Now that the participants have moved on to Stage Four, the overall design of the experiment can be revealed.
Stage One was designed to mimic how the Simeons Protocol is used in the real world. Which is to say, mostly ‘rogue,’ as his followers say. On the HCG forums I’ve visited, it’s clear that people do not often strictly follow Simeons’ protocol as written in Pounds and Inches in any way. For example, take Simeons’ own words about changing the HCG dose:
1: “If the daily dose of HCG is raised to 200 or more units daily its action often appears to be reversed, possibly because larger doses evoke diencephalic counter-regulations.”
2: “Of such a solution 0.25 cc. contain the 125 I.U. which is the standard dose for all cases and which should never be exceeded.”
Despite this clear warning, so-called ‘Simeons Experts’ on these forums still insist that “Hunger is dose dependent. If you’re hungry, you need to adjust the dose.” And an “adjustment” could mean taking less — or it could mean taking more. Given what we now know about HCG’s adipogenic nature (and what we still do not know about the long-term effects of a pregnancy hormone on the bodies of non-pregnant women and men), this is not only sad, it’s dangerous. It’s nothing less than non-doctors advising people they do not know and whose lab results they never see, to inject a possible overdose of a prescription drug. Yet they continue to blithely and incorrectly ‘counsel’ forum members as if everyone who takes HCG has the same metabolic problems or needs.
And that’s just the people who inject HCG, a smaller proportion of those who use homeopathic drops. The good news for them is that the amount of the drug is so small, new fat cell creation is also likely to be small. Otherwise, the drops do the same thing as the injections in terms of ‘fat liberation and loss of hunger’: nada.
When it comes to food consumption, it appears that few Simeons followers eat precisely as he described either. Since Simeons does not tell participants to measure or quantify the vegetables they eat, the protocol cannot be classified as a”500 calories” diet, but is actually 500+ calories. Even so, many people eat forbidden fat, different foods, more or less protein and certainly many more calories per day. Yet they too, some of them, lose weight without hunger. Many more struggle dreadfully with hunger and experience very slow or no weight loss, and quite a bit of lean muscle mass loss as well.
Simeons could have dunked his clients into a pool before starting his regime and after, to measure true fat vs. lean mass loss, but he chose not to and I’m not surprised. Given the insulin resistance of his clients and his insistence that they eat two fruits a day, there was likely quite an increase in unseen visceral fat, the most dangerous kind. You can be quite skinny, let alone thin, and have a lot of visceral fat surrounding your heart and other internal organs. He didn’t know about, nor measure for NAFLD (non-alcoholic liver disease) but given the high level of fructose consumed in relation to the low calories, my guess is that there would have been quite a bit of that, too.
The participants in our experiment have different levels and flavors of insulin resistance. Given the First Law of Losing (To the extent you are insulin resistant is the extent to which any given diet plan will work or not work for you, regardless of its rules), I expected that some participants would struggle with weight loss and hunger more than others. I predicted that HCG would do nothing whatsoever to change this, and I was correct on both counts. Those participants who were least insulin resistant would lose the most and have the least hunger. Those who were most insulin resistant would lose the least weight and have the most hunger. That turned out to be correct as well.
Hunger is defined not just by the deep desire to eat (which comes from Ghrelin: a hormone produced mainly by the cells that line the human stomach and by the pancreatic epsilon cells that stimulates hunger), but also by unwanted thoughts of food, and cravings.
Given the excessively low caloric consumption of every Simeons’ follower (always far less than the very low calories considered to be “starvation level” by the scientific community), it is not surprising that even the most insulin resistant among them do not usually suffer ravaging hunger 24/7 (the ones who do tend to drop out). This is because although lipolysis (fat burning) may be slowed or prevented by the high or even continual presence of insulin, ketosis is almost always present to some degree in the face of severe caloric restriction.
Ketosis is nature’s answer to starvation, because the brain must have some glucose to operate. If you’re not consuming glucose, the body must get it from somewhere. It will convert protein into glucose via gluconeogenesis, but if you’re eating insufficient protein for that glucose comes mainly from one place, and that is from the body’s protein reservoir: muscle.
A brief description of ketosis is: Ketones are incompletely burned carbon fragments, called Ketoacids. Ketoacids are short: four carbons long, and thus can penetrate cells to feed them when there is no glucose present. Adipose fat cells accumulate fat as long fatty acids, usually difficult to break down because they’re so long. When the body must use its fat stores for energy fat cells begin to release the long fatty acids into the blood. To be used as fuel, particularly by the brain, the fatty acids go to the liver where they are literally cut into two carbon fragments (ketoacids) and converted to ATP. The ATP is utilized (burned) by many tissues, including the brain. The leftover incompletely burned fragments are called ketones, and they are what spill into the urine to be swept from the body.
The more ketone-adapted your body becomes, however, the fewer incompletely burned fragments you will have leftover to be eliminated in urine. Nor will you usually have “ketosis breath” since those fragments are in the form of acetone, which can manifest in your breath.
But most importantly of all, because ketosis is nature’s own appetite suppressant in starvation: the deeper in ketosis you are, the less hungry you are.
How does the nutrient composition of Simeons’ protocol affect ketosis? Because there is quite a bit of glucose in via the fruit. With sufficient glucose to feed the brain, ketosis even in starvation may not be needed.
How does being insulin resistant affect ketosis? To the extent that in IR, even limited amounts of ingested protein can and will be converted to glucose, ketosis even in starvation may only be lightly needed or not at all. And if this is the case — you will be hungry, because lipolysis does not occur (and remember, lipolysis opens the fat cells, allowing the fat to be burned for fuel and making your body believe you’ve consumed many more calories than you have) — and because ketosis will not heavily occur either.
Why haven’t all our participants had dark purple on their ketostix? To the extent they are insulin resistant and eat protein and fruit, ketosis even in starvation may only be lightly needed or not at all. Hence the ‘negative’ and ‘trace’ numbers from our most insulin resistant participants.
One question to be answered later: is long-term ketosis in terms of weight-loss a good thing, or a bad thing?
In sum: Stage One not only showed how participants actually “did” Simeons’ Protocol, but that it worked well or not according to their individual insulin resistances. Check.
Stage Two was designed to show that despite Simeons’ (untested and unproven) theory that in all cases where an HCG dose equals 125 I.U. the drug will “transition abnormal fat, and while in transition HCG will open the fat cells to liberate the fat, which will be burned as fuel as if the patient ate many more calories. Hence, even while eating a very low-calorie diet, there will be no hunger” — is false.
True fat liberation is dependent not on HCG, but on lipolysis, which can only take place in the absence of insulin. Increase insulin and to the extent you are insulin resistant you will decrease lipolysis, and hunger will follow. Weight loss may or may not ensue, given starvation level calories, depending upon your level of IR. The more insulin resistant you are, the more likely it is that you are “losing” muscle mass rather than fat. And what increases insulin production even faster than fruit, especially in the insulin resistant? Sugar.
So in Stage Two, participants were told to continue their HCG, to continue to eat 500 calories (which, in the case of those who ate a bit more, was still starvation level), yet to eat 250 of those calories in the form of low-fat or fat-free sugar. They could eat candy, cookies, ice-cream, doughnuts, pastries and regular sodas. If Simeons’ theory was incorrect and mine was correct, to the extent participants were insulin resistant would be the extent to which their blood glucose would rise (the glucose meters proved this), their weight loss would cease (or even increase), the color on the ketostix would lessen or disappear (deep ketosis happens only when there is insufficient glucose in the blood), and they would be hungry. Which is precisely what happened. HCG was powerless to prevent any of this, since HCG does nothing whatsoever to fat (and thus, hunger) unless you suffer from Froelich’s Syndrome.
Had Stage Two gone on for several weeks, all participants would have gained weight and suffered from terrible hunger (with no ketosis to abate it), but this experiment was only designed to prove various points, not make participants suffer. And the point that Simeons’ only works for many people not because of HCG, but because of the composition (very low carbohydrate) of the diet — change the composition and you change the results — was made. And it answered Simeons’ bewildered “I don’t know the answer” question as to why such a huge proportion of patients (30-40% — nearly half!) failed completely on this diet. Those patients must have been the most insulin resistant, and many of them may well have had PCOS and/or hyperinsulinimea, made worse by the the diet’s composition.
Any reader doubting this can easily try Stage Two for themselves after first getting a fasting glucose and fasting insulin test done, and obtaining a blood glucose meter.
This stage also explains why some HCG users state that they’ve tried, without success, to follow Atkins. Given all the fat they ate they didn’t really suffer from hunger, but many did not lose weight. Or lost very slowly for a while and then stopped. Atkins is relatively high in protein, which, in the case of the insulin resistant, turns to glucose just as surely as if they’d eaten sugar. Furthermore, this stage also explains why HCG users state that they’d tried other VLCD before without HCG and were so hungry they couldn’t stay with it. Most VLCD’s become very low-calorie by eliminating fat, yes … but also by allowing a lot of sugar in the form of shakes, bars, fat-free but sugar-filled foods, etc.
Simeons eliminates those foods, so to the extent that you are not insulin resistant, lipolysis and ketosis will take place, causing fat loss and thus lack of hunger.
However, to the extent that you are insulin resistant, of course you will be hungry if you eat sugar. High (and especially spiked) insulin levels mean that blood glucose, though also high at first (during the two Post-Prandial hours after a meal), will drop dramatically as the insulin wipes all the sugar from the blood stream and blood sugar drops. When that happens the brain immediately sends signals for the hormone ghrelin to be created, which sends you hunger signals, which satisfies the brain that more fuel intake is on the way.
Stage Three was simply designed to get even our most insulin resistant participants stabilized in terms of blood glucose readings and hunger.
Parts I, II, III and IV in this series clearly demonstrated, using Simeons’ own words, logic and science, that HCG is neither “necessary nor sufficient” to explain why many Simeons’ patients and current followers lost a lot of weight/fat without hunger. And the series has shown that the biological process of lipolysis — the one and only true “fat liberator” — is necessary to meet both Simeons’ conditions: loss of weight/fat without hunger. But is lipolysis also sufficient to meet both conditions? Is lipolysis the only thing that is required to open adipose fat cells, release the fat, burn it for fuel, and allow rapid weight loss to occur on a VLCD without hunger?
Stage Four was designed to show us whether or not this is true.
Here’s something about insulin resistance that hasn’t been mentioned so far: the consumption of saturated fat, especially when eaten with whatever carbohydrates are consumed, helps reduce insulin spikes (the most dangerous kind of high insulin, because if over 140 it begins to damage organs), helps to make insulin more efficient in dealing with ingested carbohydrates, helps to lower blood glucose, and helps to alleviate hunger. That’s a pretty powerful tool in an IR and overweight person’s arsenal.
How does fat work to accomplish so much? Let’s say you’re in a cold cabin in the woods that has a fireplace. You fill it with an enormous mass of crumpled newspapers and sure enough when you light the match the entire mass is set ablaze. The problem is it’s all light and no heat, and it’s gone in minutes. Trying to light a thick log on fire is a lot harder, but once you get it going it will burn for hours, giving off a little light but a lot of heat.
Carbohydrates are the newspapers: depending on their composition, the body converts them to glucose fast or faster and consumes them just as quickly. It really is like giving candy to a baby. Fats are harder to convert to fuel. It takes longer and it consumes many more calories to get it to the point where it can be burned.
But that fat does more; when you eat sufficient amounts of it with your carbohydrates, it actually slows down the rate of carb conversion to glucose. Which slows down the rate of insulin production. Which prevents spikes and stabilizes your blood sugar system, so that each meal takes a lot longer to be digested — which keeps you from receiving ghrelin signals — which keeps you from being hungry between meals. Which has the added benefit of allowing you to go longer between meals, which keeps insulin low, which promotes longer lipolysis, which burns more adipose fat. Nice.
And yet, in our insane fat-phobic society (around when Simeons’ was practicing), fat is the first thing that’s removed from diets. That’s nice too, if you define nice as crazy as a loon, and I’m sure I’ve just insulted loons.
Dr. Jan Kwasniewski from Poland, originator of the Optimal Diet, knew this. Atkins, who was very familiar with Kwasniewski’s work, also knew this and fed his cardiac patients a very high fat diet, though that part of it got unfortunately tempered in Atkins’ first book.
But Kwasniewski, whose goal was to create the healthiest diet a human can eat, also realized something Atkins did not (or discarded since at the time it was clinically unproven): excess protein is, like carbohydrates, also converted to glucose. If you are insulin resistant, this is a problem, and if you are fat, you are insulin resistant.
Thus, even though his excess protein theory (like his “not all carbs are the same; starch is better than sugar” theory) would not be proven correct for many decades after he created it, he came up with a formula to determine how much/how little animal protein a person truly needs to eat, based on mass. And in deciding how many carbohydrates should properly fit into this formula, he took into consideration not only mass, but over-fat/insulin resistance. And something more: ketosis.
Dr. K knew that someone eating fat to “satiety” would never be hungry, especially since all the patients in his clinics are fed 2000 calories a day, regardless of IR or diabetes. So ketosis certainly wouldn’t be necessary for abating hunger. No starvation there. However, his deep studies on obesity showed him that, like excess protein, deep ketosis put an enormous strain on the liver. And, as Robert Atkins discovered, when you eliminate carbs (glucose) and force the body via the liver (which manipulates all the metabolic functions, including thyroid hormones) to create it via gluconeogenesis — and you do this for an extended period — hypothyroidism in the form of thyroid hormone resistance commences.
Once Atkins began to see this pattern in his patients he sought advice from thyroid specialists but the advice he got was: ramp up carbohydrates. Which advice he took, in the form of his OWL steps, but which of course has often been ignored by his followers, who sometimes stay on Induction for months if not years. After all, if really low carbs are better than lots of carbs (little distinction is made between starch and sugar, or non-grain and grain carbs), then really low carbs must be the perfect way to eat!
What Dr. K stated and practiced: eat just enough carbs to stay out of heavy ketosis — has been echoed by every sane doctor and obesity researcher, from Wolfgang Lutz to John Yudkin to Barry Groves to Gary Taubes. Peter at Hyperlipid has a brief discussion on this too: http://high-fat-nutrition.blogspot.com/2009/11/brief-discussion-of-ketosis.html
So, the ideal weight loss formula for the insulin resistant would be: lots of saturated fat and limited protein, with just enough carbohydrates to stay out of trouble.
But what about calories? The Optimal Diet is very high in calories, and while it will get you and keep you in tip-top health (for more reasons than can be gone into here), and is absolutely perfect for keeping whatever weight you have lost off for the rest of your life, many people have had trouble losing a lot of weight on it. Sure, those who come from failed Atkins attempts lose a lot at first just by cutting down the protein and adding much more fat than they’re used to eating (because protein is also satiating, so folks on Atkins tend to eat much more protein than on OD, and less fat). But loss tends to slow down dramatically or even stop. I lost a lot of weight on the OD, but never, ever more than by half a pound a week after the first month or so.
The Atkins diet is also high in calories, and has the added problem of excess protein for the insulin resistant since different flavors of IR (especially PCOS) are never taken into account. Which is why men on Atkins tend to lose quickly and steadily, no matter how much weight they need to lose.
As you know by now, I’m a firm believer that CICO is less a valid theory and more a lunatic’s fantasy. And VLCD’s, especially long-term, do nothing but bludgeon the body into submission in the short run while creating major health and metabolic problems in the long run. But by synthesizing Simeons’, Atkins and Kwasniewski theories, could a reduced calorie protocol be devised that, for the short-term — two to three weeks at most — metabolically mimic the way of eating that our ancient ancestors practiced and thus kick our insulin resistant metabolic behinds into gear again?
After all, those ancestors didn’t have three square meals a day delivered by Pizza Hut. They often went a week or longer without prey going by. And when it did they often had to hunt it to exhaustion for many more days, and then drag a mega-ton beast back to camp. There were many, many days when calories were very few. That’s when ketosis-lipolysis kicked in, to use any adipose reserves (put there by evolutions’ having hard-wired a sweet tooth into us for just that purpose) so that the brain could function at high levels without sacrificing the muscles that would be needed for the hunt.
Would such a diet (which would have protein amounts calculated for each participant’s mass) promote lipolysis? Would lipolysis then be shown to be “sufficient” to cause fat liberation, fat burn and therefore rapid weight/fat loss — without hunger, despite the lack of HCG and many calories? Given what we now know about the importance of dietary fat for teeth, bone, and cardiovascular maintenance, and even for the proper absorption of fat-soluble essential vitamins and minerals, such a diet would be far saner and healthier than Simeons’ — and when you add in the benefit of not having to inject an adipogenic hormone, such a diet would help to heal the metabolism, not continue to harm it.
And isn’t that the real point (or at least it should be) of changing how one eats? To become healthier, and not just to “lose weight?” You can lose a lot of weight in one day by cutting off your legs, but no one would think of doing that. Yet HCG followers do the equivalent by pounding their bodies into submission with a fat-free, starvation level diet that from what I can see tends to make their insulin resistance worse, no matter how many pounds they lose initially. The body needs fat. A lot of it. It’s what we evolved to eat.
In the short-term, a few weeks perhaps, the release of stored fat (assuming low levels of IR and no hyperinsulinimea) may provide some levels of required fat for the body, but despite Simeons’ unproven (and incorrect) theory that the nutrients originally stored away in adipose cells will come out un-oxidized and in usable shape, this is simply wishful thinking. More than a few weeks at a time (even if we disregard the long-term harm of HCG) of eating this way is unhealthy and will ultimately make the already broken metabolism worse.
This modified protocol however, as I envisioned it, would have to accomplish several things. It would have to promote lipolysis, and thus rapid weight and/or fat loss. Those two terms are not mutually inclusive, because as we’ve seen in the recent NY Times article on a major Liposuction study:
“Obesity researchers say they are not surprised that the women’s fat came back. The body, they say “defends” its fat. If you lose weight, even by dieting, it comes back. And, the study showed, if you suck out the fat with liposuction, even if it’s only a pound, as it was for subjects in the study, it still comes back.”
In other words, when you have a body that one might call “devoted” to maintaining fat because it is so essential to that body’s survival, and then force that body to give up even truly excess fat — it fights back. And the body/brain has many more tools to do that, than we have tools to fight it. Including never, ever permanently letting go of a single fat cell, not even by liposuction, except temporarily. You may empty the fat from those cells, and become quite slim. But the cell itself remains, just waiting to be filled again some day. Which one of the biggest problems with HCG: it promotes the creation of more fat cells, which will also then never be lost and which will sit there, waiting to be filled some day.
One of the first things the body does when lipolysis has taken place over the course of a few weeks, and you’ve lost a fair bit of fat (rather than lean muscle mass) — is to fill up those fat cells with water. Either by volume or by weight; it’s still a mystery as to why the body chooses which way each time. The reason the body does this is to provide a “place-holder” for the fat it hopes will soon return, once you’re rescued from that desert isle.
Sometimes the water is released in a few days, but sometimes the body holds on to it for a month or more. So you’ve lost fat through lipolysis but you get on the scale and you haven’t lost an ounce. In fact, when you are truly in ketosis-lipolysis, sometimes the only way to tell just how much fat you’ve lost is by tossing the scale and grabbing your trusty tape measure. If you’ve lost inches, especially around the middle — you’ve lost adipose fat.
So the modified protocol would have to promote rapid fat (and then weight) loss. It would have to be low-calorie to mimic the lack of food for a week or two, yet abate hunger via lipolysis. It should also help to lessen insulin resistance (unlike Simeons’ protocol as written) and increase insulin sensitivity as measured on a glucose meter. It would have to provide a protein ratio geared to an individual’s mass such that gluconeogenesis would be severely curtailed if not eliminated, also as measured on a glucose meter, and should provide sufficient calories/energy to make the person eating it able to work, play and sleep well. And it should provide just enough non-sugar carbohydrates to stay above deep ketosis.
But even that is not enough. The modified protocol should do all the above for two to three weeks, but after that, when on maintenance (the same formula with increased fat, carbohydrates and calories) — the weight loss must stabilize and remain off within a pound or two.
More: this modified protocol must be so predictable (if followed precisely as written, without going ‘rogue’) that after four to six weeks of stabilization, one can follow it for another few weeks and have the same level of weight/fat loss as before. And be able to do it (protocol/maintenance) over and over again until a healthy weight is reached.
Therefore, the following formula was created and a calorie count made up for each individual participant:
- No HCG. At all.
- 50 grams of saturated fat per day for everyone = 450 calories
- 25 grams of non-sugar carbohydrates (no counting green leafy veggies, just like Simeons) per day for everyone = 100 calories
- 52 to 64 grams of protein per day for each participant, depending on mass.
- Calories therefore range from 750 to 798 calories per day.
Will blood glucose levels fall and/or stabilize? Will participants lose weight/fat even while eating fat? Will hunger be abated even better than it was for very insulin resistant participants on HCG? Will participants feel better eating this way than eating the original protocol? Will they be measurably healthier on their next lab tests?
And most especially, will Stage Four show that HCG and a 500-calorie-a-day diet is completely unnecessary for successful, hunger-free weight and fat loss even for the most insulin resistant?
Let’s find out.