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Case Studies - 1st 25 Patients    

The charts presented in the outcome statistics section pertain to our overall experience.  This section tells the stories of our first 25 weight loss patients.  Within each case study I will try to emphasize a key point of the program or discuss a link between overweight stature and one or more cardiovascular conditions or risk factors.  Case studies involving patients without CV disease will also be presented (we aren't' going to wait for you to get sick before we try to help you).
Last updated 6/28/09
          

M0  Wise doctors learn from their patients M1  Helping an old friend reverse the ageing process
M2  Weight control in the complex cardiac patient M3  54 lbs. in 4 months in the pre-surgical complex cardiac patient
M4  57 lbs. over 4 months in the stable cardiac patient M5  "Pre-Cruise" weight loss program for heart patients
W1  26 pounds in 28 days without much fuss W2   Off to a good start:  20 pounds in 14 days
W3  Reducing future disease risk in a young person W4  Weight regain; you do need to follow the protocol
W5

 Rapid weight loss requires rapid insulin dose reduction

W6  Body fat falls and muscle mass increases
M5a  BP falls with the eleventh doctor M6  Great record keeping and a great result
W7  Great records and another positive result W8  20 pounds down and fewer drugs
M7  Lose the weight and lose the inflammation W9  A treatment for the American way of eating
M8  29 lbs. in 40 days and better overall health W10  21 lbs. in 40 days with a decrease in meds
M9

 49 lbs. in 40 days and feeling great

W13  23 pounds and better BP control
W12   24 pounds in a world traveler W13a  Cosmetic weight loss - five pounds but three inches
W14  Switching from sl to subcutaneous HCG to abate hunger    
M12  Weight loss when you are allergic to everything M14  On treatment insulin needs fell from 240 to 30 units/day

 


Wise doctors learn from their patients - M0

Wise doctors learn from their patients.  My patients are well read and awfully smart.  Hopefully I am wise enough to learn from them.  M1 presented in 2001 with a lateral wall heart attack. Clot busting therapy was given followed by stent placement to the circumflex coronary artery.  Coronary angiography was required in '03 and '06 to address recurrent pain, the later study revealing 90% narrowings in two branch vessels.  EECP along with an extensive medical and nutritional program resolved M1's symptoms, but had little affect on his risk factors.  M1's lipid panel was  impossible to control.  In 4/02 his cholesterol was 258 with triglycerides at 576.  Lipitor, lescol, crestor, tricor, and zetia were tried and all produced side effects.  While M0's blood sugar was not elevated, on the theory that insulin insensitivity was playing a role in M0's hyperlipidemia, metformin was added to M0's program with positive results (overweight leads to insulin insensitivity, which leads to elevated lipids, especially triglycerides - metformin improves insulin sensitivity at the level of the liver, the triglyceride producer).  By mid '08 M0's cholesterol was down to 209 with a triglycerides of 237, but his CRP (C-Reactive Protein, a marker of inappropriate immune system activation) remained elevated (5.4 in the fall of '08, 5.4 in 1/06, and 7.5 in 4/06 - we want a low CRP, ideally 2 or below).  M0 had been overweight for years, with predominant abdominal adiposity, and we now realize that this central, abdominal fat tissue plays a major role in systemic inflammation and CRP elevation.  I did not begin M0 on a weight loss program.  I was busy giving him drugs and organizing his nutritional supplements.  I didn't know the first think about weight loss science.  In late '08 M0 came in for a planned office visit looking different.  His weight was down and he was feeling great.  M0 related that he had been working with an outside practitioner who had put him on a new weight loss protocol.  M0 had lost 40 lbs. since his last visit.  I was impressed.  M0 asked me to learn about this "new HCG protocol" and I did so.  In the interim, M0 underwent a second round of HCG therapy and lost another 20 lbs.  M0's CRP fell to 1.7, cholesterol dropped from 209 to 184, triglycerides from 237 to 75, and HDL increased from 30 to 45 (we want a high HDL - HDL "unoxidizes" oxidized HDL and mediates reverse cholesterol transport).  While this was going on I was able to decrease M0's metformin and beta-blocker doses by 50%.  This was all a little embarrassing.  I had spent years adjusting M0s treatment regimen.  Then some guy who isn't even a cardiologist helps M0 lose 60 lbs, resolving his lipid and inflammatory problems (note that all of my drugs had been ineffective).  This was also really cool.  I got to work studying the weight loss literature, went to a meeting, and now we have our program.  Funny thing, the HCG protocol isn't new; actually its older than I am.  Wise doctors do learn from their patients.

  Pre-Weight Loss Post-Weight Loss
Cholesterol 209 184
Triglycerides 237 75
HDL 30 45
CRP 5.4 and 7.5 1.7

 Helping an old friend reverse the (metabolic) ageing process - M1

M1 is an old friend, but he isn't old (he's my age which by my definition is not old) but metabolically he was ageing fast.  M1 didn't have active coronary disease, but he was brewing it, with a carotid IMT near the 75% percentile and a coronary calcium score of 23; not things we want in our early to mid-50s.  M1 was troubled by hypertension, hyperlipidemia, and type II diabetes.  With medical therapy, M1's cholesterol and triglyceride levels had fallen from 372 and 1842 in 2006 down to 163 and 319 in 2008, but despite 110 units/day of long-acting insulin his HbA1c values remained elevated between 7 and 8 (our goal is 6), and short acting insulin was required throughout the day.  M1's BP was difficult to control.  Even with triple drug maintenance therapy on board short acting clonidine was frequently required.  M1 was overweight and insulin insensitive - this was the real problem - and the problem that we addressed with HCG weight loss.

I do cut back on medication as you begin the 500 cal. diet, but in M1's case I did not cut back enough.  By day 10 M1's weight had fallen from 242 to 223.  BUN and creatinine (markers of kidney function and fluid volume status) were elevated at 36 and 1.8 (normal is <25 and <1.3) and M1's potassium was up to 5.8 (normal is < 5.0).  These were all side of effects of his drugs, drugs that were no longer necessary as the driving force behind M1's hypertension, being overweight, was rapidly resolving.  Another point, as you lose excess weight, the fluid you retain with your weight is rapidly released, and this can lead to relative dehydration if you do not keep your fluid intake up, or in M1's case, if I do not back off on your meds rapidly enough.  We know that we cannot predict how rapidly a given individual will respond to the HCG program, so in individuals like M1, who are on a number of medication, we will periodically check lab studies, looking specifically for "medication over sensitivity" that inevitably occurs.  We decreased M1's meds further, his lab studies normalized, and he completed the program without difficulty.   We ask you not to lose more weight during step seven, the three week post-HCG time period when your new set point weight is "locked in".  If your weight continues to fall, we ask you to increase your non-carbohydrate food intake in an effort to stabilize your weight.  Here M1 had a little trouble.  M1 was burning through his work, on his feet all day, getting things done.  He ate all he could, but he lost 5 more lbs.  I do not think this will be a problem, as the weight loss was due to increased activity, not due to insufficient caloric intake.  M1's blood sugar fell rapidly and M1 tapered down his insulin dose accordingly.  Insulin promotes weight gain, while metformin, an agent that increases insulin sensitivity (the real problem in DM II) does not; thus we stopped insulin and kept M1 on metformin, actually increasing the dose a little.  If in the future M1's weight falls further, we may be able to drop this agent too.  M1's response to the HCG weight loss program is not atypical of our overall experience.  The key point here is the speed with which his mediation requirement changed.  M1 did his lab work as requested, so we caught this problem.  If we request lab work at a specified time, please realize the importance of this request and have the requested lab studies carried out.  Weight loss and risk factor reduction of this nature will slow down the metabolic ageing process and add decades to your life.  My old friend and I will drink a toast to this process when we are old - at what age will that be?

 

  Pre-Weight Loss Post-Weight Loss Meds Pre-Weight Loss Post-Weight Loss
Cholesterol 163 134 Insulin 110 units Stopped
Triglycerides 319 203 Metformin 1000 mg 1500 mg
HDL 35 32 Quinapril 80 mg Stopped
LDL 65 62 Spironolactone 25 mg Stopped
      Amlodipine 10 mg 10 mg
      Atenolol 200 mg 175 mg
      Lipid Control Vytorin 10/40 & Tricor 145 mg Simvastatin 40 mg

Weight control in the complex cardiac patient - M2

Our focus here is weight loss, but given my background in Invasive and Integrative Cardiology, most of our initial weight loss patients were also troubled by recurrent or complicated cardiac disease.  This was the case with M2.  M2 experienced a heart attack in '93, followed by circumflex coronary artery angioplasty and later stent placement.  Left anterior descending stent placement and diagonal artery angioplasty were required in '02.  Poor left ventricular pump function (ejection fraction 35%) led to defibrillator placement in '04.  M2 and I began working together soon thereafter.  Persistent angina was addressed successfully with a 33 hour program of EECP.  An '06 stress perfusion study revealed only a fixed inferior wall perfusion abnormality, consistent with M2's prior heart attack.  Angina recurred in '07.  A high grade, non-dilatable narrowing was seen in the circumflex coronary artery; the other vessels looked good and M2's ejection fraction had increased to 35-40%.  A 25 hour course of EECP in '08 quieted things down.  Several Methyl Cycle genomic abnormalities were identified in late '08 and addressed with dietary sulfate restriction and a change in M3's nutritional program.  Immune modulation therapy was begun in early '09; M2 felt better and residual angina all but resolved.  M2 had received all of our "big gun" integrative therapies and had done well.  We were pleased, M2 was pleased, but M2 still required an extensive medical regimen to control high blood pressure, hyperlipidemia, and type II diabetes.  Overweight was underlying these conditions, M2's difficult to treat (limited tolerance to CPAP) sleep apnea, and of course his coronary disease.  We had thrown cold water on the flames, but never put out the embers underlying the atherosclerotic fire.  Given M1's success with the weight loss program, we thought this approach might be of value to M2. 

M2 lost 22 lbs, from 235 to 213, over his first 20 days in the HCG program.  Eight more pounds were lost as M2 completed a 40 day.  That's not all that M2 lost.  He lost 4 inches around his waist, from 42 to 38.  M2 also lost five drugs, two for BP control, two for sugar control, and one for his mood.  M2's mood did pick up.  Why wouldn't it?  Angina remained quiescent; M2 is going to begin an exercise program.  M2's BP and glucose values will likely rise during step seven, the low carb "lock in" period, and for this reason metformin (the glucose lowering therapy least likely to cause CV side effects and contribute to weight gain) will be added to M2's program.  M2 can also use regular insulin as needed and clonidine as needed for short term BP control.  If we have "fall back" agents such as short acting insulin and clonidine on board for "as needed" use, then I can back off more rapidly on your long acting drugs, lessening the risk of "over treatment" as your need for the long acting agents decreases. 

Meds Pre-Weight Loss 20 Days
   Long Acting Insulin 180 units Stopped
     Januvia 100 mg Stopped
Tekturna 300 mg Stopped
Norvasc 10 mg Stopped
       Quinapril 40 mg 40 mg
        Inspra 50 mg 50 mg
Furosemide 40 mg 40 mg
Carvedilol 75 mg 75 mg
        Metformin None 1000 mg
        Remeron 15 mg Stopped
       Lipitor 20 mg 20 mg

54 lbs. in 4 months in the pre-surgical complex cardiac patient - M3

M3 has most known cardiovascular conditions.  M3 needs open heart surgery, but with a scale weight of 323 on a 5'9'' frame, M3's surgical risk, let alone his catheterization risk, would be excessive.  Thus we needed to help M3 lower his weight to a more manageable level.  M3 presented to us in 5/08 with fatigue and shortness of breath upon effort.  Non-invasive testing revealed aortic stenosis (the valve allowing blood to leave the heart to serve the extremities and internal organs was severely narrowed, putting undue strain on the left ventricle, the heart's pumping chamber - aortic stenosis inevitably progresses and there are no therapies available to blunt its progression) and atrial fibrillation (the atrial, pump priming chambers were no longer contracting in a rhythmic fashion).  Adult onset diabetes was being addressed with metformin 500 mg daily, hypertension with amlodipine 10 mg, metoprolol 25 mg, and lisinopril 40 mg, all once a day, and heart failure with furosemide 80 mg twice a day and eplerenone 50 mg (both diuretics). 

We adjusted M3's medical program and made a few additions to an already comprehensive and well thought out nutritional program.  Methyl Cycle abnormalities were identified and addressed nutritionally.  M3 felt better, but we were left with the problem of aortic stenosis (peak and mean across the valve pressure gradients of 59 and 44 mmHg by echo study in 9/08).  M3 also needed surgery to address a kidney stone, but without corrective heart surgery, I felt his risks would be too high, but without weight loss, I felt that M3's heart surgery risk would be even greater.

What a dilemma!  M3 needed to lose weight in order to have heart surgery, but his advanced heart disease really precluded a meaningful exercise program.  It wasn't that M3 was chronically overeating; he just couldn't lose weight.  Our theory is that Mother Nature (human physiology, the forces of evolution, the intent of our creator, or all the above) assumes that we humans have a purpose for all of our actions, and that if we overeat, there must be a good reason.  A few hundred years ago it was difficult to overeat; the struggle was to find enough food just to survive.  We didn't die of heart disease or cancer and diabetes was unheard of.  We died of trauma, infection, or just as likely, starvation.  Humans overate only when food was abundant, and then only to prepare for the famine that was to come.  Crops would fail, there could be long droughts, or pestilence would strike that animal herds.  Life was really feast or famine - in a literal sense.  The skinny people died.  The overweight survived and passed on their genes.  Evolution thus favored those of us who were good at packing on the pounds.  The ability to hold on to weight is not adaptive today, but evolution has not caught up to this new behavior of humans.  Our body determines that the weight you are carrying is protective.  She doesn't want you to starve in the next famine; thus she resists your efforts to reduce.  This is why you diet long and hard, lose only a few pounds (mostly muscle) and then yo-yo back up to your pre-diet weight, and likely a little more.  The hypothalamus controls appetite and weight maintenance, and right now its not helping you; at least it was not helping M3.  The Simeons HCG methodology is designed to give the hypothalamus a "release the fat stores" signal, mimicking the same message that HCG gives the hypothalamus during pregnancy (his book is reproduced in the Weight Loss Programs Available section).  During pregnancy, under the influence of HCG (you make 1,000,000 units a day when you are carrying a baby), body fat is constantly being broken down into circulating triglycerides, ensuring a constant trickle of energy to the developing baby, whether his/her Mom eats or not.  Remember, in the feast or famine world in which mankind evolved, it would not be unusual for a pregnant woman to go for several days without eating, not a problem for her, as she has fat stores (even trim people have enough fat to last them for days to weeks), but a problem for the developing baby who has no fat of his/her own.  Thus Mother Nature devised this "release the fat stores" signaling molecule that we call HCG. 

M3 began daily IM injections of HCG at a dose of 125 IU /day (the placenta makes 1,000,000 units per day so you can see that we have quite a safety margin built in to our program) while following the 500 calorie Simeons' diet.  M3's weight dropped from 323 to 290 lbs. over 23 days.  We had to reduce his furosemide dose by 50% and drop amlodipine from his program.  During the step eight, post-500 calorie low carb period, M3's weight rose to 309 (family events and professional meetings) but by applying the post-diet Simeons principles his weight fell to 296, then 6 weeks out.  M3 has since carried out a second round of modified HCG therapy, 40 treatment days divided into two sessions (interrupted by a professional meeting).  Twenty seven pounds were lost - from 296 to 269.  M3's functional status continues to improve.  Summing up the number of pounds lost in the two cycles, M3 has lost 60 lbs.  His net weight loss (pre-HCG weight minus current post-HCG weight) is 54 lbs.  Thus over a 4 months period, M3's weight has dropped by 54 lbs. - 17% of his baseline body weight.  M3 hasn't finished yet.  M3 knows a good pathway to health when he sees it.  Round three will begin later this summer, and we can keep up with this approach until M3 reaches a physiologically healthful weight.  We know that weight loss is of value in coronary disease and CHF, but it is not likely going to prevent further narrowing of M3's aortic valve, but when catheterization and surgery are carried out, M3's risks will obviously be lower. 


57 lbs. over four months in the stable cardiac patient - M4

M4 is one of our favorite patients.  He brings in flowers for the staff and always has something positive to say.  M4's vocation is to help other people, people who are sometimes difficult to help.  M4 is a good man, but he also has some health issues.  In his youth, M4 didn't jump out of planes, but he did everything else.   He hasn't broken as many bones as Evil Knievel, but he's tried.  M4's angiographic study in 1/03 revealed a 50-60% single vessel narrowing, but with conservative management M4 has done well.  M4 has always been on the heavy side, but over the past few years his weight has increased.  Now that we have a methodology to address overweight, M4 and I decided to use it.

M4's baseline weight was 279, falling to 245 at 28 days.  M4 lost 34 lbs, 12% of his body weight, in 28 days, and he kept it off over the three week step eight low carb transition period.  Six weeks out M4's weight remained stable at 246.  M4 began his second round of HCG weight loss in early 5/09; he lost another 28 pounds over 40 days.  His net loss at this point is 57 lbs. - 20% of his baseline weight.  M4 is also starting to look like Sean Connery.  M4 feels well, and he still brings flowers in for the staff (Hmm, I always wondered why M4 got all the good slots on the schedule). 


Our "Pre-Cruise" weight loss program for cardiac patients - M5

Maybe I could market our program to the cruise lines.  M5 had a cruise coming up.  His clothes weren't exactly lose and M5 wasn't pleased about this.  We had only 23 days to work with so we could only help M5 lose 29 pounds, from 284 to 255. Blood pressure normalized and quinapril was dropped.  M5 felt well throughout this process, able to work out as usual without difficulty.  M5 does have coronary disease.  He actually experienced a heart attack in the office following a stress test.  His symptoms and overall condition responded beautifully to EECP followed by MME (see EECP and MME for Acute and Chronic Coronary Insufficiency - CD).  M5 did have kidney dysfunction (creatinine 1.4 mg/dl but this marker of kidney function fell to 1.1 following lead detoxification), so now he doesn't have kidney dysfunction.  Clinically M5 has been dong well.  Our goal here was to decrease M5's medication requirement and risk factor status - and to get him ready for the beach.  We succeeded in doing so.  M5 enjoyed the cruise.  M5 will likely carry out a second round of HCG therapy in the future.     

 


26 pounds in 28 days without much fuss - W1

                       Body Mass Index (BMI)

BMI is estimated by dividing height (in inches) by the square of your weight, and then multiplying the result by the conversion factor 703.  Our  bioimpedance bariatric scale makes a direct calculation.  You can do the math yourself, or use the online calculator, courtesy of the National Heart, Lung, and Blood Institute at nhlbi.nih.gov. 

  • Underweight = <18.5

  • Normal weight = 18.5-24.9

  • Overweight = 25-29.9

  • Obesity = BMI of 30 or greater

 

W1 does not have hypertension, diabetes, or coronary disease, but her weight is (was) above what it should.  Her body mass index (BMI) was 29, at the transition point between overweight and obesity.  She also happens to be married to M1, who really needed to lose weight to address several active health conditions.  Thus M1 and W1 began the program together.  This makes sense and is something that we encourage.  On our program patients feel reasonably energetic and free of hunger cravings, but its kind of difficult to follow the 500 calorie diet while your spouse/significant other is enjoying a three course dinner.  W1 began the program.  She did experience a few days of hunger sensation, but this passed and her weight dropped from 164 to 148, a total of 26 lbs. in 28 days.  Her BMI fell from 29, high overweight, to 26, the lower limit of overweight.  Six weeks out M1 has maintained her weight and feels well.  He statistical risk for heart disease, malignancy, and the weight related cardiovascular risk conditions (hypertension, hyperlipidemia, and  type II diabetes) have plummeted, as have her risks for other age related conditions such as arthritis and gout.  We did this without drugs (other than HCG), and she only needed HCG for 28 days.  This is cool medicine.                        

 


Off to a good start:  20 pounds in 14 days - W2

W2 is troubled by hypertension, recurrent atrial fibrillation, and arthritis.  The later two problems have come under control with an integrative program of pharmacologic and nutritional support.  Arthritis has not come under control, not with a weight of 305 lbs. and a BMI of 49.  W2 required right knee replacement in 2004.  Left knee pain was tolerable, and up until recently W2 was able to exercise.  W2 enjoyed the exercise and these regular work outs helped keep a long standing weight challenge under control.  Left knee pain worsened in late 2008.  W2 had to cut back, and later stop, her exercise program.  Weight rose, and she experienced a flare up of arrhythmia.  We needed to get W2's weight down, and we needed to resolve her pain.  Glucosamine/chondroitin/MSM was not getting the job done.  Life long NSAID (prescription arthritic pain relievers) therapy would likely increase W2's blood pressure and expose her to a host of other side effects.  Left knee replacement is thus the logical next step, but recovery from this procedure is going to be difficult at 305 lbs. 

We needed to help W2 lose weight and we needed to do so is an expeditious and safe fashion.  We know how to do this.  On our protocol W2's weight fell from 305 to 285 in 14 days, and she feels well.  When W2 reaches 34 lbs. of total weight or 40 HCG days have elapsed, she will transition from the step six HCG/500 calorie diet into the three day step seven off HCG/still 500 calorie diet phase.  W2 will then follow a sugar and starch avoidance but calorie unlimited, and protein replete, diet for three weeks (step eight), and then she will be ready for knee surgery.  Her risks will be lower and we anticipate that rehab will be easier.  When she is ready, W2 can repeat the program and lose more weight.  Her BP med requirement will likely fall, and probably also her risk for atrial fibrillation (I can't prove this with a study, but overweight does increase ones risk for hypertension and sleep apnea, two important underlying causes of atrial arrhythmia, and weight loss will lessen cardiovascular inflammation, which plays a role in arrhythmia as well as in atherosclerosis).

Two points can be made here:
1.  Most treatments in medicine require a good deal of effort, some risk, and a not inconsiderable expense, and you might not see a result for months.  Often we do not see results, and this is why we keep adding medications to your program, on which you may or may not feel better.  We feel that our approach is quite effective, reasonable in cost, and safe (provided we watch closely for the need to reduce your drugs).  Our approach does not impact significantly on your life style or ability to work and interact with others, but is does require some effort, and the willpower to follow the 26-43 day diet.  If you make the commitment and put in the effort, then its good to see results, and to see results early.  This early, positive feedback energizes our patients and motivates them to keep up with the program.
2.  Outside of exceptional situations, we would not want you on the step six 500 calorie diet right up to the time of surgery.  During step six you are borderline protein deficient.  The protein content of your diet is technically not enough, but it is supplemented by the protein released into your system under the influence of HCG.  We do not mean that you are resorbing muscle (this would be undesirable and we can measure muscle weight with our bariatric scale) but from the scaffolding of the the fat tissue that is resorbed.  When you enter step eight, it is important that you increase your calorie intake at least up to your BMR (Basal Metabolic Rate, which we can measure) and preferably a little more, and that you emphasize protein.  If not, the protein content of your blood will fall and you will begin to retain water (this is why Dr. Simeons recommends a "Steak Day" should weight rise during stage eight).  And pertinent to M2, we would not want you to go into surgery with a low protein status, as this could compromise wound healing and your general recovery - thus the time table that we constructed for M2.  We respected biological principles and we got the job done.

 


Reducing future disease risk in a young person - W3

W3 has been weight challenged for years.  Mitral valve prolapse is present and rarely will W3 experience palpitations, but otherwise at age 35 W2 is enjoying good health.  However, she has a family history of heart disease, and while W3's BP is normal, her LDL cholesterol is high at 183, inflammation is present with a CRP of 4.9, her Lp(a) is above the 90th percentile at 35 mg/dl, and her antioxidant defenses are on the low side (45th percentile for Americans).  Before we start throwing drugs at a young person, we should first help them lose weight, and that is what we did with W3.

W3 lost 20 lbs. in 28 days, decreasing her BMI form 36.3 to 32.4.  This took some effort.  W3 experienced more hunger than do most patients, but she had the will power to stick with the program.  Exercise was a little more difficult as well.  Activities of daily living were not an issue, but when W3 went for a brisk walk, this seemed to increase her sense of hunger.  W3 stopped pushing herself, remained on the program, and was rewarded with a 20 lb. weight loss. 

W3 maintained her weight and felt well during the phase three low carbohydrate lock in period.  She began a second round of HCG therapy six weeks later.  This time hunger was less of an issue, especially towards the end of the cycle.  W3 lost 19 more pounds, for a total loss of 39 pounds, 20% of her baseline body weight and she feels great.  W3 feels great.  She will begin her third cycle later this summer.  We will repeat her labs when W3 reaches her healthful body weight. 

Two points to make here:
1.  While Lp(a) is under genetic control and antioxidant defense status is related to the balance between dietary antioxidants and environmental pro-oxidants, CRP and LDL are quite weight sensitive.  Using drugs to lower LDL and CRP in an overweight young person who does not have symptomatic vascular disease is (in my mind) a colossal mistake.  It involves exposing a young person to life long therapy with drugs that we have only been using for 10-20 years, primarily in older individuals with active disease.  It involves not dealing with the underlying cause (overweight), but instead dealing with secondary manifestations of overweight.  This makes little sense to me.  It's kind of like bailing out your boat without also rowing out of the rain.  So if you are young and have cardiovascular risk factors and you are overweight, please ignore the drug adds and please do lose the weight.  Row a little to avoid a life long rain storm.
2.  Hunger is less of an issue in men than in women, and seems to be more of a problem in younger as opposed to more senior women.  We cannot explain this.  On treatment hunger does seem to attenuate over time.  If not, we can carry out a dose increase (from 125 to 250 IU) or a change in delivery (from subcut to IM or from subcut/IM to sublingual or visa versa).  A minority of individuals are going to experience hunger no matter what we try and here we will need to rely on willpower..


Weight regain during step eight; you do need to follow the protocol - W4

W4 did OK with our program, but she didn't do great.  She lost 9 lbs. in 14 days, and with this we had to decrease her Cozaar (BP control) and Metformin (sugar control) doses by 50%.  She stopped the program at 26 days (13 pounds overall), as she had some family gatherings coming up.  Her weight loss was only 13 lbs, but her waist circumference decreased by 2 inches.  W4 was not able to follow the diet closely.  Her husband, who is not weight challenged, ate real food across from her and snacked at night - OK for him but a challenge for an HCG dieter.  During the 3 week low carb transition period, W4 did not follow Dr. Simeons' protocol.  She did not carry out a steak day the day her morning weight was up 2 lbs.  Consequently she regained 6 lbs.  W4 related that she has had a life long struggle with her appetite, and that appetite suppressants were required in the past.  I should have done a better job educating and motivating W4.  She did benefit from the program.  A net seven pound weight loss is not a negative, but our other patients have received a greater benefit.  We will keep working on these issues with W4. 

Key point:
Following the 500 calorie diet while on HCG is not that difficult, but it is when you are sitting across the table from someone who is not.  One thought is to begin the protocol when your spouse/table mate is out of town, or if they are also weight challenged, to follow the protocol together.  Another option - omit real food altogether and take in three 160 cal. Center for Medical Weight Loss shakes.  This is working for our patients.  Some don't want to sit at a table full of food, others are on the go and don't have time to prepare the low calorie plates.  Some patients alternate between 500 calorie food and the shakes, depending on their schedule.  As long as the program is working for you, we can be flexible in helping you achieve your goals.  If W4 wants to try the program again, I will suggest that she try the shake method, or to wait until her husband is out of town for a few weeks when she gets started.


Rapid weight loss requires rapid insulin dose reduction - W5

W5 was overweight but she had enjoyed good health - that is until 2002 when routine evaluation revealed the presence of hypertension, hyperlipidemia, hypothyroid status, and adult onset diabetes with proteinuria.  Medical therapy was initiated.  Her risk factor lab values fell but her weight went up (blood pressure and glucose lowering drugs will do this).  Atrial fibrillation developed in 2007.  Medical therapy worked rapidly and we were able to get W5 off coumadin anticoagulation rapidly (coumadin is necessary in atrial fib to prevent blood clots, but this agent depletes the body of Vitamin K2, which is needed to prevent abnormal calcification of arteries, valves, and joints).  Sleep apnea was diagnosed  (sleep apnea is a driving force underlying atrial fibrillation, hypertension, and atherosclerosis - in turn, overweight is the driving force underlying most cases of sleep apnea).  Getting used to CPAP was a struggle for W5, but her energy level did improve with this treatment.

Thus at age 57 W5 had a host of problems (BP, DM, sleep apnea, high lipids, and arrhythmia) all of which are caused by or driven by overweight status.  We had been treating her with a lengthening list of drugs, many of which can lead to weight gain.  This is the standard of care.  Your insurance companies monitor my charts to make sure that I am giving you these "correct" drugs if you have these medical conditions.  Not once have they inquired as to whether or not I was doing anything to address your overweight status.  I do not see the wisdom in this approach.  For years I went along with this thinking (? thinking) so I was part of the problem.  So now I am doing my part to promulgate the solution.  We began to help W5 lose weight (her husband has coronary disease with a prior bypass and is following the protocol along with W5).

W5 lost 26 pounds over 40 days; her home scale weight fell from 228 to 201.6.  Her medication needs plummeted, actually faster than I had anticipated, and she had an episode of symptomatic hypoglycemia that responded to sugar intake (an orange) and a further reduction in her medications.  W5's BP was well controlled (on 200 mg of metoprolol and 80 mg of quinapril).  Now it is well controlled on 50 mg of metoprolol. 

       Meds Pre-Weight Loss 40 Days
   Lantus Insulin 68 units Stopped
     Metformin 1000 mg 500 mg
       Quinapril 80 mg Stopped
Metoprolol 200 mg 50 mg
Simvastatin 10 mg 10 mg
       Synthroid 125 mcg 125 mcg

W5 has maintained her weight loss during step seven (the three week low carbohydrate period).  Her plan is to undergo another round of HCG treatment later this summer.  Her weight will likely fall further, with a concomitant improvement in her overall health and a further reduction in her medications.  I wonder how much W5 can get for her CPAP machine on eBay?

Key point:
Close monitoring of glucose status in necessary when diabetic patients on insulin or sulfonylurea agents begin the program.  We had decreased W5's metformin dose by 50% and she was watching her sugar levels and decreasing her insulin dose accordingly, but she still had a hypoglycemic episode, one that responded to taking in an orange.  We need to be watchful here.  We know that your medication requirement is going to fall, but before we start we can't say for certain how far.  This is why I ask you to monitor and chart your glucose and BP values along with your weight, and why we construct for you contingency plans (regular insulin coverage as needed for sugar spikes or clonidine as needed for BP spikes - these "fall back" measures allow us to back off more rapidly on you long acting or maintenance drugs, thus reducing your risk of hypoglycemia and medication related BP drops).


Body fat falls and muscle mass rises - W6

Calorie restriction without HCG will lead to weight loss.  Percent body fat will decrease, but unfortunately so will muscle mass.  Remember, your physiology thinks that you gained and then maintained this weight to prevent starvation during the next famine.  When you restrict your calories, she will respond by decreasing your metabolic rate.  She will allow you to resorb muscle, in an effort to preserve what she feels to be "vital" fat stores.  Our theory is that HCG-assisted calorie restriction bypasses these "save the fat" mechanisms, allowing you to lose body fat without losing muscle.  The bariatric scale allows us to measure percent body fat, muscle mass, and body water.  Let's see how our theory holds up in practice.

W6 had no complications of overweight.  She was not hypertensive, her blood sugar was normal, and hyperlipidemia was not present, but W6 did not want those conditions to develop, so she chose to lose weight now.  W6 took her HCG sublingually, 125 IU twice a day.  Over some weeks she followed the Simeons 500 calorie diet, while on others she took in three Center for Medical Weight Loss shakes or two shakes and a bar.  Weight loss proceeded smoothly.  Over the 43 day program W6 lost 22 lbs., from 164.5 to 142.5 on her home scale, and 19.5 lbs., from 164.5 to 145 on the office bariatric scale (note that your home, first thing after voiding morning weight is the most accurate measure - your office weight, taken at different times of the day, will be influenced by transient fluids shifts).  This is a good result, 22 lbs. in 43 days, without undue hunger or fatigue.

 

W6's result was even better if you analyze her weight loss from the perspective of body composition, .  W6's BMI fell from 30 to 27, with a total loss of 19.5 lbs. on the office scale.  Her fat mass fell by 19.5 lbs., from 64 to 44.5, muscle mass rose by 3 lbs., from 25.5 to 28.5, and body water decreased by 3 lbs.  Scale weight reflects fat loss, but doesn't tell you about muscle gain, and muscle gain is a long term plus.  Our bariatric scale gives us this information, which we then use to guide your program.  The point is not weight loss; rather it's fat loss without muscle loss, and W6 more than achieved this goal with the HCG program.


BP falls with the eleventh doctor - M5a

M5a's weight loss results are not included in our outcome statistics, as his 23 day program included a 6 day hiatus (off HCG due to travel), but I do want to report M5a's medical result - a full resolution of long standing hypertension.  M5a had a 15 year history of difficult to control hypertension.  Four BP related hospitalizations had been required.  Ten different doctors did their best to find the answer.  Secondary causes of hypertension (renal artery stenosis, adrenaline secreted adrenal adenoma, and aortic coarctation) had been excluded.  M5a's diagnosis was essential hypertension, our term for the age related high blood pressure that occurs in millions of Americans. 

Many different drugs and drug combinations had been tried; most were ineffective or produced side effects.  M5's BP was typically in the 150s/100s range, with occasional spikes to 180 systolic.  M5 sustained a stroke in relation to a BP spike, compromising vision in one eye.  Fortunately M5a's visual field defect improved with MME (see the MME section in the heartfixer website).  M5a required an admission for hypertensive encephalopathy (a change in mental status due to severe hypertension) six months prior to beginning our program.  M5a's meds were advanced; BP did fall, but M5a didn't feel well. 

M5a began the program on a beta blocker, a diuretic, and an angiotensin II receptor blocker (ARB).  His weight was 177 with a BP in the 140s/100s range.  He did receive three IV magnesium treatments over the first two weeks.  M5a followed the 500 calorie diet with precision, but half way through he needed to take six days off due to a travel commitment.  Overall M5a was able to follow the program for 23 days.  M5a's 23 day weight was 163.  He lost only 14 pounds, but as M5a lost these 14 pounds his BP fell into the 120s/upper70s-low80s range, and M5a was able to stop all three of his BP meds.  M5a is maintaining his post-diet weight.  He is exercising on a regular basis, and he feels well.

Weight loss, even numerically modest as in M5a's case, can have a dramatic effect on BP control.  We need to emphasize that overweight is an important cause of hypertension, and in the US, where two thirds of adults weigh more than they should, overweight is probably the most important cause of hypertension (and sleep apnea, which also leads to hypertension, atrial fib, and heart disease).  If we can help people like M5a lose their excess weight, then we can help them lower their BP, and in the process lose many of their medications.


Great record keeping and a great result - M6

M6 followed the program precisely.  He lost a lot of weight.  Multiple health conditions improved.  M6 also kept precise records.  This helped me help him, and allows us to use M6's case study to illustrate several important points.  M6 has a long history of hypertension and hyperlipidemia, both well controlled medically, along with type II diabetes that was more difficult to keep in check.  Right coronary artery stent placement was required in 2003.  Circumflex coronary artery disease presented itself 10 months later, also requiring stent intervention.  We began working together in late 2005.  M6's LDL cholesterol looked good at 66, but his triglycerides were elevated at 345, related to type II diabetes, which remained difficult to control despite 45 units of Lantus insulin (later advanced to 130 units), 2000 mg/day of metformin, and 10 mg/day of glucotrol.  M6 was also troubled by sleep apnea, and like many patients, M6 had trouble with the CPAP mask, such that his sleep remained troubled.

We found that M6 had a Lipoprotein (a) above the 95th percentile at 64, which we addressed with lysine, proline, and vitamin C.  Low testosterone was addressed with testosterone pellet placement every six months.  Our usual program of antioxidants, fish oil, Co-Enzyme Q10, iodine, and vitamin K2 was added to M6's already complete pharmacologic regimen.  Chest tightness scared us in late 2005, but catheterization revealed a benign picture, with no narrowings greater than 40%.  M6 was hospitalized with lower extremity cellulitis in 2007.  He was also slowed down in 2008 by lumbar disc disease.  Fortunately M6's CV status remained stable. 

M6 began our program at a weight of 232.  He felt well on the HCG diet.  Energy was not a problem and M6 found that he was sleeping better.  M6's weight decreased in steady fashion to 199, an overall loss of 33 lbs.  M6's medication needs dropped considerably, and keeping up with this was work for both of us.  Serum creatinine is a lab marker of kidney function and volume status.  Creatinine is produced at a constant rate by muscle.  It is cleared from the body via the kidneys.  Thus a rise in serum creatinine may reflect a reduction in fluid volume, kidney function, or both.  In general, short term changes reflect fluid volume, while long term changes in creatinine reflect kidney health.  We watch for changes in serum creatinine when we make medication changes and when patients under treatment for blood pressure and heart disease lose weight in our program.  M6's baseline creatinine was 1.3 mg/dl, within normal limits.  On the program for six days, M6 lost 4 lbs. (6 lbs. from his post-fat loading second day weight).  His systolic blood pressure had fallen from 170 to 140, and his creatinine had increased from 1.3 to 1.5.  We reduced M6's meds as he began the program, but obviously not enough.  His weight continued to fall, his BP improved further, and his creatinine rose to 1.7 mg/dl.  I cut back further on M6's meds and his creatinine returned to baseline.  M6 had reached a new equilibrium:  Lower weight ® less inflammation ® less need for medication ® better health M6 lost 33 lbs.  Ankle swelling fully resolved.  His waist line decreased from 49.5 to 46 inches.  M6 is sleeping better.  He's going to have to buy new clothes (he can use the money saved on medication co-pays). 

M6 has been able to maintain his weight during the 3 week step eight low carbohydrate period, making good use of Dr. Simeons' "steak day" protocol when his morning weight rose above his new baseline (see chart).  While M6's weight has been maintained, his BP has increased a little, prompting us to resume HCTZ (diuretic) at a lower than baseline dose, and his sugar has increased, necessitating reinstitution of metformin and glyburide, along with Lantus at a lower than baseline dose.  This is not uncommon nor a disappointment.  One round of HCG is not going to obviate the need for all of one's medications, and M6 is still overweight at 199 pounds.  M6 will probably repeat the HCG program in the future, and after that he will likely not be overweight.  We will likely need to decrease his meds further, and again M6 will need to buy new clothes, and maybe some running shoes.

 

 


Great records and another positive result - W7

W7 happens to be married to M6, so we get the same great record keeping, and the same great result.  W7 lost 21 pounds, from 180 to 159.  Her waist line decreased by one inch, and her thighs by two.  W7's blood pressure medication requirement fell in the expected fashion.  Men typically lose 30 pounds and women 20, but in both genders, medication needs fall considerably.  We aren't sure why men lose more.  It's probably that their starting weights are greater, or maybe they are more sensitive to the HCG effect.  We will try to figure this out (on the other hand, I've never really been able to figure out women).

   

BP Medications

Medication

Pre-Weight Loss

40 Days

Atenolol 25 mg 25 mg
HCTZ 12.5 mg 12.5 mg
Quinapril 60 mg Stopped

 


20 pounds down and fewer drugs - W8

W8 has been under my care since 1994.  She has undergone seven angiographic studies and three rounds of PCI (balloon angioplasty or stent placement); bypass surgery was required in mid-2000.  W8's most recent angiographic study (2005) revealed a 50% narrowing within her right coronary artery stent, occlusion of the marginal branch of the circumflex with well developed collateral flow, distal circumflex disease, and a patent LIMA graft to the occluded left anterior descending.  With medical and nutritional management W8 remains asymptomatic.  Lipid and BP control has been achieved on a well tolerated treatment program, but W8 has been and remained overweight.  On the HCG program W8 lost 20 pounds, from 178 to 158, and we were able to back off on her BP meds in the usual fashion.  We've removed another driving force (overweight) underlying her atherosclerotic diathesis, at the same time decreasing her risk for future drug related side effects (less drugs = lower side effect risk).  In removing drugs from coronary patients with high blood pressure, we start with the diuretics, which have no anti-atherosclerotic value, and then, if necessary, we remove the vasodilators, keeping in mind that ACEI and ARBs (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) do have protective effects beyond simple BP control.  We will remove them if your body tells us to.  If your weight falls, your BP will fall in like fashion.  Inflammation will fall, and with this your need for BP meds, as well as your need for their other protective actions.  Beta blockers are the last to go, as we use these agents not just for BP control, but to address potential myocardial ischemia (symptoms or abnormal physiology on the basis of reduced blood supply to the heart due to coronary artery blockages).  Thus we make these medication decisions in a deliberate, step-by-step fashion, and this is why you don't want to follow the HCG program on your own, especially if you have cardiovascular disease or are taking a number of medications.

BP and Heart Medications

Medication

Pre-Weight Loss

40 Days

Lopressor 50 mg 50 mg
Cozaar 50 mg 25 mg
HCTZ 25 mg Stopped

Lose the weight and lose the inflammation - M7

M7 presented in 1997 with persistent angina due to LAD (left anterior descending coronary artery) occlusion.  We treated M7 with EECP, then a "new" therapy, and with this M7's angina resolved.  Additional rounds of EECP were required and in 2003 M7 needed bypass surgery to address new narrowings in the RCA (right coronary artery) and Circ (circumflex, which serves the side wall of the heart).  We had been addressing M7's risk factors, and we hadn't done a bad job (off treatment cholesterol 343 and on treatment 181), but we had not addressed overweight, a key driving force underlying systemic inflammation (M7's CRP was 3.7 mg/liter). 

On our program M7's weight fell by 26 pounds over 26 days.  His cholesterol fell from 181 to 168 (even with a reduction in simvastatin from 80 to 40 mg), and his CRP decreased to 1.8 mg/liter.  M7's kidney chemistries had been abnormal (creatinine 1.4 - 1.6 mg/dl - normal is <1.2) in 2008.  M7 began to lose weight on his own in early 2009.  His BP fell, quinapril was discontinued, and M7's creatinine fell to 1.3.  Following the 26 pound weight loss, M7's creatinine is down to 0.8 (overweight also strains the kidneys).     


A treatment for the American way of eating - W9

W9 grew up in Russia.  Foods were less processed.  People did more walking and less driving.  W9 picked up our dietary and health habits after emigrating to the US  - and with this she also picked up 100 pounds.  W9 lost 50 pounds on Weight Watchers, and gained only half of it back.  W9 is not troubled by hypertension or diabetes, but she is troubled by spinal stenosis.  Exercise is thus difficult, and thus so will be weight loss and maintenance of weight loss.  W9 entered our program at 198.5 lbs., with a BMI of 36 and 43% body fat.  W9 chose the sublingual approach and found that appetite control was satisfactory.  Early on she had trouble with headache and a sluggish GI tract, but these problems resolved.  W9's energy level was good and she was able to continue in water aerobics without difficulty.  W9 lost 19 pounds over 40 days, just less than 10% of her overall weight.   


29 lbs. in 40 days and better overall health - M8

This 55 year old man was not troubled by hypertension, hyperlipidemia, or an elevated glucose, but he knew that these issues could develop if his overweight status was not addressed (scale weight 213, BMI 31, with a fat mass of 53 lbs.).  M8 was under treatment for BPH (benign prostatic hypertrophy) with cardura and avodart; mild SAD (seasonal affective disorder - the winter "blues") was being addressed with zoloft over the winter months.  M8's pre-weight loss BP was 120/80.  M8 lost 29 lbs., from 213 to 184, over 40 days in our program.  Estimated fat mass fell from 53 to 32 lbs.  Postural dizziness responded to a reduction in cardura from 8 to 4 mg/day.  At M8's 30 day on treatment visit his BP was 110/60.

Key point:
Cardura is an "alpha blocker".  It blocks the action of norepinephrine on alpha receptors of the autonomic nervous system.  By this mechanism cardura relaxes the prostatic urethra, facilitating urine flow in patients with BPH.  The alpha receptor also mediates arterial vasoconstriction; thus we can use cardura in the treatment of hypertension.  A not uncommon side effect of cardura in either circumstance is postural hypotension, a drop in BP with rapid standing.  Levels of norepinephrine and other vasoconstrictive and inflammatory molecules fall when you lose weight.  We advise patients to be on the lookout for consequent reductions in blood pressure, and we can easily address this problem with a decrease in medication dose, as was the case for M8.  M8 was also on avodart.  This agent, like proscar, blocks the conversion of testosterone into dihydrotestosterone, the molecule that mediates enlargement of the prostate.  Avodart has no effect on BP.  M8's BPH symptoms did not worsen on the reduced dose of cardura.


21 lbs. in 40 days with a decrease in meds - W10

W10 weighed 204 pounds on a 5'5" frame - and she had type II diabetes, hypertension, and gout to show for it.  On our program W10 lost 21 pounds over 40 days.  She received HCG via the sublingual approach and alternated between the Simeons 500 calorie diet and three CMWL shakes/day.  Her BP fell, allowing a medication reduction from Hyzaar 100/25 (Cozaar 100mg plus 25 mg of the diuretic HCTZ) to Cozaar 25 mg/day.  Blood sugar control improved, allowing a reduction in metformin from 1500 to 1000 mg/day.  Prior therapy with allopurinol and moduretic 5/50 was left on board to prophylaxis against gout and kidney stones and no problems were encountered.  


49 lbs. in 40 days and feeling great - M9

The problem with most weight loss diet programs is resistance at the level of the hypothalamus.  According to Dr. Simeons' theory, the hypothalamus thinks that you gained your weight for a reason, specifically to prevent starvation during an upcoming famine.  Your attempt to lose weight with dieting is interpreted by the hypothalamus as the beginning of the famine.  She responds by slowing down your metabolism and releasing neural mediators to increase appetite, forcing you to put back on this "protective weight".  The Simeons protocol is designed to work around this problem - biochemically convincing the hypothalamus that your on-HCG weight loss is healthful.  Thus the starvation response is not initiated.  However, Dr. Simeons cautioned that a single session weight loss above 34 pounds could breakthrough the HCG biochemical cloak, such that an undesirable starvation response could occur.  Other practitioners, however, have advised me that this is not necessarily the case.  They feel that it isn't mandatory to stop a patient at a specified weight loss limit as long as they are feeling well and still losing weight.

M9 began the program in good overall health.  Sleep apnea and testosterone replacement therapy were proceeding smoothly.  M9 had been following a comprehensive nutritional program for years.  Blood sugar, blood pressure, and lipids were all within reasonable limits and did not require medical therapy.  M9 didn't just feel OK on treatment - he felt great.  Cognition, memory, energy, and sleep were all improved over his baseline status.  He got to 34 pounds at 30 days, but as he was feeling so well I did not stop him.  M9 lost a total of 49 pounds, and he has had no trouble maintaining his weight within a two pound range during the step eight, low carbohydrate, new set point lock in period. 

M9 has his appetite under control.  He is enjoying his food, actually a lot more than before.  M9 is eating more slowly, enjoying the taste of his food, and he is now able to sense when he has had enough.  Our body does tell us when we have had enough.  An elaborate system of chemical messengers is released at various stages of a meal, and if we eat slowly, we can sense them.  When we wolf down our food, or eat on the run, or if we are stressed, we just don't get the message.  M9 now gets the message.  M9 has control of his appetite.  M9 is exercising more.  M9 is going to continue to lose weight on his own, but if he gets stuck, we can easily carry our another round of HCG therapy.

                                                                        M9 is our current record holder. How long will his record stand?


24 pounds in a world traveler - W12

W12 is always on the go; quite literally all over the world.  We had her in town for 40 days.  She took sublingual HCG twice a day, and three Center for Medical Weight Loss shake.  W12 felt well as she lost 24 pounds, and she had no trouble keeping up with her busy in-town schedule.  On day 41 she was off to Europe, but had no trouble staying within the step eight two pound window.  Without meaning to she lost three more pounds - it just happened.  W12 describes "a new relationship" with food.  It tastes better.  Food is now something to savor and definitely not something to take in on the run.  Unhealthy food now tastes - well - unhealthy.  Sugar, fried, and greasy food no longer have any appeal.  I have heard this from other patients.  It's almost like your palate has been cleared and you get to start all over choosing which foods you like and which foods you like to avoid.  Cravings for unhealthy foods resolve and you remain in charge - even in Europe.


23 pounds and better BP control - W13

Currently 50 years of age, this overall healthy woman had been troubled by a progressive rise in BP, with onset around age 45.  A reasonably well tolerated medical regimen was initiated and was getting the job done.  Two years ago, while on vacation, W13 missed just one day's worth of treatment.  Her BP shot up to 198/110.  Severe headache led to a hospitalization; fortunately no damage was done.  Medical therapy was advanced further and W13's BP fell.  At one point she was on a beta blocker (metoprolol), and angiotensin receptor blocker (avapro), two diuretics (HCTZ and spironolactone), and clonidine as needed for BP spikes.  Her response to spironolactone was marked, consistent with a genetic up regulation in ACE (angiotensin converting enzyme - discussed in detail in the methyl cycle genomics section).  By advancing this drug we were able to cut back on the others.  Overweight was felt to be playing a role, so W13 decided to participate in our program.

W13's weight dropped 23 pounds, from 198 to 175.  Metoprolol had previously been weaned off, HCTZ was discontinued, and W13's spironolactone and avapro doses were decreased by 50%.  Her BP is now 115/70 and W13 feels great.  For W13, weight control worked well to obtain BP control, certainly better than more drugs.


Cosmetic weight loss - five pounds but three inches - W13a

This 27 year old didn't look like our usual patient.  At 140 pounds on a 5' frame, her BMI was 21 with a percent body fat of 22%, healthful numbers - but W13a didn't like the way she looked.  W13a pointed out that her BMI and percent body fat were much lower a few years earlier, when she was in school and more active in sports.  She wasn't happy with her figure.  I didn't think that W13a had much to be unhappy about, but what do I know? - I'm in my mid-50s.  So, to obtain an accurate and scientific assessment, I consulted with my 23 year old sons.    They rated W13a as a 9. 

We modified the program for W13a.  Over 23 days, she followed a 800 calorie diet, while taking HCG 125 units sl twice a day.  Her weight fell 5 pounds (8 if you consider her post-gorge weight as the baseline).  W13a's BMI fell from 22 to 21, but she lost 3 inches from her waist, from 35 to 32.  The boys now rate her as a 10.

W13a's weight loss illustrates an interesting point.  The HCG program reduces body fat, and it also shifts body fat from where it is unhealthful (waistline visceral fat) to where it is healthful (padding internal organs and bony surfaces).  Dr. Simeons rule is that one's waistline will decrease by one centimeter for each kilogram reduction in body weight; this translates to a one inch waist reduction for every 5.5 pounds you lose.  W13 did better than average, losing three inches around her waist with only 5 pounds weight reduction.  Fat was lost and fat was transferred - and now W13a is a 10.


  Weight loss when you are allergic to everything - M12

M12 is, in his words, "allergic to everything".  Most foods, and nearly every medicine I've tried, all produce prominent respiratory and neuropathic symptoms - a real problem as M12 is also troubled by coronary artery disease, intermittent atrial fib, and congestive heart failure.  The one dietary program that M12 can tolerate is the "grape diet".  On this program M12 will lose weight, his blood sugar will fall, and he feels reasonably well.  Off this diet he feels poorly.  The problem here is that one can't live indefinitely on grapes alone.  You do need protein and some fat, so M12 would alternate between the grape diet (where he feels well) and eating a balanced diet (where he will feel lousy).

M12 has some weight to lose; his baseline weight was 240 pounds, and we both felt that this was contributing to his cardiac problems.  M12 thus began our program, and felt poorly.  He couldn't tolerate the foods on the Simeons' diet, nor could he tolerate the shakes and energy bars that we sometimes use as a substitute for real food.  M12 then went on the grape diet, while taking sublingual HCG - this didn't work too well, so at 10 days we switched from sublingual to subcutaneous HCG - this worked great.  M12's weight fell from 240 to 216 pounds; his blood sugar and blood pressure values have improved.  We will likely repeat this "grape diet with HCG program" periodically until M12 slims down to a physiologic weight, expecting continued improvements in his diabetic and cardiovascular status.


On treatment insulin needs fell from 240 to 30 units/day - M14

Hypertension, type II diabetes, and an impossible to treat lipid abnormality (intolerant to multiple drugs with a cholesterol of 328) led to bypass surgery in 2000, lower extremity revascularization in 2002, carotid endarterectomy in 2004, and right lower extremity amputation in 2008.  In the spring of 2009 M14's glucose levels were out of control, despite 240 units/day of insulin.  On the modified HCG program M14 lost 27 pounds, from 264 to 237, and on this program his insulin requirement fell to 30 units/day.  BP fell, forcing us to discontinue lisinopril.  M14 has maintained his weight off the 500 calorie diet, but his sugars have increased; insulin has been increased to 200 units per day with satisfactory results.  BP has increased into the high normal range and lisinopril was resumed.  If we keep this up, whittling away 20-30 pounds periodically, such that a healthful body weight is eventually achieved, M14 should wind up with adequate BP and sugar control with minimal pharmacologic intervention.  M14's case illustrates why overweight diabetic patients should not try to carry out aggressive weight loss on their own - frequent med adjustments are necessary and close physician monitoring is thus critical.


Switching from sublingual to subcutaneous HCG to abate hunger - W14

W14 experienced a positive result, losing 23 pounds, from 180 to 157, but she had to work at it.  Hunger was a major issue early on, as has been the experience of other younger women (HCG is 49) whom we have worked with.  Hunger became much less of an issue when W14 switched form sublingual to subcutaneous HCG at day 10.  Nobody likes needles, and some patients do just fine with sublingual therapy, but others, like W14, seem to experience less hunger when receiving HCG by injection.  W14 is planning on repeating the protocol in several months, and this time we will use subcutaneous HCG all the way.  Some patients strongly prefer the sublingual route, and we can certainly accommodate that wish, but if your initial results are not satisfactory than I might twist your arm a bit to convert over to the subcutaneous approach.

 Please note - It is the position of the FDA and FTC that 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 more attractive or “normal” distribution of fat, or that it decrease the hunger and discomfort associated with calorie-restricted diets.