Extreme Dieting: The Feeding Tube Diet is Catching On

Some brides-to-be are prepping to say ‘I do’ by inserting a feeding tube in their nose. Also known as the K-E method, it’s the latest wedding crash diet, and it’s raising eyebrows among health experts. The 10-day plan requires brides-to-be to live with a nasogastric tube inserted through their nose and threaded into their stomach. A protein pack dispenses a liquid mix of nutrients, but no carbs, supplying about 800 calories a day. (Most experts recommend healthy adult women get about 2,000 to 2,400 calories a day.) The feeding tube diet throws the body into starvation, and is touted as helping followers drop 20 pounds in 10 days. “People are taking an unnecessary medical risk by putting in a [feeding] tube,” David Heber, director of the UCLA Risk Factor Obesity Program, told Time. “To do it for no reason seems to me overly risky. Without medical supervision … it’s not safe.”

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Is a Gluten-Free Diet Smart for Weight Loss?

Miley Cyrus is looking leaner than ever these days, fueling mass speculation of an eating disorder. Earlier this month, she took to Twitter to defend her slim physique: “For everyone calling me anorexic, I have a gluten and lactose allergy. It’s not about weight, it’s about health. Gluten is crapppp anyway!”

While Cyrus’ weight loss may be due to a legitimate food allergy, scads of other celebrities and non-famous folks alike are adopting a gluten-free diet—for weight reasons, not health. “It’s definitely trendy now. Everyone is talking about it,” says Elisabetta Politi, nutrition director at the Duke Diet and Fitness Center in Durham, N.C. And the food industry is apparently cashing in on the trend, too: By 2015, sales of gluten-free foods and beverages are expected to hit $5 billion, according to Packaged Facts, a market research firm. “I see the positive side of being more aware of gluten and trying not to overdo it,” says Politi, “but I don’t think it’s a good way to lose weight.”

Gluten is a protein found in wheat, barley, and rye, as well as many common food additives. It gives dough elasticity and baked goods their chewiness. (It’s found in pizza, beer, burgers, and pancakes, for example.) Those who have celiac disease—caused by an overactive immune response to gluten in the small intestine—are encouraged to go gluten-free to avoid digestive symptoms like pain and diarrhea, and even permanent intestinal damage or malnutrition. There’s no cure or medication other than a gluten-free diet. About 1 percent of the population suffers from celiac and about 10 percent have a less specific sensitivity, according to the Mayo Clinic. [Read more: Is a Gluten-Free Diet Smart for Weight Loss?]

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Surprisingly Unhealthy Restaurant Meals

Everyone knows that trademark fast food like Whoppers and Big Macs doesn’t fit comfortably under a “diet” label. But sit-down family chains have eye-opening menu entries, too, that can supply as much or more fat or salt as anything dished out at a drive-thru window. Here’s a look at some of America’s favorite family restaurants—and one juice joint—and their surprisingly unhealthy offerings.

Boston Market. You may think grabbing a Boston Market salad in lieu of rotisserie chicken is the healthier choice. Think again. Its chicken Caesar salad has 660 calories and 43 grams of fat—slightly more than what’s in the half-chicken á la carte. The salad also has 1,590 mg of salt, approaching the 2,300 mg per day the government recommends you stay below, and exceeding the 1,500-mg limit for anyone who is 51 or older, African-American, or has hypertension, diabetes, or chronic kidney disease.

Olive Garden. “When you’re here, you’re family,” goes the Olive Garden pitch, but you might think twice about feeding your family this much fat. The government urges adults to ingest no more than 20 to 35 percent of daily calories from fat. That equates to a max of 44 to 78 grams of total fat per day if you’re on a 2,000-calorie-a-day diet. Olive Garden’s fettuccini Alfredo has a whopping 1,220 calories, 75 grams of fat, and 1,350 mg of salt—the caloric equivalent of two Big Macs and an order of small fries—and that’s before the all-you-can-eat breadsticks, which have 150 calories each. Even without the creamy Alfredo sauce, the restaurant’s dishes can be packed with calories, salt, and fat. The chicken and shrimp carbonara has 1,440 calories, 88 grams of fat, and 3,000 mg of salt, while the chicken parmigiana has 1,090 calories, 49 grams of fat, and 3,380 mg of salt, for example. [Read more: Surprisingly Unhealthy Restaurant Meals]

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I have previously expressed my concerns that weight loss and common sense have trouble co-habitating, and might even be at war. The discord is understandable: Desperation breeds gullibility, and wishful thinking. People with more than ample common sense are lulled into a state of hypnotized bemusement by magical claims of effortless weight loss. Again, and again, and again.

Certainly nothing else accounts for the popularity of such patent nonsense as the HCG diet. The diet gained fame by combining a 500 calorie/day meal plan with injections of a pregnancy hormone. The pregnancy hormone — essentially, Dumbo’s feather — has induced legions of people to pay a fortune to lose weight by starving themselves. If they were to starve themselves at no extra charge, they would lose weight just as fast.

Leaving aside the fact that clinical trials robustly debunk HCG diet claims, there is the simple expediency of common sense. Anyone who has ever had anything to do with pregnancy knows that those hormones are NOT turning off appetite or inducing weight loss! I have plenty of firsthand experience, and not just as a doctor; my wife and I have 5 kids. There were times in any of my wife’s third trimesters when if food was not readily at hand, I feared she my eat my arm! And absent the influence of those pregnancy hormones, my wife — who happens to be French — is a very thoughtful, moderate eater.

I thought common sense couldn’t go any deeper into a coma than believing that pregnancy hormones were the reason a 500kcal diet was causing weight loss. But I was wrong. Common sense, it seems — along with medical ethics — has come off life support altogether with the advent of the “K-E diet.”

“K-E” stands for ketogenic enteral nutrition. “Ketogenic” may sound familiar, because it refers to the burning of ketone bodies that occurs with a very low intake of carbohydrates. It figured in the original Atkins diet, and more recently in the Atkins diet with a French accent — the Dukan diet. Another example of dietary common sense lapsing into unconsciousness, by the way, but we’ve got bigger fish to fry.

“Enteral” is a medical term that refers to putting food into the gastrointestinal system. In contrast, “parenteral” feeding bypasses the GI tract altogether by putting nutrients directly into the bloodstream.

A better, more descriptive term for the new diet is the nasogastric tube diet. The K-E diet involves inserting a feeding tube into the nose, down the esophagus, through the stomach, and into the duodenum, and then infusing a feeding solution continuously.

This is done in the hospital routinely for people who can’t eat. But that’s not what the K-E diet is about. It’s about brides-to-be who want to lose 10 pounds or so in a hurry to look good in a wedding dress.

This “diet” is little short of lunacy on the part of any such bride-to-be, colossally misplaced priorities on the part of any groom-to-be watching it happen, and as profound an abrogation of professional ethics on the part of doctors peddling it (for $1,500) as I have ever seen.

Everything about this is appalling. Not so much because of the risk of metabolic complications from a ketogenic diet over a period of just 10 days. These are real, and include stresses on the liver, kidneys, and skeleton — but for people healthy at the start, such concerns are both minor and remote. Bone loss will occur, but will be inconsequential if limited to a 10-day span. Constipation is the one complication that will occur almost without fail. A ketogenic diet is used in medical practice to treat intractable seizures — but that’s a case where the inconvenience and adverse effects of the diet are the lesser of two evils, because the alternative is uncontrollable epilepsy.

What makes the K-E diet truly appalling is that it transforms a medical therapy into the indulgence of a short-term, short-sighted, vanity-driven whim. It opens up a whole new world of shockingly bad ideas:

Why not chemotherapy-induced nausea and anorexia for weight loss? If you don’t need a medical condition for a nasogastric tube, why should cancer be required for chemotherapy? Why not a medically-induced coma/anesthesia for weight loss? Or perhaps a serious metabolic stress to melt off the pounds — such as — why not medically-controlled anaphylaxis?

If self-induced vomiting after meals constitutes an eating disorder, what, exactly, is infusing liquid formula through a tube into the duodenum without medical indication? If the K-E diet survives a while — and I sure hope it doesn’t — I bet it will come to be defined as an eating disorder in its own right. I fully appreciate the frustration many people feel when trying to lose weight — but if bulimia is not the right answer for that problem, neither is this!

A nasogastric tube is an unpleasant, undesirable medical procedure we impose on sick patients who can’t eat. It carries with it a risk of aspiration pneumonia, which can be fatal. Ladies, not to put too fine a point on it, but: do you really want to marry a guy who stands by while you risk your life to lose 10 pounds? If my then-wife-to-be had proposed any such thing (not that she would have), my answer would have been equally emphatic and immediate: over my dead body!

In terms of quick weight loss, this dangerous nonsense is a guarantee of quick rebound with interest, since it involves no useful behavior change whatsoever. It has nothing at all to do with health, and basically endorses the notion that weight loss by any means is acceptable. If that is so, why not a 10-day pre-nuptial cocaine binge? It will work as well or better, and almost certainly be more fun, than a nasogastric tube.

As for the doctors involved in peddling this travesty, I condemn their actions. The job of physicians is not to come up with any way to satisfy a patient’s whim, no matter how fundamentally at odds with health.

Our professional mission is to promote and protect health, and to serve the patient in that context. In that context, the patient is the boss — and we are, or should be, at their service. But we are abdicating our profound responsibilities and most sacred pledges when we renounce a commitment to health, and adopt an “oh, what the hell” approach to make some extra money by exploiting a patient’s faith in us, and their desperation. On behalf of my profession, I am ashamed.

This is weight loss lunacy. Resuscitate your common sense while there’s still time. Love the skin you’re in — 10 extra pounds and all — and marry a guy who does, too!

Step away from the nasogastric tube — and one less person will get hurt.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

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It’s “turnabout is fair play” time at the Bethel and Springfield school districts.

Usually, it’s teachers and staff who are keeping students in line. But when it comes to healthy eating for the next few weeks, it will be up to the younger set to keep tabs on their elders.

They’ll be watching to see how many times the grown-ups choose apples or carrots for an afternoon snack instead of cookies or potato chips. And the pressure will be on for the adults to perform, because whichever elementary, middle and high school in the two districts gobbles up the most fruits and vegetables by May 11 will win $1,000 to support wellness programs in their schools.

The idea for the Healthy Life Schools Challenge came from PacificSource Health Plans, the health insurance company that covers employees in both school districts.

“We launched this wellness program because we’re very committed to public awareness of the health benefits of eating well,” PacificSource spokeswoman Alexa Shook said. “A program like this one benefits not only people who are covered by our insurance plans but the larger community, and that’s very important to us. So we’re asking teachers and staff in these schools to model good eating behavior by replacing at least one high-calorie snack each day with a healthy one.”

PacificSource and the school districts kicked off the contest last week with an assembly at Yolanda Elementary School in Springfield. Laura Pavlat, wellness coordinator for the Springfield School District, said everyone seemed gung ho.

“The kids will be asking their teachers to eat fruit and vegetables, and we also want the teachers to encourage the kids to do it at the same time,” Pavlat said. “PacificSource will be delivering boxes of fruits and vegetables to the schools every week, and that will be another reminder to students and staff to keep it up.”

For four weeks, teachers and staff members will use online charts to enter their individual food choices, and there will be another chart on the website at healthylifechallenge.org so everyone can see how the contest is progressing, she said. If everyone takes the challenge, as many as 1,600 people in the two school districts could participate.

PacificSource offered free biometric screenings — blood pressure, blood glucose and body mass index — to participants at the beginning of the challenge and will repeat them at the end.

“In just four weeks, most people’s numbers may not change all that much, but if they really stick to it, they might be able to show the students that eating healthy foods really can help,” Shook said.

Several fourth-grade classes — seven in Springfield and two in Bethel — also are taking part in another PacificSource nutrition wellness program called “Veggie U,” she said. “We give the schools kits with seeds, grow lights, worms and soil, and they start their own gardens at the same time that they study about healthy eating and the benefits of fruits and vegetables in the diet.”

It’s been a very popular program — it teaches health education and agriculture in one class. Doing that along with the fruit-and-vegetable challenge is another good way to encourage children to try new, healthy foods, as well as teach them that they can grow some of these foods for themselves and their families.”

As for how the three winning schools might spend their $1,000 prizes, Pavlat said it depends on their individual needs, but health-and-fitness equipment is a good guess.

“I could see them maybe using the money to purchase new gym equipment, because in this economic situation many schools don’t have good equipment,” she said.

“But they have to have a plan. It can only be used to benefit wellness of students or staff.”

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