Pounds & Inches
A NEW APPROACH TO
OBESITY
BY: A.T.W. SIMEONS,
M.D.
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 -
ROME
VIALE
MURA GIANICOLENSI, 77
FOREWORD
This
book discusses a new interpretation of the nature of obesity, and
while it does not advocate yet another fancy slimming diet it does
describe a method of treatment which has grown out of theoretical
considerations based on clinical observation.
What I
have to say is, 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 Mundi International Hospital
in Rome. For some of them the time they could spare has been too
short to get a full grasp of the technique, and in any case the
number of those whom I have been able to meet personally is small
compared with the many requests for further detailed information
which keep coming in. I have tried to keep up with these demands by
correspondence, but the volume of this work has become unmanageable
and that is one excuse for writing this book.
In
dealing with a disorder in which the patient must take an active
part in the treatment, it is, I believe, essential that he or she
have an understanding of what is being done and why. Only then can
there be intelligent cooperation between physician and patient. In
order to avoid writing two books, one for the physician and another
for the patient - a prospect which would probably have resulted in
no book at all - I have tried to meet the requirements of both in a
single book. This is a rather difficult enterprise in which I may
not have succeeded. The expert will grumble about long-windedness
while the lay-reader may occasionally have to look up an unfamiliar
word in the glossary provided for him.
To make
the text more readable I shall be unashamedly authoritative and
avoid all the hedging and tentativeness with which it is 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 mechanisms. Persons
suffering from this particular disorder will get fat regardless of
whether they eat excessively, normally or less than normal. A person
who is free of the disorder will never get fat, even if he
frequently overeats.
Those
in whom the disorder is severe will accumulate fat very rapidly,
those in whom it is moderate will gradually increase in weight and
those in whom it is mild may be able to keep their excess weight
stationary for long periods. In all these cases a loss of weight
brought about by dieting, treatments with thyroid, appetite-reducing
drugs, laxatives, violent exercise, massage, 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 went along.
The
whole structure of man's omnivorous digestive tract is, like that of
an ape, rat or pig, adjusted to the continual nibbling of tidbits.
It is not suited to occasional gorging as is, for instance, the
intestine of the carnivorous cat family. Thus the institution of
regular meals, particularly of food rendered rapidly, placed a great
burden on modern man's ability to cope with large quantities of food
suddenly pouring into his system from the intestinal tract.
The
institution of regular meals meant that man had to eat more than his
body required at the moment of eating so as to tide him over until
the next meal. Food rendered easily digestible suddenly flooded his
body with nourishment of which he was in no need at the moment.
Somehow, somewhere this surplus had to be stored.
Three
Kinds of Fat
In the
human body we can distinguish three kinds of fat. The first is the
structural fat which fills the gaps between various organs, a sort
of packing material. Structural fat also performs such important
functions as bedding the kidneys in soft elastic tissue, protecting
the coronary arteries and keeping the skin smooth and taut. It also
provides the springy cushion of hard fat under the bones of the
feet, without which we would be unable to walk.
The
second type of fat is a normal reserve of fuel upon which the body
can freely draw when the nutritional income from the intestinal
tract is insufficient to meet the demand. Such normal reserves are
localized all over the body. Fat is a substance which packs the
highest caloric value into the smallest space so that normal
reserves of fuel for muscular activity and the maintenance of body
temperature can be most economically stored in this form. Both these
types of fat, structural and reserve, are normal, and even if the
body stocks them to capacity this can never be called obesity.
But
there is a third type of fat which is entirely abnormal. It is the
accumulation of such fat, and of such fat only, from which the
overweight patient suffers. This abnormal fat is also a potential
reserve of fuel, but unlike the normal reserves it is not available
to the body in a nutritional emergency. It is, so to speak, locked
away in a fixed deposit and is not kept in a current account, as are
the normal reserves.
When an
obese patient tries to reduce by starving himself, he will first
lose his normal fat reserves. When these are exhausted he begins to
burn up structural fat, and only as a last resort will the body
yield its abnormal reserves, though by that time the patient usually
feels so weak and hungry that the diet is abandoned. It is just for
this reason that obese patients complain that when they diet they
lose the wrong fat. They feel famished and tired and their face
becomes drawn and haggard, but their belly, hips, thighs and upper
arms show little improvement. The fat they have come to detest stays
on and the fat they need to cover their bones gets less and less.
Their skin wrinkles and they look old and miserable. And that is one
of the most frustrating and depressing experiences a human being can
have.
Injustice to the Obese
When
then obese patients are accused of cheating, gluttony, lack of will
power, greed and sexual complexes, the strong become indignant and
decide that modern medicine is a fraud and its representatives
fools, while the weak just give up the struggle in despair. In
either case the result is the same: a further gain in weight,
resignation to an abominable fate and the resolution at least to
live tolerably the short span allotted to them - a fig for doctors
and insurance companies.
Obese
patients only feel physically well as long as they are stationary or
gaining weight. They may feel guilty, owing to the lethargy and
indolence always associated with obesity. They may feel ashamed of
what they have been led to believe is a lack of control. They may
feel horrified by the appearance of their nude body and the
tightness of their clothes. But they have a primitive feeling of
animal content which turns to misery and suffering as soon as they
make a resolute attempt to reduce. For this there are sound reasons.
In the
first place, more caloric energy is required to keep a large body at
a certain temperature than to heat a small body. Secondly the
muscular effort of moving a heavy body is greater than in the case
of a light body. The muscular effort consumes calories which must be
provided by food. Thus, all other factors being equal, a fat person
requires more food than a lean one. One might therefore reason that
if a fat person eats only the additional food his body requires he
should be able to keep his weight stationary. Yet every physician
who has studied obese patients under rigorously controlled
conditions knows that this is not true. Many obese patients actually
gain weight on a diet which is calorically deficient for their basic
needs. There must thus be some other mechanism at work.
Glandular Theories
At one
time it was thought that this mechanism might be concerned with the
sex glands. Such a connection was suggested by the fact that many
juvenile obese patients show an under-development of the sex organs.
The middle-age spread in men and the tendency of many women to put
on weight in the menopause seemed to indicate a causal connection
between diminishing sex function and overweight. Yet, when highly
active sex hormones became available, it was found that their
administration had no effect whatsoever on obesity. The sex glands
could therefore not be the seat of the disorder.
The
Thyroid Gland
When it
was discovered that the thyroid gland controls the rate at which
body-fuel is consumed, it was thought that by administering thyroid
gland to obese patients their abnormal fat deposits could be burned
up more rapidly. This too proved to be entirely disappointing,
because as we now know, these abnormal deposits take no part in the
body's energy-turnover - they are inaccessibly locked away. Thyroid
medication merely forces the body to consume its normal fat
reserves, which are already depleted in obese patients, and then to
break down structurally essential fat without touching the abnormal
deposits. In this way a patient may be brought to the brink of
starvation in spite of having a hundred pounds of fat to spare. Thus
any weight loss brought about by thyroid medication is always at the
expense of fat of which the body is in dire need.
While
the majority of obese patients have a perfectly normal thyroid gland
and some even have an overactive thyroid, one also occasionally sees
a case with a real thyroid deficiency. In such cases, treatment with
thyroid brings about a small loss of weight, but this is not due to
the loss of any abnormal fat. It is entirely the result of the
elimination of a mucoid substance, called myxedema, which the body
accumulates when there is a marked primary thyroid deficiency.
Moreover, patients suffering only from a severe lack of thyroid
hormone never become obese in the true sense. Possibly also the
observation that normal persons - though not the obese - lose weight
rapidly when their thyroid becomes overactive may have contributed
to the false notion that thyroid deficiency and obesity are
connected. Much misunderstanding about the supposed role of the
thyroid gland in obesity is still met with, and it is now really
high time that thyroid preparations be once and for all struck off
the list of remedies for obesity. This is particularly so because
giving thyroid gland to an obese patient whose thyroid is either
normal or overactive, besides being useless, is decidedly dangerous.
The
Pituitary Gland
The
next gland to be falsely incriminated was the anterior lobe of the
pituitary. This most important gland lies well protected in a bony
capsule at the base of the skull. It has a vast number of functions
in the body, among which is the regulation of all the other
important endocrine glands. The fact that various signs of anterior
pituitary deficiency are often associated with obesity raised the
hope that the seat of the disorder might be in this gland. But
although a large number of pituitary hormones have been isolated and
many extracts of the gland prepared, not a single one or any
combination of such factors proved to be of any value in the
treatment of obesity. Quite recently, however, a fat-mobilizing
factor has been found in pituitary glands, but it is still too early
to say whether this factor is destined to play a role in the
treatment of obesity.
The
Adrenals
Recently, a long series of brilliant discoveries concerning the
working of the adrenal or suprarenal glands, small bodies which sit
atop the kidneys, have created tremendous interest. This interest
also turned to the problem of obesity when it was discovered that a
condition which in some respects resembles a severe case of obesity
- the so called Cushing's Syndrome - was caused by a glandular
new-growth of the adrenals or by their excessive stimulation with
ACTH, which is the pituitary hormone governing the activity of the
outer rind or cortex of the adrenals.
When we
learned that an abnormal stimulation of the adrenal cortex could
produce signs that resemble true obesity, this knowledge furnished
no practical means of treating obesity by decreasing the activity of
the adrenal cortex. There is no evidence to suggest that in obesity
there is any excess of adrenocortical activity; in fact, all the
evidence points to the contrary. There seems to be rather a lack of
adrenocortical function and a decrease in the secretion of ACTH from
the anterior pituitary lobe.
So here
again our search for the mechanism which produces obesity led us
into a blind alley. Recently, many students of obesity have reverted
to the nihilistic attitude that obesity is caused simply by
overeating and that it can only be cured by under eating.
The
Diencephalon or Hypothalamus
For
those of us who refused to be discouraged there remained one slight
hope. Buried deep down in the massive human brain there is a part
which we have in common with all vertebrate animals the so-called
diencephalon. It is a very primitive part of the brain and has in
man been almost smothered by the huge masses of nervous tissue with
which we think, reason and voluntarily move our body. The
diencephalon is the part from which the central nervous system
controls all the automatic animal functions of the body, such as
breathing, the heart beat, digestion, sleep, sex, the urinary
system, the autonomous or vegetative nervous system and via the
pituitary the whole interplay of the endocrine glands.
It was
therefore not unreasonable to suppose that the complex operation of
storing and issuing fuel to the body might also be controlled by the
diencephalon. It has long been known that the content of sugar -
another form of fuel - in the blood depends on a certain nervous
center in the diencephalon. When this center is destroyed in
laboratory animals,
they
develop a condition rather similar to human stable diabetes. It has
also long been known that the destruction of another diencephalic
center produces a voracious appetite and a rapid gain in weight in
animals which never get fat spontaneously.
The
Fat- bank
Assuming that in man such a center controlling the movement of fat
does exist, its function would have to be much like that of a bank.
When the body assimilates from the intestinal tract more fuel than
it needs at the moment, this surplus is deposited in what may be
compared with a current account. Out of this account it can always
be withdrawn as required. All normal fat reserves are in such a
current account, and it is probable that a diencephalic center
manages the deposits and withdrawals.
When
now, for reasons which will be discussed later, the deposits grow
rapidly while small withdrawals become more frequent, a point may be
reached which goes beyond the diencephalon's banking capacity. Just
as a banker might suggest to a wealthy client that instead of
accumulating a large and unmanageable current account he should
invest his surplus capital, the body appears to establish a fixed
deposit into which all surplus funds go but from which they can no
longer be withdrawn by the procedure used in a current account. In
this way the diencephalic "fat-bank" frees itself from all work
which goes beyond its normal banking capacity. The onset of obesity
dates from the moment the diencephalon adopts this labor-saving
ruse. Once a fixed deposit has been established the normal fat
reserves are held at a minimum, while every available surplus is
locked away in the fixed deposit and is therefore taken out of
normal circulation.
Three Basic Causes of Obesity
1 – The Inherited
Factor
Assuming that there is a limit to the diencephalon's fat banking
capacity, it follows that there are three basic ways in which
obesity can become manifest. The first is that the 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 diencephalic center which controls the function of the anterior
pituitary. In order to cope with this additional burden the center
appears to draw more and more energy away from other centers, such
as those concerned with emotional stability, the blood circulation
(hot flushes) and other autonomous nervous regulations, particularly
also from the not so vitally important fat-bank.
The so
called stable type of diabetes involves the diencephalic blood sugar
regulating center the diencephalon tries to meet this abnormal load
by switching energy destined for the fat bank over to the
sugar-regulating center, with the result that the fat-banking
capacity is reduced to the point at which it is forced to establish
a fixed deposit and thus initiate the disorder we call obesity. In
this case one would have to consider the diabetes the primary cause
of the obesity, but it is also possible that the process is reversed
in the sense that a deficient or overworked fat-center draws energy
from the sugar-center, in which case the obesity would be the cause
of that type of diabetes in which the pancreas is not primarily
involved. Finally, it is conceivable that in Cushing's syndrome
those symptoms which resemble obesity are entirely due to the
withdrawal of energy from the diencephalic fat-bank in order to make
it available to the highly disturbed center which governs the
anterior pituitary adrenocortical system.
Whether
obesity is caused by a marked inherited deficiency of the fat-center
or by some entirely different diencephalic regulatory disorder, its
insurgence obviously has nothing to do with overeating and in either
case obesity is certain to develop regardless of dietary
restrictions. In these cases any enforced food deficit is made up
from essential fat reserves and normal structural fat, much to the
disadvantage of the patient's general health.
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 by overeating.
Secondly, in many of these cases the amount of food eaten remains
the same and it is only the consumption of fuel which is suddenly
decreased, as when an athlete is confined to bed for many weeks with
a broken bone or when a man leading a highly active life is suddenly
tied to his desk in an office and to television at home. Similarly,
when a person, grown up in a cold climate, is transferred to a
tropical country and continues to eat as before, he may develop
obesity because in the heat far less fuel is required to maintain
the normal body temperature.
When a
person suffers a long period of privation, be it due to chronic
illness, poverty, famine or the exigencies of war, his diencephalic
regulations adjust themselves to some extent to the low food intake.
When then suddenly these conditions change and he is free to eat all
the food he wants, this is liable to overwhelm his fat-regulating
center. During the 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 obesity.
In a
person eating coarse and unrefined food, the digestion is slow and
only a little nourishment at a time is assimilated from the
intestinal tract. When such a person is suddenly able to obtain
highly refined foods such as sugar, white flour, butter and oil
these are so rapidly digested and assimilated that the rush of
incoming fuel which occurs at every meal may eventually overpower
the diencenphalic regulatory mechanisms and thus lead to obesity.
This is commonly seen in the poor man who suddenly becomes rich
enough to buy the more expensive refined foods, though his total
caloric intake remains the same or is even less than before.
Psychological Aspects
Much
has been written about the psychological aspects of obesity. Among
its many functions the diencephalon is also the seat of our
primitive animal instincts, and just as in an emergency it can
switch energy from one center to another, so it seems to be able to
transfer pressure from one instinct to another. Thus, a lonely and
unhappy person deprived of all emotional comfort and of all instinct
gratification except the stilling of hunger and thirst can use these
as outlets for pent up instinct pressure and so develop obesity. Yet
once that has happened, no amount of psychotherapy or analysis,
happiness, company or the gratification of other instincts will
correct the condition.
Compulsive Eating
No end
of injustice is done to obese patients by accusing them of
compulsive eating, which is a form of diverted sex gratification.
Most obese patients do not suffer from compulsive eating; they
suffer genuine hunger - real, gnawing, torturing hunger - which has
nothing whatever to do with compulsive eating. Even their sudden
desire for sweets is merely the result of the experience that
sweets, pastries and alcohol will most rapidly of all foods allay
the pangs of hunger. This has nothing to do with diverted instincts.
On the
other hand, compulsive eating does occur in some obese patients,
particularly in girls in their late teens or early twenties.
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 alarms her.
There
are a number of signs and symptoms which are characteristic of
obesity. In manifest obesity many and often all these signs and
symptoms are present. In latent or just beginning cases some are
always found, and it should be a rule that if two or more of the
bodily signs are present, the case must be regarded as one that
needs immediate help.
Signs and symptoms of
obesity
The
bodily signs may be divided into such as have developed before
puberty, indicating a strong inherited factor, and those which
develop at the onset of manifest disorder. Early signs are a
disproportionately large size of the two upper front teeth, the
first incisor, or a dimple on both sides of the sacral bone just
above the buttocks. When the arms are outstretched with the palms
upward, the forearms appear sharply angled outward from the upper
arms. The same applies to the lower extremities. The patient cannot
bring his feet together without the knees overlapping; he is, in
fact, knock-kneed.
The
beginning accumulation of abnormal fat shows as a little pad just
below the nape of the neck, colloquially known as the Duchess' Hump.
There is a triangular fatty bulge in front of the armpit when the
arm is held against the body. When the skin is stretched by fat
rapidly accumulating under it, it 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 chubby.
Another
typical sign is a pad of fat on the insides of the knees, a spot
where normal fat reserves are never stored. There may be a fold of
skin over the pubic area and another fold may stretch round both
sides of the chest, where a loose roll of fat can be picked up
between two fingers. In the male an excessive accumulation of fat in
the breasts is always indicative, while in the female the breast is
usually, but not necessarily, large. Obviously excessive fat on the
abdomen, the hips, thighs, upper arms, chin and shoulders are
characteristic, and it is important to remember that any number of
these signs may be present in persons whose weight is statistically
normal; particularly if they are dieting on their own with iron
determination.
Common
clinical symptoms which are indicative only in their association and
in the frame of the whole clinical picture are: frequent headaches,
rheumatic pains without detectable bony abnormality; a feeling of
laziness and lethargy, often both physical and mental and frequently
associated with insomnia, the patients saying that all they want is
to rest; the frightening feeling of being famished and sometimes
weak with hunger two to three hours after a hearty meal and an
irresistible yearning for sweets and starchy food which often
overcomes the patient quite suddenly and is sometimes substituted by
a desire for alcohol; constipation and a spastic or irritable colon
are unusually common among the obese, and so are menstrual
disorders.
Returning once more to our sylphlike lady, we can say that a
combination of some of these symptoms with a few of the typical
bodily signs is sufficient evidence to take her case seriously. A
human figure, male or female, can only be judged in the nude; any
opinion based on the dressed appearance can be quite fantastically
wide off the mark, and I feel myself driven to the conclusion that
apart from frankly psychotic patients such as cases of anorexia
nervosa; a morbid weight fixation does not exist. I have yet to see
a patient who continues to complain after the figure has been
rendered normal by adequate treatment.
The Emaciated Lady
I
remember the case of a lady who was escorted into my consulting room
while I was telephoning. She sat down in front of my desk, and when
I looked up to greet her I saw the typical picture of advanced
emaciation. Her dry skin hung loosely over the bones of her face,
her neck was scrawny and collarbones and ribs stuck out from deep
hollows. I immediately thought of cancer and decided to which of my
colleagues at the hospital I would refer her. Indeed, I felt a
little annoyed that my assistant had not explained to her that her
case did not fall under my specialty. In answer to my query as to
what I could do for her, she replied that she wanted to reduce. I
tried to hide my surprise, but she must have noted a fleeting
expression, for she smiled and said “I know that you think I'm mad,
but just wait.” With that she rose and came round to my side of the
desk. Jutting out from a tiny waist she had enormous hips and
thighs.
By
using a technique which will presently be described, the abnormal
fat on her hips was transferred to the rest of her body which had
been emaciated by months of very severe dieting. At the end of a
treatment lasting five weeks, she, a small woman, had lost 8 inches
round her hips, while her face looked fresh and florid, the ribs
were no longer visible and her weight was the same to the ounce as
it had been at the first consultation.
Fat but not Obese
While a
person who is statistically underweight may still be suffering from
the disorder which causes obesity, it is also possible for a person
to be statistically overweight without suffering from obesity. For
such persons weight is no problem, as they can gain or lose at will
and experience no difficulty in reducing their caloric intake. They
are masters of their weight, which the obese are not. Moreover,
their excess fat shows no preference for certain typical regions of
the body, as does the fat in all cases of obesity. Thus, the
decision whether a borderline case is really suffering from obesity
or not cannot be made merely by consulting weight tables.
The
Treatment Of Obesity
If
obesity is always due to one very specific diencephalic deficiency,
it follows that the only way to cure it is to correct this
deficiency. At first this seemed an utterly hopeless undertaking.
The greatest obstacle was that one could hardly hope to correct an
inherited trait localized deep inside the brain, and while we did
possess a number of drugs whose point of action was believed to be
in the 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, often with undescended
testicles.
It also
became known that in these cases the sex organs could he developed
by giving the patients injections of a substance extracted from the
urine of pregnant women, it having been shown that when this
substance was injected into sexually immature rats it made them
precociously mature. The amount of substance which produced this
effect in one rat was called one International Unit, and the
purified extract was accordingly called “Human Chorionic
Gonadotrophin” whereby chorionic signifies that it is produced in
the placenta and gonadotropin that its action is sex gland directed.
The
usual way of treating “fat boys” with underdeveloped genitals is to
inject several hundred international Units twice a week. Human
Chorionic Gonadotrophin which we shall henceforth simply call HCG is
expensive and as “fat boys” are fairly common among Indians I tried
to establish the smallest effective dose. In the course of this
study three interesting things emerged. The first was that when
fresh pregnancy-urine from the female ward was given in quantities
of about 300 cc. by retention enema, as good results could be
obtained as by injecting the pure substance. The second was that
small daily doses appeared to be just as effective as much larger
ones given twice a week. Thirdly, and that is the observation that
concerns us here, when such patients were given small daily doses
they seemed to lose their ravenous appetite though they neither
gained nor lost weight. Strangely enough however, their shape did
change. Though they were not restricted in diet, there was a
distinct decrease in the circumference of their hips.
Fat on the Move
Remembering this, it occurred to me that the change in shape could
only be explained by a movement of fat away from abnormal deposits
on the hips, and if that were so there was just a chance that while
such fat was in transition it might be available to the body as
fuel. This was easy to find out, as in that case, fat on the move
would be able to replace food. It should then he possible to keep a
“fat boy” on a severely restricted diet without a feeling of hunger,
in spite of a rapid loss of weight. When I tried this in typical
cases of Froehlich's syndrome, I found that as long as such patients
were given small daily doses of HCG they could comfortably go about
their usual occupations on a diet of only 500 Calories daily and
lose an average of about one pound per day. It was also perfectly
evident that only abnormal fat was being consumed, as there were no
signs of any depletion of normal fat. Their skin remained fresh and
turgid, and gradually their figures became entirely normal.
The
daily administration of HCG appeared to have no side-effects other
than beneficial ones.
From
this point it was a small step to try the same method in all other
forms of obesity. It took a few hundred cases to establish beyond
reasonable doubt that the mechanism operates in exactly the same way
and seemingly without exception in every case of obesity. I found
that, though most patients were treated in the outpatients
department, gross dietary errors rarely occurred. On the contrary,
most patients complained that the two meals of 250 calories each
were more than they could manage, as they continually had a feeling
of just having had a large meal.
Pregnancy and Obesity
Once
this trail was opened, further observations seemed to fall into
line. It is 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
diencephalic fat banking capacity is unlimited. It is only during
pregnancy that fixed fat deposits can be transferred back into the
normal current account and freely drawn upon to make up for any
nutritional deficit. During pregnancy, every ounce of reserve fat is
placed at the disposal of the growing fetus. Were this not so, an
obese woman, whose normal reserves are already depleted, would have
the greatest difficulties in bringing her pregnancy to full term.
There is considerable evidence to suggest that it is the HCG
produced in large quantities in the placenta which brings about this
diencephalic change.
Though
we may be able to increase the diencephalic fat banking capacity by
injecting HCG, this does not in itself affect the weight, just as
transferring monetary funds from a fixed deposit into a current
account does not make a man any poorer; to become poorer it is also
necessary that he freely spends the money which thus becomes
available. In pregnancy the needs of the growing embryo take care of
this to some extent, but in the treatment of obesity there is no
embryo, and so a very severe dietary restriction must take its place
for the duration of treatment.
Only
when the fat which is in transit under the effect of HCG is actually
consumed can more fat be withdrawn from the fixed deposits. In
pregnancy it would be most undesirable if the fetus were offered
ample food only when there is a high influx from the intestinal
tract. Ideal nutritional conditions for the fetus can only be
achieved when the mother's blood is continually saturated with food,
regardless of whether she eats or not, as otherwise a period of
starvation might hamper the steady growth of the embryo. It seems
that HCG brings about this continual saturation of the blood, which
is the reason why obese patients under treatment with HCG never feel
hungry in spite of their drastically reduced food intake.
The Nature of Human Chorionic Gonadotropin
HCG is
never found in the human body except during pregnancy and in those
rare cases in which a residue of placental tissue continues to grow
in the womb in what is known as a chorionic epithelioma. It is never
found in the male. The human type of chorionic gonadotrophin is
found only during the pregnancy of women and the great apes. It is
produced in enormous quantities, so that during certain phases of
her pregnancy a woman may excrete as much as one million
International Units per day in her urine - enough to render a
million infantile rats precociously mature. Other mammals make use
of a different hormone, which can be extracted from their blood
serum but not from their urine. Their placenta differs in this and
other respects from that of man and the great apes. This animal
chorionic gonadotrophin is much less rapidly broken down in the
human body than HCG, and it is also less suitable for the treatment
of obesity.
As
often happens in medicine, much confusion has been caused by giving
HCG its name before its true mode of action was understood. It has
been explained that gonadotrophin literally means a sex-gland
directed substance or hormone, and this is quite misleading. It
dates from the early days when it was first found that HCG is able
to render infantile sex glands mature, whereby it was entirely
overlooked that it has no stimulating effect whatsoever on normally
developed and normally functioning sex-glands. No amount of HCG is
ever able to increase a normal sex function. It can only improve an
abnormal one and in the young hasten the onset of puberty. However,
this is no direct effect. HCG acts exclusively at a diencephalic
level and there brings about a considerable increase in the
functional capacity of all those centers which are working at
maximum capacity.
The Real Gonadotrophins
Two
hormones known in the female as follicle stimulating hormone (FSH)
and corpus luteum stimulating hormone (LSH) are secreted by the
anterior lobe of the pituitary gland. These hormones are real
gonadotrophins because they directly govern the function of the
ovaries. The anterior pituitary is in turn governed by the
diencephalon, and so when there is an ovarian deficiency the
diencephalic center concerned is hard put to correct matters by
increasing the secretion from the anterior pituitary of FSH or LSH,
as the case may be. When sexual deficiency is clinically present,
this is a sign that the diencephalic center concerned is unable, in
spite of maximal exertion, to cope with the demand for anterior
pituitary stimulation. When then the administration of HCG increases
the functional capacity of the diencephalon, all demands can be
fully satisfied and the sex deficiency is corrected.
That
this is the true mechanism underlying the presumed gonadotrophic
action of HCG is confirmed by the fact that when the pituitary gland
of infantile rats is removed before they are given HCG, the latter
has no effect on their sex-glands. HCG cannot therefore have a
direct sex gland stimulating action like that of the anterior
pituitary gonadotrophins, as FSH and LSH are justly called. The
latter are entirely different substances from that which can be
extracted from pregnancy urine and which, unfortunately, is called
chorionic gonadotrophin. It would be no more clumsy, and certainly
far more appropriate, if HCG were henceforth called chorionic
diencephalotrophin.
HCG no Sex Hormone
It
cannot he sufficiently emphasized that HCG is not sex-hormone, that
its action is identical in men, women, children and in those cases
in which the sex-glands no longer function owing to old age or their
surgical removal. The only sexual change it can bring about after
puberty is an improvement of a pre-existing deficiency, but never
stimulation beyond the normal. In an indirect way via the anterior
pituitary, HCG regulates menstruation and facilitates conception,
but it never virilizes a woman or feminizes a man. It neither makes
men grow breasts nor does it interfere with their virility, though
where this was deficient it may improve it. It never makes women
grow a beard or develop a gruff voice. I have stressed this point
only for the sake of my lay readers, because, it is our daily
experience that when patients hear the word hormone they immediately
jump to the conclusion that this must have something to do with the
sex- sphere. They are not accustomed as we are, to think thyroid,
insulin, cortisone, adrenalin etc, as hormones.
Importance and Potency of HCG
Owing
to the fact that HCG has no direct action on any endocrine gland,
its enormous importance in pregnancy has been overlooked and its
potency underestimated. Though a pregnant woman can produce as much
as one million units per day, we find that the injection of only 125
units per day is ample to reduce weight at the rate of roughly one
pound per day, even in a colossus weighing 400 pounds, when
associated with a 500-calorie diet. It is no exaggeration to say
that the flooding of the female body with HCG is by far the most
spectacular hormonal event in pregnancy. It has an enormous
protective importance for mother and child, and I even go so far as
to say that no woman, and certainly not an obese one, could carry
her pregnancy to term without it.
If I
can be forgiven for comparing my fellow-endocrinologists with wicked
Godmothers, HCG has certainly been their Cinderella, and I can only
romantically hope that its extraordinary effect on abnormal fat will
prove to be its Fairy Godmother.
HCG has
been known for over half a century. It is the substance which
Aschheim and Zondek so brilliantly used to diagnose early pregnancy
out of the urine. Apart from that, the only thing it did in the
experimental laboratory was to produce precocious rats, and that was
not particularly stimulating to further research at a time when much
more thrilling endocrinological discoveries were pouring in from all
sides, sweeping, HCG into the stiller back waters.
Complicating
Disorders
Some
complicating disorders are often associated with obesity, and these
we must briefly discuss. The most important associated disorders and
the ones in which obesity seems to play a precipitating or at least
an aggravating role are the following: the stable type of diabetes,
gout, rheumatism and arthritis, high blood pressure and hardening of
the arteries, coronary disease and cerebral hemorrhage.
Apart
from the fact that they are often - though not necessarily -
associated with obesity, these disorders have two things in common.
In all of them, modern research is becoming more and more inclined
to believe that diencephalic regulations play a dominant role in
their causation. The other common factor is that they either improve
or do not occur during pregnancy. In the latter respect they are
joined by many other disorders not necessarily associated with
obesity. Such disorders are, for instance, colitis, duodenal or
gastric ulcers, certain allergies, psoriasis, loss of hair, brittle
fingernails, migraine, etc.
If HCG
+ diet does in the obese bring about those diencephalic changes
which are characteristic of pregnancy, one would expect to see an
improvement in all these conditions comparable to that seen in real
pregnancy. The administration of HCG does in fact do this in a
remarkable way.
Diabetes
In an
obese patient suffering from a fairly advanced case of stable
diabetes of many years duration in which the blood sugar may range
from 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.
Rheumatism
All
rheumatic pains, even those associated with demonstrable bony
lesions, improve subjectively within a few days of treatment, and
often require neither cortisone nor salicylates. Again this is a
well known phenomenon in pregnancy, and while under treatment with
HCG + diet the effect is no less dramatic. As it does 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.
Cholesterol
The
exact extent to which the blood cholesterol is involved in hardening
of the arteries, high blood pressure and coronary disease is not as
yet known, but it is now widely admitted that the blood cholesterol
level is governed by diencephalic mechanisms. The behavior of
circulating cholesterol is therefore of particular interest during
the treatment of obesity with HCG. Cholesterol circulates in two
forms, which we call free and esterified. Normally these fractions
are present in a proportion of about 25% free to 75% esterified
cholesterol, and it is the latter fraction which damages the walls
of the arteries. In pregnancy this proportion is reversed and it may
he taken for granted that arteriosclerosis never gets worse during
pregnancy for this very reason.
To my
knowledge, the only other condition in which the proportion of free
to esterified cholesterol is reversed is during the treatment of
obesity with HCG + diet, when exactly the same phenomenon takes
place. This seems an important indication of how closely a patient
under HCG treatment resembles a pregnant woman in diencephalic
behavior.
When
the total amount of circulating cholesterol is normal before
treatment, this absolute amount is neither significantly increased
nor decreased. But when an obese patient with an abnormally high
cholesterol and already showing signs of arteriosclerosis is treated
with HCG, his blood pressure drops and his coronary circulation
seems to improve, and yet his total blood cholesterol may soar to
heights never before reached.
At
first this greatly alarmed us. But 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 cholesterol deposits that have not
yet undergone calcification in the arterial wall and is therefore
highly beneficial.
Gout
An
identical behavior is found in the blood uric acid level of patients
suffering from gout. Predictably such patients get an acute and
often severe attack after the first few days of HCG treatment but
then remain entirely free of pain, in spite of the fact that their
blood uric acid often shows a marked increase which may persist for
several months after treatment. Those patients who have regained
their normal weight remain free of symptoms regardless of what they
eat, while those that require a second course of treatment get
another attack of gout as soon as the second course is initiated. We
do not yet know what diencephalic mechanisms are involved in gout;
possibly emotional factors play a role, and it is worth remembering
that the disease does not occur in women of childbearing age. We now
give 2 tablets daily of ZYLORIC to all patients who give a history
of gout and have a high blood uric acid level. In this way we can
completely avoid attacks during treatment.
Blood Pressure
Patients who have brought themselves to the brink of malnutrition by
exaggerated dieting, laxatives etc, often have an abnormally low
blood pressure. In these cases the blood pressure rises to normal
values at the beginning of treatment and then very gradually drops,
as it always does in patients with a normal blood pressure. Normal
values are always regained a few days after the treatment is over.
Of this lowering of the blood pressure during treatment the patients
are not aware. When the blood pressure is abnormally high, and
provided there are no detectable renal lesions, the pressure drops,
as it usually does in pregnancy. The drop is often very rapid, so
rapid in fact that it sometimes is advisable to slow down the
process with pressure sustaining medication until the circulation
has had a few days time to adjust itself to the new situation. On
the other hand, among the thousands of cases treated, we have never
seen any incident which could be attributed to the rather sudden
drop in high blond pressure.
When a
woman suffering from high blood pressure becomes pregnant her blood
pressure very soon drops, but after her confinement it may gradually
rise back to its former level. Similarly, a high blood pressure
present before HCG treatment tends to rise again after the treatment
is over, though this is not always the case. But the former high
levels are rarely reached, and we have gathered the impression that
such relapses respond better to orthodox drugs such as Reserpine
than before treatment.
Peptic Ulcers
In our
cases of obesity with gastric or duodenal ulcers we have noticed a
surprising subjective improvement in spite of a diet which would
generally be considered most inappropriate for an ulcer patient.
Here, too, there is a similarity with pregnancy, in which peptic
ulcers hardly ever occur. However we have seen two cases with a
previous history of several hemorrhages in which a bleeding occurred
within 2 weeks of the end of treatment.
Psoriasis, Fingernails, Hair Varicose Ulcers
As in
pregnancy, psoriasis greatly improves during treatment but may
relapse when the treatment is over. Most patients spontaneously
report a marked improvement in the condition of brittle fingernails.
The loss of hair not infrequently associated with obesity is
temporarily arrested, though in very rare cases an increased loss of
hair has been reported. I remember a case in which a patient
developed a patchy baldness - so called alopecia areata - after a
severe emotional shock, just before she was about to start an HCG
treatment. Our dermatologist diagnosed the case as a particularly
severe one, predicting that all the hair would be lost. He counseled
against the reducing treatment, but in view of my previous
experience and as the patient was very anxious not to postpone
reducing, I discussed the matter with the dermatologist and it was
agreed that, having fully acquainted the patient with the situation,
the treatment should be started. During the treatment, which lasted
four weeks, the further development of the bald patches was almost,
if not quite, arrested; however, within a week of having finished
the course of HCG, all the remaining hair fell out as predicted by
the dermatologist. The interesting point is that the treatment was
able to postpone this result but not to prevent it. The patient has
now grown a new shock of hair of which she is justly proud.
In
obese patients with large varicose ulcers we were surprised to find
that these ulcers heal rapidly under treatment with HCG. We have
since treated non obese patients suffering from varicose ulcers with
daily injections of HCG on normal diet with equally good results.
The “Pregnant" Male
When a
male patient hears that he is about to be put into a condition which
in some respects resembles pregnancy, he is usually shocked and
horrified. The physician must therefore carefully explain that this
does not mean that he will be feminized and that HCG in no way
interferes with his sex. He must be made to understand that in the
interest of the propagation of the species nature provides for a
perfect functioning of the regulatory headquarters in the
diencephalon during pregnancy and that we are merely using this
natural safeguard as a means of correcting the diencephalic disorder
which is responsible for his overweight.
Technique
Warnings
I must
warn the lay reader that what follows is mainly for the treating
physician and most certainly not a do-it-yourself primer. Many of
the expressions used mean something entirely different to a
qualified doctor than that which their common use implies, and only
a physician can correctly interpret the symptoms which may arise
during treatment. Any patient who thinks he can reduce by taking a
few “shots” and eating less is not only sure to be disappointed but
may be heading for serious trouble. The benefit the patient can
derive from reading this part of the book is a fuller realization of
how very important it is for him to follow to the letter his
physician's instructions.
In
treating obesity with the HCG + diet method we are handling what is
perhaps the most complex organ in the human body. The diencephalon's
functional equilibrium is delicately poised, so that whatever
happens in one part has repercussions in others. In obesity this
balance is out of kilter and can only be restored if the technique I
am about to describe is followed implicitly. Even seemingly
insignificant deviations, particularly those that at first sight
seem to be an improvement, are very liable to produce most
disappointing results and even annul the effect completely. For
instance, if the diet is increased from 500 to 600 or 700 Calories,
the loss of weight is quite unsatisfactory. If the daily dose of HCG
is raised to 200 or more units daily its action often appears to be
reversed, possibly because larger doses evoke diencephalic
counter-regulations. On the other hand, the diencephalon is an
extremely robust organ in spite of its unbelievable intricacy. From
an evolutionary point of view it is one of the oldest organs in our
body and its evolutionary history dates back more than 500 million
years. This has tendered it extraordinarily adaptable to all natural
exigencies, and that is one of the main reasons why the human
species was able to evolve. What its evolution did not prepare it
for were the conditions to which human culture and civilization now
expose it.
History taking
When a
patient first presents himself for treatment, we take a general
history and note the time when the first signs of overweight were
observed. We try to establish the highest weight the patient has
ever had in his life (obviously excluding pregnancy), when this was,
and what measures have hitherto been taken in an effort to reduce.
It has
been our experience that those patients who have been taking thyroid
preparations for long periods have a slightly lower average loss of
weight under treatment with HCG than those who have never taken
thyroid. This is even so in those patients who have been taking
thyroid because they had an abnormally low basal metabolic rate. In
many of these cases the low BMR is not due to any intrinsic
deficiency of the thyroid gland, but rather to a lack of
diencephalic stimulation of the thyroid gland via the anterior
pituitary lobe. We never allow thyroid to be taken during treatment,
and yet a BMR which was very low before treatment is usually found
to be normal after a week or two of HCG + diet. Needless to say,
this does not apply to those cases in which a thyroid deficiency has
been produced by the surgical removal of a part of an overactive
gland. It is also most important to ascertain whether the patient
has taken diuretics (water eliminating pills) as this also decreases
the weight loss under the HCG regimen.
Returning to our procedure, we next ask the patient a few questions
to which he is held to reply simply with “yes” or “no”. These
questions are: Do you suffer from headaches? rheumatic pains?
menstrual disorders? constipation? breathlessness or exertion?
swollen ankles? Do you consider yourself greedy? Do you feel the
need to eat snacks between meals?
The
patient then strips and is weighed and measured. The normal weight
for his height, age, skeletal and muscular build is established from
tables of statistical averages, whereby in women it is often
necessary to make an allowance for particularly large and heavy
breasts. The degree of overweight is then calculated, and from this
the duration of treatment can be roughly assessed on the basis of an
average loss of weight of a little less than a pound, say 300-400
grams-per injection, per day. It is a particularly interesting
feature of the HCG treatment that in reasonably cooperative patients
this figure is remarkably constant, regardless of sex, age and
degree of overweight.
The Duration of Treatment
Patients who need to lose 15 pounds (7 kg.) or less require 26 days
treatment with 23 daily injections. The extra three days are needed
because all patients must continue the 500-calorie diet for three
days after the last injection. This is a very essential part of the
treatment, because if they start eating normally as long as there is
even a trace of HCG in their body they put on weight alarmingly at
the end of the treatment. After three days when all the HCG has been
eliminated this does not happen, because the blood is then no longer
saturated with food and can thus accommodate an extra influx from
the intestines without increasing its volume by retaining water.
We
never give a treatment lasting less than 26 days, even in patients
needing to lose only 5 pounds. It seems that even in the mildest
cases of obesity the diencephalon requires about three weeks rest
from the maximal exertion to which it has been previously subjected
in order to regain fully its normal fat-banking capacity. Clinically
this expresses itself, in the fact that, when in these mild cases,
treatment is stopped as soon as the weight is normal, which may be
achieved in a week, it is much more easily regained than after a
full course of 23 injections.
As soon
as such patients have lost all their abnormal superfluous fat, they
at once begin to feel ravenously hungry 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 weeks.
Such
early cases are common among actresses, models, and persons who are
tired of obesity, having seen its ravages in other members of their
family. Film actresses frequently explain that they must weigh less
than normal. With this request we flatly refuse to comply, first,
because we undertake to cure a disorder, not to create a new one,
and second, because it is in the nature of the HCG method that it is
self limiting. It becomes completely ineffective as soon as all
abnormal fat is consumed. Actresses with a slight tendency to
obesity, having tried all manner of reducing methods, invariably
come to the conclusion that their figure is satisfactory only when
they are underweight, simply because none of these methods remove
their superfluous fat deposits. When they see that under HCG their
figure improves out of all proportion to the amount of weight lost,
they are nearly always content to remain within their normal
weight-range.
When a
patient has more than 15 pounds to lose the treatment takes longer
but the maximum we give in a single course is 40 injections, nor do
we as a rule allow patients to lose more than 34 lbs. (15 Kg.) at a
time. The treatment is stopped when either 34 lbs. have been lost or
40 injections have been given. The only exception we make is in the
case of grotesquely obese patients who may be allowed to lose an
additional 5-6 lbs. if this occurs before the 40 injections are up.
Immunity to HCG
The
reason for limiting a course to 40 injections is that by then some
patients may begin to show signs of HCG immunity. Though this
phenomenon is well known, we cannot as yet define the underlying
mechanism. Maybe after a certain length of time the body learns to
break down and eliminate HCG very rapidly, or possibly prolonged
treatment leads to some sort of counter-regulation which annuls the
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 phenomenon occurs.
Menstruation
During
menstruation no injections are given, but the diet is continued and
causes no hardship; yet as soon as the menstruation is over, the
patients become extremely hungry unless the injections are resumed
at once. It is very impressive to see the suffering of a woman who
has continued her diet for a day or two beyond the end of the period
without coming for her injection and then to hear the next day that
all hunger ceased within a few hours after the injection and to see
her once again content, florid and cheerful. While on the question
of menstruation it must he added that in teenaged girls the period
may in some rare cases be delayed and exceptionally stop altogether.
If then later this is artificially induced some weight may be
regained.
Further Courses
Patients requiring the loss of more than 34 lbs. must have a second
or even more courses. A second course can be started after an
interval of not less than six weeks, though the pause can be more
than six weeks. When a third, fourth or even fifth course is
necessary, the interval between courses should be made progressively
longer. Between a second and third course eight weeks should elapse,
between a third and fourth course twelve weeks, between a fourth and
fifth course twenty weeks and between a fifth and sixth course six
months. In this way it is possible to bring about a weight reduction
of 100 lbs. and more if required without the least hardship to the
patient.
In
general, men do slightly better than women and often reach a
somewhat higher average daily loss. Very advanced cases do a little
better than early ones, but it is a remarkable fact that this
difference is only just statistically significant.
Conditions that must be accepted before treatment
On the
basis of these data the probable duration of treatment can he
calculated with considerable accuracy, and this is explained to the
patient. It is made clear to him that during the course of treatment
he must attend the clinic daily to be weighed, injected and
generally checked. All patients that live in Rome or have resident
friends or relations with whom they can stay are treated as
out-patients, but patients coming from abroad must stay in the
hospital, as no hotel or restaurant can be relied upon to prepare
the diet with sufficient accuracy. These patients have their meals,
sleep, and attend the clinic in the hospital, but are otherwise free
to spend their time as they please in the city and its surroundings
sightseeing, 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 statistically normal weight, we do not insist that he
commit himself to that extent. Even a partial loss of overweight is
highly beneficial, and it is our experience that once a patient has
completed a first course he is so enthusiastic about the ease with
which the - to him surprising - results are achieved that he almost
invariably comes back for more. There certainly can be no doubt that
in my clinic more time is spent on damping 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
available.
We
distinguish between the first three injections, which we call
“non-effective” as far as the loss of weight is concerned, and the
subsequent injections given while the patient is dieting, which we
call “effective”. The average loss of weight is calculated on the
number of effective injections and from the weight reached on the
day of the third injection which may be well above what it was two
days earlier when the first injection was given.
Most
patients who have been struggling with diets for years and know how
rapidly they gain if they let themselves go are very hard to
convince of the absolute necessity of gorging for at least two days,
and yet this must he insisted upon categorically if the further
course of treatment is to run smoothly. Those patients who have to
be put on forced feeding for a week before starting the injections
usually gain weight rapidly - four to six pounds in 24 hours is not
unusual - but after a day or two this rapid gain generally levels
off. In any case, the whole gain is usually lost in the first 48
hours of dieting. It is necessary to proceed in this manner because
the gain re-stocks the depleted normal reserves, whereas the
subsequent loss is from the abnormal deposits only.
Patients in a satisfactory general condition and those who have not
just previously restricted their diet start forced feeding on the
day of the first injection. Some patents say that they can no longer
overeat because their stomach has shrunk after years of
restrictions. While we know that no stomach ever shrinks, we
compromise by insisting that they eat frequently of highly
concentrated foods such as milk chocolate, pastries with whipped
cream sugar, fried meats (particularly pork), eggs and bacon,
mayonnaise, bread with thick butter and jam, etc. The time and
trouble spent on pressing this point upon incredulous or reluctant
patients is always amply rewarded afterwards by the complete absence
of those difficulties which patients who have disregarded these
instructions are liable to experience.
During
the two days of forced feeding from the first to the third injection
- many patients are surprised that contrary to their previous
experience they do not gain weight and some even lose. The
explanation is that in these cases there is a compensatory flow of
urine, which drains excessive water from the body. To some extent
this seems to be a direct action of HCG, but it may also be due to a
higher protein intake, as we know that a protein-deficient diet
makes the body retain water.
Starting treatment
In
menstruating women, the best time to start treatment is immediately
after a period. Treatment may also be started later, but it is
advisable to have at least ten days in hand before the onset of the
next period. Similarly, the end of a course 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 Diet
The 500
calorie diet is explained on the day of the second injection to
those patients who will be preparing their own food, and it is most
important that the person who will actually cook is present - the
wife, the mother or the cook, as the case may be. Here in Italy
patients are given the following diet sheet.
Breakfast: Tea
or coffee in any quantity without sugar. Only one tablespoonful of
milk allowed in 24 hours. Saccharin or Stevia may be used.
Lunch: 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 Melba toast.
An
apple or a handful of strawberries or one-half grapefruit.
Dinner: The
same four choices as lunch.
The
juice of one lemon daily is allowed for all purposes. Salt, pepper,
vinegar, mustard powder, garlic, sweet basil, parsley, thyme,
majoram, etc., may be used for seasoning, but no oil, butter or
dressing.
Tea,
coffee, plain water, or mineral water are the only drinks allowed,
but they may be taken in any quantity and at all times.
In
fact, the patient should drink about 2 liters of these fluids per
day. Many patients are afraid to drink so much because they fear
that this may make them retain more water. This is a wrong notion as
the body is more inclined to store water when the intake falls below
its normal requirements.
The
fruit or the breadstick may be eaten between meals instead of with
lunch or dinner, but not more than four items listed for lunch and
dinner may be eaten at one meal.
No
medicines or cosmetics other than lipstick, eyebrow pencil and
powder may he used without special permission
Every
item in the list is gone over carefully, continually stressing the
point that no variations other than those listed may be introduced.
All things not listed are forbidden, and the patient is assured that
nothing permissible has been left out. The 100 grams of meat must he
scrupulously weighed raw after all visible fat has been removed. To
do this accurately the patient must have a letter-scale, as kitchen
scales are not sufficiently accurate and the butcher should
certainly not be relied upon. Those not uncommon patients who feel
that even so little food is too much for them, can omit anything
they wish.
There
is no objection to breaking up the two meals. For instance having a
breadstick and an apple for breakfast or before going to bed,
provided they are deducted from the regular meals. The whole daily
ration of two breadsticks or two fruits may not be eaten at the same
time, nor can any item saved from the previous day be added on the
following day. In the beginning patients are advised to check every
meal against their diet sheet before starting to eat and not to rely
on their memory. It is also worth pointing out that any attempt to
observe this diet without HCG will lead to trouble in two to three
days. We have had cases in which patients have proudly flaunted
their dieting powers in front of their friends without mentioning
the fact that they are also receiving treatment with HCG. They let
their friends try the same diet, and when this proves to be a
failure - as it necessarily must - the patient starts raking in
unmerited kudos for superhuman willpower.
It
should also be mentioned that two small apples weighing as much as
one large one never the less have a higher caloric value and are
therefore not allowed though there is no restriction on the size of
one apple. Some people do not realize that chicken breast does not
mean the breast of any other fowl, nor does it mean a wing or
drumstick.
The
most tiresome patients are those who start counting calories and
then come up with all manner of ingenious variations which they
compile from their little books. When one has spent years of weary
research trying to make a diet as attractive as possible without
jeopardizing the loss of weight, culinary geniuses who are out to
improve their unhappy lot are hard to take.
Making up the Calories
The
diet used in conjunction with HCG must not exceed 500 calories per
day, and the way these calories are made up is of utmost importance.
For instance, if a patient drops the apple and eats an extra
breadstick instead, he will not be getting more calories but he will
not lose weight. There are a number of foods, particularly fruits
and vegetables, which have the same or even lower caloric values
than those listed as permissible, and yet we find that they
interfere with the regular loss of weight under HCG, presumably
owing to the nature of their composition. Pimiento peppers, okra,
artichokes and pears are examples of this.
While
this diet works satisfactorily in Italy, certain modifications have
to be made in other countries. For instance, American beef has
almost double the caloric value of South Italian beef, which is not
marbled with fat. This marbling is impossible to remove. In America,
therefore, low-grade veal should be used for one meal and fish
(excluding all those species such as herring, mackerel, tuna,
salmon, eel, etc., which have a high fat content, and all dried,
smoked or pickled fish), chicken breast, lobster, crawfish, prawns
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 of starch.
Just as
the daily dose of HCG is the same in all cases, so the same diet
proves to be satisfactory for a small elderly lady of leisure or a
hard working muscular giant. Under the effect of HCG the obese body
is always able to obtain all the calories it needs from the abnormal
fat deposits, regardless of whether it uses up 1500 or 4000 per day.
It must be made very clear to the patient that he is living to a far
greater extent on the fat which he is losing than on what he eats.
Many
patients ask why eggs are not allowed. The contents of two good
sized eggs are roughly equivalent to 100 grams of meat, but
fortunately the yolk contains a large amount of fat, which is
undesirable. Very occasionally we allow egg - boiled, poached or raw
- to patients who develop an aversion to meat, but in this case they
must add the white of three eggs to the one they eat whole. In
countries where cottage cheese made from skimmed milk is available
100 grams may occasionally be used instead of the meat, but no other
cheeses are allowed.
Vegetarians
Strict
vegetarians such as orthodox Hindus present a special problem,
because milk and curds are the only animal protein they will eat. To
supply them with sufficient protein of animal origin they must drink
500 cc. of skimmed milk per day, though part of this ration can be
taken as curds. As far as fruit, vegetables and starch are
concerned, their diet is the same as that of non-vegetarians; they
cannot be allowed their usual intake of vegetable proteins from
leguminous plants such as beans or from wheat or nuts, nor can they
have their customary rice. In spite of these severe restrictions,
their average loss is about half that of non-vegetarians, presumably
owing to the sugar content of the milk.
Faulty Dieting
Few
patients will take one's word for it that the slightest deviation
from the diet has under HCG disastrous results as far as the weight
is concerned. This extreme sensitivity has the advantage that the
smallest error is immediately detectable at the daily weighing but
most patients have to make the experience before they will believe
it.
Persons
in high official positions such as embassy personnel, politicians,
senior executives, etc., who are obliged to attend social functions
to which they cannot bring their meager meal must be told beforehand
that an official dinner will cost them the loss of about three days
treatment, however careful they are and in spite of a friendly and
would-be cooperative host. We generally advise them to avoid all
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 season.
Vitamins and anemia
Sooner
or later most patients express a fear that they may be running out
of vitamins or that the restricted diet may make them anemic. On
this score the physician can confidently relieve their apprehension
by explaining that every time they lose a pound of fatty tissue,
which they do almost daily, only the actual fat is burned up; all
the vitamins, the proteins, the blood, and the minerals which this
tissue contains in abundance are fed back into the body. Actually, a
low blood count not due to any serious disorder of the blood forming
tissues improves during treatment, and we have never encountered a
significant protein deficiency nor signs of a lack of vitamins in
patients who are dieting regularly.
The First Days of Treatment
On the
day of the third injection it is almost routine to hear two remarks.
One is: “You know, Doctor, I'm sure it's only psychological, but I
already feel quite different”. So common is this remark, even from
very skeptical patients that we hesitate to accept the psychological
interpretation. The other typical remark is: “Now that I have been
allowed to eat anything I want, I can't get it down. Since yesterday
I feel like a stuffed pig. Food just doesn't seem to interest me any
more, and I am longing to get on with your diet”. Many patients
notice that they are passing more urine and that the swelling in
their ankles is less even before they start dieting.
On the
day of the fourth injection most patients declare that they are
feeling fine. They have usually lost two pounds or more, some say
they feel a bit empty but hasten to explain that this does not
amount to hunger. Some complain of a mild headache of which they
have been forewarned and for which they have been given permission
to take aspirin.
During
the second and third day of dieting - that is, the fifth and sixth
injection-these minor complaints improve while the weight continues
to drop at about double the usually overall average of almost one
pound per day, so that a moderately severe case may by the fourth
day of dieting have lost as much as 8- 10 lbs.
It is
usually at this point that a difference appears between those
patients who have literally eaten to capacity during the first two
days of treatment and those who have not. The former feel remarkably
well; they have no hunger, nor do they feel tempted when others eat
normally at the same table. They feel lighter, more clear-headed and
notice a desire to move quite contrary to their previous lethargy.
Those who have disregarded the advice to eat to capacity continue to
have minor discomforts and do not have the same euphoric sense of
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 Plateau
The
second type of interruption we call a “plateau”. A plateau lasts 4-6
days and frequently occurs during the second half of a full course,
particularly in patients that have been doing well and whose overall
average of nearly a pound per effective injection has been
maintained. Those who are losing more than the average all have a
plateau sooner or later. A plateau always corrects, itself, but many
patients who have become accustomed to a regular daily loss get
unnecessarily worried. 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.
Menstrual Interruption
The
fourth type of interruption is the one which often occurs a few days
before and during the menstrual period and in some women at the time
of ovulation. It must also be mentioned that when a woman becomes
pregnant during treatment - and this is by no means uncommon - she
at once ceases to lose weight. An unexplained arrest of reduction
has on several occasions raised our suspicion before the first
period was missed. If in such cases, menstruation is delayed, we
stop injecting and do a precipitation test five days later. No
pregnancy test should be carried out earlier than five days after
the last injection, as otherwise the HCG may give a false positive
result.
Oral
contraceptives may be used during treatment.
Dietary Errors
Any
interruption of the normal loss of weight which does not fit
perfectly into one of those categories is always due to some
possibly very minor dietary error. Similarly, any gain of more than
100 grams is invariably the result of some transgression or mistake,
unless it happens on or about the day of ovulation or during the
three days preceding the onset of menstruation, in which case it is
ignored. In all other cases the reason for the gain must be
established at once.
The
patient who frankly admits that he has stepped out of his regimen
when told that something has gone wrong is no problem. He is always
surprised at being found out, because unless he has seen this
himself he will not believe that a salted almond, a couple of potato
chips, a glass of tomato juice or an extra orange will bring about a
definite increase in his weight on the following day.
Very
often he wants to know why extra food weighing one ounce should
increase his weight by six ounces. We explain this in the following
way: Under the influence of HCG the blood is saturated with food and
the blood volume has adapted itself so that it can only just
accommodate the 500 calories which come in from the intestinal tract
in the course of the day. Any additional income, however little this
may be, cannot be accommodated and the blood is therefore forced to
increase its volume sufficiently to hold the extra food, which it
can only do in a very diluted form. Thus it is not the weight of
what is eaten that plays the determining role but rather the amount
of water which the body must retain to accommodate this food.
This
can be illustrated by mentioning the case of salt. In order to hold
one teaspoonful of salt the body requires one liter of water, as it
cannot accommodate salt in any higher concentration. Thus, if a
person eats one teaspoonfull of salt his weight will go up by more
than two pounds as soon as this salt is absorbed from his intestine.
To this
explanation many patients reply: Well, if I put on that much every
time I eat a little extra, how can I hold my weight after the
treatment? It must therefore be made clear that this only happens as
long as they are under HCG. When treatment is over, the blood is no
longer saturated and can easily accommodate extra food without
having to increase its volume. Here again the professional reader
will be aware that this interpretation is a simplification of an
extremely intricate physiological process which actually accounts
for the phenomenon.
Salt and Reducing
While
we are on the subject of salt, I can take this opportunity to
explain that we make no restriction in the use of salt and insist
that the patients drink large quantities of water throughout the
treatment. We are out to reduce abnormal fat and are not in the
least interested in such illusory weight losses as can be achieved
by depriving the body of salt and by desiccating it. Though we allow
the free use of salt, the daily amount taken should be roughly the
same, as a sudden increase will of course be followed by a
corresponding increase in weight as shown by the scale. An increase
in the intake of salt is one of the most common causes for an
increase in weight from one day to the next. Such an increase can be
ignored, provided it is accounted for, it in no way influences the
regular loss of fat.
Water
Patients are usually hard to convince that the amount of water they
retain has nothing to do with the amount of water they drink. When
the body is forced to retain water, it will do this at all costs. If
the fluid intake is insufficient to provide all the water required,
the body withholds water from the kidneys and the urine becomes
scanty and highly concentrated, imposing a certain strain on the
kidneys. If that is insufficient, excessive water will be with-drawn
from the intestinal tract, with the result that the feces become
hard and dry. On the other hand if a patient drinks more than his
body requires, the surplus is promptly and easily eliminated. Trying
to prevent the body from retaining water by drinking less is
therefore not only futile but even harmful.
Constipation
An
excess of water keeps the feces soft, and that is very important in
the obese, who commonly suffer from constipation and a spastic
colon. While a patient is under treatment we never permit the use of
any kind of laxative taken by mouth. We explain that owing to the
restricted diet it is perfectly satisfactory and normal to have an
evacuation of the bowel only once every three to four days and that,
provided plenty of fluids are taken, this never leads to any
disturbance. Only in those patients who begin to fret after four
days do we allow the use of a suppository. Patients who observe this
rule find that after treatment they have a perfectly normal bowel
action and this delights many of them almost as much as their loss
of weight.
Investigating Dietary Errors
When
the reason for a slight gain in weight is not immediately evident,
it is necessary to investigate further. A patient who is unaware of
having committed an error or is unwilling to admit a mistake
protests indignantly when told he has done something he ought not to
have done. In that atmosphere no fruitful investigation can be
conducted; so we calmly explain that we are not accusing him of
anything but that we know for certain from our not inconsiderable
experience that something has gone wrong and that we must now sit
down quietly together and try and find out what it was. Once the
patient realizes that it is in his own interest that he play an
active and not merely a passive role in this search, the reason for
the setback is almost invariably discovered. Having been through
hundreds of such sessions, we are nearly always able to distinguish
the deliberate liar from the patient who is merely fooling himself
or is really unaware of having erred.
Liars and Fools
When we
see obese patients there are generally two of us present in order to
speed up routine handling. Thus when we have to investigate a rise
in weight, a glance is sufficient to make sure that we agree or
disagree. If after a few questions we both feel reasonably sure that
the patient is deliberately lying, we tell him that this is our
opinion and warn him that unless he comes clean we may refuse
further treatment. The way he reacts to this furnishes additional
proof whether we are on the right track or not we now very rarely
make a mistake.
If the
patient breaks down and confesses, we melt and are all forgiveness
and treatment proceeds. Yet if such performances have to be repeated
more than two or three times, we refuse further treatment. This
happens in less than 1% of our cases. If the patient is stubborn and
will not admit what he has been up to, we usually give him one more
chance and continue even though we have been unable to find the
reason for his gain. In many such cases there is no repetition, and
frequently the patient does then confess a few days later after he
has thought things over.
The
patient who is fooling himself is the one who has committed some
trifling, offense against the rules but who has been able to
convince himself that this is of no importance and cannot possibly
account for the gain in weight. Women seem particularly prone to
getting themselves entangled in such delusions. On the other hand,
it does frequently happen that a patient will in the midst of a
conversation unthinkingly spear an olive or forget that he has
already eaten his breadstick.
A
mother preparing food for the family may out of sheer habit forget
that she must not taste the sauce to see whether it needs more salt.
Sometimes a rich maiden aunt cannot be offended by refusing a cup of
tea into which she has put two teaspoons of sugar, thoughtfully
remembering the patient's taste from previous occasions. Such
incidents are legion and are usually confessed without hesitation,
but some patients seem genuinely able to forget these lapses and
remember them with a visible shock only after insistent questioning.
In
these cases we go carefully over the day. Sometimes the patient has
been invited to a meal or gone to a restaurant, naively believing
that the food has actually been prepared exactly according to
instructions. They will say: “Yes, now that I come to think of it
the steak did seem a bit bigger than the one I have at home, and it
did taste better; maybe there was a little fat on it, though I
specially told them to cut it all away”. Sometimes the breadsticks
were broken and a few fragments eaten, and “Maybe they were a little
more than one”. It is not uncommon for patients to place too much
reliance on their memory of the diet-sheet and start eating carrots,
beans or peas and then to seem genuinely surprised when their
attention is called to the fact that these are forbidden, as they
have not been listed.
Cosmetics
When no
dietary error is elicited we turn to cosmetics. Most women find it
hard to believe that fats, oils, creams and ointments applied to the
skin are absorbed and interfere with weight reduction by HCG just as
if they had been eaten. This almost incredible sensitivity to even
such very minor increases in nutritional intake is a peculiar
feature of the HCG method. For instance, we find that persons who
habitually handle organic fats, such as workers in beauty parlors,
masseurs, butchers, etc. never show what we consider a satisfactory
loss of weight unless they can avoid fat coming into contact with
their skin.
The
point is so important that I will illustrate it with two cases. A
lady who was cooperating perfectly suddenly increased half a pound.
Careful questioning brought nothing to light. She had certainly made
no dietary error nor had she used any kind of face cream, and she
was already in the menopause. As we felt that we could trust her
implicitly, we left the question suspended. Yet just as she was
about to leave the consulting room she suddenly stopped, turned and
snapped her fingers. “I've got it,” she said. This is what had
happened : She had bought herself a new set of make-up pots and
bottles and, using her fingers, had transferred her large assortment
of cosmetics to the new containers in anticipation of the day she
would be able to use them again after her treatment.
The
other case concerns a man who impressed us as being very
conscientious. He was about 20 lbs. overweight but did not lose
satisfactorily from the onset of treatment. Again and again we tried
to find the reason but with no success, until one day he said: “I
never told you this, but I have a glass eye. In fact, I have a whole
set of them. I frequently change them, and every time I do that I
put a special ointment in my eye socket. Do you think that could
have anything to do with it?” As we thought just that, we asked him
to stop using this ointment, and from that day on his weight-loss
was regular.
We are
particularly averse to those modern cosmetics which contain
hormones, as any interference with endocrine regulations during
treatment must be absolutely avoided. Many women whose skin has in
the course of years become adjusted to the use of fat containing
cosmetics find that their skin gets dry as soon as they stop using
them. In such cases we permit the use of plain mineral oil, which
has no nutritional value. On the other hand, mineral oil should not
be used in preparing the food, first because of its undesirable
laxative quality, and second because it absorbs some fat-soluble
vitamins, which are then lost in the stool. We do permit the use of
lipstick, powder and such lotions as are entirely free of fatty
substances. We also allow brilliantine to be used on the hair but it
must not be rubbed into the scalp. Obviously sun-tan oil is
prohibited.
Many
women are horrified when told that for the duration of treatment
they cannot use face creams or have facial massages. They fear that
this and the loss of weight will ruin their complexion. They can be
fully reassured. Under treatment normal fat is restored to the skin,
which rapidly becomes fresh and turgid, making the expression much
more youthful. This is a characteristic of the HCG method which is a
constant source of wonder to patients who have experienced or seen
in others the facial ravages produced by the usual methods of
reducing. An obese woman of 70 obviously cannot expect to have her
pued face reduced to normal without a wrinkle, but it is remarkable
how youthful her face remains in spite of her age.
The Voice
Incidentally, another interesting feature of the HCG method is that
it does not ruin a singing voice. The typically obese prima donna
usually finds that when she tries to reduce, the timbre of her voice
is liable to change, and understandably this terrifies her. Under
HCG this does not happen; indeed, in many cases the voice improves
and the breathing invariably does. We have had many cases of
professional singers very carefully controlled by expert voice
teachers, and 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 type.
Occasionally we allow a sleeping tablet or a tranquilizer, but
patients should be told that while under treatment they need and may
get less sleep. For instance, here in Italy where it is customary to
sleep during the siesta which lasts from one to four in the
afternoon most patients find that though they lie down they are
unable to sleep.
We
encourage swimming and sun bathing during treatment, but it should
be remembered that a severe sunburn always produces a temporary rise
in weight, evidently due to water retention. The same may be seen
when a patient gets a common cold during treatment. Finally, the
weight can temporarily increase - paradoxical though this may sound
- after an exceptional physical exertion of long duration leading to
a feeling of exhaustion. A game of tennis, a vigorous swim, a run, a
ride on horseback or a round of golf do not have this effect; but a
long trek, a day of skiing, rowing or cycling or dancing into the
small hours usually result in a gain of weight on the following day,
unless the patient is in perfect training. In patients coming from
abroad, where they always use their cars, we often see this effect
after a strenuous day of shopping on foot, sightseeing and visits to
galleries and museums. Though the extra muscular effort involved
does consume some additional calories, this appears to be offset by
the retention of water which the tired circulation cannot at once
eliminate.
Appetite-reducing Drugs
We
hardly ever use amphetamines, the appetite-reducing drugs such as
Dexedrin, Dexamil, Preludin, etc., as there seems to be no need for
them during the HCG treatment. The only time we find them useful is
when a patient is, for impelling and unforeseen reasons, obliged to
forego the injections for three to four days and yet wishes to
continue the diet so that he need not interrupt the course.
Unforeseen Interruptions of Treatment
If an
interruption of treatment lasting more than four days is necessary,
the patient must increase his diet to at least 800 calories by
adding meat, eggs, cheese, and milk to his diet after the third day,
as otherwise he will find himself so hungry and weak that he is
unable to go about his usual occupation. If the interval lasts less
than two weeks the patient can directly resume injections and the
500-calorie diet, but if the interruption lasts longer he must again
eat normally until he has had his third injection.
When a
patient knows beforehand that he will have to travel and be absent
for more than four days, it is always better to stop injections
three days before he is due to leave so that he can have the three
days of strict dieting which are necessary after the last injection
at home. This saves him from the almost impossible task of having to
arrange the 500 calorie diet while en route, and he can thus enjoy a
much greater dietary freedom from the day of his departure.
Interruptions occurring before 20 effective injections have been
given are most undesirable, because with less than that number of
injections some weight is liable to be regained. After the 20th
injection an unavoidable interruption is merely a loss of time.
Muscular Fatigue
Towards
the end of a full course, when a good deal of fat has been rapidly
lost, some patients complain that lifting a weight or climbing
stairs requires a greater muscular effort than before. They feel
neither breathlessness nor exhaustion but simply that their muscles
have to work harder. This phenomenon, which disappears soon after
the end of the treatment, is caused by the removal of abnormal fat
deposited between, in, and around the muscles. The removal of this
fat makes the muscles too long, and so in order to achieve a certain
skeletal movement - say the bending of an arm - the muscles have to
perform greater contraction than before. Within a short while the
muscle adjusts itself perfectly to the new situation, but under HCG
the loss of fat is so rapid that this adjustment cannot keep up with
it. Patients often have to be reassured that this does not mean that
they are “getting weak”. This phenomenon does not occur in patients
who regularly take vigorous exercise and continue to do so during
treatment.
Massage
I never
allow any kind of massage during treatment. It is entirely
unnecessary and merely disturbs a very delicate process which is
going on in the tissues. Few indeed are the masseurs and masseuses
who can resist the temptation to knead and hammer abnormal fat
deposits. In the course of rapid reduction it is sometimes possible
to pick up a fold of skin which has not yet had time to adjust
itself, as it always does under HCG, to the changed figure. This
fold contains its normal subcutaneous fat and may be almost an inch
thick. It is one of the main objects of the HCG treatment to keep
that fat there. Patients and their masseurs do not always understand
this and give this fat a working-over. I have seen such patients who
were as black and blue as if they had received a sound thrashing.
In my
opinion, massage, thumping, rolling, kneading, and shivering
undertaken for the purpose of reducing abnormal fat can do nothing
but harm. We once had the honor of treating the proprietress of a
high class institution that specialized in such antics. She had the
audacity to confess that she was taking our treatment to convince
her clients of the efficacy of her methods, which she had found
useless in her own case.
How
anyone in his right mind is able to believe that fatty tissue can be
shifted mechanically or be made to vanish by squeezing is beyond my
comprehension. The only effect obtained is severe bruising. The torn
tissue then forms scars, and these slowly contracts making the fatty
tissue even harder and more unyielding.
A lady
once consulted us for her most ungainly legs. Large masses of fat
bulged over the ankles of her tiny feet, and there were about 40
lbs. too much on her hips and thighs. We assured her that this
overweight could be lost and that her ankles would markedly improve
in the process. Her treatment progressed most satisfactorily but to
our surprise there was no improvement in her ankles. We then
discovered that she had for years been taking every kind of
mechanical, electric and heat treatment for her legs and that she
had made up her mind to resort to plastic surgery if we failed.
Re-examining the fat above her ankles, we found that it was
unusually hard. We attributed this to the countless minor injuries
inflicted by kneading. These injuries had healed but had left a
tough network of connective scar-tissue in which the fat was
imprisoned. Ready to try anything, she was put to bed for the
remaining three weeks of her first course with her lower legs
tightly strapped in unyielding bandages. Every day the pressure was
increased. The combination of HCG, diet and strapping brought about
a marked improvement in the shape of her ankles. At the end of her
first course she returned to her home abroad. Three months later she
came back for her second course. She had maintained both her weight
and the improvement of her ankles. The same procedure was repeated,
and after five weeks she left the hospital with a normal weight and
legs that, if not exactly shapely, were at least unobtrusive. Where
no such injuries of the tissues have been inflicted by inappropriate
methods of treatment, these drastic measures are never necessary.
Blood Sugar
Towards
the end of a course or when a patient has nearly reached his normal
weight it occasionally happens that the blood sugar drops below
normal, and we have even seen this in patients who had an abnormally
high blood sugar before treatment. Such an attack of hypoglycemia is
almost identical with the one seen in diabetics who have taken too
much insulin. The attack comes on suddenly; there is the same
feeling of light-headedness, weakness in the knees, trembling, and
unmotivated sweating. But under HCG, hypoglycemia does not produce
any feeling of hunger. All these symptoms are almost instantly
relieved by taking two heaped teaspoons of sugar.
In the
course of treatment the possibility of such an attack is explained
to those patients who are in a phase in which a drop in blood sugar
may occur. They are instructed to keep sugar or glucose sweets
handy, particularly when driving a car. They are also told to watch
the effect of taking sugar very carefully and report the following
day. This is important, because anxious patients to whom such an
attack has been explained are apt to take sugar unnecessarily, in
which case it inevitably produces a gain in weight and does not
dramatically relieve the symptoms for which it was taken, proving
that these were not due to hypoglycemia. Some patients mistake the
effects of emotional stress for hypoglycemia. When the symptoms are
quickly relieved by sugar this is proof that they were indeed due to
an abnormal lowering of the blood sugar, and in that case there is
no increase in the weight on the following day. We always suggest
that sugar be taken if the patient is in doubt.
Once
such an attack has been relieved with sugar we have never seen it
recur on the immediately subsequent days, and only very rarely does
a patient have two such attacks separated by several days during a
course of treatment. In patients who have not eaten sufficiently
during the first two days of treatment we sometimes give sugar when
the minor symptoms usually felt during the first 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 empty.
As we
are usually treating a fair number of patients at the same time, we
prefer to use vials containing 5000 units. With these the
manufactures also supply 10 cc. of solvent. Of such a solution 0.25
cc. contain the 125 I.U., which is the standard dose for all cases
and which should never be exceeded. This small amount is awkward to
handle accurately (it requires an insulin syringe) and is wasteful,
because there is a loss of solution in the nozzle of the syringe and
in the needle. We therefore prefer a higher dilution, which we
prepare in the following way: The solvent supplied is injected into
the rubber capped bottle containing the 5000 I.U . As these bottles
are too small to hold more solvent, we
withdraw 5 cc., inject it into an empty rubber-capped bottle and add
5 cc. of normal saline to each bottle. This gives us 10 cc. of
solution in each bottle, and of this solution 0.5 cc. contains 125
I.U. This amount is convenient to inject with an ordinary syringe.
Injecting
HCG
produces little or no tissue-reaction, it is completely painless and
in the many thousands of injections we have given we have never seen
an inflammatory or suppurative reaction at the site of the
injection.
One
should avoid leaving a vacuum in the bottle after preparing the
solution or after withdrawal of the amount required for the
injections as otherwise alcohol used for sterilizing a frequently
perforated rubber cap might be drawn into the solution. When sharp
needles are used, it sometimes happens that a little bit of rubber
is punched out of the rubber cap and can be seen as a small black
speck floating in the solution. As these bits of rubber are heavier
than the solution they rapidly settle out, and it is thus easy to
avoid drawing them into the syringe.
We use
very fine needles that are two inches long and inject deep
intragluteally in the outer upper quadrant of the buttocks. The
injection should if possible not be given into the superficial fat
layers, which in very obese patients must be compressed so as to
enable the needle to reach the muscle. It is also important that the
daily injection should be given at intervals as close to 24 hours as
possible. Any attempt to economize in time by giving larger doses at
longer intervals is doomed to produce less satisfactory results.
There
are hardly any contraindications to the HCG method. Treatment can be
continued in the presence of abscesses, suppuration, large infected
wounds and major fractures. Surgery and general anesthesia are no
reason to stop and we have given treatment during a severe attack of
malaria. Acne or boils are no contraindication, the former usually
clears up, and furunculosis comes to an end. Thrombophlebitis is no
contraindication, and we have treated several obese patients with
HCG and the 500-calorie diet while suffering from this condition.
Our impression has been that in obese patients the phlebitis does
rather better and certainly no worse than under the usual treatment
alone. This also applies to patients suffering from varicose ulcers
which tend to heal rapidly.
Fibroids
While
uterine fibroids seem to be in no way affected by HCG in the doses
we use, we have found that very large, externally palpable uterine
myomas are apt to give trouble. We are convinced that this is
entirely due to the rather sudden disappearance of fat from the
pelvic bed upon which they rest and that it is the weight of the
tumor pressing on the underlying tissues which accounts for the
discomfort or pain which may arise during treatment. While we
disregard even fair-sized or multiple myomas, we insist that very
large ones be operated before treatment. We have had patients
present themselves for reducing fat from their abdomen who showed no
signs of obesity, but had a large abdominal tumor.
Gallstones
Small
stones in the gall bladder may in patients who have recently had
typical colics cause more frequent colics under treatment with HCG.
This may be due to the almost complete absence of fat from the diet,
which prevents the normal emptying of the gall bladder. Before
undertaking treatment we explain to such patients that there is a
risk of more frequent and possibly severe symptoms and that it may
become necessary to operate. If they are prepared to take this risk
and provided they agree to undergo an operation if we consider this
imperative, we proceed with treatment, as after weight reduction
with HCG the operative risk is considerably reduced in an obese
patient. In such cases we always give a drug which stimulates the
flow of bile, and in the majority of cases nothing untoward happens.
On the other hand, we have looked for and not found any evidence to
suggest that the HCG treatment leads to the formation of gallstones
as pregnancy sometimes does.
The Heart
Disorders of the heart are not as a rule contraindications. In fact,
the removal of abnormal fat - particularly from the heart-muscle and
from the surrounding of the coronary arteries - can only be
beneficial in cases of myocardial weakness, and many such patients
are referred to us by cardiologists. Within the first week of
treatment all patients - not only heart cases - remark that they
have lost much of their breathlessness.
Coronary Occlusion
In
obese patients who have recently survived a coronary occlusion, we
adopt the following procedure in collaboration with the
cardiologist. We wait until no further electrocardiographic changes
have occurred for a period of three months. Routine treatment is
then started under careful control and it is usual to find a further
electrocardiographic improvement of a condition which was previously
stationary.
In the
thousands of cases we have treated we have not once seen any sort of
coronary incident occur during or shortly after treatment. The same
applies to cerebral vascular accidents. Nor have we ever seen a case
of thrombosis of any sort develop during treatment, even though a
high blood pressure is rapidly lowered. In this respect, too, the
HCG treatment resembles pregnancy.
Teeth and Vitamins
Patients whose teeth are in poor repair sometimes get more trouble
under prolonged treatment, just as may occur in pregnancy. In such
cases we do allow calcium and vitamin D, though not in an oily
solution. The only other vitamin we permit is vitamin C, which we
use in large doses combined with an antihistamine at the onset of a
common cold. There is no objection to the use of an antibiotic if
this is required, for instance by the dentist. In cases of bronchial
asthma and hay fever we have occasionally resorted to cortisone
during treatment and find that triamcinolone is the least likely to
interfere with the loss of weight, but many asthmatics improve with
HCG alone.
Alcohol
Obese
heavy drinkers, even those bordering on alcoholism, often do
surprisingly well under HCG and it is exceptional for them to take a
drink while under treatment. When they do, they find that a
relatively small quantity of alcohol produces intoxication. Such
patients say that they do not feel the need to drink This may in
part be due to the euphoria which the treatment produces and in part
to the complete absence of the need for quick sustenance from which
most obese patients suffer.
Though
we have had a few cases that have continued abstinence long after
treatment, others relapse as soon as they are back on a normal diet.
We have a few “regular customers” who, having once been reduced to
their normal weight, start to drink again though watching their
weight. Then after some months they purposely overeat in order to
gain sufficient weight for another course of HCG which temporarily
gets them out of their drinking routine. We do not particularly
welcome such cases, but we see no reason for refusing their request.
Tuberculosis
It is
interesting that obese patients suffering from inactive pulmonary
tuberculosis can be safely treated. We have under very careful
control treated patients as early as three months after they were
pronounced inactive and have never seen a relapse occur during or
shortly after treatment. In fact, we only have one case on our
records in which active tuberculosis developed in a young man about
one year after a treatment which had lasted three weeks. Earlier
X-rays showed a calcified spot from a childhood infection which had
not produced clinical symptoms. There was a family history of
tuberculosis, and his illness started under adverse conditions which
certainly had nothing to do with the treatment. Residual
calcifications from an early infection are exceedingly common, and
we never consider them a contraindication to treatment.
The Painful Heel
In
obese patients who have been trying desperately to keep their weight
down by severe dieting, a curious symptom sometimes occurs. They
complain of an unbearable pain in their heels which they feel only
while standing or walking. As soon as they take the weight off their
heels the pain ceases. These cases are the bane of the
rheumatologists and orthopedic surgeons who have treated them before
they come to us. All the usual investigations are entirely negative,
and there is not the slightest response to anti- rheumatic
medication or physiotherapy. The pain may be so severe that the
patients are obliged to give up their occupation, and they are not
infrequently labeled as a case of
hysteria. When their heels are carefully examined one finds that the
sole is softer than normal and that the heel bone - the calcaneus -
can be distinctly felt, which is not the case in a normal foot.
We
interpret the condition as a lack of the hard fatty pad on which the
calcaneus rests and which protects both the bone and the skin of the
sole from pressure. This fat is like a springy cushion which carries
the weight of the body. Standing on a heel in which this fat is
missing or reduced must obviously be very painful. In their efforts
to keep their weight down these patients have consumed this normal
structural fat.
Those
patients who have a normal or subnormal weight while showing the
typically obese fat deposits are made to eat to capacity, often much
against their will, for one week. They gain weight rapidly but there
is no improvement in the painful heels. They are then started on the
routine HCG treatment. Overweight patients are treated immediately.
In both cases the pain completely disappears in 10-20 days of
dieting, usually around the 15th day of treatment, and so far no
case has had a relapse. 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 breakfast.
It
takes about 3 weeks before the weight reached at the end of the
treatment becomes stable, i.e. does not show violent fluctuations
after an occasional excess. During this period patients must realize
that the so-called carbohydrates, that is sugar, rice, bread,
potatoes, pastries etc, are by far the most dangerous. If no
carbohydrates whatsoever are eaten, fats can be indulged in somewhat
more liberally and even small quantities of alcohol, such as a glass
of wine with meals, does no harm, but as soon as fats and starch are
combined things are very liable to get out of hand. This has to be
observed very carefully during the first 3 weeks after the treatment
is ended otherwise disappointments are almost sure to occur.
Skipping a Meal
As long
as their weight stays within two pounds of the weight reached on the
day of the last injection, patients should take no notice of any
increase but the moment the scale goes beyond two pounds, even if
this is only a few ounces, they must on that same day entirely skip
breakfast and lunch but take plenty to drink. In the evening they
must eat a huge steak with only an apple or a raw tomato. Of course
this rule applies only to the morning weight. Ex-obese patients
should never check their weight during the day, as there may be wide
fluctuations and these are merely alarming and confusing.
It is
of utmost importance that the meal is skipped on the same day as the
scale registers an increase of more than two pounds and that missing
the meals is not postponed until the following day. If a meal is
skipped on the day in which a gain is registered in the morning this
brings about an immediate drop of often over a pound. But if the
skipping of the meal - and skipping means literally skipping, not
just having a light meal - is postponed the phenomenon does not
occur and several days of strict dieting may be necessary to correct
the situation.
Most
patients hardly ever need to skip a meal. If they have eaten a heavy
lunch they feel no desire to eat their dinner, and in this case no
increase takes place. If they keep their weight at the point reached
at the end of the treatment, even a heavy dinner does not bring
about an increase of two pounds on the next morning and does not
therefore call for any special measures. Most patients are surprised
how small their appetite has become and yet how much they can eat
without gaining weight. They no longer suffer from an
abnormal appetite and feel satisfied with much less food than
before. In fact, they are usually disappointed that they cannot
manage their first normal meal, which they have been planning for
weeks.
Losing more Weight
An
ex-patient should never gain more than two pounds without
immediately correcting this, but it is equally undesirable that more
than two lbs. be lost after treatment, because a greater loss is
always achieved at the expense of normal fat. Any normal fat that is
lost is invariably regained as soon as more food is taken, and it
often happens that this rebound overshoots the upper two lbs. limit.
Trouble After Treatment
Two
difficulties may be encountered in the immediate post-treatment
period. When a patient has consumed all his abnormal fat or, when
after a full course, the injection has temporarily lost its efficacy
owing to the body having gradually evolved a counter regulation, the
patient at once begins to feel much more hungry and even weak. In
spite of repeated warnings, some over-enthusiastic patients do not
report this. However, in about two days the fact that they are being
undernourished becomes visible in their faces, and treatment is then
stopped at once. In such cases - and only in such cases - we allow a
very slight increase in the diet, such as an extra apple, 150 grams
of meat or two or three extra breadsticks during the three days of
dieting after the last injection.
When
abnormal fat is no longer being put into circulation either because
it has been consumed or because immunity has set in, this is always
felt by the patient as sudden, intolerable and constant hunger. In
this sense, the HCG method is completely 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.
Protein deficiency
Here
too, the explanation is quite simple. During treatment the patient
has been only just above the verge of protein deficiency and has had
the advantage of protein being fed back into his system from the
breakdown of fatty tissue. Once the treatment is over there is no
more HCG in the body and this process no longer takes place. Unless
an adequate amount of protein is eaten as soon as the treatment is
over, protein deficiency is bound to develop, and this inevitably
causes the marked retention of water known as hunger- edema.
The
treatment is very simple. The patient is told to eat two eggs for
breakfast and a huge steak for lunch and dinner followed by a large
helping of cheese and to phone through the weight the next morning.
When these instructions are followed a stunned voice is heard to
report that two lbs. have vanished overnight, that the ankles are
normal but that sleep was disturbed, owing to an extraordinary need
to pass large quantities of water. The patient having learned this
lesson usually has no further trouble.
Relapses
As a
general rule one can say that 60%-70% of our cases experience little
or no difficulty in holding their weight permanently. Relapses may
be due to negligence in the basic rule of daily weighing. Many
patients think that this is unnecessary and that they can judge any
increase from the fit of their clothes. Some do not carry their
scale with them on a journey as it is cumbersome and takes a big
bite out of their luggage-allowance when flying. This is a
disastrous mistake, because after a course of HCG as much as 10 lbs.
can be regained without any noticeable change in the fit of the
clothes. The reason for this is that after treatment newly acquired
fat is at first evenly distributed and does not show the former
preference for certain parts of the body.
Pregnancy or the menopause may annul the effect of a previous
treatment. Women who take treatment during the one year after the
last menstruation - that is at the onset of the menopause - do just
as well as others, but among them the relapse rate is higher until
the menopause is fully established. The period of one year after the
last menstruation applies only to women who are not being treated
with ovarian hormones. If these are taken, the premenopausal period
may be indefinitely prolonged.
Late
teenage girls who suffer from attacks of compulsive eating have by
far the worst record of all as far as relapses are concerned.
Patients who have once taken the treatment never seem to hesitate to
come back for another short course as soon as they notice that their
weight is once again getting out of hand. They come quite cheerfully
and hopefully, assured that they can be helped again. Repeat courses
are often even more satisfactory than the first treatment and have
the advantage, as do second courses, that the patient already, knows
that he will feel comfortable throughout.
Plan of a Normal
Course
125
I.U. of HCG daily (except during menstruation) 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 fruit).
After 3
weeks, very gradually add starch in small quantities, always
controlled by morning weighing.
CONCLUSION
The HCG
+ diet method can bring relief to every case of obesity, but the
method is not simple. It is very time consuming and requires perfect
cooperation between physician and patient. Each case must be handled
individually, and the physician must have time to answer questions,
allay fears and remove misunderstandings. He must also check the
patient daily. When something goes wrong he must at once investigate
until he finds the reason for any gain that may have occurred. In
most cases it is useless to hand the patient a diet-sheet and let
the nurse give him a "shot."
The
method involves a highly complex bodily mechanism, and 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.
GLOSSARY
ACNE . . . Common
skin disease in which pimples, often containing pus, appear on face,
neck and shoulders.
ACTH . . . Abbreviation
for adrenocorticotrophic hormone. One of the many hormones produced
by the anterior lobe of the pituitary gland. ACTH controls the outer
part, rind or cortex of the adrenal glands. When ACTH is injected it
dramatically relieves arthritic pain, but it has many undesirable
side effects, among which is a condition similar to severe obesity.
ACTH is now usually replaced by cortisone.
ADRENALIN . . . Hormone
produced by the inner part of the Adrenals. Among many other
functions, adrenalin is concerned with blood pressure, emotional
stress, fear and cold.
ADRENALS . . . Endocrine
glands. Small bodies situated atop the kidneys and hence also known
as suprarenal glands. The adrenals have an outer rind or cortex
which produces vitally important hormones, among which are Cortisone
similar substances. The adrenal cortex is controlled by ACTH. The
inner part of the adrenals, the medulla, secretes adrenalin and is
chiefly controlled by the autonomous nervous system.
ADRENOCORTEX... See
adrenals.
AMPHETAMINES . . . Synthetic
drugs which reduce the awareness of hunger and stimulate mental
activity, rendering sleep impossible. When used for the latter two
purposes they are dangerously habit-forming. They do not diminish
the body's need for food, but merely suppress the perception of that
need. The original drug was known as Benzedrine, from which modern
variants such as Dexedrine, Dexamil, and Preludin 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
dietician's Calorie (always written with a capital C) is 1000 times
greater. Thus when we speak of a 500 Calorie diet this means that
the body is being supplied with as much fuel as would be required to
raise the temperature of 500 liters of water by 1 degree Centigrade
or 50 liters by 10 degrees. This is quite insufficient to cover the
heat and energy requirements of an adult body. In the HCG method the
deficit is made up from the abnormal fat-deposits, of which 1 lb.
furnishes the body with more than 2000 Calories. As this is roughly
the amount lost every day, a patient under HCG is never short of
fuel.
CEREBRAL . . . Of
the brain. Cerebral vascular disease is a disorder concerning the
blood vessels of the brain, such as cerebral thrombosis or
hemorrhage, known as apoplexy or stroke.
CHOLESTEROL . . . A
fatlike substance contained in almost every cell of the body. In the
blood it exists in two forms, known as free and esterified. The
latter form is under certain conditions deposited in the inner
lining of the arteries (see arteriosclerosis). No clear and definite
relationship between fat intake and cholesterol-level in the blood
has yet been established.
CHORIONIC . . . Of
the chorion, which is part of the placenta or after-birth. The term
chorionic is justly applied to HCG, as this hormone is exclusively
produced in the placenta, from where it enters the human mother's
blood and is later excreted in her urine.
COMPULSIVE EATING. . . A
form of oral gratification with which a repressed sex-instinct is
sometimes vicariously relieved. Compulsive eating must not be
confused with the real hunger from which most obese patients suffer.
CONGENITAL . . . Any
condition which exists at or before birth.
CORONARY ARTERIES . . . Two blood vessels which encircle the heart
and supply all the blood required by the heart-muscle.
CORPUS LUTEUM . . . A
yellow body which forms in the ovary at the follicle from which an
egg has been detached. This body acts as an endocrine gland and
plays an important role in menstruation and pregnancy. Its secretion
is one of the sex hormones, and it is stimulated by another hormone
known as LSH, which stands for luteum stimulating hormones. LSH is
produced in the anterior lobe of the pituitary gland. LSH is truly
gonadotrophic and must never be confused with HCG, which is a
totally different substance, having no direct action on the corpus
luteum.
CORTEX . . . Outer
covering or rind. The term is applied to the outer part of the
adrenals but is also used to describe the gray matter which covers
the white matter of the brain.
CORTISONE . . . A
synthetic substance which acts like an adrenal hormone. It is today
used in the treatment of a large number of illnesses, and several
chemical variants have been produced, among which are prednisone and
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 obtainable.
ENDOCRINE . . . We
distinguish endocrine and exocrine glands. The former produce
hormones, chemical regulators, which they secrete directly into the
blood circulation in the gland and from where they are carried all
over the body. Examples of endocrine glands are the pituitary, the
thyroid and the adrenals. Exocrine glands produce a visible
secretion such as saliva, sweat, urine. There are also glands which
are endocrine and exocrine. Examples are the testicles, the prostate
and the pancreas, which produces the hormone insulin and digestive
ferments which flow from the gland into the intestinal tract.
Endocrine glands are closely interdependent of each other, they are
linked to the autonomous nervous system and the diencephalon
presides over this whole incredibly complex regulatory system.
EMACIATED . . . Grossly
undernourished.
EUPHORIA . . . A
feeling of particular physical and mental well being.
FERAL . . . Wild,
unrestrained.
FIBROID . . . Any
benign new growth of connective tissue. When such a tumor originates
from a muscle, it is known as a myoma. The most common seat of
myomas is the uterus.
FOLLICLE . . . Any
small bodily cyst or sac containing a liquid. Here the term applies
to the ovarian cyst in which the egg is formed. The egg is expelled
when a ripe follicle bursts and this is known as ovulation (see
corpus luteurn).
FSH . . . Abbreviation
for follicle-stimulating hormone. FSH is another (see corpus luteum)
anterior pituitary hormone which acts directly on the ovarian
follicle and is therefore correctly called a gonadotrophin.
GLANDS . . . See
endocrine.
GONADOTROPHIN . . . See
corpus luteum, follicle and FSH. Gonadotrophic literally means sex
gland-directed. FSH, LSH and the equivalent hormones in the male,
all produced in the anterior lobe of the pituitary gland, are true
gonadotrophins. Unfortunately and confusingly, the term
gonadotrophin has also been applied to the placental hormone of
pregnancy known as human chorionic gonadotrophin (HCG). This hormone
acts on the diencephalon and can only indirectly influence the
sex-glands via the anterior lobe of the pituitary.
HCG . . . Abbreviation
for human chorionic gonadotrophin
HORMONES . . . See
endocrine.
HYPERTENSION . . . High
blood pressure.
HYPOGLYCEMIA . . . A
condition in which the blood sugar is below normal. It can be
relieved by eating sugar.
HYPOPHYSIS . . . Another
name for the pituitary gland.
HYPOTHESIS . . . A
tentative explanation or speculation on how observed facts and
isolated scientific data can be brought into an intellectually
satisfying relationship of cause and effect. Hypotheses are useful
for directing further research, but they are not necessarily an
exposition of what is believed to be the truth. Before a hypothesis
can advance to the dignity of a theory or a law, it must be
confirmed by all future research. As soon as research turns up data
which no longer fit the hypothesis, it is immediately abandoned for
a better one.
LSH . . . See
corpus luteum.
METABOLISM . . . See
basal metabolism.
MIGRAINE . . . Severe
half-sided headache often associated with vomiting.
MUCOID . . . Slime-like.
MYOCARDIUM . . . The
heart-muscle.
MYOMA . . . See
fibroid.
MYXEDEMA . . . Accumulation
of a mucoid substance in the tissues which occurs in cases of severe
primary thyroid deficiency.
NEOLITHIC . . . In
the history of human culture we distinguish the Early Stone Age or
Paleolithic, the Middle Stone Age or Mesolithic and the New Stone
Age or Neolithic period. The Neolithic period started about 8000
years ago when the first attempts at agriculture, pottery and animal
domestication made at the end of the Mesolithic period suddenly
began to develop rapidly along the road that led to modern
civilization.
NORMAL SALINE . . . A
low concentration of salt in water equal to the salinity of body
fluids.
PHLEBITIS . . . An
inflammation of the veins. When a blood-clot forms at the site of
the inflammation, we speak of thrombophlebitis.
PITUITARY . . . A
very complex endocrine gland which lies at the base of the skull,
consisting chiefly of an anterior and a posterior lobe. The
pituitary is controlled by the diencephalon, which regulates the
anterior lobe by means of hormones which reach it through small
blood vessels. The posterior lobe is controlled by nerves which run
from the diencephalon into this part of the gland. The anterior lobe
secretes many hormones, among which are those that regulate other
glands such as the thyroid, the adrenals and the sex glands.
PLACENTA . . . The
after-birth. In women, a large and highly complex organ through
which the child in the womb receives its nourishment from the
mother's body. It is the organ in which HCG is manufactured and then
given off into the mother's blood.
PROTEIN . . . The
living substance in plant and animal cells. Herbivorous animals can
thrive on plant protein alone, but man must base some protein of
animal origin (milk, eggs or flesh) to live healthily. When
insufficient protein is eaten, the body retains water.
PSORIASIS . . . A
skin disease which produces scaly patches. These tend to disappear
during pregnancy and during the treatment of obesity by the HCG
method.
RENAL . . . Of
the kidney.
RESERPINE . . . An
Indian drug extensively used in the treatment of high blood pressure
and some forms of mental disorder.
RETENTION ENEMA . . . The
slow infusion of a liquid into the rectum, from where it is absorbed
and not evacuated.
SACRUM . . . A
fusion of the lower vertebrate into the large bony mass to which the
pelvis is attached.
SEDIMENTATION RATE . . . The
speed at which a suspension of red blood cells settles out. A rapid
settling out is called a high sedimentation rate and may be
indicative of a large number of bodily disorders of pregnancy.
SEXUAL SELECTION . . . A
sexual preference for individuals which show certain traits. If this
preference or selection goes on generation after generation, more
and more individuals showing the trait will appear among the general
population. The natural environment has little or nothing to do with
this process. Sexual selection therefore differs from natural
selection, to which modern man is no longer subject because he
changes his environment rather than let the environment change him.
STRIATION . . . Tearing
of the lower layers of the skin owing to rapid stretching in obesity
or during pregnancy. When first formed striae are dark reddish lines
which later change into white scars.
SUPRARENAL GLANDS . . . See
adrenals.
SYNDROME . . . A
group of symptoms which in their association are characteristic of a
particular disorder.
THROMBOPHLEBITIS . . . See
phlebitis.
THROMBUS . . . A
blood-clot in a blood-vessel.
TRIAMCINOLONE . . . A
modern derivative of cortisone.
URIC ACID . . . A
product of incomplete protein-breakdown or utilization in the body.
When uric acid becomes deposited in the gristle of the joints we
speak of gout.
VARICOSE ULCERS . . . Chronic
ulceration above the ankles due to varicose veins which interfere
with the normal blood circulation in the affected areas.
VEGETATIVE . . . See
autonomous.
VERTEBRATE . . . Any
animal that has a back-bone
