Unconventional surgery yields dramatic results
Eliminates need for insulin in some patients
A surgeon who has performed more than 1,000 gastric bypass procedures on morbidly obese patients at East Carolina University in Greenville, NC, is quick to admit the procedure is controversial among many of his colleagues.
But he notes while the technique is not widely accepted among the medical community, it can have dramatic benefits for obese diabetic patients.
"I can’t tell you what it’s like to have a patient who needs 90 units of insulin and a few days later needs none at all," says Walter Pories, MD. The professor of surgery and biochemistry at East Carolina is a pioneer of the surgery designed to reduce caloric and nutrient absorption which has had unexpected results for diabetics. The procedure bands or staples the patient’s stomach into a small pouch, then attaches a Y-shaped section of the small intestine that allows food to bypass the duodenum and part of the jejunum.
The downside of gastric bypass surgery is the potential for serious vitamin and mineral deficiencies, the potential for serious side effects from those deficiencies, and the certain need for supplementation throughout the patient’s life.
Pories, however, says those are issues the patient and physician can easily handle. He speaks with a passion about routine medical recommendations for diet and exercise: "To recommend exercise to a patient who weighs 400 pounds is simply cruel."
Pories says he is so excited he "can hardly stand it" about the impact of the surgery on diabetic patients: the 200 who underwent the gastric bypass suddenly and dramatically eliminated their need for insulin.
Pories is the first to admit he has no idea why gastric bypass surgery has such a remarkable effect on diabetic patients, but he has some ideas.
"I believe we are bypassing an overactive signaling mechanism from the intestine. I think diabetes is a disease where the intestine oversignals the pancreas," says Pories.
He also was surprised to find a dramatically reduced mortality in patients who underwent the gastric bypass, compared to a group of 72 patients who underwent the work-up for the gastric bypass but later decided not to have the surgery for a variety of reasons.
"There was a 1% mortality rate per year for those who had the surgery, and that’s a little higher than in the normal population," says Pories. But the patients who did not undergo the surgery had a much larger annual mortality rate: 4.5% per year. "This is the first demonstration of any surgery that can reduce mortality from all causes," he says.
The positive results seen in about 87% of his patients have been dramatic in terms of weight loss, says Pories. Most lose 30 pounds in the first month, 60 pounds in six months, and 100 pounds in a year.
No supermodels, modest losses
He warns his patients they will never look like supermodels. In fact, for reasons he does not understand, Pories says most of his patients come to a weight loss plateau at 10% to 20% over their optimal weight. "I guess that’s good, or they’d just keep on losing and eventually disappear," he adds.
Rewrite too awkward: The National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH) in Bethesda, MD, includes gastric surgery (gastric banding, bypass, and extensive bypass) among its options for weight reduction in severely obese people (those with a body mass index (BMI) of over 40) and for those with a BMI of 35 to 40 who with diabetes and patients with life-threatening cardiopulmonary problems.
NIH literature warns that the gastric bypass works by causing a malabsorption of food and may result in a variety of side effects including deficiencies of iron, vitamin B12, and calcium as well as a variety of complications associated with those deficiencies.
Pories says medical insurers will usually pay for the surgery because of the NIH’s endorsement.
Marian Parrott, MD, vice president for clinical affairs of the American Diabetes Association, says gastric surgery has its merits, but expresses reservations because it is risky and drastic. "I would like to see people try nonsurgical treatments before they consider surgery."
[Walter Pories can be reached at (252) 816-4629.]
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