Help, I could get a toaster for this!

I have a friend that I met at my first support group meeting.  Both of us were looking to have the lap band but after the meeting we had decided to have the RNY.  Now, as most of you know, I want to have the DS but she is probalby going to have the RNY.  I have kept in touch with her and have told her about my decision to have the ds.  Well, she still says she wants the RNY but has kind of been asking me questions with each email she writes.  The latest "questions" I need some help with.  I thought you might be able to help with it.  Here is what she wrote: "Isn't the cure (not actually a cure) rate for diabetes directly related to just losing the weight?  I guess what you are saying is that your chances of losing a greater amount of weight and keeping it off is better with DS than RNY.  Is that it?  My doctor told me that losing the excess would, in most cases, take away the diabetes.  I won't say it's a cure.  They tell me once you have it, there is "no cure".  It's just controlled.  I know you are pre-diabetic and that is probably different.  Just don't let it get full blown.  Mine is.  I take medicine now.  I guess once your pancreas quits doing some of what it is supposed to do it doesn't go back.  I don't know.  I guess if you were to eat a lot of fat after DS you would have a problem.  I know I took Xenical (which causes you to not absorb fat) and I'm telling you it's nasty if you eat fat.  It goes right through you and you can't control it some times.  Your bowels secrete the fat (thin, yellow, really oily, nasty). I didn't mean to get yucky!  I do like the idea of keeping your stomach and pyloric valve.  That part does appeal to me, but the malabsorption still really concerns me.  I don't know how much difference there is between this part of DS and RNY. I just know I can't wait much longer to get "something" done and I'm so close now.  I'm 58 and they won't hardly do anything once you are 60.  I know with my history I can't control this weight by myself and my health problems increase with every year so it's now or never for me.  I'm so glad you are younger and your chances of really helping yourself and your health (which is the most important thing to me) are really good!  Hang in there and please keep me informed on what is going on with you." Now, if I understand it correctly, it is a cure.  I also know that in Europe they are doing just part of the surgery (isn't it the ds part of the pbd/ds) on poeple that are not over weight to actually cure the diabetes.  Do I have that right?  I do plan on telling her about this.  But I guess what I really need help with is the other things she brought up.  From what I have heard from all of you I don't think you have the problems like she had with the Xenical.  I don't know tho, so thats why I'm asking.   Thanks, Ronnie  

There is something about the DS that for many people cures the DS.  For some people they leave the hospital off all diabetes medications, for others it takes a little while but even in those cases the diabetes seems to be better controlled with fewer meds.  Your friend is wrong in assuming that it is the weight loss that controls the diabetes.  It is something about the rerouting of the intestines.  But this is for type II diabetes.   For the most part we DSers do not experience that Xenical effect that your friend spoke of.  I have read about it and thank God I have never experienced this. Also there are many people who have this surgery well into their sixties. Red

Thanks Red.  I just found the info that I was going to send her about the type II diabetes it says:  "The ds surgery without gastric reduction has been performed on non-obese, diabetic patients since 1997 and is increasing in popularity in Europe as an IMMEIATE CURE for type II diabetes.  Latest studies on this technique report a 98% rate of cure.  This is attributed in theory to the malabasorption component of the DS  The RNY does not cure diabetes.  It only puts it in remission, and the disease oftentimes comes back in two or three years - even if the patient maintains most of their weight loss.  It seems even a small weight gain long-term (which is the norm) will cause diabetes relapse." I think she will be glad to hear about the age thing.

I'm interested in your source for this as I have a RnY friend--10 years post-op, weight regain over 50#--who maintains that the "cure" is due to weight loss.  I just emailed her Diana's excellent discussion, but I'd like to slam-dunk this because what you quoted directly points out the RnY failure. Thanks.

Well, I have been trying to find out exactly whose blog I found this on.  I cut and pasted the info. from the blog and now I can't find it.  All I know is her name is Betty.  So I'm actually just going by what she has on her blog.  I do know she has this study as well but I don't know if it is where she got it.  I'm sorry I can't really help you with that.   

Results of Ten Years or More Post-DS by Dr. Douglas S Hess (128-138) (preprint which was recently published as “The Biliopancreatic Diversion eith the Duodenal Switch: Results Beyond 10 Years,” Hess, Douglas S.; Hess, Douglas W.; Oakley, Richard S.; Obesity Surgery, March 2005, vol. 15, no. 3 pp. 408-416(9) which concludes, “…it can be seen that the DS procedure is a safe and extremely effective procedure for weight loss, in fact more effective long-term than the more commonly used Roux-en-Y gastric bypass surgery. It is essentially a cure for Type II diabetes. Other long-term studies have shown little or no serious or irremediable nutritional sequellae, contrary to frequently expressed--but unsubstantiated--concerns. It has been successfully performed in our practice for wver ten years, and for several years longer in other practices, and has in our opinion become, if not the “gold standard,” the “platinum standard” for bariatric surgery. It is certainly no longer considered an experimental or investigational procedure, either by the American Society for Bariatric Surgery (ASBS) or by the surgeons who perform it”.

The DS minus the stomach resection is performed in Europe for cure of diabetes in the NON morbidly obese:

Duodenal Switch without Gastric Resection: Results and Observations after 6 Years Journal Obesity Surgery Publisher Springer New York ISSN 0960-8923 (Print) 1708-0428 (Online) Issue Volume 14, Number 10 / November, 2004 DOI 10.1381/0960892042583851 Pages 1354-1359 Subject Collection Medicine SpringerLink Date Friday, August 24, 2007

 

Duodenal Switch without Gastric Resection: Results and Observations after 6 Years

Maria Laura Cossu¹, Giuseppe Noya², Gian Carlo Tonolo³, Stefano Profili⁴, Giovanni B Meloni⁵, Matteo Ruggiu⁶, Patrizia Brizzi⁷, Franca Cossu⁸, Luca Pilo⁹ and Pier Luigi Tilocca¹⁰

(1)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(2)	Dipartimento di Scienze Chirurgiche, Universita' di Perugia, Italy

(3)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(4)	Istituto di Scienze Radiologiche, Universita' di Sassari, Italy

(5)	Istituto di Scienze Radiologiche, Universita' di Sassari, Italy

(6)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(7)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(8)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(9)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(10)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

Published online: 01 November 2004

Background: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia. Methods: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m². 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients. Results: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceri-demia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD. Conclusions: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.

The time to cure for type 2 diabetes with the DS depends to some extent on the length of time the person has been diabetic, and the extent to which the person's pancreatic islet cells have been damaged by the constant overproduction of insulin caused by their insulin resistance. The amelioration in insulin resistance by the DS is nearly instantaneous.  Most diabetics leave the hospital 3 days after their DS OFF OF ALL DIABETIC MEDICATION.  This is because it is the mechanics and biochemistry of the DS that CURES the insulin resistance and thus the diabetes.  Those patients who take longer to get off the meds are probably those whose islet cells have been damaged, and for whom it takes a while for enough insulin-producing capacity to be recovered.  And then there is the small number of patients whose type 2 diabetes has actually progressed to type 3, which is in essence the same as type 1, but from a different cause -- their insulin producing capacity has been damaged beyond repair and they will always be diabetic. Yes, they are doing the intestinal part of the DS in Europe and South America to treat type 2 diabetes in the non-morbidly obese.  There are also clinical trials being conducted in the US and elsewhere: http://clinicaltrials.gov/ct2/results?term=diabetes+surgery+ duodenal Some DSers have issues with loose stools with eating a VAST amount of fat.  Most of us don't have that problem, most likely because it takes more dietary fat to cause issues with us than the amount that causes issues when taking Xenical.  I eat about 50% fat in my diet and rarely if ever have diarrhea.  My stools are soft and sometimes loose, but that's not diarrhea, and it certainly isn't uncontrollable!

Wow!  Great info.  Thanks. 

Thank God you are back on OH--you deliver us all from the Land of Stupidity with a clarity and humor that we all need!  I now cut and paste your wonderful answers and place them on my hard drive with your attribution, just in case you get banned from the board again and we have to pinch-hit on these questions someday. I will credit you at that time, I assure you! Nicolle

Go to www.pubmed.com and search on "gastric bypass diabetes cure". 

You'll find studies like this one:

http://www.ncbi.nlm.nih.gov/pubmed/17630003?ordinalpos=1&ito ol=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_R VDocSum which state "RESULTS: In GK rats, IT significantly improved glucose tolerance, insulin sensitivity, and acute insulin response without affecting body weight and food intake." and  CONCLUSIONS: This study gives strong evidences for the crucial role of the hindgut in the resolution of diabetes after Roux-en-Y gastric bypass (GBP) and biliopancreatic diversion (BPD). Moreover, these findings confirm at the preclinical level that IT is a surgical procedure of possible relevance in the therapy of type 2 diabetes in non-overweight and mildly obese patients. IT is Ileal Transport.   Here is another study specific to Gastric Bypass and diabetes: http://www.ncbi.nlm.nih.gov/pubmed/15946424?ordinalpos=3&ito ol=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_R VDocSum which states "CONCLUSION: The changes in insulin resistance seen after gastric bypass, which are responsible for the resolution or improvement of type 2 diabetes occur within 6 days of the surgery, before any appreciable weight loss has occurred." There are studies as early as 1987 showing 5-10 year follow-up on gastric bypass patients showing about a 95% resolution or improvement of diabetes in RNY patients.    See this study: http://www.ncbi.nlm.nih.gov/pubmed/3632094?ordinalpos=1&itoo l=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RV AbstractPlus which states "The normalization of glucose metabolism after gastric bypass may not be related solely to weight loss and restriction of caloric intake, but may also be due to the bypass of the antrum and duodenum." So *MY* question is - the medical community has known FOR TWENTY YEARS that there is a surgical solution for diabetes, and yet we still have to fight tooth and nail to get it approved.  WTF?   When is this going to be accepted and known to the general public?    That's TWENTY YEARS of diabetes many people have had to suffer through for no reason.   --BT