From 01 January 2021, it will be possible to have obesity surgery from a BMI of 30+ with concomitant type 2 diabetes. One of the prerequisites is that diabetes can no longer be safely controlled by conventional means. Only a few specialist clinics are authorised to perform such operations. This also includes the clinics of Swiss1Chirurgie, which offer such procedures in the Helvetia Holding AG network. Learn more about the BAG’s decision.
Overweight surgery possible from BMI 30 with diabetes as of 2021
Being overweight is not something to be trifled with. All those affected know this just as well as we do as medical specialists. For years, the experts at Swiss1Chirurgie have been observing the development of obesity in modern industrialised countries. It is becoming increasingly clear that the proportion of overweight people is growing. Associated with this are not only the individual restrictions and complaints. Healthy societies quickly become sick societies through an oversupply of food at any time in any place and correspondingly wrong nutritional behaviour, whose lack is above all abundance.
So far, health insurers and medical organisations, together with politicians in Switzerland, have agreed that surgical interventions to reduce weight are only possible for a BMI of 35 or higher and are financed accordingly. It was completely ignored that a BMI of 35 or more is already an enormously high value, which is already associated with numerous secondary diseases and complaints. Such concomitant diseases not only complicate the lives of the patients themselves, but are often also a clear obstacle in the preparation and implementation of necessary obesity surgery.
From 2021 the threshold is BMI 30
In accordance with the interventions of the medical specialists and a close observation of the development, the politicians together with the medical profession have decided to lower the threshold value for bariatric surgery in the context of obesity surgery now to a BMI of 30, provided that the patients are affected by diabetes at the same time.
This long overdue decision will benefit patients who, despite being diagnosed with obesity and the corresponding symptoms, were previously not included in the group of patients for whom obesity surgery was an option.
This means that a wide range of conditions closely related to obesity can be treated much sooner and necessary and desired surgical interventions can also be carried out. This will have a lasting impact on the quality of life of people with a BMI over 30 and diabetes, and ultimately reduce the proportion of severely overweight people, along with the social and economic costs.
Advantages especially for humans
The decisive advantages of this decision now lie above all with those people who, with a BMI of 30 or more and diabetes, are already clearly affected by morbid obesity. Now the suffering of these people can be significantly shortened. This is also because it obviously does not make sense to wait for an enormously high BMI of 35 and more until a surgical intervention for weight reduction is made possible by the regulations.
A major advantage of this decision is that the extent of overweight and the associated concomitant and secondary diseases such as diabetes, cardiovascular diseases and arthrosis can be significantly reduced. The psychological suffering can also be significantly shortened and patients with a BMI of 30 or more with diabetes may now place themselves in the hands of the experienced specialists in obesity surgery. The Swiss1Chirurgie clinics are among the specialist medical clinics that will be authorised to perform surgical procedures to reduce excess weight from a BMI of 30 with diabetes from 01.01.2021.
Determine your BMI here and find out whether and under what conditions you belong to the circle of possible candidates for obesity surgery.
In addition, we recommend that all severely overweight people contact a Swiss1Chirurgie clinic. By doing so, you will take the first step towards a better, healthier future in 2021 and use the possibilities of modern medicine to improve your life.
Those who suffer from morbid obesity look for quick solutions. The use of a gastric balloon promises such a quick solution. However, such a gastric balloon is nothing more than a “crutch” in the treatment of obesity. The obesity experts at Swiss1Chirurgie, the Centre for Bariatric Surgery ZfbC and the Gastroenterology Group Practice Bern know this. In the detailed article, the benefits of bariatric surgery are contrasted with the rapid effects of a gastric balloon. Here is the full report.
The gastric balloon – the best way to cheat yourself?
Why a gastric balloon is the worse alternative to bariatric surgery?
Those who suffer permanently from severe overweight and feel stigmatised by their social environment often look for quick solutions to reduce their body weight. People affected by obesity and the associated concomitant and secondary diseases want effective measures and treatments to change their life situation. The so-called gastric balloon promises such a quick remedy. Without any surgical intervention, without restrictive diets, in the wrong perception and even without a change in exercise behaviour, a quick weight reduction could be achieved with a gastric balloon. But the first impression is just as deceptive as the first successes.
How the gastric balloon works
The gastric balloon promises quick success in losing weight. Find out why this is only half the truth in the detailed article by the obesity experts at Swiss1Chirurgie.
The gastric balloon is usually inserted into the stomach by means of gastroscopy and filled with a saline solution in the same procedure. Recently, some centres have also been promoting a “swallowable” version – the balloon is swallowed and filled via a tube – without the need for a gastroscopy. This installs a foreign body in the stomach that significantly reduces the stomach volume available for food intake.
As a result, a feeling of satiety is produced even after eating comparatively small amounts of food, but this can be very deceptive. Because of this early onset of satiety, many patients think they can lose weight quickly, easily and permanently with the intragastric balloon without surgery. However, this is often accompanied by complaints such as nausea and frequent vomiting, which indirectly help to lose weight in a rather unpleasant way.
In fact, there are reports that the gastric balloon can be used to lose ten to 25 kilograms over a reasonable period of time. It should be remembered, however, that efficient weight loss attempts are less about quantity and more about the quality of the food. Anyone who consumes very high-calorie drinks, fatty foods or a lot of sugar-heavy food to satisfy their needs after the insertion of a gastric balloon will not automatically achieve success even with the reduced mass. Without a consistent change in diet and exercise, attempts to lose weight are hardly successful in the long term, even with the gastric balloon. Especially since a gastric balloon can only ever be used temporarily.
Self-deception with a system
Experts in the treatment of obesity speak of self-deception with a system when favouring a gastric balloon for weight reduction. After all, such a gastric balloon is a foreign body in the stomach and at best something like a crutch in the treatment of obesity. And a crutch is not a leg on which you can stand safely.
It is also worth considering that the gastric balloon is not a permanent solution. Depending on the quality, such a gastric balloon can remain in the stomach for a maximum of 3, 6 or, more recently, 12 months and must then be removed. Although a new intragastric balloon can be placed immediately, this only continues the actual self-deception.
From the reports of those affected, it can also be learned that in addition to some good successes, a large number of negative experiences can also be registered. This ranges from persistent nausea to spontaneous vomiting to an unpleasant feeling of fullness, which does not contribute to the patients’ well-being. If the intragastric balloon is worn for the recommended maximum period of six months, there is a risk that the balloon will lose the saline solution, which in itself is not tragic. Much more dangerous is that the then flaccid envelope of the balloon can migrate into the intestine and lead to a dangerous intestinal obstruction.
Bariatric surgery is the better methodology
Given the problems associated with the use of a gastric balloon, bariatric surgery is the better option in the vast majority of cases in patients with BMI over 30 kg/m2 with diabetes, or in patients with BMI over 35 kg/m2 without diabetes. The preferred methods are stomach reduction by forming a tube stomach or gastric bypass. Such interventions aim to consistently and permanently reduce the volume of the stomach or to virtually bypass the stomach. Both methods involve surgical procedures, but these are now performed as minimally invasive laporoscopic operations. In addition to the bariatric operations, further therapeutic offers are provided with the aim of achieving and securing long-term success in weight reduction. This means that in the vast majority of cases, surgical intervention is the better, more reliable and permanently more successful way to treat morbid obesity in the long term.
When the use of a gastric balloon can be useful
Even if a gastric balloon does not appear to be a target for long-term weight reduction, it can still be a sensible temporary solution in individual cases. For example, if a surgical intervention is not (yet) an option because of a very high excess weight. Then the gastric balloon can help to achieve a weight reduction that makes surgery possible. But that’s all.
If we consider once again that the intragastric balloon is basically a foreign body that can only be used temporarily and is ultimately only a “crutch” for weight loss, the intragastric balloon is ruled out as a long-term and efficient solution to the problem of obesity.
Counselling ensures best treatment results
Anyone who is confronted with the physical, social and psychological impairments caused by morbid obesity should seek specialist medical advice and professional care. A good place to start may be the Swiss1Chirurgie clinics, the Centre for Bariatric Surgery ZfbC or the Gastroenterology Group Practice in Bern. Here, patients are advised in detail, individually and openly about the chances, risks and possibilities of permanent weight reduction. Obesity experts are always concerned with long-term solutions and less with quick but less reliable success.
In a special consultation at Swiss1Chirurgie, patients also learn in which rather rare cases the temporary use of a gastric balloon in preparation for bariatric surgery can be useful. At the same time, however, it is always made clear that the use of a gastric balloon can never be the permanently helpful solution to a pathological obesity problem.
Adipositas-Podcast.ch – Know what’s what
With the obesity podcast, you can find the latest and essential information on obesity, its origins, development, consequences and treatment options at adipositas-podcast.ch. Here, real experts talk about the causes and development of morbid obesity, which, with its manifestations such as overweight, cardiovascular diseases, shortness of breath, organ diseases, diabetes, limited mobility and performance as well as social stigmatisation, severely restricts the lives of those affected. On adipositas-podcast.ch we always want to inform you professionally and comprehensively and at the same time show you ways to break the vicious circle of obesity.
One can accept obesity as a seemingly inevitable fate and surrender defencelessly to the dire consequences. But in the same way, obesity can also be understood in its development and ways can be found to return to a self-determined, happy and desirable life. What is your path?
Listen to experts from Swiss1Chirurgie, the Centre for Bariatric Surgery or the Gastroenterological Group Practice Bern and learn what obesity is, what it means for an individual’s life and which paths lead out of the disease. In this way, you will gain valuable knowledge that can significantly accompany your own path out of obesity. Testimonials from patients and sufferers and the knowledge of obesity experts will help you find your own way out of the fatal obesity career and lead a healthier and happier life.
If we analyse the cases of oesophageal cancer in Switzerland, we find that around 600 people suffer from this serious disease every year. The main risk for the development of oesophageal cancer are reflux diseases, which clearly favour the development of cancer in the oesophagus due to the pathological acid regurgitation. About three quarters of those affected are men. One of the promising therapies for oesophageal cancer is oesophagectomy, which will be explained in more detail in this article.
More information and interesting insights directly from Prof. Dr. med. Jörg Zehetner can be experienced in a Zoom Online lecture. Date: 10 March 2021, 6:30 pm to 7:30 pm.
Let’s start by explaining the technical terms that are important for this topic
The medical term reflux refers to the backflow of gastric acid from the stomach into the oesophagus. In layman’s terms, this is described as acid reflux. The cause of the backflow of stomach acid into the oesophagus is a weakening of the muscle at the end of the oesophagus (cardia). In addition to the actual acid regurgitation, patients describe such things as frequent heartburn, burning in the chest area or also stomach burning.
The oesophagus is called the oesophagus in medical vocabulary. Functionally, the oesophagus is a kind of muscular tube that transports food into the stomach through contractions. In the stomach, stomach acid, among other things, is responsible for breaking down the food as part of the digestion process. To protect the oesophagus from the constant acid attack, there is a muscle at the bottom of the oesophagus that closes it when it is functioning normally. If the function of this muscle is impaired, the reflux described above occurs.
In medicine, resection is the surgical removal of an organ or part of an organ. With reference to our topic, oesophagectomy is accordingly the surgical removal of the largest part of the oesophagus.
The risk factors for the development of oesophageal cancer
Over the years, the main risk factors for developing oesophageal cancer have changed somewhat. Whereas in the past it was smoking and excessive alcohol consumption, today it is persistent (pathological) acid regurgitation and obesity that significantly increase the risk of oesophageal cancer. If you follow the relevant advice books, acid blockers and diets are often recommended to get the problem of reflux under control. However, this only addresses the individually noticeable phenomena, but not the cause. Therefore, the risk of developing oesophageal cancer remains in the medium and long term unless the causes of acid regurgitation are consistently addressed. What remains is the no longer correctly functioning “valve” at the end of the oesophagus, i.e. the muscle that prevents the stomach acid from rising into the oesophagus. If no improvement can be achieved here, then the constant acid attack on the oesophagus ultimately threatens oesophageal cancer. Surgery on the reflux muscle at the right time can significantly reduce the risk.
From complaints to diagnosis
One of the most common complaints that bring patients to the doctor is difficulty swallowing. After anamnesis and a more detailed description of the symptoms, a gastroscopy is often performed. If malignant tissue is discovered or suspected in the oesophagus or at the transition to the stomach, it can be removed under a short anaesthetic using a type of mini forceps. A laboratory examination will confirm whether or not this is malignant tissue. In the former case, it must then be assumed that there is oesophageal cancer, which must be treated surgically as a matter of urgency. Once the diagnosis of oesophageal cancer has been made, the decision for a suitable therapy must be made.
Recommendation: Combined therapy
Before therapeutic steps are taken, the severity of the disease and the spatial spread of the oesophageal cancer must first be examined more closely and determined in detail. Computer tomography (CT) of the chest and abdomen is the method of choice for this. In this way, it is also possible to assess whether there are deposits in the lungs and liver. An ultrasound scan of the oesophagus can also assess deposits in the lymph glands.
A common feature of the work of the medical specialists at Swiss1Chirurgie and at the Beau-Site Clinic is an interdisciplinary tumour board, where specialists from all the disciplines involved carry out a precise assessment of the symptoms, risks and treatment options. In addition to recommending therapeutic measures, this also includes timely clarification of follow-up treatment.
In most of the cases, a combined therapy is considered by the tumour board. This combination consists of an upstream chemotherapy, which is to be understood as a preparation for the actual surgical intervention within the scope of the oesophageal resection. If necessary, radiotherapy can also be part of the treatment. The surgical intervention takes place a few weeks after the start of chemotherapy or radiotherapy.
The esophagectomy procedure
Thanks to modern surgical techniques, the removal of the oesophagus (oesophagectomy) can be performed as a minimally invasive procedure (also called keyhole surgery). The operation itself takes about three to four hours and is performed under anaesthesia. Through small incisions in the abdominal wall, the connections of the oesophagus to the stomach and at the diaphragm are loosened. The lymph glands in the abdomen are then removed, followed by removal of the oesophagus itself either through the abdomen or through the chest. The adjacent tissue, which may also be affected by tumour cells, is also removed.
In a further step, the stomach is formed into a tube. This stomach tube is finally connected to the upper remaining end of the oesophagus in the neck area. Afterwards, the success of the surgical procedure is checked using a method specially developed by Dr. Jörg Zehetner. For this purpose, a fluorescent substance is injected into the patient’s bloodstream. Within five to ten seconds, a laser camera can be used to determine whether the result of the operation is satisfactory.
Rapid mobilisation and recovery of patients
A clear advantage of modern surgical techniques in the context of oesophageal resection is the short time patients spend in hospital. With independent breathing, the operated patients wake up from the anaesthesia and remain in the intensive care unit for one to two days, depending on their condition, to monitor their bodily functions. In the normal ward, a swallowing X-ray is taken as early as five days after the operation to check whether the connection between the stomach tube and the beginning of the oesophagus has healed well. If this can be confirmed, the diet can be slowly built up.
Depending on the individual development, the clinic stay itself lasts about one week to ten days. This is followed by a two-week rehabilitation measure, which helps the patient to heal quickly. After just three months, the patient experiences his or her original quality of life, now without oesophageal cancer and the unpleasant accompanying symptoms. In principle, everything can now be eaten again, perhaps in smaller portions, but spread over several meals a day.
More information and interesting insights directly from Prof. Dr. med. Jörg Zehetner can be experienced in a Zoom Online lecture. Date: 10 March 2021, 6:30 pm to 7:30 pm.
In the USA, the US Preventive Services Task Force has come out with a recommendation for earlier bowel cancer screening from the age of 45. According to the study, the risk of severe to fatal colorectal cancer increases significantly, which clearly underlines the sense of screening for colorectal cancer before the age of 50. Accordingly, not only patients at risk, for example those with obesity, but also other groups are affected.
In the wake of the COVID19 pandemic, the problem of unnoticed regular screening is intensifying, which is likely to develop as a time bomb with a fuse of up to ten years.
The specialists of Swiss1Chirurgie and the Gastroenterological Group Practice GGP Bern point out the importance and great benefit of regular preventive examinations. In view of the developments in the USA and beyond, this should not only become more of a focus for people over 50, but also open up the discussion for universal pension provision from the age of 45 in Switzerland. The counselling service offered by Swiss1Chirurgie and the Gastroenterology Group Practice GGP takes this topic extremely seriously and provides important information on bowel cancer screening.
Read more about the recommendation of the US Preventive Services Task Force and the position of Swiss1Chirurgie and the Gastroenterological Group Practice GGP in the detailed article.
“This is a time bomb with a ten-year fuse”.
The US Preventive Services Task Force recommends colorectal cancer screening starting at 45
When the US news channel CNN reports in detail, it is on issues with implications. This is also the case in a report dated 18 May 2021, which deals in detail with the recommendation of bowel cancer screening from the age of 45.
Until now, at least in the USA, screening for colorectal cancer was recommended from the age of 50. If one follows the research results and the statements of renowned medical specialists on the subject, then bowel cancer diseases are reaching more and more people, including younger people. Accordingly, the lowering of the recommended age was only a question of common sense and forward-looking care.
The US Preventive Services Task Force is the leading advisory body on medical issues in the US and had already presented the draft of this recommendation in October 2020. The final version now available suggests that all people aged 45 to 75 years should be screened for colorectal cancer.
The reasoning
In a detailed justification, the makers of the recommendation explain that with colorectal cancer screening from the age of 50, about 50 cases in a number of 1,000 persons could be detected and avoided and, in addition, 25 deaths could be prevented.
Lowering the recommended age for colorectal cancer screening from 50 to 45 could effectively achieve two to three more cases of colorectal cancer and at least one death over and above the numbers achieved so far, he said.
This is the assumption of Dr Michael Barry, who, as vice-chairman of the US Preventive Services Task Force, has spoken to CNN on the subject.
Bowel cancer is the third most common cause of cancer deaths
This is true at least for the USA, but is also likely to be the case internationally. If you follow the figures in the USA, it is predicted that around 53,000 people will die of colorectal cancer in 2021, and the trend is rising. It is noteworthy that about 10.5 percent of newly diagnosed colorectal cancers occur in people under the age of 50. In the first 15 years since the turn of the millennium, cases have increased by a worrying 15 percent among adults aged 40-49. This, too, puts the US Preventive Services Task Force on alert to focus carefully on colorectal cancer at an earlier age.
Whereas colorectal cancer was previously mainly observed as a result of the risk factor obesity, the intestinal disease is increasingly affecting people who do not have such risk factors. Dr Benjamin Lebwohl, a gastroenterologist at NewYork-Presbyterian and Columbia University Medical Center, confirms this when he tells CNN: “To some degree, it can be driven in part by obesity, but there are many people younger than 50 who are not obese who develop colorectal cancer without any identifiable risk factors.”
American scientists and doctors have not yet been able to clearly define why cases of colorectal cancer are now also increasing in the age groups under 50. What is certain, however, is that cases can also be detected much earlier and treated more effectively through earlier screening.
The time bomb is ticking
What comes across here as an ominous scenario is justified when one takes a closer look at the figures. In 2018 alone, about 31 percent of eligible people in the US were not up to date on their colorectal cancer screening.
This number is likely to increase even further in the context of the Corona pandemic, as many adults are skipping the necessary screening examinations out of uncertainty, especially in the current phase. This is just as true in the USA as it is in Europe and Switzerland.
If one follows the opinion of Dr Michael Zinner, CEO and senior medical director of Baptist Health’s Miami Cancer Institute, it could be that “delayed screening due to Covid is a ticking time bomb with a ten-year fuse”.
Accordingly, doctors are increasingly urging their patients to catch up on bowel cancer screening examinations that they have not attended. The emphasis is that any test that has been done is always better than a test that has not been done.
Conclusions from the perspective of Swiss1Chirurgie and the GGP Bern
From the point of view of Swiss1Chirurgie and the Gastroenterology Group Practice GGP, bowel cancer screening has been the best and safest means of detecting and treating bowel cancer in good time for decades. Accordingly, attention should be paid to preventive examinations.
In Switzerland, too, this affects not only older women and men, not only people with certain risk factors such as obesity or a genetic predisposition, but practically every adult. From middle age at the latest, people should actively address this issue and talk about it with their family doctor or a specialist.
Although many developments from the USA only arrive in Europe and Switzerland with a certain delay, great vigilance must be maintained, especially in the case of colorectal cancer. To continue to wait here would allow the aforementioned time bomb to continue ticking and lay the extended fuse in this country as well.
The clear call is therefore to take advantage of the opportunities for bowel cancer screening in any case. And they do so regularly and even when there are individual concerns, such as during the COVID19 pandemic.
Professor (USC) MMM, FACS, FEBS (hon.)
In Switzerland, the recommendation is still to have a colonoscopy as a preventive examination from the age of 50. However, this does not apply to patients with stool irregularities, blood in the stool, chronic abdominal pain, or alternating diarrhoea and constipation, or relatives who have already had bowel cancer. If necessary, these patients should have a colonoscopy at an earlier stage so that changes can be diagnosed and treated in time.
Dr. med. Jörg Zehetner on the problem of obesity and what it means for those affected.
As part of the lecture series of Helvetius Holding AG, Dr. med. Jörg Zehetner, Professor USC, took a stand on the stigmatisation of overweight people and the resulting consequences for those affected. In his lecture in the Saaser-Stube Saas-Fee, the experienced physician, who also deals intensively with obesity problems, described the circumstances that obesity patients have to live with practically every day.
They are among us
At the beginning of the lecture, Dr Zehetner made it clear that practically everyone knows the overweight. In one’s own family, in one’s circle of friends or in the circle of colleagues, they exist everywhere and the number of those affected is constantly increasing. And the lives of patients with obesity are not easy.
Where stigmatisation begins
Look at the fat guy! Oh, she’s fat. The fat man should exercise more. Look what he’s got in his shopping basket, and he’s already fat enough.
This is how the stigmatisation of overweight people begins. Without asking why or wherefore, without taking into account how people are personally affected, they are consciously or unconsciously pigeonholed into a category in which they neither belong nor can free themselves from it. Besides the flippant remarks, there are also those that really hurt and don’t help the people concerned at all.
Reduce prejudices
Anyone who has studied the problems of obesity and adiposity in depth knows that those affected suffer greatly from their current life situation. A first step towards at least reducing this unfortunate situation would be to dismantle popular prejudices. It’s always the best moment for that.
The fight against obesity requires a professional network
Hardly any overweight person with a serious problem will be able to successfully face the disease alone in the long term. Even though overweight surgery is now a proven and successful means of fighting the extra pounds, it requires targeted networking before, during and after the medical intervention. For this purpose, a professional network has been established under the umbrella of Helvetius Holding AG, which provides advice, support and assistance to patients in all phases.
Large social alliance against stigmatisation necessary
The topic of obesity is present everywhere. Not only in everyday life, but also in the media, people are encountering this topic more and more frequently and intensively, in addition to the commonly known jokes and remarks about being overweight. From stigmatisation, the path to discrimination is usually a very short one. Obese people are associated with a conceptual world that is anything but pleasant or appreciative. Especially when you don’t know these people personally. This stigmatisation extends far into the personal and social lives of those affected. Even professional life is not excluded. To change this, a large social consensus is needed.
Steps out of stigmatisation
If the spiral of stigmatisation and discrimination against overweight people is to be broken, a clear line is needed. And this begins precisely where obesity is understood as a disease and thus also as treatable and curable. Only then can an active approach be made to these people, who can then actively face their problems themselves without having to continue to hide.
A further step would be to significantly rethink the approach to these patients. And in every area of life and in every encounter with overweight people. Only when the stigma is taken away from these people will they themselves be able to actively enter into the process of their recovery. Dignity, respect and tolerance are exactly the right keywords here.
It is important to also perceive overweight people as valuable members of our society and to recognise that they are not lazy, sedentary, unpleasant and low performers, but sick. And something can be done about diseases, including morbid obesity.
Define obesity as a disease
Anyone who takes a closer look at overweight and obesity will quickly be able to understand them as actual diseases. As with any organic disease, there are clear definitions and developments, but also therapeutic interventions that clearly speak for a clinical picture. A first indication of this is the division into different classifications of overweight, starting from the Body Mass Index, BMI.
Although obesity surgery is a helpful intervention, it does not by itself solve the problem. Being morbidly overweight is and remains a chronic disease that requires lifelong attention, but not disparaging stigmatisation.
More in-depth information on the topic is available in the video recording of the lecture (LINK) and directly on the Swiss1Chirurgie website.
Dr. med. Michaela Neagu FMH Gastroenterology and Internal Medicine GGP Bern
In a lecture by the gastroenterological group practice GGP Bern AG (a company of Helvetius Holding AG), the gastroenterologist Dr. med. Michaela Neagu illustrates the connections between fatty liver and diabetes. Following the lecture, it becomes clear that fatty liver and diabetes form a vicious circle in which both diseases trigger and drive each other. In addition to diagnostics and the effects on overall health, the lecture also opens up a clear picture of how the course of the disease can be successfully influenced and, in the best case, reversed. We have made the lecture by Dr Michaela Neagu available in text form, but also as a video lecture and as a PowerPoint presentation. You can find out more here.
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Fatty liver disease and diabetes mellitus – are there correlations?
The experts at Helvetius Holding AG clarify
In a lecture by GGP Bern AG, Dr. med. Michaela Neagu presented the connections between fatty liver disease and diabetes mellitus. This is less about medical jargon and more about educating people about what a fatty liver is, what it means for people’s lives and whether there is a connection to diabetes mellitus.
Dr Michaela Neagu is a specialist in gastroenterology (gastrointestinal diseases) and general internal medicine in the Gastroenterology Group Practice Bern, a partner of Helvetius Holding AG, and has extensive experience and expertise in her specialist field.
In her lecture, Michaela Neagu, MD, highlights the clear connections between fatty liver and diabetes mellitus.
The fatty liver disease
Basically, a distinction is made between alcoholic fatty liver disease and non-alcoholic (metabolic) fatty liver disease. As the different names suggest, one form of fatty liver disease is related to excessive alcohol consumption, the other has nothing to do with alcohol consumption. In addition, there are manifestations such as viral liver diseases, autoimmune diseases, iron storage disorders and other conditions that promote fatty liver disease or make it possible in the first place.
Worldwide, about 25 percent of the population is affected by fatty liver disease. This makes fatty liver the most common liver disease of all. Among diabetics themselves, about 30 to 40 percent have a fatty liver. Also, about half of patients with severe dyslipidemia suffer from fatty liver disease.
How does a fatty liver develop?
A fatty liver occurs when the capacity of the liver cells to absorb fat is exceeded. This causes fat to be deposited in the liver itself, which can no longer be broken down by the liver. The accumulation of fat in the liver cells causes these cells to become inflamed and then send out messenger substances that inhibit the supply of insulin to the liver. Eventually, a kind of insulin resistance develops, so that insulin cannot work in the body as nature intended.
As a result, hyperglycaemia occurs in the body. This sends out a stimulus that causes even more insulin to be produced. The increased insulin level then further leads to increased fat absorption, fat synthesis and fat storage as well. This creates a cycle of action that deposits more and more fat in the liver, but also generally increases fat storage in the body far beyond normal levels.
What do people affected by fatty liver notice?
It is sobering to note that about half of all those affected live practically asymptomatic and accordingly do not worry at all about their liver health, for example. On the one hand, this may have a calming effect, but on the other hand, it is an alarm signal that effective therapeutic interventions only start late, usually very late.
Some patients experience general but rather non-specific fatigue. A certain faintness and perhaps once undifferentiated slight pain in the upper abdomen indicate that a serious condition could be present here. Mostly, however, this is not taken seriously by the patients themselves.
As a result, in most cases the fatty liver remains an incidental finding that only comes to light during the treatment of other diseases. This could be, for example, elevated liver values during a health check or visible changes in the liver during a standard ultrasound examination.
In general, there is a risk that untreated fatty liver can progress to cirrhosis. At the latest then, those affected realise that their liver is sick. Typical signs are then the well-known large water belly, certain bypass circuits in the organism and other signs come very late, however. In practice, everything is possible with the clinical picture of fatty liver, from no symptoms to severe and dangerous courses of the disease.
Between 50 and 90 percent of people with fatty liver are obese, i.e. clearly overweight. Signs of a metabolic syndrome are recognisable.
How can a fatty liver be diagnosed with certainty?
A few years ago, biopsy was the method of choice when the condition of the liver cells needed to be determined more precisely. To do this, a needle is inserted directly into the organ and a small tissue sample is taken. This tissue sample can then be further examined for fatty liver cells.
Thanks to advances in medical technology, we can now diagnose fatty liver without a biopsy in 90 percent of cases. With different imaging methods such as ultrasound or computer tomography, absolutely painless examinations can be carried out today without interfering with the body. Thanks to the excellent presentation, the fat content in the liver can be determined comparatively well with reliable values.
The basis for the evaluation of the ultrasound examinations is, for example, a comparison of liver and kidney tissue. If both organs are healthy, they have approximately the same structure and colour in the image. If the kidney tissue appears darker than that of the liver, then the lighter parts in the liver indicate fat deposits. In this way, a fatty liver can already be recognised with a fairly high degree of certainty.
If the specialists then decide to take a tissue sample, usually to exclude or detect additional liver diseases, the differences become even clearer. A healthy liver consists of neatly arranged and clearly differentiated cells. In fatty liver, the disturbance of the cell architecture due to the fatty deposits is clearly visible. This becomes even more obvious in the case of a pronounced fatty liver with infected cells.
What is the path to fatty liver
From a healthy liver to a fatty liver always takes time and certain circumstances. Various unfavourable factors cause fat storage in the liver cells, which can then further lead to infection in the liver itself. It doesn’t have to be, but it can be. However, when such an infection takes place, a certain remodelling in the connective tissue is driven forward, which can lead to complete scarring of the liver if left untreated. Then the stage of liver cirrhosis has already been reached. Liver cirrhosis, in turn, is a favourable factor for the development of liver cancer. This applies to about two percent of those affected. But even when liver cirrhosis has not yet been diagnosed, more and more cases of liver cancer in fatty liver are becoming known. And in the USA, fatty liver is now considered the most common reason for liver transplantation.
A look at diabetes mellitus
Usually we are talking about diabetes here. This is diagnosed when chronically elevated sugar levels are found in the blood. The body is over-sugared, so to speak. The factors that cause high blood glucose levels are a reduction in the effect of insulin and, in the course of time, often an insulin deficiency.
Currently, about six percent of the world’s population, including children, are affected by diabetes. In children, type 1 diabetes is mostly observed. With the increase in morbid obesity, also in children, type 2 is also becoming more common. Diabetes can be diagnosed in a very reliable and uncomplicated way in various test procedures.
What does diabetes mellitus mean for people’s lives?
The presence of diabetes mellitus is actually associated with serious risks and consequences for the health and life of those affected. One problem is the damage to the small veins. This mainly affects the kidneys, the retina of the eye and the nervous system. The range extends from relatively mild kidney problems to complete kidney failure requiring dialysis. In the case of retinal diseases, such disorders can lead to blindness due to diabetes mellitus. In terms of damage to the nervous system, there is a loss of certain sensory impressions, which can manifest itself, for example, in patients no longer being able to feel the ground beneath their feet. Problems with coordination and spatial position change are also observed. Gastrointestinal disorders with diarrhoea and other symptoms are also reported. Cardiac arrhythmias can complete the picture.
In addition to damage to the small veins, damage to the large veins is also a consequence of diabetes mellitus. Particularly worth mentioning here are coronary heart diseases. At least here, the risk of diabetes patients is significantly higher compared to the normal population. For diabetics, this risk can be assessed as about twice as high. A full 75 percent of diabetics die from a cardiovascular event.
The risk of suffering a stroke is also about 2.5 times higher than in the comparison group of people without diabetes. A circulatory disorder, especially in the legs, has a risk of 4.5 times more than in the comparison group. The diabetic foot is well known, which is caused by precisely these circulatory disorders and can even lead to the necessary amputation.
Diabetes mellitus also generally increases the risk of infection in relation to practically all infectious diseases.
The relationship of fatty liver and diabetes mellitus
What is special about the relationship between fatty liver disease and diabetes mellitus is the fact that both diseases can be mutual and reciprocal triggers as well as consequences of the other disease. This means: fatty liver patients are or often become diabetics and diabetics often suffer from fatty liver. So there is a causal relationship between fatty liver and diabetes.
Let us imagine a possible course of events: An initially physically completely healthy and normal person begins to gain weight for various reasons. Fat tissue increases and at some point the ability to store fat is exhausted. This then leads to a veritable flooding of the entire organism with free fatty acids. At some point, the organism becomes resistant to the effect of insulin and hyperglycaemia occurs. Now the question arises: Where to put the sugar?
Some of the free fatty acids are deposited in the liver cells, where they lead to the fatty liver already described. This significantly limits the liver’s ability to metabolise healthy fats. In addition, there is an increasingly pronounced insulin residual tendency, which in turn affects blood sugar in the interaction and ultimately leads to type 2 diabetes. Other effects are always included here, such as high blood pressure, disorders of the function of the pancreas, etc.
The mutual condition of fatty liver and diabetes creates a vicious circle that is difficult to break, and then only with radical methodology.
What can be done?
At least up to a body mass index BMI of 30, maximum 35, it is still possible to take countermeasures and something should be done actively. It is worth noting that the fatty liver is reversible, i.e. it can also be regressed. Even if liver infection has already occurred, the process can still be reversed. Timely action is crucial. If cirrhosis of the liver has already occurred, it can hardly be stopped. Nevertheless, even then, consistent lifestyle adjustments and regular check-ups should be aimed at preventing further liver damage.
The way back to a healthy liver is always through a reduction in body weight and a corresponding reduction in the over-fatness of the organism. Even a five percent reduction in body weight leads to a relevant defatting of the liver.
With seven to ten percent weight loss, infections in the liver or incipient scarring of the liver tissue can also be reversed. These are encouraging facts that have been sufficiently tested and researched.
Several factors are crucial for weight loss. This starts with a significant reduction in calorie intake and continues with healthy and regular exercise. A period of at least eight weeks, but usually considerably more, is to be set. The closest possible consultation and care by specialists is highly advisable, as other risk factors must also be observed and ruled out. This applies especially to cardiovascular risks.
Toxic foods such as alcohol, drinks with a high fructose content and nicotine should be avoided at all costs.
You can watch the entire lecture by Dr. med. Michaela Neagu with a lot of additional interesting information and further questions and answers here in the video lecture.
A PowerPoint presentation on the topic illustrates and complements the lecture.
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