Stories about: Nicholas Stylopoulos

Why does bariatric surgery ease diabetes?

diabetes gastric bypass

Many people who have Roux-en-Y gastric bypass surgery for obesity experience a striking but welcome side effect. In up to 80 percent of patients who also have type 2 diabetes, the diabetes abates even before they lose weight. A new study helps explain why, and suggests possible ways to combat diabetes (and obesity) without having to actually perform bariatric surgery.

“Our aim is to ‘reverse engineer’ the surgery, to find how it works and apply the mechanisms to new, less invasive treatments,” said study lead author Margaret Stefater, MD, PhD, a fellow in the lab of Nicholas Stylopoulos, MD, in a press release.

The Stylopoulos Lab, in Boston Children’s Hospital’s Division of Endocrinology, previously showed in a seminal 2013 paper that the bypass operation causes the small intestine to ramp up its sugar intake. In rodents, this appeared to account for resolution of their diabetes. Stylopoulos, together with collaborator Anita Courcoulas, MD, MPH of the University of Pittsburgh, then started an NIH-funded observational study of people undergoing Roux-en-Y gastric bypass surgery.

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Could Burmese pythons shed light on diabetes?

Burmese pythons diabetes

Originally from Southeast Asia, Burmese pythons are perhaps best known in the U.S. for the havoc they’ve been creating in the Everglades. Kept as pets and released into the wild, they can grow to nearly 20 feet long, and are hunting animals like marsh rabbits toward extinction (a problem Florida is trying to address with an annual Python Removal Competition).

But in the lab, at a diminutive 3 feet in length, Burmese pythons may hold valuable lessons about diabetes.

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Can we bypass the bypass to treat diabetes?

Diagram of Roux-en-Y gastric bypass
Gastric bypass surgery creates a small pouch in the stomach and connects it directly to the small intestine. Why does it help type 2 diabetes? (Wikimedia Commons)

Research shows that gastric bypass surgery, aside from inducing weight loss, resolves type 2 diabetes. Though weight loss and improved diabetes often go hand-in-hand, patients who undergo gastric bypass usually end up seeing an improvement in their type 2 diabetes even before they lose weight.

But why? To investigate, a research team led by Nicholas Stylopoulos, MD, of Boston Children’s Hospital’s Division of Endocrinology, spent a year studying rats and observed that after gastric bypass surgery, the way in which the small intestine processes glucose changes. They saw the intestine using and disposing of glucose, and showed that it thereby regulates blood glucose levels in the rest of the body, helping to resolve type 2 diabetes.

Basically, as the team reported recently in Science, the small intestine—widely believed to be a passive organ—is actually a major contributor to the body’s metabolism.

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