Unpacking the "Magic" of HCG: Is it the Low-Carbohydrate Very Low Calorie Diet?
Having worked in a medically-supervised weight management program exclusively for over nine years as a registered dietitian, I sincerely empathize with men and women searching for an effective weight loss solution. Frequently, during phone conversations with potential clients, these individuals share, often tearfully, their frustrations, disappointments and, yes, still hope, that they will be able to lose and maintain weight to feel better and be healthier. I also hear from physicians who, understanding the medical benefits of weight loss for their patients, are appreciative of a weight loss method which provides quicker improvement of medical conditions and, therefore, renewed motivation and commitment by their patients. Is it no wonder that the HCG diet, which promises quick weight loss with the absence of hunger and cravings, seems appealing both to patients and even some medical professionals?
What is HCG? It is human chorionic gonadotropin, a hormone approved for use by the FDA for treatment of delayed sexual development for pre-pubertal boys and fertility problems in women. It was A.T.W. Simeons’ observation of weight loss while using HCG for reproductive treatment that prompted him to recommend HCG in combination with a 500-calorie diet as a weight loss treatment in the early 1950s.
HCG is administered either as injections or oral drops. The oral drops, if proven to really contain HCG, would contain a hormone with a molecular weight categorized as “high.” In other words, the hormone is too “big” to be absorbed under the tongue. Oral HCG drops also eventually pass into the GI tract where, as a protein, they are broken down into small peptides and amino acids by gastric acid—just like your dinner portion of chicken! If administered by injection, the long-term effects are unknown, and therefore, present a level of risk. While administration routes of hormones may vary, there are significant factors impacting absorption and efficacy. If all hormones were easily administered by mouth, then diabetics would no longer need to take insulin shots!
A 1995 meta-analysis of the research which reviewed 8 uncontrolled and 16 controlled studies concluded that there is no scientific evidence that HCG is effective in the treatment of obesity.
It is important to note that the FDA has NOT approved the use of HCG as a weight loss aid, and since 1975, the FDA has required labeling and advertising of HCG to state:
HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.
Drug labels identify ovarian hyperstimulation syndrome as a potential side effect of HCG injections and emphasize that HCG should NOT be used with the following medical conditions: asthma, cardiovascular disease, cryptorchidism, migraines, renal impairment and seizure disorders. In April 2011, the FDA updated label safety warnings to include anaphylaxis and other hypersensitivity reactions which have been reported with urinary derived HCG products. On May 9, 2011, a naturopathic physician in Washington pled guilty to importing misbranded drugs; the boxes shipped to him contained HCG which he had been distributing as a weight loss drug. The products were manufactured in Chinaand distributed by a company in India, raising safety and quality concerns for consumers.
In 1976, the Federal Trade Commission ordered the Simeon Management Corporation, Simeon Weight Clinics Foundation, Bariatrics Management Corporation, C.M. Norcal, Inc., and HCG Weight Clinics Foundation and their officers to stop claiming that their HCG-based programs were safe, effective, and/or approved by the FDA for weight-control. It required that patients who contract for the treatment be informed in writing that:
These weight reduction treatments include the injection of HCG, a drug which has not been approved by the Food and Drug Administration as safe and effective in the treatment of obesity or weight control. There is no substantial evidence that HCG increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restrictive diets.
In 2009, the American Society of Bariatric Physicians issued a position statement: Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The diet used in the Simeons method provides a lower protein intake than is advisable in view of current knowledge and practice. There are few medical literature reports favorable to the Simeons method; the overwhelming majority of medical reports are critical of it. Physicians employing either the HCG or the diet recommended by Simeons may expose themselves to criticism from other physicians, from insurers, or from government bodies.
So, what COULD be the reason for weight loss plus decreased hunger and cravings on the HCG plan? It is likely ketosis resulting from the low-carbohydrate nutritional profile of the 500 calorie diet prescribed along with HCG.
What is ketosis? If a person reduces their carbohydrate intake, typically less than 50 grams/day, their body “switches” to accessing fat stores for primary “fuel,” and the resulting ketones produced tend to be associated with reduced hunger and cravings. One of our medically-supervised very low calorie diet programs utilizes this benefit to great advantage for patients. Using meal replacement products formulated to minimize side effects, patients experience, with predictable consistency, reduced hunger and cravings about 3-5 days after starting the diet—WITHOUT the “benefit” of HCG, it should be noted! It is interesting to observe that many websites marketing HCG offer tips on how to maintain ketosis. So, it does cause one to wonder what effects HCG can really claim, apart from generating extra income and fees for providers.
But what about ketotic very low calorie diets—are they risky? If unsupervised, they could be! Food-based very low calorie diets used in the 1970s led to nutritional deficiencies and electrolyte abnormalities associated with heart rhythm disorders resulting in death. That’s why the NIH/NHLBI recommends that VLCDs should be used only by specialized practitioners experienced in their use. Medical supervision should include a screening appointment, medication adjustments and weekly monitoring, periodic labs and EKGs. The benefits? For a type 2 diabetic who will experience a very quick reduction in blood sugar levels with corresponding reductions in medications, the benefits definitely outweigh the risks, as it does for many patients facing medical problems related to obesity, including bariatric surgery patients who have experienced weight regain. The evidence? ADA’s Evidence Analysis Library, assigning a Grade I , or Good, for the research review and evidence on VLCDs, concluded that“adherence to a very low calorie diet, defined as 800 kcals or 6 - 10 kcal/kg or less, results in significant weight loss,”
Last, one should also consider the all-important maintenance phase. A very low calorie diet is an INITIAL phase which offers patients weight loss results, often translating to ongoing motivation and commitment. However, that initial phase should always be followed by a transitional and maintenance phase supported by continued education, skill-building and support, preferably by a multi-disciplinary staff which includes counselors and dietitians.
Given the absence of research evidence, the side effects and the fraudulent nature associated with HCG, it would make sense for consumers to seek out a program which provides an evidence-based, nutritionally-enhanced very low calorie diet program along with medical monitoring to provide a safe method for quick weight loss with reduced hunger and cravings and education for successful maintenance.