It's been known for some time that gastric bypass surgery
doesn't just help obese patients lose weight, it also cures diabetes in the majority of patients that undergo it. Type 2 diabetes is linked to diabetes but studies have found that gastric bypass surgery can rapidly put diabetes into a state of remission - regardless of weight loss.
Improved insulin resistance within the first week after surgery remains unexplained but a new paper in Endocrinology says it may be explained by the actions of specialized cells in the intestine that secrete a cocktail of powerful hormones when we eat.
During the research, the team showed that gut hormone cells previously thought to contain just one hormone, had up to six hormones including the hunger hormone ghrelin.
Study team leader, Dr Craig Smith, a Senior Lecturer in Molecular Cell Physiology at the University of Manchester, said, "Our research centered on enteroendocrine cells that 'taste' what we eat and in response release a cocktail of hormones that communicate with the pancreas, to control insulin release to the brain, to convey the sense of being full and to optimize and maximize digestion and absorption of nutrients.
"Under normal circumstances these are all important factors in keeping us healthy and nourished. But these cells may malfunction and result in under or over eating."
A meta-analysis (Buchwald, et al. JAMA. 2004;292:1724–1737) reported improved glycemic control and remission of type 2 diabetes in 83.8% of patients following gastric bypass surgery and understanding how bypass surgery cures diabetes is the crux of ongoing research.
Smith,"This is where things start to get really interesting because the most common type of gastric bypass actually also bypasses a proportion of the gut hormone cells. It is thought that this causes the gut hormone cells to change and be reprogrammed. For us, understanding how these cells change in response to surgery is likely to hold the key to a cure for diabetes."
In the UK, approximately 2.9 million people are affected by diabetes and the most common form of the disease is Type 2 diabetes which is linked to genes, ethnicity, obesity and diet.
"Understanding the messages the gut sends out when we eat food and when things go wrong, as is the case in diabetes, is our next challenge and hopefully one that will result in the development of drugs which could be used instead of surgery to cure obesity and prevent diabetes," said Smith.