Two seemingly groundbreaking studies, published this week in the New England Journal of Medicine, found that type 2 diabetes, or “diabesity,” could be cured with gastric bypass surgery. The flurry of media attention and medical commentary hail this as a great advancement in the fight against diabetes. The cure was finally discovered for what was always thought to be a progressive incurable disease. But is this really a step backwards? Yes, and here’s why.

For Diabetes Treatment
Dietary and Lifestyle Changes
Are More Effective Than Surgery

No one is asking the most obvious question. How did the surgery cure the diabetes? Did the surgeons simply cut out the diabetes like a cancerous tumor? No. The patients in the studies changed their diet. They changed what they put in their stomach and that’s something that doesn’t require surgery to change.

If they had surgery and they didn’t stop binging on donuts and soda, they would get violently ill and vomit and have diarrhea. That’s enough to scare anyone skinny. If I designed a study that gave someone an electric shock every time they ate too much or the wrong thing, I could reverse diabetes in a few weeks. But you can get the benefits of a gastric bypass without the pain of surgery, vomiting and malnutrition.

Most don’t realize that after gastric bypass diabetes can disappear within a week or two while people are still morbidly obese. How does that happen? It is because food is the most powerful drug on the planet and real whole and fresh food can turn on thousands of healing genes and hundreds of healing hormones and molecules that create health within days or weeks. In fact, what you put on your fork is more powerful than anything you can find in a prescription bottle.

The researchers asked the wrong questions. It should not have been: Does surgery work better than medication, but does surgery work better than intensive lifestyle and diet change.

Astonishingly, the researchers just compared surgery to medication, which has been proven over and over not to reverse diabetes, and often promotes progressive worsening of the diabetes. Patients who get on insulin gain weight and their blood pressure and cholesterol go up. And according to recent studies, those who had the most aggressive medical therapy to lower blood sugar had higher rates of heart attack and death.

These two new studies on gastric bypass should have included a treatment group that had intensive lifestyle therapy as well as medical therapy or surgery.

Lifestyle and dietary changes work faster, better and are cheaper than any medication. They are as or more effective than gastric bypass without any side effects or long-term complications. These changes are not easy, but then neither is gastric bypass.

A recent study, titled “Reversal of Type 2 Diabetes: Normalization of Beta Cell Function in Association with Decrease Pancreas and Liver Triglicerides,” has proved that diet alone could reverse type 2 diabetes. The bottom line: A dramatic diet change (protein shake, low glycemic load, plant-based low-calorie diet but no exercise) in diabetics reversed most features of diabetes within one week and all features by eight weeks. That’s right, diabetes was reversed in one week. That’s more powerful than any drug known to modern science and as or more effective than gastric bypass. But since it was a diet study, it got no press or attention. Other research proves that intensive lifestyle therapy can achieve the same results. We don’t have to heal with steel, we can heal with meals.

As I write this, new guidelines and insurance coverage for this new surgical diabetes cure are in motion. But this is a grave mistake. One in four people over 65 years of age, nearly one in five African Americans, and almost one out of ten of our whole population have type 2 diabetes. By 2050 there will be one in three Americans with type 2 diabetes.

Recommending gastric bypass as a national solution for our diabetes epidemic is bad medicine and bad economics. If the nearly 30 million diabetics in America took advantage of this new miracle cure at $25,000 a pop, it would cost three quarters of a trillion dollars ($750,000,000,000). If we paid people $100 a pound to lose weight we would still be better off. To treat the nearly 400 million diabetics around the globe would cost $10 trillion. Does this make any sense?

Shrinking someone’s stomach to the size of a walnut with surgery is one way to battle obesity and diabetes and may be lifesaving for a few, but it doesn’t address the underlying causes. And many will regain the weight because they didn’t change their understanding of their bodies or relationship to food.

Clearly, weight loss is critical and important for obtaining optimal health. However, what we are finding in patients who have gastric bypass surgery is that a change in diet in a short period of time creates dramatic metabolic changes.

All the parameters that we thought were related to obesity, such as high blood sugar, high cholesterol, high blood pressure, inflammation and clotting, are dramatically reduced even without significant weight loss because of the rapid effects of dietary changes that control which genes get turned on or off. This is called nutrigenomics – the way food talks to your genes. While weight loss is important, what’s more important is the quality of food we put in our bodies. Food is information that quickly changes metabolism and genes.

Unless we address the root causes – what we eat, our sedentary lifestyle and the social and environmental conditions that drive obesity and disease – we will have tens of millions more diabetics lining up for stomach stapling. The only ones to benefit would be the bariatric surgeons, the makers of the surgical instruments and the hospitals that are paid handsomely. To paraphrase an election campaign slogan from President Bill Clinton: “It’s the Food, Stupid!”

My book, “The Blood Sugar Solution,” is a personal plan for individuals to get healthy, to get healthy together in our communities and to take back our health as a society. Obesity and diabetes are a social disease and we need a social cure, not a surgical one.

My personal hope is that together we can create a national conversation about real, practical solutions for the prevention, treatment and reversal of our diabesity epidemic.

To learn more and to get a free sneak-preview of my book, go to www.drhyman.com.

Now I’d like to hear from you. Do you think we should promote a gastric bypass as a national strategy to deal with the diabetes epidemic? Have you been able to reverse diabetes with diet changes? Have you had gastric bypass surgery, and did you maintain the weight loss or gain it back?

Please leave your thoughts by adding a comment below.

Mark Hyman, MD is a physician and widely acclaimed book author. He is chairman of the Institute for Functional Medicine and serves on the board of directors of The Center for Mind-Body Medicine. He is the founder and medical director of The Ultra Wellness Center in Lenox, Mass.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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The study report was presented at a conference sponsored by the CDC, titled “Weight of the Nation” (May 7 to 8, 2012) in Washington D.C. and simultaneously published in the American Journal for Preventive Medicine.

Two U.S. Government Agencies
Warn of Dire Prospects for
The Nation’s Health

While it is difficult to make these kinds of forecasts, it is clear that obesity trends that started in the 1980s and 1990s continue on their paths. Currently, over 60 percent of Americans have weight problems and over 30 percent are diagnosed as obese. Even more worrisome are the growing rates among young people. Over 20 percent of children and adolescents are obese today.

Obesity can cause a host of chronic health problems such as cardiovascular disease, diabetes and also certain forms of cancer. Many people who develop weight-related illnesses during childhood are likely to face at least some of the consequences throughout their adult-lives.

“The prospect of such increasing rates, particularly those of severely obese Americans, is alarming, especially since efforts aimed at helping people to lose weight have so far proven relatively ineffective,” said Dr. Eric Finkelstein, one of the authors of the CDC report.

For a long time, the causes of obesity have been in dispute. One popular explanation is that people just eat too much and exercise too little. Some health experts say it’s not that simple. In a separate report on America’s obesity epidemic that was also released at the “Weight of the Nation” conference, the Institute of Medicine (IOM) concluded that the crisis is deeply rooted in the environment we live in, which is, as the report called it, “obesogenic.” According to the IOM, it is not so much people’s behavior that has changed over the past few decades but rather a number of factors that are beyond any individual’s control, including agricultural policies and food manufacturing.

“When you see the increase in obesity, you ask, what changed? The answer is, the environment,” said Dr. Shiriki Kumanyika, a professor at the University of Pennsylvania of Medicine and IOM committee member in an interview with Reuters. “The average person cannot maintain a healthy weight in this obesity-promoting environment.”

Instead of appealing to “personal responsibility,” the report suggests for policy makers to pursue structural changes like shifting subsidies from corn and wheat farms to fruit and vegetable growers, creating more pedestrian-friendly infrastructure, and limiting the number of fast food outlets near schools and residential areas and so on. The hot-button-issue of imposing surtaxes on sodas to curb consumption was also mentioned.

The Center for Consumer Freedom, an advocacy group for the food manufacturing and restaurant industry, rejected the IOM report and argued that Americans should be free in making their own food choices but should act responsibly. It accused the IOM of joining forces with the nation’s “food nannies,” according to a Reuters report (5/8/2012).

By contrast, the IOM panel said that blaming obesity on a failure of personal responsibility and individual willpower has long been used by the industry as the basis for resisting legislative and regulatory efforts to address the problem.

The costs for treating obesity and obesity-related diseases are responsible for about 20 percent of all spending on healthcare today, about $190 billion annually, not counting rising insurance premiums, lost productivity and missed work days due to illness. The IOM urges employers and insurance companies to participate more aggressively in the fight against obesity, if for no other reason than their own bottom line.

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Obesity is commonly associated with increased health risks, reduced quality of life and rising health care costs. Diseases in connection with weight problems include diabetes, high blood pressure, heart disease and some forms of cancer.

African-Americans and Hispanics
Have the Highest Rates of Weight Problems

The current obesity rate of Mexican-American adults is about 41 percent, significantly higher than the overall national average of about 36 percent of Americans who are obese, which is considred as roughly 30 or more pounds over a healthy weight range, according to the NCHS special report on nutrition and chronic health conditions of Hispanics living in the U.S. (3/28/2012).

African-Americans have the highest obesity rates at almost 50 percent. Among African-American women, the numbers are especially dramatic. Four out of five are overweight or obese, according to the Office of Minority Health (OMH), a subdivision of the U.S. Department of Health and Human Services (HHS).

In response to these alarming statistics, the U.S. government set as a specific goal the elimination of health disparities among racial and ethnic populations. “Given the overall high prevalence of obesity and the significant differences among non-Hispanic blacks, non-Hispanic whites and Hispanics, effective policies and environmental strategies that promote healthy eating and physical activity are needed for all populations and geographic areas, but particularly for those populations and areas disproportionally affected by obesity,” states a CDC report in 2008, titled “Differences in Prevalence of Obesity.”

Health problems affecting minorities are a grave concern for the country as a whole. The Hispanic population is the fastest-growing ethnic group in the U.S., and Hispanics of Mexican origin account for the largest portion. It is estimated that by 2050 over 130 million Hispanics will be living here.

Already over 20 percent of Mexican-Americans suffer from high blood pressure and high cholesterol levels caused by weight problems, and by all indications these numbers will keep rising. In terms of future health care costs, the prospects are dismal as well. Only about half of the Mexican American population has health insurance, according to the CDC’s National Health and Nutrition Examination Survey (NHANES). For many, emergency care will be their only option for treatment.

First generation immigrants seem to be less prone to develop weight problems due to changing environments and lifestyles than their descendents. Second and third-generation Mexican-Americans are more than twice as likely to become obese, according to a study conducted by the Arnold School of Public Health at the University of South Carolina and published in the Journal of Nutrition. One reason may be changing preferences from a traditional Mexican diet, dominated by fresh foods like corn, beans and vegetables, to an American-style diet based on meat products and processed foods.

Socio-economic circumstances and lack of nutritional education may also play a role. Healthier food items like fresh produce are often too expensive for low-income immigrant families. Many minority women are completely unfamiliar with concepts like counting calories, balancing food groups and adopting leaner cooking techniques. “The typical Mexican recipe calls for ‘enough’ or ‘not too much’ of an ingredient, rather than specific measurements, said Dr. Nangel Lindberg, a researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon, and lead author of a study funded by the National Institutes of Health (NIH), which was published in the Journal of Immigrant and Minority Health.

In connection with the study, a “culturally tailored weight management program” was established to help participating Hispanic women better understand how portion sizes and calorie intake can be controlled and educate them about healthier cooking styles. The one-year program, named “De Por Vida” (For Life), by itself was a success as it helped most participants to lose on average over 15 pounds.

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According to the CDC, asthma ranks among the leading chronic illnesses affecting young people. It is one of the most frequent causes of school absenteeism. About 10 percent of school children miss classes because of asthma at least once a year.

Chronic Airway Disorders Are on The Rise

Especially low-income populations are at an increased risk. 11.2 percent of Americans living below the poverty line are reportedly affected. Females seem more prone to developing the disease than males.

Asthma is a chronic inflammatory disorder of the airways. This can include narrowing of the bronchial tubes, swelling of the bronchial tube lining and an increase of mucus secretion to the point where the airways become blocked. In case of a so-called asthma attack, a person’s airways are so obstructed that it becomes difficult to breath, which can lead to a life-threatening situation. Thanks to faster intervention and preventive treatments, death rates in connection with asthma have dropped by a third compared to 10 years ago.

Asthma is often misdiagnosed as allergies. Not all people who experience allergy symptoms have asthma. Like allergies, asthma is associated with exposure to allergens and also smoking, chemicals and air pollution.

Identifying and controlling potential triggers of asthma attacks is crucial for effective treatment. Although there is no known cure or even prevention of asthma, multiple steps can be taken to limit exposure to allergens and other irritants.

The CDC recommends the creation of more asthma-friendly environments such as schools by implementing policies and procedures that allow students to successfully manage their asthma. These can include providing access to asthma care clinicians and school nurses, educational and awareness-building programs, training of teachers and school staff, community outreach and so forth.

In the home, it is recommended to keep dust and dirt from accumulating. Dust mites are notorious asthma attack triggers. Ventilation and air filtering is equally as important. Pet animals can be a significant source of allergens and should be kept away from asthma sufferers. Exposure to a whole range of potential irritants, including tobacco smoke, wood and coal fire smoke, strong odors from cooking, household chemicals, paint fumes and cosmetic products should be avoided as well.

Even dietary precautions may be necessary. Some food-borne allergens can become triggers and it is crucial to identify and eliminate them as much as possible. Some people may be able to tolerate smaller amounts of foods they are allergic to. Only experience can determine the limits.

There is no medication that can cure asthma. But medications are available to control asthma symptoms. There are different types and they come in different forms such as pills, aerosol inhalers, powder inhalers, liquids and injections.

The two main types of medications are anti-inflammatories and bronchodilators. Anti-inflammatories reduce swelling and mucus production in the airways. They can lower the intensity of asthma symptoms and allow for better airflow. Bronchodilators relax the muscles around the airways, thereby easing breathing. Bronchodilators are especially effective during asthma attacks.

The primary purpose of taking asthma medications is to control and relieve. Most asthma medications must be taken regularly, often daily. So-called reliever or rescue medicines are only to be used during acute attacks.

How often an asthma patient has to take medications depends on the severity of his or her symptoms. Some are affected only during certain times of the year, e.g. in the spring. However, no one should experiment with asthma medication dosages without prior consultation with a doctor.

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More than 450 members of the Sports, Cardiovascular, and Wellness Nutrition (SCAN) practice group, the nation’s largest professional group of Sports and Cardiovascular Nutritionists (SCANdpg.org), convened in Baltimore in April 2012 to celebrate its 30th birthday and to learn the latest sports nutrition news. Here are a few highlights to help you “eat to win.”

• Beets, like rhubarb and arugula, are rich sources of dietary nitrates, a compound that gets converted into nitric oxide (NO). Nitric oxide dilates blood vessels, lowers blood pressure, and allows a person to exercise using less oxygen. In a study, cyclists consumed pre-ride beets, and then three hours later (when NO peaks), they rode in a time trial. Every cyclist improved (on average by 2.8 percent) as compared to the time trial with no beets. Impressive! The amount of nitrates in 7 ounces (200 grams) beets is an effective dose. How about enjoying beets or a bowl of borscht in your next pre-game meal?

• Fuel up while cooling down is a wise mantra for athletes who exercise intensely. Immediate replenishment of carbs and protein can decrease muscle soreness and inflammation, plus enhance muscle repair. What you eat before you exercise can also effectively reduce post-exercise recovery. In a study, trained athletes consumed two 10.5-oz. bottles per day of tart cherry juice a week before an excruciating exercise test. They recovered faster and lost only 4 percent of their pre-test strength, compared with 22 percent loss in the group without cherry juice.

Tart cherries can help not only athletes but also individuals who suffer from the pain and inflammation associated with fibromyalgia and osteoarthritis. Consuming tart cherry juice (two 10.5-ounce bottles/day for 10 days) reduced the muscle soreness associated with “fibro-flares” and enhanced recovery rate. Similar findings occurred in people suffering from osteoarthritis. Drinking tart cherry juice for three weeks reduced arthritis pain.

Tart cherries (the kind used in baking pies, not the sweet cherries enjoyed as snacks) have both antioxidant and anti-inflammatory properties. Other foods that have high antioxidant and anti-inflammatory activity include raspberries, blackberries, and strawberries. Fruit smoothies, anyone?

Research to date has studied the effects of drinking 21 ounces of tart cherry juice per day for one to three weeks. (That’s the equivalent of eating 90 tart cherries/day). More research will determine the most effective dose and time-course. Because 21 ounces of tart cherry juice adds 260 calories to one’s energy intake, athletes will need to reduce other fruits or foods to make space for this addition to their daily intake.

• Sleeping used to be our most common “activity,” today it is sitting. The average person sits for nine hours a day. Prolonged sitting is a risk factor for heart disease and creates health problems, including deep vein thrombosis (as can happen on planes and during long computer work/games). Athletes who exercise for one or two hours daily still need to do more activity instead of sitting in front of a screen all day. How about a treadmill desk or “desk-ercycle”?

• While we may be sitting more than in past years, we’re sleeping less. 80 percent of teenagers report getting less than the recommended nine hours of sleep; nearly 30 percent of adults report sleeping less than six hours per night. Not good. Sleep is a biological necessity. It is restorative and helps align our circadian rhythms.

Sleep deprivation (less than five hours per night) erodes well-being, has detrimental effects on health and contributes to fat gain. When we become tired, grehlin, a hormone that makes us feel hungry, becomes more active and can easily lead to overeating. Sleep deprivation is also linked with type 2 diabetes, high blood pressure and heart disease.

Sleep deprivation is common among athletes who travel through different time zones. This can impact performance by disrupting their circadian rhythms and causing undue fatigue and reduced motivation. By comparison, extending sleep can enhance performance. A study involving basketball players indicates they shot more baskets and completed more free throws when they were well rested versus sleep deprived. For top performance, make sleep a priority.

• In a few communities in the world, an usually high number of people live to be older than 100 years. What happens in those communities that contributes to the longer life? Some factors include choosing a plant-based diet, rarely overeating, having a life filled with purpose and meaning, connecting with others in the community, moving naturally and/or socially (as in bike commuting and walking with family and friends), enjoying alcohol socially and in moderation, and not smoking. If you want to join the centenarians, take steps to re-create those life-enhancing practices.

Creating that life-extending culture has been done, to a certain extent, in Albert Lea, Minnesota. The “Blue Zone” project included improving sidewalks and building walking paths around a lake. Restaurants supported the program by not bringing a bread basket automatically to customers, and not serving French fries (unless requested) with meals. These and many other environmental changes contributed to a healthier lifestyle that resulted in an impressive 40 percent drop in city employees’ healthcare costs over two years.

• Many athletes, as well as obese people, commonly struggle with the belief that their body is not “good enough.” This struggle gets too little attention from health care providers who focus more on the medical concerns of heart disease, cancer and hypertension. Yet, whether you are lean or obese, having a poor body image often coincides with having low self-esteem. This combination generates poor self-care.

In a five-year study with teenagers, low body satisfaction stimulated extreme and destructive dieting behaviors that led to weight gain, not weight loss. The same pattern is typical among many seemingly “healthy” athletes. If you want help finding peace with your body, please seek it from a sports dietitian. Use SCAN’s referral network, www.SCANdpg.org, to help you find someone local. What are you waiting for?

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her “Sports Nutrition Guidebook” and food guides for new runners, marathoners and soccer players offer additional information. They are available at www.nancyclarkrd.com and sportsnutritionworkshop.com.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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You may say: “I have been here before.” Programs like these don’t work for me. Well, you are invited to give it another try, because this one may just be right for you. SEE ALL POSTS »

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Consistently maintaining healthy eating habits is not nearly as difficult as it sounds. Yes, there are temptations everywhere that can make you fall off the proverbial wagon. When you eat out or travel, it can be especially hard to stick to your ideal diet. As a dietitian and health counselor who also travels extensively, I had to develop my own strategies to always eat healthy and stay fit and do as I preach to others. I don’t deny the difficulties, but it gets easier over time, especially when you have a plan.

Designing a Health-Conscious Life

As soon as people find out what I do for a living, they ask me without fail the same question: “What should I eat?” Everybody seems so confused these days about nutrition, dieting, fitness, food safety, food politics and so on and so on. The reasons for this are obvious. We are constantly bombarded with news about nutrition studies, breakthrough diets, food contaminations, product recalls and ever-changing dietary guidelines – the stream of often conflicting and contradictory messages never ends.

Still, maintaining a healthy lifestyle should not have to be so complicated. Yes, it can be hard to restrict one’s diet to fresh organically grown produce and other high-quality food products, especially when you want to stay within a reasonable budget. But that doesn’t mean you have to give up on feeding yourself and your loved ones in a health-conscious way. In this new series, I will talk a lot about smart grocery shopping strategies that give you the biggest bang for your buck without having to resort to less than desirable food choices.

Home cooking will be another issue of great interest. Don’t expect a cookbook or recipe collection in this part of the blog  – you can find these under the postings called “Eating Lighter – Eating Smarter” and “Recipe Modifications.” Here, I want to talk about the importance of making tasty and healthful meals from scratch. It is a sad fact that home cooking is rapidly going out of fashion, especially among young professionals who are constantly pressed for time and whose diet consists of little else than restaurant food and take-outs.

As I mentioned before, I also travels extensively, both for business and pleasure. That is the time when even my eating habits face considerable challenges. It took me quite some time to develop workable strategies to always eat healthy and stay fit and do as I preach when I’m on the road or in the air. If you are interested in travel- and health tips, you may find some of my reports in the Travel & Health section quite helpful. Of course, I’m always keen to hear about your experiences too.

Having sounded off enough warnings about restaurant food, I also must confess that I love dining out once in a while. Whether it’s pizza, Chinese or French gourmet, it all has its place, as long as it’s done in moderation. I have written numerous restaurant guides in my professional life and there is a good selection in the “Dining Out” section of this blog. But I’m not a food critic. Instead of handing out “stars” for taste, service and ambiance, I put up warning signs where you should tread carefully and give my thumbs up where the territory is safe – I’m strictly speaking from a dietitian’s perspective, of course.

There cannot be any meaningful conversation about healthy living without involving the utmost importance of a regular exercise and fitness routine. But I’m no Jane Fonda. You’re not going to see me jump up and down in leotards and calf warmers (so nineteen-eighties), just to show you that I mean it when I say that you must move your body to stay healthy.

Last but not least, I will talk more about stress management and sleep hygiene as essential components of a healthy lifestyle. Both topics also relate closely to the improvement of one’s eating habits. Many people can’t get their weight under control because food can be such a great comfort when they’re anxious or exhausted.

The way I would like you to read the “Eat Like a Dietitian” section is not so much as a blueprint for health-conscious living and the likes, but rather as a personal diary of someone who struggles as much as you do with making the right choices – but who also has some good insights how to do better.

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