Category Archives: Bariatric Surgery

May 29, 2020 · 7:00 AM

Gastric Bypass Surgery Improves Heart and Kidney Outcomes in Type 2 Diabetes

Steve Parker MD, bariatric surgery, gastric bypass

Band Gastric Bypass Surgery

From a recent Diabetes Care article:

Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.

Source: Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits | Diabetes Care

Because of the risk of surgery, I’d make sure first that diet modification was seriously tried and failed.

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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Filed under Bariatric Surgery, Heart Disease, kidney disease

December 6, 2019 · 7:00 AM

Bariatric Surgery Prolongs Life in PWDs (formerly “diabetics”)

bariatric surgery, Steve Parker MD

Band-type gastric bypass, a type of metabolic surgery

Bariatric surgeries are considered by some experts (mostly surgeons?) to be the most effective way to treat or cure type 2 diabetes. They are effective, assuming you survive the original operation and potential complications, which may require further surgery.

From JAMA Network:

Among patients with type 2 diabetes and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident [heart attack, ischemic stroke, and mortality]. The findings from this observational study must be confirmed in randomized clinical trials.

Source: Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity | Bariatric Surgery | JAMA | JAMA Network

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

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Filed under Bariatric Surgery, Longevity

October 10, 2019 · 8:00 AM

Sure, Gastric Bypass Works for Adolescents, But for How Long?

bariatric surgery, Steve Parker MD

Band-type gastric bypass

From The New England Journal of Medicine:

Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults.

Note, however,

Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P=0.003).

Source: Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults | NEJM

I readily admit that gastric bypass is very effective method of weight loss and way to put type 2 diabetes into remission. But it’s a roll of the dice, and expensive.

Steve Parker, M.D.

low-carb mediterranean diet

Not linked to any deaths as far as I know. Click pic to purchase at Amazon.com.

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September 11, 2016 · 3:38 AM

Save $26,000 on Weight-Loss Surgery and Do This Instead

Dr. Sarah Hallberg makes a hell of a lot of sense in her New York Times article:

“Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.

It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.”

Source: Before You Spend $26,000 on Weight-Loss Surgery, Do This – The New York Times

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Filed under Bariatric Surgery, Weight Loss

November 14, 2013 · 12:59 AM

Type 2 Diabetes “Cure” After Gastric Bypass Doesn’t Necessarily Last

…according to Seattle researchers.

They looked at over 4,000 diabetics who had gastric bypass surgery for weight loss, following their cases over many subsequent years. Almost seven in 10 had a “complete diabetes remission” within five years of surgery. (Remission was defined as non-diabetic lab values on blood tests and absence of diabetic drug use.) Of those going into remission, 35% redeveloped diabetes within five years of surgery. Those with the more severe or longstanding cases of diabetes before surgery were  more likely to have a recurrence of diabetes.

bariatric surgery, Steve Parker MD

Band Gastric Bypass Surgery (not the only type of gastric bypass)

So it looks to me like, on average, gastric bypass surgery “cures” half of the cases of type 2 diabetes, as measured five years after surgery. As the years pass, even more failures will arise. Nevertheless, that’s an impressive improvement. Given the potential complications of bypass surgery, I’d try a very-low-carb diet before going under the knife. Examples are Dr. Bernstein’s Diabetes Solution and Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

PS: Cure or remission of type 2 diabetes could be defined in other ways. For instance, a more reliable definition of cure might include return of normal pancreas/insulin function as judged by insulin levels and insulin sensitivity. If you have normal blood sugar levels and hemoglobin A1c, yet have ongoing insulin resistance, you’re more likely to develop overt diabetes going forward.

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July 3, 2009 · 2:00 AM

A Chance to Cut is a Chance to Cure

"Has anybody seen my pen?"

"Has anybody seen my pen?"

Gastric bypass is the most common bariatric surgery in the U.S.  The odds of dying from that procedure are roughly 1 in 200.  Thousands of people sign on the dotted line for it every year.  Why do they take that risk?

A recent study out of Sweden shows that people who undergo various bariatric surgeries reduce their risk of death over the next 11 years by 25%.

In the Swedish Obese Subjects Study, 2010 subjects underwent bariatric surgery and 2037 received conventional treatment.  Overall mortality was recorded over the next 11 years.  Only three of the subjects were lost to follow-up (unknown whether alive or not).  The average body mass index (BMI) for all subjects was 41.

Out of the conventional treatment group, 126 died.  In the surgery group, only 101 died.  Average weight change in the conventional treatment group was up or down only 2%.  People in the surgery group were given one of three operations: gastric bypass, vertical-banded gastroplasty, or banding.  After 10 years, average weight loss of the groups was 25%, 16%, and 14%, respectively.

Over the course of 11 years, people in the surgery group had 25% less chance of dying when compared to the conventional treatment group.  The most common causes of death were heart attacks and cancer.

Even better results were found back in the U.S.  Researchers in Utah looked at mortality rates of 7925 patients who had undergone gastric bypass surgery between 1984 and 2002.  They compared death rates to a control group (also 7925 people) of obese people who applied for driver’s licenses.  Subjects were matched for sex, body mass index, and age.  Average BMI of the surgical group was 45.

Over the course of seven years, there were 321 deaths in the control group and 213 in the surgery group.  Deaths from any cause were reduced by 40% in the surgery group, compare to the control group.  Surgery patients had less death from cardiovascular disease, diabetes, and cancer.

Surgery is definitely a roll of the dice.  Now you know why people play the game.

Steve Parker, M.D.

References:

Sjostrom, Lars, et al.  Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects.  New England Journal of Medicine, 357 (2007):  741-752.

Adams, Ted, et al.  Long-Term Mortality after Gastric Bypass Surgery.  New England Journal of Medicine, 357 (2007): 753-761. 

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Filed under Bariatric Surgery, Overweight and Obesity

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