Among the hundreds of drastic and unproven weight loss plans, the controversial hCG diet may take the cake.
Discredited by researchers in the 1970s, the near-starvation diet restricts followers to 500 calories a day for six weeks. At the same time, dieters regularly inject themselves with human chorionic gonadotropin, or hCG, a hormone taken from pregnant women's urine. Proponents say the hCG curbs hunger pangs, makes it easier to stay on a very low-calorie diet — and even releases stored body fat from trouble spots like the belly, hips and thighs.
Followers of the hCG diet acknowledge that the severe calorie restriction feels like a "forced death march." Both supporters and critics agree that evidence is scant to show the hCG works any better than a placebo. Meanwhile, safety data are lacking on long-term use of hCG for weight loss.
"Starving yourself is never a good idea," said Pieter Cohen, an associate professor of medicine at Harvard Medical School, who criticized the hCG diet this year on "The Dr. Oz Show." "Injecting yourself with ineffective hormones is an even worse idea."
Yet, the long-discredited diet is making a comeback, and the renewed interest has spawned a cottage industry for products that haven't been tested for quality, safety or efficacy, including drops and sprays.
What's also different this time around is that though the hCG diet still exists largely in the realm of alternative medicine practitioners and Internet hucksters, it's also making inroads in integrative clinics headed by medical doctors, where it's offered as part of a "medically supervised" weight loss plan. At least one physicians group is offering hCG training to doctors. And wellness centers and medical spas also tout the hCG diet as the long-awaited magic bullet.
Dr. Mehmet Oz fueled interest in the diet — and appalled some medical colleagues — by featuring anecdotal success stories on his TV show. Whenever scientific studies show something doesn't work, "yet you have real human beings saying they tried it and it works, I get curious," explained Oz, who called the diet "portion-control shock therapy."
There's no question that men and women do lose weight on the diet — as would anyone who eats 500 calories a day. The pounds melt off quickly, and the instant gratification can be intensely motivating to the patients, who have often exhausted most other options. And because so few obesity treatments are successful, some proponents say the anecdotal evidence shouldn't be dismissed.
"If it was as simple as reducing calories and increasing exercise, we'd all be thin," said Nikol Margiotta, who directs the Longevity HCG Diet at the Raby Institute for Integrative Medicine at Northwestern, which is not part of Northwestern Memorial Hospital. Margiotta is a naprapath, a health care practitioner who treats connective tissue disorders using nutrition and hands-on therapy.
On the hCG diet, "there's a focus, a single-minded drive that comes over you," said Margiotta, who went on the diet herself and said she lost 22 pounds in five weeks. "The problem is that you get addicted to the weight loss."
Still, the bulk of research has found no evidence that taking hCG brings about weight loss or fat redistribution, reduces hunger or improves mood. Since the 1970s, the U.S. Food and Drug Administration has required labels to state that the hormone "is not an effective adjunctive therapy" for weight loss.
If dieters lose weight on the regimen, the effect is from the ultralow-calorie diet, most studies have concluded, and the hCG is a placebo.
"Unfortunately that placebo comes with other potential harms," said Dr. Melinda Ring, director of the Northwestern Center for Integrative Medicine and Wellness. "In human and animal studies, hCG injections have been associated with many problems, including excessive stimulation of the ovaries, elevated leptin, insulin and cortisol."
One common side effect of the hCG diet is hair loss; calorie restriction starves the body of essential nutrients, though the diet's proponents believe the body gets the calories it needs from existing fat. HCG can also increase the risk of blood clots, headaches, irritability and fatigue.
In men, hCG stimulates testosterone production, which is why hCG is considered a performance-enhancing substance for athletes. But for a woman of childbearing age, hCG taken by injection, nasal spray or orally could generate antibodies that put future pregnancies in danger, said Dr. Rasa Kazlauskaite, an endocrinologist and preventive medicine expert at Rush University Medical Center who specializes in weight gain.
Taking hCG, she said, "may immunize yourself to your own pregnancy," said Kazlauskaite. "You could still get pregnant, but you could potentially have an antibody to the hormone that is needed to maintain the pregnancy," she said. "The longer you use hCG, the higher the chance you could get the antibody."
HCG is a hormone produced by the placenta to help nourish the womb. The injected version is a prescription drug approved by the U.S. Food and Drug Administration to treat fertility issues and endocrine disorders. Last month Merck announced a shortage of its hCG drug, Pregnyl, due to increased demand, and the diet's popularity is "absolutely a contributing factor," said Cynthia Reilly of the American Society of Health System Pharmacists.
The hCG diet comes in a variety of forms, ranging from medically supervised to do-it-yourself. Most people on the diet use an hCG nose spray or oral drops, said Kazlauskaite. These are not tightly regulated by the FDA — over-the-counter products containing hCG are considered by the FDA to be supplements — and there's no way to know how much of the hormone, if any, is in these preparations.
HCG taken by mouth is destroyed by stomach acid, Kazlauskaite said, and if the hCG is injected, about 80 percent of it is inactivated within the body within 24 hours.
At the Raby Institute, dieters can't begin the program until they're medically cleared by Dr. Their Griego Raby. The 45-day protocol starts with a two-day binge on high-fat foods. Then dieters are allowed 500 calories per day of specific protein, fruits and vegetables and light or no exercise; the last three days on the diet, there are no injections.
Then the patient begins a 30-day "transition" period, when a wider variety of foods, fats, vegetables and fruits are added back to the diet. During this period, dieters must still avoid sugar, starchy carbohydrates and alcohol.
The weight stays off, said Margiotta, because the diet changes their approach to food. "That's where the coaching and lifestyle changes come in," she said.
The cash price for the program is $895, which includes the hCG and weekly sessions. Insurance often covers the visits, but not the hCG, depending on the carrier, said Margiotta.
Recently at the Raby Institute, 14 women gathered in a sunny conference room for "community," a weekly support group session. During the meeting, nearly all the women reported some weight loss and had their blood pressure taken. Margiotta asked whether there were any concerns.
One woman raised her hand. "I only lost three pounds last week. Do I have a problem?"
Margiotta smiled and waited for the question to sink in. "Did everyone hear that? I 'only' lost three pounds?"
"On this diet," said Margiotta, "every night is like Christmas Eve and every morning is like Christmas Day, waiting to unwrap the shiny package of weight loss."
Darien's Cecelia Hylak-Reinholtz has felt the euphoria. Since February, the 36-year-old has lost 100 pounds; her goal dress — a size 12 from Ann Taylor — is hanging in the back of her closet.
To the diet's critics, she said, simply, "look at my results." But she's referring to more than her dramatic weight loss. Hylak-Reinholtz, who owns a lobbying and consulting firm, is also seeing a therapist and learning how to make better food choices. With her increased energy, she has started golf lessons, dancing, bike riding and "wogging," a cross between walking and jogging.
"This time it's different because I'm different," said Hylak-Reinholtz, who now eats in a week what she used to eat in a day — and far more slowly. "I'm doing things with my body that I haven't done before. My whole outlook has changed."
The larger battle for anyone on the diet, however, is keeping the weight off. VJ Sleight first tried hCG in February 2008. It worked — she lost 40 pounds over a year and a half — but the weight crept back and "it seemed impossible to get back off," she said.
Last year Sleight's breast cancer returned after a 23-year absence. "I'm now back to where I was before I started the hCG — mainly due to inactivity due to my surgeries and overindulging in comfort foods during my treatment," said Sleight, of La Quinta, Calif.
Today Sleight said she has no regrets but added that she wouldn't use hCG again. "I never really could 'hold' my weight for more than a few months at a time, and so I'd do another cycle of hCG," she said. "It never really worked as well as it did the first time."
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