Type 2 Diabetes Remission Greater With Gastric Bypass vs Intensive Lifestyle Intervention

RNY works for Type 2 Diabetes.  Studies keep proving it.

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Roux-en-Y gastric bypass (RYGB) surgery yielded greater type 2 diabetes remission in mild or moderately obese patients compared with intensive lifestyle and medical intervention, according to data published in Diabetologia.

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.”

Reference

  1. Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomized controlled trial. Diabetologia. 2016. doi: 10.1007/s00125-016-3903-x.

Understanding and Managing Food #Addiction (and SUGAR!) Livestream Video Via Obesity Action Coalition (OAC)

  • 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.
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Recommended Carbohydrate Levels After Gastric Bypass

Via Bariatric Times

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After you read this study, let's discuss:  

  • 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.



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http://bariatrictimes.com/recommended-levels-of-carbohydrate-after-bariatric-surgery/

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Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

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*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

Visit NBCNews.com for breaking news, world news, and news about the economy

Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

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.

Pear

So maybe being pear-shaped is not such a good thing?

Pear

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.
Chicago Tribune – via Journal of Clinical Endocrinology

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.

Benefit of bariatric surgery may be temporary

This is not new news – however it just hit my Google alerts from my local news –
A major benefit of bariatric surgery, a cure for diabetes, may only be temporary.

Bariatric surgery for diabetes tops innovation rankings

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.

And, number one —

Via Cleveland Clinic

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.