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Toward a National Diabetes Reversal Strategy – Part 1
The type 2 diabetes epidemic is crushing the health and economy of all nations throughout the world.
In the US, one in three Americans are projected to get diabetes at some point, unless we find a way to turn the tide and start reversing this epidemic.
Currently, we can achieve remissions of type 2 diabetes in 3 ways. I would like us to consider how we can design a national strategy to dramatically increase the remission rates on a grand scale.
The most reliable method for achieving remission of type 2 diabetes is via “diabetes reversal surgery” (gastric bypass surgery for the purpose of diabetes remission). With gastric bypass surgery (usually accomplished via laparoscopic surgery) remission occurs in about 80% of patients with type 2 diabetes, typically within days or weeks. Remission occurs well before substantial weight loss occurs, apparently as a result of keeping ingested food from making contact with the duodenum (the first part of the small intestine). There are experimental procedures under development to further simplify the diabetes reversal surgery (making stomach shrinkage optional) and I believe the procedure will eventually be conducted endoscopically (via the oral cavity) rather than laparoscopically (via small abdominal incisions). The diabetes reversal surgery causes remission by a complex combination of multiple beneficial effects, and the long duration of the diabetes remission (probably one or more decades) is no doubt enhanced by major weight losses. There are potential complications of this type of surgery, and about one in 1000 patients may die from the procedure, although this varies depending on the skill and experience of the surgeon.
The second most reliable method for achieving remission of type 2 diabetes is via lapband surgery for weight loss. A band is placed to compress the stomach into a small pouch, which limits the amount of food one can comfortably eat at one sitting. The band can be tightened or loosened or removed altogether months or years after the procedure. Long-term weight loss in the 50 pound range is typical, and the type 2 diabetes often goes into remission once enough weight comes off. Remission is a direct result of the weight loss rather than a result of the complex beneficial hormonal and anatomical effects that reverse diabetes after gastric bypass surgery. The diabetes remission rate appears to be in the 80-50% range, depending on how much weight is lost and how long patient has had diabetes. There is every reason to believe the remissions are not as long-lasting as those resulting from gastric bypass surgery. However, the risk of serious complications is lower, and death risk is probably 10 times less than from gastric bypass surgery.
The safest path to type 2 diabetes remission is excess fat loss via lifestyle change, although it is less reliable than surgical remission methods. The weight loss required for remission is typically in the 35 to 50 pound range (10 to 20% of starting body weight), although long-standing diabetes (over 10 years) may not necessarily go into remission even if one loses all the excess body fat and gets into good shape. I suspect 75-80% of patients with type 2 diabetes could achieve remission if they could lose enough body fat and get enough exercise. Naturally, adherence barriers hinder the potential of lifestyle change, and the remission rates are closer to 25% in my own practice. Moreover, the remission duration is highly dependent on one’s ability to successfully maintain lost weight by maintaining the lifestyle changes in the long term.
So, given the enormous toll the diabetes epidemic, and the availability of these three options for diabetes remission, do you believe we should try to develop a national diabetes reversal strategy? If yes, then I would welcome any ideas you have about how to raise awareness and potentially promote diabetes reversal methods on a large scale.
- Michael Dansinger, MD
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Labels: diabetes, eating, fitness, food, gatric bypass, lapband, obestiy, weight loss
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