Resurrecting the Pancreas

“Gut Reaction” may soon describe a process of pancreatic rebirth in Type 2 patients after gastric bypass surgery. Echoing the positive experience of   Marla Evans, a Cleveland Clinic patient whose gastric bypass was described in IN last year, a new Cleveland Clinic study not only shows a return of normal pancreatic function for many patients, but also indicates that the pancreas is far more resilient than experts have believed. After both 1- and 2-year follow ups, bypass patients achieved near normal glucose tolerance, just like Evans. This is particularly amazing in patients who were on insulin due to near total pancreas failure entirely prior to surgery.

“Gut hormones not only control your appetite, but also your glucose metabolism,” said Dr. Sangeeta R. Kashyap, one of the study’s authors. “When we manipulate the GI tract during surgery, we affect hormones that stimulate the pancreas.”

Kashyap went on to say that losing weight was only one factor that encourages pancreatic rebirth. It seems that losing belly fat in particular, not just weight, directly correlates with dramatic improvements in pancreatic function. “Weight loss doesn’t explain all the metabolic effects of the procedure,” she said. “There is something very powerful about the bypass, which we don’t yet fully understand.”

Just as gut hormones talk to the brain, so does belly fat.  Researchers think belly fat contains dangerous hormones that lead to insulin resistance, which over years causes the pancreas to overwork itself and essentially poop out, leaving injectable insulin the only alternative.  Despite similar weight loss, those who underwent gastric bypass saw a much greater reduction in belly fat compared to those who underwent the sleeve gastrectomy surgery (which unlike a complete gastric bypass, does not involve re-routing of the intestinal tract). So, for now, bypass surgery wins out over sleeve techniques for the best diabetes results.

Cleveland Clinic researchers will continue for  three more years to follow the original group of patients with diabetes who underwent various forms of gastric bypass surgery.  IN will report new findings as they become available.