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Dr. Pedram: Hey! It's Dr. Pedram, back with Dr. Sara. Hi!
Dr. Sara: Hi everybody. Hi Pedram. Dr. Pedram: Hi, nice to see you. Hello everybody.
Today's topic that we want to talk about is this recent AMA designation of obesity as
a diagnosable disease. It sent a lot of ripples into the media. There's been arguments on
both sides of this, and it's complicated, right? It's a complicated debate. It's something
that we all are affected by one way or another, and so what we wanted to do is tease out both
sides of this argument really today, and bring to light some of the challenges and issues
with this so that we can talk about it and stoke a debate, because it isn't black and
white. Most things aren't, and so for us to bring out those topics and debate them I think
might be a healthy way to go about it. Dr. Sara: I love that Pedram. I love that.
Should we dive in the pro versus con? If you like, we're going to do a Saturday Night Life
skit tonight. Dr. Pedram: It might turn into one. Okay,
so here we go. I'll do the pros and the cons here. The pro is that ... Okay, the American
Medical ... AMA basically seen a 1/3 of adults, 17% of children have basically medical conditions
that are coming from obesity, right, so it's obviously leading to the fallout of all the
stuff is already there, right? That is a given. Obesity is causing a lot of these problems.
That isn't really being argued. They're saying it will encourage primary care physicians
to get over their discomfort about raising weight concerns with obese patients, and studies
have found that more than half of the obese patients have never been told by a medical
professional that they need to lose weight. Okay, so ...
Dr. Sara: Wait! Can we hold right there? Dr. Pedram: Absolutely.
Dr. Sara: Isn't that a stunner? I mean, really, half of people who are obese have not been
told that they really should lose weight? I find that shocking and maybe a little depressing.
It also makes me feel like, "Okay.î It's a good idea if it raises awareness because
it seems like we're in the dark ages about obesity and the clarity about how to approach
it. I think another thing that we should talk about today very briefly is some of the determinants
of why people become obese, but I'm going to try to stay on topic right now.. Didn't
you find that stunning that ...? Dr. Pedram: I really did. If you fly to San
Antonio, if you fly to certain parts of the Midwest, and there's a great percentage of
the people in the community probably including the doctors that are overweight and have a
high BMI. It just becomes this kind of given, right? It's gotten to the point where there
are so many obese patients that the doctors go, "whoa!"
I've been in rooms with cardiologist who say, "Well, we could prescribe diet and exercise
but we know they're not going to listen, so baaa," right, and they chuckle about it and
go about their conversations about what drugs we're going to give them because it's ... there
seems to be the sense of dismay in the medical industry where we were ... a lot of our colleagues
have given up, right? That's a problem. Dr. Sara: Well then, this is an important
intervention for them, right? If it's going to take those among us who are jaded as physicians,
who are not talking about the lifestyle changes that are proven to move the needle when it
comes to weight loss, then I think this is one of the arguments in favor of it. I think
I would agree with that. I mean, I can really see both sides of the issue, but this is one
that I think is important in terms of raising awareness.
Dr. Pedram: Yeah. Dr. Sara: Can I just define Body Mass Index.
I mean, maybe everyone already knows their BMI, but Body Mass Index just is the proportion,
the ratio of your weight to height. Ideally, you want that to be between about 18 and 25.
That's the normal weight, and then 25 to 30 for Body Mass Index is your overweight category.
Above 30 is obesity. Dr. Pedram: Yup, and there's a lot of people
in the obesity. I mean, most Americans are nudging up into higher BMIs, and then the
obesity is starting to take the lead in a lot of these markets. It's obviously an important
issue, right? We all know that weight gain leads to heart disease, the diabetes, fallout
from diabetes, all the stuff that comes from diabetes, so it is obviously relevant for
all of these. The real question is, "Is obesity itself a disease?" That's where ... You could
say it's just a word, but it's not because once you have a diagnosis ... Let me be clear.
The AMA designating this in this capacity doesn't make it a diagnosis. It hasn't ... It's
more of a suggestion by an industry leader, so it's nudging the argument in that direction,
but that's not particularly what's happened yet, right?
Dr. Sara: That's right. Dr. Pedram: Okay, so let me just tease this
out real quick, so we can then just keep going through this. Obviously they haven't been
told, which is a huge issue. Then the causes of obesity are complex because of genetic
stress food, medications, and all that. There is an argument to say that self-discipline
can't cure obesity alone, so it really brings out and brings to light some of those issues.
Basically, it's not going to change. What the AMA did isn't going to change it, but
what they're trying to do is stoke up greater communication on this topic.
Then one of the things that they're trying to push forward, if it is a disease, then
insurance companies will be more supportive of obese people, and researchers will probably
pursue it more aggressively, and there'll be a lot more public health efforts to go
about this as something that is a national dilemma, and this issue go, but obviously
there's a wide range of topics and health problems that come which is high blood pressure,
diabetes, cardiovascular disease, which we already talked about, but there's also an
increased risk of cancer. A couple of the arguments for classifying
it as a disease are potentially people can receive coverage from their insurance and
are more likely to receive nutritional counseling, because right now people say, "Well, I can't
afford a nutritionist." Then you just look at the dollars and sense of this whole thing,
and the direct cost of obesity is over 535 billion dollars a year, so what we're trying
to do is Ö in this is saying that for raising awareness, we could potentially lower our
healthcare spending for problems related to obesity.
Dr. Sara: This is another place Pedram where I find it somewhat depressing that we need
to classify obesity as a diagnosis in order to have these structural changes in terms
of getting insurance to pay for some of the treatments, in terms of doctors talking about
it more in their offices and letting go of some of that jadedness. I wish that it didnít
come to this. I wish it didnít require the structural changes for it to be a more front
and centered topic in those seven-minute appointments that are the average for appointments across
the United States, but maybe we need that. Dr. Pedram: Well, I mean push came to [inaudible
00:07:10] I guess. Weíve been talking about it. Every week, itís in the news somehow,
right, and so if the country is not getting skinnier, itís getting fatter, and our health
problems are starting to catapult. Iím going to make an argument probably later. Iím going
to talk about the [inaudible 00:07:27] equip, and Iím going to make an argument for it.
I side with Mark Hyman on this in the you spend so many hours in the healthcare system
and maybe three, four or five hours at the doctorís office in any given year. Then you
have 8,000 something hours that youíre just going about living your life.
I would put it to everyone that thatís where health really happens. I know you stand on
that same side of that fence. I donít think itís Ö Once you get to the doctorís office,
it is a disease process, and thatís a problem, but the question is how do we educate people
and move the needle on the front side of this so that it doesnít lead to these epidemic
proportions, and you donít need to get all this bypasses and stents, and all this really
expensive interventions once itís already a huge problem, right?
Dr. Sara: Youíre absolutely right. I mean, weíre at this place right now as you were
describing where two-thirds of the population is either overweight or obese. I agree with
you that the rebar hits the road where you really are talking about the lifestyle changes,
the small decisions that we make every day about the food that we eat, the exercise that
we get, but I also think itís important to recognize even with all of our research in
awareness about the drivers of obesity, that food and exercise alone doesnít explain the
whole story. You mentioned this briefly before. We have
to look at some of these other reasons for obesity such as environmental toxins. It seems
like that comes up every time you and I are in conversation as well as genetics, as well
as the microbiome which I hope weíre going to talk about in the future session. I think
some of this data that we have on microbiota, the bacteria, that many pounds of bacteria
that you have in your system, and how they change depending on which you eat, whether
you have more sugar, more fat, that changes the bacteria and makes you more likely to
be obesogenic. It sounds like weíre going to go to the cons
next. Are we ready for the cons? Dr. Pedram: Yeah, Letís just *** it out
and then start talking about it. I guess, letís get it all on the table, because there
are strong arguments on the con side of this as well. What people are saying, obesity should
not be diagnosed as a disease. Basically theyíre saying, excuse me, telling all obese people
that they have a disease has end up reducing their sense of control over it. There is evidence
that suggests that people with addictions or telling that they have addiction basically
makes that Ö makes Ö it turns it into some sort of self-defeating spiral, right? Then
theyíre saying, ìLook, if insurance will make adjustments to cover these procedures
that will treat obesity, more people will opt for bariatric surgery and maybe not Öî
which is obviously a lot more drastic of a route than going for say nutritional intervention
or lifestyle coaching, or things that would potentially change it, but it take a little
of buying from people. It might be an easy up doubt is one of the
arguments. Patients could use the disease classification as a crotch. Weíve seen this
with other things, and say, ìOh well, I have this.î Then basically one of the arguments
is, ìWhat about GMOs? What about chemical additives? What about all these endocrine
disruptors? All stuff that youíre talking about right now that might Ö There are lifestyle
and society problems that we need to look at beyond what people are doing that are obese.î
There are obesogenic types of things out there. Then that really begets the question of why,
right? Why is America obese? Why is this a disease?
Then thereís the socioeconomic stuff. Impoverished communities donít have access to or canít
afford properly balanced diets in a lot of ways. If all you can afford is a dollar a
meal at McDonaldís for your kids every day, and at least itís food, I understand that.
You got to feed your kids, so not having access to proper nutrition and information about
the nutrition, and all the kind of disproportionate carbo loading in cheaper food is also a big
problem with this obesity thing. That is something that needs to be talked about again I think
on a macroeconomic society scale. Thatís really the argument, because theyíre
saying these changes needed are political economic, and so if we had safe neighborhoods
where people could go out and play, and play in the park and exercise like they used to.
Maybe that isnít the thing. Having availability to foods and access, and make it more affordable,
and making the workplaces maybe a little more encouraging towards health and fitness, and
allowing midday breaks to go out and do stuff and not being so production-oriented is a
big argument. Then there is one of the smaller argument
that talks about the BMI calculator maybe being a little too general and not accommodating
for some individual characteristics, and so some doctors are arguing for a better standard
to diagnose these patients. Thereís obviously a lot of argument that we can make on both
sides of that, but thatís the long and the short of what I can have in front of us here
to go for. I know you have a lot of opinions on it, so Iíll let you start, and then weíll
keep circling around in finding if we could find some common ground with the other people.
Dr. Sara: Well, this argument against it Ö The arguments that you just listed I think
are Ö many of them are compelling and really great fruitful thought. I heard the learned
helplessness argument that people are just going to have this sense of, ìOh! Well, Iím
doomed. Iím obese. Itís a disease, and so Iím going to give up my power around this
and take the latest pharmaceutical,î instead of stepping into the lifestyle tweaks, the
redesign that you and I know and love. I think that argument for me is less persuasive. I
can see it on more a population level how that is true.
Some of the things you mentioned about structural changes and how itís not just the physiology;
itís also the governmental and societal issues that lead to a more obesogenic culture. Those
remind me of an Atlantic article that I just read about Michael Pollen. I happen to live
here in Berkeley with Michael Pollan, journalist-author. He is a proponent of really stepping away
from the big food industry and focusing on eating the foods that our great grandparents
would recognize. This Atlantic article was saying, ìTo really
affect change in terms of food in this country, we have to work with big food.î How do we
do that? Itís not going to be as successful to work outside of the system. I think that
thatís an argument that is also in favor of opposing obesity as a diagnosis. Give me
your opinion on that. Dr. Pedram: I got a few. Let me tease them
out. One is Ö I spent some time with Bruce Lipton who talks a lot about placebo effect
and positive impact on your belief systems and how your outcomes are in health, but the
obvious opposite of that is that is the nocebo effect which is if you tell someone they some
negative disease or diagnosis, then all of a sudden, it starts this negative spiral,
right? We know this from people who are given cancer diagnoses. Itís almost like a curse
because then in a lot of ways, itís like, ìOh my God! Iím going to die.î Then they
got to change their whole headspace and their frame because we tend to be that way. We tend
to be hypochondriacs by nature, and when youíre given some disease classification, a lot of
people take it the wrong way. Being told you have this disease called obesity
is a challenge, because I do believe in medical cursing. I do believe that we have to be very
careful in how we diagnose and communicate diagnosis because it can dramatically impact
the way theyíre going to orient with that news, and so Ö Iíve been around healthcare
long enough to say that not many of our colleagues are the best communicators.
Dr. Sara: Oh no, Pedram, really? Dr. Pedram: I mean, God bless them. Theyíre
out there doing good work, but itís just that they just Ö I got someone coming in
seven minutes, and I got to go in there and tell this lady sheís got breast cancer. Okay,
right? Itís horrible. Thatís the way the system is set up. For me, that drags us back
into that macroeconomic systemic thing. We talked about this in the vitality movie. I
know you and I talk about this all the time is that there is a broken medical system.
Itís all about the reimbursement and driving units through machines and generating revenue
for things. Itís dehumanizing in a lot of ways, and so
I think that that element of that dehumanizing capacity of the system which Ö There is a
lot of good news on there. We can talk about that later in the later show, but thereís
a lot of positive light coming through in different models for healthcare now, but the
traditional system has been very bad at that, right? Itís alienated a lot of people. It
made people with heart disease go to reiki healers exclusively, and go off their medications
sometimes for better or for worse, and so thereís been a lashed back that has I think
come from some of the miscommunication and the poor bedside manner that comes from the
nocebo effect. But systemically, I couldnít agree more.
Weíre doing a story. We were with just LYFE Kitchen. Weíre doing a story with a number
of these big food suppliers, and thereís a lot of these guys. LYFE Kitchen just got
a couple operations guys, former McDonaldís guys that I think are trying to burn off some
karma now, right? Theyíre doing a clean supply chain, healthy food model in a fast food capacity.
Youíre right. The systems are already there. All you really need to do is replace bad food
with good food, and youíve got yourself a very finely-tuned trillion-dollar food delivery
system thatís already in place. If the consumer says, ìHey! I donít want
to eat this garbage. I want organic. I want non-GMO. I want this. I want that,î then
Ö and theyíve [inaudible 00:17:39] with their dollars and they put their money where
their mouth is, then the corporations are happy to oblige because, ìHey look!î Theyíre
in the business of selling whatever it is so long as they have their spread in their
margin. Iím a big advocate of voting with your dollars and changing the healthcare system
on the frontend. Look, if you are already coming in with hypertension,
youíre on six drugs, and you need a stent, itís hard to say, ìWell, you should start
eating broccoli, and youíre going to be okay.î Itís a great thing to say, ìFor the long
term Öî Dr. Sara: [Inaudible 00:18:08] might say that.
Dr. Pedram: [Inaudible 00:18:09] would say that. Yeah. Thereís so much liability there
that if someone has a heart attack the next day, are you at fault? A lot of doctors really
shy away from that because of the liability, and thereís a lot of lawyers out there sharpening
their Ö Thereís amount of medical malpractice. Thatís a big thing, right? Thereís medical
malpractice, and then thereís lawyers that are going after doctors doing whatever they
do. My take on it is if you systemically start
changing the food delivery system, and dealing with macroeconomics. Weíve talked about this
the other day with the farm Bill. Now there are some provisions in there to really allocate
some of the subsidies for healthier food options and organic produce. To me, that is a very
welcomed news because I think that that can move this whole debate around much more than
doctors changing a word and turning it into a diagnosis.
Dr. Sara: I agree with that. I love this idea. I want to translate the vote with your dollars
into a message which is go to McDonaldís and demand your kill. How is that?
Dr. Pedram: I want that. Dr. Sara: When I think about some of the fast
food places that I go to, and I can think of a couple that are here in the Bay Area
and around nationally. One is [Chipotle 00:19:24], I can get a really good meal in [Chipotle
00:19:25]. I can also go to Ö There is another place. Iím blanking on the name of it right
now, but they actually have a kill salad on their menu, and itís a fast food restaurant.
I do feel like we Ö Iím a big fan of using these large systems that are in place already
in getting better food, getting the organic produce, getting the more nutrient dense foods
to people as a way of countering the obesogenic diet that we tend to eat.
When we started talking about some of these other drivers of obesity beyond how much you
eat, and it turns out that weíre actually eating less now than we were recently. We
are turning that ship around. Weíre not exercising more. We need to work on that. These other
drivers like the genetics, the microbiome, the environmental toxins, I want to maybe
give a hopeful message around now, because I have found in my practice, and I think you
found this too Pedram, that there are many ways to amplify the innate intelligence of
the body, and to improve your detoxification whether itís as simple as taking probiotics
which has been shown now in humans to reduce insulin resistance, the early root cause that
leads to obesity. You can do that with things like your fork,
with probiotics that you take. I just was reviewing the study looking at five different
supplements that increase insulin sensitivity. Thereís many strategies that people can use.
I donít want this to just be a dim and gloom conversation about should it be a disease
or not, and to have a sense of hopelessness about trying to reduce or reverse the obesity
of epidemic. Dr. Pedram: I love it. I think we should just
jump into this because this is where people are really struggling too is. I think we can
agree that the old model of calorie counting and input versus output is itís obviously
failing for a lot of people for a plenty of reasons. Letís tease some of the stuff out.
You have people who have insulin sensitivity, insulin resistance issues. Basically, theyíre
uncontrolled in their blood sugar, and then their adrenals jumped in. Every time the adrenals
jump in to try to balance out the blood sugar, you get a cortisol bump, and cortisol tells
your body, ìHey! Go ahead and store some fat for a rainy day,î weíre in trouble.
You have that whole adrenal access. Then you have the stuff that we talked about in a previous
show when we talked about endocrine disruptors and toxins coming in the body, and being stored
in the fat. One of the articles I think at that point we had reviewed was this whole
notion that fat cells will hold the toxins that our body doesnít know what to do with.
Then once we go through some detox and the body starts letting go of these toxins by
utilizing the fat, these toxins are in the bloodstream. The body doesnít know what to
do with them again, and so it signals the thyroid to slow down, and get us to get fat.
Dr. Sara: Thatís right. Yeah, the toxic load goes up as you lose weight, which is one of
those terrible ironies. Thatís also one other important point. I donít want to interrupt
you, but very briefly. For folks who were overweight and obese who have more fat, they
also have a higher toxic load at these environmental disruptors. Compared to lean individuals,
they have more of these environmental toxins. Itís just another factor that throw in in
terms of that vicious cycle that you were talking about of getting fatter and fatter
and fatter no matter what you do. Dr. Pedram: Yeah, and then thereís also the
skinny fat, right, because you get people who donít necessarily present as obese but
then you start measuring their visceral fat, and theyíre still carrying a lot around the
organs, which then itís the insulin resistance, and then the whole metabolic syndrome stuff
starts coming up again. Whatís the number one reason people go to the doctorís office?
A lot of times itís fatigue. I donít feel well, [inaudible 00:23:34], and so what is
that; where is it coming from? Also, I think that the IFM and some of these
different groups that are doing some wonderful work and advancing medicine at this point
are bringing to light some of the more complicated array of medical conditions that are coming
from environmental and lifestyle issues right now that 90% of the doctors out there have
no idea about. Theyíre still in that old model. Guys, the Science is there. The Science
is there, and it takes the industry 10 to 20 years to catch up with the Science sometimes.
Remember, medicine is a business, but Science is Science, and so if youíre following good
Science and you see the stuff there, are you going to wait 10 to 20 years for the medical
industry or the business to catch up and finally have your old guard doctor say, ìHey! It
turns out broccoli is good for you,î or are you going to spend the next 20 years getting
better and thriving and living with vitality in this world?
I really encourage people who are listening to this to really look at whatís out there
and whatís some of the new data is pointing to and showing. If you got one of those bah
humbug doctors, you might want to go ask around a little bit because ... and youíre reviewing
literature all the time as am I. I got studies lighting on my desk every day. It just makes
you scratch your head and say, ìOh my goodness! This is huge. How do people not know about
this?î Dr. Sara: I know. Itís still stunning to
me that almost every day I get pushed back from conventional doctors who say, ìAdrenal
dysregulation, thatís not an entity. Your adrenals are either perfectly fine or theyíre
in failure. Thereís no middle ground.î You and I both know that thatís not true. Actually,
thereís thousands of studies to show that your adrenals and their function in that in
between state is really important to pay attention to, and can be assisted with lots of problems
including the obesity, and high blood sugar, and insulin resistance.
Dr. Pedram: Mark Hyman calls it diabesity. Really, I mean the crisis that we have in
this country is really a blood sugar crisis in a lot of ways, because people we had this
common nonfat thing going on for a long time. A lot of things that weíre looking at now
is how the body processes sugar, and how that sugar gets transformed to the fat, right?
If youíre up in the morning having your whole grain cereal with your low fat milk and your
cup of orange juice thinking youíre doing yourself a favor, you might want to look again
because thatís pretty much getting converted into triglycerides, and leading to this problem.
At some point, I know you were told that thatís a good breakfast.
Dr. Sara: Yeah, not anymore, right? What did you have for breakfast today Pedram?
Dr. Pedram: I had Turkey vegan and a free-range organic eggs, and some broccoli and some carrot
sticks in the car on the way in. Dr. Sara: Nice, nice.
Dr. Pedram: Yeah. I got some veg in there. I got some good protein source. I like eating
a good solid breakfast because I need my energy all day. Iím not going to borrow from tomorrowís
energy today by drinking coffee all day just to get through, right? Everyday should be
its own kind of profit center if you will every day.
Dr. Sara: Okay, weíre getting some really good quotes out of you today. Itís pretty
stunning. I want to add in one little piece here. I have recently started testing my blood
sugar almost every morning, and yes, I am a total MIT biohacker, but even so, itís
not expensive to do this. You can get a little kit from the pharmacist. I was learning just
last year from Mark Hyman when his book Blood Sugar Solution came out about how the range
that we use as usual, the normal range that we use for fasting blood sugar in the morning
which has been 70 to 99 for decades is probably outdated.
If you want to use an optimal range, itís really more 70 to 86. When you have a fasting
blood sugar 87 or higher, that signals some of the early faces of insulin resistance,
so I love to give our listeners practical tools that you can use, and testing your fasting
blood sugar might be one of those, or even take a look at the fasting blood sugar that
your conventional doctor has tested for you. Usually, theyíre willing to do that one.
See what your score is. If your score is 99, thatís not good; thatís not normal. We need
to do something about it. Dr. Pedram: Yeah, I couldnít agree more.
I mean, just because I mean what is it, 120s? If you have a fasting blood glucose of 127
three times in a row or something, then all of a sudden you are diabetic, right? What
if youíre a 125, does that suddenly make you not diabetic, or does that make you on
the road to diabetes and something that really needs to be looked at? That leads us back
to this obesity as a diagnosable illness type of thing.
At what point is that a problem? Well, itís a problem when itís a problem on a functional
level, when your body systems start to breakdown. Theyíre not working correctly, and youíre
not processing sugar and youíre storing it as fat that you donít need. Do you wait until
you have 30 more pounds of that fat you donít need to call it a problem, or do we Ö do
you sort out the problem when the body systems are yelling and screaming saying, ìHey, I
have an issue here,î so that you can course-correct along the way.
If youíre fasting blood sugarís already coming up, if you are already hovering high
in the hundreds but not quite at 127, that is a functional blood sugar issue, as far
as Iím concerned, period. That needs to be looked at because itís going to mess with
your hormones. Itís going to mess with your adrenals. Itís going to mess with your mood.
Iíll tell you, itís going to mess with your marriage. I canít tell you how many hypoglycemics
marriages Iíve saved just by fixing blood sugar issues with people, because people get
cranky man. It is not pretty. Dr. Sara: It is not pretty. Iím telling you
a coupleís therapy is not the answer in that situation. It can be as simple as getting
some protein and getting the right vegetables. I totally agree with that.
Dr. Pedram: Yeah, and you could talk it out all you want. If I go too long without eating
A, Iíll eat this desk. I donít care what it is. I was just on a consult with a patient
this morning actually about this. She missis meals all the time. Then someone brings in
donuts or cookies or what have you into the office, and once youíre already hungry that
youíre already in survival mode, the brain is saying, ìLook on me. Go get me some sugar,
and I donít care,î so youíre not in your frontal lobe. Youíre not in your cognitive
rational thinking parts of your brain to say, ìOh! That might not be good for me.î You
just grab and say, ìYum, sugar,î right? Itís pretty predictable guys. I can predict
every single day right around noon, Iím going to be hungry, right? It always shocks me when
people are like, ìOh my God! Iím so hungry.î Well, itís lunch time; what do you expect?
We can really look at predicting that stuff. Yeah, youíre a popular gal over there doc.
Dr. Sara: Yeah, sorry about that. Dr. Pedram: No, itísís all right. The problem
is when the phones arenít ringing, right? We know youíre relevant.
Dr. Sara: I think itís the plumber. Dr. Pedram: Long story short guys, have snacks
around. I mean, we canít get into the very specifics on this show right now in this format,
but we can drill into it later. I was thinking of maybe having Mark Hyman, maybe Johnny Bonn,
maybe getting some of our colleagues and friends on a show with us in this near future to talk
about this stuff, and taking questions from people too to be able to hash out some of
these things. Long story short, have healthy snacks around, so youíre not surprised when
youíre hungry. If you are already hungry and itís too late kind of thing, just nosh
here and there a little bit. Then you donít go to these big valleys where there all of
a sudden you got to eat a double cheese burger because youíre starving.
Dr. Sara: Really good point, and I was just looking this morning at Mark Hymanís list
of Ö on his quiz where he is asking people whether they might be insulin resistant or
not. You just raised a few of them, but I think it might be worthwhile just to mention
some of them. One is getting irritable or cranky if you go more than two to three hours
without a meal. Thatís a sign that your blood sugar is swinging wildly too high and then
too low. Also, if you feel really calm after eating,
like if you eat, and then you feel really calm, that can be a sign of these blood sugar
swings that are happening, having increased thirsts. There is a long list on his website.
Heís got many different factors that he asks people about, but also that patient you were
describing who skips a meal and then hears jungle drums unless she starts eating donuts,
thatís a really common one, not being able to stop when she started eating carbohydrates.
Thereís a long list of symptoms that we can talk about.
I also wanted to say for our listeners. If you have questions for us, put them in the
comments section. We want to hear your questions. Suggest future topics. We really want to hear
from you. Dr. Pedram: Yeah absolutely. Weíre doing
this for you guys. We hope this was useful and relevant. If so, share it with your friends,
and get it out there. Let us know what you want to hear. Let us know who youíd like
on the show, and weíll get them for you. We got a lot of friends in high places, and
weíll bring these wonderful people to the party.
The whole point is to stoke a dialogue. Itís not about saying black or white; obesity is
disease or not disease. Itís the why, and gray is where all the magic happens. For us
to delve into the why is really where I think we can fix a lot of these things by educating
people to learn how to help themselves. Doc, I want to thank you very much for your
time. Dr. Sara: We got so many good quotes out of
you today Pedram. Dr. Pedram: Excellent!
Dr. Sara: Yeah, my pleasure. Iím going to be careful not to borrow it from tomorrow
today. Iím going to stay within my profit center today. Thank you for that one.
Dr. Pedram: Itís all yours. Dr. Sara: Thank you.
Dr. Pedram: All right, weíll see you again next week.
Dr. Sara: Okay, bye everybody. Dr. Pedram: Bye everybody.