Pounds and Inches

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Pounds and Inches

A NEW APPROACH TO OBESITY

 BY:  Dr. A.T.W. SIMEONS

 SALVATOR MUNDI INTERNATIONAL HOSPITAL

00152 – ROME VIALE MURA GIANICOLENSI, 77

Table of Contents:

 FOREWORD – introduction by Dr. Simeons

This book discusses a new
interpretation of the nature of obesity, and while it does not advocate
yet another fancy slimming diet it does describe a method of treatment
which has grown out of theoretical considerations based on clinical
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 Mutidi International Hospital in Rome. For some of them the
time they could spare has been too short to get a full grasp of the
technique, and in any case the number of those whom I have been able to
meet personally is small compared with the many requests for further
detailed information which keep coming in. I have tried to keep up with
these demands by correspondence, but the volume of this work has become
unmanageable and that is one excuse for writing this 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 chanisms. Persons suffering from this particular disorder
will get fat regardless of whether they eat excessively, normally or
less than normal. A person who is free of the disorder will never get
fat, even if he frequently overeats.

Those in whom the disorder is severe
will accumulate fat very rapidly, those in whom it is moderate will
gradually increase in weight and those in whom it is mild may be able to
keep their excess weight stationary for long periods.  In all
these cases a loss of weight brought about by dieting, treatments with
thyroid, appetite-reducing drugs, laxatives, violent exercise, massage,
or baths is only temporary and will be rapidly regained as soon as the
reducing regimen is relaxed. The reason is simply that none of these
measures corrects the basic disorder.

While there are great variations in
the severity of obesity, we shall consider all the different forms in
both sexes and at all ages as always being due to the same disorder.
Variations in form would then be partly a matter of degree, partly an
inherited bodily constitution and partly the result of a secondary
involvement of endocrine glands such as the pituitary, the thyroid, the
adrenals or the sex glands. On the other hand, we postulate that no
deficiency of any of these glands can ever directly produce the common
disorder known as obesity.

If this reasoning is correct, it
follows that a treatment aimed at curing the disorder must be equally
effective in both sexes, at all ages and in all forms of obesity. Unless
this is so, we are entitled to harbor grave doubts as to whether a
given treatment corrects the underlying disorder. Moreover, any claim
that the disorder has been corrected must be substantiated by the
ability of the patient to eat normally of any food he pleases without
regaining abnormal fat after treatment. Only if these conditions are
fulfilled can we legitimately speak of curing obesity rather than of
reducing weight.

Our problem thus presents itself as
an enquiry into the localization and the nature of the disorder which
leads to obesity. The history of this enquiry is a long series of high
hopes and bitter disappointments.

The History of Obesity

There was a time, not so long ago,
when obesity was considered a sign of health and prosperity in man and
of beauty, amorousness and fecundity in women. This attitude probably
dates back to Neolithic times, about 8000 years ago; when for the first
time in the history of culture, man began to own property, domestic
animals, arable land, houses, pottery and metal tools. Before that, with
the possible exception of some races such as the Hottentots, obesity
was almost non-existent, as it still is in all wild animals and most
primitive races.

Today obesity is extremely common
among all civilized races, because a disposition to the disorder can be
inherited. Wherever abnormal fat was regarded as an asset, sexual
selection tended to propagate the trait. It is only in very recent times
that manifest obesity has lost some of its allure, though the cult of
the outsize bust – always a sign of latent obesity – shows that the
trend still lingers on.

 back

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 back

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 back

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 back

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 back

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 diericephalic “fat-bank” frees itself from all
work which goes beyond its normal banking capacity. The onset of
obesity dates from the moment the diencephalon adopts this labor-saving
ruse. Once a fixed deposit has been established the normal fat reserves
are held at a minimum, while every available surplus is locked away in
the fixed deposit and is therefore taken out of normal circulation.

 

Three Basic Causes of Obesity back

(1) The Inherited Factor

Assuming that there is a limit to
the diencephalon’s fat banking capacity., it follows that there are
three basic ways in which obesity can become manifest. The first is that
the fat-banking capacity is abnormally low from birth. Such a
congenitally low diencephalic capacity would then represent the
inherited factor in obesity. When this abnormal trait is markedly
present, obesity will develop at an early age in spite of normal
feeding; this could explain why among brothers and sisters eating the
same food at the same table some become obese and others do not.

(2) Other Diencephalic Disorders

The second way in which obesity can
become established is the lowering of a previously normal fat-banking
capacity owing to some other diencephalic disorder. It seems to be a
general rule that when one of the many diencephalic centers is
particularly overtaxed; it tries to increase its capacity at the expense
of other centers.

In the menopause and after
castration the hormones previously produced in the sex-glands no longer
circulate in the body. In the presence of normally functioning
sex-glands their hormones act as a brake on the secretion of the
sex-gland stimulating hormones of the anterior pituitary. When this
brake is removed the anterior pituitary enormously increases its output
of these sex-gland stimulating hormones, though they are now no longer
effective. In the absence of any response from the non-functioning or
missing sex glands, there is nothing to stop the anterior pituitary from
producing more and more of these hormones. This situation causes an
excessive strain on the diericephalic center which controls the function
of the anterior pituitary. In order to cope with this additional burden
the center appears to draw more and more energy away from other
centers, such as those concerned with emotional stability, the blood
circulation (hot flushes) and other autonomous nervous regulations,
particularly also from the not so vitally important fat-bank.

The so called stable type of
diabetes involves the diencephalic blood sugar regulating center the
diencephalon tries to meet this abnormal load by switching energy
destined for the fat bank over to the sugar-regulating center, with the
result that the fat-banking capacity is reduced to the point at which it
is forced to establish a fixed deposit and thus initiate the disorder
we call obesity.  In this case one would have to consider the
diabetes the primary cause of the obesity, but it is also possible that
the process is reversed in the sense that a deficient or overworked
fat-center draws energy from the sugar-center, in which case the obesity
would be the cause of that type of diabetes in which the pancreas is
not primarily involved. Finally, it is conceivable that in Cushing’s
syndrome those symptoms which resemble obesity are entirely due to the
withdrawal of energy from the diencephalic fat-bank in order to make it
available to the highly disturbed center which governs the anterior
pituitary 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 diecenphalic regulatory mechanisms and thus lead to
obesity. This is commonly seen in the poor man who suddenly becomes rich
enough to buy the more expensive refined foods, though his total
caloric intake remains the same or is even less than before.

Three Basic Causes Of Obesityback

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 Obesityback

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 dicncephalic fat banking capacity is
unlimited. It is only during pregnancy that fixed fat deposits can be
transferred back into the normal current account and freely drawn upon
to make up for any nutritional deficit. During pregnancy, every ounce of
reserve fat is placed at the disposal of the growing fetus. Were this
not so, an obese woman, whose normal reserves are already depleted,
would have the greatest difficulties in bringing her pregnancy to full
term. There is considerable evidence to suggest that it is the HCG
produced in large quantities in the placenta which brings about this
diencephalic change.

Though we may be able to increase
the dieneephalic fat banking capacity by injecting HCG, this does not in
itself affect the weight, just as transferring monetary funds from a
fixed deposit into a current account does not make a man any poorer; to
become poorer it is also necessary that he freely spends the money which
thus becomes available.  In pregnancy the needs of the growing
embryo take care of this to some extent, but in the treatment of obesity
there is no embryo, and so a very severe dietary restriction must take
its place for the duration of 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 back

HCG is never found in the human body
except during pregnancy and in those rare cases in which a residue of
placental tissue continues to grow in the womb in what is known as a
chorionic epithelioma. It is never found in the male. The human type of
chorionic gonadotrophin is found only during the pregnancy of women and
the great apes. It is produced in enormous quantities, so that during
certain phases of her pregnancy a woman may excrete as much as one
million International Units per day in her urine – enough to render a
million infantile rats precociously mature. Other mammals make use of a
different hormone, which can be extracted from their blood serum but not
from their urine. Their placenta differs in this and other respects
from that of man and the great apes. This animal chorionic gonadotrophin
is much less rapidly broken down in the human body than HCG, and it is
also less suitable for the treatment of obesity.

As often happens in medicine, much
confusion has been caused by giving HCG its name before its true mode of
action was understood. It has been explained that gonadotrophin
literally means a sex-gland directed substance or hormone, and this is
quite misleading. It dates from the early days when it was first found
that HCG is able to render infantile sex glands mature, whereby it was
entirely overlooked that it has no stimulating effect whatsoever on
normally developed and normally functioning sex-glands. No amount of HCG
is ever able to increase a normal sex function.  It can only
improve an abnormal one and in the young hasten the onset of puberty.
However, this is no direct effect. HCG acts exclusively at a
diencephalic level and there brings about a considerable increase in the
functional capacity of all those centers which are working at maximum
capacity.

The Real Gonadotrophins

Two hormones known in the female as
follicle stimulating hormone (FSH) and corpus luteum stimulating hormone
(LSH) are secreted by the anterior lobe of the pituitary gland. These
hormones are real gonadotropilins because they directly govern the
function of the ovaries. The anterior pituitary is in turn governed by
the diencephalon, and so when there is an ovarian deficiency the
diencephalic center concerned is hard put to correct matters by
increasing the secretion from the anterior pituitary of FSH or LSH, as
the case may be. When sexual deficiency is clinically present, this is a
sign that the diencephalic center concerned is unable, in spite of
maximal exertion, to cope with the demand for anterior pituitary
stimulation. When then the administration of HCG increases the
functional capacity of the diencephalon, all demands can be fully
satisfied and the sex deficiency is corrected.

That this is the true mechanism
underlying the presumed gonadotrophic action of HCG is confirmed by 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
dienccphalotrophin.

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 HCGback

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 dioncephalic mechanisms are involved in gout; possibly
emotional factors play a role, and it is worth remembering that the
disease does not occur in women of childbearing age. We now give 2
tablets daily of ZYLORIC to all patients who give a history of gout and
have a high blood uric acid level. In this way we can completely avoid
attacks during 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” Maleback

When a male patient hears that he is
about to be put into a condition which in some respects resembles
pregnancy, he is usually shocked and horrified. The physician must
therefore carefully explain that this does not mean that he will be
feminized and that HCG in no way interferes with his sex. He must be
made to understand that in the interest of the propagation of the
species nature provides for a perfect functioning of the regulatory
headquarters in the diencephalun during pregnancy and that we are merely
using this natural safeguard as a means of correcting the dicncephalic
disorder which is responsible for his overweight.

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 HCGback

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 stastically normal
weight, we do not insist that he commit himself to that extent. Even a
partial loss of overweight is highly beneficial, and it is our
experience that once a patient has completed a first course he is so
enthusiastic about the ease with which the – to him surprising – results
are achieved that he almost invariably comes back for more. There
certainly can be no doubt that in my clinic more time is spent on
damping over-enthusiasm than on insisting that the rules of the
treatment be observed.

Examining the patient

Only when agreement is reached on
the points so far discussed do we proceed with the examination of the
patient. A note is made of the size of the first upper incisor, of a pad
of fat on the nape of the neck, at the axilla and on the inside of the
knees. The presence of striation, a suprapubic fold, a thoracic fold,
angulation of elbow and knee joint, breast-development in men and women,
edema of the ankles and the state of genital development in the male
are noted.

Wherever this seems indicated we
X-ray the sella turcica, as the bony capsule which contains the
pituitary gland is called, measure the basal metabolic rate, X-ray the
chest and take an electrocardiogram. We do a blood-count and a
sedimentation rate and estimate uric acid, cholesterol, iodine and sugar
in the fasting blood.

Gain before Loss

Patients whose general condition is
low, owing to excessive previous dieting, must eat to capacity for about
one week before starting treatment, regardless of how much weight they
may gain in the process. One cannot keep a patient comfortably on 500
Calories unless his normal fat reserves are reasonably well stocked. It
is for this reason also that every case, even those that are actually
gaining must eat to capacity of the most fattening food they can get
down until they have had the third injection. It is a fundamental
mistake to put a patient on 500 Calories as soon as the injections are
started, as it seems to take about three injections before abnormally
deposited fat begins to circulate and thus become 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 treatmentback

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 Dietback

The 500 calorie diet is explained on
the day of the second injection to those patients who will be preparing
their own food, and it is most important that the person who will
actually cook is present – the wife, the mother or the cook, as the case
may be. Here in Italy patients are given the following diet sheet.

Breakfast:

Tea
or coffee in any quantity without sugar. Only one tablespoonful of milk
allowed in 24 hours. Saccharin or Stevia may be used.

Lunch:
  1. 100 grams of veal, beef,
    chicken breast, fresh white fish, lobster, crab, or shrimp. All visible
    fat must be carefully removed before cooking, and the meat must be
    weighed raw. It must be boiled or grilled without additional fat.
    Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The
    chicken breast must be removed from the bird. 
  2. One type of vegetable
    only to be chosen from the following: spinach, chard, chicory,
    beet-greens, green salad, tomatoes, celery, fennel, onions, red
    radishes, cucumbers, asparagus, cabbage. 
  3. One breadstick (grissino) or one Melba toast. 
  4. An apple or a handful of strawberries or one-half grapefruit. 

Dinner :

The same four choices as lunch.

The juice of one lemon daily is
allowed for all purposes. Salt, pepper, vinegar, mustard powder, garlic,
sweet basil, parsley, thyme, majoram, etc., may be used for seasoning,
but no oil, butter or dressing.

Tea, coffee, plain water, or mineral water are the only drinks allowed, but they may be taken in any quantity and at all times.

In fact, the patient should drink
about 2 liters of these fluids per day. Many patients are afraid to
drink so much because they fear that this may make them retain more
water. This is a wrong notion as the body is more inclined to store
water when the intake falls below its normal requirements.

The fruit or the breadstick may be
eaten between meals instead of with lunch or dinner, but not more than
than four items listed for lunch and dinner may be eaten at one meal.

No medicines or cosmetics other than lipstick, eyebrow pencil and powder may 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 Caloriesback

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 back

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 back

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 back

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 back

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 back

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 back

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 back

When no dietary error is elicited we
turn to cosmetics. Most women find it hard to believe that fats, oils,
creams and ointments applied to the skin are absorbed and interfere with
weight reduction by HCG just as if they had been eaten. This almost
incredible sensitivity to even such very minor increases in nutritional
intake is a peculiar feature of the HCG method. For instance, we find
that persons who habitually handle organic fats, such as workers in
beauty parlors, masseurs, butchers, etc. never show what we consider a
satisfactory loss of weight unless they can avoid fat coming into
contact with their skin.

The point is so important that I
will illustrate it with two cases. A lady who was cooperating perfectly
suddenly increased half a pound. Careful questioning brought nothing to
light. She had certainly made no dietary error nor had she used any kind
of face cream, and she was already in the menopause. As we felt that we
could trust her implicitly, we left the question suspended. Yet just as
she was about to leave the consulting room she suddenly stopped, turned
and snapped her fingers. “I’ve got it,” she said. This is what had
happened : She had bought herself a new set of make-up pots and bottles
and, using her fingers, had transferred her large assortment of
cosmetics to the new containers in anticipation of the day she would be
able to use them again after her treatment.

The other case concerns a man who
impressed us as being very conscientious. He was about 20 lbs.
overweight but did not lose satisfactorily from the onset of treatment.
Again and again we tried to find the reason but with no success, until
one day he said:“I never told you this, but I have a glass eye. In fact,
I have a whole set of them. I frequently change them, and every time I
do that I put a special ointment in my eyesocket.. Do you think that
could have anything to do with it?” As we thought just that, we asked
him to stop using this ointment, and from that day on his weight-loss
was regular.

We are particularly averse to those
modern cosmetics which contain hormones, as any interference with
endocrine regulations during treatment must be absolutely avoided. Many
women whose skin has in the course of years become adjusted to the use
of fat containing cosmetics find that their skin gets dry as soon as
they stop using them. In such cases we permit the use of plain mineral
oil, which has no nutritional value. On the other hand, mineral oil
should not be used in preparing the food, first because of its
undesirable laxative quality, and second because it absorbs some
fat-soluble vitamins, which are then lost in the stool. We do permit the
use of lipstick, powder and such lotions as are entirely free of fatty
substances. We also allow brilliantine to be used on the hair but it
must not be rubbed into the scalp. Obviously sun-tan oil is prohibited.

Many women are horrified when told
that for the duration of treatment they cannot use face creams or have
facial massages. They fear that this and the loss of weight will ruin
their complexion. They can be fully reassured. Under treatment normal
fat is restored to the skin, which rapidly becomes fresh and turgid,
making the expression much more youthful. This is a characteristic of
the HCG method which is a constant source of wonder to patients who have
experienced or seen in others the facial ravages produced by the usual
methods of reducing. An obese woman of 70 obviously cannot expect to
have her pued face reduced to normal without a wrinkle, but it is
remarkable how youthful her face remains in spite of her age.

The Voice

Incidentally, another interesting
feature of the HCG method is that it does not ruin a singing voice. The
typically obese prima donna usually finds that when she tries to reduce,
the timbre of her voice is liable to change, and understandably this
terrifies her. Under HCG this does not happen; indeed, in many cases the
voice improves and the breathing invariably does. We have had many
cases of professional singers very carefully controlled by expert voice
teachers, and 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 back

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 back

Human chorionic gonadotrophin comes
on the market as a highly soluble powder which is the pure substance
extracted from the urine of pregnant women. Such preparations are
carefully standardized, and any brand made by a reliable pharmaceutical
company is probably as good as any other. The substance should be
extracted from the urine and not from the placenta, and it must of
course be of human and not of animal origin. The powder is sealed in
ampoules or in rubber-capped bottles in varying amounts which are stated
in International Units. In this form HCG is stable; however, only such
preparations should be used that have the date of manufacture and the
date of expiry clearly stated on the label or package. A suitable
solvent is always supplied in a separate ampoule in the same package.

Once HCG is in solution it is far
less stable. It may be kept at room-temperature for two to three days,
but if the solution must be kept longer it should always be
refrigerated. When treating only one or two cases simultaneously, vials
containing a small number of units say 1000 I.U. should be used. The 10
cc. of solvent which is supplied by the manufacturer is injected into
the rubber- capped bottle containing the HCG, and the powder must
dissolve instantly. Of this solution 1 .25 cc. are withdrawn for each
injection. One such bottle of 1000 I.U. therefore furnishes 8
injections. When more than one patient is being treated, they should not
each have their own bottle but rather all be injected from the same
vial and a fresh solution made when this is empty.

As we are usually treating a fair
number of patients at the same time, we prefer to use vials containing
5000 units. With these the manufactures also supply 10 cc. of solvent.
Of such a solution 0.25 cc. contain the 125 I.U., which is the standard
dose for all cases and which should never be exceeded. This small amount
is awkward to handle accurately (it requires an insulin syringe) and is
wasteful, because there is a loss of solution in the nozzle of the
syringe and in the needle. We therefore prefer a higher dilution, which
we prepare in the following way: The solvent supplied is injected into
the rubbercapped bottle containing the 5000 I.U . As these bottles are
too small to hold more solvent, we

withdraw 5 cc., inject it into an
empty rubber-capped bottle and add 5 cc. of normal saline to each
bottle. This gives us 10 cc. of solution in each bottle, and of this
solution 0.5 cc. contains 125 I.U. This amount is convenient to inject
with an ordinary syringe.

Injecting back

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 broncial
asthma and hay fever we have occasionally resorted to cortisone during
treatment and find that triamcinolone is the least likely to interfere
with the loss of weight, but many asthmatics improve with HCG alone.

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 back

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 back

ACNE . . . Common skin disease in which pimples, often containing pus, appear on face, neck and shoulders.

ACTH . . . Abbreviation for
adrenocorticotrophic hormone. One of the many hormones produced by the
anterior lobe of the pituitary gland. ACTH controls the outer part, rind
or cortex of the adrenal glands. When ACTH is injected it dramatically
relieves arthritic pain, but it has many undesirable side effects, among
which is a condition similar to severe obesity. ACTH is now usually
replaced by cortisone.

ADRENALIN . . . Hormone
produced by the inner part of the Adrenals. Among many other functions,
adrenalin is concerned with blood pressure, emotional stress, fear and
cold.

ADRENALS . . . Endocrine
glands. Small bodies situated atop the kidneys and hence also known as
suprarenal glands. The adrenals have an outer rind or cortex which
produces vitally important hormones, among which are Cortisone similar
substances. The adrenal cortex is controlled by ACTH. The inner part of
the adrenals, the medulla, secretes adrenalin and is chiefly controlled
by the autonomous nervous system.

ADRENOCORTEX… See adrenals.

AMPHETAMINES . . . Synthetic
drugs which reduce the awareness of hunger and stimulate mental
activity, rendering sleep impossible. When used for the latter two
purposes they are dangerously habit-forming. They do not diminish the
body’s need for food, but merely suppress the perception of that need.
The original drug was known as Benzedrine, from which modern variants
such as Dexedrine, Dexamil, and Preludin have been derived. Amphetamines
may help an obese patient to prevent a further increase in weight but
are unsatisfactory for reducing, as they do not cure the underlying
disorder and as their prolonged use may lead to malnutrition and
addiction.

ARTERIOSCLEROSIS . . . Hardening of the arterial wall through the calcification of abnormal deposits of a fatlike substance known as cholesterol.

ASCHFIE1M-ZONDEK . . .
Authors of a test by which early pregnancy can be diagnosed by injecting
a woman’s urine into female mice. The HCG present in pregnancy urine
produces certain changes in the vagina of these animals. Many similar
tests, using other animals such as rabbits, frogs, etc. have been
devised.

ASSIMILATE . . . Absorbed digested food from the intestines.

AUTONOMOUS . . . Here used to describe the independent or vegetative nervous system which manages the automatic regulations of the body.

BASAL METABOLISM . . . The
body’s chemical turnover at complete rest and when fasting. The basal
metabolic rate is expressed as the amount of oxygen used up in a given
time. The basal metabolic rate (BMR) is controlled by the thyroid gland.

CALORIE . . . The physicist’s calorie is the amount of heat required to raise the temperature of 1 cc. of water by 1 degree Centigrade. The dieticiari’s Calorie (always written with a capital C) is 1000 times greater.
Thus when we speak of a 500 Calorie diet this means that the body is
being supplied with as much fuel as would be required to raise the
temperature of 500 liters of water by 1 degree Centigrade or 50 liters
by 10 degrees. This is quite insufficient to cover the heat and energy
requirements of an adult body.  In the HCG method the deficit is
made up from the abnormal fat-deposits, of which 1 lb. furnishes the body with more than 2000 Calories. As this is roughly the amount lost every day, a patient under HCG is never short of fuel.

CEREBRAL . . . Of the brain.
Cerebral vascular disease is a disorder concerning the blood vessels of
the brain, such as cerebral thrombosis or hemorrhage, known as apoplexy
or stroke.

CHOLESTEROL . . . A fatlike
substance contained in almost every cell of the body. In the blood it
exists in two forms, known as free and esterified. The latter form is
under certain conditions deposited in 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
inter dependent of each other, they are linked to the autonomous nervous
system and the diencephalon presides over this whole incredibly complex
regulatory system.

EMACIATED . . . Grossly undernourished.

EUPHORIA . . . A feeling of particular physical and mental well being.

FERAL . . . Wild, unrestrained.

FIBROID . . . Any benign new
growth of connective tissue. When such a tumor originates from a muscle,
it is known as a myoma. The most common seat of myomas is the uterus.

FOLLICLE . . . Any small
bodily cyst or sac containing a liquid. Here the term applies to the
ovarian cyst in which the egg is formed. The egg is expelled when a ripe
follicle bursts and this is known as ovulation (see corpus luteurn).

FSH . . . Abbreviation for
follicle-stimulating hormone. FSH is another (see corpus luteum)
anterior pituitary hormone which acts directly on the ovarian follicle
and is therefore correctly called a gonadotrophin.

GLANDS . . . See endocrine.

GONADOTROPHIN . . . See
corpus luteum, follicle and FSH. Gonadotrophic literally means sex
gland-directed. FSH, LSH and the equivalent hormones in the male, all
produced in the anterior lobe of the pituitary gland, are true
gonadotrophins. Unfortunately and confusingly, the term gonadotrophin
has also been applied to the placental hormone of pregnancy known as
human chorionic gonadotrophin (HCG). This hormone acts on the
diencephalon and can only indirectly influence the sex-glands via the
anterior lobe of the pituitary.

HCG . . . Abbreviation for human chorionic gonadotrophin

HORMONES . . . See endocrine.

HYPERTENSION . . . High blood pressure.

HYPOGLYCEMIA . . . A condition in which the blood sugar is below normal. It can be relieved by eating sugar.

HYPOPHYSIS . . . Another name for the pituitary gland.

HYPOTHESIS . . . A tentative
explanation or speculation on how observed facts and isolated scientific
data can be brought into an intellectually satisfying relationship of
cause and effect. Hypotheses are useful for directing further research,
but they are not necessarily an exposition of what is believed to be the
truth. Before a hypothesis can advance to the dignity of a theory or a
law, it must be confirmed by all future research. As soon as research
turns up data which no longer fit the hypothesis, it is immediately
abandoned for a better one.

LSH . . . See corpus luteum.

METABOLISM . . . See basal metabolism.

MIGRAINE . . . Severe half-sided headache often associated with vomiting.

MUCOID . . . Slime-like.

MYOCARDIUM . . . The heart-muscle.

MYOMA . . . See fibroid.

MYXEDEMA . . . Accumulation of a mucoid substance in the tissues which occurs in cases of severe primary thyroid deficiency.

NEOLITHIC . . . In the
history of human culture we distinguish the Early Stone Age or
Paleolithic, the Middle Stone Age or Mesolithic and the New Stone Age or
Neolithic period. The Neolithic period started about 8000 years ago
when the first attempts at agriculture, pottery and animal domestication
made at the end of the Mesolithic period suddenly began to develop
rapidly along the road that led to modern civilization.

NORMAL SALINE . . . A low concentration of salt in water equal to the salinity of body fluids.

PHLEBITIS . . . An inflammation of the veins. When a blood-clot forms at the site of the inflammation, we speak of thrombophlebitis.

PITUITARY . . . A very
complex endocrine gland which lies at the base of the skull, consisting
chiefly of an anterior and a posterior lobe. The pituitary is controlled
by the diencephalon, which regulates the anterior lobe by means of
hormones which reach it through small blood vessels. The posterior lobe
is controlled by nerves which run from the diencephalon into this part
of the gland. The anterior lobe secretes many hormones, among which are
those that regulate other glands such as the thyroid, the adrenals and
the sex glands.

PLACENTA . . . The
after-birth. In women, a large and highly complex organ through which
the child in the womb receives its nourishment from the mother’s body.
It is the organ in which HCG is manufactured and then given off into the
mother’s blood.

PROTEIN . . . The living
substance in plant and animal cells. Herbivorous animals can thrive on
plant protein alone, but man must 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.