New solution or simply admitting failure?

SurgeryLast week the International Diabetes Federation (IDF) announced that gastric bypass surgery is a cost-effective treatment for type 2 diabetes. This marks the first time in modern medicine that cutting out normal tissue is now considered good medicine. It also indicates the pathetic state of medical science for the treatment of diabetes.

Make no mistake: Type 2 diabetes is now a pandemic, affecting approximately 300 million people worldwide. This is projected to increase to some 450 million people worldwide by 2030. Since diabetes is one of the most costly chronic disease conditions, it is the most likely to break the financial backbone of health-care systems in every advanced country.

The typical gastric bypass surgery costs from $15,000 to $24,000. Just for argument's sake, let's assume it is $20,000 for each surgery. Since some 26 million people in the United States have type 2 diabetes, then a mere $520 billion dollars spent on gastric bypass surgery would solve our growing epidemic. Obviously we don't have that type of money floating in the health-care system.

Furthermore, the 10-year failure rate is relatively high for this type of surgery (1). For example, 20 percent of patients who were initially obese (BMI >50 percent) could not maintain their long-term BMI below 35 percent (the definition of morbidly obese). This failure rate rises to 58 percent for those whose initial BMI was greater than 50.

The key feature as to why gastric bypass surgery works is the almost immediate suppression of hunger, mediated by improved release of hormones from the gut (i.e. PYY) that go directly to the brain to tell the patient to stop eating. Over time it would appear that this initial enhancement of PYY release is being compromised. As a result, those patients regain the lost weight.

So maybe gastric bypass is not the best long-term solution (and definitely not a cost-effective one in those patients that regain much of their lost weight) for solving the current epidemic of diabetes. So what's the alternative? One solution would be an anti-inflammatory diet that supplies adequate protein to stimulate PYY release as well as control the levels of cellular inflammation in the pancreas, the underlying reason why insufficient insulin levels are secreted in the first place (2).

Call me crazy, but this dietary approach appears far more cost-effective.


  1. Christou NV, Look D, and MacLean LD. “Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.” Ann Surg 244: 734-740 (2006)
  2. Donath MY,Boni-Schnetzler M, Ellingsgaard H, and Ehses JA. “Islet inflammation impairs the pancreatic beta-cell in type 2 diabetes.” Physiology 24: 325-331 (2009)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

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This entry was posted in Zone Diet and tagged , , , by Dr. Barry Sears. Bookmark the permalink.

About Dr. Barry Sears

Dr. Barry Sears is a leading authority on the impact of the diet on hormonal response, genetic expression, and inflammation. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his research efforts over the past 30 years to the study of lipids. He has published more than 30 scientific articles and holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease. He has also written 13 books, including the New York Times #1 best-seller "The Zone". These books have sold more than 5 million copies in the U.S. and have been translated into 22 different languages.

24 thoughts on “New solution or simply admitting failure?

  1. This isn’t directly related to gastric bypass surgery but, in order to control insulin and insulin spikes, especially from carbs with a high glycemic index and also taking into account the glycemic load, wouldn’t it be wise to take a suitable soluble fiber supplement every time you eat? The soluble fiber will slow the absorption of glucose into the bloodstream and the continued regular use of fiber supplements every time you eat should stabilize insulin. Is this as easy as it seems to me or am I missing something?

    • Adding soluble fiber will reduce the rate of entry of any carbohydrate into the blood and thus reduce the rate of secretion of insulin as a consequence. But the same time you need to supply adequate levels of protein to cause the secretion of glucagon and as well as control the balance of omega-6 to omega-3 fatty acids to control cellular inflammation.

      A lot of things to do in additional to adding some soluble fiber, but every little counts.

  2. Dr. Sears,

    I think gastric bypass is the most expensive and invasive “band aid” treatment I’ve ever heard of. I wonder what it will take to get the medical community and the general population to smarten up in regard to this issue and to placing a greater emphasis on preventative measures in all areas of health. By the way, the increased PYY release stimulated by Zone foods has immensely improved my satiety. Kudos to you for inventing these foods. They are pure genius!

    • I agree with your comments and the fact that gastric bypass is the “best” that can offered to diabetic patients is an indication of the truly pathetic state of current diabetes treatments.

      The key to gastric bypass is its impact on greater satiety. That’s why I optimistic that the new Zone Foods will become much more elegant alternative to gastric bypass to increasing satiety. If you aren’t hungry, then cutting back on calories is much more likely to be accomplished.

  3. Can it be both?? I mean, if you have a gastric bypass surgery and mantain the results with an anti-inflammatory diet. I’ve known about some people with excelent results in a short period of time.
    I think this could work for people who are too obese… But i’m not a doctor, it’s just my point of view…

    • Manuel’s most recent blood tests again indicate that he remains the one of healthiest individuals in Mexico. His blood sugar is perfect, his total cholesterol is perfect, his blood lipids are perfect, and his blood pressure is perfect. It will just take time to reduce the excess fat which is a slow process.

  4. Not the first time… this country does routine newborn circumcision… which is the cutting out of normal tissue considered good medicine…

  5. Dr. Sears, I had gastric bypass surgery and now am paying the consequences. Sure, I lost weight, but started putting it back on because I had not changed my eating habits. Thank goodness I didn’t put very much back on before I got a clue. I have recently become a vegan and wondered if you have any plans for those of us who are meatless?

    I do not recommend gastric bypass. I have a problem with absorption of iron a now have to have it administered via IV and all types of gastric problems.

    I never felt healthier or lost weight more consistently than when I followed the Zone Diet and am craving a vegan solution.

      • Doesn’t drinking soy products have something to do with blocking absorption of iron? I wish I could remember where I read that…

        • I would like to know this as well. I was just diagnosed with iron deficiency anemia due to blocked absorption of iron. I have to have IV treatments that are expensive and definitely not pleasant. I don’t eat a lot of soy, but some and I eat a ton of spinach, kale and all that good stuff filled with iron and I eat it raw or in a green drink but it doesn’t help because of the absorption problem.

  6. About five years ago, I’ve introduced the Zone Diet to my friend who is an expert of Bypass surgery. However, he wasn’t interested in any preventive measures because he firmly believed that those preventions are not working for the morbidly obese people.

  7. Dr. Sears….I appreciate the insight. You ain’t crazy, like a fox!.
    I understand that State of South Carolina, via MUSC is undertaking a trial for the determination if GBP surgery is cost effective for their employees. Essentially a bail out of their bankrupt health fund allocations.
    Fiscal impact of T2DM Tx is quite variable in US.
    My experience in hospital based services and medicine (money maker service lines) from the past is that the price is usually 3-12 times the internal cost [ sic. real cost of GBP surgery may be under . I suspect that policy makers are also looking at this aspect. Maybe a GBP surgical treatment will terminate future claims to T2DM treatment access?
    Can you remind us what the best evidence based way is to monitor post surgical inflammatory state in the hopes of optimizing PYY.

    • Gastric bypass surgery (cleverly renamed metabolic surgery) remains a major profit center for most hospitals.

      The AA/EPA ratio remains the best way of determining the levels of residual inflammation after surgery.

  8. What comments do you have on Rob Thmpson,MD, writer the the Glycemic-Load Diet and the Low-Starch Diabetes Solution. FLLOWING THIS<We have lowered our blood sugar levels…haven't lost much weight but the diabetes is under control….and we are taking your fish oil regularly!.

  9. Lowering the glycemic load of the diet is one of major principles of the Zone diet. However, to get maximum hormonal benefits you have to balance the protein to glycemic load the best you can at every meal in addition to reducing the intake of omega-6 and saturated fats to reduce cellular inflammation. Adding the extra fish oil is great addition to further lower cellular inflammation. This is why your diabetes is being controlled with relatively low amounts of weight loss since the insulin resistance the drives diabetes comes from increased cellular inflammation.

  10. I am an Italian doctor, Zone Consultant since 2003. I have a lot of type 2 diabetes patients and all of them are healthy. All have returned to be actually non-diabetic according to the official parameters. To cut out a normal tissue is not only bad medicine but it is a delirious medical practice. gino

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