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Study: WLS is not a Diabetes Cure

There's a new study that fails to support the theory that weight loss surgery cures type II diabetes. MedPage Today published an article on it, entitled 'AACE: Bariatric Surgery May Just Mask Diabetes.'

A larger study was posted on the same topic in 2009, there were earlier studies with the same conclusions, and I've always suspected that these studies are right; that WLS doesn't cure diabetes.

We all know what kind of money and influence is behind the people promoting weight loss surgery; the surgeon's groups and the drug companies that manufacture the devices. Surgery candidates want to believe that WLS is worth the risks, because they want the social rewards that come with being thin. If they have or fear getting diabetes, then the claim that WLS "cures diabetes" can be a powerful influence.

But it doesn't really make sense that WLS cures diabetes, does it?

This is how I see it. No doubt it's an oversimplified way of looking at things. I'm not a medical professional, but there are people in my family with type II diabetes and I'm at risk of getting it myself, so I've done a lot of reading.

Type II diabetes is primarily a genetic syndrome, although the easiest way to diagnose and track it is to measure blood sugar. However, if someone can't eat a normal meal - if they're basically starving - then their blood sugar is not going to be high even if they're diabetic. If a diabetic is constantly running a calorie deficit (as they would after WLS), then the fact that their cells aren't responding to insulin - which tells the cells to store fat - isn't really going to matter, because they're losing fat stores, not adding to them. Does that mean that the diabetes is cured? No. As soon as their weight stabilizes and they go back to sometimes using energy and sometimes storing it, then the diabetes will once again become easy to detect.

From the Medpage article:

The researchers also cited flaws in the 621 studies involved in a meta-analysis by Buchwald et al, which concluded that bariatric surgery was a cure for diabetes.

They said most of the studies were retrospective, single-armed, and made up of relatively young women. Also, only 1.6% of them provided Class I evidence.

Marina concluded that HbA1c and fasting blood glucose measurements aren't sufficient criteria to establish a "curing" of type 2 diabetes after gastric bypass surgery.

References:

  • The new study-
    American Association of Clinical Endocrinologists, Marina AL, Trence DL "Is diabetes mellitus really cured by gastric bypass surgery?" AACE 2010; Abstract 210.
  • The older study-
    Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.

Kirstie Alley on Dancing With the Stars | The coming Fatpocalypse

richie79's picture
richie79
March 26th, 2011 | Link | Well it certainly wasn't for

Well it certainly wasn't for my wife, who (without getting into too much detail) didn't have blood sugar problems before but who following a full RNY and subsequent repairs now has great difficulty controlling her glucose, not least because of the huge list of common foods she can no longer tolerate. In any case, whilst Type II diabetes is no barrel of laughs, it's a primarily genetic condition and one which can now be successfully managed. It is surely infinitely preferable to some of the less pleasant complications of WLS.

Of course, when I try to explain to colleagues, acquaintances etc who are considering undergoing the surgery now that it's more widely available why it's a bad idea (it doesn't ultimately make you thin, and certainly doesn't make you healthy, so why bother?) I'm looked at as though I'm some kind of weirdo for daring criticise something they've no doubt been convinced by doctors, 'celebs' and the myriad online WLS groups is all rainbows and butterflies.

If there were one thing I wish we as a species could 'uninvent' it would still be nuclear weapons (watch 'Threads' to see how they can ruin your whole day) but WLS in all its forms comes in a very close second. I guess the best we can hope for (besides a ban on bariatric interference in all but the most extreme cases) is for the future development of more expertise in reversing and repairing the damage done to so many people by this current frenzy of cutting and banding.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

vesta44's picture
vesta44
March 26th, 2011 | Link | Of course HbA1c and fasting

Of course HbA1c and fasting glucose tests aren't a good indication of whether one's type 2 diabetes has been "cured" by WLS. What most people don't realize about the HbA1c test is that it is basically an average, over 3 months, of your blood sugar. So if you've had highs and lows in there along with a lot of numbers that show up as average, you're going to come out with an average HbA1c that shows you've been "cured". However, if most type 2's who have had WLS kept on testing their blood sugar after they had their WLS, they would see those highs and be rightly worried (most don't have to test to know that they've gone low, symptoms alone will tell them that, testing only confirms how low they've gone). And it is possible to have high blood glucose numbers after WLS. As Richie said, WLS messes with what foods one can eat, and high fiber foods are not usually on the list of edibles (and fiber slows down the absorbtion of carbs, which lowers their effect on blood sugar) because they're harder to digest, fill you up faster, and can make you vomit more often (been there done that).
As you said, deeleigh, while they're running a calorie deficit, they're not going to be using some energy and storing some energy, they're going to be using their fat stores and not adding to them. But as soon as their weight loss stops, and they start the using/storing cycle again, then the insulin resistance problem comes back into play and their type 2 diabetes is out of remission (because that's what it is - it's in remission, it's not "cured") and needs to be treated again. Only now, it's going to be more difficult to treat with oral medication because you've added malabsorbtion issues to the mix, and that malabsorbtion doesn't apply just to nutrients from food, it also applies to medications - something people don't consider when they have WLS is how it's going to affect them when they have to take antibiotics or other oral medications. Those medicines don't do you much good if you can't absorb them and they pass right out of your system. Which means type 2 diabetics who were controlling their t2d with diet, exercise, and oral meds are now going to need insulin, an added expense, on top of all the other possible added expenses of WLS.
As a footnote: I wonder if the Buchwald involved in the meta-analysis is the same Buchwald at the U of M who did my VBG (and the 2 VBGs on my best friend, the latter of which killed her). The Buchwald at the U of M used to teach doctors how to do VBGs (seeing how mine failed, and my friend had to have 2 of them, I'm not so sure that's a good recommendation).

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

MichMurphy March 28th, 2011 | Link | Thanks for posting this,

Thanks for posting this, Dee.

richie79's picture
richie79
April 13th, 2011 | Link | The BBC have been leading

The BBC have been leading all day with the results of a study which claims the exact opposite to this. At least they don't try to hide that the report was produced by the National Bariatric Surgery Registry (now I wonder how they stand to gain from exaggerating the scale of the 'problem' and the benefits of WLS in order to increase the takeup rate?) and that the claims that it 'reverses' type II diabetes are based on asessing patients 12 months after surgery, ie. within the initial 'honeymoon period'. On the other hand, the article ignores countless other relevant information so as not to undermine its pro-WLS position (what DOES the Beeb gain from this constant cheerleading for it anyway, especially under a system where most such procedures are now carried out not in private clinics but on the NHS?)

These include the facts that not all 'obese' people are type II diabetic, that relatively few type II diabetics are fat, or that the considerable post-op complication and revision rate (measured over a much longer period than a year) would devastate the NHS far more effectively than so-called 'obesity-related diseases' should all of those 1m+ 'potentials' opt to undergo it. Rather than linking to the earlier studies, the 'related stories' selected are about the cost of uprated bariatric ambulances and an earlier version of the 'long-term savings' claim, this one from the Office of Health Economics (carried out on behalf of the WLS supplies industry). I would post the links myself but (unusually for a Beeb fat story) there's no comment facility; given the tone of the responses on other similar reports, I'm not sure that's a bad thing.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

vesta44's picture
vesta44
April 13th, 2011 | Link | Yeah, the part in there

Yeah, the part in there about people developing coronary heart disease because they didn't do 2 ten-mile runs a day and ate some bacon sandwiches in an earlier life cracked me up. Do these asshats really expect everyone to run 20 miles every day? When are we supposed to find the time to do that? And where are we supposed to do that? Not a lot of jogging trails in the poor areas of most cities, not to mention it's not really safe to jog in those areas either. And not everyone can afford a gym membership so they can run on a treadmill. Yeah, talk about unrealistic expectations - they haz dem.
One of the main problems the NHS has with type 2 diabetics not being able to control their diabetes very well is the fault of the NHS - the NHS refuses to give type 2 diabetics enough test strips to be able to test their blood sugar more than once a day (I know this because we have several list members from the UK in my diabetes groups and they've ranted about this). It's hard to control your blood sugar when you can't test your blood before meals, after meals, and at bedtime in order to figure out how much of your meds you need to take (and some oral meds for type 2 diabetes can be dosed according to what your blood sugar is and the number of carbs you're going to be having at a meal). If you don't know what your blood sugar is before you eat, you don't know how to dose your meds for your current blood sugar and how the meal will raise it, which is why testing is so important.
I'm betting that type 2's who have had WLS have been told they're "cured", based simply on their fasting blood glucose and HbA1c, and since they aren't allowed to test as often as they need to, they don't know they're having high blood glucose spikes after meals. The big problem with those spikes - they're doing damage to one's body until they're discovered and corrected. That's the criminal part of these doctors pushing WLS as a "cure" for type 2 diabetes - it's not a "cure", it only puts it into remission for a short time, then the insulin resistance and high blood glucose problems come back, but they aren't detected because the t2d WLS patients aren't testing their blood and it's not showing up on fasting blood glucose or HbA1c, so damage to nerves and eyes, etc is being done, all in the name of a "cure" that doesn't exist for a moral panic over a created "epidemic".

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

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