Dr Rupy: On the show, I am delighted to welcome Dr Andrew Jenkinson, a consultant surgeon with a specialist interest in advanced laparoscopic surgery who treats bariatric patients. He's also part of an expert team developing advances in GI surgery at University College Hospital, London, and author of the book Why We Eat Too Much. Now, obesity is a particular problem for the UK, having the sixth highest prevalence of obesity and where 26% of adults are classified as obese, and it disproportionately affects both adults and children in lower socioeconomic groups. Because of the prevalence and the dire comorbidities associated with this condition, there is a strong public health incentive to find effective treatments and preventative measures. Now, you might have heard on the radio or TV, the war on obesity or the obesity challenge. But the debate about obesity is shrouded with oversimplification, a lack of appreciation of the foundations and the history of how we got here, as well as a lack of empathy for sufferers of this disease. And I say disease with a lot of purpose, as you'll find out in the in the podcast. On the other hand, people whose interests are to protect the mental health of those who suffer with being overweight, and whilst their intentions may be genuine, fail to appreciate that there is a need to recognise a problem which needs treatment. Now, this episode isn't geared towards fat shaming or pointing the finger at obese people as commonly occurs in the media. In the same way, previous podcast episodes about eating for migraines, PCOS or eating for IBD aren't geared towards pointing the finger at those people for having those conditions. This is for general information purposes only and to help everyone, and I mean everyone, understand the mechanisms behind why some people struggle with weight versus others and to cease the oversimplification of calories in versus calories out and to recognise the potential interventions before we have to entertain drastic measures such as bariatric surgery, something that Dr Andrew is a specialist in. On the show today, we talk about how patient stories encouraged Andrew to dig deeper into the mechanisms behind obesity and actually challenge his own prejudice. We talk about prejudice in the NHS against obese people, why obesity is better defined as a disease and what that means for treatment, the interplay of genes, hormones, neurotransmitters in the likelihood of obesity and your propensity towards the disease, basal metabolic rate and weight set point and how that is the challenge to overcome, leptin resistance, insulin, cortisol and mitochondrial function in obesity, why low-calorie diets work and then don't work, and the impact of COVID on his job and particularly for bariatric patients, poverty, the food environment and Andrew's tips for weight loss. Now, I'd highly encourage you to check out the book Why We Eat Too Much, which is available now. Check out the end of the podcast for Andrew's tips and don't forget to subscribe to the newsletter at thedoctorskitchen.com. I really hope you find this podcast episode enjoyable, informational and there is a lot of misinformation out there from both sides and hopefully this will rectify or put some effort into rectifying that situation and just add some more clarity. Without too much more chatter, this is my podcast conversation with Dr Andrew Jenkinson. I was going to ask you how the last three months have been for you in terms of your clinical work and how you've been affected.
Dr Andrew Jenkinson: It sort of came on quite suddenly, didn't it? That the number of people affected suddenly escalated and we had this sort of first social distancing advice and then a sudden sort of lockdown and everything shut. And in the hospital, obviously, our elective surgery, so the operations on obese people and hernias and whatever, were totally shut down because it was too unsafe for these people to come into hospital, because hospital were actually a bit of a breeding ground for COVID cross-infection. So it's been from that point of view, it was actually quite quiet. Lots of my clinics turned into telephone clinics, and we just had the odd little bit of on-call general surgical emergencies. And then, obviously, a bit of manual work in intensive care now and again when we were required, right at the height of the crisis. UCH had intensive care, which is actually one of the biggest intensive cares in in the UK, I think 30 beds, 35 beds was full. So yeah, it was it was different and a sort of very reflective time as well, I think, because the times that we weren't working and we were at home, it was yeah, just much more reflective.
Dr Rupy: And your day job, just for those who don't know, it's bariatric surgery. And I mentioned that to a non-medical colleague of mine and they looked at me quite funny. So I don't think it's like a well-accepted term, but maybe you could talk a bit about how you got into this type of surgery and your.
Dr Andrew Jenkinson: So I'm one of these surgeons who does operations to help really obese people. So we're talking sort of 20 stone or 120 kilograms and upwards really. So people who have suffered severely with their weight. And as you know, a lot of these people have other conditions such as diabetes, blood pressure, high cholesterol, and sleep apnoea. So my job, most of my job is to help these patients by doing operations to reset their weight so that they become from 20 stone, they go down to 11 or 12 stone. And the operations are basically designed to either remove part of the stomach or bypass part of the stomach. So it sort of sounds pretty drastic, but we've got quite good at it and it's keyhole surgery, so no big cuts. It takes about an hour, hour and a half, and people, because there's no big cut in the abdomen, people go home the next day and just take a week off work. And it's actually so it's relatively safe, pretty safe, but really, really highly effective. So it's becoming much more popular. Now, the the sort of controversy is that a lot of people don't really understand obesity and how it is a real trap and a real real disease caused by this sort of breakdown of our hormones, which I'll explain later. And a lot of people, even a lot of my colleagues think, you know, why don't we just scrap bariatric surgery and force people, you know, onto a boot camp or whatever. But they have a profound misunderstanding, I think, of weight regulation, which actually, when I first went into the field, I probably had as well.
Dr Rupy: That's very interesting that when you went into the field, you feel like you had a misunderstanding of the mechanisms behind obesity. I wonder if you could talk a little bit more to that effect, actually, about A, why you went into bariatric surgery initially and and what you learned along your journey as well.
Dr Andrew Jenkinson: So I think you'll probably agree, Rupy, that when we were at medical school, I don't know where you went to, I went to Southampton.
Dr Rupy: I was at Imperial, around the corner.
Dr Andrew Jenkinson: So we so we sort of didn't really receive a great deal of training about weight regulation. And obviously you're at medical school a little bit later than me. So I was there in the 80s and 90s. And at the time, there wasn't, this was just right at the start of the obesity crisis, just starting to come. But it wasn't until, you know, late 90s, 2000s and then more recently that we've got a third of people obese. So we didn't have, we had 10% of the population were obese when I was at medical school. So it wasn't like a massive problem. It has become now. So this condition that causes early death, diabetes, etc, etc, has become a condition that affects a third of our patients, all of our patients, wasn't taught in medical school. We were, I think we probably had like an hour or two hours in medical school, a lecture on calorie balance. But calorie balance is massively too simplified. So when I went into bariatric surgery from other, you know, doing cancer and, you know, hernias and gallbladder and general surgery, I got a job with a colleague who I trained with before I could do gastric surgery. So I got this job as a consultant bariatric surgeon, and my waiting room was full of massively obese people. And I certainly had some prejudice at first. It was sort of a little bit like most people would be now, like, can't you just get some self-control? Surely, if you just ate a little bit less and did a little bit more activity until your weight stabilised and then just do a little bit more and it will start to come down, then the problem's gone away. That was my sort of feelings. Why would you want such drastic surgery? Is your character, you know, so bad? Is your willpower so bad that you can't do something simple? And that's really how most people think, many, many people think, because we have this sort of limited and simplified understanding of obesity and weight regulation. But my patients sort of told me different. So I've seen hundreds of patients in my 15 years as a bariatric surgery, and they all sit down in front of you and they're quite often tearful and they tell you their years and years of dietary failure. And they all have really, really, really similar stories. And obviously they're not colluding, but they have the same story. So the stories are that yes, they can lose weight on a diet. They can lose a stone, a stone and a half, two stone, 10, 15 kilograms. But then they feel profoundly fatigued and tired as their metabolism decreases, and they have this rebound, you know, voracious, terrible appetite, almost like a thirst. So they'll find that a couple of a few weeks or a couple of months into a diet after they've lost some weight, so the weight will go down and then it plateaus despite them complying with the diet. They'll go to their GP, their GP will say, well, you're obviously not complying with the diet anymore because you're not losing weight. And then they, you know, become disheartened, go back onto normal eating and always will put all the weight back on. And the story is they always say they put a little bit more on as well as a sort of insulation, you know, evolutionary protective mechanism against future perceived famines by the by the body. So this sort of made me think, well, you know, how can something so simple actually be so difficult? Why would these people want such drastic surgery? So I went away and just studied, you know, the whole area of metabolism and appetite. Metabolism was, you know, the real eye-opener. So I'm sure you know about basal metabolic rate. So this is the amount of energy that we use before we move, basically. So it's non-movement energy. So you can lay down all day and your basal metabolic rate is the amount of energy you burn just by not moving. So heating your body, chemical reactions, breathing, heartbeat. And as you know, that takes up actually 70% of our energy expenditure is basal metabolism. And it's not under our control. It's not, you know, we can't increase it by going to the to the gym particularly. And it's massively variable between individuals of the same size. So you will have learned in medical school, we can sort of estimate someone's basal metabolism by this complicated equation, putting in your age, your sex, and your your fat-free mass, the amount of muscle you have. And if we sort of compare people of the same sort of size and age, they should have similar metabolisms. But actually, if you look at the research, and if you look at 10 people who have the same age and height and weight and sex, there is a difference between the highest and the lowest metabolizers, the highest and lowest 5% of 700 kilocalories a day. So this is massive inter-individual variability in our not controllable metabolism.
Dr Rupy: I just want to double click on that for a second, actually, for the listeners, because I think what you've just said there is pretty stark. Out of a collection of people with the same aesthetic, if you like, or the same weight, their basal metabolic rate, which is responsible for a huge amount of, you know, weight regulation, can be a difference of how much did you say? 700?
Dr Andrew Jenkinson: 700 kilocalories. So if you take 10 people, just to make it sort of, you know, visually easy for people, if you take a group of 10 people who look the same, so maybe 10 people who look like you, and the same height and muscle mass, and you look at their actual metabolic rate, the actual amount of energy they're burning seamlessly, you know, without conscious effort, and you look at the lowest metabolizer to the highest metabolizer, the difference between the lowest and the highest of those 10 people will be about 700 kilocalories, which is the same as three-quarters of a meal, a massive, you know, burger and Coke and fries, or a 10k run. So you've got one person who's probably struggling and going for that 10k run, and the other person who's it's easy, you know, what's your problem, you know? So, and this is why we see so many slim people who, you know, eat terrible, you know, they have a naturally high metabolic rate. And actually, a lot of people who suffer with obesity do try a lot, you know, and they don't overeat. I've got many patients who dieted all their lives, and if they go above 1,200 kilocalories, they'll start putting weight on. So our whole concept of certainly calories in, calories out is the ultimate equation, but it's actually a lot more complicated in that the calories out, the amount we burn, isn't just how busy we are at work or how long we go to the gym. It's much more important the basal metabolism, which is not really controllable.
Dr Rupy: You mentioned something earlier there that I just wanted to pick up on as well. Obesity being a disease. And I think this is a hot topic across the field about whether we can regard obesity as a disease or not. I wonder if we could just talk about what constitutes a disease versus obesity being a symptom, perhaps, of what traditionally might be thought of as poor self-control or a behavioural issue.
Dr Andrew Jenkinson: Yeah, I mean, I think a disease is something that will cause, you know, symptoms and early death for for for people, a condition that will cause, you know, early death, diabetes, etc, etc. Whether it's a self-administered disease or something that you can't control, such as, you know, you may say people who have lung cancer, some of them smoke and some of them don't, but they still have lung cancer. With obesity, we know that it is an abnormal condition caused by this this condition, this this problem with the negative feedback loop in our weight regulation to do with leptin. So I'm sure you've sort of heard in that that one lecture you had at medical school on weight regulation, a little bit about leptin. So leptin is this controlling hormone. It's like the master weight controller, and it is a hormone that actually is made by fat cells, goes into your bloodstream, and it's picked up by your hypothalamus, which is a little pea-sized gland within the middle of your brain, which controls, has, you know, the ultimate control of your of your weight, whether you're going to be fat or thin or normal weight. So leptin is looked, so the hypothalamus, the weight control centre in your brain is looking for leptin. It's looking, this is the signal from the body of how much weight you have. So the more fat you have, the more leptin is produced into your blood, and the hypothalamus just has this guide. And it's a little bit like, you know, a gas tank or a petrol tank on your on your car. You know how much fuel you've got in the system. So that's how leptin works. It's almost like a gas tank. Now, as your weight increases and you develop obesity, the leptin signal keeps on going up in your blood, but it doesn't get read by the hypothalamus. It's been blocked by a couple of factors, insulin, complicated thing, insulin and TNF alpha, so inflammatory conditions and insulin. And so despite having a like a massive amount of energy on board, the brain doesn't doesn't see it. It can't see the leptin anymore. And it's a little bit, the analogy is you're you're sort of driving along the M1 in your car and you see that your petrol meter is on empty and you sort of start panicking, you want to fill up. You know, you get to the petrol station and you start filling up and actually the tank's full. The problem is the petrol tank meter, which is broken. And this is this is a great analogy for leptin resistance. So the body clearly has far too much energy on board to be, you know, biologically suitable. It doesn't need that. But the hypothalamus can't read it. And in fact, the hypothalamus reads that there isn't much leptin around. It's a little bit like having that broken gas meter and panicking on the M1 and having to fill up. So you will find that, you know, despite being massively obese, actually, obese people have a voracious appetite compared to people who are not obese. And they will avoid eating in public because, you know, it's embarrassing. They will quite commonly binge at home on, you know, convenience and processed foods with high calories. So this is leptin resistance. This is the disease obesity that, you know, people don't really understand. And it's quite it's quite it's quite a, you know, it's sad. It's a sad disease. When you understand it, it's really sad because these people are stuck. It's clear they're obese. Everyone can see they're obese. No one really understands why they're obese, apart from people who have really looked into into this into weight regulation on a more scientific level. And they're almost like like lepers in society. You can see that there's something wrong with them, but it's sort of, you know.
Dr Rupy: Yeah, and I'm really glad that we're starting off with this aspect of it, because I think people need to understand that obesity is a disease where you have a plethora of different factors that impact someone's propensity towards suffering with it. And there are a number of complicating factors that make it far more of an obstacle rather than just going on a low-calorie diet. And I think when you, like you said, when you understand the factors that go into it, you actually begin to empathise a lot more. And I think within the NHS, as you've bravely sort of admitted at the start, we have obesity, we have prejudice against obese patients. They're less likely to get treatment, they're less likely to have an empathic conversation with their primary care physician, they're less likely to have access to the the correct sort of modalities of treatment that we have. So, yeah, I think it's really important to to establish this quite early on.
Dr Andrew Jenkinson: And until we understand weight regulation, you know, we're not actually really going to get a joined-up government policy about tackling the obesity crisis. So if we go back to, you know, what I was saying about metabolism and how, you know, some people metabolise and burn a lot of energy easily and some people are the opposite and they just maintain, you know, their energy, they don't burn much off at all. And we go back to those patients I was seeing in clinic who have dieted their whole lives, and you think, well, you know, it's really difficult to fight against this, you know, dynamic metabolism. So the more you diet, the lower your metabolism gets. And so the book, Why We Eat Too Much, which explains all these areas, then goes on to, the book is based upon actually called the weight set point theory. And that basically explains how each individual person will have their own weight setting. And we sort of all really know what our weight setting is. I'm sure you've been similar weight for for many years. And you can put a little bit of weight on on holiday and it will tend to come off, you know, fairly simply, maybe a little bit of gym work or careful eating. Or you can be sick and your weight will come back up to that weight setting. It's not variable, it's just your individual weight setting. And people who have obesity have, you know, their own individual weight setting. It just happens to be set too high. And the book explains, you know, what determines an individual's weight setting. And it's basically on a combination of your genes, so what you've inherited from your family, and your environment. So the amount of stress you have, the amount of sleep, and the amount of the quality of the food that you eat. And all of these things affect your your your internal hormonal balance, your amount of cortisol, insulin, and we also explain a little bit about polyunsaturated fatty acids and how these can set your weight set point upwards or downwards. So you obviously can't change your genetics, but you can change the external environment. And if you the the the basis of the book is if you understand the weight set point, and you understand what you can change, you can actually permanently reset your weight. If you try and do that by dieting, yeah, you will, you will over a short-term period of time, you know, go away from your weight setting, but eventually your body will pull you back up to it.
Dr Rupy: So that essentially explains why low-calorie diets work, but then they don't work. So they can work for a short period of time. And this is something that I think every primary care physician has experienced or, you know, someone who's gone on a diet for an extended period of time, whether it be two or three months, they definitely lose the weight, they plateau, they fall off the wagon, or they start eating, you know, normally or perhaps an extra 100 or 200 calories per day, and then they will go right back up to what was similar to their previous weight.
Dr Andrew Jenkinson: Yeah, I mean, you can have this, I mean, very common story will be that a patient, a person suffering with obesity will go on a 1,200 kilocalorie or even a 1,000 kilocalorie or even 800 kilocalorie diet, and they will lose this weight initially. But then when you look at the metabolic rate, and we're actually doing some research at UCH to, you know, to actually confirm historical research that has shown this, the further you go along with a low-calorie diet, the lower your metabolism goes, your basal metabolism goes. So eventually your body will adapt to that diet and you will be becoming, you know, you will be burning a similar amount to the amount you're taking in. And actually, the book sort of explains also that this works the other way. So most people overeat. And if we look at a population overeating, they should be gaining a lot more weight than they are because we we adapt to overeating, we have a metabolize. So I think the first chapter of the book actually does explain that we have this question of, you know, why as a population we're we're eating 500 kilocalories more per day than we were 30 years ago, but we I don't think we're going to the gym or exercising more than we did. And if you calculate that, if you plug that into that very simple energy in, energy out balance, then 500 kilocalories a day is 3,500 a week, which is half a kilogram. And then over a year, you're putting on, you know, 25 kilograms, four stone or so in weight as a population. So over that 20 years, you know, everyone's going to be 200, you know, they're going to be massive, you know, 200, 50 stone or whatever. So it doesn't work that way. So as a population overeats, it starts to over metabolize. And again, going into like actually really interesting medical stuff, the way that works is explained. So we think there is a lot of evidence there that actually the sympathetic nervous system increases in tone. And this would explain why actually a population that overeats actually become hypertensive. They tend to have low-grade tachycardia and things like this. And again, if you undereat and you go on a diet, actually the the mechanism of the metabolism decreasing is you go into sort of parasympathetic overdrive. So this relaxation mode of the body where you don't burn off much, your blood pressure goes much lower, you get you get a low pulse rate, you know, your temperature goes low, you feel profoundly tired. This is what dieters do. So your this metabolism is really, really adaptable and it will protect you against a diet and protect you against overeating.
Dr Rupy: Yeah, to the point that you make in the book, I think you mentioned a couple of studies. One that sticks out is the Rockefeller study, looking at how an increase of weight actually increased their metabolism. And it worked exactly the same way if they lost a similar amount of weight. Is that correct?
Dr Andrew Jenkinson: Yeah, so there were the Rockefeller studies in New York that sort of forced their their lab students to overeat or or undereat and either gain 10% of their weight or decrease and lose 10% of their weight. And then they actually quite accurately looked at their sympathetic tone. And those studies were inspired by these like crazy studies, like the Vermont prison study, which is mentioned in the book, where they forced prisoners or encouraged prisoners to overeat by by offering early parole. And they found actually that some of the prisoners just no matter how much they ate, couldn't put on any more weight. They'd reached saturation point even with 10,000 kilocalories a day. And then the other study looking at conscientious objectors towards the end of the Second World War in America, the Minnesota starvation study, which starved these guys, they wanted to be to help the war effort, and they wanted the scientists wanted to know what happened when people were starved. And again, these guys didn't lose as much weight as predicted, and then put it all back on and more actually when they came off the study. So these studies were really fascinating historical studies that were repeated by Rockefeller. And we are now actually using, um, the the cardiac pulmonary exercise machine adapted to look at metabolism at UCH.
Dr Rupy: Oh, brilliant. Okay. Is that part of a research study that you're involved in at the moment?
Dr Andrew Jenkinson: Yeah, I mean, it was on hold a little bit because of COVID, but yeah, it's restarting. So, um, yeah, we're looking at, you know, a calculation of energy expenditure by actually basal oxygen consumption and carbon dioxide production. And you can put that into an equation and get a daily basal metabolism.
Dr Rupy: We've talked a bit about metabolic adaptation according to energy intake, a bit about leptin resistance and why that's important and how fat cells produce it. One thing that you alluded to a little bit earlier is the role of insulin. I wonder if we could talk a little bit about insulin and its impact on obesity.
Dr Andrew Jenkinson: Yeah, so we know that as doctors, you probably hear more than me, if we treat a patient with insulin, they will gain weight. Their weight setting will just increase. They may put on a stone or two stone or they have to be really, really careful, whatever. And then if we withdraw that treatment, their weight setting will go back to what it was before insulin was given. So insulin is an anabolic hormone that causes growth, usually of fat. Insulin can also be got not just by, you know, us prescribing it, but also via the diet. So any diet that has very high amounts of sugar and refined carbohydrates like wheat will produce much higher levels of insulin on average than a diet that's more natural. And that's the theory in the book is that that is one of the reasons that the weight setting of someone will go up because the quality of their diet is very Western diet quality. So sugar, refined carbohydrates, processed foods, and they're getting their own via that, it's almost like a proxy drug. That's how they're getting their insulin. And that's why their weight setting is going up. It's not really directly to do with the calories, because if the calories were from normal food and they had a normal weight setting, they would just burn them off. But if you, if your food then gives you a high insulin level on average, your weight setting will go up just as if we injected someone with insulin for treatment. One of the one of the ways of getting the weight, your weight setting down, one of several ways, is the first, in fact, the first advice at the end of the book, in order to try and control things is it's very simple advice that people know anyway, but it actually sort of explains why it works. So to try and avoid sugar and refined carbohydrates if possible, unless you're a special occasion or whatever, try and, you know, get them away from the house and substitute them with more natural foods. And if that occurs, your weight setting will decrease slowly. So you'll lose a stone or two stone, depending on how big you are, will depend on how much weight you'll lose. You may lose a stone if you're sort of just struggling a bit, but that could be the only thing you need to do, just actually change your diet to give up those two things. The second thing would be, you know, to actually do an exercise that you enjoy. And the final thing, I mean, in the book, there's five sort of factors that we look at. But the final thing would be then to look at once you've given up sugar and refined carbohydrates and you're doing a bit of activity, but actually if you want to lose even more weight, actually look at the amount, the total amount of sugar, so we call it the glycemic load in the book, in your diet. Again, the book has got an index of all the foods and how much sugar is in them, even things like celery and potatoes, whatever, how much sugar is in those. And if you can go onto a sort of lowish carb diet without going ketogenic, you'll lose even more weight because your insulin will go down even lower. I think, you know, these simple lifestyle changes that are can benefit someone, can improve your quality of life, but also have this positive effect on your weight setting goes down. This means you're not fighting your weight. The weight is just naturally lower. That's the whole concept of the book.
Dr Rupy: Yeah, absolutely. Well, it's a it's a fabulous book. I think a lot of people can learn a lot of things from it. As well as a bit about bariatric surgery as well, linked to some of your your website materials. One thing I would say is you're also involved in a BBC program, right? I don't think I caught the BBC program, but it's about access to bariatric surgery and how it's quite limited in the NHS. What are your opinions on?
Dr Andrew Jenkinson: Yeah, that was a that was a documentary a couple of years ago by my colleague, mainly by my colleague Rachel Batterham, Professor Batterham, who's a physician at UCH. And she was basically looking at the, you know, the the inequality in access to bariatric surgery services throughout the UK. And, you know, really driven by a lot of prejudice and misunderstanding of obesity. So, yeah, it was quite a interesting documentary.
Dr Rupy: Yeah, and do you think that's still rife at the moment? And the the challenge of obesity is access to bariatric surgery, or do you think it really has to be rooted in the lifestyle education and the food environment that we should change?
Dr Andrew Jenkinson: So, I mean, again, I don't want to put myself out of a job, but yeah, we can, I think the government are actually going to expand bariatric services. So I've got a few junior colleagues that are going to be looking for jobs soon, so it's fantastic news for them. And it is really good surgery. It's like, it's really relatively safe, fast recovery and life-changing. It's not too bad on your quality of life afterwards. But we can't do that on everyone. And we're almost like firefighters. It's like, but there's fires coming up all over the, you know, you've got to as a firefighter, you've got to look at what's causing the fires in the first place. You can't just employ more and more firefighters. So the crucial part is to change, you know, the government understanding of obesity and weight regulation and change the food environment totally. That's the that's the only thing that's going to get rid of the obesity crisis. You can't, you know, encourage people to start counting calories when they don't understand what the type of food does to their hormones, you know, their insulin, their cortisol, whatever. And it's actually, I mean, the answers are really easy. If you cook vegetables, meat, fish, and dairy products, and it's all home prepared, and you don't have to go to the supermarket, you just go to the fishmongers, butchers and greengrocers. If you cook that food and eat that food, you'll lose a lot of weight. And that's basically the end message of the book and what the government advice should be.
Dr Rupy: Brilliant. Yeah. I mean, my books are not diet books, and the number of anecdotes I get of people saying, I followed your recipes for the last month or so and I've lost so much weight. I'm like, I, that wasn't even my intention. It was just because it's real food. Yeah.
Dr Andrew Jenkinson: It's real food. Yeah, exactly. So, uh, and a lot of this stuff in supermarkets is disguised as real food. It's not real food. Real food comes from the farm, you know, you don't need an intermediary of the supermarket there. The supermarket has got real food, but it's actually a real tempter to go into the centre of the supermarket where all that tasty stuff is.
Dr Rupy: Absolutely. Well, Andrew, this has been brilliant. Thank you so much for your time. We'll definitely have to do this again. I'm sure we're going to get loads of questions, so we could even do like an an AMA or something whilst we cook some food.
Dr Andrew Jenkinson: When the kitchen's open. Yeah.
Dr Rupy: Yeah.
