Do no harm. Remember that.

Apr 25, 2012 - 10 comments
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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.

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WOW.  I'm shocked to read this. REALLY?  A feeding tube diet?  Who's the genius that came up with THAT?  Like you said, it is just a fast track to starvation, but it also has a lot of other unhealthy components.  For one, you are skipping the "taste" aspect of eating, which is very important, and you are bypassing the swallowing mechanism.  I'm not sure how long the NG tube is to stay in place, but if for an extended period of time, it could actually cause more problems, due to basically bypassing the normal, physiological process of eating.

I also have to mention that I find it extremely disrespectful to those who have had a feeding tube for various medical conditions, be it throat cancer, malnutrition, strokes, etc.  Those people would love to be able to eat like everyone else does, and like you described, inserting an NG is an unpleasant procedure as it is, with many associated risks.  What's next?  Surgical procedures to put in a permanent G-Tube?  Just amazing.

I shouldn't be shocked to read something like this, but I always am.  I agree with you that I wouldn't be quick to call a doctor prescribing this kind of weight loss treatment a true "health care profesional".  If you are willing to do things that carry a strong possibility of actually causing harm (when there are MUCH better approaches to the same outcome), then is becomes about money, and not about looking out for a patient's best interest.

Thank you for posting this, and thank you for being the type of doctor the world needs.

Agree wtih nursegirl, this is ABSOLUTELY ridiculous. Some physicians have NO shame when it comes to greed and money. I think medicine is "going to hell in a handbasket" myself. I think the days of "quackery" are back. It's changing for the worse.

I'm not a Dr. nor do I work in the medical profession, but I admit I don't understand the rational here. I know that I count on my family physician to act in my best interest wherever possible. I count on him to "prescribe" what might seem like common sense solutions - a healthy diet, excercise, or whatever the case may be. It scares me that we have strayed so far from the conversations we once had with our Dr.'s on how to lead a healthy lifestyle and how to do what was best for our families. I guess those day's are gone. I find it sad. No, I would never consider a feeding tube (unless of course for an actual medical reason). I would turn to the internet for diagnosis and advice first...and that is truly sad, let alone scary.

This a very scary and will lead to many more disorders , which I am sure we are already seeing with this huge emphasis on eating nowadys it has become obsessional and creating large guilt in over weight children .I think emphasis should be on exercise and sports.

Wow.... Thats all I can say x

I am on a feeding tube due to nothing working yet for my gastroparesis. I currently have a NJ tube and I am soon to get a GJ tube, if this last med does not help. They will then look into a gastric pacemaker. I am on tube feeds to sustain my life. I lost over 50 lbs in less than a few months without the tube. I could not move or think clearly because I was so dehydrayted and malnurished. I am able to function a bit with my tube. How I would love to be able to eat. I am hungry and it is so hard not to eat, but in my case it is followed by severe nausea, vomitting, bloating and pain, so it is not worth it. I have met so many others that depend on tube feeding too. It does kind of make me mad that this is being used for vanity when we use it to be able to live. Although they are great, they are a pain too. I have had two sinus infections and a sore throat since having it placed. Did I mention if you throw up with it in, it is scary, as you can throw up the tube through your mouth and it feels as if you are choking(sorry-TMI, but true). If You ever forget that the tube is there, the people staring at you will remind you that you have a tube up your nose. It is not a new thing to help you lose a few pounds, it is a life sustaining blessing for those of us struggling to survive.

And people don't think we need healthcare reform?

Feeding tubes are for a singular purpose, the feeding of patients who cannot accept or tolerate a normal diet.
NOT for fad diets. Not for "slimming programs". Not for entertainment.
Such interventions DO carry their own risks, hence are to be used for valid medical purposes, when all other methods have failed to feed a patient.
If the medical professional community cannot police itself, it CAN AND SHOULD be policed via legislation.
I HATE medical professionals who prostitute their practice!

Do they sedate the person for this period too? What's to stop them from self feeding?

I can understand the desperation around weight loss and the need to look and feel better. I have struggled with weight loss and body image issues for much of my life. The irony is that now I have metastatic breast cancer I see how trivial and meaningless that pursuit is. Health is everything. We shouldn't be so reckless with it.

If anybody has on-going weight or body image issues they should discuss them with a competent health professional.

Wzrad we need Policing ???



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