, nausea and food intolerance to bleeding, kidney failure and other serious complications.   Additionally, some patients gain their weight back over time.

Extreme Diet

There may yet be good news for obese diabetics looking for a non-surgical route to control their condition.  

A new British study published on Friday in the journal Diabetologia found that people with obesity-related type 2 diabetes have been cured, at least in the short term, by eating an extreme, low-calorie, diet for two months.

The early stage clinical trial of 11 participants showed that all reversed their diabetes by dramatically reducing their food intake to just 600 calories a day for two months.

After three months, seven of the participants remained free of diabetes.

“To have people free of diabetes after years with the condition is remarkable – and all because of an eight week diet,” said study leader Professor Roy Taylor of Newcastle University.

“This is a radical change in understanding Type 2 diabetes.  It will change how we can explain it to people newly diagnosed with the condition,” he said.

“While it has long been believed that someone with Type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition.”

The researchers said the study demonstrates that people who keep to a very low calorie diet can remove fat that is clogging up the pancreas, allowing normal insulin secretion to resume.

The 11 study participants were put on an extreme diet of just 600 calories a day consisting of liquid diet drinks and non-starchy vegetables.  They were then matched to a control group of people without diabetes, and monitored over the course of eight weeks.

The researchers measured insulin production from the participants’ pancreas, along with fat content in both the liver and the pancreas. After just one week, the team found that the participants’ pre-breakfast blood sugar levels had returned to normal. Furthermore, a special MRI scan of their pancreas’ revealed that the fat levels had returned from an elevated level to normal (from around 8% to 6%). 

In step with this, the pancreas regained the normal ability to make insulin and, as a result, post-meal blood sugar levels steadily improved.

The researchers followed up with the participants three months later, during which time the volunteers had returned to their normal eating habits. 

Of the ten people re-tested, seven remained free of diabetes.

“We believe this shows that Type 2 diabetes is all about energy balance in the body,” explained Professor Taylor.

“If you are eating more than you burn, then the excess is stored in the liver and pancreas as fat which can lead to Type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others.”

“I no longer needed my diabetes tablets” said Gordon Parmley, 67, who took part in the study.

“I love playing golf but I was finding that when I was out on the course sometimes my vision would go fuzzy and I would have trouble focusing.  It was after this that I was diagnosed with Type 2 diabetes. That was about six years ago and from then on, I had to control the diabetes with a daily combination of tablets – the diabetes drug, gliclazide and tablets for my cholesterol,” he said.

“When my doctor mentioned the trial I thought I would give it a go as it might help me and other diabetics. I came off my tablets and had three diet shakes a day and some salad or vegetables but it was very, very difficult,” he said.

“At first the hunger was quite severe and I had to distract myself with something else ““ walking the dog, playing golf ““ or doing anything to occupy myself and take my mind off food but I lost an astounding amount of weight in a short space of time.”

“At the end of the trial, I was told my insulin levels were normal and after six years, I no longer needed my diabetes tablets,” he said.

“Still today, 18 months on, I don’t take them. It’s astonishing really that a diet ““ hard as it was ““ could change my health so drastically. After six years of having diabetes I can tell the difference – I feel better, even walking round the golf course is easier,” he said.

Dr. Iain Frame, Director of Research at Diabetes UK in Britain, praised the study, but warned about the potential difficulty in keeping to such a restrictive diet.

“We welcome the results of this research because it shows that Type 2 diabetes can be reversed, on a par with successful surgery without the side effects,” he said.

“However, this diet is not an easy fix and Diabetes UK strongly recommends that such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term.”

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