By BRIAN SODOMA
VIEW ON HEALTH
For some, it may seem incomprehensible. Subsist on 500 calories a day while supplementing with a hormone naturally found in pregnant women for four weeks and you'll lose a lot of weight. Medical degree not required for that conclusion. But despite how dangerous such a proposition sounds, the HCG (Human Chorionic Gonadotropin) diet has been a media sensation for the past few years as dieters look for another quick fix or alternative to good old fashioned calorie counting and exercise.
Health care practitioners are divided on whether to use the diet as a kick-start, how to use it or whether to use it at all. But regardless of doctor opinion, the consumer is driving an HCG retail industry that has many questioning its safety. One thing is for certain. There are certainly a few things you need to know, if considering the HCG diet.
The diet began in the 1950's when Dr. Albert Simeons, a British-born physician with a practice in Italy, used it with his patients. His claims were that taking HCG helped the body mobilize stored fat while suppressing appetite, ultimately redistributing fat. All the while, a person could live comfortably on what appears to be a semi-starvation diet of 500 calories per-day.
The approach was a hit initially, but safety concerns arose and the FDA eventually required product manufacturers to post a claim on bottles indicating the hormone is not medically proven to help with dieting or weight loss. By the late 1970s, it had essentially been erased from any bariatric professional's list of approaches to helping patients lose weight.
Fast forward to 2007 when infomercial giant Kevin Trudeau launched his book, "The Weight Loss Cure They Don't Want You to Know About," which suggested a medical industry conspiracy to keep the diet under wraps so that physician patient counts kept growing. Trudeau was pursued in court by the Federal Trade Commission, particularly for what it viewed as misleading information about the ease of implementation of the diet, and by 2008 he was ordered to pay a $37 million fine.
Nonetheless, interest was piqued and since then America has gone HCG crazy, with a retail market swelling with new and different pills, drops, pellets or sprays and homeopathic preparations of the substance.
MEDICAL COMMUNITY DIVIDED
In 2009, the American Society of Bariatric Physicians issued a position statement against the HCG diet, indicating numerous placebo-controlled trials have shown the diet to be ineffective in producing weight loss results. The statement also highlighted that an overwhelming number of reports are critical of it, as opposed to the few that are in favor of it.
Dr. Craig Primack, who owns Arizona's Scottsdale Weight Loss Center and is an ASBP board member, says people will undoubtedly lose weight on such a severe calorie restricting diet. Last November, at an ASBP conference, Primack cited 15 articles using randomized placebo-controlled studies where patients and doctors were not told if they were getting actual HCG injections or not, that highlighted the ineffectiveness of the HCG diet. He said patients didn't know if they were taking sugar water or HCG and it didn't matter. A diet that he says essentially boils down to a person eating a couple chicken breasts a day, some salads, fruit and soup is not a healthy way to lose the weight.
"It ruins your metabolism. As you don't take in proper protein, your muscle is consumed for energy. Your overall lean muscle mass diminishes," he adds. "People doing this haven't heard of these articles and they don't want to. ... It's something where a bunch of chiropractors and naturopaths want to make a quick buck."
KICK START USE
But not all doctors are on board with Primack, and some believe HCG may be the perfect kick-start to get someone to a desired weight loss goal, initially, while learning effective maintenance techniques along the way.
Dr. Donald Tice, a D.O. (Doctor of Osteopathy), is the medical weight loss program director for Gastric Band Institute in Las Vegas. The surgical center is also home to the Why Diet Weight Management and Wellness Center, which offers approaches to weight loss other than surgery. Tice is an ASBP member who has been using HCG for the past six months with patients. He adds that it is not a focus on his practice, just another tool.
"It's hard to look at the thousands of people it has helped lose weight and not say it works. If medically supervised, it can be a tremendous tool," he says.
Rachel Azoulay, a naturopathic doctor and owner of Revive Weight Loss Clinic, in Las Vegas, also uses HCG as a kick start for the right situations. Like Tice, she says it's not for everyone, and a very thorough blood work-up is required before considering the diet. Those with blood pressure problems, androgenic problems like prostate issues and blood clots may see detrimental side effects from using HCG, Tice notes. That's why both Azoulay and Tice say and HCG diet must be monitored closely by a physician and not self-administered like Trudeau had claimed. Tice uses a 23 to 40 day cycle with a 3-week "wash-out" period between cycles.
Both doctors also say, while on HCG, lifestyle counseling is in order. Tice also says he doesn't hold to the 500 calorie restriction. His patients are more likely to be eating a diet in the 800 to 1,100 calorie range and Azoulay says calorie counts should take into consideration a patient's way of living and working.
"A person who works physically during the day needs more calories," she adds.
FINDING REAL HCG
HCG is produced in the placenta of pregnant women and the drug is derived from a pregnant woman's urine. But the drug is not specifically approved for weight loss, instead for inducing ovulation (for conception), boosting testosterone production in boys who are underdeveloped and for those whose testes may not have dropped into the scrotum yet. Multiple births have been tied to dieters on HCG as well.
Today, there are HCG injections and oral doses that have FDA (Food and Drug Administration) approval. Health professionals who use the oral doses with patients claim 30 or 40 percent is usually broken down by the stomach, so more dosing is often required.
"I don't like to flood the body with HCG," adds Azoulay. "I like to give the absolute minimum amount needed to produced an effect."
HCG is also considered a Schedule III drug under the U.S. Controlled Substances Act, which means it can lead to moderate or low physical or psychological dependence and has a current medical treatment use in the U.S.
"Being schedule three means it cannot be obtained without a prescription and must be dispensed by a pharmacy," Tice clarifies. "This is nothing like something you get at GNC."
In a January 2010 USA Today article, the FDA called any HCG weight-loss products sold in the retail environment "fraudulent." Homeopathic preparations, in particular, were targeted for the fraud claim in the article.
Azoulay also only uses the FDA approved versions of HCG, and says there are not enough accurate testing measures to really show if a homeopathic preparation really does have HCG in it or not. The premise for homeopathy revolves around using a severely diluted form of a substance while issuing many doses.
"It's very hard to find the molecules in it. There's not enough equipment to really check it," she adds.
Too often, she has people coming into her office with bottles of pills they purchased on the Internet and are unaware of how to effectively navigate the diet. Her greater concern is that some people develop an immunity to HCG. Their bodies become resistant to it, making it more difficult to achieve their weight-loss goals.
"I see a lot of different experiences people have with it, even those who are not losing weight," she adds.
Primack also says, given the placebo controlled trial information available today, that someone doesn't know if they are getting a sugar pill or not with over-the-counter treatments. A lot of the claimed weight-loss results may simply be tied to psychology and a very calorie restricted diet.
"This stuff is as safe or harmless as aspirin," Tice adds about the many over the counter products. "You can kill yourself with aspirin."
And with the growing number of products coming out of Europe and Canada, Tice offers similar words of caution.
"A lot of stuff you get from overseas may be anything but what you think it is," he adds.
KEEPING IT OFF
Where the three health professionals seem to agree is with treating the underlying issues in a patient regardless of the type of program they may use to initiate their weight loss goal. All of them indicate a thorough health assessment is in order to understand the unique physical and mental traits a patient is bringing to the situation.
"We use special (blood) panels and try to see why you gained the weight in the first place," Azoulay adds, while explaining that some people could have achieved weight gain from menopause, taking certain medications, emotional reasons, low testosterone, insulin resistance or a host of other factors.
Azoulay designs a special eating program that takes into consideration these findings both while on the HCG program as well as after getting off of it.
Primack's practice involves some 20 classes patients can take, 11 of which are behavior related.
In order to not fall into the category of roughly 90 percent of successful American dieters that gained all or more of their weight back, Tice also works on lifestyle changes and has patients in classes during and after the HCG cycle.
"Obesity is not a cosmetic or social problem," he says. "What we're really shooting for is to metabolically correct the damage that's been done over periods of years."
FUTURE USE AND PROOF
HCG success stories and testimonials on the Internet are a tough sell to skeptical health professionals. Doctors are looking for more thorough scientific evidence showing why the diet does or doesn't work.
"If anything I'd like to see a better explanation of the biochemistry of why it works. We're just not there yet," Tice says.
Primack says large calorie restriction and the body falling into a state of ketosis, a term made popular by the Atkins diet craze, are likely the two primary drivers behind some of the results people see while on HCG.
"When you go back to 1950 (HCG's beginnings) no one knew about medical ketosis, where the body breaks down fat as the primary food source. It's not brought up in any of these (early) studies. Atkins made the concept a real thing," he says.
Primack, like many others, also believes HCG is a fad, one he sees going away someday soon.
"The FDA already has the oral form on its list of things to take action against. But it's a low priority for now," he adds. "This will blow over. It's' just a question of when will the FDA take action."