Dealing with loose skin during weight loss -

Dealing with loose skin during weight loss
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. 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. have been lost or 40 injections have been given. In all these cases a loss of weight brought about by dieting, treatments with thyroid, appetite-reducing drugs, laxatives, violent exercise, massage, baths, etc. Usually after about 40 injections patients may feel the onset of immunity as hunger which was previously absent. I immediately thought of cancer and decided to which of my colleagues at the hospital I would refer her. 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. 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. The only way to find out is to treat such patients. One cannot keep a patient comfortably on 500 Calories unless his normal fat reserves are reasonably well stocked. 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. When such a patient is carefully examined one finds many signs of potential obesity, which is just about to become manifest as overweight. When such a person is suddenly able to obtain highly refined foods such as sugar, white flour, butter and oil these are so rapidly digested and assimilated that the rush of incoming fuel which occurs at every meal may eventually overpower the diecenphalic regulatory mechanisms and thus lead to obesity. Recently, many students of obesity have reverted to the nihilistic attitude that obesity is caused simply by overeating and that it can only be cured by under eating. In the first place, more caloric energy is required to keep a large body at a certain temperature than to heat a small body. 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. 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 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. 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. The interesting point is that the treatment was able to postpone this result but not to prevent it. This was easy to find out, as in that case, fat on the move would be able to replace food. 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. 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. The only exception we make is in the case of grotesquely obese patients who may be allowed to lose an additional 5-6 lbs. 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. Normal values are always regained a few days after the treatment is over. 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. From this point it was a small step to try the same method in all other forms of obesity. Some patients are deeply attached to their fat and cannot bear the thought of losing it. Very advanced cases do a little better than early ones, but it is a remarkable fact that this difference is only just statistically significant. 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. In all of them, modern research is becoming more and more inclined to believe that diencephalic regulations play a dominant role in their causation. 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. 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. 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. 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. In obese patients with large varicose ulcers we were surprised to find that these ulcers heal rapidly under treatment with HCG. 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. 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. 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. 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. 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. A person who is free of the disorder will never get fat, even if he frequently overeats. 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. As in pregnancy, this phenomenon is not observed in the brittle type of diabetes, and as some cases that are predominantly stable may have a small brittle factor in their clinical makeup, all obese diabetics have to be kept under a very careful and expert watch. 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. If they are intelligent, popular and successful in spite of their handicap, this is a source of pride. Only then can there be intelligent cooperation between physician and patient. For instance, if the diet is increased from 500 to 600 or 700 Calories, the loss of weight is quite unsatisfactory. In many cases striation is so fine that the small white lines are only just visible. 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 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. Moreover, their excess fat shows no preference for certain typical regions of the body, as does the fat in all cases of obesity. She can drastically reduce her diet without feeling hunger or discomfort and lose weight without in any way harming the child in her womb. 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. In the course of this study three interesting things emerged. 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. 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. ) at a time. The muscular effort consumes Calories which must be provided by food. Her dry skin hung loosely over the bones of her face, her neck was scrawny and collarbones and ribs stuck out from deep hollows. 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. 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. The explanation is that in these cases there is a compensatory flow of urine, which drains excessive water from the body. The treatment is stopped when either 34 lbs. They may feel horrified by the appearance of their nude body and the tightness of their clothes. Weight alone is not a satisfactory criterion by which to judge whether a person is suffering from the disorder we call obesity or not. 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. But there is a third type of fat which is entirely abnormal. They are not accustomed as we are, to think thyroid, insulin, cortisone, adrenalin etc, as hormones. 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. 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. 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. Treating them for obesity is a heartrending job. An affectionate attachment to abnormal fat is usually seen in patients who became obese in childhood, but this is not necessarily so. 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. When the skin is stretched by fat rapidly accumulating under it, it may split in the lower layers. As often happens in medicine, much confusion has been caused by giving HCG its name before its true mode of action was understood. 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. It has also long been known that the destruction of another diencephalic center produces a voracious appetite and a rapid gain in weight in animals which never get fat spontaneously. Cholesterol circulates in two forms, which we call free and esterified. When the arms are outstretched with the palms upward, the forearms appear sharply angled outward from the upper arms. When this center is destroyed in laboratory animals, they develop a condition rather similar to human stable diabetes. 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. 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. Somehow, somewhere this surplus had to be stored. 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. 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. and more if required without the least hardship to the patient. 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 theater-going. 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. When the blood pressure is abnormally high, and provided there are no detectable renal lesions, the pressure drops, as it usually does in pregnancy. Thus, all other factors being equal, a fat person requires more food than a lean one. When sexual deficiency is clinically present, this is a sign that the diencephalic center concerned is unable, in spite of maximal exertion, to cope with the demand for anterior pituitary stimulation. These hormones are real gonadotrophins because they directly govern the function of the ovaries. 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. Patients who need only 23 injections may be injected daily, including Sundays, as they never develop immunity. This most important gland lies well protected in a bony capsule at the base of the skull. 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. 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. Their skin wrinkles and they look old and miserable. 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. Though this phenomenon is well known, we cannot as yet define the underlying mechanism. The human type of chorionic gonadotrophin is found only during the pregnancy of women and the great apes. 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. It is the substance which Aschheim and Zondek so brilliantly used to diagnose early pregnancy out of the urine. We do a blood-count and a sedimentation rate and estimate uric acid, cholesterol, iodine and sugar in the fasting blood. 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. But although a large number of pituitary hormones have been isolated and many extracts of the gland prepared, not a single one or any combination of such factors proved to be of any value in the treatment of obesity. 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. 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. 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 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. The diencephalon is the part from which the central nervous system controls all the automatic animal functions of the body, such as breathing, the heart beat, digestion, sleep, sex, the urinary system, the autonomous or vegetative nervous system and via the pituitary the whole interplay of the endocrine glands. Within about three months, 85% were suffering from obesity. 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. 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. 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. A woman may gain weight during pregnancy, but she never becomes obese in the strict sense of the word. The first is the structural fat which fills the gaps between various organs, a sort of packing material. On the other hand, the diencephalon is an extremely robust organ in spite of its unbelievable intricacy. At one time it was thought that this mechanism might be concerned with the sex glands. 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. Some complicating disorders are often associated with obesity, and these we must briefly discuss. 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. Today we believe that the rise is entirely due to the liberation of recent cholesterol deposits that have not yet undergone calcification in the arterial wall and therefore highly beneficial. 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. 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. In menstruating women, the best time to start treatment is immediately after a period. What its evolution did not prepare it for were the conditions to which human culture and civilization now expose it. 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 diencephalic effect. 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. Wherever abnormal fat was regarded as an asset, sexual selection tended to propagate the trait. As in pregnancy, psoriasis greatly improves during treatment but may relapse when the treatment is over. It becomes completely ineffective as soon as all abnormal fat is consumed. Thus any weight loss brought about by thyroid medication is always at the expense of fat of which the body is in dire need. In obesity this balance is out of kilter and can only be restored if the technique I am about to describe is followed implicitly. 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. Only then are the patients free to eat anything they please except sugar and starches for the next three weeks. Other mammals make use of a different hormone, which can be extracted from their blood serum but not from their urine. What it must do is to give us an intellectually satisfying interpretation of what is happening in the obese body. The next gland to be falsely incriminated was the anterior lobe of the pituitary, or hypophysis. 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. We have grown pretty sure that the tendency to accumulate abnormal fat is a very definite metabolic disorder, much as is, for instance, diabetes. In the menopause and after castration the hormones previously produced in the sex-glands no longer circulate in the body. 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. 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. 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. 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. Similarly, the end of a course of HCG should never be made to coincide with menstruation. 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. 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. 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. 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. 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. 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. 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. 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. 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. I felt that we were merely nibbling at the fringe of a great problem, as, indeed, do most serious students of overweight. 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. Such a connection was suggested by the fact that many juvenile obese patients show an under-development of the sex organs. 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. She sat down in front of my desk, and when I looked up to greet her I saw the typical picture of advanced emaciation. 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. A second course can be started after an interval of not less than six weeks, though the pause can be more than six weeks. We have since treated non obese patients suffering from varicose ulcers with daily injections of HCG on normal diet with equally good results. 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. All normal fat reserves are in such a current account, and it is probable that a diencephalic center manages the deposits and withdrawals. From that moment on she is suffering from obesity and is subject to all its consequences. They are always a sure sign of obesity, and though this may be slight at the time of examination such patients can usually remember a period in their childhood when they were excessively chubby. In pre-Neolithic times, man ate only when he was hungry and on1y as much as he required to still the pangs of hunger. The patient then strips and is weighed and measured. 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. 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. In any case, the whole gain is usually lost in the first 48 hours of dieting. At confinement she is suddenly deprived of HCG, and her diencephalic fat-center reverts to its normal capacity. 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. 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. 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. When the total amount of circulating cholesterol is normal before treatment, this absolute amount is neither significantly increased nor decreased. Such normal reserves are localized all over the body. 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. When they see that under HCG their figure improves out of all proportion to the amount of weight lost, they are nearly always content to remain within their normal weight-range. 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. Most patients spontaneously report a marked improvement in the condition of brittle fingernails. 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 book discusses a new interpretation of the nature of obesity, and while it does not advocate yet another fancy slimming diet it does describe a method of treatment which has grown out of theoretical considerations based on clinical observation. I have never yet seen or heard of such a lady being convinced by either procedure. 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. It is only then that the abnormally accumulated fat is locked away again in a fixed deposit. This is a complete rendering of the original document, with slight formatting changes to make the paragraphs look nice. If then later this is artificially induced some weight may be regained. 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. Only if these conditions are fulfilled can we legitimately speak of curing obesity rather than of reducing weight. 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. 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. 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. 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. Obese patients only feel physically well as long as they are stationary or gaining weight. We never give a treatment lasting less than 26 days, even in patients needing to lose only 5 pounds. 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. Today obesity is extremely common among all civilized races, because a disposition to the disorder can be inherited. 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. The fat they have come to detest stays on and the fat they need to cover their bones gets less and less. This has nothing to do with diverted instincts. Yet every physician who has studied obese patients under rigorously controlled conditions knows that this is not true. The average loss of weight is calculated on the number of effective injections and from the weight reached on the day of the third injection which may be well above what it was two days earlier when the first injection was given. I must warn the lay reader that what follows is mainly for the treating physician and most certainly not a do-it-yourself primer. 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. The blood sugar continues to drop from day to day and often reaches normal values in 2-3 weeks. In pregnancy this proportion is reversed and it may he taken for granted that arteriosclerosis never gets worse during pregnancy for this very reason. It has been explained that gonadotrophin literally means a sex-gland directed substance or hormone, and this is quite misleading. 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. 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. Only when agreement is reached on the points so far discussed do we proceed with the examination of the patient. Though they were not restricted in diet, there was a distinct decrease in the circumference of their hips. ) or less require 26 days treatment with 23 daily injections. 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. The pressure is then let off through another primitive channel, which is oral gratification. I have yet to see a patient who continues to complain after the figure has been rendered normal by adequate treatment. On the other hand, compulsive eating does occur in some obese patients, particularly in girls in their late teens or early twenties. This rule need not be observed in such patients who have reached their normal weight before the end of treatment and are already on a higher caloric diet. The onset of obesity dates from the moment the diencephalon adopts this labor-saving ruse. The second was that small daily doses appeared to be just as effective as much larger ones given twice a week. 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. must have a second or even more courses. It is, for instance, well known that during pregnancy an obese woman can very easily lose weight. This change was the institution of regular meals. After 40 daily injections it takes about six weeks before this so called immunity is lost and HCG again becomes fully effective. Persons suffering from this particular disorder will get fat regardless of whether they eat excessively, normally or less than normal. 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. At that time we knew very little about the function of the diencephalon, and my interest centered round the pituitary gland. 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 is no exaggeration to say that the flooding of the female body with HCG is by far the most spectacular hormonal event in pregnancy. There is considerable evidence to suggest that it is the HCG produced in large quantities in the placenta which brings about this diencephalic change. 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. if this occurs before the 40 injections are up. To me this requirement seems basic, and it has always been the center of my interest. When an obese patient tries to reduce by starving himself, he will first lose his normal fat reserves. by retention enema, as good results could be obtained as by injecting the pure substance. For such persons weight is no problem, as they can gain or lose at will and experience no difficulty in reducing their caloric intake. 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. 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. 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. The patient distinctly feels that something is wrong with her, that a subtle change is taking place in her body, and this alarms her. 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. There seems to be rather a lack of adrenocortical function and a decrease in the secretion of ACTH from the anterior pituitary lobe. Here, too, there is a similarity with pregnancy, in which peptic ulcers hardly ever occur. Their placenta differs in this and other respects from that of man and the great apes. 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. Clinically this expresses itself, in the fact that, when in these mild cases, treatment is stopped as soon as the weight is normal, which may be achieved in a week, it is much more easily regained than after a full course of 23 injections. 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. And then, as in a jig saw puzzle, little clusters of fragments began to form, though they seemed to fit in nowhere. Patients suffering from real compulsive eating are comparatively rare. 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 has an enormous protective importance for mother and child, and I even go so far as to say that no woman, and certainly not an obese one, could carry her pregnancy to term without it. 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. A summary of the 500 calorie diet in this manuscript is available here. But invariably the results were disappointing and lacking in uniformity. As soon as their statistically normal weight is reached, these patients are put on 800-1000 Calories for the rest of the treatment. 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. Pregnancy seems to be the only normal human condition in which the diencephalic fat-banking capacity is unlimited. Moreover, patients suffering only from a severe lack of thyroid hormone never become obese in the true sense. 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. In manifest obesity many and often all these signs and symptoms are present. The reason for limiting a course to 40 injections is that by then some patients may begin to show signs of HCG immunity. 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. Some fat girls look upon their condition as a safeguard against erotic involvements, of which they are afraid. 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. 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. 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. For those of us who refused to be discouraged there remained one slight hope. Some patents say that they can no longer overeat because their stomach has shrunk after years of restrictions. However we have seen two cases with a previous history of several hemorrhages in which a bleeding occurred within 2 weeks of the end of treatment. 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. The extra three days are needed because all patients must continue the 500-Calorie diet for three days after the last injection. Patients who have successfully established an erotic transfer to their psychiatrist are often better able to bear their suffering as a secret labor of love. They may feel guilty, owing to the lethargy and indolence always associated with obesity. Much has been written about the psychological aspects of obesity. 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. It is not suited to occasional gorging as is, for instance, the intestine of the carnivorous cat family. You can download a PDF version of the document here. 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. Secondly the muscular effort of moving a heavy body is greater than in the case of a light body. 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. 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. 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. The reason is simply that none of these measures corrects the basic disorder. 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. The administration of HCG does in fact do this in a remarkable way. 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. It is the accumulation of such fat, and of such fat only, from which the overweight patient suffers. 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. 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. At first this seemed an utterly hopeless undertaking. It neither makes men grow breasts nor does it interfere with their virility, though where this was deficient it may improve it. 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. 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. As the years passed these clusters grew bigger and started to amalgamate until, about sixteen years ago, a complete picture became dimly discernible. Another typical sign is a pad of fat on the insides of the knees, a spot where normal fat reserves are never stored. 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. 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. In these many years of specialized work thousands of cases have passed through my hands and were carefully studied. The other common factor is that they either improve or do not occur during pregnancy. 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. 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. 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. At the end of a treatment lasting five weeks, she, a small woman, had lost 8 inches round her hips, while her face looked fresh and florid, the ribs were no longer visible and her weight was the same to the ounce as it had been at the first consultation. 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. 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. The reason is that in my experience the lady is nearly always right and the doctor wrong. 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. On the days on which they do not receive the injections they usually feel a slight sensation of hunger. 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. 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. The latter are entirely different substances from that which can be extracted from pregnancy urine and which, unfortunately, is called chorionic gonadotrophin. In these cases I have found that psychotherapy may make the patient fully understand the mechanism, but it does nothing to stop it. 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. 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. 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. 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. 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. 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. I found that, though most patients were treated in the outpatients department, gross dietary errors rarely occurred. Those who tried were obliged to gain their own experience through the many trials and errors which I have long since overcome. No end of injustice is done to obese patients by accusing them of compulsive eating, which is a form of diverted sex gratification. 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. When large and fresh, such tears are purple, but later they are transformed into white scar-tissue. It was also perfectly evident that only abnormal fat was being consumed, as there were no signs of any depletion of normal fat. 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. If we can from the outset establish this as a mutually accepted convention, I hope to avoid being accused of speculative exuberance. Of this lowering of the blood pressure during treatment the patients are not aware. 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. 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. 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. Search the site and manuscript using the search menu above, or to answer some of the most common questions, view our FAQ. The history of this enquiry is a long series of high hopes and bitter disappointments. 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. HCG cannot therefore have a direct sex gland stimulating action like that of the anterior pituitary gonadotrophins, as FSH and LSH are justly called. Mulling over this depressing situation, I remembered a rather curious observation made many years ago in India. In general, men do slightly better than women and often reach a somewhat higher average daily loss. Such a congenitally low diencephalic capacity would then represent the inherited factor in obesity. This is even so in those patients who have been taking thyroid because they had an abnormally low basal metabolic rate. 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. The patient has now grown a new shock of hair of which she is justly proud. This is not only undesirable, but normal fat is also instantly regained as soon as the patient is returned to a free diet. 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. In this way it is possible to bring about a weight reduction of 100 lbs. It is, so to speak, locked away in a fixed deposit and is not kept in a current account, as are the normal reserves. 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. They may feel ashamed of what they have been led to believe is a lack of control. They feel famished and tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper arms show little improvement. Our dermatologist diagnosed the case as a particularly severe one, predicting that all the hair would be lost. 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. 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. 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. It comes on in attacks and is never associated with real hunger, a fact which is readily admitted by the patients. I remember the case of a lady who was escorted into my consulting room while I was telephoning. Film actresses frequently explain that they must weigh less than normal. 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. 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. Out of this account it can always be withdrawn as required. 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. Some have a feeling that reducing means giving up an almost cherished and intimate part of themselves. It is also surprising to what extent a woman can suffer from pregnancy-vomiting without coming to any real harm. Thus, the decision whether a borderline case is really suffering from obesity or not cannot be made merely by consulting weight tables. 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. 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. It never makes women grow a beard or develop a gruff voice. 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. 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. 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. The behavior of circulating cholesterol is therefore of particular interest during the treatment of obesity with HCG. Indeed, I felt a little annoyed that my assistant had not explained to her that her case did not fall under my specialty. Food rendered easily digestible suddenly flooded his body with nourishment of which he was in no need at the moment. They do perfectly well between attacks, but a single bout occurring while under treatment may annul several weeks of therapy. 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. Alternatively, at least three injections should be given after the period, followed by the usual three days of dieting. HCG has been known for over half a century. 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. 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 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. 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. 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 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. There must thus be some other mechanism at work. They are masters of their weight, which the obese are not. In answer to my query as to what I could do for her, she replied that she wanted to reduce. Yet the localization and the nature of this disorder remained a mystery. In the human body we can distinguish three kinds of fat. Patients who need to lose 15 pounds (7 kg. Unless this is so, we are entitled to harbor grave doubts as to whether a given treatment corrects the underlying disorder. 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. Such disorders are, for instance, colitis, duodenal or gastric ulcers, certain allergies, psoriasis, loss of hair, brittle fingernails, migraine, etc. Many obese patients actually gain weight on a diet which is calorically deficient for their basic needs. 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. This seems an important indication of how closely a patient under HCG treatment resembles a pregnant woman in diencephalic behavior. So here again our search for the mechanism which produces obesity led us into a blind alley. 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. The so-called stable type of diabetes heavily involves the diencephalic blood sugar regulating center. The first was that when fresh pregnancy-urine from the female ward was given in quantities of about 300 cc. In any case, the HCG method makes it possible in obese arthritic patients to interrupt prolonged cortisone treatment without a recurrence of pain. It is a particularly interesting feature of the HCG treatment that in reasonably cooperative patients this figure is remarkably constant, regardless of sex, age and degree of overweight. It also provides the springy cushion of hard fat under the bones of the feet, without which we would be unable to walk. Patients requiring the loss of more than 34 lbs. 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. 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. 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. When a third, fourth or even fifth course is necessary, the interval between courses should be made progressively longer. 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. 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. Yet once that has happened, no amount of psychotherapy or analysis, happiness, company or the gratification of other instincts will correct the condition. 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. Patients who have brought themselves to the brink of malnutrition by exaggerated dieting, laxatives etc, often have an abnormally low blood pressure. 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. 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. There is a triangular fatty bulge in front of the armpit when the arm is held against the body. Jutting out from a tiny waist she had enormous hips and thighs. 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. It seems that even in the mildest cases of obesity the diencephalon requires about three weeks rest from the maximal exertion to which it has been previously subjected in order to regain fully its normal fat-banking capacity. 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. Once this trail was opened, further observations seemed to fall into line. 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. There are a number of signs and symptoms which are characteristic of obesity. In this way a patient may be brought to the brink of starvation in spite of having a hundred pounds of fat to spare. 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. The first is that the fat-banking capacity is abnormally low from birth. Moreover, much of his food was raw and all of it was unrefined. This situation causes an excessive strain on the diencephalic center which controls the function of the anterior pituitary. Assuming that in man such a center controlling the movement of fat does exist, its function would have to be much like tha