“The field has suffered from a checkered history 20, 30 years ago, when there were operations that were dangerous. But modern metabolic surgery is very safe,” Cummings said. “The risk of dying from a laparoscopic gastric bypass is a little bit less than the risk of dying from having your gallbladder or appendix removed. But we never consider those risky surgeries; they’re totally bread-and-butter procedures.”

Not until I actually got this book into my hands could I see that its subtitle read "A medical approach that can slow, stop, even cure Type 2 Diabetes". If I'd known about the subtitle, I wouldn't have been interested in reading the book, since the "medical approach" bit indicated for me that it consisted of traditional precepts penned by a doctor, and also I am not particularly interested in Type 2 diabetes, only Type 1, which I myself have.

A wide scatter of absolute levels of pancreas triacylglycerol has been reported, with a tendency for higher levels in people with diabetes (57). This large population study showed overlap between diabetic and weight-matched control groups. These findings were also observed in a more recent smaller study that used a more precise method (21). Why would one person have normal β-cell function with a pancreas fat level of, for example, 8%, whereas another has type 2 diabetes with a pancreas fat level of 5%? There must be varying degrees of liposusceptibility of the metabolic organs, and this has been demonstrated in relation to ethnic differences (72). If the fat is simply not available to the body, then the susceptibility of the pancreas will not be tested, whereas if the individual acquires excess fat stores, then β-cell failure may or may not develop depending on degree of liposusceptibility. In any group of people with type 2 diabetes, simple inspection reveals that diabetes develops in some with a body mass index (BMI) in the normal or overweight range, whereas others have a very high BMI. The pathophysiologic changes in insulin secretion and insulin sensitivity are not different in obese and normal weight people (73), and the upswing in population rates of type 2 diabetes relates to a right shift in the whole BMI distribution. Hence, the person with a BMI of 24 and type 2 diabetes would in a previous era have had a BMI of 21 and no diabetes. It is clear that individual susceptibility factors determine the onset of the condition, and both genetic and epigenetic factors may contribute. Given that diabetes cannot occur without loss of acute insulin response to food, it can be postulated that this failure of acute insulin secretion could relate to both accumulation of fat and susceptibility to the adverse effect of excess fat in the pancreas.

Sulfonylureasmay increase the risk of death from cardiovascular disease. Prolonged exercise and alcohol intake increase the risk for hypoglycemia. Patients undergoing surgery or who have had recent trauma, stress, or infection may need to switch from a sulfonylurea to insulin to manage blood sugar levels. People with kidney or liver disease need to take precaution.

One easy way to increase your fat content and quit snacking is to begin your meal by eating an avocado. I and others I know have used this trick to easily quit snacking. Avocados protect you from one of the reasons some dietary research wrongly claims that high-fat diets are bad for you: the danger of gorging yourself on delicious, fatty foods. With plain avocados, there is little danger of gorging. Another danger is clogging your arteries and giving yourself heart disease. But it’s been amply shown that the blame for that falls squarely on trans fats, like margarine. If you see any product with the words “partially hydrogenated” or “hydrogenated” in the list of ingredients, put it back, it’s a trans fat. On the other hand, any fat that comes directly from an animal or plant is not a trans fat and can be safely consumed.