Across the river for water: Surgery for diabetes

In Sweden we have an ideom: “Don’t walk across the river to get water”. I’m sure you see why – but not everybody thinks like that.

Many scientists are amazed today. They don’t know how to explain why so many type 2 diabetics are cured by gastric bypass surgery, when their stomach is removed. At least they need a lot less insulin – from day one!

What’s the cause?

A mystery

Researchers are feverishly searching for the explanation. Can it be because of some gut hormone? Or because of the change in the blood flow? The goal is to identify the effect so it can be emulated in a drug and packaged in a profitable pill.

I wonder if these scientists have heard about Occam’s razor? Usually it’s not meaningful to make up new complicated theories when there already is a simple explanation.

A simple solution

Many type 2 diabetics in Sweden are now starting to eat LCHF-food and improving their health. Some of them are my patients. They quickly notice that they need a lot less insulin – from day one!

Carbohydrates is the food that turns into simple sugars in the gut, and is absorbed into the blood as blood sugar. The less carbs a diabetic eats, the less the blood sugar will rise and the less insulin they need.

It’s basic physiology – check any text book on the subject.

The choice for type 2 diabetics is thus simple. Either they cut away their stomach so that they can’t eat big servings of carbs anymore. Or they keep their stomach and choose to eat other things instead: e.g. meat, fish, vegetables, butter, eggs.

Sorry all researchers. You are not likely to find a pill that can replace good food.

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25 Comments

  1. Jon
    Spam
  2. Jon
    Angry rant, deleted /Doc
  3. Kärnfrisk
    Jon, give it a rest!

    This is a LCHF-blog, not a vegan voodoo site, if you haven't noticed.

  4. Milton
    Most modified diets that are used to treat diabetes are similar in at least one respect: they restrict or eliminate the use of refined sugar and flour. Many such intervention diets also restrict or eliminate wheat and other grains, and some reduce starch intake as well. The diets of people in poor areas tend to be particularly high in carbs from sugar, flour, and starch.

    It should, therefore, come as no surprise when a change to a healthier diet produces favorable results in both weight loss and general health. It must also be noted that several different types of diets-- including low-carb-- show similar success stories and probably similar success rates. The people who support a particular diet will point at that specific diet (and complain about "ideology" in others) but few people bother to look at the factors that those diets share. Why? Due to a dogmatic adherence to a particular dietary ideology.

    What research makes pretty clear is that reducing or eliminating refined sugar, white flour, wheat and grains, and starchy foods can have a dramatic effect on a person's weight and health. Or we can just spam links showing the benefits of low-carb or low-grain or other diets in treating type-2 diabetes and wonder why so many different approaches seem to work. Gee, what could the common link be????

    http://www.mercola.com/article/carbohydrates/scientific_evidence_low_...
    http://www.nutritionandmetabolism.com/content/3/1/22
    http://www.nutritionandmetabolism.com/content/3/1/16
    http://www.menshealth.com/health/cure-diabetes

  5. Jon
    Spam
  6. Milton
    @Jon: I do not champion the LCHF diet, but I highly doubt that there are "tons" of studies showing that it is unhealthy. There are probably a number of observational or poorly-controlled studies that "show a link" between LCHF and low-health, but there are many studies in a similar vein that "show a link" between LCHF and health benefits. The links I posted regarding low-grain/carb and improvements in type-2 diabetes took me less than a minute to find, and there were plenty more.

    In any case, my point is that most intervention diets of any type will improve the health of people eating such lousy diets (diets high in refined sugar, flour, grains and yes, starchy foods). Much of the starch eaten as a part of such diets is in the form of foods that are fried in vegetable oils and heavily salted. Starch itself is not bad, but it does lend itself to excess in most people.

    Pointing to one person's experiment with potatoes is misleading. You are aware that one person managed to lose weight on a diet heavy in sugary candies and confections, aren't you? Does his experience make you want to ditch your salad for a diet rich in Snickers bars and Twinkies?

    As for Mercola's credentials, I find myself again wondering why someone who asked me to look past ideology and focus on substance (and who gets most of his links direct from vegsource.com) is dismissing a link so readily. Especially when the article in question has a full page with 60 references at the end. Oh well...

    As for the healthiest and trimmest people, I'm not sure how that is determined. But I'm sure that some will point at the Masai and similar tribes of people whose diet is high in fatty meat and dairy and who manage to enjoy excellent health. Until they begin to eat a diet high in carbs, anyway. Pointing at a single population to prove your point does just the opposite, since as I have said before, there are plenty of cases that do not support your beliefs.

    As for anecdotal evidence, well... I eat around 1800-2200 calories per day, with a split of about 20/35/45 protein/carb/fat. I eat very little sugar and flour, no wheat/grains, and keep my starch intake fairly low. I have brought down my weight, my most recent blood test is almost perfectly normal, my cholesterol and blood pressure are under control, and I feel great. What does that prove? That my diet works for me. That's about it, really.

  7. Jon
    Milton,

    you are starting to sound more reasonable. I am glad that diet works for you. As said, everyone who used to Bic-Mac Meal and now skips the fries and coke and sticks to the burger will see improvement in their health. But nevertheless, that's is still not healthy way of eating. By leaving refined carbs (candies, cookies, processed grains) one can notice very rapid improvement in health. However, there's diet which work even better for you, I am 100% confident with that.

    The personal 60-day trial does not prove a thing, you are correct. People can easily fast 60 days on water, improve their health and feel fine . However when a man is able to eat 2200kals a day from plain potatoes, looses weight significantly and wittness dramatic improvements in his blood and cholestrol profile, that's a time for LCHF-crew to start to question their gurus.

    Sugar from non-whole food sources bad. Refined, processed grains bad. Carbs, not bad. People only gain weight with them and run into problems once they combine their carbs with high-fat diet.

    And Doc, skip the fish. That's been continously linked to prostate cancer among other not-so nice stuff.

    Ouh...Masai is such a small tribe whose life-span is not impressive). Are there any Masai over the age of 35? There's nothing but poor observations on them. We know the case of Inuits with better precision :) And that's not a nice story in terms of health. I suggest you go by the odds and eat like tke Okinawa folk (mostly a plant-based diet, over 90% kals from plant-sources, a very low-fat diet, 10% of kals max).

  8. Peggy Holloway
    For the skeptics, I highly recommend a new book by two highly-esteemed researchers in the field of human metabolism that explains the benefits of carbohydrate-restriction in scientific terms. It is written primarily for health professionals. It is replete with references to clinical studies, including the many peer- reviewed, published studies of the authors (over 100 combined). If you read this and still doubt the scientific validity of a well-formulated, low-carbohydrate diet in reversing "Type II Diabetes" without insulin or drugs, then I will respect that and say "case closed." Please read this before making further comments disparaging this approach.
    "The Art and Science of Low-Carbohydrate Living" by Stephen Phinney and Jeff Volek.
    It is available on Amazon.
  9. Milton
    I've always been reasonable, and I've been willing to try different diets and different approaches. I've tried low-fat in the past and while it allowed me to lose weight, I also had less energy and more hunger. I've found a diet that works for me, and I continue to test different approaches to see what helps and what doesn't. I read any number of sites that deal with food and health, many of which disagree with each other (after all, I read this site regularly though I do not eat LCHF). I prefer to research whatever I read, because most information will come with a bit of bias, but the web allows us to find a range of views.

    For example, I did a number of searches and read a few sites on the diet eaten by the people in Okinawa, and there is a fair amount of conflicting information. It is very likely that people are taking the information that fits their particular agenda, and emphasizing it to the exclusion of other data. Some sites claim that the diet is heavy in grains. Others that it is plant-heavy. Others insist that Okinawans eat plenty of fish and pork cooked in lard. It seems to me that people report the parts that support what they want to believe.

    But again, if we look at the parts where everyone seems to agree, a pattern emerges: the Okinawan people eat a diet with plenty of whole natural foods, primarily fruits and vegetables and some natural grains. They also eat fish and pork at least a few times a week and lead active lives. They avoid refined sugars and refined carbs. They likely avoid vegetable oils, but I saw no specific claim in that regard. It is difficult to know just how much of their daily intake is from fat, and the 10% number is based on the incomplete reports from people who want to promote that ideal.

    As with lots of other research, you have a group of people who engage in behavior that is generally accepted as being healthy, but people with an agenda point to a secondary factor instead. An active life and healthy whole foods that include meat and fish, and a dietary approach that emphasizes portion control ("eat until you are 80% full") seem to provide the people of Okinawa with a long and healthy life. That is my current approach, I think it's a good one.

  10. Jon #7,
    Oh, so now fish is out as well, based on weak observational data? If you continue like that there probably will be nothing left for you to eat soon.

    Btw, I deleted some of your posts. Like I said before, if you want to repeat the same ideas hundreds of times you'll have to do it in a blog of your own. Doing it here is considered spamming.

  11. James
    Hi Doc,

    Maybe leave the angry vegan rants up. You remain transparent in your endeavours, they look foolish. I have had the gastric band not quite as sever as getting the gut removed but still bad. Guess what it didn't work. I was hungry all the time miserable and terrible acid re-flux. LCHF keeps me sane I have had the band opened and now control carbs. No more burning in the oesophagus, no more starving at the cellular level.

    Lowering insulin by lowering carbs.....LCHF can't put that in a pill.

    Keep up the good work Doc.......Jim

  12. James,
    I try to be transparent, but when there are one hundred comments in a couple of weeks saying the same thing it just drowns out anything else and turns into spam.
  13. Mariah
    Trolls, or what you call them, make web sites interesting to read. Bless them. Some will ban them, which has happened before at Doc's Swedish blog. If you want the truth or other aspects of low carb diets you'll have to search "outside the box".
  14. Katy
    Please keep deleting the spam. I come here to read about low carb topics, and really don't want to have to sift through hundreds of emails on the so-called benefits of veganism. Hijacking someone's blog is rude. As the Doc says, vegans can create their own blogs for those who are interested in that WOE.
  15. Barb
    Doc, I love it. Your blog, your rules. Trolls are such onorous creatures.
  16. Angel
    One thing that trolls do (that they really don't understand) is reveal some of the character of the people they are attacking. You've been handling the trolls really well, Doc. Even if I didn't believe in LCHF, I'd have some serious respect for your integrity and your general ability to conduct yourself like a reasonable adult.

    Thank you for your blog, and your great work. Oh yeah, and LCHF rules!

  17. Sjovall
    With all this talk about spam I was reminded of the Monty Python Spam Song. This Diner has a Low Carb Menu.

    http://www.youtube.com/watch?v=g8huXkSaL7o&NR=1

  18. Anyone interested in the discussion about veganism and LCHF is welcome på read my post "My LCHF buddy the gorilla" at LCHF.com

    http://www.lchf.com/?p=171

    It´s about why a vegan diet is the perfect healthy diet for a gorilla - who actually gets 57 % of their energy from saturated short chain fatty acids by fermenting fibers - and why evoution made the human species less effective in converting vegetable fibers to fatty acids. It is also about why both humans and gorillas get fat and suffers heart disease if we eat a grain based, starchy diet with a lot of added sugar. Enjoy!

  19. Alexandra
    Gastric bypass forces most to eat very low carb to prevent a lovely side effect called "carb dumping"...which means throwing up! The problem is not the person or their mind or body, the problem is the horrid dietary advice we have been force fed for the past 40 years.
    Don't cut up your amazing body parts..cut the carbs and eat many cuts of fatty meat.
  20. Margaretrc
    @Jon, I don't know why you keep bringing up the Inuits as an example of the dangers of a high fat, primarily meat diet. Studies have shown that, despite their high fat diet with relatively little in the way of vegetables and fruits, those who STICK TO THE TRADITIONAL DIET do not suffer the so called "western" diseases or diseases of civilization. If they do have a shorter average (AVERAGE) life span, it more than likely is due to the harsh life they live in a harsh climate. Those who stray from the traditional diet and incorporate starches and sugars into it do suffer diseases of civilization at alarming rates. Likewise the Masai in Africa. I've met some of them (I was in Africa a year ago) and again, if they stick to their traditional diet, they do not get heart disease, diabetes, etc. and are among the best looking people I've seen as a group--not a fat or obese one in the lot and their facial features tend to be very symmetrical and attractive. However, their traditional life entails a lot of danger, so--if their average life span is, as you say, shorter--that would account for it. Not their diet and not the chronic western diseases that are largely a consequence of a poor diet.

    @Milton, sounds like you've found something that works for you and, truthfully, it works for a lot of people around the world who have not messed up their metabolism by eating a low fat, high carbohydrate diet high in refined starches and sugar. And there are, indeed, many different traditional diets that are not associated with the health problems many in this country suffer. But for anyone who has type II diabetes or is insulin resistant, the only thing that makes sense is to cut out consumption of the foods that dump a bunch of sugar into the blood stream--sugars, starches of all kinds (it doesn't matter if they are whole grains or not, grains still dump a whole bunch of glucose into the bloodstream)--and eat low sugar fruit in moderation. Thanks for the links, BTW. I am going to pass them on to a friend whose husband who has type II diabetes.

    @Peggy, thanks for the book suggestion. I've come across those names before and will be sure to get it one way or another and read it. I want as much information as I can get my hands on--science based information, that is!

  21. I'm with Katy, keep deleting the troll. This isn't the Jon show, I come here for your viewpoint and the comments of like minded fans, not argumentation & controversy, or I won't come here anymore.
  22. CMCM
    I'm as big a believer as there can be about the value of LCHF. When I first tried Atkins in 2003, it was a revelation on many levels: I dropped weight effortlessly, and felt physically better than I ever had. I later learned I had celiac disease, so of course the elimination of grains made a huge difference in how I felt digestively. Bit by bit over the years, I've realized how badly I am affected by all sugars, including fruit. Mostly I have banished the sugar entirely, but I'm still frustrated by trying to eliminate probably the last 10 or so pounds and getting my fat levels down below 30%, where I seem to be stuck. Any sugars or starches at all as a treat, even for a day or two, and up I go bloating and weight-wise. I seem to be highly sugar sensitive even though I've always had normal blood sugar readings. A bowl of fruit salad, however, can make me feel very sick. So most of the time I eat no added sugar, no fruits, no starches, no grains, no legumes. Since I also have to minimize dairy (supposedly I am sensitive to casein), sometimes it's hard to eat a varied diet. I do include a bit of dairy such as half and half in my cappuccino, occasional cheese. I do best with eggs, meats, poultry, some fish (not a lot), green veggies, water. I have small amounts of nuts and seeds as well. If I eat anything else, all bets are off, cravings begin, I'm driven to eat more and more sugar and it can get out of control extremely quickly, in just a day or two. I continue reading everything I can to understand the science behind low carb because I do think it is the ultimate answer, even though so many people reject it outright (love the Taubes books). I'm always experimenting with myself and trying to figure out what my body runs best on and how to keep the sugar entirely at bay and in the process drop that last excess fat (I've managed to drop 20 lbs but it took me a full year). This is a most interesting site, by the way, and being of Swedish heritage myself it's even more interesting to see what is going on in Sweden with the low carb ideas.
  23. I love this Swedish phrase!

    My younger sister was very obese and had lap band surgery in 2009. She has lost 140 pounds since then, resolved a number of health issues, and looks and feels great.

    That being said....

    I am overweight myself. I had been thinking about getting lap-band surgery after witnessing my sister's success, but decided to try LCHF first this January, and see what results I could get from it. This remains the only diet that I have ever stuck to for longer than a couple of months, and the most effective diet I have ever been on. It is my way of life.

    I will not get lap-band surgery.

    First of all, LCHF works and I am losing weight, thus I don't need surgery.

    Second: this kind of surgery has some really unpleasant side effects and, once you've learned behavior modification, you're stuck with the band unless you go the extra step to remove it, which insurance will often not cover.

    Third: truthfully, my sister lost all of her weight because of intense caloric restriction, but because lap-band forces you to practically give up starches (they don't go down well, and often come back up again) and because you have to prioritize protein over other macronutrients (she calls it food stacking), you really eat a lot less fewer carbs anyway.

    If I can get similar results (probably not as quickly, but then again, I have 50 pounds to lose not 140) by giving up carbs voluntarily, without surgery and unpleasant side effects, that seems like a better choice to me.

    Good health to you all!!

    Kate
    at getfitkatie.blogspot.com

  24. Many people just cannot live with their overweight anymore thus they are looking for ways how to get rid of their health problems.
    Gastric bypass surgery is one of the ways, it is only very important to choose the best surgeon: http://www.nordbariatric.com/en/surgeon-almantas-maleckas Like in Lithuania and in Sweden working professor Almantas Maleckas.
  25. My sister is diabetic on an insulin pump and has been very sick. Her HBa1c was 10.8. She has begun to try LCHF and in US very hard to get a Dr. to help you with this. In 3 mos. she was able to lower HBa1c to 9.2 (15% drop). She's got a long way to go but she knows she doesn't have to cross the river.
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