You may have heard that weight-loss surgery can help people with type 2 diabetes manage their condition. For some people, surgery may even send their type 2 diabetes into remission — when their blood sugar levels return to normal without the need for diabetes medications.
We’re learning more about the benefits of weight-loss surgery all the time. For instance, I think it’s exciting — and, potentially, something that may bring new hope to many people — that emerging research now suggests that bariatric surgery may also help reverse a common complication of diabetes: nerve damage.
What is diabetic neuropathy?
Nerve damage — what doctors call neuropathy — is one of the more troublesome complications of diabetes. It happens when high glucose levels damage the nerves over time.
Like other tissues, your nerves need plenty of blood and oxygen to function well. When someone has neuropathy, the blood vessels' capillaries and other tiny structures that nourish the nerves are damaged. As a result, the nerves don’t receive a nourishing supply of oxygen-rich blood.
When nerve problems affect the legs, feet, hands, or arms, it’s known as peripheral neuropathy. Symptoms include pain, numbness, and a loss of sensation.
Bariatric surgery as diabetes treatment
Bariatric surgery can improve diabetes control in a couple of ways:
Weight loss
For many people with diabetes, losing weight can help improve their blood sugar control. But reducing body weight isn’t easy. Bariatric surgery helps people achieve lasting weight loss by reducing the stomach size and sometimes changing the digestive tract. As my patients lose excess weight, their bodies require less insulin to control blood sugar, which can lead to a reduced need for medications and better control of their diabetes.
Changes to the digestive tract
One type of bariatric surgery—Roux-en-Y gastric bypass—helps stabilize blood sugar even without weight loss. This surgery reroutes part of the small intestine, changing how the body registers food intake and secretes insulin. I often see improvements in my patients’ glucose levels before they leave the hospital.
People with diabetes who have bypass surgery benefit in two ways: the surgery changes the digestive tract's anatomy and leads to weight loss. Together, these effects make it a powerful diabetes treatment, with over 80% of patients experiencing remission.
With gastric sleeve — another type of bariatric surgery — around 60% of people see their type 2 diabetes resolve, an improvement connected mainly to the weight they lose as a result of the procedure.
How might bariatric surgery improve nerve damage?
The fact that type 2 diabetes can go into remission after bariatric surgery is well-known. But just in the past few years, studies have suggested that some people who have neuropathy may see their symptoms improve after bariatric surgery once their diabetes improves.
How? As I mentioned, nerves depend on very subtle microvascular structures to feed them with all the nutrition they need to grow. Diabetes damages those tiny blood vessels, which in turn damages the nerves.
But, as I explain to my patients, nerves have an incredible ability to regenerate — if they’re given a stable, healthy environment. Over time, bariatric surgery can improve that environment by helping a person achieve strict glucose control.
That control can help stop or reduce the ongoing damage to the blood vessels caused by diabetes. Once that happens, the body may be able to grow new blood vessels, a process called revascularization.
That revascularization improves the supply of blood and oxygen to the damaged nerves. And that’s when you may see the nerves regenerate and the nerve fiber density start improving — healing the neuropathy
This is a promising area of research. While we haven’t studied this at Temple, I have seen how some of my patients with diabetes and neuropathy appear to have benefited from bariatric surgery. In addition to losing weight, some have been able to come off their diabetes medications, including those they took for neuropathy.
Could the reversal of diabetes-related neuropathy be another benefit of bariatric surgery? The evidence suggests that it could. However, we need more studies, including clinical trials, comparing the outcomes of people from different groups.
Further research could help answer important questions. For example, we don’t yet know at what level nerve damage could be considered reversible — whether it’s only possible in the early stages or if improvements can happen later.
It may be a while before we have definitive answers. But if you’re concerned about diabetes and neuropathy and you’re eligible for bariatric surgery, I would encourage you not to wait.
While we’re still learning about how weight-loss surgery can improve neuropathy, we do know it can offer life-changing health improvements for people with diabetes and other obesity-related conditions. Ask your doctor how bariatric surgery might help you.
Start your weight-loss journey
At Temple, a team of bariatric surgery specialists can offer you minimally invasive bariatric procedures, along with the support you need to lose weight and keep it off. Schedule an appointment online or call 800-TEMPLE-MED (800-836-7536) today.
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