Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Doctor Archiinasadu is our guest. She's an indochronologist board certified
that means hormones, and she specializes in diabetes. She is
the director of the System Diabetes Program at Houston Methodist.
And we're talking about ozimpic, something that keeps coming up
in conversation after conversation as I talk to people who
you compliment you look great, you've lost weight, and they
(00:22):
say ozimpic or some variation of that drug class. Doctor Sadu,
I want to go back to you gave three items.
Number three was appetite suppression. Number two was raising the
ability of the pancreas to secrete insulin. The first was,
as I understood it, delaying the food vacating in your stomach.
(00:42):
Does that mean it's holding the food longer in your
stomach so that you feel full and you don't have
a need to refill that. I want to make sure
I understand that exactly.
Speaker 2 (00:53):
Yeah, So it is delaying the emptying process of the stomach,
and so the gastric content whatever you've eaten or sitting
in the stomach a little bit longer. The stomach wall
is stretched out a little bit more, and so that
in and of self signals your brain to stop eating
as much because obviously you don't want to. Normally you
(01:16):
don't want to overeat the stomach volume. So it's called
delayed gas string emptying. It's the well known effect of
the drug that we actually desire because one it makes
you eat less. Two it allows your body to handle
the nutrients more slowly and efficiently.
Speaker 1 (01:35):
And our body can't do that on its own.
Speaker 2 (01:38):
Well, we normally do. And as I mentioned, this hormone
is in all of us, but there may be different
levels for different people, and that could be genetic, that
could be environmental, that could be we don't know all
the different reasons why some people who may overeat may
not have enough of GLP one that is active, and
(02:00):
so these drugs are used to enhance those effects multifold
than what we normally have in our own natural eating process.
Speaker 1 (02:10):
Let's go to item number two. It raises the pancreas's
ability to secrete insulin. My father is a very brittle diabetic.
He was released honorably, discharged honorably from the Coastguard sixty
three years ago because diabetes. They thought they didn't think
he would live, and he didn't have I've talked to.
(02:33):
There was the head of the diabetes program at Johns
Hopkins was flying back from Africa on a flight next
to me years ago, and he said, your dad knows
as much about diabetes as any doctor, because he's kept
all his fingers toes and vision for all these years
with diabetes. Because our knowledge is relatively recent. When we
talk about the pancreas secreting insulin, talk a little bit
(02:56):
about what that does and why some people, particularly diabetics,
pancreas doesn't seem to function.
Speaker 2 (03:02):
So I want to first make a distinction in the
type of diabetes, which I'm not sure which one your
father had, but there is type one and type two,
just to be very simplistic. So in type one diabetes
that pancreas, the problem is those celves don't make any insulin,
so these drugs are not used for that type of diabetes.
(03:22):
They're solely for type two diabetes. So the underlying problem
with type two diabetes is not that the pancreas doesn't
make insulin. It does, but it has to make multifold
of a normal person without diabetes to overcome insulin resistance
throughout the body. So insulin resistance means that even though
(03:46):
your celves are seeing insulin, it's not working as efficiently
to get the job done. And that insulin resistance can
come from sedentary lifestyles, poor diets, being over weight, OBEs,
and genetic factors. So what this drug is. It helped
at the level of the cells that make insulin in
(04:09):
the pancreas. It helps them be more efficient. And it's
not only insulin. It actually affects another hormone in the
pancreas called glucagon that normally raises our blood sugars. It
suppresses that hormone and enhances the effectiveness and secretion of insulin.
So by doing those two modulations in the pancreas, the
(04:31):
patient will experience more even blood sugar control. And this
is what you know. Time and time again, patients come
back telling us I feel like my blood sugars are
more even more controlled, And then when we actually have
measurements to back that up, we can see that it
really stabilizes the blood sugars, particularly after eating meals when
(04:52):
it's most active.
Speaker 1 (04:54):
Yeah, the variations, the spikes and drops or gets my
dad in trouble. He was a five in one shot
today again, now he's on a pump, but the pumps
don't always function well and it's a constant stressor. But
how well does ozempic treat the type two diabetic which
he is, I should tell you how well does ozempic
treat that?
Speaker 2 (05:14):
So not just ozempic, but all of these in these
classes have just been remarkable. They've been such a valuable
tool for those of us who have been managing diabetes
type two diabetes for decades. We've really not had anything
as effective as this class of drugs. We are seeing
patients almost normalize their blood sugars on these drugs, especially
(05:37):
if you add on the weight loss and healthy lifestyle interventions,
get them a non regular exercise programs. I've been able
to take patients off insulin that they've been on for many,
many years, as well as other diabetes drugs, and it's
just been a great tool for us, really rewarding not
(05:57):
only in the scientific data but in real life life
with patients. And that's the reason for its popularity because
it's very effective for our patients with diabetes. Now we
can talk about the weight loss indication separately, but it's
just been a very effective class of drugs for us.
Speaker 1 (06:16):
And how difficult is it for your patients to find
ozimpic today? Because I have my dad's not on ozmpic,
but my niece's husband is, and this is an issue
that I care about. And he talks about the difficulty
in getting ozempic or something in that class of drugs.
How difficult has that become.
Speaker 2 (06:36):
So this is a first in my career where a
diabetes drug has been in shortage like this. And really
what happened is when semaglue tide was approved for diabetes
and we were using it, you know, using it as
much as we could to help our patients, and then
it got the approval for weight loss and is the
(06:58):
same drug. What happened was the demand for weight loss
went up tremendously, and as I understand, there was also
some supply production problems with the company and the manufacturing plants,
so that there was not as much drug available to
(07:20):
meet the demand. So even if you're using it for
weight loss, and when that drug with GOVY was not available,
people just switched over to the diabetes version ozempic And
again it's the same drug, so you get the same effect.
And that really domino effect in terms of supply chain,
(07:41):
and for the last year we have seen unprecedented demands
for this drug, lack of supply and disruptions in our
care for patients with diabetes who relied on it. Really
for the Blachergar control, so tons of phone calls as
soon as this tragedy started from patients, my sugars are
(08:03):
out of control, I need something else. We had to
get patients immediately on insulin who weren't on insulin, or
if they were on insulin as well, just bring up
the doses much higher than they were, and of course
insulin has a lot more side effects that we don't want,
particularly low blood sugars. So this has really been a
scramble situation for those of us who manage diabetes when
(08:25):
all of a sudden this drug is withdrawn and we
have to substitute and come up with other treatment plans
immediately and even resulted in hospitalizations.
Speaker 1 (08:35):
Doctor Archinal Sadhu is our guest. She is a diabetes
expert and she runs a system diabetes program at Houston Methodist.
More with her coming out the Michael Berry Joe.
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(09:06):
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Speaker 1 (09:29):
Doctor Archino Sadu is our guest. She is a board
certified indo chronologist that means hormones, and she is a
diabetes expert. She is the director of the System Diabetes
Program at Houston Methodist. And we're talking specifically about ozembic
and drugs in that category, both in treating diabetes and
(09:54):
in the wider issue as a weight loss drug. You know,
when you doctor south Over the years, a number of
my friend's wives when they lose weight, and I'll comment, oh,
you know, Susie looks great, she's lost how much she lost,
you know, twenty pounds? That's a lot for a woman,
right if she was one forty and she's won twenty,
(10:16):
you really see a difference. And there was a class
of drugs I remember, I can't remember their names, but
Vivance was one of them. There were several, but it
sounded like they were really just amped up speed and
that made that made women sort of jittery. It made
them they couldn't sleep. It was in a class of drugs.
(10:39):
Is this a Can you compare those two because that
seems to have kind of gone away in favor of
this and people seem to really prefer ozempic in this
class of drugs.
Speaker 2 (10:49):
Yeah. So, you know, it's interesting the timeline of obesity
drugs and how many were introduced and approved by FDA
and withdrawn over the years, and you're talking about more
of the amphetamine based drugs. Fen Fen is another one.
So they were all popular for some time but subsequently
(11:13):
found to have pretty unacceptable side effects for patients, and
exactly cardiovascular side effects heart racing, high blood pressure were
just not worth the effectiveness of the drug, which really
is nowhere near these drugs we're talking about now. So
(11:34):
at that time and any FDA approval criteria for a
weight loss drug was you should lose at least five
percent of your body weight and of course have acceptable
side effects. But these drugs, the Regovi and the Manjaro,
they're up to twenty percent of your baseline body weight.
(11:57):
Between twelve to twenty percent is where the studies are showing,
So it's three fourfold the basic criteria of the old drugs.
So for that reason, there's no really driving force to
use any of the previous obesity drugs, not to mention
the fact that they have had really detrimental side effects,
(12:18):
including suicides and suicidal ideations. And these drugs do have
side effects, don't get me wrong. They are there, and
everyone who's taking them should be aware of them and
make sure that their risk to benefit ratio is in
their favor to use the drugs.
Speaker 1 (12:33):
Let's talk about those, because that was my next round
of questions. What are some of the risk factors to
this drug, to ozembic and drugs in that category.
Speaker 2 (12:43):
So the side effects commonly are gastrointestinal because that's where
the drug is working. So as you can imagine, if
you're emptying your stomach lower at a lower rate, you're
going to have a little bit more nausea, maybe even
vomiting sometimes causes diarrhea, other times constipation a reflux of
(13:05):
food is a really common issue. And then abdominal cramping
and abdominal pain. So those are common and have been
found in the studies and are found in real life.
And to mitigate those, we really recommend a very slow
titration on the doses and that that schedule has been
you know, on the drug label. But the more serious
(13:26):
side effects really are a pancreatitis and that can even
be deadly, an acritizing pancreatitis where the pancreast becomes so enflained,
and other things include gallstones or acute gall bladder attacks.
We've seen many cases of that and that's been shown.
It also does elevate the heart rate a little bit,
(13:49):
usually not to a degree where it's causing any problems,
but you can have a higher heart rate. And then
the very serious side effect is in a thy special
thyroid cancer or rare thyrowid cancer called medullary tyrowid cancer,
and that is an absolute contra indication if you have
a family history or personal history of that kind of
(14:09):
thyroid cancer.
Speaker 1 (14:10):
Our guest is the director of the system diabetes program
at Houston Methodist doctor Archi and Us said, when we
hear doctor said, when we hear these risk factors, you know,
at the end of it's been within the last you know,
not that many years that pharmaceutical companies were able to
advertise on television and now they're one of the biggest
(14:32):
class of advertisers. And after you hear all the wonderful
things that can do and all the pretty people, whether
they're about to have sex in a tub, out on
the beach, or they're old and now all of a
sudden they can see their grand children playing ball, or
they've fallen in love, or all these wonderful things these
drugs can do for you. And at the end it says,
you know, your eyeballs could fall out, your throat could
(14:54):
cave in. When you talk about risk factors, I think
we sort of block those out, which was not the point.
How often are we seeing significant side effects, you know,
even to the point of some of the more serious
stuff there and I mean beyond nausea. I got that,
But how like is it one in a thousand, is
(15:14):
it one in a million?
Speaker 2 (15:17):
It's somewhere in between. It's really not as common as
it's not so common that it would prohibit people from
using the drug, and I think that's where the demand comes.
I don't recall the exact statistics, but for instance, the
medullary thyroid cancer that has not been found in humans necessarily,
(15:38):
but in the rap studies it was much higher than placebo,
so it's on the label as a potential risk. But
a recent study in humans done in Europe, actually in France,
looking at their database of patients who've used these drugs,
they are seeing up to a threefold more incidents than
(16:02):
diagnosis of syroid cancers for patients on the drug compared
to those not on the drug. Now, this is a
retrospective study, so it's not entirely controlled for everything, so
we don't put as much stock in in the results
of a retrospective study as a randomized control study, but
it is showing some kind of signal there that maybe
(16:23):
we should be looking at this more. Other things that
have come up. In fact, recently there's been in Europe
again some reports have increased suicide for patients taking this drug.
So the EUAY, their version of our FDA, is actually
looking into these kind of reports to see if there's
any merit to this and if we should be looking
(16:45):
at it even more closely, especially because now it's being
used so widely. So all of the randomized control trials
are not popular this big populations, and they're not forever.
They're limited usually around two years or last. So we're
starting to see things in the real world that maybe
(17:06):
we need to pay more attention to and study more.
Speaker 1 (17:09):
Doctor Archinal Sado hold right there. We'll talk more with her.
We'll get to the big issue which everyone wants to
know about, is the appetite suppression. Imagine if you didn't
have all these cravings, how skinny you would be coming out.
Speaker 3 (17:24):
We're gonna add a little bit about these warhouses I
know all about.
Speaker 1 (17:27):
Ramon wants to know what around the world is.
Speaker 4 (17:29):
Whistling bungholes, spleen splitters, whisker biscuits, honkey riders, whoskerdos, whosker
don'ts nips and dazers, whether without the scooter stick or
one single whistling kiddy Jason.
Speaker 1 (17:42):
Doctor Archino Sadou is our guest. She is a board
certified indo chronologist that means hormones, and she is a
diabetes expert. She is the director of the system Diabetes
program at Houston Methodists, and we're talking specifically about ozembic
and drugs in that category, both in treating diabetes and
(18:06):
in the wider issue as a weight loss drug. You know,
when you doctor SAIDU. Over the years, a number of
my friend's wives when they lose weight, and I'll comment, oh,
you know, Susie looks great, she's lost how much she lost?
You know, twenty pounds. That's a lot for a woman,
right if she was one forty and she's won twenty.
(18:27):
You really see a difference. And there was a class
of drugs I remember, I can't remember their names, but
Vivance was one of them. There were several, but it
sounded like they were really just amped up speed and
that made women sort of jittery. It made them it
couldn't sleep. It was in a class of drugs. Is
(18:49):
this a Can you compare those two because that seems
to have kind of gone away in favor of this
and people seem to really prefer ozempic in this class
of drugs.
Speaker 2 (18:59):
Yeah. So you know, it's interesting the timeline of obesity
drugs and how many were introduced and approved by FDA
and then withdrawn over the years, and you're talking about
more of the amphetamine based drugs. Fen Fen is another one.
So they were all popular for some time but subsequently
(19:22):
found to have pretty unacceptable side effects for patients, and
exactly cardiovascular side effects heart racing, high blood pressure were
just not worth the effectiveness of the drug, which really
is nowhere near these drugs we're talking about now. So
at that time and any FDA approval criteria for a
(19:46):
weight loss drug was you should lose at least five
percent of your body weight and of course have acceptable
side effects. But these drugs, the Wagov and the Manjaro,
they're up to twenty percent of your baseline body weight.
Between twelve to twenty percent is where the studies are showing,
(20:06):
so it's three fourfold the basic criteria of the old drugs.
So for that reason, there's no really driving force to
use any of the previous obesity drugs, not to mention
the fact that they have had really detrimental side effects,
including suicides and suicidal ideations. And these drugs do have
(20:28):
side effects, don't get me wrong. They are there, and
everyone who's taking them should be aware of them and
make sure that their risk to benefit ratio is in
their favor to use the drugs.
Speaker 1 (20:38):
Let's talk about those, because that was my next round
of questions. What are some of the risk factors to
this drug, to ozembic and drugs in that category.
Speaker 2 (20:47):
So the side effects commonly are gastrointestinal because that's where
the drug is working. So as you can imagine, if
you're empten your stomach lower at a lower rate, you're
going to have a little bit more nausea, maybe even vomiting.
Sometimes it causes diarrhea, other times constipation a reflux of
(21:08):
food is a really common issue. And then abdominal cramping
and abdominal pain. So those are common and have been
found in the studies and are found in real life.
And to mitigate those, we really recommend a very slow
titration on the doses and that that schedule has been
you know, on the drug label. But the more serious
(21:28):
side effects really are a pancreatitis and that can even
be deadly, an adcvertizing pancreatitis where the pancreast becomes so enflamed.
And other things include gallstones or acute gall bladder attacks.
We've seen many cases of that and that's been shown.
It also does elevate the heart rate a little bit,
(21:50):
usually not to a degree where it's causing any problems,
but you can have a higher heart rate. And then
the very serious side effect is in a special thyroid cancer,
a rare thyroid cancer called medullary tyrowid cancer, and that
is an absolute contra indication if you have a family
history or personal history of that kind of thyroid cancer.
Speaker 1 (22:10):
Our guest is the director of the System Diabetes program
at Houston Methodist doctor Archi and Us said, when we hear,
doctor said, when we hear these risk factors, you know,
at the end of it's been within the last you know,
not that many years that pharmaceutical companies were able to
advertise on television, and now they're one of the biggest
(22:31):
class of advertisers. And after you hear all the wonderful
things it can do, and all the pretty people, whether
they're about to have sex in a tub out on
the beach, or they're old and now all of a
sudden they can see their grand children playing ball, or
they've fallen in love, or all these wonderful things that
these drugs can do for you. And at the end,
it says, you know, your eyeballs could fall out, your
throat could cave in. When you talk about risk factors,
(22:56):
I think we sort of block those out, which was
not the point. How often are we seeing significant side effects,
you know, even to the point of some of the
more serious stuff there, and I mean beyond nausea. I
got that, But how like is it one in a thousand,
is it one in a million.
Speaker 2 (23:14):
It's somewhere in between. It's really not as common as
it's not so common that it would prohibit people from
using the drug. And I think that's where the demand comes.
I don't recall the exact statistics, but for instance, the
medullary thyroid cancer that has not been found in humans necessarily,
(23:34):
but in the rat studies it was much higher than placebo,
so it's on the label as a potential risk. But
a recent study in humans done in Europe, actually in France,
looking at their database of patients who've used these drugs,
they are seeing up to a threefold more incidents than
(23:57):
diagnosis of thyroid cancers for patients on the drug compared
to those not on the drug. Now, this is a
retrospective study, so it's not entirely controlled for everything, so
we don't put as much stock in the results of
a retrospective study as a randomized control study, but it
is showing some kind of signal there that maybe we
(24:17):
should be looking at this more. Other things that have
come up. In fact, recently there's been in Europe again
some reports have increased suicide for patients taking these drug
So the EUA, their version of our FBA, is actually
looking into these kind of reports to see if there's
any merit to this and if we should be looking
(24:38):
at it even more closely, especially because now it's being
used so widely. So all of the randomized control trials
are not popular this big populations, and they're not forever.
They're limited usually around two years or least. So we're
starting to see things in the real world that maybe
(24:58):
we need to pay more attention to you and study more.
Speaker 1 (25:01):
Doctor archinal sad hold right there. We'll talk more with her.
We'll get to the big issue which everyone wants to
know about, is the appetite suppression. Imagine if you didn't
have all these cravings, how skinny you would be. It's
easy and out the world as we know it. The
Michael Verry show, Ends of the World coming up, nine
(25:24):
meal five. Doctor Archina Saudu is our guest. She's an indochronologist,
board certified. It's amazing to me how I lost seventy
pounds about two years ago. And yeah, it's amazing to
me how as I lost weight, I wanted to work
(25:46):
out more. And the more I worked out, I didn't
want to eat bad foods. I want to eat all day.
The intermittent fasting made it almost, I don't want to
say easy. But once I changed that behavior, the thinner
I got, the more I wanted to work out, the
less I wanted to drink, the less I wanted to
stay up all night. It sort of went hand in hand.
(26:07):
So it's sort of getting jump started that becomes that
difficult thing. And to me, that's the hope that one
of these drugs or veriatric surgery or all those sorts
of things can play into. But doctor Souther, let me
conclude with this. We talk a lot about avoidance of
things that we either enjoy or they're convenient. Fast food,
food out of a box, processed food, you know, these
(26:31):
processed starches and carbs. What are some of the things
that we should encourage. My wife grew up on a
very different diet than I did, and growing up in India,
she grew up on a very healthy diet, not that
every Indian does, but she doesn't eat sweets naturally. She
eats vegetables instead of French fries. And when you talk
(26:52):
about the things that if you're giving people, hey focus
on these things and learn to crave these because you
will in time. What are some of those really good
things we can do?
Speaker 2 (27:01):
So I always tell my patients, make sure what you're
eating is coming from the earth and as less touched
by man as possible. So fresh fruits and vegetables that
are not covered in a sauce or you know, some
type of heavy salad dressing, which will then just negate
the effects of the fresh vegetables you're trying to consume.
(27:25):
So grilling is really a very light and minimally disruptive
way to have your food. And most importantly, though, is
know what's in what you're eating. And the only way
you will know is if you prepared it. And this
is where the convenience and time factor comes in. We
often go out to eat, We often get fast food
(27:47):
because we prioritize other things in our schedule and sacrifice
the nutrition of our food. But you don't know what
it is when you're picking this up prepared by somebody else,
and it could being labeled as a healthy item, or
you perceive it as a healthy item, but there's hidden
ingredients that really are not that healthy and raise the
(28:09):
caloric content of that food. So keep it home cooked
as much as possible, and do as little to it
as possible, and just enjoy the flavor of the actual
ingredient that's coming from a fresh source, rather than trying
to cover it with sauces and other condiments that'll just
(28:31):
make it very unhealthy. And that's really how our body
was designed to process food. So we just have to
match our habits to how our body was designed. We
were not designed for donuts and big Max. That's not
how our digestive truck works. That's not how our metabolism
was created to work. And that's where the problem is. Now.
(28:52):
We're having all these processed, high calorie foods that our
bodies cannot handle, and we're going awry. That's why obesity
is on the rise. I have been on the rise.
Speaker 1 (29:02):
I will speak from my own experience, not anyone else's,
but I will tell you that I was raised able
to list every president from the first to the present
without understanding you know that good nutrition, which foods are
good for me, which are bad? What the effects of
those foods have. Basic finance is important. I mean when
(29:24):
you talk about your basic life skills, this is the
sort of thing eating is an afterthought. And I also
think that a big result and the reason you have
so many diabetics in these programs coming to you for
help is that we don't plan ahead. We have become
so much busier, We do so many more things for
(29:45):
longer that take more of our time. We're stuck in
the car longer, the kids do more activities. That food
becomes or eating food becomes this sort of afterthought, and
there is this convenience of the fast food that's relatively affordable,
that is fast, that is delicious. I love fast food.
And the other thing I would say, and I'd ask
(30:06):
you to speak to that. But the other thing I
would say is I will often post of me eating
a bowl of ice cream or eating a bad you know,
a food that's atypical that I might eat once every
two weeks, and people will say, I thought you were
eating right now. I thought you And I think there
is a lack of understanding. And my wife really taught
me this. You can't deny yourself one hundred percent of
the time. Look forward to a bowl of ice cream
(30:28):
and eat it once a month, as opposed to, well,
if I'm eating bad, I'm eating bad all the time,
and if I'm eating well, I'm eating well all the time.
And I think you never have any real rewards. Does
that make sense?
Speaker 2 (30:41):
Absolutely, you've hit the nail on the head. We're not
saying that everything that goes into your mouth must be
of maximal nutritional value and no pleasure, but we've tipped
the balance. Now it's been all about taste and convenience
at the expense of obesity, diabetes, heart disease, kidney disease,
(31:03):
liver disease. So we've really got to move that balance back.
And what you said about not teaching our children how
to eat that is such a failure of our society
and even our medical community. You know, we are now
just putting band aids on the problem that's been going
on for thirty years or more. When you look at
(31:25):
the data on the increase in obesity just in the
last twelve years, it's so remarkable and it really coincides
with industrialization. I think it started back then when food
became so much more easy to manufacture and consume. But definitely,
(31:45):
how we are living our daily lives, we're not prioritizing
that planning or what am I going to eat today?
Can I make sure it's healthy? When am I going
to have statiscal activity today? And that's really resulted in
very grave consequences for our society and our future health
and more importantly for future generations. And yeah, you can
(32:09):
have cheat days for a cheat meal, that's very acceptable
as long as eighty percent of the time you're doing
everything else right. Your body can handle that one meal
or that one treat.
Speaker 1 (32:21):
But if it's and you know what I find, doctor Southey,
is this idea of celibacy for sinful food, this idea
that well, I'll never get to eat anything other than
you know, leafy vegetables for the rest of my life.
It creates this sort of crash and then it creates
this binge behavior. And I know I've been guilty of it.
If I can never have ice cream again in my
(32:43):
life because I've cleared it out of the house. So
what I do is I don't keep bad things in
the house, so ice cream is a on the way somewhere.
I haven't done anything bad. We've got an extra hour
to kill. Hey, kids, let's go to Marble Slab. I
do it there. And you know, I've known of people
to quit drinking by they don't drink get home, so
they can only drink out and they limit their you know,
going out. These are the sorts of things that require
(33:05):
a strategy, though, And that's I talk about this with
with personal finance, with building your business, with building your friendships,
with managing your time. You have to have a strategy
for when I'm going to eat and what I'm going
to eat. It can't just be I'm really hungry, because
you make bad decisions when you get to that point.
Speaker 2 (33:21):
Exactly. These little behavioral modifications can go a long way.
If you have a food is that is very pleasurable
to you, you put it in a context where it's
not very frequent, and you allow yourself to have that pleasure.
But it's not frequent, though it won't be as harmful.
Speaker 1 (33:39):
I promised you I would get you out on time.
Doctor Argenti Sadu sa Dhu. You can find her online.
She specializes in diabetes. She's the director of the System
Diabetes Program at Houston Methodist. You're wonderful, Thanks for coming
on and explaining this to us.
Speaker 2 (33:55):
My pleasure