I read an intriguing article in the 5 October, 2010 edition of Annals of Internal Medicine, then saw the accompanying editorial. The article was titled "Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity" and was densely scientific, even for me; the editorial was titled "Sleep Well and Stay Slim: Dream or Reality." I decided to start with the commentary and then return to the study itself.

Having read both in detail, I'm comfortable with what's said and what the limitations of the study, done at the University of Chicago and the University of Wisconsin, might be. So let's start there.

The researchers put newspaper ads in local papers to recruit a small number of subjects for a short-term study. They ended up with ten volunteers who didn't smoke, were overweight, but otherwise healthy. The study protocol was detailed ,but basically each of the subjects was on a two-week diet with eight hours or sleep and another similar period with five and a half hours of sleep.

They lost similar amounts of weight in both study periods, but lost more fat during the time they when they dieted and slept well. So sleeping less and dieting resulted in the loss of "fat-free body mass." In other words they lost more fat and less muscle when they slept longer and vice versa when they slept less.

How does this apply to the rest of us? Well there is some data linking a decreased sleep duration with an increase in obesity rates in larger groups. There are rodent studies supporting the theory. There are some larger human studies showing shorter periods of sleep are associated with changes in two hormones that affect appetite and one that showed an association between snacking and less sleep.

So there's a lot of data accumulating that strongly suggests, but does not yet, from a strictly scientific point of view prove, that if we need to lose fat we should diet and also get adequate amounts of sleep.

It makes sense to me. I wouldn't hold my breath waiting for large studies in general populations that confirm this small-scale research. We are a chronically under-slept nation, a number of sources have proclaimed, and I think they're right.

So cutting your hours of sleep while you diet appears to be self-defeating and sleeping a full eight hours, give or take a little, is probably better if you want to lose fat.

A friend told me how much weight she had lost on the HCG diet and I have to admit I was impressed. She mentioned others people I know who also had been trying the program.

So I tried to find out more about the diet, which more appropriately should be called the hCG diet. Human chorionic gonadotropin was first discovered in urine samples of pregnant women in 1927 and it plays a number of roles as a hormone in pregnancy. One is making sure the fetus gets the calories needed for growth and development.

The peak level of hCG in the serum of a pregnant woman is found relatively early in the gestational period, usually at nine to twelve weeks after the last menstrual period. Many women are unaware they are pregnant at this point and may not be "eating for two" (I put this in quotes because I'm certainly not an Ob-Gyn physician and I'm unaware of what current dietary recommendations are for pregnancy).  Fat is released from storage areas (hips, buttocks, thighs and abdomen) when hCG is present and, if the Mom-to-be isn't eating enough for normal fetal growth, the fat calories and other nutrients can sustain fetal development.

From there it was only a step to the research of Dr. A.T.W. Simeons showing that daily injections of hCG might result in weight loss when accompanied by a severely calorie-restricted diet (500 calories per day). I'll paste in the original diet from Dr. Simeons.

Breakfast:Tea or coffee in any quantity without sugar. Only one tablespoonful of milk allowed in 24 hours. Saccharin or Stevia may be used.

Lunch: 1.    100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp. All visible fat must be carefully removed before cooking, and the meat must be weighed raw. It must be boiled or grilled without additional fat. Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The chicken breast must be removed from the bird. 2.    One type of vegetable only to be chosen from the following: spinach, chard, chicory, beet-greens, green salad, tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage. 3.    One breadstick (grissino) or one Melba toast. 4.    An apple, orange, or a handful of strawberries or one-half grapefruit.

Dinner : The same four choices as lunch.

Simeons  published a 1954 article in the British medical journal the Lancet reporting on a group of patients who followed his program for forty days and lost twenty to thirty pounds. He stated 70% had maintained their weight loss after finishing his diet.

Now things get convoluted with many controlled studies over the next forty years denying Simeons' findings and position papers from major medical organizations against the hCG diet.

But in 2007 a popular book was published that rejuvenated interest in the program and ever since then it has received enormous amounts of public attention and hCG clinics have become widespread. There are both injectable and, now, oral forms of hCG advertised on the Web.  Programs with the injectable form run from 26 to 43 days, with daily injections on all but three of those days.

Incidentally the author of that book has served jail time for fraud, was sued by a number of states for running a pyramid scheme (he and his company settled the suit with the states for $185,000)  and, in 2004, agreed to a lifetime ban on informercials, excluding his books. I've just watched "20/20" interview with him and would not buy a used car from him.

So that's the background I've been able to find on the hCG diet. More to come, I'm sure. My real question is what happens after the program is finished? I want to see if the weight loss can be maintained. At the moment I'm a skeptic.