It seems obvious that cutting away part of the stomach and intestine should cause weight loss. With a smaller stomach and less intestine fewer calories can be absorbed per day causing weight loss. Surgeons who perform gastric by-pass were puzzled however, by how fast their patients showed metabolic improvement after undergoing this procedure. They noticed many of their diabetic patients could be taken off diabetic medication immediately after surgery before weight had been lost. Scientists looking into this phenomena discovered unsuspected ways gastric by-pass improved metabolism.
The intestines produce hormones which regulate blood sugar and appetite. GLP-1 is among the best known of these intestinal hormones. GLP-1 is the basis of a whole new generation of medications used to treat diabetes such as Byetta, Victoza, Januvia and Onglyza. GLP-1 lowers blood sugar, stimulates the pancreas and reduces appetite. After gastric by-pass increased amounts of GLP-1 are produced by the remaining intestine. In a study published in the Journal of Clinical Endocrinology and Metabolism (95:4072-4076, 2010), researchers at St. Lukeâ€™s Hospital in New York discovered that levels of oxyntomodulin, another intestinal hormone that suppresses appetite and acts like GLP-1 on blood sugar levels, is doubled after gastric by-pass.
These exciting discoveries help explain why obese diabetics can often be sent home without any medication to control blood sugar immediately after undergoing gastric by-pass surgery. Although most insurance plans do not cover gastric by-pass surgery, dramatic improvements in patients after the procedure with greatly reduced medication costs may convince insurance companies that paying for the procedure will result in better outcomes and save them money in the long run.
Gary Pepper, M.D.
A. Lazzara, member of metabolism.com, posts the following to the discussion of gastric by-pass surgery for weight loss.
Thank you for posting this but you havent posted all the information just parts of it.
Most people who have bariatric surgery really DO it as a last resort.
While you are right about that the one sole gastric bypass surgery is NOT a quick solution to the problem, however there are other bariatric procedures that are available to consider. One of them being the latest one called vertical sleeve which just cuts your stomach smaller and does not do all the plumbing that the drastic gastric bypass does. Another form is the popular lapband which is just a band thats inserted over your abdominal to restrict the food.
Any of the bariatric doctors do WARN the patient that with the gastric bypass that you run the risk of malabsorption and that can be detrimental in the long run.
As far as bariatric procedures are concerned I know TEN people who had various bariatric surgeries. I know 8 of them that are doing great! I know my cousin had the gastric bypass and she didnt do well. She has to go back in and get it removed because it was dangerous for her. But this was when gastric bypass first started out as a new procedure. The other person i dont know what procedure she had done but her situation is that she stopped taking the vitamins that she was supposed to take so she became ill. Shes doing better now that she is taking her supplements.
Iâ€ve been to many bariatric seminars and i strongly recommend the vertical sleeve. Out of the ten i mentioned I know two of them had that done and are doing fantastic. They do not get malabsorption and just mainly control what they eat. If people are concerned then i suggest they opt for the lapband and if its not for them they can have it removed.
I personally cannot have ANY of these procedures even if i had the money for it. In 1996 I had acute pancreatitis(which left me diabetic) and they did abdominal surgery on me therefore the bariatric doctors will not touch anyone who had any kind of abdominal surgery due to that it might cause complications. How i dont know though. Iâ€™m hoping to find out.
Do know this that you can have any surgery and STILL gain the weight back. You can still eat tons of milk shakes with the lapband or constantly eat small portions with the vertical sleeve and re-stretch out your stomach. So they arenâ€™t a cure all.
Recent studies are confirming that weight loss surgery canÂ provide dramatic improvements in treatment ofÂ people with Type 2 Diabetes.Â One such recent study compared the results of many other studies of weight loss surgery andÂ was publishedÂ in the JAMA. Â Type 2 diabetes, or adult onset diabetes,Â is generally seen in over-weight adults. When an individual gainsÂ weight the body must produce more and more insulin to compensate for the additional fat. Once the pancreas has reached maximum porduction and cannot produce enough to keep the blood sugar normal,Â the result is called Type 2 diabetes.Â By causing rapid weight loss via gastric by-pass or gastric banding surgery the body declines in size to a point where the pancreas is now again able to supply the proper amounts of insulin and the diabetes is “cured”.Â Â If the person regains the weight the diabetes will return.Â Some experts believe that gastric surgery also improves other hormones that effect blood sugarÂ and that weight loss itself is not even necessary to see better blood sugar levels.
Weight loss surgery is not like cosmetic surgery. The risks are seen as relativelyÂ greater than cosmetic surgeryÂ and there are frequent complications involving the digestive system.Â Costs of surgery are high and are generally not covered by insurance. For this reason many peopleÂ travel outside of the US to obtain the surgery and wind up saving money.
Currently in the US the guideline for consideration for surgical treatment of diabetes is a BMI (search this term in metabolism.com) of greater than 40 or a BMI of 35 or more associated with some complication of diabetes such as leg ulceration.Â Doctors are now struggling to decide if these guidelines should be relaxed so more people with diabetes would qualify for weight loss surgery.
Gary Pepper, M.D.
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