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Study yields surprising results

Sayeed Ikramuddin, M.D. (Photo: Scott Streble)

U researchers explore benefits of gastric bypass, lifestyle changes

Which is better at controlling type 2 diabetes, gastric bypass surgery or lifestyle management?

That was the question University of Minnesota researcher Sayeed Ikramuddin, M.D.—along with scientists at Columbia University and in Taiwan—aimed to answer when they began a three-year study in 2011.

“This had never been tested in this way before,” says Ikramuddin.

They fully expected that the two test groups—60 patients having gastric bypass surgery and 60 patients making drastic lifestyle changes—would experience roughly similar results. Aft er all, both groups would lose weight—typically the best way to reverse type 2 diabetes.

But the results weren’t even close: After one year, 19 percent of the lifestyle-management group had met the health standards set by the study’s sponsor, the American Diabetes Association, and a whopping 49 percent of the gastric bypass participants had reached the goal.

Even more astonishing, the gastric-bypass patients’ type 2 diabetes was controlled in days, sometimes hours, postsurgery—long before they had actually lost weight.

To find out why, Ikramuddin teamed up with U researcher David Bernlohr, Ph.D., who specializes in adipose biology.

“We thought that the group on the low-cal diet would, in essence, perform the same as the surgery group,” says Bernlohr, “but there were molecular changes [in surgery patients] that happened because of the surgery.”

One patient’s story

Take 65-year-old LaVonne A. Swenson. A type 2 diabetic for approximately 15 years, Swenson applied to the study. “Family members have died from complications of diabetes,” she says, explaining her motivation. She especially wanted to participate in memory of her son, who died after struggling with a kidney disorder.

After reviewing the potential risks, Swenson underwent surgery in September 2011. Immediately afterward, her type 2 diabetes was reversed, and her blood pressure dropped below 130. Nearly two years later, her blood sugar is at 4.9, down from 10.1; her cholesterol numbers are in the healthy range; and she weighs 155 pounds—down from 240—thanks to the surgery and her determination to eat a healthy diet and exercise.

“Fantastic numbers—I still can’t believe that’s really me,” says Swenson, who adds that she’s healthier and more active now than she’s been in 30 years.

A nonsurgical approach

Swenson’s all-around positive results make sense. Recent University of Minnesota studies have pointed to the efficacy of healthy lifestyle choices—like eating breakfast and walking after meals—for people with type 2 diabetes. But Bernlohr and Ikramuddin don’t yet know why the surgery sparked such decisive results.

Regardless of the surgery’s clear results, gastric bypass is not a likely long-term future treatment for diabetics, because not all patients can benefit, given the risks of surgery.

“What we need to find are inroads— nonsurgical ways—to accomplish this result,” says Bernlohr, who is busy studying the biology of the patients’ adipose, or fat, tissue and why its inflammation is reversed.

Bernlohr notes that funds donated by a U diabetes research supporter paid for some of his equipment. “It’s very important to have access to philanthropic dollars, so that we can move quickly,” he says.

So while their one-year data collection in December 2012 provided the early findings they needed for publication in June 2013, Ikramuddin and Bernlohr are now collecting two-year data and determining how gastric bypass surgery affects mitochondrial function, or energy production, in adipose tissue.

“What is it about that tissue that can drive improvements in diabetes?” Ikramuddin asks. He’s hopeful that studies like theirs will reenergize the National Institutes of Health and other major funders to invest in large-scale trials. He and Bernlohr will complete their current study in July 2014, with the hope of developing a nonsurgical intervention.

Meanwhile, Swenson loves her new life: her husband has taken up cooking nutritional meals; she walks about 7,000 steps a day; and now she’s able to play with her grandchildren. “I used to be the cheerleader on the sidelines,” she says.

Diabetes is a growing problem in the Lower Sioux Community, of which Swenson is a member. She says she is determined to spread the news of healthful living. “I want to go to all of the reservations in the state, tell my story, and show before-and-after pictures.”

By Karin Miller

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