Is There a Surgical Cure for Diabetes?

Fielding also is part of the opposition, arguing that Rubino's idea boils down to one impolite word used to refer to the excrement of steers. "When people with gastric bypass regain their weight, and some of them do, their diabetes comes right back," he says. "If Rubino were right, that wouldn't happen." There's a reason the disease recedes in gastric-bypass patients so quickly after surgery, he adds: The patients have to switch to a liquid diet for two weeks before the operation. That regimen alone causes them to shed about 20 pounds, he says, which is enough of a change that the body soon goes back to properly processing its insulin.

Rubino says he can answer both those objections. First, he says, diabetes recurrence after gastric bypass is quite rare. (Actual data on recurrence are difficult to come by. One study found that gastric bypass surgery resolves 80 percent of diabetes cases.) Second, liquid diets don't cause significant weight loss in rats, and besides, his human patients don't go on them prior to surgery. Still, Fielding has yet another complaint. He points to a recent study in the Journal of the American Medical Association showing that adjustable gastric banding, a different type of weight-loss operation—one he happens to perform—treats diabetes just as well as bypass surgery does, even though it doesn't remove or bypass any part of the gut.

Undaunted, Rubino continues to operate on obese patients, and he's even exploring the idea of treating those 20 percent of patients with diabetes who aren't overweight (and thus would otherwise never need gastric bypass surgery). Roughly a hundred have already enrolled in small clinical trials run by other surgeons in Brazil, Mexico, India and elsewhere, and Rubino sometimes acts as a consultant. Those trials are yielding "encouraging results," he says. He hopes to soon start two small U.S. trials of his own in patients who either are "moderately obese" or "might be overweight but aren't obese." They're just trials, he hastens to add, and insists, "this is still not ready for prime time." But if Rubino's theories turn out to be right, he may need to get ready for prime time himself.

Editor's Note: In an earlier version of this story we reported that a series of intestine operations in the 1940's had cured rats of ulcers and gastric cancers. The operations were done on humans, not rats.

© 2008