Surgery Reverses Diabetes – T2D3

By Jason Fung, MD

Could Type 2 Diabetes really be a disease that reverses? We’ve outlined in our previous post how most specialists, doctors and researchers view T2D as a progressive chronic disease. That means that once you have it, it will eventually progress no matter what you do. However, in truth, T2D is actually a reversible, curable dietary disease. And I can quite easily prove it to you.

Let me show you several examples. One of the most well studied examples comes from the literature surrounding bariatric surgery. This is commonly called stomach stapling surgery, and there are many kinds.

The earliest surgery was called the Roux-en-Y surgery where the stomach would be cut to the size of a walnut and the small intestines rewired in order for the remaining food to be not properly absorbed into the body. This is an example of a combined restrictive (causing restriction on how much can be eaten) and malabsorptive (food is not properly absorbed) surgery. This surgery has multiple complications, but does tend to work, as you may well imagine.

Another form of surgery is the sleeve gastrectomy, where only the stomach is cut to the size of a walnut. This is a purely restrictive form of surgery and also works quite well. With the stomach so small, it is often impossible to eat very much food at all. Often people will need to resort to a liquid diet. Any attempt to eat more than a thimbleful will result in severe gastric distention (ballooning of the miniature stomach) and results in persistent nausea and vomiting.

A third type of bariatric surgery is the lap band. This involves the surgical implantation of a band that wraps around your stomach, thereby reducing the size to that of a walnut, without actually cutting anything out. It can also be gradually tightened to restrict food.

I don’t really recommend any of these surgeries for anybody, but there is no denying that they can often be effective in the short term. Many of the longer term studies show varied effectiveness, though. However, my point is not to praise or condemn these surgeries. As with anything else in medicine, I suppose they do have their place.

My question is about T2D. What happens when you take a severely obese, diabetic patient and perform one of these surgeries. Surely those patients must have chronic incurable progressive disease? According to conventional thought, the pancreas is ‘burned out’ and nothing you do will change that. Also, as per conventional thought, insulin resistance is high and nothing can change that either. So therefore, since both abnormalities of T2D are irreversible, the diabetes should continue unabated by the surgery. Right? Actually, in virtually all cases, the diabetes completely disappears!

What?! I thought T2D was a chronic and progressive disease! They told me that in medical school! The American Diabetes Association spews that line all the time! The Diabetes Education Centres all say so! WTF??

In fact, the T2D is entirely reversible, even in patients that weigh 500 pounds and have had their diabetes for 20 years. In a matter of weeks, before even any substantial weight loss, the diabetes disappears. Yes. It just goes away.

Let’s look at this study (STAMPEDE) entitled “Bariatric Surgery versus intensive medical therapy for diabetes” published in the New England Journal of Medicine 2012.

Patients were initially randomized to one of three groups. Two different types of surgery were compared with intensive medical treatment – in other words, continuing to take their drugs for diabetes. The results were compared over the 3 years of the study. At baseline, the average age was 48, with a HbA1C of 9.3% (very poor control) and BMI of 36 (obese)

The medical treatment group basically continued on as they had before. Their weight did not really change much and their medication they used for T2D slightly increased over three years. That means their T2D was getting worse, since they required more medication to keep control of their sugars.

But look at both surgical groups. Within 3 months of surgery, the average number of medications was significantly reduce and a number were off meds entirely. The interesting part about these results is that the T2D disappears before most of the weight is lost. Assuming a patient starts off at 400 pounds, after 3 months, they probably still weigh over 350 pounds. So they are still massively overweight, yet the T2D still goes away. We will get to the reason why this happens in a later post, but it has to do with visceral fat.

By 3 years, a full 38% of the Roux-En-Y group had a A1C < 6% compared to 5% of the intensive medical therapy group. Furthermore, many of these were not on medications. This would technically mean that these patients no longer had diabetes. In other words, T2D is reversible – even curable!

Actually, this fact had been known since 1982. The 10 year follow up of a group of surgical patients had shown that many patients maintained normal blood sugars even off medications. Furthermore, the vast majority of patients showed reversibility within 2 months of surgery. It is both rapid and long lasting reversibility.

It wasn’t simply their sugars that returned to normal. Many of the metabolic abnormalities seen in T2D reverted back to normal as well.

In T2D, insulin levels are quite high to ‘overcome’ the insulin resistance. You can see in the above graph that insulin levels are dropped quite dramatically by surgical treatment.

In the 1 year after surgery, blood sugars dropped in half, but fasting insulin (a marker of insulin resistance) dropped 73%.  Maximum insulin release dropped 18% since these high insulin levels are no longer needed as the resistance has dropped. Glucose disappearance rates increase as it comes out of the blood much better.

This is quite important. Remember that T2D is a disease of high insulin resistance. The high blood sugars is only a symptom of the disease. This is why treating blood sugars is so ineffective – because it is only a symptom and not the actual disease.

Again, I don’t generally recommend these surgeries for a variety of reasons. However, my point is this. T2D is an entirely reversible disease, even in the extremely obese, with decades of diabesity. It is not a chronic and progressive thing like, say, age. You simply can’t get younger no matter how much you want to. However, T2D is not like that at all. It is fully and completely reversible. It is only a matter of understanding how to reverse it.

But even better – it is reversible within a matter of weeks! With the proper interventions, you simply do not need to suffer from T2D at all. Here’s the most important take home message from all these trials of bariatrics – T2D is a fully curable disease.

Start here with ‘My Journey
Continue to T2D 4 – “Fasting Cures Type 2 Diabetes”
See the lecture ‘The Two Big Lies of Type 2 Diabetes

By The Fasting Method

For many health reasons, losing weight is important. It can improve your blood sugars, blood pressure and metabolic health, lowering your risk of heart disease, stroke and cancer. But it’s not easy. That’s where we can help.

Jason Fung, MD

By Jason Fung, MD

Jason Fung, M.D., is a Toronto-based nephrologist (kidney specialist) and a world leading expert in intermittent fasting and low-carb diets.

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