Position Paper Regarding HCG Injections Along with a Very Low Calorie Diet for Weight Loss
by Dr. Kathryn Retzler
Portland, Oregon
The "HCG Diet" has become popular over the last few years due to the accessibility of the Internet and advertising by clinics that perform the protocol. I've read ATW Simeons protocol "Pounds and Inches: a New Approach to Obesity" several times. The paper is intriguing in terms of Simeons' theories about weight gain and the role of hypothalamic dysfunction in prevention of weight loss. It's also bold - Simeons claims that the protocol is easy to follow and uniformly effective in suppressing appetite, elevating mood, and enabling "abnormal", stubborn fat to be lost. He also states that HCG resets the hypothalamus to prevent lost weight from being regained. "Pounds and Inches" is available from several sources on the Internet. If you're interested, you can order a copy of Simeons' paper describing his protocol published in 1954 from the Lancet.[1]
HCG or "human chorionic gonadotropin" is a hormone produced during pregnancy. It's also produced by tumors in women (hydatidiform mole) and men (testicular cancer). HCG injections are used medically since part of its molecular structure mimics luteinizing hormone (LH). HCG injections (in dosages ranging from 1000 to 2000 units, 2-3 times per week) are used to increase testosterone production in men with low testosterone who want to preserve fertility. HCG injections (5,000 to 10,000 units) are sometimes used in women to induce ovulation.
Simeons protocol uses minute dosages of HCG (125 units), 6-7 days per week for 23 to 40 days, along with a very low calorie (VLC) diet of 500 calories per day. Since HCG does share some of its molecular structure with LH and thyroid stimulating hormone (TSH), theoretically, it may increase testosterone production, ovulation and progesterone production, or release of thyroid hormone. It may also cause excess stimulation of the ovary and ovarian cysts. However, the dosage used is very small and these effects are unlikely. A VLC diet (with or without HCG) can precipitate gallstones (since it's very low in fat), and may cause symptoms of toxicity (since fat tissue stores toxins).
Research regarding HCG injections and weight loss is nearly all negative. In other words, most trials where patients received either HCG injections or placebo and followed identical VLC diets, show no difference in amount of weight lost, type of weight lost, hunger level, or mood. A summary of published studies follows this paper.
No study that I've read has looked at long-term maintenance of weight lost with the HCG protocol. Randomized controlled trials of VLC diets show a large variation in regain of initial weight loss percentage. Participants in these trial regained 7-122% of initial weight lost by one year, and 26-121% by 5 years. [2]Active follow-up weight maintenance programs that include behavior therapy, nutritional education, and exercise are more effective at improving weight maintenance.
It would be worthwhile to perform a clinical trial to see if participants following the HCG protocol are more successful at maintaining weight loss than VLC diet alone. Simeons claims patients who follow his protocol maintain weight loss 60-70% of the time, although I don't think he published data to back up this claim.
I've spoken to many patients who've followed the HCG protocol with great success - they've lost significant amounts of weight, claim not to have been hungry, and had an increased sense of well-being. Many of these people have sustained their weight loss, many have not. I've personally gone through Simeons protocol, documenting all calories consumed as well as calories burned (by wearing a Bodybugg). I also measured my fat and muscle percentage before and after the diet using bioelectrical impedance analysis. I lost 12 pounds and 4% body fat during the 23 day protocol. I was extremely hungry throughout the entire protocol, although I did exercise every day. Some proponents of the protocol recommend not exercising, although this seems like bad advice given the overwhelming health benefits of regular exercise. I've also undergone a VLC diet, documenting all calories consumed and burned, without using HCG injections. I lost a similar percentage of excess weight.
My position on the HCG protocol for weight loss is that I do not think it's harmful. I also don't think it has any effect over placebo. I do not discount the power of any placebo. The placebo response is really a measure of the power of the self-healing ability. Many people are willing to follow a VLC diet if they inject themselves or take oral HCG since they believe the HCG will suppress their appetite and help them lose weight. I do believe that physicians who perform this protocol should disclose the negative research regarding HCG benefits to patients. I also believe it is ignorant of them at best, and unethical at worst, to prescribe a substance and oftentimes, charge high fees, for a product or protocol thathas shownno benefitover placebo.
Note that since 1975, the FDA requires the following information to be given with any HCG advertised or promoted for weight loss:
HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.
If you are interested in following the HCG protocol, I think you should be informed about the research regarding HCG and weight loss. You should also make sure your physician is aware of your current health status before you follow any VLC diet, and that causes of abnormal weight gain (e.g., hypothyroidism, hypogonadism, Cushing's, and other endocrine problems) have been ruled out. Before going on any VLC diet, I'd also recommend undergoing a detox program that supports Phase I and Phase II liver function. Make sure you don't have pre-existing gallstones, liver, or kidney disease. If you're using insulin for diabetes management, you must make sure your dosage is adjusted based on blood sugar levels, and that you don't develop ketoacidosis, which can be fatal.
If you do undergo a VLC diet (with our without HCG) you owe it to yourself to change the factors that caused you to become overweight in the first place: improve your overall diet and nutrition knowledge, honestly evaluate causes of emotional eating, decrease stress, and increase exercise frequency and intensitya"otherwise, the chance of you gaining back the weight you've lost is nearly 100%.
I welcome comments or questions regarding my position. In addition, if you're aware of any research using the HCG protocol that I have not listed here, or if you believe my conclusions are incorrect, please contact me: drretzler@hormonesynergy.com.
Kathryn Retzler, ND
www.hormonesynergy.com
Summary of Research and Articles RE: HCG Injections & VLC Diet for Weight Loss
Note: Dr. Simeons does not state that HCG alone accomplishes weight loss; rather, he states patients treated with HCG will not be hungry or tired, will lose a different kind of weight ("abnormal fat" that is difficult to lose), and will experience an increased sense of well-being. He also claims that weight lost is unlikely to be regained ("60-70%" of patients keep weight off) due to a resetting of the hypothalamus.
Positive Papers:
Asher W, Harper H. Effect of human chorionic gonadotrophin on weight loss, hunger, and feeling of well-being. Am J Clin Nutr. 1973;26(2):211-8.
