A NEW APPROACH TO OBESITY
BY: Dr. A.T.W. SIMEONS
SALVATOR MUNDI INTERNATIONAL HOSPITAL,
00152 - ROME VIALE MURA GIANICOLENSI, 77
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FOREWORD - introduction by Dr. Simeons
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
What I have to say is, in essence, the
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 then, when 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 Mutidi 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
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 customarily 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.
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 chanisms. 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, or baths 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 on1y as
much as he required too still the pangs of hunger. Moreover, much of
his food was raw and all of it was unrefined. He roasted his meat,
but he did not boil it, as he had no pots, and what little he may
have grubbed from the Earth and picked from the trees, he ate as he
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, 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.
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. 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.
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
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
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.
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 diericephalic "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 fat-banking capacity is abnormally low from birth. Such a
congenitally low diencephalic capacity would then represent the
inherited factor in obesity. When this abnormal trait is markedly
present, obesity will develop at an early age in spite of normal
feeding; this could explain why among brothers and sisters eating
the same food at the same table some become obese and others do not.
(2) Other Diencephalic Disorders
The second way in which obesity can
become established is the lowering of a previously normal
fat-banking capacity owing to some other diencephalic disorder. It
seems to be a general rule that when one of the many diencephalic
centers is particularly overtaxed; it tries to increase its capacity
at the expense of other centers.
In the menopause and after castration the
hormones previously produced in the sex-glands no longer circulate
in the body. In the presence of normally functioning sex-glands
their hormones act as a brake on the secretion of the sex-gland
stimulating hormones of the anterior pituitary. When this brake is
removed the anterior pituitary enormously increases its output of
these sex-gland stimulating hormones, though they are now no longer
effective. In the absence of any response from the non-functioning
or missing sex glands, there is nothing to stop the anterior
pituitary from producing more and more of these hormones. This
situation causes an excessive strain on the diericephalic center
which controls the function of the anterior pituitary. In order to
cope with this additional burden the center appears to draw more and
more energy away from other centers, such as those concerned with
emotional stability, the blood circulation (hot flushes) and other
autonomous nervous regulations, particularly also from the not so
vitally important fat-bank.
The so called stable type of diabetes
involves the diencephalic blood sugar regulating center the
diencephalon tries to meet this abnormal load by switching energy
destined for the fat bank over to the sugar-regulating center, with
the result that the fat-banking capacity is reduced to the point at
which it is forced to establish a fixed deposit and thus initiate
the disorder we call obesity. In this case one would have to
consider the diabetes the primary cause of the obesity, but it is
also possible that the process is reversed in the sense that a
deficient or overworked fat-center draws energy from the
sugar-center, in which case the obesity would be the cause of that
type of diabetes in which the pancreas is not primarily involved.
Finally, it is conceivable that in Cushing's syndrome those symptoms
which resemble obesity are entirely due to the withdrawal of energy
from the diencephalic fat-bank in order to make it available to the
highly disturbed center which governs the anterior pituitary
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
(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 (with emphasis 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 the only persons who
have some inherited trait in this direction can become obese merely
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
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 WWII
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
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
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.
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
On the other hand, compulsive eating does
occur in some obese patients, particularly in girls in their late
teens or early twenties. Fortunately from the obese patients'
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 them. In many of these cases
psychotherapy can be helpful, as it enables these patients to sec
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
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
many 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
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 diencephalons, 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 wee 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.
Proehlich 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,
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
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
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
restricted diet without a feeling of
hunger, in spite of a rapid loss of weight. When I tried this in
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. The daily administration of hCG appeared to
have no side-effects other than
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
Pregnancy and Obesity
Once this trail was opened, further
observations seemed to fall into line. It is well known that during
pregnancy an obese woman can very easily lose weight. She can
drastically reduce her diet without feeling hunger or discomfort and
lose weight without in any way harming the child in her womb. It is
also surprising to what extent a woman can suffer from
pregnancy-vomiting without coming to any real harm.
Pregnancy is an obese woman's one great
chance to reduce her excess weight. That she so rarely makes use of
this opportunity is due to the erroneous notion, usually fostered by
her elder relations, that she now has “two mouths to feed” and must
“keep up her strength for the coming event. All modern obstetricians
know that this is nonsense and that the more superfluous fat is lost
the less difficult will be the confinement, though some still
hesitate to prescribe a diet sufficiently low in calories to bring
about a drastic reduction.
A woman may gain weight during pregnancy,
but she never becomes obese in the strict sense of the word. Under
the influence of the hCG which circulates in enormous quantities in
her body during pregnancy, her diencephalic banking capacity seems
to be unlimited, and abnormal fixed deposits are never formed. At
confinement she is suddenly deprived of hCG, and her diencephalic
fat-center reverts to its normal capacity. It is only then that the
abnormally accumulated fat is locked away again in a fixed deposit.
From that moment on she is again suffering from obesity and is
subject to all its consequences.
Pregnancy seems to be the only normal
human condition in which the dicncephalic fat banking capacity is
unlimited. It is only during pregnancy that fixed fat deposits can
be transferred back into the normal current account and freely drawn
upon to make up for any nutritional deficit. During pregnancy, every
ounce of reserve fat is placed at the disposal of the growing fetus.
Were this not so, an obese woman, whose normal reserves are already
depleted, would have the greatest difficulties in bringing her
pregnancy to full term. There is considerable evidence to suggest
that it is the hCG produced in large quantities in the placenta
which brings about this diencephalic change.
Though we may be able to increase the
dieneephalic fat banking capacity by injecting hCG, this does not in
itself affect the weight, just as transferring monetary funds from a
fixed deposit into a current account does not make a man any poorer;
to become poorer it is also necessary that he freely spends the
money which thus becomes available. In pregnancy the needs of the
growing embryo take care of this to some extent, but in the
treatment of obesity there is no embryo, and so a very severe
dietary restriction must take its place for the duration of
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
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
gonadotropilins because they directly govern the function of the
ovaries. The anterior pituitary is in turn governed by the
diencephalon, and so when there is an ovarian deficiency the
diencephalic center concerned is hard put to correct matters by
increasing the secretion from the anterior pituitary of FSH or LSH,
as the case may be. When sexual deficiency is clinically present,
this is a sign that the diencephalic center concerned is unable, in
spite of maximal exertion, to cope with the demand for anterior
pituitary stimulation. When then the administration of hCG increases
the functional capacity of the diencephalon, all demands can be
fully satisfied and the sex deficiency is corrected.
That this is the true mechanism
underlying the presumed gonadotrophic action of hCG is confirmed by
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
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 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
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.
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,
If an 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.
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
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 300-400 mg, it is often
possible to stop all anti-diabetes 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.
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 an hCG diet the effect is no less
dramatic. As it does not 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.
sterol 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
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 an 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
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
when we saw that the patients came to no harm even if treatment was
continued and we found the same in follow-up examinations undertaken
some months after treatment was continued as we found in
examinations undertaken some months before treatment. As the
increase is mostly in the form of the not dangerous form of the free
cholesterol, we gradually came to welcome the phenomenon. Today we
believe that the rise is entirely due to the liberation of recent
that have not yet undergone calcification
in the arterial wall and is therefore highly beneficial.
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 dioncephalic
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
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 incident which
could be attributed to the rather sudden drop in high blond
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.
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
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
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 diencephalun during pregnancy and that we are
merely using this natural safeguard as a means of correcting the
dicncephalic disorder which is responsible for his overweight.
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.
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 with 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
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 dencepbahic 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
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.
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
Conditions that must be accepted before
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, sun-bathing or theater-going.
It is also made clear that between
courses the patient gets no treatment and is free to eat anything he
pleases except starches and sugar during the first 3 weeks. It is
impressed upon him that he will have to follow the prescribed diet
to the letter and that after the first three days this will cost him
no effort, as he will feel no hunger and may indeed have difficulty
in getting down the 500 Calories which he will be given. If these
conditions are not acceptable the case is refused, as any compromise
or half measure is bound to prove utterly disappointing to patient
and physician alike and is a waste of time and energy.
Though a patient can only consider
himself really cured when he has been reduced to his stastically
normal weight, we do not insist that he commit himself to that
extent. Even a partial loss of overweight is highly beneficial, and
it is our experience that once a patient has completed a first
course he is so enthusiastic about the ease with which the - to him
surprising - results are achieved that he almost invariably comes
back for more. There certainly can be no doubt that in my clinic
more time is spent on damping over-enthusiasm than on insisting that
the rules of the treatment be observed.
Examining the Patient
Only when agreement is reached on the
points so far discussed do we proceed with the examination of the
patient. A note is made of the size of the first upper incisor, of a
pad of fat on the nape of the neck, at the axilla and on the inside
of the knees. The presence of striation, a suprapubic fold, a
thoracic fold, angulation of elbow and knee joint,
breast-development in men and women, edema of the ankles and the
state of genital development in the male are noted.
Wherever this seems indicated we X-ray
the sella turcica, as the bony capsule which contains the pituitary
gland is called, measure the basal metabolic rate, X-ray the chest
and take an electrocardiogram. We do a blood-count and a
sedimentation rate and estimate uric acid, cholesterol, iodine and
sugar in the fasting blood.
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
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
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
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.
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
should never be made to coincide with onset of 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 base 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 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
Tea or coffee in any quantity without
sugar. Only one tablespoonful of milk allowed in 24 hours. Saccharin
or Stevia may be used.
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.
One type of vegetable only to be
chosen from the following: spinach, chard, chicory, beet-greens,
green salad, tomatoes, celery, fennel, onions, red radishes,
cucumbers, asparagus, cabbage.
One breadstick (grissino) or one
An apple or a handful of strawberries
or one-half grapefruit.
The same four choices as lunch.
The juice of one lemon daily is allowed
for all purposes. Salt, pepper, vinegar, mustard powder, garlic,
sweet basil, parsley, thyme, majoram, etc., may be used for
seasoning, but no oil, butter or dressing.
Tea, coffee, plain water, or mineral
water are the only drinks allowed, but they may be taken in any
quantity and at all times.
In fact, the patient should drink about 2
liters of these fluids per day. Many patients are afraid to drink so
much because they fear that this may make them retain more water.
This is a wrong notion as the body is more inclined to store water
when the intake falls below its normal requirements.
The fruit or the breadstick may be eaten
between meals instead of with lunch or dinner, but not more than
than four items listed for lunch and dinner may be eaten at one
No medicines or cosmetics other than
lipstick, eyebrow pencil and powder may he used without special
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 be 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 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
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 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
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 or shrimp, crabmeat or kidneys for the
other meal. Where the Italian breadsticks, the so-called grissini,
are not available, one Melba toast may be used instead, though they
are psychologically less satisfying. A Melba toast has about the
same weight as the very porous grissini which is much more to look
at and to chew.
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
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.
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
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 around 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, bide 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
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
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 self-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 clay, and there is a smaller urinary output. Men often
continue to lose regularly at that rate, but women are more
irregular in spite of faultless dieting. There may be no drop at all
for two or three days and then a sudden loss which reestablishes the
normal average. These fluctuations are entirely due to variations in
the retention and elimination of water, which are more marked in
women than in men.
The weight registered by the scale is
determined by two processes not necessarily synchronized under the
influence of hCG. Fat is being extracted from the cells, in which it
is stored in the fatty tissue. When these cells are empty and
therefore serve no purpose, the body breaks down the cellular
structure and absorbs it, but breaking up of useless cells,
connective tissue, blood vessels, etc., may lag behind the process
of fat-extraction. When this happens the body appears to replace
some of the extracted fat with water which is retained for this
purpose. As water is heavier than fat the scales may show no loss of
weight, although sufficient fat has actually been consumed to make
up for the deficit in the 500-Calorie diet. When 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 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. No
amount of explanation convinces them that a plateau does not mean
that they are no longer responding normally to treatment.
In such cases we consider it permissible,
for purely psychological reasons, to break up the plateau. This can
be done in two ways. One is a so-called “apple day”. An apple-day
begins at lunch and continues until just before lunch of the
following day. The patients are given six large apples and are told
to eat one whenever they feel the desire though six apples is the
maximum allowed. During an apple-day no other food or liquids except
plain water are allowed and of water they may only drink just enough
to quench an uncomfortable thirst if eating an apple still leaves
them thirsty. Most patients feel no need for water and are quite
happy with their six apples. Needless to say, an apple-day may never
be given on the day on which there is no injection. The apple-day
produces a gratifying loss of weight on the following day, chiefly
due to the elimination of water. This water is not regained when the
patients resume their normal 500-calorie diet at lunch, and on the
following days they continue to lose weight satisfactorily.
The other way to break up a plateau is by
giving a non-mercurial diuretic for one day. 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.
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
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.
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
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
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 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.
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
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.
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 they 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
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.
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
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.
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.
I never allow any kind of massage during
treatment. It is entirely unnecessary and merely disturbs a very
delicate process which is going on in the tissues. Few indeed are
the masseurs and masseuses who can resist the temptation to knead
and hammer abnormal fat deposits. In the course of rapid reduction
it is sometimes possible to pick up a fold of skin which has not yet
had time to adjust itself, as it always does under hCG, to the
changed figure. This fold contains its normal subcutaneous fat and
may be almost an inch thick. It is one of the main objects of the
hCG treatment to keep that fat there. Patients and their masseurs
do not always understand this and give
this fat a working-over. I have seen such patients who were as black
and blue as if they had received a sound thrashing.
In my opinion, massage, thumping,
rolling, kneading, and shivering undertaken for the purpose of
reducing abnormal fat can do nothing but harm. We once had the honor
of treating the proprietress of a high class institution that
specialized in such antics. She had the audacity to confess that she
was taking our treatment to convince her clients of the efficacy of
her methods, which she had found useless in her own case.
How anyone in his right mind is able to
believe that fatty tissue can be shifted mechanically or be made to
vanish by squeezing is beyond my comprehension. The only effect
obtained is severe bruising. The torn tissue then forms scars, and
these slowly contracts making the fatty tissue even harder and more
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.
Towards the end of a course or when a
patient has nearly reached his normal weight it occasionally happens
that the blood sugar drops below normal, and we have even seen this
in patients who had an abnormally high blood sugar before treatment.
Such an attack of hypoglycemia is almost identical with the one seen
in diabetics who have taken too much insulin. The attack comes on
suddenly; there is the same feeling of light-headedness, weakness in
the knees, trembling, and unmotivated sweating. But under hCG,
hypoglycemia does not produce any feeling of hunger. All these
symptoms are almost instantly relieved by taking two heaped
teaspoons of sugar.
In the course of treatment the
possibility of such an attack is explained to those patients who are
in a phase in which a drop in blood sugar may occur. They are
instructed to keep sugar or glucose sweets handy, particularly when
driving a car. They are also told to watch the effect of taking
sugar very carefully and report the following day. This is
important, because anxious patients to whom such an attack has been
explained are apt to take sugar unnecessarily, in which case it
inevitably produces a gain in weight and does not dramatically
relieve the symptoms for which it was taken, proving that these were
not due to hypoglycemia. Some patients mistake the effects of
emotional stress for hypoglycemia. When the symptoms are quickly
relieved by sugar this is proof that they were indeed due to an
abnormal lowering of the blood sugar, and in that case there is no
increase in the weight on the following day. We always suggest that
sugar be taken if the patient is in doubt.
Once such an attack has been relieved
with sugar we have never seen it recur on the immediately subsequent
days, and only very rarely does a patient have two such attacks
separated by several days during a course of treatment. In patients
who have not eaten sufficiently during the first two days of
treatment we sometimes give sugar when the minor symptoms usually
felt during the first there 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
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.
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.
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
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
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
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
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
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 broncial 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.
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.
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. 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 bathroom-scale always at hand, particularly while
traveling. They must without fail weight 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
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
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
When abnormal fat is no longer being put
into circulation either because it has been consumed or because
immunity has set in, this is always felt by the patient as sudden,
intolerable and constant hunger. In this sense, the hCG method is
completely self-limiting. With hCG it is impossible to reduce a
patient, however enthusiastic, beyond his normal weight. As soon as
no more abnormal fat is being issued, the body starts consuming
normal fat, and this is always regained as soon as ordinary feeding
is resumed. The patient then finds that the 2-3 lbs. he has lost
during the last days of treatment are immediately regained. A meal
is skipped and maybe a pound is lost. The next day this pound is
regained, in spite of a careful watch over the food intake. In a few
days a tearful patient is back in the consulting room, convinced
that her case is a failure.
All that is happening is that the
essential fat lost at the end of the treatment, owing to the
patient's reluctance to report a much greater hunger, is being
replaced. The weight at which such a patient must stabilize thus
lies 2-3 lbs. higher than the weight reached at the end of the
treatment. Once this higher basic level is established, further
difficulties in controlling the weight at the new point of
stabilization hardly arise.
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.
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
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) ui 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
After 3 weeks, very gradually add starch
in small quantities, always controlled by morning weighing.
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
The method involves a highly complex
bodily mechanism, and 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, 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.
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 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.
ASCHFIE1M-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 . . . Absorbed 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
lining of the arteries (see
arteriosclerosis). No clear and definite relationship between fat
intake and cholesterol-level in the blood has yet been established.
CHORIONIC . . . Of the chorion, which is part of the placenta or
after-birth. The term chorionic is justly applied to hCG, as this
hormone is exclusively produced in the placenta, from where it
enters the human mother's blood and is later excreted in her urine.
COMPULSIVE EATING. . . A form of oral gratification with which a
repressed sex-instinct is sometimes vicariously relieved. Compulsive
eating must not be confused with the real hunger from which most
obese patients suffer.
CONGENITAL . . . Any condition which exists at or before birth.
CORONARY ARTERIES . . . Two blood vessels which encircle the heart
and supply all the blood required by the heart-muscle.
CORPUS LUTEUM . . . A yellow body which forms in the ovary at the
follicle from which an egg has been detached. This body acts as an
endocrine gland and plays an important role in menstruation and
pregnancy. Its secretion is one of the sex hormones, and it is
stimulated by another hormone known as LSH, which stands for luteum
stimulating hormones. LSH is produced in the anterior lobe of the
pituitary gland. LSH is truly gonadotrophic and must never be
confused with hCG, which is a totally different substance, having no
direct action on the corpus luteum.
CORTEX . . . Outer covering or rind. The term is applied to the
outer part of the adrenals but is also used to describe the gray
matter which covers the white matter of the brain.
CORTISONE . . . A synthetic substance which acts like an adrenal
hormone. It is today used in the treatment of a large number of
illnesses, and several chemical variants have been produced, among
which are prednisone and triaincinolone.
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
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
EMACIATED . . . Grossly undernourished.
EUPHORIA . . . A feeling of particular physical and mental well
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
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
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
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
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
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
base some protein of animal origin (milk, eggs or flesh) to live
healthily. When insufficient protein is eaten, the body retains
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.
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