The K-E Diet: Weight Loss Lunacy

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.
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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.


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