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.
Didn’t Robin Williams star in Jejunum? The rest of his films haven’t been worth a @hit either.
I’m off, the late night boweling league is having an exploratory meeting.
There are a gazillion articles in the internet about discoveries of associated/causative genes in the last couple of years.
It "runs in families" for a really good reason.
Could be. That part of the digestive tract shoots a lot of digestive stuff into the system. Most would probably not want to know all the details, but it is very complicated and lots of big words.
Part of the "gathering" in "Hunter Gatherer" ~ your Ice Age lifestyle choice.
Thanks to ya’ll!
Hope I find it as easy as you two.
That's a great idea, thanks! I do so love my potatoes! Now if I can just find a replacement for my pintos....
I suggest that everyone research the side effects of all their prescription drugs. I was on a BP drug for two years until I was told that I had Type II diabetes. In doing my own research on diabetes and the drug, I found out that one of the side effects of the drug I had been on for over two years was “increased blood sugar.” My doctor did “NOTHING” as my blood sugar climbed. I have filed a “quality of care” complaint on this supposed medical doctor. Not to insult any Freeper docs, IMO, many doctors are pill pushers pimping for the drug companies. After stopping the BP drug, my sugar is back to normal.
pinging me.
Bump for later reading as well
But how’s your BP?
right, nuts and berries in season. Meat in season year round. Primary diet of protiens, fats, and limited carbs. The carbs are all natural.
Another way to think of the diet is “God food” versus manufactured food.
Most of the "manufactured" foods you're thinking of are just wheat/barley/rye byproducts prepared in various configurations, and then baked, fried, soaked in oil, doused in sugar, or whatever.
Doesn't bother me. I don't eat wheat/barley/rye byproducts.
What about something like millet?
Does yeast have anything to do with it, you think?
Possibly unleavened bread would still be OK?
http://www.presstv.ir/detail.aspx?id=45600§ionid=3510210 (pops)
It’s the wheat gluten.
Sun, 02 Mar 2008 22:17:34
Norwegian scientists have recently found that consuming cod liver oil supplements can lower bone mass density in middle-aged women.
Cod liver oil is commonly used as a source of vitamin D to fortify different foods especially in countries with fewer sunny days.
Vitamin D, produced in skin exposed to sunlight, promotes bone formation and mineralization.
According to the article published in the American Journal of Epidemiology, cod liver oil's high vitamin A content has negative effects on the bones and subsequently increases the fracture risk.
Cod liver oil is also used for its heart-healthy omega-3 fatty acids as well as its effect in alleviating arthritis symptoms.
The American Heart Association recommends taking at least 1,000 milligrams equal to approximately one tablespoon of fish oil every day.
Try Parsnips!
Much better than turnips!
BEER!
No way!
Say HONEST!
I’m gonna die! Someday...
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