Gastric bypass surgery can lead to some impressive results in obese patients, including remission of diabetes type 2. But what really makes the difference — the surgery itself or the restrictive diet that you’re forced to follow afterwards? A study led by Dr. Ildiko Lingvay of the University of Texas Southwestern Medical Center examined 10 people in a controlled, inpatient setting to find out.
The results were recently published in medical journal Diabetes Care, but Dr. Lingvay summarizes the study in a sentence, “We found that the reduction of patients’ caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself.”
The patients involved in the study all had the Roux-en-Y gastric bypass (RYGB), which is well-established to be associated with fast weight loss and the corresponding improvement in the symptoms of type 2 diabetes.
For example, a six-year study of RYGB performed under the auspices of the National Institutes of Health found that severely obese patients weighed less, were more likely to have their diabetes in remission, and were in better health than control patients who didn’t get the operation. Like all surgery, it has its risks, and not every obese patient will be a candidate, but it can really make a difference for the right person.
In the new study, the patients were examined in a hospital setting for 10 days both before and after the surgery in order to make sure that they were getting only the special restrictive diet of less than 2,000 calories a day. As a result, the researchers discovered that the patients who hadn’t yet had surgery but who kept the post-surgical style diet experienced almost as much reduction in their blood glucose levels as they did after they actually had the surgery and again returned to the strict diet — 15 percent versus an 18 percent drop.
In other words, if there was only a way to maintain the extremely strict diet outside a hospital setting, then the patients would do almost or just as well without the surgery. Unfortunately, that’s impractical. The RYGB gastric bypass actually reduces the size of the stomach and bypasses the top of the small intestine — making it difficult or impossible to overeat because there’s really no place to hold the food.
Dr. Lingvay is not suggesting that obese people skip the surgery. The “restrictive diet is nearly impossible to adhere to long-term in the absence of bariatric surgery,” she explained.
However, the new research does give science a better idea of why the process actually works, leading to new hope that one day we’ll develop nonsurgical techniques that can duplicate the effects of gastric bypass.
[photo Dr. Ildiko Lingvay courtesy UT Southwestern Medical Center]
[healthy grilled veggies photo courtesy Salim Fadhley and Wikipedia Commons]