A controversial New York doctor is poised to begin surgical trials on non-obese diabetes patients in an attempt to reverse their disease with gastric bypass surgery. Dr. Francesco Rubino, the chief of gastrointestinal surgery at New York-Presbyterian/Weill Cornell Medical Center, believes that because gastric surgery has been shown to be highly effective in remitting diabetes symptoms, the procedure should now be allowed among non-overweight type 2s.

Rubino has long touted the beneficial side effect of diabetes remission in obese type 2 patients who have undergone the surgery as a last-ditch attempt to shed weight. Until now, the surgery, which reduces the size of the stomach and thereby lessens appetite, has been recommended only for patients with a body mass index of 35 or more. (A BMI of 35 or more, which factors in weight versus height and sex, is considered obese. People of normal weight for their height and sex usually have BMIs in the low to mid 20s.)

Rubino, who has been doing gastric bypass surgery since 1999, noticed early on that most of his obese patients who also had type 2 diabetes experienced an almost instant remission in their diabetes symptoms after the surgery. (Other doctors through the years have noticed the same effect. Although there is no exact percentage of remissions reported for post-gastric surgery type 2s, the most conservative number reported is 80 percent.)

Part of Rubino's theory that non-obese type 2s can benefit from the surgery is based on his observation that post-operative diabetes remissions happen far more rapidly than could be accounted for by the weight loss that the surgery is designed to induce. He reasons that excess weight alone, in the form of visceral "belly" fat, is not enough to explain the origin of type 2 diabetes. Instead, he thinks that the disease's origin is in the gut, most likely the upper digestive tract, and that gastric bypass surgery somehow short-circuits the malfunctioning digestive process that leads to diabetes.

Recently Rubino has become more outspoken about removing the restriction that limits the surgery to obese patients, saying that it should become a more routine procedure that doctors should be free to offer their type 2 patients, especially those who have been unable to control the disease despite careful diet, regular exercise, and drugs.

Why the Controversy?

Despite the statistical evidence that gastric bypass surgery has a powerful effect on type 2 diabetes, Rubino's campaign to make it more freely available has stirred controversy. That controversy centers on several concerns and objections:

• The long-term effects of diabetes remission are unknown. Even if the effect in permanent, what are the possible ill effects or drawbacks years down the road?
• There's a related worry that gastric bypass surgery could become so routine that it becomes dangerously overprescribed, much like lobotomy was in the mid-20^th century, only to wind up being discredited like lobotomy.
• Critics say that Rubino, as a weight-loss surgeon, may be advocating the procedure as a means of increasing his own and his peers' business.
• Critics also dispute the actual beneficial effects of the surgery when before-and-after statistics are scrutinized. One critic at Diabetes Update (see link below) says that the blood glucose figures given as proof of "remission" are way too high to qualify as proof that the disease is under control.
• Some people assert that a much simpler procedure, gastric banding, can produce the same effects as bypass surgery at far less cost and danger to patients. Gastric bands, which are placed at the top of the stomach, are inserted through the esophagus in a non-surgical procedure, often in an outpatient setting. Any subsequent problems can almost always be solved simply by removing the band.

For further reading on this topic, go to these sources:

• New York Daily News article, "Manhattan doc claims gastric bypass surgery can reverse diabetes in non-obese patients"
• Diabetes Update article, "The REAL Truth About Gastric Bypass's Supposed "Cure" of Type 2 Diabetes
• Newsweek article, "Is There a Surgical Cure for Diabetes?"