“Roux-en-Y gastric bypass surgery (RYGB) is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported.” These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. Severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery?

To answer that question, researchers put diabetics on the exact same diet as one would eat post-RYGB surgery, with or without the actual surgery. As I discuss in Reversing Diabetes with Surgery, the researchers found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery.

Blood sugar control improved more in the absence of surgery.

This suggests that the whole surgical-diabetes-reversal is not due to the surgery at all, but rather because of the diet people have to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have just as much potential to resolve diabetes as major surgery does.

If you’re familiar with my video Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Namely, “[t]ype 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat”—that is, too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating about 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels (blood sugar levels) can normalize, thanks to a fall in liver fat. If you look at CT scans, you can actually see a 35 percent reduction in liver volume as all the fat is cleared out. Then, the body starts pulling fat out of the pancreas. When the cause of diabetes goes away, the diabetes goes away.

The insulin-producing beta cells of the pancreas “had woken up!… Clearly, the [beta] cells are not permanently damaged in Type 2 diabetes, but are merely metabolically inhibited.” Studies show a reversal of diabetes up to 28 years after diagnosis.

So, diabetics motivated enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. “For many people, this may prove too high a price to pay,” as it’s hard to voluntarily restrict food intake that much.

In that case, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.

Of course, major surgery carries major risks—during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There has got to be a better way. And there is!

Instead of changing the quantity of food eaten, whether voluntarily or involuntarily, is it possible to reverse diabetes by changing the quality of the food? Watch my videos Reversing Diabetes with Food and Diabetes Reversal: Is It the Calories or the Food? to get the complete picture.

For the lowdown on saturated fat, check out Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Interested in taking a deeper dive into underlying causes of type 2 diabetes? You may be interested in these:

And, for an overview, see How Not to Die from Diabetes.

In health,

Michael Greger, M.D.