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Taiz, Yemen – For the past few months, a sharp influx in diabetes patients at Taiz’s Republican Hospital has been driven by one thing: they decided to stop taking their prescribed medication and subsequently fell seriously ill.
“We stabilise them in the emergency room and immediately refer them to specialised doctors within the hospital to provide the necessary care,” Dr Hamza al-Qusais, head of the hospital’s emergency department, told Al Jazeera.
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He explained that the patients were followers of a controversial diet and health philosophy that has taken Yemen and much of the wider Arab world by storm: el-tayebat, the Arabic word for ‘those that are good’.
The diet was popularised by Diaa el-Awadi, a former Egyptian doctor who was struck off by his country’s medical authorities and had two of his health clinics shut down in March. Egypt’s health ministry cited him as a health risk after his opinions on diet and medicine became popular online through his viral social media videos and website.
El-Awadi’s notoriety grew when two months later, after his media appearances were banned in Egypt, he died in the United Arab Emirates of a heart attack, according to the Egyptian foreign ministry.
The news led to the spread of conspiracies – even as Egyptian authorities emphasised that there were no suspicious circumstances surrounding his death – and that has only led to an increase in his popularity – and the number of sick diabetes patients arriving at the hospital in Taiz.
Murad al-Adimi, a 67-year-old construction labourer who has battled diabetes for more than 15 years, is one of them.
He used to take his medication daily until a friend recommended he take a look at el-Awadi and his diet. The former doctor said that diabetes patients didn’t need to take insulin, or their pills, contradicting medical advice. Instead, diabetes sufferers could simply go on his highly -restrictive diet, avoiding foods such as salad greens, citrus fruits, eggs and legumes, and they would eventually be cured.
Murad liked the idea.
“The medicine is expensive, and I was thrilled to hear that simply avoiding certain foods would allow me to stop buying it,” he told Al Jazeera.
One day without his medication quickly turned into 10. Murad felt fine. Overjoyed, he started telling his friends.
Then he fainted.
Medical professionals emphasise that diabetes patients in Yemen are risking their lives by not taking their prescribed medications [Nasser al-Sakkaf/Al Jazeera]‘It was a mistake’
Murad was rushed to the Republican Hospital, where he is now recovering after being treated by doctors. Walking with difficulty, he’s frustrated.
“My happiness was short-lived,” he said. “I saved money on prescriptions, but I was about to lose my life. It was a mistake not to follow my doctor’s instructions.”
“My advice to all diabetes patients is never to stop your medication without consulting your doctor, or you will fall victim to rumours,” he added.
But saving money, even if it is by foregoing medication, is appealing in a country that was already the poorest in the Middle East before the civil war started more than a decade ago.
“Most patients who stop taking their medication are either impoverished individuals who view the diet as an economic reprieve from high prescription costs, or those who lack the health literacy to critically evaluate online claims,” Dr Sadeq Aqlan, a cardiologist at the Republican Hospital, told Al Jazeera. “It is deeply disheartening to see them arrive in such critical states, requiring urgent medical examinations and aggressive therapeutic intervention to stabilise.”
“People are free to follow any diet they prefer, but patients must never discontinue prescribed medications unless explicitly approved by their doctor,” he added.
Eggs are among the foods restricted by Diaa el-Awadi’s diet recommendations, leading to a drop in the price of eggs in Taiz [Nasser al-Sakkaf/Al Jazeera]Restrictive diet
The popularity of el-Awadi and his methods across Yemen and the Arab world continues to frustrate medical professionals, but it perhaps stems in part from the promise of agency, frustration at living with chronic illnesses, medication side effects and impersonal healthcare.
Industrial food practices have also led to a worldwide weakening of trust in the groceries people buy.
But social media in particular has allowed for unverified medical advice to spread – and the dangers are becoming evident.
El-Awadi’s contestation that insulin is “poison” is an example of that. Insulin is a hormone naturally produced by the body that regulates blood glucose – diabetes patients are however not able to produce it or can’t utilise it properly and therefore can’t control their blood sugar. If untreated, it will eventually lead to diabetic ketoacidosis, when the body breaks down fat for energy, leading to the build up of dangerous acids in the body and potential death.
Depending on the type of diabetes they have, patients may need insulin or other glucose-lowering medication to treat the condition, highlighting the dangers of foregoing them on the back of el-Awadi’s advice.
The el-tayebat diet is perhaps less dangerous when it comes to food – even if it restricts foods that are beneficial, such as leafy greens, eggs, many fruits and most dairy products.
The popularity of the diet has already led to the price of foods on the “bad” list to drop sharply.
A tray of eggs in Taiz that once sold for $3.50 has decreased to $1.60. Shopkeeper Nashwan al-Hufa told Al Jazeera that he is only selling a quarter of the amount of eggs he was selling just two months ago and the same goes for whole chickens.
“I am not familiar with this el-tayebat diet people are talking about, but I used to sell around 20 chickens a day,” he said. “Now, I sell five or fewer. People tell me it isn’t healthy food, but I don’t believe it.”
Rafat Abdu Yassin, 39, is a follower of el-tayebat and said it helped him recover from heartburn. But doctors and nutritionists warn that the diet avoids foods that are beneficial to the body [Nasser al-Sakkaf/Al Jazeera]No scientific basis
Rafat Abdu Yassin, 39, said he has battled severe heartburn for more than five years. He explained that doctors had given him medication to treat the condition, but the symptoms always returned once he stopped taking the medication.
He learned about el-tayebat last month and decided to give it a go as he was not taking any medication.
“I felt better after just two days,” Rafat said. “The heartburn completely disappeared and the stomach bloating stopped.”
Yemeni nutritionists such as Maram Fuad are now faced with trying to explain to people like Rafat that el-tayebat may not be the answer to their problems. She said that there were beneficial aspects to the diet, such as fasting. But banning entire food groups is problematic, as followers of the diet will be left with nutritional deficiencies.
“[Those food groups] provide dietary fibres, vitamins, minerals, and proteins.”
Fuad added that there was no scientific basis for dividing foods into “good” and “bad” categories. Instead she emphasised that the regimen was unsustainable and unsafe for both healthy individuals and chronic-disease patients, such as those with diabetes and hypertension.
“Each chronic-disease patient requires an individualised, balanced diet under the direct supervision of a specialist or a nutritionist. The el-tayebat diet simply deprives them of what their bodies fundamentally need,” she added.
The nutritionist went on to explain that correlation does not imply causation, and that some individuals reporting that they felt better after going on the diet did not mean that it was a miracle cure.
“This improvement happens simply because they stopped consuming specific heartburn triggers, not because depriving their bodies of vital nutrients is beneficial,” she said, adding that a professional would typically advise heartburn patients to eliminate common triggers, such as white flour and hydrogenated oils, which would likely lead to similar results, without the excessive deprivation that the el-tayebat diet entailed.
“The core problem is that [some] Yemenis do not consult doctors or nutritionists for appropriate treatment or guidance, instead they chase rumours spreading on social media,” Fuad warned. “Those who currently claim to feel better on this diet will likely face severe health consequences in the near future as their health deteriorates.”
Even with his seemingly positive experience, Rafat is already wary of what may happen if he continues with the diet. He’s worried about the nutrients he’s depriving his body of by restricting himself from so many different foods.
“A doctor recently told me that simply cutting out flour might be enough to eliminate the heartburn while allowing me to still enjoy fruits and vegetables,” he explained. “But I haven’t tried that approach yet.”
