Dr. Sekula on weight loss, fitness and nutrition

Jeff Garlin, co-star and executive producer of Curb Your Enthusiasm, has written a memoir about his lifelong struggles with weight. In an interview for ABC news, Garlin talks about his addiction to food and his new diet. You can read the interview and watch a video here.

This is sad. Really sad. He said he’d eat and eat and eat and never feel full. Stand-bys included gourmet sandwiches, pop-tarts and Cap-n-Crunch cereal. In the video, he talks about donuts and milkshakes. Also, knowing that a single donut or any sugar-filled food would send him over the top, meant these foods were forbidden and that moderation was not possible.

He alluded to his lifelong struggle with weight. Although not prominent, I’m sure there were never-ending attempts to lose weight. Well-wishers like Larry David, his wife and others, I’m sure, encouraged him to lose weight. I’ve never met a person that was overweight who didn’t want to lose weight. Really, I’ve never known an overweight person that hasn’t tried every diet under the sun.

At age 37, he suffered a stroke. At his heaviest, he weighed 320 pounds. Through various changes he’s down to the upper 260’s. I’ll talk about those changes in a second. 

So what’s going on? What’s the problem? Why can’t Jeff Garlin, et al just buckle down and lose weight? The answer lies in the ubiquitous message of energy balance. Accordingly, you can eat what you want, just eat less and the weight will disappear. Not in Jeff Garlin’s case.

Despite the fact he’d eat a half-dozen donuts and a milkshake, he was never full. He talks about stopping at In-N-Out Burger on the way home from work to get two double cheeseburgers because dinner at home would not be enough. He also mentions the ability to eat an entire pizza and wash it down with five boxes of instant pudding, topped off with graham cracker crust. I wouldn’t be surprised if that didn’t fill him up, either. 

The problem with the energy balance equation is that it assumes we can simply restrict calories and lose weight. Completely ignoring the real issue, insulin, of which Mr. Garlin could not be a more perfect example

As Gary Taubes eloquently pointed out in Good Calories, Bad Calories, hyperinsulinemia  drives fat storage and dictates cellular starvation, regardless of food intake. This is spelled out specifically in Chapter 22, The Carbohydrate Hypothesis. More specifically, on page 399 (paperback), he discusses the role of lipoprotein lipase (LPL) and fat storage. As insulin levels rise, triglycerides are preferentially stored in adipose tissue.

During caloric restriction (as I’m sure Mr. Garlin tried, you know, eat less, exercise more?), weight loss becomes more difficult and even problematic. Fewer calories lead to decreased muscle mass and smaller organs (brain and kidneys, for example), in the face of hyperinsulinemia. It’s a feedback loop, driven by insulin, that works to maintain body fat levels, even in the face of decreased organ systems.

So Jeff Garlin likely went on a typical diet of eat less, without changing the types of food he ate. Since his insulin levels were still high, it only made him hungry. Probably hungry as hell. And he could only hold on for so long.

One thing those foods will do is elevate insulin. All that glucose has to go somewhere. I’m sure he Jeff wasn’t exercising. Even if he was, there’s no way in Hades he was depleting his glycogen stores, so that glucose went somewhere. It got converted to fat and stored.

All of this brings me back to his new approach. I wish him well, but I have my reservations. Here’s what he’s doing. He meditates daily, 5:30am. He cut out sugar, fast-food and binge-eating. He doesn’t eat salt, chicken, turkey, red meat or ham, although he does still eat fish. He eats fruit, vegetables and whole grains. “It’s all very boring,” he says. Giving up sugar was, “really, really hard.”

He’s done pretty well. Lost about 50 pounds. Gave up sugar, salt and most forms of protein and he meditates. I think he’s been successful so far because of sugar elimination. I have no idea how much sugar he was eating, but with milkshakes, pizza, cereal and donuts, it had to be a boatload. I’m guessing 400-500 grams, minimum.

The problem I see, however, is the whole grains and fruit. His insulin is down, which helps the cravings. For the long run, however, it’s not down enough. He’ll find caloric balance soon and will get stuck, probably several pounds away from his goal weight. Then what? Probably try to eat less, again.

What will be the culprit then?

*Photo courtesy of abcnews.com.

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