Posted on 03/06/2008 2:52:56 PM PST by blam
Diabetes May Be Disorder Of Upper Intestine: Surgery May Correct It
Growing evidence shows that surgery may effectively cure Type 2 diabetes -- an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes. (Credit: iStockphoto/Jacob Wackerhausen)
ScienceDaily (Mar. 6, 2008) — Growing evidence shows that surgery may effectively cure Type 2 diabetes — an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes.
A new article — published in a special supplement to the February issue of Diabetes Care by a leading expert in the emerging field of diabetes surgery — points to the small bowel as the possible site of critical mechanisms for the development of diabetes.
The study's author, Dr. Francesco Rubino of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, presents scientific evidence on the mechanisms of diabetes control after surgery. Clinical studies have shown that procedures that simply restrict the stomach's size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese.
"By answering the question of how diabetes surgery works, we may be answering the question of how diabetes itself works," says Dr. Rubino, who is a professor in the Department of Surgery at Weill Cornell Medical College and chief of gastrointestinal metabolic surgery at NewYork-Presbyterian/Weill Cornell.
Dr. Rubino's prior research has shown that the primary mechanisms by which gastrointestinal bypass procedures control diabetes specifically rely on the bypass of the upper small intestine — the duodenum and jejunum. This is a key finding that may point to the origins of diabetes.
"When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem," says Dr. Rubino, who is heading up NewYork-Presbyterian/Weill Cornell's Diabetes Surgery Center.
In fact, it has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism. "It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes," Dr. Rubino says.
While other gastrointestinal operations may cure diabetes as an effect of changes that improve blood sugar levels, Dr. Rubino's research findings in animals show that procedures based on a bypass of the upper intestine may work instead by reversing abnormalities of blood glucose regulation.
In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels. "When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose," says Dr. Rubino. In striking contrast, when nutrients' passage is diverted from the upper intestine of diabetic patients, diabetes resolves.
This, he explains, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.
How exactly the upper intestine is dysfunctional remains to be seen. Dr. Rubino proposes an original explanation known in the scientific community as the "anti-incretin theory."
Incretins are gastrointestinal hormones, produced in response to the transit of nutrients, that boost insulin production. Because an excess of insulin can determine hypoglycemia (extremely low levels of blood sugar) — a life-threatening condition — Dr. Rubino speculates that the body has a counter-regulatory mechanism (or "anti-incretin" mechanism), activated by the same passage of nutrients through the upper intestine. The latter mechanism would act to decrease both the secretion and the action of insulin.
"In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream," he explains. "In some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in Type 2 diabetes."
Indeed, in Type 2 diabetes, cells are resistant to the action of insulin ("insulin resistance"), while the pancreas is unable to produce enough insulin to overcome the resistance.
After gastrointestinal bypass procedures, the exclusion of the upper small intestine from the transit of nutrients may offset the abnormal production of anti-incretin, thereby resulting in remission of diabetes.
In order to better understand these mechanisms, and help make the potential benefits of diabetes surgery more widely available, Dr. Rubino calls for prioritizing research in diabetes surgery. "Further research on the exact molecular mechanisms of diabetes, surgical control of diabetes and the role played by the bowel in the disease may bring us closer to the cause of diabetes."
Today, most patients with diabetes are not offered a surgical option, and bariatric surgery is recommended only for those with severe obesity (a body mass index, or BMI, of greater than 35kg).
"It has become clear, however, that BMI cut-offs can no longer be used to determine who is an ideal candidate for surgical treatment of diabetes," says Dr. Rubino.
"There is, in fact, growing evidence that diabetes surgery can be effective even for patients who are only slightly obese or just overweight. Clinical trials in this field are therefore a priority as they allow us to compare diabetes surgery to other treatment options in the attempt to understand when the benefits of surgery outweigh its risks. Clinical guidelines for diabetes surgery will certainly be different from those for bariatric surgery, and should not be based only on BMI levels," he notes.
"The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease," adds Dr. Rubino.
Type 2 diabetes, which accounts for 90 to 95 percent of all cases of diabetes, is a growing epidemic that afflicts more than 200 million people worldwide.
At a time when diabetes is growing epidemically worldwide, Dr. Rubino says that finding new treatment strategies is a race against time. "At this point, missing the opportunity that surgery offers is not an option."
In addition to having performed landmark studies in the field of diabetes surgery, Dr. Rubino was the principal organizer of an influential Diabetes Surgery Summit, held in Rome in March 2007. This international consensus conference helped establish the field, making international recommendations for the use of surgery and creating an International Diabetes Surgery Task Force. Dr. Rubino serves as a founding member.
Adapted from materials provided by New York- Presbyterian Hospital/Weill Cornell Medical Center.
Guess they have a whole, big bunch of folks there who need a gluten free diet ~ this is right where Southern/Central Illinois blends into Northern Illinois with its Scandinavian majority, so that may explain part of it.
There’s also yet another allele variant out there that tells your T-cells to react to oat protein as well as wheat protein. It’s kind of rare, so everybody with it is most likely a close relative of all the others.
I prefer nuts.
I also prefer my chickens to not be contaminated with West Nile Virus, so no "free range" stuff.
But I have learn how to read the labels and has some pretty low carb bread that don't take up your whole mean alotment.
That's fine, but grains, whole or otherwise, contain starches and sugars.
Example 
Total carbs 17g minus fiber 5g so it is only 12g. which for 2 slices makes it 24g. (it might be only 12g(??)since serving size listed is two slices.
Some packages are 1 servings.
There are some lower or higher in grams
Hubby and I decided to cut all flour, sugar, rice and potatoes from our diets. It was hard at first to adjust my cooking, but we have found and/or developed delicious very low carb substitutes for everything we love ... waffles, bread, crackers, loaded baked potatoes, muffins, etc. We have no trouble staying at 30-50 carbs per day.
He has lost 50 pounds and reduced his diabetes medication by 2/3 within 6 months of diagnosis. Now his doctor says if he can lose another 50 pounds, he probably can get off all meds.
And our cholesterol and blood pressure levels have dropped drastically, even considering we use real butter and extra virgin olive oil daily.
Budweiser Select. 99 cal, 3 carbs.
That turns more of the starch into sugar so the yeast can eat it and produce gas to make the multi-grain bread rise.
Not sure this is good for you.
Cooking/baking doesn't destroy all that alpha amylase in the white kidney bean extract, so you get that added to your complement of things turning starch into sugar in your body and it's gotta' have a major effect on your blood sugar level.
So, yeah, low carb bread can turn into high carb bread when you eat it!
It's a trick.
Well what can I say only that is dose not effect my two hour blood fast test when I test.
As long as I get non diabetic feed back in my test I am doing just fine!
Which is good. Still, I didn’t want you to think those low carb multigrain breads are really “low carb” once they get inside your gut ~ they’re not!
once they get inside your gut
That is so uncouth!
Well, it happens. Can’t be helped either unless you give up eating.
Grains are a gift from God not a curse!
In matters of health, even regulators bow to the CDC; for instance, the upcoming new ozone standards for EPA air quality requirements are going to be lowered from the current 80PPB. The CDC recommends dropping them to 60PPB while the current Administration wants to go in steps starting with a drop now to 75PPB and a gradual lowering to reach 60PPB.
Each increment has estimated health benefits that promise less sickness and more lives saved as you go down the scale. This makes the argument very emotional and disallows any true evaluation of actual clinical cases having been studied.
When we consider that right after 1970 when the EPA was established under Nixon the original ozone standard was pegged at 300PPB, a figure then considered a point at which no harm to the public ought to be expected one should ask just what harm has now been detected and what benefits have already been realized.
Over the past 30 years the standard has been lowered almost immediately after a majority of states have attained it, verified by testing the air, yet the process goes on unabated and more vocal with each new, harder to reach, standard.
Expect to see the same thing with the coming allowable CO2 levels for which standards will be applied.
Modern science ignores the law of diminishing returns.
What’s the connection between wheat and lactose intolerance? I’m lactose intolerant and my sensitivity to it varies widely. Is wheat a contributing factor?
That's probably why the ribs at Texas Roadhouse are causing me grief. I'll have to stick to grilled beef without the sauces.
When I get exposed to wheat, the initial reaction is a runny nose within 2 to 5 minutes. That develops into a heavy, post nasal drip that persists for days. The lactose intolerance shows up within a few days. I know that I'm in trouble if I have to start clearing my throat at a meal. By then it's too late to do anything about it.
Given the common contamination of oats with wheat, you would have to be very careful to isolate the oat protein to be certain. I haven't dusted off my lab skills in immunology and molecular biology in many years. It would be interesting to find a means of doing a lab test to detect some of these problems without having to subject a person to contact with the antigen.
Gluten intolerance manifests with damage to the villi in the small intestine. The tips of the villi produce lactase. Exposure to gluten proteins from wheat/barley/rye can damage the villi and their ability to make lactase.
There are other reasons to end up lactose intolerant. Some of it can be traced to genetic and racial heritage. Lactase production can drop as individuals age. It can happen even if you aren't gluten intolerant. I counted myself in this category for years and just avoided foods containing fresh milk. Coffee with heavy cream has no lactose and never upset my stomach.
My parents spent lots of money carting me to ear, nose and throat doctors. My sinuses were always a disaster. I was subjected to a tonsillectomy in hopes that removing the tonsils would remove a reservoir of infection. That did nothing. Perpetually living on antihistamines wasn't really helping either. Discovering the wheat connection was a total accident. I removed wheat and diary from my diet about 10 years ago. My sinuses were clear for the first time in my life. About 18 months into this happy state, I came home to find the house fragrant with a freshly baked pizza. I ate one piece and triggered the running nose, throat clearing and three ring circus in my gut.
I suggest reading through "The Gluten Connection". You would be surprised how many different ways a gluten intolerance can be manifested in humans.
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