The International Diabetes Federation has endorsed bariatric (Gastric Bypass Roux-en-Y) surgery as a treatment for type-2 diabetes, citing studies indicating that hormonal alterations triggered by it bring about remission in about 85 percent to 95 percent of the patients. Bariatric surgery (as noted by Dr Walter Pories, Chief of surgery at East Carolina University’s, Brody School of Medicine, USA) proved to be a long term solution for over 4 out of 5 obese diabetic patients. It also has beneficial effects on high Blood Pressure and Cholesterol. Obesity is now recognized as a disease and not just a behavioral problem.

Studies on the after effects of Gastric By-pass surgery have shown that the weight loss and the beneficial effect of it on type 2 diabetes, may be due more to the effect of the changes in micro-flora in the gut and certain hormones and amino acids released by the microbes there than due to the surgery. Simply re-plumbing the GI tract reprogrammes the body’s hormones and re-sets its metabolism.

Bariatric and Gastric By-pass surgery have often resulted in the unexpected benefit of controlling diabetes for many patients. This clearly shows that weight loss is not the sole way for control of diabetes. Surgeons across the world have observed excellent results with about 85 percent to 95 percent remission of Type-2 Diabetes. Improvements are also seen in the patients triglycerides, cholesterol, kidney function and leg pain. The only life-style change required thereafter is that the patient needs to consume smaller portions of food at a time, but can do so more often (4 to 6 times a day).

Ileal transposition is being done as a surgical treatment of diabetes in non morbidly obese patients. For really obese diabetic patients, Bariatric surgery (reducing the pouch of the stomach) may also be required. Laparoscopic Sleeve Gastrectomy (LSG), a restrictive bariatric operation in which an impermeable silicon sleeve fitted into the lower part of the stomach, fencing off the duodenum, seems to mimic the effects of gastric bypass surgery, prompting weight loss and control of Type-2 diabetes in obese patients. Diabetes is resolved in almost all Diabetic patients and hypertension is resolved in about 93 percent and improved in the rest of the patients.

However, any surgery is to be resorted to only as a last option with proper advice from your Physician. The Low-Carb or the Ketogenic diet recommended herein, effects your Gut micro-flora and hence, if followed strictly for at least a year, should gain you much of the same benefits as the surgery.

In around 2010, Blandine Laferrere, an Endocrinologist at the New York Obesity & Nutrition Research Centre at St. Lakes and Christopher Newgard, a biochemist at Duke University Medical Centre, noted that blood levels of three essential branched-chain, amino acids (BCAAs) – leucine, isoleucine and valine found in foods like fish, eggs and legumes are, high in obese people and those with type-2 diabetes and that these levels drop after Gastric Bypass Surgery. This suggests a link between BCAAs and diabetes. Two other amino acids (tyrosine and phenylamine) can also be predictive of diabetes.

The question then is which is the real reason, or which is the cause and which the effect? Is it eating too many amino acids, or is it poor metabolizing of amino acids or is it the sugars and carbohydrates in our diet, that is responsible for the obesity and diabetes which then messes up our amino – metabolism. A possible life-style change might then be to switch to a low-protein diet eg: eating less of meat, nuts and lentils, the main sources of BCAAs or follow the Low – Carb Diet as recommended herein. Ketones are preferentially metabolized compared to BCAA’s leaving higher levels of them around, which promotes longevity and increased muscle mass. This suggests that a Ketogenic diet is even better. You decide for yourself after following the Low – Carb Diet for at least 5 weeks, and then following the Ketogenic diet for the next 5 weeks, even if you are a vegetarian.

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