You are on page 1of 59

Pounds & Inches

A NEW APPROACH TO OBESITY BY: A.T.W. SIMEONS, M.D. SEVENTH EDITION 1971 __________ ALL RIGHTS RESERVED __________

Tab e o! Con"en"s Forward The Nature of Obe !t" Obe !t" a D! order G$a%du$ar Theor!e Three 'a !( )au e of Obe !t" +1, The I%her!ted Fa(tor +*, Other D!e%(e-ha$!( D! order +., The E/hau t!o% of the Fat0ba%1 2 "(ho$o3!(a$ A -e(t )o4-u$ !5e Eat!%3 Re$u(ta%(e to Lo e 6e!3ht Not b" 6e!3ht A$o%e S!3% a%d S"4-to4 of Obe !t" The E4a(!ated Lad" Fat 'ut Not Obe e The Treat4e%t Of Obe !t" A )ur!ou Ob er5at!o% Fat o% the 8o5e 2re3%a%(" a%d Obe !t" The Nature of Hu4a% )hor!o%!( Go%adotro-!% The Rea$ Go%adotro-h!% H)G %o Se/ Hor4o%e I4-orta%(e a%d 2ote%(" of H)G )o4-$!(at!%3 D! order D!abete Rheu4at! 4 )ho$e tero$ Gout '$ood 2re ure 2e-t!( :$(er 2 or!a ! ; F!%3er%a!$ ; Ha!r Var!(o e :$(er The <2re3%a%t= 8a$e Te(h%!>ue 6ar%!%3 H! tor" ta1!%3 The Durat!o% of Treat4e%t I44u%!t" to H)G 8e% trua!o% Further )our e )o%d!t!o% that 4u t be a((e-ted before treat4e%t E/a4!%!%3 the 2at!e%t Ga!% 'efore Lo Start!%3 Treat4e%t The D!et 8a1!%3 u- the )a$or!e 2 4 # # & 1* 1* 1* 1. 1. 14 17 17 1# 17 17 1& 1& 19 19 *9 *1 *1 ** ** ** *. *. *4 *4 *7 *7 *7 *# *# *# *7 *& *& *9 *9 .9 .9 .1 .* .4

Ve3etar!a% Fau$t" D!et!%3 V!ta4!% a%d A%e4!a The F!r t Da" of Treat4e%t F$u(tuat!o% !% 6e!3ht Lo I%terru-t!o% of 6e!3ht Lo The 2$ateau +A--$e Da", Rea(h!%3 a For4er Le5e$ 8e% trua$ I%terru-t!o% D!etar" Error Sa$t a%d Redu(!%3 6ater )o% t!-at!o% I%5e t!3at!%3 D!etar" Error L!ar a%d Foo$ )o 4et!( The Vo!(e Other Rea o% for a Ga!% A--et!te0redu(!%3 Dru3 :%fore ee% I%terru-t!o% of Treat4e%t 8u (u$ar Fat!3ue 8a a3e '$ood Su3ar The Rat!o of 2ou%d to I%(he 2re-ar!%3 the So$ut!o% I%?e(t!%3 F!bro!d Ga$$ to%e The Heart )oro%ar" O(($u !o% Teeth a%d V!ta4!% A$(oho$ Tuber(u$o ! The 2a!%fu$ Hee$ The S1e-t!(a$ 2at!e%t )o%($ud!%3 a )our e S1!--!%3 a 8ea$ +Stea1 Da", Lo !%3 4ore 6e!3ht Troub$e After Treat4e%t 'eware of O5er0e%thu !a 4 2rote!% Def!(!e%(" Re$a- e 2$a% of a Nor4a$ )our e )ON)L:SION GLOSSAR@

.7 .7 .7 .7 .# .7 .7 .7 .& .& .9 .9 .9 .9 49 41 4* 4* 4* 4. 4. 4. 44 47 47 4# 4# 47 47 47 47 4& 4& 4& 49 49 79 79 79 71 71 7* 7* 7* 74

#OREWORD Th! boo1 d! (u e a %ew !%ter-retat!o% of the %ature of obe !t"; a%d wh!$e !t doe %ot ad5o(ate "et a%other fa%(" $!44!%3 d!et !t doe de (r!be a 4ethod of treat4e%t wh!(h ha 3row% out of theoret!(a$ (o% !derat!o% ba ed o% ($!%!(a$ ob er5at!o%A 6hat I ha5e to a" ! a% e e%(e of 5!ew d! t!$$ed out of fort" "ear of 3ra--$!%3 w!th the fu%da4e%ta$ -rob$e4 of obe !t"; !t (au e ; !t "4-to4 ; a%d !t 5er" %atureA I% the e 4a%" "ear of -e(!a$!Bed wor1; thou a%d of (a e ha5e -a ed throu3h 4" ha%d a%d were (arefu$$" tud!edA E5er" %ew theor"; e5er" %ew 4ethod; e5er" -ro4! !%3 $ead wa (o% !dered; e/-er!4e%ta$$" (ree%ed a%d (r!t!(a$$" e5a$uated a oo% a !t be(a4e 1%ow%A 'ut !%5ar!ab$" the re u$t were d! a--o!%t!%3 a%d $a(1!%3 !% u%!for4!t"A I fe$t that we were 4ere$" %!bb$!%3 at the fr!%3e of a 3reat -rob$e4; a ; !%deed; do 4o t er!ou tude%t of o5erwe!3htA 6e ha5e 3row% -rett" ure that the te%de%(" to a((u4u$ate ab%or4a$ fat ! a 5er" def!%!te 4etabo$!( d! order; 4u(h a ! ; for !% ta%(e; d!abete A @et the $o(a$!Bat!o% a%d the %ature of th! d! order re4a!%ed a 4" ter"A E5er" %ew a--roa(h ee4ed to $ead !%to a b$!%d a$$e"; a%d thou3h -at!e%t were to$d that the" are fat be(au e the" eat too 4u(h; we be$!e5ed that th! ! %e!ther the who$e truth %or the $a t word !% the 4atterA Refu !%3 to be !de0tra(1ed b" a% a$$ too fa(!$e !%ter-retat!o% of obe !t"; I ha5e a$wa" he$d that o5ereat!%3 ! the re u$t of the d! order; %ot !t (au e; a%d that we (a% 4a1e $!tt$e headwa" u%t!$ we (a% bu!$d for our e$5e o4e ort of theoret!(a$ tru(ture w!th wh!(h to e/-$a!% the (o%d!t!o%A 6hether u(h a tru(ture re-re e%t the truth ! %ot !4-orta%t at th! 4o4e%tA 6hat !t 4u t do ! to 3!5e u a% !%te$$e(tua$$" at! f"!%3 !%ter-retat!o% of what ! ha--e%!%3 !% the obe e bod"A It 4u t a$ o be ab$e to w!th ta%d the o% $au3ht of a$$ h!therto 1%ow% ($!%!(a$ fa(t a%d fur%! h a hard ba(13rou%d a3a!% t wh!(h the re u$t of treat4e%t (a% be a((urate$" a e edA To 4e th! re>u!re4e%t ee4 ba !(; a%d !t ha a$wa" bee% the (e%ter of 4" !%tere tA I% dea$!%3 w!th obe e -at!e%t !t be(a4e a hab!t to re3! ter a%d order e5er" ($!%!(a$ e/-er!e%(e a !f !t were a% odd $oo1!%3 -!e(e of a ?!30 aw -uBB$eA A%d the%; a !% a ?!30 aw -uBB$e; $!tt$e ($u ter of fra34e%t be3a% to for4; thou3h the" ee4ed to f!t !% %owhereA A the "ear -a ed the e ($u ter 3rew b!33er a%d tarted to a4a$3a4ate u%t!$; about !/tee% "ear a3o; a (o4-$ete -!(ture be(a4e d!4$" d! (er%!b$eA Th! -!(ture wa ; a%d t!$$ ! ; dotted w!th 3afor wh!(h I (a%%ot f!%d the -!e(e ; but I do %ow fee$ that a theoret!(a$ tru(ture ! 5! !b$e a a who$eA 6!th 4ou%t!%3 e/-er!e%(e 4ore a%d 4ore fa(t ee4ed to f!t %u3$" !%to the %ew fra4ewor1; a%d whe% the% a treat4e%t ba ed o% u(h -e(u$at!o% howed (o% ! te%t$" at! fa(tor" re u$t ; I wa ure that o4e -ra(t!(a$ ad5a%(e had bee% 4ade; re3ard$e of whether the theoret!(a$ !%ter-retat!o% of the e re u$t ! (orre(t or %otA The ($!%!(a$ re u$t of the %ew treat4e%t ha5e bee% -ub$! hed !% (!e%t!f!( ?our%a$ C a%d the e re-ort ha5e bee% 3e%era$$" we$$ re(e!5ed b" the -rofe !o%; but the 5er" %ature of a (!e%t!f!( art!($e doe %ot -er4!t the fu$$ -re e%tat!o% of %ew theoret!(a$ (o%(e-t %or ! there roo4 to d! (u the f!%er -o!%t of te(h%!>ue a%d the rea o% for ob er5!%3 the4A

Dur!%3 the 1# "ear that ha5e e$a- ed !%(e I f!r t -ub$! hed 4" f!%d!%3 ; I ha5e had 4a%" hu%dred of !%>u!r!e fro4 re ear(h !% t!tute ; do(tor a%d -at!e%t A H!therto I (ou$d o%$" refer tho e !%tere ted to 4" (!e%t!f!( -a-er ; thou3h I rea$!Bed that the e d!d %ot (o%ta!% uff!(!e%t !%for4at!o% to e%ab$e do(tor to (o%du(t the %ew treat4e%t at! fa(tor!$"A Tho e who tr!ed were ob$!3ed to 3a!% the!r ow% e/-er!e%(e throu3h the 4a%" tr!a$ a%d error wh!(h I ha5e $o%3 !%(e o5er(o4eA Do(tor fro4 a$$ o5er the wor$d ha5e (o4e to Ita$" to tud" the 4ethod; f!r t ha%d !% 4" ($!%!( !% the Sa$5ator 8u%d! I%ter%at!o%a$ Ho -!ta$ !% Ro4eA For o4e of the4 the t!4e the" (ou$d -are ha bee% too hort to 3et a fu$$ 3ra - of the te(h%!>ue; a%d !% a%" (a e the %u4ber of tho e who4 I ha5e bee% ab$e to 4eet -er o%a$$" ! 4a$$ (o4-ared w!th the 4a%" re>ue t for further deta!$ed !%for4at!o% wh!(h 1ee- (o4!%3 !%A I ha5e tr!ed to 1ee- u- w!th the e de4a%d b" (orre -o%de%(e; but the 5o$u4e of th! wor1 ha be(o4e u%4a%a3eab$e a%d that ! o%e e/(u e for wr!t!%3 th! boo1A I% dea$!%3 w!th a d! order !% wh!(h the -at!e%t 4u t ta1e a% a(t!5e -art !% the treat4e%t; !t ! ; I be$!e5e; e e%t!a$ that he or he ha5e a% u%der ta%d!%3 of what ! be!%3 do%e a%d wh"A O%$" the% (a% there be !%te$$!3e%t (oo-erat!o% betwee% -h" !(!a% a%d -at!e%tA I% order to a5o!d wr!t!%3 two boo1 ; o%e for the -h" !(!a% a%d a%other for the -at!e%t 0 a -ro -e(t wh!(h wou$d -robab$" ha5e re u$ted !% %o boo1 at a$$ 0 I ha5e tr!ed to 4eet the re>u!re4e%t of both !% a !%3$e boo1A Th! ! a rather d!ff!(u$t e%ter-r! e !% wh!(h I 4a" %ot ha5e u((eededA The e/-ert w!$$ 3ru4b$e about $o%30w!%ded%e ; wh!$e the $a"0reader 4a" o((a !o%a$$" ha5e to $oo1 u- a% u%fa4!$!ar word !% the 3$o ar" -ro5!ded for h!4A To 4a1e the te/t 4ore readab$e I ha$$ be u%a ha4ed$" author!tat!5e a%d a5o!d a$$ the hed3!%3 a%d te%tat!5e%e w!th wh!(h !t ! (u to4ar" to e/-re %ew (!e%t!f!( (o%(e-t 3row% out of ($!%!(a$ e/-er!e%(e a%d %ot a "et (o%f!r4ed b" ($ear0(ut $aborator" e/-er!4e%t A Thu whe% I 4a1e what read $!1e a fa(tua$ tate4e%t; the -rofe !o%a$ reader 4a" ha5e to tra% $ate !%toD clinical experience seems to suggest that such and such an observation might be tentatively explained by such and such a working hypothesis, requiring a vast amount of further research before the hypothesis can be considered a valid theoryA If we (a% fro4 the out et e tab$! h th! a a 4utua$$" a((e-ted (o%5e%t!o%; I ho-e to a5o!d be!%3 a((u ed of -e(u$at!5e e/ubera%(eA

THE NAT$RE O# OBESITY Obesity a Disorder A a ba ! for our d! (u !o% we -o tu$ate that obe !t" !% a$$ !t 4a%" for4 ! due to a% ab%or4a$ fu%(t!o%!%3 of o4e -art of the bod" a%d that e5er" ou%(e of ab%or4a$$" a((u4u$ated fat ! a$wa" the re u$t of the a4e d! order of (erta!% re3u$ator" 4e(ha%! 4 A 2er o% uffer!%3 fro4 th! -art!(u$ar d! order w!$$ 3et fat re3ard$e of whether the" eat e/(e !5e$"; %or4a$$" or $e tha% %or4a$A A -er o% who ! free of the d! order w!$$ %e5er 3et fat; e5e% !f he fre>ue%t$" o5ereat A Tho e !% who4 the d! order ! e5ere w!$$ a((u4u$ate fat 5er" ra-!d$"; tho e !% who4 !t ! 4oderate w!$$ 3radua$$" !%(rea e !% we!3ht a%d tho e !% who4 !t ! 4!$d 4a" be ab$e to 1eethe!r e/(e we!3ht tat!o%ar" for $o%3 -er!od A I% a$$ the e (a e a $o of we!3ht brou3ht about b" d!et!%3; treat4e%t w!th th"ro!d; a--et!te0redu(!%3 dru3 ; $a/at!5e ; 5!o$e%t e/er(! e; 4a a3e; bath ; et(A; ! o%$" te4-orar" a%d w!$$ be ra-!d$" re3a!%ed a oo% a the redu(!%3 re3!4e% ! re$a/edA The rea o% ! !4-$" that %o%e of the e 4ea ure (orre(t the ba !( d! orderA 6h!$e there are 3reat 5ar!at!o% !% the e5er!t" of obe !t"; we ha$$ (o% !der a$$ the d!ffere%t for4 !% both e/e a%d at a$$ a3e a a$wa" be!%3 due to the a4e d! orderA Var!at!o% !% for4 wou$d the% be -art$" a 4atter of de3ree; -art$" a% !%her!ted bod!$" (o% t!tut!o% a%d -art$" the re u$t of a e(o%dar" !%5o$5e4e%t of e%do(r!%e 3$a%d u(h a the -!tu!tar"; the th"ro!d; the adre%a$ or the e/ 3$a%d A O% the other ha%d; we -o tu$ate that %o def!(!e%(" of a%" of the e 3$a%d (a% e5er d!re(t$" -rodu(e the (o44o% d! order 1%ow% a obe !t"A If th! rea o%!%3 ! (orre(t; !t fo$$ow that a treat4e%t a!4ed at (ur!%3 the d! order 4u t be e>ua$$" effe(t!5e !% both e/e ; at a$$ a3e a%d !% a$$ for4 of obe !t"A :%$e th! ! o; we are e%t!t$ed to harbor 3ra5e doubt a to whether a 3!5e% treat4e%t (orre(t the u%der$"!%3 d! orderA 8oreo5er; a%" ($a!4 that the d! order ha bee% (orre(ted 4u t be ub ta%t!ated b" the ab!$!t" of the -at!e%t to eat %or4a$$" of a%" food he -$ea e w!thout re3a!%!%3 ab%or4a$ fat after treat4e%tA O%$" !f the e (o%d!t!o% are fu$f!$$ed (a% we $e3!t!4ate$" -ea1 of (ur!%3 obe !t" rather tha% of redu(!%3 we!3htA Our -rob$e4 thu -re e%t !t e$f a a% e%>u!r" !%to the $o(a$!Bat!o% a%d the %ature of the d! order wh!(h $ead to obe !t"A The h! tor" of th! e%>u!r" ! a $o%3 er!e of h!3h ho-e a%d b!tter d! a--o!%t4e%t A The History of Obesity There wa a t!4e; %ot o $o%3 a3o; whe% obe !t" wa (o% !dered a !3% of hea$th a%d -ro -er!t" !% 4a% a%d of beaut"; a4orou %e a%d fe(u%d!t" !% wo4e%A Th! att!tude -robab$" date ba(1 to Neo$!th!( t!4e ; about &999 "ear a3oE whe% for the f!r t t!4e !% the h! tor" of (u$ture; 4a% be3a% to ow% -ro-ert"; do4e t!( a%!4a$ ; arab$e $a%d; hou e ; -otter" a%d 4eta$ too$ A 'efore that; w!th the -o !b$e e/(e-t!o% of o4e ra(e u(h a the Hotte%tot ; obe !t" wa a$4o t %o%0e/! te%t; a !t t!$$ ! !% a$$ w!$d a%!4a$ a%d 4o t -r!4!t!5e ra(e A Toda" obe !t" ! e/tre4e$" (o44o% a4o%3 a$$ (!5!$!Bed ra(e ; be(au e a d! -o !t!o% to the 6

d! order (a% be !%her!tedA 6here5er ab%or4a$ fat wa re3arded a a% a et; e/ua$ e$e(t!o% te%ded to -ro-a3ate the tra!tA It ! o%$" !% 5er" re(e%t t!4e that 4a%!fe t obe !t" ha $o t o4e of !t a$$ure; thou3h the (u$t of the out !Be bu t 0 a$wa" a !3% of $ate%t obe !t" 0 how that the tre%d t!$$ $!%3er o%A The Significance of Regular Meals I% the ear$" Neo$!th!( t!4e a%other (ha%3e too1 -$a(e wh!(h 4a" we$$ a((ou%t for the fa(t that toda" %ear$" a$$ !%her!ted d! -o !t!o% oo%er or $ater de5e$o- !%to 4a%!fe t obe !t"A Th! (ha%3e wa the !% t!tut!o% of re3u$ar 4ea$ A I% -re0Neo$!th!( t!4e ; 4a% ate o%$" whe% he wa hu%3r" a%d o%1" a 4u(h a he re>u!red too t!$$ the -a%3 of hu%3erA 8oreo5er; 4u(h of h! food wa raw a%d a$$ of !t wa u%ref!%edA He roa ted h! 4eat; but he d!d %ot bo!$ !t; a he had %o -ot ; a%d what $!tt$e he 4a" ha5e 3rubbed fro4 the Earth a%d -!(1ed fro4 the tree ; he ate a he we%t a$o%3A The who$e tru(ture of 4a%F o4%!5orou d!3e t!5e tra(t ! ; $!1e that of a% a-e; rat or -!3; ad?u ted to the (o%t!%ua$ %!bb$!%3 of t!db!t A It ! %ot u!ted to o((a !o%a$ 3or3!%3 a ! ; for !% ta%(e; the !%te t!%e of the (ar%!5orou (at fa4!$"A Thu the !% t!tut!o% of re3u$ar 4ea$ ; -art!(u$ar$" of food re%dered ra-!d$" a !4!$ab$e; -$a(ed a 3reat burde% o% 4oder% 4a%F ab!$!t" to (o-e w!th $ar3e >ua%t!t!e of food udde%$" -our!%3 !%to h! " te4 fro4 the !%te t!%a$ tra(tA The !% t!tut!o% of re3u$ar 4ea$ 4ea%t that 4a% had to eat 4ore tha% h! bod" re>u!red at the 4o4e%t of eat!%3 o a to t!de h!4 o5er u%t!$ the %e/t 4ea$A Food re%dered ea !$" d!3e t!b$e udde%$" f$ooded h! bod" w!th %our! h4e%t of wh!(h he wa !% %o %eed at the 4o4e%tA So4ehow; o4ewhere th! ur-$u had to be toredA Three Kinds of Fat I% the hu4a% bod" we (a% d! t!%3u! h three 1!%d of fatA The f!r t ! the tru(tura$ fat wh!(h f!$$ the 3a- betwee% 5ar!ou or3a% ; a ort of -a(1!%3 4ater!a$A Stru(tura$ fat a$ o -erfor4 u(h !4-orta%t fu%(t!o% a bedd!%3 the 1!d%e" !% oft e$a t!( t! ue; -rote(t!%3 the (oro%ar" arter!e a%d 1ee-!%3 the 1!% 4ooth a%d tautA It a$ o -ro5!de the -r!%3" (u h!o% of hard fat u%der the bo%e of the feet; w!thout wh!(h we wou$d be u%ab$e to wa$1A The e(o%d t"-e of fat ! a %or4a$ re er5e of fue$ u-o% wh!(h the bod" (a% free$" draw whe% the %utr!t!o%a$ !%(o4e fro4 the !%te t!%a$ tra(t ! !% uff!(!e%t to 4eet the de4a%dA Su(h %or4a$ re er5e are $o(a$!Bed a$$ o5er the bod"A Fat ! a ub ta%(e wh!(h -a(1 the h!3he t (a$or!( 5a$ue !%to the 4a$$e t -a(e o that %or4a$ re er5e of fue$ for 4u (u$ar a(t!5!t" a%d the 4a!%te%a%(e of bod" te4-erature (a% be 4o t e(o%o4!(a$$" tored !% th! for4A 'oth the e t"-e of fat; tru(tura$ a%d re er5e; are %or4a$; a%d e5e% !f the bod" to(1 the4 to (a-a(!t" th! (a% %e5er be (a$$ed obe !t"A 'ut there ! a th!rd t"-e of fat wh!(h ! e%t!re$" ab%or4a$A It ! the a((u4u$at!o% of u(h fat; a%d of u(h fat o%$"; fro4 wh!(h the o5erwe!3ht -at!e%t uffer A Th! ab%or4a$ fat ! a$ o a -ote%t!a$ re er5e of fue$; but u%$!1e the %or4a$ re er5e !t ! %ot a5a!$ab$e to the bod" !% a %utr!t!o%a$ e4er3e%("A It ! ; o to -ea1; $o(1ed awa" !% a f!/ed de-o !t a%d ! %ot 1e-t !% a (urre%t a((ou%t; a are the %or4a$ re er5e A

6he% a% obe e -at!e%t tr!e to redu(e b" tar5!%3 h!4 e$f; he w!$$ f!r t $o e h! %or4a$ fat re er5e A 6he% the e are e/hau ted he be3!% to bur% u- tru(tura$ fat; a%d o%$" a a $a t re ort w!$$ the bod" "!e$d !t ab%or4a$ re er5e ; thou3h b" that t!4e the -at!e%t u ua$$" fee$ o wea1 a%d hu%3r" that the d!et ! aba%do%edA It ! ?u t for th! rea o% that obe e -at!e%t (o4-$a!% that whe% the" d!et the" $o e the wro%3 fatA The" fee$ fa4! hed a%d t!red a%d the!r fa(e be(o4e draw% a%d ha33ard; but the!r be$$"; h!- ; th!3h a%d u--er ar4 how $!tt$e !4-ro5e4e%tA The fat the" ha5e (o4e to dete t ta" o% a%d the fat the" %eed to (o5er the!r bo%e 3et $e a%d $e A The!r 1!% wr!%1$e a%d the" $oo1 o$d a%d 4! erab$eA A%d that ! o%e of the 4o t fru trat!%3 a%d de-re !%3 e/-er!e%(e a hu4a% be!%3 (a% ha5eA Injustice to the Obese 6he% the% obe e -at!e%t are a((u ed of (heat!%3; 3$utto%"; $a(1 of w!$$ -ower; 3reed a%d e/ua$ (o4-$e/e ; the tro%3 be(o4e !%d!3%a%t a%d de(!de that 4oder% 4ed!(!%e ! a fraud a%d !t re-re e%tat!5e foo$ ; wh!$e the wea1 ?u t 3!5e u- the tru33$e !% de -a!rA I% e!ther (a e the re u$t ! the a4eD a further 3a!% !% we!3ht; re !3%at!o% to a% abo4!%ab$e fate a%d the re o$ut!o% at $ea t to $!5e to$erab$" the hort -a% a$$otted to the4 0 a f!3 for do(tor a%d !% ura%(e (o4-a%!e A Obe e -at!e%t o%$" fee$ -h" !(a$$" we$$ a $o%3 a the" are tat!o%ar" or 3a!%!%3 we!3htA The" 4a" fee$ 3u!$t"; ow!%3 to the $ethar3" a%d !%do$e%(e a$wa" a o(!ated w!th obe !t"A The" 4a" fee$ a ha4ed of what the" ha5e bee% $ed to be$!e5e ! a $a(1 of (o%tro$A The" 4a" fee$ horr!f!ed b" the a--eara%(e of the!r %ude bod" a%d the t!3ht%e of the!r ($othe A 'ut the" ha5e a -r!4!t!5e fee$!%3 of a%!4a$ (o%te%t wh!(h tur% to 4! er" a%d uffer!%3 a oo% a the" 4a1e a re o$ute atte4-t to redu(eA For th! there are ou%d rea o% A I% the f!r t -$a(e; 4ore (a$or!( e%er3" ! re>u!red to 1ee- a $ar3e bod" at a (erta!% te4-erature tha% to heat a 4a$$ bod"A Se(o%d$" the 4u (u$ar effort of 4o5!%3 a hea5" bod" ! 3reater tha% !% the (a e of a $!3ht bod"A The 4u (u$ar effort (o% u4e )a$or!e wh!(h 4u t be -ro5!ded b" foodA Thu ; a$$ other fa(tor be!%3 e>ua$; a fat -er o% re>u!re 4ore food tha% a $ea% o%eA O%e 4!3ht therefore rea o% that !f a fat -er o% eat o%$" the add!t!o%a$ food h! bod" re>u!re he hou$d be ab$e to 1ee- h! we!3ht tat!o%ar"A @et e5er" -h" !(!a% who ha tud!ed obe e -at!e%t u%der r!3orou $" (o%tro$$ed (o%d!t!o% 1%ow that th! ! %ot trueA 8a%" obe e -at!e%t a(tua$$" 3a!% we!3ht o% a d!et wh!(h ! (a$or!(a$$" def!(!e%t for the!r ba !( %eed A There 4u t thu be o4e other 4e(ha%! 4 at wor1A Glandular Theories At o%e t!4e !t wa thou3ht that th! 4e(ha%! 4 4!3ht be (o%(er%ed w!th the e/ 3$a%d A Su(h a (o%%e(t!o% wa u33e ted b" the fa(t that 4a%" ?u5e%!$e obe e -at!e%t how a% u%der0 de5e$o-4e%t of the e/ or3a% A The 4!dd$e0a3e -read !% 4e% a%d the te%de%(" of 4a%" wo4e% to -ut o% we!3ht !% the 4e%o-au e ee4ed to !%d!(ate a (au a$ (o%%e(t!o% betwee% d!4!%! h!%3 e/ fu%(t!o% a%d o5erwe!3htA @et; whe% h!3h$" a(t!5e e/ hor4o%e be(a4e a5a!$ab$e; !t wa fou%d that the!r ad4!%! trat!o% had %o effe(t what oe5er o% obe !t"A The e/ 3$a%d (ou$d therefore %ot be the eat of the d! orderA

The Thyroid Gland 6he% !t wa d! (o5ered that the th"ro!d 3$a%d (o%tro$ the rate at wh!(h bod"0fue$ ! (o% u4ed; !t wa thou3ht that b" ad4!%! ter!%3 th"ro!d 3$a%d to obe e -at!e%t the!r ab%or4a$ fat de-o !t (ou$d be bur%ed u- 4ore ra-!d$"A Th! too -ro5ed to be e%t!re$" d! a--o!%t!%3; be(au e a we %ow 1%ow; the e ab%or4a$ de-o !t ta1e %o -art !% the bod"F e%er3"0 tur%o5er 0 the" are !%a((e !b$" $o(1ed awa"A Th"ro!d 4ed!(at!o% 4ere$" for(e the bod" to (o% u4e !t %or4a$ fat re er5e ; wh!(h are a$read" de-$eted !% obe e -at!e%t ; a%d the% to brea1 dow% tru(tura$$" e e%t!a$ fat w!thout tou(h!%3 the ab%or4a$ de-o !t A I% th! wa" a -at!e%t 4a" be brou3ht to the br!%1 of tar5at!o% !% -!te of ha5!%3 a hu%dred -ou%d of fat to -areA Thu a%" we!3ht $o brou3ht about b" th"ro!d 4ed!(at!o% ! a$wa" at the e/-e% e of fat of wh!(h the bod" ! !% d!re %eedA 6h!$e the 4a?or!t" of obe e -at!e%t ha5e a -erfe(t$" %or4a$ th"ro!d 3$a%d a%d o4e e5e% ha5e a% o5era(t!5e th"ro!d; o%e a$ o o((a !o%a$$" ee a (a e w!th a rea$ th"ro!d def!(!e%("A I% u(h (a e ; treat4e%t w!th th"ro!d br!%3 about a 4a$$ $o of we!3ht; but th! ! %ot due to the $o of a%" ab%or4a$ fatA It ! e%t!re$" the re u$t of the e$!4!%at!o% of a 4u(o!d ub ta%(e; (a$$ed 4"/ede4a; wh!(h the bod" a((u4u$ate whe% there ! a 4ar1ed -r!4ar" th"ro!d def!(!e%("A 8oreo5er; -at!e%t uffer!%3 o%$" fro4 a e5ere $a(1 of th"ro!d hor4o%e %e5er be(o4e obe e !% the true e% eA 2o !b$" a$ o the ob er5at!o% that %or4a$ -er o% 0 thou3h %ot the obe e 0 $o e we!3ht ra-!d$" whe% the!r th"ro!d be(o4e o5era(t!5e 4a" ha5e (o%tr!buted to the fa$ e %ot!o% that th"ro!d def!(!e%(" a%d obe !t" are (o%%e(tedA 8u(h 4! u%der ta%d!%3 about the u--o ed ro$e of the th"ro!d 3$a%d !% obe !t" ! t!$$ 4et w!th; a%d !t ! %ow rea$$" h!3h t!4e that th"ro!d -re-arat!o% be o%(e a%d for a$$ tru(1 off the $! t of re4ed!e for obe !t"A Th! ! -art!(u$ar$" o be(au e 3!5!%3 th"ro!d 3$a%d to a% obe e -at!e%t who e th"ro!d ! e!ther %or4a$ or o5era(t!5e; be !de be!%3 u e$e ; ! de(!ded$" da%3erou A The Pituitary Gland The %e/t 3$a%d to be fa$ e$" !%(r!4!%ated wa the a%ter!or $obe of the -!tu!tar" or h"-o-h" ! A Th! 4o t !4-orta%t 3$a%d $!e we$$ -rote(ted !% a bo%" (a- u$e at the ba e of the 1u$$A It ha a 5a t %u4ber of fu%(t!o% !% the bod"; a4o%3 wh!(h ! the re3u$at!o% of a$$ the other !4-orta%t e%do(r!%e 3$a%d A The fa(t that 5ar!ou !3% of a%ter!or -!tu!tar" def!(!e%(" are ofte% a o(!ated w!th obe !t" ra! ed the ho-e that the eat of the d! order 4!3ht be !% th! 3$a%dA 'ut a$thou3h a $ar3e %u4ber of -!tu!tar" hor4o%e ha5e bee% ! o$ated a%d 4a%" e/tra(t of the 3$a%d -re-ared; %ot a !%3$e o%e or a%" (o4b!%at!o% of u(h fa(tor -ro5ed to be of a%" 5a$ue !% the treat4e%t of obe !t"A Gu!te re(e%t$"; howe5er; a fat04ob!$!B!%3 fa(tor ha bee% fou%d !% -!tu!tar" 3$a%d ; but !t ! t!$$ too ear$" to a" whether th! fa(tor ! de t!%ed to -$a" a ro$e !% the treat4e%t of obe !t"A The drenals Re(e%t$"; a $o%3 er!e of br!$$!a%t d! (o5er!e (o%(er%!%3 the wor1!%3 of the adre%a$ or u-rare%a$ 3$a%d ; 4a$$ bod!e wh!(h !t ato- the 1!d%e" ; ha5e (reated tre4e%dou !%tere tA Th! !%tere t a$ o tur%ed to the -rob$e4 of obe !t" whe% !t wa d! (o5ered that a (o%d!t!o% wh!(h !% o4e re -e(t re e4b$e a e5ere (a e of obe !t" 0 the o0(a$$ed )u h!%3F S"%dro4e 0 wa (au ed b" a 3$a%du$ar %ew03rowth of the adre%a$ or b" the!r e/(e !5e t!4u$at!o% w!th A)TH; wh!(h ! the -!tu!tar" hor4o%e 3o5er%!%3 the a(t!5!t" of the outer r!%d 9

or (orte/ of the adre%a$ A 6he% we $ear%ed that a% ab%or4a$ t!4u$at!o% of the adre%a$ (orte/ (ou$d -rodu(e !3% that re e4b$e true obe !t"; th! 1%ow$ed3e fur%! hed %o -ra(t!(a$ 4ea% of treat!%3 obe !t" b" de(rea !%3 the a(t!5!t" of the adre%a$ (orte/A There ! %o e5!de%(e to u33e t that !% obe !t" there ! a%" e/(e of adre%o(ort!(a$ a(t!5!t"E !% fa(t; a$$ the e5!de%(e -o!%t to the (o%trar"A There ee4 to be rather a $a(1 of adre%o(ort!(a$ fu%(t!o% a%d a de(rea e !% the e(ret!o% of A)TH fro4 the a%ter!or -!tu!tar" $obeA C So here a3a!% our ear(h for the 4e(ha%! 4 wh!(h -rodu(e obe !t" $ed u !%to a b$!%d a$$e"A Re(e%t$"; 4a%" tude%t of obe !t" ha5e re5erted to the %!h!$! t!( att!tude that obe !t" ! (au ed !4-$" b" o5ereat!%3 a%d that !t (a% o%$" be (ured b" u%der eat!%3A The Dience!halon or Hy!othala"us For tho e of u who refu ed to be d! (oura3ed there re4a!%ed o%e $!3ht ho-eA 'ur!ed deedow% !% the 4a !5e hu4a% bra!% there ! a -art wh!(h we ha5e !% (o44o% w!th a$$ 5ertebrate a%!4a$ ; the o0(a$$ed d!e%(e-ha$o%A It ! a 5er" -r!4!t!5e -art of the bra!% a%d ha !% 4a% bee% a$4o t 4othered b" the hu3e 4a e of %er5ou t! ue w!th wh!(h we th!%1; rea o% a%d 5o$u%tar!$" 4o5e our bod"A The d!e%(e-ha$o% ! the -art fro4 wh!(h the (e%tra$ %er5ou " te4 (o%tro$ a$$ the auto4at!( a%!4a$ fu%(t!o% of the bod"; u(h a breath!%3; the heart beat; d!3e t!o%; $ee-; e/; the ur!%ar" " te4; the auto%o4ou or 5e3etat!5e %er5ou " te4 a%d 5!a the -!tu!tar" the who$e !%ter-$a" of the e%do(r!%e 3$a%d A It wa therefore %ot u%rea o%ab$e to u--o e that the (o4-$e/ o-erat!o% of tor!%3 a%d ! u!%3 fue$ to the bod" 4!3ht a$ o be (o%tro$$ed b" the d!e%(e-ha$o%A It ha $o%3 bee% 1%ow% that the (o%te%t of u3ar 0 a%other for4 of fue$ 0 !% the b$ood de-e%d o% a (erta!% %er5ou (e%ter !% the d!e%(e-ha$o%A 6he% th! (e%ter ! de tro"ed !% $aborator" a%!4a$ ; the" de5e$oa (o%d!t!o% rather !4!$ar to hu4a% tab$e d!abete A It ha a$ o $o%3 bee% 1%ow% that the de tru(t!o% of a%other d!e%(e-ha$!( (e%ter -rodu(e a 5ora(!ou a--et!te a%d a ra-!d 3a!% !% we!3ht !% a%!4a$ wh!(h %e5er 3et fat -o%ta%eou $"A C There ! o4e ($!%!(a$ e5!de%(e to u33e t that tho e "4-to4 of )u h!%3H S"%dro4e wh!(h re e4b$e true obe !t" are (au ed b" the a4e 4e(ha%! 4 wh!(h (au e (o44o% obe !t"; wh!$e the other "4-to4 of the "%dro4e are d!re(t$" due to adre%o(ort!(a$ d" fu%(t!o%A

10

The Fat#ban$ A u4!%3 that !% 4a% u(h a (e%ter (o%tro$$!%3 the 4o5e4e%t of fat doe e/! t; !t fu%(t!o% wou$d ha5e to be 4u(h $!1e that of a ba%1A 6he% the bod" a !4!$ate fro4 the !%te t!%a$ tra(t 4ore fue$ tha% !t %eed at the 4o4e%t; th! ur-$u ! de-o !ted !% what 4a" be (o4-ared w!th a (urre%t a((ou%tA Out of th! a((ou%t !t (a% a$wa" be w!thdraw% a re>u!redA A$$ %or4a$ fat re er5e are !% u(h a (urre%t a((ou%t; a%d !t ! -robab$e that a d!e%(e-ha$!( (e%ter 4a%a3e the de-o !t a%d w!thdrawa$ A 6he% %ow; for rea o% wh!(h w!$$ be d! (u ed $ater; the de-o !t 3row ra-!d$" wh!$e 4a$$ w!thdrawa$ be(o4e 4ore fre>ue%t; a -o!%t 4a" be rea(hed wh!(h 3oe be"o%d the d!e%(e-ha$o%F ba%1!%3 (a-a(!t"A Iu t a a ba%1er 4!3ht u33e t to a wea$th" ($!e%t that !% tead of a((u4u$at!%3 a $ar3e a%d u%4a%a3eab$e (urre%t a((ou%t he hou$d !%5e t h! ur-$u (a-!ta$; the bod" a--ear to e tab$! h a f!/ed de-o !t !%to wh!(h a$$ ur-$u fu%d 3o but fro4 wh!(h the" (a% %o $o%3er be w!thdraw% b" the -ro(edure u ed !% a (urre%t a((ou%tA I% th! wa" the d!e%(e-ha$!( =fat0ba%1= free !t e$f fro4 a$$ wor1 wh!(h 3oe be"o%d !t %or4a$ ba%1!%3 (a-a(!t"A The o% et of obe !t" date fro4 the 4o4e%t the d!e%(e-ha$o% ado-t th! $abor0 a5!%3 ru eA O%(e a f!/ed de-o !t ha bee% e tab$! hed the %or4a$ fat re er5e are he$d at a 4!%!4u4; wh!$e e5er" a5a!$ab$e ur-$u ! $o(1ed awa" !% the f!/ed de-o !t a%d ! therefore ta1e% out of %or4a$ (!r(u$at!o%A

11

THREE BASIC CA$SES O# OBESITY: %&' The Inherited Factor A u4!%3 that there ! a $!4!t to the d!e%(e-ha$o%F fat ba%1!%3 (a-a(!t"; !t fo$$ow that there are three ba !( wa" !% wh!(h obe !t" (a% be(o4e 4a%!fe tA The f!r t ! that the fat0ba%1!%3 (a-a(!t" ! ab%or4a$$" $ow fro4 b!rthA Su(h a (o%3e%!ta$$" $ow d!e%(e-ha$!( (a-a(!t" wou$d the% re-re e%t the !%her!ted fa(tor !% obe !t"A 6he% th! ab%or4a$ tra!t ! 4ar1ed$" -re e%t; obe !t" w!$$ de5e$o- at a% ear$" a3e !% -!te of %or4a$ feed!%3E th! (ou$d e/-$a!% wh" a4o%3 brother a%d ! ter eat!%3 the a4e food at the a4e tab$e o4e be(o4e obe e a%d other do %otA %(' Other Dience!halic Disorders The e(o%d wa" !% wh!(h obe !t" (a% be(o4e e tab$! hed ! the $ower!%3 of a -re5!ou $" %or4a$ fat0ba%1!%3 (a-a(!t" ow!%3 to o4e other d!e%(e-ha$!( d! orderA It ee4 to be a 3e%era$ ru$e that whe% o%e of the 4a%" d!e%(e-ha$!( (e%ter ! -art!(u$ar$" o5erta/edE !t tr!e to !%(rea e !t (a-a(!t" at the e/-e% e of other (e%ter A I% the 4e%o-au e a%d after (a trat!o% the hor4o%e -re5!ou $" -rodu(ed !% the e/ 3$a%d %o $o%3er (!r(u$ate !% the bod"A I% the -re e%(e of %or4a$$" fu%(t!o%!%3 e/ 3$a%d the!r hor4o%e a(t a a bra1e o% the e(ret!o% of the e/ 3$a%d t!4u$at!%3 hor4o%e of the a%ter!or -!tu!tar"A 6he% th! bra1e ! re4o5ed the a%ter!or -!tu!tar" e%or4ou $" !%(rea e !t out-ut of the e e/ 3$a%d t!4u$at!%3 hor4o%e ; thou3h the" are %ow %o $o%3er effe(t!5eA I% the ab e%(e of a%" re -o% e fro4 the %o%0fu%(t!o%!%3 or 4! !%3 e/ 3$a%d ; there ! %oth!%3 to to- the a%ter!or -!tu!tar" fro4 -rodu(!%3 4ore a%d 4ore of the e hor4o%e A Th! !tuat!o% (au e a% e/(e !5e tra!% o% the d!e%(e-ha$!( (e%ter wh!(h (o%tro$ the fu%(t!o% of the a%ter!or -!tu!tar"A I% order to (o-e w!th th! add!t!o%a$ burde% the (e%ter a--ear to draw 4ore a%d 4ore e%er3" awa" fro4 other (e%ter ; u(h a tho e (o%(er%ed w!th e4ot!o%a$ tab!$!t"; the b$ood (!r(u$at!o% +hot f$u he , a%d other auto%o4ou %er5ou re3u$at!o% ; -art!(u$ar$" a$ o fro4 the %ot o 5!ta$$" !4-orta%t fat0ba%1A The o0(a$$ed tab$e t"-e of d!abete hea5!$" !%5o$5e the d!e%(e-ha$!( b$ood u3ar re3u$at!%3 (e%terA The d!e%(e-ha$o% tr!e to 4eet th! ab%or4a$ $oad b" w!t(h!%3 e%er3" de t!%ed for the fat0ba%1 o5er to the u3ar0re3u$at!%3 (e%ter; w!th the re u$t that the fat0ba%1!%3 (a-a(!t" ! redu(ed to the -o!%t at wh!(h !t ! for(ed to e tab$! h a f!/ed de-o !t a%d thu !%!t!ate the d! order we (a$$ obe !t"A I% th! (a e o%e wou$d ha5e to (o% !der the d!abete the -r!4ar" (au e of the obe !t"; but !t ! a$ o -o !b$e that the -ro(e ! re5er ed !% the e% e that a def!(!e%t or o5erwor1ed fat0(e%ter draw e%er3" fro4 the u3ar0(e%ter; !% wh!(h (a e the obe !t" wou$d be the (au e of that t"-e of d!abete !% wh!(h the -a%(rea ! %ot -r!4ar!$" !%5o$5edA F!%a$$"; !t ! (o%(e!5ab$e that !% )u h!%3F "%dro4e tho e "4-to4 wh!(h re e4b$e obe !t" are e%t!re$" due to the w!thdrawa$ of e%er3" fro4 the d!e%(e-ha$!( fat0ba%1 !% order to 4a1e !t a5a!$ab$e to the h!3h$" d! turbed (e%ter wh!(h 3o5er% the a%ter!or -!tu!tar"0 adre%o(ort!(a$ " te4A 6hether obe !t" ! (au ed b" a 4ar1ed !%her!ted def!(!e%(" of the fat0(e%ter or b" o4e e%t!re$" d!ffere%t d!e%(e-ha$!( re3u$ator" d! order; !t !% ur3e%(e ob5!ou $" ha %oth!%3 to do 12

w!th o5ereat!%3 a%d !% e!ther (a e obe !t" ! (erta!% to de5e$o- re3ard$e of d!etar" re tr!(t!o% A I% the e (a e a%" e%for(ed food def!(!t ! 4ade u- fro4 e e%t!a$ fat re er5e a%d %or4a$ tru(tura$ fat; 4u(h to the d! ad5a%ta3e of the -at!e%tF 3e%era$ hea$thA %)' The *+haustion of the Fat#ban$ 'ut there ! t!$$ a th!rd wa" !% wh!(h obe !t" (a% be(o4e e tab$! hed; a%d that ! whe% a -re u4ab$" %or4a$ fat0(e%ter ! udde%$" 0 the e4-ha ! ! o% udde%$" 0 (a$$ed u-o% to dea$ w!th a% e%or4ou !%f$u/ of food far !% e/(e of 4o4e%tar" re>u!re4e%t A At f!r t 3$a%(e !t doe ee4 that here we ha5e a tra!3ht0forward (a e of o5ereat!%3 be!%3 re -o% !b$e for obe !t"; but o% further a%a$" ! !t oo% be(o4e ($ear that the re$at!o% of (au e a%d effe(t ! %ot o !4-$eA I% the f!r t -$a(e we are 4ere$" a u4!%3 that the (a-a(!t" of the fat0(e%ter ! %or4a$ wh!$e !t ! -o !b$e a%d e5e% -robab$e that o%$" -er o% who ha5e o4e !%her!ted tra!t !% th! d!re(t!o% (a% be(o4e obe e 4ere$" b" o5ereat!%3A Se(o%d$"; !% 4a%" of the e (a e the a4ou%t of food eate% re4a!% the a4e a%d !t ! o%$" the (o% u4-t!o% of fue$ wh!(h ! udde%$" de(rea ed; a whe% a% ath$ete ! (o%f!%ed to bed for 4a%" wee1 w!th a bro1e% bo%e or whe% a 4a% $ead!%3 a h!3h$" a(t!5e $!fe ! udde%$" t!ed to h! de 1 !% a% off!(e a%d to te$e5! !o% at ho4eA S!4!$ar$"; whe% a -er o%; 3row% u- !% a (o$d ($!4ate; ! tra% ferred to a tro-!(a$ (ou%tr" a%d (o%t!%ue to eat a before; he 4a" de5e$oobe !t" be(au e !% the heat far $e fue$ ! re>u!red to 4a!%ta!% the %or4a$ bod" te4-eratureA 6he% a -er o% uffer a $o%3 -er!od of -r!5at!o%; be !t due to (hro%!( !$$%e ; -o5ert"; fa4!%e or the e/!3e%(!e of war; h! d!e%(e-ha$!( re3u$at!o% ad?u t the4 e$5e to o4e e/te%t to the $ow food !%ta1eA 6he% the% udde%$" the e (o%d!t!o% (ha%3e a%d he ! free to eat a$$ the food he wa%t ; th! ! $!ab$e to o5erwhe$4 h! fat0re3u$at!%3 (e%terA Dur!%3 the $a t war about #999 3ro $" u%derfed 2o$! h refu3ee who had -e%t harrow!%3 "ear !% Ru !a were tra% ferred to a (a4- !% I%d!a where the" were we$$ hou ed; 3!5e% %or4a$ 'r!t! h ar4" rat!o% a%d o4e (a h to bu" a few e/tra A 6!th!% about three 4o%th ; &7J were uffer!%3 fro4 obe !t"A I% a -er o% eat!%3 (oar e a%d u%ref!%ed food; the d!3e t!o% ! $ow a%d o%$" a $!tt$e %our! h4e%t at a t!4e ! a !4!$ated fro4 the !%te t!%a$ tra(tA 6he% u(h a -er o% ! udde%$" ab$e to obta!% h!3h$" ref!%ed food u(h a u3ar; wh!te f$our; butter a%d o!$ the e are o ra-!d$" d!3e ted a%d a !4!$ated that the ru h of !%(o4!%3 fue$ wh!(h o((ur at e5er" 4ea$ 4a" e5e%tua$$" o5er-ower the d!e(e%-ha$!( re3u$ator" 4e(ha%! 4 a%d thu $ead to obe !t"A Th! ! (o44o%$" ee% !% the -oor 4a% who udde%$" be(o4e r!(h e%ou3h to bu" the 4ore e/-e% !5e ref!%ed food ; thou3h h! tota$ (a$or!( !%ta1e re4a!% the a4e or ! e5e% $e tha% beforeA Psychological s!ects 8u(h ha bee% wr!tte% about the - "(ho$o3!(a$ a -e(t of obe !t"A A4o%3 !t 4a%" fu%(t!o% the d!e%(e-ha$o% ! a$ o the eat of our -r!4!t!5e a%!4a$ !% t!%(t ; a%d ?u t a !% a% e4er3e%(" !t (a% w!t(h e%er3" fro4 o%e (e%ter to a%other; o !t ee4 to be ab$e to tra% fer -re ure fro4 o%e !% t!%(t to a%otherA Thu ; a $o%e$" a%d u%ha--" -er o% de-r!5ed of a$$ e4ot!o%a$ (o4fort a%d of a$$ !% t!%(t 3rat!f!(at!o% e/(e-t the t!$$!%3 of hu%3er a%d th!r t (a% u e the e a out$et for -e%t u- !% t!%(t -re ure a%d o de5e$o- obe !t"A @et o%(e that ha 13

ha--e%ed; %o a4ou%t of - "(hothera-" or a%a$" ! ; ha--!%e of other !% t!%(t w!$$ (orre(t the (o%d!t!o%A ,o"!ulsi-e *ating

; (o4-a%" or the 3rat!f!(at!o%

No e%d of !%?u t!(e ! do%e to obe e -at!e%t b" a((u !%3 the4 of (o4-u$ !5e eat!%3; wh!(h ! a for4 of d!5erted e/03rat!f!(at!o%A 8o t obe e -at!e%t do %ot uffer fro4 (o4-u$ !5e eat!%3E the" uffer 3e%u!%e hu%3er 0 rea$; 3%aw!%3; tortur!%3 hu%3er 0 wh!(h ha %oth!%3 whate5er to do w!th (o4-u$ !5e eat!%3A E5e% the!r udde% de !re for weet ! 4ere$" the re u$t of the e/-er!e%(e that weet ; -a tr!e a%d a$(oho$ w!$$ 4o t ra-!d$" of a$$ food a$$a" the -a%3 of hu%3erA Th! ha %oth!%3 to do w!th d!5erted !% t!%(t A O% the other ha%d; (o4-u$ !5e eat!%3 doe o((ur !% o4e obe e -at!e%t ; -art!(u$ar$" !% 3!r$ !% the!r $ate tee% or ear$" twe%t!e A )o4-u$ !5e eat!%3 d!ffer fu%da4e%ta$$" fro4 the obe e -at!e%tH 3reater %eed for foodA It (o4e o% !% atta(1 a%d ! %e5er a o(!ated w!th rea$ hu%3er; a fa(t wh!(h ! read!$" ad4!tted b" the -at!e%t A The" o%$" fee$ a fera$ de !re to tuffA Two -ou%d of (ho(o$ate 4a" be de5oured !% a few 4!%ute E (o$d; 3rea " food fro4 the refr!3erator; ta$e bread; $efto5er o% ta(1ed -$ate ; a$4o t a%"th!%3 ed!b$e ! (ra44ed dow% w!th terr!f"!%3 -eed a%d fero(!t"A I ha5e o((a !o%a$$" bee% ab$e to wat(h u(h a% atta(1 w!thout the -at!e%tF 1%ow$ed3e; a%d !t ! a fr!3hte%!%3; u3$" -e(ta($e to beho$d; e5e% !f o%e doe rea$!Be that 4e(ha%! 4 e%t!re$" be"o%d the -at!e%tF (o%tro$ are at wor1A A (arefu$ e%>u!r" !%to what 4a" ha5e brou3ht o% u(h a% atta(1 a$4o t !%5ar!ab$" re5ea$ that !t ! -re(eded b" a tro%3 u%re o$5ed e/0 t!4u$at!o%; the h!3her (e%ter of the bra!% ha5!%3 b$o(1ed -r!4!t!5e d!e%(e-ha$!( !% t!%(t 3rat!f!(at!o%A The -re ure ! the% $et off throu3h a%other -r!4!t!5e (ha%%e$; wh!(h ! ora$ 3rat!f!(at!o%A I% 4" e/-er!e%(e the o%$" th!%3 that w!$$ (ure th! (o%d!t!o% ! u%!%h!b!ted e/; a thera-eut!( -ro(edure wh!(h ! hard$" e5er fea !b$e; for !f !t were; the -at!e%t wou$d ha5e ado-ted !t w!thout -rofe !o%a$ -ro4-t!%3; %or wou$d th! !% a%" wa" (orre(t the a o(!ated obe !t"A It wou$d o%$" ra! e %ew a%d ofte% 3reater -rob$e4 !f u ed a a thera-eut!( 4ea ureA 2at!e%t uffer!%3 fro4 rea$ (o4-u$ !5e eat!%3 are (o4-arat!5e$" rareA I% 4" -ra(t!(e the" (o% t!tute about 10*JA Treat!%3 the4 for obe !t" ! a heartre%d!%3 ?obA The" do -erfe(t$" we$$ betwee% atta(1 ; but a !%3$e bout o((urr!%3 wh!$e u%der treat4e%t 4a" a%%u$ e5era$ wee1 of thera-"A L!tt$e wo%der that u(h -at!e%t be(o4e d! (oura3edA I% the e (a e I ha5e fou%d that - "(hothera-" 4a" 4a1e the -at!e%t fu$$" u%der ta%d the 4e(ha%! 4; but !t doe %oth!%3 to to- !tA 2erha- o(!et"F 3row!%3 e/ua$ -er4! !5e%e w!$$ 4a1e (o4-u$ !5e eat!%3 e5e% rarerA 6hether a -at!e%t ! rea$$" uffer!%3 fro4 (o4-u$ !5e eat!%3 or %ot ! hard to de(!de before treat4e%t be(au e 4a%" obe e -at!e%t th!%1 that the!r de !re for food 0 to the4 u%4ot!5ated 0 ! due to (o4-u$ !5e eat!%3; wh!$e a$$ the t!4e !t ! 4ere$" a 3reater %eed for foodA The o%$" wa" to f!%d out ! to treat u(h -at!e%t A Tho e that uffer fro4 rea$ (o4-u$ !5e eat!%3 (o%t!%ue to ha5e u(h atta(1 ; wh!$e tho e who are %ot (o4-u$ !5e eater %e5er 3et a% atta(1 dur!%3 treat4e%tA

14

Reluctance to .ose /eight So4e -at!e%t are dee-$" atta(hed to the!r fat a%d (a%%ot bear the thou3ht of $o !%3 !tA If the" are !%te$$!3e%t; -o-u$ar a%d u((e fu$ !% -!te of the!r ha%d!(a-; th! ! a our(e of -r!deA So4e fat 3!r$ $oo1 u-o% the!r (o%d!t!o% a a afe3uard a3a!% t erot!( !%5o$5e4e%t ; of wh!(h the" are afra!dA The" wor1 out a -atter% of $!fe !% wh!(h the!r obe !t" -$a" a deter4!%!%3 ro$e a%d the% be(o4e re$u(ta%t to u- et th! -atter% a%d fa(e a %ew 1!%d of $!fe wh!(h w!$$ be e%t!re$" d!ffere%t after the!r f!3ure ha be(o4e %or4a$ a%d ofte% 5er" attra(t!5eA The" fear that -eo-$e w!$$ $!1e the4 0 or be ?ea$ou 0 o% a((ou%t of the!r f!3ure rather tha% be attra(ted b" the!r !%te$$!3e%(e or (hara(ter o%$"A So4e ha5e a fee$!%3 that redu(!%3 4ea% 3!5!%3 u- a% a$4o t (her! hed a%d !%t!4ate -art of the4 e$5e A I% 4a%" of the e (a e - "(hothera-" (a% be he$-fu$; a !t e%ab$e the e -at!e%t to ee the who$e !tuat!o% !% the fu$$ $!3ht of (o% (!ou %e A A% affe(t!o%ate atta(h4e%t to ab%or4a$ fat ! u ua$$" ee% !% -at!e%t who be(a4e obe e !% (h!$dhood; but th! ! %ot %e(e ar!$" oA I% a$$ other (a e the be t - "(hothera-" (a% do !% the u ua$ treat4e%t of obe !t" ! to re%der the burde% of hu%3er a%d %e5er0e%d!%3 d!etar" re tr!(t!o% $!3ht$" 4ore to$erab$eA 2at!e%t who ha5e u((e fu$$" e tab$! hed a% erot!( tra% fer to the!r - "(h!atr! t are ofte% better ab$e to bear the!r uffer!%3 a a e(ret $abor of $o5eA There are thu a $ar3e %u4ber of wa" !% wh!(h obe !t" (a% be !%!t!ated; thou3h the d! order !t e$f ! a$wa" due to the a4e 4e(ha%! 4; a% !%ade>ua(" of the d!e%(e-ha$!( fat0(e%ter a%d the $a"!%3 dow% of ab%or4a$$" f!/ed fat de-o !t !% ab%or4a$ -$a(e A Th! 4ea% that o%(e obe !t" ha be(o4e e tab$! hed; !t (a% %o 4ore be (ured b" e$!4!%at!%3 tho e fa(tor wh!(h brou3ht !t o% tha% a f!re (a% be e/t!%3u! hed b" re4o5!%3 the (au e of the (o%f$a3rat!o%A Thu a d! (u !o% of the 5ar!ou wa" !% wh!(h obe !t" (a% be(o4e e tab$! hed ! u efu$ fro4 a -re5e%tat!5e -o!%t of 5!ew; but !t ha %o bear!%3 o% the treat4e%t of the e tab$! hed (o%d!t!o%A The e$!4!%at!o% of fa(tor wh!(h are ($ear$" ha te%!%3 the (our e of the d! order 4a" $ow dow% !t -ro3re or e5e% ha$t !t; but the" (a% %e5er (orre(t !tA 0ot by /eight alone1 6e!3ht a$o%e ! %ot a at! fa(tor" (r!ter!o% b" wh!(h to ?ud3e whether a -er o% ! uffer!%3 fro4 the d! order we (a$$ obe !t" or %otA E5er" -h" !(!a% ! fa4!$!ar w!th the "$-h$!1e $ad" who e%ter the (o% u$t!%3 roo4 a%d de($are e4-hat!(a$$" that he ! 3ett!%3 horr!b$" fat a%d w! he to redu(eA 8a%" a% ho%e t a%d "4-athet!( -h" !(!a% at o%(e (o%($ude that he ! dea$!%3 w!th a <%utAK If he ! bu " he w!$$ 3!5e her hort hr!ft; but !f he ha t!4e he w!$$ we!3h her a%d how her tab$e to -ro5e that he ! a(tua$$" u%derwe!3htA I ha5e %e5er "et ee% or heard of u(h a $ad" be!%3 (o%5!%(ed b" e!ther -ro(edureA The rea o% ! that !% 4" e/-er!e%(e the $ad" ! %ear$" a$wa" r!3ht a%d the do(tor wro%3A 6he% u(h a -at!e%t ! (arefu$$" e/a4!%ed o%e f!%d 4a%" !3% of -ote%t!a$ obe !t"; wh!(h ! ?u t about to be(o4e 4a%!fe t a o5erwe!3htA The -at!e%t d! t!%(t$" fee$ that o4eth!%3 ! wro%3 w!th her; that a ubt$e (ha%3e ! ta1!%3 -$a(e !% her bod"; a%d th! a$ar4 herA There are a %u4ber of !3% a%d "4-to4 wh!(h are (hara(ter! t!( of obe !t"A I% 4a%!fe t obe !t" 4a%" a%d ofte% a$$ the e !3% a%d "4-to4 are -re e%tA I% $ate%t or ?u t be3!%%!%3 (a e o4e are a$wa" fou%d; a%d !t hou$d be a ru$e that !f two or 4ore of the bod!$" !3% 15

are -re e%t; the (a e 4u t be re3arded a o%e that %eed !44ed!ate he$-A Signs and sy"!to"s of obesity The bod!$" !3% 4a" be d!5!ded !%to u(h a ha5e de5e$o-ed before -ubert"; !%d!(at!%3 a tro%3 !%her!ted fa(tor; a%d tho e wh!(h de5e$o- at the o% et of 4a%!fe t d! orderA Ear$" !3% are a d! -ro-ort!o%ate$" $ar3e !Be of the two u--er fro%t teeth; the f!r t !%(! or; or a d!4-$e o% both !de of the a(ra$ bo%e ?u t abo5e the butto(1 A 6he% the ar4 are out tret(hed w!th the -a$4 u-ward; the forear4 a--ear har-$" a%3$ed outward fro4 the u--er ar4 A The a4e a--$!e to the $ower e/tre4!t!e A The -at!e%t (a%%ot br!%3 h! feet to3ether w!thout the 1%ee o5er$a--!%3E he ! ; !% fa(t; 1%o(101%eedA The be3!%%!%3 a((u4u$at!o% of ab%or4a$ fat how a a $!tt$e -ad ?u t be$ow the %a-e of the %e(1; (o$$o>u!a$$" 1%ow% a the Du(he F Hu4-A There ! a tr!a%3u$ar fatt" bu$3e !% fro%t of the ar4-!t whe% the ar4 ! he$d a3a!% t the bod"A 6he% the 1!% ! tret(hed b" fat ra-!d$" a((u4u$at!%3 u%der !t; !t 4a" -$!t !% the $ower $a"er A 6he% $ar3e a%d fre h; u(h tear are -ur-$e; but $ater the" are tra% for4ed !%to wh!te (ar0t! ueA Su(h tr!at!o%; a !t ! (a$$ed; (o44o%$" o((ur o% the abdo4e% of wo4e% dur!%3 -re3%a%("; but !% obe !t" !t ! fre>ue%t$" fou%d o% the brea t ; the h!- a%d o((a !o%a$$" o% the hou$der A I% 4a%" (a e tr!at!o% ! o f!%e that the 4a$$ wh!te $!%e are o%$" ?u t 5! !b$eA The" are a$wa" a ure !3% of obe !t"; a%d thou3h th! 4a" be $!3ht at the t!4e of e/a4!%at!o% u(h -at!e%t (a% u ua$$" re4e4ber a -er!od !% the!r (h!$dhood whe% the" were e/(e !5e$" (hubb"A A%other t"-!(a$ !3% ! a -ad of fat o% the !% !de of the 1%ee ; a -ot where %or4a$ fat re er5e are %e5er toredA There 4a" be a fo$d of 1!% o5er the -ub!( area a%d a%other fo$d 4a" tret(h rou%d both !de of the (he t; where a $oo e ro$$ of fat (a% be -!(1ed u- betwee% two f!%3er A I% the 4a$e a% e/(e !5e a((u4u$at!o% of fat !% the brea t ! a$wa" !%d!(at!5e; wh!$e !% the fe4a$e the brea t ! u ua$$"; but %ot %e(e ar!$"; $ar3eA Ob5!ou $" e/(e !5e fat o% the abdo4e%; the h!- ; th!3h ; u--er ar4 ; (h!% a%d hou$der are (hara(ter! t!(; a%d !t ! !4-orta%t to re4e4ber that a%" %u4ber of the e !3% 4a" be -re e%t !% -er o% who e we!3ht ! tat! t!(a$$" %or4a$E -art!(u$ar$" !f the" are d!et!%3 o% the!r ow% w!th !ro% deter4!%at!o%A )o44o% ($!%!(a$ "4-to4 wh!(h are !%d!(at!5e o%$" !% the!r a o(!at!o% a%d !% the fra4e of the who$e ($!%!(a$ -!(ture areD fre>ue%t heada(he ; rheu4at!( -a!% w!thout dete(tab$e bo%" ab%or4a$!t"E a fee$!%3 of $aB!%e a%d $ethar3"; ofte% both -h" !(a$ a%d 4e%ta$ a%d fre>ue%t$" a o(!ated w!th !% o4%!a; the -at!e%t a"!%3 that a$$ the" wa%t ! to re tE the fr!3hte%!%3 fee$!%3 of be!%3 fa4! hed a%d o4et!4e wea1 w!th hu%3er two to three hour after a heart" 4ea$ a%d a% !rre ! t!b$e "ear%!%3 for weet a%d tar(h" food wh!(h ofte% o5er(o4e the -at!e%t >u!te udde%$" a%d ! o4et!4e ub t!tuted b" a de !re for a$(oho$E (o% t!-at!o% a%d a -a t!( or !rr!tab$e (o$o% are u%u ua$$" (o44o% a4o%3 the obe e; a%d o are 4e% trua$ d! order A Retur%!%3 o%(e 4ore to our "$-h$!1e $ad"; we (a% a" that a (o4b!%at!o% of o4e of the e "4-to4 w!th a few of the t"-!(a$ bod!$" !3% ! uff!(!e%t e5!de%(e to ta1e her (a e er!ou $"A A hu4a% f!3ure; 4a$e or fe4a$e; (a% o%$" be ?ud3ed !% the %udeE a%" o-!%!o% ba ed o% the dre ed a--eara%(e (a% be >u!te fa%ta t!(a$$" w!de off the 4ar1; a%d I fee$ 4" e$f dr!5e% to the (o%($u !o% that a-art fro4 fra%1$" - "(hot!( -at!e%t u(h a (a e of a%ore/!a %er5o a a <4orb!d we!3ht f!/at!o%K doe %ot e/! tA I ha5e "et to ee a -at!e%t who (o%t!%ue to 16

(o4-$a!% after the f!3ure ha bee% re%dered %or4a$ b" ade>uate treat4e%tA The *"aciated .ady I re4e4ber the (a e of a $ad" who wa e (orted !%to 4" (o% u$t!%3 roo4 wh!$e I wa te$e-ho%!%3A She at dow% !% fro%t of 4" de 1; a%d whe% I $oo1ed u- to 3reet her I aw the t"-!(a$ -!(ture of ad5a%(ed e4a(!at!o%A Her dr" 1!% hu%3 $oo e$" o5er the bo%e of her fa(e; her %e(1 wa (raw%" a%d (o$$arbo%e a%d r!b tu(1 out fro4 dee- ho$$ow A I !44ed!ate$" thou3ht of (a%(er a%d de(!ded to wh!(h of 4" (o$$ea3ue at the ho -!ta$ I wou$d refer herA I%deed; I fe$t a $!tt$e a%%o"ed that 4" a ! ta%t had %ot e/-$a!%ed to her that her (a e d!d %ot fa$$ u%der 4" -e(!a$t"A I% a% wer to 4" >uer" a to what I (ou$d do for her; he re-$!ed that he wa%ted to redu(eA I tr!ed to h!de 4" ur-r! e; but he 4u t ha5e %oted a f$eet!%3 e/-re !o%; for he 4!$ed a%d a!d <I 1%ow that "ou th!%1 IF4 4ad; but ?u t wa!tAK 6!th that he ro e a%d (a4e rou%d to 4" !de of the de 1A Iutt!%3 out fro4 a t!%" wa! t he had e%or4ou h!- a%d th!3h A '" u !%3 a te(h%!>ue wh!(h w!$$ -re e%t$" be de (r!bed; the ab%or4a$ fat o% her h!- wa tra% ferred to the re t of her bod" wh!(h had bee% e4a(!ated b" 4o%th of 5er" e5ere d!et!%3A At the e%d of a treat4e%t $a t!%3 f!5e wee1 ; he; a 4a$$ wo4a%; had $o t & !%(he rou%d her h!- ; wh!$e her fa(e $oo1ed fre h a%d f$or!d; the r!b were %o $o%3er 5! !b$e a%d her we!3ht wa the a4e to the ou%(e a !t had bee% at the f!r t (o% u$tat!o%A Fat but not Obese 6h!$e a -er o% who ! tat! t!(a$$" u%derwe!3ht 4a" t!$$ be uffer!%3 fro4 the d! order wh!(h (au e obe !t"; !t ! a$ o -o !b$e for a -er o% to be tat! t!(a$$" o5erwe!3ht w!thout uffer!%3 fro4 obe !t"A For u(h -er o% we!3ht ! %o -rob$e4; a the" (a% 3a!% or $o e at w!$$ a%d e/-er!e%(e %o d!ff!(u$t" !% redu(!%3 the!r (a$or!( !%ta1eA The" are 4a ter of the!r we!3ht; wh!(h the obe e are %otA 8oreo5er; the!r e/(e fat how %o -refere%(e for (erta!% t"-!(a$ re3!o% of the bod"; a doe the fat !% a$$ (a e of obe !t"A Thu ; the de(! !o% whether a border$!%e (a e ! rea$$" uffer!%3 fro4 obe !t" or %ot (a%%ot be 4ade 4ere$" b" (o% u$t!%3 we!3ht tab$e A

17

THE TREATMENT O# OBESITY If obe !t" ! a$wa" due to o%e 5er" -e(!f!( d!e%(e-ha$!( def!(!e%("; !t fo$$ow that the o%$" wa" to (ure !t ! to (orre(t th! def!(!e%("A At f!r t th! ee4ed a% utter$" ho-e$e u%derta1!%3A The 3reate t ob ta($e wa that o%e (ou$d hard$" ho-e to (orre(t a% !%her!ted tra!t $o(a$!Bed dee- !% !de the bra!%; a%d wh!$e we d!d -o e a %u4ber of dru3 who e -o!%t of a(t!o% wa be$!e5ed to be !% the d!e%(e-ha$o%; %o%e of the4 had the $!3hte t effe(t o% the fat0(e%terA There wa %ot e5e% a -o!%ter how!%3 a d!re(t!o% !% wh!(h -har4a(o$o3!(a$ re ear(h (ou$d 4o5e to f!%d a dru3 that had u(h a -e(!f!( a(t!o%A The ($o e t a--roa(h were the a--et!te0 redu(!%3 dru3 0 the a4-heta4!%e 0 but the e (ured %oth!%3A A Cu%&ous Obse%'a"&on 8u$$!%3 o5er th! de-re !%3 !tuat!o%; I re4e4bered a rather (ur!ou ob er5at!o% 4ade 4a%" "ear a3o !% I%d!aA At that t!4e we 1%ew 5er" $!tt$e about the fu%(t!o% of the d!e%(e-ha$o%; a%d 4" !%tere t (e%tered rou%d the -!tu!tar" 3$a%dA Froeh$!(h had de (r!bed (a e of e/tre4e obe !t" a%d e/ua$ u%derde5e$o-4e%t !% "outh uffer!%3 fro4 a %ew 3rowth of the a%ter!or -!tu!tar" $obe; -rodu(!%3 what the% be(a4e 1%ow% a Froeh$!(hF d! ea eA Howe5er; !t wa 5er" oo% d! (o5ered that the !de%t!(a$ "%dro4e; thou3h ru%%!%3 a $e fu$4!%at!%3 (our e; wa >u!te (o44o% !% -at!e%t who e -!tu!tar" 3$a%d wa -erfe(t$" %or4a$A The e are the o0 (a$$ed <fat bo" K w!th $o%3; $e%der ha%d ; brea t a%" f$at0(he ted 4a!de% wou$d be -roud to -o e ; $ar3e h!- ; butto(1 a%d th!3h w!th tr!at!o%; 1%o(101%ee a%d u%derde5e$o-ed 3e%!ta$ ; ofte% w!th u%de (e%ded te t!($e A It a$ o be(a4e 1%ow% that !% the e (a e the e/ or3a% (ou$d be de5e$o-ed b" 3!5!%3 the -at!e%t do e of a ub ta%(e e/tra(ted fro4 the ur!%e of -re3%a%t wo4e%; !t ha5!%3 bee% how% that whe% th! ub ta%(e wa !%?e(ted !%to e/ua$$" !44ature rat !t 4ade the4 -re(o(!ou $" 4atureA The a4ou%t of ub ta%(e wh!(h -rodu(ed th! effe(t !% o%e rat wa (a$$ed o%e I%ter%at!o%a$ :%!t; a%d the -ur!f!ed e/tra(t wa a((ord!%3$" (a$$ed <Hu4a% )hor!o%!( Go%adotro-h!%K whereb" chorionic !3%!f!e that !t ! -rodu(ed !% the -$a(e%ta a%d gonadotropin that !t a(t!o% ! e/ 3$a%d d!re(tedA The u ua$ wa" of treat!%3 <fat bo" K w!th u%derde5e$o-ed 3e%!ta$ ! to !%?e(t e5era$ hu%dred I%ter%at!o%a$ :%!t tw!(e a wee1A Hu4a% )hor!o%!( Go%adotro-h!% wh!(h we ha$$ he%(eforth !4-$" (a$$ H)G ! e/-e% !5e; a%d a <fat bo" K are fa!r$" (o44o% a4o%3 I%d!a% I tr!ed to e tab$! h the 4a$$e t effe(t!5e do eA I% the (our e of th! tud" three !%tere t!%3 th!%3 e4er3edA The f!r t wa that whe% fre h -re3%a%("0ur!%e fro4 the fe4a$e ward wa 3!5e% !% >ua%t!t!e of about .99 ((A b" rete%t!o% e%e4a; a 3ood re u$t (ou$d be obta!%ed a b" !%?e(t!%3 the -ure ub ta%(eA The e(o%d wa that 4a$$ da!$" do e a--eared to be ?u t a effe(t!5e a 4u(h $ar3er o%e 3!5e% tw!(e a wee1A Th!rd$"; a%d that ! the ob er5at!o% that (o%(er% u here; whe% u(h -at!e%t were 3!5e% 4a$$ da!$" do e the" ee4ed to $o e the!r ra5e%ou a--et!te thou3h the" %e!ther 3a!%ed %or $o t we!3htA Stra%3e$" e%ou3h howe5er; the!r ha-e d!d (ha%3eA Thou3h the" were %ot re tr!(ted !% d!et; there wa a d! t!%(t de(rea e !% the (!r(u4fere%(e of the!r h!- A

18

#a" on "he Mo'e Re4e4ber!%3 th! ; !t o((urred to 4e that the (ha%3e !% ha-e (ou$d o%$" be e/-$a!%ed b" a 4o5e4e%t of fat awa" fro4 ab%or4a$ de-o !t o% the h!- ; a%d !f that were o there wa ?u t a (ha%(e that wh!$e u(h fat wa !% tra% !t!o% !t 4!3ht be a5a!$ab$e to the bod" a fue$A Th! wa ea " to f!%d out; a !% that (a e; fat o% the 4o5e wou$d be ab$e to re-$a(e foodA It hou$d the% be -o !b$e to 1ee- a <fat bo"K o% a e5ere$" re tr!(ted d!et w!thout a fee$!%3 of hu%3er; !% -!te of a ra-!d $o of we!3htA 6he% I tr!ed th! !% t"-!(a$ (a e of Froeh$!(hF "%dro4e; I fou%d that a $o%3 a u(h -at!e%t were 3!5e% 4a$$ da!$" do e of H)G the" (ou$d (o4fortab$" 3o about the!r u ua$ o((u-at!o% o% a d!et of o%$" 799 )a$or!e da!$" a%d $o e a% a5era3e of about o%e -ou%d -er da"A It wa a$ o -erfe(t$" e5!de%t that o%$" ab%or4a$ fat wa be!%3 (o% u4ed; a there were %o !3% of a%" de-$et!o% of %or4a$ fatA The!r 1!% re4a!%ed fre h a%d tur3!d; a%d 3radua$$" the!r f!3ure be(a4e e%t!re$" %or4a$; %or d!d the da!$" ad4!%! trat!o% of H)G a--ear to ha5e a%" !de0effe(t other tha% be%ef!(!a$A Fro4 th! -o!%t !t wa a 4a$$ te- to tr" the a4e 4ethod !% a$$ other for4 of obe !t"A It too1 a few hu%dred (a e to e tab$! h be"o%d rea o%ab$e doubt that the 4e(ha%! 4 o-erate !% e/a(t$" the a4e wa" a%d ee4!%3$" w!thout e/(e-t!o% !% e5er" (a e of obe !t"A I fou%d that; thou3h 4o t -at!e%t were treated !% the out-at!e%t de-art4e%t; 3ro d!etar" error rare$" o((urredA O% the (o%trar"; 4o t -at!e%t (o4-$a!%ed that the two 4ea$ of *79 )a$or!e ea(h were 4ore tha% the" (ou$d 4a%a3e; a the" (o%t!%ua$$" had a fee$!%3 of ?u t ha5!%3 had a $ar3e 4ea$A P%e(nanc) and Obes&") O%(e th! tra!$ wa o-e%ed; further ob er5at!o% ee4ed to fa$$ !%to $!%eA It ! ; for !% ta%(e; we$$ 1%ow% that dur!%3 -re3%a%(" a% obe e wo4a% (a% 5er" ea !$" $o e we!3htA She (a% dra t!(a$$" redu(e her d!et w!thout fee$!%3 hu%3er or d! (o4fort a%d $o e we!3ht w!thout !% a%" wa" har4!%3 the (h!$d !% her wo4bA It ! a$ o ur-r! !%3 to what e/te%t a wo4a% (a% uffer fro4 -re3%a%("05o4!t!%3 w!thout (o4!%3 to a%" rea$ har4A 2re3%a%(" ! a% obe e wo4a%F o%e 3reat (ha%(e to redu(e her e/(e we!3htA That he o rare$" 4a1e u e of th! o--ortu%!t" ! due to the erro%eou %ot!o%; u ua$$" fo tered b" her e$der re$at!o% ; that he %ow ha <two 4outh to feedK a%d 4u t <1ee- u- her tre%3th for the (o4!%3 e5e%tAK A$$ 4oder% ob tetr!(!a% 1%ow that th! ! %o% e% e a%d that the 4ore u-erf$uou fat ! $o t the $e d!ff!(u$t w!$$ be the (o%f!%e4e%t; thou3h o4e t!$$ he !tate to -re (r!be a d!et uff!(!e%t$" $ow !% )a$or!e to br!%3 about a dra t!( redu(t!o%A A wo4a% 4a" 3a!% we!3ht dur!%3 -re3%a%("; but he %e5er be(o4e obe e !% the tr!(t e% e of the wordA :%der the !%f$ue%(e of the H)G wh!(h (!r(u$ate !% e%or4ou >ua%t!t!e !% her bod" dur!%3 -re3%a%("; her d!e%(e-ha$!( ba%1!%3 (a-a(!t" ee4 to be u%$!4!ted; a%d ab%or4a$ f!/ed de-o !t are %e5er for4edA At (o%f!%e4e%t he ! udde%$" de-r!5ed of H)G; a%d her d!e%(e-ha$!( fat0(e%ter re5ert to !t %or4a$ (a-a(!t"A It ! o%$" the% that the ab%or4a$$" a((u4u$ated fat ! $o(1ed awa" a3a!% !% a f!/ed de-o !tA Fro4 that 4o4e%t o% he ! uffer!%3 fro4 obe !t" a%d ! ub?e(t to a$$ !t (o% e>ue%(e A 2re3%a%(" ee4 to be the o%$" %or4a$ hu4a% (o%d!t!o% !% wh!(h the d!e%(e-ha$!( fat0 ba%1!%3 (a-a(!t" ! u%$!4!tedA It ! o%$" dur!%3 -re3%a%(" that f!/ed fat de-o !t (a% be 19

tra% ferred ba(1 !%to the %or4a$ (urre%t a((ou%t a%d free$" draw% u-o% to 4a1e u- for a%" %utr!t!o%a$ def!(!tA Dur!%3 -re3%a%("; e5er" ou%(e of re er5e fat ! -$a(ed at the d! -o a$ of the 3row!%3 fetu A 6ere th! %ot o; a% obe e wo4a%; who e %or4a$ re er5e are a$read" de-$eted; wou$d ha5e the 3reate t d!ff!(u$t!e !% br!%3!%3 her -re3%a%(" to fu$$ ter4A There ! (o% !derab$e e5!de%(e to u33e t that !t ! the H)G -rodu(ed !% $ar3e >ua%t!t!e !% the -$a(e%ta wh!(h br!%3 about th! d!e%(e-ha$!( (ha%3eA Thou3h we 4a" be ab$e to !%(rea e the d!e%ee-ha$!( fat0ba%1!%3 (a-a(!t" b" !%?e(t!%3 H)G; th! doe %ot !% !t e$f affe(t the we!3ht; ?u t a tra% ferr!%3 4o%etar" fu%d fro4 a f!/ed de-o !t !%to a (urre%t a((ou%t doe %ot 4a1e a 4a% a%" -oorerE to be(o4e -oorer !t ! a$ o %e(e ar" that he free$" -e%d the 4o%e" wh!(h thu be(o4e a5a!$ab$eA I% -re3%a%(" the %eed of the 3row!%3 e4br"o ta1e (are of th! to o4e e/te%t; but !% the treat4e%t of obe !t" there ! %o e4br"o; a%d o a 5er" e5ere d!etar" re tr!(t!o% 4u t ta1e !t -$a(e for the durat!o% of treat4e%tA O%$" whe% the fat wh!(h ! !% tra% !t u%der the effe(t of H)G ! a(tua$$" (o% u4ed (a% 4ore fat be w!thdraw% fro4 the f!/ed de-o !t A I% -re3%a%(" !t wou$d be 4o t u%de !rab$e !f the fetu were offered a4-$e food o%$" whe% there ! a h!3h !%f$u/ fro4 the !%te t!%a$ tra(tA Idea$ %utr!t!o%a$ (o%d!t!o% for the fetu (a% o%$" be a(h!e5ed whe% the 4otherF b$ood ! (o%t!%ua$$" aturated w!th food; re3ard$e of whether he eat or %ot; a otherw! e a -er!od of tar5at!o% 4!3ht ha4-er the tead" 3rowth of the e4br"oA It ee4 that H)G br!%3 about th! (o%t!%ua$ aturat!o% of the b$ood; wh!(h ! the rea o% wh" obe e -at!e%t u%der treat4e%t w!th H)G %e5er fee$ hu%3r" !% -!te of the!r dra t!(a$$" redu(ed food !%ta1eA The Na"u%e o! Hu*an Cho%&on&c +onado"%o,&n H)G ! %e5er fou%d !% the hu4a% bod" e/(e-t dur!%3 -re3%a%(" a%d !% tho e rare (a e !% wh!(h a re !due of -$a(e%ta$ t! ue (o%t!%ue to 3row !% the wo4b !% what ! 1%ow% a a (hor!o%!( e-!the$!o4aA It ! %e5er fou%d !% the 4a$eA The hu4a% t"-e of (hor!o%!( 3o%adotro-h!% ! fou%d o%$" dur!%3 the -re3%a%(" of wo4e% a%d the 3reat a-e A It ! -rodu(ed !% e%or4ou >ua%t!t!e ; o that dur!%3 (erta!% -ha e of her -re3%a%(" a wo4a% 4a" e/(rete a 4u(h a o%e 4!$$!o% I%ter%at!o%a$ :%!t -er da" !% her ur!%e 0 e%ou3h to re%der a 4!$$!o% !%fa%t!$e rat -re(o(!ou $" 4atureA Other 4a44a$ 4a1e u e of a d!ffere%t hor4o%e; wh!(h (a% be e/tra(ted fro4 the!r b$ood eru4 but %ot fro4 the!r ur!%eA The!r -$a(e%ta d!ffer !% th! a%d other re -e(t fro4 that of 4a% a%d the 3reat a-e A Th! a%!4a$ (hor!o%!( 3o%adotro-h!% ! 4u(h $e ra-!d$" bro1e% dow% !% the hu4a% bod" tha% H)G; a%d !t ! a$ o $e u!tab$e for the treat4e%t of obe !t"A A ofte% ha--e% !% 4ed!(!%e; 4u(h (o%fu !o% ha bee% (au ed b" 3!5!%3 H)G !t %a4e before !t true 4ode of a(t!o% wa u%der toodA It ha bee% e/-$a!%ed that gonadotrophin $!tera$$" 4ea% a e/ 3$a%d d!re(ted ub ta%(e or hor4o%e; a%d th! ! >u!te 4! $ead!%3A It date fro4 the ear$" da" whe% !t wa f!r t fou%d that H)G ! ab$e to re%der !%fa%t!$e e/ 3$a%d 4ature; whereb" !t wa e%t!re$" o5er$oo1ed that !t ha %o t!4u$at!%3 effe(t what oe5er o% %or4a$$" de5e$o-ed a%d %or4a$$" fu%(t!o%!%3 e/ 3$a%d A No a4ou%t of H)G ! e5er ab$e to !%(rea e a %or4a$ e/ fu%(t!o%E !t (a% o%$" !4-ro5e a% ab%or4a$ o%e a%d !% the "ou%3 ha te% the o% et of -ubert"A Howe5er; th! ! %o d!re(t effe(tA H)G a(t e/($u !5e$" at a d!e%(e-ha$!( $e5e$ a%d there br!%3 about a (o% !derab$e !%(rea e !% the fu%(t!o%a$ (a-a(!t" of a$$ tho e (e%ter wh!(h are wor1!%3 at 4a/!4u4 (a-a(!t"A 20

The Rea +onado"%o,h&ns Two hor4o%e 1%ow% !% the fe4a$e a fo$$!($e t!4u$at!%3 hor4o%e +FSH, a%d (or-u $uteu4 t!4u$at!%3 hor4o%e +LSH, are e(reted b" the a%ter!or $obe of the -!tu!tar" 3$a%dA The e hor4o%e are rea$ 3o%adotro-h!% be(au e the" d!re(t$" 3o5er% the fu%(t!o% of the o5ar!e A The a%ter!or -!tu!tar" ! !% tur% 3o5er%ed b" the d!e%(e-ha$o%; a%d o whe% there ! a% o5ar!a% def!(!e%(" the d!e%(e-ha$!( (e%ter (o%(er%ed ! hard -ut to (orre(t 4atter b" !%(rea !%3 the e(ret!o% fro4 the a%ter!or -!tu!tar" of FSH or LSH; a the (a e 4a" beA 6he% e/ua$ def!(!e%(" ! ($!%!(a$$" -re e%t; th! ! a !3% that the d!e%(e-ha$!( (e%ter (o%(er%ed ! u%ab$e; !% -!te of 4a/!4a$ e/ert!o%; to (o-e w!th the de4a%d for a%ter!or -!tu!tar" t!4u$at!o%A C 6he% the% the ad4!%! trat!o% of H)G !%(rea e the fu%(t!o%a$ (a-a(!t" of the d!e%(e-ha$o%; a$$ de4a%d (a% be fu$$" at! f!ed a%d the e/ def!(!e%(" ! (orre(tedA That th! ! the true 4e(ha%! 4 u%der$"!%3 the -re u4ed 3o%adotro-h!( a(t!o% of H)G ! (o%f!r4ed b" the fa(t that whe% the -!tu!tar" 3$a%d of !%fa%t!$e rat ! re4o5ed before the" are 3!5e% H)G; the $atter ha %o effe(t o% the!r e/ 3$a%d A H)G (a%%ot therefore ha5e a d!re(t e/ 3$a%d t!4u$at!%3 a(t!o% $!1e that of the a%ter!or -!tu!tar" 3o%adotro-h!% ; a FSH a%d LSH are ?u t$" (a$$edA The $atter are e%t!re$" d!ffere%t ub ta%(e fro4 that wh!(h (a% be e/tra(ted fro4 -re3%a%(" ur!%e a%d wh!(h; u%fortu%ate$"; ! (a$$ed (hor!o%!( 3o%adotro-h!%A It wou$d be %o 4ore ($u4 "; a%d (erta!%$" far 4ore a--ro-r!ate; !f H)G were he%(eforth (a$$ed (hor!o%!( d!e%(e-ha$otro-h!%A HC+ no Se- Ho%*one It (a%%ot be uff!(!e%t$" e4-ha !Bed that H)G ! %ot a e/ hor4o%e; that !t a(t!o% ! !de%t!(a$ !% 4e%; wo4e%; (h!$dre% a%d !% tho e (a e !% wh!(h the e/ 3$a%d %o $o%3er fu%(t!o% ow!%3 to o$d a3e or the!r ur3!(a$ re4o5a$A The o%$" e/ua$ (ha%3e !t (a% br!%3 about after -ubert" ! a% !4-ro5e4e%t of a -re0e/! t!%3 def!(!e%("; but %e5er a t!4u$at!o% be"o%d the %or4a$A I% a% !%d!re(t wa" 5!a the a%ter!or -!tu!tar"; H)G re3u$ate 4e% truat!o% a%d fa(!$!tate (o%(e-t!o%; but !t %e5er 5!r!$!Be a wo4a% or fe4!%!Be a 4a%A It %e!ther 4a1e 4e% 3row brea t %or doe !t !%terfere w!th the!r 5!r!$!t"; thou3h where th! wa def!(!e%t !t 4a" !4-ro5e !tA It %e5er 4a1e wo4e% 3row a beard or de5e$o- a 3ruff 5o!(eA I ha5e tre ed th! -o!%t o%$" for the a1e of 4" $a" reader ; be(au e !t ! our da!$" e/-er!e%(e that whe% -at!e%t hear the word hor4o%e the" !44ed!ate$" ?u4- to the (o%($u !o% that th! 4u t ha5e o4eth!%3 to do w!th the e/0 -hereA The" are %ot a((u to4ed a we are; to th!%1 th"ro!d; !% u$!%; (ort! o%e; adre%a$!% et(; a hor4o%e A

C A we are -ea1!%3 of -ure$" re3u$ator" d! order ; we ob5!ou $" e/($ude a$$ u(h (a e !% wh!(h there are 3ro or3a%!( $e !o% of the -!tu!tar" or the e/ 3$a%d the4 e$5e A

21

I*,o%"ance and Po"enc) o! HC+ Ow!%3 to the fa(t that H)G ha %o d!re(t a(t!o% o% a%" e%do(r!%e 3$a%d; !t e%or4ou !4-orta%(e !% -re3%a%(" ha bee% o5er$oo1ed a%d !t -ote%(" u%dere t!4atedA Thou3h a -re3%a%t wo4a% (a% -rodu(e a 4u(h a o%e 4!$$!o% u%!t -er da"; we f!%d that the do e of o%$" 1*7 u%!t -er da" ! a4-$e to redu(e we!3ht at the rate of rou3h$" o%e -ou%d -er da"; e5e% !% a (o$o u we!3h!%3 499 -ou%d ; whe% a o(!ated w!th a 7990)a$or!e d!etA It ! %o e/a33erat!o% to a" that the f$ood!%3 of the fe4a$e bod" w!th H)G ! b" far the 4o t -e(ta(u$ar hor4o%a$ e5e%t !% -re3%a%("A It ha a% e%or4ou -rote(t!5e !4-orta%(e for 4other a%d (h!$d; a%d I e5e% 3o o far a to a" that %o wo4a%; a%d (erta!%$" %ot a% obe e o%e; (ou$d (arr" her -re3%a%(" to ter4 w!thout !tA If I (a% be for3!5e% for (o4-ar!%3 4" fe$$ow0e%do(r!%o$o3! t w!th w!(1ed God4other ; H)G ha (erta!%$" bee% the!r )!%dere$$a; a%d I (a% o%$" ro4a%t!(a$$" ho-e that !t e/traord!%ar" effe(t o% ab%or4a$ fat w!$$ -ro5e to be !t Fa!r" God4otherA H)G ha bee% 1%ow% for o5er ha$f a (e%tur"A It ! the ub ta%(e wh!(h A (hhe!4 a%d Lo%de1 o br!$$!a%t$" u ed to d!a3%o e ear$" -re3%a%(" out of the ur!%eA A-art fro4 that; the o%$" th!%3 !t d!d !% the e/-er!4e%ta$ $aborator" wa to -rodu(e -re(o(!ou rat ; a%d that wa %ot -art!(u$ar$" t!4u$at!%3 to further re ear(h at a t!4e whe% 4u(h 4ore thr!$$!%3 e%do(r!%o$o3!(a$ d! (o5er!e were -our!%3 !% fro4 a$$ !de ; wee-!%3 H)G !%to the t!$$er ba(1 water A ,o"!licating Disorders So4e (o4-$!(at!%3 d! order are ofte% a o(!ated w!th obe !t"; a%d the e we 4u t br!ef$" d! (u A The 4o t !4-orta%t a o(!ated d! order a%d the o%e !% wh!(h obe !t" ee4 to -$a" a -re(!-!tat!%3 or at $ea t a% a33ra5at!%3 ro$e are the fo$$ow!%3D the tab$e t"-e of d!abete ; 3out; rheu4at! 4 a%d arthr!t! ; h!3h b$ood -re ure a%d harde%!%3 of the arter!e ; (oro%ar" d! ea e a%d (erebra$ he4orrha3eA A-art fro4 the fa(t that the" are ofte% 0 thou3h %ot %e(e ar!$" 0 a o(!ated w!th obe !t"; the e d! order ha5e two th!%3 !% (o44o%A I% a$$ of the4; 4oder% re ear(h ! be(o4!%3 4ore a%d 4ore !%($!%ed to be$!e5e that d!e%(e-ha$!( re3u$at!o% -$a" a do4!%a%t ro$e !% the!r (au at!o%A The other (o44o% fa(tor ! that the" e!ther !4-ro5e or do %ot o((ur dur!%3 -re3%a%("A I% the $atter re -e(t the" are ?o!%ed b" 4a%" other d! order %ot %e(e ar!$" a o(!ated w!th obe !t"A Su(h d! order are; for !% ta%(e; (o$!t! ; duode%a$ or 3a tr!( u$(er ; (erta!% a$$er3!e ; - or!a ! ; $o of ha!r; br!tt$e f!%3er%a!$ ; 4!3ra!%e; et(A If H)G M d!et doe !% the obe e br!%3 about tho e d!e%(e-ha$!( (ha%3e wh!(h are (hara(ter! t!( of -re3%a%("; o%e wou$d e/-e(t to ee a% !4-ro5e4e%t !% a$$ the e (o%d!t!o% (o4-arab$e to that ee% !% rea$ -re3%a%("A The ad4!%! trat!o% of H)G doe !% fa(t do th! !% a re4ar1ab$e wa"A D&abe"es I% a% obe e -at!e%t uffer!%3 fro4 a fa!r$" ad5a%(ed (a e of tab$e d!abete of 4a%" "ear durat!o% !% wh!(h the b$ood u3ar 4a" ra%3e fro4 .0499 43J; !t ! ofte% -o !b$e to to- a$$ a%t!d!abet!( 4ed!(at!o% after the f!r t few da" of treat4e%tA The b$ood u3ar (o%t!%ue to dro- fro4 da" to da" a%d ofte% rea(he %or4a$ 5a$ue !% *0. wee1 A A !% -re3%a%("; th! 22

-he%o4e%o% ! %ot ob er5ed !% the br!tt$e t"-e of d!abete ; a%d a o4e (a e that are -redo4!%a%t$" tab$e 4a" ha5e a 4a$$ br!tt$e fa(tor !% the!r ($!%!(a$ 4a1eu-; a$$ obe e d!abet!( ha5e to be 1e-t u%der a 5er" (arefu$ a%d e/-ert wat(hA A br!tt$e (a e of d!abete ! -r!4ar!$" due to the !%ab!$!t" of the -a%(rea to -rodu(e uff!(!e%t !% u$!%; wh!$e !% the tab$e t"-e; d!e%(e-ha$!( re3u$at!o% ee4 to be of 3reater !4-orta%(eA That ! -o !b$" the rea o% wh" the tab$e for4 re -o%d o we$$ to the H)G 4ethod of treat!%3 obe !t"; wherea the br!tt$e t"-e doe %otA Obe e -at!e%t are 3e%era$$" uffer!%3 fro4 the tab$e t"-e; but a tab$e t"-e 4a" 3radua$$" (ha%3e !%to a br!tt$e o%e; wh!(h ! u ua$$" a o(!ated w!th a $o of we!3htA Thu ; whe% a% obe e d!abet!( f!%d that he ! $o !%3 we!3ht w!thout d!et or treat4e%t; he hou$d at o%(e ha5e h! d!abete e/-ert$" atte%ded toA There ! o4e e5!de%(e to u33e t that the (ha%3e fro4 tab$e to br!tt$e ! 4ore $!ab$e to o((ur !% -at!e%t who are ta1!%3 !% u$!% for the!r tab$e d!abete A Rheu*a"&s* A$$ rheu4at!( -a!% ; e5e% tho e a o(!ated w!th de4o% trab$e bo%" $e !o% ; !4-ro5e ub?e(t!5e$" w!th!% a few da" of treat4e%t; a%d ofte% re>u!re %e!ther (ort! o%e %or a$!("$ate A A3a!% th! ! a we$$ 1%ow% -he%o4e%o% !% -re3%a%("; a%d wh!$e u%der treat4e%t w!th H)G M d!et the effe(t ! %o $e dra4at!(A A !t doe after -re3%a%("; the -a!% of defor4ed ?o!%t retur% after treat4e%t; but 4a$$er do e of -a!%0re$!e5!%3 dru3 ee4 ab$e to (o%tro$ !t at! fa(tor!$" after we!3ht redu(t!o%A I% a%" (a e; the H)G 4ethod 4a1e !t -o !b$e !% obe e arthr!t!( -at!e%t to !%terru-t -ro$o%3ed (ort! o%e treat4e%t w!thout a re(urre%(e of -a!%A Th! !% !t e$f ! 4o t we$(o4e; but there ! the added ad5a%ta3e that the treat4e%t t!4u$ate the e(ret!o% of A)TH !% a -h" !o$o3!(a$ 4a%%er a%d that th! re3e%erate the adre%a$ (orte/; wh!(h ! a-t to uffer u%der -ro$o%3ed (ort! o%e treat4e%tA Cho es"e%o The e/a(t e/te%t to wh!(h the b$ood (ho$e tero$ ! !%5o$5ed !% harde%!%3 of the arter!e ; h!3h b$ood -re ure a%d (oro%ar" d! ea e ! %ot a "et 1%ow%; but !t ! %ow w!de$" ad4!tted that the b$ood (ho$e tero$ $e5e$ ! 3o5er%ed b" d!e%(e-ha$!( 4e(ha%! 4 A The beha5!or of (!r(u$at!%3 (ho$e tero$ ! therefore of -art!(u$ar !%tere t dur!%3 the treat4e%t of obe !t" w!th H)GA )ho$e tero$ (!r(u$ate !% two for4 ; wh!(h we (a$$ free a%d e ter!f!edA Nor4a$$" the e fra(t!o% are -re e%t !% a -ro-ort!o% of about *7J free to 77J e ter!f!ed (ho$e tero$; a%d !t ! the $atter fra(t!o% wh!(h da4a3e the wa$$ of the arter!e A I% -re3%a%(" th! -ro-ort!o% ! re5er ed a%d !t 4a" he ta1e% for 3ra%ted that arter!o ($ero ! %e5er 3et wor e dur!%3 -re3%a%(" for th! 5er" rea o%A To 4" 1%ow$ed3e; the o%$" other (o%d!t!o% !% wh!(h the -ro-ort!o% of free to e ter!f!ed (ho$e tero$ ! re5er ed ! dur!%3 the treat4e%t of obe !t" w!th H)G M d!et; whe% e/a(t$" the a4e -he%o4e%o% ta1e -$a(eA Th! ee4 a% !4-orta%t !%d!(at!o% of how ($o e$" a -at!e%t u%der H)G treat4e%t re e4b$e a -re3%a%t wo4a% !% d!e%(e-ha$!( beha5!orA 6he% the tota$ a4ou%t of (!r(u$at!%3 (ho$e tero$ ! %or4a$ before treat4e%t; th! ab o$ute a4ou%t ! %e!ther !3%!f!(a%t$" !%(rea ed %or de(rea edA 'ut whe% a% obe e -at!e%t w!th a% ab%or4a$$" h!3h (ho$e tero$ a%d a$read" how!%3 !3% of arter!o ($ero ! ! treated w!th H)G; h! b$ood -re ure dro- a%d h! (oro%ar" (!r(u$at!o% ee4 to !4-ro5e; a%d "et h! 23

tota$ b$ood (ho$e tero$ 4a" oar to he!3ht %e5er before rea(hedA At f!r t th! 3reat$" a$ar4ed u A 'ut the% we aw that the -at!e%t (a4e to %o har4 e5e% !f treat4e%t wa (o%t!%ued a%d we fou%d !% fo$$ow0u- e/a4!%at!o% u%derta1e% o4e 4o%th after treat4e%t that the (ho$e tero$ wa 4u(h better tha% !t had bee% before treat4e%tA A the !%(rea e ! 4o t$" !% the for4 of the %ot da%3erou free (ho$e tero$; we 3radua$$" (a4e to we$(o4e the -he%o4e%o%A Toda" we be$!e5e that the r! e ! e%t!re$" due to the $!berat!o% of re(e%t (ho$e tero$ de-o !t that ha5e %ot "et u%der3o%e (a$(!f!(at!o% !% the arter!a$ wa$$ a%d therefore h!3h$" be%ef!(!a$A +ou" A% !de%t!(a$ beha5!or ! fou%d !% the b$ood ur!( a(!d $e5e$ of -at!e%t uffer!%3 fro4 3outA 2red!(tab$" u(h -at!e%t 3et a% a(ute a%d ofte% e5ere atta(1 after the f!r t few da" of H)G treat4e%t but the% re4a!% e%t!re$" free of -a!%; !% -!te of the fa(t that the!r b$ood ur!( a(!d ofte% how a 4ar1ed !%(rea e wh!(h 4a" -er ! t for e5era$ 4o%th after treat4e%tA Tho e -at!e%t who ha5e re3a!%ed the!r %or4a$ we!3ht re4a!% free of "4-to4 re3ard$e of what the" eat; wh!$e tho e that re>u!re a e(o%d (our e of treat4e%t 3et a%other atta(1 of 3out a oo% a the e(o%d (our e ! !%!t!atedA 6e do %ot "et 1%ow what d!e%(e-ha$!( 4e(ha%! 4 are !%5o$5ed !% 3outE -o !b$" e4ot!o%a$ fa(tor -$a" a ro$e; a%d !t ! worth re4e4ber!%3 that the d! ea e doe %ot o((ur !% wo4e% of (h!$dbear!%3 a3eA 6e %ow 3!5e * tab$et da!$" of L@LORI) to a$$ -at!e%t who 3!5e a h! tor" of 3out a%d ha5e a h!3h b$ood ur!( a(!d $e5e$A I% th! wa" we (a% (o4-$ete$" a5o!d atta(1 dur!%3 treat4e%tA B ood P%essu%e 2at!e%t who ha5e brou3ht the4 e$5e to the br!%1 of 4a$%utr!t!o% b" e/a33erated d!et!%3; $a/at!5e et(; ofte% ha5e a% ab%or4a$$" $ow b$ood -re ureA I% the e (a e the b$ood -re ure r! e to %or4a$ 5a$ue at the be3!%%!%3 of treat4e%t a%d the% 5er" 3radua$$" dro- ; a !t a$wa" doe !% -at!e%t w!th a %or4a$ b$ood -re ureA Nor4a$ 5a$ue are a$wa" re3a!%ed a few da" after the treat4e%t ! o5erA Of th! $ower!%3 of the b$ood -re ure dur!%3 treat4e%t the -at!e%t are %ot awareA 6he% the b$ood -re ure ! ab%or4a$$" h!3h; a%d -ro5!ded there are %o dete(tab$e re%a$ $e !o% ; the -re ure dro- ; a !t u ua$$" doe !% -re3%a%("A The dro! ofte% 5er" ra-!d; o ra-!d !% fa(t that !t o4et!4e ! ad5! ab$e to $ow dow% the -ro(e w!th -re ure0 u ta!%!%3 4ed!(at!o% u%t!$ the (!r(u$at!o% ha had a few da" t!4e to ad?u t !t e$f to the %ew !tuat!o%A O% the other ha%d; a4o%3 the thou a%d of (a e treated we ha5e %e5er ee% a%" u%toward !%(!de%t wh!(h (ou$d be attr!buted to the rather udde% dro- !% h!3h b$ood -re ureA 6he% a wo4a% uffer!%3 fro4 h!3h b$ood -re ure be(o4e -re3%a%t her b$ood -re ure 5er" oo% dro- ; but after her (o%f!%e4e%t !t 4a" 3radua$$" r! e ba(1 to !t for4er $e5e$A S!4!$ar$"; a h!3h b$ood -re ure -re e%t before H)G treat4e%t te%d to r! e a3a!% after the treat4e%t ! o5er; thou3h th! ! %ot a$wa" the (a eA 'ut the for4er h!3h $e5e$ are rare$" rea(hed; a%d we ha5e 3athered the !4-re !o% that u(h re$a- e re -o%d better to orthodo/ dru3 u(h a Re er-!%e tha% before treat4e%tA

24

Pe,"&c $ ce%s I% our (a e of obe !t" w!th 3a tr!( or duode%a$ u$(er we ha5e %ot!(ed a ur-r! !%3 ub?e(t!5e !4-ro5e4e%t !% -!te of a d!et wh!(h wou$d 3e%era$$" be (o% !dered 4o t !%a--ro-r!ate for a% u$(er -at!e%tA Here; too; there ! a !4!$ar!t" w!th -re3%a%("; !% wh!(h -e-t!( u$(er hard$" e5er o((urA Howe5er we ha5e ee% two (a e w!th a -re5!ou h! tor" of e5era$ he4orrha3e !% wh!(h a b$eed!%3 o((urred w!th!% * wee1 of the e%d of treat4e%tA Pso%&as&s, #&n(e%na& s, Ha&%, .a%&cose $ ce%s A !% -re3%a%("; - or!a ! 3reat$" !4-ro5e dur!%3 treat4e%t but 4a" re$a- e whe% the treat4e%t ! o5erA 8o t -at!e%t -o%ta%eou $" re-ort a 4ar1ed !4-ro5e4e%t !% the (o%d!t!o% of br!tt$e f!%3er%a!$ A The $o of ha!r %ot !%fre>ue%t$" a o(!ated w!th obe !t" ! te4-orar!$" arre ted; thou3h !% 5er" rare (a e a% !%(rea ed $o of ha!r ha bee% re-ortedA I re4e4ber a (a e !% wh!(h a -at!e%t de5e$o-ed a -at(h" ba$d%e N o0(a$$ed alopecia areata 0 after a e5ere e4ot!o%a$ ho(1; ?u t before he wa about to tart a% H)G treat4e%tA Our der4ato$o3! t d!a3%o ed the (a e a a -art!(u$ar$" e5ere o%e; -red!(t!%3 that a$$ the ha!r wou$d be $o tA He (ou% e$ed a3a!% t the redu(!%3 treat4e%t; but !% 5!ew of 4" -re5!ou e/-er!e%(e a%d a the -at!e%t wa 5er" a%/!ou %ot to -o t-o%e redu(!%3; I d! (u ed the 4atter w!th the der4ato$o3! t a%d !t wa a3reed that; ha5!%3 fu$$" a(>ua!%ted the -at!e%t w!th the !tuat!o%; the treat4e%t hou$d be tartedA Dur!%3 the treat4e%t; wh!(h $a ted four wee1 ; the further de5e$o-4e%t of the ba$d -at(he wa a$4o t; !f %ot >u!te; arre tedE howe5er; w!th!% a wee1 of ha5!%3 f!%! hed the (our e of H)G; a$$ the re4a!%!%3 ha!r fe$$ out a -red!(ted b" the der4ato$o3! tA The !%tere t!%3 -o!%t ! that the treat4e%t wa ab$e to -o t-o%e th! re u$t but %ot to -re5e%t !tA The -at!e%t ha %ow 3row% a %ew to(1 of ha!r of wh!(h he ! ?u t$" -roudA I% obe e -at!e%t w!th $ar3e 5ar!(o e u$(er we were ur-r! ed to f!%d that the e u$(er hea$ ra-!d$" u%der treat4e%t w!th H)GA 6e ha5e !%(e treated %o% obe e -at!e%t uffer!%3 fro4 5ar!(o e u$(er w!th da!$" do e of H)G o% %or4a$ d!et w!th e>ua$$" 3ood re u$t A The /P%e(nan"0 Ma e 6he% a 4a$e -at!e%t hear that he ! about to be -ut !%to a (o%d!t!o% wh!(h !% o4e re -e(t re e4b$e -re3%a%("; he ! u ua$$" ho(1ed a%d horr!f!edA The -h" !(!a% 4u t therefore (arefu$$" e/-$a!% that th! doe %ot 4ea% that he w!$$ be fe4!%!Bed a%d that H)G !% %o wa" !%terfere w!th h! e/A He 4u t be 4ade to u%der ta%d that !% the !%tere t of the -ro-a3at!o% of the -e(!e %ature -ro5!de for a -erfe(t fu%(t!o%!%3 of the re3u$ator" head>uarter !% the d!e%(e-ha$o% dur!%3 -re3%a%(" a%d that we are 4ere$" u !%3 th! %atura$ afe3uard a a 4ea% of (orre(t!%3 the d!e%(e-ha$!( d! order wh!(h ! re -o% !b$e for h! o5erwe!3htA

25

TECHNI1$E Wa%n&n(s I 4u t war% the $a" reader that what fo$$ow ! 4a!%$" for the treat!%3 -h" !(!a% a%d 4o t (erta!%$" %ot a do0!t0"our e$f -r!4erA 8a%" of the e/-re !o% u ed 4ea% o4eth!%3 e%t!re$" d!ffere%t to a >ua$!f!ed do(tor tha% that wh!(h the!r (o44o% u e !4-$!e ; a%d o%$" a -h" !(!a% (a% (orre(t$" !%ter-ret the "4-to4 wh!(h 4a" ar! e dur!%3 treat4e%tA A%" -at!e%t who th!%1 he (a% redu(e b" ta1!%3 a few < hot K a%d eat!%3 $e ! %ot o%$" ure to be d! a--o!%ted but 4a" be head!%3 for er!ou troub$eA The be%ef!t the -at!e%t (a% der!5e fro4 read!%3 th! -art of the boo1 ! a fu$$er rea$!Bat!o% of how 5er" !4-orta%t !t ! for h!4 to fo$$ow to the $etter h! -h" !(!a%F !% tru(t!o% A I% treat!%3 obe !t" w!th the H)G M d!et 4ethod we are ha%d$!%3 what ! -erha- the 4o t (o4-$e/ or3a% !% the hu4a% bod"A The d!e%(e-ha$o%F fu%(t!o%a$ e>u!$!br!u4 ! de$!(ate$" -o! ed; o that whate5er ha--e% !% o%e -art ha re-er(u !o% !% other A I% obe !t" th! ba$a%(e ! out of 1!$ter a%d (a% o%$" be re tored !f the te(h%!>ue I a4 about to de (r!be ! fo$$owed !4-$!(!t$"A E5e% ee4!%3$" !% !3%!f!(a%t de5!at!o% ; -art!(u$ar$" tho e that at f!r t !3ht ee4 to be a% !4-ro5e4e%t; are 5er" $!ab$e to -rodu(e 4o t d! a--o!%t!%3 re u$t a%d e5e% a%%u$ the effe(t (o4-$ete$"A For !% ta%(e; !f the d!et ! !%(rea ed fro4 799 to #99 or 799 )a$or!e ; the $o of we!3ht ! >u!te u% at! fa(tor"A If the da!$" do e of H)G ! ra! ed to *99 or 4ore u%!t da!$" !t a(t!o% ofte% a--ear to be re5er ed; -o !b$" be(au e $ar3er do e e5o1e d!e%(e-ha$!( (ou%ter0re3u$at!o% A O% the other ha%d; the d!e%(e-ha$o% ! a% e/tre4e$" robu t or3a% !% -!te of !t u%be$!e5ab$e !%tr!(a("A Fro4 a% e5o$ut!o%ar" -o!%t of 5!ew !t ! o%e of the o$de t or3a% !% our bod" a%d !t e5o$ut!o%ar" h! tor" date ba(1 4ore tha% 799 4!$$!o% "ear A Th! ha te%dered !t e/traord!%ar!$" ada-tab$e to a$$ %atura$ e/!3e%(!e ; a%d that ! o%e of the 4a!% rea o% wh" the hu4a% -e(!e wa ab$e to e5o$5eA 6hat !t e5o$ut!o% d!d %ot -re-are !t for were the (o%d!t!o% to wh!(h hu4a% (u$ture a%d (!5!$!Bat!o% %ow e/-o e !tA H&s"o%) "a2&n( 6he% a -at!e%t f!r t -re e%t h!4 e$f for treat4e%t; we ta1e a 3e%era$ h! tor" a%d %ote the t!4e whe% the f!r t !3% of o5erwe!3ht were ob er5edA 6e tr" to e tab$! h the h!3he t we!3ht the -at!e%t ha e5er had !% h! $!fe +ob5!ou $" e/($ud!%3 -re3%a%(",; whe% th! wa ; a%d what 4ea ure ha5e h!therto bee% ta1e% !% a% effort to redu(eA It ha bee% our e/-er!e%(e that tho e -at!e%t who ha5e bee% ta1!%3 th"ro!d -re-arat!o% for $o%3 -er!od ha5e a $!3ht$" $ower a5era3e $o of we!3ht u%der treat4e%t w!th H)G tha% tho e who ha5e %e5er ta1e% th"ro!dA Th! ! e5e% o !% tho e -at!e%t who ha5e bee% ta1!%3 th"ro!d be(au e the" had a% ab%or4a$$" $ow ba a$ 4etabo$!( rateA I% 4a%" of the e (a e the $ow '8R ! %ot due to a%" !%tr!% !( def!(!e%(" of the th"ro!d 3$a%d; but rather to a $a(1 of d!e%(e-ha$!( t!4u$at!o% of the th"ro!d 3$a%d 5!a the a%ter!or -!tu!tar" $obeA 6e %e5er a$$ow th"ro!d to be ta1e% dur!%3 treat4e%t; a%d "et a '8R wh!(h wa 5er" $ow before treat4e%t ! u ua$$" fou%d to be %or4a$ after a wee1 or two of H)G M d!etA Need$e to a"; th! doe %ot a--$" to tho e (a e !% wh!(h a th"ro!d def!(!e%(" ha bee% -rodu(ed b" the ur3!(a$ re4o5a$ of a -art of a% o5era(t!5e 3$a%dA It ! a$ o 4o t !4-orta%t to a (erta!% whether the -at!e%t ha ta1e% d!uret!( +water e$!4!%at!%3 -!$$ , a th! a$ o de(rea e the we!3ht $o u%der the H)G 26

re3!4e%A Retur%!%3 to our -ro(edure; we %e/t a 1 the -at!e%t a few >ue t!o% to wh!(h he ! he$d to re-$" !4-$" w!th <"e K or <%oKA The e >ue t!o% areD Do "ou uffer fro4 heada(he O rheu4at!( -a!% O 4e% trua$ d! order O (o% t!-at!o%O breath$e %e or e/ert!o%O wo$$e% a%1$e O Do "ou (o% !der "our e$f 3reed"O Do "ou fee$ the %eed to eat %a(1 betwee% 4ea$ O The -at!e%t the% tr!- a%d ! we!3hed a%d 4ea uredA The %or4a$ we!3ht for h! he!3ht; a3e; 1e$eta$ a%d 4u (u$ar bu!$d ! e tab$! hed fro4 tab$e of tat! t!(a$ a5era3e ; whereb" !% wo4e% !t ! ofte% %e(e ar" to 4a1e a% a$$owa%(e for -art!(u$ar$" $ar3e a%d hea5" brea t A The de3ree of o5erwe!3ht ! the% (a$(u$ated; a%d fro4 th! the durat!o% of treat4e%t (a% be rou3h$" a e ed o% the ba ! of a% a5era3e $o of we!3ht of a $!tt$e $e tha% a -ou%d; a" .990499 3ra4 0-er do e; -er da"A It ! a -art!(u$ar$" !%tere t!%3 feature of the H)G treat4e%t that !% rea o%ab$" (oo-erat!5e -at!e%t th! f!3ure ! re4ar1ab$" (o% ta%t; re3ard$e of e/; a3e a%d de3ree of o5erwe!3htA The Du%a"&on o! T%ea"*en" 2at!e%t who %eed to $o e 17 -ou%d +7 13A, or $e re>u!re *# da" treat4e%t w!th *. da!$" do e A The e/tra three da" are %eeded be(au e a$$ -at!e%t 4u t (o%t!%ue the 7990)a$or!e d!et for three da" after the $a tA Th! ! a 5er" e e%t!a$ -art of the treat4e%t; be(au e !f the" tart eat!%3 %or4a$$" a $o%3 a there ! e5e% a tra(e of H)G !% the!r bod" the" -ut o% we!3ht a$ar4!%3$" at the e%d of the treat4e%tA After three da" whe% a$$ the H)G ha bee% e$!4!%ated th! doe %ot ha--e%; be(au e the b$ood ! the% %o $o%3er aturated w!th food a%d (a% thu a((o44odate a% e/tra !%f$u/ fro4 the !%te t!%e w!thout !%(rea !%3 !t 5o$u4e b" reta!%!%3 waterA 6e %e5er 3!5e a treat4e%t $a t!%3 $e tha% *# da" ; e5e% !% -at!e%t %eed!%3 to $o e o%$" 7 -ou%d A It ee4 that e5e% !% the 4!$de t (a e of obe !t" the d!e%(e-ha$o% re>u!re about three wee1 re t fro4 the 4a/!4a$ e/ert!o% to wh!(h !t ha bee% -re5!ou $" ub?e(ted !% order to re3a!% fu$$" !t %or4a$ fat0ba%1!%3 (a-a(!t"A )$!%!(a$$" th! e/-re e !t e$f !% the fa(t that whe% !% the e 4!$d (a e treat4e%t ! to--ed a oo% a the we!3ht ! %or4a$; wh!(h 4a" be a(h!e5ed !% a wee1; !t ! 4u(h 4ore ea !$" re3a!%ed tha% after a fu$$ (our e of *. do e A A oo% a u(h -at!e%t ha5e $o t a$$ the!r ab%or4a$ u-erf$uou fat; the" at o%(e be3!% to fee$ ra5e%ou $" hu%3r" !% -!te of (o%t!%ued do e A Th! ! be(au e H)G o%$" -ut ab%or4a$ fat !%to (!r(u$at!o% a%d (a%%ot; !% the do e u ed; $!berate %or4a$ fat de-o !t E !%deed; !t ee4 to -re5e%t the!r (o% u4-t!o%A A oo% a the!r tat! t!(a$$" %or4a$ we!3ht ! rea(hed; the e -at!e%t are -ut o% &9901999 )a$or!e for the re t of the treat4e%tA The d!et ! arra%3ed !% u(h a wa" that the we!3ht re4a!% -erfe(t$" tat!o%ar" a%d ! thu (o%t!%ued for three da" after the *.rd do eA O%$" the% are the -at!e%t free to eat a%"th!%3 the" -$ea e e/(e-t u3ar a%d tar(he for the %e/t three wee1 A Su(h ear$" (a e are (o44o% a4o%3 a(tre e ; 4ode$ ; a%d -er o% who are t!red of obe !t"; ha5!%3 ee% !t ra5a3e !% other 4e4ber of the!r fa4!$"A F!$4 a(tre e fre>ue%t$" e/-$a!% that the" 4u t we!3h $e tha% %or4a$A 6!th th! re>ue t we f$at$" refu e to (o4-$"; f!r t; be(au e we u%derta1e to (ure a d! order; %ot to (reate a %ew o%e; a%d e(o%d; be(au e 27

!t ! !% the %ature of the H)G 4ethod that !t ! e$f $!4!t!%3A It be(o4e (o4-$ete$" !%effe(t!5e a oo% a a$$ ab%or4a$ fat ! (o% u4edA A(tre e w!th a $!3ht te%de%(" to obe !t"; ha5!%3 tr!ed a$$ 4a%%er of redu(!%3 4ethod ; !%5ar!ab$" (o4e to the (o%($u !o% that the!r f!3ure ! at! fa(tor" o%$" whe% the" are u%derwe!3ht; !4-$" be(au e %o%e of the e 4ethod re4o5e the!r u-erf$uou fat de-o !t A 6he% the" ee that u%der H)G the!r f!3ure !4-ro5e out of a$$ -ro-ort!o% to the a4ou%t of we!3ht $o t; the" are %ear$" a$wa" (o%te%t to re4a!% w!th!% the!r %or4a$ we!3ht0ra%3eA 6he% a -at!e%t ha 4ore tha% 17 -ou%d to $o e the treat4e%t ta1e $o%3er but the 4a/!4u4 we 3!5e !% a !%3$e (our e ! 49 do e ; %or do we a a ru$e a$$ow -at!e%t to $o e 4ore tha% .4 $b A +17 P3A, at a t!4eA The treat4e%t ! to--ed whe% e!ther .4 $b A ha5e bee% $o t or 49 do e ha5e bee% 3!5e%A The o%$" e/(e-t!o% we 4a1e ! !% the (a e of 3rote >ue$" obe e -at!e%t who 4a" be a$$owed to $o e a% add!t!o%a$ 70# $b A !f th! o((ur before the 49 do e are u-A I**un&") "o HC+ The rea o% for $!4!t!%3 a (our e to 49 do e ! that b" the% o4e -at!e%t 4a" be3!% to how !3% of H)G !44u%!t"A Thou3h th! -he%o4e%o% ! we$$ 1%ow%; we (a%%ot a "et def!%e the u%der$"!%3 4e(ha%! 4A 8a"be after a (erta!% $e%3th of t!4e the bod" $ear% to brea1 dow% a%d e$!4!%ate H)G 5er" ra-!d$"; or -o !b$" -ro$o%3ed treat4e%t $ead to o4e ort of (ou%ter0re3u$at!o% wh!(h a%%u$ the d!e%(e-ha$!( effe(tA After 49 da!$" do e !t ta1e about !/ wee1 before th! o0(a$$ed !44u%!t" ! $o t a%d H)G a3a!% be(o4e fu$$" effe(t!5eA : ua$$" after about 49 do e -at!e%t 4a" fee$ the o% et of !44u%!t" a hu%3er wh!(h wa -re5!ou $" ab e%tA I% tho e (o4-arat!5e$" rare (a e !% wh!(h !3% of !44u%!t" de5e$o- before the fu$$ (our e of 49 do e ha bee% (o4-$eted 0 a" at the .7th do e 0 treat4e%t 4u t be to--ed at o%(e; be(au e !f !t ! (o%t!%ued the -at!e%t be3!% to $oo1 wear" a%d draw%; fee$ wea1 a%d hu%3r" a%d a%" further $o of we!3ht a(h!e5ed ! the% a$wa" at the e/-e% e of %or4a$ fatA Th! ! %ot o%$" u%de !rab$e; but %or4a$ fat ! a$ o !% ta%t$" re3a!%ed a oo% a the -at!e%t ! retur%ed to a free d!etA 2at!e%t who %eed o%$" *. do e 4a" be !%?e(ted da!$"; !%($ud!%3 Su%da" ; a the" %e5er de5e$o- !44u%!t"A I% tho e that ta1e 49 do e the o% et of !44u%!t" (a% be de$a"ed !f the" are 3!5e% o%$" !/ do e a wee1; $ea5!%3 out Su%da" or a%" other da" the" (hoo e; -ro5!ded that !t ! a$wa" the a4e da"A O% the da" o% wh!(h the" do %ot re(e!5e the do e the" u ua$$" fee$ a $!3ht e% at!o% of hu%3erA At f!r t we thou3ht that th! 4!3ht be -ure$" - "(ho$o3!(a$; but we fou%d that whe% %or4a$ a$!%e ! !%?e(ted w!thout the -at!e%tF 1%ow$ed3e the a4e -he%o4e%o% o((ur A Mens"%ua"&on Dur!%3 4e% truat!o% %o do e are 3!5e%; but the d!et ! (o%t!%ued a%d (au e %o hard h!-E "et a oo% a the 4e% truat!o% ! o5er; the -at!e%t be(o4e e/tre4e$" hu%3r" u%$e the do e are re u4ed at o%(eA It ! 5er" !4-re !5e to ee the uffer!%3 of a wo4a% who ha (o%t!%ued her d!et for a da" or two be"o%d the e%d of the -er!od w!thout (o4!%3 for her do e a%d the% to hear the %e/t da" that a$$ hu%3er (ea ed w!th!% a few hour after the do e a%d to ee her o%(e a3a!% (o%te%t; f$or!d a%d (heerfu$A 6h!$e o% the >ue t!o% of 4e% truat!o% !t 4u t he added that !% tee%a3ed 3!r$ the -er!od 4a" !% o4e rare (a e be de$a"ed a%d 28

e/(e-t!o%a$$" to- a$to3etherA If the% $ater th! ! art!f!(!a$$" !%du(ed o4e we!3ht 4a" be re3a!%edA #u%"he% Cou%ses 2at!e%t re>u!r!%3 the $o of 4ore tha% .4 $b A 4u t ha5e a e(o%d or e5e% 4ore (our e A A e(o%d (our e (a% be tarted after a% !%ter5a$ of %ot $e tha% !/ wee1 ; thou3h the -au e (a% be 4ore tha% !/ wee1 A 6he% a th!rd; fourth or e5e% f!fth (our e ! %e(e ar"; the !%ter5a$ betwee% (our e hou$d be 4ade -ro3re !5e$" $o%3erA 'etwee% a e(o%d a%d th!rd (our e e!3ht wee1 hou$d e$a- e; betwee% a th!rd a%d fourth (our e twe$5e wee1 ; betwee% a fourth a%d f!fth (our e twe%t" wee1 a%d betwee% a f!fth a%d !/th (our e !/ 4o%th A I% th! wa" !t ! -o !b$e to br!%3 about a we!3ht redu(t!o% of 199 $b A a%d 4ore !f re>u!red w!thout the $ea t hard h!- to the -at!e%tA I% 3e%era$; 4e% do $!3ht$" better tha% wo4e% a%d ofte% rea(h a o4ewhat h!3her a5era3e da!$" $o A Ver" ad5a%(ed (a e do a $!tt$e better tha% ear$" o%e ; but !t ! a re4ar1ab$e fa(t that th! d!ffere%(e ! o%$" ?u t tat! t!(a$$" !3%!f!(a%tA Cond&"&ons "ha" *us" be acce,"ed be!o%e "%ea"*en" O% the ba ! of the e data the -robab$e durat!o% of treat4e%t (a% he (a$(u$ated w!th (o% !derab$e a((ura("; a%d th! ! e/-$a!%ed to the -at!e%tA It ! 4ade ($ear to h!4 that dur!%3 the (our e of treat4e%t he 4u t atte%d the ($!%!( da!$" to be we!3hed; !%?e(ted a%d 3e%era$$" (he(1edA A$$ -at!e%t that $!5e !% Ro4e or ha5e re !de%t fr!e%d or re$at!o% w!th who4 the" (a% ta" are treated a out0-at!e%t ; but -at!e%t (o4!%3 fro4 abroad 4u t ta" !% the ho -!ta$; a %o hote$ or re taura%t (a% be re$!ed u-o% to -re-are the d!et w!th uff!(!e%t a((ura("A The e -at!e%t ha5e the!r 4ea$ ; $ee-; a%d atte%d the ($!%!( !% the ho -!ta$; but are otherw! e free to -e%d the!r t!4e a the" -$ea e !% the (!t" a%d !t urrou%d!%3 !3ht ee!%3; bath!%3 or theater03o!%3A It ! a$ o 4ade ($ear that betwee% (our e the -at!e%t 3et %o treat4e%t a%d ! free to eat a%"th!%3 he -$ea e e/(e-t tar(he a%d u3ar dur!%3 the f!r t . wee1 A It ! !4-re ed u-o% h!4 that he w!$$ ha5e to fo$$ow the -re (r!bed d!et to the $etter a%d that after the f!r t three da" th! w!$$ (o t h!4 %o effort; a he w!$$ fee$ %o hu%3er a%d 4a" !%deed ha5e d!ff!(u$t" !% 3ett!%3 dow% the 799 )a$or!e wh!(h he w!$$ be 3!5e%A If the e (o%d!t!o% are %ot a((e-tab$e the (a e ! refu ed; a a%" (o4-ro4! e or ha$f04ea ure ! bou%d to -ro5e utter$" d! a--o!%t!%3 to -at!e%t a%d -h" !(!a% a$!1e a%d ! a wa te of t!4e a%d e%er3"A Thou3h a -at!e%t (a% o%$" (o% !der h!4 e$f rea$$" (ured whe% he ha bee% redu(ed to h! ta t!(a$$" %or4a$ we!3ht; we do %ot !% ! t that he (o44!t h!4 e$f to that e/te%tA E5e% a -art!a$ $o of o5erwe!3ht ! h!3h$" be%ef!(!a$; a%d !t ! our e/-er!e%(e that o%(e a -at!e%t ha (o4-$eted a f!r t (our e he ! o e%thu !a t!( about the ea e w!th wh!(h the 0 to h!4 ur-r! !%3 0 re u$t are a(h!e5ed that he a$4o t !%5ar!ab$" (o4e ba(1 for 4oreA There (erta!%$" (a% be %o doubt that !% 4" ($!%!( 4ore t!4e ! -e%t o% da4-!%3 o5er0e%thu !a 4 tha% o% !% ! t!%3 that the ru$e of the treat4e%t be ob er5edA

29

E-a*&n&n( "he ,a"&en" O%$" whe% a3ree4e%t ! rea(hed o% the -o!%t o far d! (u ed do we -ro(eed w!th the e/a4!%at!o% of the -at!e%tA A %ote ! 4ade of the !Be of the f!r t u--er !%(! or; of a -ad of fat o% the %a-e of the %e(1; at the a/!$$a a%d o% the !% !de of the 1%ee A The -re e%(e of tr!at!o%; a u-ra-ub!( fo$d; a thora(!( fo$d; a%3u$at!o% of e$bow a%d 1%ee ?o!%t; brea t0de5e$o-4e%t !% 4e% a%d wo4e%; ede4a of the a%1$e a%d the tate of 3e%!ta$ de5e$o-4e%t !% the 4a$e are %otedA 6here5er th! ee4 !%d!(ated we Q0ra" the e$$a tur(!(a; a the bo%" (a- u$e wh!(h (o%ta!% the -!tu!tar" 3$a%d ! (a$$ed; 4ea ure the ba a$ 4etabo$!( rate; Q0ra" the (he t a%d ta1e a% e$e(tro(ard!o3ra4A 6e do a b$ood0(ou%t a%d a ed!4e%tat!o% rate a%d e t!4ate ur!( a(!d; (ho$e tero$; !od!%e a%d u3ar !% the fa t!%3 b$oodA +a&n be!o%e 3oss 2at!e%t who e 3e%era$ (o%d!t!o% ! $ow; ow!%3 to e/(e !5e -re5!ou d!et!%3; 4u t eat to (a-a(!t" for about o%e wee1 before tart!%3 treat4e%t; re3ard$e of how 4u(h we!3ht the" 4a" 3a!% !% the -ro(e A O%e (a%%ot 1ee- a -at!e%t (o4fortab$" o% 799 )a$or!e u%$e h! %or4a$ fat re er5e are rea o%ab$" we$$ to(1edA It ! for th! rea o% a$ o that e5er" (a e; e5e% tho e that are a(tua$$" 3a!%!%3 4u t eat to (a-a(!t" of the 4o t fatte%!%3 food the" (a% 3et dow% u%t!$ the" ha5e had the th!rd do eA It ! a fu%da4e%ta$ 4! ta1e to -ut a -at!e%t o% 799 )a$or!e a oo% a the do e are tarted; a !t ee4 to ta1e about three do e before ab%or4a$$" de-o !ted fat be3!% to (!r(u$ate a%d thu be(o4e a5a!$ab$eA 6e d! t!%3u! h betwee% the f!r t three do e ; wh!(h we (a$$ <%o%0effe(t!5eK a far a the $o of we!3ht ! (o%(er%ed; a%d the ub e>ue%t do e 3!5e% wh!$e the -at!e%t ! d!et!%3; wh!(h we (a$$ <effe(t!5eKA The a5era3e $o of we!3ht ! (a$(u$ated o% the %u4ber of effe(t!5e do e a%d fro4 the we!3ht rea(hed o% the da" of the th!rd do e; wh!(h 4a" be we$$ abo5e what !t wa two da" ear$!er whe% the f!r t do e wa 3!5e%A 8o t -at!e%t who ha5e bee% tru33$!%3 w!th d!et for "ear a%d 1%ow how ra-!d$" the" 3a!% !f the" $et the4 e$5e 3o are 5er" hard to (o%5!%(e of the ab o$ute %e(e !t" of 3or3!%3 for at $ea t two da" ; a%d "et th! 4u t he !% ! ted u-o% (ate3or!(a$$" !f the further (our e of treat4e%t ! to ru% 4ooth$"A Tho e -at!e%t who ha5e to be -ut o% for(ed feed!%3 for a wee1 before tart!%3 the do e u ua$$" 3a!% we!3ht ra-!d$" 0 four to !/ -ou%d !% *4 hour ! %ot u%u ua$ 0 but after a da" or two th! ra-!d 3a!% 3e%era$$" $e5e$ offA I% a%" (a e; the who$e 3a!% ! u ua$$" $o t !% the f!r t 4& hour of d!et!%3A It ! %e(e ar" to -ro(eed !% th! 4a%%er be(au e the 3a!% re0 to(1 the de-$eted %or4a$ re er5e ; wherea the ub e>ue%t $o ! fro4 the ab%or4a$ de-o !t o%$"A 2at!e%t !% a at! fa(tor" 3e%era$ (o%d!t!o% a%d tho e who ha5e %ot ?u t -re5!ou $" re tr!(ted the!r d!et tart for(ed feed!%3 o% the da" of the f!r t do eA So4e -ate%t a" that the" (a% %o $o%3er o5ereat be(au e the!r < to4a(h ha hru%1K after "ear of re tr!(t!o% A 6h!$e we 1%ow that %o to4a(h e5er hr!%1 ; we (o4-ro4! e b" !% ! t!%3 that the" eat fre>ue%t$" of h!3h$" (o%(e%trated food u(h a 4!$1 (ho(o$ate; -a tr!e w!th wh!--ed (rea4; u3ar; fr!ed 4eat +-art!(u$ar$" -or1,; e33 a%d ba(o%; 4a"o%%a! e; bread w!th th!(1 butter a%d ?a4; et(A The t!4e a%d troub$e -e%t o% -re !%3 th! -o!%t u-o% !%(redu$ou or re$u(ta%t -at!e%t ! a$wa" 30

a4-$" rewarded afterward b" the (o4-$ete ab e%(e of tho e d!ff!(u$t!e wh!(h -at!e%t who ha5e d! re3arded the e !% tru(t!o% are $!ab$e to e/-er!e%(eA Dur!%3 the two da" of for(ed feed!%3 fro4 the f!r t to the th!rd do e 0 4a%" -at!e%t are ur-r! ed that (o%trar" to the!r -re5!ou e/-er!e%(e the" do %ot 3a!% we!3ht a%d o4e e5e% $o eA The e/-$a%at!o% ! that !% the e (a e there ! a (o4-e% ator" f$ow of ur!%e; wh!(h dra!% e/(e !5e water fro4 the bod"A To o4e e/te%t th! ee4 to be a d!re(t a(t!o% of H)G; but !t 4a" a$ o be due to a h!3her -rote!% !%ta1e; a we 1%ow that a -rote!%0def!(!e%t d!et 4a1e the bod" reta!% waterA S"a%"&n( "%ea"*en" I% 4e% truat!%3 wo4e%; the be t t!4e to tart treat4e%t ! !44ed!ate$" after a -er!odA Treat4e%t 4a" a$ o be tarted $ater; but !t ! ad5! ab$e to ha5e at $ea t te% da" !% ha%d before the o% et of the %e/t -er!odA S!4!$ar$"; the e%d of a (our e of H)G hou$d %e5er be 4ade to (o!%(!de w!th 4e% truat!o%A If th!%3 hou$d ha--e% to wor1 out that wa"; !t ! better to 3!5e the $a t do e three da" before the e/-e(ted date of the 4e% e o that a %or4a$ d!et (a% he re u4ed at o% etA A$ter%at!5e$"; at $ea t three do e hou$d be 3!5e% after the -er!od; fo$$owed b" the u ua$ three da" of d!et!%3A Th! ru$e %eed %ot be ob er5ed !% u(h -at!e%t who ha5e rea(hed the!r %or4a$ we!3ht before the e%d of treat4e%t a%d are a$read" o% a h!3her (a$or!( d!etA 2at!e%t who re>u!re 4ore tha% the 4!%!4u4 of *. do e a%d who therefore 1!- o%e da" a wee1 !% order to -o t-o%e !44u%!t" to H)G (a%%ot ha5e the!r th!rd do e o% the da" before the !%ter5a$A Thu !f !t ! de(!ded to 1!- Su%da" ; the treat4e%t (a% be tarted o% a%" da" of the wee1 e/(e-t Thur da" A Su--o !%3 the" tart o% Thur da"; the" w!$$ ha5e the!r th!rd do e o% Saturda"; wh!(h ! a$ o the da" o% wh!(h the" tart the!r 799 )a$or!e d!etA The" wou$d the% ha5e %o do e o% the e(o%d da" of d!et!%3E th! e/-o e the4 to a% u%%e(e ar" hard h!-; a w!thout the do e the" w!$$ fee$ -art!(u$ar$" hu%3r"A Of (our e; the d!ff!(u$t" (a% be o5er(o4e b" e/(e-t!o%a$$" !%?e(t!%3 the4 o% the f!r t Su%da"A If th! da" fa$$ betwee% the f!r t a%d e(o%d or betwee% the e(o%d a%d th!rd do e; we u ua$$" -refer to 3!5e the -at!e%t the e/tra da" of for(ed feed!%3; wh!(h the 4a?or!t" ra-turou $" e%?o"A

31

The D&e" The 799 )a$or!e d!et ! e/-$a!%ed o% the da" of the e(o%d do e to tho e -at!e%t who w!$$ be -re-ar!%3 the!r ow% food; a%d !t ! 4o t !4-orta%t that the -er o% who w!$$ a(tua$$" (oo1 ! -re e%t 0 the w!fe; the 4other or the (oo1; a the (a e 4a" beA Here !% Ita$" -at!e%t are 3!5e% the fo$$ow!%3 d!et heetA 'rea1fa tD Tea or (offee !% a%" >ua%t!t" w!thout u3arA O%$" o%e tab$e -oo%fu$ of 4!$1 a$$owed !% *4 hour A Sa((har!% or other weete%er 4a" be u edA

Lu%(hD 199 3ra4 of 5ea$; beef; (h!(1e% brea t; fre h wh!te f! h; $ob ter; (rab or hr!4-A A$$ 5! !b$e fat 4u t be (arefu$$" re4o5ed before (oo1!%3; a%d the 4eat 4u t be we!3hed rawA It 4u t be bo!$ed or 3r!$$ed w!thout add!t!o%a$ fatA Sa$4o%; ee$; tu%a; herr!%3; dr!ed or -!(1$ed f! h are %ot a$$owedA The (h!(1e% brea t 4u t be re4o5ed raw fro4 the b!rdA O%e t"-e of 5e3etab$e o%$" to be (ho e% fro4 the fo$$ow!%3D -!%a(h; (hard; (h!(or"; beet0 3ree% ; 3ree% a$ad; to4atoe ; (e$er"; fe%%e$; o%!o% ; red rad! he ; (u(u4ber ; a -ara3u ; (abba3eA .A O2TIONALD O%e bread t!(1 +3r! !%o, or o%e 8e$ba toa tA 4A A% a--$e or a% ora%3e or a ha%dfu$ of trawberr!e or o%e0ha$f 3ra-efru!tA

32

D!%%erD

The a4e four (ho!(e a $u%(h

The ?u!(e of o%e $e4o% da!$" ! a$$owed for a$$ -ur-o e A Sa$t; -e--er; 5!%e3ar; 4u tard -owder; 3ar$!(; weet ba !$; -ar $e"; th"4e; 4a?ora4; et(A; 4a" be u ed for ea o%!%3; but %o o!$; butter or dre !%3A Tea; (offee; -$a!% water; or 4!%era$ water are the o%$" dr!%1 a$$owed; but the" 4a" be ta1e% !% a%" >ua%t!t" a%d at a$$ t!4e A I% fa(t; the -at!e%t hou$d dr!%1 about * $!ter of the e f$u!d -er da"A 8a%" -at!e%t are afra!d to dr!%1 o 4u(h be(au e the" fear that th! 4a" 4a1e the4 reta!% 4ore waterA Th! ! a wro%3 %ot!o% a the bod" ! 4ore !%($!%ed to tore water whe% the !%ta1e fa$$ be$ow !t %or4a$ re>u!re4e%t A The fru!t or the bread t!(1 4a" be eate% betwee% 4ea$ !% tead of w!th $u%(h or d!%%er; but %ot 4ore tha% tha% four !te4 $! ted for $u%(h a%d d!%%er 4a" be eate% at o%e 4ea$A No 4ed!(!%e or (o 4et!( other tha% $!- t!(1; e"ebrow -e%(!$ a%d -owder 4a" be u ed w!thout -e(!a$ -er4! !o% E5er" !te4 !% the $! t ! 3o%e o5er (arefu$$"; (o%t!%ua$$" tre !%3 the -o!%t that %o 5ar!at!o% other tha% tho e $! ted 4a" be !%trodu(edA A$$ th!%3 %ot $! ted are forb!dde%; a%d the -at!e%t ! a ured that %oth!%3 -er4! !b$e ha bee% $eft outA The 199 3ra4 of 4eat 4u t he (ru-u$ou $" we!3hed raw after a$$ 5! !b$e fat ha bee% re4o5edA To do th! a((urate$" the -at!e%t 4u t ha5e a $etter0 (a$e; a 1!t(he% (a$e are %ot uff!(!e%t$" a((urate a%d the but(her hou$d (erta!%$" %ot be re$!ed u-o%A Tho e %ot u%(o44o% -at!e%t who fee$ that e5e% o $!tt$e food ! too 4u(h for the4; (a% o4!t a%"th!%3 the" w! hA There ! %o ob?e(t!o% to brea1!%3 u- the two 4ea$ A For !% ta%(e ha5!%3 a bread t!(1 a%d a% a--$e for brea1fa t or a% ora%3e before 3o!%3 to bed; -ro5!ded the" are dedu(ted fro4 the re3u$ar 4ea$ A The who$e da!$" rat!o% of two bread t!(1 or two fru!t 4a" %ot be eate% at the a4e t!4e; %or (a% a%" !te4 a5ed fro4 the -re5!ou da" be added o% the fo$$ow!%3 da"A I% the be3!%%!%3 -at!e%t are ad5! ed to (he(1 e5er" 4ea$ a3a!% t the!r d!et heet before tart!%3 to eat a%d %ot to re$" o% the!r 4e4or"A It ! a$ o worth -o!%t!%3 out that a%" atte4-t to ob er5e th! d!et w!thout H)G w!$$ $ead to troub$e !% two to three da" A 6e ha5e had (a e !% wh!(h -at!e%t ha5e -roud$" f$au%ted the!r d!et!%3 -ower !% fro%t of the!r fr!e%d w!thout 4e%t!o%!%3 the fa(t that the" are a$ o re(e!5!%3 treat4e%t w!th H)GA The" $et the!r fr!e%d tr" the a4e d!et; a%d whe% th! -ro5e to be a fa!$ure 0 a !t %e(e ar!$" 4u t 0 the -at!e%t tart ra1!%3 !% u%4er!ted 1udo for u-erhu4a% w!$$-owerA It hou$d a$ o be 4e%t!o%ed that two 4a$$ a--$e we!3h!%3 a 4u(h a o%e $ar3e o%e %e5erthe$e ha5e a h!3her (a$or!( 5a$ue a%d are therefore %ot a$$owed; thou3h there ! %o re tr!(t!o% o% the !Be of o%e a--$eA So4e -eo-$e do %ot rea$!Be that a ta%3er!%e ! %ot a% ora%3e a%d that (h!(1e% brea t doe %ot 4ea% the brea t of a%" other fow$; %or doe !t 4ea% 33

a w!%3 or dru4 t!(1A The 4o t t!re o4e -at!e%t are tho e who tart (ou%t!%3 )a$or!e a%d the% (o4e u- w!th a$$ 4a%%er of !%3e%!ou 5ar!at!o% wh!(h the" (o4-!$e fro4 the!r $!tt$e boo1 A 6he% o%e ha -e%t "ear of wear" re ear(h tr"!%3 to 4a1e a d!et a attra(t!5e a -o !b$e w!thout ?eo-ard!B!%3 the $o of we!3ht; (u$!%ar" 3e%!u e who are out to !4-ro5e the!r u%ha--" $ot are hard to ta1eA Ma2&n( u, "he Ca o%&es The d!et u ed !% (o%?u%(t!o% w!th H)G 4u t %ot e/(eed 799 )a$or!e -er da"; a%d the wa" the e )a$or!e are 4ade u- ! of ut4o t !4-orta%(eA For !% ta%(e; !f a -at!e%t dro- the a--$e a%d eat a% e/tra bread t!(1 !% tead; he w!$$ %ot be 3ett!%3 4ore )a$or!e but he w!$$ %ot $o e we!3htA There are a %u4ber of food ; -art!(u$ar$" fru!t a%d 5e3etab$e ; wh!(h ha5e the a4e or e5e% $ower (a$or!( 5a$ue tha% tho e $! ted a -er4! !b$e; a%d "et we f!%d that the" !%terfere w!th the re3u$ar $o of we!3ht u%der H)G; -re u4ab$" ow!%3 to the %ature of the!r (o4-o !t!o%A 2!4!e%to -e--er ; o1ra; art!(ho1e a%d -ear are e/a4-$e of th! A 6h!$e th! d!et wor1 at! fa(tor!$" !% Ita$"; (erta!% 4od!f!(at!o% ha5e to be 4ade !% other (ou%tr!e A For !% ta%(e; A4er!(a% beef ha a$4o t doub$e the (a$or!( 5a$ue of South Ita$!a% beef; wh!(h ! %ot 4arb$ed w!th fatA Th! 4arb$!%3 ! !4-o !b$e to re4o5eA I% A4er!(a; therefore; $ow03rade 5ea$ hou$d be u ed for o%e 4ea$ a%d f! h +e/($ud!%3 a$$ tho e -e(!e u(h a herr!%3; 4a(1ere$; tu%a; a$4o%; ee$; et(A; wh!(h ha5e a h!3h fat (o%te%t; a%d a$$ dr!ed; 4o1ed or -!(1$ed f! h,; (h!(1e% brea t; $ob ter; (rawf! h; -raw% ; hr!4- ; (rab4eat or 1!d%e" for the other 4ea$A 6here the Ita$!a% bread t!(1 ; the o0(a$$ed 3r! !%!; are %ot a5a!$ab$e; o%e 8e$ba toa t 4a" be u ed !% tead; thou3h the" are - "(ho$o3!(a$$" $e at! f"!%3A A 8e$ba toa t ha about the a4e we!3ht a the 5er" -orou 3r! !%! wh!(h ! 4u(h 4ore to $oo1 at a%d to (hewA I% 4a%" (ou%tr!e -e(!a$$" -re-ared u% weete%ed a%d $ow )a$or!e food are free$" a5a!$ab$e; a%d o4e of the e (a% be te%tat!5e$" u edA 6he% $o(a$ (o%d!t!o% or the feed!%3 hab!t of the -o-u$at!o% 4a1e (ha%3e %e(e ar"; !t 4u t be bor%e !% 4!%d that the tota$ da!$" !%ta1e 4u t %ot e/(eed 799 )a$or!e !f the be t -o !b$e re u$t are to be obta!%ed; that the da!$" rat!o% hou$d (o%ta!% *99 3ra4 of fat0free -rote!% a%d a 5er" 4a$$ a4ou%t of tar(hA Iu t a the da!$" do e of H)G ! the a4e !% a$$ (a e ; o the a4e d!et -ro5e to be at! fa(tor" for a 4a$$ e$der$" $ad" of $e! ure or a hard wor1!%3 4u (u$ar 3!a%tA :%der the effe(t of H)G the obe e bod" ! a$wa" ab$e to obta!% a$$ the )a$or!e !t %eed fro4 the ab%or4a$ fat de-o !t ; re3ard$e of whether !t u e u- 1799 or 4999 -er da"A It 4u t be 4ade 5er" ($ear to the -at!e%t that he ! $!5!%3 to a far 3reater e/te%t o% the fat wh!(h he ! $o !%3 tha% o% what he eat A 8a%" -at!e%t a 1 wh" e33 are %ot a$$owedA The (o%te%t of two 3ood !Bed e33 are rou3h$" e>u!5a$e%t to 199 3ra4 of 4eat; but fortu%ate$" the "o$1 (o%ta!% a $ar3e a4ou%t of fat; wh!(h ! u%de !rab$eA Ver" o((a !o%a$$" we a$$ow e33 0 bo!$ed; -oa(hed or raw 0 to -at!e%t who de5e$o- a% a5er !o% to 4eat; but !% th! (a e the" 4u t add the wh!te of three e33 to the o%e the" eat who$eA I% (ou%tr!e where (otta3e (hee e 4ade fro4 1!44ed 4!$1 ! a5a!$ab$e 199 3ra4 4a" o((a !o%a$$" be u ed !% tead of the 4eat; but %o other (hee e are 34

a$$owedA .e(e"a%&ans Str!(t 5e3etar!a% u(h a orthodo/ H!%du -re e%t a -e(!a$ -rob$e4; be(au e 4!$1 a%d (urd are the o%$" a%!4a$ -rote!% the" w!$$ eatA To u--$" the4 w!th uff!(!e%t -rote!% of a%!4a$ or!3!% the" 4u t dr!%1 799 ((A of 1!44ed 4!$1 -er da"; thou3h -art of th! rat!o% (a% be ta1e% a (urd A A far a fru!t; 5e3etab$e a%d tar(h are (o%(er%ed; the!r d!et ! the a4e a that of %o%05e3etar!a% E the" (a%%ot be a$$owed the!r u ua$ !%ta1e of 5e3etab$e -rote!% fro4 $e3u4!%ou -$a%t u(h a bea% or fro4 wheat or %ut ; %or (a% the" ha5e the!r (u to4ar" r!(eA I% -!te of the e e5ere re tr!(t!o% ; the!r a5era3e $o ! about ha$f that of %o%0 5e3etar!a% ; -re u4ab$" ow!%3 to the u3ar (o%te%t of the 4!$1A #au ") D&e"&n( Few -at!e%t w!$$ ta1e o%eF word for !t that the $!3hte t de5!at!o% fro4 the d!et ha u%der H)G d! a trou re u$t a far a the we!3ht ! (o%(er%edA Th! e/tre4e e% !t!5!t" ha the ad5a%ta3e that the 4a$$e t error ! !44ed!ate$" dete(tab$e at the da!$" we!3h!%3 but 4o t -at!e%t ha5e to 4a1e the e/-er!e%(e before the" w!$$ be$!e5e !tA 2er o% !% h!3h off!(!a$ -o !t!o% u(h a e4ba " -er o%%e$; -o$!t!(!a% ; e%!or e/e(ut!5e ; et(A; who are ob$!3ed to atte%d o(!a$ fu%(t!o% to wh!(h the" (a%%ot br!%3 the!r 4ea3er 4ea$ 4u t be to$d beforeha%d that a% off!(!a$ d!%%er w!$$ (o t the4 the $o of about three da" treat4e%t; howe5er (arefu$ the" are a%d !% -!te of a fr!e%d$" a%d wou$d0be (oo-erat!5e ho tA 6e 3e%era$$" ad5! e the4 to a5o!d a$$0rou%d e4barra 4e%t; the a$4o t !%e5!tab$e tur% of (o%5er at!o% to the!r we!3ht -rob$e4 a%d the out-our!%3 of $a" (ou% e$ fro4 the!r tab$e -art%er b" %ot $ett!%3 !t be 1%ow% that the" are u%der treat4e%tA The" hou$d ta1e da!%t" er5!%3 of e5er"th!%3; h!de what the" (a% u%der the (ut$er" a%d boo1 the 3a!% wh!(h 4a" ta1e three da" to 3et r!d of a o%e of the a(r!f!(e wh!(h the!r -rofe !o% e%ta!$ A A$$ow!%3 three da" for the!r (orre(t!o% u(h !%(!de%t do %ot ?eo-ard!Be the treat4e%t; -ro5!ded the" do %ot o((ur a$$ too fre>ue%t$"; !% wh!(h (a e treat4e%t hou$d be -o t-o%ed to a o(!a$$" 4ore -ea(efu$ ea o%A .&"a*&ns and ane*&a Soo%er or $ater 4o t -at!e%t e/-re a fear that the" 4a" be ru%%!%3 out of 5!ta4!% or that the re tr!(ted d!et 4a" 4a1e the4 a%e4!(A O% th! (ore the -h" !(!a% (a% (o%f!de%t$" re$!e5e the!r a--rehe% !o% b" e/-$a!%!%3 that e5er" t!4e the" $o e a -ou%d of fatt" t! ue; wh!(h the" do a$4o t da!$"; o%$" the a(tua$ fat ! bur%ed u-E a$$ the 5!ta4!% ; the -rote!% ; the b$ood; a%d the 4!%era$ wh!(h th! t! ue (o%ta!% !% abu%da%(e are fed ba(1 !%to the bod"A A(tua$$"; a $ow b$ood (ou%t %ot due to a%" er!ou d! order of the b$ood for4!%3 t! ue !4-ro5e dur!%3 treat4e%t; a%d we ha5e %e5er e%(ou%tered a !3%!f!(a%t -rote!% def!(!e%(" %or !3% of a $a(1 of 5!ta4!% !% -at!e%t who are d!et!%3 re3u$ar$"A The #&%s" Da)s o! T%ea"*en" O% the da" of the th!rd do e !t ! a$4o t rout!%e to hear two re4ar1 A O%e ! D <@ou 1%ow; Do(tor; IF4 ure !tF o%$" - "(ho$o3!(a$; but I a$read" fee$ >u!te d!ffere%tKA So (o44o% ! th! 35

re4ar1; e5e% fro4 5er" 1e-t!(a$ -at!e%t ; that we he !tate to a((e-t the - "(ho$o3!(a$ !%ter-retat!o%A The other t"-!(a$ re4ar1 ! D <Now that I ha5e bee% a$$owed to eat a%"th!%3 I wa%t; I (a%Ft 3et !t dow%A S!%(e "e terda" I fee$ $!1e a tuffed -!3A Food ?u t doe %Ft ee4 to !%tere t 4e a%" 4ore; a%d I a4 $o%3!%3 to 3et o% w!th "our d!etKA 8a%" -at!e%t %ot!(e that the" are -a !%3 4ore ur!%e a%d that the we$$!%3 !% the!r a%1$e ! $e e5e% before the" tart d!et!%3A O% the da" of the fourth do e 4o t -at!e%t de($are that the" are fee$!%3 f!%eA The" ha5e u ua$$" $o t two -ou%d or 4ore; o4e a" the" fee$ a b!t e4-t" but ha te% to e/-$a!% that th! doe %ot a4ou%t to hu%3erA So4e (o4-$a!% of a 4!$d heada(he of wh!(h the" ha5e bee% forewar%ed a%d for wh!(h the" ha5e bee% 3!5e% -er4! !o% to ta1e a -!r!%A Dur!%3 the e(o%d a%d th!rd da" of d!et!%3 0 that ! ; the f!fth a%d !/th do e 0 the e 4!%or (o4-$a!%t !4-ro5e wh!$e the we!3ht (o%t!%ue to dro- at about doub$e the u ua$$" o5era$$ a5era3e of a$4o t o%e -ou%d -er da"; o that a 4oderate$" e5ere (a e 4a" b" the fourth da" of d!et!%3 ha5e $o t a 4u(h a &019 $b A It ! u ua$$" at th! -o!%t that a d!ffere%(e a--ear betwee% tho e -at!e%t who ha5e $!tera$$" eate% to (a-a(!t" dur!%3 the f!r t two da" of treat4e%t a%d tho e who ha5e %otA The for4er fee$ re4ar1ab$" we$$E the" ha5e %o hu%3er; %or do the" fee$ te4-ted whe% other eat %or4a$$" at the a4e tab$eA The" fee$ $!3hter; 4ore ($ear0headed a%d %ot!(e a de !re to 4o5e >u!te (o%trar" to the!r -re5!ou $ethar3"A Tho e who ha5e d! re3arded the ad5!(e to eat to (a-a(!t" (o%t!%ue to ha5e 4!%or d! (o4fort a%d do %ot ha5e the a4e eu-hor!( e% e of we$$0be!%3 u%t!$ about a wee1 $aterA It ee4 that the!r %or4a$ fat re er5e re>u!re that 4u(h 4ore t!4e before the" are fu$$" to(1edA # uc"ua"&ons &n 4e&(h" oss After the fourth or f!fth da" of d!et!%3 the da!$" $o of we!3ht be3!% to de(rea e to o%e -ou%d or o4ewhat $e -er ($a"; a%d there ! a 4a$$er ur!%ar" out-utA 8e% ofte% (o%t!%ue to $o e re3u$ar$" at that rate; but wo4e% are 4ore !rre3u$ar; !% -!te of fau$t$e d!et!%3A There 4a" be %o dro- at a$$ for two or three da" a%d the% a udde% $o wh!(h ree tab$! he the %or4a$ a5era3eA The e f$u(tuat!o% are e%t!re$" due to 5ar!at!o% !% the rete%t!o% a%d e$!4!%at!o% of water; wh!(h are 4ore 4ar1ed !% wo4e% tha% !% 4e%A The we!3ht re3! tered b" the (a$e ! deter4!%ed b" two -ro(e e ; %ot %e(e ar!$" "%(hro%!BedA :%der the !%f$ue%(e of H)G fat ! be!%3 e/tra(ted fro4 the (e$$ ; !% wh!(h !t ! tored !% the fatt" t! ueA 6he% the e (e$$ are e4-t" a%d therefore er5e %o -ur-o e; the bod" brea1 dow% the (e$$u$ar tru(ture a%d ab orb !t; but brea1!%3 u- of u e$e (e$$ ; (o%%e(t!5e t! ue; b$ood 5e e$ ; et(A; 4a" $a3 beh!%d the -ro(e of fat0e/tra(t!o%A 6he% th! ha--e% ; the bod" a--ear to re-$a(e o4e of the e/tra(ted fat w!th water wh!(h ! reta!%ed for th! -ur-o eA A water ! hea5!er tha% fat the (a$e 4a" how %o $o of we!3ht; a$thou3h uff!(!e%t fat ha a(tua$$" bee% (o% u4ed to 4a1e u- for the def!(!t !% the 7990)a$or!e d!etA 6he% the% u(h t! ue ! f!%a$$" bro1e% dow%; the water ! $!berated a%d there ! a udde% f$ood of ur!%e a%d a 4ar1ed $o of we!3htA Th! !4-$e !%ter-retat!o% of what ! rea$$" a% e/tre4e$" (o4-$e/ 4e(ha%! 4 ! the o%e we 3!5e tho e -at!e%t who wa%t to 1%ow wh" !t ! that o% (erta!% da" the" do %ot $o e; thou3h the" ha5e (o44!tted %o d!etar" errorA

36

2at!e%t who ha5e -re5!ou $" re3u$ar$" u ed d!uret!( a a 4ethod of redu(!%3; $o e fat dur!%3 the f!r t two or three wee1 of treat4e%t wh!(h how !% the!r 4ea ure4e%t ; but the (a$e 4a" how $!tt$e or %o $o be(au e the" are re-$a(!%3 the %or4a$ water (o%te%t of the!r bod" wh!(h ha bee% deh"dratedA D!uret!( hou$d %e5er be u ed for redu(!%3A In"e%%u,"&ons o! We&(h" 3oss 6e d! t!%3u! h four t"-e of !%terru-t!o% !% the re3u$ar da!$" $o A The f!r t ! the o%e that ha a$read" bee% 4e%t!o%ed !% wh!(h the we!3ht ta" tat!o%ar" for a da" or two; a%d th! o((ur ; -art!(u$ar$" toward the e%d of a (our e; !% a$4o t e5er" (a eA The P a"eau The e(o%d t"-e of !%terru-t!o% we (a$$ a <-$ateauKA A -$ateau $a t 40# da" a%d fre>ue%t$" o((ur dur!%3 the e(o%d ha$f of a fu$$ (our e; -art!(u$ar$" !% -at!e%t that ha5e bee% do!%3 we$$ a%d who e o5era$$ a5era3e of %ear$" a -ou%d -er effe(t!5e do e ha bee% 4a!%ta!%edA Tho e who are $o !%3 4ore tha% the a5era3e a$$ ha5e a -$ateau oo%er or $aterA A -$ateau a$wa" (orre(t ; !t e$f; but 4a%" -at!e%t who ha5e be(o4e a((u to4ed to a re3u$ar da!$" $o 3et u%%e(e ar!$" worr!ed a%d be3!% to fretA No a4ou%t of e/-$a%at!o% (o%5!%(e the4 that a -$ateau doe %ot 4ea% that the" are %o $o%3er re -o%d!%3 %or4a$$" to treat4e%tA I% u(h (a e we (o% !der !t -er4! !b$e; for -ure$" - "(ho$o3!(a$ rea o% ; to brea1 u- the -$ateauA Th! (a% be do%e !% two wa" A O%e ! a o0(a$$ed <a--$e da"KA A% a--$e0da" be3!% at $u%(h a%d (o%t!%ue u%t!$ ?u t before $u%(h of the fo$$ow!%3 da"A The -at!e%t are 3!5e% !/ $ar3e a--$e a%d are to$d to eat o%e whe%e5er the" fee$ the de !re thou3h !/ a--$e ! the 4a/!4u4 a$$owedA Dur!%3 a% a--$e0da" %o other food or $!>u!d e/(e-t -$a!% water are a$$owed a%d of water the" 4a" o%$" dr!%1 ?u t e%ou3h to >ue%(h a% u%(o4fortab$e th!r t !f eat!%3 a% a--$e t!$$ $ea5e the4 th!r t"A 8o t -at!e%t fee$ %o %eed for water a%d are >u!te ha--" w!th the!r !/ a--$e A Need$e to a"; a% a--$e0da" 4a" %e5er be 3!5e% o% the da" o% wh!(h there ! %o do eA The a--$e0da" -rodu(e a 3rat!f"!%3 $o of we!3ht o% the fo$$ow!%3 da"; (h!ef$" due to the e$!4!%at!o% of waterA Th! water ! %ot re3a!%ed whe% the -at!e%t re u4e the!r %or4a$ 7990)a$or!e d!et at $u%(h; a%d o% the fo$$ow!%3 da" the" (o%t!%ue to $o e we!3ht at! fa(tor!$"A The other wa" to brea1 u- a -$ateau ! b" 3!5!%3 a %o%04er(ur!a$ d!uret!( +we u e 1 tab$et of h"3roto%, for o%e da"A Th! ! !4-$er for the -at!e%t; but we -refer the a--$e0da"; a we o4et!4e f!%d that thou3h the d!uret!( ! 5er" effe(t!5e o% the fo$$ow!%3 da" !t 4a" ta1e two to three da" before the %or4a$ da!$" redu(t!o% ! re u4ed; throw!%3 the -at!e%t !%to a %ew f!t of de -a!rA It ! u e$e to 3!5e e!ther a% a--$e0da" or a d!uret!( u%$e the we!3ht ha bee% tat!o%ar" for at $ea t four da" w!thout a%" d!etar" error ha5!%3 bee% (o44!ttedA Reach&n( a #o%*e% 3e'e The th!rd t"-e of !%terru-t!o% !% the re3u$ar $o of we!3ht 4a" $a t 4u(h $o%3er 0 te% da" to two wee1 A Fortu%ate$"; !t ! rare a%d o%$" o((ur !% 5er" ad5a%(ed (a e ; a%d the% hard$" e5er dur!%3 the f!r t (our e of treat4e%tA It ! ee% o%$" !% tho e -at!e%t who dur!%3 o4e 37

-er!od of the!r $!5e ha5e 4a!%ta!%ed a (erta!% f!/ed de3ree of obe !t" for te% "ear or 4ore a%d ha5e the% at o4e t!4e ra-!d$" !%(rea ed be"o%d that we!3htA 6he% the% !% the (our e of treat4e%t the for4er $e5e$ ! rea(hed; !t 4a" ta1e two wee1 of %o $o ; !% -!te of H)G a%d d!et; before further redu(t!o% ! %or4a$$" re u4edA Mens"%ua In"e%%u,"&on The fourth t"-e of !%terru-t!o% ! the o%e wh!(h ofte% o((ur a few da" before a%d dur!%3 the 4e% trua$ -er!od a%d !% o4e wo4e% at the t!4e of o5u$at!o%A It 4u t a$ o be 4e%t!o%ed that whe% a wo4a% be(o4e -re3%a%t dur!%3 treat4e%t 0 a%d th! ! b" %o 4ea% u%(o44o% 0 he at o%(e (ea e to $o e we!3htA A% u%e/-$a!%ed arre t of redu(t!o% ha o% e5era$ o((a !o% ra! ed our u -!(!o% before the f!r t -er!od wa 4! edA If !% u(h (a e ; 4e% truat!o% ! de$a"ed; we to- !%?e(t!%3 a%d do a -re(!-!tat!o% te t f!5e da" $aterA No -re3%a%(" te t hou$d be (arr!ed out ear$!er tha% f!5e da" after the $a t do e; a otherw! e the H)G 4a" 3!5e a fa$ e -o !t!5e re u$tA Ora$ (o%tra(e-t!5e 4a" be u ed dur!%3 treat4e%tA D&e"a%) E%%o%s A%" !%terru-t!o% of the %or4a$ $o of we!3ht wh!(h doe %ot f!t -erfe(t$" !%to o%e of tho e (ate3or!e ! a$wa" due to o4e -o !b$" 5er" 4!%or d!etar" errorA S!4!$ar$"; a%" 3a!% of 4ore tha% 199 3ra4 ! !%5ar!ab$" the re u$t of o4e tra% 3re !o% or 4! ta1e; u%$e !t ha--e% o% or about the da" of o5u$at!o% or dur!%3 the three da" -re(ed!%3 the o% et of 4e% truat!o%; !% wh!(h (a e !t ! !3%oredA I% a$$ other (a e the rea o% for the 3a!% 4u t be e tab$! hed at o%(eA The -at!e%t who fra%1$" ad4!t that he ha te--ed out of h! re3!4e% whe% to$d that o4eth!%3 ha 3o%e wro%3 ! %o -rob$e4A He ! a$wa" ur-r! ed at be!%3 fou%d out; be(au e u%$e he ha ee% th! h!4 e$f he w!$$ %ot be$!e5e that a a$ted a$4o%d; a (ou-$e of -otato (h!- ; a 3$a of to4ato ?u!(e or a% e/tra ora%3e w!$$ br!%3 about a def!%!te !%(rea e !% h! we!3ht o% the fo$$ow!%3 da"A Ver" ofte% he wa%t to 1%ow wh" e/tra food we!3h!%3 o%e ou%(e hou$d !%(rea e h! we!3ht b" !/ ou%(e A 6e e/-$a!% th! !% the fo$$ow!%3 wa"D :%der the !%f$ue%(e of H)G the b$ood ! aturated w!th food a%d the b$ood 5o$u4e ha ada-ted !t e$f o that !t (a% o%$" ?u t a((o44odate the 799 )a$or!e wh!(h (o4e !% fro4 the !%te t!%a$ tra(t !% the (our e of the da"A A%" add!t!o%a$ !%(o4e; howe5er $!tt$e th! 4a" be; (a%%ot be a((o44odated a%d the b$ood ! therefore for(ed to !%(rea e !t 5o$u4e uff!(!e%t$" to ho$d the e/tra food; wh!(h !t (a% o%$" do !% a 5er" d!$uted for4A Thu !t ! %ot the we!3ht of what ! eate% that -$a" the deter4!%!%3 ro$e but rather the a4ou%t of water wh!(h the bod" 4u t reta!% to a((o44odate th! foodA Th! (a% be !$$u trated b" 4e%t!o%!%3 the (a e of a$tA I% order to ho$d o%e tea -oo%fu$ of a$t the bod" re>u!re o%e $!ter of water; a !t (a%%ot a((o44odate a$t !% a%" h!3her (o%(e%trat!o%A Thu ; !f a -er o% eat o%e tea -oo%fu$ of a$t h! we!3ht w!$$ 3o u- b" 4ore tha% two -ou%d a oo% a th! a$t ! ab orbed fro4 h! !%te t!%eA

38

To th! e/-$a%at!o% 4a%" -at!e%t re-$"D <6e$$; !f I -ut o% that 4u(h e5er" t!4e I eat a $!tt$e e/tra; how (a% I ho$d 4" we!3ht after the treat4e%tOK It 4u t therefore be 4ade ($ear that th! o%$" ha--e% a $o%3 a the" are u%der H)GA 6he% treat4e%t ! o5er; the b$ood ! %o $o%3er aturated a%d (a% ea !$" a((o44odate e/tra food w!thout ha5!%3 to !%(rea e !t 5o$u4eA Here a3a!% the -rofe !o%a$ reader w!$$ be aware that th! !%ter-retat!o% ! a !4-$!f!(at!o% of a% e/tre4e$" !%tr!(ate -h" !o$o3!(a$ -ro(e wh!(h a(tua$$" a((ou%t for the -he%o4e%o%A Sa " and Reduc&n( 6h!$e we are o% the ub?e(t of a$t; I (a% ta1e th! o--ortu%!t" to e/-$a!% that we 4a1e %o re tr!(t!o% !% the u e of a$t a%d !% ! t that the -at!e%t dr!%1 $ar3e >ua%t!t!e of water throu3hout the treat4e%tA 6e are out to redu(e ab%or4a$ fat a%d are %ot !% the $ea t !%tere ted !% u(h !$$u or" we!3ht $o e a (a% be a(h!e5ed b" de-r!5!%3 the bod" of a$t a%d b" de !((at!%3 !tA Thou3h we a$$ow the free u e of a$t; the da!$" a4ou%t ta1e% hou$d be rou3h$" the a4e; a a udde% !%(rea e w!$$ of (our e be fo$$owed b" a (orre -o%d!%3 !%(rea e !% we!3ht a how% b" the (a$eA A% !%(rea e !% the !%ta1e of a$t ! o%e of the 4o t (o44o% (au e for a% !%(rea e !% we!3ht fro4 o%e da" to the %e/tA Su(h a% !%(rea e (a% be !3%ored; -ro5!ded !t ! a((ou%ted forA It !% %o wa" !%f$ue%(e the re3u$ar $o of fatA Wa"e% 2at!e%t are u ua$$" hard to (o%5!%(e that the a4ou%t of water the" reta!% ha %oth!%3 to do w!th the a4ou%t of water the" dr!%1A 6he% the bod" ! for(ed to reta!% water; !t w!$$ do th! at a$$ (o t A If the f$u!d !%ta1e ! !% uff!(!e%t to -ro5!de a$$ the water re>u!red; the bod" w!thho$d water fro4 the 1!d%e" a%d the ur!%e be(o4e (a%t" a%d h!3h$" (o%(e%trated; !4-o !%3 a (erta!% tra!% o% the 1!d%e" A If that ! !% uff!(!e%t; e/(e !5e water w!$$ be w!th0draw% fro4 the !%te t!%a$ tra(t; w!th the re u$t that the fe(e be(o4e hard a%d dr"A O% the other ha%d !f a -at!e%t dr!%1 4ore tha% h! bod" re>u!re ; the ur-$u ! -ro4-t$" a%d ea !$" e$!4!%atedA Tr"!%3 to -re5e%t the bod" fro4 reta!%!%3 water b" dr!%1!%3 $e ! therefore %ot o%$" fut!$e but e5e% har4fu$A Cons"&,a"&on A% e/(e of water 1ee- the fe(e oft; a%d that ! 5er" !4-orta%t !% the obe e; who (o44o%$" uffer fro4 (o% t!-at!o% a%d a -a t!( (o$o%A 6h!$e a -at!e%t ! u%der treat4e%t we %e5er -er4!t the u e of a%" 1!%d of $a/at!5e ta1e% b" 4outhA 6e e/-$a!% that ow!%3 to the re tr!(ted d!et !t ! -erfe(t$" at! fa(tor" a%d %or4a$ to ha5e a% e5a(uat!o% of the bowe$ o%$" o%(e e5er" three to four da" a%d that; -ro5!ded -$e%t" of f$u!d are ta1e%; th! %e5er $ead to a%" d! turba%(eA O%$" !% tho e -at!e%t who be3!% to fret after four da" do we a$$ow the u e of a u--o !tor"A 2at!e%t who ob er5e th! ru$e f!%d that after treat4e%t the" ha5e a -erfe(t$" %or4a$ bowe$ a(t!o% a%d th! de$!3ht 4a%" of the4 a$4o t a 4u(h a the!r $o of we!3htA In'es"&(a"&n( D&e"a%) E%%o%s 6he% the rea o% for a $!3ht 3a!% !% we!3ht ! %ot !44ed!ate$" e5!de%t; !t ! %e(e ar" to !%5e t!3ate furtherA A -at!e%t who ! u%aware of ha5!%3 (o44!tted a% error or ! u%w!$$!%3 to ad4!t a 4! ta1e -rote t !%d!3%a%t$" whe% to$d he ha do%e o4eth!%3 he ou3ht %ot to ha5e 39

do%eA I% that at4o -here %o fru!tfu$ !%5e t!3at!o% (a% be (o%du(tedE o we (a$4$" e/-$a!% that we are %ot a((u !%3 h!4 of a%"th!%3 but that we 1%ow for (erta!% fro4 our %ot !%(o% !derab$e e/-er!e%(e that o4eth!%3 ha 3o%e wro%3 a%d that we 4u t %ow !t dow% >u!et$" to3ether a%d tr" a%d f!%d out what !t wa A O%(e the -at!e%t rea$!Be that !t ! !% h! ow% !%tere t that he -$a" a% a(t!5e a%d %ot 4ere$" a -a !5e ro$e !% th! ear(h; the rea o% for the etba(1 ! a$4o t !%5ar!ab$" d! (o5eredA Ha5!%3 bee% throu3h hu%dred of u(h e !o% ; we are %ear$" a$wa" ab$e to d! t!%3u! h the de$!berate $!ar fro4 the -at!e%t who ! 4ere$" foo$!%3 h!4 e$f or ! rea$$" u%aware of ha5!%3 erredA 3&a%s and #oo s 6he% we ee obe e -at!e%t there are 3e%era$$" two of u -re e%t !% order to -eed urout!%e ha%d$!%3A Thu whe% we ha5e to !%5e t!3ate a r! e !% we!3ht; a 3$a%(e ! uff!(!e%t to 4a1e ure that we a3ree or d! a3reeA If after a few >ue t!o% we both fee$ rea o%ab$" ure that the -at!e%t ! de$!berate$" $"!%3; we te$$ h!4 that th! ! our o-!%!o% a%d war% h!4 that u%$e he (o4e ($ea% we 4a" refu e further treat4e%tA The wa" he rea(t to th! fur%! he add!t!o%a$ -roof whether we are o% the r!3ht tra(1 or %otE we %ow 5er" rare$" 4a1e a 4! ta1eA If the -at!e%t brea1 dow% a%d (o%fe e ; we 4e$t a%d are a$$ for3!5e%e a%d treat4e%t -ro(eed A @et !f u(h -erfor4a%(e ha5e to be re-eated 4ore tha% two or three t!4e ; we refu e further treat4e%tA Th! ha--e% !% $e tha% 1J of our (a e A If the -at!e%t ! tubbor% a%d w!$$ %ot ad4!t what he ha bee% u- to; we u ua$$" 3!5e h!4 o%e 4ore (ha%(e a%d (o%t!%ue treat4e%t e5e% thou3h we ha5e bee% u%ab$e to f!%d the rea o% for h! 3a!%A I% 4a%" u(h (a e there ! %o re-et!t!o%; a%d fre>ue%t$" the -at!e%t doe the% (o%fe a few da" $ater after he ha thou3ht th!%3 o5erA The -at!e%t who ! foo$!%3 h!4 e$f ! the o%e who ha (o44!tted o4e tr!f$!%3; offe% e a3a!% t the ru$e but who ha bee% ab$e to (o%5!%(e h!4 e$f that th! ! of %o !4-orta%(e a%d (a%%ot -o !b$" a((ou%t for the 3a!% !% we!3htA 6o4e% ee4 -art!(u$ar$" -ro%e to 3ett!%3 the4 e$5e e%ta%3$ed !% u(h de$u !o% A O% the other ha%d; !t doe fre>ue%t$" ha--e% that a -at!e%t w!$$ !% the 4!d t of a (o%5er at!o% u%th!%1!%3$" -ear a% o$!5e or for3et that he ha a$read" eate% h! bread t!(1A A 4other -re-ar!%3 food for the fa4!$" 4a" out of heer hab!t for3et that he 4u t %ot ta te the au(e to ee whether !t %eed 4ore a$tA So4et!4e a r!(h 4a!de% au%t (a%%ot be offe%ded b" refu !%3 a (u- of tea !%to wh!(h he ha -ut two tea -oo% of u3ar; thou3htfu$$" re4e4ber!%3 the -at!e%tF ta te fro4 -re5!ou o((a !o% A Su(h !%(!de%t are $e3!o% a%d are u ua$$" (o%fe ed w!thout he !tat!o%; but o4e -at!e%t ee4 3e%u!%e$" ab$e to for3et the e $a- e a%d re4e4ber the4 w!th a 5! !b$e ho(1 o%$" after !% ! te%t >ue t!o%!%3A I% the e (a e we 3o (arefu$$" o5er the da"A So4et!4e the -at!e%t ha bee% !%5!ted to a 4ea$ or 3o%e to a re taura%t; %a!5e$" be$!e5!%3 that the food ha a(tua$$" bee% -re-ared e/a(t$" a((ord!%3 to !% tru(t!o% A The" w!$$ a"D <@e ; %ow that I (o4e to th!%1 of !t the tea1 d!d ee4 a b!t b!33er tha% the o%e I ha5e at ho4e; a%d !t d!d ta te betterE 4a"be there wa a $!tt$e fat o% !t; thou3h I -e(!a$$" to$d the4 to (ut !t a$$ awa"KA So4et!4e the bread t!(1 were bro1e% a%d a few fra34e%t eate%; a%d <8a"be the" were a $!tt$e 4ore tha% o%eKA It ! %ot u%(o44o% for -at!e%t to -$a(e too 4u(h re$!a%(e o% the!r 4e4or" of the d!et0 heet a%d tart eat!%3 (arrot ; bea% or -ea a%d the% to ee4 3e%u!%e$" ur-r! ed whe% the!r atte%t!o% ! 40

(a$$ed to the fa(t that the e are forb!dde%; a the" ha5e %ot bee% $! tedA Cos*e"&cs 6he% %o d!etar" error ! e$!(!ted we tur% to (o 4et!( A 8o t wo4e% f!%d !t hard to be$!e5e that fat ; o!$ ; (rea4 a%d o!%t4e%t a--$!ed to the 1!% are ab orbed a%d !%terfere w!th we!3ht redu(t!o% b" H)G ?u t a !f the" had bee% eate%A Th! a$4o t !%(red!b$e e% !t!5!t" to e5e% u(h 5er" 4!%or !%(rea e !% %utr!t!o%a$ !%ta1e ! a -e(u$!ar feature of the H)G 4ethodA For !% ta%(e; we f!%d that -er o% who hab!tua$$" ha%d$e or3a%!( fat ; u(h a wor1er !% beaut" -ar$or ; 4a eur ; but(her ; et(A %e5er how what we (o% !der a at! fa(tor" $o of we!3ht u%$e the" (a% a5o!d fat (o4!%3 !%to (o%ta(t w!th the!r 1!%A The -o!%t ! o !4-orta%t that I w!$$ !$$u trate !t w!th two (a e A A $ad" who wa (oo-erat!%3 -erfe(t$" udde%$" !%(rea ed ha$f a -ou%dA )arefu$ >ue t!o%!%3 brou3ht %oth!%3 to $!3htA She had (erta!%$" 4ade %o d!etar" error %or had he u ed a%" 1!%d of fa(e (rea4; a%d he wa a$read" !% the 4e%o-au eA A we fe$t that we (ou$d tru t her !4-$!(!t$"; we $eft the >ue t!o% u -e%dedA @et ?u t a he wa about to $ea5e the (o% u$t!%3 roo4 he udde%$" to--ed; tur%ed a%d %a--ed her f!%3er A <IF5e 3ot !t;K he a!dA Th! ! what had ha--e%edD She had bou3ht her e$f a %ew et of 4a1e0u- -ot a%d bott$e a%d; u !%3 her f!%3er ; had tra% ferred her $ar3e a ort4e%t of (o 4et!( to the %ew (o%ta!%er !% a%t!(!-at!o% of the da" he wou$d be ab$e to u e the4 a3a!% after her treat4e%tA The other (a e (o%(er% a 4a% who !4-re ed u a be!%3 5er" (o% (!e%t!ou A He wa about *9 $b A o5erwe!3ht but d!d %ot $o e at! fa(tor!$" fro4 the o% et of treat4e%tA A3a!% a%d a3a!% we tr!ed to f!%d the rea o% but w!th %o u((e ; u%t!$ o%e da" he a!dD <I %e5er to$d "ou th! ; but I ha5e a 3$a e"eA I% fa(t; I ha5e a who$e et of the4A I fre>ue%t$" (ha%3e the4; a%d e5er" t!4e I do that I -ut a -e(!a$ o!%t4e%t !% 4" e"e o(1etA Do "ou th!%1 that (ou$d ha5e a%"th!%3 to do w!th !tOK A we thou3ht ?u t that; we a 1ed h!4 to to- u !%3 th! o!%t4e%t; a%d fro4 that da" o% h! we!3ht0$o wa re3u$arA 6e are -art!(u$ar$" a5er e to tho e 4oder% (o 4et!( wh!(h (o%ta!% hor4o%e ; a a%" !%terfere%(e w!th e%do(r!%e re3u$at!o% dur!%3 treat4e%t 4u t be ab o$ute$" a5o!dedA 8a%" wo4e% who e 1!% ha !% the (our e of "ear be(o4e ad?u ted to the u e of fat (o%ta!%!%3 (o 4et!( f!%d that the!r 1!% 3et dr" a oo% a the" to- u !%3 the4A I% u(h (a e we -er4!t the u e of -$a!% 4!%era$ o!$; wh!(h ha %o %utr!t!o%a$ 5a$ueA O% the other ha%d; 4!%era$ o!$ hou$d %ot be u ed !% -re-ar!%3 the food; f!r t be(au e of !t u%de !rab$e $a/at!5e >ua$!t"; a%d e(o%d be(au e !t ab orb o4e fat0 o$ub$e 5!ta4!% ; wh!(h are the% $o t !% the too$A 6e do -er4!t the u e of $!- t!(1; -owder a%d u(h $ot!o% a are e%t!re$" free of fatt" ub ta%(e A 6e a$ o a$$ow br!$$!a%t!%e to be u ed o% the ha!r but !t 4u t %ot be rubbed !%to the (a$-A Ob5!ou $" u%0ta% o!$ ! -roh!b!tedA 8a%" wo4e% are horr!f!ed whe% to$d that for the durat!o% of treat4e%t the" (a%%ot u e fa(e (rea4 or ha5e fa(!a$ 4a a3e A The" fear that th! a%d the $o of we!3ht w!$$ ru!% the!r (o4-$e/!o%A The" (a% be fu$$" rea uredA :%der treat4e%t %or4a$ fat ! re tored to the 1!%; wh!(h ra-!d$" be(o4e fre h a%d tur3!d; 4a1!%3 the e/-re !o% 4u(h 4ore "outhfu$A Th! ! a (hara(ter! t!( of the H)G 4ethod wh!(h ! a (o% ta%t our(e of wo%der to -at!e%t who ha5e e/-er!e%(ed or ee% !% other the fa(!a$ ra5a3e -rodu(ed b" the u ua$ 4ethod of redu(!%3A A% obe e wo4a% of 79 ob5!ou $" (a%%ot e/-e(t to ha5e her -ued fa(e redu(ed to %or4a$ 41

w!thout a wr!%1$e; but !t ! re4ar1ab$e how "outhfu$ her fa(e re4a!% !% -!te of her a3eA The .o&ce I%(!de%ta$$"; a%other !%tere t!%3 feature of the H)G 4ethod ! that !t doe %ot ru!% a !%3!%3 5o!(eA The t"-!(a$$" obe e -r!4a do%%a u ua$$" f!%d that whe% he tr!e to redu(e the t!4bre of her 5o!(e ! $!ab$e to (ha%3e; a%d u%der ta%dab$" th! terr!f!e herA :%der H)G th! doe %ot ha--e%E !%deed; !% 4a%" (a e the 5o!(e !4-ro5e a%d the breath!%3 !%5ar!ab$" doe A 6e ha5e had 4a%" (a e of -rofe !o%a$ !%3er 5er" (arefu$$" (o%tro$$ed b" e/-ert 5o!(e tea(her ; a%d the 4ae tro ha5e bee% o e%thu !a t!( that the" %ow fre>ue%t$" e%d u -at!e%t A O"he% Reasons !o% a +a&n A-art fro4 d!et a%d (o 4et!( there (a% be a few other rea o% for a 4a$$ r! e !% we!3htA So4e -at!e%t u%w!tt!%3$" ta1e (hew!%3 3u4; throat -a t!$$e ; 5!ta4!% -!$$ ; (ou3h "ru- et(A; w!thout rea$!B!%3 that the u3ar or fat the" (o%ta!% 4a" !%terfere w!th a re3u$ar $o of we!3htA Se/ hor4o%e or (ort! o%e !% !t 5ar!ou 4oder% for4 4u t be a5o!ded; thou3h ora$ (o%tra(e-t!5e are -er4!ttedA I% fa(t the o%$" e$f04ed!(at!o% we a$$ow ! a -!r!% for a heada(he; thou3h heada(he a$4o t !%5ar!ab$" d! a--ear after a wee1 of treat4e%t; -art!(u$ar$" !f of the 4!3ra!%e t"-eA O((a !o%a$$" we a$$ow a $ee-!%3 tab$et or a tra%>u!$!Ber; but -at!e%t hou$d be to$d that wh!$e u%der treat4e%t the" %eed a%d 4a" 3et $e $ee-A For !% ta%(e; here !% Ita$" where !t ! (u to4ar" to $ee- dur!%3 the !e ta wh!(h $a t fro4 o%e to four !% the after%oo% 4o t -at!e%t f!%d that thou3h the" $!e dow% the" are u%ab$e to $ee-A 6e e%(oura3e w!44!%3 a%d u% bath!%3 dur!%3 treat4e%t; but !t hou$d be re4e4bered that a e5ere u%bur% a$wa" -rodu(e a te4-orar" r! e !% we!3ht; e5!de%t$" due to water rete%t!o%A The a4e 4a" be ee% whe% a -at!e%t 3et a (o44o% (o$d dur!%3 treat4e%tA F!%a$$"; the we!3ht (a% te4-orar!$" !%(rea e 0 -arado/!(a$ thou3h th! 4a" ou%d 0 after a% e/(e-t!o%a$ -h" !(a$ e/ert!o% of $o%3 durat!o% $ead!%3 to a fee$!%3 of e/hau t!o%A A 3a4e of te%%! ; a 5!3orou w!4; a ru%; a r!de o% hor eba(1 or a rou%d of 3o$f do %ot ha5e th! effe(tE but a $o%3 tre1; a da" of 1!!%3; row!%3 or ("($!%3 or da%(!%3 !%to the 4a$$ hour u ua$$" re u$t !% a 3a!% of we!3ht o% the fo$$ow!%3 da"; u%$e the -at!e%t ! !% -erfe(t tra!%!%3A I% -at!e%t (o4!%3 fro4 abroad; where the" a$wa" u e the!r (ar ; we ofte% ee th! effe(t after a tre%uou da" of ho--!%3 o% foot; !3ht ee!%3 a%d 5! !t to 3a$$er!e a%d 4u eu4 A Thou3h the e/tra 4u (u$ar effort !%5o$5ed doe (o% u4e o4e add!t!o%a$ )a$or!e ; th! a--ear to be off et b" the rete%t!o% of water wh!(h the t!red (!r(u$at!o% (a%%ot at o%(e e$!4!%ateA A,,e"&"e5%educ&n( D%u(s 6e hard$" e5er u e a4-heta4!%e ; the a--et!te0redu(!%3 dru3 u(h a De/edr!%; De/a4!$; 2re$ud!%; et(A; a there ee4 to be %o %eed for the4 dur!%3 the H)G treat4e%tA The o%$" t!4e we f!%d the4 u efu$ ! whe% a -at!e%t ! for !4-e$$!%3 a%d u%fore ee% rea o% ob$!3ed to fore3o the do e for three to four da" a%d "et w! he to (o%t!%ue the d!et o that he %eed %ot !%terru-t the (our eA

42

$n!o%eseen In"e%%u,"&ons o! T%ea"*en" If a% !%terru-t!o% of treat4e%t $a t!%3 4ore tha% four da" ! %e(e ar"; the -at!e%t 4u t !%(rea e h! d!et to at $ea t &99 )a$or!e b" add!%3 4eat; e33 ; (hee e; a%d 4!$1 to h! d!et after the th!rd da"; a otherw! e he w!$$ f!%d h!4 e$f o hu%3r" a%d wea1 that he ! u%ab$e to 3o about h! u ua$ o((u-at!o%A If the !%ter5a$ $a t $e tha% two wee1 the -at!e%t (a% d!re(t$" re u4e do e a%d the 7990)a$or!e d!et; but !f the !%terru-t!o% $a t $o%3er he 4u t a3a!% eat %or4a$$" u%t!$ he ha had h! th!rd do eA 6he% a -at!e%t 1%ow beforeha%d that he w!$$ ha5e to tra5e$ a%d be ab e%t for 4ore tha% four da" ; !t ! a$wa" better to to- do e three da" before he ! due to $ea5e o that he (a% ha5e the three da" of tr!(t d!et!%3 wh!(h are %e(e ar" after the $a t do e at ho4eA Th! a5e h!4 fro4 the a$4o t !4-o !b$e ta 1 of ha5!%3 to arra%3e the 799 )a$or!e d!et wh!$e e% route; a%d he (a% thu e%?o" a 4u(h 3reater d!etar" freedo4 fro4 the da" of h! de-artureA I%terru-t!o% o((urr!%3 before *9 effe(t!5e do e ha5e bee% 3!5e% are 4o t u%de !rab$e; be(au e w!th $e tha% that %u4ber of do e o4e we!3ht ! $!ab$e to be re3a!%edA After the *9th do e a% u%a5o!dab$e !%terru-t!o% ! 4ere$" a $o of t!4eA Muscu a% #a"&(ue Toward the e%d of a fu$$ (our e; whe% a 3ood dea$ of fat ha bee% ra-!d$" $o t; o4e -at!e%t (o4-$a!% that $!ft!%3 a we!3ht or ($!4b!%3 ta!r re>u!re a 3reater 4u (u$ar effort tha% beforeA The" fee$ %e!ther breath$e %e %or e/hau t!o% but !4-$" that the!r 4u ($e ha5e to wor1 harderA Th! -he%o4e%o%; wh!(h d! a--ear oo% after the e%d of the treat4e%t; ! (au ed b" the re4o5a$ of ab%or4a$ fat de-o !ted betwee%; !%; a%d arou%d the 4u ($e A The re4o5a$ of th! fat 4a1e the 4u ($e too $o%3; a%d o !% order to a(h!e5e a (erta!% 1e$eta$ 4o5e4e%t 0 a" the be%d!%3 of a% ar4 0 the 4u ($e ha5e to -erfor4 3reater (o%tra(t!o% tha% beforeA 6!th!% a hort wh!$e the 4u ($e ad?u t !t e$f -erfe(t$" to the %ew !tuat!o%; but u%der H)G the $o of fat ! o ra-!d that th! ad?u t4e%t (a%%ot 1ee- u- w!th !tA 2at!e%t ofte% ha5e to be rea ured that th! doe %ot 4ea% that the" are <3ett!%3 wea1KA Th! -he%o4e%o% doe %ot o((ur !% -at!e%t who re3u$ar$" ta1e 5!3orou e/er(! e a%d (o%t!%ue to do o dur!%3 treat4e%tA Massa(e I %e5er a$$ow a%" 1!%d of 4a a3e dur!%3 treat4e%tA It ! e%t!re$" u%%e(e ar" a%d 4ere$" d! turb a 5er" de$!(ate -ro(e wh!(h ! 3o!%3 o% !% the t! ue A Few !%deed are the 4a eur a%d 4a eu e who (a% re ! t the te4-tat!o% to 1%ead a%d ha44er ab%or4a$ fat de-o !t A I% the (our e of ra-!d redu(t!o% !t ! o4et!4e -o !b$e to -!(1 u- a fo$d of 1!% wh!(h ha %ot "et had t!4e to ad?u t !t e$f; a !t a$wa" doe u%der H)G; to the (ha%3ed f!3ureA Th! fo$d (o%ta!% !t %or4a$ ub(uta%eou fat a%d 4a" be a$4o t a% !%(h th!(1A It ! o%e of the 4a!% ob?e(t of the H)G treat4e%t to 1ee- that fat thereA 2at!e%t a%d the!r 4a eur do %ot a$wa" u%der ta%d th! a%d 3!5e th! fat a wor1!%30o5erA I ha5e ee% u(h -at!e%t who were a b$a(1 a%d b$ue a !f the" had re(e!5ed a ou%d thra h!%3A I% 4" o-!%!o%; 4a a3e; thu4-!%3; ro$$!%3; 1%ead!%3; a%d h!5er!%3 u%derta1e% for the -ur-o e of redu(!%3 ab%or4a$ fat (a% do %oth!%3 but har4A 6e o%(e had the ho%or of treat!%3 the -ro-r!etre of a h!3h ($a !% t!tut!o% that -e(!a$!Bed !% u(h a%t!( A She had the auda(!t" to (o%fe that he wa ta1!%3 our treat4e%t to (o%5!%(e her ($!e%t of the eff!(a(" of 43

her 4ethod ; wh!(h he had fou%d u e$e

!% her ow% (a eA

How a%"o%e !% h! r!3ht 4!%d ! ab$e to be$!e5e that fatt" t! ue (a% be h!fted 4e(ha%!(a$$" or be 4ade to 5a%! h b" >ueeB!%3 ! be"o%d 4" (o4-rehe% !o%A The o%$" effe(t obta!%ed ! e5ere bru! !%3A The tor% t! ue the% for4 (ar ; a%d the e $ow$" (o%tra(t 4a1!%3 the fatt" t! ue e5e% harder a%d 4ore u%"!e$d!%3A A $ad" o%(e (o% u$ted u for her 4o t u%3a!%$" $e3 A Lar3e 4a e of fat bu$3ed o5er the a%1$e of her t!%" feet; a%d there were about 49 $b A too 4u(h o% her h!- a%d th!3h A 6e a ured her that th! o5erwe!3ht (ou$d be $o t a%d that her a%1$e wou$d 4ar1ed$" !4-ro5e !% the -ro(e A Her treat4e%t -ro3re ed 4o t at! fa(tor!$" but to our ur-r! e there wa %o !4-ro5e4e%t !% her a%1$e A 6e the% d! (o5ered that he had for "ear bee% ta1!%3 e5er" 1!%d of 4e(ha%!(a$; e$e(tr!( a%d heat treat4e%t for her $e3 a%d that he had 4ade u- her 4!%d to re ort to -$a t!( ur3er" !f we fa!$edA Re0e/a4!%!%3 the fat abo5e her a%1$e ; we fou%d that !t wa u%u ua$$" hardA 6e attr!buted th! to the (ou%t$e 4!%or !%?ur!e !%f$!(ted b" 1%ead!%3A The e !%?ur!e had hea$ed but had $eft a tou3h %etwor1 of (o%%e(t!5e (ar0t! ue !% wh!(h the fat wa !4-r! o%edA Read" to tr" a%"th!%3; he wa -ut to bed for the re4a!%!%3 three wee1 of her f!r t (our e w!th her $ower $e3 t!3ht$" tra--ed !% u%"!e$d!%3 ba%da3e A E5er" da" the -re ure wa !%(rea edA The (o4b!%at!o% of H)G; d!et a%d tra--!%3 brou3ht about a 4ar1ed !4-ro5e4e%t !% the ha-e of her a%1$e A At the e%d of her f!r t (our e he retur%ed to her ho4e abroadA Three 4o%th $ater he (a4e ba(1 for her e(o%d (our eA She had 4a!%ta!%ed both her we!3ht a%d the !4-ro5e4e%t of her a%1$e A The a4e -ro(edure wa re-eated; a%d after f!5e wee1 he $eft the ho -!ta$ w!th a %or4a$ we!3ht a%d $e3 that; !f %ot e/a(t$" ha-e$"; were at $ea t u%obtru !5eA 6here %o u(h !%?ur!e of the t! ue ha5e bee% !%f$!(ted b" !%a--ro-r!ate 4ethod of treat4e%t; the e dra t!( 4ea ure are %e5er %e(e ar"A B ood Su(a% Toward the e%d of a (our e or whe% a -at!e%t ha %ear$" rea(hed h! %or4a$ we!3ht !t o((a !o%a$$" ha--e% that the b$ood u3ar dro- be$ow %or4a$; a%d we ha5e e5e% ee% th! !% -at!e%t who had a% ab%or4a$$" h!3h b$ood u3ar before treat4e%tA Su(h a% atta(1 of h"-o3$"(e4!a ! a$4o t !de%t!(a$ w!th the o%e ee% !% d!abet!( who ha5e ta1e% too 4u(h !% u$!%A The atta(1 (o4e o% udde%$"E there ! the a4e fee$!%3 of $!3ht0headed%e ; wea1%e !% the 1%ee ; tre4b$!%3; a%d u%4ot!5ated weat!%3E but u%der H)G h"-o3$"(e4!a doe %ot -rodu(e a%" fee$!%3 of hu%3erA A$$ the e "4-to4 are a$4o t !% ta%t$" re$!e5ed b" ta1!%3 two hea-ed tea -oo% of u3arA I% the (our e of treat4e%t the -o !b!$!t" of u(h a% atta(1 ! e/-$a!%ed to tho e -at!e%t who are !% a -ha e !% wh!(h a dro- !% b$ood u3ar 4a" o((urA The" are !% tru(ted to 1ee- u3ar or 3$u(o e weet ha%d"; -art!(u$ar$" whe% dr!5!%3 a (arA The" are a$ o to$d to wat(h the effe(t of ta1!%3 u3ar 5er" (arefu$$" a%d re-ort the fo$$ow!%3 da"A Th! ! !4-orta%t; be(au e a%/!ou -at!e%t to who4 u(h a% atta(1 ha bee% e/-$a!%ed are a-t to ta1e u3ar u%%e(e ar!$"; !% wh!(h (a e !t !%e5!tab$" -rodu(e a 3a!% !% we!3ht a%d doe %ot dra4at!(a$$" re$!e5e the "4-to4 for wh!(h !t wa ta1e%; -ro5!%3 that the e were %ot due to h"-o3$"(e4!aA So4e -at!e%t 4! ta1e the effe(t of e4ot!o%a$ tre for h"-o3$"(e4!aA 6he% the "4-to4 are >u!(1$" re$!e5ed b" u3ar th! ! -roof that the" were !%deed due to a% ab%or4a$ $ower!%3 of 44

the b$ood u3ar; a%d !% that (a e there ! %o !%(rea e !% the we!3ht o% the fo$$ow!%3 da"A 6e a$wa" u33e t that u3ar be ta1e% !f the -at!e%t ! !% doubtA O%(e u(h a% atta(1 ha bee% re$!e5ed w!th u3ar we ha5e %e5er ee% !t re(ur o% the !44ed!ate$" ub e>ue%t da" ; a%d o%$" 5er" rare$" doe a -at!e%t ha5e two u(h atta(1 e-arated b" e5era$ da" dur!%3 a (our e of treat4e%tA I% -at!e%t who ha5e %ot eate% uff!(!e%t$" dur!%3 the f!r t two da" of treat4e%t we o4et!4e 3!5e u3ar whe% the 4!%or "4-to4 u ua$$" fe$t dur!%3 the f!r t three da" of treat4e%t (o%t!%ue be"o%d that t!4e; a%d !% o4e (a e th! ha ee4ed to -eed u- the eu-hor!a ord!%ar!$" a o(!ated w!th the H)G 4ethodA The Ra"&o o! Pounds "o Inches A% !%tere t!%3 feature of the H)G 4ethod ! that; re3ard$e of how fat a -at!e%t ! ; the 3reate t (!r(u4fere%(e 0 abdo4e% or h!- a the (a e 4a" be 0 ! redu(ed at a (o% ta%t rate wh!(h ! e/traord!%ar!$" ($o e to 1 (4A -er 1!$o3ra4 of we!3ht $o tA At the be3!%%!%3 of treat4e%t the (ha%3e !% 4ea ure4e%t ! o4ewhat 3reater tha% th! ; but at the e%d of a (our e !t ! a$4o t !%5ar!ab$" fou%d that the 3!rth ! a 4a%" (e%t!4eter $e a the %u4ber of 1!$o3ra4 b" wh!(h the we!3ht ha bee% redu(edA I ha5e %e5er ee% th! ($ear (ut re$at!o% h!!% -at!e%t that tr" to redu(e b" d!et!%3 o%$"A P%e,a%&n( "he So u"&on Hu4a% (hor!o%!( 3o%adotro-h!% (o4e o% the 4ar1et a a h!3h$" o$ub$e -owder wh!(h ! the -ure ub ta%(e e/tra(ted fro4 the ur!%e of -re3%a%t wo4e%A Su(h -re-arat!o% are (arefu$$" ta%dard!Bed; a%d a%" bra%d 4ade b" a re$!ab$e -har4a(eut!(a$ (o4-a%" ! -robab$" a 3ood a a%" otherA The ub ta%(e hou$d be e/tra(ted fro4 the ur!%e a%d %ot fro4 the -$a(e%ta; a%d !t 4u t of (our e be of hu4a% a%d %ot of a%!4a$ or!3!%A The -owder ! ea$ed !% a4-ou$e or !% rubber0(a--ed bott$e !% 5ar"!%3 a4ou%t wh!(h are tated !% I%ter%at!o%a$ :%!t A I% th! for4 H)G ! tab$eE howe5er; o%$" u(h -re-arat!o% hou$d be u ed that ha5e the date of 4a%ufa(ture a%d the date of e/-!r" ($ear$" tated o% the $abe$ or -a(1a3eA A u!tab$e o$5e%t ! a$wa" u--$!ed !% a e-arate a4-ou$e !% the a4e -a(1a3eA O%(e H)G ! !% o$ut!o% !t ! far $e tab$eA It 4a" be 1e-t at roo40te4-erature for two to three da" ; but !f the o$ut!o% 4u t be 1e-t $o%3er !t hou$d a$wa" be refr!3eratedA 6he% treat!%3 o%$" o%e or two (a e !4u$ta%eou $"; 5!a$ (o%ta!%!%3 a 4a$$ %u4ber of u%!t a" 1999 IA:A hou$d be u edA The 19 ((A of o$5e%t wh!(h ! u--$!ed b" the 4a%ufa(turer ! !%?e(ted !%to the rubber0 (a--ed bott$e (o%ta!%!%3 the H)G; a%d the -owder 4u t d! o$5e !% ta%t$"A Of th! o$ut!o% 1A*7 ((A are w!thdraw% for ea(h do eA O%e u(h bott$e of 1999 IA:A therefore fur%! he & do e A 6he% 4ore tha% o%e -at!e%t ! be!%3 treated; the" hou$d %ot ea(h ha5e the!r ow% bott$e but rather a$$ be !%?e(ted fro4 the a4e 5!a$ a%d a fre h o$ut!o% 4ade whe% th! ! e4-t"A A we are u ua$$" treat!%3 a fa!r %u4ber of -at!e%t at the a4e t!4e; we -refer to u e 5!a$ (o%ta!%!%3 7999 u%!t A 6!th the e the 4a%ufa(ture a$ o u--$" 19 ((A of o$5e%tA Of u(h a o$ut!o% 9A*7 ((A (o%ta!% the 1*7 IA:A wh!(h ! the ta%dard do e for a$$ (a e a%d wh!(h hou$d %e5er be e/(eededA Th! 4a$$ a4ou%t ! aw1ward to ha%d$e a((urate$" +!t re>u!re a% !% u$!% "r!%3e, a%d ! wa tefu$; be(au e there ! a $o of o$ut!o% !% the %oBB$e of the "r!%3e 45

a%d !% the %eed$eA 6e therefore -refer a h!3her d!$ut!o%; wh!(h we -re-are !% the fo$$ow!%3 wa"D The o$5e%t u--$!ed ! !%?e(ted !%to the rubber(a--ed bott$e (o%ta!%!%3 the 7999 IA:A A the e bott$e are too 4a$$ to ho$d 4ore o$5e%t; we w!thdraw 7 ((A; !%?e(t !t !%to a% e4-t" rubber0(a--ed bott$e a%d add 7 ((A of %or4a$ a$!%e to ea(h bott$eA Th! 3!5e u 19 ((A of o$ut!o% !% ea(h bott$e; a%d of th! o$ut!o% 9A7 ((A (o%ta!% 1*7 IA:A Th! a4ou%t ! (o%5e%!e%t to !%?e(t w!th a% ord!%ar" "r!%3eA In6ec"&n( H)G -rodu(e $!tt$e or %o t! ue0rea(t!o%; !t ! (o4-$ete$" -a!%$e a%d !% the 4a%" thou a%d of do e we ha5e 3!5e% we ha5e %e5er ee% a% !%f$a44ator" or u--urat!5e rea(t!o% at the !te of the do eA O%e hou$d a5o!d $ea5!%3 a 5a(uu4 !% the bott$e after -re-ar!%3 the o$ut!o% or after w!thdrawa$ of the a4ou%t re>u!red for the do e a otherw! e a$(oho$ u ed for ter!$!B!%3 a fre>ue%t$" -erforated rubber (a- 4!3ht be draw% !%to the o$ut!o%A 6he% har- %eed$e are u ed; !t o4et!4e ha--e% that a $!tt$e b!t of rubber ! -u%(hed out of the rubber (a- a%d (a% be ee% a a 4a$$ b$a(1 -e(1 f$oat!%3 !% the o$ut!o%A A the e b!t of rubber are hea5!er tha% the o$ut!o% the" ra-!d$" ett$e out; a%d !t ! thu ea " to a5o!d draw!%3 the4 !%to the "r!%3eA 6e u e 5er" f!%e %eed$e that are two !%(he $o%3 a%d !%?e(t dee- !%tra3$utea$$" !% the outer u--er >uadra%t of the butto(1 A The do e hou$d !f -o !b$e %ot be 3!5e% !%to the u-erf!(!a$ fat $a"er ; wh!(h !% 5er" obe e -at!e%t 4u t be (o4-re ed o a to e%ab$e the %eed$e to rea(h the 4u ($eA Ob5!ou $" %eed$e a%d "r!%3e 4u t be (arefu$$" wa hed; ter!$!Bed a%d ha%d$ed a e-t!(a$$"A It ! a$ o !4-orta%t that the da!$" do e hou$d be 3!5e% at !%ter5a$ a ($o e to *4 hour a -o !b$eA A%" atte4-t to e(o%o4!Be !% t!4e b" 3!5!%3 $ar3er do e at $o%3er !%ter5a$ ! doo4ed to -rodu(e $e at! fa(tor" re u$t A There are hard$" a%" (o%tra!%d!(at!o% to the H)G 4ethodA Treat4e%t (a% be (o%t!%ued !% the -re e%(e of ab (e e ; u--urat!o%; $ar3e !%fe(ted wou%d a%d 4a?or fra(ture A Sur3er" a%d 3e%era$ a%e the !a are %o rea o% to to- a%d we ha5e 3!5e% treat4e%t dur!%3 a e5ere atta(1 of 4a$ar!aA A(%e or bo!$ are %o (o%tra!%d!(at!o%E the for4er u ua$$" ($ear u-; a%d furu%(u$o ! (o4e to a% e%dA Thro4bo-h$eb!t! ! %o (o%tra!%d!(at!o%; a%d we ha5e treated e5era$ obe e -at!e%t w!th H)G a%d the 7990)a$or!e d!et wh!$e uffer!%3 fro4 th! (o%d!t!o%A Our !4-re !o% ha bee% that !% obe e -at!e%t the -h$eb!t! doe rather better a%d (erta!%$" %o wor e tha% u%der the u ua$ treat4e%t a$o%eA Th! a$ o a--$!e to -at!e%t uffer!%3 fro4 5ar!(o e u$(er wh!(h te%d to hea$ ra-!d$"A #&b%o&ds 6h!$e uter!%e f!bro!d ee4 to be !% %o wa" affe(ted b" H)G !% the do e we u e; we ha5e fou%d that 5er" $ar3e; e/ter%a$$" -a$-ab$e uter!%e 4"o4a are a-t to 3!5e troub$eA 6e are (o%5!%(ed that th! ! e%t!re$" due to the rather udde% d! a--eara%(e of fat fro4 the -e$5!( bed u-o% wh!(h the" re t a%d that !t ! the we!3ht of the tu4or -re !%3 o% the u%der$"!%3 t! ue wh!(h a((ou%t for the d! (o4fort or -a!% wh!(h 4a" ar! e dur!%3 treat4e%tA 6h!$e we d! re3ard e5e% fa!r0 !Bed or 4u$t!-$e 4"o4a ; we !% ! t that 5er" $ar3e o%e be o-erated before treat4e%tA 6e ha5e had -at!e%t -re e%t the4 e$5e for redu(!%3 fat fro4 the!r 46

abdo4e% who howed %o !3% of obe !t"; but had a $ar3e abdo4!%a$ tu4orA +a s"ones S4a$$ to%e !% the 3a$$ b$adder 4a" !% -at!e%t who ha5e re(e%t$" had t"-!(a$ (o$!( (au e 4ore fre>ue%t (o$!( u%der treat4e%t w!th H)GA Th! 4a" be due to the a$4o t (o4-$ete ab e%(e of fat fro4 the d!et; wh!(h -re5e%t the %or4a$ e4-t"!%3 of the 3a$$ b$adderA 'efore u%derta1!%3 treat4e%t we e/-$a!% to u(h -at!e%t that there ! a r! 1 of 4ore fre>ue%t a%d -o !b$" e5ere "4-to4 a%d that !t 4a" be(o4e %e(e ar" to o-erateA If the" are -re-ared to ta1e th! r! 1 a%d -ro5!ded the" a3ree to u%der3o a% o-erat!o% !f we (o% !der th! !4-erat!5e; we -ro(eed w!th treat4e%t; a after we!3ht redu(t!o% w!th H)G the o-erat!5e r! 1 ! (o% !derab$" redu(ed !% a% obe e -at!e%tA I% u(h (a e we a$wa" 3!5e a dru3 wh!(h t!4u$ate the f$ow of b!$e; a%d !% the 4a?or!t" of (a e %oth!%3 u%toward ha--e% A O% the other ha%d; we ha5e $oo1ed for a%d %ot fou%d a%" e5!de%(e to u33e t that the H)G treat4e%t $ead to the for4at!o% of 3a$$ to%e a -re3%a%(" o4et!4e doe A The Hea%" D! order of the heart are %ot a a ru$e (o%tra!%d!(at!o% A I% fa(t; the re4o5a$ of ab%or4a$ fat 0 -art!(u$ar$" fro4 the heart04u ($e a%d fro4 the urrou%d!%3 of the (oro%ar" arter!e 0 (a% o%$" be be%ef!(!a$ !% (a e of 4"o(ard!a$ wea1%e ; a%d 4a%" u(h -at!e%t are referred to u b" (ard!o$o3! t A 6!th!% the f!r t wee1 of treat4e%t a$$ -at!e%t 0 %ot o%$" heart (a e 0 re4ar1 that the" ha5e $o t 4u(h of the!r breath$e %e A Co%ona%) Occ us&on I% obe e -at!e%t who ha5e re(e%t$" ur5!5ed a (oro%ar" o(($u !o%; we ado-t the fo$$ow!%3 -ro(edure !% (o$$aborat!o% w!th the (ard!o$o3! tA 6e wa!t u%t!$ %o further e$e(tro(ard!o3ra-h!( (ha%3e ha5e o((urred for a -er!od of three 4o%th A Rout!%e treat4e%t ! the% tarted u%der (arefu$ (o%tro$ a%d !t ! u ua$ to f!%d a further e$e(tro(ard!o3ra-h!( !4-ro5e4e%t of a (o%d!t!o% wh!(h wa -re5!ou $" tat!o%ar"A I% the thou a%d of (a e we ha5e treated we ha5e %ot o%(e ee% a%" ort of (oro%ar" !%(!de%t o((ur dur!%3 or hort$" after treat4e%tA The a4e a--$!e to (erebra$ 5a (u$ar a((!de%t A Nor ha5e we e5er ee% a (a e of thro4bo ! of a%" ort de5e$o- dur!%3 treat4e%t; e5e% thou3h a h!3h b$ood -re ure ! ra-!d$" $oweredA I% th! re -e(t; too; the H)G treat4e%t re e4b$e -re3%a%("A Tee"h and .&"a*&ns 2at!e%t who e teeth are !% -oor re-a!r o4et!4e 3et 4ore troub$e u%der -ro$o%3ed treat4e%t; ?u t a 4a" o((ur !% -re3%a%("A I% u(h (a e we do a$$ow (a$(!u4 a%d 5!ta4!% D; thou3h %ot !% a% o!$" o$ut!o%A The o%$" other 5!ta4!% we -er4!t ! 5!ta4!% ); wh!(h we u e !% $ar3e do e (o4b!%ed w!th a% a%t!h! ta4!%e at the o% et of a (o44o% (o$dA There ! %o ob?e(t!o% to the u e of a% a%t!b!ot!( !f th! ! re>u!red; for !% ta%(e b" the de%t! tA I% (a e of bro%(h!a$ a th4a a%d ha" fe5er we ha5e o((a !o%a$$" re orted to (ort! o%e dur!%3 treat4e%t a%d f!%d that tr!a4(!%o$o%e ! the $ea t $!1e$" to !%terfere w!th the $o of we!3ht; but 4a%" a th4at!( !4-ro5e w!th H)G a$o%eA 47

A coho Obe e hea5" dr!%1er ; e5e% tho e border!%3 o% a$(oho$! 4; ofte% do ur-r! !%3$" we$$ u%der H)G a%d !t ! e/(e-t!o%a$ for the4 to ta1e a dr!%1 wh!$e u%der treat4e%tA 6he% the" do; the" f!%d that a re$at!5e$" 4a$$ >ua%t!t" of a$(oho$ -rodu(e !%to/!(at!o%A Su(h -at!e%t a" that the" do %ot fee$ the %eed to dr!%1 Th! 4a" !% -art be due to the eu-hor!a wh!(h the treat4e%t -rodu(e a%d !% -art to the (o4-$ete ab e%(e of the %eed for >u!(1 u te%a%(e fro4 wh!(h 4o t obe e -at!e%t ufferA Thou3h we ha5e had a few (a e that ha5e (o%t!%ued ab t!%e%(e $o%3 after treat4e%t; other re$a- e a oo% a the" are ba(1 o% a %or4a$ d!etA 6e ha5e a few <re3u$ar (u to4er K who; ha5!%3 o%(e bee% redu(ed to the!r %or4a$ we!3ht; tart to dr!%1 a3a!% thou3h wat(h!%3 the!r we!3htA The% after o4e 4o%th the" -ur-o e$" o5ereat !% order to 3a!% uff!(!e%t we!3ht for a%other (our e of H)G wh!(h te4-orar!$" 3et the4 out of the!r dr!%1!%3 rout!%eA 6e do %ot -art!(u$ar$" we$(o4e u(h (a e ; but we ee %o rea o% for refu !%3 the!r re>ue tA Tube%cu os&s It ! !%tere t!%3 that obe e -at!e%t uffer!%3 fro4 !%a(t!5e -u$4o%ar" tuber(u$o ! (a% be afe$" treatedA 6e ha5e u%der 5er" (arefu$ (o%tro$ treated -at!e%t a ear$" a three 4o%th after the" were -ro%ou%(ed !%a(t!5e a%d ha5e %e5er ee% a re$a- e o((ur dur!%3 or hort$" after treat4e%tA I% fa(t; we o%$" ha5e o%e (a e o% our re(ord !% wh!(h a(t!5e tuber(u$o ! de5e$o-ed !% a "ou%3 4a% about o%e "ear after a treat4e%t wh!(h had $a ted three wee1 A Ear$!er Q0ra" howed a (a$(!f!ed -ot fro4 a (h!$dhood !%fe(t!o% wh!(h had %ot -rodu(ed ($!%!(a$ "4-to4 A There wa a fa4!$" h! tor" of tuber(u$o ! ; a%d h! !$$%e tarted u%der ad5er e (o%d!t!o% wh!(h (erta!%$" had %oth!%3 to do w!th the treat4e%tA Re !dua$ (a$(!f!(at!o% fro4 a% ear$" !%fe(t!o% are e/(eed!%3$" (o44o%; a%d we %e5er (o% !der the4 a (o%tra!%d!(at!o% to treat4e%tA The Pa&n!u Hee I% obe e -at!e%t who ha5e bee% tr"!%3 de -erate$" to 1ee- the!r we!3ht dow% b" e5ere d!et!%3; a (ur!ou "4-to4 o4et!4e o((ur A The" (o4-$a!% of a% u%bearab$e -a!% !% the!r hee$ wh!(h the" fee$ o%$" wh!$e ta%d!%3 or wa$1!%3A A oo% a the" ta1e the we!3ht off the!r hee$ the -a!% (ea e A The e (a e are the ba%e of the rheu4ato$o3! t a%d ortho-ed!( ur3eo% who ha5e treated the4 before the" (o4e to u A A$$ the u ua$ !%5e t!3at!o% are e%t!re$" %e3at!5e; a%d there ! %ot the $!3hte t re -o% e to a%t!0 rheu4at!( 4ed!(at!o% or -h" !othera-"A The -a!% 4a" be o e5ere that the -at!e%t are ob$!3ed to 3!5e u- the!r o((u-at!o%; a%d the" are %ot !%fre>ue%t$" $abe$ed a a (a e of h" ter!aA 6he% the!r hee$ are (arefu$$" e/a4!%ed o%e f!%d that the o$e ! ofter tha% %or4a$ a%d that the hee$ bo%e 0 the (a$(a%eu 0 (a% be d! t!%(t$" fe$t; wh!(h ! %ot the (a e !% a %or4a$ footA 6e !%ter-ret the (o%d!t!o% a a $a(1 of the hard fatt" -ad o% wh!(h the (a$(a%eu re t a%d wh!(h -rote(t both the bo%e a%d the 1!% of the o$e fro4 -re ureA Th! fat ! $!1e a -r!%3" (u h!o% wh!(h (arr!e the we!3ht of the bod"A Sta%d!%3 o% a hee$ !% wh!(h th! fat ! 4! !%3 or redu(ed 4u t ob5!ou $" be 5er" -a!%fu$A I% the!r effort to 1ee- the!r we!3ht dow% the e -at!e%t ha5e (o% u4ed th! %or4a$ tru(tura$ fatA

48

Tho e -at!e%t who ha5e a %or4a$ or ub%or4a$ we!3ht wh!$e how!%3 the t"-!(a$$" obe e fat de-o !t are 4ade to eat to (a-a(!t"; ofte% 4u(h a3a!% t the!r w!$$; for o%e wee1A The" 3a!% we!3ht ra-!d$" but there ! %o !4-ro5e4e%t !% the -a!%fu$ hee$ A The" are the% tarted o% the rout!%e H)G treat4e%tA O5erwe!3ht -at!e%t are treated !44ed!ate$"A I% both (a e the -a!% (o4-$ete$" d! a--ear !% 190*9 da" of d!et!%3; u ua$$" arou%d the 17th da" of treat4e%t; a%d o far %o (a e ha had a re$a- e; thou3h we ha5e bee% ab$e to fo$$ow u- u(h -at!e%t for "ear A 6e are -art!(u$ar$" !%tere ted !% the e (a e ; a the" fur%! h further -roof of the (o%te%t!o% that H)G M 799 )a$or!e %ot o%$" re4o5e ab%or4a$ fat but a(tua$$" -er4!t %or4a$ fat to be re-$a(ed; !% -!te of the def!(!e%t food !%ta1eA It ! (erta!%$" %ot o that the 4ere $o of we!3ht redu(e the -a!%; be(au e !t fre>ue%t$" d! a--ear before the we!3ht the -at!e%t had -r!or to the -er!od of for(ed feed!%3 ! rea(hedA The S2e,"&ca Pa"&en" A%" do(tor who tart u !%3 the H)G 4ethod for the f!r t t!4e w!$$ ha5e (o% !derab$e d!ff!(u$t"; -art!(u$ar$" !f he h!4 e$f ! %ot fu$$" (o%5!%(ed; !% 4a1!%3 -at!e%t be$!e5e that the" w!$$ %ot fee$ hu%3r" o% 799 )a$or!e a%d that the!r fa(e w!$$ %ot (o$$a- eA New -at!e%t a$wa" a%t!(!-ate the -he%o4e%a the" 1%ow o we$$ fro4 -re5!ou treat4e%t a%d d!et a%d are !%(redu$ou whe% to$d that the e w!$$ %ot o((urA 6e o5er(o4e a$$ th! b" $ett!%3 %ew -at!e%t -e%d a $!tt$e t!4e !% the wa!t!%3 roo4 w!th o$der ha%d ; who (a% a$wa" be re$!ed u-o% to a$$a" the e fear w!th e5a%3e$! t!( Bea$; ofte% de4o% trat!%3 the f!%er -o!%t o% the!r ow% bod"A A wa!t!%30roo4 f!$$ed w!th obe e -at!e%t who (o%3re3ate da!$" ! a ort of 3rou- thera-"A The" (o4-are %ote a%d -o- ba(1 !%to the wa!t!%3 roo4 after the (o% u$tat!o% to a%%ou%(e the (ore of the $a t *4 hour to a% e%thra$$ed aud!e%(eA The" (ro 0(he(1 o% the!r d!et a%d o4et!4e (o%fe !% wh!(h the" tr" to h!de fro4 u ; u ua$$" w!th the re u$t that the -at!e%t !% who4 the" ha5e (o%f!ded -a$-!tat!%3$" tatt$e the who$e d! 3ra(efu$ tor" to u w!th a <'ut do%Ft $et her 1%ow I to$d "ouAK Conc ud&n( a Cou%se 6he% the three da" of d!et!%3 after the $a t do e are o5er; the -at!e%t are to$d that the" 4a" %ow eat a%"th!%3 the" -$ea e; e/(e-t u3ar a%d tar(h; -ro5!ded the" fa!thfu$$" ob er5e o%e !4-$e ru$eA Th! ru$e ! that the" 4u t ha5e the!r ow% -ortab$e bathroo40 (a$e a$wa" at ha%d; -art!(u$ar$" wh!$e tra5e$!%3A The" 4u t w!thout fa!$ we!3h the4 e$5e e5er" 4or%!%3 a the" 3et out of bed; ha5!%3 f!r t e4-t!ed the!r b$adderA If the" are !% the hab!t of ha5!%3 brea1fa t !% bed; the" 4u t we!3h before brea1fa tA It ta1e about . wee1 before the we!3ht rea(hed at the e%d of the treat4e%t be(o4e tab$e; !AeA doe %ot how 5!o$e%t f$u(tuat!o% after a% o((a !o%a$ e/(e A Dur!%3 th! -er!od -at!e%t 4u t rea$!Be that the o0(a$$ed (arboh"drate ; that ! u3ar; r!(e; bread; -otatoe ; -a tr!e et(; are b" far the 4o t da%3erou A If %o (arboh"drate what oe5er are eate%; fat (a% be !%du$3ed !% o4ewhat 4ore $!bera$$" a%d e5e% 4a$$ >ua%t!t!e of a$(oho$; u(h a a 3$a of w!%e w!th 4ea$ ; doe %o har4; but a oo% a fat a%d tar(h are (o4b!%ed th!%3 are 5er" $!ab$e to 3et out of ha%dA Th! ha to be ob er5ed 5er" (arefu$$" dur!%3 the f!r t . wee1 after the treat4e%t ! e%ded otherw! e d! a--o!%t4e%t are a$4o t ure to o((urA 49

S2&,,&n( a Mea A $o%3 a the!r we!3ht ta" w!th!% two -ou%d of the we!3ht rea(hed o% the da" of the $a t do e; -at!e%t hou$d ta1e %o %ot!(e of a%" !%(rea eE but the 4o4e%t the (a$e 3oe be"o%d two -ou%d ; e5e% !f th! ! o%$" a few ou%(e ; the" 4u t o% that a4e da" e%t!re$" 1!brea1fa t a%d $u%(h but ta1e -$e%t" to dr!%1A I% the e5e%!%3 the" 4u t eat a hu3e tea1 w!th o%$" a% a--$e or a raw to4atoA Of (our e th! ru$e a--$!e o%$" to the 4or%!%3 we!3htA E/0 obe e -at!e%t hou$d %e5er (he(1 the!r we!3ht dur!%3 the da"; a there 4a" be w!de f$u(tuat!o% a%d the e are 4ere$" a$ar4!%3 a%d (o%fu !%3A I" &s o! u"*os" &*,o%"ance "ha" "he *ea &s s2&,,ed on "he sa*e da) as "he sca e %e(&s"e%s an &nc%ease o! *o%e "han "4o ,ounds and "ha" *&ss&n( "he *ea s &s no" ,os",oned un"& "he !o o4&n( da). If a 4ea$ ! 1!--ed o% the da" !% wh!(h a 3a!% ! re3! tered !% the 4or%!%3; th! br!%3 about a% !44ed!ate dro- of ofte% o5er a -ou%dA 'ut !f the 1!--!%3 of the 4ea$ 0 a%d 1!--!%3 4ea% $!tera$$" 1!--!%3; %ot ?u t ha5!%3 a $!3ht 4ea$ 0 ! -o t-o%ed; the -he%o4e%o% doe %ot o((ur a%d e5era$ da" of tr!(t d!et!%3 4a" be %e(e ar" to (orre(t the !tuat!o%A 8o t -at!e%t hard$" e5er %eed to 1!- a 4ea$A If the" ha5e eate% a hea5" $u%(h the" fee$ %o de !re to eat the!r d!%%er; a%d !% th! (a e %o !%(rea e ta1e -$a(eA If the" 1ee- the!r we!3ht at the -o!%t rea(hed at the e%d of the treat4e%t; e5e% a hea5" d!%%er doe %ot br!%3 about a% !%(rea e of two -ou%d o% the %e/t 4or%!%3 a%d doe %ot therefore (a$$ for a%" -e(!a$ 4ea ure A 8o t -at!e%t are ur-r! ed how 4a$$ the!r a--et!te ha be(o4e a%d "et how 4u(h the" (a% eat w!thout 3a!%!%3 we!3htA The" %o $o%3er uffer fro4 a% ab%or4a$ a--et!te a%d fee$ at! f!ed w!th 4u(h $e food tha% beforeA I% fa(t; the" are u ua$$" d! a--o!%ted that the" (a%%ot 4a%a3e the!r f!r t %or4a$ 4ea$; wh!(h the" ha5e bee% -$a%%!%3 for wee1 A 3os&n( *o%e We&(h" An e-5,a"&en" shou d ne'e% (a&n *o%e "han "4o ,ounds 4&"hou" &**ed&a"e ) co%%ec"&n( "h&s, bu" &" &s e7ua ) undes&%ab e "ha" *o%e "han "4o bs. be os" a!"e% "%ea"*en", because a (%ea"e% oss &s a 4a)s ach&e'ed a" "he e-,ense o! no%*a !a". A%" %or4a$ fat that ! $o t ! !%5ar!ab$" re3a!%ed a oo% a 4ore food ! ta1e%; a%d !t ofte% ha--e% that th! rebou%d o5er hoot the u--er two $b A $!4!tA T%oub e A!"e% T%ea"*en" Two d!ff!(u$t!e 4a" be e%(ou%tered !% the !44ed!ate -o t0treat4e%t -er!odA 6he% a -at!e%t ha (o% u4ed a$$ h! ab%or4a$ fat or whe%; after a fu$$ (our e; the do e ha te4-orar!$" $o t !t eff!(a(" ow!%3 to the bod" ha5!%3 3radua$$" e5o$5ed a (ou%ter re3u$at!o%; the -at!e%t at o%(e be3!% to fee$ 4u(h 4ore hu%3r" a%d e5e% wea1A I% -!te of re-eated war%!%3 ; o4e o5er0e%thu !a t!( -at!e%t do %ot re-ort th! A Howe5er; !% about two da" the fa(t that the" are be!%3 u%der%our! hed be(o4e 5! !b$e !% the!r fa(e ; a%d treat4e%t ! the% to--ed at o%(eA I% u(h (a e 0 a%d o%$" !% u(h (a e 0 we a$$ow a 5er" $!3ht !%(rea e !% the d!et; u(h a a% e/tra a--$e; 179 3ra4 of 4eat or two or three e/tra bread t!(1 dur!%3 the three da" of d!et!%3 after the $a t do eA 6he% ab%or4a$ fat ! %o $o%3er be!%3 -ut !%to (!r(u$at!o% e!ther be(au e !t ha bee% 50

(o% u4ed or be(au e !44u%!t" ha et !%; th! ! a$wa" fe$t b" the -at!e%t a udde%; !%to$erab$e a%d (o% ta%t hu%3erA I% th! e% e the H)G 4ethod ! (o4-$ete$" e$f0$!4!t!%3A 6!th H)G !t ! !4-o !b$e to redu(e a -at!e%t; howe5er e%thu !a t!(; be"o%d h! %or4a$ we!3htA A oo% a %o 4ore ab%or4a$ fat ! be!%3 ! ued; the bod" tart (o% u4!%3 %or4a$ fat; a%d th! ! a$wa" re3a!%ed a oo% a ord!%ar" feed!%3 ! re u4edA The -at!e%t the% f!%d that the *0. $b A he ha $o t dur!%3 the $a t da" of treat4e%t are !44ed!ate$" re3a!%edA A 4ea$ ! 1!--ed a%d 4a"be a -ou%d ! $o tA The %e/t da" th! -ou%d ! re3a!%ed; !% -!te of a (arefu$ wat(h o5er the food !%ta1eA I% a few da" a tearfu$ -at!e%t ! ba(1 !% the (o% u$t!%3 roo4; (o%5!%(ed that her (a e ! a fa!$ureA A$$ that ! ha--e%!%3 ! that the e e%t!a$ fat $o t at the e%d of the treat4e%t; ow!%3 to the -at!e%tF re$u(ta%(e to re-ort a 4u(h 3reater hu%3er; ! be!%3 re-$a(edA The we!3ht at wh!(h u(h a -at!e%t 4u t tab!$!Be thu $!e *0. $b A h!3her tha% the we!3ht rea(hed at the e%d of the treat4e%tA O%(e th! h!3her ba !( $e5e$ ! e tab$! hed; further d!ff!(u$t!e !% (o%tro$$!%3 the we!3ht at the %ew -o!%t of tab!$!Bat!o% hard$" ar! eA Be4a%e o! O'e%5en"hus&as* The other troub$e wh!(h ! fre>ue%t$" e%(ou%tered !44ed!ate$" after treat4e%t ! a3a!% due to o5er0e%thu !a 4A So4e -at!e%t (a%%ot be$!e5e that the" (a% eat fa!r$" %or4a$$" w!thout re3a!%!%3 we!3htA The" d! re3ard the ad5!(e to eat a%"th!%3 the" -$ea e e/(e-t u3ar a%d tar(h a%d wa%t to -$a" afeA The" tr" 4ore or $e to (o%t!%ue the 7990)a$or!e d!et o% wh!(h the" fe$t o we$$ dur!%3 treat4e%t a%d 4a1e o%$" 4!%or 5ar!at!o% ; u(h a re-$a(!%3 the 4eat w!th a% e33; (hee e; or a 3$a of 4!$1A To the!r horror the" f!%d that !% -!te of th! bra5ura; the!r we!3ht 3oe u-A So; fo$$ow!%3 !% tru(t!o% ; the" 1!- o%e 4ea3er $u%(h a%d at %!3ht eat o%$" a $!tt$e a$ad a%d dr!%1 a -ot of u% weete%ed tea; be(o4!%3 !%(rea !%3$" hu%3r" a%d wea1A The %e/t 4or%!%3 the" f!%d that the" ha5e !%(rea ed "et a%other -ou%dA The" fee$ terr!b$e; a%d e5e% the dreaded we$$!%3 of the!r a%1$e ! ba(1A Nor4a$$" we (he(1 our -at!e%t o%e wee1 after the" ha5e bee% eat!%3 free$"; but the e (a e retur% !% a few da" A E!ther the!r e"e are f!$$ed w!th tear or the" a%3r!$" !4-$" that whe% we to$d the4 to eat %or4a$$" we were ?u t foo$!%3 the4A P%o"e&n de!&c&enc) Here too; the e/-$a%at!o% ! >u!te !4-$eA Dur!%3 treat4e%t the -at!e%t ha bee% o%$" ?u t abo5e the 5er3e of -rote!% def!(!e%(" a%d ha had the ad5a%ta3e of -rote!% be!%3 fed ba(1 !%to h! " te4 fro4 the brea1dow% of fatt" t! ueA O%(e the treat4e%t ! o5er there ! %o 4ore H)G !% the bod" a%d th! -ro(e %o $o%3er ta1e -$a(eA :%$e a% ade>uate a4ou%t of -rote!% ! eate% a oo% a the treat4e%t ! o5er; -rote!% def!(!e%(" ! bou%d to de5e$o-; a%d th! !%e5!tab$" (au e the 4ar1ed rete%t!o% of water 1%ow% a hu%3er0 ede4aA The treat4e%t ! 5er" !4-$eA The -at!e%t ! to$d to eat two e33 for brea1fa t a%d a hu3e tea1 for $u%(h a%d d!%%er fo$$owed b" a $ar3e he$-!%3 of (hee e a%d to -ho%e throu3h the we!3ht the %e/t 4or%!%3A 6he% the e !% tru(t!o% are fo$$owed a tu%%ed 5o!(e ! heard to re-ort that two $b A ha5e 5a%! hed o5er%!3ht; that the a%1$e are %or4a$ but that $ee- wa d! turbed; ow!%3 to a% e/traord!%ar" %eed to -a $ar3e >ua%t!t!e of waterA The -at!e%t ha5!%3 $ear%ed th! $e o% u ua$$" ha %o further troub$eA 51

Re a,ses A a 3e%era$ ru$e o%e (a% a" that #9J079J of our (a e e/-er!e%(e $!tt$e or %o d!ff!(u$t" !% ho$d!%3 the!r we!3ht -er4a%e%t$"A Re$a- e 4a" be due to %e3$!3e%(e !% the ba !( ru$e of da!$" we!3h!%3A 8a%" -at!e%t th!%1 that th! ! u%%e(e ar" a%d that the" (a% ?ud3e a%" !%(rea e fro4 the f!t of the!r ($othe A So4e do %ot (arr" the!r (a$e w!th the4 o% a ?our%e" a !t ! (u4ber o4e a%d ta1e a b!3 b!te out of the!r $u33a3e0a$$owa%(e whe% f$"!%3A Th! ! a d! a trou 4! ta1e; be(au e after a (our e of H)G a 4u(h a 19 $b A (a% be re3a!%ed w!thout a%" %ot!(eab$e (ha%3e !% the f!t of the ($othe A The rea o% for th! ! that after treat4e%t %ew$" a(>u!red fat ! at f!r t e5e%$" d! tr!buted a%d doe %ot how the for4er -refere%(e for (erta!% -art of the bod"A 2re3%a%(" or the 4e%o-au e 4a" a%%u$ the effe(t of a -re5!ou treat4e%tA 6o4e% who ta1e treat4e%t dur!%3 the o%e "ear after the $a t 4e% truat!o% 0 that ! at the o% et of the 4e%o-au e 0 do ?u t a we$$ a other ; but a4o%3 the4 the re$a- e rate ! h!3her u%t!$ the 4e%o-au e ! fu$$" e tab$! hedA The -er!od of o%e "ear after the $a t 4e% truat!o% a--$!e o%$" to wo4e% who are %ot be!%3 treated w!th o5ar!a% hor4o%e A If the e are ta1e%; the -re4e%o-au a$ -er!od 4a" be !%def!%!te$" -ro$o%3edA Late tee%a3e 3!r$ who uffer fro4 atta(1 of (o4-u$ !5e eat!%3 ha5e b" far the wor t re(ord of a$$ a far a re$a- e are (o%(er%edA 2at!e%t who ha5e o%(e ta1e% the treat4e%t %e5er ee4 to he !tate to (o4e ba(1 for a%other hort (our e a oo% a the" %ot!(e that the!r we!3ht ! o%(e a3a!% 3ett!%3 out of ha%dA The" (o4e >u!te (heerfu$$" a%d ho-efu$$"; a ured that the" (a% be he$-ed a3a!%A Re-eat (our e are ofte% e5e% 4ore at! fa(tor" tha% the f!r t treat4e%t a%d ha5e the ad5a%ta3e; a do e(o%d (our e ; that the -at!e%t a$read" 1%ow that he w!$$ fee$ (o4fortab$e throu3houtA Plan of a 0or"al ,ourse 1*7 IA:A of H)G da!$" +e/(e-t dur!%3 4e% truat!o%, u%t!$ 49 do e ha5e bee% 3!5e%A :%t!$ .rd do e for(ed feed!%3A After .rd do e; 799 (a$or!e d!et to be (o%t!%ued u%t!$ 7* hour after the $a t do eA For the fo$$ow!%3 . wee1 ; a$$ food a$$owed e/(e-t tar(h a%d u3ar !% a%" for4 +(arefu$ w!th 5er" weet fru!t,A After . wee1 ; 5er" 3radua$$" add tar(h !% 4a$$ >ua%t!t!e ; a$wa" (o%tro$$ed b" 4or%!%3 we!3h!%3A ,O0,.2SIO0 The H)G M d!et 4ethod (a% br!%3 re$!ef to e5er" (a e of obe !t"; but the 4ethod ! %ot !4-$eA It ! 5er" t!4e (o% u4!%3 a%d re>u!re -erfe(t (oo-erat!o% betwee% -h" !(!a% a%d -at!e%tA Ea(h (a e 4u t be ha%d$ed !%d!5!dua$$"; a%d the -h" !(!a% 4u t ha5e t!4e to a% wer >ue t!o% ; a$$a" fear a%d re4o5e 4! u%der ta%d!%3 A He 4u t a$ o (he(1 the -at!e%t da!$"A 6he% o4eth!%3 3oe wro%3 he 4u t at o%(e !%5e t!3ate u%t!$ he f!%d the rea o% for a%" 52

3a!% that 4a" ha5e o((urredA I% 4o t (a e !t ! u e$e $et the %ur e 3!5e h!4 a = hotA=

to ha%d the -at!e%t a d!et0 heet a%d

The 4ethod !%5o$5e a h!3h$" (o4-$e/ bod!$" 4e(ha%! 4; a%d e5e% thou3h our theor" 4a" be wro%3 the -h" !(!a% 4u t 4a1e h!4 e$f o4e ort of -!(ture of what ! a(tua$$" ha--e%!%3E otherw! e he w!$$ %ot be ab$e to dea$ w!th u(h d!ff!(u$t!e a 4a" ar! e dur!%3 treat4e%tA I 4u t be3 tho e tr"!%3 the 4ethod for the f!r t t!4e to adhere 5er" tr!(t$" to the te(h%!>ue a%d the !%ter-retat!o% here out$!%ed a%d thu treat a few hu%dred (a e before e4bar1!%3 o% e/-er!4e%t of the!r ow%; a%d u%t!$ the% refra!% fro4 !%trodu(!%3 !%%o5at!o% ; howe5er thr!$$!%3 the" 4a" ee4A I% a %ew 4ethod; !%%o5at!o% or de-arture fro4 the or!3!%a$ te(h%!>ue (a% o%$" be u efu$$" e5a$uated a3a!% t a ub ta%t!a$ ba(13rou%d of e/-er!e%(e w!th what ! at the 4o4e%t the orthodo/ -ro(edureA I ha5e tr!ed to (o5er a$$ the -rob$e4 that (o4e to 4" 4!%dA @et a bew!$der!%3 arra" of %ew >ue t!o% 1ee- ar! !%3; a%d 4" !%ter-retat!o% are t!$$ f$u!dA I% -art!(u$ar; I ha5e %e5er had a% o--ortu%!t" of (o%du(t!%3 the $aborator" !%5e t!3at!o% wh!(h are o %e(e ar" for a theoret!(a$ u%der ta%d!%3 of ($!%!(a$ ob er5at!o% ; a%d I (a% o%$" ho-e that tho e 4ore fortu%ate$" -$a(ed w!$$ !% t!4e be ab$e to f!$$ th! 3a-A The -rob$e4 of obe !t" are -erha- %ot o dra4at!( a the -rob$e4 of (a%(er or -o$!o; but the" ofte% (au e $!fe0$o%3 uffer!%3A How 4a%" -ro4! !%3 (areer ha5e bee% ru!%ed b" e/(e !5e fatE how 4a%" $!5e ha5e bee% horte%edA If o4e wa" 0 howe5er (u4ber o4e 0 (a% be fou%d to (o-e effe(t!5e$" w!th th! u%!5er a$ -rob$e4 of 4oder% (!5!$!Bed 4a%; our wor$d w!$$ be a ha--!er -$a(e for (ou%t$e fe$$ow 4e% a%d wo4e%A

53

G.OSS R3 4 C 6here5er u%fa4!$!ar ter4 are u ed; the" w!$$ be fou%d !% the!r re -e(t!5e a$-habet!(a$ -$a(eA The $a" reader (a% therefore 4a1e h! ow% (ro 0refere%(e A ACNE . . . )o44o% 1!% d! ea e !% wh!(h -!4-$e ; ofte% (o%ta!%!%3 -u ; a--ear o% fa(e; %e(1 a%d hou$der A ACTH . . . Abbre5!at!o% for adre%o(ort!(otro-h!( hor4o%eA O%e of the 4a%" hor4o%e -rodu(ed b" the a%ter!or $obe of the -!tu!tar" 3$a%dA A)TH (o%tro$ the outer -art; r!%d or (orte/ of the adre%a$ 3$a%d A 6he% A)TH ! !%?e(ted !t dra4at!(a$$" re$!e5e arthr!t!( -a!%; but !t ha 4a%" u%de !rab$e !de effe(t ; a4o%3 wh!(h ! a (o%d!t!o% !4!$ar to e5ere obe !t"A A)TH ! %ow u ua$$" re-$a(ed b" (ort! o%eA ADRENA3IN . . . Hor4o%e -rodu(ed b" the !%%er -art of the Adre%a$ A A4o%3 4a%" other fu%(t!o% ; adre%a$!% ! (o%(er%ed w!th b$ood -re ure; e4ot!o%a$ tre ; fear a%d (o$dA ADRENA3S . . . E%do(r!%e 3$a%d A S4a$$ bod!e !tuated ato- the 1!d%e" a%d he%(e a$ o 1%ow% a u-rare%a$ 3$a%d A The adre%a$ ha5e a% outer r!%d or (orte/ wh!(h -rodu(e 5!ta$$" !4-orta%t hor4o%e ; a4o%3 wh!(h are )ort! o%e0 !4!$ar ub ta%(e A The adre%a$ (orte/ ! (o%tro$$ed b" A)THA The !%%er -art of the adre%a$ ; the 4edu$$a; e(rete adre%a$!% a%d ! (h!ef$" (o%tro$$ed b" the auto%o4ou %er5ou " te4A ADRENOCORTE8... See adre%a$ A AMPHETAMINES . . . S"%thet!( dru3 wh!(h redu(e the aware%e of hu%3er a%d t!4u$ate 4e%ta$ a(t!5!t"; re%der!%3 $ee- !4-o !b$eA 6he% u ed for the $atter two -ur-o e the" are da%3erou $" hab!t0for4!%3A The" do %ot d!4!%! h the bod"F %eed for food; but 4ere$" u--re the -er(e-t!o% of that %eedA The or!3!%a$ dru3 wa 1%ow% a 'e%Bedr!%e; fro4 wh!(h 4oder% 5ar!a%t u(h a De/edr!%e; De/a4!$; a%d 2re$ud!%; et(A; ha5e bee% der!5edA A4-heta4!%e 4a" he$- a% obe e -at!e%t to -re5e%t a further !%(rea e !% we!3ht but are u% at! fa(tor" for redu(!%3; a the" do %ot (ure the u%der$"!%3 d! order a%d a the!r -ro$o%3ed u e 4a" $ead to 4a$%utr!t!o% a%d add!(t!o%A ARTERIOSC3EROSIS . . . Harde%!%3 of the arter!a$ wa$$ throu3h the (a$(!f!(at!o% of ab%or4a$ de-o !t of a fat$!1e ub ta%(e 1%ow% a (ho$e tero$A ASCHHE9M5:ONDE; . . . Author of a te t b" wh!(h ear$" -re3%a%(" (a% be d!a3%o ed b" !%?e(t!%3 a wo4a%F ur!%e !%to fe4a$e 4!(eA The H)G -re e%t !% -re3%a%(" ur!%e -rodu(e (erta!% (ha%3e !% the 5a3!%a of the e a%!4a$ A 8a%" !4!$ar te t ; u !%3 other a%!4a$ u(h a rabb!t ; fro3 ; et(A ha5e bee% de5! edA ASSIMI3ATE . . . Ab orb d!3e ted food fro4 the !%te t!%e A A$TONOMO$S . . . Here u ed to de (r!be the !%de-e%de%t or 5e3etat!5e %er5ou wh!(h 4a%a3e the auto4at!( re3u$at!o% of the bod"A " te4

BASA3 METABO3ISM . . . The bod"F (he4!(a$ tur%o5er at (o4-$ete re t a%d whe% fa t!%3A The ba a$ 4etabo$!( rate ! e/-re ed a the a4ou%t of o/"3e% u ed u- !% a 3!5e% t!4eA The 54

ba a$ 4etabo$!( rate +'8R, ! (o%tro$$ed b" the th"ro!d 3$a%dA CA3ORIE . . . The -h" !(! tF (a$or!e ! the a4ou%t of heat re>u!red to ra! e the te4-erature of 1 ((A of water b" 1 de3ree )e%t!3radeA The d!et!(!a%F )a$or!e +a$wa" wr!tte% w!th a (a-!ta$ ), ! 1999 t!4e 3reaterA Thu whe% we -ea1 of a 799 )a$or!e d!et th! 4ea% that the bod" ! be!%3 u--$!ed w!th a 4u(h fue$ a wou$d be re>u!red to ra! e the te4-erature of 799 $!ter of water b" 1 de3ree )e%t!3rade or 79 $!ter b" 19 de3ree A Th! ! >u!te !% uff!(!e%t to (o5er the heat a%d e%er3" re>u!re4e%t of a% adu$t bod"A I% the H)G 4ethod the def!(!t ! 4ade ufro4 the ab%or4a$ fat0de-o !t ; of wh!(h 1 $bA fur%! he the bod" w!th 4ore tha% *999 )a$or!e A A th! ! rou3h$" the a4ou%t $o t e5er" da"; a -at!e%t u%der H)G ! %e5er hort of fue$A CEREBRA3 . . . Of the bra!%A )erebra$ 5a (u$ar d! ea e ! a d! order (o%(er%!%3 the b$ood 5e e$ of the bra!%; u(h a (erebra$ thro4bo ! or he4orrha3e; 1%ow% a a-o-$e/" or tro1eA CHO3ESTERO3 . . . A fat$!1e ub ta%(e (o%ta!%ed !% a$4o t e5er" (e$$ of the bod"A I% the b$ood !t e/! t !% two for4 ; 1%ow% a free a%d e ter!f!edA The $atter for4 ! u%der (erta!% (o%d!t!o% de-o !ted !% the !%%er $!%!%3 of the arter!e + ee arter!o ($ero ! ,A No ($ear a%d def!%!te re$at!o% h!- betwee% fat !%ta1e a%d (ho$e tero$0$e5e$ !% the b$ood ha "et bee% e tab$! hedA CHORIONIC . . . Of the (hor!o%; wh!(h ! -art of the -$a(e%ta or after0b!rthA The ter4 (hor!o%!( ! ?u t$" a--$!ed to H)G; a th! hor4o%e ! e/($u !5e$" -rodu(ed !% the -$a(e%ta; fro4 where !t e%ter the hu4a% 4otherF b$ood a%d ! $ater e/(reted !% her ur!%eA COMP$3SI.E EATIN+. . . A for4 of ora$ 3rat!f!(at!o% w!th wh!(h a re-re ed e/0!% t!%(t ! o4et!4e 5!(ar!ou $" re$!e5edA )o4-u$ !5e eat!%3 4u t %ot be (o%fu ed w!th the rea$ hu%3er fro4 wh!(h 4o t obe e -at!e%t ufferA CON+ENITA3 . . . A%" (o%d!t!o% wh!(h e/! t at or before b!rthA CORONARY ARTERIES A A A Two b$ood 5e b$ood re>u!red b" the heart04u ($eA e$ wh!(h e%(!r($e the heart a%d u--$" a$$ the

CORP$S 3$TE$M . . . A "e$$ow bod" wh!(h for4 !% the o5ar" at the fo$$!($e fro4 wh!(h a% e33 ha bee% deta(hedA Th! bod" a(t a a% e%do(r!%e 3$a%d a%d -$a" a% !4-orta%t ro$e !% 4e% truat!o% a%d -re3%a%("A It e(ret!o% ! o%e of the e/ hor4o%e ; a%d !t ! t!4u$ated b" a%other hor4o%e 1%ow% a LSH; wh!(h ta%d for $uteu4 t!4u$at!%3 hor4o%e A LSH ! -rodu(ed !% the a%ter!or $obe of the -!tu!tar" 3$a%dA LSH ! tru$" 3o%adotro-h!( a%d 4u t %e5er be (o%fu ed w!th H)G; wh!(h ! a tota$$" d!ffere%t ub ta%(e; ha5!%3 %o d!re(t a(t!o% o% the (or-u $uteu4A CORTE8 . . . Outer (o5er!%3 or r!%dA The ter4 ! a--$!ed to the outer -art of the adre%a$ but ! a$ o u ed to de (r!be the 3ra" 4atter wh!(h (o5er the wh!te 4atter of the bra!%A CORTISONE . . . A "%thet!( ub ta%(e wh!(h a(t $!1e a% adre%a$ hor4o%eA It ! toda" u ed !% the treat4e%t of a $ar3e %u4ber of !$$%e e ; a%d e5era$ (he4!(a$ 5ar!a%t ha5e bee% -rodu(ed; a4o%3 wh!(h are -red%! o%e a%d tr!a4(!%o$o%eA 55

C$SHIN+ . . . A 3reat A4er!(a% bra!% ur3eo% who de (r!bed a (o%d!t!o% of e/tre4e obe !t" a o(!ated w!th "4-to4 of adre%a$ d! orderA )u h!%3F S"%dro4e 4a" be (au ed b" or3a%!( d! ea e of the -!tu!tar" or the adre%a$ 3$a%d but; a wa $ater d! (o5ered; !t a$ o o((ur a a re u$t of e/(e !5e A)TH 4ed!(at!o%A DIENCEPHA3ON . . . A -r!4!t!5e a%d he%(e 5er" o$d -art of the bra!% wh!(h $!e betwee% a%d u%der the two $ar3e he4! -here A I% 4a% the d!e%(e-ha$o% +or h"-otha$a4u , ! ubord!%ate to the h!3her bra!% or (orte/; a%d "et !t u$t!4ate$" (o%tro$ a$$ that ha--e% !% !de the bod"A It re3u$ate a$$ the e%do(r!%e 3$a%d ; the auto%o4ou %er5ou " te4; the tur%o5er of fat a%d u3arA It ee4 a$ o to be the eat of the -r!4!t!5e a%!4a$ !% t!%(t a%d ! the re$a" tat!o% at wh!(h e4ot!o% are tra% $ated !%to bod!$" rea(t!o% A DI$RETIC. . . A%" ub ta%(e that !%(rea e the f$ow of ur!%eA DYS#$NCTION . . . Ab%or4a$ fu%(t!o%!%3 of a%" or3a%; be th! e/(e wa" a$teredA EDEMA . . . A% ab%or4a$ a((u4u$at!o% of water !% the t! ue A !5e; def!(!e%t or !% a%"

E3ECTROCARDIO+RAM . . . Tra(!%3 of e$e(tr!( -he%o4e%a ta1!%3 -$a(e !% the heart dur!%3 ea(h beatA The tra(!%3 -ro5!de !%for4at!o% about the (o%d!t!o% a%d wor1!%3 of the heart wh!(h ! %ot otherw! e obta!%ab$eA ENDOCRINE . . . 6e d! t!%3u! h e%do(r!%e a%d e/o(r!%e 3$a%d A The for4er -rodu(e hor4o%e ; (he4!(a$ re3u$ator ; wh!(h the" e(rete d!re(t$" !%to the b$ood (!r(u$at!o% !% the 3$a%d a%d fro4 where the" are (arr!ed a$$ o5er the bod"A E/a4-$e of e%do(r!%e 3$a%d are the -!tu!tar"; the th"ro!d a%d the adre%a$ A E/o(r!%e 3$a%d -rodu(e a 5! !b$e e(ret!o% u(h a a$!5a; weat; ur!%eA There are a$ o 3$a%d wh!(h are e%do(r!%e a%d e/o(r!%eA E/a4-$e are the te t!($e ; the -ro tate a%d the -a%(rea ; wh!(h -rodu(e the hor4o%e !% u$!% a%d d!3e t!5e fer4e%t wh!(h f$ow fro4 the 3$a%d !%to the !%te t!%a$ tra(tA E%do(r!%e 3$a%d are ($o e$" !%ter0de-e%de%t of ea(h other; the" are $!%1ed to the auto%o4ou %er5ou " te4 a%d the d!e%(e-ha$o% -re !de o5er th! who$e !%(red!b$" (o4-$e/ re3u$ator" " te4A EMACIATED . . . Gro $" u%der%our! hedA

E$PHORIA . . . A fee$!%3 of -art!(u$ar -h" !(a$ a%d 4e%ta$ we$$ be!%3A #ERA3 . . . 6!$d; u%re tra!%edA #IBROID . . . A%" be%!3% %ew 3rowth of (o%%e(t!5e t! ueA 6he% u(h a tu4or or!3!%ate fro4 a 4u ($e; !t ! 1%ow% a a 4"o4aA The 4o t (o44o% eat of 4"o4a ! the uteru A #O33IC3E . . . A%" 4a$$ bod!$" (" t or a( (o%ta!%!%3 a $!>u!dA Here the ter4 a--$!e to the o5ar!a% (" t !% wh!(h the e33 ! for4edA The e33 ! e/-e$$ed whe% a r!-e fo$$!($e bur t a%d th! ! 1%ow% a o5u$at!o% + ee (or-u $uteur%,A #SH . . . Abbre5!at!o% for fo$$!($e0 t!4u$at!%3 hor4o%eA FSH ! a%other + ee (or-u $uteu4, a%ter!or -!tu!tar" hor4o%e wh!(h a(t d!re(t$" o% the o5ar!a% fo$$!($e a%d ! therefore (orre(t$" (a$$ed a 3o%adotro-h!%A

56

+3ANDS . . . See e%do(r!%eA +ONADOTROPHIN . . . See (or-u $uteu4; fo$$!($e a%d FSHA Go%adotro-h!( $!tera$$" 4ea% e/ 3$a%d0d!re(tedA FSH; LSH a%d the e>u!5a$e%t hor4o%e !% the 4a$e; a$$ -rodu(ed !% the a%ter!or $obe of the -!tu!tar" 3$a%d; are true 3o%adotro-h!% A :%fortu%ate$" a%d (o%fu !%3$"; the ter4 3o%adotro-h!% ha a$ o bee% a--$!ed to the -$a(e%ta$ hor4o%e of -re3%a%(" 1%ow% a hu4a% (hor!o%!( 3o%adotro-h!% +H)G,A Th! hor4o%e a(t o% the d!e%(e-ha$o% a%d (a% o%$" !%d!re(t$" !%f$ue%(e the e/ 3$a%d 5!a the a%ter!or $obe of the -!tu!tar"A HC+ . . . Abbre5!at!o% for hu4a% (hor!o%!( 3o%adotro-h!% HORMONES . . . See e%do(r!%eA HYPERTENSION . . . H!3h b$ood -re ureA

HYPO+3YCEMIA . . . A (o%d!t!o% !% wh!(h the b$ood u3ar ! be$ow %or4a$A It (a% be re$!e5ed b" eat!%3 u3arA HYPOPHYSIS . . . A%other %a4e for the -!tu!tar" 3$a%dA HYPOTHESIS . . . A te%tat!5e e/-$a%at!o% or -e(u$at!o% o% how ob er5ed fa(t a%d ! o$ated (!e%t!f!( data (a% be brou3ht !%to a% !%te$$e(tua$$" at! f"!%3 re$at!o% h!- of (au e a%d effe(tA H"-othe e are u efu$ for d!re(t!%3 further re ear(h; but the" are %ot %e(e ar!$" a% e/-o !t!o% of what ! be$!e5ed to be the truthA 'efore a h"-othe ! (a% ad5a%(e to the d!3%!t" of a theor" or a $aw; !t 4u t be (o%f!r4ed b" a$$ future re ear(hA A oo% a re ear(h tur% udata wh!(h %o $o%3er f!t the h"-othe ! ; !t ! !44ed!ate$" aba%do%ed for a better o%eA 3SH . . . See (or-u $uteu4A METABO3ISM . . . See ba a$ 4etabo$! 4A MI+RAINE . . . Se5ere ha$f0 !ded heada(he ofte% a o(!ated w!th 5o4!t!%3A M$COID . . . S$!4e0$!1eA MYOCARDI$M . . . The heart04u ($eA MYOMA . . . See f!bro!dA MY8EDEMA . . . A((u4u$at!o% of a 4u(o!d ub ta%(e !% the t! e5ere -r!4ar" th"ro!d def!(!e%("A ue wh!(h o((ur !% (a e of

NEO3ITHIC . . . I% the h! tor" of hu4a% (u$ture we d! t!%3u! h the Ear$" Sto%e A3e or 2a$eo$!th!(; the 8!dd$e Sto%e A3e or 8e o$!th!( a%d the New Sto%e A3e or Neo$!th!( -er!odA The Neo$!th!( -er!od tarted about &999 "ear a3o whe% the f!r t atte4-t at a3r!(u$ture; -otter" a%d a%!4a$ do4e t!(at!o% 4ade at the e%d of the 8e o$!th!( -er!od udde%$" be3a% to de5e$o- ra-!d$" a$o%3 the road that $ed to 4oder% (!5!$!Bat!o%A NORMA3 SA3INE . . . A $ow (o%(e%trat!o% of a$t !% water e>ua$ to the a$!%!t" of bod" f$u!d A PH3EBITIS . . . A% !%f$a44at!o% of the 5e!% A 6he% a b$ood0($ot for4 at the !te of the 57

!%f$a44at!o%; we -ea1 of thro4bo-h$eb!t! A PIT$ITARY . . . A 5er" (o4-$e/ e%do(r!%e 3$a%d wh!(h $!e at the ba e of the 1u$$; (o% ! t!%3 (h!ef$" of a% a%ter!or a%d a -o ter!or $obeA The -!tu!tar" ! (o%tro$$ed b" the d!e%(e-ha$o%; wh!(h re3u$ate the a%ter!or $obe b" 4ea% of hor4o%e wh!(h rea(h !t throu3h 4a$$ b$ood 5e e$ A The -o ter!or $obe ! (o%tro$$ed b" %er5e wh!(h ru% fro4 the d!e%(e-ha$o% !%to th! -art of the 3$a%dA The a%ter!or $obe e(rete 4a%" hor4o%e ; a4o%3 wh!(h are tho e that re3u$ate other 3$a%d u(h a the th"ro!d; the adre%a$ a%d the e/ 3$a%d A P3ACENTA . . . The after0b!rthA I% wo4e%; a $ar3e a%d h!3h$" (o4-$e/ or3a% throu3h wh!(h the (h!$d !% the wo4b re(e!5e !t %our! h4e%t fro4 the 4otherF bod"A It ! the or3a% !% wh!(h H)G ! 4a%ufa(tured a%d the% 3!5e% off !%to the 4otherF b$oodA PROTEIN . . . The $!5!%3 ub ta%(e !% -$a%t a%d a%!4a$ (e$$ A Herb!5orou a%!4a$ (a% thr!5e o% -$a%t -rote!% a$o%e; but 4a% 4u t ha5e o4e -rote!% of a%!4a$ or!3!% +4!$1; e33 or f$e h, to $!5e hea$th!$"A 6he% !% uff!(!e%t -rote!% ! eate%; the bod" reta!% waterA PSORIASIS . . . A 1!% d! ea e wh!(h -rodu(e (a$" -at(he A The e te%d to d! a--ear dur!%3 -re3%a%(" a%d dur!%3 the treat4e%t of obe !t" b" the H)G 4ethodA RENA3 . . . Of the 1!d%e"A RESERPINE . . . A% I%d!a% dru3 e/te% !5e$" u ed !% the treat4e%t of h!3h b$ood -re o4e for4 of 4e%ta$ d! orderA RETENTION ENEMA . . . The $ow !%fu !o% of a $!>u!d !%to the re(tu4; fro4 where !t ! ab orbed a%d %ot e5a(uatedA SACR$M . . . A fu !o% of the $ower 5ertebrate !%to the $ar3e bo%" 4a atta(hedA to wh!(h the -e$5! ! ure a%d

SEDIMENTATION RATE . . . The -eed at wh!(h a u -e% !o% of red b$ood (e$$ ett$e outA A ra-!d ett$!%3 out ! (a$$ed a h!3h ed!4e%tat!o% rate a%d 4a" be !%d!(at!5e of a $ar3e %u4ber of bod!$" d! order of -re3%a%("A SE8$A3 SE3ECTION . . . A e/ua$ -refere%(e for !%d!5!dua$ wh!(h how (erta!% tra!t A If th! -refere%(e or e$e(t!o% 3oe o% 3e%erat!o% after 3e%erat!o%; 4ore a%d 4ore !%d!5!dua$ how!%3 the tra!t w!$$ a--ear a4o%3 the 3e%era$ -o-u$at!o%A The %atura$ e%5!ro%4e%t ha $!tt$e or %oth!%3 to do w!th th! -ro(e A Se/ua$ e$e(t!o% therefore d!ffer fro4 %atura$ e$e(t!o%; to wh!(h 4oder% 4a% ! %o $o%3er ub?e(t be(au e he (ha%3e h! e%5!ro%4e%t rather tha% $et the e%5!ro%4e%t (ha%3e h!4A STRIATION . . . Tear!%3 of the $ower $a"er of the 1!% ow!%3 to ra-!d tret(h!%3 !% obe !t" or dur!%3 -re3%a%("A 6he% f!r t for4ed tr!ae are dar1 redd! h $!%e wh!(h $ater (ha%3e !%to wh!te (ar A S$PRARENA3 +3ANDS . . . See adre%a$ A SYNDROME . . . A 3rou- of "4-to4 wh!(h !% the!r a -art!(u$ar d! orderA 58 o(!at!o% are (hara(ter! t!( of a

THROMBOPH3EBITIS . . . See -h$eb!t! A THROMB$S . . . A b$ood0($ot !% a b$ood05e e$A

TRIAMCINO3ONE . . . A 4oder% der!5at!5e of (ort! o%eA $RIC ACID . . . A -rodu(t of !%(o4-$ete -rote!%0brea1dow% or ut!$!Bat!o% !% the bod"A 6he% ur!( a(!d be(o4e de-o !ted !% the 3r! t$e of the ?o!%t we -ea1 of 3outA .ARICOSE $3CERS . . . )hro%!( u$(erat!o% abo5e the a%1$e due to 5ar!(o e 5e!% wh!(h !%terfere w!th the %or4a$ b$ood (!r(u$at!o% !% the affe(ted area A .E+ETATI.E . . . See auto%o4ou A .ERTEBRATE . . . A%" a%!4a$ that ha a ba(10bo%eA

59

Related Interests