Alvin McCray was fighting a losing battle with his weight.
“I was close to 400 pounds and I was getting a shot every day of insulin, and my blood pressure was up there. I was trying to lose weight, would lose a little and gain more,” McCray said.
He had developed diabetes, which, he recalled, started out with doctors telling him to watch what he ate, “then it progressed to pills and then to insulin for 2½ years.”
“That’s when I decided to do a gastric bypass,” McCray said.
The surgery involved creating a small pouch about the size of an egg in his stomach, bypassing the rest of the stomach and the upper portion of the small intestine.
Now, a year and a half later and 150 pounds lighter, McCray, who works in waste management for Miami-Dade County, is off the insulin shots, has good blood sugar readings and his diabetes is almost gone.
His bariatric surgeon, Dr. Nestor de la Cruz-Muñoz with UHealth-University of Miami Health System, said the gastric bypass is the most effective of all the bariatric (weight-loss) surgeries in dealing with Type 2 diabetes and high cholesterol.
“We have known for decades that weight-loss surgery will result in a reduction of Type 2 diabetes,” said Dr. Raul Rosenthal. A bariatric surgeon, he is the new president of the American Society of Bariatric and Metabolic Surgeons and chief of staff at Cleveland Clinic Florida.
Today most gastric bypass surgeries are done laparoscopically, requiring less cutting. “Patients can return to their daily activities a week to 10 days after surgery,” Rosenthal said.
Depending on the severity of the disease and the patient’s age, “between 72 percent and 90 percent of the patients” who have had diabetes for less than five years can experience a remission. The rate “can drop down to 55 percent” for those who have had Type 2 diabetes for more than five years, Rosenthal said.
“The longer they have had diabetes, the harder it is to get it to go away,” de la Cruz-Muñoz said. “It’s probably because the pancreas has taken a beating over the years,” he added.
The other bariatric surgery used to combat diabetes is the sleeve gastrectomy, in which a large portion of the stomach is removed, but there’s no rerouting of the food stream.
“Both gastric bypass and sleeve gastrectomy have proven to be significantly better than medical treatment” in dealing with diabetes, Rosenthal said.
De la Cruz-Muñoz said while the sleeve is very popular, it doesn’t work as well as the laparoscopic gastric bypass for diabetes.
In both cases, the smaller stomach results in a significant loss of appetite, but there seems to be something else in play.
“We call our operations metabolic procedures because the effects are not only related to weight loss, but also sleep apnea, hypoglycemia, hyperlipidemia [high cholesterol] and diabetes,” Rosenthal said.
“That’s what the discussion of metabolic surgery is about. The weight loss is actually secondary. The main reasons we’re doing these surgeries is to get rid of the diabetes,” de la Cruz-Muñoz said. He recently attended the World Congress in London dedicated to the emerging field of diabetes surgery.
“The leading theory is probably the way the bile is used and reabsorbed in the intestines,” de la Cruz-Muñoz said. “We do know there’s a difference in thin people’s gut bacteria and obese people’s gut bacteria,” he added.
“The interesting thing is that the diabetes and hypoglycemia go into remission unrelated to the weight loss. The effects are seen due to hormonal changes,” Rosenthal said, adding that some patients leave the hospital after surgery with blood glucose levels that are normal.
One of those patients was Ralph Moccia of West Boynton Beach.
“The day of surgery was the last diabetic medicine I’ve had,” said Moccia, 70, who had a gastric bypass 10 years ago.
“I was actually on a cane and couldn’t drive,” Moccia recalled.
After the surgery, Moccia lost 150 pounds.
“I started out in the pool, doing a little walking,” Moccia said of his post-operative recovery. Now he rides a bike 10 to 15 miles a day as one of the bike patrol volunteers with the Palm Beach Sheriff’s Department. He also watches what he eats.
“It’s not a diet; it’s a lifestyle,” said Moccia, who has only gained back 25 pounds.
Moccia eats small meals that are high in protein, low in carbs and fat. McCray eats a lot of salads and works out in the gym, things he didn’t do before his bariatric surgery.
Of the 200,000 bariatric surgeries performed yearly in the United States, de la Cruz-Muñoz said 25 to 30 percent are for diabetic patients.
The surgery is recommended for diabetics who are obese, with a Body Mass Index of 35 or above.
“Everybody thinks it’s only for the morbidly obese, yet studies have shown that surgery is a more effective option for treating diabetes than medical treatment in terms of getting normal blood sugars,” de la Cruz-Muñoz said.
He said the surgery “would be much more common if diabetics understood that there was something out there that could potentially get rid of their diabetes.”