When it comes to hormones, there are levels that are optimal and levels that wreak havoc. Certainly insulin falls into this category. This is confirmed by the ACCORD trials, where diabetics used insulin more aggressively, but the trial was stopped because these subjects using aggressive insulin were dying 40% faster.
The problem with diabetes has never been about the insulin. Certainly our body’s ability to produce insulin from the beta cells of the pancreas is an integral component to the progression of diabetes. This is why a prediabetic finally tips over into diabetes–because the pancreas can no longer produce the elevated insulin required to compensate for the real problem.
The relationship between the cells and insulin is the most important component of the diabetic / prediabetic process. Anything that improves that relationship (exercise, wise dietary choices, targeted supplementation) is good and anything that harms (stress, environmental chemicals, poor quality diets) is bad. While metformin does improve this relationship, it does so ONLY in the liver. I had a patient come in recently who was put on metformin because it helped insulin do its work in the heart. This is NOT true and she was mislead.
So…on to this particular study. This study looked at what happened to diabetics who underwent the Roux-en-Y gastric bypass and found that two important things happened.
First, the diabetes went away based on blood glucose. Second, insulin levels decreased dramatically. So, lower insulin = lower blood sugar. Somewhat opposite of what we normally think, huh?
But, insulin resistance, the situation that created the diabetes in the first place, was unchanged.
A few comments on this. First, don’t run out and schedule your bypass surgery today to get rid of your diabetes. We’ve seen studies using a very low calorie diet get insulin dependent diabetics off their insulin in a week. And the bypass surgery will forever alter your body’s absorption and utilization of nutrients and may increase your risk of colorectal cancer, which the low calorie diet does not do.
Second, without the insulin resistance being fixed through the proper lifestyle changes, it is very possible that this is why studies show a high percentage of patients end up with regain of weight in the following years.
More than anything, though, this shows how powerful the things we put into our mouths can be. In the case of the bypass surgery, there is no question that the caloric intake is drastically reduced, although many are not educated on the quality of foods to be eaten. And yet, the affect on glucose handling is, without a doubt, powerful.
So, do not EVER discount the power of diet to modify our progression to our away from diabetes. Medications did not achieve this. While this study used surgery, the outcome can be done without permanently modifying the way your digestive system works.
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