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Pounds & Inches
A NEW APPROACH TO OBESITY
BY: A.T.W. SIMEONS, M.D.
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 -
VIALE MURA GIANICOLENSI, 77
SEVENTH EDITION
1971
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ALL RIGHTS RESERVED
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PRINTED IN ITALY
Arti Grafiche Scalia -
FOREWORD
This book discusses a new interpretation of the nature of obesity, and while it does not advocate yet another fancy slimming diet it does describe a method of treatment which has grown out of theoretical considerations based on clinical observation.
What I have to say is an essence of views distilled out of forty years of grappling with the fundamental problems of obesity, its causes, its symptoms, and its very nature. In these many years of specialized work, thousands of cases have passed through my hands and were carefully studied. Every new theory, every new method, every promising lead was considered, experimentally screened and critically evaluated as soon as it became known. But invariably the results were disappointing and lacking in uniformity.
I felt that we were merely nibbling at the fringe of a great problem, as, indeed, do most serious students of overweight. We have grown pretty sure that the tendency to accumulate abnormal fat is a very definite metabolic disorder, much as is, for instance, diabetes. Yet the localization and the nature of this disorder remained a mystery. Every new approach seemed to lead into a blind alley, and though patients were told that they are fat because they eat too much, we believed that this is neither the whole truth nor the last word in the matter.
Refusing to be side-
To me this requirement seems basic, and it has always been the center of my interest.
In dealing with obese patients it became a habit to register and order every clinical
experience as if it were an odd looking piece of a jig-
With mounting experience more and more facts seemed to fit snugly into the new framework, and when then a treatment based on such speculations showed consistently satisfactory results, I was sure that some practical advance had been made, regardless of whether the theoretical interpretation of these results is correct or not.
The clinical results of the new treatment have been published in scientific journal * and these reports have been generally well received by the profession, but the very nature of a scientific article does not permit the full presentation of new theoretical concepts nor is there room to discuss the finer points of technique and the reasons for observing them.
During the 16 years that have elapsed since I first published my findings, I have had many hundreds of inquiries from research institutes, doctors and patients. Hitherto I could only refer those interested to my scientific papers, though I realized that these did not contain sufficient information to enable doctors to conduct the new treatment satisfactorily. Those who tried were obliged to gain their own experience through the many trials and errors which I have long since overcome.
Doctors from all over the world have come to Italy to study the method, first hand in my clinic in the Salvator Mundi International Hospital in Rome. For some of them the time they could spare has been too short to get a full grasp of the technique, and in any case the number of those whom I have been able to meet personally is small compared with the many requests for further detailed information which keep coming in. I have tried to keep up with these demands by correspondence, but the volume of this work has become unmanageable and that is one excuse for writing this book.
In dealing with a disorder in which the patient must take an active part in the treatment,
it is, I believe, essential that he or she have an understanding of what is being
done and why. Only then can there be intelligent cooperation between physician and
patient. In order to avoid writing two books, one for the physician and another for
the patient -
To make the text more readable I shall be unashamedly authoritative and avoid all
the hedging and tentativeness with which it is customary to express new scientific
concepts grown out of clinical experience and not as yet confirmed by clear-
_____
*A list of references to the more important articles is given at the end of this booklet
THE NATURE OF OBESITY
Obesity a Disorder
As a basis for our discussion we postulate that obesity in all its many forms is due to an abnormal functioning of some part of the body and that every ounce of abnormally accumulated fat is always the result of the same disorder of certain regulatory mechanisms. Persons suffering from this particular disorder will get fat regardless of whether they eat excessively, normally or less than normal. A person who is free of the disorder will never get fat, even if he frequently overeats.
Those in whom the disorder is severe will accumulate fat very rapidly, those in whom
it is moderate will gradually increase in weight and those in whom it is mild may
be able to keep their excess weight stationary for long periods. In all these cases
a loss of weight brought about by dieting, treatments with thyroid, appetite-
While there are great variations in the severity of obesity, we shall consider all the different forms in both sexes and at all ages as always being due to the same disorder. Variations in form would then be partly a matter of degree, partly an inherited bodily constitution and partly the result of a secondary involvement of endocrine glands such as the pituitary, the thyroid, the adrenals or the sex glands. On the other hand, we postulate that no deficiency of any of these glands can ever directly produce the common disorder known as obesity.
If this reasoning is correct, it follows that a treatment aimed at curing the disorder must be equally effective in both sexes, at all ages and in all forms of obesity. Unless this is so, we are entitled to harbor grave doubts as to whether a given treatment corrects the underlying disorder. Moreover, any claim that the disorder has been corrected must be substantiated by the ability of the patient to eat normally of any food he pleases without regaining abnormal fat after treatment. Only if these conditions are fulfilled can we legitimately speak of curing obesity rather than of reducing weight.
Our problem thus presents itself as an enquiry into the localization and the nature of the disorder which leads to obesity. The history of this enquiry is a long series of high hopes and bitter disappointments.
The History of Obesity
There was a time, not so long ago, when obesity was considered a sign of health and
prosperity in man and of beauty, amorousness and fecundity in women. This attitude
probably dates back to Neolithic times, about 8000 years ago; when for the first
time in the history of culture, man began to own property, domestic animals, arable
land, houses, pottery and metal tools. Before that, with the possible exception
of some races such as the Hottentots, obesity was almost non-
Today obesity is extremely common among all civilized races, because a disposition
to the disorder can be inherited. Wherever abnormal fat was regarded as an asset,
sexual selection tended to propagate the trait. It is only in very recent times
that manifest obesity has lost some of its allure, though the cult of the outsize
bust -
The Significance of Regular Meals
In the early Neolithic times another change took place which may well account for
the fact that today nearly all inherited dispositions sooner or later develop into
manifest obesity. This change was the institution of regular meals. In pre-
The whole structure of man's omnivorous digestive tract is, like that of an ape, rat or pig, adjusted to the continual nibbling of tidbits. It is not suited to occasional gorging as is, for instance, the intestine of the carnivorous cat family. Thus the institution of regular meals, particularly of food rendered rapidly assimilable, placed a great burden on modern man's ability to cope with large quantities of food suddenly pouring into his system from the intestinal tract.
The institution of regular meals meant that man had to eat more than his body required at the moment of eating so as to tide him over until the next meal. Food rendered easily digestible suddenly flooded his body with nourishment of which he was in no need at the moment. Somehow, somewhere this surplus had to be stored.
Three Kinds of Fat
In the human body we can distinguish three kinds of fat. The first is the structural fat which fills the gaps between various organs, a sort of packing material. Structural fat also performs such important functions as bedding the kidneys in soft elastic tissue, protecting the coronary arteries and keeping the skin smooth and taut. It also provides the springy cushion of hard fat under the bones of the feet, without which we would be unable to walk.
The second type of fat is a normal reserve of fuel upon which the body can freely draw when the nutritional income from the intestinal tract is insufficient to meet the demand. Such normal reserves are localized all over the body. Fat is a substance which packs the highest caloric value into the smallest space so that normal reserves of fuel for muscular activity and the maintenance of body temperature can be most economically stored in this form. Both these types of fat, structural and reserve, are normal, and even if the body stocks them to capacity this can never be called obesity.
But there is a third type of fat which is entirely abnormal. It is the accumulation of such fat, and of such fat only, from which the overweight patient suffers. This abnormal fat is also a potential reserve of fuel, but unlike the normal reserves it is not available to the body in a nutritional emergency. It is, so to speak, locked away in a fixed deposit and is not kept in a current account, as are the normal reserves.
When an obese patient tries to reduce by starving himself, he will first lose his normal fat reserves. When these are exhausted he begins to burn up structural fat, and only as a last resort will the body yield its abnormal reserves, though by that time the patient usually feels so weak and hungry that the diet is abandoned. It is just for this reason that obese patients complain that when they diet they lose the wrong fat. They feel famished and tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper arms show little improvement. The fat they have come to detest stays on and the fat they need to cover their bones gets less and less. Their skin wrinkles and they look old and miserable. And that is one of the most frustrating and depressing experiences a human being can have.
Injustice to the Obese
When then obese patients are accused of cheating, gluttony, lack of will power, greed
and sexual complexes, the strong become indignant and decide that modern medicine
is a fraud and its representatives fools, while the weak just give up the struggle
in despair. In either case the result is the same: a further gain in weight, resignation
to an abominable fate and the resolution at least to live tolerably the short span
allotted to them -
Obese patients only feel physically well as long as they are stationary or gaining weight. They may feel guilty, owing to the lethargy and indolence always associated with obesity. They may feel ashamed of what they have been led to believe is a lack of control. They may feel horrified by the appearance of their nude body and the tightness of their clothes. But they have a primitive feeling of animal content which turns to misery and suffering as soon as they make a resolute attempt to reduce. For this there are sound reasons.
In the first place, more caloric energy is required to keep a large body at a certain temperature than to heat a small body. Secondly the muscular effort of moving a heavy body is greater than in the case of a light body. The muscular effort consumes Calories which must be provided by food. Thus, all other factors being equal, a fat person requires more food than a lean one. One might therefore reason that if a fat person eats only the additional food his body requires he should be able to keep his weight stationary. Yet every physician who has studied obese patients under rigorously controlled conditions knows that this is not true. Many obese patients actually gain weight on a diet which is calorically deficient for their basic needs. There must thus be some other mechanism at work.
Glandular Theories
At one time it was thought that this mechanism might be concerned with the sex glands.
Such a connection was suggested by the fact that many juvenile obese patients show
an under-
The Thyroid Gland
When it was discovered that the thyroid gland controls the rate at which body-
While the majority of obese patients have a perfectly normal thyroid gland and some
even have an overactive thyroid, one also occasionally sees a case with a real thyroid
deficiency. In such cases, treatment with thyroid brings about a small loss of weight,
but this is not due to the loss of any abnormal fat. It is entirely the result of
the elimination of a mucoid substance, called myxedema, which the body accumulates
when there is a marked primary thyroid deficiency. Moreover, patients suffering
only from a severe lack of thyroid hormone never become obese in the true sense.
Possibly also the observation that normal persons -
The Pituitary Gland
The next gland to be falsely incriminated was the anterior lobe of the pituitary
or hypophysis. This most important gland lies well protected in a bony capsule at
the base of the skull. It has a vast number of functions in the body, among which
is the regulation of all the other important endocrine glands. The fact that various
signs of anterior pituitary deficiency are often associated with obesity raised the
hope that the seat of the disorder might be in this gland. But although a large
number of pituitary hormones have been isolated and many extracts of the gland prepared,
not a single one or any combination of such factors proved to be of any value in
the treatment of obesity. Quite recently, however, a fat-
The Adrenals
Recently, a long series of brilliant discoveries concerning the working of the adrenal
or suprarenal glands, small bodies which sit atop the kidneys, have created tremendous
interest. This interest also turned to the problem of obesity when it was discovered
that a condition which in some respects resembles a severe case of obesity -
When we learned that an abnormal stimulation of the adrenal cortex could produce signs that resemble true obesity, this knowledge furnished no practical means of treating obesity by decreasing the activity of the adrenal cortex. There is no evidence to suggest that in obesity there is any excess of adrenocortical activity; in fact, all the evidence points to the contrary. There seems to be rather a lack of adrenocortical function and a decrease in the secretion of ACTH from the anterior pituitary lobe. *
So here again our search for the mechanism which produces obesity led us into a blind alley. Recently, many students of obesity have reverted to the nihilistic attitude that obesity is caused simply by overeating and that it can only be cured by under eating.
The Diencephalon or Hypothalamus
For those of us who refused to be discouraged there remained one slight hope. Buried
deep down in the massive human brain there is a part which we have in common with
all vertebrate animals, the so-
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* There is some clinical evidence to suggest that those symptoms of Cushing’s Syndrome which resemble true obesity are caused by the same mechanism which causes common obesity, while the other symptoms of the syndrome are directly due to adrenocortical dysfunction.
It was therefore not unreasonable to suppose that the complex operation of storing
and issuing fuel to the body might also be controlled by the diencephalon. It has
long been known that the content of sugar -
The Fat-
Assuming that in man such a center controlling the movement of fat does exist, its function would have to be much like that of a bank. When the body assimilates from the intestinal tract more fuel than it needs at the moment, this surplus is deposited in what may be compared with a current account. Out of this account it can always be withdrawn as required. All normal fat reserves are in such a current account, and it is probable that a diencephalic center manages the deposits and withdrawals.
When now, for reasons which will be discussed later, the deposits grow rapidly while
small withdrawals become more frequent, a point may be reached which goes beyond
the diencephalon's banking capacity. Just as a banker might suggest to a wealthy
client that instead of accumulating a large and unmanageable current account he should
invest his surplus capital, the body appears to establish a fixed deposit into which
all surplus funds go but from which they can no longer be withdrawn by the procedure
used in a current account. In this way the diencephalic "fat-
THREE BASIC CAUSES OF OBESITY:
(1) The Inherited Factor
Assuming that there is a limit to the diencephalon's fat banking capacity, it follows
that there are three basic ways in which obesity can become manifest. The first
is that the fat-
(2) Other Diencephalic Disorders
The second way in which obesity can become established is the lowering of a previously
normal fat-
In the menopause and after castration the hormones previously produced in the sex
glands no longer circulate in the body. In the presence of normally functioning
sex glands their hormones act as a brake on the secretion of the sex gland stimulating
hormones of the anterior pituitary. When this brake is removed the anterior pituitary
enormously increases its output of these sex gland stimulating hormones, though they
are now no longer effective. In the absence of any response from the non-
The so-
Whether obesity is caused by a marked inherited deficiency of the fat-
(3) The Exhaustion of the Fat-
But there is still a third way in which obesity can become established, and that
is when a presumably normal fat-
Secondly, in many of these cases the amount of food eaten remains the same and it is only the consumption of fuel which is suddenly decreased, as when an athlete is confined to bed for many weeks with a broken bone or when a man leading a highly active life is suddenly tied to his desk in an office and to television at home. Similarly, when a person, grown up in a cold climate, is transferred to a tropical country and continues to eat as before, he may develop obesity because in the heat far less fuel is required to maintain the normal body temperature.
When a person suffers a long period of privation, be it due to chronic illness, poverty,
famine or the exigencies of war, his diencephalic regulations adjust themselves to
some extent to the low food intake. When then suddenly these conditions change and
he is free to eat all the food he wants, this is liable to overwhelm his fat-
In a person eating coarse and unrefined food, the digestion is slow and only a little nourishment at a time is assimilated from the intestinal tract. When such a person is suddenly able to obtain highly refined foods such as sugar, white flour, butter and oil these are so rapidly digested and assimilated that the rush of incoming fuel which occurs at every meal may eventually overpower the diecenphalic regulatory mechanisms and thus lead to obesity. This is commonly seen in the poor man who suddenly becomes rich enough to buy the more expensive refined foods, though his total caloric intake remains the same or is even less than before.
Psychological Aspects
Much has been written about the psychological aspects of obesity. Among its many functions the diencephalon is also the seat of our primitive animal instincts, and just as in an emergency it can switch energy from one center to another, so it seems to be able to transfer pressure from one instinct to another. Thus, a lonely and unhappy person deprived of all emotional comfort and of all instinct gratification except the stilling of hunger and thirst can use these as outlets for pent up instinct pressure and so develop obesity. Yet once that has happened, no amount of psychotherapy or analysis, happiness, company or the gratification of other instincts will correct the condition.
Compulsive Eating
No end of injustice is done to obese patients by accusing them of compulsive eating,
which is a form of diverted sex-
On the other hand, compulsive eating does occur in some obese patients, particularly in girls in their late teens or early twenties. Compulsive eating differs fundamentally from the obese patient’s greater need for food. It comes on in attacks and is never associated with real hunger, a fact which is readily admitted by the patients. They only feel a feral desire to stuff. Two pounds of chocolates may be devoured in a few minutes; cold, greasy food from the refrigerator, stale bread, leftovers on stacked plates, almost anything edible is crammed down with terrifying speed and ferocity.
I have occasionally been able to watch such an attack without the patient's knowledge,
and it is a frightening, ugly spectacle to behold, even if one does realize that
mechanisms entirely beyond the patient's control are at work. A careful enquiry
into what may have brought on such an attack almost invariably reveals that it is
preceded by a strong unresolved sex-
Patients suffering from real compulsive eating are comparatively rare. In my practice
they constitute about 1-
Whether a patient is really suffering from compulsive eating or not is hard to decide
before treatment because many obese patients think that their desire for food -
Reluctance to Lose Weight
Some patients are deeply attached to their fat and cannot bear the thought of losing
it. If they are intelligent, popular and successful in spite of their handicap,
this is a source of pride. Some fat girls look upon their condition as a safeguard
against erotic involvements, of which they are afraid. They work out a pattern of
life in which their obesity plays a determining role and then become reluctant to
upset this pattern and face a new kind of life which will be entirely different after
their figure has become normal and often very attractive. They fear that people
will like them -
In all other cases the best psychotherapy can do in the usual treatment of obesity
is to render the burden of hunger and never-
There are thus a large number of ways in which obesity can be initiated, though the
disorder itself is always due to the same mechanism, an inadequacy of the diencephalic
fat-
Not by Weight alone…
Weight alone is not a satisfactory criterion by which to judge whether a person is suffering from the disorder we call obesity or not. Every physician is familiar with the sylphlike lady who enters the consulting room and declares emphatically that she is getting horribly fat and wishes to reduce. Many an honest and sympathetic physician at once concludes that he is dealing with a “nut.” If he is busy he will give her short shrift, but if he has time he will weigh her and show her tables to prove that she is actually underweight.
I have never yet seen or heard of such a lady being convinced by either procedure. The reason is that in my experience the lady is nearly always right and the doctor wrong. When such a patient is carefully examined one finds many signs of potential obesity, which is just about to become manifest as overweight. The patient distinctly feels that something is wrong with her, that a subtle change is taking place in her body, and this alarms her.
There are a number of signs and symptoms which are characteristic of obesity. In manifest obesity many and often all these signs and symptoms are present. In latent or just beginning cases some are always found, and it should be a rule that if two or more of the bodily signs are present, the case must be regarded as one that needs immediate help.
Signs and symptoms of obesity
The bodily signs may be divided into such as have developed before puberty, indicating
a strong inherited factor, and those which develop at the onset of manifest disorder.
Early signs are a disproportionately large size of the two upper front teeth, the
first incisor, or a dimple on both sides of the sacral bone just above the buttocks.
When the arms are outstretched with the palms upward, the forearms appear sharply
angled outward from the upper arms. The same applies to the lower extremities. The
patient cannot bring his feet together without the knees overlapping; he is, in fact,
knock-
The beginning accumulation of abnormal fat shows as a little pad just below the nape
of the neck, colloquially known as the Duchess' Hump. There is a triangular fatty
bulge in front of the armpit when the arm is held against the body. When the skin
is stretched by fat rapidly accumulating under it, it may split in the lower layers.
When large and fresh, such tears are purple, but later they are transformed into
white scar-
Another typical sign is a pad of fat on the insides of the knees, a spot where normal fat reserves are never stored. There may be a fold of skin over the pubic area and another fold may stretch round both sides of the chest, where a loose roll of fat can be picked up between two fingers. In the male an excessive accumulation of fat in the breasts is always indicative, while in the female the breast is usually, but not necessarily, large. Obviously excessive fat on the abdomen, the hips, thighs, upper arms, chin and shoulders are characteristic, and it is important to remember that any number of these signs may be present in persons whose weight is statistically normal; particularly if they are dieting on their own with iron determination.
Common clinical symptoms which are indicative only in their association and in the frame of the whole clinical picture are: frequent headaches, rheumatic pains without detectable bony abnormality; a feeling of laziness and lethargy, often both physical and mental and frequently associated with insomnia, the patients saying that all they want is to rest; the frightening feeling of being famished and sometimes weak with hunger two to three hours after a hearty meal and an irresistible yearning for sweets and starchy food which often overcomes the patient quite suddenly and is sometimes substituted by a desire for alcohol; constipation and a spastic or irritable colon are unusually common among the obese, and so are menstrual disorders.
Returning once more to our sylphlike lady, we can say that a combination of some of these symptoms with a few of the typical bodily signs is sufficient evidence to take her case seriously. A human figure, male or female, can only be judged in the nude; any opinion based on the dressed appearance can be quite fantastically wide off the mark, and I feel myself driven to the conclusion that apart from frankly psychotic patients such as cases of anorexia nervosa a “morbid weight fixation” does not exist. I have yet to see a patient who continues to complain after the figure has been rendered normal by adequate treatment.
The Emaciated Lady
I remember the case of a lady who was escorted into my consulting room while I was telephoning. She sat down in front of my desk, and when I looked up to greet her I saw the typical picture of advanced emaciation. Her dry skin hung loosely over the bones of her face, her neck was scrawny and collarbones and ribs stuck out from deep hollows. I immediately thought of cancer and decided to which of my colleagues at the hospital I would refer her. Indeed, I felt a little annoyed that my assistant had not explained to her that her case did not fall under my specialty. In answer to my query as to what I could do for her, she replied that she wanted to reduce. I tried to hide my surprise, but she must have noted a fleeting expression, for she smiled and said “I know that you think I'm mad, but just wait.” With that she rose and came round to my side of the desk. Jutting out from a tiny waist she had enormous hips and thighs.
By using a technique which will presently be described, the abnormal fat on her hips was transferred to the rest of her body which had been emaciated by months of very severe dieting. At the end of a treatment lasting five weeks, she, a small woman, had lost 8 inches round her hips, while her face looked fresh and florid, the ribs were no longer visible and her weight was the same to the ounce as it had been at the first consultation.
Fat but not Obese
While a person who is statistically underweight may still be suffering from the disorder which causes obesity, it is also possible for a person to be statistically overweight without suffering from obesity. For such persons weight is no problem, as they can gain or lose at will and experience no difficulty in reducing their caloric intake. They are masters of their weight, which the obese are not. Moreover, their excess fat shows no preference for certain typical regions of the body, as does the fat in all cases of obesity. Thus, the decision whether a borderline case is really suffering from obesity or not cannot be made merely by consulting weight tables.
THE TREATMENT OF OBESITY
If obesity is always due to one very specific diencephalic deficiency, it follows
that the only way to cure it is to correct this deficiency. At first this seemed
an utterly hopeless undertaking. The greatest obstacle was that one could hardly
hope to correct an inherited trait localized deep inside the brain, and while we
did possess a number of drugs whose point of action was believed to be in the diencephalon,
none of them had the slightest effect on the fat-
A Curious Observation
Mulling over this depressing situation, I remembered a rather curious observation
made many years ago in India. At that time we knew very little about the function
of the diencephalon, and my interest centered round the pituitary gland. Froehlich
had described cases of extreme obesity and sexual underdevelopment in youths suffering
from a new growth of the anterior pituitary lobe, producing what then became known
as Froehlich's disease. However, it was very soon discovered that the identical
syndrome, though running a less fulminating course, was quite common in patients
whose pituitary gland was perfectly normal. These are the so-
It also became known that in these cases the sex organs could he developed by giving the patients injections of a substance extracted from the urine of pregnant women, it having been shown that when this substance was injected into sexually immature rats it made them precociously mature. The amount of substance which produced this effect in one rat was called one International Unit, and the purified extract was accordingly called “Human Chorionic Gonadotrophin” whereby chorionic signifies that it is produced in the placenta and gonadotropin that its action is sex gland directed.
The usual way of treating “fat boys” with underdeveloped genitals is to inject several
hundred International Units twice a week. Human Chorionic Gonadotrophin which we
shall henceforth simply call HCG is expensive, and as “fat boys” are fairly common
among Indians I tried to establish the smallest effective dose. In the course of
this study three interesting things emerged. The first was that when fresh pregnancy-
Fat on the Move
Remembering this, it occurred to me that the change in shape could only be explained
by a movement of fat away from abnormal deposits on the hips, and if that were so
there was just a chance that while such fat was in transition it might be available
to the body as fuel. This was easy to find out, as in that case, fat on the move
would be able to replace food. It should then he possible to keep a “fat boy” on
a severely restricted diet without a feeling of hunger, in spite of a rapid loss
of weight. When I tried this in typical cases of Froehlich's syndrome, I found that
as long as such patients were given small daily doses of HCG they could comfortably
go about their usual occupations on a diet of only 500 Calories daily and lose an
average of about one pound per day. It was also perfectly evident that only abnormal
fat was being consumed, as there were no signs of any depletion of normal fat. Their
skin remained fresh and turgid, and gradually their figures became entirely normal,
nor did the daily administration of HCG appear to have any side-
From this point it was a small step to try the same method in all other forms of obesity. It took a few hundred cases to establish beyond reasonable doubt that the mechanism operates in exactly the same way and seemingly without exception in every case of obesity. I found that, though most patients were treated in the outpatients department, gross dietary errors rarely occurred. On the contrary, most patients complained that the two meals of 250 Calories each were more than they could manage, as they continually had a feeling of just having had a large meal.
Pregnancy and Obesity
Once this trail was opened, further observations seemed to fall into line. It is,
for instance, well known that during pregnancy an obese woman can very easily lose
weight. She can drastically reduce her diet without feeling hunger or discomfort
and lose weight without in any way harming the child in her womb. It is also surprising
to what extent a woman can suffer from pregnancy-
Pregnancy is an obese woman's one great chance to reduce her excess weight. That she so rarely makes use of this opportunity is due to the erroneous notion, usually fostered by her elder relations, that she now has “two mouths to feed” and must “keep up her strength for the coming event.” All modern obstetricians know that this is nonsense and that the more superfluous fat is lost the less difficult will be the confinement, though some still hesitate to prescribe a diet sufficiently low in Calories to bring about a drastic reduction.
A woman may gain weight during pregnancy, but she never becomes obese in the strict
sense of the word. Under the influence of the HCG which circulates in enormous quantities
in her body during pregnancy, her diencephalic banking capacity seems to be unlimited,
and abnormal fixed deposits are never formed. At confinement she is suddenly deprived
of HCG, and her diencephalic fat-
Pregnancy seems to be the only normal human condition in which the diencephalic fat-
Though we may be able to increase the dieneephalic fat-
Only when the fat which is in transit under the effect of HCG is actually consumed can more fat be withdrawn from the fixed deposits. In pregnancy it would be most undesirable if the fetus were offered ample food only when there is a high influx from the intestinal tract. Ideal nutritional conditions for the fetus can only be achieved when the mother's blood is continually saturated with food, regardless of whether she eats or not, as otherwise a period of starvation might hamper the steady growth of the embryo. It seems that HCG brings about this continual saturation of the blood, which is the reason why obese patients under treatment with HCG never feel hungry in spite of their drastically reduced food intake.
The Nature of Human Chorionic Gonadotropin
HCG is never found in the human body except during pregnancy and in those rare cases
in which a residue of placental tissue continues to grow in the womb in what is known
as a chorionic epithelioma. It is never found in the male. The human type of chorionic
gonadotrophin is found only during the pregnancy of women and the great apes. It
is produced in enormous quantities, so that during certain phases of her pregnancy
a woman may excrete as much as one million International Units per day in her urine
-
As often happens in medicine, much confusion has been caused by giving HCG its name before its true mode of action was understood. It has been explained that gonadotrophin literally means a sex gland directed substance or hormone, and this is quite misleading. It dates from the early days when it was first found that HCG is able to render infantile sex glands mature, whereby it was entirely overlooked that it has no stimulating effect whatsoever on normally developed and normally functioning sex glands. No amount of HCG is ever able to increase a normal sex function; it can only improve an abnormal one and in the young hasten the onset of puberty. However, this is no direct effect. HCG acts exclusively at a diencephalic level and there brings about a considerable increase in the functional capacity of all those centers which are working at maximum capacity.
The Real Gonadotrophins
Two hormones known in the female as follicle stimulating hormone (FSH) and corpus luteum stimulating hormone (LSH) are secreted by the anterior lobe of the pituitary gland. These hormones are real gonadotrophins because they directly govern the function of the ovaries. The anterior pituitary is in turn governed by the diencephalon, and so when there is an ovarian deficiency the diencephalic center concerned is hard put to correct matters by increasing the secretion from the anterior pituitary of FSH or LSH, as the case may be. When sexual deficiency is clinically present, this is a sign that the diencephalic center concerned is unable, in spite of maximal exertion, to cope with the demand for anterior pituitary stimulation. * When then the administration of HCG increases the functional capacity of the diencephalon, all demands can be fully satisfied and the sex deficiency is corrected.
That this is the true mechanism underlying the presumed gonadotrophic action of HCG is confirmed by the fact that when the pituitary gland of infantile rats is removed before they are given HCG, the latter has no effect on their sex glands. HCG cannot therefore have a direct sex gland stimulating action like that of the anterior pituitary gonadotrophins, as FSH and LSH are justly called. The latter are entirely different substances from that which can be extracted from pregnancy urine and which, unfortunately, is called chorionic gonadotrophin. It would be no more clumsy, and certainly far more appropriate, if HCG were henceforth called chorionic diencephalotrophin.
HCG no Sex Hormone
It cannot he sufficiently emphasized that HCG is not a sex hormone, that its action
is identical in men, women, children and in those cases in which the sex glands no
longer function owing to old age or their surgical removal. The only sexual change
it can bring about after puberty is an improvement of a pre-
* As we are speaking of purely regulatory disorders, we obviously exclude all such cases in which there are gross organic lesions of the pituitary or the sex glands themselves.
virility, though where this was deficient it may improve it. It never makes women
grow a beard or develop a gruff voice. I have stressed this point only for the sake
of my lay readers, because it is our daily experience that when patients hear the
word hormone they immediately jump to the conclusion that this must have something
to do with the sex-
Importance and Potency of HCG
Owing to the fact that HCG has no direct action on any endocrine gland, its enormous
importance in pregnancy has been overlooked and its potency underestimated. Though
a pregnant woman can produce as much as one million units per day, we find that the
injection of only 125 units per day is ample to reduce weight at the rate of roughly
one pound per day, even in a colossus weighing 400 pounds, when associated with a
500-
If I can be forgiven for comparing my fellow-
HCG has been known for over half a century. It is the substance which Aschheim and Zondek so brilliantly used to diagnose early pregnancy out of the urine. Apart from that, the only thing it did in the experimental laboratory was to produce precocious rats, and that was not particularly stimulating to further research at a time when much more thrilling endocrinological discoveries were pouring in from all sides, sweeping HCG into the stiller back waters.
Complicating Disorders
Some complicating disorders are often associated with obesity, and these we must briefly discuss. The most important associated disorders and the ones in which obesity seems to play a precipitating or at least an aggravating role are the following: the stable type of diabetes, gout, rheumatism and arthritis, high blood pressure and hardening of the arteries, coronary disease and cerebral hemorrhage.
Apart from the fact that they are often -
If HCG + diet does in the obese bring about those diencephalic changes which are characteristic of pregnancy, one would expect to see an improvement in all these conditions comparable to that seen in real pregnancy. The administration of HCG does in fact do this in a remarkable way.
Diabetes
In an obese patient suffering from a fairly advanced case of stable diabetes of many
years duration in which the blood sugar may range from 3-
A brittle case of diabetes is primarily due to the inability of the pancreas to produce sufficient insulin, while in the stable type, diencephalic regulations seem to be of greater importance. That is possibly the reason why the stable form responds so well to the HCG method of treating obesity, whereas the brittle type does not. Obese patients are generally suffering from the stable type, but a stable type may gradually change into a brittle one, which is usually associated with a loss of weight. Thus, when an obese diabetic finds that he is losing weight without diet or treatment, he should at once have his diabetes expertly attended to. There is some evidence to suggest that the change from stable to brittle is more liable to occur in patients who are taking insulin for their stable diabetes.
Rheumatism
All rheumatic pains, even those associated with demonstrable bony lesions, improve
subjectively within a few days of treatment, and often require neither cortisone
nor salicylates. Again this is a well known phenomenon in pregnancy, and while under
treatment with HCG + diet the effect is no less dramatic. As it does after pregnancy,
the pain of deformed joints returns after treatment, but smaller doses of pain-
Cholesterol
The exact extent to which the blood cholesterol is involved in hardening of the arteries, high blood pressure and coronary disease is not as yet known, but it is now widely admitted that the blood cholesterol level is governed by diencephalic mechanisms. The behavior of circulating cholesterol is therefore of particular interest during the treatment of obesity with HCG. Cholesterol circulates in two forms, which we call free and esterified. Normally these fractions are present in a proportion of about 25% free to 75% esterified cholesterol, and it is the latter fraction which damages the walls of the arteries. In pregnancy this proportion is reversed and it may he taken for granted that arteriosclerosis never gets worse during pregnancy for this very reason.
To my knowledge, the only other condition in which the proportion of free to esterified cholesterol is reversed is during the treatment of obesity with HCG + diet, when exactly the same phenomenon takes place. This seems an important indication of how closely a patient under HCG treatment resembles a pregnant woman in diencephalic behavior.
When the total amount of circulating cholesterol is normal before treatment, this absolute amount is neither significantly increased nor decreased. But when an obese patient with an abnormally high cholesterol and already showing signs of arteriosclerosis is treated with HCG, his blood pressure drops and his coronary circulation seems to improve, and yet his total blood cholesterol may soar to heights never before reached.
At first this greatly alarmed us. But then we saw that the patients came to no harm
even if treatment was continued and we found in follow-
Gout
An identical behavior is found in the blood uric acid level of patients suffering from gout. Predictably such patients get an acute and often severe attack after the first few days of HCG treatment but then remain entirely free of pain, in spite of the fact that their blood uric acid often shows a marked increase which may persist for several months after treatment. Those patients who have regained their normal weight remain free of symptoms regardless of what they eat, while those that require a second course of treatment get another attack of gout as soon as the second course is initiated. We do not yet know what diencephalic mechanisms are involved in gout; possibly emotional factors play a role, and it is worth remembering that the disease does not occur in women of childbearing age. We now give 2 tablets daily of ZYLORIC to all patients who give a history of gout and have a high blood uric acid level. In this way we can completely avoid attacks during treatment.
Blood Pressure
Patients who have brought themselves to the brink of malnutrition by exaggerated
dieting, laxatives etc, often have an abnormally low blood pressure. In these cases
the blood pressure rises to normal values at the beginning of treatment and then
very gradually drops, as it always does in patients with a normal blood pressure.
Normal values are always regained a few days after the treatment is over. Of this
lowering of the blood pressure during treatment the patients are not aware. When
the blood pressure is abnormally high, and provided there are no detectable renal
lesions, the pressure drops, as it usually does in pregnancy. The drop is often
very rapid, so rapid in fact that it sometimes is advisable to slow down the process
with pressure-
When a woman suffering from high blood pressure becomes pregnant her blood pressure very soon drops, but after her confinement it may gradually rise back to its former level. Similarly, a high blood pressure present before HCG treatment tends to rise again after the treatment is over, though this is not always the case. But the former high levels are rarely reached, and we have gathered the impression that such relapses respond better to orthodox drugs such as Reserpine than before treatment.
Peptic Ulcers
In our cases of obesity with gastric or duodenal ulcers we have noticed a surprising subjective improvement in spite of a diet which would generally be considered most inappropriate for an ulcer patient. Here, too, there is a similarity with pregnancy, in which peptic ulcers hardly ever occur. However we have seen two cases with a previous history of several hemorrhages in which a bleeding occurred within 2 weeks of the end of treatment.
Psoriasis, Fingernails, Hair, Varicose Ulcers
As in pregnancy, psoriasis greatly improves during treatment but may relapse when
the treatment is over. Most patients spontaneously report a marked improvement in
the condition of brittle fingernails. The loss of hair not infrequently associated
with obesity is temporarily arrested, though in very rare cases an increased loss
of hair has been reported. I remember a case in which a patient developed a patchy
baldness – so-
In obese patients with large varicose ulcers we were surprised to find that these ulcers heal rapidly under treatment with HCG. We have since treated non obese patients suffering from varicose ulcers with daily injections of HCG on normal diet with equally good results.
The “Pregnant" Male
When a male patient hears that he is about to be put into a condition which in some respects resembles pregnancy, he is usually shocked and horrified. The physician must therefore carefully explain that this does not mean that he will be feminized and that HCG in no way interferes with his sex. He must be made to understand that in the interest of the propagation of the species nature provides for a perfect functioning of the regulatory headquarters in the diencephalon during pregnancy and that we are merely using this natural safeguard as a means of correcting the diencephalic disorder which is responsible for his overweight.
TECHNIQUE
Warnings
I must warn the lay reader that what follows is mainly for the treating physician
and most certainly not a do-
In treating obesity with the HCG + diet method we are handling what is perhaps the
most complex organ in the human body. The diencephalon's functional equilibrium
is delicately poised, so that whatever happens in one part has repercussions in others.
In obesity this balance is out of kilter and can only be restored if the technique
I am about to describe is followed implicitly. Even seemingly insignificant deviations,
particularly those that at first sight seem to be an improvement, are very liable
to produce most disappointing results and even annul the effect completely. For
instance, if the diet is increased from 500 to 600 or 700 Calories, the loss of weight
is quite unsatisfactory. If the daily dose of HCG is raised to 200 or more units
daily its action often appears to be reversed, possibly because larger doses evoke
diencephalic counter-
History taking
When a patient first presents himself for treatment, we take a general history and note the time when the first signs of overweight were observed. We try to establish the highest weight the patient has ever had in his life (obviously excluding pregnancy), when this was, and what measures have hitherto been taken in an effort to reduce.
It has been our experience that those patients who have been taking thyroid preparations for long periods have a slightly lower average loss of weight under treatment with HCG than those who have never taken thyroid. This is even so in those patients who have been taking thyroid because they had an abnormally low basal metabolic rate. In many of these cases the low BMR is not due to any intrinsic deficiency of the thyroid gland, but rather to a lack of diencephalic stimulation of the thyroid gland via the anterior pituitary lobe. We never allow thyroid to be taken during treatment, and yet a BMR which was very low before treatment is usually found to be normal after a week or two of HCG + diet. Needless to say, this does not apply to those cases in which a thyroid deficiency has been produced by the surgical removal of a part of an overactive gland. It is also most important to ascertain whether the patient has taken diuretics (water eliminating pills) as this also decreases the weight loss under the HCG regimen.
Returning to our procedure, we next ask the patient a few questions to which he is held to reply simply with “yes” or “no”. These questions are: Do you suffer from headaches? rheumatic pains? menstrual disorders? constipation? breathlessness or exertion? swollen ankles? Do you consider yourself greedy? Do you feel the need to eat snacks between meals?
The patient then strips and is weighed and measured. The normal weight for his height,
age, skeletal and muscular build is established from tables of statistical averages,
whereby in women it is often necessary to make an allowance for particularly large
and heavy breasts. The degree of overweight is then calculated, and from this the
duration of treatment can be roughly assessed on the basis of an average loss of
weight of a little less than a pound, say 300-
The Duration of Treatment
Patients who need to lose 15 pounds (7 kg.) or less require 26 days treatment with
23 daily injections. The extra three days are needed because all patients must continue
the 500-
We never give a treatment lasting less than 26 days, even in patients needing to
lose only 5 pounds. It seems that even in the mildest cases of obesity the diencephalon
requires about three weeks rest from the maximal exertion to which it has been previously
subjected in order to regain fully its normal fat-
As soon as such patients have lost all their abnormal superfluous fat, they at once
begin to feel ravenously hungry in spite of continued injections. This is because
HCG only puts abnormal fat into circulation and cannot, in the doses used, liberate
normal fat deposits; indeed, it seems to prevent their consumption. As soon as their
statistically normal weight is reached, these patients are put on 800-
Such early cases are common among actresses, models, and persons who are tired of
obesity, having seen its ravages in other members of their family. Film actresses
frequently explain that they must weigh less than normal. With this request we flatly
refuse to comply, first, because we undertake to cure a disorder, not to create a
new one, and second, because it is in the nature of the HCG method that it is self
limiting. It becomes completely ineffective as soon as all abnormal fat is consumed.
Actresses with a slight tendency to obesity, having tried all manner of reducing
methods, invariably come to the conclusion that their figure is satisfactory only
when they are underweight, simply because none of these methods remove their superfluous
fat deposits. When they see that under HCG their figure improves out of all proportion
to the amount of weight lost, they are nearly always content to remain within their
normal weight-
When a patient has more than 15 pounds to lose the treatment takes longer but the
maximum we give in a single course is 40 injections, nor do we as a rule allow patients
to lose more than 34 lbs. (15 Kg.) at a time. The treatment is stopped when either
34 lbs. have been lost or 40 injections have been given. The only exception we make
is in the case of grotesquely obese patients who may be allowed to lose an additional
5-
Immunity to HCG
The reason for limiting a course to 40 injections is that by then some patients may
begin to show signs of HCG immunity. Though this phenomenon is well known, we cannot
as yet define the underlying mechanism. Maybe after a certain length of time the
body learns to break down and eliminate HCG very rapidly, or possibly prolonged treatment
leads to some sort of counter-
After 40 daily injections it takes about six weeks before this so-
Patients who need only 23 injections may be injected daily, including Sundays, as they never develop immunity. In those that take 40 injections the onset of immunity can be delayed if they are given only six injections a week, leaving out Sundays or any other day they choose, provided that it is always the same day. On the days on which they do not receive the injections they usually feel a slight sensation of hunger. At first we thought that this might be purely psychological, but we found that when normal saline is injected without the patient's knowledge the same phenomenon occurs.
Menstruation
During menstruation no injections are given, but the diet is continued and causes no hardship; yet as soon as the menstruation is over, the patients become extremely hungry unless the injections are resumed at once. It is very impressive to see the suffering of a woman who has continued her diet for a day or two beyond the end of the period without coming for her injection and then to hear the next day that all hunger ceased within a few hours after the injection and to see her once again content, florid and cheerful. While on the question of menstruation it must he added that in teenaged girls the period may in some rare cases be delayed and exceptionally stop altogether. If then later this is artificially induced some weight may be regained.
Further Courses
Patients requiring the loss of more than 34 lbs. must have a second or even more courses. A second course can be started after an interval of not less than six weeks, though the pause can be more than six weeks. When a third, fourth or even fifth course is necessary, the interval between courses should be made progressively longer. Between a second and third course eight weeks should elapse, between a third and fourth course twelve weeks, between a fourth and fifth course twenty weeks and between a fifth and sixth course six months. In this way it is possible to bring about a weight reduction of 100 lbs. and more if required without the least hardship to the patient.
In general, men do slightly better than women and often reach a somewhat higher average daily loss. Very advanced cases do a little better than early ones, but it is a remarkable fact that this difference is only just statistically significant.
Conditions that must be accepted before treatment
On the basis of these data the probable duration of treatment can he calculated with
considerable accuracy, and this is explained to the patient. It is made clear to
him that during the course of treatment he must attend the clinic daily to be weighed,
injected and generally checked. All patients that live in Rome or have resident
friends or relations with whom they can stay are treated as out-
It is also made clear that between courses the patient gets no treatment and is free
to eat anything he pleases except starches and sugar during the first 3 weeks. It
is impressed upon him that he will have to follow the prescribed diet to the letter
and that after the first three days this will cost him no effort, as he will feel
no hunger and may indeed have difficulty in getting down the 500 Calories which he
will be given. If these conditions are not acceptable the case is refused, as any
compromise or half-
Though a patient can only consider himself really cured when he has been reduced
to his stastically normal weight, we do not insist that he commit himself to that
extent. Even a partial loss of overweight is highly beneficial, and it is our experience
that once a patient has completed a first course he is so enthusiastic about the
ease with which the -
Examining the patient
Only when agreement is reached on the points so far discussed do we proceed with
the examination of the patient. A note is made of the size of the first upper incisor,
of a pad of fat on the nape of the neck, at the axilla and on the inside of the knees.
The presence of striation, a suprapubic fold, a thoracic fold, angulation of elbow
and knee joint, breast-
Wherever this seems indicated we X-
Gain before Loss
Patients whose general condition is low, owing to excessive previous dieting, must eat to capacity for about one week before starting treatment, regardless of how much weight they may gain in the process. One cannot keep a patient comfortably on 500 Calories unless his normal fat reserves are reasonably well stocked. It is for this reason also that every case, even those that are actually gaining must eat to capacity of the most fattening food they can get down until they have had the third injection. It is a fundamental mistake to put a patient on 500 Calories as soon as the injections are started, as it seems to take about three injections before abnormally deposited fat begins to circulate and thus become available.
We distinguish between the first three injections, which we call “non-
Most patients who have been struggling with diets for years and know how rapidly
they gain if they let themselves go are very hard to convince of the absolute necessity
of gorging for at least two days, and yet this must he insisted upon categorically
if the further course of treatment is to run smoothly. Those patients who have to
be put on forced feeding for a week before starting the injections usually gain weight
rapidly -
Patients in a satisfactory general condition and those who have not just previously restricted their diet start forced feeding on the day of the first injection. Some patents say that they can no longer overeat because their “stomach has shrunk” after years of restrictions. While we know that no stomach ever shrinks, we compromise by insisting that they eat frequently of highly concentrated foods such as milk chocolate, pastries with whipped cream, sugar, fried meats (particularly pork), eggs and bacon, mayonnaise, bread with thick butter and jam, etc. The time and trouble spent on pressing this point upon incredulous or reluctant patients is always amply rewarded afterwards by the complete absence of those difficulties which patients who have disregarded these instructions are liable to experience.
During the two days of forced feeding from the first to the third injection -
Starting treatment
In menstruating women, the best time to start treatment is immediately after a period. Treatment may also be started later, but it is advisable to have at least ten days in hand before the onset of the next period. Similarly, the end of a course of HCG should never be made to coincide with menstruation. If things should happen to work out that way, it is better to give the last injection three days before the expected date of the menses so that a normal diet can he resumed at onset. Alternatively, at least three injections should be given after the period, followed by the usual three days of dieting. This rule need not be observed in such patients who have reached their normal weight before the end of treatment and are already on a higher caloric diet.
Patients who require more than the minimum of 23 injections and who therefore skip one day a week in order to postpone immunity to HCG cannot have their third injections on the day before the interval. Thus if it is decided to skip Sundays, the treatment can be started on any day of the week except Thursdays. Supposing they start on Thursday, they will have their third injection on Saturday, which is also the day on which they start their 500 Calorie diet. They would then have no injection on the second day of dieting; this exposes them to an unnecessary hardship, as without the injection they will feel particularly hungry. Of course, the difficulty can be overcome by exceptionally injecting them on the first Sunday. If this day falls between the first and second or between the second and third injection, we usually prefer to give the patient the extra day of forced feeding, which the majority rapturously enjoy.
The Diet
The 500 Calorie diet is explained on the day of the second injection to those patients
who will be preparing their own food, and it is most important that the person who
will actually cook is present -
Breakfast:
Tea or coffee in any quantity without sugar. Only one tablespoonful of milk allowed in 24 hours. Saccharin or other sweeteners may be used.
Lunch:
1. 100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab or shrimp. All visible fat must be carefully removed before cooking, and the meat must be weighed raw. It must be boiled or grilled without additional fat. Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The chicken breast must be removed raw from the bird.
2. One type of vegetable only to be chosen from the following: spinach, chard,
chicory, beet-
3. One breadstick (grissino) or one Melba toast.
4. An apple or an orange or a handful of strawberries or one-
Dinner :
The same four choices as lunch.
The juice of one lemon daily is allowed for all purposes. Salt, pepper, vinegar, mustard powder, garlic, sweet basil, parsley, thyme, majoram, etc., may be used for seasoning, but no oil, butter or dressing.
Tea, coffee, plain water, or mineral water are the only drinks allowed, but they may be taken in any quantity and at all times.
In fact, the patient should drink about 2 liters of these fluids per day. Many patients are afraid to drink so much because they fear that this may make them retain more water. This is a wrong notion as the body is more inclined to store water when the intake falls below its normal requirements.
The fruit or the breadstick may be eaten between meals instead of with lunch or dinner, but not more than than four items listed for lunch and dinner may be eaten at one meal.
No medicines or cosmetics other than lipstick, eyebrow pencil and powder may be used without special permission
Every item in the list is gone over carefully, continually stressing the point that
no variations other than those listed may be introduced. All things not listed are
forbidden, and the patient is assured that nothing permissible has been left out.
The 100 grams of meat must he scrupulously weighed raw after all visible fat has
been removed. To do this accurately the patient must have a letter-
There is no objection to breaking up the two meals. For instance having a breadstick
and an apple for breakfast or an orange before going to bed, provided they are deducted
from the regular meals. The whole daily ration of two breadsticks or two fruits
may not be eaten at the same time, nor can any item saved from the previous day be
added on the following day. In the beginning patients are advised to check every
meal against their diet sheet before starting to eat and not to rely on their memory.
It is also worth pointing out that any attempt to observe this diet without HCG
will lead to trouble in two to three days. We have had cases in which patients have
proudly flaunted their dieting powers in front of their friends without mentioning
the fact that they are also receiving treatment with HCG. They let their friends
try the same diet, and when this proves to be a failure -
It should also be mentioned that two small apples weighing as much as one large one nevertheless have a higher caloric value and are therefore not allowed, though there is no restriction on the size of one apple. Some people do not realize that a tangerine is not an orange and that chicken breast does not mean the breast of any other fowl, nor does it mean a wing or drumstick.
The most tiresome patients are those who start counting Calories and then come up with all manner of ingenious variations which they compile from their little books. When one has spent years of weary research trying to make a diet as attractive as possible without jeopardizing the loss of weight, culinary geniuses who are out to improve their unhappy lot are hard to take.
Making up the Calories
The diet used in conjunction with HCG must not exceed 500 Calories per day, and the way these Calories are made up is of utmost importance. For instance, if a patient drops the apple and eats an extra breadstick instead, he will not be getting more Calories but he will not lose weight. There are a number of foods, particularly fruits and vegetables, which have the same or even lower caloric values than those listed as permissible, and yet we find that they interfere with the regular loss of weight under HCG, presumably owing to the nature of their composition. Pimiento peppers, okra, artichokes and pears are examples of this.
While this diet works satisfactorily in Italy, certain modifications have to be made
in other countries. For instance, American beef has almost double the caloric value
of South Italian beef, which is not marbled with fat. This marbling is impossible
to remove. In America, therefore, low-
In many countries specially prepared unsweetened and low Calorie foods are freely
available, and some of these can be tentatively used. When local conditions or the
feeding habits of the population make changes necessary, it must be borne in mind
that the total daily intake must not exceed 500 Calories if the best possible results
are to be obtained, that the daily ration should contain 200 grams of fat-
Just as the daily dose of HCG is the same in all cases, so the same diet proves to be satisfactory for a small elderly lady of leisure or a hard working muscular giant. Under the effect of HCG the obese body is always able to obtain all the Calories it needs from the abnormal fat deposits, regardless of whether it uses up 1500 or 4000 per day. It must be made very clear to the patient that he is living to a far greater extent on the fat which he is losing than on what he eats.
Many patients ask why eggs are not allowed. The contents of two good sized eggs
are roughly equivalent to 100 grams of meat, but fortunately the yolk contains a
large amount of fat, which is undesirable. Very occasionally we allow egg -
Vegetarians
Strict vegetarians such as orthodox Hindus present a special problem, because milk
and curds are the only animal protein they will eat. To supply them with sufficient
protein of animal origin they must drink 500 cc. of skimmed milk per day, though
part of this ration can be taken as curds. As far as fruit, vegetables and starch
are concerned, their diet is the same as that of non-
Faulty Dieting
Few patients will take one's word for it that the slightest deviation from the diet has under HCG disastrous results as far as the weight is concerned. This extreme sensitivity has the advantage that the smallest error is immediately detectable at the daily weighing but most patients have to make the experience before they will believe it.
Persons in high official positions such as embassy personnel, politicians, senior
executives, etc., who are obliged to attend social functions to which they cannot
bring their meager meal must be told beforehand that an official dinner will cost
them the loss of about three days treatment, however careful they are and in spite
of a friendly and would-
Vitamins and anemia
Sooner or later most patients express a fear that they may be running out of vitamins or that the restricted diet may make them anemic. On this score the physician can confidently relieve their apprehension by explaining that every time they lose a pound of fatty tissue, which they do almost daily, only the actual fat is burned up; all the vitamins, the proteins, the blood, and the minerals which this tissue contains in abundance are fed back into the body. Actually, a low blood count not due to any serious disorder of the blood forming tissues improves during treatment, and we have never encountered a significant protein deficiency nor signs of a lack of vitamins in patients who are dieting regularly.
The First Days of Treatment
On the day of the third injection it is almost routine to hear two remarks. One is: “You know, Doctor, I'm sure it's only psychological, but I already feel quite different”. So common is this remark, even from very skeptical patients, that we hesitate to accept the psychological interpretation. The other typical remark is: “Now that I have been allowed to eat anything I want, I can't get it down. Since yesterday I feel like a stuffed pig. Food just doesn't seem to interest me any more, and I am longing to get on with your diet”. Many patients notice that they are passing more urine and that the swelling in their ankles is less even before they start dieting.
On the day of the fourth injection most patients declare that they are feeling fine. They have usually lost two pounds or more, some say they feel a bit empty but hasten to explain that this does not amount to hunger. Some complain of a mild headache of which they have been forewarned and for which they have been given permission to take aspirin.
During the second and third day of dieting -
It is usually at this point that a difference appears between those patients who
have literally eaten to capacity during the first two days of treatment and those
who have not. The former feel remarkably well; they have no hunger, nor do they
feel tempted when others eat normally at the same table. They feel lighter, more
clear-
Fluctuations in weight loss
After the fourth or fifth day of dieting the daily loss of weight begins to decrease to one pound or somewhat less per clay, and there is a smaller urinary output. Men often continue to lose regularly at that rate, but women are more irregular, in spite of faultless dieting. There may be no drop at all for two or three days and then a sudden loss which reestablishes the normal average. These fluctuations are entirely due to variations in the retention and elimination of water, which are more marked in women than in men.
The weight registered by the scale is determined by two processes, not necessarily
synchronized. Under the influence of HCG fat is being extracted from the cells,
in which it is stored in the fatty tissue. When these cells are empty and therefore
serve no purpose, the body breaks down the cellular structure and absorbs it, but
breaking up of useless cells, connective tissue, blood vessels, etc., may lag behind
the process of fat-
Patients who have previously regularly used diuretics as a method of reducing, lose fat during the first two or three weeks of treatment which shows in their measurements, but the scale may show little or no loss because they are replacing the normal water content of their body which has been dehydrated. Diuretics should never be used for reducing.
Interruptions of Weight Loss
We distinguish four types of interruption in the regular daily loss. The first is the one that has already been mentioned in which the weight stays stationary for a day or two, and this occurs, particularly towards the end of a course, in almost every case.
The Plateau
The second type of interruption we call a “plateau”. A plateau lasts 4-
In such cases we consider it permissible, for purely psychological reasons, to break
up the plateau. This can be done in two ways. One is a so-
The other way to break up a plateau is by giving a non-
* We use 1 tablet of hygroton.
This is simpler for the patient, but we prefer the apple-
Reaching a Former Level
The third type of interruption in the regular loss of weight may last much longer
-
Menstrual Interruption
The fourth type of interruption is the one which often occurs a few days before and
during the menstrual period and in some women at the time of ovulation. It must
also be mentioned that when a woman becomes pregnant during treatment -
Oral contraceptives may be used during treatment.
Dietary Errors
Any interruption of the normal loss of weight which does not fit perfectly into one of those categories is always due to some possibly very minor dietary error. Similarly, any gain of more than 100 grams is invariably the result of some transgression or mistake, unless it happens on or about the day of ovulation or during the three days preceding the onset of menstruation, in which case it is ignored. In all other cases the reason for the gain must be established at once.
The patient who frankly admits that he has stepped out of his regimen when told that something has gone wrong is no problem. He is always surprised at being found out, because unless he has seen this himself he will not believe that a salted almond, a couple of potato chips, a glass of tomato juice or an extra orange will bring about a definite increase in his weight on the following day.
Very often he wants to know why extra food weighing one ounce should increase his weight by six ounces. We explain this in the following way: Under the influence of HCG the blood is saturated with food and the blood volume has adapted itself so that it can only just accommodate the 500 Calories which come in from the intestinal tract in the course of the day. Any additional income, however little this may be, cannot be accommodated and the blood is therefore forced to increase its volume sufficiently to hold the extra food, which it can only do in a very diluted form. Thus it is not the weight of what is eaten that plays the determining role but rather the amount of water which the body must retain to accommodate this food.
This can be illustrated by mentioning the case of salt. In order to hold one teaspoonful of salt the body requires one liter of water, as it cannot accommodate salt in any higher concentration. Thus, if a person eats one teaspoonful of salt his weight will go up by more than two pounds as soon as this salt is absorbed from his intestine.
To this explanation many patients reply: “Well, if I put on that much every time I eat a little extra, how can I hold my weight after the treatment?” It must therefore be made clear that this only happens as long as they are under HCG. When treatment is over, the blood is no longer saturated and can easily accommodate extra food without having to increase its volume. Here again the professional reader will be aware that this interpretation is a simplification of an extremely intricate physiological process which actually accounts for the phenomenon.
Salt and Reducing
While we are on the subject of salt, I can take this opportunity to explain that we make no restriction in the use of salt and insist that the patients drink large quantities of water throughout the treatment. We are out to reduce abnormal fat and are not in the least interested in such illusory weight losses as can be achieved by depriving the body of salt and by desiccating it. Though we allow the free use of salt, the daily amount taken should be roughly the same, as a sudden increase will of course be followed by a corresponding increase in weight as shown by the scale. An increase in the intake of salt is one of the most common causes for an increase in weight from one day to the next. Such an increase can be ignored, provided it is accounted for. It in no way influences the regular loss of fat.
Water
Patients are usually hard to convince that the amount of water they retain has nothing
to do with the amount of water they drink. When the body is forced to retain water,
it will do this at all costs. If the fluid intake is insufficient to provide all
the water required, the body withholds water from the kidneys and the urine becomes
scanty and highly concentrated, imposing a certain strain on the kidneys. If that
is insufficient, excessive water will be with-
Constipation
An excess of water keeps the feces soft, and that is very important in the obese, who commonly suffer from constipation and a spastic colon. While a patient is under treatment we never permit the use of any kind of laxative taken by mouth. We explain that owing to the restricted diet it is perfectly satisfactory and normal to have an evacuation of the bowel only once every three to four days and that, provided plenty of fluids are taken, this never leads to any disturbance. Only in those patients who begin to fret after four days do we allow the use of a suppository. Patients who observe this rule find that after treatment they have a perfectly normal bowel action and this delights many of them almost as much as their loss of weight.
Investigating Dietary Errors
When the reason for a slight gain in weight is not immediately evident, it is necessary to investigate further. A patient who is unaware of having committed an error or is unwilling to admit a mistake protests indignantly when told he has done something he ought not to have done. In that atmosphere no fruitful investigation can be conducted; so we calmly explain that we are not accusing him of anything but that we know for certain from our not inconsiderable experience that something has gone wrong and that we must now sit down quietly together and try and find out what it was. Once the patient realizes that it is in his own interest that he play an active and not merely a passive role in this search, the reason for the setback is almost invariably discovered. Having been through hundreds of such sessions, we are nearly always able to distinguish the deliberate liar from the patient who is merely fooling himself or is really unaware of having erred.
Liars and Fools
When we see obese patients there are generally two of us present in order to speed up routine handling. Thus when we have to investigate a rise in weight, a glance is sufficient to make sure that we agree or disagree. If after a few questions we both feel reasonably sure that the patient is deliberately lying, we tell him that this is our opinion and warn him that unless he comes clean we may refuse further treatment. The way he reacts to this furnishes additional proof whether we are on the right track or not; we now very rarely make a mistake.
If the patient breaks down and confesses, we melt and are all forgiveness and treatment proceeds. Yet if such performances have to be repeated more than two or three times, we refuse further treatment. This happens in less than 1% of our cases. If the patient is stubborn and will not admit what he has been up to, we usually give him one more chance and continue treatment even though we have been unable to find the reason for his gain. In many such cases there is no repetition, and frequently the patient does then confess a few days later after he has thought things over.
The patient who is fooling himself is the one who has committed some trifling, offense against the rules but who has been able to convince himself that this is of no importance and cannot possibly account for the gain in weight. Women seem particularly prone to getting themselves entangled in such delusions. On the other hand, it does frequently happen that a patient will in the midst of a conversation unthinkingly spear an olive or forget that he has already eaten his breadstick.
A mother preparing food for the family may out of sheer habit forget that she must not taste the sauce to see whether it needs more salt. Sometimes a rich maiden aunt cannot be offended by refusing a cup of tea into which she has put two teaspoons of sugar, thoughtfully remembering the patient's taste from previous occasions. Such incidents are legion and are usually confessed without hesitation, but some patients seem genuinely able to forget these lapses and remember them with a visible shock only after insistent questioning.
In these cases we go carefully over the day. Sometimes the patient has been invited
to a meal or gone to a restaurant, naively believing that the food has actually been
prepared exactly according to instructions. They will say: “Yes, now that I come
to think of it the steak did seem a bit bigger than the one I have at home, and it
did taste better; maybe there was a little fat on it, though I specially told them
to cut it all away”. Sometimes the breadsticks were broken and a few fragments eaten,
and “Maybe they were a little more than one”. It is not uncommon for patients to
place too much reliance on their memory of the diet-
Cosmetics
When no dietary error is elicited we turn to cosmetics. Most women find it hard to believe that fats, oils, creams and ointments applied to the skin are absorbed and interfere with weight reduction by HCG just as if they had been eaten. This almost incredible sensitivity to even such very minor increases in nutritional intake is a peculiar feature of the HCG method. For instance, we find that persons who habitually handle organic fats, such as workers in beauty parlors, masseurs, butchers, etc. never show what we consider a satisfactory loss of weight unless they can avoid fat coming into contact with their skin.
The point is so important that I will illustrate it with two cases. A lady who was
cooperating perfectly suddenly increased half a pound. Careful questioning brought
nothing to light. She had certainly made no dietary error nor had she used any kind
of face cream, and she was already in the menopause. As we felt that we could trust
her implicitly, we left the question suspended. Yet just as she was about to leave
the consulting room she suddenly stopped, turned and snapped her fingers. “I've
got it,” she said. This is what had happened: She had bought herself a new set
of make-
The other case concerns a man who impressed us as being very conscientious. He was
about 20 lbs. overweight but did not lose satisfactorily from the onset of treatment.
Again and again we tried to find the reason but with no success, until one day he
said: “I never told you this, but I have a glass eye. In fact, I have a whole set
of them. I frequently change them, and every time I do that I put a special ointment
in my eyesocket. Do you think that could have anything to do with it?” As we thought
just that, we asked him to stop using this ointment, and from that day on his weight-
We are particularly averse to those modern cosmetics which contain hormones, as any
interference with endocrine regulations during treatment must be absolutely avoided.
Many women whose skin has in the course of years become adjusted to the use of fat
containing cosmetics find that their skin gets dry as soon as they stop using them.
In such cases we permit the use of plain mineral oil, which has no nutritional value.
On the other hand, mineral oil should not be used in preparing the food, first because
of its undesirable laxative quality, and second because it absorbs some fat-
Many women are horrified when told that for the duration of treatment they cannot use face creams or have facial massages. They fear that this and the loss of weight will ruin their complexion. They can be fully reassured. Under treatment normal fat is restored to the skin, which rapidly becomes fresh and turgid, making the expression much more youthful. This is a characteristic of the HCG method which is a constant source of wonder to patients who have experienced or seen in others the facial ravages produced by the usual methods of reducing. An obese woman of 70 obviously cannot expect to have her pued face reduced to normal without a wrinkle, but it is remarkable how youthful her face remains in spite of her age.
The Voice
Incidentally, another interesting feature of the HCG method is that it does not ruin a singing voice. The typically obese prima donna usually finds that when she tries to reduce the timbre of her voice is liable to change, and understandably this terrifies her. Under HCG this does not happen; indeed, in many cases the voice improves and the breathing invariably does. We have had many cases of professional singers very carefully controlled by expert voice teachers, and the maestros have been so enthusiastic that they now frequently send us patients.
Other Reasons for a Gain
Apart from diet and cosmetics there can be a few other reasons for a small rise in
weight. Some patients unwittingly take chewing gum, throat pastilles, vitamin pills,
cough syrups etc., without realizing that the sugar or fats they contain may interfere
with a regular loss of weight. Sex hormones or cortisone in its various modern forms
must be avoided, though oral contraceptives are permitted. In fact the only self-
Occasionally we allow a sleeping tablet or a tranquilizer, but patients should be told that while under treatment they need and may get less sleep. For instance, here in Italy where it is customary to sleep during the siesta which lasts from one to four in the afternoon most patients find that though they lie down they are unable to sleep.
We encourage swimming and sun bathing during treatment, but it should be remembered
that a severe sunburn always produces a temporary rise in weight, evidently due to
water retention. The same may be seen when a patient gets a common cold during treatment.
Finally, the weight can temporarily increase -
Appetite-
We hardly ever use amphetamines, the appetite-
Unforeseen Interruptions of Treatment
If an interruption of treatment lasting more than four days is necessary, the patient
must increase his diet to at least 800 Calories by adding meat, eggs, cheese, and
milk to his diet after the third day, as otherwise he will find himself so hungry
and weak that he is unable to go about his usual occupation. If the interval lasts
less than two weeks the patient can directly resume injections and the 500-
When a patient knows beforehand that he will have to travel and be absent for more than four days, it is always better to stop injections three days before he is due to leave so that he can have the three days of strict dieting which are necessary after the last injection at home. This saves him from the almost impossible task of having to arrange the 500 Calorie diet while en route, and he can thus enjoy a much greater dietary freedom from the day of his departure. Interruptions occurring before 20 effective injections have been given are most undesirable, because with less than that number of injections some weight is liable to be regained. After the 20th injection an unavoidable interruption is merely a loss of time.
Muscular Fatigue
Towards the end of a full course, when a good deal of fat has been rapidly lost,
some patients complain that lifting a weight or climbing stairs requires a greater
muscular effort than before. They feel neither breathlessness nor exhaustion but
simply that their muscles have to work harder. This phenomenon, which disappears
soon after the end of the treatment, is caused by the removal of abnormal fat deposited
between, in, and around the muscles. The removal of this fat makes the muscles too
long, and so in order to achieve a certain skeletal movement -
Massage
I never allow any kind of massage during treatment. It is entirely unnecessary and
merely disturbs a very delicate process which is going on in the tissues. Few indeed
are the masseurs and masseuses who can resist the temptation to knead and hammer
abnormal fat deposits. In the course of rapid reduction it is sometimes possible
to pick up a fold of skin which has not yet had time to adjust itself, as it always
does under HCG, to the changed figure. This fold contains its normal subcutaneous
fat and may be almost an inch thick. It is one of the main objects of the HCG treatment
to keep that fat there. Patients and their masseurs do not always understand this
and give this fat a working-
In my opinion, massage, thumping, rolling, kneading, and shivering undertaken for the purpose of reducing abnormal fat can do nothing but harm. We once had the honor of treating the proprietress of a high class institution that specialized in such antics. She had the audacity to confess that she was taking our treatment to convince her clients of the efficacy of her methods, which she had found useless in her own case.
How anyone in his right mind is able to believe that fatty tissue can be shifted mechanically or be made to vanish by squeezing is beyond my comprehension. The only effect obtained is severe bruising. The torn tissue then forms scars, and these slowly contracts making the fatty tissue even harder and more unyielding.
A lady once consulted us for her most ungainly legs. Large masses of fat bulged over the ankles of her tiny feet, and there were about 40 lbs. too much on her hips and thighs. We assured her that this overweight could be lost and that her ankles would markedly improve in the process. Her treatment progressed most satisfactorily but to our surprise there was no improvement in her ankles. We then discovered that she had for years been taking every kind of mechanical, electric and heat treatment for her legs and that she had made up her mind to resort to plastic surgery if we failed.
Re-
Blood Sugar
Towards the end of a course or when a patient has nearly reached his normal weight
it occasionally happens that the blood sugar drops below normal, and we have even
seen this in patients who had an abnormally high blood sugar before treatment. Such
an attack of hypoglycemia is almost identical with the one seen in diabetics who
have taken too much insulin. The attack comes on suddenly; there is the same feeling
of light-
In the course of treatment the possibility of such an attack is explained to those patients who are in a phase in which a drop in blood sugar may occur. They are instructed to keep sugar or glucose sweets handy, particularly when driving a car. They are also told to watch the effect of taking sugar very carefully and report the following day. This is important, because anxious patients to whom such an attack has been explained are apt to take sugar unnecessarily, in which case it inevitably produces a gain in weight and does not dramatically relieve the symptoms for which it was taken, proving that these were not due to hypoglycemia. Some patients mistake the effects of emotional stress for hypoglycemia. When the symptoms are quickly relieved by sugar this is proof that they were indeed due to an abnormal lowering of the blood sugar, and in that case there is no increase in the weight on the following day. We always suggest that sugar be taken if the patient is in doubt.
Once such an attack has been relieved with sugar we have never seen it recur on the immediately subsequent days, and only very rarely does a patient have two such attacks separated by several days during a course of treatment. In patients who have not eaten sufficiently during the first two days of treatment we sometimes give sugar when the minor symptoms usually felt during the first three days of treatment continue beyond that time, and in some cases this has seemed to speed up the euphoria ordinarily associated with the HCG method.
Ratio of Pounds to Inches
An interesting feature of the HCG method is that, regardless of how fat a patient
is, the greatest circumference -
Preparing the Solution
Human chorionic gonadotrophin comes on the market as a highly soluble powder which
is the pure substance extracted from the urine of pregnant women. Such preparations
are carefully standardized, and any brand made by a reliable pharmaceutical company
is probably as good as any other. The substance should be extracted from the urine
and not from the placenta, and it must of course be of human and not of animal origin.
The powder is sealed in ampoules or in rubber-
Once HCG is in solution it is far less stable. It may be kept at room-
As we are usually treating a fair number of patients at the same time, we prefer
to use vials containing 5000 units. With these the manufactures also supply 10 cc.
of solvent. Of such a solution 0.25 cc. contain the 125 I.U. which is the standard
dose for all cases and which should never be exceeded. This small amount is awkward
to handle accurately (it requires an insulin syringe) and is wasteful, because there
is a loss of solution in the nozzle of the syringe and in the needle. We therefore
prefer a higher dilution, which we prepare in the following way: The solvent supplied
is injected into the rubbercapped bottle containing the 5000 I.U. As these bottles
are too small to hold more solvent, we withdraw 5 cc., inject it into an empty rubber-
Injecting
HCG produces little or no tissue-
One should avoid leaving a vacuum in the bottle after preparing the solution or after withdrawal of the amount required for the injections as otherwise alcohol used for sterilizing a frequently perforated rubber cap might be drawn into the solution. When sharp needles are used, it sometimes happens that a little bit of rubber is punched out of the rubber cap and can be seen as a small black speck floating in the solution. As these bits of rubber are heavier than the solution they rapidly settle out, and it is thus easy to avoid drawing them into the syringe.
We use very fine needles that are two inches long and inject deep intragluteally in the outer upper quadrant of the buttocks. The injection should if possible not be given into the superficial fat layers, which in very obese patients must be compressed so as to enable the needle to reach the muscle. Obviously needles and syringes must be carefully washed, sterilized and handled aseptically. It is also important that the daily injection should be given at intervals as close to 24 hours as possible. Any attempt to economize in time by giving larger doses at longer intervals is doomed to produce less satisfactory results.
There are hardly any contraindications to the HCG method. Treatment can be continued
in the presence of abscesses, suppuration, large infected wounds and major fractures.
Surgery and general anesthesia are no reason to stop and we have given treatment
during a severe attack of malaria. Acne or boils are no contraindication; the former
usually clears up, and furunculosis comes to an end. Thrombophlebitis is no contraindication,
and we have treated several obese patients with HCG and the 500-
Fibroids
While uterine fibroids seem to be in no way affected by HCG in the doses we use,
we have found that very large, externally palpable uterine myomas are apt to give
trouble. We are convinced that this is entirely due to the rather sudden disappearance
of fat from the pelvic bed upon which they rest and that it is the weight of the
tumor pressing on the underlying tissues which accounts for the discomfort or pain
which may arise during treatment. While we disregard even fair-
Gallstones
Small stones in the gall bladder may in patients who have recently had typical colics cause more frequent colics under treatment with HCG. This may be due to the almost complete absence of fat from the diet, which prevents the normal emptying of the gall bladder. Before undertaking treatment we explain to such patients that there is a risk of more frequent and possibly severe symptoms and that it may become necessary to operate. If they are prepared to take this risk and provided they agree to undergo an operation if we consider this imperative, we proceed with treatment, as after weight reduction with HCG the operative risk is considerably reduced in an obese patient. In such cases we always give a drug which stimulates the flow of bile, and in the majority of cases nothing untoward happens. On the other hand, we have looked for and not found any evidence to suggest that the HCG treatment leads to the formation of gallstones as pregnancy sometimes does.
The Heart
Disorders of the heart are not as a rule contraindications. In fact, the removal
of abnormal fat -
Coronary Occlusion
In obese patients who have recently survived a coronary occlusion, we adopt the following procedure in collaboration with the cardiologist. We wait until no further electrocardiographic changes have occurred for a period of three months. Routine treatment is then started under careful control and it is usual to find a further electrocardiographic improvement of a condition which was previously stationary.
In the thousands of cases we have treated we have not once seen any sort of coronary incident occur during or shortly after treatment. The same applies to cerebral vascular accidents. Nor have we ever seen a case of thrombosis of any sort develop during treatment, even though a high blood pressure is rapidly lowered. In this respect, too, the HCG treatment resembles pregnancy.
Teeth and Vitamins
Patients whose teeth are in poor repair sometimes get more trouble under prolonged treatment, just as may occur in pregnancy. In such cases we do allow calcium and vitamin D, though not in an oily solution. The only other vitamin we permit is vitamin C, which we use in large doses combined with an antihistamine at the onset of a common cold. There is no objection to the use of an antibiotic if this is required, for instance by the dentist. In cases of bronchial asthma and hay fever we have occasionally resorted to cortisone during treatment and find that triamcinolone is the least likely to interfere with the loss of weight, but many asthmatics improve with HCG alone.
Alcohol
Obese heavy drinkers, even those bordering on alcoholism, often do surprisingly well under HCG and it is exceptional for them to take a drink while under treatment. When they do, they find that a relatively small quantity of alcohol produces intoxication. Such patients say that they do not feel the need to drink This may in part be due to the euphoria which the treatment produces and in part to the complete absence of the need for quick sustenance from which most obese patients suffer.
Though we have had a few cases that have continued abstinence long after treatment, others relapse as soon as they are back on a normal diet. We have a few “regular customers” who, having once been reduced to their normal weight, start to drink again though watching their weight. Then after some months they purposely overeat in order to gain sufficient weight for another course of HCG which temporarily gets them out of their drinking routine. We do not particularly welcome such cases, but we see no reason for refusing their request.
Tuberculosis
It is interesting that obese patients suffering from inactive pulmonary tuberculosis
can be safely treated. We have under very careful control treated patients as early
as three months after they were pronounced inactive and have never seen a relapse
occur during or shortly after treatment. In fact, we only have one case on our records
in which active tuberculosis developed in a young man about one year after a treatment
which had lasted three weeks. Earlier X-
The Painful Heel
In obese patients who have been trying desperately to keep their weight down by severe
dieting, a curious symptom sometimes occurs. They complain of an unbearable pain
in their heels which they feel only while standing or walking. As soon as they take
the weight off their heels the pain ceases. These cases are the bane of the rheumatologists
and orthopedic surgeons who have treated them before they come to us. All the usual
investigations are entirely negative, and there is not the slightest response to
anti-
hysteria. When their heels are carefully examined one finds that the sole is softer
than normal and that the heel bone -
We interpret the condition as a lack of the hard fatty pad on which the calcaneus rests and which protects both the bone and the skin of the sole from pressure. This fat is like a springy cushion which carries the weight of the body. Standing on a heel in which this fat is missing or reduced must obviously be very painful. In their efforts to keep their weight down these patients have consumed this normal structural fat.
Those patients who have a normal or subnormal weight while showing the typically
obese fat deposits are made to eat to capacity, often much against their will, for
one week. They gain weight rapidly but there is no improvement in the painful heels.
They are then started on the routine HCG treatment. Overweight patients are treated
immediately. In both cases the pain completely disappears in 10-
We are particularly interested in these cases, as they furnish further proof of the contention that HCG + 500 Calories not only removes abnormal fat but actually permits normal fat to be replaced, in spite of the deficient food intake. It is certainly not so that the mere loss of weight reduces the pain, because it frequently disappears before the weight the patient had prior to the period of forced feeding is reached.
The Skeptical Patient
Any doctor who starts using the HCG method for the first time will have considerable difficulty, particularly if he himself is not fully convinced, in making patients believe that they will not feel hungry on 500 Calories and that their face will not collapse. New patients always anticipate the phenomena they know so well from previous treatments and diets and are incredulous when told that these will not occur. We overcome all this by letting new patients spend a little time in the waiting room with older hands, who can always be relied upon to allay these fears with evangelistic zeal, often demonstrating the finer points on their own body.
A waiting-
Concluding a Course
When the three days of dieting after the last injection are over, the patients are
told that they may now eat anything they please, except sugar and starch, provided
they faithfully observe one simple rule. This rule is that they must have their
own portable bathroom-
It takes about 3 weeks before the weight reached at the end of the treatment becomes
stable, i.e. does not show violent fluctuations after an occasional excess. During
this period patients must realize that the so-
Skipping a Meal
As long as their weight stays within two pounds of the weight reached on the day
of the last injection, patients should take no notice of any increase; but the moment
the scale goes beyond two pounds, even if this is only a few ounces, they must on
that same day entirely skip breakfast and lunch but take plenty to drink. In the
evening they must eat a huge steak with only an apple or a raw tomato. Of course
this rule applies only to the morning weight. Ex-
It is of utmost importance that the meal is skipped on the same day as the scale
registers an increase of more than two pounds and that missing the meals is not postponed
until the following day. If a meal is skipped on the day in which a gain is registered
in the morning, this brings about an immediate drop of often over a pound. But if
the skipping of the meal -
Most patients hardly ever need to skip a meal. If they have eaten a heavy lunch they feel no desire to eat their dinner, and in this case no increase takes place. If they keep their weight at the point reached at the end of the treatment, even a heavy dinner does not bring about an increase of two pounds on the next morning and does not therefore call for any special measures. Most patients are surprised how small their appetite has become and yet how much they can eat without gaining weight. They no longer suffer from an abnormal appetite and feel satisfied with much less food than before. In fact, they are usually disappointed that they cannot manage their first normal meal, which they have been planning for weeks.
Losing more Weight
An ex-
Trouble After Treatment
Two difficulties may be encountered in the immediate post-
When abnormal fat is no longer being put into circulation either because it has been
consumed or because immunity has set in, this is always felt by the patient as sudden,
intolerable and constant hunger. In this sense the HCG method is completely self-
All that is happening is that the essential fat lost at the end of the treatment,
owing to the patient's reluctance to report a much greater hunger, is being replaced.
The weight at which such a patient must stabilize thus lies 2-
Beware of Over-
The other trouble which is frequently encountered immediately after treatment is
again due to over-
Protein deficiency
Here too, the explanation is quite simple. During treatment the patient has been
only just above the verge of protein deficiency and has had the advantage of protein
being fed back into his system from the breakdown of fatty tissue. Once the treatment
is over there is no more HCG in the body and this process no longer takes place.
Unless an adequate amount of protein is eaten as soon as the treatment is over,
protein deficiency is bound to develop, and this inevitably causes the marked retention
of water known as hunger-
The treatment is very simple. The patient is told to eat two eggs for breakfast and a huge steak for lunch and dinner followed by a large helping of cheese and to phone through the weight the next morning. When these instructions are followed a stunned voice is heard to report that two lbs. have vanished overnight, that the ankles are normal but that sleep was disturbed, owing to an extraordinary need to pass large quantities of water. The patient having learned this lesson usually has no further trouble.
Relapses
As a general rule one can say that 60%-
Pregnancy or the menopause may annul the effect of a previous treatment. Women who
take treatment during the one year after the last menstruation -
Late teenage girls who suffer from attacks of compulsive eating have by far the worst record of all as far as relapses are concerned.
Patients who have once taken the treatment never seem to hesitate to come back for another short course as soon as they notice that their weight is once again getting out of hand. They come quite cheerfully and hopefully, assured that they can be helped again. Repeat courses are often even more satisfactory than the first treatment and have the advantage, as do second courses, that the patient already knows that he will feel comfortable throughout.
Plan of a Normal Course
125 I.U. of HCG daily (except during menstruation) until 40 injections have been given.
Until 3rd injection forced feeding.
After 3rd injection, 500 calorie diet to be continued until 72 hours after the last injection.
For the following 3 weeks, all foods allowed except starch and sugar in any form (careful with very sweet fruit).
After 3 weeks, very gradually add starch in small quantities, always controlled by morning weighing.
CONCLUSION
The HCG + diet method can bring relief to every case of obesity, but the method is
not simple. It is very time consuming and requires perfect cooperation between physician
and patient. Each case must be handled individually, and the physician must have
time to answer questions, allay fears and remove misunderstandings. He must also
check the patient daily. When something goes wrong he must at once investigate until
he finds the reason for any gain that may have occurred. In most cases it is useless
to hand the patient a diet-
The method involves a highly complex bodily mechanism, and even though our theory may be wrong the physician must make himself some sort of picture of what is actually happening; otherwise he will not be able to deal with such difficulties as may arise during treatment.
I must beg those trying the method for the first time to adhere very strictly to the technique and the interpretations here outlined and thus treat a few hundred cases before embarking on experiments of their own, and until then refrain from introducing innovations, however thrilling they may seem. In a new method, innovations or departures from the original technique can only be usefully evaluated against a substantial background of experience with what is at the moment the orthodox procedure.
I have tried to cover all the problems that come to my mind. Yet a bewildering array of new questions keeps arising, and my interpretations are still fluid. In particular, I have never had an opportunity of conducting the laboratory investigations which are so necessary for a theoretical understanding of clinical observations, and I can only hope that those more fortunately placed will in time be able to fill this gap.
The problems of obesity are perhaps not so dramatic as the problems of cancer or
polio, but they often cause life-
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