—William Shakespeare A MAN OF UNCONTROLLABLE APPETITE

A MAN OF UNCONTROLLABLE APPETITE One evening, after I had given a lecture in New York, a man approached me to ask about seeing me as a patient. He was rotund, with a round, ruddy face, a booming voice, and a gentle manner. Everything about him was large—his appetites, his belly, and his heart. He seemed tentatively curious about my work, and I was surprised when he showed up in my office. Samuel was almost 60 years old, and his love of everything big was waning as he felt the encroachment of death. He described years of feeding his fat, drinking a pint of heavy whipping cream every night before bed to keep his weight up. At times he would have a change of heart and try to lose weight. He tried to lose weight as he gained it—with big attempts and extreme diets, but he always gained back more than he lost. Finally, he realized that the big presence his more than 300-lb corpus gave him was not worth the infirmities he suffered. He was doggedly fatigued and short of breath at nearly every step, his nose was congested, and his legs were swollen. His skin was dry, and yeast grew over his body, fermenting on the sweetness of his skin. He was not aware that he was diabetic, had dangerous cholesterol levels, angina, sleep apnea, and a sluggish thyroid. He did notice that his leg hair was gone and that his face and chest had a feminine appearance. Because of the estrogen produced by his fat cells, his level of female hormones was that of a woman. He did not realize he was rusting inside, that his liver couldn’t keep up with his body’s detoxification demands, or that his body could not burn fat effectively anymore. At one time, his large appetite for life created his personality, and he controlled it. Now his appetite controlled him and he felt powerless to stop it, no matter how hard he tried to will the cravings away. His testing showed severe sleep apnea; a thallium stress test with myocardial ischemia; atherogenic small, dense LDL and HDL cholesterol particles; large triglyceride particles; and high fasting insulin and blood glucose levels. His hormones were completely out of balance—his insulin was over 200 μIU/mL (normal <20) after a 75-g glucose load, his estrogen was high, his thyroid-stimulating hormone (TSH) was high and his free T3 low, and his growth hormone was very low. He also had IgG food sensitivities, impaired hepatic detoxification, and fatty liver (nonalcoholic steatohepatitis). I told him that if he did everything I suggested, he would lose weight, feel better, and his symptoms would go away. Everything he had done, he did to himself and could undo. I prescribed a simple program for him. I had him eat a whole-foods, unrefined diet without any restriction on calories or portion size. I taught him the concept of nutrient density—foods with lots of nutrients and fewer calories such as whole grains, vegetables, fruits, and nuts. I had him start walking and slowly build up his exercise and ultimately include interval training. I gave him supplements to balance his blood glucose (magnesium, chromium, vitamin A); antioxidants such as lipoic acid, which helps reduce blood sugar and improve mitochondrial energy production; and coenzyme Q10 for his heart. I also recommended herbs to heal his fatty liver, fish oil, and extra fiber. I also gave him a small dose of Armour thyroid to balance his thyroid, and treated his sleep apnea with a continuous positive airway pressure (CPAP) machine. Enthusiastic, though somewhat skeptical, he left my office determined. Three months later I spoke to him. He had lost 30 pounds, had more energy, and was beginning to look forward to exercise. His nasal congestion was gone and his fluid-filled, swollen legs were better. All of his cravings were gone, he never felt hungry, and he found the program easy to follow. Eight months later I saw him again and repeated his blood tests. I was shocked when he weighed in. He had lost 110 pounds without being on a strict deprivation diet. He simply changed his eating habits and lifestyle. His diabetes was cured, his blood sugar had dropped from 130 to 74 (>126 fasting denotes diabetes). His HDL and LDL cholesterol and triglycerides were normal without any medication. His liver function test returned to normal. He was exercising vigorously 3-4 times a week and felt 20 years younger. He had, after a lifetime of uncontrollable appetite, finally found balance and health without suffering, as well as continued pleasure in food.