The Feeding Tube Diet

Seth Roberts

In The Shangri-La Diet I noted that hospital patients given intravenous feeding often lose a lot of weight without hunger. I said this supported my theory that the body fat set point is raised by the smell of food. Without smell, the set point goes down. When your set point goes down you lose weight without becoming hungry.

You should be able achieve the same effect by nose-clipping all your food. A new diet, however, makes smell avoidance considerably more difficult and expensive.

The K-E diet, which boasts promises of shedding 20 pounds in 10 days, is an increasingly popular alternative to ordinary calorie-counting programs. The program has dieters inserting a feeding tube into their nose that runs to the stomach. They’re fed a constant slow drip of protein and fat, mixed with water, which contains zero carbohydrates and totals 800 calories a day. Body fat is burned off through a process called ketosis, which leaves muscle intact, Dr. Oliver Di Pietro of Bay Harbor Islands, Fla., said.

It is a hunger-free, effective way of dieting,” Di Pietro said. “Within a few hours and your hunger and appetite go away completely, so patients are actually not hungry at all for the whole 10 days. That’s what is so amazing about this diet.”

Di Pietro says patients are under a doctor’s supervision, although they’re not hospitalized during the dieting process. Instead, they carry the food solution with them, in a bag, like a purse, keeping the tube in their nose for 10 days straight. . . .

Schnaider said she was never hungry throughout the 10 days she was on the K-E diet, but admits that it still wasn’t easy. “It was emotionally difficult, the 10 days of not eating,” Schnaider said. . . . Although the K-E diet is new to the United States, it has been around for years in Europe. Dr. Di Pietro charges $1,500 for the 10-day plan, and says the before-and-after pictures sell themselves.

I sympathize with the “emotionally difficult.” When I lost 30 pounds in 3 months drinking sugar water, I ate maybe 50% of my usual calorie intake. I was never hungry and that too was bad. The world seemed drab without hunger.

Thanks to Tom George.

18 thoughts on “The Feeding Tube Diet”

  1. You can lose a lot of weight quickly without a feeding tube if you cut out all carbs like they do in this diet. When you stop eating carbohydrates, your body will start burning Glycogen for energy. With every molecule of Glycogen you lose four molecules of water — depleting Glycogen stores can, by itself, add up to a 5 kg “weight loss” in which NO FAT AT ALL has been burned.
    Since the health effects of weight loss are mediated by fat loss and not water loss, this isn’t a diet for people who are interested in health. As far as I’ve seen, they aren’t marketing it as such either (which I admire them for), but rather market it toward people who just want the illusion of being slim and healthy, for example for a photo shoot or a wedding.
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  2. @Adam,
    I agree. Although, in general, I do think that losing “water weight” has greater than zero value. If a relatively obese person ends up losing 5 or 10 or 20 pounds of water weight (not necessarily with the above described diet), I think that could add to their quality of life, mobility, self esteem, and ability to be active and continue the process of becoming healthful. So, IMO, while losing fat would have greater benefits, losing water weight would have some health benefit as well (in addition to the aesthetic benefits that you point out).
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  3. Dr. Roberts- would you ever think of setting up a SLD Clinic? Basically a formal way to try to get into the habit? Or some sort of community App where people could start it with thier friends, virtual or real?

    Seth: Thanks for the suggestion. Yeah, I would consider setting up a SLD Clinic. I’ll mull it over. As for “community app” the Shangri-La Diet forumsare sort of like that.
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  4. @Adam, I disagree. The K-E solution could be changed to include 25% carbs (and 15% protein and 60% fats) , and so long as the client perceived no flavor, it would be as effective for weight loss as is the current solution. If this does not make sense, read Seth’s paper about the science of the Shangri-La Diet.
    @Seth, I wonder if the perceived “emotional difficulty” of flavorless dieting is due to the high quantity of “pleasure mental objects” we moderns have become accustomed to experiencing due to flavored foods. (I am using Cabanac’s concepts as he argues in his Fifth Influence book.) If that quantity is removed, then either we feel deprived of pleasure, or we need to adjust our senses and behavior to obtain a replacement quantity of pleasurable mental objects from other sources.
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  6. @Kirk, I’m not 100% convinced that the Shangri-La Diet works for the reasons Seth thinks it does. The only way to find out for sure would be to give it a go. I wonder if they trialed using other combinations of macronutrients… if so, why did they settle on the combo that they use if it isn’t the most efficient? Also, 25% of 800 calories would still be only 50 grams of carbohydrate, which would still be sufficient to put many people into ketosis. Where is the paper about the science of the Shangri-La Diet? Maybe I can convince myself. Thanks for your feedback.

    Seth: Here is the paper (“What makes food fattening? A Pavlovian theory of weight control”) about the science of the Shangri-La Diet:

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  7. I’ve seen papers that support and papers that refute the set point hypothesis. So I think the jury is still out. It seems fairly certain to me that the brain is in the loop on energy regulation in non-simple ways.
    So maybe this model (feeding people through a nasal tube) is a way to disentangle some of the variables. It cuts out of the major hard-to-control variables (the nasal and tongue receptors signaling things to the brain as you eat). It’s a simple matter to vary the macronutrient ratios without the test subject being aware of what they’re being fed. This makes control subjects better controls as well. It’s hard to be a good control if you know you’re a control.
    In electronics (I’m an EE) when you have a circuit loop that is misbehaving, the way to understand it is to break the loop so you can observe the in-out behavior of the individual parts of the loop. Find the broken bit, reattach the loop and see if it works. In a system with multiple interacting feedback loops (as with human diet), understanding it by observing the dynamic behavior is a futile approach.
    So if there are methods like this that help break the loops, researchers should jump on them and do all sorts of experiments.
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  8. @David,
    Can you provide links to some of the papers which argue against the set point? It has become a new hobby of mine to read about set points. I have seen some of the more knowledgeable bloggers in the Paleo Nutrition sphere argue against a ponderostat, but they never provide links to scientific papers, nor due they explain how scientists such as Cabanac designed incorrect experiments or misunderstood the results.
    Bonus points if the papers aren’t hidden behind a paywall!
    Seth: Yeah. And those who don’t believe in a set point or ponderostat have yet to discover new ways of losing weight. In contrast to Cabanac and me. A serious problem with their position that they don’t seem to understand.
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  9. Seth,
    you might like the flavour of this abstract . I like C elegans for a number of reasons.
    Feeding behaviour is modulated by both environmental cues and internal physiological states. Appetite is commonly boosted by the pleasant smell (or appearance) of food and destroyed by a bad taste. In reality, animals sense multiple environmental cues at the same time and it is not clear how these sensory inputs are integrated and a decision is made to regulate feeding behaviour accordingly. Here we show that feeding behaviour in Caenorhabditis elegans can be either facilitated by attractive odours or suppressed by repellents. By identifying mutants that are defective for sensory-mediated feeding regulation, we dissected a central flip-flop circuit that integrates two contradictory sensory inputs and generates bistable hormone output to regulate feeding behaviour. As feeding regulation is fundamental to animal survival, we speculate that the basic organizational logic identified here in C. elegans is likely convergent throughout different phyla.
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  11. Kirk,
    Hyperlipid first pointed me to some anti set point papers. I’ll go and dig them up. I didn’t keep records. This web site pointed me to the supporting papers I’ve seen.
    Personally I can see why SPT is convincing. My own personal experience is of set-point like behavior. 245Lbs by for years. High fat, Low carb got me down to 215, but no further. I’ve been at this weight for a year and now I can ‘eat badly’ and stay pretty much at 215. It sure looks like a set point. But stable feedback states can look like a set point when it is stable state is actually sensitive to other inputs that aren’t being exercised.
    I’m about to give Shangri-La a go. My goals are more to do with my waistline that in doing science.
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  12. Kirk,
    I started here: https://high-fat-nutrition.blogspot.com/2011/10/adipostat-ballon.html.
    Which points here: https://www.ncbi.nlm.nih.gov/pubmed/14500570
    and here: https://www.ncbi.nlm.nih.gov/pubmed/19190032
    Peter’s article argues that these two papers give evidence to argue against set point theory. I don’t see it myself, but then I’m not nearly as smart as Peter.
    Stephan Guyenet wrote about Cabanac here https://wholehealthsource.blogspot.com/2011/08/food-palatability-and-body-fatness.htmland links to the original papers.
    There were at least two other papers I didn’t find. I got them by searching pubmed. What is see is the antis saying the mechanisms aren’t set point like and the pros saying but it looks like a set point when we try it. Mechanism vs Effect. Apples aren’t being compared with apples.
    Seth: In his comment at the end, Stephen Guyenet says “this supports the hypothesis that there is a body weight setpoint.” True. What Stephen doesn’t say, and what is the essence of Cabanac’s contribution, is that Cabanac showed you can use the setpoint idea to find powerful new experimental effects. The setpoint idea itself is ancient — from the 1950s. I took the setpoint idea even further: I used it to find new ways of losing weight that work in the real world. I think ideas are ultimately judged by what they can do for us, not by whether they are “true”, whatever that means.
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  13. @David,
    Thanks for the links. I have to admit, I don’t understand much of anything written at Hyperlipid. My guess is that the author at Hyperlipid believes the cause of excess weight is malfunctioning mitochondria (which is almost a good enough phrase for a band name). As for the abstracts, the first abstract uses the word ‘suggests’ several times, which indicates to me that they wade deep in speculation. The second abstract proposes a model based upon a review of the literature; alas, models by definition are speculation. I find it interesting that the abstract says, ‘Adiposity is known to be carefully regulated’, given that regulation is exactly Cabanac’s argument.
    My hunch is that the people who oppose the concept of a ponderostat do so because they have their own favorite hunch as to THE Cause of Obesity and a ponderostat does not fit their theory.
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  14. I’m curious being on the seth diet I’ll call it, is the nose clipping part of life for good? Or just for the few months it takes to lose weight?
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  16. Seth wrote:
    > … Yeah, I would consider setting up a SLD Clinic. …
    I can imagine:
    “Welcome to the Shangri-La Clinic! Please sit here for an hour.”
    (Hour passes.)
    “Now pinch your nose shut and drink this oil…. Good! Now sit here for another hour.”
    (Hour passes.)
    “That’s great! You can go home now. Come back tomorrow!”
    ????
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  17. Why stop at a feeding tube? Why not walk around with an IV? Maybe hook up electrodes to your head to shock your brain whenever you think of food? Hey, self lipo-surgery sounds good too.
    Seems what people really need is a little discipline and common sense.
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  18. what’s the ideal ratio of water and sugar for drinking sugar water? I purchased the book but it didn’t cover much on the sugar water method so I’d appreciate it if someone can clarify for me! Thanks.
    Reply

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