Human Chorionic Gonadotropin (hCG) is the most thoroughly debunked weight loss gimmick in medical history. We have known since the mid-1970’s that hCG has no impact on body weight whatsoever. I’ve discussed it a number of times, and it always amazes me just how much evidence there is that hCG is no better than a placebo. My favourite hCG-related quote comes from this systematic review, which sums things up pretty nicely:
“there is no scientific evidence that hCG is effective in the treatment of obesity; it does not bring about weight loss or fat redistribution, nor does it reduce hunger or induce a feeling of well-being”.
And don’t forget that it comes from the urine of pregnant women who are often misled into thinking that it is going to be used for fertility treatments (a legitimate use of hCG). Seriously. From the same review as above:
“hCG is obtained from the urine of pregnant women who donate their urine idealistically in the belief that it will be used to treat an entirely different condition, namely infertility”
So when it comes to body weight, it seems pretty clear that hCG is nothing but a placebo. An expensive placebo that is obtained by misleading pregnant women into donating their urine, but a placebo nonetheless. It couldn’t get any worse for proponents of hCG for weight loss, right?
Actually, it could.
It turns out that urine-derived fertility treatments like hCG could transmit prions, the misfolded proteins responsible for brain-wasting diseases like mad cow disease, and it’s human equivalent, Creutzfeldt-Jakob disease.
These findings come from a paper published in PLoS One earlier this week. As I mentioned in passing up above, hCG and other gonadotropin hormones are derived from the urine of pregnant women to be used as a legitimate fertility treatment. In this new paper Alain Van Dorsselaer and colleagues examined hCG and these other urine-derived treatments for the presence of non-gonadotropin protein. They found that prion protein was a major source of non-gonadotropin protein in urine-derived hCG. In other words, prions have made their way from the donors into the hCG.
So there are prions in the urine-derived hCG – should we be concerned? From the paper (emphasis mine):
Current urine collection systems pool the urine of thousands of donors and, unlike the blood collection system, do not allow for donor tracing. There is also no mechanism of ensuring that the designated donor is actually the one who provides the urine, as donation is normally done at home. However, even if donor management and tracing were flawless, the fact that prionuria may exist well before the onset of clinically overt prion disease, without being detectable by current methods, remains a cause for concern. Furthermore, the now indisputable detection of prions in urine of experimental animals, the lack of a species barrier for human-to-human transmission, the relative efficiency of the intramuscular injection route for prion transmission, and the young age of fertility drug recipients all support application of the ‘precautionary principle’ for urinary derived pharmaceuticals. As risk management paradigms shift towards more proactive approaches intended to ‘anticipate and prevent’ emerging risks –, a careful examination of the risk of transmission of human prion disease through the use of urine-derived hormones and peptides would appear to be warranted.
Now I personally don’t know much about prions, but I’m taking this to mean that we should probably investigate this more closely if we’re going to continue giving people urine-derived hCG for any reason. Also, we should stop giving hCG to people who don’t need it! Interestingly, this exact issue was discussed in the February issue of the West Virginia Medical Journal (what, you don’t read WVMJ?). Although his editorial was published before the new paper in PLoS ONE, Dr Roger Toffle argues that prions could theoretically be passed from donor to recipient resulting in Creutzfeld-Jakob disease, and cites the initial discontinuation of human-derived gonadotropins as being due to concerns over this very issue (Dr Toffle also explains that increased demand for hCG among people trying to lose weight has resulted in shortages and increased costs for those attempting to procure it for legitimate fertility-related purposes – yet another downside to the promotion of hCG for weight loss).
In their new PLoS ONE paper, Dr Van Dorsselaer and colleagues are quick to point out that while these new results suggest that it is theoretically plausible that prions could be transmitted through urine, there have not been any documented cases of it actually happening. Still, we have now arrived at an odd situation where a common weight loss gimmick may have a better chance of giving you mad cow disease than helping you lose weight.
Let’s just briefly recap:
- hCG is obtained by misleading pregnant women who think they are donating their urine to help people get pregnant,
- hCG is no better than a placebo in promoting weight loss,
- The (nonsensical) demand for hCG in the treatment of obesity has resulted in increased costs for people who need hCG for legitimate uses, and finally
- hCG may give you mad cow disease
The cost-benefit ratio clearly doesn’t make sense when it comes to hCG for weight loss.
Van Dorsselaer, A., Carapito, C., Delalande, F., Schaeffer-Reiss, C., Thierse, D., Diemer, H., McNair, D., Krewski, D., & Cashman, N. (2011). Detection of Prion Protein in Urine-Derived Injectable Fertility Products by a Targeted Proteomic Approach PLoS ONE, 6 (3) DOI: 10.1371/journal.pone.0017815