As a medical intern, I spent a lot of time around feeding tubes and the people who needed them.

I remember unpacking the tube from its plastic wrapper and submerging the tip in ice water so that I could form a small bend that would help the tube pass through the nasopharynx and down into the esophagus.  The patient would sit bolt upright, and I would take care to direct the tube to the side of the nostril so as not to damage the nasal septum.  I would encourage the patient to sip cold water and swallow as I inserted the feeding tube, so as to reduce the risk of it passing into the lungs instead of the stomach.  I can't forget the look on the patients' faces as their wide eyes watered as I encouraged them to swallow.  Like any medical procedure that is uncomfortable or carries risks, health care providers take solace in the fact that we are helping someone - and informed consent is used beforehand to make sure that everyone is on the same page about the potential risks and possible benefits and alternatives.

Does this sound like your idea of a diet?  Some doctors apparently think so.  There has been a lot of buzz recently about this "feeding tube diet" which is effectively a creative path to starvation.  The subject (it's hard for me to think of them as patients, much in the same way that it's hard to think about their doctors as health care providers) has a tube placed in the nose and into the stomach.  And during the next several days she or he receives protein/fat liquid nutrition with minimal or no carbohydrates.  The concept is to put the body into "starvation mode" from depleting glycogen stores - which results in breaking down fat (and likely some muscle) to supply energy.  Hence - weight loss.  The most popular form of this experiment involves delivering just 800 calories a day.

A lot has already been written about this program and what it says about us as a society, the pressures to be thinner, and the depths to which some physicians go to make a buck.  And I'll be the first to say that we haven't yet come up with a decent solution.  Corporations and individuals both need to take responsibility.  Our rapidly evolving world makes healthy lifestyles less convenient to maintain.

But I still like to think that our health care providers - charged with providing responsible counsel and safe advice - have the ultimate responsibility to do no harm.  We can't be part of the part of the problem.  Our patients are counting on us.

What do you think?  Would you ever consider a feeding tube diet?  Follow Dr. Beckerman on Twitter @jamesbeckerman and let him know.

We have livers and kidneys for a reason, right?

But don’t tell that to the millions of Americans who routinely participate in detoxification or cleansing rituals which are perpetuated as scientific approaches to remove dangerous toxins from our bodies that accumulate as a result of exposures to pollution, environmental factors, and our own diets which are heavy in processed foods.

The question is - do they have a point?

Many detoxification programs combine limited calorie intake, hydration, increased consumption of raw fruits and vegetables, and a host of expensive supplements (not to mention the occasional enema) for a period of days or weeks.  It’s true that many of us could benefit from fewer calories, more water, and more fruits and veggies.  And while most supplements don’t have scientific data to support them, we also don’t have much data to suggest that most are particularly dangerous - it’s your money after all.  But do two or three weeks of a monastic existence actually accomplish anything other than help you lose a few pounds (starvation works!) which you will ultimately regain once you settle back into your super-sized lifestyle?

No.  There is little evidence to suggest that a person with healthy kidneys and liver actually needs an intensive program to do what the body is already supposed to do.  And the fact that detoxifications or cleanses are generally brief suggests that they are not designed to be sustainable.  But healthy lifestyles should be sustainable.

That’s not to say that individuals who do one of these programs won’t experience some short-term benefit - but the benefit is secondary to limiting alcohol and caffeine, or improving hydration, or not overeating - it’s not because toxins are magically whisked away.  The useful elements of detoxification or cleansing are in the more healthful behaviors that they encourage in the short term, but not in the mechanism they use to justify them.  The key is making the short-term acceptable enough that you can stick with it in the long-term.  That way you can enjoy a balanced lifestyle and maintain a healthier weight, even when your friends have regained the pounds they previously lost and are heading back to the internet to buy another three month supply of vitamins.

In the end, it’s a more balanced life that seems a little less toxic - don’t you think?

Over a year ago, I posted a blog arguing against the use of Human Growth Hormone as a weight loss supplement.  But little did I know that when many people read “HGH,” they instead think “HCG.”  Who knew?  But as a result of this visual similarity, I’ve found that a good number of the posted comments were written in defense of this “miracle” diet, which combines supplementation with a hormone first detected in the urine of pregnant women (yep) and...a daily 500 calorie restriction.   So I thought it was a good idea to readdress the issue, with a renewed focus on HCG this time.  Drum roll please...

I think the HCG Diet is a bad idea for at least three reasons.

1) Supplementation with HCG has not been proven to be effective as compared to placebo.  Multiple double-blind placebo controlled studies have not demonstrated a beneficial effect.  Not much else to say about this.  It just doesn’t work.  Please note - I am not talking about the prolonged and severe calorie restriction that accompanies it.  That works just fine.  It just isn’t healthy.  See #2.

2) This diet requires prolonged and severe calorie restriction.  While some forms of the diet might be so liberal as to allow 700 calories, the most common recommendations hover in the 500 calorie range.  That’s a bagel with cream cheese - for an entire day.  Sure, you will lose weight, but ultimately isn’t the goal is to get healthier?  Balanced nutrition, fewer trans fats, less processed food, and smaller portions will help accomplish that, with more than the double the daily calorie intake.  Extreme calorie restriction also raises the likelihood of nutritional deficiencies and electrolyte imbalances, which can impact heart health in particular.

3. It’s not sustainable.  Severe calorie restriction or any significantly lopsided approach never works in the longer term.  People claim success during the first few weeks, or even months, but you don’t see as many ardent supporters five years later.  We know all too well how difficult it can be for most of us to lose weight and keep it off.  But if you want to give yourself a fighting chance of maintaining your success down the line, you will have a much better shot if you start with a more balanced approach that lets you enjoy good food, family celebrations, and the twists and turns that life inevitably takes - without making false promises.  

But because of a combination of viral marketing, a small but vocal group of supporters, and blog posts like this that stir the pot, there will continue to be publicity around the HCG Diet until the next miracle comes into fashion.  You don’t see too many people extolling the virtues of hoodia or acai berry anymore, do you?  

Hmmm...just you wait.  

Hi everyone!

I hope you all are having a happy and healthy holiday season.

I'm so excited to announce that The Flex Diet: Design-Your-Own Weight Loss Plan is now available in stores and at Amazon.com.  The concept of the book is simple - use 200 different solutions to help create your own personalized approach to weight loss and wellness.  It's evidence-based, easy to read, and avoids the pitfalls of fads and extremes that are so common in this type of book.  It took nearly three years to research, write, and publish, from start to finish, and here we are!

Please take a look at the book website at www.theflexdiet.com, on Facebook at www.facebook.com/theflexdiet, or check it out on Amazon.  And if you have any questions about the book or any of its solutions, please post right here on MedHelp with subject line "The Flex DIet," and I will be sure to answer!

Thanks so much for your support, and I wish you all the best!
Jamie