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Sometimes scientists come across intuitions that they were not looking for. For example, when Alexander Fleming discovered penicillin or when Wilhelm Röntgen was playing with radiation and accidentally took a picture of the bones in his wife's hand
or when he came to the researchers that surgery to him. Obesity works not only because there is less food. magesekken.
There must be more forces in turn.
Immediate recovery
As early as 1955, a group of researchers wrote that the digestive system involved not only influenced the weight, but it's also proven to be very effective against diabetes.
It seems, at first, not so sensational. Because we know that diabetes – and many other metabolic problems – are closely related to obesity. So when the operation helps patients lose weight, it's no wonder that they are also recovering in other wounds.
If only the effect seems in many cases to be immediate.
Blood glucose levels go against normal. Some patients are free from diabetes and can give up all the drugs, already a few days after the surgery, and this, long before they undergo a significant decrease in weight.
Several studies have shown that surgery itself seems to lead to changes in metabolism in the body, regardless of weight loss
Should we operate more?
Villy Våge, the researcher and surgeon who has worked the longest with obesity surgery in Norway, can also confirm that the operation has its own effect on diabetes. – This is an effect in addition to obesity, says Våge, who runs the Norwegian Quality Registry for Obesity Surgery, and is a senior physician at Haraldsplass Hospital. Diakonale in Bergen
And this leads to two important questions:
First, what mechanisms can they be behind? If we discover how obesity surgery actually works on metabolism, we could have more knowledge about what essentially causes metabolic diseases like diabetes.
And secondly, does this mean that we can – and should – operate on diabetic patients being overweight? Or normal weight?
Reserved heaviest
The debate on the last question is in full swing. It has already led to changes in the definitions of who should receive obesity surgery, writes David E. Cummings and Francesco Rubino recently in a summary in Diabetologia.
He can confirm the vote.
Surgeons in many countries had long been to the recommendations issued by the National Institute of Health in 1991. These guidelines establish that surgery should be reserved for patients with severe obesity, defined by a body mass index higher than 35.
However, in 2016, a group of international experts met to discuss the use of obesity surgery to treat diabetes. They recommend surgery for diabetic patients with mild obesity
Surgery should be considered for patients with diabetes 2 and BMI between 30 and 35 if blood sugar is not controlled by medication, the researchers wrote
For Asian patients, the border is completely down. a BMI of 27.5. In many places, the procedure is now called metabolic surgery, instead of obesity surgery
– that's because you see that it works, says Våge.
But is it the right limit now? Although diabetes often accompanies obesity, there are also many diabetic patients with normal weight or just a little overweight. [19659000] Controversial
Already in 2011, Andrei Keidar wrote in Diabetes Care:
– The sensational results of diabetes in humans obesity, as well as research on animals with and without obesity, emphasizes that surgery can also work for people without obesity.
In 2015, Chinese researcher Hui Liang wrote that we should consider surgery even for normal weight. He himself had conducted a study in which the researchers had operated on patients with a BMI less than 28, but with diabetes who did not treat enough drugs.
But this is controversial. Some studies in animals have suggested that surgery can also work against diabetes in normal weight. But we have little data from people. Naturally, he did very little research on obesity operations for normal weight.
The heaviest often get a better effect
– It is not acceptable to operate a normal weight for diabetes today. "
– We see that obesity surgery has less effect on diabetes, his easier patient is essentially reduction of obesity and the other mechanisms, it will be a more powerful effect, "said Våge, who has published studies on how obesity surgery works on diabetes. But we also know that some genes are related to the disease. And people with severe diabetes 2, despite their normal weight, probably have a strong genetic predisposition, "said Våge
. He points out at the same time that there are many things we do not know about the mechanisms of diabetes 2.
Learn more about how obesity surgery affects the disease, we also a better chance of finding treatment methods that work.
According to Våge, researchers have two possible mechanisms in the binoculars.
Upper and lower hemispheres the so-called foregut hypothesis. It is the fact that the first part of the small intestine probably plays an important role in controlling blood sugar, perhaps because the cells distinguish hormones or other signal substances that lead to an increase in insulin resistance.
in people with diabetes. When disconnected, the resistance to insulin is lowered.
The second idea is called the hypothesis of the posterior intestine. It seems that the lower part of the small intestine also seems to help regulate the production of insulin and blood sugar. This part of the intestine is likely to be more stimulated after surgery because the food and gallbladder arrive shortly after the meal.
But there may also be other mechanisms, according to Våge
. stimulate the production of gastrin gastrin in the stomach, which can in turn affect diabetes. In addition, the interaction between the intestine, intestinal flora and brain can be important.
However, much research is still needed. Not only to understand what the obesity operations of today actually do with metabolism. But also to try to develop more specialized and less extensive interventions that can affect diabetes.
– Experimental studies have already been done with such interventions, "said Våge
Feeding Inside the Bowel
.Experiments were presented in June, on Digestive Disease Week 2018.
The two studies involved the upper part of the small intestine, just below the stomach.
A team of researchers had simply fed the intestine of diabetic patients with a snake, which prevented the food from coming in contact with the intestinal walls.The result after 10 months showed that patients with the hose fell more by weight and had better blood sugar than patients without a hose. 19659002] The other team had heat treatment to destroy intestinal cells of the small intestine in diabetics with and without obesity.The goal was to change the way this bowel works.
The researchers compared the patients to a group that received a fool in which the intestinal wall was not damaged. The results showed that the heat treatment was safe, and preliminary measurements suggested that it also helped with blood sugar.
But in this area, we are far from the goal. Researchers have just started testing ideas, and no one knows how these new treatments work in the long run.
– We learned a lot, but there are still many things we do not know, says Våge
. exciting!
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