We have an epidemic of obesity. (While not related to the pandemic- these folks are at greater risk from the pandemic.)

More importantly, those who are obese are likely to be suffering from Type 2 diabetes. Interestingly, these folks manifest cellular overgrowth in the duodenum (a portion of the intestine). One researcher, Dr. Harith Rajagopalan, believes these overgrowths result from years- perhaps even decades- of abysmal eating choices.

A little digestive facts would come in handy now. When we eat, duodenal cells secret a hormone, gastric inhibitory polypeptide (GIP), which affects a slew of other hormones that affect how we metabolize the nutrients (foods) that we ingest. And, those folks who manifest Type 2 diabetes secrete more GIP than ‘normal’ folks.
It has been Rajagopalan’s premise that if one removes these excess gut cells the hormonal responses would be more like those of normal patients.

Which may explain why he’s developed a company (Fractyl ) that effects what he terms the Rectiva DMR (duodenal mucosal resurfacing) process.

And, what is this DMR? An endoscopic tube is inserted down the subject’s throat (while one is sedated, of course) until it reaches the first portions of the small intestine (the duodenum). And, then, water- at 75C-  is flushed down the tube. Which kills those outermost cell layers. (This process is called hydrothermal ablation.)

Some 300 folks (via 20 clinical centers in four European countries and Brazil) have been so treated. And, 34 of them have been tracked for about 2 years. While those who underwent the treatment still manifest Type 2 diabetes, their HbA1c (long-term blood glucose level indicator) dropped from 8.5% to 7.5%.

Unfortunately, the results from his new study- the one that was supposed to be presented in San Francisco (Endo 2020 Conference)- never did get presented. Thanks to the pandemic quarantine that prevails around the US. Rajagopalan intended to provide the results of a randomized 70 person trial; half the folks underwent the treatment and the others underwent the tube insertion- but not the 75 C water flush.

After 3 months, those patients who received the real treatment demonstrated better glucose control and liver health (i.e.,  fatty liver disease was no longer prevalent). Those who underwent the procedure manifested a decrease in their fasting glucose level by 41 mg/dL, which compares favorably to the control group (which only manifested a 15 mg/dL drop). (Plus a 3 kg weight loss- obviously, not enough to drop the obese characterization from the patients’ charts.)

The paper is going to be published in a special supplemental section of the Journal of the Endocrine Society this next month; the Endo 2020 conference will be presented virtually over the summer.

One of the problems with the DMR process is that if the patients continue their bad eating habits, it’s simply a matter of time before those extra cells lining the duodenum reappear. The other is the mechanism by which glucose control is improved is unknown.

(Right now, gastric bypass- where the stomach is made smaller and bypasses the large intestine to reach the small intestine directly, or via a sleeve insertion into the duodenum that diminished cell contact with the food- are viable alternatives for the obese who don’t lose weight via changes in diet and exercise.)

(Rajagopalan also asserts that his process can eliminate the need for daily insulin injections.  Stay tuned!)

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