Pounds & Inches
Pounds & Inches
A NEW APPROACH TO OBESITY
BY: DR. A.T.W. SIMEONS
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 – ROME VIALE MURA GIANICOLENSI, 77
FOREWORD
This book discusses a new interpretation of the nature of obesity, and
while it does not advocate yet another fancy slimming diet it does
describe a method of treatment which has grown out of theoretical
considerations based on clinical observation.
What I have to say is an essence of views distilled out of forty years
of grappling with the fundamental problems of obesity, its causes, its
symptoms, and its very nature. In these many years of specialized work
thousands of cases have passed through my hands and were carefully
studied. Every new theory, every new method, every promising lead was
considered, experimentally screened and critically evaluated as soon as
it became known. But invariably the results were disappointing and
lacking in uniformity.
I felt that we were merely nibbling at the fringe of a great problem,
as, indeed, do most serious students of overweight. We have grown
pretty sure that the tendency to accumulate abnormal fat is a very
definite metabolic disorder, much as is, for instance, diabetes. Yet
the localization and the nature of this disorder remained a mystery.
Every new approach seemed to lead into a blind alley, and though
patients were told that they are fat because they eat too much, we
believed that this is neither the whole truth nor the last word in the
matter.
Refusing to be side-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.
THE NATURE OF OBESITY
Obesity a Disorder
As a basis for our discussion we postulate that obesity in all its many
forms is due to an abnormal functioning of some part of the body and
that every ounce of abnormally accumulated fat is always the result of
the same disorder of certain regulatory mechanisms. Persons suffering
from this particular disorder will get fat regardless of whether they
eat excessively, normally or less than normal. A person who is free of
the disorder will never get fat, even if he frequently overeats.
Those in whom the disorder is severe will accumulate fat very rapidly,
those in whom it is moderate will gradually increase in weight and
those in whom it is mild may be able to keep their excess weight
stationary for long periods. In all these cases a loss of weight
brought about by dieting, treatments with thyroid, appetite-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.
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.
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 only as much as he required to 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.
Three Kinds of Fat
In the human body we can distinguish three kinds of fat. The first is
the structural fat which fills the gaps between various organs, a sort
of packing material. Structural fat also performs such important
functions as bedding the kidneys in soft elastic tissue, protecting
the coronary arteries and keeping the skin smooth and taut. It also
provides the springy cushion of hard fat under the bones of the feet,
without which we would be unable to walk.
The second type of fat is a normal reserve of fuel upon which the body
can freely draw when the nutritional income from the intestinal tract
is insufficient to meet the demand. Such normal reserves are localized
all over the body. Fat is a substance which packs the highest caloric
value into the smallest space so that normal reserves of fuel for
muscular activity and the maintenance of body temperature can be most
economically stored in this form. Both these types of fat, structural
and reserve, are normal, and even if the body stocks them to capacity
this can never be called obesity.
But there is a third type of fat which is entirely abnormal. It is the
accumulation of such fat, and of such fat only, from which the
overweight patient suffers. This abnormal fat is also a potential
reserve of fuel, but unlike the normal reserves it is not available to
the body in a nutritional emergency. It is, so to speak, locked away
in a fixed deposit and is not kept in a current account, as are the
normal reserves.
When an obese patient tries to reduce by starving himself, he will
first lose his normal fat reserves. When these are exhausted he begins
to burn up structural fat, and only as a last resort will the body
yield its abnormal reserves, though by that time the patient usually
feels so weak and hungry that the diet is abandoned. It is just for
this reason that obese patients complain that when they diet they lose
the wrong fat. They feel famished and tired and their face becomes
drawn and haggard, but their belly, hips, thighs and upper arms show
little improvement. The fat they have come to detest stays on and the
fat they need to cover their bones gets less and less. Their skin
wrinkles and they look old and miserable. And that is one of the most
frustrating and depressing experiences a human being can have.
Injustice to the Obese
When then obese patients are accused of cheating, gluttony, lack of
will power, greed and sexual complexes, the strong become indignant
and decide that modern medicine is a fraud and its representatives
fools, while the weak just give up the struggle in despair. In either
case the result is the same: a further gain in weight, resignation to
an abominable fate and the resolution at least to live tolerably the
short span allotted to them – 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.
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.
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.
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.
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.
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.
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.
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.
THREE BASIC CAUSES OF OBESITY:
(1) The Inherited Factor
Assuming that there is a limit to the diencephalon’s fat banking
capacity, it follows that there are three basic ways in which obesity
can become manifest. The first is that the fatbanking 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.
(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 sexglands 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 fatbank.
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 fatbanking
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.
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 [4] 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.
Psychological Aspects
Much has been written about the psychological aspects of obesity. Among
its many functions the diencephalon is also the seat of our primitive
animal instincts, and just as in an emergency it can switch energy
from one center to another, so it seems to be able to transfer
pressure from one instinct to another. Thus, a lonely and unhappy
person deprived of all emotional comfort and of all instinct
gratification except the stilling of hunger and thirst can use these
as outlets for pent up instinct pressure and so develop obesity. Yet
once that has happened, no amount of psychotherapy or analysis,
happiness, company or the gratification of other instincts will
correct the condition.
Compulsive Eating
No end of injustice is done to obese patients by accusing them of
compulsive eating, which is a form of diverted sex 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.
Reluctance to Lose Weight
Some patients are deeply attached to their fat and cannot bear the
thought of losing it. If they are intelligent, popular and successful
in spite of their handicap, this is a source of pride. Some fat girls
look upon their condition as a safeguard against erotic involvements,
of which they are afraid. They work out a pattern of life in which
their obesity plays a determining role and then become reluctant to
upset this pattern and face a new kind of life which will be entirely
different after their figure has become normal and often very
attractive. They fear that people will like them – 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.
Not by Weight alone…
Weight alone is not a satisfactory criterion by which to judge whether
a person is suffering from the disorder we call obesity or not. Every
physician is familiar with the sylphlike lady who enters the
consulting room and declares emphatically that she is getting horribly
fat and wishes to reduce. Many an honest and sympathetic physician at
once concludes that he is dealing with a “nut.” If he is busy he will
give her short shrift, but if he has time he will weigh her and show
her tables to prove that she is actually underweight.
I have never yet seen or heard of such a lady being convinced by either
procedure. The reason is that in my experience the lady is nearly
always right and the doctor wrong. When such a patient is carefully
examined one finds many signs of potential obesity, which is just
about to become manifest as overweight. The patient distinctly feels
that something is wrong with her, that a subtle change is taking place
in her body, and this alarms her.
There are a number of signs and symptoms which are characteristic of
obesity. In manifest obesity many and often all these signs and
symptoms are present. In latent or just beginning cases some are
always found, and it should be a rule that if two or more of the
bodily signs are present, the case must be regarded as one that needs
immediate help.
Signs and symptoms of obesity
The bodily signs may be divided into such as have developed before
puberty, indicating a strong inherited factor, and those which develop
at the onset of manifest disorder. Early signs are a
disproportionately large size of the two upper front teeth, the first
incisor, or a dimple on both sides of the sacral bone just above the
buttocks. When the arms are outstretched with the palms upward, the
forearms appear sharply angled outward from the upper arms. The same
applies to the lower extremities. The patient cannot bring his feet
together without the knees overlapping; he is, in fact, knock-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.
The Emaciated Lady
I remember the case of a lady who was escorted into my consulting room
while I was telephoning. She sat down in front of my desk, and when I
looked up to greet her I saw the typical picture of advanced
emaciation. Her dry skin hung loosely over the bones of her face, her
neck was scrawny and collarbones and ribs stuck out from deep hollows.
I immediately thought of cancer and decided to which of my colleagues
at the hospital I would refer her. Indeed, I felt a little annoyed
that my assistant had not explained to her that her case did not fall
under my specialty. In answer to my query as to what I could do for
her, she replied that she wanted to reduce. I tried to hide my
surprise, but she must have noted a fleeting expression, for she
smiled and said “I know that you think I’m mad, but just wait.” With
that she rose and came round to my side of the desk. Jutting out from
a tiny waist she had enormous hips and thighs.
By using a technique which will presently be described, the abnormal
fat on her hips was transferred to the rest of her body which had been
emaciated by months of very severe dieting. At the end of a treatment
lasting five weeks, she, a small woman, had lost 8 inches round her
hips, while her face looked fresh and florid, the ribs were no longer
visible and her weight was the same to the ounce as it had been at the
first consultation.
Fat but not Obese
While a person who is statistically underweight may still be suffering
from the disorder which causes obesity, it is also possible for a
person to be statistically overweight without suffering from obesity.
For such persons weight is no problem, as they can gain or lose at
will and experience no difficulty in reducing their caloric intake.
They are masters of their weight, which the obese are not. Moreover,
their excess fat shows no preference for certain typical regions of
the body, as does the fat in all cases of obesity. Thus, the decision
whether a borderline case is really suffering from obesity or not
cannot be made merely by consulting weight tables.
The Treatment Of Obesity
If obesity is always due to one very specific diencephalic deficiency,
it follows that the only way to cure it is to correct this deficiency.
At first this seemed an utterly hopeless undertaking. The greatest
obstacle was that one could hardly hope to correct an inherited trait
localized deep inside the brain, and while we did possess a number of
drugs whose point of action was believed to be in the diencephalon,
none of them had the slightest effect on the fat-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.
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.
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 sideeffects 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.
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 [5] 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 fatbanking 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.
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.
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. [6] When then the administration of HCG increases the
functional capacity of the diencephalon, all demands can be fully
satisfied and the sex deficiency is corrected.
That this is the true mechanism underlying the presumed gonadotrophic
action of HCG is confirmed by the fact that when the pituitary gland
of infantile rats is removed before they are given HCG, the latter has
no effect on their sex-glands. HCG cannot therefore have a direct sex
gland stimulating action like that of the anterior pituitary
gonadotrophins, as FSH and LSH are justly called. The latter are
entirely different substances from that which can be extracted from
pregnancy urine and which, unfortunately, is called chorionic
gonadotrophin. It would be no more clumsy, and certainly far more
appropriate, if HCG were henceforth called chorionic
diencephalotrophin.
HCG no Sex Hormone
It cannot he sufficiently emphasized that HCG is not 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 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.
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.
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.
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.
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.
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.
Gout
An identical behavior is found in the blood uric acid level of patients
suffering from gout. Predictably such patients get an acute and often
severe attack after the first few days of HCG treatment but then
remain entirely free of pain, in spite of the fact that their blood
uric acid often shows a marked increase which may persist for several
months after treatment. Those patients who have regained their normal
weight remain free of symptoms regardless of what they eat, while
those that require a second course of treatment get another attack of
gout as soon as the second course is initiated. We do not yet know
what diencephalic mechanisms are involved in gout; possibly emotional
factors play a role, and it is worth remembering that the disease does
not occur in women of childbearing age. We now give 2 tablets daily of
ZYLORIC to all patients who give a history of gout and have a high
blood uric acid level. In this way we can completely avoid attacks
during treatment.
Blood Pressure
Patients who have brought themselves to the brink of malnutrition by
exaggerated dieting, laxatives etc, often have an abnormally low blood
pressure. In these cases the blood pressure rises to normal values at
the beginning of treatment and then very gradually drops, as it always
does in patients with a normal blood pressure. Normal values are
always regained a few days after the treatment is over. Of this
lowering of the blood pressure during treatment the patients are not
aware. When the blood pressure is abnormally high, and provided there
are no detectable renal lesions, the pressure drops, as it usually
does in pregnancy. The drop is often very rapid, so rapid in fact that
it sometimes is advisable to slow down the process with pressure
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.
Peptic Ulcers
In our cases of obesity with gastric or duodenal ulcers we have noticed
a surprising subjective improvement in spite of a diet which would
generally be considered most inappropriate for an ulcer patient. Here,
too, there is a similarity with pregnancy, in which peptic ulcers
hardly ever occur. However we have seen two cases with a previous
history of several hemorrhages in which a bleeding occurred within 2
weeks of the end of treatment.
Psoriasis, Fingernails, Hair, Varicose Ulcers
As in pregnancy, psoriasis greatly improves during treatment but may
relapse when the treatment is over. Most patients spontaneously report
a marked improvement in the condition of brittle fingernails. The loss
of hair not infrequently associated with obesity is temporarily
arrested, though in very rare cases an increased loss of hair has been
reported. I remember a case in which a patient developed a patchy
baldness – so 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.
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.
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.
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.
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.
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.
Menstruation
During menstruation no injections are given, but the diet is continued
and causes no hardship; yet as soon as the menstruation is over, the
patients become extremely hungry unless the injections are resumed at
once. It is very impressive to see the suffering of a woman who has
continued her diet for a day or two beyond the end of the period
without coming for her injection and then to hear the next day that
all hunger ceased within a few hours after the injection and to see
her once again content, florid and cheerful. While on the question of
menstruation it must he added that in teenaged girls the period may in
some rare cases be delayed and exceptionally stop altogether. If then
later this is artificially induced some weight may be regained.
Further Courses
Patients requiring the loss of more than 34 lbs. must have a second or
even more courses. A second course can be started after an interval of
not less than six weeks, though the pause can be more than six weeks.
When a third, fourth or even fifth course is necessary, the interval
between courses should be made progressively longer. Between a second
and third course eight weeks should elapse, between a third and fourth
course twelve weeks, between a fourth and fifth course twenty weeks
and between a fifth and sixth course six months. In this way it is
possible to bring about a weight reduction of 100 lbs. and more if
required without the least hardship to the patient.
In general, men do slightly better than women and often reach a
somewhat higher average daily loss. Very advanced cases do a little
better than early ones, but it is a remarkable fact that this
difference is only just statistically significant.
Conditions that must be accepted before treatment
On the basis of these data the probable duration of treatment can he
calculated with considerable accuracy, and this is explained to the
patient. It is made clear to him that during the course of treatment
he must attend the clinic daily to be weighed, injected and generally
checked. All patients that live in Rome or have resident friends or
relations with whom they can stay are treated as out-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 statistically 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 overenthusiasm than on
insisting that the rules of the treatment be observed.
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, breastdevelopment 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.
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.
Starting treatment
In menstruating women, the best time to start treatment is immediately
after a period. Treatment may also be started later, but it is
advisable to have at least ten days in hand before the onset of the
next period. Similarly, the end of a course of HCG should never be
made to coincide with menstruation. If things should happen to work out
that way, it is better to give the last injection three days before
the expected date of the menses so that a normal diet can he resumed
at onset. Alternatively, at least three injections should be given
after the period, followed by the usual three days of dieting. This
rule need not be observed in such patients who have reached their
normal weight before the end of treatment and are already on a higher
caloric diet.
Patients who require more than the minimum of 23 injections and who
therefore skip one day a week in order to postpone immunity to HCG
cannot have their third injections on the day before the interval.
Thus if it is decided to skip Sundays, the treatment can be started on
any day of the week except Thursdays. Supposing they start on Thursday,
they will have their third injection on Saturday, which is also the
day on which they start their 500 Calorie diet. They would then have
no injection on the second day of dieting; this exposes them to an
unnecessary hardship, as without the injection they will feel
particularly hungry. Of course, the difficulty can be overcome by
exceptionally injecting them on the first Sunday. If this day falls
between the first and second or between the second and third
injection, we usually prefer to give the patient the extra day of
forced feeding, which the majority rapturously enjoy.
The Diet
The 500 Calorie diet is explained on the day of the second injection to
those patients who will be preparing their own food, and it is most
important that the person who will actually cook is present – 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 Stevia may be used.
Lunch:
1. 100 grams of veal, beef, chicken breast, fresh white fish,
lobster, crab, or shrimp. All visible fat must be carefully removed
before cooking, and the meat must be weighed raw. It must be boiled
or grilled without additional fat. Salmon, eel, tuna, herring, dried
or pickled fish are not allowed. The chicken breast must be
removed from the bird.
2. 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.
3. One breadstick (grissino) or one Melba toast.
4. An apple, orange, or a handful of strawberries or one-half
grapefruit.
Dinner :
The same four choices as lunch (above.)
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 never the less have a higher caloric value and are
therefore not allowed though there is no restriction on the size of
one apple. Some people do not realize that a tangerine is not an
orange and that chicken breast does not mean the breast of any other
fowl, nor does it mean a wing or drumstick.
The most tiresome patients are those who start counting Calories and
then come up with all manner of ingenious variations which they
compile from their little books. When one has spent years of weary
research trying to make a diet as attractive as possible without
jeopardizing the loss of weight, culinary geniuses who are out to
improve their unhappy lot are hard to take.
Making up the Calories
The diet used in conjunction with HCG must not exceed 500 Calories per
day, and the way these Calories are made up is of utmost importance.
For instance, if a patient drops the apple and eats an extra
breadstick instead, he will not be getting more Calories but he will
not lose weight. There are a number of foods, particularly fruits and
vegetables, which have the same or even lower caloric values than
those listed as permissible, and yet we find that they interfere with
the regular loss of weight under HCG, presumably owing to the nature
of their composition. Pimiento peppers, okra, artichokes and pears are
examples of this.
While this diet works satisfactorily in Italy, certain modifications
have to be made in other countries. For instance, American beef has
almost double the caloric value of South Italian beef, which is not
marbled with fat. This marbling is impossible to remove. In America,
therefore, low-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 socalled 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.
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.
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.
Vitamins and Anemia
Sooner or later most patients express a fear that they may be running
out of vitamins or that the restricted diet may make them anemic. On
this score the physician can confidently relieve their apprehension by
explaining that every time they lose a pound of fatty tissue, which
they do almost daily, only the actual fat is burned up; all the
vitamins, the proteins, the blood, and the minerals which this tissue
contains in abundance are fed back into the body. Actually, a low
blood count not due to any serious disorder of the blood forming
tissues improves during treatment, and we have never encountered a
significant protein deficiency nor signs of a lack of vitamins in
patients who are dieting regularly.
The First Days of Treatment
On the day of the third injection it is almost routine to hear two
remarks. One is: “You know, Doctor, I’m sure it’s only psychological,
but I already feel quite different”. So common is this remark, even
from very skeptical patients that we hesitate to accept the
psychological interpretation. The other typical remark is: “Now that I
have been allowed to eat anything I want, I can’t get it down. Since
yesterday I feel like a stuffed pig. Food just doesn’t seem to
interest me any more, and I am longing to get on with your diet”. Many
patients notice that they are passing more urine and that the swelling
in their ankles is less even before they start dieting.
On the day of the fourth injection most patients declare that they are
feeling fine. They have usually lost two pounds or more, some say they
feel a bit empty but hasten to explain that this does not amount to
hunger. Some complain of a mild headache of which they have been
forewarned and for which they have been given permission to take
aspirin.
During the second and third day of dieting – 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.
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 day, 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 fatextraction. 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.
Interruptions of Weight Loss
We distinguish four types of interruption in the regular daily loss.
The first is the one that has already been mentioned in which the
weight stays stationary for a day or two, and this occurs,
particularly towards the end of a course, in almost every case.
The Plateau
The second type of interruption we call a “plateau”. A plateau lasts
4-6 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 [7] for one day. 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.
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.
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.
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 teaspoonfull of salt his weight will go up by more
than two pounds as soon as this salt is absorbed from his intestine.
To this explanation many patients reply: Well, if I put on that much
every time I eat a little extra, how can I hold my weight after the
treatment? It must therefore be made clear that this only happens as
long as they are under HCG. When treatment is over, the blood is no
longer saturated and can easily accommodate extra food without having
to increase its volume. Here again the professional reader will be
aware that this interpretation is a simplification of an extremely
intricate physiological process which actually accounts for the
phenomenon.
Salt and Reducing
While we are on the subject of salt, I can take this opportunity to
explain that we make no restriction in the use of salt and insist that
the patients drink large quantities of water throughout the treatment.
We are out to reduce abnormal fat and are not in the least interested
in such illusory weight losses as can be achieved by depriving the body
of salt and by desiccating it. Though we allow the free use of salt,
the daily amount taken should be roughly the same, as a sudden
increase will of course be followed by a corresponding increase in
weight as shown by the scale. An increase in the intake of salt is one
of the most common causes for an increase in weight from one day to
the next. Such an increase can be ignored, provided it is accounted
for. It in no way influences the regular loss of fat.
Water
Patients are usually hard to convince that the amount of water they
retain has nothing to do with the amount of water they drink. When the
body is forced to retain water, it will do this at all costs. If the
fluid intake is insufficient to provide all the water required, the
body withholds water from the kidneys and the urine becomes scanty and
highly concentrated, imposing a certain strain on the kidneys. If that
is insufficient, excessive water will be with-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.
Constipation
An excess of water keeps the feces soft, and that is very important in
the obese, who commonly suffer from constipation and a spastic colon.
While a patient is under treatment we never permit the use of any kind
of laxative taken by mouth. We explain that owing to the restricted
diet it is perfectly satisfactory and normal to have an evacuation of
the bowel only once every three to four days and that, provided plenty
of fluids are taken, this never leads to any disturbance. Only in
those patients who begin to fret after four days do we allow the use
of a suppository. Patients who observe this rule find that after
treatment they have a perfectly normal bowel action and this delights
many of them almost as much as their loss of weight.
Investigating Dietary Errors
When the reason for a slight gain in weight is not immediately evident,
it is necessary to investigate further. A patient who is unaware of
having committed an error or is unwilling to admit a mistake protests
indignantly when told he has done something he ought not to have done.
In that atmosphere no fruitful investigation can be conducted; so we
calmly explain that we are not accusing him of anything but that we
know for certain from our not inconsiderable experience that something
has gone wrong and that we must now sit down quietly together and try
and find out what it was. Once the patient realizes that it is in his
own interest that he play an active and not merely a passive role in
this search, the reason for the setback is almost invariably
discovered. Having been through hundreds of such sessions, we are
nearly always able to distinguish the deliberate liar from the patient
who is merely fooling himself or is really unaware of having erred.
Liars and Fools
When we see obese patients there are generally two of us present in
order to speed up routine handling. Thus when we have to investigate a
rise in weight, a glance is sufficient to make sure that we agree or
disagree. If after a few questions we both feel reasonably sure that
the patient is deliberately lying, we tell him that this is our opinion
and warn him that unless he comes clean we may refuse further
treatment. The way he reacts to this furnishes additional proof
whether we are on the right track or not we now very rarely make a
mistake.
If the patient breaks down and confesses, we melt and are all
forgiveness and treatment proceeds. Yet if such performances have to
be repeated more than two or three times, we refuse further treatment.
This happens in less than 1% of our cases. If the patient is stubborn
and will not admit what he has been up to, we usually give him one more
chance and continue treatment even though we have been unable to find
the reason for his gain. In many such cases there is no repetition,
and frequently the patient does then confess a few days later after he
has thought things over.
The patient who is fooling himself is the one who has committed some
trifling, offense against the rules but who has been able to convince
himself that this is of no importance and cannot possibly account for
the gain in weight. Women seem particularly prone to getting
themselves entangled in such delusions. On the other hand, it does
frequently happen that a patient will in the midst of a conversation
unthinkingly spear an olive or forget that he has already eaten his
breadstick.
A mother preparing food for the family may out of sheer habit forget
that she must not taste the sauce to see whether it needs more salt.
Sometimes a rich maiden aunt cannot be offended by refusing a cup of
tea into which she has put two teaspoons of sugar, thoughtfully
remembering the patient’s taste from previous occasions. Such incidents
are legion and are usually confessed without hesitation, but some
patients seem genuinely able to forget these lapses and remember them
with a visible shock only after insistent questioning.
In these cases we go carefully over the day. Sometimes the patient has
been invited to a meal or gone to a restaurant, naively believing that
the food has actually been prepared exactly according to instructions.
They will say: “Yes, now that I come to think of it the steak did seem
a bit bigger than the one I have at home, and it did taste better;
maybe there was a little fat on it, though I specially told them to
cut it all away”. Sometimes the breadsticks were broken and a few
fragments eaten, and “Maybe they were a little more than one”. It is
not uncommon for patients to place too much reliance on their memory of
the diet-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.
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.
The Voice
Incidentally, another interesting feature of the HCG method is that it
does not ruin a singing voice. The typically obese prima donna usually
finds that when she tries to reduce, the timbre of her voice is liable
to change, and understandably this terrifies her. Under HCG this does
not happen; indeed, in many cases the voice improves and the breathing
invariably does. We have had many cases of professional singers very
carefully controlled by expert voice teachers, and the maestros have
been so enthusiastic that they now frequently send us patients.
Other Reasons for a Gain
Apart from diet and cosmetics there can be a few other reasons for a
small rise in weight. Some patients unwittingly take chewing gum,
throat pastilles, vitamin pills, cough syrups etc., without realizing
that the sugar or fats they contain may interfere with a regular loss
of weight. Sex hormones or cortisone in its various modern forms must
be avoided, though oral contraceptives are permitted. In fact the only
self-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.
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.
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.
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.
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 contract 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.
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 lightheadedness, 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.
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.
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.
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. [8] 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.
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.
Gallstones
Small stones in the gall bladder may in patients who have recently had
typical colics cause more frequent colics under treatment with HCG.
This may be due to the almost complete absence of fat from the diet,
which prevents the normal emptying of the gall bladder. Before
undertaking treatment we explain to such patients that there is a risk
of more frequent and possibly severe symptoms and that it may become
necessary to operate. If they are prepared to take this risk and
provided they agree to undergo an operation if we consider this
imperative, we proceed with treatment, as after weight reduction with
HCG the operative risk is considerably reduced in an obese patient. In
such cases we always give a drug which stimulates the flow of bile, and
in the majority of cases nothing untoward happens. On the other hand,
we have looked for and not found any evidence to suggest that the HCG
treatment leads to the formation of gallstones as pregnancy sometimes
does.
The Heart
Disorders of the heart are not as a rule contraindications. In fact,
the removal of abnormal fat – 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.
Coronary Occlusion
In obese patients who have recently survived a coronary occlusion, we
adopt the following procedure in collaboration with the cardiologist.
We wait until no further electrocardiographic changes have occurred
for a period of three months. Routine treatment is then started under
careful control and it is usual to find a further electrocardiographic
improvement of a condition which was previously stationary.
In the thousands of cases we have treated we have not once seen any
sort of coronary incident occur during or shortly after treatment. The
same applies to cerebral vascular accidents. Nor have we ever seen a
case of thrombosis of any sort develop during treatment, even though a
high blood pressure is rapidly lowered. In this respect, too, the HCG
treatment resembles pregnancy.
Teeth and Vitamins
Patients whose teeth are in poor repair sometimes get more trouble
under prolonged treatment, just as may occur in pregnancy. In such
cases we do allow calcium and vitamin D, though not in an oily
solution. The only other vitamin we permit is vitamin C, which we use
in large doses combined with an antihistamine at the onset of a common
cold. There is no objection to the use of an antibiotic if this is
required, for instance by the dentist. In cases of bronchial asthma
and hay fever we have occasionally resorted to cortisone during
treatment and find that triamcinolone is the least likely to interfere
with the loss of weight, but many asthmatics improve with HCG alone.
Alcohol
Obese heavy drinkers, even those bordering on alcoholism, often do
surprisingly well under HCG and it is exceptional for them to take a
drink while under treatment. When they do, they find that a relatively
small quantity of alcohol produces intoxication. Such patients say
that they do not feel the need to drink. This may in part be due to the
euphoria which the treatment produces and in part to the complete
absence of the need for quick sustenance from which most obese
patients suffer.
Though we have had a few cases that have continued abstinence long
after treatment, others relapse as soon as they are back on a normal
diet. We have a few “regular customers” who, having once been reduced
to their normal weight, start to drink again though watching their
weight. Then after some months they purposely overeat in order to gain
sufficient weight for another course of HCG which temporarily gets them
out of their drinking routine. We do not particularly welcome such
cases, but we see no reason for refusing their request.
Tuberculosis
It is interesting that obese patients suffering from inactive pulmonary
tuberculosis can be safely treated. We have under very careful control
treated patients as early as three months after they were pronounced
inactive and have never seen a relapse occur during or shortly after
treatment. In fact, we only have one case on our records in which
active tuberculosis developed in a young man about one year after a
treatment which had lasted three weeks. Earlier X-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.
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.
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.”
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 bathroomscale
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.
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.
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.
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 selflimiting. 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.
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.
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.
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.
Plan of a Normal Course
125 I.U. of HCG daily (except during menstruation) until 40 injections
have been given.
Until 3rd injection forced feeding.
After 3rd injection, 500 Calorie diet to be continued until 72 hours
after the last injection. For the following 3 weeks, all foods
allowed except starch and sugar in any form (careful with very sweet
fruit).
After 3 weeks, very gradually add starch in small quantities, always
controlled by morning weighing.
CONCLUSION
The HCG + diet method can bring relief to every case of obesity, but
the method is not simple. It is very time consuming and requires
perfect cooperation between physician and patient. Each case must be
handled individually, and the physician must have time to answer
questions, allay fears and remove misunderstandings. He must also check
the patient daily. When something goes wrong he must at once
investigate until he finds the reason for any gain that may have
occurred. In most cases it is useless to hand the patient a diet-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.
GLOSSARY
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.
ASCHHIEIM-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.
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
dieticiari’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 sexinstinct 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.
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.
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.
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.
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.
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.
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
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 Uitgeverij, N.V.
Amsterdam
MAN’S PRESUMPTUOUS BRAIN Longman’s, Green, London E.P. Dutton, New
York (hardback) Dutton Paperbacks, New York
