ForewordWe grew confident that the tendency to accumulate abnormal fat is a definite metabolic disorder.  Yet the localization and the nature of this disorder remained a mystery. Every new approach seemed to lead into a blind alley.  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 – and now we have an answer!

When the patient must take an active part in the treatment, I believe it is essential that he or she have an understanding of what is being done and why. Only then can there be intelligent cooperation between physician and patient.

   Obesity in all its many forms is due to abnormal functioning of some part of the body.  Every ounce of abnormally accumulated fat is always the result of the disorder of regulatory mechanisms. Persons suffering from this disorder will get fat regardless of whether they eat excessively, normally or less than normal. A person who is free of the disorder will never get fat, even if he frequently overeats.

Those in whom the disorder is severe will accumulate fat very rapidly, those in whom it is moderate will gradually increase in weight and those in whom it is mild may be able to keep their excess weight stationary for long periods.  In all these cases, a loss of weight brought about by dieting, treatments with thyroid, appetite-reducing drugs, laxatives, violent exercise, massage, baths, etc., is only temporary!  It will be rapidly regained as soon as the reducing regimen is relaxed. The reason is simply that none of these measures corrects the basic disorder.

The History of Obesity

There was a time, not so long ago, when obesity was considered a sign of health and prosperity in men – and of beauty, amorousness and fecundity in women. This attitude probably dates back to Neolithic times, about 8000 years ago.  For the first time in the history of culture, man began to own property, domestic animals, arable land, houses, pottery and metal tools.  Before that, obesity was almost non-existent, as it still is in all wild animals and most primitive races.

   Today obesity is extremely common among all civilized races.  It is only in very recent times that manifest obesity has lost some of its allure (though the cult of the outsize bust – always a sign of latent obesity – shows that the trend still lingers on).

The Significance of Regular Meals

In the early Neolithic times another change took place.  This change was the institution of regular meals.  In pre-Neolithic times, man ate only when he was hungry and, then, only as much as he required to still the pangs of hunger.  Moreover, much of his food was raw and all of it was unrefined.  He roasted his meat, but he did not boil it, as he had no pots.  What little he may have grubbed from the Earth and picked from the trees, he ate as he went along.

The whole structure of man’s omnivorous digestive tract is like that of an ape, rat or pig.  It was adjusted to the continual nibbling of tidbits.  It is not suited to occasional gorging as is the intestine of the carnivorous cat family. Thus the institution of regular meals, particularly of food rendered rapidly absorbable!  It placed a great burden on modern man’s ability to cope with large quantities of food suddenly pouring into his system from the intestinal tract.

The institution of regular meals also meant that man had to eat more than his body required when eating.  It had to tide him over until the next meal. This easily digestible food suddenly flooded his body with nourishment.  He had no need of much of this nourishment at the moment so, somehow, it had to be stored!

Injustice to the Obese

When then obese patients are accused of cheating, gluttony, lack of will power, the strong become indignant.  The weak just give up the struggle in despair.  In either case the result is the same: a further gain in weight.
They may feel guilty, they may feel ashamed of what they have been led to believe is a lack of control.  They may feel horrified by the appearance of their nude body and the tightness of their clothes.

   Most obese patients do not suffer from compulsive eating.  They suffer genuine hunger – real, gnawing hunger – which has nothing whatever to do with compulsive eating.

   Compulsive eating differs fundamentally from the obese patient’s greater need for food.   It comes on in attacks and is never associated with real hunger, a fact which is readily admitted by the patients.   Patients suffering from real compulsive eating are comparatively rare.  In my practice they constitute about 1-2%.

The Emaciated Lady

I remember the case of a lady who was escorted into my consulting room while I on the phone.  In answer to my query as to what I could do for her, she replied that she wanted to reduce. I tried to hide my surprise, but she must have noted a fleeting expression.  She smiled and said “I know that you think I’m mad, but just wait.”  With that she rose and came round to my side of the desk.  Jutting out from a tiny waist she had enormous hips and thighs.

By using our techniqu, the abnormal fat on her hips was transferred to the rest of her body which had been emaciated by months of very severe dieting.  At the end of a treatment lasting five weeks, she had lost 8 inches round her hips, while her face looked fresh and florid.  Her ribs were no longer visible and her weight was the same to the ounce as it had been at the first consultation.

Fat but not Obese

It is also possible for a person to be statistically overweight without suffering from obesity.  For such persons weight is no problem, as they can gain or lose at will and experience no difficulty in reducing their caloric intake. They are masters of their weight, which the obese are not.  Moreover, their excess fat shows no preference for certain typical regions of the body, as does the fat in all cases of obesity.  Thus, the decision whether a borderline case is really suffering from obesity or not cannot be made merely by consulting weight tables.

The Treatment of ObesityIf obesity is always due to one very specific hypothalamus deficiency, it follows that the only way to cure it is to correct this deficiency.

A Curious Observation

Human Chorionic Gonadotrophin, which we shall henceforth simply call HCG is expensive!  Since it is expensive, I tried to establish the smallest effective dose in treating “fat boys” (fairly common among Indians). When such patients were given small daily doses, they seemed to lose their ravenous appetite though they neither gained nor lost weight. Strangely enough however, their shape did change

Fat on the Move

I found that, as long as such patients were given small daily doses of HCG, they could comfortably go about their usual occupations on a diet of only 500 Calories daily and lose an average of about one pound per day!

   It was also perfectly evident that only abnormal fat was being consumed, as there were no signs of any depletion of normal fat.  Gross dietary errors rarely occurred. On the contrary, most patients complained that the two meals of 250 Calories each were more than they could manage, as they continually had a feeling of just having had a large meal.

Pregnancy and Obesity

It is interesting that 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, a period of starvation will hamper the steady growth of the embryo.  It seems that HCG brings about this continual saturation of the blood.  This is the reason why obese patients under treatment with HCG never feel hungry in spite of their drastically reduced food intake.

HCG mimics pregnancy’s metabolism but is not sex-hormone.  This can work for you since HCG’s action is identical in men, women, and children.  An injection of only 125 units per day is ample to reduce weight at the rate of roughly one pound per day when associated with a 500 Calorie diet.

Diabetes – An obese patient, suffering from a fairly advanced case of stable diabetes of many years duration, may have 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.

Rheumatism – All rheumatic pains, even those associated with demonstrable bony lesions, improve subjectively within a few days of treatment.  They often require neither cortisone nor salicylates.

Cholesterol – It is now widely admitted that the blood cholesterol level is governed by hypothalamus mechanisms.  As the increase is mostly in the form of the not dangerous free cholesterol, we gradually came to welcome the phenomenon.  Today we believe that the rise is highly beneficial.

Gout – Predictably, such patients get an acute and often severe attack after the first few days of HCG treatment.  Then remain entirely free of pain!  This is in spite of the fact that their blood uric acid often shows a marked increase which may persist for several months after treatment.

Blood Pressure – Patients, who have brought themselves to the brink of malnutrition by exaggerated dieting, laxatives etc, often have an abnormally low blood pressure.  In these cases the blood pressure rises to normal values at the beginning of treatment.  Then it very gradually drops, as it always does in patients with a normal blood pressure.  Normal values are always regained a few days after the treatment is over.

Peptic Ulcers – In our cases of obesity with gastric or duodenal ulcers we have noticed a surprising improvement in spite of a diet which would generally be considered most inappropriate for an ulcer patient.

Psoriasis, Fingernails, Hair, Varicose Ulcers – Psoriasis greatly improves during treatment but may relapse when the treatment is over.  Most patients spontaneously report a marked improvement in the condition of brittle fingernails.  The loss of hair not infrequently associated with obesity is temporarily arrested, though in very rare cases an increased loss of hair has been reported.

The “Pregnant” Male – When a male patient hears that he is about to be put into a condition which in some respects resembles pregnancy, he is usually shocked and horrified.  Be assured that this does not mean that he will be feminized and that HCG in no way interferes with his sex.

TechniqueWarnings

The hypothalamus’ functional equilibrium is delicately poised, so that whatever happens in one part has repercussions in others. This balance is out of kilter and can only be restored if the technique is followed implicitly!  For instance, if the diet is increased from 500 calories to 600-700 calories, the loss of weight is quite unsatisfactory.

History taking

We try to establish the highest weight the patient has ever had in his life (excluding pregnancy).  When this was, and what measures have been taken in an effort to reduce.  We ask if you suffer from headaches, rheumatic pains, menstrual disorders, constipation, breathlessness, exertion or swollen ankles.  Do you feel the need to eat snacks between meals?

The patient is weighed and measured.  The normal weight for their height, age, skeletal and muscular build is established.  The degree of overweight is then calculated, and from this the duration of treatment can be roughly assessed.  This may be an average loss of weight of a little less than a pound per day.

The Duration of Treatment

All patients must continue the 500-Calorie diet for three days after the last injection.  This is a very essential part of the treatment.  If they start eating normally as long as there is even a trace of HCG in their body they put on weight alarmingly at the end of the treatment.  After three days, when all the HCG has been eliminated, this does not happen.

We never give a treatment lasting less than 26 days, even in patients needing to lose only 5 pounds.  It seems that, even in the mildest cases of obesity, the hypothalamus requires about three weeks rest from the maximal exertion to which it has been previously subjected.  This is in order to regain fully its normal fat-banking capacity.

As soon as such patients have lost all their abnormal superfluous fat, they at once begin to feel ravenously hungry in spite of continued injections.  This is because HCG only puts abnormal fat into circulation and cannot, in the doses used, liberate normal fat deposits.  It actually seems to prevent their consumption.  As soon as their statistically normal weight is reached, these patients are put on 800-1000 Calories for the rest of the treatment.

The diet is arranged in such a way that the weight remains perfectly stationary and is thus continued for three days after the 23rd injection.  Only then are the patients free to eat anything they please except sugar and starches for the next three weeks.

When a patient has more than 15 pounds to lose the treatment takes longer but the maximum we give in a single course is 40 injections.  Nor do we as a rule allow patients to lose more than 34 lbs. (15 Kg.) at a time. The treatment is stopped when either 34 lbs. have been lost or 40 injections have been given.

Immunity to HCG

The reason for limiting a course to 40 injections is that by then some patients may begin to show signs of HCG immunity.  Patients requiring the loss of more than 34 lbs. must have a second course.  A second course can be started after an interval of not less than six weeks, though the pause can be more than six weeks.  When a third, fourth or even fifth course is necessary, the interval between courses should be made progressively longer.

Conditions That Must Be Accepted Before TreatmentIt is made clear that, during the course of treatment, he must attend the clinic several times to be weighed, injected and generally checked.

   It is also made clear that between courses the patient gets no treatment and is free to eat anything he pleases except starches and sugar during the first 3 weeks.

   It is impressed upon him that he will have to follow the prescribed diet to the letter.  After the first three days this will cost him little effort.  He will feel no hunger and may indeed have difficulty in getting down the 500 Calories which he will be given.  If these conditions are not acceptable the case is refused, as any compromise or half measure is bound to prove utterly disappointing to patient and physician alike and is a waste of time and energy.

Gain before Loss

Some patients have low general fat reserves.  This is usually from excessive previous dieting.  They must actually eat to capacity for about one week before starting treatment.  The weight gain is for a reason.  It is hard to keep a patient comfortably on 500 Calories unless his normal fat reserves are reasonably well stocked.  It is for this reason that every case must eat to capacity of the most fattening food they can get down until they have had the third injection.

Most patients who have been struggling with diets for years are very hard to convince of the absolute necessity of gorging for at least two days.  Yet this must he insisted upon categorically if the further course of treatment is to run smoothly.  In any case, the whole gain is usually lost in the first 48 hours of dieting.  It is necessary to proceed in this manner because the gain re-stocks the depleted normal reserves.  The subsequent loss is from the abnormal deposits only.

The Diet

The 500 Calorie diet is explained on the day of the second injection to those patients who will be preparing their own food.  It is important that the person who will actually cook is present.

Tea or coffee in any quantity without sugar.  Only one tablespoonful of milk allowed in 24 hours.  Saccharin or Stevia may be used.

1.    100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp.  All visible fat must be carefully removed before cooking, and the meat must be weighed raw.  It must be boiled or grilled without additional fat.  Salmon, eel, tuna, herring, dried or pickled fish are not allowed.  The chicken breast must be removed from the bird.

2.    One type of vegetable only to be chosen from the following: spinach, chard, chicory, beet-greens, green salad, tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage.

3.    One breadstick (grissino) or one Melba toast.

4.    An apple, orange, or a handful of strawberries or one-half grapefruit.

Dinner:

The same four choices as lunch (above.)

(Any attempt to observe the following without HCG will lead to trouble in two to three days.)

The juice of one lemon daily is allowed for all purposes.

Salt, pepper,  vinegar, mustard powder, garlic, sweet basil, parsley, thyme, majoram, etc., may be used for seasoning, but no oil, butter or dressing.

Tea, coffee, plain water, or mineral water are the only drinks allowed, but they may be taken in any quantity and at all times.

The patient should drink about 2 liters of these fluids per day. Many patients are afraid to drink so much because they fear that this may make them retain more water. This is a wrong notion as the body is more inclined to store water when the intake falls below its normal requirements.

The fruit or the breadstick may be eaten between meals instead of with lunch or dinner, but not more than four items listed for lunch and dinner may be eaten at one meal.

No medicines or cosmetics other than lipstick, eyebrow pencil and powder may be used without special permission.

Every item in the list is gone over carefully, continually stressing the point that no variations other than those listed may be introduced.  All things not listed are forbidden, and the patient is assured that nothing permissible has been left out.

The 100 grams of meat must he scrupulously weighed raw after all visible fat has been removed.  To do this accurately the patient must have a letter-scale, as kitchen scales are not sufficiently accurate and the butcher should certainly not be relied upon.

There is no objection to breaking up the two meals.

The whole daily ration of two breadsticks or two fruits may not be eaten at the same time.  Nor can any item saved from the previous day be added on the following day.

It should also be mentioned that two small apples weighing as much as one large one never have a higher caloric value.  They are, therefore, not allowed though there is no restriction on the size of one apple.  Some people do not realize that a tangerine is not an orange and that chicken breast does not mean the breast of any other fowl, nor does it mean a wing or drumstick.

The most tiresome patients are those who start counting Calories and then come up with all manner of ingenious variations which they compile from their little books.  When one has spent years of weary research trying to make a diet as attractive as possible without jeopardizing the loss of weight, culinary geniuses who are out to improve their unhappy lot are hard to take.

Making up the Calories

The diet used in conjunction with HCG must not exceed 500 Calories per day, and the way these Calories are made up is of utmost importance.  For instance, if a patient drops the apple and eats an extra breadstick instead, he will not be getting more Calories but he will not lose weight.  They interfere with the regular loss of weight under HCG, presumably owing to the nature of their composition.

While this diet works satisfactorily in Italy, certain modifications have to be made in other countries.  For instance, American beef has almost double the caloric value of South Italian beef, which is not marbled with fat.  In America, therefore, low-grade veal or extra lean meat should be used for one meal.  Fish (excluding all those species such as tuna, salmon, etc., which have a high fat content), chicken breast, lobster, prawns, shrimps, crabmeat for the other meal.  Where the Italian breadsticks, the so-called grissini, are not available, one Melba toast may be used instead, though they are psychologically less satisfying.

Just as the daily dose of HCG is the same in all cases, so the same diet proves to be satisfactory for a small elderly lady or a hard man.  Under the effect of HCG the obese body is always able to obtain all the Calories it needs from the abnormal fat deposits, regardless of whether it uses up 1500 or 4000 per day.  It must be made very clear to the patient that he is living to a far greater extent on the fat which he is losing than on what he eats.

Many patients ask why eggs are not allowed.  The contents of two good sized eggs are roughly equivalent to 100 grams of meat.  Unfortunately the yolk contains a large amount of fat, which is undesirable.  Occasionally we allow egg – boiled, poached or raw – to patients who develop an aversion to meat.  But, in this case, they must add the white of three eggs to the one they eat whole.  In countries where cottage cheese made from skimmed milk is available, 100 grams may occasionally be used instead of the meat.  No other cheeses are allowed.

Faulty Dieting

Few patients will take one’s word for it that the slightest deviation from the diet has under HCG disastrous results as far as the weight is concerned.  This extreme sensitivity has the advantage that the smallest error is immediately detectable at the daily weighing but most patients have to make the experience before they will believe it.

   Sooner or later most patients express a fear that they may be running out of vitamins or that the restricted diet may make them anemic. However, every time they lose a pound of fatty tissue, which they do almost daily, only the actual fat is burned up.  All the vitamins, the proteins, the blood, and the minerals which this tissue contains in abundance are fed back into the body.

The First Days of TreatmentOn the day of the third injection it is almost routine to hear two remarks. One is: “You know, Doctor, I’m sure it’s only psychological, but I already feel quite different”.  The other typical remark is: “Now that I have been allowed to eat anything I want, I can’t get it down.  Food just doesn’t seem to interest me anymore.

   On the day of the fourth injection most patients declare that they are feeling fine.  They have usually lost two pounds or more.  Some say they feel a bit empty but hasten to explain that this does not amount to hunger.  A few complain of a mild headache, and for which they have been given permission to take aspirin.

During the second and third day of dieting – that is, the fifth and sixth injection-these minor complaints improve while the weight continues to drop at about double the usually overall average of almost one pound per day, so that a moderately severe case may by the fourth day of dieting have lost as much as 8- 10 lbs.

It is usually at this point that a difference appears between those patients who have literally eaten to capacity during the first two days of treatment and those who have not.  The former feel remarkably well; they have no hunger, nor do they feel tempted when others eat normally at the same table.  They feel lighter, more clear-headed and notice a desire to move quite contrary to their previous lethargy.

Fluctuations in weight loss

After the fourth or fifth day of dieting the daily loss of weight begins to decrease to one pound or somewhat less per day, and there is a smaller urinary output.  Men often continue to lose regularly at that rate, but women are more irregular in spite of faultless dieting.  There may be no drop at all for two or three days and then a sudden loss which reestablishes the normal average.  These fluctuations are entirely due to variations in the retention and elimination of water, which are more marked in women than in men.

Patients, who have previously regularly used diuretics as a method of reducing, lose fat during the first two or three weeks of treatment.  The scale may show little or no loss because they are replacing the normal water content of their body which has been dehydrated.  (Diuretics should never be used for reducing.)

Interruptions of Weight LossWe distinguish four types of interruption in the regular daily loss.

Dietary Errors

Any interruption of the normal loss of weight which does not fit perfectly into one of those categories is always due to some possibly very minor dietary error.  Similarly, any gain of more than 100 grams is invariably the result of some transgression or mistake.

This can be illustrated by mentioning the case of salt.  In order to hold one teaspoonful of salt the body requires one liter of water, as it cannot accommodate salt in any higher concentration.  Thus, if a person eats one teaspoon of salt his weight will go up by more than two pounds as soon as this salt is absorbed from his intestine.

Salt and Reducing

We make no restriction in the use of salt and insist that the patients drink large quantities of water throughout the treatment.  We are out to reduce abnormal fat and are not in the least interested in such illusory weight losses as can be achieved by depriving the body of salt and by desiccating it.  Though we allow the free use of salt, the daily amount taken should be roughly the same.  An increase in the intake of salt is one of the most common causes for an increase in weight from one day to the next.

Water

When the body is forced to retain water, it will do this at all costs.  If the fluid intake is insufficient to provide all the water required, the body withholds water from the kidneys.  The urine becomes scanty and highly concentrated, imposing a certain strain on the kidneys.

Constipation

An excess of water keeps the feces soft, and that is very important in the obese, who commonly suffer from constipation and a spastic colon.  While a patient is under treatment we never permit the use of any kind of laxative taken by mouth.

Once the patient realizes that it is in his own interest, they play an active and not merely a passive role in this search.  Then the reason for the setback is almost invariably discovered.  Having been through hundreds of such sessions, we are nearly always able to distinguish a patient who is merely fooling himself or is really unaware of having erred.

Messing up

The patient who is fooling himself is the one who has committed some trifling, offense against the rules.  However, they have been able to convince himself that this is of no importance and cannot possibly account for the gain in weight.  It is not uncommon for patients to place too much reliance on their memory of the diet-sheet and start eating carrots, beans or peas.  They are genuinely surprised when their attention is called to the fact that these are forbidden, as they have not been listed.

   Once the patient realizes that it is in his own interest, they play an active and not merely a passive role in this search.  Then the reason for the setback is almost invariably discovered.  Having been through hundreds of such sessions, we are nearly always able to distinguish a patient who is merely fooling himself or is really unaware of having erred.

Cosmetics

Most women find it hard to believe that fats, oils, creams and ointments applied to the skin are absorbed.  They can interfere with weight reduction by HCG just as if they had been eaten.  This almost incredible sensitivity to even such very minor increases in nutritional intake is a peculiar feature of the HCG method.

   This is especially true of modern cosmetics which contain hormones.  Any interference with endocrine regulations during treatment must be absolutely avoided. We permit the use of plain mineral oil (which has no nutritional value).  On the other hand, mineral oil should not be used in preparing the food.  It has undesirable laxative quality and it absorbs some fat-soluble vitamins.

   We do permit the use of lipstick, powder and such lotions as are entirely free of fatty substances.  We also allow brilliantine to be used on the hair but it must not be rubbed into the scalp.  Obviously sun-tan oil is prohibited.

Under treatment normal fat is restored to the skin, which rapidly becomes fresh and turgid, making the expression much more youthful.  This is a characteristic of the HCG method which is a constant source of wonder to patients.  They have experienced or seen in others the facial ravages produced by the usual methods of reducing.

Other Reasons for a Gain

Apart from diet and cosmetics there can be a few other reasons for a small rise in weight.  Some patients unwittingly take chewing gum, throat pastilles, vitamin pills, cough syrups etc., without realizing that the sugar or fats they contain may interfere with a regular loss of weight.  Sex hormones or cortisone in its various modern forms must be avoided, though oral contraceptives are permitted.  In fact the only self-medication we allow is aspirin for a headache.

We encourage swimming and sun bathing during treatment.  Surprisingly, it can temporarily weight increase after an exceptional physical exertion and lead to a feeling of exhaustion.  Though the extra muscular effort involved does consume some additional calories, it is offset by the retention of water which the tired circulation cannot eliminate right away.

Unforeseen Interruptions of Treatment

If an interruption of treatment lasting more than four days is necessary, the patient must increase his diet to at least 800 Calories.  They can add meat, eggs, cheese, and milk to his diet after the third day.  Otherwise, he will find himself so hungry and weak that he is unable to go about his usual occupation.  If the interval lasts less than two weeks the patient can directly resume injections and the 500-Calorie diet.  If the interruption lasts longer he must again eat normally until he has had his third injection.

When a patient knows beforehand that he will have to travel and be absent for more than four days, it is always better to stop injections three days before he is due to leave.  They he can have the three days of strict dieting which are necessary after the last injection at home.  This saves him from the almost impossible task of having to arrange the 500 Calorie diet while en route.  He can thus enjoy a much greater dietary freedom from the day of his departure.

   Interruptions occurring before 20 effective injections have been given are most undesirable.  Less than that number of injections some weight is liable to be regained.  After the 20th injection an unavoidable interruption is merely a loss of time.

Muscular Fatigue

Towards the end of a full course, when a good deal of fat has been rapidly lost, some patients complain that lifting a weight or climbing stairs requires a greater muscular effort than before.  This phenomenon soon disappears soon after the end of the treatment.  This phenomenon does not occur in patients who regularly take vigorous exercise and continue to do so during treatment.

Blood Sugar

Towards the end of a course or when a patient has nearly reached his normal weight it occasionally happens that the blood sugar drops below normal.  We have even seen this in patients who had an abnormally high blood sugar before treatment.  These symptoms are almost instantly relieved by taking two heaped teaspoons of sugar.  We always suggest that sugar be taken if the patient is in doubt.

Preparing the Solution

Human chorionic gonadotrophin powder is sealed in ampoules or in rubber-capped bottles in varying amounts which are stated in International Units.  In this form HCG is stable.   Once HCG is in solution it is far less stable.  It may be kept at room-temperature for two to three days.  If the solution must be kept longer it should always be refrigerated.

Injecting

HCG produces little or no tissue-reaction.  It is completely painless and in the many thousands of injections we have given we have never seen an inflammatory or supportive reaction at the site of the injection.

One should avoid leaving a vacuum in the bottle after preparing the solution or after withdrawal of the amount required for the injections.  Otherwise alcohol used for sterilizing a frequently perforated rubber cap might be drawn into the solution.  Daily injection should be given at intervals as close to 24 hours as possible.  Any attempt to economize in time by giving larger doses at longer intervals is doomed to produce less satisfactory results.

The Heart

Disorders of the heart are not as a rule contraindications.  In fact, the removal of abnormal fat – particularly from the heart-muscle and from the surrounding of the coronary arteries – can only be beneficial in cases of myocardial weakness.  Many such patients are referred to us by cardiologists.

Teeth and Vitamins

Patients whose teeth are in poor repair sometimes get more trouble under prolonged treatment, just as may occur in pregnancy.  In such cases we do allow calcium and vitamin D, though not in an oily solution.  The only other vitamin we permit is vitamin C, which we use in large doses, combined with an antihistamine, at the onset of a common cold.

Alcohol

Obese heavy drinkers, even those bordering on alcoholism, often do surprisingly well under HCG.  It is exceptional for them to take a drink while under treatment.  When they do, they find that a relatively small quantity of alcohol produces intoxication.  Such patients say that they do not feel the need to drink.  This may in part be due to the euphoria which the treatment produces and in part to the complete absence of the need for quick sustenance from which most obese patients suffer.

Concluding a Course

When the three days of dieting after the last injection are over, the patients are told that they may now eat anything they please, except sugar and starch, provided they faithfully observe one simple rule.  This rule is that they must have their own portable bathroom-scale always at hand, particularly while traveling.  They must without fail weigh themselves every morning as they get out of bed, having first emptied their bladder.  If they are in the habit of having breakfast in bed, they must weigh before breakfast.

   It takes about 3 weeks before the weight reached at the end of the treatment becomes stable.  It then does not show violent fluctuations after an occasional excess.  During this period patients must realize that carbohydrates of sugar, rice, bread, potatoes, pastries, etc, are by far the most dangerous.  If no carbohydrates whatsoever are eaten, fats can be indulged in somewhat more liberally.  Even small quantities of alcohol, such as a glass of wine with meals, will do no harm.  However, as soon as fats and starch are combined things are very liable to get out of hand.  This has to be observed very carefully during the first 3 weeks after the treatment is ended otherwise disappointments are almost sure to occur.

As long as their weight stays within two pounds of the weight reached on the day of the last injection, patients should not worry about weight increase.  But the moment the scale goes beyond two pounds, even if this is only a few ounces, they must entirely skip breakfast and lunch and take plenty to drink.  In the evening they must eat a huge steak with only an apple or a raw tomato.  Of course this rule applies only to the morning weight.

   It is of utmost importance that the meal is skipped on the same day as the scale registers an increase of more than two pounds. Don’t skip it until the following day.  Most patients are surprised how small their appetite has become and yet how much they can eat without gaining weight.  They no longer suffer from an abnormal appetite and feel satisfied with much less food than before.  In fact, they are usually disappointed that they cannot manage their first normal meal, which they have been planning for weeks.

Losing more Weight

An ex-patient should never gain more than two pounds without immediately correcting this.  It is equally undesirable that more than two lbs. be lost after treatment, because a greater loss is always achieved at the expense of normal fat.  Any normal fat that is lost is invariably regained as soon as more food is taken, and it often happens that this rebound overshoots the upper two lbs. limit.

Trouble after Treatment

Two difficulties may be encountered in the immediate post-treatment period.  If a patient has consumed all his abnormal fat or when, after a full meal, the injection has temporarily lost its efficacy, the body has gradually evolved a counter regulation.  The patient at once begins to feel much more hungry and even weak.  In spite of repeated warnings, some over-enthusiastic patients do not report this.  However, in about two days the fact that they are being undernourished becomes visible in their faces, and treatment is then stopped at once.  In such cases – and only in such cases – we allow a very slight increase in the diet.  This can be an extra apple, 150 grams of meat or two or three extra breadsticks during the three days of dieting after the last injection.

When abnormal fat is no longer being put into circulation because it has been consumed or because immunity has set in, this is always felt by the patient as sudden, intolerable and constant hunger.  In this sense, the HCG method is completely self-limiting.  With HCG it is impossible to reduce weight futher, however enthusiastic, beyond his normal weight.  As soon as no more abnormal fat is being issued, the body starts consuming normal fat.  Normal fat is always regained as soon as ordinary feeding is resumed.  The patient then finds that the 2-3 lbs. he has lost during the last days of treatment are immediately regained.  A meal is skipped and maybe a pound is lost.  The next day this pound is regained, in spite of a careful watch over the food intake.  In a few days a tearful patient is back in the consulting room, convinced that her case is a failure.

All that is happening is that the essential fat lost at the end of the treatment, owing to the patient’s reluctance to report a much greater hunger, is being replaced.  The weight at which such a patient must stabilize thus lies 2-3 lbs. higher than the weight reached at the end of the treatment.  Once this higher basic level is established, further difficulties in controlling the weight at the new point of stabilization hardly arise.

Beware of Over-enthusiasm

The other trouble which is frequently encountered immediately after treatment is again due to over-enthusiasm.  Some patients cannot believe that they can eat fairly normally without regaining weight.  They disregard the advice to eat anything they please (except sugar and starch) and want to play safe.  They try more or less to continue the 500-Calorie diet on which they felt so well during treatment.  They’ll make only minor variations, such as replacing the meat with an egg, cheese, or a glass of milk.  To their horror they find that in spite of this bravura, their weight goes up.  So, following instructions, they skip one meager lunch and at night eat only a little salad and drink a pot of unsweetened tea, becoming increasingly hungry and weak.  The next morning they find that they have increased yet another pound.

Protein deficiency

Here too, the explanation is quite simple. During treatment the patient has been only just above the verge of protein deficiency.  They had the advantage of protein being fed back into his system from the breakdown of fatty tissue.