Apr 25, 2012
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.