[yksin]

I saw a 60 Minutes about bariatric surgery in April. They had several people on it who had all had gastric bypass surgery, & the interviewer asked them, how many of you had diabetes prior to your surgery? Every person raised their hand. How many of you have diabetes now? No one raised their hand. About three quarters had sleep apnea prior to surgery; none have it now. The surgery also appears to significantly lower rates of cancer, which is closely correlated with obesity.

Furthermore, they said that diabetic symptoms such as high blood sugars went away almost immediately after surgery, even before the weight loss. So there does appear to be a relationship between diabetes & the portions of the stomach/duodenum that the bypass passes by. This has been confirmed in studies on diabetic rats: give them the bypass surgery, & their diabetes disappears; reverse the surgery, & the diabetes comes back. Apparently they are now doing a control study on a group of non-obese Type 2 diabetics, I believe in Brazil, to see if the surgery will relieve their diabetes. Normally, at least in the U.S., the only people who can get approval for this kind of surgery are people who are considered morbidly obese.

After seeing that show -- well. I will admit to previously having had a residual prejudice about the surgery, I think because of internalized judgments about all that crap about "fat people lacking willpower to control their eating" that is all over the culture, that has hit me too. And has also had affect on my feelings about my mom, who died in November 2005 of heart-related complications of diabetes. In her later years, all of us kids felt helpless & at the same time angry due to the perception that she wasn't doing enough to help herself, that she wasn't controlling what she ate. And the logical conclusion to that is that all the health problems she suffered at the end, & ultimately her death, was her fault. I've been struggling with that ever since -- blaming her for her own death. But now I know, without question, that that's not so. From what I understand now, yes, there is a metabolic problem that leads to obesity, over which the obese person has no control. It appears to be related to the metabolism of carbohydrates in particular (& hence, blood sugars & insulin), particularly refined carbs. Which are also implicated in cancer, cardiovascular disease, & other conditions. (Yes, & sleep apnea.) But what are you going to do in a society in which the government, all the major health organizations, & most doctors & nutritionists are insisting that high-carb diets are what we should be eating, & the entire food industry is geared for that? It makes it difficult to, as they say, "eat clean," even if one knows what, or what not, to eat. I don't think it will become "easy" if ever until the entire society takes a big huge paradigm shift.

I’m not saying that “low carb is the answer for everyone” – but it is becoming increasingly clear that diets high in carbs, especially refined carbs, are bad news for people who are insulin resistant/prediabetic/diabetic . And yet, the American Diabetes Association continues to recommend high-carb diets to diabetics – in my opinion, only making them sicker. There is also continued blame cast at the obese for being obese, & at obesity as the “cause” of insulin resistance & Type 2 diabetes, when recent research seems to be showing that it just might be the other way around: that people (or many people) become obese because they are insulin resistant. With related metabolic affects which have an impact on appetite & satiety: it's not just "emotional" eating, but also metabolically-driven hunger (affects of leptin & ghrelin, insuiln, & blood sugar volatility) that makes obese people eat. Let's also not forget the affect that wacked out blood sugars & related metabolic problems have on mood, which also can lead to hunger & the desire for "comfort food."

So was it my mom's fault that she died before her time of Type 2 complications? No. As much as I wish we'd known enough to support her in her early endeavors to eat low carb back in the '70s, I also wish we'd known about gastric bypass in the ‘80s & ‘90s. It might have saved her life too.

That said, I don’t believe that gastric bypass is really a “cure” for diabetes. I think it hits symptoms, not causes. Although followup studies I’ve looked at in PubMed indicate positive longterm outcomes for weight loss surgery, I’ve also seen references to people who’ve had the surgery still being obese – just not as obese. It doesn’t lead to lifestyle changes, though undoubtedly some individuals who have the surgery make changes on their own. In the end, it seems a typical Western medicine way of putting a bandaid on a problem with drugs or surgery, when we need to go a lot deeper than that – such as persuading our public health agencies & nonprofits like the ADA & American Heart Association to pay attention to health in their nutritional recommendations, instead of to which lobbyists from Big Agriculture or Big Pharma are lining their pockets.

I am prediabetic myself, & have been working pretty darn hard ever since my mom’s death awakened me to my own danger, to change my health including getting rid of my excess bodyfat. I’m doing it with diet (moderate or, currently, low carbs) & exercise. It’s really not as hard as “they” say it is, when one has the right information. Just don’t go to the ADA, the AHA, the USDA, or most medical doctors for it. My own experts (thus far) have been Diana Schwarzbein, Tom Venuto, John Berardi, & Lyle McDonald.

-- Mel