Commentary by Ralph Campbell, M.D.
(OMNS May 1, 2012) It is so easy to accept the razzle-dazzle of "medicine" and medicines that will "cure" ills and its superiority over the tedious and disciplined act of taking care of your body in the first place. When illness strikes, medicine may seem more appropriate than following a healthful corrective change in lifestyle.
TV and other media depictions of new drugs and "medical breakthroughs" have great appeal for those seeking a short cut. Especially when they put down old-fashioned and cumbersome advice that touts good nutrition and vitamin supplements.
In addition to pharmaceuticals, surgery plays a big role in the PR campaign of "medicine". Along with the highly technical "imaging" that goes with it and the fact that most surgical procedures and accompanying tests are covered by health insurance, a convincing picture is painted for the "quick fix".
Recently, on the TV evening news, I saw a classic (and sickening) example. Here's their punchline. "Why should the obese suffering from Type 2 diabetes out there in TV land put up with all the rigmarole of losing weight the slow way, when they can have bariatric surgery?" This was based on a study at the Cleveland Clinic . The obese folks with diabetes were put into 3 groups: two different types of gastric surgery and the control group which had medical treatment only. In the follow-up session, the learned men of the Clinic, clad in white lab coats, nodded their heads in agreement that putting diabetes into remission [a term usually reserved to describe "successful" cancer treatment.] was truly amazing.
I have found that the usual source of medical news for evening TV news is garnered from Medscape (an exclusive doctor's website). But somehow, the news broadcasters get their "scoops" the day before I do. Sure enough, the Cleveland Clinic breakthrough study arrived on my computer the next morning.
One hundred and fifty obese individuals were selected for this study and placed into one of three groups. Two different types of gastric surgical procedures made up the first two groups; with the third being the control group. Those in the control group had "individualized medical therapy and strictly monitored diet and life-style intervention (exercise)." There was no mention of what the monitored diet consisted of, the intensity of exercise, or compliance rates.
In a short time, the surgical patients had "spectacular" results in terms of diabetes control. But those obese individuals didn't get that way overnight. For one reason or another, their diet must have included too many calories and not enough exercise. We aren't told at what point intervention with wimpy or questionably effective glucose control drugs, diet control and exercise were entertained. Nor were we told how long they stuck with the program before caving in to the acceptance of surgery.
The study raises a question: why, in the long run, should bariatric surgery be better for improving diabetes than adhering to a proper diet and exercising? Both methods will produce weight (fat) loss and, with a little body movement, will shift some insulin receptors from fat cells to muscle. Continually paying attention to diet and exercise and the high level of self-discipline that enables sticking with the program, that should have been required pre-op, will be just as necessary post-op. Very likely, for someone in this worrisome condition, now is an opportune time to accept the value of optimal amounts of vitamins and to get serious about the details of what constitutes a truly good diet.
Short term pitfalls such as surgical complications are not emphasized in these studies. But long-term complications, resulting from a greatly diminished absorptive and secretory stomach-lining surface must be carefully monitored. The metabolism of magnesium, calcium and essential trace minerals critically depends on adequate gastric hydrochloric acid. Any surgeon who is more than a technician should be aware of the consequences of vitamin B12 deficiency and of their responsibility to so inform the patient. Surely candidates for surgery are told, in advance, of the necessity of small, frequent and well-planned meals. The long-term consequences of such surgical treatment are serious, and if the lifestyle is not adequately modified, can be life-threatening. Thus, it is puzzling to me that those contemplating this surgery, after watching all the positive testimonies from participants in successful weight-loss programs, would not choose to tough it out rather than undergo all the drawbacks accompanying surgery.
It would be more honest, and fairer to the medical professionals involved, to expose the TV audience to the whole study rather than this half-truth presentation. This is a tortoise and hare scenario. The tortoise, in this case the one who modifies lifestyle with an excellent diet, is definitely the victor.
(Ralph Campbell, M.D., is a board-certified pediatrician and lifelong advocate of nutritional medicine. He is coauthor of The Vitamin Cure for Children's Health Problems, and is an active orchard farmer at age 85.).
1. Schauer PR, Kashyap SR, Wolski K, Brethauer SA et al. (2012) Bariatric Surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012; 366:1567-1576
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