Pounds & Inches
A NEW APPROACH TO OBESITY
BY: DR. A.T.W. SIMEONS
SALVATOR MUNDI INTERNATIONAL HOSPITAL
00152 - ROME VIALE MURA GIANICOLENSI, 77
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This book discusses a new interpretation of the nature of
obesity, and while it does not advocate yet another fancy
slimming diet it does describe a method of treatment which has
grown out of theoretical considerations based on clinical
What I have to say is an essence of 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
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 when then a treatment based
on such speculations showed consistently satisfactory results, I
was sure that some practical advance had been made, regardless
of whether the theoretical interpretation of these results is
correct or not.
The clinical results of the new treatment
have been published in scientific journal
and these reports have been generally well received by the
profession, but the very nature of a scientific article does not
permit the full presentation of new theoretical concepts nor is
there room to discuss the finer points of technique and the
reasons for observing them.
During the 16 years that have elapsed since I first published my
findings, I have had many hundreds of inquiries from research
institutes, doctors and patients. Hitherto I could only refer
those interested to my scientific papers, though I realized that
these did not contain sufficient information to enable doctors
to conduct the new treatment satisfactorily. Those who tried
were obliged to gain their own experience through the many
trials and errors which I have long since overcome.
Doctors from all over the world
have come to Italy to study the method, first hand in my clinic
in the Salvator Mundi International Hospital in Rome. For some
of them the time they could spare has been too short to get a
full grasp of the technique, and in any case the number of those
whom I have been able to meet personally is small compared with
the many requests for further detailed information which keep
coming in. I have tried to keep up with these demands by
correspondence, but the volume of this work has become
unmanageable and that is one excuse for writing this book.
In dealing with a disorder in which the patient must take an
active part in the treatment, it is, I believe, essential that
he or she have an understanding of what is being done and why.
Only then can there be intelligent cooperation between physician
and patient. In order to avoid writing two books, one for the
physician and another for the patient - a prospect which would
probably have resulted in no book at all - I have tried to meet
the requirements of both in a single book. This is a rather
difficult enterprise in which I may not have succeeded. The
expert will grumble about long-windedness while the lay-reader
may occasionally have to look up an unfamiliar word in the
glossary provided for him.
To make the text more readable I shall be unashamedly
authoritative and avoid all the hedging and tentativeness with
which it is customary 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
THE NATURE OF OBESITY
Obesity a Disorder
As a basis for our discussion we postulate that obesity in all
its many forms is due to an abnormal functioning of some part of
the body and that every ounce of abnormally accumulated fat is
always the result of the same disorder of certain regulatory
mechanisms. Persons suffering from this particular disorder will
get fat regardless of whether they eat excessively, normally or
less than normal. A person who is free of the disorder will
never get fat, even if he frequently overeats.
Those in whom the disorder is severe will accumulate fat very
rapidly, those in whom it is moderate will gradually increase in
weight and those in whom it is mild may be able to keep their
excess weight stationary for long periods. In all these cases a
loss of weight brought about by dieting, treatments with
thyroid, appetite-reducing drugs, laxatives, violent exercise,
massage, baths, etc., 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
While there are great variations in the severity of obesity, we
shall consider all the different forms in both sexes and at all
ages as always being due to the same disorder. Variations in
form would then be partly a matter of degree, partly an
inherited bodily constitution and partly the result of a
secondary involvement of endocrine glands such as the pituitary,
the thyroid, the adrenals or the sex glands. On the other hand,
we postulate that no deficiency of any of these glands can ever
directly produce the common disorder known as obesity.
If this reasoning is correct, it follows that a treatment aimed
at curing the disorder must be equally effective in both sexes,
at all ages and in all forms of obesity. Unless this is so, we
are entitled to harbor grave doubts as to whether a given
treatment corrects the underlying disorder. Moreover, any claim
that the disorder has been corrected must be substantiated by
the ability of the patient to eat normally of any food he
pleases without regaining abnormal fat after treatment. Only if
these conditions are fulfilled can we legitimately speak of
curing obesity rather than of reducing weight.
Our problem thus presents itself as an enquiry into the
localization and the nature of the disorder which leads to
obesity. The history of this enquiry is a long series of high
hopes and bitter disappointments.
The History of Obesity
There was a time, not so long ago, when obesity was considered a
sign of health and prosperity in man and of beauty, amorousness
and fecundity in women. This attitude probably dates back to
Neolithic times, about 8000 years ago; when for the first time
in the history of culture, man began to own property, domestic
animals, arable land, houses, pottery and metal tools. Before
that, with the possible exception of some races such as the
Hottentots, obesity was almost non-existent, as it still is in
all wild animals and most primitive races.
Today obesity is extremely common among all civilized races,
because a disposition to the disorder can be inherited. Wherever
abnormal fat was regarded as an asset, sexual selection tended
to propagate the trait. It is only in very recent times that
manifest obesity has lost some of its allure, though the cult of
the outsize bust - always a sign of latent obesity - shows that
the trend still lingers on.
The Significance of Regular Meals
In the early Neolithic times another change took place which may
well account for the fact that today nearly all inherited
dispositions sooner or later develop into manifest obesity. This
change was the institution of regular meals. In pre-Neolithic
times, man ate only when he was hungry and on1y as much as he
required to 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 assimilable, placed a
great burden on modern man's ability to cope with large
quantities of food suddenly pouring into his system from the
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
Three Kinds of Fat
In the human body we can distinguish three kinds of fat. The
first is the structural fat which fills the gaps between various
organs, a sort of packing material. Structural fat also performs
such important functions as bedding the kidneys in soft elastic
tissue, protecting the coronary arteries and keeping the skin
smooth and taut. It also provides the springy cushion of hard
fat under the bones of the feet, without which we would be
unable to walk.
The second type of fat is a normal reserve of fuel upon which
the body can freely draw when the nutritional income from the
intestinal tract is insufficient to meet the demand. Such normal
reserves are localized all over the body. Fat is a substance
which packs the highest caloric value into the smallest space so
that normal reserves of fuel for muscular activity and the
maintenance of body temperature can be most economically stored
in this form. Both these types of fat, structural and reserve,
are normal, and even if the body stocks them to capacity this
can never be called obesity.
But there is a third type of fat which is
entirely abnormal. It is the accumulation of such fat, and of
such fat only, from which the overweight patient suffers. This
abnormal fat is also a potential reserve of fuel, but unlike the
normal reserves it is not available to the body in a nutritional
emergency. It is, so to speak, locked away in a fixed deposit
and is not kept in a current account,
as are the normal reserves.
When an obese patient tries to reduce by starving himself, he
will first lose his normal fat reserves. When these are
exhausted he begins to burn up structural fat, and only as a
last resort will the body yield its abnormal reserves, though by
that time the patient usually feels so weak and hungry that the
diet is abandoned. It is just for this reason that obese
patients complain that when they diet they lose the wrong fat.
They feel famished and tired and their face becomes drawn and
haggard, but their belly, hips, thighs and upper arms show
little improvement. The fat they have come to detest stays on
and the fat they need to cover their bones gets less and less.
Their skin wrinkles and they look old and miserable. And that is
one of the most frustrating and depressing experiences a human
being can have.
Injustice to the Obese
When then obese patients are accused of cheating, gluttony, lack
of will power, greed and sexual complexes, the strong become
indignant and decide that modern medicine is a fraud and its
representatives fools, while the weak just give up the struggle
in despair. In either case the result is the same: a further
gain in weight, resignation to an abominable fate and the
resolution at least to live tolerably the short span allotted to
them - a fig for doctors and insurance companies.
Obese patients only feel physically well as long as they are
stationary or gaining weight. They may feel guilty, owing to the
lethargy and indolence always associated with obesity. They may
feel ashamed of what they have been led to believe is a lack of
control. They may feel horrified by the appearance of their nude
body and the tightness of their clothes. But they have a
primitive feeling of animal content which turns to misery and
suffering as soon as they make a resolute attempt to reduce. For
this there are sound reasons.
In the first place, more caloric energy is required to keep a
large body at a certain temperature than to heat a small body.
Secondly the muscular effort of moving a heavy body is greater
than in the case of a light body. The muscular effort consumes
Calories which must be provided by food. Thus, all other factors
being equal, a fat person requires more food than a lean one.
One might therefore reason that if a fat person eats only the
additional food his body requires he should be able to keep his
weight stationary. Yet every physician who has studied obese
patients under rigorously controlled conditions knows that this
is not true.
Many obese patients actually gain weight on a diet which is
calorically deficient for their basic needs. There must thus be
some other mechanism at work.
At one time it was thought that this mechanism might be
concerned with the sex glands. Such a connection was suggested
by the fact that many juvenile obese patients show an
under-development of the sex organs. The middle-age spread in
men and the tendency of many women to put on weight in the
menopause seemed to indicate a causal connection between
diminishing sex function and overweight. Yet, when highly active
sex hormones became available, it was found that their
administration had no effect whatsoever on obesity. The sex
glands could therefore not be the seat of the disorder.
The Thyroid Gland
When it was discovered that the thyroid gland controls the rate
at which body-fuel is consumed, it was thought that by
administering thyroid gland to obese patients their abnormal fat
deposits could be burned up more rapidly. This too proved to be
entirely disappointing, because as we now know, these abnormal
deposits take no part in the body's energy-turnover - they are
inaccessibly locked away. Thyroid medication merely forces the
body to consume its normal fat reserves, which are already
depleted in obese patients, and then to break down structurally
essential fat without touching the abnormal deposits. In this
way a patient may be brought to the brink of starvation in spite
of having a hundred pounds of fat to spare. Thus any weight loss
brought about by thyroid medication is always at the expense of
fat of which the body is in dire need.
While the majority of obese
patients have a perfectly normal thyroid gland and some even
have an overactive thyroid, one also occasionally sees a case
with a real thyroid deficiency. In such cases, treatment with
thyroid brings about a small loss of weight, but this is not due
to the loss of any abnormal fat. It is entirely the result of
the elimination of a mucoid substance, called myxedema, which
the body accumulates when there is a marked primary thyroid
deficiency. Moreover, patients suffering only from a severe lack
of thyroid hormone never become obese in the true sense.
Possibly also the observation that normal persons - though not
the obese - lose weight rapidly when their thyroid becomes
overactive may have contributed to the false notion that thyroid
deficiency and obesity are connected. Much misunderstanding
about the supposed role of the thyroid gland in obesity is still
met with, and it is now really high time that thyroid
preparations be once and for all struck off the list of remedies
for obesity. This is particularly so because giving thyroid
gland to an obese patient whose thyroid is either normal or
overactive, besides being useless, is decidedly dangerous.
The Pituitary Gland
The next gland to be falsely
incriminated was the anterior lobe of the pituitary, or
hypophysis. 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
value in the treatment of obesity. Quite recently, however, a
fat-mobilizing factor has been found in pituitary glands, but it
is still too early to say whether this factor is destined to
play a role in the treatment of obesity.
Recently, a long series of brilliant discoveries concerning the
working of the adrenal or suprarenal glands, small bodies which
sit atop the kidneys, have created tremendous interest. This
interest also turned to the problem of obesity when it was
discovered that a condition which in some respects resembles a
severe case of obesity - the so called Cushing's Syndrome - was
caused by a glandular new-growth of the adrenals or by their
excessive stimulation with ACTH, which is the pituitary hormone
governing the activity of the outer rind or cortex of the
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
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
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
Assuming that in man such a
center controlling the movement of fat does exist, its function
would have to be much like that of a bank. When the body
assimilates from the intestinal tract more fuel than it needs at
the moment, this surplus is deposited in what may be compared
with a current account. Out of this account it can always be
withdrawn as required. All normal fat reserves are in such a
current account, and it is probable that a diencephalic center
manages the deposits and withdrawals.
When now, for reasons which will
be discussed later, the deposits grow rapidly while small
withdrawals become more frequent, a point may be reached which
goes beyond the diencephalon's banking capacity. Just as a
banker might suggest to a wealthy client that instead of
accumulating a large and unmanageable current account he should
invest his surplus capital, the body appears to establish a
fixed deposit into which all surplus funds go but from which
they can no longer be withdrawn by the procedure used in a
current account. In this way the diencephalic "fat-bank" frees
itself from all work which goes beyond its normal banking
capacity. The onset of obesity dates from the moment the
diencephalon adopts this labor-saving ruse. Once a fixed deposit
has been established the normal fat reserves are held at a
minimum, while every available surplus is locked away in the
fixed deposit and is therefore taken out of normal circulation.
THREE BASIC CAUSES OF OBESITY:
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
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.
Other Diencephalic Disorders
The second way in which obesity
can become established is the lowering of a previously normal
fat-banking capacity owing to some other diencephalic disorder.
It seems to be a general rule that when one of the many
diencephalic centers is particularly overtaxed; it tries to
increase its capacity at the expense of other centers.
In the menopause and after
castration the hormones previously produced in the sex-glands no
longer circulate in the body. In the presence of normally
functioning sex-glands their hormones act as a brake on the
secretion of the sex-gland stimulating hormones of the anterior
pituitary. When this brake is removed the anterior pituitary
enormously increases its output of these sex-gland stimulating
hormones, though they are now no longer effective. In the
absence of any response from the non-functioning or missing sex
glands, there is nothing to stop the anterior pituitary from
producing more and more of these hormones. This situation causes
an excessive strain on the diencephalic center which controls
the function of the anterior pituitary. In order to cope with
this additional burden the center appears to draw more and more
energy away from other centers, such as those concerned with
emotional stability, the blood circulation (hot flushes) and
other autonomous nervous regulations, particularly also from the
not so vitally important fat-bank.
The so-called stable type of
diabetes heavily 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.
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 -- the emphasis is 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 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 last war
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
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.
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
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. Compulsive eating differs fundamentally from the obese
patient’s 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
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 themselves. In many
of these cases psychotherapy can be helpful, as it enables these
patients to see 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.
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 may 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
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
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
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.
Treatment Of Obesity
If obesity is always due to one
very specific diencephalic deficiency, it follows that the only
way to cure it is to correct this deficiency. At first this
seemed an utterly hopeless undertaking. The greatest obstacle
was that one could hardly hope to correct an inherited trait
localized deep inside the brain, and while we did possess a
number of drugs whose point of action was believed to be in the
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
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
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
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
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
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
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
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 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
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.
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.
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
A brittle case of diabetes is
primarily due to the inability of the pancreas to produce
sufficient insulin, while in the stable type, diencephalic
regulations seem to be of greater importance. That is possibly
the reason why the stable form responds so well to the HCG
method of treating obesity, whereas the brittle type does not.
Obese patients are generally suffering from the stable type, but
a stable type may gradually change into a brittle one, which is
usually associated with a loss of weight. Thus, when an obese
diabetic finds that he is losing weight without diet or
treatment, he should at once have his diabetes expertly attended
to. There is some evidence to suggest that the change from
stable to brittle is more liable to occur in patients who are
taking insulin for their stable diabetes.
All rheumatic pains, even those
associated with demonstrable bony lesions, improve subjectively
within a few days of treatment, and often require neither
cortisone nor salicylates. Again this is a well known phenomenon
in pregnancy, and while under treatment with HCG + 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.
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
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 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
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
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
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.
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
Psoriasis, Fingernails, Hair,
As in pregnancy, psoriasis
greatly improves during treatment but may relapse when the
treatment is over. Most patients spontaneously report a marked
improvement in the condition of brittle fingernails. The loss of
hair not infrequently associated with obesity is temporarily
arrested, though in very rare cases an increased loss of hair
has been reported. I remember a case in which a patient
developed a patchy baldness - so called alopecia areata - after
a severe emotional shock, just before she was about to start an
HCG treatment. Our dermatologist diagnosed the case as a
particularly severe one, predicting that all the hair would be
lost. He counseled against the reducing treatment, but in view
of my previous experience and as the patient was very anxious
not to postpone reducing, I discussed the matter with the
dermatologist and it was agreed that, having fully
acquainted the patient with the situation, the treatment should
be started. During the treatment, which lasted four weeks, the
further development of the bald patches was almost, if not
quite, arrested; however, within a week of having finished the
course of HCG, all the remaining hair fell out as predicted by
the dermatologist. The interesting point is that the treatment
was able to postpone this result but not to prevent it. The
patient has now grown a new shock of hair of which she is justly
In obese patients with large varicose ulcers we were surprised
to find that these ulcers heal rapidly under treatment with HCG.
We have since treated non obese patients suffering from varicose
ulcers with daily injections of HCG on normal diet with equally
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.
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
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
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
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
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
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
As soon as such patients have lost all their abnormal
superfluous fat, they at once begin to feel ravenously hungry in
spite of 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
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
When a patient has more than 15 pounds to lose the treatment
takes longer but the maximum we give in a single course is 40
injections, nor do we as a rule allow patients to lose more than
34 lbs. (15 Kg.) at a time. The treatment is stopped when either
34 lbs. have been lost or 40 injections have been given. The
only exception we make is in the case of grotesquely obese
patients who may be allowed to lose an additional 5-6 lbs. if
this occurs before the 40 injections are up.
Immunity to HCG
The reason for limiting a course
to 40 injections is that by then some patients may begin to show
signs of HCG immunity. Though this phenomenon is well known, we
cannot as yet define the underlying mechanism. Maybe after a
certain length of time the body learns to break down and
eliminate HCG very rapidly, or possibly prolonged treatment
leads to some sort of counter-regulation which annuls the
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.
During menstruation no injections are given, but the diet is
continued and causes no hardship; yet as soon as the
menstruation is over, the patients become extremely hungry
unless the injections are resumed at once. It is very impressive
to see the suffering of a woman who has continued her diet for a
day or two beyond the end of the period without coming for her
injection and then to hear the next day that all hunger ceased
within a few hours after the injection and to see her once again
content, florid and cheerful. While on the question of
menstruation it must he added that in teenaged girls the period
may in some rare cases be delayed and exceptionally stop
altogether. If then later this is artificially induced some
weight may be regained.
Patients requiring the loss of more than 34 lbs. must have a
second or even more courses. A second course can be started
after an interval of not less than six weeks, though the pause
can be more than six weeks. When a third, fourth or even fifth
course is necessary, the interval between courses should be made
progressively longer. Between a second and third course eight
weeks should elapse, between a third and fourth course twelve
weeks, between a fourth and fifth course twenty weeks and
between a fifth and sixth course six months. In this way it is
possible to bring about a weight reduction of 100 lbs. and more
if required without the least hardship to the patient.
In general, men do slightly better than women and often reach a
somewhat higher average daily loss. Very advanced cases do a
little better than early ones, but it is a remarkable fact that
this difference is only just statistically significant.
Conditions that must be accepted
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, bathing or
It is also made clear that between courses the patient gets no
treatment and is free to eat anything he pleases except starches
and sugar during the first 3 weeks. It is impressed upon him
that he will have to follow the prescribed diet to the letter
and that after the first three days this will cost him no
effort, as he will feel no hunger and may indeed have difficulty
in getting down the 500 Calories which he will be given. If
these conditions are not acceptable the case is refused, as any
compromise or half measure is bound to prove utterly
disappointing to patient and physician alike and is a waste of
time and energy.
Though a patient can only consider himself really cured when he
has been reduced to his statistically normal weight, we do not
insist that he commit himself to that extent. Even a partial
loss of overweight is highly beneficial, and it is our
experience that once a patient has completed a first course he
is so enthusiastic about the ease with which the - to him
surprising - results are achieved that he almost invariably
comes back for more. There certainly can be no doubt that in my
clinic more time is spent on damping over-enthusiasm than on
insisting that the rules of the treatment be observed.
Examining the patient
Only when agreement is reached on
the points so far discussed do we proceed with the examination
of the patient. A note is made of the size of the first upper
incisor, of a pad of fat on the nape of the neck, at the axilla
and on the inside of the knees. The presence of striation, a
suprapubic fold, a thoracic fold, angulation of elbow and knee
joint, breast-development in men and women, edema of the ankles
and the state of genital development in the male are noted.
Wherever this seems indicated we
X-ray the sella turcica, as the bony capsule which contains the
pituitary gland is called, measure the basal metabolic rate,
X-ray the chest and take an electrocardiogram. We do a
blood-count and a sedimentation rate and estimate uric acid,
cholesterol, iodine and sugar in the fasting blood.
Gain before Loss
Patients whose general condition
is low, owing to excessive previous dieting, must eat to
capacity for about one week before starting treatment,
regardless of how much weight they may gain in the process. One
cannot keep a patient comfortably on 500 Calories unless his
normal fat reserves are reasonably well stocked.
It is for this reason also that every case, even those that are
actually gaining must eat to capacity of the most fattening food
they can get down until they have had the third injection.
It is a fundamental mistake to put a patient on 500 Calories as
soon as the injections are started, as it seems to take about
three injections before abnormally deposited fat begins to
circulate and thus become available.
We distinguish between the first three injections, which we call
“non-effective” as far as the loss of weight is concerned, and
the subsequent injections given while the patient is dieting,
which we call “effective”. The average loss of weight is
calculated on the number of effective injections and from the
weight reached on the day of the third injection which may be
well above what it was two days earlier when the first injection
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.
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 of HCG
should never be made to coincide with 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
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 have no injection on the
second day of dieting; this exposes them to an unnecessary
hardship, as without the injection they will feel particularly
hungry. Of course, the difficulty can be overcome by
exceptionally injecting them on the first Sunday. If this day
falls between the first and second or between the second and
third injection, we usually prefer to give the patient the extra
day of forced feeding, which the majority rapturously enjoy.
The 500 Calorie diet is explained on the day of the second
injection to those patients who will be preparing their own
food, and it is most important that the person who will actually
cook is present - the wife, the mother or the cook, as the case
may be. Here in Italy patients are given the following diet
Tea or coffee in any quantity without sugar. Only
one tablespoonful of milk allowed in 24 hours.
Saccharin or Stevia may be used.
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,
3. One breadstick (grissino) or
one Melba toast.
4. An apple, orange, or a handful
of strawberries or one-half grapefruit.
The same four choices as lunch (above.)
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 be 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 an orange
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 a
tangerine is not an orange and that chicken breast does not mean
the breast of any other fowl, nor does it mean a wing or
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
Making up the Calories
The diet used in conjunction with HCG must not exceed 500
Calories per day, and the way these Calories are made up is of
utmost importance. For instance, if a patient drops the apple
and eats an extra breadstick instead, he will not be getting
more Calories but he will not lose weight. There are a number of
foods, particularly fruits and vegetables, which have the same
or even lower caloric values than those listed as permissible,
and yet we find that they interfere with the regular loss of
weight under HCG, presumably owing to the nature of their
composition. Pimiento peppers, okra, artichokes and pears are
examples of this.
While this diet works satisfactorily in Italy, certain
modifications have to be made in other countries. For instance,
American beef has almost double the caloric value of South
Italian beef, which is not marbled with fat. This marbling is
impossible to remove. In America, therefore, low-grade veal
should be used for one meal and fish (excluding all those
species such as herring, mackerel, tuna, salmon, eel, etc.,
which have a high fat content, and all dried, smoked or pickled
breast, lobster, crawfish, prawns, shrimps, 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.
In many countries specially prepared unsweetened and low Calorie
foods are freely available, and some of these can be tentatively
used. 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.
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.
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-round 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
take dainty servings of everything, hide what they can under the
cutlery and book the gain which may take three days to get rid
of as one of the sacrifices which their profession entails.
Allowing three days for their correction, such incidents do not
jeopardize the treatment, provided they do not occur all too
frequently in which case treatment should be postponed to a
socially more peaceful season.
Vitamins and Anemia
Sooner or later most patients express a fear that they may be
running out of vitamins or that the restricted diet may make
them anemic. On this score the physician can confidently relieve
their apprehension by explaining that every time they lose a
pound of fatty tissue, which they do almost daily, only the
actual fat is burned up; all the vitamins, the proteins, the
blood, and the minerals which this tissue contains in abundance
are fed back into the body. Actually, a low blood count not due
to any serious disorder of the blood forming tissues improves
during treatment, and we have never encountered a significant
protein deficiency nor signs of a lack of vitamins in patients
who are dieting regularly.
The First Days of Treatment
On the day of the third injection it is almost routine to hear
two remarks. One is: “You know, Doctor, I'm sure it's only
psychological, but I already feel quite different”. So common is
this remark, even from very skeptical patients that we hesitate
to accept the psychological interpretation. The other typical
remark is: “Now that I have been allowed to eat anything I want,
I can't get it down. Since yesterday I feel like a stuffed pig.
Food just doesn't seem to interest me any more, and I am longing
to get on with your diet”. Many patients notice that they are
passing more urine and that the swelling in their ankles is less
even before they start dieting.
On the day of the fourth injection most patients declare that
they are feeling fine. They have usually lost two pounds or
more, some say they feel a bit empty but hasten to explain that
this does not amount to hunger. Some complain of a mild headache
of which they have been forewarned and for which they have been
given permission to take aspirin.
During the second and third day of dieting - that is, the fifth
and sixth injection-these minor complaints improve while the
weight continues to drop at about double the usually overall
average of almost one pound per day, so that a moderately severe
case may by the fourth day of dieting have lost as much as 8- 10
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 well-being until
about a week later. It seems that their normal fat reserves
require that much more time before they are fully stocked.
Fluctuations in weight loss
After the fourth or fifth day of dieting the daily loss of
weight begins to decrease to one pound or somewhat less per day,
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 then 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
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 and begin to
fret. No amount of explanation convinces them that a plateau
does not mean that they are no longer responding normally to
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
Reaching a Former Level
The third type of interruption in the regular loss of weight may
last much longer - ten days to two weeks. Fortunately, it is
rare and only occurs in very advanced cases, and then hardly
ever during the first course of treatment. It is seen only in
those patients who during some period of their lives have
maintained a certain fixed degree of obesity for ten years or
more and have then at some time rapidly increased beyond that
weight. When then in the course of treatment the former level is
reached, it may take two weeks of no loss, in spite of HCG and
diet, before further reduction is normally resumed.
The fourth type of interruption is the one which often occurs a
few days before and during the menstrual period and in some
women at the time of ovulation. It must also be mentioned that
when a woman becomes pregnant during treatment - and this is by
no means uncommon - she at once ceases to lose weight. An
unexplained arrest of reduction has on several occasions raised
our suspicion before the first period was missed. If in such
cases, menstruation is delayed, we stop injecting and do a
precipitation test five days later. No pregnancy test should be
carried out earlier than five days after the last injection, as
otherwise the HCG may give a false positive result.
Oral contraceptives may be used during treatment.
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
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
Salt and Reducing
While we are on the subject of salt, I can take this opportunity
to explain that we make no restriction in the use of salt and
insist that the patients drink large quantities of water
throughout the treatment. We are out to reduce abnormal fat and
are not in the least interested in such illusory weight losses
as can be achieved by depriving the body of salt and by
desiccating it. Though we allow the free use of salt, the daily
amount taken should be roughly the same, as a sudden increase
will of course be followed by a corresponding increase in weight
as shown by the scale. An increase in the intake of salt is one
of the most common causes for an increase in weight from one day
to the next. Such an increase can be ignored, provided it is
accounted for. It in no way influences the regular loss of fat.
Patients are usually hard to convince that the amount of water
they retain has nothing to do with the amount of water they
drink. When the body is forced to retain water, it will do this
at all costs. If the fluid intake is insufficient to provide all
the water required, the body withholds water from the kidneys
and the urine becomes scanty and highly concentrated, imposing a
certain strain on the kidneys. If that is insufficient,
excessive water will be with-drawn from the intestinal tract,
with the result that the feces become hard and dry. On the other
hand if a patient drinks more than his body requires, the
surplus is promptly and easily eliminated. Trying to prevent the
body from retaining water by drinking less is therefore not only
futile but even harmful.
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
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 treatment
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
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
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
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
We are particularly averse to those modern cosmetics which
contain hormones, as any interference with endocrine regulations
during treatment must be absolutely avoided. Many women whose
skin has in the course of years become adjusted to the use of
fat containing cosmetics find that their skin gets dry as soon
as they stop using them. In such cases we permit the use of
plain mineral oil, which has no nutritional value. On the other
hand, mineral oil should not be used in preparing the food,
first because of its undesirable laxative quality, and second
because it absorbs some fat-soluble vitamins, which are then
lost in the stool. We do permit the use of lipstick, powder and
such lotions as are entirely free of fatty substances. We also
allow brilliantine to be used on the hair but it must not be
rubbed into the scalp. Obviously sun-tan oil is prohibited.
Many women are horrified when told that for the duration of
treatment they cannot use face creams or have facial massages.
They fear that this and the loss
of weight will ruin their complexion. They can be fully
reassured. Under treatment normal fat is restored to the skin,
which rapidly becomes fresh and turgid, making the expression
much more youthful. This is a characteristic of the HCG method
which is a constant source of wonder to patients who have
experienced or seen in others the facial ravages produced by the
usual methods of reducing. An obese woman of 70 obviously cannot
expect to have her pued face reduced to normal without a
wrinkle, but it is remarkable how youthful her face remains in
spite of her age.
Incidentally, another interesting feature of the HCG method is
that it does not ruin a singing voice. The typically obese prima
donna usually finds that when she tries to reduce, the timbre of
her voice is liable to change, and understandably this terrifies
her. Under HCG this does not happen; indeed, in many cases the
voice improves and the breathing invariably does. We have had
many cases of professional singers very carefully controlled by
expert voice teachers, and the maestros 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.
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
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.
Towards the end of a full course, when a good deal of fat has
been rapidly lost, some patients complain that lifting a weight
or climbing stairs requires a greater muscular effort than
before. They feel neither breathlessness nor exhaustion but
simply that their muscles have to work harder. This phenomenon,
which disappears soon after the end of the treatment, is caused
by the removal of abnormal fat deposited between, in, and around
the muscles. The removal of this fat makes the muscles too long,
and so in order to achieve a certain skeletal movement - say the
bending of an arm - the muscles have to perform greater
contraction than before. Within a short while the muscle adjusts
itself perfectly to the new situation, but under HCG the loss of
fat is so rapid that this adjustment cannot keep up with it.
Patients often have to be reassured that this does not mean that
they are “getting weak”. This phenomenon does not occur in
patients who regularly take vigorous exercise and continue to do
so during treatment.
I never allow any kind of massage during treatment. It is
entirely unnecessary and merely disturbs a very delicate process
which is going on in the tissues. Few indeed are the masseurs
and masseuses who can resist the temptation to knead and hammer
abnormal fat deposits. In the course of rapid reduction it is
sometimes possible to pick up a fold of skin which has not yet
had time to adjust itself, as it always does under HCG, to the
changed figure. This fold contains its normal subcutaneous fat
and may be almost an inch thick. It is one of the main objects
of the HCG treatment to keep that fat there. Patients and their
masseurs do not always understand this and give this fat a
working-over. I have seen such patients who were as black and
blue as if they had received a sound thrashing.
In my opinion, massage, thumping, rolling, kneading, and
shivering undertaken for the purpose of reducing abnormal fat
can do nothing but harm. We once had the honor of treating the
proprietress of a high class institution that specialized in
such antics. She had the audacity to confess that she was taking
our treatment to convince her clients of the efficacy of her
methods, which she had found useless in her own case.
How anyone in his right mind is able to believe that fatty
tissue can be shifted mechanically or be made to vanish by
squeezing is beyond my comprehension. The only effect obtained
is severe bruising. The torn tissue then forms scars, and these
slowly contract making the fatty tissue even harder and more
A lady once consulted us for her most ungainly legs. Large
masses of fat bulged over the ankles of her tiny feet, and there
were about 40 lbs. too much on her hips and thighs. We assured
her that this overweight could be lost and that her ankles would
markedly improve in the process. Her treatment progressed most
satisfactorily but to our surprise there was no improvement in
her ankles. We then discovered that she had for years been
taking every kind of mechanical, electric and heat treatment for
her legs and that she had made up her mind to resort to plastic
surgery if we failed.
Re-examining the fat above her ankles, we found that it was
unusually hard. We attributed this to the countless minor
injuries inflicted by kneading. These injuries had healed but
had left a tough network of connective scar-tissue in which the
fat was imprisoned. Ready to try anything, she was put to bed
for the remaining three weeks of her first course with her lower
legs tightly strapped in unyielding bandages. Every day the
pressure was increased. The combination of HCG, diet and
strapping brought about a marked improvement in the shape of her
ankles. At the end of her first course she returned to her home
abroad. Three months later she came back for her second course.
She had maintained both her weight and the improvement of her
ankles. The same procedure was repeated, and after five weeks
she left the hospital with a normal weight and legs that, if not
exactly shapely, were at least unobtrusive. Where no such
injuries of the tissues have been inflicted by inappropriate
methods of treatment, these drastic measures are never
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 three days of treatment continue beyond that time, and
in some cases this has seemed to speed up the euphoria
ordinarily associated with the HCG method.
The Ratio of Pounds to Inches
An interesting feature of the HCG method is that, regardless of
how fat a patient is, the greatest circumference -- abdomen or
hips as the case may be is reduced at a constant rate which is
extraordinarily close to 1 cm. per kilogram of weight lost. At
the beginning of treatment the change in measurements is
somewhat greater than this, but at the end of a course it is
almost invariably found that the girth is as many centimeters
less as the number of kilograms by which the weight has been
reduced. I have never seen this clear cut relationship in
patients that try to reduce by dieting only.
Preparing the Solution
Human chorionic gonadotrophin
comes on the market as a highly soluble powder which is the pure
substance extracted from the urine of pregnant women. Such
preparations are carefully standardized, and any brand made by a
reliable pharmaceutical company is probably as good as any
other. The substance should be extracted from the urine and not
from the placenta, and it must of course be of human and not of
animal origin. The powder is sealed in ampoules or in
rubber-capped bottles in varying amounts which are stated in
International Units. In this form HCG is stable; however, only
such preparations should be used that have the date of
manufacture and the date of expiry clearly stated on the label
or package. A suitable solvent is always supplied in a separate
ampoule in the same package.
Once HCG is in solution it is far less stable. It may be kept at
room-temperature for two to three days, but if the solution must
be kept longer it should always be refrigerated. When treating
only one or two cases simultaneously, vials containing a small
number of units say 1000 I.U. should be used. The 10 cc. of
solvent which is supplied by the manufacturer is injected into
the rubber- capped bottle containing the HCG, and the powder
must dissolve instantly. Of this solution 1.25 cc. are withdrawn
for each injection. One such bottle of 1000 I.U. therefore
furnishes 8 injections. When more than one patient is being
treated, they should not each have their own bottle but rather
all be injected from the same vial and a fresh solution made
when this is empty.
As we are usually treating a fair
number of patients at the same time, we prefer to use vials
containing 5000 units. With these the manufactures also supply
10 cc. of solvent. Of such a solution 0.25 cc. contain the 125
I.U., which is the standard dose for all cases and which should
never be exceeded. This small amount is awkward to handle
accurately (it requires an insulin syringe) and is wasteful,
because there is a loss of solution in the nozzle of the syringe
and in the needle. We therefore prefer a higher dilution, which
we prepare in the following way: The solvent supplied is
injected into the 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
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
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
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. Obviously needles and syringes must be
carefully washed, sterilized and handled aseptically.
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
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.
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
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.
In obese patients who have recently survived a coronary
occlusion, we adopt the following procedure in collaboration
with the cardiologist. We wait until no further
electrocardiographic changes have occurred for a period of three
months. Routine treatment is then started under careful control
and it is usual to find a further electrocardiographic
improvement of a condition which was previously stationary.
In the thousands of cases we have treated we have not once seen
any sort of coronary incident occur during or shortly after
treatment. The same applies to cerebral vascular accidents. Nor
have we ever seen a case of thrombosis of any sort develop
during treatment, even though a high blood pressure is rapidly
lowered. In this respect, too, the HCG treatment resembles
Teeth and Vitamins
Patients whose teeth are in poor
repair sometimes get more trouble under prolonged treatment,
just as may occur in pregnancy. In such cases we do allow
calcium and vitamin D, though not in an oily solution. The only
other vitamin we permit is vitamin C, which we use in large
doses combined with an antihistamine at the onset of a common
cold. There is no objection to the use of an antibiotic if this
is required, for instance by the dentist. In cases of bronchial
asthma and hay fever we have occasionally resorted to cortisone
during treatment and find that triamcinolone is the least likely
to interfere with the loss of weight, but many asthmatics
improve with HCG alone.
Obese heavy drinkers, even those bordering on alcoholism, often
do surprisingly well under HCG and it is exceptional for them to
take a drink while under treatment. When they do, they find that
a relatively small quantity of alcohol produces intoxication.
Such patients say that they do not feel the need to drink. This
may in part be due to the euphoria which the treatment produces
and in part to the complete absence of the need for quick
sustenance from which most obese patients suffer.
Though we have had a few cases that have continued abstinence
long after treatment, others relapse as soon as they are back on
a normal diet. We have a few “regular customers” who, having
once been reduced to their normal weight, start to drink again
though watching their weight. Then after some months they
purposely overeat in order to gain sufficient weight for another
course of HCG which temporarily gets them out of their drinking
routine. We do not particularly welcome such cases, but we see
no reason for refusing their request.
It is interesting that obese patients suffering from inactive
pulmonary tuberculosis can be safely treated. We have under very
careful control treated patients as early as three months after
they were pronounced inactive and have never seen a relapse
occur during or shortly after treatment. In fact, we only have
one case on our records in which active tuberculosis developed
in a young man about one year after a treatment which had lasted
three weeks. Earlier X-rays showed a calcified spot from a
childhood infection which had not produced clinical symptoms.
There was a family history of tuberculosis, and his illness
started under adverse conditions which certainly had nothing to
do with the treatment. Residual calcifications from an early
infection are exceedingly common, and we never consider them a
contraindication to treatment.
The Painful Heel
In obese patients who have been
trying desperately to keep their weight down by severe dieting,
a curious symptom sometimes occurs. They complain of an
unbearable pain in their heels which they feel only while
standing or walking. As soon as they take the weight off their
heels the pain ceases. These cases are the bane of the
rheumatologists and orthopedic surgeons who have treated them
before they come to us. All the usual investigations are
entirely negative, and there is not the slightest response to
anti- rheumatic medication or physiotherapy. The pain may be so
severe that the patients are obliged to give up their
occupation, and they are not infrequently labeled as a case of
hysteria. When their heels are carefully examined one finds that
the sole is softer than normal and that the heel bone - the
calcaneus - can be distinctly felt, which is not the case in a
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
though we have been able to follow up such patients for years.
We are particularly interested in these cases, as they furnish
further proof of the contention that HCG + 500 Calories not only
removes abnormal fat but actually permits normal fat to be
replaced, in spite of the deficient food intake. It is certainly
not so that the mere loss of weight reduces the pain, because it
frequently disappears before the weight the patient had prior to
the period of forced feeding is reached.
The Skeptical Patient
Any doctor who starts using the HCG method for the first time
will have considerable difficulty, particularly if he himself is
not fully convinced, in making patients believe that they will
not feel hungry on 500 Calories and that their face will not
collapse. New patients always anticipate the phenomena they know
so well from previous treatments and diets and are incredulous
when told that these will not occur. We overcome all this by
letting new patients spend a little time in the waiting room
with older hands, who can always be relied upon to allay these
fears with evangelistic zeal, often demonstrating the finer
points on their own body.
A waiting-room filled with obese
patients who congregate daily is a sort of group therapy. They
compare notes and pop back into the waiting room after the
consultation to announce the score of the last 24 hours to an
enthralled audience. They cross-check on their diets and
sometimes confess sins which they try to hide from us, usually
with the result that the patient in whom they have confided
palpitatingly tattles the whole disgraceful story to us with a
“But don't let her know I told you.”
Concluding a Course
When the three days of dieting after the last injection are
over, the patients are told that they may now eat anything they
please, except sugar and starch provided they faithfully observe
one simple rule. This rule is that they must have their own
portable bathroom-scale always at hand, particularly while
traveling. They must without fail weigh 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
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.
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
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
Plan of a Normal Course
125 I.U. of HCG daily (except during menstruation) until 40
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.
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 even
though our theory may be wrong 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
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
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
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, or polio, but they often cause life long
suffering. How many promising careers have been ruined by
excessive fat; how many lives have been shortened. If some way
-however cumbersome - can be found to cope effectively with this
universal problem of modern civilized man, our world will be a
happier place for countless fellow men and women.
ACNE . . .
Common skin disease in which pimples, often containing pus,
appear on face, neck and shoulders.
ACTH . . .
Abbreviation for adrenocorticotrophic hormone. One of the many
hormones produced by the anterior lobe of the pituitary gland.
ACTH controls the outer part, rind or cortex of the adrenal
glands. When ACTH is injected it dramatically relieves arthritic
pain, but it has many undesirable side effects, among which is a
condition similar to severe obesity. ACTH is now usually
replaced by cortisone.
ADRENALIN . . .
Hormone produced by the inner part of the Adrenals. Among many
other functions, adrenalin is concerned with blood pressure,
emotional stress, fear and cold.
ADRENALS . . .
Endocrine glands. Small bodies situated atop the kidneys and
hence also known as suprarenal glands. The adrenals have an
outer rind or cortex which produces vitally important hormones,
among which are Cortisone similar substances. The adrenal cortex
is controlled by ACTH. The inner part of the adrenals, the
medulla, secretes adrenalin and is chiefly controlled by the
autonomous nervous system.
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, etc., 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.
ASCHHIEIM-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 . . .
Absorb 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
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
CONGENITAL . . .
Any condition which exists at or before birth.
. . . 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 triamcinolone.
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
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 . . .
EUPHORIA . . .
A feeling of particular physical and mental well being.
FERAL . . .
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 . . .
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
HCG . . .
Abbreviation for human chorionic gonadotrophin
HORMONES . . .
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 . . .
MYOCARDIUM . . .
MYOMA . . .
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
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
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 have 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
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
SUPRARENAL GLANDS . . .
SYNDROME . . .
A group of symptoms which in their association are
characteristic of a particular disorder.
THROMBOPHLEBITIS . . .
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
VEGETATIVE . . .
VERTEBRATE . . .
Any animal that has a back-bone.
Literary References to the Use of
Nov. 6, 1954
Nov. 15, 1958
Letter to Editor
July 29, 1961
Letter to Editor
Dec. 9, 1961
Dec. 9, 1961
Letter to Editor
Jan. 6, 1962
Letter to Editor
Nov. 26, 1966
Letter to Editor
THE JOURNAL OF THE AMERICAN GERIATRIC SOCIETY
Jan. 1956 Article
THE AMERICAN JOURNAL OF CLINICAL NUTRITION
Craig et al.
Letter to Editor
Letter to Editor
Letter to Editor
THE JOURNAL OF PLASTIC SURGERY (British)
THE SOUTH AFRICAN MEDICAL JOURNAL
Feb 1963 Article
Politzer, Berson & Flaks
POUNDS AND INCHES Privately
printed: obtainable only from A.T.W. Simeons, Salvator Mundi
International Hospital, Rome, Italy
VETSUCHT (Netherlands Edition)
Wetenschappelijke Uitgeverij, N.V. Amsterdam
MAN’S PRESUMPTUOUS BRAIN Longman’s, Green, London
E.P. Dutton, New York (hardback)
Dutton Paperbacks, New York
A list of
references to the more important articles is given at
the end of this booklet.
account” is the British name for what Americans call a
some clinical evidence to suggest that those symptoms of
Cushing’s Syndrome which resemble true obesity are
caused by the same mechanism which causes common
obesity, while the other symptoms of the syndrome
are directly due to adrenocortical dysfunction.
= the concluding state of pregnancy
As we are
speaking of purely regulatory disorders, we obviously
exclude all such cases in which there are gross organic
lesions of the pituitary or of the sex-glands
We use 1
tablet of hygroton.
practice is obsolete. Modern sanitary methods
dictate throwing away used needles and syringes and
using new ones for each injection.
unfamiliar terms are used, they will be found in their
respective alphabetical place. The lay reader can
therefore make his own cross-reference.