Weight Loss: 500 calorie HCG Diet vs. 800 Calorie HCG Diet:
Multiple studies of 400 to 800 calorie very low calorie diets confirm that here are no differences in weight loss when calories are reduced much below 800 calories. Here is a summary from the NIH: “VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from −7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance.” Dietary plateaus, while they occur are less frequent in the HCG diet.
800 Calorie HCG Diet Compared to Dr Simeons Original Diet
As a scientist and endocrinologist, Dr. Simeons was brilliant and well ahead of his time. The HCG program he developed early in the 1950’s produced successful weight loss for overweight people over the past 50 years. As scientists have been confronted with the ever increasing problem of obesity in modern life–not only in the US, but all over the world–more and more studiess about metabolism, fat accumulation and treatment of obesity have been published. At the same time, food companies spurred by the low carb craze of the early 2000s, and the increasing number of obese individuals and diabetics, have developed better and better low calorie, zero sugar and zero fat products unknown to Dr. Simeons.
Dr. Simeons died suddenly in 1970 and had no chance to update his 1954 protocol. Dr. Simeons wrote:
“The diet used in conjunction with HCG must not exceed 500 calories per day, and the way these calories are made up is of utmost importance… This includes only 200 grams of protein divided between lunch and dinner. For instance, having a bread stick and an apple for breakfast in addition to a single bread stick, tea or coffee with only one tablespoon of milk.”
Dr. Simeons based his 500 calorie HCG diet on putting the body into “starvation” mode which forces it to burn stored fat for fuel. Indeed this happens when carbs and fat are reduced to these levels. However, since 1954 when Dr. Simeons wrote Pounds and Inches, there have been hundreds of weight loss studies with what are called Very Low Calorie Diets (VLCD’s). They reveal no difference in weight loss between eating 500 or 800 calories a day. In fact, more weight loss and protein sparing have been found at the 800 calorie level. In addition, adding 200-300 calories per day, especially in the form of lean protein for breakfast and a little more protein at the evening meal makes a lot of sense.
My patients have tried varying levels of calorie intake, from 500 to 800 calories with little difference in weight loss. In addition, adding 200-300 calories per day, especially in the form of lean protein for breakfast and a little more protein at the evening meal, seems to control hunger much better than the original 500 calorie plan of Dr. Simeons. Here is a comparison of the two calorie regimens:
1. Lean Protein and Fruit for Breakfast – Simeons Protocol Eliminated Breakfast
In Pounds and Inches, Dr. Simeons writes breakfast should consist of “tea or coffee in any quantity, only one tablespoon of sugar… a bread stick or apple.” This appeals to many overweight people who make a habit of skipping breakfast completely. Many researchers believe skipping breakfast may be one of the fundamental reasons for the increase in obesity since Dr. Simeons’s time.
What is the relation of breakfast to weight loss? Well, breakfast is a simple term which says all about itself in one word. You are “breaking” the “fast”, which you did by not eating for the past 8-12 hours. When you eat breakfast you are reversing the fasting state while providing energy for the metabolism to function normally. You are also giving yourself a little help in preventing severe hunger at lunch, and are helping to give the body a good head start. Thousands of studies since Dr Simeons’s time have revealed that having lean protein in the form of eggs, protein supplemented shakes, bars or even low sugar yogurt increases weight loss and makes adherence to any weight loss attempt easier. Low fat egg beaters is one of my favorite additions to breakfast. It contains all the protein without the fat found in whole eggs. An omelet made from egg beaters and vegetables makes a great nutritious breakfast.
In a study from the American Journal of Epidemiology, volunteers who obtained 22 to 55 percent of their total calories at breakfast gained only 1.7 pounds while those that ate no breakfast or ate no more than 10% of their calories at breakfast gained more than 3 lb. over the same time period. In another study published in the same journal, volunteers who reported regularly skipping breakfast had 4.5 times the risk of obesity than those who had something to eat for breakfast.
Dr. Simeons mentioned the use of eggs in his protocol, but was concerned because of the high fat found in the yolk. No-fat Egg Beaters, a product developed after Dr. Simeons died, makes a great addition to your breakfast choices. It provides high protein and low calories. Portions are easy to control; few people will eat more than ½ of a cup of Egg Beaters. If they did, the calories are so low, it really would not matter.
Egg whites are another breakfast choice. They are so low in calories, the amount is really unimportant. If you are truly on-the-go, grab an apple, a small piece of no fat cheese, or a protein bar or shake. Something is better than nothing at breakfast.
2. More Lean Protein for Lunch and Dinner – Simeons Protocol Has Equal Portions
I advocate more protein for lunch and dinner. Dr Simeons believed that one should eat only “100 grams of lean protein, weighed raw, boiled or grilled with a handful of vegetables and an orange or a few strawberries… dinner is the same four choices as lunch” as he wrote in Pounds and Inches. Unfortunately, since Dr. Simeons time, much as changed in family life. More women are working and in some families, the father has two jobs. Having time to weigh and prepare “100 grams” of protein becomes difficult, especially at lunch. Although most individuals can be satisfied with this small a lunch, many expect and need more food for the evening meal. Trying to make them equal does not often work.
In the New 800 calorie hcg diet, increased portions of protein are found in the evening meal, accompanied by unlimited (with a few exceptions) salads and vegetables. Vegetable substitutes for rice, pasta and potatoes are added either to lunch or dinner in the form of cauliflower rice or zucchini noodles. I also suggest using zero sugar, near zero fat protein shakes as replacement meals or even snacks. Most shakes have only 1 or 2 grams of fat, many have zero sugar and most have at least 15 to 25 grams of protein. Using these as meal replacements for breakfast or lunch, or small amounts for snacks, has been very useful for my patients. They provide energy and prevent hunger. Dr. Simeons stated that one can not have the same protein for lunch and dinner. This makes no sense to me. I have ignored it and told my patients to ignore such silly ideas as well.
This is a low carb, high protein and fiber wrap very suitable for lunch in the new plan. It is no different in calories (about 50), carbs, fiber or protein from Dr. Simeons Melba toasts. This is good example of using products from today to augment the 1954 HCG Diet.
3. Three or More Servings of Fruit per Day and Unlimited Vegetables – Simeons: 2 Servings of Fruit, Limited Vegetables
Dr Simeons’s protocol allows for “an apple, an orange, a handful of strawberries or ½ of a grapefruit.” The recent low carb craze and the development of the glycemic index reveals many more fruits and vegetables to be appropriate, including blueberries, raspberries, pears, cherries, peaches and unlimited quantities of salads and many vegetables except for corn, peas and carrots. Most green vegetables average 30 to 45 calories a cup. Vegetables are healthy, contain no carbs or fat, and add bulk to the diet. Increasing the portion of vegetables, especially large salads, makes the meal look larger and lengthens the eating time. Since it takes 15 to 20 minutes to feel “full”, the longer a meal takes to eat, the more full one feels. The result is fullness and satisfaction rather than hunger or deprivation.
4.Unlimited Zero Calorie, Zero Fat Drinks – Zero Calorie Drinks did not Exist in 1954!
In Pounds and Inches, Dr Simeons writes, “tea, coffee, plain water or mineral water are the only drinks allowed.” He adds, “…saccharin or other sweeteners may be used… In many countries especially prepared unsweetened and low calorie foods are freely available and some of these can be tentatively used.” Does this mean that artificially sweetened drinks and foods are disallowed or does it reflect the fact that few artificial sweeteners were available in 1950-60’s Italy where Dr Simeons did his research. The intense debate about the usefulness of artificial sweeteners will be reviewed in further posts. Suffice it to say, for most overweight people and especially diabetics this author has found them useful, safe and effective. Since Dr. Simeons approved of Saccharine and Stevia, might he have approved of Aspartame (Nutra-Sweet®, Equal®) and Sucralose (Splenda®)? I strongly believe that any zero calorie, zero sugar and zero fat drink is acceptable on the HCG protocol and I encourage their use.
5. Eliminate Bingeing and Overeating in the First Few Days – Simeons Included Bingeing
Dr Simeons writes in Pounds and Inches, “…patients must eat to capacity for about one week before starting treatment, regardless of how much weight they may gain in the process… Normal fat reserves need to be well stocked… gorging for at least two days must be insisted upon categorically… The subsequent loss is from the abnormal fat deposits only.”
Telling an individual struggling with their weight and compulsive eating to go out and eat as much fatty food as they are able may seem at first to be very appealing, but what is the proof that it leads to more weight loss? Over the past year I have my patients decide whether to “binge” or start the HCG phase 2 protocol (500-700 calories) on day one. Talking weekly with more than 1000 patients during their HCG diets, I am unable to tell which binged and which did not. Numerous VLCD diet plans have been used in the past twenty years. Not one as advocated such bingeing as a technique to increase weight loss. All the work of fat cells in overweight individuals indicate there are already “filled” and “well stocked” from years of overeating. Adding more fat, if that were even possible, seems to be unnecessary.
6. Six Week Treatment Plans and Lack of Immunity to HCG – Simeons Believed in Immunity
Dr. Simeons writes, “The reason for limiting a course to 40 injections is that by then some patients may begin to show signs of HCG immunity… we can not define its mechanism.” He goes on to say, “Patients who need 23 injections may be injected daily including Sundays.”
Are all of these complicated treatment plans and artificial limitations really necessary? Do people taking HCG administered intra-muscularly (as Dr. Simeons insisted it be done) really get immune to the hormone, or is HCG no different than insulin, growth hormone and numerous other naturally occurring hormones where no significant immunity is seen even after years of treatment?
Was the immunity Dr. Simeons thought he saw due to the fact that he used injections of HCG rather than the orally administered hormone?. It;s well known that taking a medication orally is much less likely to produce antibodies than taking it by injection. Was the HCG immunity Dr. Simeons saw due to the relative impurity in his HCG preparations as compared to current day HCG? The answers to all of these questions will never really be known.
Here are better explanations to the slowdown in weight loss Dr. Simeons observed, and erroneously interpreted as immunity to HCG, which led to his arbitrarily limiting his patients’ HCG dosages:
- Normal response to weight loss is to slow metabolism to prevent further weight loss. Slow downs are seen in every diet.
- Weight loss is proportional to what a person weighs. So after a lot of weight loss one would expect a slow down in the rate of weight loss in each individual.
- Dr. Simeons’s HCG food plan was limited and boring. People naturally start cheating which causes the apparent slowdown.
All of these explanations may play a role in the apparent slow down in weight loss of the HCG diet in the past. If a person is doing well on the diet, then there are no reasons to stop– especially if they are taking daily vitamin and mineral supplements and their required medications.
6. Daily Vitamin & Mineral Supplementation is Required. Medications Should Not Be Discontinued
Thyroid hormone medication: In Pounds and Inches, Dr. Simeons states very emphatically, “We never allow thyroid [replacement] to be taken during treatment… a BMR [old fashioned measure of thyroid function] which is low before treatment is usually found normal after a week or two of treatment.” Dr. Simeons is inferring that taking HCG will cause a low thyroid to become normal after a week of treatment! The evidence for this is not presented. Patients that are on thyroid replacement therapy should not stop taking their medications, contrary to what Dr. Simeons suggests.
Other medications: Dr. Simeons writes, “No medications or cosmetics… may be used without special permission.” I hope the beginning dieter will never follow this advice about stopping all medications. Its simply baseless, often dangerous and certainly not necessary. Ask your own physician if you are in doubt and see the cosmetic issue below.
7. Vitamin and Mineral Supplements – Simeons Did Not Believe in Supplements
Dr. Simeons in Pounds and Inches, writes, “Every time they lose a pound of fatty tissue… only the actual Fat is burned up, all of the vitamins, the proteins in the blood and the minerals contained in this tissue in abundance are fed back into the body… we have never encountered signs of lack of vitamins [in patients] who are dieting regularly.”
It is true that fat cells contain many nutrients, however most of the nutrients the body needs are not stored primarily in fat cells. Among the fat soluble vitamins A, D, E, and K, only vitamin K is stored in fat cells. Vitamin A and D are stored in the liver. Water soluble vitamins B and C are hardly stored at all, they circulate and are excreted in the urine. Vitamin B is stored in the liver. The major storage of calcium and magnesium is in bones rather than fat cells. Current day treatment with VLCD diets add vitamins and minerals as routine without question. It’s simple, inexpensive and safe to to add a multivitamin, sublingual Vitamin B12, and oral potassium.
8. Cosmetics Do Not Stop Weight Loss – Simeons Believed You Should Stop All Cosmetics
In Pounds and Inches, Dr. Simeons spends a great deal of time condemning cosmetics as interfering with weight loss. He writes, “When no dietary error is elicited we turn to cosmetics. Most women find it hard to believe that fats, oils, creams and ointments applied to the skin are absorbed and interfere with weight reduction with HCG just as if they are eaten… we find that beauty parlor operators, masseurs, and butchers never show satisfactory weight loss unless they can avoid fat coming into contact with their skin.” Dr. Simeons gives examples of a women transferring cosmetics and a man with a glass eye ball coming into contact with fatty products through skin. He ends, “We are practically averse to those modern cosmetics [Dr Simeons is writing his protocol in Rome in the 1960’s] which contain hormones, as any interference with endocrine regulations during treatment must be absolutely avoided.”
Endocrine active substances or hormonally active substances are chemicals that may alter the function of the endocrine system. Although in studies of laboratory animals a variety of chemicals have been found at very high doses and in some populations of fish and wildlife to disrupt the endocrine system, the FDA has found no evidence that ingredients used in current day cosmetic and personal care products cause endocrine disruption or alter metabolism in humans. See http://www.fda.gov/Cosmetics/default.htm
Cosmetics in the United States have been regulated for the past twenty years by the FD&C (Federal Food, Drug and Cosmetic Act) Act and the Fair Packaging and Labeling Act. The FD&C Act defines cosmetics by their intended use, as “articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body… for cleansing, beautifying, promoting attractiveness, or altering the appearance” [FD&C Act, sec. 201(i)]. Among the products included in this definition are skin moisturizers, perfumes, lipsticks, fingernail polishes, eye and facial makeup preparations, shampoos, permanent waves, hair colors, toothpastes, and deodorants, as well as any material intended for use as a component of a cosmetic product.
These and other government rules have led to the elimination of a number of metals, including lead, arsenic, mercury, aluminum, zinc, chromium and iron as well as hormones like estrogen that were once found in cosmetics ranging from lipstick to whitening toothpaste, eyeliner, nail color and more. The FDA has published a notice that describes the safe levels of certain hormone-active ingredients that can be used in products. See: http://www.fda.gov/Drugs/default.htm. Other sources:
- US EPA research activities: http://www.epa.gov/endocrine/
- US EPA screening and prioritization activities: https://www.epa.gov/endocrine-disruption/endocrine-disruptor-screening-program-edsp-overview
- The FDA’s Statement about parabens and estrogen activity: http://www.cfsan.fda.gov/
- The FDA’s Statement about Phthalates and health affects: http://www.cfsan.fda.gov/
9. HCG Can Be Taken Effectively Orally As Well As by Injection – Simeons Only Tested Injectable HCG
In Pounds and Inches, Dr. Simeons explains that his HCG can be given only by injection. He writes, “Once HCG is in solution it is far less stable. It can be kept only a few days at room temperature and longer refrigerated. Two inch long needles are used and injected deep intra-glutally. The Injection should if possible not be given in the superficial fat layers.”
There are few current proponents of the Simeons Protocol that call for the HCG to prepared every few days and fewer that require an injection deep into the buttocks. This type of injection should only be done by a medical professional and cannot be very easily accomplished by the patient themselves. Dr. Simeons treated patients as both in- and outpatients in his Rome hospital. The only HCG he used was that extracted from pregnant women’s urine. In that setting it was convenient to administer HCG as he indicated.
Today, few overweight patients want to see a medical professional daily. Also, today, highly purified synthetically produced HCG is used. It’s not necessary or practical to prepare HCG daily. Actually, there is no such thing as “oral” HCG. HCG can not be swallowed so as to come into contact with stomach acids. Like insulin, stomach acids brake down the HCG molecule to render it ineffective. Oral HCG really means taking it sublingually (under the tongue). In the area right under everyone’s tongue is a complex set of tiny capillaries which permit rapid absorption of drugs when placed there by an oral syringe. HCG taken sublingually is equally effective as if taken intra-muscularly. The dose and frequency is increased to lessen any amount of HCG that is inadvertently swallowed. The invention of oral HCG is good news for those who want to avoid injections.
Richard Lipman MD is a endocrinologist and board certified internist who has treated more than 10,000 overweight patients in his Miami office with his new 800 calorie HCG diet for the past 10 years in Miami, Fl