|
Pounds & Inches
A NEW APPROACH TO OBESITY
BY: A.T.W. SIMEONS, M.D.
Obesity a Disorder
The History of Obesity
The Significance of Regular
Meals
Three Kinds of Fat
Injustice to the Obese
Glandular
Theories
The Thyroid Gland
The Pituitary Gland
The Adrenals
The Diencephalon or Hypothalamus
The Fat-bank
(1) The
Inherited Factor
(2) Other
Diencephalic Disorders
(3) The
Exhaustion of the Fat-bank
Psychological Aspects
Compulsive Eating
Reluctance to Lose Weight
Not by Weight alone…
Signs and symptoms of obesity
The Emaciated Lady
Fat but not Obese
A Curious Observation
Fat on the Move
Pregnancy and Obesity
The Nature of Human
Chorionic Gonadotropin
The Real Gonadotrophins
HCG no Sex
Hormone
Importance and Potency of HCG
Complicating
Disorders
Diabetes
Rheumatism
Cholesterol
Gout
Blood Pressure
Peptic Ulcers
Psoriasis,
Fingernails, Hair, Varicose Ulcers
The “Pregnant" Male
Warnings
History taking
The Duration of Treatment
Immunity to HCG
Menstruation
Further Courses
Conditions that
must be accepted before treatment
Examining the patient
Gain before Loss
Starting treatment
The Diet
Making up the Calories
Vegetarians
Faulty Dieting
Vitamins and Anemia
The First Days of Treatment
Fluctuations in weight loss
Interruptions of Weight Loss
The Plateau
Reaching a Former Level
Menstrual Interruption
Dietary Errors
Salt and Reducing
Water
Constipation
Investigating Dietary Errors
Liars and Fools
Cosmetics
The Voice
Other Reasons for a Gain
Appetite-reducing Drugs
Unforeseen Interruptions of
Treatment
Muscular Fatigue
Massage
Blood Sugar
The Ratio of Pounds to Inches
Preparing the Solution
Injecting
Fibroids
Gallstones
The Heart
Coronary Occlusion
Teeth and Vitamins
Alcohol
Tuberculosis
The Painful Heel
The Skeptical Patient
Concluding a Course
Skipping a Meal
Losing more Weight
Trouble After Treatment
Beware of Over-enthusiasm
Protein deficiency
Relapses
Plan of a Normal Course
CONCLUSION
Glossary
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-tracked by an all too facile interpretation of obesity, I
have always held that overeating is the result of the disorder, not its cause,
and that we can make little headway until we can build for ourselves some sort
of theoretical structure with which to explain the condition. Whether such a
structure represents the truth is not important at this moment. What it must do
is to give us an intellectually satisfying interpretation of what is happening
in the obese body. It must also be able to withstand the onslaught of all
hitherto known clinical facts and furnish a hard background against which the
results of treatment can be accurately assessed.
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-saw
puzzle. And then, as in a jig-saw puzzle, little clusters of fragments began to
form, though they seemed to fit in nowhere. As the years passed these clusters
grew bigger and started to amalgamate until, about sixteen years ago, a complete
picture became dimly discernible. This picture was, and still is, dotted with
gaps for which I cannot find the pieces, but I do now feel that a theoretical
structure is visible as a whole.
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 - a prospect which would probably have
resulted in no book at all - I have tried to meet the requirements of both in a
single book. This is a rather difficult enterprise in which I may not have
succeeded. The expert will grumble about long-windedness, while the lay-reader
may occasionally have to look up an unfamiliar word in the glossary provided for
him.
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-cut laboratory experiments. Thus when I make what reads like a factual
statement, the professional reader may have to translate into: clinical
experience seems to suggest that such and such an observation might be
tentatively explained by such and such a working hypothesis, requiring a vast
amount of further research before the hypothesis can be considered a valid
theory. If we can from the outset establish this as a mutually accepted
convention, I hope to avoid being accused of speculative exuberance.
Back to Top
_____
*A list of references to the more important
articles is given at the end of this booklet
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-reducing drugs, laxatives, violent exercise, massage, baths,
etc., is only temporary and will be rapidly regained as soon as the reducing
regimen is relaxed. The reason is simply that none of these measures corrects
the basic disorder.
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.
Back to Top
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-existent, as it still is in all wild animals and most primitive
races.
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 - always a sign of latent obesity - shows
that the trend still lingers on.
Back to Top
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-Neolithic times, man ate only when he was hungry and on1y as much
as he required too still the pangs of hunger. Moreover, much of his food was
raw and all of it was unrefined. He roasted his meat, but he did not boil it,
as he had no pots, and what little he may have grubbed from the Earth and picked
from the trees, he ate as he went along.
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.
Back to Top
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.
Back to Top
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 - a fig for doctors and
insurance companies.
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.
Back to Top
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-development of the sex organs. The middle-age
spread in men and the tendency of many women to put on weight in the menopause
seemed to indicate a causal connection between diminishing sex function and
overweight. Yet, when highly active sex hormones became available, it was found
that their administration had no effect whatsoever on obesity. The sex glands
could therefore not be the seat of the disorder.
Back to Top
The Thyroid Gland
When it was discovered that the thyroid gland controls the rate at which
body-fuel is consumed, it was thought that by administering thyroid gland to
obese patients their abnormal fat deposits could be burned up more rapidly.
This too proved to be entirely disappointing, because as we now know, these
abnormal deposits take no part in the body's energy-turnover - they are
inaccessibly locked away. Thyroid medication merely forces the body to consume
its normal fat reserves, which are already depleted in obese patients, and then
to break down structurally essential fat without touching the abnormal deposits.
In this way a patient may be brought to the brink of starvation in spite of
having a hundred pounds of fat to spare. Thus any weight loss brought about by
thyroid medication is always at the expense of fat of which the body is in dire
need.
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 - though not the obese - lose weight rapidly when their thyroid becomes
overactive may have contributed to the false notion that thyroid deficiency and
obesity are connected. Much misunderstanding about the supposed role of the
thyroid gland in obesity is still met with, and it is now really high time that
thyroid preparations be once and for all struck off the list of remedies for
obesity. This is particularly so because giving thyroid gland to an obese
patient whose thyroid is either normal or overactive, besides being useless, is
decidedly dangerous.
Back to Top
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-mobilizing factor has been found in
pituitary glands, but it is still too early to say whether this factor is
destined to play a role in the treatment of obesity.
Back to Top
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 - the so-called Cushing's Syndrome - was caused by a
glandular new-growth of the adrenals or by their excessive stimulation with
ACTH, which is the pituitary hormone governing the activity of the outer rind or
cortex of the adrenals.
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.
Back to Top
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-called diencephalon. It is a very
primitive part of the brain and has in man been almost smothered by the huge
masses of nervous tissue with which we think, reason and voluntarily move our
body. The diencephalon is the part from which the central nervous system
controls all the automatic animal functions of the body, such as breathing, the
heart beat, digestion, sleep, sex, the urinary system, the autonomous or
vegetative nervous system and via the pituitary the whole interplay of the
endocrine glands.
_____
* 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 - another form
of fuel - in the blood depends on a certain nervous center in the diencephalon.
When this center is destroyed in laboratory animals, they develop a condition
rather similar to human stable diabetes. It has also long been known that the
destruction of another diencephalic center produces a voracious appetite and a
rapid gain in weight in animals which never get fat spontaneously.
Back to Top
The Fat-bank
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-bank" frees itself from all work
which goes beyond its normal banking capacity. The onset of obesity dates from
the moment the diencephalon adopts this labor-saving ruse. Once a fixed deposit
has been established the normal fat reserves are held at a minimum, while every
available surplus is locked away in the fixed deposit and is therefore taken out
of normal circulation.
Back to Top
(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-banking capacity is abnormally low from birth. Such
a congenitally low diencephalic capacity would then represent the inherited
factor in obesity. When this abnormal trait is markedly present, obesity will
develop at an early age in spite of normal feeding; this could explain why among
brothers and sisters eating the same food at the same table some become obese
and others do not.
Back to Top
(2) Other Diencephalic
Disorders
The second way in which obesity can become established is the lowering of a
previously normal fat-banking capacity owing to some other diencephalic
disorder. It seems to be a general rule that when one of the many diencephalic
centers is particularly overtaxed; it tries to increase its capacity at the
expense of other centers.
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-functioning or missing sex glands, there is
nothing to stop the anterior pituitary from producing more and more of these
hormones. This situation causes an excessive strain on the diencephalic center
which controls the function of the anterior pituitary. In order to cope with
this additional burden the center appears to draw more and more energy away from
other centers, such as those concerned with emotional stability, the blood
circulation (hot flushes) and other autonomous nervous regulations, particularly
also from the not so vitally important fat-bank.
The so-called stable type of diabetes heavily involves the diencephalic blood
sugar regulating center. The diencephalon tries to meet this abnormal load by
switching energy destined for the fat-bank over to the sugar-regulating center,
with the result that the fat-banking capacity is reduced to the point at which
it is forced to establish a fixed deposit and thus initiate the disorder we call
obesity. In this case one would have to consider the diabetes the primary cause
of the obesity, but it is also possible that the process is reversed in the
sense that a deficient or overworked fat-center draws energy from the
sugar-center, in which case the obesity would be the cause of that type of
diabetes in which the pancreas is not primarily involved. Finally, it is
conceivable that in Cushing's syndrome those symptoms which resemble obesity are
entirely due to the withdrawal of energy from the diencephalic fat-bank in order
to make it available to the highly disturbed center which governs the anterior
pituitary-adrenocortical system.
Whether obesity is caused by a marked inherited deficiency of the fat-center
or by some entirely different diencephalic regulatory disorder, its insurgence
obviously has nothing to do with overeating and in either case obesity is
certain to develop regardless of dietary restrictions. In these cases any
enforced food deficit is made up from essential fat reserves and normal
structural fat, much to the disadvantage of the patient's general health.
Back to Top
(3) The Exhaustion of the
Fat-bank
But there is still a third way in which obesity can become established, and
that is when a presumably normal fat-center is suddenly - the emphasis is on
suddenly - called upon to deal with an enormous influx of food far in excess of
momentary requirements. At first glance it does seem that here we have a
straight-forward case of overeating being responsible for obesity, but on
further analysis it soon becomes clear that the relation of cause and effect is
not so simple. In the first place we are merely assuming that the capacity of
the fat-center is normal while it is possible and even probable that only
persons who have some inherited trait in this direction can become obese merely
by overeating.
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-regulating center. During the last war about 6000
grossly underfed Polish refugees who had spent harrowing years in Russia were
transferred to a camp in India where they were well housed, given normal British
army rations and some cash to buy a few extras. Within about three months, 85%
were suffering from obesity.
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.
Back to Top
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.
Back to Top
Compulsive Eating
No end of injustice is done to obese patients by accusing them of compulsive
eating, which is a form of diverted sex-gratification. Most obese patients do
not suffer from compulsive eating; they suffer genuine hunger - real, gnawing,
torturing hunger - which has nothing whatever to do with compulsive eating.
Even their sudden desire for sweets is merely the result of the experience that
sweets, pastries and alcohol will most rapidly of all foods allay the pangs of
hunger. This has nothing to do with diverted instincts.
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-stimulation, the higher
centers of the brain having blocked primitive diencephalic instinct
gratification. The pressure is then let off through another primitive channel,
which is oral gratification. In my experience the only thing that will cure
this condition is uninhibited sex, a therapeutic procedure which is hardly ever
feasible, for if it were, the patient would have adopted it without professional
prompting, nor would this in any way correct the associated obesity. It would
only raise new and often greater problems if used as a therapeutic measure.
Patients suffering from real compulsive eating are comparatively rare. In my
practice they constitute about 1-2%. Treating them for obesity is a
heartrending job. They do perfectly well between attacks, but a single bout
occurring while under treatment may annul several weeks of therapy. Little
wonder that such patients become discouraged. In these cases I have found that
psychotherapy may make the patient fully understand the mechanism, but it does
nothing to stop it. Perhaps society's growing sexual permissiveness will make
compulsive eating even rarer.
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 - to them unmotivated - is due to compulsive eating, while all the time
it is merely a greater need for food. The only way to find out is to treat such
patients. Those that suffer from real compulsive eating continue to have such
attacks, while those who are not compulsive eaters never get an attack during
treatment.
Back to Top
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 - or be jealous - on account
of their figure rather than be attracted by their intelligence or character
only. Some have a feeling that reducing means giving up an almost cherished
and intimate part of themselves. In many of these cases psychotherapy can be
helpful, as it enables these patients to see the whole situation in the full
light of consciousness. An affectionate attachment to abnormal fat is usually
seen in patients who became obese in childhood, but this is not necessarily so.
In all other cases the best psychotherapy can do in the usual treatment of
obesity is to render the burden of hunger and never-ending dietary restrictions
slightly more tolerable. Patients who have successfully established an erotic
transfer to their psychiatrist are often better able to bear their suffering as
a secret labor of love.
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-center and the laying down of abnormally fixed fat deposits
in abnormal places. This means that once obesity has become established, it can
no more be cured by eliminating those factors which brought it on than a fire
can be extinguished by removing the cause of the conflagration. Thus a
discussion of the various ways in which obesity can become established is useful
from a preventative point of view, but it has no bearing on the treatment of the
established condition. The elimination of factors which are clearly hastening
the course of the disorder may slow down its progress or even halt it, but they
can never correct it.
Back to Top
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.
Back to Top
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-kneed.
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-tissue. Such striation, as it is
called, commonly occurs on the abdomen of women during pregnancy, but in obesity
it is frequently found on the breasts, the hips and occasionally on the
shoulders. In many cases striation is so fine that the small white lines are
only just visible. They are always a sure sign of obesity, and though this may
be slight at the time of examination such patients can usually remember a period
in their childhood when they were excessively chubby.
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.
Back to Top
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.
Back to Top
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.
Back to Top
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-center.
There was not even a pointer showing a direction in which pharmacological
research could move to find a drug that had such a specific action. The closest
approach were the appetite-reducing drugs - the amphetamines - but these cured
nothing.
Back to Top
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-called “fat boys” with long, slender hands,
breasts any flat-chested maiden would be proud to posses, large hips, buttocks
and thighs with striation, knock-knees and underdeveloped genitals, often with
undescended testicles.
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-urine from the female ward was given in
quantities of about 300 cc. by retention enema, as good results could be
obtained as by injecting the pure substance. The second was that small daily
doses appeared to be just as effective as much larger ones given twice a week.
Thirdly, and that is the observation that concerns us here, when such patients
were given small daily doses they seemed to lose their ravenous appetite though
they neither gained nor lost weight. Strangely enough however, their shape did
change. Though they were not restricted in diet, there was a distinct decrease
in the circumference of their hips.
Back to Top
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-effects other than
beneficial.
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.
Back to Top
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-vomiting
without coming to any real harm.
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-center
reverts to its normal capacity. It is only then that the abnormally accumulated
fat is locked away again in a fixed deposit. From that moment on she is
suffering from obesity and is subject to all its consequences.
Pregnancy seems to be the only normal human condition in which the
diencephalic fat-banking capacity is unlimited. It is only during pregnancy
that fixed fat deposits can be transferred back into the normal current account
and freely drawn upon to make up for any nutritional deficit. During pregnancy,
every ounce of reserve fat is placed at the disposal of the growing fetus. Were
this not so, an obese woman, whose normal reserves are already depleted, would
have the greatest difficulties in bringing her pregnancy to full term. There is
considerable evidence to suggest that it is the HCG produced in large quantities
in the placenta which brings about this diencephalic change.
Though we may be able to increase the dieneephalic fat-banking capacity by
injecting HCG, this does not in itself affect the weight, just as transferring
monetary funds from a fixed deposit into a current account does not make a man
any poorer; to become poorer it is also necessary that he freely spends the
money which thus becomes available. In pregnancy the needs of the growing
embryo take care of this to some extent, but in the treatment of obesity there
is no embryo, and so a very severe dietary restriction must take its place for
the duration of treatment.
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.
Back to Top
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 - enough to render a million infantile
rats precociously mature. Other mammals make use of a different hormone, which
can be extracted from their blood serum but not from their urine. Their
placenta differs in this and other respects from that of man and the great apes.
This animal chorionic gonadotrophin is much less rapidly broken down in the
human body than HCG, and it is also less suitable for the treatment of obesity.
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.
Back to Top
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.
Back to Top
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-existing deficiency, but never a stimulation beyond the normal. In an
indirect way via the anterior pituitary, HCG regulates menstruation and
facilitates conception, but it never virilizes a woman or feminizes a man. It
neither makes men grow breasts nor does it interfere with their _____
* 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- sphere. They are not accustomed as we
are, to think thyroid, insulin, cortisone, adrenalin etc, as hormones.
Back to Top
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-Calorie diet. It is no
exaggeration to say that the flooding of the female body with HCG is by far the
most spectacular hormonal event in pregnancy. It has an enormous protective
importance for mother and child, and I even go so far as to say that no woman,
and certainly not an obese one, could carry her pregnancy to term without it.
If I can be forgiven for comparing my fellow-endocrinologists with wicked
Godmothers, HCG has certainly been their Cinderella, and I can only romantically
hope that its extraordinary effect on abnormal fat will prove to be its Fairy
Godmother.
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.
Back to Top
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 - though not necessarily - associated
with obesity, these disorders have two things in common. In all of them, modern
research is becoming more and more inclined to believe that diencephalic
regulations play a dominant role in their causation. The other common factor is
that they either improve or do not occur during pregnancy. In the latter
respect they are joined by many other disorders not necessarily associated with
obesity. Such disorders are, for instance, colitis, duodenal or gastric ulcers,
certain allergies, psoriasis, loss of hair, brittle fingernails, migraine, etc.
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.
Back to Top
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 3-400 mg%, it is
often possible to stop all antidiabetic medication after the first few days of
treatment. The blood sugar continues to drop from day to day and often reaches
normal values in 2-3 weeks. As in pregnancy, this phenomenon is not observed in
the brittle type of diabetes, and as some cases that are predominantly stable
may have a small brittle factor in their clinical makeup, all obese diabetics
have to be kept under a very careful and expert watch.
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.
Back to Top
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-relieving drugs seem able to control it satisfactorily
after weight reduction. In any case, the HCG method makes it possible in obese
arthritic patients to interrupt prolonged cortisone treatment without a
recurrence of pain. This in itself is most welcome, but there is the added
advantage that the treatment stimulates the secretion of ACTH in a physiological
manner and that this regenerates the adrenal cortex, which is apt to suffer
under prolonged cortisone treatment.
Back to Top
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-up examinations
undertaken some months after treatment that the cholesterol was much better than
it had been before treatment. As the increase is mostly in the form of the not
dangerous free cholesterol, we gradually came to welcome the phenomenon. Today
we believe that the rise is entirely due to the liberation of recent cholesterol
deposits that have not yet undergone calcification in the arterial wall and
therefore highly beneficial.
Back to Top
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.
Back to Top
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-sustaining
medication until the circulation has had a few days time to adjust itself to the
new situation. On the other hand, among the thousands of cases treated we have
never seen any untoward incident which could be attributed to the rather sudden
drop in high blood 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.
Back to Top
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.
Back to Top
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-called alopecia areata -
after a severe emotional shock, just before she was about to start an HCG
treatment. Our dermatologist diagnosed the case as a particularly severe one,
predicting that all the hair would be lost. He counseled against the reducing
treatment, but in view of my previous experience and as the patient was very
anxious not to postpone reducing, I discussed the matter with the dermatologist
and it was agreed that, having fully acquainted the patient with the situation,
the treatment should be started. During the treatment, which lasted four weeks,
the further development of the bald patches was almost, if not quite, arrested;
however, within a week of having finished the course of HCG, all the remaining
hair fell out as predicted by the dermatologist. The interesting point is that
the treatment was able to postpone this result but not to prevent it. The
patient has now grown a new shock of hair of which she is justly proud.
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.
Back to Top
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.
Back to Top
Warnings
I must warn the lay reader that what follows is mainly for the treating
physician and most certainly not a do-it-yourself primer. Many of the
expressions used mean something entirely different to a qualified doctor than
that which their common use implies, and only a physician can correctly
interpret the symptoms which may arise during treatment. Any patient who thinks
he can reduce by taking a few “shots” and eating less is not only sure to be
disappointed but may be heading for serious trouble. The benefit the patient
can derive from reading this part of the book is a fuller realization of how
very important it is for him to follow to the letter his physician's
instructions.
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-regulations. On the other hand, the diencephalon is an extremely robust
organ in spite of its unbelievable intricacy. From an evolutionary point of
view it is one of the oldest organs in our body and its evolutionary history
dates back more than 500 million years. This has tendered it extraordinarily
adaptable to all natural exigencies, and that is one of the main reasons why the
human species was able to evolve. What its evolution did not prepare it for
were the conditions to which human culture and civilization now expose it.
Back to Top
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
300-400 grams-per injection, per day. It is a particularly interesting feature
of the HCG treatment that in reasonably cooperative patients this figure is
remarkably constant, regardless of sex, age and degree of overweight.
Back to Top
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-Calorie diet for three days after the last injection.
This is a very essential part of the treatment, because if they start eating
normally as long as there is even a trace of HCG in their body they put on
weight alarmingly at the end of the treatment. After three days when all the
HCG has been eliminated this does not happen, because the blood is then no
longer saturated with food and can thus accommodate an extra influx from the
intestines without increasing its volume by retaining water.
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-banking
capacity. Clinically this expresses itself in the fact that when in these mild
cases treatment is stopped as soon as the weight is normal, which may be
achieved in a week, it is much more easily regained than after a full course of
23 injections.
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 800-1000 Calories for the rest of the treatment. The diet
is arranged in such a way that the weight remains perfectly stationary and is
thus continued for three days after the 23rd injection. Only then are the
patients free to eat anything they please except sugar and starches for the next
three weeks.
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-range.
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 5-6 lbs. if this occurs before the 40
injections are up.
Back to Top
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-regulation which annuls the diencephalic effect.
After 40 daily injections it takes about six weeks before
this so-called immunity is lost and HCG again becomes fully effective. Usually
after about 40 injections patients may feel the onset of immunity as hunger
which was previously absent. In those comparatively rare cases in which signs
of immunity develop before the full course of 40 injections has been completed -
say at the 35th injection - treatment must be stopped at once, because if it is
continued the patients begin to look weary and drawn, feel weak and hungry and
any further loss of weight achieved is then always at the expense of normal fat.
This is not only undesirable, but normal fat is also instantly regained as soon
as the patient is returned to a free diet.
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.
Back to Top
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.
Back to Top
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.
Back to Top
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-patients, but patients coming from abroad must stay in the
hospital, as no hotel or restaurant can be relied upon to prepare the diet with
sufficient accuracy. These patients have their meals, sleep, and attend the
clinic in the hospital, but are otherwise free to spend their time as they
please in the city and its surroundings sightseeing, bathing or theater-going.
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-measure is bound to prove utterly
disappointing to patient and physician alike and is a waste of time and energy.
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 - to him surprising - results are
achieved that he almost invariably comes back for more. There certainly can be
no doubt that in my clinic more time is spent on damping over-enthusiasm than on
insisting that the rules of the treatment be observed.
Back to Top
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-development in men and women,
edema of the ankles and the state of genital development in the male are noted.
Wherever this seems indicated we X-ray the sella turcica, as the bony capsule
which contains the pituitary gland is called, measure the basal metabolic rate,
X-ray the chest and take an electrocardiogram. We do a blood-count and a
sedimentation rate and estimate uric acid, cholesterol, iodine and sugar in the
fasting blood.
Back to Top
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-effective” as far as the loss of weight is concerned, and the subsequent
injections given while the patient is dieting, which we call “effective”. The
average loss of weight is calculated on the number of effective injections and
from the weight reached on the day of the third injection, which may be well
above what it was two days earlier when the first injection was given.
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 - four to six pounds in 24
hours is not unusual - but after a day or two this rapid gain generally levels
off. In any case, the whole gain is usually lost in the first 48 hours of
dieting. It is necessary to proceed in this manner because the gain re-stocks
the depleted normal reserves, whereas the subsequent loss is from the abnormal
deposits only.
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 -
many patients are surprised that contrary to their previous experience they do
not gain weight and some even lose. The explanation is that in these cases
there is a compensatory flow of urine, which drains excessive water from the
body. To some extent this seems to be a direct action of HCG, but it may also
be due to a higher protein intake, as we know that a protein-deficient diet
makes the body retain water.
Back to Top
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.
Back to Top
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 - the wife, the mother or the cook, as
the case may be. Here in Italy patients are given the following diet sheet.
|
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: |
- 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.
- One type of vegetable only to be chosen from the
following: spinach, chard, chicory, beet-greens, green salad, tomatoes,
celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage.
- One breadstick (grissino) or one Melba toast.
- An apple or an orange or a handful of strawberries
or one-half grapefruit.
|
|
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-scale, as kitchen scales are not sufficiently accurate and the butcher
should certainly not be relied upon. Those not uncommon patients who feel that
even so little food is too much for them, can omit anything they wish.
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 - as it necessarily must - the
patient starts raking in unmerited kudos for superhuman willpower.
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.
Back to Top
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-grade veal should
be used for one meal and fish (excluding all those species such as herring,
mackerel, tuna, salmon, eel, etc., which have a high fat content, and all dried,
smoked or pickled fish), chicken breast, lobster, crawfish, prawns, shrimps,
crabmeat or kidneys for the other meal. Where the Italian breadsticks, the
so-called grissini, are not available, one Melba toast may be used instead,
though they are psychologically less satisfying. A Melba toast has about the
same weight as the very porous grissini which is much more to look at and to
chew.
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-free protein and a very small amount of starch.
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 - boiled, poached or raw - to patients who develop an aversion to
meat, but in this case they must add the white of three eggs to the one they eat
whole. In countries where cottage cheese made from skimmed milk is available
100 grams may occasionally be used instead of the meat, but no other cheeses are
allowed.
Back to Top
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-vegetarians; they cannot be allowed their usual intake of vegetable proteins
from leguminous plants such as beans or from wheat or nuts, nor can they have
their customary rice. In spite of these severe restrictions, their average loss
is about half that of non-vegetarians, presumably owing to the sugar content of
the milk.
Back to Top
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-be cooperative host. We generally
advise them to avoid all-round embarrassment, the almost inevitable turn of
conversation to their weight problem and the outpouring of lay counsel from
their table partners by not letting it be known that they are under treatment.
They should take dainty servings of everything, hide what they can under the
cutlery and book the gain which may take three days to get rid of as one of the
sacrifices which their profession entails. Allowing three days for their
correction such incidents do not jeopardize the treatment, provided they do not
occur all too frequently, in which case treatment should be postponed to a
socially more peaceful season.
Back to Top
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.
Back to Top
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 - that is, the fifth and sixth
injection - these minor complaints improve while the weight continues to drop at
about double the usually overall average of almost one pound per day, so that a
moderately severe case may by the fourth day of dieting have lost as much as
8-10 lbs.
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-headed and notice a desire to move quite contrary to their
previous lethargy. Those who have disregarded the advice to eat to capacity
continue to have minor discomforts and do not have the same euphoric sense of
well-being until about a week later. It seems that their normal fat reserves
require that much more time before they are fully stocked.
Back to Top
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-extraction. When this
happens, the body appears to replace some of the extracted fat with water which
is retained for this purpose. As water is heavier than fat the scales may show
no loss of weight, although sufficient fat has actually been consumed to make up
for the deficit in the 500-Calorie diet. When then such tissue is finally
broken down, the water is liberated and there is a sudden flood of urine and a
marked loss of weight. This simple interpretation of what is really an
extremely complex mechanism is the one we give those patients who want to know
why it is that on certain days they do not lose, though they have committed no
dietary error.
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.
Back to Top
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.
Back to Top
The Plateau
The second type of interruption we call a “plateau”. A plateau lasts 4-6
days and frequently occurs during the second half of a full course, particularly
in patients that have been doing well and whose overall average of nearly a
pound per effective injection has been maintained. Those who are losing more
than the average all have a plateau sooner or later. A plateau always corrects,
itself, but many patients who have become accustomed to a regular daily loss get
unnecessarily worried and begin to fret. No amount of explanation convinces
them that a plateau does not mean that they are no longer responding normally to
treatment.
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-called
“apple day”. An apple-day begins at lunch and continues until just before lunch
of the following day. The patients are given six large apples and are told to
eat one whenever they feel the desire though six apples is the maximum allowed.
During an apple-day no other food or liquids except plain water are allowed and
of water they may only drink just enough to quench an uncomfortable thirst if
eating an apple still leaves them thirsty. Most patients feel no need for water
and are quite happy with their six apples. Needless to say, an apple-day may
never be given on the day on which there is no injection. The apple-day
produces a gratifying loss of weight on the following day, chiefly due to the
elimination of water. This water is not regained when the patients resume their
normal 500-Calorie diet at lunch, and on the following days they continue to
lose weight satisfactorily.
The other way to break up a plateau is by giving a non-mercurial diuretic *
for one day.
* We use 1 tablet of hygroton.
This is simpler for the patient, but we prefer the apple-day, as we sometimes
find that though the diuretic is very effective on the following day it may take
two to three days before the normal daily reduction is resumed, throwing the
patient into a new fit of despair. It is useless to give either an apple-day or
a diuretic unless the weight has been stationary for at least four days without
any dietary error having been committed.
Back to Top
Reaching a Former Level
The third type of interruption in the regular loss of weight may last much
longer - ten days to two weeks. Fortunately, it is rare and only occurs in very
advanced cases, and then hardly ever during the first course of treatment. It
is seen only in those patients who during some period of their lives have
maintained a certain fixed degree of obesity for ten years or more and have then
at some time rapidly increased beyond that weight. When then in the course of
treatment the former level is reached, it may take two weeks of no loss, in
spite of HCG and diet, before further reduction is normally resumed.
Back to Top
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 - and this is by no means uncommon - she at once ceases to lose
weight. An unexplained arrest of reduction has on several occasions raised our
suspicion before the first period was missed. If in such cases, menstruation is
delayed, we stop injecting and do a precipitation test five days later. No
pregnancy test should be carried out earlier than five days after the last
injection, as otherwise the HCG may give a false positive result.
Oral contraceptives may be used during treatment.
Back to Top
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.
Back to Top
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.
Back to Top
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-drawn from the intestinal tract, with the result that the feces become hard
and dry. On the other hand if a patient drinks more than his body requires, the
surplus is promptly and easily eliminated. Trying to prevent the body from
retaining water by drinking less is therefore not only futile but even harmful.
Back to Top
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.
Back to Top
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.
Back to Top
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-sheet and start eating carrots, beans or peas and then to
seem genuinely surprised when their attention is called to the fact that these
are forbidden, as they have not been listed.
Back to Top
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-up pots and bottles and,
using her fingers, had transferred her large assortment of cosmetics to the new
containers in anticipation of the day she would be able to use them again after
her treatment.
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-loss was regular.
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-soluble vitamins, which are then
lost in the stool. We do permit the use of lipstick, powder and such lotions as
are entirely free of fatty substances. We also allow brilliantine to be used on
the hair but it must not be rubbed into the scalp. Obviously sun-tan oil is
prohibited.
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.
Back to Top
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.
Back to Top
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-medication
we allow is aspirin for a headache, though headaches almost invariably disappear
after a week of treatment, particularly if of the migraine type.
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 -
paradoxical though this may sound - after an exceptional physical exertion of
long duration leading to a feeling of exhaustion. A game of tennis, a vigorous
swim, a run, a ride on horseback or a round of golf do not have this effect; but
a long trek, a day of skiing, rowing or cycling or dancing into the small hours
usually result in a gain of weight on the following day, unless the patient is
in perfect training. In patients coming from abroad, where they always use
their cars, we often see this effect after a strenuous day of shopping on foot,
sightseeing and visits to galleries and museums. Though the extra muscular
effort involved does consume some additional Calories, this appears to be offset
by the retention of water which the tired circulation cannot at once eliminate.
Back to Top
Appetite-reducing Drugs
We hardly ever use amphetamines, the appetite-reducing drugs such as Dexedrin,
Dexamil, Preludin, etc., as there seems to be no need for them during the HCG
treatment. The only time we find them useful is when a patient is for impelling
and unforeseen reasons obliged to forego the injections for three to four days
and yet wishes to continue the diet so that he need not interrupt the course.
Back to Top
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-Calorie diet, but if the interruption lasts longer he
must again eat normally until he has had his third injection.
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.
Back to Top
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 - say the bending of an arm - the muscles have to perform
greater contraction than before. Within a short while the muscle adjusts itself
perfectly to the new situation, but under HCG the loss of fat is so rapid that
this adjustment cannot keep up with it. Patients often have to be reassured
that this does not mean that they are “getting weak”. This phenomenon does not
occur in patients who regularly take vigorous exercise and continue to do so
during treatment.
Back to Top
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-over. I have seen such patients who were as black and blue as if they
had received a sound thrashing.
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-examining the fat above her ankles, we found that it was unusually hard.
We attributed this to the countless minor injuries inflicted by kneading.
These injuries had healed but had left a tough network of connective
scar-tissue in which the fat was imprisoned. Ready to try anything, she was put
to bed for the remaining three weeks of her first course with her lower legs
tightly strapped in unyielding bandages. Every day the pressure was increased.
The combination of HCG, diet and strapping brought about a marked improvement
in the shape of her ankles. At the end of her first course she returned to her
home abroad. Three months later she came back for her second course. She had
maintained both her weight and the improvement of her ankles. The same
procedure was repeated, and after five weeks she left the hospital with a normal
weight and legs that, if not exactly shapely, were at least unobtrusive. Where
no such injuries of the tissues have been inflicted by inappropriate methods of
treatment, these drastic measures are never necessary.
Back to Top
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-headedness, weakness in the knees, trembling,
and unmotivated sweating; but under HCG hypoglycemia does not produce any
feeling of hunger. All these symptoms are almost instantly relieved by taking
two heaped teaspoons of sugar.
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.
Back to Top
The Ratio of Pounds to Inches
An interesting feature of the HCG method is that, regardless of how fat a
patient is, the greatest circumference - abdomen or hips as the case may be -
is reduced at a constant rate which is extraordinarily close to 1 cm. per
kilogram of weight lost. At the beginning of treatment the change in
measurements is somewhat greater than this, but at the end of a course it is
almost invariably found that the girth is as many centimeters less as the number
of kilograms by which the weight has been reduced. I have never seen this clear
cut relationship in patients that try to reduce by dieting only.
Back to Top
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-capped bottles in varying amounts which are stated in International
Units. In this form HCG is stable; however, only such preparations should be
used that have the date of manufacture and the date of expiry clearly stated on
the label or package. A suitable solvent is always supplied in a separate
ampoule in the same package.
Once HCG is in solution it is far less stable. It may be kept at
room-temperature for two to three days, but if the solution must be kept longer
it should always be refrigerated. When treating only one or two cases
simultaneously, vials containing a small number of units say 1000 I.U. should be
used. The 10 cc. of solvent which is supplied by the manufacturer is injected
into the rubber- capped bottle containing the HCG, and the powder must dissolve
instantly. Of this solution 1.25 cc. are withdrawn for each injection. One
such bottle of 1000 I.U. therefore furnishes 8 injections. When more than one
patient is being treated, they should not each have their own bottle but rather
all be injected from the same vial and a fresh solution made when this is empty.
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-capped
bottle and add 5 cc. of normal saline to each bottle. This gives us 10 cc. of
solution in each bottle, and of this solution 0.5 cc. contains 125 I.U. This
amount is convenient to inject with an ordinary syringe.
Back to Top
Injecting
HCG produces little or no tissue-reaction, it is completely painless and in
the many thousands of injections we have given we have never seen an
inflammatory or suppurative reaction at the site of the injection.
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-Calorie diet while suffering from this condition.
Our impression has been that in obese patients the phlebitis does rather better
and certainly no worse than under the usual treatment alone. This also applies
to patients suffering from varicose ulcers which tend to heal rapidly.
Back to Top
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-sized or multiple myomas, we insist that very large ones be operated
before treatment. We have had patients present themselves for reducing fat from
their abdomen who showed no signs of obesity, but had a large abdominal tumor.
Back to Top
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.
Back to Top
The Heart
Disorders of the heart are not as a rule contraindications. In fact, the
removal of abnormal fat - particularly from the heart-muscle and from the
surrounding of the coronary arteries - can only be beneficial in cases of
myocardial weakness, and many such patients are referred to us by cardiologists.
Within the first week of treatment all patients - not only heart cases - remark
that they have lost much of their breathlessness.
Back to Top
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.
Back to Top
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.
Back to Top
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.
Back to Top
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-rays showed a calcified spot from a childhood infection which had not produced
clinical symptoms. There was a family history of tuberculosis, and his illness
started under adverse conditions which certainly had nothing to do with the
treatment. Residual calcifications from an early infection are exceedingly
common, and we never consider them a contraindication to treatment.
Back to Top
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- rheumatic medication
or physiotherapy. The pain may be so severe that the patients are obliged to
give up their occupation, and they are not infrequently labeled as a case of
hysteria. When their heels are carefully examined one finds that the sole is
softer than normal and that the heel bone - the calcaneus - can be distinctly
felt, which is not the case in a normal foot.
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 10-20 days of dieting, usually around the 15th day of treatment,
and so far no case has had a relapse, though we have been able to follow up such
patients for years.
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.
Back to Top
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-room filled with obese patients who congregate daily is a sort of
group therapy. They compare notes and pop back into the waiting room after the
consultation to announce the score of the last 24 hours to an enthralled
audience. They cross-check on their diets and sometimes confess sins which they
try to hide from us, usually with the result that the patient in whom they have
confided palpitatingly tattles the whole disgraceful story to us with a “But
don't let her know I told you.”
Back to Top
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-scale always at hand, particularly
while traveling. They must without fail weigh themselves every morning as they
get out of bed, having first emptied their bladder. If they are in the habit of
having breakfast in bed, they must weigh before breakfast.
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-called
carbohydrates, that is sugar, rice, bread, potatoes, pastries etc, are by far
the most dangerous. If no carbohydrates whatsoever are eaten, fats can be
indulged in somewhat more liberally and even small quantities of alcohol, such
as a glass of wine with meals, does no harm, but as soon as fats and starch are
combined things are very liable to get out of hand. This has to be observed
very carefully during the first 3 weeks after the treatment is ended otherwise
disappointments are almost sure to occur.
Back to Top
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-obese
patients should never check their weight during the day, as there may be wide
fluctuations and these are merely alarming and confusing.
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 - and skipping
means literally skipping, not just having a light meal - is postponed, the
phenomenon does not occur and several days of strict dieting may be necessary to
correct the situation.
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.
Back to Top
Losing more Weight
An ex-patient should never gain more than two pounds without immediately
correcting this, but it is equally undesirable that more than two lbs. be lost
after treatment, because a greater loss is always achieved at the expense of
normal fat. Any normal fat that is lost is invariably regained as soon as
more food is taken, and it often happens that this rebound overshoots the upper
two lbs. limit.
Back to Top
Trouble After Treatment
Two difficulties may be encountered in the immediate post-treatment period.
When a patient has consumed all his abnormal fat or when, after a full course,
the injection has temporarily lost its efficacy owing to the body having
gradually evolved a counter regulation, the patient at once begins to feel much
more hungry and even weak. In spite of repeated warnings, some
over-enthusiastic patients do not report this. However, in about two days the
fact that they are being undernourished becomes visible in their faces, and
treatment is then stopped at once. In such cases - and only in such cases - we
allow a very slight increase in the diet, such as an extra apple, 150 grams of
meat or two or three extra breadsticks during the three days of dieting after
the last injection.
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-limiting. With HCG it is impossible to reduce a
patient, however enthusiastic, beyond his normal weight. As soon as no more
abnormal fat is being issued, the body starts consuming normal fat, and this is
always regained as soon as ordinary feeding is resumed. The patient then finds
that the 2-3 lbs. he has lost during the last days of treatment are immediately
regained. A meal is skipped and maybe a pound is lost. The next day this pound
is regained, in spite of a careful watch over the food intake. In a few days a
tearful patient is back in the consulting room, convinced that her case is a
failure.
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 2-3
lbs. higher than the weight reached at the end of the treatment. Once this
higher basic level is established, further difficulties in controlling the
weight at the new point of stabilization hardly arise.
Back to Top
Beware of Over-enthusiasm
The other trouble which is frequently encountered immediately after treatment
is again due to over-enthusiasm. Some patients cannot believe that they can eat
fairly normally without regaining weight. They disregard the advice to eat
anything they please except sugar and starch and want to play safe. They try
more or less to continue the 500-Calorie diet on which they felt so well during
treatment and make only minor variations, such as replacing the meat with an
egg, cheese, or a glass of milk. To their horror they find that in spite of
this bravura, their weight goes up. So, following instructions, they skip one
meager lunch and at night eat only a little salad and drink a pot of unsweetened
tea, becoming increasingly hungry and weak. The next morning they find that
they have increased yet another pound. They feel terrible, and even the dreaded
swelling of their ankles is back. Normally we check our patients one week after
they have been eating freely, but these cases return in a few days. Either
their eyes are filled with tears or they angrily imply that when we told them to
eat normally we were just fooling them.
Back to Top
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- edema.
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.
Back to Top
Relapses
As a general rule one can say that 60%-70% of our cases experience little or
no difficulty in holding their weight permanently. Relapses may be due to
negligence in the basic rule of daily weighing. Many patients think that this
is unnecessary and that they can judge any increase from the fit of their
clothes. Some do not carry their scale with them on a journey as it is
cumbersome and takes a big bite out of their luggage-allowance when flying.
This is a disastrous mistake, because after a course of HCG as much as 10 lbs.
can be regained without any noticeable change in the fit of the clothes. The
reason for this is that after treatment newly acquired fat is at first evenly
distributed and does not show the former preference for certain parts of the
body.
Pregnancy or the menopause may annul the effect of a previous treatment.
Women who take treatment during the one year after the last menstruation - that
is at the onset of the menopause - do just as well as others, but among them the
relapse rate is higher until the menopause is fully established. The period of
one year after the last menstruation applies only to women who are not being
treated with ovarian hormones. If these are taken, the premenopausal period may
be indefinitely prolonged.
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.
Back to Top
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.
Back to Top
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-sheet and let the nurse give him a "shot."
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-long suffering. How many promising careers
have been ruined by excessive fat; how many lives have been shortened. If some
way - however cumbersome - can be found to cope effectively with this universal
problem of modern civilized man, our world will be a happier place for countless
fellow men and women.
Back to Top
ACNE . . . Common skin disease in which pimples, often
containing pus, appear on face, neck and shoulders.
ACTH . . . Abbreviation for adrenocorticotrophic hormone.
One of the many hormones produced by the anterior lobe of the pituitary gland.
ACTH controls the outer part, rind or cortex of the adrenal glands. When ACTH
is injected it dramatically relieves arthritic pain, but it has many undesirable
side effects, among which is a condition similar to severe obesity. ACTH is now
usually replaced by cortisone.
ADRENALIN . . . Hormone produced by the inner part of the
Adrenals. Among many other functions, adrenalin is concerned with blood
pressure, emotional stress, fear and cold.
ADRENALS . . . Endocrine glands. Small bodies situated atop
the kidneys and hence also known as suprarenal glands. The adrenals have an
outer rind or cortex which produces vitally important hormones, among which are
Cortisone-similar substances. The adrenal cortex is controlled by ACTH. The
inner part of the adrenals, the medulla, secretes adrenalin and is chiefly
controlled by the autonomous nervous system.
ADRENOCORTEX... See adrenals.
AMPHETAMINES . . . Synthetic drugs which reduce the
awareness of hunger and stimulate mental activity, rendering sleep impossible.
When used for the latter two purposes they are dangerously habit-forming. They
do not diminish the body's need for food, but merely suppress the perception of
that need. The original drug was known as Benzedrine, from which modern
variants such as Dexedrine, Dexamil, and Preludin, etc., have been derived.
Amphetamines may help an obese patient to prevent a further increase in weight
but are unsatisfactory for reducing, as they do not cure the underlying disorder
and as their prolonged use may lead to malnutrition and addiction.
ARTERIOSCLEROSIS . . . Hardening of the arterial wall
through the calcification of abnormal deposits of a fatlike substance known as
cholesterol.
ASCHHE1M-ZONDEK . . . Authors of a test by which early
pregnancy can be diagnosed by injecting a woman's urine into female mice. The
HCG present in pregnancy urine produces certain changes in the vagina of these
animals. Many similar tests, using other animals such as rabbits, frogs, etc.
have been devised.
ASSIMILATE . . . Absorb digested food from the intestines.
Back to Top
______
* Wherever unfamiliar terms are used, they
will be found in their respective alphabetical place. The lay reader can
therefore make his own cross-references.
AUTONOMOUS . . . Here used to describe the independent or
vegetative nervous system which manages the automatic regulations of the body.
BASAL METABOLISM . . . The body's chemical turnover at
complete rest and when fasting. The basal metabolic rate is expressed as the
amount of oxygen used up in a given time. The basal metabolic rate (BMR) is
controlled by the thyroid gland.
CALORIE . . . The physicist's calorie is the amount of heat
required to raise the temperature of 1 cc. of water by 1 degree Centigrade. The
dietician's Calorie (always written with a capital C) is 1000 times greater.
Thus when we speak of a 500 Calorie diet this means that the body is being
supplied with as much fuel as would be required to raise the temperature of 500
liters of water by 1 degree Centigrade or 50 liters by 10 degrees. This is
quite insufficient to cover the heat and energy requirements of an adult body.
In the HCG method the deficit is made up from the abnormal fat-deposits, of
which 1 lb. furnishes the body with more than 2000 Calories. As this is roughly
the amount lost every day, a patient under HCG is never short of fuel.
CEREBRAL . . . Of the brain. Cerebral vascular disease is a
disorder concerning the blood vessels of the brain, such as cerebral thrombosis
or hemorrhage, known as apoplexy or stroke.
CHOLESTEROL . . . A fatlike substance contained in almost
every cell of the body. In the blood it exists in two forms, known as free and
esterified. The latter form is under certain conditions deposited in the inner
lining of the arteries (see arteriosclerosis). No clear and definite
relationship between fat intake and cholesterol-level in the blood has yet been
established.
CHORIONIC . . . Of the chorion, which is part of the
placenta or after-birth. The term chorionic is justly applied to HCG, as this
hormone is exclusively produced in the placenta, from where it enters the human
mother's blood and is later excreted in her urine.
COMPULSIVE EATING. . . A form of oral gratification with
which a repressed sex-instinct is sometimes vicariously relieved. Compulsive
eating must not be confused with the real hunger from which most obese patients
suffer.
CONGENITAL . . . Any condition which exists at or before
birth.
CORONARY ARTERIES . . . Two blood vessels which encircle the heart and
supply all the blood required by the heart-muscle.
CORPUS LUTEUM . . . A yellow body which forms in the ovary
at the follicle from which an egg has been detached. This body acts as an
endocrine gland and plays an important role in menstruation and pregnancy. Its
secretion is one of the sex hormones, and it is stimulated by another hormone
known as LSH, which stands for luteum stimulating hormones. LSH is produced in
the anterior lobe of the pituitary gland. LSH is truly gonadotrophic and must
never be confused with HCG, which is a totally different substance, having no
direct action on the corpus luteum.
CORTEX . . . Outer covering or rind. The term is applied to
the outer part of the adrenals but is also used to describe the gray matter
which covers the white matter of the brain.
CORTISONE . . . A synthetic substance which acts like an
adrenal hormone. It is today used in the treatment of a large number of
illnesses, and several chemical variants have been produced, among which are
prednisone and triamcinolone.
CUSHING . . . A great American brain surgeon who described a
condition of extreme obesity associated with symptoms of adrenal disorder.
Cushing's Syndrome may be caused by organic disease of the pituitary or the
adrenal glands but, as was later discovered, it also occurs as a result of
excessive ACTH medication.
Back to Top
DIENCEPHALON . . . A primitive and hence very old part of
the brain which lies between and under the two large hemispheres. In man the
diencephalon (or hypothalamus) is subordinate to the higher brain or cortex, and
yet it ultimately controls all that happens inside the body. It regulates all
the endocrine glands, the autonomous nervous system, the turnover of fat and
sugar. It seems also to be the seat of the primitive animal instincts and is
the relay station at which emotions are translated into bodily reactions.
DIURETIC. . . Any substance that increases the flow of
urine.
DYSFUNCTION . . . Abnormal functioning of any organ, be this
excessive, deficient or in any way altered.
EDEMA . . . An abnormal accumulation of water in the
tissues.
ELECTROCARDIOGRAM . . . Tracing of electric phenomena taking
place in the heart during each beat. The tracing provides information about the
condition and working of the heart which is not otherwise obtainable.
ENDOCRINE . . . We distinguish endocrine and exocrine
glands. The former produce hormones, chemical regulators, which they secrete
directly into the blood circulation in the gland and from where they are carried
all over the body. Examples of endocrine glands are the pituitary, the thyroid
and the adrenals. Exocrine glands produce a visible secretion such as saliva,
sweat, urine. There are also glands which are endocrine and exocrine. Examples
are the testicles, the prostate and the pancreas, which produces the hormone
insulin and digestive ferments which flow from the gland into the intestinal
tract. Endocrine glands are closely inter-dependent of each other, they are
linked to the autonomous nervous system and the diencephalon presides over this
whole incredibly complex regulatory system.
EMACIATED . . . Grossly undernourished.
EUPHORIA . . . A feeling of particular physical and mental
well being.
FERAL . . . Wild, unrestrained.
FIBROID . . . Any benign new growth of connective tissue.
When such a tumor originates from a muscle, it is known as a myoma. The most
common seat of myomas is the uterus.
FOLLICLE . . . Any small bodily cyst or sac containing a
liquid. Here the term applies to the ovarian cyst in which the egg is formed.
The egg is expelled when a ripe follicle bursts and this is known as ovulation
(see corpus luteurn).
FSH . . . Abbreviation for follicle-stimulating hormone. FSH
is another (see corpus luteum) anterior pituitary hormone which acts directly on
the ovarian follicle and is therefore correctly called a gonadotrophin.
Back to Top
GLANDS . . . See endocrine.
GONADOTROPHIN . . . See corpus luteum, follicle and FSH. Gonadotrophic
literally means sex gland-directed. FSH, LSH and the equivalent hormones in the
male, all produced in the anterior lobe of the pituitary gland, are true
gonadotrophins. Unfortunately and confusingly, the term gonadotrophin has also
been applied to the placental hormone of pregnancy known as human chorionic
gonadotrophin (HCG). This hormone acts on the diencephalon and can only
indirectly influence the sex glands via the anterior lobe of the pituitary.
HCG . . . Abbreviation for human chorionic gonadotrophin
HORMONES . . . See endocrine.
HYPERTENSION . . . High blood pressure.
HYPOGLYCEMIA . . . A condition in which the blood sugar is
below normal. It can be relieved by eating sugar.
HYPOPHYSIS . . . Another name for the pituitary gland.
HYPOTHESIS . . . A tentative explanation or speculation on
how observed facts and isolated scientific data can be brought into an
intellectually satisfying relationship of cause and effect. Hypotheses are
useful for directing further research, but they are not necessarily an
exposition of what is believed to be the truth. Before a hypothesis can advance
to the dignity of a theory or a law, it must be confirmed by all future
research. As soon as research turns up data which no longer fit the hypothesis,
it is immediately abandoned for a better one.
Back to Top
LSH . . . See corpus luteum.
METABOLISM . . . See basal metabolism.
MIGRAINE . . . Severe half-sided headache often associated
with vomiting.
MUCOID . . . Slime-like.
MYOCARDIUM . . . The heart-muscle.
MYOMA . . . See fibroid.
MYXEDEMA . . . Accumulation of a mucoid substance in the
tissues which occurs in cases of severe primary thyroid deficiency.
NEOLITHIC . . . In the history of human culture we
distinguish the Early Stone Age or Paleolithic, the Middle Stone Age or
Mesolithic and the New Stone Age or Neolithic period. The Neolithic period
started about 8000 years ago when the first attempts at agriculture, pottery and
animal domestication made at the end of the Mesolithic period suddenly began to
develop rapidly along the road that led to modern civilization.
NORMAL SALINE . . . A low concentration of salt in water
equal to the salinity of body fluids.
Back to Top
PHLEBITIS . . . An inflammation of the veins. When a
blood-clot forms at the site of the inflammation, we speak of thrombophlebitis.
PITUITARY . . . A very complex endocrine gland which lies at
the base of the skull, consisting chiefly of an anterior and a posterior lobe.
The pituitary is controlled by the diencephalon, which regulates the anterior
lobe by means of hormones which reach it through small blood vessels. The
posterior lobe is controlled by nerves which run from the diencephalon into this
part of the gland. The anterior lobe secretes many hormones, among which are
those that regulate other glands such as the thyroid, the adrenals and the sex
glands.
PLACENTA . . . The after-birth. In women, a large and
highly complex organ through which the child in the womb receives its
nourishment from the mother's body. It is the organ in which HCG is
manufactured and then given off into the mother's blood.
PROTEIN . . . The living substance in plant and animal
cells. Herbivorous animals can thrive on plant protein alone, but man must have
some protein of animal origin (milk, eggs or flesh) to live healthily. When
insufficient protein is eaten, the body retains water.
PSORIASIS . . . A skin disease which produces scaly patches.
These tend to disappear during pregnancy and during the treatment of obesity by
the HCG method.
RENAL . . . Of the kidney.
RESERPINE . . . An Indian drug extensively used in the
treatment of high blood pressure and some forms of mental disorder.
RETENTION ENEMA . . . The slow infusion of a liquid into the
rectum, from where it is absorbed and not evacuated.
Back to Top
SACRUM . . . A fusion of the lower vertebrate into the large
bony mass to which the pelvis is attached.
SEDIMENTATION RATE . . . The speed at which a suspension of
red blood cells settles out. A rapid settling out is called a high
sedimentation rate and may be indicative of a large number of bodily disorders
of pregnancy.
SEXUAL SELECTION . . . A sexual preference for individuals
which show certain traits. If this preference or selection goes on generation
after generation, more and more individuals showing the trait will appear among
the general population. The natural environment has little or nothing to do
with this process. Sexual selection therefore differs from natural selection,
to which modern man is no longer subject because he changes his environment
rather than let the environment change him.
STRIATION . . . Tearing of the lower layers of the skin
owing to rapid stretching in obesity or during pregnancy. When first formed
striae are dark reddish lines which later change into white scars.
SUPRARENAL GLANDS . . . See adrenals.
SYNDROME . . . A group of symptoms which in their
association are characteristic of a particular disorder.
THROMBOPHLEBITIS . . . See phlebitis.
THROMBUS . . . A blood-clot in a blood-vessel.
TRIAMCINOLONE . . . A modern derivative of cortisone.
URIC ACID . . . A product of incomplete protein-breakdown or
utilization in the body. When uric acid becomes deposited in the gristle of the
joints we speak of gout.
VARICOSE ULCERS . . . Chronic ulceration above the ankles
due to varicose veins which interfere with the normal blood circulation in the
affected areas.
VEGETATIVE . . . See autonomous.
VERTEBRATE . . . Any animal that has a back-bone.
Back to Top
Literary References to
the Use of Chorionic Gonadotrophin in Obesity
THE LANCET
Nov. 6, 1954
Article Simeons
Nov.
15, 1958 Letter to
Editor Simeons
July 29, 1961 Letter to
Editor Lebon
Dec. 9, 1961
Article Carne
Dec. 9, 1961 Letter to
Editor Kalina
Jan. 6, 1962 Letter to
Editor Simeons
Nov. 26, 1966 Letter to
Editor Lebon
THE JOURNAL OF THE
AMERICAN GERIATRIC SOCIETY
Jan. 1956
Article Simeons
Oct. 1964
Article Harris & Warsaw
Feb. 1966
Article Lebon
THE AMERICAN JOURNAL OF
CLINICAL NUTRITION
Sept.-Oct. 1959
Article Sohar
March 1963
Article Craig et al.
Sept. 1963 Letter to
Editor Simeons
March 1964
Article Frank
Sept. 1964 Letter to
Editor Simeons
Feb. 1965 Letter to
Editor Hutton
June 1969
Editorial Albrink
June 1969 Special
Article Gusman
THE JOURNAL OF PLASTIC
SURGERY (British)
April 1962
Article Lebon
THE SOUTH AFRICAN
MEDICAL JOURNAL
Feb. 1963
Article Politzer, Berson &Flaks
BOOKS
A.T.W. SIMEONS
POUNDS
AND INCHES Privately printed: obtainable only from A.T.W. Simeons, Salvator
Mundi International Hospital, Rome,
Italy
VETSUCHT (Netherlands Edition) Wetenschappelijke Uitgeverlj, N.V. Amsterdam
MAN’S PRESUMPTUOUS
BRAIN Longman’s, Green, London
* * * E. P. Dutton, New
York (hardback)
* * * Dutton Paperbacks,
New York
|