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Systems Biology: The Gut-Brain–Fat Cell Connection and Obesity

Mark A. Hyman, MD

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.

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