With a body mass index (BMI) of 33.8, Rahele Malanca’s weight did not fall within the clinical parameters for obesity. So in her hometown of Geneva, Switzerland, she was not considered a candidate for gastric bypass surgery – a surgery commonly used for weight loss.
But Ms. Malanca desperately wanted to have the surgery – not to lose weight, but to take back control of her life from her type 2 diabetes. Her hopes were pinned on a cure.
A Struggle for Control
Ms. Malanca had been unable to focus on her four children or her career as a psychotherapist due to the diabetes she had been battling as an adult. The health complications that stemmed from the diabetes eclipsed everything else. And at 37 years old, she had no energy. She had developed diabetes when she was pregnant with her first child. It subsided after the pregnancy but “came back with a vengeance” a year later, she says. When she was pregnant with her second child she was forced to inject 700 units of insulin a day to keep her diabetes under control. That amount is 7 times what is considered to be a high level for a young adult. She had laser surgery on her eyes three times to correct complications from the disease and was suffering from high blood pressure.
“I kept thinking, ‘What will happen five years or 10 years from now if I continue to suffer the consequences of diabetes?’” Ms. Malanca says. “I need to live for my kids. I want a long, healthy, happy life.” Knowing that it was being studied as a possible cure for diabetes, her doctor in Switzerland cautiously recommended she consider gastric bypass surgery. “It was a huge decision,” she says. But in researching gastric bypass surgery she learned a lot about its potential benefits in treating diabetes. And, she says, as she was looking around the same name kept popping up: Philip Schauer, MD, director of Cleveland Clinic’s bariatric surgery program.
“I wanted the best,” Ms. Malanca says about traveling to the United States for surgery at Cleveland Clinic. “My goal was to get my diabetes as much under control as possible. It is important to put yourself in good hands. You don’t necessarily go with what is most convenient when it comes to your health.”
As Good as Cured
So in February of 2007, Ms. Malanca made her first contact with Cleveland Clinic to discuss her options for the surgery. Dr. Schauer, she says, “immediately put me at ease.”
After much preparation, she underwent gastric bypass surgery in August. Since then she has been able to stop taking all of her diabetes medicine. She has lost 55 pounds and her BMI has dropped from 33.8 to 25.5. “She’s about as close to a cure for (type 2) diabetes as you can get,” says Dr. Schauer.
Ms. Malanca, of course, is pleased. But she cautions people not to think of this surgery as the easy way out. She still must be careful with her diet and she exercises regularly. “This is not a surgery for everyone,” she says. “It was right for me but it is not a magic bullet. It is a tool.” She advises those who are facing this decision to do the appropriate research on the surgery and commit to taking responsibility for their health afterward.
“Don’t rush into it, but don’t wait too long either,” Ms. Malanca says. “It can improve the quality of your life.”
Gastric Bypass Surgery: Still an Option for Weight Loss
In September 2006 Mohammad Boland weighed 475 pounds. His obesity had led to kidney failure, which had necessitated a kidney transplant. Diabetes, acid reflux, sleep apnea and osteoarthritis were also making life unbearable. And on top of that, he was embarrassed by his body.
Today, at 40, Mr. Boland is full of hope. He underwent laparoscopic gastric bypass surgery, shed 205 pounds and has begun exercising.
“I can actually see myself losing weight. I sleep better, and feel better about life,” says Mr. Boland, a mechanical engineer with the Kuwait Fire Department.
Philip Schauer, MD, performed Mr. Boland’s surgery. Dr. Schauer, director of Cleveland Clinic’s bariatric surgery program, created a small gastric pouch in the upper stomach to restrict food intake, then connected that stomach section to the bowels. The surgery was minimally invasive; Dr. Schauer made only small incisions in the abdomen. The result: no scarring, little blood loss, less pain and a quicker recovery time.
“Mr. Boland came here as a very high-risk patient,” Dr. Schauer says. “He struggled with his weight all his life, and seemed to have given up. Now, he has hope for a longer, healthier life. And every pound he loses will further improve his health.”
Prior to surgery, Mr. Boland followed a strict diet for about four months and dropped about 60 pounds. Six weeks later he was another 36 pounds lighter. The bariatric program utilizes a team of endocrinologists, psychologists, physical therapists, nutritionists, dietitians and social workers to give patients a ready support system, which encourages them to succeed in their weight loss.
Bariatric Surgery and Diabetes –What’s the Connection?
The notion of using surgery to treat diabetes is radical, admits bariatric (weight-loss) surgery expert Philip Schauer, MD. But a number of studies have shown its benefits. Reports regarding the positive effects of bariatric surgery on diabetes first began to surface in the early 1990s. Five studies of a total of 3,568 people who underwent a type of gastric bypass called Roux-en-Y showed that the diabetes went into remission in the majority of cases after the surgery. In those cases patients were able to safely stop taking their diabetic medications.
Since then more than 20 studies have been conducted that show the same type of results. Roux-en-Y gastric bypass yields a diabetes remission rate of 75 to 85 percent, while the less invasive gastric banding procedure results in a remission rate of 40 to 50 percent.
The weight loss that results from these bariatric surgeries plays a role – but is likely not the only factor in improving or forcing diabetes into remission. Investigators theorize that digestive hormones secreted by the intestines positively or negatively affect insulin resistance or secretion from the pancreatic beta cells. Gastric bypass surgery that reroutes the flow of food through the digestive tract to avoid the stomach and duodenum (part of the small intestine) can improve diabetes by enhancing secretion of these beneficial hormones.
