I have read, studied and written a lot about diets over the years, both from a medical and a personal standpoint, having struggled with my weight for most of my adult life. As many women who have gone through childbirth can attest, it can be very frustrating to realize that your body just does not respond the same way when you’ve gone through hormonal changes. The same can be said for women who’ve never been pregnant but dealt with hormonal issues and especially for the menopausal woman. Remember when you could cut out sweets for two or three weeks and easily lose 10 pounds? While I tried to stay away from crash diets, over the years I have done low-carb, personal trainer, Weight Watchers and various eating patterns to try to trigger that stubborn metabolism to increase. These attempts were somewhat effective, if excruciatingly slow, but there seemed to always be a return to baseline, with added friends. The goal is to achieve your set-point, that is, your weight that is stable despite a variation of calorie intake and physical exertion, within reason. Whenever I was on Weight Watchers and would be obsessively diligent about making sure my “points” were accurate, I would always think in the back of my mind, “can’t you just relax and eat nutritiously without the fear of deviating from your acceptable numeric intake and without immediate weight gain?” The answer for anyone who has been on any of the commercial calorie reduction weight loss programs (WW, Jenny Craig, Nutrisystem, LA Weight Loss) is a resounding “NO!” The maintenance phase of these programs is sheer torture for those who are attempting to maintain what amounts to starvation. That’s because it is actually well-known among nutrition researchers that calorie-restriction almost always results in rebound weight gain, with more added on, unless there is rigorous, almost zealous adherence to one’s particular protocol. If you think the business people of those weight loss programs don’t know that, think again. They are not stupid; they know the studies showing just how many people gain their weight back. What a great business plan! “Regainers” will be back for more eventually, along with all the self-flagellation and remorse for being a complete failure at attaining the superhuman willpower of some idealized version of perfection, say Jillian Michaels.

Then there’s the exercise mania focus where bone-headed if well-meaning trainers (especially those who have never had a weight problem, love them!) tell poor clients, “You just need to eat less and ramp up your cardio!” This is a sure recipe for burning out your adrenal glands and dropping your metabolic rate and body temperature (the poor man’s indicator of metabolism). If I had a dollar for every Zumba and aerobics instructor who tells me how tired she is all the time, I would have…well, you know what I mean. Now, don’t get me wrong, I love Zumba, certainly more enjoyable than mindless miles on a treadmill. However good it is for increasing stamina and endurance and building muscle tone, it’s not that great for weight loss, as most exercise is not. In preparation for my husband and me renewing our wedding vows on our 10th anniversary, I spent about three months faithfully doing Zumba twice a week along with weight training once or twice a week. And I lost nothing, zilch, blech. Toned up, yes, inches lost, but it was a whole lot of effort and time for not much return.

Certainly, knowing all I do about hormones, supplementation and stress, I took time to check out all these areas in my own life. I definitely made positive changes plus worked hard to clean up my diet, making an effort to get away from processed foods, artificial sweeteners, sweets and eat whole, natural, and organic if possible, foods. My overall health and wellbeing responded very positively as I usually have great energy, great sleep, great bowel elimination, normal body temperatures, and I am clearly not lacking in the fertility department (*wink*). However, all these different modalities were not making a dent in the number on the scale or that stubborn abdominal fat. I can tell you that I eat better than most people I know, yet you may not think so based on the scale. I have always had a curvy shape that could carry weight pretty well, but over the years given the impact of stress, dietary choices, environmental influences, and hormonal changes, it has been harder and harder to feel “normal.” It has been a sore spot for me with my patients as well, because I have felt embarrassed by the fact that many people may question my medical expertise in different areas, if I don’t have a normal, healthy appearance myself. At the same time, I have great respect for the fact that the human body is so brilliantly designed and complex, and that the mantra “eat less, exercise more” just didn’t work for most people, especially women with hormone issues. So I have always been very skeptical about various scams, crash diets, unhealthy long-term exclusion of various macronutrients, etc. for achieving that downward trend on the scale.

Well, a funny thing happened during my last pregnancy (boy number five, born March 2009). I lost weight. Not intentionally, as I was still eating how I normally do which is healthy the majority of the time, but I was becoming noticeably thinner in my face, arms and overall shape, but not in my pregnant belly. I attributed this to the aforementioned changes I made and even blogged about it (see “Done With Dieting”) as this had not happened in any of my other pregnancies. I gained about 15 pounds compared to my average 35 pounds. I figured that after I gave birth to this healthy 7#10oz child, I would continue to see the weight loss which had finally kicked in due to my focus on wellness. Certainly I did not start eating poorly (with the occasional exception) because I was breastfeeding and I know how important nutrition and calories are when you are nourishing your baby, especially in that critical 6 month window before he starts eating solids. Unfortunately the party was over and while I was not gaining, I was also not losing and still holding on to belly fat. Around the summertime, I began to have patients come in who had been losing weight on the HCG diet. Automatically suspicious of any fads, as soon as I heard that you took HCG in conjunction with a 500-calorie diet, I stopped listening. Since I already knew the damage of severe calorie restriction (breakdown of muscle, dropping metabolic rate), not to mention the mental and emotional torture of such a severely low calorie diet, I immediately wrote it off as unsafe despite the obvious success of some of my patients had who explored it. Then I went to a symposium on optimal health put on by the St. Louis Institute of Integrative Medicine (SLiiM). One of the speakers was Dr. Todd Frisch, a chiropractor with a successful practice for 30 years. What I liked about him was not only his excellent medical advice about detoxification, but he spoke openly and freely about his faith in God and how it guided his practice. Don’t get me wrong, just because a person says they believe in God doesn’t mean I then blindly accept everything they say as “gospel” truth! But there was something about this doctor’s compassionate nature and sincerity that really spoke to me. I got to meet him at a later date and that’s when I found out that his practice has exploded since he has been using homeopathic HCG to help his patients lose weight. He and his wife had also successfully lost weight, an issue his menopausal wife had struggled with for years, despite all they know about healthy living and a wholistic approach (gee, sounds familiar!). I was intrigued enough by a respected professional that I decided to take a closer look at the program I had once pooh-poohed. I read Dr. A.T.W Simeon’s protocol, the British physician who originated the HCG diet. I was immediately impressed when he started discussing the complexity of obesity and how often health care providers who are unable to supply help to their patients turn on them. “When then obese patients are accused of cheating, gluttony, lack of will power, greed and sexual complexes, the strong become indignant and decide that modern medicine is a fraud and its representatives, fools, while the weak just give up the struggle in despair. In either case, the result is the same: a further gain in weight, resignation to an abominable fate and the resolution at least to live tolerably the short span allotted to them — a fig for doctors and insurance companies.”

Ever the science nerd, I was even more excited when he started discussing the hypothalamus. So often we focus on the thyroid gland, the pituitary gland and the adrenal glands (the cortisol, “stress hormone” producers) as the culprits. In our stress-saturated society, we are constantly pumping out cortisol and adrenaline in an effort to outrun our modern-day bears. We begin to crave sweets in an effort to beat our adrenals into creating more sex steroids to deal with the mountain of stressors we encounter, worsening the belly fat problem. Many people, especially skinny, calorie-restricted, over-exercising, hormonal women, eventually burn out their adrenals and some quite literally collapse in physical and emotional exhaustion. While hypothyroidism can certainly decrease the metabolic rate, the weight loss from thyroid therapy is irritatingly small. Insulin resistance is an ongoing epidemic. A genetic predisposition is triggered by excessive refined carbohydrates and other hormone imbalances and causes the cells to quit responding normally to insulin, which normally shuttles glucose into the cell for metabolic utilization. Another problem with most starvation-based approaches (this would also include bariatric surgery cases) is that it causes weight loss of non-proportional, structural fat, the kind that provides normal contouring and shape to the body and keeps the skin smooth. To quote Dr. Simeon, “When an obese patient tries to reduce by starving himself, he will first lose his normal fat reserves. When these are exhausted, he begins to burn up structural fat, and only as a last resort will the body yield its abnormal reserves, though by that time the patient usually feels so weak and hungry that the diet is abandoned. It is just for this reason that obese patients complain that when they diet, they lose the wrong fat. They feel famished and tired and their face becomes drawn and haggard, but their belly, hips, thighs and upper arms show little improvement [and often require plastic surgery after bariatric surgery due not just to the volume of weight loss but because of their still misshapen body italics added by Dr. Poppy]. Their skin wrinkles and they look old and miserable. And that is one of the most frustrating and depressing experiences a human being can have.”

So where does that leave us? The hypothalamus, of course. It’s the boss of the pituitary, thyroid and adrenal, as well as the ovaries, testes and other endocrine systems. This tiny gland at the base of the brain is a powerhouse that secretes hypothalamic releasing and inhibitory hormones to regulate the hormonal functions of the body, most of which work on a negative feedback system. Recently scientists have identified a hormone called leptin, which is secreted by adipose tissue. As a measure of nutritional status and fat stores, its function is to feedback and let the hypothalamus know, hey we are full (or satiated), we have enough food, stop being hungry and sending neurological impulses to eat. Unfortunately, what most people who are obese have undergone is similar to insulin resistance, except it’s called leptin resistance. Although there may be high levels of leptin in the body indicating the body is full, satisfied, nourished, the brain is not getting that signal. In fact, with many people its seems their brains are actually getting the “starvation” message, which according to Dr. Jeffrey Friedman, the scientist who discovered leptin, results in decreased body temperatures, hyperphagia (excessive hunger resulting in ravenous eating), decreased metabolism/energy expenditure and frequently decreased immunity and increased rates of infertility. When leptin levels are low, the hypothalamus sends out signals for the body to undergo glycolysis where adipose or fat tissue is dissolved to provide energy to the body. Such a complex mechanism involves multiple hormones including cortisol, growth hormone and thyroid hormone. Many people with leptin resistance DO have an accompanying slowing down of their thyroid, although thyroid medication doesn’t really address the obesity because it’s ultimately a hypothalamic problem. So how did we get so much leptin resistance? Probably the same reason we have so much insulin resistance. That is, the progressive degrading of the food supply with excessive sugars/fructose (worse offender: high fructose corn syrup), processed grains, and hydrogenated oils and subsequent pervasive vitamin/nutrient deficiencies, as well as environmental toxin exposure. My favorite blogs that address metabolism: http://www.180degreehealth.blogspot.com/, http://www.proteinpower.com/drmike/, http://thehealthyskeptic.org/, http://www.mercola.com/, www.westonaprice.org

The solution to the obesity problem would be to overcome leptin resistance and enable the hypothalamus to reset our bodies’ weight set-point. And that solution appears to be, ironically, a pregnancy hormone called HCG. Human chorionic gonadotropin (HCG) is a glycoprotein rather than a sex steroid (derived from cholesterol). When a woman becomes pregnant, the embryo’s trophoblastic cells will begin to produce HCG in high amounts to cause the corpus luteum (ovulated egg) to make large amounts of progesterone and estrogen to nourish the embryo and endometrial lining of the uterus. HCG continues to be produced in large amounts by the placenta during pregnancy although production decreases after the 16-20 week mark. Another interesting function of HCG is that it exerts an effect on the testes which causes the male fetus to produce enough testosterone to make male sex organs and for the testicles to descend. Therefore the treatment for undescended testicles in boys is, you guessed it, HCG. How is it then in pregnancy, that an obese woman can eat moderately or even nothing, in the case of severe vomiting (hyperemesis gravadarum), and have a normal size baby? The circulating HCG in her body during pregnancy causes mobilization of fat stores to help provide nutrition to the growing baby, but does not cause the mother to lay down excess abnormal fat deposits. This protective mechanism can of course be overridden by excessive overconsumption of poor food, particularly those offenders I mentioned before: refined carbs/grains, HFCS, hydrogenated oils, etc. and accompanying co-morbidities/chronic disease states with their associated vitamin/nutrient deficiencies. The HCG effect is that the body feels it’s being saturated with food from the mobilization of the fat stores and the woman does not feel hungry, although her intake may be drastically reduced. The health and wellness of the mother will naturally affect the health of the baby. Although genetics are a factor, my belief based on current research is that genetic influence can be modified, albeit not nullified, by nutritious diet, prolonged breastfeeding, limiting toxin exposure and good, general health practices. How does the pregnant body deal with inconsistent food intake? Says Dr. Simeon, “Ideal nutritional conditions for the fetus can only be achieved when the mother’s blood is continually saturated with food, regardless of whether she eats or not, as otherwise a period of starvation might hamper the steady growth of the embryo. It seems that HCG brings about this continual saturation of the blood, which is the reason why obese patients under treatment with HCG never feel hungry in spite of their drastically reduced intake.”

Rewind to my pregnancy story. Remember when I said that I really didn’t change my healthy, although not low calorie, diet and yet my shape was improving and my weight gain was minimal (15- nearly 8 for baby, maybe 2 for the placenta and rest of the fluids, leaving only 5 pounds). Finally, the pieces were beginning to come together. I spoke at length with Dr. Frisch about my initial misgivings regarding this “diet.” He related well to my concerns given our similar wholistic approach. But he told me that in the course of treating nearly 300 patients, his success rate was 100% with the least amount of weight lost at 16 pounds for a 40 day period. He also related as an added benefit to the weight loss, a significant improvement in patients with inflammatory conditions like rheumatoid arthritis, lupus, fibromyalgia, etc. As the dietary portion is very “clean,” the anti-inflammatory effect enables patients to achieve overall healing, not just weight loss.

It’s important to discuss the emotional, psychological and spiritual factors that play a role in obesity. The reason this diet must be supervised by a health care provider is that the vast reduction of food, and for some the rather austere food choices, can be very difficult for those who are immersed in our fast food, instant gratification, smorgasbord society. Patients must in many cases relearn what “real food” tastes like in a simpler form without modern society’s artificial food enhancements. Gluttony is an issue. We must learn to practice discipline rather than succumbing to the “Super-Size” mentality; just because more is available, bigger and fattier, does not mean it is wisdom to eat it. Those who have traumatic, abusive, or psychological triggers when it comes to food or those that pacify every negative experience or emotion with food will not succeed on this or any other positive modification unless those issues are dealt with through inner healing, counseling, and spiritual support. If I’ve learned anything through my journey, it’s that food is only a temporary high, and as with anything in life, can have long-term fall-out when abused. Some people sabotage their own progress at the first steps of a discipline because they assume they will not be successful or because of psychological or spiritual stress.

The benefit that I have experienced with my own use of HCG has been the consistent weight loss. Most patients can expect to lose between 0.5 to 1 pound a day on average. Though drastically faster than most programs, the weight lost is definitely from abnormal fat deposits (my husband commented that he liked that my shape was preserved instead of losing it in, um, important places). Many people are skeptical of the potency of homeopathic drops although that is just one of the modalities I use. Understand that really no one would be able to maintain a 500 calorie a day diet for very long without the hormonal support of the HCG. Nonetheless, there are other patients that would benefit more from the compounded HCG in cream or sublingual form (stronger dose-wise). I hate shots (except for B12 shots with a tiny needle) for hormone therapy which is why the transdermal route appeals to me. The source of the HCG is an important issue. I have heard of people getting HCG shipped to them from India or China, which is always suspect to me. Also if the HCG is obtained from placentas, I have a big concern that it is being extracted from abortion products which is completely unacceptable to me. Dr. Frisch is in agreement, and so his products, as well as the compounded products we use, are extracted from the urine of pregnant women. Somewhat ironic, given all the uproar over Premarin (made from pregnant horses’ urine). Seems no one had a problem with taking that for many years from an aesthetic standpoint.

I also feel if other hormone imbalances, vitamin/mineral deficiencies and medical problems are not adequately addressed, those patients will have limited success with HCG. Due to our wholistic approach, we already are usually dealing with these issues with our patients, so I see that as a benefit to our program for those who have failed with a round of HCG. The diet must be closely supervised as many people will begin to have drops in blood pressure, blood sugar and be able to come of some of their medication, which requires frequent follow up visits every 1-2 weeks after the initial consultation. The bare bones of the program involve a 21 or 40 day period of HCG treatment plus the 500 calorie a day, or restricted calorie diet (RCD). After that time, there are 2-3 more days of RCD without HCG to help achieve setpoint, followed by 3 weeks of no sugar or starch (NOT no carbohydrate). After that, normal diet is resumed, with the caveat that you need to avoid those foods which contributed to the overweight in the first place. If you go back to the “Supersize” diet or resume other unhappy practices, you can assume that you will regain weight. However, those committed to pursuing a healthy lifestyle should expect to maintain their weight with average losses for 21 day protocol being 15-20 pounds, for the 40 day, 25-30 pounds. For those who have more than that to lose, the protocol requires a 6 week rest period before starting another round of HCG to avoid immunity to the hormone. The first two days of treatment are a period of gorging so as to increase normal fat stores for subsequent loss. Those who don’t “load” effectively will not lose effectively. Exercise is not recommended during the diet to allow for adrenal recovery. More details will be provided to patients during their initial consultation. In light of the holidays, and the inevitable attempts at reduction following, my office is offering an initial consultation of $125, not including cost of HCG and other costs depending on individual patients’ needs. This price is very low and will continue through the 14th of January, at which time the price will go back up, closer to what other practitioners are currently charging. If you are interested in having a consultation to see if you are an appropriate candidate for the HCG diet, please call our office. It is so rewarding to learn more lessons from patients and other like-minded professionals. May we all have a wonderfully healthy and rewarding 2011!