The table is set, the knives are out, and everyone is prepared to appease that warring blood sugar. Only this is not dinner. This is surgery. It is a person on that table, and the knives are cutting through the thick yellow layer of subcutaneous fat and on through the beautiful red striated muscles. And now two-thirds of the stomach, all along its greater curvature, are about to get benched in one of most important games of life: digestion.
It was a wake up call to stumble across an article published earlier this year promoting gastric bypass surgery as a treatment option for type 2 diabetes . Surgery for type 2 diabetes! Remember, this is a condition considered preventable or otherwise dealt with through lifestyle measures. This is a condition affecting 1 in 3 Americans, and almost two million Canadians [2,3]
Just last year a 3-year old was diagnosed with type 2 diabetes . This little girl is now doing much better and is able to maintain her health through diet and lifestyle modifications . Type 2 diabetes, which used to be called adult-onset diabetes, now accounts for 45% of adolescent diabetes cases and is clearly a problem in the pediatric population as well . Would you want your child to go through a surgery that obliterates most of their stomach? It’s not exactly on the list of top life experiences. How can we help families make healthy food choices and prevent the need for surgery? For example, a recent study indicated that involving adolescents in food preparation was associated with better dietary quality . But what do “healthy” food choices look like when even in the literature every set of research uses a slightly different definition of “healthy” food? And do we know what is “healthy”? Consider flaxseed, which was very popular as a health food when I was growing up. A paper published earlier this week suggests that flaxseed could actually increase insulin resistance in certain circumstances . Of course, this is one study in rats and a direct translation to humans cannot be made at this point. However, it is important to be aware of what we do not yet know about foods we consider “healthy”.
Diabetes costs Canadian healthcare upwards of nine billion dollars per year and it wasn’t long after moving to the United States that I started hearing stories of people not being able to afford to look after their diabetes . The article states that costs would be made back in two years relative to the costs of medication and care . Then again we have to compare this to the somewhat minimal costs of lifestyle modifications as well as to the potential complications from the surgery. One also has to consider if the patient is actually willing to make lifestyle changes. If not, surgery might be the best bet for improving their quality of life.
It must be acknowledged that this surgery seems to be quite effective for people who have struggled with other treatment options . It appears to have a direct influence on glucose homeostasis and bile acid production as well as affecting the gut microbiota . The effects on diabetes are not (as previously thought) solely due to weight loss post surgery .
However, this article signals a warning that we need to up our prevention game. What are we doing to aid in prevention? Let’s not let it get to the point of surgery.
One last note - If you are interested in rates of diabetes in Canada I found a nice map of diabetes prevalence by province here.
Rubino, Francesco. Medical research: Time to think differently about diabetes. Nature News. 2016;533(7604):459.
Available at: http://www.cdc.gov/diabetes/prevention/prediabetes-type2/index.html. Accessed August 21, 2016.
Available at: http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/diabete-eng.php. Accessed August 21, 2016.
Yafi M, Collins K. A Toddler With Type 2 Diabetes Abstracts of 51st EASD Annual Meeting. Diabetologia. 2015.
Type 2 Diabetes in Youth: Epidemiology and Pathophysiology. Diabetes Care. 2011;34(Supplement 2):S161.
Berge, J. M., MacLehose, R. F., Larson, N., Laska, M., & Neumark-Sztainer, D. (2016). Family Food Preparation and Its Effects on Adolescent Dietary Quality and Eating Patterns. The Journal Of Adolescent Health: Official Publication Of The Society For Adolescent Medicine, doi:10.1016/j.jadohealth.2016.06.007
Guarda, D. S., de Moura, E. G., Carvalho, J. C., Reis, A. M. dos, Soares, P. N., Lisboa, P. C., … Ross, M. (2016). Maternal flaxseed oil intake during lactation changes body fat, inflammatory markers and glucose homeostasis in the adult progeny: role of gender dimorphism. The Journal of Nutritional Biochemistry, 35, 74–80. http://doi.org/10.1016/j.jnutbio.2016.05.011