Weight-loss surgery's side effect: Diabetes disappears

Mary Writesel wrestled with obesity for a couple of decades, but it wasn't until she was diagnosed with diabetes that she considered a drastic solution: Weight-reduction surgery.

Even before she left the hospital after the surgery last August, her blood sugar levels had fallen so much she no longer needed medication for diabetes, high blood pressure and high cholesterol.

A year later and 60 pounds lighter, "I'm considered diabetes free," the 55-year-old Portsmouth resident said. "I can't tell you what a relief it is."

That by no means happens to all diabetics who go through weight-reduction surgery, but it happens enough that researchers are taking note.

Writesel agreed to donate a sample of fat removed during her surgery for a study being conducted by researchers at Norfolk's Eastern Virginia Medical School. "I told them they could have as much of that as they wanted."

The local medical school study is one of many exploring why diabetes sometimes goes away after weight-reduction surgery. At first, the phenomenon was chalked up to weight loss, but some patients were shedding the disease before losing a pound or even leaving the hospital.

Researchers at the EVMS Strelitz Diabetes Center decided to study different types of body fat to see whether certain aspects are more likely to result in problems such as diabetes and heart problems.

They're particularly interested in visceral fat - what most people refer to as belly fat - that surrounds internal organs. People with a lot of that type of fat are generally apple-shaped and are at higher risk for Type 2 diabetes and heart disease.

People who are pear-shaped tend to have fat that is under the skin - subcutaneous fat - that shows up in the hips, thighs and buttocks area.

The researchers are focusing on an enzyme in fat called lipoxygenase, which can cause inflammation that damages blood vessels. If they can determine how the enzyme causes the inflammation, that could lead to medical treatments to correct it.

Dr. Jerry Nadler, director of the Strelitz center, said the study also wants to determine why patients who have gastric bypass surgery seem to be more likely to stop being diabetic than those who have "lap-band" surgery. Gastric bypass is a procedure that restricts the stomach so food bypasses part of the intestine; lap-band is less invasive, with a band placed on the upper part of the stomach to make it smaller.

Anca Dobrian, an assistant professor of physiological sciences at EVMS and lead author of the study, said fat samples from 34 people have been collected during the past year for the pilot study, which will eventually include 40. Half the patients will have had gastric bypass surgery, the other half the lap-band procedure. In each category, half are diabetic and half are not.

Samples of both belly fat and fat beneath the skin are being studied.

Dobrian said that so far the study is showing that the diabetics have certain enzymes that are different from non-diabetics, and that enzymes in the bloodstream change after gastric bypass surgery.

The initial results were presented at an American Diabetes Association conference in June, and they are intriguing enough that the researchers believe they can get more funding to expand the study.

Dr. Stephen Wohlgemuth, medical director at Sentara Norfolk General Hospital's weight-loss center, is working in conjunction with the researchers by collecting samples from his patients.

He's been doing weight-reduction surgery for a decade. He said many gastric bypass patients have gone home from the hospital without needing their diabetes medication, or stopped taking it within weeks of the surgery, even before they've lost much weight.

Across the globe, there have been other studies of weight-reduction surgery patients whose Type 2 diabetes disappeared after surgery. One study published in the Journal of the American Medical Association in 2004 found that 70 percent of 22,000 obese patients with diabetes had the disease go into remission after gastric bypass surgery. Some doctors are even recommending the surgery to diabetics who don't meet the usual requirements for weight-reduction surgery.

There are critics, however, who contend that people can manage diabetes through diet, exercise and medication rather than risk complications of surgery and the expense of hospitalization. People can also regain weight after surgery and become diabetic again.

Insurance companies require patients to have a certain body mass index, and health complications such as diabetes or heart disease, to qualify for weight-reduction surgery coverage.

Nadler said there is a lot of discussion among health experts about the best treatments for diabetes and obesity, and for good reason. The medical costs of obesity are estimated to be as high as $147 billion a year; the American Diabetes Association pegs the costs of diabetes at about $116 billion a year.

Nadler is hopeful that the EVMS study will provide some answers. Blocking the enzymes that cause inflammation could help stem the damage of diabetes and heart disease.

Writesel, an executive secretary at Sentara Norfolk General, had been on high blood pressure medication since she was 19, shortly after her father died of a massive heart attack. When she was 50, her cholesterol was high, so she added more medication for that.

She was diagnosed with diabetes three years ago.

"I was devastated," Writesel said. "I thought, 'I can't have one more thing go wrong with my body.' "

The diabetes medications brought her up to six to eight medications a day. By this time, she weighed 250 pounds.

Six months before her gastric bypass surgery she started classes to learn about nutrition and how to change her diet. By the time she had the surgery, she was down to 238 pounds, and her blood sugar levels were improving. Writesel was on a liquid diet for a week before the surgery and was taking her diabetes medication up until a few days before her surgery.

That was the last time she took it. As soon as she came home from the surgery, she felt more energetic. She's lost 60 more pounds and wants to lose another 30. She walks two miles a day.

Instead of needing to see her primary care doctor every three months, she was advised to come back in a year.

"You don't know how good that sounded," Writesel said.

Audrey Floyd, 54, is another participant in the study. The Virginia Beach woman had lap-band surgery in May because the procedure did not require her to take as much time off work as gastric bypass. She's lost 10 pounds so far. She still has diabetes, but she is hopeful it will fade away as she loses more weight.

She said her primary care doctor didn't recommend the weight-reduction surgery but suggested instead that she "push away from the table."

Floyd hopes the fat she donated to the study will help other people like her: "Diabetes runs in my family. We are all getting it as we get older."

Elizabeth Simpson,(757) 446-2635, elizabeth.simpson@pilotonline.com