Experiments

It shouldn't be too hard to test the pressure theory. Here are some suggestions:

1. Loosen the "U." Splice a section of intestine, or a silicone tube, into the chyme path right at the beginning of the duodenum near the stomach. Leave the valve intact. Make the intestine or tube long enough so that it stretches the duodenum out to the place it would sproing out to if you were performing a RYGB operation. If necessary, in conjunction with this, design a piece of silicone that fits between the pancreas and the far side (from the stomach) of the duodenum and pushes the duodenum away from the pancreas (or find a way to pull it off). -- Imagine the implications if diabetes is resolved by doing this! So many possibilities would be eliminated: fat (except that it causes pressure), anti-incretins from the duodenum, incretins from the ilium, adinoponectin, the YY peptide, GLP-1, temporary changes in diet. All you could reasonably say (I think) is that the pancreas works better because pressure is relieved.

2. See if you can cause diabetes in a healthy animal by putting a net around the stomach and yanking the stomach away from the pancreas. Tie the net off on the abdominal wall on the animal's left side. You have produced the same effect on the stomach/duodenum/pancreas, we hope, as fat or some pregnancies do. If diabetes develops, it's because of the rearrangement of the organs - and my theory is confirmed.

3. Carefully cut the arteries between the duodenum and pancreas. Then reconnect the pancreatic arteries along one path and the duodenal arteries along another. Put a barrier between the pancreas and the duodenum so that pressure is not transferred to the pancreas. This will ensure that there is an adequate flow of blood to the pancreas. Check for the return of the insulin surge and the reversal of diabetes.

4. Develop a silicone device that attaches between the stomach and the jejunal side of the duodenum and pushes out so that the duodenum is stretched outward. Design the device to protect the duodenum/pancreas from pressure: the bottom of this piece of plastic goes between the duodenum and the fold of the jejunem that presses against the duodenum, the sides prevent pressure from crushing the arterial connections of the duodenum/pancreas. This piece of plastic should be strong enough to prevent upward pressure from fat, liver, intestines, whatever from reaching the pancreas.

5. Bypass the inferior or superior pancreaticoduodenal arteries. Connect a blood supply to all the major inlets of those arteries to the pancreas. See if you get the post prandial insulin surge back.

6. In a healthy animal, squeeze the duodenum around the pancreas. See if diabetes develops.

7. In a fat, diabetic animal, remove visceral fat that puts pressure on the pancreas. Leave all other visceral fat.

8. Take a large group of animals (rats, for instance). Divide the group in half. Keep the control group thin and non diabetic. Feed the other half too much, disallow exercise, make sure they have diabetes. Kill all the animals. Carefully check the small offshoots of the inferior and super pancreaticoduodenal arteries under a microscope to see if there are any differences between diabetic and non diabetic animals.

9. Bypass the duodenum, but leave the duodenum exactly where it was. If diabetes does not abate, you've shown that it's not the duodenum per se that causes diabetes, but pressure that causes it. One way to bypass the duodenum while leaving it in place would be to cut a hole in the duodenum near the stomach and attach a silicone tube or cadaver intestine (Do not rearrange any intestines.), attach the far end of the inserted section to the ilium in the same manner, then sew the duodenum shut on the leeward side of the tube near the stomach. Another way to perform the same experiment (on an animal, please) would be to do a RYGB operation using a silicone tube or cadaver intestine to link from the sectioned stomach to the ilium (or is it the jejunem?). Leave all the bypassed part of the stomach in place. Pressure would remain but the chyme path would be exactly the same as a regular RYGB. See if diabetes abates. If it doesn't, it's probably pressure that's keeping it.