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Diver on Extreme Diet Falls Ill after an Innocuous Dive

Ambiguous DCS symptoms appear in a diver on an extreme low-calorie diet and hCG hormone.After completing my dive, I came out of the water, removed my equipment and ran to the bathroom. When I returned, my legs and right arm felt weird. I told my buddy, and she asked if I had eaten. I told her no, so she gave me some cheese-flavored crackers. My condition improved, and I could feel my arm and legs again.

The dive shop staff performed a five-minute neurological exam and did not find any abnormalities. . As I was taking care of my diving equipment, I started to feel sick again. I got a headache and felt nauseous. It kept getting worse, so one of the divers gave me an oxygen bottle to breathe off of. After a while with no improvement, someone called 911.

An ambulance transported me to the hospital, and I was on oxygen the whole time. After lots of blood samples and tests, it was determined that I was ok. My symptoms started to go away, and I was able to leave the hospital. The ER doctor said I had a mild DCS (decompression sickness) hit that had resolved, but I should return to the ER if symptoms reappeared.

Here is the profile of my dive:
I have recently lost some weight (I'm currently 62 inches tall and weigh 145 pounds) and have not used my drysuit since. I have been certified for five years and have completed 170 dives. The symptoms that this diver experienced retrospectively may be classified only as ambiguous. A "weird" feeling in the legs and arms could have been a manifestation of DCS, but the transitory nature and absence of obvious neurological signs cast some doubts. The headache alone does not make a diagnosis of DCS or arterial gas embolism (AGE).

Due to the combination of both symptoms, the decompression illness (DCI) was properly considered, and the diver was evacuated to the hospital. The professional medical evaluation did not find any objective sign of DCI. The symptoms improved with receiving intravenous fluids and breathing oxygen at surface. Recompression treatment was not necessary. The diagnosis remains ambiguous: possible mild but not definitive DCI. The depth-time profile the dive computer recorded shows no excesses.

Further review of possible contributing factors brought to our attention the fact that this diver recently lost a lot of weight. The weight of 146 pounds for the body height of 62 inches seemed quite normal (BMI 26.7). Asking for more details, we got this answer:

"I started losing weight more than a year ago. My weight at that time was 196 pounds (BMI = 35.8; obese). My diet consisted of some vegan food, and I somewhat followed the Weight Watchers program. While I was dieting I wanted to start running, so I was training for a local 5k. I am not sure exactly when I started running, but I've continued; until this incident I was running two or three times a week up to 3 miles a day. I was able to maintain the 40 pounds I had lost for some time, and then started a new diet that my parents had great success with through Metabolic Research Clinic. This diet included HCG and a low-calorie diet. I currently weigh 145 pounds. Fortunately, my weight loss was intentional and not from disease. I should mention that I continued to dive avidly all year and have had no other problems. In addition, my parents were on the Metabolic Research Clinic diet plan most of the year, and they continued to dive as well., even taking a few dive vacations (more than 20 dives in a week) without issue. My father is a cave and wreck diver; he did several deco dives this year without issue."

HCG is human chorionic gonadotropin (hCG), a hormone that bodies of pregnant women produce in pregnancy. It is marketed by supplement manufacturers for weight loss. This diet limits you to 500 calories a day for eight weeks while taking hCG, either by injection or by oral drops, pellets or sprays sold over the counter. The U.S. Food and Drug Administration (FDA) has not approved any of this for weight loss. The shots are approved to treat fertility issues, but over-the-counter hCG products are not. The FDA has sent warning letters to several companies that market homeopathic hCG products.

If you limit your food intake to 500 calories per day, you will lose weight, but hCg has nothing to do with it. However, living on just 500 calories a day is dangerous. The lowest recommended caloric intake per day is 1,200 calories for women and 1,500 for men, according to the National Institutes of Health. Restricting calories beyond those limits should only be done under doctor supervision because of the health risks.

More than a dozen clinical trials have failed to support a role for hCG in weight loss. Listen to the comments of Pieter Cohen of Harvard Medical School.
"The hCG diet is not only a silly fad diet," he said, "but it's also a dangerous one."

Diving while on an extreme diet is dangerous. Diving while on an extreme low-calorie diet and hCG may be even more dangerous. The fact that this diver and her parents dived many times without consequence should not provide the peace of mind to them or to other divers. Such a practice is an ill-advised experiment that will yield no usable knowledge but may cause some casualties.

— Dr. Petar J. Denoble, MD. D.Sc.


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