K-E Diet: Does It Work?

Since it was featured in a New York Times article last week, the K-E Diet (short for Ketogenic Enteral Nutrition) has been a source of curiosity. Do some people (most notably, brides) really use a nasogastric or "feeding" tube to lose weight?

The plastic or rubber tube, which enters the body through the nose, is snaked through the esophagus and into the stomach and is a common tool for surgical patients and anyone else with an obstructed ability to eat. The K-E diet, by contrast, is its first known weight loss application in the United States.

“It’s pretty unique,” Christine Ren-Fielding, M.D., associate professor in the Department of Surgery and director of the weight management program at NYU Langone Medical Center, told The Huffington Post. “Typically, when you put a tube in the nose, it’s for making people gain weight.”

“Unique” is one word for it. Other words that have been used since the story appeared include “gross” and “disturbing." But is it dangerous? And does it work?

So far, the diet is offered exclusively at a Florida clinic run by Dr. Oliver R. Di Pietro, its creator and an internal medicine specialist. A brochure promises that, over 10 days, the diet can lead to about 20 pounds of weight loss -- or about 10 percent of a patient’s total weight.

A patient is intubated with the feeding device and given a 10-day supply of a powdered food supplement (to be mixed with water), made entirely of protein and fat and amounting to 800 calories per day. Patients may drink water, unsweetened tea and black coffee during their treatment, but nothing else can pass their lips. They carry the solution in a tote bag at all times, where it provides a steady 24-hour drip of nutritional supplementation.

There’s nothing particularly invasive about a nasogastric tube, though there is a slight risk of choking. Any surgeon knows that intubated patients can sometimes experience aspiration. In fact, a 2003 review of clinical nutritional care established how common this complication can be. That’s because the tube leaves open the upper and lower esophageal sphincters that normally close to separate the stomach from the esophagus. This prevents acidic stomach fluids from eroding the esophagus – and prevents debris from entering the pharynx, which can lead to obstructions and choking. Bacteria from the stomach can also, according to the study, colonize in the throat, causing infection.

Other side effects, according to Di Pietro, include bad breath and constipation (another approved substance: Miralax laxitive), as well as potential kidney problems. Those with kidney disease, high blood pressure or diabetes may not be good candidates. And, as with any restricted calorie diet, there are risks of headaches, weakness, dehydration and fatigue.

Despite this -- and the tube’s dramatic appearance -- the K-E Diet isn't the most dangerous weight loss fad on the block, according to Ren-Fielding. That doesn’t mean it’s a good solution for excess weight.

Any quick weight loss scheme -- whether via tube, straw or fork -- is a short-term solution. It will result in dropped pounds, but those come from lost water and muscle mass, rather than fat. The trouble with weight loss of this type is that it returns as soon as the diet ends -- and, it is more likely to return as fat, rather than muscle.

“To lose weight from fat takes several weeks,” says Ren-Fielding. “The liver stores energy, muscle stores energy. Only once you’ve depleted that, will you get into fat.”

She added that exercise can help to preserve muscle tissue in this scenario, but that major levels of exertion would be complicated by a feeding tube and bag.

Di Pietro asserts that the diet leads to fat loss only. He told ABC News that the combination of protein and fat leads to a process called ‘ketosis’ that leaves muscle tissue intact. But according to the literature, ketosis simply suppresses appetite -- it cannot control where weight loss comes from.

In the end, this quick fix might work in the short term -- but it's no panacea for major weight loss. And it certainly doesn't address the underlying factors that lead to a healthy body: healthful, mindful eating and exercise.

"It seems to be illogical to do this for one fairy-tale day when most brides have plenty of time before their weddings to lose weight in a healthy way," said Suzy Weems, a Baylor University professor and a former chair of a public policy committee for the American Dietetic Association. "The long-term solution to maintain a good weight is eat right and exercise."

Ren-Fielding had a different take: "It's a sad commentary," she said. "It's a reflection of how desperate so many people are to lose weight. So many people that would pay money for this, even when it seems so absurd."

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