Beware the fad diet online! It could be killing you

Umesh Anand

A tall and strapping man since his youth, nothing about CB was even remotely frail — not until recently when a stringent diet meant to bring his diabetes under control reduced him to skin and bones in a matter of months.

The diet made him obsessive about his food, sent his digestive system out of whack and so shook his self-confidence that he has had to turn to a psychiatrist to deal with his anxieties. He has been reduced to a shadow of his former self.

“All your organs are in shock because of the way you have starved your body,” a doctor he finally turned to said. “You have to give them a chance to recover.”

As CB strives to restore his body’s balance, he is sheepish about how his world has turned upside down because of his own choice of a regimen on the internet without direct in-person medical supervision.

It was a Facebook post by an acquaintance that prompted CB’s decision to go on the diet, which finally cost him dearly in terms of his health. He opted for it on impulse.

Hooked by the diet’s immediate results in the first few weeks, which were a dramatic loss of weight and a decline in his blood sugar levels, he was not willing to listen to words of caution from anyone.

He even fobbed off a friend who surfaced and narrated her own experience of being on the diet and ending up in an intensive care unit. “I thought hers was a one-off case,” says CB.

But his resolute adherence to the diet lasted only until he found his own body packing up. By then he had spent three months on the diet.

What he regarded as gains were misleading. In reality, much damage had been done.

CB is 65. He was diagnosed as being diabetic at the age of 54. For most of the 11 years in between, life went on pretty much normally.

There was some medication, regular moderate exercise and the usual dietary controls. He was cheerfully non-vegetarian in his choices and didn’t shy away from the evening drink or two.

But then came the pandemic, which meant he began eating and drinking a lot more than the calories he was expending in his daily activities because he was cooped up at home in his flat in Bengaluru. He was accustomed to a daily brisk walk in the compound of his apartment complex, but gave that up as well for fear of getting infected by other walkers or catching the virus in the lift.

Once the pandemic finally eased, he decided to go in for a health check-up at a hospital and found his blood sugar levels had risen worryingly. His weight and BMI had gone up too. His blood pressure was steady, because of the medication he was on, but the extra weight and higher blood sugar were cause for concern. 

While heading home from the hospital, he saw on his phone the Facebook post extolling the benefits of the diet. Instead of going to his general physician for advice, CB plunged into the diet programme. It was in keeping with his personality of being a quick decision-maker.

In accordance with the stipulations of the diet, he went vegan overnight. No meats, no dairy, no grains, no alcohol, nothing sweet. He was only permitted millets and quinoa, vegetables and smoothies made from an amalgam of healthy green leaves.

After meals, even as frugal as these, he found himself climbing up and down stairs as suggested by the managers of the diet programme.

 

SHEDDING WEIGHT

In barely a week, CB’s blood sugar levels came down to normal. He shed weight and his clothes began hanging on him. In two months, he went from 86 kg to 73 kg. His BMI fell from 26 to 21. He is six feet tall.

CB was overjoyed. He congratulated himself on making a brilliant choice and transforming his life. Pockets of fat he had struggled to get rid of for years he could now see melting away. His sugar stayed down, which was like salvation from diabetes.

“I became obsessive about my food. Just how obsessive, let me describe to you. When my wife and I went to Kolkata for a break, we stayed at Tollygunge Club. Before leaving Bengaluru, I hunted on the internet for restaurants from where I could source a vegan meal,” says CB.

“I finally found that Peerless Inn in Kolkata could provide vegan food. So, while we stayed at the Tolly, my meals came from Peerless Inn. I also persuaded the Tolly’s chefs to cook millets and quinoa for me. Those were the extremes to which I was going,” recalls CB with a shudder.

But his enthusiasm for the diet was soon to be dented. He began noticing a lack of balance in his system. He felt his body was wasting away. Instead of a sense of well-being he began feeling stressed and anxious. He felt concerned when his BMI went below 21.

He began having gastrointestinal problems. His bowel movements changed and he went to the toilet multiple times a day. Such was the frequency that he even stopped meeting people for fear of having to rush to the toilet in between conversations. In addition, he suffered from flatulence, which once again deterred him from making appointments. He didn’t want to embarrass himself.

“When I sought a change in diet and pleaded that a one-size-fits-all approach was perhaps not suiting me, the dietician given to me under the programme refused to listen,” says CB.

After repeated requests the dietician was changed, but to no great benefit. All of CB’s interactions were over the internet. He never once met his caregivers and there was no physical exam to better understand what he was experiencing.

Finally, he asked to speak to the physician who had created the programme — the founder. He never got to meet him.

“Feeling abandoned, I went back to my general physician, who connected me with a dietician and a diabetologist. Among other things, they told me my gut flora had probably got rearranged. My GP also sent me to a psychiatrist, who after a long consultation gave me medicines to calm me. The medicines have helped and there are fewer trips to the toilet,” says CB.

He has begun adding rice and wheat and small portions of fish and chicken to his meals. The occasional evening drink is back. He feels more cheerful.

He is also going to the gym to bring back some muscle mass and improve his metabolism. His blood sugar levels have stayed down thus far, but there is no certainty that they will continue to be so.

 

LIKE PONZI SCHEMES?

The internet is flooded with personal health programmes offering miraculous solutions to metabolic disorders such as diabetes or promising weight loss and muscle gain.

As with Ponzi schemes that promise unbelievable financial gains, these diet and exercise programmes raise expectations of results in very short periods of time.

There is no record of the number of people who drop out dissatisfied with the programme or, worse still, fall ill as in the case of CB or his acquaintance who ended up in intensive care.

Their hard-luck stories never get told. Instead, testimonials of people who say they have benefitted are propagated prominently. In the absence of public scrutiny or third-party verification it is difficult to put the testimonials in context.

People demur from calling out such programmes for fear of reprisals. So they stay silent and move on. Despite being prodded several times, CB refuses to name the doctor and the programme that has messed up his health. He would, however, like his story to be told.

Advertised on the internet, a diet programme can reach millions of inboxes and even if a small percentage of people sign up, there are windfall profits to be made. CB signed up by paying `36,000. If 10,000 people like him joined, `36 crore would be made.

What prompts educated and socially empowered individuals to act so gullibly? CB, after all, is a former banker and currently runs his own consultancy. Why wasn’t he more circumspect?

It perhaps has something to do with the way choices are made on the internet in a fast-moving world. Everything happens so quickly and recommendations fly thick and fast. Social media tends to amplify benefits and testimonials in a style that they seem undeniably true.

CB got introduced to the programme on the day he went to the hospital for his check-up for the first time after the easing of the pandemic. He left the hospital with his head full of disquieting news about his health. As he headed home in the back seat of his car, chauffeur-driven, he saw the Facebook post extolling the virtues of the diet plan.

It was one of those coincidences in a networked world that the message should have reached him when he was most vulnerable.

What followed was a willing suspension of disbelief. No further click bait was needed for CB to follow a link and arrive at a page which promised freedom from diabetes through severe changes in diet. He never once thought of getting back to his general physician to double check.

 

A BALANCED DIET

What kind of diet should be given to a diabetic? CB was put on a spartan vegan diet which was devoid of meat and dairy and extremely low on carbohydrates. In one stroke, he was denied the foods his body was accustomed to.

A medically proven diabetes diet, on the contrary, is well-balanced. It includes carbohydrates, proteins and fats. It restricts calories consumed in a day. But it isn’t too low-calorie either. For instance, an average Indian diet tends to consist of 65 percent carbohydrates. For a person developing diabetes, this would be restricted to 55 percent. The protein intake of Indians is low at 10 percent. A balanced diet could seek to raise this to 15 percent. Fat usually accounts for 30 percent of what Indians eat. There should be fat, but a good diet would  typically reduce saturated fats to 10 percent of the 30 percent.

So, everything in a normal diet would remain. It is just the composition and the quanties that would to make meals halthier and bring down the number of calories consumed.

“For the past 40 years, in treating diabetes, the diet has been calorie restrictive, which means overall low calories, but not too low, and with balanced macronutrients and foodstuff. This is the diet for diabetes. There’s nothing great about it. There is no diabetic diet as such that you have to cook something else for a diabetic patient. Everybody can eat the same diet,” says Dr Anoop Misra.

Dr Misra is a diabetologist of high standing who is chairman of the Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology in Delhi.

Asked if he has ever removed a basic food from the diet of a patient, he says: “I have never taken away something and put it at zero. People go for the gluten-free diet, people go for a dairy-free diet. I never have unless the patient is gluten-sensitive or has some allergy to milk.”

“On the other hand, if you want to make carbohydrates more complex,
you can by adding besan or bajra. That’s fine. We do it all the time. In this way, we are changing quality, but we are not putting it at zero. I never take away
rice, but I change it to brown rice if possible. And, similarly, I say eat potato, but take a small amount of potato with plenty of vegetables. So I mix and match several nutrients,” Dr Misra explains.

Treating a diabetic patient involves finding a new balance for the body from which also derives weight loss. For instance, if a diabetic is consuming 1,600 calories a day, a diet could reduce that by 200 calories to 1,400. An hour of walking could mean another 300 calories consumed. Together that would mean a reduction of 500 calories in a day. Such a regimen could hope to achieve a reduction of one kg in body weight over 15 days.

The ketogenic diet, which has been a fad globally, does away with carbohydrates and replaces them with protein and fat. It brings down body weight rapidly in a few months. So also with intermittent fasting in which people don’t eat for 14 hours or more.

The consequences of such low-calorie diets have not been adequately studied. Their impact on the body in the long term is not known. In the short term, they invariably lead to nutritional deficiencies which cause imbalances in the body.

A rise in ketones, as induced by the ketogenic diet, could be good for weight loss in the short term, but results in raising cholesterol levels and putting pressure on the heart.

A recent study that compares people on intermittent fasting and others on a balanced but calorie-controlled diet shows that there was no real difference in the outcomes.

Another direct study done in Britain found that diabetes reversal was possible through a diet of 800 to 1,000 calories which resulted in a loss of 10 to 15 kg. But this was for a sample that consisted of people who had not been diabetic for more than five years, were not on insulin or too many other medications and had no complications from other diseases. It remains to be seen if they become diabetic again over the years.

While going on a diet, how important is the advice of a doctor who knows your case well? Dr Misra says he advises weight-loss diets for only 10 to 15 percent of the patients he sees. These are patients who have recently become diabetic, are obese and do not have liver, kidney or heart problems. In the case of a 65-year-old, he would move extremely cautiously. Diabetes reversal through rigorous dieting alone doesn’t happen in people who have had the disease for a decade.

Clearly, there is more to being on a diet than signing up for a programme on the internet. If, like CB, you are 65, have been diabetic for a decade and also have hypertension you are perhaps better off being in the care of a physician who knows you well and knows to deal with diabetes beyond fad diets.