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The HCG Diet: Yet another ineffective quick fix diet plan and supplement

I contribute biweekly to Science-Based Medicine and could easily devote every post to writing about weight loss supplements, and never run out of topics. As soon as one quick fix falls out of favour, another inevitably replaces it. Some wax and wane in popularity. And pharmacies don’t help the situation. I cringe every time I walk down the aisle where weight loss products and kits are located. Detox? Hoodia? The “fat blaster”?  Here are pharmacists, well educated and perfectly positioned to provide good advice to consumers, but standing behind a wall of boxes with ridiculous weight loss promises.  Yet pharmacists tell me that these products are not only sought out by customers, but they actually sell well. It’s a lost opportunity to provide good advice, and consumers pay the price.

Perhaps because consumers associate these products with pharmacies, I get regular questions about weight loss programs. I end up developing some degree of familiarity with many of them, if only to be able to credibly redirect away from some of the more harmful plans and approaches. It’s that philosophy that I used recently when I was asked about how to best to manage a “plateau” on the HCG diet. I’d never dispensed human chorionic gonadotropin (HCG) before, but knew of its use for the treatment of infertility, where it promotes egg release. But weight loss? I couldn’t think of a mechanism for how HCG could promote weight loss. So I did some digging, and found a long, rich vein of pseudoscience that dates back decades.

HCG is a hormone secreted by the placenta during pregnancy.  Its use as a weight loss adjunct has roots that date back to the 1950s, when Italian physican ATW Simeons announced [PDF] case studies of weight loss in patients given HCG injection and placed on very low calorie diets — about 500 kcal/day. Simeons’ data failed to be replicated in later studies, and interest seemed to deservedly fade. The diet leapt back into consciousness when telemarketer and convicted felon Kevin Trudeau started promoting the diet again in 2007, claiming the TRUTH had been suppressed by the American Medical Association and the FDA. Since then, HCG (also called the Simeons method) has been on a bit of tear, and it’s currently enjoying a resurgence of popularity.

The Evidence

With HCG, we’re not facing a situation of unproven efficacy. Rather, there’s good evidence to demonstrate that it does not have any meaningful effect.  Multiple studies and meta-analyses have evaluated the HCG diet and found no evidence that HCG injections offer any incremental benefit. The studies date go way back to the 1970s [PDF], and their conclusions are consistent and persuasive: The weight loss effect on the HCG diet is due to the dramatic calorie reduction, and the HCG has no measurable effect on weight loss. Not surprisingly, there are no medical associations that I could find that endorse the use of HCG for weight loss. The American Society of Bariatric Physicians warns,

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 does the HCG Diet Work?

Any weight loss from the HCG diet is actually due to the dramatic calorie restriction required as part of the diet plans — in some cases, as low as 500 calories per day. This near-starvation diet is dramatically below appropriate levels for weight loss or maintenance, and escalates the risk of malnutrition if prolonged. Even if it wasn’t immediately harmful, a 500kcal diet is simply unsustainable. Weight maintenance is the real challenge with obesity.

HCG injections are not innocuous. It may be teratogenic (cause birth defects) in pregnant women. Reported side effects include headache, fatigue, irritability, restlessness, ovarian overstimulation, ascites, and edema.

Regulatory status

The FDA has long maintained that HCG is ineffective for weight loss and in the 1970′s mandated this warning with all HCG diet advertisements:

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.

What’s appeared over the past several years have been  non-prescription (i.e., over-the-counter) HCG products, including “homeopathic” HCG which if you follow the absurd principles of homeopathy, should cause weight gain, not loss. Moreover, HCG is a protein that would be digested if consumed orally. But scientific cogency isn’t a necessary component of a good sales pitch, and you’ll see homeopathic versions sold widely. The FDA noted this and took action this past December, when it began to pull all unapproved HCG products completely off the market.  This has put the supplement industry into the positon of creating “HCG-free” versions of their products become infused with “radionics” where the HCG “energy” is transferred to vitamins or amino acids. The FDA emphasizes in its warnings that all non-prescription versions of HCG are fraudulent and ineffective, as non-prescription HCG does not exist.  Even “homeopathic” HCG is prohibited:

“Deceptive advertising about weight loss products is one of the most prevalent types of fraud,” said David Vladeck, director of the FTC’s Bureau of Consumer Protection. “Any advertiser who makes health claims about a product is required by federal law to back them up with competent and reliable scientific evidence, so consumers have the accurate information they need to make good decisions.”

The FDA even notes that the infamous Quack Miranda warning is insufficient warning to consumers, when it comes to HCG:

We recognize that a number of pages on your website contain a disclaimer stating that the products are not intended to diagnose, treat, cure, or prevent any disease. However, notwithstanding this disclaimer, the claims made on your website for “HCG Fusion 30″ and “HCG Fusion 43″ clearly demonstrate that these products are drugs as defined by section 201(g)(1) of the Act [21 U.S.C. § 321(g)(1)], because they are intended to affect the structure or any function of the body.

The Alternative Universe

The lack of evidence for HCG, and the explicit FDA warnings haven’t stopped a thriving business model among those that promote alternatives to science-based medicine. In the United States, for example, a naturopath has formed the “HCG Diet Council” and is collecting anecdotes from providers and users as part of their “standardized research program” of both HCG and homeopathic HCG. “Does the FDA Want to Keep America Fat?” the council asks. In Canada,  naturopaths at the Northern Centre for Integrative Medicine thumb their nose at the evidence, and Health Canada’s warning:

HCG (Human Chorionic Gonadotrophin) is authorized in Canada only for treatment of women with infertility, and only in an injectable form. There is no scientific evidence that the use of HCG either by mouth (as drops under the tongue, as advertised on the Internet) or as a self-administered injection, could promote weight loss.

NCIM honors the intent of Health Canada’s statement, which is protective in nature. Health Canada’s statement does not address the more substantive issue, which is the significant risk of not taking action to reduce your weight and risking future illness. The NCIM HCG Rx+ weight loss intervention cannot make any guarantees, it nevertheless provides a time-tested approach to weight loss that is physician supervised and individually monitored for safety and effectiveness.

And NCIM doesn’t honour the intent of the statement at all. It notes that the prescription it provides for HCG injections may be covered by private drug insurance.

And a post on HCG can’t neglect it’s biggest television promoter after Kevin Trudeau: Dr. Oz, who having recommended against the HCG diet, turned around and subsequently promoted it on his show, prompting obesity specialist Dr. Yoni Freedhoff to ask “Dr. Oz — so corrupted by fame he even sells himself out?

Conclusion

There’s no persuasive evidence that HCG injections has any meaningful effects on weight loss. And “homeopathic” HCG is quite literally, nothing. If the HCG diet shows one thing at all, it’s the tenacity of an idea once it’s been planted. Despite warnings by researchers, health professionals, and regulators since at least 1976 about the lack of evidence for HCG as a weight loss adjunct, it continues to attract attention and new users, now promoted by naturopaths and television personalities that are indifferent to the evidence. It’s gratifying to see a regulator (the FDA in this case) take off the gloves with supplement vendors and other purveyors of HCG pseudoscience. When it comes to weight loss there are no quick fixes.

 

Posted in: Health Fraud, Herbs & Supplements, Naturopathy, Pharmaceuticals

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23 thoughts on “The HCG Diet: Yet another ineffective quick fix diet plan and supplement

  1. Harriet Hall says:

    I spoke at an ASBP conference two years ago http://www.sciencebasedmedicine.org/index.php/a-report-from-the-bariatric-trenches/ and pointed out that the ASBP had recently issued an official policy statement that HCG does not work for weight loss and that the HCG diet is not recommended.

    The last speaker on the program challenged the ASBP’s position. He claimed that the “con” studies were flawed, that more studies are needed, and that meanwhile HCG should only be used by physicians with special training and expertise (like him). One of his slides said “It is OK to use a placebo;” he added the caveat “as long as it works.”

  2. Jimmylegs says:

    @HH:

    Wow… so did that doctor get his license revoked? Probably not… I’m not sure why anyone would use anything that has been shown to not work and is dangerous. Studies can be flawed, but I find it hard to believe that studies would be flawed for decades.

    Of course he didn’t want people buying it OTC when he could make money off of it directly. I really wonder where these people get their ethics and morality from.

  3. Harriet Hall says:

    “Wow… so did that doctor get his license revoked?”

    No, and he was rewarded with a $1500 speaker’s fee.
    He believes in HCG because he gives it to his patients and it works; so he thinks there must be something wrong with the science.

  4. passionlessDrone says:

    Hello friends –

    I do believe that this stuff works as advertised. A friend if ours went on the diet and lost ~ 30 lbs in a month. My wife got a bottle, we tried it for three days or so before bailing due to the creepiness factor.

    The OP is correct in that you lose the weight by bring on a very very restricted diet, but misses the mechanism of action. Taking HCG allows you to eat 500 calories a day without going crazy from hunger, you just aren’t hungry. Ultimately the potential side effects and my continuing thoughts that we aren’t clever enough to sledge hammer basic processes like hunger made me throw the stuff out, but make no mistake; it is a powerful hunger suppressant. I really doubt that is all it is though.

    - pD

    1. Scott Gavura says:

      @pD:
      Multiple studies have evaluated the effect of HCG on feelings of hunger and reported no effect. See table 3 in the meta-analysis I linked to above.

  5. Jan Willem Nienhuys says:

    I recently got an e-mail from a friend advertising HCG Ultra. These are drops. Of course it’s a scam. I tried to find out what is actually in it. I couldn’t find it, but if it’s drops no hormone can get into you, and probably it’s just homeopathic or ‘radionic’ (the ‘frequency’ of the real HCG is radiated into water – balderdash to the third power*).

    The FAQ of the HCG Ultra Drops said:

    HCG drops are a homeopathic HCG formula with additional weight loss ingredients tailored to your fat loss goals.

    Nowadays ‘homeopathic’ means not only ultradiluted, but may also mean ‘obtained by a so-called remedy maker’, i.e. radionic.

    But I found YouTube movies with this Oz-character advertising HCG:

    part 1 http://www.youtube.com/watch?v=SPKkfU-RURw
    part 2 http://www.youtube.com/watch?v=jN610dtwf0w&feature=relmfu
    and then you’ll see part 3 in the sidebar.

    It’s a torture to watch.

    * first power = HCG does anything at all to your weight
    * second power = tiny amounts of HCG suffice (a typical complete six week HCG weight loss treatment uses all in all about a quarter of the amount a pregnant woman excretes in her urine during one day)
    * third power = homeopathic and radionic amounts of HCG suffice.

  6. Jan Willem Nienhuys says:

    500 calories a day without going crazy from hunger, you just aren’t hungry.

    I guess lots of people who are obese can stand not eating quite well. It probably varies.

  7. Quill says:

    Let me see if I understand this. With these HCG products absence of evidence is evidence of efficacy and when the FDA requires additional disclaimers beyond the Quack Miranda warning it’s proof not only of conspiracy but also of the validity of everything claimed for the product?

    Ooof. I do -not- envy the job of any pharmacist these days!

  8. Jann Bellamy says:

    There are now small chains of clinics in the US offering HCG weight loss programs. Here’s one where you fill out a form on-line, have a “tele-consultation” with an doctor, then get your prescription:

    http://nuimagemedical.com/

  9. the bug guy says:

    Slightly off topic, but seeing an article on fad diets makes me wonder if we will see an analysis of the paleo diet trend. So far to me, it looks like a mix of some good ideas with some bad interpretations of human evolution.

  10. Jimmylegs says:

    @passion:

    So you threw out the drops because it did not subside your hungry but claim it is a powerful hunger suppressant or am I reading that wrong? Also anyone who loses more than ~2 lbs a week (which is the absolute max) is taking risks.

    You believe the stuff works from anecdotes (people giving credit to HCG) but not from the mounds of research (all pointing at caloric restriction causes weight loss, not HCG), I would go over this again and reevaluate other claims you believe / accept to make sure you are not taking it at face value and/or with anecdotes.

    Not surprised it only took 4 post to get a proponent of this here, let’s see if more come out to play.

    @Jan:

    I’ve seen the “liquid” HCG diet stuff, which claims to have no HCG in it, but has the same effects (nothing). Oddly enough when I try to find ingredient lists none exist. It sickens me that people would promote such nonsense for profit, knowing (at least willfully denying) that it doesn’t work. As a side note the man promoting the HCG-like diet is a chiropractor (ha!), not that him practicing that automatically makes him a quack but he has no credentials for nutrition or medicine.

  11. Janet Camp says:

    Why not simply consume the urine of a pregnant woman?

    And to think I lost weight by simply eating less and have maintained it by the same method–and regular weighing. You get used to feeling a little hungry and it is much less self-destructive than being fat.

  12. Jan Willem Nienhuys says:

    Oddly enough when I try to find ingredient lists none exist. It sickens me that people would promote such nonsense for profit,

    You better not think about the rich and powerful producers of homeopathic ‘medicines’ like Heel and Schwabe and Boiron and others with a joint turnover of at least 1 billion euro. Compared to that these HCG drops are peanuts.

  13. passionlessDrone says:

    @Scott Guvara –

    I took an oral solution, not injections, so maybe that is the difference from the studies you mentioned. Perhaps it was dose? Maybe the fact that I’m a male makes a difference. (?) Other studies appeared to use obese individuals, which I state later, is a condition I do not quality for.

    I have been performing open label tests of ‘am I hungry’ several times a day, every single day, for forty years or so, and I can tell you that in my sample of one, I simply was not hungry on days that I tried HCG. I’ve tried fasting before for other reasons and I know what hunger feels like. It is a remarkably simple determination to make.

    @Jimmylegs –

    You read that wrong. (sorry was typing on an iphone).

    It worked like crazy at suppressing my hunger. I threw it out because I wasn’t comfortable with the idea of what else it might be doing; I figured that you don’t get to tinker around with processes as primary as hunger without tinkering with lots of other processes.

    @Jan Willem Nienhuys –

    I was not obese at the time, nor at this time, but nice dig. Though if your statement was accurate, it does make me wonder why there are so many people that are obese, if going to 500 / calories a day is so easy.

    - pD

  14. Jimmylegs says:

    @Jan:

    Yes I did read about the companies having to point out money, I read the article here as a matter of fact. We wont be able to stop them over night but when the FDA and FTC buckle down and get involved it usually doesn’t end well for the companies.

    @passion:

    Ah I understand now. I doubt that it actually worked, because research says otherwise, but if you want to take anecdotes I found a forum (easily and sadly) that is all about HCG diet and many post complaining about hunger.

    Yes it is really unfortunate that such forums exist and I’m positive if anyone ever attempted to post about how it does not work with decades of research behind them they would be banned.

  15. Narad says:

    Why not simply consume the urine of a pregnant woman?

    Figuring there had to be a decent fly agaric joke in there somewhere, I instead stumbled across this. Could be the next big thing: a one-two punch, if you will.

  16. mousethatroared says:

    I was took injections of an HCG – Pergonal, for fertility treatment. Since I heard about HCG for weight loss, I wondered how they manage that. Is the dose different? If the dose were the same, it seems like there would be a very high risk of multiple birth pregnancies.

    In my experience, Pergonal for fertility caused extreme irritability (PMS cubed) and uncomortable bloating. I can’t imagining using it for weightlss. Not worth the misery.

    I also wanted to add that the extremely ow calorie diet itself, is dangerous. Some of the HCG diet proponents try to say that the HCG changes the hormone level enough to make a starvation diet safe, but as I understand things, that is not the case.

  17. RD says:

    Thank you for the great article! I really enjoyed the point about weight mantainance is more of the challenge then losing weight. What people don’t realize going on these fad diets/programs, is that they are just setting themselves up both physically and psycologically for gaining weight back…and often more weight. Whenever calories are overly restricted, our body still needs fuel for the basic body processes. In theory we would like to think the body uses extra fat first for energy, but since it is not a ‘clean’ fuel, our body uses protein along with fat. Where does the body get this protein you ask? Our body can start to use our muscle for energy. The less mucsle we have, the slower our metabolism is. Hence when you go back to even a moderate amount of calories, wt gain occurs.

    Also, it is my understanding that when the body is in ketosis, there is a decrease in appetite, which easily happens on only 500 calories a day.

    I work with post bariatric surgery patients, and at our clinic, we want those individuals to be consuming more then 500 calories!

    It truly is amazing all the diets/programs out there for weight loss. People claim to want to lose weight for their health, yet programs, like the HCG program, don’t seem healthy!?!? Women are requesting tube feedings for quick wt loss. Yoga specialists have some interesting ‘cleanses’ and techniques. For example (I can’t remember the name of it) but it is basically drink close to a gallon of salt water as fast as possible and then vomiting it up, working best after a ‘naughty’ meal. Sounds like something else I have seen…….

    What is next….’Medically managed tape worms!’

  18. elburto says:

    @pd – the placebo effect is a marvellous thing.

    @jimmylegs – having had a bad reaction to metformin that caused dramatic, accelerated weight-loss, I can confirm (at least anecdotally) that the warnings about safe weight-loss should be heeded.

    It took eight weeks before I could stand up quickly without fainting, and my endocrinologistwas very worried about my ECG results for the following twelve months.

    I cringe when I see the likes of “Lose 5lbs in just a week with our Beach Body diet!” on magazine covers.

  19. qetzal says:

    @passionlessDrone

    Do you really think it’s fair to conclude that oral HCG ‘worked’ for you? Consider that HCG is a) a moderate sized protein that would very likely be completely inactivated during digestion, and b) Scott Guavara has cited lots of research indicated it doesn’t work, even after injection.

    I will readily take you at your word that you didn’t feel hungry while your were taking that “HCG” product. But in light of the above, what’s the most likely explanation for that? Possibilities include:

    1) Your lack of hunger was some sort of placebo response.

    2) That “HCG” product may have been adulterated with something else that affected you. (Apparently not that uncommon a problem in some of these types of products.)

    3) The product really contained HCG, which really survived your digestive tract, was adsorbed intact, and really did suppress your hunger, despite mutiple research studies finding that it’s ineffective.

    I suggest (1) or (2) are vastly more likely than (3).

  20. Anecdotes are powerful. Someone in my circle of friends tired this diet and lost an astonishing amount of weight very quickly with no apparent problems afterward. For people who have lost weight in the glacially slow traditional way, this method is compelling. Even scientists in the group who knew better were mightily tempted.

  21. Guy Chapman says:

    The miracle diet industry is, unfortunately, an ethical vacuum. I wonder if the doctors prescribing HCG for use in this quack diet feel any unease in using a product derived from material donated by patients, for a purpose other than that for which they gave consent?

    You noted that Beth Golden, ND (as in: Not a Doctor) is working on some policy-based evidence. I have talked about this here: http://chapmancentral.co.uk/blahg/2012/01/the-hcg-diet-council/ – as far as I can tell the only actual doctor in that crowd has long since crossed the Woobicon, he sells hyperbaric oxygen, chelation and various kinds of energy quackery.

    There is still a considerable amount of HCG on sale on eBay, including homeopathic HCG and the lunatic “vibratonal” version as well. I report a batch from time to time – a lot of sellers did get closed down at one point.

    Last time I blogged about this I was accused of selling my own miracle diet for profit by someone calling themselves “HCG Doctors Group – 800VLCD”. That gave me a good laugh as the only diet I advocate is ELEM – Eat Less, Exercise More – and the only miracle diet accessory I advocate is the humble bicycle, from sales of which which I make precisely no money at all. The email address belongs to one Sonia Russell, who is of course an HCG diet scammer.

    In addition tot he ASBP position statement I commonly refer people to the May Clinic’s succinct commentary here: http://www.mayoclinic.com/health/hcg-diet/an02091

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