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.
That's the first problem with it. It has a protein (gluten) that can irritate T-cells in the gut to produce so many antibodies that they kill off the villi in your small intestine.
They take three days to grow back. In the meantime you get to pass undigested food.
It's probably one of the ways the body gets to eliminate certain types of poison ~ e.g. poisonous plants that grow in wheat fields ~ before they kill our kidneys.
Well of course you either drug it or cut it...
Have you ever considered that your husband might have celiac disease or so-called gluten enteropathy? The estimate is 1% of the population has this. It is associated with diabetes. Stopping wheat and all gluten-containing products can reverse this.
It causes mal-absorption in the intestines. Check his vitamin D level. Just a thought.
.......Type 2 diabetes, which accounts for 90 to 95 percent of all cases of diabetes, is a growing epidemic .......
The growth is in large part a function of revised diagnosis thresholds. At one time as recent as perhaps 2000 the fating blood sugar level was the threshold. At some time after that the level was reduced to 126.
That is 140 - 126 = 14. 14/140 = 0.10, or 10%. I had a chance to ask a major diabetes researcher on a radio conference call, why the reduction, why 10% not 9 or 12. He told me it was an arbitrary reduction.
Ping for later
We do that too. We always cook everything from scratch. But we have always used my mother-in-law’s recipes. Now we are buying all new cookbooks. We have always been perimeter shoppers. Some times I miss potatoes.
We use turnips a lot now, they are lower in carbs/starch. I made turnip au gratin the other day. Tasted a LOT like potato au gratin.
bookmark
I had gastric bypass which removes part of the upper intestine. I was insulin Type 2 diabetic. I haven’t used insulin or anything for 5 years come May of this year. I always fear it will come back, but last HBA1C was below 6 (non-diabetic).
Our cat died of celiac disease. He has already added vit. D to his daily routine. He has already cut out all wheat and thus all gluten. Our friend has celiac disease and he cut out all wheat/gluten/bread/beer. he feels a lot better!
Interesting.
WE MISS PIZZA, and tacos, and nachos, and my homemade bread and my homemade biscuits, and my homemade pies, etc. LOL but they are gone now. We didn’t have them often. I was raised on things like for dinner one thin tiny pork chop and some green beans and green salad. That was it. no gravy or dessert or bread. That is how my mom cooked. none of us developed diabetes. My husband has a SWEET TOOTH. I never did.
ping
As a Type 2 diabetic, I find this encouraging. What we don’t know about the human body is only rivaled by what we don’t know about the environment we live in.
Yet there are those who would tell us what not to eat and that CO2 a natural by product of life itself is a pollutant. But I am not worried. When the second coming, Obama, the second coming, becomes President, the sky will open. Evil will be banished, our environment will become pristine and angels will carry us all to the promised land.
I am so glad I had that surgery. I had been putting it off. What a difference it made. I had three major attacks before, and they were brutal.
When they took it out, it was gangrenous. Would have died in the old days.
The scope surgery is so easy compared to the old way. My doc even gave me a DVD with the whole surgery just as he saw it. Very cool. They actually put a plastic bag inside me, put the GB into it, closed the bag, and hauled it out. Amazing. The guy does 300+ a year.
The worst pain was a blood blister under a piece of tape.
My idea of a meal heavy with carbs is a baked potato every 2 weeks, or 4 ounces of potato chips every now and then.
Having eliminated all gluten containing products from my diet, it's somewhat of a chore to find enough carbs to get as high as 50 grams in a day. 300 grams is normal for the people with those genetic mutations that enable them to eat wheat.
Pizza toppings are pretty good!
Ping
There is no spreading epidemic. It’s not a communicable disease. For the most part you can’t be a Type II diabetic unless you have certain genes. If you don’t have those genes you will never become a Type II diabetic.
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