Tuesday, April 3, 2012

The hCG Diet and Other Bad Ideas

This morning I received an email from yet another company advertising classes to get health care providers trained to use their latest "weight loss innovations".  As a nutritionist, I receive a fair number of these. Most of the time I delete them, because I frequently find that I disagree with many aspects of the programs advertised.  So when I saw the program calling itself an "alternative to weight loss," I thought, “is someone finally seeing reason?” I do tend to believe there are far too many folks pushing dangerous weight loss schemes, and the language initially made it sound as though this program was focusing on “health gain”. Another point in its favor, the program was being advertised by a natural health advocate. So out of curiosity I clicked through the links to find out more information.

Once I managed to slog through the vague and misleading advertising language, I finally found a FAQ section and decided to start there.  I quickly found that the diet being promoted was a variant of the hCG diet, but instead of using injectable or homeopathic hCG (since the FDA has been cracking down on all non-prescription and off-label hCG supplies), the program uses some other homeopathic formula they've created to help suppress appetite and speed up weight loss.

Suffice to say that there was so much foolishness in the FAQ that I stopped reading it about half-way down (I couldn't handle extensive misspelling of words like "menstrual" and the absolute mangling of the spelling for several nutrients, nor could I handle the faulty science throughout ).  The final straw was the section on personal health care products, where a claim was made that apparently even topically applied fat is going to make you fat. The man whose diet this is actually claims that those on his program have to avoid the “fats” found in skin care products like oil-based foundations and moisturizers, because they might interfere with weight loss.  I suppose he believes that someone eating only 500 calories a day may become so overwhelmed with hunger that they resort to licking their makeup off their faces in an effort to get more calories in...

Since variations of this foolishness have been making their way around my world quite a lot lately (I have fielded more questions about the hCG diet in the past few months than I can count), I thought it would be useful to explain in a bit more detail exactly why these diets are a bad idea.

Let's start with a basic concept called "basal metabolic rate." This is the number of calories a body burns while at rest over the course of 24 hours. Calories are units of energy (heat, actually), and our body needs a certain number of calories just to run basic body functions like your heart beating and your blood circulating, the involuntary muscle movement involved with breathing, that sort of thing.  If you were to lie in a coma for 24 hours, there would still be a set number of calories your body needs just to stay alive.  That number is your basal metabolic rate. Any additional movement or activity requires additional calories to be burned. So the number of calories you *actually* burn over 24 hours varies quite a bit based on your overall activity level, but your basal metabolic rate is based on how much metabolically active tissue (muscles & organs) that you have.  We're talking a basic cellular head-count.

If your calorie intake is consistently below your required basic basal metabolic rate, your body doesn't have enough calories to keep normal body functions running. This is called "starvation".  Your body changes modes - there's a complex series of hormonal changes that will occur, including slowing down your production of thyroid hormones. Your body is going to do whatever it needs to do to try and not die, because your body considers starvation to be a life-threatening condition. So what happens? Your appetite levels increase, your blood sugar drops (which can cause crankiness, headache, irritability, hot flashes, chills, shakes and many other symptoms), all kinds of other short and long term body chemistry changes happen, all geared towards surviving a famine. Furthermore, your ability to burn FAT decreases, and you're actually more likely to start burning muscle instead of fat for fuel.

With very low calorie dieting, your actual fat stores may stay about the same (at least for awhile) while your body kills off healthy muscle tissue for fuel first.  This is a clever adaptation indeed. Muscle cells are metabolically active - meaning, they are cells that burn calories (ie: they "eat"). Fat cells, however, are metabolically inactive - they mostly just store stuff. Fat is a complex molecule, and you actually need enough regular fuel coming in for your body to have enough energy to actually burn it off.  It is far easier for the body to convert protein into blood sugar than to convert fat.  And you definitely need to be bringing in calories at least equal to your basal metabolic rate in order to burn fat.

Here's a grotesque metaphor to illustrate how this works.  Imagine you had 10 people at the table, all of whom need to eat a set amount of food. As long as you consistently serve 10 plates, everyone's happy.  Now imagine you start "dieting", and now only 6 plates are served. The contents of the plates cannot be redistributed to feed 10; the amount on one plate is required to feed one eater.  So what happens?  Well, only 6 plates get served. And over time if only 6 plates keep coming out, then 4 of the other eaters are killed and served to the remaining eaters.  So now there are only 6 eaters left.  That's your basic low-calorie diet.   Not enough calories to preserve health as-is, so some healthy metabolically active tissue is killed off and redistributed as fuel for the other cells. 

Now what happens when you start serving enough food for 10 eaters again?  Well, there are only 6 eaters left at the table, so you end up with 4 extra plates. So the 4 extra plates are now put into storage.  This is why if you do a very low calorie diet for long enough, then go back to your "normal" eating habits, even if you are not eating more than you were before, you will most likely gain all the weight back plus 5-10 more pounds.  The extra weight gain is precisely because you've now reduced your basal metabolic rate by destroying metabolically active tissue - you've reduced your ability to burn calories by inappropriately dieting.  This is why short term, low calorie diets DO NOT WORK for improving health or maintaining long term weight changes. This is really basic anatomy and physiology; these are not hard concepts to grasp.

All the credible research I've evaluated (and I've been doing this work for 11 years now) indicates to me that simply losing weight, without evaluating what kind of weight you're losing, is not always going to lead to health improvement, and will sometimes lead to a worsening of health.  Having a higher body fat to muscle mass percentage (regardless of the number on the scale) increases a person's risk for metabolic diseases like diabetes and heart disease. Which actually means that if you lose the wrong kind of weight, or lose it in the wrong way, not only have you not improved your metabolic risks, you may have actually just made your risks worse.  I'd rather see my clients stay at the same scale weight and convert fat into muscle (by exercising, better managing stress, increasing healthy protein intake, decreasing processed carbs, eating balanced meals at or above their basal metabolic rate calorie-wise, and getting enough sleep) than lose a bunch of muscle weight and mistakenly think they've helped their health. 

There are times when weight loss may be indicated for improving health, and if done with health as the number one goal, there are times when this may be useful. However, if the weight is truly "excess" weight and not just a person's normal healthy size, the excess weight is most likely a byproduct of poor diet or lifestyle, or some underlying health problem. If you are eating junky and not exercising or taking care of yourself, many things may start going wrong in your body. Your weight may increase, but also you may have other health concerns showing up. And the other health concerns are, quite frankly, the more important problem needing to be addressed.

If you focus on health gain rather than weight loss, often your weight will reduce. Possibly not to fashion magazine thinness, but then whatever weight is lost becomes a side effect of an overall health improvement, as your body moves towards overall health.  The amount of healthy "weight loss" will vary depending on many health factors.  And as stated earlier, knowing your basal metabolic rate is your golden number.  Basal metabolic rate can be measured using machines like BioElectric Impedance Analyzers, or calculated by hand (there are many formulas available online for calculating basal metabolic rate).

 As a practitioner, I am not anti-weight loss, when the weight loss is done in healthy and appropriate (and respectful, and emotionally healthy) ways, and when the weight loss is secondary to healthy lifestyle changes (when the weight loss is one of hopefully several signs of overall health improvement).  But I am not blanket pro-weight loss either. And I am definitely against folks putting their health and sanity at risk simply for being "smaller", while justifying that body hatred with incorrect pseudo-medical language and techniques.

Back to the hCG diet... hCG, or human chorionic gonadotropin, is a hormone produced during pregnancy by the developing embryo.  hCG is also produced by certain cancerous tumors.  In the 1950s, an endocrinologist named Albert Simeons began experimenting with hCG as a weight loss enhancing drug.  His diet involved injected folks with low doses of hCG alongside very low calorie diets (under 500 calories).  He claimed that hCG would produce feelings of satiety and well-being, speed up weight loss, cause body fat to redistribute and increase lean muscle mass.  Modern day variants of the diet include medical centers who will administer the injections, or quite a few programs selling homeopathic or oral hCG supplements to be taken alongside a 21-40 day very low calorie diet.  Medical programs may cost up to $700 or more for a 40 day program.

Despite over 14 clinical trials researching the effectiveness of this diet, the diet has never been shown to work more than placebo.  Studies have shown that, just like any other fad crash diet, folks will lose a bunch of weight when sticking with a 500 calorie diet, and then generally gain it all back plus more. And worse, hCG itself has never been shown to help with weight loss (all the weight loss appears to be from the 500 cal diet; additional "benefits" have never been shown to be anything other than placebo effect), but side effects of hCG can include headaches, blood clots, leg cramps, temporary hair thinning, constipation, and breast tenderness. At least one person on record ended up with a pulmonary embolism after receiving hCG injections.  The Journal of the American Medical Association and the American Journal of Clinical Nutrition both warn that this diet is neither safe nor effective. And the United States Food and Drug Administration has stated that over the counter products containing hCG are fraudulent and ineffective for weight loss, cracking down on the sale of such products (including homeopathic formulations that contain trace amounts of hCG).

The hCG diet is a perfect example of why I consider fat-phobia to be a life-threatening societal issue. Because the fear of being "fat" / the hatred towards "fat" trumps common sense, and causes people to do stupid and dangerous things to their bodies (or pressure other people to do dangerous things). And certain so-called health care professionals and the diet industry make lots of money off of the fat-panic that causes people to turn off their common sense. And I think that's unconscionable.


  1. Thank you, thank you. The oft-repeated misconceptions about both diet and exercise as they relate to exercise drive me nuts, too! The root problems with the public conversations about these seem to be: lack of VERY basic science literacy (e.g., topical fat leading to stored body fat,) and a misunderstanding of how dynamic the body actually is and how many variables are involved (e.g., how running and walking cause different changes to how the body functions, beyond the number of calories burned during exercise sessions.)

  2. Oops .. that would be "... diet and exercise as they relate to weight loss ... "

  3. While I don't discount your research, I have several friends that have lost over 60 lbs. using the pharmaceutical grade HCG and they have kept off the weight for over 18 months. The calorie restriction has taught them to make better food choices and if they cheat, how to do so smartly. The HCG Diet also promotes using organic foods and meat that has not been injected by hormones. There are pros and cons to every diet, I think people are free to do what best works for them.