Is HCG the "Dirty Little Secret" of Low Carbers?

There's a popular diet plan out there that is supposed to melt the pounds off of you.  Inject yourself with HCG a hormone produced by the placenta of pregnant women.  This has been around since the 1950's when Dr. Simeon devised the original program.  Perhaps spurred by Kevin Trudeau's 2007 book on the diet, it seems to have experienced a resurgence in recent years.  The diet itself lasts for several weeks where someone eats 500 calories/day in two meals.  Here's Simeon's original plan:

• 125 I.U. of HCG daily (except during menstruation) until 40 injections have been given.
• Until 3rd injection forced feeding.
• After 3rd injection, 500 Calorie diet to be continued until 72 hours after the last injection.
• For the following 3 weeks, all foods allowed except starch and sugar in any form (careful with very sweet fruit).
• After 3 weeks, very gradually add starch in small quantities, always controlled by morning weighing.

This amounts to 3 days of overfeeding, almost 6 weeks of 500 cal/day, followed by 3 weeks of ad libitum VLC (e.g. Atkins Induction).  After that you get to add starches in as the bathroom scale permits.  Is it any wonder most struggle with that last phase?   And here's a sample menu:  

Breakfast:  Just black coffee (or 1T milk max/day) with artificial sweetener

Lunch & Dinner:  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.  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.  One breadstick (grissino) or one Melba toast.  An apple, orange, or a handful of strawberries or one-half grapefruit.

The pounds melt off and the HCG keeps hunger at bay.  Variations these days involve sublingual drops instead of injections, and this is even more suspect IMO.   Call me jaded, but until I see a study demonstrating that (a) HCG has an appetite suppressive effect, or (b) HCG has some other hormonal effect so that weight is lost on a higher calorie diet, say 1000 cal/day, I'm not going to be wasting my money on this solution.  Your mileage may vary.

What's intriguing about this is that low carbers should instinctively reject this plan.  It's got all the wrong elements compared to the glories of low carb living.  Right?   Let's see:

• It's a quintessential starvation diet 
• It's dangerously low calorie 
• That little food is going to tank your metabolism
• You have to weigh your food!
• It's low fat (both amount and percent), high protein (by percent)
• Big Pharma makes HCG and doctors are profiting from putting clients on starvation diets and a drug.  Low Carbers don't need no stinking drugs dammit!
• It's unsustainable for the long haul.  Remember the LC outcry over the diabetes "crash diet" cure?  One focus was the unsustainability of such a diet, forgetting that the 600 cal/day phase was not in all perpetuity, just as it's not in this diet.  Dukan?  No can do can!  KimKins?  Well that was a disaster!!  (Nevermind that Jimmy's terroir is littered with former 100+ lb KK success stories, many of whom have regained and are not having much success re-losing the weight on the new high fat, pass-the-coconut-oil version of ad libitum VLC.  
• It's low carb anyway (there's not much carb in a melba toast) so calorie restriction should not be necessary, right?  Or just ditch the melba toast and the pounds will melt away, right?

For all of those who are reluctant to acknowledge the role of calories in weight loss, doesn't the use of HCG in the low carb community just drip ... nay gush ... of irony?   But CarbSane, there may be HCG veterans who find their way to the LC community ... surely that's it?!  This may well be true of the HCG following of Leptin Man, but it's not seemingly so for the HCG'ers on various LC forums.  There are mega HCG threads  on Active Low Carbers (as of this posting ALC site has vaporized so I posted a Google search), and over at Low Carb Friends HCG enjoys it's own subforum area!  There weren't too many trying HCG over on Jimmy's forum, but there were some brave souls who would admit resorting to HCG when weight loss stalled.   I guess so long as the basis for maintenance is essentially a low carb plan, consistent with the "carbs make you fat" dogma ....

Before I get to what ultimately prompted this post, allow me to return to Leptin Man for a moment.  It seems that many refuges of HCG have turned to Dr. Jack Kruse -- NeeeeuuuroSURGEON!! -- for assistance.  So many, apparently, that he wrote a specific blog post just for them:  HERE.   Although he seems to equate HCG with cigarette smoking (something he unequivocally promoted the use of Chantix for quitting over on PaleoHacks recently), he also seems to have a special draw for these folks.   He's also eluded to looking into HCG was what prompted his reading up on leptin.  Coupled with the sheer number of HCG/LRRx posters that flooded PH recently, it does make one wonder whether Kruse is a closet HCG advocate or perhaps dabbled in the stuff himself?  Yes, I know that is rank speculation.  But it all seems so strange to me that Leptin Reset and HCG would yield so many hits, not to mention that "patients" give testimony ....

But let's move on to the real impetus.  A recent post by the cookbook author whose website used to herald that she was "Fighting the Low Fat Lie" for fifteen years, Dana Carpender.  Here's the post:  So What Happened to Me.  Now, at least Dana does acknowledge the role of calories in diet and weight loss, but she's also pretty snarky about any conventional approach to weight loss and maintenance.  It apparently didn't work for her while low carb did.  Wonderful!  But we hear this story all too often to just brush on by.  While Dana never seemingly gained all of her weight back, she did regain quite a bit a few years back (and no, an abdominal fibroid the size of a 5 month fetus can't be blamed for face fat).  A few have taken me to task for being too hard on Dana.  After all, she's not obese, she's 50 (+/- a couple of years, I'm not sure) and all that.  Well, that's fine, but she does blog regularly about gaining and losing more than just a few pounds of water weight especially during recipe development.  Clearly LC is NOT the panacea for her.  And despite touting all the health benefits she attributes to LC, the diet hasn't cured other health issues. But was it even how she lost the weight to begin with?  

I had, in the past, tried the much-written-about HCG protocol. I had been willing to try it because it was clear that Dr. Simeons, who developed it, had a deep distrust of carbohydrates. I figured that made him my kind of guy. Indeed, his basic instructions for maintenance are "No starch or sugar for the first several weeks, and be cautious with them for the rest of your life." The Simeons protocol is radical - inject low doses of HCG (human chorionic gonadatropin) once a day, and eat a low everything diet - just 500 calories a day. (I, characteristically, left out the allowed bread stick or Melba toast.)

The Simeons protocol had worked as advertised for me, though it was not a rollicking good time.

Huh?  Here I thought just low carb was the key!  Let me get this straight.  The calorie restricting, generally low fat, diets are misguided and the dopes who believe that dang CICO stuff are just ... well ... rubes lacking the enlightenment of Taubesians.  You see, we are to believe that Dana tried -- and adhered to -- various standard calorie restricting diets -- that for a 5'2" woman would amount to no more than 1200 cal/day.  This did not work for her.  But LC did.  But at some point ... it must have stopped.  If not, why do we have this admission that she had done the HCG diet in the past?   When in the past?  For those last 20 lbs?  To drop the 2008 weight?   

Still, since then I'd talked to two doctors who did, indeed, feel that HCG was a safe and useful adjunct to weight loss whether you used Dr. Simeons protocol or not. One of those doctors was the fellow who diagnosed me with polycystic ovarian syndrome and attention deficit disorder. Quite a lot of his practice revolves around weight loss, and the effects of diet on straightening out hormones, and the effects of hormones on weight. He knows whereof he speaks.

So I thought I'd try the Simeons protocol again.

If she hadn't previously named her doctor on her blog/podcast before (Andry) I might wonder if she weren't getting some diet advice with a side of neurosurgery in Tennessee.  And so ... why is Dana trying HCG again?  Well, she's got a cooking show in the works, and apparently she doesn't want to have to go the Eades route and don the super Spanx.  Still I can't help but wonder why she didn't do the 6 Week Cure??!!  I mean Dana is a friend and fan of Eades.  Oh, and the circumstances couldn't be more similar! Wants to lose some middle aged middle to look better on TV in relatively short order?  I'm not quite sure what this says about the Eades at this point if even Protein Power enthusiasts don't consider their plan worth a darn.   Even more telling is that Dana is admitting what we can all plainly see.  Low carb works, to a point, but not nearly as "ideally" as advertised.  If low carb is this ultimate solution, should she need a crash diet to film a cooking show??  Dana is consistently VLC.  Her weight gains are attributed to eating a few too many coconut flour pancakes and starchy stew veggies like (yikes!) carrots!  I thought this was all about being able to eat that big breakfast she likes, and never being hungry and all that.  How about the usual fixes?  Induction only, ZC, heck, why not an egg-fast??  

So Dana, who prior to this was taking meds for thyroid, ADHD, sleep disorders and diabetes meds for insulin resistance, decides to ... take another medication to drop a quick few!   Only a funny thing happened:

I discovered that the Simeons protocol made my blood sugar go seriously wonky - up as high as 126 one morning. I started taking my blood sugar after meals, and discovered quite quickly that a supper of chicken breast and cabbage (a very tasty salad) left me with sugar of 147 two hours after dinner. Clearly this was not working out for me. I quit after just two days of the 500 calorie per day phase of the protocol.

TWO DAYS???  First off, this is not enough time to assess anything.  So two morning BG's elevated?  Yikes!  I must say, that 15 years of low carbing seems to have really messed up Dana's body.  Did she do the loading for 3 days?  She can't eat "normal" low carb without rising fasting blood glucose.  Good job lowering that insulin!  And eating chicken and cabbage spikes her blood glucose through the roof?  Ah well, but LC is the way to go.  So she decides to tweak things a bit:

But I had the HCG in the house, and the assurance of two doctors I respect that low-dose HCG is safe, and helpful for weight loss in general. I decided to keep using the HCG and try the Atkins Fat Fast. [AFF]

Which begs the question, why not just do the AFF from the get go and forget injecting physiologically inappropriate foreign hormones into your body?  For those unfamiliar with the fat fast, it is suggested for those "rare few" who don't lose on LC.  It is a 1000-1200 cal/day diet with over 85% fat content.  That's not a lot of food choices -- egg yolks with mayo, heavy whipping cream, cream cheese, butter, etc.  A favorite challenge of mine to those who claim to consume thousands of fat calories without gaining weight or losing like bonkers is to ask why Atkins specifically limited calories, rather severely, on this diet.  After all, this super-keto form of his diet should have had you peeing out even more ketone cals.  But anyway, Dana does this and viola!  After six days strict 1000 cal/day and a couple days more at higher calories, the scale registers a 6 pound loss.  

Did the HCG help?  Eh ...  Water weight and all that (and not knowing if 2 500 cal days are included in the time frame)  and I'd say the first week of a non-protein sparing modified fast yielded the expected results w/o placental hormone doing any additional magic (though Dana attributes it to looking like more than 6 lbs to the HCG).  Oh ooh!  But ... how come she didn't consider that the AFF is unsustainable!!  Indeed she lasted less than a week on this and liberalized.  But the good thing is her fasting BG normalized in a week!

What makes me even more happy is what this super-high-fat diet has done to my blood sugar: It is normal. Normal, normal, normal. I have stopped taking my metformin and Victoza, and my morning blood glucose is consistently in the 80-95 range. This thrills me to the core.

I don't know whether the very high fat percentage is responsible for this, or if it's the caloric restriction, or both. My best guess is that it's the fact that I'm eating considerably less protein than I formerly have - apparently my body is really good at converting protein into sugar. (It should also be noted that I am not drinking alcohol these days, again, in the interests of looking as good as possible for the television taping. I do not know what effect this has.)

I think I have found my new "normal" low carb diet - super high fat, super low carb, moderate protein. I also think I will do perhaps three days of the Fat Fast at least a couple of times a month; clearly my body approves. I've been toying with the idea of doing the Fat Fast Monday through Wednesday, then liberalizing from Thursday through Sunday. This sounds very liveable to me.

I suspect that the fact she lost 6 pounds (at least half of those fat), ate almost no fat for two days at 500 cals and then went six days in significant calorie deficit has more to do with it than the amount of protein she's ingesting.  Realize this woman normally aims for 75% fat in her diet and there's little evidence that substrate availability drives gluconeogenesis.  Furthermore, we have no details of exactly when in this whole short timeline she stopped the Victoza and metformin.   Victory over blood sugar is declared!   The post continues: 

Since I wrote this, I have changed my approach a bit: I am Fat Fasting every other day, while on the days in between I am eating ad lib, as much as I like, but still focusing on staying quite low carb and getting enough fat. I have not been losing more weight, though I have been maintaining with ease. However, my blood sugar is still stone normal. Was 92 when I got up this morning. It appears that so long as I eat this way, I don't have any blood sugar trouble at all.

This both thrills and annoys me. The "thrills" part is obvious. The "annoys" part is because I did not realize when I started this experiment that I was signing on for a lifetime of limiting myself to 1000 calories, mostly of fat, every other day.  {Dana doesn't provide a timeline here, but the blog post is dated 11/6 and the CarbSmart article 10/14.}

Yes, this annoys me too ... but for different reasons that it annoys Dana.  You see, she is among the smug low carbers who routinely deride those who are going to similar "extremes", just based on other nutritional philosophies.  I suspect that were Simeons' post-500 cal recs not low carb, she would deride that plan as well.  After all, she signed up for almost 6 weeks of 500 ultra-low fat, essentially dairy-free calories at least twice in her life, right?   And now, if a low fat advocate or weight loss success story were to blog how they had to do such a major "tweak" to lose those extra "not made for TV" pounds and control their blood sugar, only that tweak involved going super low fat every other day, she'd be talking about how unsustainable that is.  Oh ... and what of the HCG?  Still taking that?   Dana is eating a starvation diet* every other day and hasn't lost any more weight in roughly 3 weeks of doing so.      *Standard LC definition, not mine!

But the other revelation here is yet another prominent member of the LC field of success stories with what I consider a hypocritical skeleton in the closet.  By that I mean that if we were to find that Valerie Bertinelli had to continue to eat only Jenny Craig foods every other day to maintain her weight loss what would you think of her hawking that plan?  If she were diagnosed with PCOS and put on not one but two diabetes meds, would they not be fingering the evil carbs in her diet?  As would they be calling JC ineffective and somewhat a failure if Valerie had to go on a crash diet before filming Hot in Cleveland episodes each season.   In other words, were Bertinelli touting her success with JC but actually doing other things to achieve/maintain in conjunction (or instead) she'd be rightly criticized.  If LC is Dana's bees knees ... or any other low carber's for that matter ... what's with all the HCG flying around??

This brings up a related trend in low carb circles:  intermittent fasting.  I'm not against IF ... indeed it's kind of an old wives tale that us ladies should probably be somewhat IF'ing as we reach a certain age anyway -- eating two meals/day vs. three.  But if all of a sudden we started seeing NutriSystem-IF or Weight Watchers Fasting Minus, you can be darned sure these tactics would be poo pooed as unsustainable, not workable, etc.etc.   And ultimately IF is a form of calorie restriction.

I guess I just don't get it folks.  When LC stops working -- particularly for us women -- there seems to be far more leniency shown toward radical, unsustainable solutions that stay true to LC.  But employ something even less radical or not intended to be for all eternity to resolve a critical health crisis like a diabetes diagnosis?  Then we're dealing with idiots all around!  

Please don't get me wrong here either.  I'm happy for Dana that she's found something that is apparently working for her, and I hope it continues.  And I do credit her with sharing this with her readers.  But the rub is that most of those people who may watch her cooking show someday, or read her books etc., probably don't read the blog and have any clue to the back story.  And to be fair, we have no clue the true back stories (or follow-up progress) of various prominent weight loss successes.  But I would really like to see more consistency in this regard ... and if some of these LC success stories are really HCG success stories, I'd like to know that too.  For that matter, how many others crediting just LC for their outcomes need to come clean?  Perhaps it may be worth trying after all.  (At this point I'm still in the "when GT and I become best buds" camp on this, but never say never.)  

In the meantime, Dana can probably worry less over the following:

Every time I got up in the morning and my blood glucose was over 100, I would think in dismay, "I'm rotting!" Elevated blood sugar, even modestly elevated blood sugar, speeds aging, causing irreversible damage. It is, officially, A Very Bad Thing.

After all, the lowest rates of all cause mortality *centered* on a FBG of 99.   Maybe it's the cortisol from stressing over the hyperbole of Wheat Belly, Rosedale, Taubes, Lustig, etc. ad infinitum in the LC world.  I'm wondering if HCG is in the 2012 New Years "gonna kick this regain to the curb this year for once and for all"  plan of a certain low carber?      Nah ... I don't think HCG is paleo.