Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
23 Jan

Lap Bands and Type 2 Diabetes

Lap Band GBS

While caution is required in interpreting the longer-term benefits of surgery and weight loss, this study presents strong evidence to support the early consideration of surgically induced loss of weight in the treatment of obese patients with type 2 diabetes.

via Science Daily

I have to comment on this recent study that confirms, albeit circuitously, what we have said here for years: type 2 diabetes can be cured. In this case, the so-called medical solution falls under my Rube Goldberg term “Digging a hole to put the ladder in to wash the basement windows.” In this study we see that portion control – when rigorously enforced using risky lap-banding surgery – actually improves insulin sensitivity and, hence, returns blood sugar to more normal levels. Duh. And don’t you love this quote: “Type 2 diabetes is a disease that should aggressively be treated with surgery and not merely controlled with medications.”? Wow.

I have said for years that type 2 diabetes is both preventable and curable in 99% of cases. It’s a matter of appropriate exercise choices, portion control and the right mix of protein and healthy fats. Cutting sugars and simple carbs is critical to the process. It doesn’t require risky surgical procedures. Watch those people on “Biggest Loser.” No matter who they are, they ALL lose weight in a matter of weeks and they all experience big improvement in blood glucose metabolism. And they’re not even cutting the carbs as much as I would have them do!

This video is from last night’s broadcast of NBC Nightly News. Watch the whole thing if you would like but pay special attention to the quote at the 1:40 mark in the video. I am almost speechless.

On a related note:

High-risk morbidly obese patients who lose 5 to 10 percent of their excess body weight before undergoing gastric bypass surgery appear to have shorter hospital stays and more rapid postoperative weight loss, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery.

via Science Daily

People who undergo bariatric surgery are encouraged to lose 10% of their body weight before the surgery to improve their recovery! If they can lose 10% of their weight themselves in time for the weight-loss surgery, why are they having the surgery at all?

Hit me up with a comment!

Photo Source

Further Reading:

The Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes

Jimmy Moore: Woman Chooses Low-Carb Over Lap Band

My Carb Pyramid

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I agree with much of what you’re saying here, but I think a blanket statement like “Type II diabetes is curable” is a little bit inaccurate. Whether it is curable or not depends in part on how much damage has been done to the pancreatic beta cells, which are responsible for producing insulin. If these cells are only beginning to quit, yes, I think Type II diabetes is probably curable. Or at least, it is possible to control it so tightly that it is as if one is cured.

    This would imply that early detection is key. However, according to my doctor, the current medically accepted definiton of diabetes is two consecutive fasting blood glucose measures over a certain number (I think 120, but I can’t remember for sure). The problem with this definition is that by the time fasting blood sugar levels are that out of whack, the patient could very well have already had a disordered glucose metabolism for years, which implies some level of damage to the beta cells. A better measure of incipient diabetes is a fasting glucose tolerance test; better still is a GTT with insulin levels. But since diabetes is not “defined” as disordered glucose metabolism outside of fasting glucose levels, many doctors refuse to order GTTs.

    Why do we advocate early detection for so many other degenerative diseases, but not diabetes?

    And my doctor is not some rural quack who is out of sync with the current wisdom. She practices and teaches at a prestigious teaching hospital affiliated with one of the finest medical schools in the country. The definition she gave me probably represents the current state of the art for diabetes diagnosis. But if I had waited until my fasting BG was elevated, I am skeptical whether diet or exercise would restore my beta cells.

    Mark, you and the worker bees have to stop writing so many great posts – a girl’s gotta get some work done!

    Migraineur wrote on January 23rd, 2008
  2. Oh my God! Dr. George should be prosecuted for that comment and lose his license! What’s he do for a living, bariatric surgery? At least check his real estate investment portfolio, I’m sure a surgery center is in there somewhere. Before this, he was probably prescribing fen-phen.

    When doctors as a group become healthier than I am, or even if I find a single MD who is healthier than I am, I will listen to what they have to say. Was it Jack LaLanne who dropped out of medical school because he found it to be a load of crap in regards to actually making people healthy.

    Medical care is a business and a business does not make money by losing its customers…

    Brian A wrote on January 23rd, 2008
  3. Is this bariatric or barbaric surgery?

    I believe a chnage to a Primal or Evolutionary Diet would be the better alternative.

    I only can see what has happened to me without surgery.

    Oxybeles wrote on January 23rd, 2008
  4. When it comes down to “weight loss” i don’t believe in quick fixes. I believe that anyone CAN lose their desired weight if they just exercise and eat the right things. If they “believe” they CAN lose 10% of their body weight, why can’t they “believe” they CAN lose “ALL” their desired weight!!! I also believe that it’s wisdom if you want to lose weight to do it slowly which is the healthier way to do it. (Just my 2 cents)

    Donna wrote on January 23rd, 2008
    • Surgery is efficient yes, but not a fix. It takes a lot of hard work and dedication to lose it as well as keep it off. Some people feel overwhelmed with such high amounts to lose. Please try not to judge.

      Laurie wrote on February 8th, 2012
  5. Of the few people I actually have any knowledge of (in this case brother of a friend) who had bariatric surgery, he ate himself back up to his pre-surgery weight even with the limitation… which meant eating until he puked, then eating again, and basically eating around the clock.

    That doesn’t say lack of education or lousy Western diet to me. That says deep psychological issue. I wouldn’t be surprised if many of the people desperate enough to undergo the pain and inconvenience suffer from a similar problem- they’re looking for a way to stop themselves, not a quick fix to avoid learning how to eat healthy.

    LabRat wrote on January 23rd, 2008
    • What you don’t have, is a comparison of people who had the surgery and DIDN’T gain it back. We are the ones that you encounter on the street or at the gym, of a normal size, who you had no clue had surgery.

      Also, the type of surgery makes a big difference. Lap band has a much lower success rate than gastric bypass. And yes, if friends brother wasn’t compliant with the program, he’d gain. Thats why its only a tool, not a cure

      Laurie wrote on February 8th, 2012
  6. Migraineur,

    I understand your concerns here about my blanket statement. I’ve made it many times before, because I hear so many docs say “once a diabetic, always a diabetic.” They are so wrong. Type 2 is really a lifestyle condition defined by blood numbers (fasting glucose, A1C, insulin, etc) and brought on by bad diet and lack of exercise. One day you’re not a diabetic – the next day you are. It’s all about the numbers according to the medical industry. But the truth is, we all are pre-diabetic and we all live on a continuum of numbers based on our lifestyles.

    The beta cells keep pumping insulin in type 2s for a long while. All of those people could be cured if they followed my instructions to the letter of the law (therein lies part of the rub). I would argue that very few type 2s so fully exhaust their beta cells that they can never recover. For the vast majority of the remaining numbers, once you re-establish insulin sensitivity and cut back on the need for more insulin all the time (diet and exercise), you allow even exhausted beta cells to recover enough to supply all the insulin the body requires.

    Sorry about posting so many good posts! It’s just that much of modern medicine has become an idiocracy and we can’t stand idly by!!!

    Mark Sisson wrote on January 23rd, 2008
    • Mark,

      As a former type II diabetic, I absolutely agree. It is curable for 99% and to refine your blanket statement, let’s stipulate that if you’re fasting glucose is less than 200 then it’s 100%.

      Mine was in the 110-120 range. After a while I was prescribed Metformin. It worked to control sugar via increased glucose tolerance.
      Eating was the problem, as I already exercised and lifted weights jumped rope, surfed, SUP, etc.

      However I noticed that if I just jumped rope for 4 minutes Tabata style or did 50 body weight squats after eating my blood sugar would get too low. Hmmm. So I stopped Metformin and would simply do some sort of very brief intense exercises and no longer needed the Metformin to come in at 100 or less blood glucose.

      I still needed to lose weight. Long story less long, I lost 35lb, going from 295 to 260 at 5’10” and blood sugar is in 70’s and 80s.

      I eat mostly primal and no starches breads pastas or other refined carbs. I had a hard time losing the 60lbs I need to lose, but maintenance for a year has gone pretty smoothly. I too contemplated lap band and too was put off by the protocol of liquid diet before and after. I figured I could just lose the weight on liquid diets and not worry about foreign objects within.

      But long term, lets face it- it’s only 2-5% who keep the weight off for good. That’s what drives doctors and patients to look for more “permanent” solutions. I’m hoping paleo eating will help. I know sleep habits made a big difference as well. Bit bottom line, yes type 2 is entirely lifestyle and very much preventable. I hope to update you when I figure out how to lose the remaining 60lbs!

      Kevin wrote on October 29th, 2012
  7. I’d like to see a comparison of people following a low carb or paleo diet vs those having surgery.

    Cindy Moore wrote on January 23rd, 2008
  8. I’m appalled that surgery is about to become the instant ‘fix’ for diabetes. However, I’m not surprised. With the wealth of misinformation available for diabetics, it’s really no wonder that the cure rate for the diet and exercise group is as low as 13%. I wonder how that would compare to a ‘caveman’ type diet, even taking into consideration noncompliance (which would be comparable to the study that uses the currently approved diabetic diet)?

    Mark,
    I agree that most cases of Type 2 diabetes would be curable given the right information; I’m not sure the rate is as high as 99%, but I would love to see the American Diabetes Association swallow some pride and change its recommendations (not likely) so we could at least see the success rate climb.

    I’m new to your blog and I’ve enjoyed checking in every couple of days. Perhaps because I am new, I’m unsure of the specific dietary recommendations that you refer to above: “…if they followed my instructions to the letter of the law…”
    Can you outline those, please?

    Thanks,
    MK

    MK Stover wrote on January 24th, 2008
  9. “if I find a single MD who is healthier than I am, I will listen to what they have to say.”
    Start paying attention, Brian A

    http://calorielab.com/news/categories/dr-j-will-see-you-now/

    Dr. J wrote on January 24th, 2008
  10. uUnfjZ Vasyu testit vasyu.net

    Vasyu wrote on August 8th, 2008
  11. Half the people getting the surgery are gluttonous fat slobs, who eat for taste rather than health. Nothing you can really do for them; they will ALWAYS make the wrong choice. But the other half I really feel for. Because they are TRYING to do the right thing, but they are being LIED to!! Look at the ADA recommendations. Look at all the carbs they TELL DIABETICS TO KEEP EATING! It’s unreal. People TRUST something called the “American Diabetes Association” and think they have their best interest in mind but they don’t. And those same sheep will think lap band surgery is the ONLY option, when it’s not.

    The worst part is we ALL pay for this. Nobody pays $30,000 out of pocket for this, insurance covers it…. and then the cost is split between everyone in higher premiums. This is why I, as a self employed person, have to pay $500+/month for GOOD health care, whether I get sick or not. You could be making MORE money at work if your company didn’t have to shell out so much money for health care. It’s THE reason the gov’t has to bail out the big 3 automakers. Runaway health care costs. Which honestly comes full circle to people not following a “primal” diet! Keep up the good work Mark.

    Fixed Gear wrote on May 11th, 2009
  12. I had lapband surgery in march 2006. I was basically a “healthy” overweight person – but I believe I was with suffering Syndrome X type problems. My blood sugars were so screwed up that it got to the point where it really didn’t seem to matter what I ate – my body was messed up – thanks for the “fat gluttonous slob” comment there Fixed Gear! :-/

    Alexandra wrote on August 29th, 2009
  13. (oops posted before I’d finished!)

    Once I had the surgery, such is the nature of the beast – very little went down. I had experimented with low-carb diets in the past and they had worked for me – to a degree. The gastric band meant that I lived for 2 years on around 500 calories a day. I did lose weight – but I was far from healthy. Last summer I had the band loosened because I was lucky enough to have had the psychological counselling needed to fix myself – nobody gets “that fat” in the first place without having deep psychologicl issues – there is most definitely something wrong when you’ll make yourself puke 10 times but still keep on eating.

    Anyway, in the last year I’ve put around 40lbs of that back on, despite only eating around 1100 calories a day. Hence I find myself back at Paleo. Carbs just don’t work for me – thankfully the band does aid me here – although it’s now fully loosened I will always have some restriction and “bread” just won’t go down – it turns to some sort of glutinous mess which literally plugs the hole – how can that be good for you?

    Good luck with anyone contemplating bariatric surgery – but please consider spending your $$ on psychology instead.

    Alexandra wrote on August 29th, 2009
  14. “My blood sugars were so screwed up that it got to the point where it really didn’t seem to matter what I ate.” Uhhhh. Yes it DOES matter. I bet you never tried a low carb, high veggie, moderate fat primal diet and REALLY stuck to it. Had you done that with 100% compliance for a week your blood sugar would even out like mine has. I was a 200 pound pre-diabetic “fat gluttonous slob” myself. After going primal for 6 months I’m 171 and stronger. With virtually NO cardio. It really IS all diet. Keep reading; buy Mark’s book. There is hope, and it’s not found in a Dr’s office. You’re on the right path. ;-)

    Fixed gear wrote on August 29th, 2009
  15. I am not looking to argue with you “Fixed Gear”. As I explained in my post there were deep underlying issues and I also used a low-carb method, not a “no-carb” method. Perhaps you can read my post again. I’m sorry you felt you were a glutinous slob – that’s not a very nice way to view yourself. :-)

    Alexandra wrote on August 30th, 2009
  16. Wow, I know this post is over three years old, but I just can’t help but respond!! First of all, those who claimed that people who had weight loss surgery are lazy slobs- wow, judge a little? The nasty things I could reply back would not make me a better person, so I will refrain.
    Full disclosure, I had gastric bypass on 10/25/10. I am a 5’11” female who weighed 330lbs at my highest. I was a former athlete who usually weighed around 180-200lbs. I am now down to 200lbs, and am so grateful for the surgery. I too, was anti surgery, until I informed myself. It is NOT the easy way out, and surgery does NOT lose the weight for you. Surgery does not prevent me from eating cookies, crackers, fried food etc, I HAVE TO CHOOSE not to eat those foods. What did surgery help me do? It helped me lose a massive amount of weight, rather quickly. Yes, I could lose it without surgery, and had- I tried every diet out there, even natural foods. Try to open your minds and not judge before learning the facts. Are there people who got the surgery who think they don’t have to work at it? Sure! Do we all know someone who had surgery and yikes, GAINED IT ALL BACK? Yes!! And I know dozens and dozens who choose other weight loss routes who gained it back, but no one holds it against them. The ones who don’t gain it back, you don’t hear from. Why? Because they are walking down the street, eating food like normal people, are active, athletic and don’t let surgery define them.
    I just recently started living the paleo lifestyle a couple weeks ago. Do I wish I had looked more into it before surgery? Yes. However, I wasn’t ready. I lost the weight by eating high protein and fruits and veggies, and low carb actually- which is what surgery promotes. Unfortuntaely, a lot of patients cannot tolerate high fat, luckily I can. I have worked out since 3 weeks post op when we are allowed to do more than walking.
    hopefully i have changed some people’s minds about surgery. It is not a fly by night decision, and with a $30k price tag- its ludacris to think that. My hospital required numerous tests, psycological, nutritional, meetins with the surgeon and NP- a promise to adopt a healthy eating style prior to surgery(and they cancel your surgery if you gain weight btw). FYI, typcially they want you to lose weight prior to surgery to ensure you don’t have such a fatty liver. Most of us didn’t have troubel losing weight, it is keeping it off that was the problem.

    Ok, rant over. Grok on!

    :) Laurie

    Laurie wrote on February 8th, 2012
    • Thanks for the thoughtful post, Laurie. I’m currently in my 6month pre-surgery weight loss period, going Primal and seeing if I still want to go through with it after 6 months of feeling healthier. Like you said, the post surgery diet is fairly primal, though the intolerance for fats is definitely a concern. The surgery is really a compliance tool, and having just had a majorly noncompliant dinner last night while on vacation, the idea of it simply not being possible is a good one. If I can stick to it with few excursions, I hope to not feel the need to have the surgery, but I don’t want to reject it as a tool to help me in my effort to get healthier.

      Kat wrote on February 8th, 2012
  17. From someone who has tried all of the above, including changing lifestyle choices, low carb, paleo, HCG, etc. etc. and has succeeded in maintaining a non-obese weight as a result, with a lot of continued daily hard work, please don’t judge! Surgery is not the “easy out” you characterize it as. It involves losing 10% first, then the risk of surgery, then eating only liquids for a month. Anyone who is at the point where they’re willing to do that has most likely tried a lot of other less-invasive ways first without success. They have also most likely already worked on improving their food choices. Please stop deciding that everyone who doesn’t do it your way is a “fat slob” and deciding that your solution will work for everyone. The psychology and biochemistry of weight is complicated. There’s no one-size-fits-all.

    Terri wrote on August 2nd, 2012
  18. i just found out my sister has diabetes, parkinson disease and weighs 233 pounds. she just told me she was thinking of try the lap band. i have turned her on to this website, gnolls.org and to keep strack and do some research livestrong.com. i told her to use her self-discipline, perserverance, will and eating like this webswite indicates to regain her health. she was a jock in school. i live on the other side of the country and have since 1972. my visual image of her is 5’10” 125 , not 5’10” and 233. i was heavy at puberty and menopause. i hope she will listen to me as she asked for my advise.

    dana pallessen wrote on October 29th, 2012
    • i miswrote, she weighs 333, not 233. no time like the present to regain her health.

      dana pallessen wrote on October 29th, 2012
  19. Hi all
    I am a female, 5’6″ turning 70 yrs of age, Dec 2012.
    As a child I was normal size and was a gymnast and a “jockette”.
    Had a brief weight problem at age 16, where I went from 110-115 lbs to 172+ lbs. within about half a year, because I started eating everything in sight, and in large quantities, while stopping sportsand exercise except for long walks.
    At that time,I went on a “Water Fast” and lost tall of the excess weight, and my eating habits became normal again after that for many decades to come. I never needed to diet, watch what I ate, or the quantities either, to maintain my wiight at 115 lbs.
    The in the yr 2000 all of a sudden, again I stared pigging out on very large quantites of food. Within a few months again, I was very fat, again.
    Read all the Diet Books I could lay my hands on and decided to do Low Carb.(Atkins, specifically) The excess weight just melted off!!!
    As I started adding carbs to my daily meals I started gaining again, and by Jan 2003 I was fat again.
    So I joined Bill Phillips Body for Life Challenge. Went on Protein Power Diet and followed the vigorous exercise program as per Bill Phillips’ book.
    Well, at a well toned 120 lbs, I was a runner up in my age Category at the end of 2003 (meaning, I was in the Top 10, out of millons of applicants to the Body for Life Challenge that year).
    To make a very long story short, I kept the weight off by continuing my workouts, and, staying on Protein Power (Maintenance) until this year (2012)
    when I quit working out and started pigging out again, almost uncontrollably ravenously hungry 24/7!!
    There I was back at 175 lbs and gaining.
    Back on Protein Power for the past 6 weeks till Diet Buddy sent me Mark’s Link…
    I made the necessary adjustments, to switch over to Mark’s Approach…:>)
    Now (Mid November 2012) I am back down to 156 and losing, with my eating habits back under control. Figured I will start exercise Program once back down to apx 140 lbs…
    I am “Apple Shaped” meaning I have the “large fat cells” around my waist and belly and internal organs. Diabetes, Type 2, runs in my Family.
    No doubt I have Insulin Resistance and/or Syndrome X…so it is even more important to stay on a healthy lifstle regimen, to save my life.
    If I can do it, so can any of you!!!!
    And thanks, Mark for all that you do.

    Dawby wrote on November 16th, 2012
  20. Bariatric surgery does not cure the desire to overstuff w/food—I bought a lap band for my (now estranged) husband in Apr of 2007 who was 6’2” and weighed as much as 500 lbs because frankly he was dying from his own gluttony. He followed his program quite well for about 18 mos and lost almost 200 lbs, especially when his band was tightened down. However, he started to have problems including stomach bleeding so after he had his band loosened up again the stuffing resumed. As of Feb 2013 he is back up to 380 lbs even after having had a 37-lb belly flap taken off (I wish I could lose 37 lbs in 2 hrs!) eating as much as he could hold of his beloved refined carbs and processed fats.
    I gave up—now living w/ daughter 600 miles from husband—gluttony is a function of greed which is a function of extreme selfishness—Grok must not have been that greedy and selfish or his genes would have died out b/c his mate and offspring would have starved to death.
    Feeling much better after just a few days of Primal eating (avg 80-90 gms/ carbs/day so expecting good news from both scale and tape measure soon!

    shrimp4me wrote on May 2nd, 2013

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