The hCG (Human Choriogonadotropin) Method for The Treatment of Obesity: Overcoming
The Test Of Time
The first report on the use of hCG for the
management of obesity was published in 1954 by the late Dr.ATW Simeons, a
German-born
Physician practicing at the Ospedale Salvatori Mundii in Rome.
Working in India, he observed that the
so-called "fat boys," who shoved Adiposogenital dystrophy improved their
undescended testis .
Later on, he extended his Investigations to
patients showing different degrees of obesity, and concluded that hCG might be useful for
the treatment of obesity because:(424-425).
1.Patients tolerated a Very Low Calorie
Diet without suffering headaches irritability, weakness, so common to this approach for
weight reduction. Maintenance period after treatment was more effective when compared with
simple dietetic procedures (Graphic 2)
2. Weight reductions were more satisfactory
than those obtained with Standard Hypocaloric Diets.
3. Apparently, patients lost more fat
(measured in centimeters) from those regions where adipose tissue accumulations were more
conspicuous.
4.He hypothesized that hCG acted at
diencephalic level, modulating hypothalamic regulatory Centers, which were in turn
responsible for the excessive fat accumulation as seen in obesity.
This preliminary communication was followed
by a myriad of reports, some of them favoring the use of hCG, and others criticizing the
procedure.(8- 26-31-47-66-95- 96- 111-130- 139- 196- 210- 325- 361- 383- 423-
442-447-517).
Finally, and after a serial of
Double-Blind Tests, which except for one were all negatives, the FDA concluded the method bears no
utility for Obesity therapy.
This Administration forced Pharmaceutical
Firms to include in their hCG leaflets of information a paragraph stating that hCG was of
no use in the management of obesity.
We have lately performed a Double Blind
study on the subject, assessing data that was not included in previous
reports.
hCG is a glycoproteic
hormone, normally
secreted by trophoblastic cells of the placenta. It consists of two
dissimilar, separately
but coordinately translated chains called the alfa and beta subunits.(46-93-160-231-369-415-483-484).
The three pituitary hormones LH
(luteinizing Hormone) are closely related to hCG in that all four are glycosylated and
have a dimeric structure comprising an Alpha and Beta chain as well.
The aminoacid sequences of the alfa chain
of all four human glycoproteic hormones are nearly identical.
Aminoacid sequences of the beta subunits
differ because of the unique immunological and biological activities of each glycoproteic
hormone. Beta -hCG contains a carboxillic residue of 30 aminoacids characteristic to
hCG.(44-45-216-395).
When it was discovered by Ascheim and
Zondek by 1927 they found out that hCG matured the infantile sex glands of experimental
animals, and it was secreted by the human placenta. From there its
denomination: Chorionic Gonadotrophin.(25-519)
However, recent data suggest that both
terms can be quite misleading: normal human tissues (231-464) plasma from non pregnant
subjects (62-353-516), trophoblastic and non-trophoblastic tumors (83 -106- 110- 226-345-
400-401-444), bacteria (3- 4- 28- 301- 312-436) and plants (138-168) express hCG or a
hCG-
like material.
After the first report on hCG use for
obesity treatment, an innumerable amount Physicians all over the world visited Dr. Simeons
in Italy, to learn from first hand the hCG original protocol.
Many of them attempted to recreate the
standard procedure without success, or obtaining undesirable results.
After many years of experience on the
subject, we would like to stress the following concerning the use of hCG for the management of
obesity:
1.hCG is not a magic
wand.
It does not cure or eradicate
obesity, but
weight losses are rapid, comfortable, and the maintenance period after treatment runs a
smoother course.
2.Weight loss might be
the same with or without hCG.
Obesity might not be only
a matter of
overweight. Dieting per se is not a treatment for obesity.
Rather, it is an ancillary procedure.
Unless we try to act upon the basic
diencephalic disturbance, any dietetic procedure will be condemned to
failure.
Just as we cannot improve diabetes just
by dieting, obesity cannot be effectively treated without some sort of medical
intervention in the diencephalon.
Anorectics point in that
direction, and
were for many years an unsuccessful approach to obesity because their side-effects.
Dr.Simeons never
maintained that weight loss under hCG were more important than untreated cases. What he suggested was that
hCG,
acting at hypothalamic level, might correct the basic hypothalamic disorder, and
consequently adipose tissue metabolism.
If this turns out to be the case, hCG could
be an excellent adjuvant procedure in the management of the disease.
The vast majority of publications concluded
hCG has no action on weight loss, rendering no better results than a current hypocaloric
diet, except for classical Asher and Harper report concluding that weight losses under hCG
were superior to placebo.
1.hCG might have an affect
on adipose tissue metabolism
Throughout the years, hCG has been reported
to exert its actions on several tissues other than gonadal.
Therefore, we are not dealing with a
"pure" sex hormone: Several clinical conditions, such as asthma,
allergies,
gastric ulcers, intermittent claudication of the lower limbs and anemia were
treated with hCG, with encouraging results. (102-175)
Available
data would indicate that hCG might also improve lypolisis in human adipose tissue, via an inhibitory
effect on lipogenesis.
Effect of hCG on adipose tissue metabolism
(161-382):
Fleigelman concluded that the
administration of hCG in rats decreased the activity of alfa-glycerophosphate
dehydrogenase and glucose-6-phosphate dehydrogenase from the liver and adipose
tissue,
suggesting a decreased lipogenic activity in both tissues under hCG(161) (Graphic 3).
Yanagihara reported that hCG accelerates
"not only the mobilization of fat from fat deposits, but also its utilization in peripheral
tissues. hCG increased the metabolism of injected fat emulsions, suggesting the
acceleration not only of fat oxidation, but also increased ketone production in the liver
and its utilization in peripheral tissues" (514). Romer reported that hCG intensifies
the metabolism of rat brown adipose tissue (391).
Administration of hCG to
humans appears to
increase the release of fatty acids that varies with the age of the subject. Melichar
demonstrated that hCG causes a marked FFA release in newborn infants.(317).
In adults, a single dose of hCG caused a
marked FFA release by p > 0.05 when compared to placebo-treated
subjects.
Consequently we
hypothesize, that hCG
might act upon adipose tissue metabolism through some mediators secreted at hypothalamic
level.
2. THE DIENCEPHALIC REGION MIGHT
BE A "TARGET ORGAN" FOR hCG ACTION.
One of the most valuable hypotheses on the
genesis of obesity sustains that the basic metabolic disorder lies in the hypothalamic
region: Like in any other clinical disorder, we have to find out who is the villain
in this story. For example: the pancreas in diabetes, the thyroid in
hypothyroidism. the adrenal glands in Addison disease.
The organ more frequently incriminated in
the genesis of fat accumulation seems to be the hypothalamus. A considerable body of
evidences points in that direction.
Interestingly, exogenous administered hCG
accumulates in hypothalamic region, particularly in Ventromedial and Lateral
Hypotalamus.
It is not therefore unreasonable to suppose that the target organ for hCG metabolic
actions might be the diencephalon.(178-513)
hCG may act at diencephalic
level, probably
modifying some neuropeptide pathways, which in turn act whether on Ventromedial or Lateral
hypothalamic Nucleus, or via Hypothalamus hypophisis.(30-209)
SUMMARY
There are no age or sex limits, and hardly any contraindications (211) to
use the hCG
method for the treatment of obesity. Tolerance to the treatment is excellent, and many patients
willingly submit to a second treatment.
Weight loss is safe and comfortable for
patients, provided that they meticulously follow the prescribed diet.
Any deviation from the protocol is apt to yield poor results. Even minor
deviations may cause
unwanted setbacks.
The hCG protocol is a
safe and appropriate
approach to the treatment of obesity that includes behavior modification as
well as pharmacological and dietetic
aspects. When properly managed, the result is rapid
weight loss and improved body shape after treatment. Clinical complications and
unfavorable results are related to unsafe modifications of the protocol.
Evidence suggest that hCG
promotes lipolytic activity. Since hCG does not mobilize in vitro lipids from the fat
cell, it was hypothesized that the hypothalamic region might be the intermediate organ in hCG
lipolytic action.
The hCG method includes
patient follow-up (daily visits to the doctor to be weighed and injected),
that helps patients with their behavior modification program.
There are some
similarities between the
behavioral program included in the hCG protocol and a current behavior modification
program for obesity treatment.
The 500 Kcal-diet as prescribed in the
original treatment proved to be safe and effective.
Results are not surpassed by any other
modality of obesity therapy. Reshaping of Body contour is more noticeable in those patients
displaying the so-called obesity types .
INTRODUCTION
The subject
of adipose tissue membrane receptors has been a subject of great interest in
recent years.
Human fat cells possess both alfa and Beta
membrane adrenoreceptors, acting differently on adipose tissue metabolism.(500).
The major function of adrenoreceptor in
white fat cells is to regulate the breakdown of triglycerides to free fatty acids and
glycerol through lipolysis. Functions and mechanisms of action of adrenoreceptors in white
fat cells are as follows:(16-17-18-19-20-21-22).
1. Beta l.2.3. receptors increase lipolysis
rate.
2. Alpha 2 decrease lipolysis
rate.
Human adipose tissue is an extremely active
organ metabolicallly : Depending on where it is localized, it shows a different
response to drug intervention. Visceral fat cells are more responsive than abdominal subcutaneous fat
cells (gluteal or femoral) to the lipolytic actions of catecholamines.
There are also sex
differences: A higher Alpha2-receptor affinity has been reported in peripheral male subcutaneous
fat cells than in the abdominal, which may explain why the regional variation in catecholamine-induced lipolysis
within the subcutaneous adipose tissue is more pronounced in men than in
women.
Fasting also modifies
the regional sensitivity
of adipose tissue: It is associated with a decrease in catecholamine-induced lipolysis
rate in peripheral, but not abdominal, subcutaneous adipose tissue. This may further
promote the development of gynoid obesity.
During fasting, Alfa activity
(antilipolytic) increases and Beta action (lipolytic) decreases in female thighs
region.(351-352).
An increase of alfa activity is related
to a decreased lipolysis, whereas a diminution of beta adrenergic activity provokes the
same effect.(366).
Therefore, it has been suggested that the
combination of both activities might explain why the female thigh region is more resistant
to dietetic procedures.
Abdominal adipocytes are more responsive to
the lipolytic action of Beta-1 adrenergic agonists, while gluteal adipocytes are more
responsive to the antilipolytic action of Alpha-2-adrenergic agonists.
In lean and obese adults, gluteal
subcutaneous adipose tissue was strikingly more responsive to antilipolytic
alpha-adrenergic stimulation, and less responsive to lipolytic beta-adrenergic
stimulation, and less responsive to lipolytic beta-adrenergic stimuli compared to
abdominal tissue(394).
This would explain why gluteal and femoral
fat pads are more resistant to dietary interventions.
Taken together, these results seem to
suggest that it should be possible to locally modulate the activity of Alfa and Beta
adrenoreceptors through the administration of Beta-adrenergic or Alfa-Blockers agents.
Beta Stimulation and/or Alfa blocking of adipocytes membrane receptors might increase
lipolysis in those areas.
Thus, a reasonable combination would be the
prescription of a Very Low Calorie Diet (such as indicated in the hCG Protocol) plus the
local administration of alfa Blockers or Beta stimulating agents.
We have found the association of both
procedures extremely useful, both from the Clinic as well as from the Aesthetic viewpoint
We currently indicate the hCG Protocol plus
the local administration (to the thigh area) of a cream containing diluted amount of Aminophyline
(metilxanthine) and Yohimbine (Alfa Blocker). This procedure is well accepted by patients
and is indicated as a good pre-surgical management of obesity. Since it can be
performed
in a consultation office inside the clinic, the plastic surgion does not lose contact
with their future patients.
No complications were reported with this
combined method .
Severe food restriction, as observed within
the hCG protocol, enhances lipid mobilization from lower limbs, improving the result
obtained with only the application of the cream.
|