Remember, you can obtain you hCG from Dr Michele Koo’s office and she will manage your weight loss program. Don’t be fooled by the inexpensive hCG, you need medical supervision to do this safely and effectively.

3.     PHASE I: until end weight goal is reached or up to 2-4 months or when you decide you want to take a break (You must stay in touch with our office and STAY ON THE PROTOCOL FOOD RECOMMENDATIONS during this period).

EVERY MORNING AND EVENING:  TAKE .5 CC (1/2 OF THE MEDICINE DROPPER TO THE .5 MARK) OF THE LIQUID hCG.  PLACE THE .5 CC  LIQUID UNDER YOUR TONGUE, LEAVE IT FOR ABOUT 5-10 MINUTES. THIS .5CC IS 165 IU WHICH IS YOUR DOSE 2X A DAY UNTIL WEIGHT GOAL IS REACHED or when you want to take a break.

Day 1 and 2: Gorge yourself on whatever you want to eat emphasizing fat rich foods, e.g., bacon, steak, eggs, cheesecake, burgers, salmon, ribs, etc. EAT HIGH FAT FOODS EVERY 2 HOURS & eat as much as you want.  You can eat sugars and carbohydrates as well but the emphasis in these 2 days is on consuming high fat foods. No matter what, you must keep eating and force yourself to eat for these 2 days. Do not worry if you gain weight, you will lose that once the 500 calorie limit begins. Your body and hypothalamus needs this replenishment to start.

The rest of the month up to 4 months as long as you are taking the hCG 2x/day
morning and night until goal weight is reached: you must stay on 500 cal/day!

Drinks and Seasonings

The juice of one lemon daily is allowed for all purposes.

Salt, pepper, vinegar, mustard powder, garlic, sweet basil, parsley, thyme, majoram, etc., may be used for seasoning, but no oil, butter or dressing.

Tea, coffee, plain water, or mineral water (2 liters of water per day is recommended) are the only drinks allowed, but they may be taken in any quantity and at all times.

The fruit or the breadstick may be eaten between meals instead of with lunch or dinner, but not more than than four items listed for lunch and dinner may be eaten at one meal.

No medicines or cosmetics other than lipstick, eyebrow pencil and powder may he used without special permission.

Portions and specially prepared unsweetened, low calorie foods

“In many countries specially prepared unsweetened and low Calorie foods are freely available, and some of these can be tentatively used… the total daily intake must not exceed 500 Calories if the best possible results are to be obtained, that the daily ration should contain 200 grams of fat-free protein and a very small amount of starch.”

• The 500 calorie limit must always be maintained.

• 2 small apples are not an acceptable exchange for “1 apple.”

• Very occasionally we allow egg - boiled, poached or raw - to patients who develop an aversion to meat, but in this case they must add the white of three eggs to the one they eat whole.

• Cottage cheese made from skimmed milk is available 100 grams may occasionally be used instead of the meat

for remainder of diet protocol for hcg weight loss, see next dr koo blog…

Dr Michele Koo has the hCG available to you at her office. You need an initial consultation to determine the exact dosing and diet that is appropriate for you to begin your weight loss journey!

While hCG is available inexpensively on line, you need to be under the direct care of a physician to ensure its safety and proper use. You also need to know that the dosing for your is appropriate and that you do not have any conflicting medical issues.

hCG Diet and How it Works

Background

hCG stands for human chorionic gonadotropin, a hormone produced in large quantity by the placenta during pregnancy .  Researchers discovered hCG in the urine of pregnant women in 1927.  Its function is to manage the woman’s metabolic processes.  hCG is what most pregnancy tests detect in a woman’s urine to determine if she is pregnant.

The late British doctor ATW Simeons, was the first to discover hCG’s relationship to weight loss in the 1950s.  In fact, in 1954, Dr. Simeons published his first report (Lancet) on hCG and the management of obesity.

Dr. Simeons found that his patients tolerated a very low calorie diet without headaches, weakness and irritability which is common to other weight loss programs.  Perhaps more importantly, people on his protocol were able to maintain their weight loss far better than those on other programs.  Further, his patients lost more body fat as opposed to body weight. That is, resistant fat such as in the neck and intra-abdominally was reduced! Therefore, Dr. Simeons hypothesized that hCG also regulated the hypothalamus which is responsible for the excessive abnormal fat accumulation seen in obesity, such as the neck, abdomen, and thighs.

The hCG diet requires that you stay on a 500 CALORIE A DAY INTAKE DURING THE HCG SUPPLEMENT (this is absolutely possible with the hCG liquid)!

How the hCG Diet Works

How is hCG used for weight reduction?

Intuitively, we all know that weight loss generally occurs only when fewer calories are taken than the body uses.  The use of hCG makes calorie restriction dieting easier because you do not get the hard to manage symptoms of traditional diets such as headaches and uncontrollable hunger.  More importantly, hCG specifically targets fat from abnormal fat storage areas like the neck, abdomen, thighs, hips and buttocks. With traditional calorie restriction diets, fat is often preferentially lost from more essential fat areas such as breasts, face, and the subcutaneous fat the under skin.  The hCG diet results in safer weight loss while providing a sculpting effect.  Accordingly, the weight loss is not only noted on the scale, but the visible results are much more desireable.

The hCG protocol is very low calorie, will I get hungry?

Because hCG utilizes stored body fat, making it available to the body as an energy source, one’s appetite is naturally reduced.  On the hCG protocol, excess stored fat provides approximately 80% of the calories the body uses.  Therefore, the body is getting the energy it requires so it does not trigger the brain to signal the need for more food.  Even though your calorie intake is reduced, your body can access the energy stored in fat cells. However, while very unusual, hunger is a remote possibility during the first week of the protocol. If you continue to feel hungry, check with your provider for either a change in the hCG dose or diet.

Wouldn’t I lose the same amount of weight eating a very low calorie diet without hCG?

While it is true that the amount of weight lost with pure calorie restriction approximates that lost with an hCG diet, the following points make the hCG diet unique and hence successful in comparison:

With hCG there is no hunger or craving and patients are comfortable. In fact, an hCG diet frequently elevates mood and increases energy.

Traditional very low calorie diets also rob calories from other soft tissues, such a muscle and connective tissue as well as essential fat storage around organs.

Essential structural fat under the skin and other areas is spared and only abnormal fat areas are targeted. This feature results in improved body contour with more inches lost in the most commonly desired areas, hips, thighs, neck, buttocks, and abdomen.

Weight loss is far more easily maintained after stopping the hCG protocol.

How will I feel while on the hCG diet?

People are typically very comfortable while on hCG and often experience an increase in energy and positive mood.  Symptoms such as headaches, mood swings or feeling lightheaded DO NOT typically occur as with other low calorie intake diets.

How much weight can I expect to lose?

In one typical 30 day cycle women can lose between 8 and 20 lbs.  In a 60 day cycle you can expect a weight loss of 35 pounds or more.  Men generally lose weight at a faster rate than women.   If you desire even greater weight loss, the oral protocol of hCG I provide can be continue until goal weight is attained (to be determined with my instruction).

hCG PROTOCOL
DO NOT DEVIATE FROM THIS PROTOCOL
Read Completely Before Beginning

1.     Weigh yourself everyday even when you go off the hCG. As soon as you wake up, urinate, and weigh yourself on the same scale naked every morning and record it.  You will continue this from now on to monitor yourself.

2.     Set your weight loss goal before beginning the protocol (under my supervision), e.g., 20, 30, 40 lbs. You will stay on the hCG for up to 2 – 4 months until your end weight goal is attained each time and then you will have to stop for a minimum of 6 weeks to let your hypothalamus recalibrate its weight set point before starting again if you wish even more weight loss. You will stay on the hCG until either you attain your goal weight or you want to take a break. You can go back on the hCG supplement as many times as you want but between times, you must wait a minimum of 6 weeks.

FOR REMAINDER OF hCG PROTOCOL see next blog on WEIGHT LOSS AND hCG

An abdominoplasty or “tummy tuck” does require general anesthesia and can take up to several hours in the operating room. The length of time for the operation depends on the amount of skin that needs to be removed and how large a tummy you have.

If you are of “good health,” that is, if you do not have health problems with your heart and lungs, and have been cleared of any previous heart and lung problems, then you are a candidate for a tummy tuck or what I call a MOMMY MAKEOVER.

You also MUST be cigarette smoke free for at least 2 weeks before and for 2 weeks after the surgery. In fact, better results are had by those who don’t smoke at all in terms of better incision healing and fewer wound healing complications.

During a tummy tuck, I repair the rectus muscles that have become split as a result of pregnancy or perhaps were split even from birth. The result is a trimmer shape and waistline!

It is misleading to think that you will be able to sustain your new shape and size after plastic surgery if you are not willing to change your eating habit and/or exercise habits. While I will change your body absolutely remarkably in a way that you couldn’t have with diet and exercise alone, your shape will not be maintained if you don’t watch what you eat afterward.

My suggestion then is to get into the habit of at least walking 2-3 times a week to begin with for 10-15 minutes at a time. Once you get used to that level of activity then you should progress to at least 30 minutes 3 times a week then to everyday.

When I speak of changing eating and lifestyle habits, it can be as simple as portion control and giving up regular soda and skipping dessert 2-3 days a week and limiting the amount of carbohydrate intake without giving it up entirely.

A tummy tuck is an absolutely EXCELLENT way of getting rid of all your excess skin, stretch marks and fat that overhangs your midriff after children or weight fluctuations. In fact, it is the ONLY way to get rid of all that excess skin. You can lose the weight and tone up the abdomen with exercise and diet but  become extremely frustrated and discouraged when you see that torso has not changed one bit and in fact may look worse with the weight loss, when the skin looks even more saggy and flaccid.

Many of my patients such as yourself will come for a consultation when their weight loss or shape change plateaus with the exercise and diet and want to know what more can be done. This is an extremely important time not to “fall off the wagon, become discouraged” and bounce back to your previous  destructive eating binges and habits.

This is an ideal time to intervene with plastic surgery which can take you to the next level of a healthier lifestyle and new body. The tummy tuck is the “kick in the rear” that you need to stay on track and to maintain your healthier lifestyle.

When you can actually SEE the results of all your hard work with an incredible new body shape, you are much more willing and likely to maintain this new lifestyle permanently.

I hope this is encouraging and helpful and I will write more on the costs and recovery in my next MOMMY MAKEOVER BLOG.

Dr Michele D Koo, MD, FACS, St Louis, Missouri, 314-984-8331, Board Certified Plastic Surgeon, Member of the Aesthetic Society believes that weight loss after pregnancy can be achieved with sensible eating habits and increasing one’s activity level. She does not think that one should worry about the weight gain during the pregnancy as long as your OB-GYN is following your rate of weight gain and which trimester you gain the most weight.

Fat deposits and weight gain is a normal part of pregnancy and is necessary for the healthy development of normal birth weight newborn. Fat accumulates during pregnancy in the same areas that plague most women even when not pregnant. The most common female areas of fat accumulation are the abdomen, hips, waist, inner and outer thighs.  The areas of fat accumulation are genetically determined that cannot be altered with diet and exercise. These are the areas that increase in size first any time there is any weight gain regardless of pregnancy.

The fat that is accumulated with pregnancy is a rapid weight gain type of fat that increases the size of the fat cells over a short period of time. There usually is not enough weight gain of 75 lbs and up that might actually stimulate the body to trigger the cells to multiply and increase the actual number of fat cells.

Short term weight gain such as with pregnancy should actually be easier to lose than weight that has accumulated over a long period of time.  Fat that has accumulated over a long period of time of years may be a result of an increase in number of fat cells and even fat deposit in the composition of muscle and internal body fat gain.

The body’s physiology may also have been altered in terms of its insulin release and response patterns, fat storage, other endocrine functions, and possibly set points for “normal weight.” However, during the post partum period, the woman may be recovering and exhausted from a newborn and perhaps other small children and attempting to return to work, and, therefore, not really devoting time and energy into healthier eating and exercising habits.  The weight then seems to be extremely “stubborn” and resistant to exercise and weight loss, but in fact the fat is very readily reduced with the same diligent adherence to exercise and healthier eating.

It is my opinion that if after 1 to 2 years post partum, a woman has not lost all of her pregnancy weight, she will not be able to do it. More importantly, even if she achieves her pre-pregnancy weight, she will not look the same unless all of the skin has tightened which becomes less and less likely with each subsequent pregnancy.

My recommendation to my patients is that, they wait 6-12 months after they have stopped breast feeding or at least 6-12 months after delivery prior to undergoing any liposuction procedure as at that point, the post partum weight is relatively stable.

It has been my experience, however, that most women after pregnancy will need some type of skin removal procedure, i.e., tummy tuck, breast lift in addition to liposuction to achieve what they are looking for. The likelihood of needing a skin resection procedure increases with a C-section and increases with the number of children a woman has had.  I discuss this at length with my patients, the pros and cons of the permanency of the scar versus the great shape that can be achieved with the addition of the skin removal.

My patient’s ultimate goal of how flat she wants her abdomen or smooth her thighs will determine whether she would be better served with liposuction alone or liposuction with skin removal. The amount of time to recover after a liposuction is not any different for post partum patients; the amount of time to recover is dependent on the amount of fat removed and the number of areas liposuctioned.

With each pregnancy there will be weight gain and skin stretching; if one is considering any kind of plastic surgery for post partum changes for unwanted fat and skin, one might want to wait until they are completely finished with having children. The most important thing that one should always know is, “that there is nothing that pregnancy or weight gain can do that Dr Michele Koo can’t fix.”

DR MICHELE D KOO, MD, FACS, ST LOUIS, MISSOURI, 314-984-8331 for individualized personal care that will change your life and let you take charge of your own destiny.