"It's My Glands"

The doctors were fed up with the 286-lb. woman patient; they were sure that she was cheating on the strict diet they had prescribed. "It's my glands," she protested, but they simply did not believe her. Finally, the 32-year-old housewife agreed to submit to a rigorous test: she would go into the University of Wisconsin hospital in Madison and stay for 30 days, subsisting on a diet of only 600 calories a day. Under such strict supervision, cheat-eating was impossible. To the astonishment of Drs. Edgar Gordon and E. Marshall Goldberg, at month's end she had lost exactly three ounces.

A whole generation of doctors has steadfastly refused to believe the innumerable fat people who blame their girth on their glands instead of their appetites. Most experts have insisted that the thyroid gland and its hormones are to blame in no more than 5% of obese patients, and this kind of thyroid disorder, they have long pointed out, is fairly easy to detect. Now, a few researchers into the mysteries of meals and metabolism are reversing their thinking. Certain thyroid disorders, possibly some involving other glands as well, are hard to detect. And these, it appears, explain a surprising number of cases in which patients insist. "I eat practically nothing and still I can't reduce."

Radioactive Breath. The young housewife in Madison, her doctors suspected, was not "burning" carbohydrates in the normal way and converting them into carbon dioxide and water. To find out just what was happening in her system, they injected into her veins a solution of sugar tagged with radioactive carbon 14. The tracer isotope should have appeared in her breath in a couple of minutes. Instead, an hour passed before it showed up. When tagged fat was injected, the radioactivity appeared in the breath in 45 seconds. Dr. Gordon's conclusion: his patient's system preferred not to burn its carbohydrates straight, but to turn them first into fat. He calls this "metabolic obesity." He put the housewife on a low-carbohydrate diet, plus liothyronine, an extract of thyroid hormone. So far, she has lost 70 lbs.

In other cases of abnormal metabolism, the timing of meals is as important as their quantity. The Wisconsin doctors knew this was true in rats; to test it in humans they sought out a cooperative housewife, 58, whose 278 lbs. and 5 ft. 4 in. gave her "the general structure of a basketball." On a 950-calorie diet, she had only fruit juice and black coffee for breakfast and coffee for lunch, but crammed nearly all her day's calorie allowance into one good meal--dinner. She lost no weight. The doctors gave her a more generous 1,200-calorie diet that was high in protein, moderate in fats and low in carbohydrates, but told her to eat it in small snacks, six to eight times a day. She has been losing weight steadily.,

Horse & Rail. Doctors in other medical centers have come to much the same conclusions as Dr. Gordon. Though calories do count, they say, there is not a simple one-to-one relationship between calories and weight. There are far too many variations in individual metabolic patterns as well as psychological variables. Among patients who have a lifelong problem keeping their weight down, Dr. Gordon estimates, as many as one-third may have a legitimate, metabolic excuse. And many more will try to hide their gluttonous bulk behind an explanation that does not apply to them.

At the opposite extreme are the people who "eat like a horse" and stay "thin as a rail." Though they burn up some energy in excess physical activity and nervous movements, says Dr. Gordon, they also have unusual metabolic pathways for getting rid of fat. These people and the irreducible fat ones represent the far ends of the same metabolic scale.

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