Liposuction May Help Keep Insulin Down

Liposuction, the most popular form of cosmetic surgery, may someday become a therapeutic tool for treating the insulin resistance associated with diabetes, according to the results of a preliminary study. Dr. Sharon Giese tells us about the promise and the problems associated with large-volume liposuction.

Dr. Sharon Giese, a plastic surgeon with a background in biochemistry and a clinical assistant professor at the State University of New York, presented the results of a year-long pilot study of the health benefits of large volume liposuction at a meeting of the North American Society of Plastic Surgery in Los Angeles this week.

Liposuction--the removal of fat accumulation, was performed in five areas of the body in 14 overweight women and eight of whom were in the pre-diabetic state known as insulin resistance.

Giese found that while all the women lost weight and kept it off for a year, they also lowered their insulin levels as well. If a new study by the National Health Institute duplicates these results, Giese will have proven that large volume liposuction has not only cosmetic advantages, but may prove to be therapeutic for health reasons as well.

Interview with Sharon Giese

The study began in spring 1999 at Georgetown, Washington D.C. Fourteen women were selected and all were overweight by 25 to 50 pounds but otherwise healthy. Their average body mass index is almost 29 (normal is 25, and 30 is clinically obese). They had no high blood pressure, no full blown diabetes. Many had dieted forever and couldn't reach their weight loss goal. If they exercised, it was three times a week, but not many were doing even that much.

Because all of the women in the study were overweight, more than half had insulin resistance, a pre-diabetic state, after liposuction, they all had normal insulin levels. After one year, they all kept the weight off and the insulin levels down. A quarter of the women made a post-surgery effort to diet and exercise. This group went down three dress sizes, lost another 15 to 20 pounds on their own for a total weight loss of about 30 pounds.

The typical areas where they had liposuction (this differs from woman to woman) are front of abdomen, flanks, media and lateral sides, maybe knees, sides, arms and butt, upper back.

"At first I thought I would easily find that their metabolism would increase as a result of the liposuction since they were experiencing an instant change of fat mass to lean muscle mass," says Giese. "But only half had an increase in their metabolism. What we found in terms of the decrease in insulin levels was equally as dramatic."

Insulin regulates glucose. Insulin levels are high when someone is suffering from diabetes. We're talking about type 2 diabetes, the adult onset diabetes. Eighty-five percent of those who have type 2 diabetes are overweight o obese. The other 15% is a mix between environment and heredity. Obesity and diabetes are intimately related. With obesity, insulin just isn't as effective in regulating blood sugars so your body produces more and that's bad.

It's the effect of elevated insulin levels that causes things like increased blood coagulation levels, which increases the risk of heart attack, coronary heart disease, and strokes. Insulin also acts on blood vessels to decrease blood flow, which, too, can result in coronary heart disease and strokes. There is also a recent finding that suggests that elevated insulin is associated with an increased risk of breast cancer recurrence.

Normal method in large-volume liposuction is to "try to get patients to lose 5 or 10 pounds before surgery," says Giese. That's the point at which the metabolism slows down and the weight loss plateaus. It's then that Giese performs the large-mass liposuction.

There are dangers involved in liposuction, which is the most popuar cosmetic surgery. But, according to Giese, many of the causes of complications are preventable. The chief dangers include:

• Fluid overload. With tumescent liposuction, you have to infuse salt water solution into the fat. When you operate on many areas, it means a lot of fluid. It can be deadly, but clearly preventable. These liposuctions always have to be done in the hospital with specially trained staff.

  
  

• Lidocaine toxicity--too much of local anesthesia.

  
  

• Pulmonary embolism (clot in the vein) can happen with any surgery, shortness of breath or sudden death.

The new study by the National Health Institute is now underway: it is for overweight women who have insulin resistance or type 2 diabetes.

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