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Nutrition and You: When Is Tube Feeding a Bad Idea? (the “K-E Diet”)
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Enteral nutrition or tube feeding is a way to sustain life when food cannot be taken orally. Technology continually


leads to improvements in this therapy: smaller tubes; low-profile tubes; backpacks for carrying formula and pumps; and smaller, more convenient pumps. Perhaps it isn’t optimal, compared to eating orally, but you can achieve health and well-being and receive all the nutrition you need.

 

How many of you receiving enteral (EN) or parenteral nutrition (PN) have had someone say to you, “I should go on that therapy. Then I won’t have to worry about what I eat!” It may have been said jokingly, but now—as many of you know—there is a new “diet” being marketed that uses short-term nasogastric feeding for weight loss! Called the “K-E Diet,” it provides a specialized high fat, high protein, very low carbohydrate (or ketogenic) diet. 

 

The physician who is promoting this “diet” places a feeding tube into the “normal” person’s stomach. The tube is kept in place for ten days and the person infuses a special powdered ketogenic EN formula that has been mixed with water. This very low calorie (800/day) and low carbohydrate (~zero) formula causes the body to create ketones as it has to metabolize its own energy stores for calories. The formula is provided twenty-four hours per day using a pump. The physician who is offering this in Florida advertises that one can lose twenty pounds in ten days—all for only $1,499!

 

The facts: 

  • A ketogenic diet has been used in children with seizures, but is very closely monitored.
  • Certain low carbohydrate oral diets have been used for years for weight loss. The major drawback is immediate weight gain when carbohydrates are added back into the diet.
  • A diet with less than 80 to 100 grams of carbohydrate is dangerous since the brain needs glucose (carbohydrates) to function.
  • When calories are severely decreased, water weight is lost, followed by muscle. With a ten-day weight loss program, the weight loss is not permanent. 

$1,499 is a lot of money—hire me and I will nag you not to eat for ten days!

 

Here is what some of the experts have said:

 

Laura Matarese, PhD, RD, Oley Board member, and Associate Professor of Gastroenterology at East Carolina University: “Enteral nutrition is a life-saving technique for those who are unable to eat by mouth. However, this is not an appropriate methodology for weight loss. The K-E Diet (short for Ketogenic Enteral Diet) was developed to induce quick weight loss. So what’s wrong with this approach? Plenty! This could be the most shocking, controversial diet ever developed, in my opinion. It is a drastic and extreme regime which amounts to controlled starvation. You will, of course, lose weight rapidly on such restricted calories—but no one should slim down that quickly. Additionally, the psychological and emotional reasons for overeating need to be addressed, which this plan fails to do. And there are potential side-effects. For example, constipation is common due to the total lack of fiber in the formula. The ketones, which are created when your body burns its own fat, are expelled via the urine and breath, so another side-effect is bad breath. Although feeding tube placement is generally considered safe and ‘low risk,’ it is not totally benign. There are potential complications, such as tube misplacement in the lung or perforation of the stomach. Bottom line: save this therapy for those who cannot eat by mouth.”

 

Lillian Harvey-Banchik, MD and nutrition support physician: “A person who, without a valid medical reason such as drug resistant epilepsy, voluntarily goes on a ketogenic enteral diet is playing Russian roulette with their life. The potential risks to both short-term and long-term health, including renal damage and cholelithiasis from rapid weight loss, negates any short-term weight loss benefit, especially since the lost weight is normally regained rapidly once the diet is stopped.”

 

Cheryl Thompson, PhD, RD, and EN researcher “For HPEN consumers and clinicians, the thought of using a medical therapy as a fad/crash diet is understandably upsetting. Tube feeding is intended to promote and restore the health of those unable to eat—not provide an unhealthy formula with the potential risk of causing health problems. It is also distressing that a physician (who is bound by the oath to first do no harm) would claim patients will ‘get used to the KE-tube within just a few minutes’ and ‘apart from being 20 lbs lighter will be in the perfect place to continue a more healthy relationship with your food’—to lure people into paying for a ten-day diet. Yet the real tragedy is that some overweight people are so desperate and gullible they are resorting to such drastic measures—often for vanity alone.

 

“Consumers who have posted on the Oley Facebook page have been quite vocal and quite right, I especially like what Lisa K. had to say: ‘As a person who has to rely on a feeding tube to survive, I find this diet for vanity absolutely appalling.’”
All of the nutrition experts agree: Effective long-term weight control, without surgery, can only be achieved by lifestyle modifications, including changes in both eating and exercise habits. Weight loss in the range of two pounds per week is considered safe and allows the individual to learn to manage their food and drink intake.

 

Those of you who are receiving HPEN because you need it to survive are the best examples of how well this therapy works. It is from you that we receive our inspiration!

 

This column has been compiled by Carol Ireton-Jones, PhD, RD, LD, CNSC, FACN; and reviewed by Laura Matarese, PhD, RD, LDN, FADA, CNSC; and Cheryl Thompson, PhD, RD.

 

LifelineLetter, May/June 2012

more Calendar

2/6/2017 » 2/10/2017
Feeding Tube Awareness Week

2/18/2017 » 2/21/2017
Oley exhibit at A.S.P.E.N.'s Clinical Nutrition Week

5/6/2017
Oley Regional Conference

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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