|
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 diencephalon,
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 were 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.
Froehlich 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 300cc. 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, nor did the daily
administration of HCG appear to have
any side-effects other than
beneficial.
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, for instance, 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
suffering from obesity and is
subject to all its consequences.
Pregnancy seems to be the only
normal human condition in which the
diencephalic fat-banking capacity is
unlimited. It is only during
pregnancy that fixed fat deposits
can be transferred back into the
normal current account and freely
drawn upon to make up for any
nutritional deficit. During
pregnancy, every ounce of reserve
fat is placed at the disposal of the
growing fetus. Were this not so, an
obese woman, whose normal reserves
are already depleted, would have the
greatest difficulties in bringing
her pregnancy to full term. There is
considerable evidence to suggest
that it is the HCG produced in large
quantities in the placenta which
brings about this diencephalic
change.
Though we may be able to increase
the 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
HCG is never found in the human body
except during pregnancy and in those
rare cases in which a residue of
placental tissue continues to grow
in the womb in what is known as a
chorionic epithelioma. It is never
found in the male. The human type of
chorionic gonadotrophin is found
only during the pregnancy of women
and the great apes. It is produced
in
enormous quantities, so that during
certain phases of her pregnancy a
woman may excrete as much as one
million International Units per day
in her urine - enough to render a
million infantile rats precociously
mature. Other mammals make use of a
different hormone, which can be
extracted from their blood serum but
not from their urine. Their placenta
differs in this and other respects
from that of man and the great apes.
This animal chorionic gonadotrophin
is much less rapidly broken down in
the human body than HCG, and it is
also less suitable for the treatment
of obesity.
As often happens in medicine, much
confusion has been caused by giving
HCG its name before its true mode of
action was understood. It has been
explained that gonadotrophin
literally means a sex-gland directed
substance or hormone, and this is
quite misleading. It dates from the
early days when it was first found
that HCG is able to render infantile
sex glands mature, whereby it was
entirely overlooked that it has no
stimulating effect whatsoever on
normally developed and normally
functioning sex-glands. No amount of
HCG is ever able to increase a
normal sex function; it can only
improve an abnormal one and in the
young hasten the onset of puberty.
However, this is no direct effect.
HCG acts exclusively at a
diencephalic level and there brings
about a considerable increase in the
functional capacity of all those
centers which are working at maximum
capacity.
The Real Gonadotrophins
Two hormones known in the female as
follicle stimulating hormone (FSH)
and corpus luteum stimulating
hormone (LSH) are secreted by the
anterior lobe of the pituitary
gland. These hormones are real
gonadotrophins because they directly
govern the function of the ovaries.
The anterior pituitary is in turn
governed by the diencephalon, and so
when there is an ovarian deficiency
the diencephalic center concerned is
hard put to correct matters by
increasing the secretion from the
anterior pituitary of FSH or LSH, as
the case may be. When sexual
deficiency is clinically present,
this is a sign that the diencephalic
center concerned is unable, in spite
of maximal exertion, to cope with
the demand for anterior pituitary
stimulation. When then the
administration of HCG increases the
functional capacity of the
diencephalon, all demands can be
fully satisfied and the sex
deficiency is corrected.
That this is the true mechanism
underlying the presumed
gonadotrophic action of HCG is
confirmed by the fact that when the
pituitary gland of infantile rats is
removed before they are given HCG,
the latter has no effect on their
sex-glands. HCG cannot therefore
have a direct sex gland stimulating
action like that of the anterior
pituitary gonadotrophins, as FSH and
LSH are justly called. The latter
are entirely different substances
from that which can be extracted
from pregnancy urine and which,
unfortunately, is called chorionic
gonadotrophin. It would be no more
clumsy, and certainly far more
appropriate, if HCG were henceforth
called chorionic diencephalotrophin.
HCG
Not a Sex Hormone
It cannot he sufficiently emphasized
that HCG is not a 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 a stimulation
beyond the normal. In an indirect
way via the anterior pituitary, HCG
regulates menstruation and
facilitates conception, but it never
virilizes a woman or feminizes a
man. It neither makes men grow
breasts nor does it interfere with
their virility, though where this
was deficient it may improve it. It
never makes women grow a beard or
develop a gruff voice. I have
stressed this point only for the
sake of my lay readers, because, it
is our daily experience that when
patients hear the word hormone they
immediately jump to the conclusion
that this must have something to do
with the sex- sphere. They are not
accustomed as we are, to think
thyroid, insulin, cortisone,
adrenalin etc, as hormones.
Importance and Potency of HCG
Owing to the fact that HCG has no
direct action on any endocrine
gland, its enormous importance in
pregnancy has been overlooked and
its potency underestimated. Though a
pregnant woman can produce as much
as one million units per day, we
find that the injection of only 125
units per day is ample to reduce
weight at the rate of roughly one
pound per day, even in a colossus
weighing 400 pounds, when associated
with a 500 calorie diet. It is no
exaggeration to say that the
flooding of the female body with HCG
is by far the most spectacular
hormonal event in pregnancy. It has
an enormous protective importance
for mother and child, and I even go
so far as to say that no woman, and
certainly not an obese one, could
carry her pregnancy to term without
it.
If I can be forgiven for comparing
my fellow-endocrinologists with
wicked Godmothers, HCG has certainly
been their Cinderella, and I can
only romantically hope that its
extraordinary effect on abnormal fat
will prove to be its Fairy
Godmother.
HCG has been known for over half a
century. It is the substance which
Aschheim and Zondek so brilliantly
used to diagnose early pregnancy out
of the urine. Apart from that, the
only thing it did in the
experimental laboratory was to
produce precocious rats, and that
was not particularly stimulating to
further research at a time when much
more thrilling endocrinological
discoveries were pouring in from all
sides, sweeping, HCG into the
stiller back waters.
Complicating Disorders
Some complicating disorders are
often associated with obesity, and
these we must briefly discuss. The
most important associated disorders
and the ones in which obesity seems
to play a precipitating or at least
an aggravating role are the
following: the stable type of
diabetes, gout, rheumatism and
arthritis, high blood pressure and
hardening of the arteries, coronary
disease and cerebral hemorrhage.
Apart from the fact that they are
often - though not necessarily -
associated with obesity, these
disorders have two things in common.
In all of them, modern research is
becoming more and more inclined to
believe that diencephalic
regulations play a dominant role in
their causation. The other common
factor is that they either improve
or do not occur during pregnancy. In
the latter respect they are joined
by many other disorders not
necessarily associated with obesity.
Such disorders are, for instance,
colitis, duodenal or gastric ulcers,
certain allergies, psoriasis, loss
of hair, brittle fingernails,
migraine, etc.
If HCG plus 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
3-400 mg%, it is often possible to
stop all antidiabetic 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 plus diet the
effect is no less dramatic. As it
does 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 plus 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 then we saw that the patients
came to no harm even if treatment
was continued and we found in
follow-up examinations undertaken
some months after treatment that the
cholesterol was much better than it
had been before treatment. As the
increase is mostly in the form of
the not dangerous 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 therefore highly beneficial.
Gout
An identical behavior is found in
the blood uric acid level of
patients suffering from gout.
Predictably such patients get an
acute and often severe attack after
the first few days of HCG treatment
but then remain entirely free of
pain, in spite of the fact that
their blood uric acid often shows a
marked increase which may persist
for several months after treatment.
Those patients who have regained
their normal weight remain free of
symptoms regardless of what they
eat, while those that require a
second course of treatment get
another attack of gout as soon as
the
second course is initiated. We do
not yet know what diencephalic
mechanisms are involved in gout;
possibly emotional factors play a
role, and it is worth remembering
that the disease does not occur in
women of childbearing age. We now
give 2 tablets daily of ZYLORIC to
all patients who give a history of
gout and have a high blood uric acid
level. In this way we can completely
avoid attacks during treatment.
Blood Pressure
Patients who have brought themselves
to the brink of malnutrition by
exaggerated dieting, laxatives etc,
often have an abnormally low blood
pressure. In these cases the blood
pressure rises to normal values at
the beginning of treatment and then
very gradually drops, as it always
does in patients with a normal blood
pressure. Normal values are always
regained a few days after the
treatment is over. Of this lowering
of the blood pressure during
treatment the patients are not
aware. When the blood pressure is
abnormally high, and provided there
are no detectable renal lesions, the
pressure drops, as it usually does
in pregnancy. The drop is often very
rapid, so rapid in fact that it
sometimes is advisable to slow down
the process with pressure sustaining
medication until the circulation has
had a few days time to adjust itself
to the new situation. On the other
hand, among the thousands of cases
treated, we have never seen any
untoward incident which could be
attributed to the rather sudden drop
in high blood pressure.
When a woman suffering from high
blood pressure becomes pregnant her
blood pressure very soon drops, but
after her confinement it may
gradually rise back to its former
level. Similarly, a high blood
pressure present before HCG
treatment
tends to rise again after the
treatment is over, though this is
not always the case. But the former
high levels are rarely reached, and
we have gathered the impression that
such relapses respond better to
orthodox drugs such as Reserpine
than before treatment.
Peptic Ulcers
In our cases of obesity with gastric
or duodenal ulcers we have noticed a
surprising subjective improvement in
spite of a diet which would
generally be considered most
inappropriate for an ulcer patient.
Here, too, there is a similarity
with pregnancy, in which peptic
ulcers hardly ever occur. However we
have seen two cases with a previous
history of several hemorrhages in
which a bleeding occurred within 2
weeks of the end of treatment.
Psoriasis, Fingernails, Hair,
Varicose Ulcers
As in pregnancy, psoriasis greatly
improves during treatment but may
relapse when the treatment is over.
Most patients spontaneously report a
marked improvement in the condition
of brittle fingernails. The loss of
hair not infrequently associated
with obesity is temporarily
arrested, though in very rare cases
an increased loss of hair has been
reported. I remember a case in which
a patient developed a patchy
baldness - so called alopecia areata
- after a severe emotional shock,
just before she was about to start
an HCG treatment. Our dermatologist
diagnosed the case as a particularly
severe one, predicting that all the
hair would be lost. He counseled
against the reducing treatment, but
in view of my previous experience
and as the patient was very anxious
not to postpone reducing, I
discussed the matter with the
dermatologist and it was agreed
that, having fully
acquainted the patient with the
situation, the treatment should be
started. During the treatment, which
lasted four weeks, the further
development of the bald patches was
almost, if not quite, arrested;
however, within a week of having
finished the course of HCG, all the
remaining hair fell out as predicted
by the dermatologist. The
interesting point is that the
treatment was able to postpone this
result but not to prevent it. The
patient has now grown a new shock of
hair of which she is justly proud.
In obese patients with large
varicose ulcers we were surprised to
find that these ulcers heal rapidly
under treatment with HCG. We have
since treated non obese patients
suffering from varicose ulcers with
daily injections of HCG on normal
diet with equally good results.
The “Pregnant" Male
When a male patient hears that he is
about to be put into a condition
which in some respects resembles
pregnancy, he is usually shocked and
horrified. The physician must
therefore carefully explain that
this does not mean that he will be
feminized and that HCG in no way
interferes with his sex. He must be
made to understand that in the
interest of the propagation of the
species nature provides for a
perfect functioning of the
regulatory headquarters in the
diencephalon during pregnancy and
that we are merely using this
natural safeguard as a means of
correcting the diencephalic disorder
which is responsible for his
overweight.
Part 5 -
HCG
Diet Protocol
|
