A Look at the HCG Diet

Exploring the Human Chorionic Gonadotropin - HCG - Diet

Cutting vegetables
AfricaImages/Getty Images

The HCG diet has been a subject of controversy, and unscrupulous online marketers have latched onto it as a money-making source. However, before the diet protocol became known in the US, Dutch hormone and weight loss expert Dirk van Lith, MD, MPH, author of the book The Original European HCG Cure, was using the HCG protocol for weight loss with his patients for many years.

For those interested in learning more about HCG, from a physician who has used it in his practice for several decades, Dr. van Lith's book provides a good foundation in the theories and application of this approach for weight loss. 

What is HCG?

HCG -- human chorionic gonadotropin – is a hormone that normally produced in large quantities in a pregnant woman's body. (Home pregnancy tests are actually testing for HCG in the urine.) In a pregnant woman, one of the functions of HCG is to mobilize the burning of fat, to ensure that energy is provided to the developing fetus and protect the pregnancy, even if the mother is facing a situation of starvation, or is only able to get limited calories. As a medication, HCG is used at high doses as a fertility treatment.

The Theory Behind HCG for Weight Loss

For weight loss, HCG is used in minute concentrations – along with a very low-calorie diet -- as a way to shift the hypothalamus and trigger fat-burning.

The combination of HCG and a very low-calorie diet is sometimes referred to as the HCG Protocol, or the HCG Diet, or in some cases it is known as the Simeons diet, after British physician Dr. A.T.W. Simeons, the doctor who first proposed it as a weight loss method in 1954. It's occasionally referred to as the "Pounds and Inches Diet" diet after Dr. Simeons' book, which was titled Pounds & Inches: A New Approach to Obesity.

The theory is that the HCG triggers the burn-off of stored fat, and allows for weight loss without the normal side effects of a low-calorie diet, such as hunger, irritability, headaches, weakness, reduced muscle mass, or reduced metabolism.

For proponents, HCG is thought to be working in a number of different ways:

  • HCG causes the hypothalamus to trigger fat to move out of storage and become available for use as immediate energy. The combination of the released stored energy, plus the energy from the low-calorie diet, add up to several thousand calories a day of energy available for daily function. But, since much of the calories are coming from stored fat, weight is lost, in particular, body fat.
  • HCG prevents the metabolism from dropping, despite being on a very low-calorie diet. The normal response to a very low-calorie diet is for the metabolism to slow down, which can cause fatigue, and stall weight loss. The theory is that the HCG circumvents this mechanism with the hypothalamus, and keeps metabolism at a stable level.
  • Because HCG focuses weight loss preferentially on fat areas, muscle mass is theoretically less likely to be lost.
  • After weight loss on HCG, hypothalamic balance is restored, and leptin and insulin resistance may also be reduced, making it easier to continue losing weight, or maintain weight loss.
  • For patients who have been yo-yo dieters, or on very low-calorie diets, hypothalamic dysfunction that has slowed metabolism or reduced their caloric needs may be reversed, and the metabolism returns to a more normal function.

The Controversy Over HCG

The use of HCG as part of a specific weight loss protocol is a controversial approach, and some physicians refuse to prescribe it. 

The main criticism of the HCG protocol is, frankly, that it's ineffective.

Critics of the HCG protocol point to research studies that have found that HCG is no more effective than placebo, and say that the effects of the diet are due to being on a very low-calorie diet of 500 calories a day, and not the HCG.

There are some vague criticisms about whether HCG is safe, but typically, the concerns cite side effects that are associated with the use of HCG for fertility. High-dose HCG for fertility treatments can result in ovarian hyperstimulation, and rupture of ovarian cysts, among other side effects. The doses used for fertility treatment, typically 5,000 - 10,000 IU are, however, much higher than the 125 IU a day typically used in the HCG protocol.

Some critics suggest that the HCG protocol is simply a ketogenic diet, and what's happening is that the limited carbohydrates in the diet are sending the body into a state called ketosis, where appetite typically is suppressed. Stored fat is burned during ketosis, but over time, there are concerns that ketosis can increase the risk of kidney stones and gallstones.

Some critics say that the HCG protocol works only because it's a very low-calorie diet that is supervised and overseen by a practitioner, and that oversight by medical professionals is what is ensuring greater success.

Some practitioners have also suggested that one of the key reasons people lose weight on the HCG diet is not the HCG, but the fact that many people on the diet eat no starches whatsoever, and are effectively on a gluten-free diet, sometimes for the first time in their lives. They attribute weight loss to eliminating gluten from the diet along with the low calories, and not necessarily the HCG.

It's also important to note that while HCG is prescribed for and has FDA approval as a fertility treatment, its use as a weight loss treatment is considered an "off-label" use and the FDA requires physicians to advise patients that HCG has not been demonstrated to be effective treatment for weight loss.

Is HCG Safe?

Physicians working with HCG point to the fact that minute doses of the hormone are used. Long-term studies of the HCG protocol for weight loss, however, have not been done.

At the same time, there are practitioners who have been using HCG successfully with their patients for years. Increasing numbers of legitimate practitioners, including physicians, hormone experts and some bariatric (weight loss) physicians, are rediscovering HCG, and using it themselves, or with patients, and finding it successful.

Even the American Society of Bariatric Physicians includes panels and sessions on the HCG debate in its annual meetings, and recognizes that there are different positions regarding the use and effectiveness of HCG among its members.

Dr. van Lith feels comfortable with the safety of HCG. He states: "In 20 years, I have not seen one single side effect. Heart patients, diabetics, metabolic syndrome, thyroid patients -- they all lose weight, and many have unsuccessfully tried everything else before."

Does HCG Work?

So the question is, despite the controversy, does HCG work?

If you ask some people who have followed the HCG Protocol, yes. I've heard from hundreds of thyroid patients who have done a 40-day course of HCG and lost 15, 20, and even as much as 40 pounds. I've also heard from some patients who found it totally ineffective. 

I've also heard from many physicians who are increasingly using HCG with patients who are unable to lose weight with traditional diet and exercise approaches.

So if we have some "patient evidence-based medicine" that shows that HCG works for some, and practitioners who prescribe HCG because they see it work with some of their patients, why don't we have research to back it up?

The truth is, there is one journal study showed greater weight loss with less hunger on HCG versus placebo. But a number of other studies have shown that HCG plus a low-calorie diet does not result in greater weight loss compared to the same diet without HCG.

HCG proponents explain this in part by pointing out that the studies have not looked at fat composition or body shape and say that the key is that HCG-treated patients lose more body fat, from the right places -- versus muscle and fat from the wrong places -- when compared to those not taking HCG.

Is that enough of an excuse? I don't know. I'll admit that while the theories behind why the HCG Protocol works make sense, there is little proven research to back it up. Part of that may be due to the fact that HCG is not patentable. Large-scale studies are rarely undertaken to evaluate drugs that can't be profitably mass-produced by a drug manufacturer.

The HCG Protocol

Generally, the HCG protocol is straightforward. The concept is that you follow a 20- or 40-day cycle of using HCG, and along with a very low-calorie diet composed of very specific foods, allowing you to lose a substantial amount of fat, primarily from areas of the body that have excess fat deposits.

While simple, proponents caution that HCG protocol needs to be followed very carefully. You can't take HCG and eat anything you want, or go above the calorie limits. The diet is specifically designed, at around 500-600 calories, to work with the HCG to achieve the results.

Dr. van Lith outlines a detailed multiphase approach in his book, including several days of higher calorie eating, followed by a detoxification, and then use of the HCG with the special diet, which is outlined in detail in the book, along with recipes.

According to Dr. van Lith, the average weight loss on a 40-day course of HCG is typically from 15 to 35 pounds.

After a cycle of HCG, according to Dr. van Lith, about 75 percent of his patients have had little to no difficulty maintaining their weight loss.

Just for Thyroid Patients

I had an opportunity to interview Kent Holtorf, MD, an integrative physician who specializes in hormone imbalances and thyroid issues. In the interview -- Long Term Weight Loss for Thyroid Patients: Hormonal Factors That Affect Diets -- Dr. Holtorf pointed out that while there are many factors involved in the inability to lose weight, almost all the overweight and obese patients he treats have demonstrable metabolic and endocrinological dysfunctions that are major contributors to the weight challenges of these patients. Dr. Holtorf focuses on resetting a low metabolic setpoint in people with hormonally related weight loss challenges.

Says Dr. Holtorf:

"In addition to optimizing the thyroid (remember, giving thyroid hormone to lose weight is not appropriate, but that's not what we are doing, here we are correcting a deficiency), Symlin (pramlintide) and/or Byetta (exenatide) can be very effective for many. Human Chorionic Gonadrotropin (HCG) is another potential option that works for some."

Dr. van Lith says in his book that thyroid patients do tend to lose weight more slowly on HCG. But he has found that switching to a natural desiccated thyroid drug can help:

"For thyroid patients, I only use natural thyroid, because I have found that synthetic T4 inhibits the HCG, and you get better results with natural thyroid. If patients tend to lose 12 kilos (26 pounds) in 6 weeks, a typical hypothyroid patient might lose 10 kilos (22 pounds.) But once they've started on natural desiccated thyroid, I find they are more likely to lose 11-12 kilos (24-26 pounds) on the next course of HCG."

For Those Interested in the HCG Diet

If you are interested in following the HCG protocol, I recommend you start by reading Dr. van Lith's book, for a thorough understanding of the HCG protocol and diet. 

Be sure to follow a medically supervised program. Do not be tempted by do-it-yourself, online, or over-the-counter HCG programs. That means you should consult with a physician before you start, and use a form of HCG prescribed and recommended for you by that physician.

The injectible HCG seems to be favored by most of the practitioners I've interviewed. Dr. van Lith, who works with both injection and sublingual prescription HCG, prefers a custom-compounded injectible HCG he formulated. He feels that it may be more effective, and patients won't forget to take a nighttime dose, a problem that can arise with the sublingual HCG.

If you are intimidated by needles, keep in mind that the needles used for HCG injections are usually very small, thin insulin needles used by diabetics for daily injections. If you've never injected yourself, see a health care practitioner for a lesson in how to safely administer an injection. If you are worried about the pain of an injection, if you have any abdominal fat – a "muffin top" – that's a particularly painless place for injections.

Dr. van Lith recommends that patients be provided with child-sized syringes used for diabetes injections. According to Dr. van Lith: "Most people can't even feel the 3 mm needle, and there is no risk of it going into the abdominal cavity."

Important Note

Some people should not use the HCG protocol, and different practitioners have different guidelines. Generally, women who are pregnant or nursing are warned not to use HCG. Some practitioners will prescribe HCG for type 2 diabetics, but not insulin-dependent diabetics. Others rule out anyone with heart disease or any current cancer or history of cancer. Some physicians also rule out anyone with gallstones, a history of gout, epilepsy, and kidney disease. Be sure that you provide accurate information about your medical history to any practitioner, and work with a reputable physician. 

Note: For more information on Dr. Dirk van Lith's HCG protocols, see his website, http://weightdrops.org/