The researchers screened 1808 adults aged 25 to 64 years with type 2 diabetes and a body mass index (BMI) ranging from 30 kg/m2 to 45 kg/m2 and allocated 43 participants by concealed, computer-generated random assignment. Participants were assigned to undergo RYGB or intensive lifestyle and medical intervention.
The participants in the intensive lifestyle/medical intervention cohort exercised 5 days per week for at least 45 minutes. Their diet was directed by a dietitian to lower weight and glucose levels, and all participants had optimal diabetes medical treatment for 1 year.
“Our trial and other relevant [randomized controlled trials] demonstrate that commonly used bariatric/metabolic operations (RYGB, sleeve gastrectomy, and gastric banding) are all more effective than a variety of medical and/or lifestyle interventions to promote weight loss, diabetes remission, glycemic control, and improvements in other CVD (cardiovascular disease) risk factors, with acceptable complications, for at least 1 to 3 years,” the authors wrote.
Fifteen participants underwent RYGB and 17 were assigned to the intensive lifestyle/medical intervention. Participants were followed for 1 year, and all were equivalent in baseline characteristics, although the RYGB cohort had a longer diabetes duration (11.4 vs 6.8 years; P=.009).
The percentage of weight loss at 1 year was 25.8% among participants who underwent RYGB and 6.4% in the intensive lifestyle/medical intervention group (P<.001). Participants in the intensive lifestyle/medical intervention exercise program had a 22% increase in VO2max (P<.001), while the VO2max levels in the RYGB group remained unchanged.
The rate of diabetes remission at 1 year was 60% in the RYGB group and 5.9% with the intensive lifestyle/medication intervention (P=.002). HbA1c declined in the RYGB cohort from 7.7% (60.7 mmol/mol) to 6.4% (46.4 mmol/mol), and the intensive lifestyle/medication intervention cohort's HbA1 declined from 7.3% (56.3 mmol/mol) to 6.9% (51.9 mmol/mol), although the decrease occurred with fewer diabetes medications after RYGB (P=.04).
“These results apply to patients with a BMI <35 kg/m2, and our study and others show that neither baseline BMI nor the amount of weight lost dependably predicts diabetes remission after RYGB, which appears to ameliorate diabetes through mechanisms beyond just weight reduction,” the authors noted.
“These findings call into serious question the longstanding practice of using strict BMI cutoffs as the primary criteria for surgical selection among patients with type 2 diabetes.”
Absolutely worth the watch if you like good brain food.
Dr. Nicole Avena is a research neuroscientist and expert in the fields of nutrition, diet and addiction. She received a Ph.D. in Neuroscience and Psychology from Princeton University, followed by a postdoctoral fellowship in molecular biology at The Rockefeller University in New York City. She has published over 50 scholarly journal articles, as well as several book chapters and a book, on topics related to food, addiction, obesity and eating disorders. She also edited the book, Animal Models of Eating Disorders (2012) and has a popular book of food and addiction coming out in 2014 (Ten Speed Press). Her research achievements have been honored by awards from several groups including the New York Academy of Sciences, the American Psychological Association, the National Institute on Drug Abuse, and her research has been funded by the National Institutes of Health (NIH) and National Eating Disorders Association. She also maintains a blog, Food Junkie, with Psychology Today.
Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?
Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates.
Limitations: The literature review was limited to papers published since 1993.
Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake)
Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery.
The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.
2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.
I was just fumbling through my morning routine of empty dishwasher, make coffee, listen to morning radio. I heard this story on NPR about Secret Menus and I stopped and thought, "Well, there's today's blog entry."
BECAUSE LOOK WHAT PANERA DID AND I WOULD HAVE NEVER KNOWN CAUSE IT WAS A BIG OLE SECRET!
Panera (Bread, which I avoid... because it is a BREAD. STORE. CLOAKED. AS. A. SIT. DOWN. RESTAURANT.) now offers on the sly, teh foods that I can enjoy, and that many of you can also enjoy, but we have to play the secret game to get them.
One thing you won't see on Panera Bread's secret menu? Bread.
As Scott Davis, who oversees menus for Panera Bread, explains, "This is probably the most extreme anti-kind of Panera diet you can have, right? It doesn't include bread and flour and that sort of stuff."
Davis says that the company had been missing out on a whole group of diners: diabetics and people who were cutting carbs or avoiding gluten. This menu lets the company tap into that growing health-conscious market.
"If someone never considered Panera before because the name 'bread' is in it ... this is a way of opening that door," says Davis.
So at its 1,800 stores around the country, Panera trained its employees to either pull out the secret menu card or scan a code that'll put the menu on a customer's mobile device.
We have heard for years that being pear-shaped was preferable to other body-shapes, that carrying excess body-fat in the hips, thighs, legs and rear was 'healthier' than the belly. That 'pears' were a preferable body-shape to have than 'apples.' This is not necessarily so.
If you're pear-shaped and smug, a new study's findings may take you down a peg: For those at slightly increased risk of developing diabetes, fat stored in the buttocks pumps out abnormal levels of two proteins associated with inflammation and insulin resistance. (And that's not good.)
The new research casts some doubt on an emerging conventional wisdom: that when it comes to cardiovascular and diabetes risk, those of us who carry some excess fat in our hips, thighs and bottoms ("pear-shaped" people) are in far better shape than those who carry most of their excess weight around the middle ("apples").
The new study was posted online this week in the Journal of Clinical Endocrinology and Metabolism, and it focuses on a number of proteins, with names such as chemerin, resistin, visfatin and omentin-1, that could one day be used to distinguish between obese people headed for medical trouble and those whose obesity is less immediately dangerous.
The subjects in the study were all people with "nascent" metabolic syndrome — meaning patients who already have at least three risk factors for developing diabetes (large waist circumference, high blood pressure, high triglcerides, low HDL, or "good" cholesterol, and high fasting blood sugar) but no cardiovascular disease or diabetes complications yet.
The researchers found these subjects' "gluteal adipose tissue" — fat in and around the buttocks — pumped out unusually high levels of chemerin, a protein that has been linked to high blood pressure, elevated levels of C-reactive protein, triglycerides and insulin resistance, and low levels of good cholesterol. The blood and subcutaneous fat drawn from gluteal tissue also contained unusually low levels of omentin-1, a protein that, when low, is linked to high triglycerides, high circulating glucose levels and low levels of good cholesterol.
"Fat in the abdomen has long been considered the most detrimental to health, and gluteal fat was thought to protect against diabetes, heart disease and metabolic syndrome," said Ishwarlal Jialal, a professor of pathology and laboratory medicine and of internal medicine at UC Davis and lead author of the study. "But our research helps to dispel the myth that gluteal fat is innocent," he added.
Cleveland Clinic announced its list of Top 10 Medical Innovations that will have a major impact on improving patient care within the next year. The list of breakthrough devices and therapies was selected by a panel of Cleveland Clinic physicians and scientists and announced today during Cleveland Clinic’s 2012 Medical Innovation Summit.
1. Bariatric Surgery for Control of Diabetes Exercise and diet alone are not effective for treating severe obesity or Type 2 diabetes. Once a person reaches 100 pounds or more above his or her ideal weight, losing the weight and keeping it off for many years almost never happens.
While the medications we have for diabetes are good, about half of the people who take them are not able to control their disease. This can often lead to heart attack, blindness, stroke, and kidney failure.
Surgery for obesity, often called bariatric surgery, shrinks the stomach into a small pouch and rearranges the digestive tract so that food enters the small intestine at a later point than usual.
Over the years, many doctors performing weight-loss operations found that the surgical procedure would rid patients of Type 2 diabetes, oftentimes before the patient left the hospital.
Many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes —and not as a last resort.
Obesity has long been associated with infertility as well as lower success rates with in vitro fertilization, and now researchers think they understand why: Obese women are more likely to have abnormalities in their eggs that make them impossible to fertilize.
Brigham and Women’s Hospital infertility researchers examined nearly 300 eggs that failed to fertilize during IVF in both severely obese women and those with a normal body weight.
They found that severely obese women were far more likely to have abnormally arranged chromosomes within their eggs compared with women who weren’t overweight, according to the study published Wednesday in the journal Human Reproduction.
21% of patients in a study had recurrence of their diabetes a few years after roux en y gastric bypass. This suggests that those with diabetes might benefit from having weight loss surgery EARLIER in the course of their obesity and disease?
A new study by researchers at the Mayo Clinic Arizona in Scottsdale, however, suggests that more than a fifth of those who are cured suffer a recurrence of their diabetes within five years, even without a weight gain. The results indicate that patients who had suffered from diabetes the longest were most likely to have a recurrence, suggesting that surgical intervention should be undertaken early in the course of the disease.
Dr. Yessica Ramos and her colleagues at Mayo studied the records of 72 obese patients who underwent a Roux-en-Y gastric bypass operation between 2000 and 2007 and who had at least three years of follow-up. They reported at a Houston meeting of the Endocrine Society that 66 of the patients (92%) had a reversal of their diabetes at some point. Within three to five years after their surgery, however, 14 of those patients (21%) had a recurrence of their diabetes. The patients who did not have a recurrence lost more weight initially and maintained a lower average weight during the study period, but they did not regain less weight than those who had a recurrence.
But the longer the patients had suffered from diabetes before the surgery, the more likely they were to have a recurrence. Patients who had had diabetes for more than five years were 3.8 times more likely to have a recurrence than those with less than a five-year history.
Two studies published in the New England Journal of Medicine show that bariatric surgery may treat, or even reverse, the effects of type 2 diabetes in overweight and obese patients with high blood sugar levels. Some fear that the risks of the operation overshadow the rewards.
CHICAGO (AP) — New research gives clear proof that weight-loss surgery can reverse and possibly cure diabetes, and doctors say the operation should be offered sooner to more people with the disease — not just as a last resort.
The two studies, released on Monday, are the first to compare stomach-reducing operations to medicines alone for "diabesity" — Type 2 diabetes brought on by obesity. Millions of Americans have this and can't make enough insulin or use what they do make to process sugar from food.
Both studies found that surgery helped far more patients achieve normal blood-sugar levels than medicines alone did.
The results were dramatic: Some people were able to stop taking insulin as soon as three days after their operations. Cholesterol and other heart risk factors also greatly improved.
Doctors don't like to say "cure" because they can't promise a disease will never come back. But in one study, most surgery patients were able to stop all diabetes drugs and have their disease stay in remission for at least two years. None of those treated with medicines alone could do that.
"It is a major advance," said Dr. John Buse of the University of North Carolina at Chapel Hill, a leading diabetes expert who had no role in the studies. Buse said he often recommends surgery to patients who are obese and can't control their blood-sugar through medications, but many are leery of it. "This evidence will help convince them that this really is an important therapy to at least consider," he said.
There were signs that the surgery itself — not just weight loss — helps reverse diabetes. Food makes the gut produce hormones to spur insulin, so trimming away part of it surgically may affect those hormones, doctors believe.
Weight-loss surgery "has proven to be a very appropriate and excellent treatment for diabetes," said one study co-leader, Dr. Francesco Rubino, chief of diabetes surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center. "The most proper name for the surgery would be diabetes surgery."
More than a third of American adults are obese, and more than 8 percent have diabetes, a major cause of heart disease, strokes and kidney failure. Between 5 million and 10 million are like the people in these studies, with both problems.
For a century, doctors have been treating diabetes with pills and insulin, and encouraging weight loss and exercise with limited success. Few very obese people can drop enough pounds without surgery, and many of the medicines used to treat diabetes can cause weight gain, making things worse.
Surgery offers hope for a long-term fix. It costs $15,000 to $25,000, and Medicare covers it for very obese people with diabetes. Gastric bypass is the most common type: Through "keyhole" surgery, doctors reduce the stomach to a small pouch and reconnect it to the small intestine.
One previous study tested stomach banding, a less drastic and reversible procedure for limiting the size of the stomach. This technique lowered blood sugar, but those patients had mild diabetes. The new studies tested permanent weight-loss surgery in people with longtime, severe diabetes.
At the Cleveland Clinic, Dr. Philip Schauer studied 150 people given one of two types of surgery plus standard medicines or a third group given medicines alone. Their A1c levels — the key blood-sugar measure — were over 9 on average at the start. A healthy A1c is 6 or below.
One year after treatment began, only 12 percent of those treated with medicines alone were at that healthy level, versus 42 percent and 37 percent of the two groups given surgery.
Use of medicines for high cholesterol and other heart risks dropped among those in the surgery groups but rose in the group on medicines alone.
"Every single one of the bypass patients who got to 6 or less got there without the need for any diabetes medicines. Almost half of them were on insulin at the start. That's pretty amazing," said a study co-leader, Dr. Steven Nissen, the Cleveland Clinic's cardiovascular chief.
An obesity surgery equipment company sponsored the study, and some of the researchers are paid consultants; the federal government also contributed grant support.
The second study was led by Dr. Geltrude Mingrone at the Catholic University in Rome, with Rubino from New York. It involved 60 patients given one of two types of surgery or medicines alone. The researchers set as their goal an A1c under 6.5 — the level at which someone is considered to have diabetes.
Two years later, 95 percent and 75 percent of the two surgery groups achieved and maintained the target blood-sugar levels without any diabetes drugs. None of those in the medicine-alone group did.
There were no deaths from surgery and only a few complications. Four patients in the Cleveland study needed second surgeries, and two in the Italian study needed hernia operations. Doctors note that uncontrolled diabetes has complications, too — many patients wind up on dialysis when their kidneys fail, and some need transplants.
An adult who has a body mass index (a calculation based on height and weight) of 30 or more is considered obese. That's 203 pounds or more for a 5-foot-9 man, for example.
The government recently lowered the criteria for use of gastric bands from a BMI of 35 down to 30 in diabetics or people with heart disease, opening the way for wider use of this and other procedures for obesity.
Dr. Alvin Powers, director of the Vanderbilt University diabetes center, said the results are very encouraging for people like those in these studies — very obese, with diabetes that can't be controlled through less drastic means.
"We still don't know the long-term outcomes of these surgeries" and whether the benefits will last for more than a few years, he said.
Others were more positive.
The studies "are likely to have a major effect on future diabetes treatment," two diabetes experts from Australia, Dr. Paul Zimmet and George Alberti, wrote in an editorial in the medical journal. Surgery "should not be seen as a last resort" and should be considered earlier in treating obese people with diabetes, they wrote.
Many post weight loss surgical patients deal with blood sugar fluctuations, particularly those of us whom have had roux en y gastric bypass. Aside from dumping, we often have a blood sugar reaction after dumping -- and sometimes without -- called reactive hypoglycemia.
There could be a REASON why we fail diets. Or -- diets fail us.
One year after initial weight reduction, levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss. Long-term strategies to counteract this change may be needed to prevent obesity relapse.
Ghrelin. You may have heard of this evil little hormone.
Hormones regulating when a person feels hungry or sated do not rapidly adjust to weight loss, which may be a factor in the yo-yo effect observed among dieters, researchers found.
One year after losing weight, levels of appetite-regulating hormones didn't revert to baseline levels, Joseph Proietto, PhD, of Heidelberg Repatriation Hospital in Australia, and colleagues reported in the Oct. 27 issue of the New England Journal of Medicine.
The findings suggest that the "high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits," Proietto and colleagues wrote.
It's well established that heavy patients who lose weight dieting often fail to keep the pounds off, the researchers explained.
Studies have shown that restricting calories can lower levels of the hormones leptin -- which tells the brain that the body is full -- and ghrelin -- which stimulates hunger.
Doesn't this also help explain why some forms of weight loss surgery ... work better overall in the long term? In certain types of WLS -- most of ghrelin producing factor -- is removed.
Go DS. Or not. It's up to you. Surgery flame wars!
Approximately 70% of the stomach is removed along the greater curvature, also called a vertical sleeve gastrectomy (VSG). The remaining stomach is fully functioning, banana shaped and about 3 - 5 oz in size which restricts the amount you can consume. The pylorus continues to control the stomach emptying into the small intestine; as a result patients do not experience "dumping". The upper portion of the duodenum remains in use; food digests to an absorbable consistency in the stomach before moving into the small intestine. This allows for better absorption of nutrients like vitamin B12, calcium, iron and protein when compared to gastric bypass procedures.
A benefit of removing a portion of the stomach is that it also greatly reduces the amount of ghrelin producing tissue and amount of acid in the stomach.
Ghrelin is the "hunger hormone" and by reducing the amount of the hormone produced the appetite is suppressed.