PREFACE
Stephen Holt MD, Holt Institute of Medicine
There is a major revival of interest in the short term use (3 or 6 weeks) of very low calorie diets (VLCD) for the induction of weight loss, especially in the obese individual ( BMI>30). This modern weight control revolution in Integrative Medicine involves a reactivation of the combined application of severe calorie restriction ( very low calorie diet, VLCD, 500 Kcalday diet), combined with injections of modest amounts of the hormone, human chorionic gonadotrophin (HCG) or the oral use of homeopathic HCG preparations (modifi ed Simeons Diet Protocols). The HCG diet is being enthusiastically applied by an increasing number of physicians who believe in its benefi ts and describe its successful outcomes. Some individuals continue to question the evidence-base for its use. Weight management concepts, involving HCG injections, were first presented in 1954 by ATW Simeons, resulting in the use of the terms “Simeons protocol” or “Simeons diet”. The widespread use of the Simeons diet in the 1960’s and early 70’s bred “fat clinics” throughout Europe and to a lesser degree in the United States. The Simeons approach was corrupted and, in some cases, modified to advantage by many healthcare givers. However, the diet fell into disrepute because few advantages of HCG plus a VLCD were recorded or observed in comparison with the use of a VLCD alone; at least under the specific conditions of several studies under which the evaluations of the HCG diet were made.
In recent times in the USA, many thousands of patients have received the Simeons protocol with apparent resounding claims of success. The modern, open-label experiences with the HCG diet imply that there are more desirable features to weight control as a consequence of the administration of HCG. Such observations include targeted removal of fat deposits, retention of muscle mass, a better body contour at the end of the HCG diet and postulations about a modifi cation of the “set-point phenomenon” (resistance to weight loss during dieting). While Simeons used an HCG diet for some individuals with only modest weight gain, many proponents of the HCG diet believe that this approach is more ideal for individuals with significant degrees of overweight status or obesity. In this book, I attempt to review the advantages, disadvantages, limitations and perceived benefi t of the Simeons approach (HCG diet) to weight control. In common with several interventions that are used in Integrative Medicine, controversies exist and there is a need to seek a clear evidence-base for this weight loss approach. That said, it is diffi cult to ignore the growing consensus of opinion on the benefi ts of the Simeons diet in its expanding application in clinical practice.
Regulatory authorities in the US have not embraced the effi cacy of the “off label” use of the injected drug HCG in weight control. Even more criticism has been leveled at “homeopathic” HCD drops. Before the “cannons of criticism” shoot down the HCG diet, a reappraisal of circumstances is required, together with more outcome research (www.worldhealth.net). The global epidemic of obesity has bred its own subspecialty practice of medicine. I wish to coin the somewhat clumsy terms “ Obesitology” or “ Bariatology” that describe areas of comprehensive medical care that are required for the “overweight diathesis”. These terms are meant to incorporate a holistic approach to the battle against an overweight status. Obesity may now be the commonest cause of premature morbidity and mortality in many industrialized countries. Excessive body weight is one of the most recalcitrant disorders in modern medicine, for which there is no simple way out. That said, complacency prevails about expanded waistlines and mounting childhood obesity is bringing tears to the eyes of industrialized society. Our recognition of “fat societies” resonates with millions of people. The message about the benefits of controlling weight makes many people sickened, tired and desperate.
The desperation of the obese individual is apparent in a common willingness of many people to respond to false promises of weight loss control. Is the HCG diet just another fad? Several physicians have published comments that the HCG diet has inherent false promises. I acknowledge that massive confusion has been created by fad diets and “gobbledygook” statements about weight loss control. It is time to tackle the horns of the “obesity bull”, with “head on” tactics. The reason for the existence of so many weight loss diets may be taken as proof that few serve any useful purpose. Notions about “quick fixes” for weight control are fantasies, but there is an emerging science of weight control that focuses on the stubborn and persistent nature of obesity.
It is time to recognize the heterogeneous nature of obesity and cut the therapeutic nihilism. This books attempts to address these issues in a short and direct manner. That said, “the scientific jury” remains out on the HCG diet. While I cannot rest any laurels on anecdote, the recently described benefi ts of the HCG diet are hard to ignore. For many years, physicians and scientists were not willing to perceive obesity as a disease. Times have changed, as science unravels the pathophysiology of obesity. Fatness has been characterized too often as a cosmetic tissue, without due consideration of its associated “ugly” disease companions. One cannot perceive weight control in a unitary dimension. A person with signifi cant and persistent excess body weight invariably presents with one or more disease complications and they are at risk formany disorders. Welcome to the forced emergence of the disciplines “obesitology” or “bariatology” (comprehensive care for the overweight individual). These days we recognize the deadly quartet of excess body weight, dyslipidemia and glucose intolerance, linked by underlying resistance to the actions of the hormone insulin. This quartet is referred to as Metabolic Syndrome X, with its obvious risks of stroke and cardiovascular disease. Metabolic Syndrome X has been referred to as the “hidden epidemic”, and it is an apparent “well kept secret”.
How can 70 million Americans be living in a status of Syndrome X, with this diagnosis often missing from a patient’s medical record? Failing to diagnose and manage Syndrome X is a huge public health problem and some proponents of HCG diets seem to ignore this disorder that is present in many of their patients who receive this intervention. The perceived “occult” nature of Syndrome X rests in the fact that there is no simple solution or pharmaceutical to tackle this problem. Syndrome X has a multi-factorial etiology (many causes). Metabolic Syndrome X is rooted in several issues including: hereditary, environmental toxicity, poor diet, chronic infl ammation, substance abuse and lack of exercise. While Syndrome X is a common forerunner to Type II diabetes mellitus, it is associated with a range of diseases that increase risks of death from all causes. The protean manifestations or disease associations of Syndrome X have been exemplifi ed by the use of the term Syndrome X, Y and Z…(Holt, 2000) to define the far reaching consequences of this potential unifying concept of much chronic disease.
Compassionate statements such as “its not you fault that you are fat”, serve mixed purposes. On the one hand, many peoplehave to accept responsibility for self-induced weight gain, but, on the other, many uncontrollable factors can operate to promote weight gain. Humankind is apt to deny, project or rationalize circumstances of “being obese”, but there is a growing group of individuals or agencies who can be faulted for their contribution to obesity. The modern food industry continues to purvey unhealthy forms of food that bear excessive calories and calorie expenditure often remains compromised by idleness (Farmyard Science). This circumstance must be evaluated with the clearunderstanding that the only proven intervention to promote longevity is calorie restriction (Holt S, The Antiaging Triad, www.stephenholtmd.com, 2011).
Beyond the unavoidable factors that promote weight gain are choices that individuals make or “feel” they have to make. Economics drive the obesity epidemic, where our poorer sector of society has a disproportionate number of overweight individuals. In fact, it seems clear that increasing the economic standing of many people may be a key factor in the combat against obesity, at least in Western Society. This apparent contrarian circumstance is matter of fact in industrialized society, especially in Europe and the USA. While literature continues to focus on the USA as the “fat density of the world”, obesity has emerged with equivalence in the Middle East and areas of the Indian subcontinent. This book skirts a vast amount of scientifi c data on the epidemiology of obesity and hypotheses of its causation, but it focuses on an evaluation of the “here and now” in the focused therapeutics of weight control in individuals with a “significant overweight status”. Humankind is paying a high price for dietary indiscretions and lack of exercise, as the phenomenon of the human “pot bellied dinosaur” emerges in this new millennium ( Syndrome X, Y and Z…). Actuarial statistics appear gloomy, with the new found circumstance of widespread overweight status and Metabolic Syndrome X.
A generation of adults exists today with knowledge that they may outlive their overweight progeny. Perhaps readers of this book may understand the difficulties that I face in addressing the HCG diet when they read the following excerpt from the national newspaper USA Today “A popular type of weight-loss products, heavily promoted on the Internet, is fraudulent and illegal, Food and Drug Administrationoffi cials say HCG weight-loss products that promise dramatic results and claim to be homeopathic are sold as drops, pellets and sprays on the Web, in drugstores and at General Nutrition Centers (modified). They are supposed to be used in combination with a very low-calorie diet of 500 calories a day. Many of the labels indicate the products contain HCG, or human chorionic gonadotropin, a hormone made by the placenta during pregnancy. The hormone itself is approved as a prescription treatment for infertility and other conditions. There is no evidence the oral over-the-counter products are effective for weight loss, says Elizabeth Miller, FDA’s leader for the Internet and health fraud team. While they may not be dangerous, they’re at least “economic fraud,” she says…. “ FDA’s Miller also has concerns about injectable versions of HCG for weight loss. The drug is not approved for weight loss, she says” (Reporter, Nanci Hellmich, USA Today, 24 Jan 2011). Dieters getting injections of the hormone from people who aren’t licensed to do so run the risk of getting infections and can’t be sure what product they’re getting”.
One may question some of these statements-vide infra.
Stephen Holt MD, Holt Institute of Medicine
There is a major revival of interest in the short term use (3 or 6 weeks) of very low calorie diets (VLCD) for the induction of weight loss, especially in the obese individual ( BMI>30). This modern weight control revolution in Integrative Medicine involves a reactivation of the combined application of severe calorie restriction ( very low calorie diet, VLCD, 500 Kcalday diet), combined with injections of modest amounts of the hormone, human chorionic gonadotrophin (HCG) or the oral use of homeopathic HCG preparations (modifi ed Simeons Diet Protocols). The HCG diet is being enthusiastically applied by an increasing number of physicians who believe in its benefi ts and describe its successful outcomes. Some individuals continue to question the evidence-base for its use. Weight management concepts, involving HCG injections, were first presented in 1954 by ATW Simeons, resulting in the use of the terms “Simeons protocol” or “Simeons diet”. The widespread use of the Simeons diet in the 1960’s and early 70’s bred “fat clinics” throughout Europe and to a lesser degree in the United States. The Simeons approach was corrupted and, in some cases, modified to advantage by many healthcare givers. However, the diet fell into disrepute because few advantages of HCG plus a VLCD were recorded or observed in comparison with the use of a VLCD alone; at least under the specific conditions of several studies under which the evaluations of the HCG diet were made.
In recent times in the USA, many thousands of patients have received the Simeons protocol with apparent resounding claims of success. The modern, open-label experiences with the HCG diet imply that there are more desirable features to weight control as a consequence of the administration of HCG. Such observations include targeted removal of fat deposits, retention of muscle mass, a better body contour at the end of the HCG diet and postulations about a modifi cation of the “set-point phenomenon” (resistance to weight loss during dieting). While Simeons used an HCG diet for some individuals with only modest weight gain, many proponents of the HCG diet believe that this approach is more ideal for individuals with significant degrees of overweight status or obesity. In this book, I attempt to review the advantages, disadvantages, limitations and perceived benefi t of the Simeons approach (HCG diet) to weight control. In common with several interventions that are used in Integrative Medicine, controversies exist and there is a need to seek a clear evidence-base for this weight loss approach. That said, it is diffi cult to ignore the growing consensus of opinion on the benefi ts of the Simeons diet in its expanding application in clinical practice.
Regulatory authorities in the US have not embraced the effi cacy of the “off label” use of the injected drug HCG in weight control. Even more criticism has been leveled at “homeopathic” HCD drops. Before the “cannons of criticism” shoot down the HCG diet, a reappraisal of circumstances is required, together with more outcome research (www.worldhealth.net). The global epidemic of obesity has bred its own subspecialty practice of medicine. I wish to coin the somewhat clumsy terms “ Obesitology” or “ Bariatology” that describe areas of comprehensive medical care that are required for the “overweight diathesis”. These terms are meant to incorporate a holistic approach to the battle against an overweight status. Obesity may now be the commonest cause of premature morbidity and mortality in many industrialized countries. Excessive body weight is one of the most recalcitrant disorders in modern medicine, for which there is no simple way out. That said, complacency prevails about expanded waistlines and mounting childhood obesity is bringing tears to the eyes of industrialized society. Our recognition of “fat societies” resonates with millions of people. The message about the benefits of controlling weight makes many people sickened, tired and desperate.
The desperation of the obese individual is apparent in a common willingness of many people to respond to false promises of weight loss control. Is the HCG diet just another fad? Several physicians have published comments that the HCG diet has inherent false promises. I acknowledge that massive confusion has been created by fad diets and “gobbledygook” statements about weight loss control. It is time to tackle the horns of the “obesity bull”, with “head on” tactics. The reason for the existence of so many weight loss diets may be taken as proof that few serve any useful purpose. Notions about “quick fixes” for weight control are fantasies, but there is an emerging science of weight control that focuses on the stubborn and persistent nature of obesity.
It is time to recognize the heterogeneous nature of obesity and cut the therapeutic nihilism. This books attempts to address these issues in a short and direct manner. That said, “the scientific jury” remains out on the HCG diet. While I cannot rest any laurels on anecdote, the recently described benefi ts of the HCG diet are hard to ignore. For many years, physicians and scientists were not willing to perceive obesity as a disease. Times have changed, as science unravels the pathophysiology of obesity. Fatness has been characterized too often as a cosmetic tissue, without due consideration of its associated “ugly” disease companions. One cannot perceive weight control in a unitary dimension. A person with signifi cant and persistent excess body weight invariably presents with one or more disease complications and they are at risk formany disorders. Welcome to the forced emergence of the disciplines “obesitology” or “bariatology” (comprehensive care for the overweight individual). These days we recognize the deadly quartet of excess body weight, dyslipidemia and glucose intolerance, linked by underlying resistance to the actions of the hormone insulin. This quartet is referred to as Metabolic Syndrome X, with its obvious risks of stroke and cardiovascular disease. Metabolic Syndrome X has been referred to as the “hidden epidemic”, and it is an apparent “well kept secret”.
How can 70 million Americans be living in a status of Syndrome X, with this diagnosis often missing from a patient’s medical record? Failing to diagnose and manage Syndrome X is a huge public health problem and some proponents of HCG diets seem to ignore this disorder that is present in many of their patients who receive this intervention. The perceived “occult” nature of Syndrome X rests in the fact that there is no simple solution or pharmaceutical to tackle this problem. Syndrome X has a multi-factorial etiology (many causes). Metabolic Syndrome X is rooted in several issues including: hereditary, environmental toxicity, poor diet, chronic infl ammation, substance abuse and lack of exercise. While Syndrome X is a common forerunner to Type II diabetes mellitus, it is associated with a range of diseases that increase risks of death from all causes. The protean manifestations or disease associations of Syndrome X have been exemplifi ed by the use of the term Syndrome X, Y and Z…(Holt, 2000) to define the far reaching consequences of this potential unifying concept of much chronic disease.
Compassionate statements such as “its not you fault that you are fat”, serve mixed purposes. On the one hand, many peoplehave to accept responsibility for self-induced weight gain, but, on the other, many uncontrollable factors can operate to promote weight gain. Humankind is apt to deny, project or rationalize circumstances of “being obese”, but there is a growing group of individuals or agencies who can be faulted for their contribution to obesity. The modern food industry continues to purvey unhealthy forms of food that bear excessive calories and calorie expenditure often remains compromised by idleness (Farmyard Science). This circumstance must be evaluated with the clearunderstanding that the only proven intervention to promote longevity is calorie restriction (Holt S, The Antiaging Triad, www.stephenholtmd.com, 2011).
Beyond the unavoidable factors that promote weight gain are choices that individuals make or “feel” they have to make. Economics drive the obesity epidemic, where our poorer sector of society has a disproportionate number of overweight individuals. In fact, it seems clear that increasing the economic standing of many people may be a key factor in the combat against obesity, at least in Western Society. This apparent contrarian circumstance is matter of fact in industrialized society, especially in Europe and the USA. While literature continues to focus on the USA as the “fat density of the world”, obesity has emerged with equivalence in the Middle East and areas of the Indian subcontinent. This book skirts a vast amount of scientifi c data on the epidemiology of obesity and hypotheses of its causation, but it focuses on an evaluation of the “here and now” in the focused therapeutics of weight control in individuals with a “significant overweight status”. Humankind is paying a high price for dietary indiscretions and lack of exercise, as the phenomenon of the human “pot bellied dinosaur” emerges in this new millennium ( Syndrome X, Y and Z…). Actuarial statistics appear gloomy, with the new found circumstance of widespread overweight status and Metabolic Syndrome X.
A generation of adults exists today with knowledge that they may outlive their overweight progeny. Perhaps readers of this book may understand the difficulties that I face in addressing the HCG diet when they read the following excerpt from the national newspaper USA Today “A popular type of weight-loss products, heavily promoted on the Internet, is fraudulent and illegal, Food and Drug Administrationoffi cials say HCG weight-loss products that promise dramatic results and claim to be homeopathic are sold as drops, pellets and sprays on the Web, in drugstores and at General Nutrition Centers (modified). They are supposed to be used in combination with a very low-calorie diet of 500 calories a day. Many of the labels indicate the products contain HCG, or human chorionic gonadotropin, a hormone made by the placenta during pregnancy. The hormone itself is approved as a prescription treatment for infertility and other conditions. There is no evidence the oral over-the-counter products are effective for weight loss, says Elizabeth Miller, FDA’s leader for the Internet and health fraud team. While they may not be dangerous, they’re at least “economic fraud,” she says…. “ FDA’s Miller also has concerns about injectable versions of HCG for weight loss. The drug is not approved for weight loss, she says” (Reporter, Nanci Hellmich, USA Today, 24 Jan 2011). Dieters getting injections of the hormone from people who aren’t licensed to do so run the risk of getting infections and can’t be sure what product they’re getting”.
One may question some of these statements-vide infra.
