Dr Alfred Dawes | Bariatric surgery the cure for diabetes [Part 2]
In my last article, I spoke about the difference between obesity and overweight, as well as the advantages that bariatric surgery has over traditional lifestyle change. Obesity is a complex disease characterised by hormonal and metabolic changes that place the individual at increased risk of developing lifestyle diseases and resists meaningful attempts at weight loss.
In other words, the treatment for overweight is lifestyle changes resulting in calories consumed being less than calories burnt. The obesity epidemic, on the other hand, cannot be successfully addressed with the current approach of preaching lifestyle changes and needs to be tackled more with the best tool we have available, bariatric surgery.
When bariatric surgery was conceptualised, the main objective was weight loss. However, when observing patients post-operatively, unbelievable results were noticed with their medical conditions.
Many persons with high cholesterol, hypertension and diabetes saw improvement in their health. Diabetes in particular was shown to be cured in up to 75 per cent of cases after gastric bypass. The results were seen long before the patient lost significant weight. This could not be explained by simply decreased insulin resistance as they lost fat.
Further research has revealed that with bariatric surgery, there are significant hormonal changes in the gut and the body. These result in more insulin released into the blood and hence, better regulation of blood sugar levels. Other theories, such as a change in the gut bacteria and changes in where gut cells get glucose, attempt to explain the observations.
Bariatric surgery the only known practical cure for diabetes
Whatever the reason, bariatric surgery is the only known practical cure for diabetes. For those patients who are not cured, they oftentimes see significant improvement in the control of their blood glucose levels. In most cases, coming off insulin injections or reducing the number and dosage of medications for optimal glucose control.
Hypertension usually improves as a patient loses weight and high cholesterol levels fall after surgery in the majority of cases. Progression of chronic kidney disease is slowed significantly. Hormonal diseases, such as the PCOS in women, often improve and they may find conceiving much easier. With the hormonal changes, fibroids have been reported to shrink after bariatric surgery. Heartburn and other reflux symptoms improve with weight loss, and even skin conditions such as psoriasis improve.
As we see more hormonal changes after bariatric surgery, it is further proof that fat is not simple storage house for excess calories consumed. Fat stores play a very important part in hormonal balance. For example, it is the excess fat that causes high levels of hormones in females with PCOS, resulting in irregular periods, acne and facial hair in some women. The more fat one has, the greater the level of insulin resistance, which leads to diabetes. Fat cells also produce hormones that may affect blood pressure and kidney function.
Diabetes leads to atherosclerosis that causes narrowing of blood vessels, especially the smaller blood vessels in the kidneys, the eyes, the heart and the lower limbs. Not surprisingly, diabetes is associated with eye diseases such as retinopathy that can lead to blindness, chronic kidney disease that may require dialysis, and amputations. The disease burden of these complications is far too high in our population.
STAGGERING ECONOMIC COST
Too many Jamaicans are left disabled or maimed by the complications of diabetes. The economic cost to the diabetic patient and to the country is staggering. It requires at least $30,000 per week for dialysis treatment.
That does not take into account the cost for hospitalisations and procedures to treat infections and complications with fistulas and catheters. We do not screen enough diabetic patients to prevent eye complications and many have poor vision by the time we pick up the problem. As a general surgeon, I can testify that dozens of toes and legs are cut off every week in Jamaica.
Things cannot continue as they are. If there is a potential cure for a disease that is disrupting so many lives and costing Jamaicans so much, why aren't we looking into it more as a solution? The evidence is there in the international literature.
The local evidence is here, where many patients who undergo bariatric surgery never look back at their diabetic medication ever again. Instead, we continue to prescribe insulin as a treatment. Insulin that has the side effect of weight gain, that, in turn, worsens insulin resistance and diabetes in the long run.
ADDRESS ROOT OF PROBLEM
We opt to treat the symptoms of lifestyle diseases on a whole. Pills to lower blood sugar that is too high. Pills to lower cholesterol. Pills to lower blood pressure. But what if we were to address the root of the problem. Instead of treating symptoms, go for the cure. Find a way to get rid of the excess fat that is disrupting the delicate hormonal balance in the body. For some, it may mean going on a plant-based or ketogenic diet. For others, the only option may be bariatric surgery.
Unfortunately, we have not moved to make these options available as first-line treatment options. We continue to peddle drugs and fatten the pockets of the big pharmaceutical companies. Not enough persons suffering from lifestyle diseases receive proper nutritional advice, but are simply told to decrease their intake of sugar and try to lose weight. With this approach to combating the greatest public health crisis of our generation, it is no surprise that we continue to fail spectacularly.