Obese? Diabetic? Try surgery!

In 2009, over 220,000 people had bariatric surgery (weight loss surgery) in the U.S. – these procedures are growing in popularity as obesity rates climb.1

The International Diabetes Federation once announced that they recommend bariatric surgery as a treatment for diabetics with a body mass index (BMI) of 35 or more; and also as an alternative treatment for diabetics with a BMI of 30-35, either when diabetes is not being adequately controlled with medication or in the presence of major cardiovascular risk factors. As its rationale, the IDF cites effective reversal of diabetes, reduced health costs, reduced risk of all-cause mortality, and reductions in cardiovascular risk factors that occur as a result of the surgery.2


Of course, bariatric surgery is effective for reversing diabetes (note however that diabetes remission rates do decrease over time3). Obesity is the primary risk factor for diabetes, and bariatric surgery forces weight loss by physically limiting either intake or absorption of food. But should bariatric surgery be recommended before radical lifestyle changes? The IDF and the American public seem to think so. Once, on Good Morning America, gastric bypass was called a “breakthrough” treatment for reversing diabetes.

According to the physician that discussed bariatric surgery on Good Morning America, “For people who are truly obese and have diabetes, diet and exercise just aren’t really effective.”

Really? Diet and exercise aren’t effective?

Hundreds of formerly obese, formerly diabetic individuals have followed my dietary recommendations and would disagree with that statement.

For example:

  • Charlotte, who lost half her body weight (133 lbs.) and reversed her diabetes
  • Calogero, who lost 100 lbs. in only seven months and reversed his diabetes
  • Richard, who was on insulin for 25 years, and was able to stop taking it after just a few days of a high nutrient diet.

Do you disagree too? Have you reversed your diabetes by changing your lifestyle? If so, let Good Morning America know about it. Comment on the article, or send them your story.

I think that the hundreds of people who have reclaimed their lives by losing over 100 pounds following my high nutrient dietary recommendations would also disagree. Scott, Bill, Sue, Theresa, Anthony, and Julia, to name a few.

It’s not that diet and exercise aren’t enough – it’s just that small changes aren’t enough. A slightly modified version of the standard American diet is not enough. Artificially sweetened sodas and processed foods, excess meat, and a modest increase in vegetable intake cannot do the job of reversing diabetes. With their position statement, the IDF is perpetuating a misguided view, that lifestyle changes are not powerful enough to reverse disease.

Only dramatic changes will produce radical results. Surgery is radical. But there is a safer radical change – a radical lifestyle change, to a natural, high-nutrient plant-based diet-style, plus exercise.
In a published study, we investigated the efficacy of a high nutrient density diet for treating diabetes – 62% of the participants reached normal (nondiabetic) HbA1C levels within seven months, and the average number of medications dropped from four to one.4 All participants were able to eliminate or reduce medication, except one, who was already on the lowest dosage of Metformin. A high nutrient density diet has tremendous therapeutic potential for diabetes, and for dramatically reducing health care costs.

To those who are considering bariatric surgery, I ask you to please consider my nutritarian (high-micronutrient) diet-style changes first. We live in an obesity and diabetes-promoting food environment, but we can find freedom from these influences. My discovery that high nutrient eating derails toxic hunger and food addictions enables my overweight clients to achieve dramatic weight loss results that parallels or exceeds the long-term results of gastric bypass, and likewise, when diabetic, it most often resolves or dramatically improves.

Diabetics should be aware that superior nutrition works and it works better than drugs or surgery. Surgery will physically limit your portion sizes, but it will not remove addictive foods from your diet, and it will not give your body the nutrients it needs to protect you against heart disease, cancer, and other chronic diseases. Most often the initial results recede over the years as most of the surgery-treated individuals gain back much of the lost weight.

Once you become a nutritarian nutritional expert, consider the sense of satisfaction, accomplishment, and improved self-esteem that can come from losing the weight and watching diabetes disappear. Consider that you may be stronger than you think you are, and that you are capable of reclaiming your health.

Also, surgery does not come without risk.

Potential complications of bariatric surgery:
Gastric bypass is the most common bariatric surgery, and carries the following risks5:

  • Infection
  • Hardening of the connection of the stomach to the small intestine
  • Bleeding
  • Obstruction of the small intestine
  • Gastrogastric fistulae (leaks between the “pouch” and the rest of the stomach), requiring additional surgery
  • Internal hernia, a potentially life-threatening complication that requires additional surgery6
  • Venous thromboembolism (blood clots)
  • Nutrient deficiencies7
  • Neurologic complications are said to be often disabling and irreversible, and many do not produce symptoms until over ten years after the surgery8
  • Bone loss

Diabetes and severe obesity both put the patient at greater risk of complications.5 Diabetes is associated with poor weight loss following gastric bypass.9

Laparoscopic gastric banding (lap-band) surgery is also not without complications – a study reported a long-term complication rate of over 40% (including leakages and band infections, and esophageal dilatation), a re-operation rate of 20.4%. The failure rate of the procedure after 10 years was 31.6%.10

Addiction and emotional attachment to food is so prevalent and so powerful in our culture that these surgical procedures seem more reasonable than diet change. But it is not – weight loss surgery is extreme and risky; my dietary approach is safe and in most cases, the results are even more effective compared to gastric-bypass surgery. It could save your life.


1. American Society for Metabolic & Bariatric Surgery [http://www.asmbs.org]
2. Surgical and Procedural Interventions in the Treatment of Obese Patients with Type 2 Diabetes: A position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention.
3. Sjostrom L, Lindroos AK, Peltonen M, et al: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. The New England journal of medicine 2004, 351:2683-2693.
4. Dunaief D, Gui-shuang Y, Fuhrman J, et al. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density diet. Presented at the 5th IANA (International Academy on Nutrition and Aging) meeting July 26 & 27, 2010 Hyatt Regency Tamaya Resort & Spa 1300 Tuyuna Trail Santa Ana Pueblo, NM, USA J Nutr Health Aging 2010;14:500.
5. Campos GM, Ciovica R, Rogers SJ, et al: Spectrum and risk factors of complications after gastric bypass. Arch Surg 2007, 142:969-975; discussion 976.
6. Schneider C, Cobb W, Scott J, et al: Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc 2010.
7. Bell BJ, Bour ES, Scott JD, et al: Management of complications after laparoscopic Roux-en-Y gastric bypass. Minerva Chir 2009, 64:265-276.
8. Juhasz-Pocsine K, Rudnicki SA, Archer RL, et al: Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 2007, 68:1843-1850.
9. Campos GM, Rabl C, Mulligan K, et al: Factors associated with weight loss after gastric bypass. Arch Surg 2008, 143:877-883; discussion 884.
10. Naef M, Mouton WG, Naef U, et al: Graft survival and complications after laparoscopic gastric banding for morbid obesity--lessons learned from a 12-year experience. Obes Surg 2010, 20:1206-1214.



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Comments (22) Read through and enter the discussion with the form at the end
StephenMarkTurner - March 31, 2011 3:22 PM

I had a frustrating phone call with a diabetic friend yesterday. He is on the verge of being told to take insulin. He was obviously intoxicated as well, and I couldn't get more than 3 words in a row in before being interrupted. His pharmacist/pusher suggested removing gluten from the diet, and also that Metformin might prevent cancer. I suspect he will end up trying several different things, except for anything I might suggest.

Regarding the article, you have to have an ABC membership to comment, perhaps just as well, because I would have found it hard not to channel my inner Henry Rollins and say stuff that would be removed.


Dustin - March 31, 2011 5:25 PM

I agree with you whole heartedly Dr. Fuhrman. It's really amazing how our society wants to pay more (bariatric surgery) that comes along with high risks of complications and even death and yet get less for our money. The 10's of thousands that is spent on surgery could buy a lot of fresh, healthy, whole-foods that are far safer and more effective at getting the job done.

Re: Steve's comment above... I'm a clinical hospital pharmacist myself and the pharmacy world and medical world in general really do push drugs and offer little nutritional advice for patients. I have made it my mission to educate both patients and other medical professionals about how safe and effective a plant-based diet is. I actually just wrote an article on type 2 diabetes and how to reverse it with this approach recently - http://fb.me/Dgy5fNCc.

Dustin Rudolph Pharm.D.

mike - March 31, 2011 7:14 PM

you may consider time on "doctor radio" from
NYU. R.D MPH samantha heller airs on fridays
1200n-200pm edst. this may be an additional
way to tell people the trith!

Wendy (Healthy Girl's Kitchen) - March 31, 2011 8:10 PM

This is so sad! Good Morning America should be promoting Dr. Fuhrman and some of the people who have reversed their diabetes with a plant-based diet. Not ridiculous stomach operations that are totally unnatural. I'm sorry, but this really is upsetting.

Pat Tyrrell - March 31, 2011 8:56 PM

Yep, I have a friend with multiple health issues; Type 2 diabetes, renal failure, hypertension, obesity, lupus and severe depression to name a few. She's on 21 different meds, most of which I think are prescribed to mitigate the effects of the others, because she's not getting any better.
I've suggested EFL, concentrating on the dark greens, but doesn't want to try that because she's lost a few of her teeth due to side effects from the meds, and thinks that all the chewing would be too hard on the rest of her teeth. Even my suggestion of eating 'confetti salads' because of the smaller sized pieces of greens has been rejected, for reasons only she knows.

I know that this is her life to live and her choice to live it any way she wants, and if that means continually being depressed because of all her health problems and rejecting any advice and help I can give, then so be it. All I can do now is pray that she sees the light, and allow herself to ask for help before she dies before her time. I can also show her what EFL has done for me, and maybe she'll be convinced.

MIke Rubino - April 1, 2011 12:12 AM

I think the medical/hospital/phara big business mentality that has gotten into the sick care field is one of the most dangerous things to affect this country in the past 100 years. WW1 and 2 had a combined death total of US men of approximately 500k .Bad diet is now killing that many Americans per year yet the answer is always some expensive drug or operation rather than following a simple diet. We are indeed a sick country in more ways than one. Doctors should be critisized for even thinking of such drastic remedies let alone performing them on a routine basis yet we have dopes like those sbove pimping their wares dailey.

For those who think this surgery has little risk I had a freind of mine die within a short time after it. He was not yet 60 but thoughtthe surgery the easy way out rather than watchhing what he ate and drank.

Michael - April 1, 2011 7:05 AM

I know a couple of people who have gotten surgery for weight loss. While they did lose weight, they looked terrible and started re-gaining the weight after a year or so because they didn't change the food they were eating or exercise.

Sara - April 1, 2011 7:50 AM

I am always shocked when people tell me they are planning bariatric surgery and are not even interested in trying a nutritional approach. Why would anyone be willing to have someone cut them if there is another way?

Daniel - April 1, 2011 10:47 AM

Dr. Fuhrman could not have written a better and more timely article. Between his book, Eat to Live and Overeaters Anonymous, I have been able to lose over 30 lbs. Gastric Bypass surgery is not necessary for the vast majority of people; only needed for extreme cases. The book and program have worked well in my case. My doctor told me that I may actually get off of the high blood pressure medication I've been on for ten years....can't wait for that day!

StephenMarkTurner - April 1, 2011 12:02 PM

Perhaps another line of attack is to consider watching less television. To a large extent the stuff I used to watch alternated commercials for bad food, then commercials for that pink stomach stuff and ED drugs. I got rid of my cable last year, and the tiny amount of antenna TV I watch now is still extremely aggravating (do Americans get the Wendy's commercial with the 'meat-atarian' guy!)

Cheers, Steve

Roxana Saez - April 1, 2011 1:08 PM

Lifestyle change is the only answer in my opinion. A friend of the family decided to get bariatric surgery because he was expecting his first child and wanted to be there for her as she reached all her life milestones. While in the recovery room no one had noticed due to his obesity that he had a kink in his line where they were administering the pain medication. He kept asking for more as he was in pain and when they finally discovered the kink and released it he received more than was a recommended dose and was out for a few days. You would think that going through all the risks this would have helped in his mission to increase his life expectancy and quality of life but unfortunately it did not. His wife is also obese and though they put in the effort the surgery did not "take" and they are no better off than when they began this journey. I myself have had a lifelong struggle with my weight as I have never had the "luxury" of knowing what is was like not to be overweight but I never gave up the dream that one day I would find a way to reach balance in my life. Hitting my 30's and suffering both personal and financial losses in my life did not make matters better and I reached my highest weight of 260lbs for my 5'00" frame. With no health insurance surgery is not even an option and to witness how it is not guaranteed made me feel more hopeless. A childhood friend that I reconnected with recommended "Eat to Live" which I began implementing into my life in December 2010 and I am now 205 lbs. I thank you Dr. Fuhrman & Danielle Zanzarov Rodriguez from the bottom of my heart because I have hope that I no longer have to live life feeling sick and tired of feeling sick and tired. My progress is not miraculous but measured and steady and for the first time I can say with confidence, will stay with me for life. Blessing to you and all the wonderful people who support you in your efforts.

carfree - April 1, 2011 2:42 PM

What happens to the people who discover the nutritarian lifestyle AFTER having had surgery? Is their stomach capacity then too low to accomodate an adequate amount of greens? How can that be addressed?... with higher caloric veggies like roots and legumes, perhaps?

StephenMarkTurner - April 1, 2011 4:28 PM

Interesting question from carfree. I suspect the juicer will be more involved. Veggie juices are much more compact.

I think Roxana's progress to date is pretty spectacular, myself.

Cheers, Steve

StephenMarkTurner - April 2, 2011 1:22 PM

I looked at a trailer for the Dr Oz show on Monday. Looks like they are going to talk about barbaric surgery for people with only 30 pounds to lose. A "radical new way of thinking", Dr Oz says!

Wow! Joe Mercola, John (I talk to dead people) Edwards, "Think yourself thin", have all been featured on his show recently. Good thing I only watch a clip or two online, rather than the show.

That stops now, though. His book mark moved from my best stuff to the bottom of my health and nutrition links, and I am removing it completely in about one minute.


Joel Fuhrman, M.D. - April 2, 2011 6:52 PM

After gastric bypass, one should still eat a micronutrient-rich diet, but might need to eat smaller meals, maybe 4 or even 5 feedings a day.

StephenMarkTurner - April 3, 2011 8:56 AM

I am not sure if this 'news' has hit American newspapers, but here in Canada, Maple Syrup is being touted as a new superfood (in an industry funded study) useful in preventing diabetes, and even cancer.

Broccoli and blueberries are old news, just guzzle a half bottle of syrup!

Cheers, Steve

sonja - April 3, 2011 8:57 PM

A wonderful post - thank you! Am presenting a case study on a GBGB (gastric bypass gone bad) this week and am trying to find the article referenced in #4 above (Dunaief D, Gui-shuang Y, Fuhrman J, et al: Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density diet. J Nutr 2010, 14(6):500).

Not having any luck in J Nutr, Pub Med or elsewhere. I would like to read this article and use as a reference if possible. Please provide the correct issue/date/pages, or perhaps send me a pdf of the published article if possible. Thank you!

Deana Ferreri, Ph.D. - April 4, 2011 2:01 PM


There is a typo - it is actually Journal of Nutrition, Health, and Aging. This was a conference abstract, and is not available free online yet.

krishnacardiac - April 5, 2011 5:05 AM

What are the main precautions to be after bariatric surgery?

MacSmiley - April 5, 2011 4:48 PM

I'd rather spend money on massive amounts of healthy food than cough up a massive co-pay for surgery.

Ryan - May 2, 2011 2:05 PM

I thought about surgery - for about 15 seconds. I just had to look at someone I know who had a bypass done and the problems and one embarrassing episode he had.

king - February 19, 2013 1:03 PM

look for the death rate

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