Wednesday, January 19, 2011

The HCG Diet - Short Term Weight Loss, Long Term Health Risks


There's so many new diets popping up promising instant weight loss and grand successes that it's hard to really know which ones are truly good for you and which ones fall short on their long term promises.  The HCG diet is the latest popular craze in the land of overnight weight loss programs.  You might have seen it advertised or promoted by the various wellness clinics, physicians, and health food stores out there.  But is it all that it's cracked up to be?  Read further as I give you insights on this diet and breakdown the science behind what it really means to choose healthy foods to get the weight loss you're looking for while promoting your long term health at the same time.

What is the HCG diet?

The HCG diet was developed by Dr. A.T.W. Simeons out of Italy.  I took the liberty of reading Dr. Simeons entire manuscript of the diet which can be found here.  All of the following information comes directly from his manuscript.

What Dr. Simeons found is that administering daily doses of a substance called Human Choriogonadotropin (HCG), a hormone produced only by pregnant women, to his patients helped control a center of the brain that is responsible for appetite and hunger sensation.  He also found that HCG helped the body convert abnormal fat reserves into usable energy without affecting normal fat reserves.  But none of this was possible unless his patients also adhered to a strict 500 calorie/day diet that enforces extreme limitations in the specific individual foods that can be consumed.  The only focus of the entire program is to reduce weight and, unfortunately, it does not address the bigger picture of long term overall health.  In addition, patients are told that they cannot use certain cosmetic items such as face creams.  Participants in the program are also not allowed to get massages and have to carry a scale with them if they are traveling to weigh in every single morning without exception.

What I found rather astonishing is that Dr. Simeons had no substantial or long term data from clinical trials or from the scientific literature attesting to the safety and efficacy of his program.  He even states this in his own words when discussing obesity in his manuscript, "...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."  And then later on, "...I have never had an opportunity of conducting the laboratory investigations which are so necessary for a theoretical understanding of clinical observations, and I can only hope that those more fortunately placed will in time be able to fill this gap."  So what Dr. Simeons is saying is that his whole program is based off of trial and error and not the mountain of scientific evidence that is already available in today's scientific world.  This scientific evidence has already proven that the safest and most effective way to lose weight and gain health over the long term is to adopt a nutrient dense, plant-based diet.  But apparently Dr. Simeons either missed this or ignored it when developing his weight loss program.

How does the HCG diet work?


1)  Daily doses of HCG are administered to the patient for anywhere from 23 to 40 days.

2)  On days 1 and 2 the patient is told to gorge on as much high fat foods as possible even if this involves
     force feeding.  These foods include deep fat fried meats (especially pork), milk chocolate, eggs,
     bacon, mayonnaise, bread with lots of butter and jam, whipped cream, pastries, etc.  This will "build
     up" their "normal fat reserves" in order to tolerate the 500 calorie/day diet according to Dr. Simeons.

3)  Starting day 3 and for the remaining duration of the diet up to and including 3 days after the last dose
     of HCG is administered the patient must adhere to a 500 calorie/day diet that includes only the
     following:
     -  Breakfast:  Tea or Coffee in any amount without sugar.  One tablespoon of milk allowed per day.
                          Saccharin or Stevia may be used for sweeteners.
     -  Lunch:  a) 100 grams exactly of veal, beef, chicken breast, fresh white fish, lobster, crab, OR
                          shrimp.  All visible fat removed, meat to be weighed raw, only boiling or grilling
                          allowed.
                      b) One vegetable from the following - spinach, chard, chicory, beet-greens, green salad,
                          tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, or cabbage.
                      c) One breadstick (grissino) OR one Melba toast.
                      d) One apple, orange, handful of strawberries, OR one-half grapefruit.
      -  Dinner:  Same four choices as for lunch above.

4)  Following the end of the 500 calorie/day diet and for 3 weeks thereafter the patient may begin eating
     normally with the exception that they cannot consume any starches or sugars in any form.

5)  After 3 weeks the patient can then gradually add small amounts of starch in the diet but never in
     conjunction with fats at the same time.

6)  Nobody is allowed to lose or gain more than 2 pounds per day or 34 pounds total during one cycle.
     Repeat cycles of the diet can be attempted only after at least a 6 week waiting period.

7)  Many physicians or nutritional counselors will tell their patients that they are not allowed to exercise
     while on the 500 calorie/day diet.

8)  There are more details on the HCG diet and further restrictions can be found in Dr. Simeons
     manuscript if you wish to learn more.

What does the scientific world say about the HCG weight loss program?

First off, let me remind you again that Dr. Simeons could provide no scientific proof that his weight loss program was both safe and effective over the long term.  While a high percentage of patients do experience weight loss with his program it is due to the calorie restriction or temporary "starvation" that the patient is experiencing and not the HCG itself.  I did a search for all published studies on the HCG diet in the scientific literature and could not find a single one to validate Dr. Simeons' claims.  Instead, here is what I found:

-  Fifty one obese women were studied in a clinic setting in a randomized, double-blind comparison over
   a 32 day period.  Approximately half of the women received daily administration of HCG injections
   and all of the women were put on a 500 calorie/day diet.  The study found that there was no
   statistically significant differences between the two groups in terms of weight loss, percent of weight
   loss, hip & waist circumference, weight loss per injections, or hunger ratings.  They concluded that
   HCG does not appear to enhance the effectiveness in a rigidly imposed regimen for weight loss [1].
-  Two hundred patients participated in a double-blind random cross over study comparing HCG to
   placebo in a weight reduction program.  They found no statistically significant differences between the
   two groups [2].
-  Another study looked at 11 obese women in a hospitalized setting.  All 11 women were put on an
   identical 500 calorie/day diet.  Six women received daily shots of HCG while 5 received daily shots of
   placebo.  The study found that patterns of plasma and urine substrates, electrolytes, & hormones were
   similar in the two groups and consistent with semistarvation and weight loss.  The study concluded
   that HCG offered no advantage over calorie restriction in promoting weight loss [3].
-  A double-blind randomized trial used either HCG injections or placebo in their subjects.  They found
   that weight loss was identical between the two groups and there was no evidence for differential effects
   on hunger, mood, or localized body measurements [4].
-  In another double-blind, placebo controlled study 40 obese women were put on an identical calorie
   restricted diet.  After six weeks on the diet the study showed that subjects receiving HCG showed no
   advantages over those receiving placebo in terms of psychological profile, hunger level, body
   circumferences, and weight loss.  The study concluded that no rationale was seen for the use of HCG
   injections in the treatment of obesity [5].
-  Eighty two premenopausal, healthy, non pregnant women participated in a randomized trial that lasted
   28 days.  All the women were put on a 500 calorie/day diet.  However, only a portion of them received
   HCG injections while others did not receive injections.  All participants experienced strong sensations
   of hunger during the first week and diet adjustments seem to improve more greatly in those not
   receiving the HCG injections.  Two individuals experienced side effects during the diet and they were
   both in the HCG group.  One woman suffered from a severe headache and one woman suffered from
   ovarian cysts. The study concluded that the success of the diet was based on motivation and good
   information and not due to HCG administration [6].
-  A review of studies on HCG was done by the German steroid toxicology panel.  They looked at 20
   available published studies on HCG and dieting.  Here's what they concluded - "In recent publications
   describing mostly well documented, double-blind studies authors largely reject HCG administration in
   dieting.  Supporters of the HCG diet must prove the efficacy of this method in controlled studies..."
   They went on to say that "HCG is ineffective in dieting and should not be used." [7]

What are the downfalls of the HCG diet?

While people do lose weight and rather quickly on the HCG diet they do so without improving their long term overall health.  This is in part due to the excessive caloric restriction of the program.

Studies on calorie restricted diets show an overall beneficial effect in terms of lowering blood pressure and cholesterol levels along with a reduced risk of cardiovascular disease and cancer mortality when calories are reduced by around 20-30% of normal caloric intake [8,9].  However, the 500 calorie/day HCG diet falls far short of the 1,400-1,600 calories/day that these studies looked at.  In fact, I would be quite confident in saying that the reason Dr. Simeons only has his patients adhere to the strict 500 calories/day for such short periods of time is because the body goes into starvation mode and this can have very negative health consequences if continued long term.  The Minnesota Starvation Experiment proves this when it evaluated men following a calorie restricted diet for 24 weeks.  In this study caloric intake was reduced by 45% from the typical intake which for the typical western diet is 2,000 calories/day.  This would equate to around 1,100 calories/day.  After 24 weeks they found that the men had serious deleterious effects, including anemia, muscle wasting, neurologic deficits, lower extremity edema, weakness, dizziness, lethargy, irritability, and depression [10].  A much healthier way to lose weight is to follow a low-fat, plant-based diet.  In fact, one study even showed that overweight women who did just this lost an average of 12.76 pounds and some even lost up to almost 20 pounds after 14 weeks without any restrictions on portion sizes or caloric intake [11].

The next downfall of the HCG diet is the way it starts out.  The first two days the patient is told to gorge themselves with the fattiest foods possible.  This is a recipe for disaster because many of the suggested foods are high in trans fat and saturated fat both of which have been shown to have negative health consequences.  Increasing dietary fat in the short term has actually been shown cause up to a 20% drop in oxygen level in the blood [12].  Also, replacing just 2% of your calories with trans fat instead of consuming polyunsaturated or monounsaturated fat will actually increase your risk of coronary artery disease by 21-24% [13].  There really is no benefit at all from consuming fatty foods as suggested in the HCG diet.  At least science hasn't been able to prove any benefit so far.

One of the biggest shortcomings of the HCG diet is not only that it includes low nutrient, high fat foods like beef, pork, veal, poultry, fish, dairy products, and on occasion eggs but that it severely limits foods that are the most healthful and nutrient dense of all - fruits, vegetables, legumes, whole grains.  Only a small portion of fruits and vegetables are allowed and legumes are all together banned.  Whole grains such as whole wheat and oat products are restricted too.  Here's the problem with this... animal-based foods such as the meat and dairy products have a much higher fat content than their healthy counterparts (plant-based foods).  See the chart below:


The other downfall of meat, dairy, and eggs is that these foods contain absolutely no fiber and little to no micronutrients.  Fiber is extremely beneficial for your overall health.  You can find out more about that topic here.  And micronutrients consist of many essential vitamins, minerals, and phytochemicals that are vital to maintaining excellent health.  These include many different types of antioxidants like the carotenoids from yellow and orange vegetables and flavanoids found in various fruits and dark chocolate.  Vitamin A, C, and E from fruits and dark leafy greens are also important in promoting health.  These are the substances that have been shown to protect against many of the chronic diseases that we experience in the world today.  Dr. Joel Fuhrman does an excellent job explaining the importance of nutrient density as it relates to food below and also touches on why calorie restrictive diets don't work in the long run.




The last thing I want to touch on is the fact that many patients are told to avoid exercising completely while on the strict 500 calorie/day diet.  Exercise has been shown to have profound and very beneficial health effects in numerous scientific studies.  Scientist have actually shown that exercise increases the ability of a naturally occurring enzyme called telomerase in our body which is responsible for repairing damaged telomeres at the end of your DNA [14,15].  This is important because telomeres are strands of DNA that determine how fast we age so by exercising we literally reduce the effects of aging on the body.  In contrast, a recent study published in the Journal of the American College of Cardiology showed a 48% increased risk of death from all causes and 125% increased risk in cardiovascular events in those spending too much time sitting in front of a screen (tv, computer, etc.) doing absolutely no physical activity [16].

Conclusion

I think it goes without saying that the short term weight loss seen with the HCG dietary program comes at the bigger expense of long term health consequences.  From the unhealthy fatty gorge to start the diet to the lack of nutrient dense, plant-based foods included to the inability to exercise while on a dangerous 500 calorie/day diet there's just nothing good about this weight loss program if you are at all concerned about your overall health.  You are much better off doing some research and educating yourself on proven methods already out there to lose weight permanently while at the same time preventing and even reversing chronic diseases such as heart disease, diabetes, osteoporosis, and more by going on a nutrient dense, plant-based diet.  You can learn more about this in my article on weight loss or by visiting my website.  I wish you much success in your weight loss endeavors and I hope you've learned something that can change the course of your life for the better today.







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by Dustin Rudolph, PharmD
Clinical Pharmacist

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References:
1 Stein MR, Julis RE, Peck CC, et al. Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study. Am J Clin Nutr. 1976 Sep;29(9):940-8.
2 Young RL, Fuchs RJ, Woltjen MJ. Chorionic gonadotropin in weight control. A double-blind crossover study. JAMA. 1976 Nov 29;236(22):2495-7.
3 Shetty KR, Kalkhoff RK. Human chorionic gonadotropin (HCG) treatment of obesity. Arch Intern Med. 1977 Feb;137(2):151-5.
4 Greenway FL, Bray GA. Human chorionic gonadotropin (HCG) in the treatment of obesity: a critical assessment of the Simeons method. West J Med. 1977 Dec;127(6):461-3.
5 Bosch B, Venter I, Stewart RI, Bertram SR. Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial. S Afr Med J. 1990 Feb 17;77(4):185-9.
6 Rabe T, Richter S, Kiesel L, Zaloumis M, Runnebaum B. Influence of human chorionic gonadotropin (hCG) in combination with a 500 calorie diet on clinical and laboratory parameters in premenopausal women with and without hormonal contraception. Aktuel Endokrinol Stoffwechsel. 1987 Jul;8(3):142-9.
7 Rabe T, Richter S, Kiesel L, Runnebaum B. Risk-benefit analysis of a hCG-500 kcal reducing diet (cura romana) in females. Geburtshilfe Frauenheilkd. 1987 May;47(5):297-307.
8 Kagawa Y. Impact of Westernization on the nutrition of Japanese: changes in physique, cancer, longevity and centenarians. Prev Med. 1978;7:205.
9 Walford RL, Mock D, Verdery R, MacCallum T. Calorie restriction in biosphere 2: alterations in physiologic, hematologic, hormonal, and biochemical parameters in humans restricted for a 2-year period. J Gerontol A Biol Sci Med Sci. 2002;57:B211.
10 Keys A, Brozek J, Henschels A, Mickelsen O, Taylor H. The Biology of Human Starvation. Vol 2. Minneapolis: University of Minnesota Press; 1950:1133.
11 Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ, Glass J. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 2005 Sep;118(9):991-7.
12 Kuo PT, Whereat AF, Horwitz O. The effect of lipemia upon coronary and peripheral arterial circulation in patients with essential hyperlipemia.  Am J Med. 1959 Jan;26(1):68-75.
13 Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr. 2009 May;63 Suppl 2:S22-33.
14 Christian Werner, MD; Tobias Fürster, MD; Thomas Widmann, MD; Janine Pöss, MD, et al.  Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall.  Circulation. 2009 Dec 15;120(4).
15 Ornish D, Lin J, Daubenmier J, Weidner G, Epel E, Kemp C, Magbanua MJ, Marlin R, Yglecias L, Carroll PR, Blackburn EH. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008 Nov;9(11):1048-57.
16 Emmanuel Stamatakis, Mark Hamer, and David W. Dunstan. Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events: Population-Based Study With Ongoing Mortality and Hospital Events Follow-Up. Journal of the American College of Cardiology, 2011; 57: 292-299 DOI: 10.1016/j.jacc.2010.05.065

5 comments:

  1. When a coworker of mine told me about this diet a few months ago I was skeptical. Turns out it is another fad diet because she is still over weight. I explained how I have lost weight with a plant-based diet and directed her to your website. I wonder if she will take the advice to lose weight and become a healthier person. Time will tell.

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  2. I understand that by doing HCG one would be on a very low nutrient diet but since it the diet is done for just a short time and a nutrient rich diet would be adopted after the weight was lost how would this effect health long term. Wouldn't those lost nutrients be replaced and damage repaired after the weight was lost?

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  3. Burton Family, from all available history and evidence, not only nutrients but all the lost weight would also be replaced after going off the diet - and more.

    The failure of almost all diets is precisely because the diet is short term. The only way to lose weight in the long term is to learn a way to eat well in the long term.

    A plant based diet teaches you that. If you can learn that, then why do a weird short term diet? If you only want a short term diet, expect to gain weight back.

    Food++

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  4. You did not include the three egg whites for breakfast, nor the 10 a.m. apple or 4 p.m orange you should have too. drinking a gallon of water also eliminates the weight. I have lost 25 pounds on it and swear by it. Got off my diabetic meds and insulin completely and am monitored DAILY by my doctor. That is the key. Do not do it without doctor supervisions. My blood sugars are now in the 100 to 150 range.

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  5. A friend sent me this link and after reading it, I find the sited studies did NOT address loss of body muscle mass in HCG vs starvation diets. I did the HCG and had my body fat tested with the bod-pod and did NOT lose muscle mass like I did on low calorie diets. I would like to see studies of this nature BEFORE you put out information such as this.

    ReplyDelete