surgery for diabetes

Surgery should always be the last option.
And it is for those who cannot control their blood glucose levels or because nothing else works!
But, it does have so many benefits!
But, your dietary intake will still need to be looked after!

Dietary lifestyle changes is always the first option especially for prediabetic patients.
Just because it is an option doesn't mean that you can ignore all others.

Low carb works and it doesn't cost the NHS a penny, it actually saves the country and the health service in care costs, pharmaceutical costs!
Losing weight and reducing carbs and sugars is the best option.

Nariman_ said:

Don't you agree with me?

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Not necessarily. Surgery seems to be primarily aimed at people who wish to lose weight. If you think that losing weight is all you have to do to cure diabetes then something doesn't sound right somewhere. It is true that some diabetics are overweight but 20% of them are not so that means there is no causal link.

Also, if it proves that diet is a significant factor then surgery may not help.

I am not against surgery for weight loss purposes, it's just that if you hope it's a cure all you may be disappointed.

[QUOTE="Nariman_, post: 1015753, member: Don't you agree with me?[/QUOTE]


No I don't!

As squire said,
Diabetes is a food disease and can be treated as such. It doesn't matter if you are overweight or not!

Surgery has to be the only option left, not as a treatment for those who won't take heed of what is causing the disease.

It isn't a magic end-all cure and a free ride, as according to the NHS people who've had the surgery will need to follow a strictly controlled diet, and exercise regularly. So it still requires a modicum of self discipline.

And such intervention can cost anything between £5,000 and £15,000 depending on the type of operation, and that would provide a hell of a lot of test strips for those of us who are trying to manage our diabetes (both glucose and weight wise) more "naturally"...

I have to wonder at NHS priorities sometimes.... I really do!

Robbity

It sounds completely nuts to me. You would think the priority would be on PROPER education instead of thinking along the lines of surgery will fix everything. As stated above the cost can be astronomical with surgery as well and it still requires commitment on the patients part.

With the government full of farmers you are never going to have low carb guidelines from the NHS

Southbeds said:

With the government full of farmers you are never going to have low carb guidelines from the NHS

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I can't really agree with that - farmers produce beef and lamb, eggs, dairy products (butter, cream, cheese...), vegetables and fruit, etc, all good low carb foods - it's not just all grain and spuds...

Robbity

Bypass surgery is nuts other than by rare exception e.g. people who just cannot manage themselves. It costs the NHS (us) loads of money. I've heard £5K quoted with pre and post op support. For quite a few it doesn't work because those who continue to overeat can overcome the good work done. I'm completely anti the NHS paying for this unless the patient is proven to be unable to manage themselves e.g. mental health condition etc. As others have said it only works for those who are T2 and grossly overweight and for those in most cases the right discipline and diet with meds if needed works very well. In addition the NHS won't operate until you've lost some weight anyway!

I doubt very much that the NHS is suddenly going to start funding these ops left, right and centre for very obese diabetics. I guess if somebody has the means to go privately, therefore not leaning on the NHS, they have got the right to do so. An individual's choice should really be paramount, just as we can choose to ignore **** NHS dietary/statins/self-monitoring advice.

This gastric balloon sounds like a much cheaper (and safer) option:

http://www.dailymail.co.uk/news/art...n-approval-use-UK-battle-against-obesity.html

I worked with two women who had had the op, and they had to put in a lot of effort in order to eat, or not to eat as the case may be - as in they could only eat small amounts, as in SMALL amounts. There were toilet issues that were alluded to, and I have read about (stools! and not the kind you sit on. Apparently it is called 'dumping syndrome' - I couldn't make this up!) One did it to treat a chronic disease, and the other to treat obesity. The latter had a media profile as a very skinny woman who went on about making sure she didn't get fat (as a writer she wrote about that very well). She never breathed a word about having had the op. (As a liar she did that very well! But that could be related to being a good writer.) She seemed extremely unhappy, period, and especially around food and drink, but she did look very nice in designer clothes.

The woman who had the op to deal with a chronic disease was much nicer! And much happier. And still alive and reasonably well. I never saw her eat. But she did make very amiable jokes about that.

I think about both those women, as I remember sitting at work and thinking I might have to have bariatric surgery one day to deal with that stubborn belly fat I knew was dangerous but didn't have a clue on how to do anything about. I felt very upset and frustrated by the fact that I knew it was dangerous but the only way I had heard anyone deal with it was surgery.

Now I know! And I have to be every bit as single-minded about food and eating as my old workmates. Just in order to keep the carb intake low, which deals with the belly fat. No surgery. I know it sounds vaguely religious. But it just happens to be true! I had no idea I was carbohydrate intolerant. Now I do. But. I have my intestines in place. No eternal hunger (which it would be for me.) My gut is doing its proper thing, or trying to. Once you get it cut out - it ain't coming back. I would imagine - it's very hard to sort out your gut biome when you don't have much of a gut left. Hard to get all the nutrients you need to be strong and healthy when you have way less guts to absorb the nutrients. (Mr Svea is saying 'gutless'. Daughter is saying 'gut free'.)

That's my bariatric surgery story. Gut surgery has probably come a long way since then? (An article on dumping syndrome, and these women's ops and these post-op lives were in the 1990s to the noughties.)

Time to put some more food in the gut!

After seeing this thread I went rummaging in you tube looking for a particular video. It is by a very experienced bariatric surgeon discussing how patients often regain significant amounts of weight at the 3-4 year mark. Also, the long term malnutrition and health complications that can arise.

Couldn't find THAT one, but I did find a huge number of other vids. Women showing their after-weight loss deflated bodies. Surgeons talking about myths, success rates, complications, long term experiences.

After watching them, it became very clear that the surgery does nothing to change the patients' relationships to food or their bodies. That is the real battle. And it doesn't require surgery to fight it.

I fail to understand why if a person cannot stick to a way of eating before having a gastric bypass op .. Why they think it will be easy to change eating habits after.
It's not going to fix your T2 diabetes .. The weight loss and low carb eating will .. Save your body from unnessary ops and get your head round fixing this yourself with the right food choices. It can be done .. But you must be brave and go against the flow .. I do LCHF and now appear to be in full remission!!

Brunneria has hit the nail on the head. The majority of people who are extremely obese have damaging issues with food and eating - rarely is it looked at as a means to imbibe proper nutrition. I was looking at the available info too, and there are often problems down the line. I believe there is usually psychological support offered after surgery, it's a crying shame this care isn't offered before the weight gets to a severe state.

Robbity said:

I can't really agree with that - farmers produce beef and lamb, eggs, dairy products (butter, cream, cheese...), vegetables and fruit, etc, all good low carb foods - it's not just all grain and spuds...

Robbity

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I can,t see the government (farming lobby) taking a hit on any produce .root veg , grains ,suger beat, or anything that would lose the farming lobby money ,

You are right ladybird64 if more effort was put in earlier it would be more beneficial. I suppose the only issue would be that the professionals all seem to have differing opinions about what direction should be taken and what they would consider to be the right way to go may in fact be the total opposite to what is required.

Dr Fung has a blog post about bariatric surgery, how it is basically a very expensive and painful way of enforcing a fasting regime. I can't post a link at the moment, but it is easy to find on intensivedietarymanagement.com
I have been referred to a bariatric info day, when diagnosed with T2D at a BMI of 40. I went just to get the information, and was not convinced at all. There is a high death rate from the surgeries, and many possible complications. To prepare for surgery, you need to be on a 1000 calorie lower carb diet for 6 weeks, to reduce the size of the liver and allow keyhole surgery. If you can do that, you can go lower carb and higher calorie to lose the weight without cutting into your own flesh and massacring healthy organs!
One tip by the dietician at the hospital was to think 20p when eating, both before and after surgery. Eat bites no bigger than a 20p coin, very slowly- it helps weight loss before, and after is all you can manage to ingest.
Anyway, on LCHF and more recently IF, my BMI has reduced to 31 currently, and the fat loss continues. My BG levels are also improving constantly, and I feel healthier, stronger and whole. I would not recommend bariatric surgery except in extreme circumstances.

From what I've read it's not an easy option and really needs careful consideration but I don't think that bariatric surgery for type 2 'remission' is necessarily simply about losing weight
There is an interesting paper that looks at the possible mechanisms.

Mechanism of Metabolic Advantages After Bariatric Surgery
It’s all gastrointestinal factors versus it’s all food restriction
Filip K. Knop, MD, PHD and Roy Taylor, MD http://care.diabetesjournals.org/content/36/Supplement_2/S287.full

With at least one form of bariatric surgery (Roux-en-Y gastric bypass) is that type 2 remission (41% with strict criteria, 80% in another trial with perhaps less strict criteria) occurs before weight loss. One recent study using this type of surgery with people who had lower BMIs than are normally operated on ( <35) achieved remission in 58/66 (87%) of people who had had diabetes for a median 9 years and none of these reverted to diabetes in follow up over a median of 5 years.

In the case of this type of surgery, a strong case has been made that 'surgically induced direct delivery of nutrients to the small intestine increases the GLP-1 response to a meal and also increases other hormones which reduce appetite'
This GLP-1 response is greatly diminished in pre diabetes and Type 2
It may be that higher levels of this incretin following surgery are responsible for the immediate reduction in hyperglycaemia.
(There are drugs such as Victoza which mimic these incretins and are used as a medication in type 2 diabetes) https://en.wikipedia.org/wiki/Glucagon-like_peptide-1

But both before and following surgery there is also an immediate huge reduction in calories. It could be that this negative calorie input is also an important mechanism in the remission This is what Professor Taylor has sought to mimic with the 'Newcastle' 600 cal diet.
(but no long term results or full trial yet )