Dr Max Pemberton: I've got a friend of mine is a beautician. She runs her own clinic and she frequently has to turn away teenagers, young young girls who are kind of 13, 14 because they've come because they want to be fully waxed because they're saying it's not natural and they don't want to do about it and they're very distressed and she has to kind of take them aside and kind of explain that actually pubic hair is normal and it's okay. And then they're kind of saying well no boys want to want to sleep with me and it's kind of a part of a much more complex kind of socio-cultural situation. So I kind of wanted in a very small way to kind of be like sort of celebrating people's bodies.
Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. And today we're talking about the importance of teaching children about health with Dr Max Pemberton. Now, he's written a children's body, mind and anatomy guide for children. It's absolutely amazing and it's beautifully illustrated. Dr Max, if you don't know, is a writer, mental health doctor and journalist. He's written three books, including the one that I read when I was a junior doctor called Trust Me, I'm a Junior Doctor. I read this about 10 years ago when I started working at Basildon Hospital, and it was amazing. It really, really did resonate with me at the time, obviously. In his second book, Where Does It Hurt, he details his experiences of working in an outreach project for the homeless and people addicted to drugs. Now, this new book explores the idea of children being aware of looking after themselves through food and nutrition. So obviously something after my own heart. And understanding the human body and how parents can facilitate that growth. Today we chatted about his experiences of transitioning from adult to children's literary projects. He's working eating disorders, why health messages, particularly over social media, are important to convey, and the messages to convey to children, but also how they inadvertently teaches parents as well. I cooked a taco recipe for Dr Max and you can check that out on YouTube. And you can find all of this information and more at thedoctorskitchen.com. Subscribe to the newsletter for weekly science-based recipes and listen to the end of the pod for a summary of our discussion. On to the pod. Tell me about your cooking habits.
Dr Max Pemberton: I'm so embarrassed about this now.
Dr Rupy: Go on, go on.
Dr Max Pemberton: I just thought I'd come and you'd just make me food and then that would be it and we would not talk about food. I don't know why I thought that.
Dr Rupy: I'm not going to interrogate you, don't worry. No judgement, no judgement.
Dr Max Pemberton: So, my cooking habits I would say are probably not very good in that I don't really do cooking. So I've got a microwave and I'm quite adept, well I say quite adept, I'm not even very adept at the microwave if I'm honest. Yeah. I mean the thing is I think it's because I love raw vegetables. So every evening I go back and I always go shopping, buy loads and loads and loads of vegetables, chop it all up. And then I'll just sit there with a massive bowl and while I'm kind of writing, I'll just sort of sit there rather than eating sort of junky food or anything. I just eat vegetables and I probably eat maybe eight, 10 portions of vegetables.
Dr Rupy: Okay.
Dr Max Pemberton: So like in a day. Um and then.
Dr Rupy: Wow, that's a lot of veg, mate. You're doing really well.
Dr Max Pemberton: Takes me all evening. I'm just sitting there. But you know you have like three peppers and like you know loads of celery and broccoli and this kind of stuff. And I really like that. It's really nice. Um and then I tend to be very, very boring. So I'll eat just the same thing repeatedly. So so I really like jacket potato and cheese.
Dr Rupy: Okay, yeah, good.
Dr Max Pemberton: Which and then I'll microwave the jacket potato. They're frozen. They're really good. I feel like I'm selling you jacket potatoes.
Dr Rupy: No, the thing is I did a whole feature on new potatoes a few weeks ago just to show people actually, you know, potatoes are very nutrient dense.
Dr Max Pemberton: Yes, they're amazing. They're like they're like the dietitians at work always talk about them being a whole food because basically you can pretty much kind of just live on just potatoes if you really needed to.
Dr Rupy: Yeah, I mean a lot of societies have based their eating habits on potatoes. You look at the Aztecs, you look at people in South America and you know, you grow tubers everywhere. It's a very whole food.
Dr Max Pemberton: Yeah. And I eat a lot of chicken breast as well.
Dr Rupy: Okay.
Dr Max Pemberton: So and I've worked out how to do that.
Dr Rupy: Okay.
Dr Max Pemberton: Which actually you know that honestly that was quite a big thing because I worked out.
Dr Rupy: Because actually chicken's much harder. You imagine it's really easy. It's actually really hard to get it to cook because otherwise it tastes a bit like rubbery.
Dr Max Pemberton: Yeah, yeah.
Dr Rupy: Or then it's like raw and a pan it makes you really ill.
Dr Max Pemberton: Exactly. Yeah, yeah. So that's why you need to use your oven actually, the one that hasn't been opened because if you put chicken in oven, all you need to do is make sure the temperature is on the correct temperature.
Dr Rupy: Which is what?
Dr Rupy: Which is depends on what you're cooking. So if you're cooking chicken thighs.
Dr Max Pemberton: So we breast, always breast, I always eat breast.
Dr Rupy: Always breast. So I'd go 180 degrees centigrade if it's fan assisted or 200 if it's not fan assisted. You would probably, yours probably is fan assisted because it sounds like a nice shiny new one. And you whack it in there for about 25 to 30 minutes and just check if the juices run clear and then you're good to go. But put a marinade on your chicken so you can buy them pre-made from a supermarket.
Dr Max Pemberton: You look really confused. Come on.
Dr Rupy: Marinade section and then chicken breast section. Put those together. Bacon tray, oven, 25 minutes.
Dr Max Pemberton: Okay.
Dr Rupy: And that will be and you'll bring them out and then you're good to go.
Dr Max Pemberton: Okay, I should probably do that. But then now I've got my flat and I want to keep my oven nice and like never used.
Dr Rupy: A brand new kitchen. You could charge an extra for that. Okay, right. So before we get into what you're here to for today with your amazing new book that I'm really excited to to talk about. Um I'm going to be cooking you something. So you can just sit there, chill, relax. I hope you like it. I know you don't eat, um you don't you don't like chilli food. Is that correct?
Dr Max Pemberton: Yeah, I'm just I've got not a very sophisticated palette.
Dr Rupy: No, no, that's absolutely fine. So I'm going to be cooking you some tacos. Um so very simple food. Um we've got whole grain tacos here. This is actually blue corn, which I I just think it looks wonderful. I mean the smell is delicious as well. Um you can get white corn taco, absolutely fine. You could just do whole grain wraps as well.
Dr Max Pemberton: Where do you get those from? Just anywhere?
Dr Rupy: This you can actually buy these online. These are really nice. Um supermarkets are getting them in a bit more often now because you know the whole gluten-free trend and these are completely gluten-free as well. So um you'll see them in supermarkets or you can buy them online. Um or you can just use the normal whole grain wraps you can buy as well. Absolutely fine. We've got some lamb's lettuce here, just fresh lamb's lettuce. We've got some pinto beans that came from a can, drained and then rinsed and that's it. So they're already cooked. We've got some baby tomatoes, some corn that you can get from supermarkets. This is actually grown in the UK as well. So down in Lincolnshire I think it is. So we're just going to use that for a little bit of salad. We've got some avocado, some red onion and some of this cooking sauce. It's tomatillo that you get from Mexico. You can buy any sort of you know cooking sauce from supermarkets. I'm going to get you to try this before I put it in the food because it does have jalapenos in.
Dr Max Pemberton: Okay.
Dr Rupy: So yeah, I just a tiny bit on the on the teaspoon. Yeah, yeah, cool. Let's just see. All right, just try a little bit of that. And if it is too hot, we could do something else. It's a very mild sauce.
Dr Max Pemberton: That's actually totally fine.
Dr Rupy: Is it all right?
Dr Max Pemberton: I was just like preparing myself. It's actually fine. That's okay. I can totally handle that. I feel quite proud of myself.
Dr Rupy: Okay, great, great. All right. So I'm going to do.
Dr Max Pemberton: What's that? Are they just flowers?
Dr Rupy: Oh yeah, these are just these are just to make my worktop look lovely. But these are edible actually. You can steep these in tea and stuff. We had um a guest in earlier. She's a medical herbalist and she's a big fan of like you know geranium and nettles and all that kind of stuff. So she she actually taught me how to make a rose petal tea, which is very nice. Yeah. Um but also they they make my worktop look very pretty. Okay, so we're just going to toast um the sweet corn. I'm going to chop this off the cob, put that in the pan, uh take it off and then I'm going to go in with the pinto beans, some of the baby tomatoes, the cooking sauce, essentially heat that up and we're going to make a very quick guacamole with some smashed avocado, olive oil, seasoning and some red onion that I'm just going to chop.
Dr Max Pemberton: This is I'm very excited about this because I do often eat guacamole but I just buy it in a little thing. And so I wouldn't even know where to start making it.
Dr Rupy: I mean honestly, you're going to have your mind blown at how easy it is to make your own and it tastes a lot better than the store bought ones. Yeah, yeah. It's kind of like hummus if you make it from fresh, great. Um and then we're just going to build our tacos and that's it. We're going to make enough for our studio audience here as well. Producers, your publishing team. Yeah. Okay, great. So Max, it's an absolute pleasure to have you here. The reason why I say that is because your book was one of the first things I read when I became a junior doctor.
Dr Max Pemberton: Oh, really?
Dr Rupy: Yeah, it was, honestly. Um the title of which evades me now, but confessions of.
Dr Max Pemberton: Trust me, I'm a junior doctor.
Dr Rupy: Trust me, I'm a junior doctor. Yeah. Um I thought it was great. Amazing, honestly. It was really good. So you you got into the publishing world what years ago?
Dr Max Pemberton: Yeah, yeah, it was so I that that book came out of a series of columns that I wrote for the Telegraph when I was like 23, just sort of you know, a junior doctor. Um and then after a year, I just got approached by um by Hodder publishers and they said, you know, hey, why don't you turn this into into a book. And then and actually the column was really popular. And so I just sort of kept writing it for actually a couple of years even while the book was sort of out and um and then I so then I did like a whole series just based on all the other columns I've been writing. Um and then the column kind of changed because there's only so many stories you can tell.
Dr Rupy: Yeah.
Dr Max Pemberton: Um like kind of.
Dr Rupy: You've got like a two-year sort of uh yeah, stint, right? So there's only so many.
Dr Max Pemberton: So then um so yeah, so so now you know even now my column's now it's all kind of comment on news and stuff. So now it's a bit more sort of serious. But um but at the time it was really interesting to sort of be able to detail um as you know, put down your your experiences um you know every week about everything that was sort of happening. So yeah, I had a really good time. I really enjoyed writing it. It was good.
Dr Rupy: It was amazing because I remember reading it before I started my um house jobs at Basildon back in like 2009 or something over 10 years ago. And um I remember reading it. I was like, oh my god, this is literally like what my life is right now. And it was so nice to actually someone who's written a book to kind of normalize my experience as well. And I think a lot of like I keep on calling them kids. I shouldn't call them kids. A lot of the junior doctors coming out now are sort of resonating a lot with stuff that you know, we were going through 10 years ago, 15 years ago.
Dr Max Pemberton: Because it has I suppose it quite there's some bits, you know, occasionally now when I you know, we'll do like a book reading or something. Um and I read back and think, oh no, that doesn't happen anymore. Like for example, there's a whole section about kind of losing x-rays. Because physical x-rays. Of course now everything's on computer. And I kind of sit there and kind of cringe fighting and think, oh god. It's like talking about tapes or you know, videos or something and people are like, what are you talking about? Um so yeah, I mean things like that, obviously have moved forward and sort of changed and even just the rotors have sort of changed quite a lot. Um and the way that sort of junior doctors now work. Because certainly when I was a junior doctor, we used to kind of work in firms, you know, kind of little teams and you'd be with your consultant for kind of six months. Whereas now, I think a lot of it is which I don't think is necessarily an improvement at all. But now they kind of move around a lot more and they're kind of not attached to a particular team and it's kind of, you know, they're just sort of like workers who kind of like, you know, attached to different bits on different days. Um so yeah, so some bits have changed, but I think probably the the essential interactions with all the patients and all the kind of feelings and all that kind of stuff, I think probably is is very similar.
Dr Rupy: It's hugely. I mean like the the the way you write is quite emotive as well and um it's very passionate and I I remember, I mean there's still working firms as well, but they they probably rotate a little bit more often. So it's like every four months rather than every six months. Um but and instead of losing sort of x-rays, it's like a new sort of issue that we have to like losing the patient number or the patient number not being linked to the right packs account and then you know, you can't access the x-rays. The bureaucracy is still there very much so it's something I have to deal with all the time in A&E.
Dr Max Pemberton: In a way it's it's kind of reassuring almost in a way to think that you know, no matter what technology technological advances there are, it's still going to be a bit rubbish.
Dr Rupy: We can still mess it up somehow. Yeah. And so after you wrote that you wrote two two books about that main one?
Dr Max Pemberton: So so three three books in that sort of series about sort of my life as a junior doctor. So the second one was um after being a junior doctor, I then went into work into mental health. I did sort of lots of different jobs. Again, you can't sort of do that so much now, but you know, kind of a while back you used to be able to sort of just do stand-alone jobs where you just go and get some experience for six months in a particular area and then sort of leave it and move on. So I worked with a like a homeless outreach project um that in the time it was covering King's Cross before kind of King's Cross became cool. Yeah, for Google moved in and stuff. Um uh so yeah, so it was based in there and uh and and we kind of covered Covent Garden, Soho and sort of all very central London. Um and and then I also then worked for a a drug and alcohol project. Um so I wrote a book about that experience. Um sort of just talking about homelessness and what it's like working with homeless people and stuff. Um and then my third book was about sort of dementia because then I then went off and worked in dementia.
Dr Rupy: Where abouts did you work in dementia?
Dr Max Pemberton: Uh so I worked up in uh it's a hospital called St Pancras Hospital. Um and uh it's kind of it's a really old Victorian I think workhouse. And it's always very scary.
Dr Rupy: Kind of like St Mary's.
Dr Max Pemberton: Yeah, it's kind of yeah, very similar architecture. You know, it's all kind of red brick. Um and it's really amazing kind of you know, working there. I really loved it. It's really beautiful. Um but um lots of the particularly the GP um people who rotated in were petrified. Really? And loads of people when they were on call, we had this like really scary on call room and there was always creaking and stuff like this and they'd all like sit in their cars and refuse to go into the on call room for the whole night in their car. Um but yeah, so um so I worked there and it's sort of again it's sort of covered just central London. So it was like dementia services for central London. And again, this is quite a while ago. So it was all kind of these, you know, elderly ladies who lived in these mansion blocks in you know, Bloomsbury and they'd sort of lived there for like 40 years or 50 years. And uh you know, then become very elderly. And now of course they'll be sold off and there's solicitors firms and all this kind of stuff. But this it was just at the sort of like ending of this kind of era of kind of older people who'd sort of, you know, moved in there maybe in their sort of 20s and 30s um and sort of just grown old there. Um and so yeah, so so now it's all sort of changed. I think the whole the whole of that service is very much changed now because of the change in demographics.
Dr Rupy: And how did you know that you wanted to go into psychiatry? Because that was that's what you're ultimately.
Dr Max Pemberton: Yeah, yeah, yeah, right. So I actually you know what I always wanted to go into psychiatry. I went into medical school to to to work in mental health.
Dr Rupy: No way. That's very rare.
Dr Max Pemberton: I know it is very rare. And actually I remember with my my medical school interview, I said this and the the professor who's kind of interviewing me kind of took off his glasses and went, why ever would you want to do that? Um uh yeah, so so when I was uh sort of 15 or 16, I was actually quite naughty at school and I used to kind of be a truant quite a lot. It's a long story short, but I was really quite naughty. Um and I sort of like ended up being taken this sort of uh woman took me under her wing really. She was a manager of a of a a small day hospital um in a place called Chalvey, which is like sort of west west of London near Slough and it's kind of quite an impoverished area. And she as sort of took me under under her wing and and sort of did work experience with me and sort of said, you know, you should be a doctor and she really encouraged me. Never occurred to me to be a doctor um until until she came along.
Dr Rupy: How old were you at this point?
Dr Max Pemberton: I was like 15, 16, something like that. And um and actually I the plan had been, my sort of family's plan for me had been that I was going to leave at 16 and go and work in a Mars bar factory, which is in Slough. And that's what, you know, one of my mum's friends' kids had done. So she was convinced like that's going to be the answer go and work in the Mars factory. Um and then this this lady Anne.
Dr Rupy: Because you wanted all the sweets and.
Dr Max Pemberton: Exactly. It's nothing to do with my future career. It's just because she liked Maltesers. Um and uh yeah, and then and then this lady Anne sort of was like saying, no, you should go off and be a doctor. And actually this this day hospital um had sort of it was like a remnant of kind of you know the old days that sort of been forgotten about almost. And it and it was kind of it was everybody who worked there seemed really passionate. They all worked there because they felt you know really strongly about sort of advocating for the patients and lots and lots of them had mental health problems. And I remember.
Dr Rupy: Themselves?
Dr Max Pemberton: As in lots of the the patients have mental health problems. So it was it was a day program for older people, but you know, often they'd had strokes or they had dementia or they had kind of you know chronic mental health problems. And so I just got this idea that actually being a doctor is about sort of standing up for people and advocating for people and and you have to kind of find, you know, the people in society that have maybe not got a voice. Um and and so it just was always in my head of like, well I want to go and work with people with mental health problems because they haven't got anyone standing up for them and sort of fighting for them. So so it was just in my head. I was like, well that's what I'm going to do. And I didn't even know how to become a doctor. So the whole thing. Because like because no one in my my dad was a milkman. So there was like no, you know, there wasn't there wasn't like a kind of idea of like, oh this is what you have to do. I didn't even know you had to go to university. So um I just quite embarrassing. So really you know Anne and sort of like said, oh no, this is what you have to do and sort of really, really helped me. Um and so then then I went to medical school, but it was with the intention of going back to somewhere like this hospital um to kind of help that kind of patient group.
Dr Rupy: Yeah, yeah. Well, it's amazing that you were dissuaded uh in the middle of your medical school interview to go into psychiatry.
Dr Max Pemberton: Did you almost feel like it was like your responsibility to prove that professor wrong?
Dr Rupy: Exactly. Do you know that's exactly what it was like. It kind of made me even more kind of think, right. You know, I'm definitely going to do it now.
Dr Max Pemberton: I'm definitely going to do this now.
Dr Rupy: Yeah. Oh, that's great. And so so now you you work in North London.
Dr Max Pemberton: Yeah, that's right. So I work up in.
Dr Rupy: You have yeah, but you have like a very varied career at this point, right? Because obviously you do columns, you write children's books now. Um you know, you're doing stuff on uh radio quite often. Yeah.
Dr Max Pemberton: Yeah, so um yeah, I feel quite privileged. I'm sure you like like you, you know, it's quite it's like I love doing medicine, but just on its own, it can become I think quite overwhelming. And it's really nice to do to have like lots of other different things to kind of keep you occupied. And particularly for me kind of being able to write, uh you know, so I write a column every week. And so you know all your kind of ideas you have in your head or the kind of things and frustrations to be able to have, you know, an outlet for that, you know, is is fantastic. I don't think I would be able to be able to so I work full time in the NHS and I don't think I'd be able to handle working full time ironically if I didn't also do other stuff.
Dr Rupy: Yeah. So you work full time?
Dr Max Pemberton: So yeah, because quite a lot of my colleagues, and I think particularly in GP, they people tend now to work part-time, which is understandable I think just because the stresses. Whereas actually.
Dr Rupy: Even I like I work uh three or two, three days a week now clinical because I've just got so much other stuff to do like smashing avocados. Which is I should for the listeners. I'm just making a guacamole. I've got no idea.
Dr Rupy: So in this pan, um we've taken out the uh sweet corn that I've just dry toasted just to bring out a little bit of the um the water and give a little bit of colour to the sweet corn.
Dr Max Pemberton: Did you put oil in the pan first?
Dr Rupy: No, no. So that was no oil in that one. Um that was just raw uh sweet corn just chopped off the off the cob. In here, we've got the pinto beans, uh the baby tomatoes that I've just halved, uh the cooking sauce, a little bit of seasoning and some paprika as well. Um a bit of pepper. That's about it. And this is this is literally just to warm it up. And now I'm making uh a guacamole that is going to blow your mind um at how simple it is. I'm just uh taking the.
Dr Max Pemberton: That was a miracle. How you just did that? I don't I don't know what I would have done. I literally don't know. If someone said dice an onion, I don't know what I would have done. I'm not 100% sure.
Dr Rupy: This is why we need culinary classes in medical school. That's that's actually something that I'm working on with culinary medicine.
Dr Max Pemberton: Do you know because actually a long time ago, I worked in in South London in a in a drugs project. And one of the main issues we had was kind of basically malnutrition amongst people because they're not prioritizing eating. And one of the things we realized was that we were sort of saying like, oh make sure you eat properly. And actually in the area it was in a kind of place of Charlton in Woolwich. And you would literally there was no shops that sold any kind of fresh vegetables or fruit. I mean nothing. And so you were sort of saying to people, well go off and eat fresh fruit and vegetables and there wasn't anywhere to buy it. And then even when then you sort of say, right, okay, you know, you know, go to Sainsbury's over here and we used to kind of get vouchers for them and stuff. They wouldn't know literally how to cook the food because they'd never and so you get sort of people in their 20s and 30s quite literally not not even knowing like how what a red pepper is and things like that.
Dr Rupy: Yeah, yeah. And it's really heartbreaking. I was at a food conference last year and we had these primary school kids that came in and some of them was the first time they'd seen a baby tomato. And they were like, what is this? I'm like, it it's a baby tomato. Like everyone should know what these sort of simple accessible ingredients. And so to go back to your point about how people don't know how to cook with the items or where to buy them as well. It's one of the things that we teach in culinary medicine to the medical students. So a, you know, food education is something that just isn't in school. So no one else you should expect a very low level of food literacy. And the second thing is you need to keep it as simple as possible um and accessible. So one pan meals that we're doing here, um foods that you can buy in food banks and also be considerate of the fact that some of these cans require a tin opener and people don't have tin openers. You know, they don't have like the basic equipment. So um yeah, no, it's a it's a real issue. And 4 million people in the UK are using food banks. I don't think a lot of people realize that. And that, you know, given that we live in one of the richest democracies in the world, it's just crazy.
Dr Max Pemberton: And I suppose it's one of the difficulty with the food bank thing is that actually it's quite sometimes quite unusual food or random food and stuff. And so actually the level of skill you need to be able to think, oh well I've got this, this and this and this and I can combine those into this meal. Actually, I mean I definitely definitely wouldn't be able to do that. You know, unless I've got like the four things I always go for. You know, if if people gave me a random selection of food, I'd have no I'd have no idea.
Dr Rupy: Totally, yeah, absolutely. And so yeah, it's one of those things I think we need to be a lot more confident at giving nutrition advice, very simple, pragmatic advice because not everyone unfortunately has access to a nutrition professional, nutritionists that work in the NHS, dietitians, you can only refer as a general practitioner uh under strict sort of circumstances. So yeah. Let's go back to the food. So you're going to eat this. So we've got our guacamole um that's just made there very quickly. Some um of the uh the sweet corn and the um uh the the lamb's lettuce. I'm just going to put this to one side. And I've just warmed the tacos on a on a dry pan behind me. And then we're just going to build it. So how would you like it? It's up to you. We can we can either go guacamole first. It's kind of like scones.
Dr Max Pemberton: What do you think? What do you think how would you do it?
Dr Rupy: I would go. I would go um and don't worry, I'm not going to make you eat it with your hands if you don't want to on camera because I'm really.
Dr Max Pemberton: I'm going to make it. I mean you can use a knife and fork, but if you want to go.
Dr Rupy: Isn't it isn't it a hand one? Yeah, yeah, it's a hand one. Yeah, yeah. Okay, cool. All right. For that with that in mind, I'm going to go in with the lamb's lettuce as the base and the sweet corn. There you go. Really do hope you like this. It's all you. This is actually literally my lunch. I haven't had lunch, so. Okay, good, good, good, good. It's our lunch as well.
Dr Max Pemberton: So you've done so you've done like two together. How did you get them to stick together?
Dr Rupy: Oh, I didn't stick them together. I just they're separate. Yeah, yeah. So I've just popped them on on like that. So we're going with a little bit of the beans here. And you can make this with like um I mean traditionally you've got like barbacoa, you've got like um uh al asador, which is kind of like a kebab. Um but we're making it slightly healthier. So we've got some beans, some like um some some tomatoes, the phytonutrients from that. And then we're just going to top it off with a little bit of that guacamole on the top here. And there we go.
Dr Max Pemberton: That's really lovely.
Dr Rupy: Good?
Dr Max Pemberton: It's not spicy at all.
Dr Rupy: Good, good. I'm glad.
Dr Max Pemberton: It's literally perfect.
Dr Rupy: I'm glad. I'm glad.
Dr Max Pemberton: That's really nice.
Dr Rupy: Good, good. I'm I'm really glad you like it.
Dr Max Pemberton: I'm pleasantly surprised. And I don't mean that in a horrible way.
Dr Rupy: I'm pleasantly surprised as well.
Dr Max Pemberton: As in like because just that doesn't look like it's going to be that amazingly tasty, but actually it's incredible.
Dr Rupy: Yeah, yeah. Good. I mean it's just like, you know, the right mix of ingredients. Um do I was going to ask you, do you eat do you eat out much? Like you know, you go to restaurants? What's what's your favourite sort of cuisine? I should have asked you that before I even got you in the kitchen.
Dr Max Pemberton: Um so I actually quite like if it's not too spicy, I quite like Wagamama. I can handle Wagamama. I always have the same things every time, but but I like that. Um and I really yeah, I kind of like anything chickeny. So I used to I was vegetarian for a really long time. And then probably about eight years ago or so, something just clicked in my head and I thought, you know, I really crave kind of chicken actually. And then um and so I thought and I just decided, you know, I'm not going to be vegetarian anymore. And so I tried red meat because I hadn't really ever eaten red meat particularly. And then I just didn't like it. So I thought I didn't really see the point of making myself eat something that I don't particularly like. So I just really like chicken, I like fish. I try not to eat too much fish for kind of environmental reasons. So then so I just pretty much just eat chicken and then vegetables.
Dr Rupy: Great.
Dr Max Pemberton: So yeah, so if there's.
Dr Rupy: And you eat 10 vegetables a day. You're doing a lot better than the general public there, mate.
Dr Max Pemberton: Well, I think the key thing is not bothering to cook it. If I had to cook it, I wouldn't bother. But it's because you just cut it up and then it's just there and you kind of sit there you're reading or whatever and just chomping away. So yeah.
Dr Rupy: Oh, that's great. So, let's talk about the marvellous adventure of being human. This is fantastic. I love the fact that you know, you're trying to educate kids in how their body works and stuff. Actually, that was one of my first introductions into why I wanted to be a doctor. Do you remember that series called how my body works?
Dr Max Pemberton: No. What channel was it on?
Dr Rupy: It was on it was like a series of books, quite similar sort of length to this, but every week it was like um I must have spent so much money on my parents did anyway.
Dr Max Pemberton: Oh my god, was this like a a thing you you were like subscribed to and you go into the thing and you get it and then you realize you think oh it's only a pound and then about you know, three years later you realize you could have actually bought a human body for like.
Dr Rupy: Exactly. Yeah, yeah. You could have actually. And in fact, I think my sister did this one. I did one called Countryfile and my sister did that one. And they actually just ended up sadly just ended up stacking up in their little plastic box.
Dr Rupy: Because you actually build a body. Like you know, one week you get the liver and it'll tell you what the liver does and stuff like that. But um yeah, that was a scam. This on the other hand.
Dr Max Pemberton: This is not a scam. It's much cheaper.
Dr Rupy: It's much cheaper and marvellously illustrated as well. So tell me what what possessed you to to write a children's book?
Dr Max Pemberton: Well, you know, I thought it would be really easy. It actually turned out to be quite difficult. It is actually it's it's actually strangely, it's probably one of the hardest books certainly that I've written. Um I like I I had this idea of kind of trying to make, you know, the human body and biology and stuff kind of a bit more interesting for children. And I was kind of inspired by this study that had been done in the British Medical Journal quite a few years ago that basically kind of just went out and it just asked random members of the general public and said stuff like, what side is your liver on? You know, what does your kidney do? And stuff like that. Yeah, adults. And they didn't know. And it kind of you know and it was published as this sort of quite startling uh sort of piece of research saying that actually, you know, doctors sit there and we talk about organs and so on. You know, really quite basic things that we assume is quite basic. And actually the people we're talking to really don't understand. And so I sat there thinking, God, you know, so I want to kind of it's really important that not only doctors maybe understand how to pitch what they're what they're saying, but also trying to educate the general public. And it occurred to me, you probably you should start with children.
Dr Rupy: Yeah, absolutely. It's the same thing with food, right? Like you want to start with teaching children how to cook, to recognize ingredients, to recognize vegetables and that kind of stuff. Um in the same way we need to teach them how to be medically literate with anatomy because I mean, I I see this all the time as an A&E doctor. Someone will come in and they'll say I've got heart pain. What they mean is I have pain in my chest or this part of my body here. But they immediately assume this is definitely cardiac. And that and you know, the same thing with kidney, I have kidney pain. Um but it's actually, you know, on the side of their abdomen. It doesn't necessarily mean it's kidney. It's a whole bunch of other things.
Dr Max Pemberton: And you sort of say to people like where's your stomach? And they all think oh it's here. And actually they don't realize your stomach is so much higher. And it's kind of you know these really basic things where when you've done, you know, years and years of medical school and you've done human dissection and you've done all this kind of stuff, you understand it's just it's just in your head and you would can't believe anybody doesn't know this. And you know, I often have people when I used to work in alcohol services and they talk about their kidneys. And I know I'm damaging my kidneys. And you think, no, no, no, you mean your liver. And they don't even understand they know that it's somehow bad for them, but they don't even understand what it is that's bad and you know, you spend I spend quite a lot of time educating uh your patients. And so and I had this idea about it maybe being making it a bit of fun and rather than it just being sort of dry like boring anatomy of this idea of like we could kind of go on a journey and kind of shrink down into these kind of you know tiny people and go around the body. And I remember watching this film, I think I must have been very, very young. I'm you know, like probably four or five. And it was in that in that that was one of the themes of the thing is that all these scientists shrunk down and had to go into somebody's body.
Dr Rupy: I think I've seen that. It was like a series. It was like a spaceship. They went into like a spaceship and they they went around the body and they had like red blood cells flying.
Dr Max Pemberton: Yeah, that's right. Yeah, yeah, yeah. So I kind of had this in my mind and I thought because I remember that and I thought, God, you know, I remember that sort of you know from 30 years ago and it's sort of stuck in my head. And I thought, you know, that's that's the kind of adventure because you I need to make it kind of exciting for kids so it's not like boring. And then so I thought that was the kind of premise that I was working on. And then I thought and I also I want to kind of bring in this idea of particularly things like food and nutrition and like why why it's important to look after your body. Um and you know, because again, I think doctors sort of sit there and say, oh you shouldn't smoke, you shouldn't drink, you should eat properly. But actually if you don't understand why, you can't put it in the context, it's just meaningless. So I wanted to kind of then litter throughout the book these kind of little nuggets of kind of you know, this is why it's important to eat properly. This is why it's important to eat, you know, vegetables because actually you need them and you know, it's nutrition and so on and so on and kind of just introduce the children to to those kind of bigger ideas.
Dr Rupy: And I suppose inadvertently what you're also doing is educating the parents that are going to be reading this book to them, right? And that's the thing. That's probably like how we sort of uh subtly educate everyone by posing as a as a children's book. But I can imagine tons of people looking at it was like, oh my god, that's like how capillaries work. And I didn't actually realize that before.
Dr Max Pemberton: That's exactly what my sister said exactly the same thing. So the first book I got, I gave to my my nephew who's sort of seven. And my sister then texted me and she said, I can't believe I I didn't know half the stuff in this book. It's quite funny.
Dr Rupy: Yeah, I mean we normalize the anatomy because it's something that we deal with all the time and you know, through medical school, six years of that or or or less, you know, it just becomes normal. Okay, everyone knows where your liver is, for example. Everyone knows your general anatomy, but actually, I'm sure as you've gone through reading or making this book, you've realized that how how illiterate we are in terms of.
Dr Max Pemberton: And also I realized I didn't know lots of stuff. Really? Do you know I sat there thinking, how does the eye work? Because you realize this is the thing about it's not very well taught. It's not very well. It's a long time in the library going, oh wow. Um because you realize it's one of those things and I remember this in journalism is that actually it's relatively easy to write for kind of like a you know, highbrow audience, you know, where everybody knows everything. You know, you can kind of summarize a government white paper quite easily. Actually what's really hard is writing for say the sun where you're actually your where you're pitching it is much lower because you have to really understand it yourself. And that's kind of how I felt about writing this book was that to in order to explain it to a child, you have to know it absolutely completely and like the back of your hand. And actually some of the things I thought, oh, do you know, I don't I'm actually not sure. How does that quite work? And so I have to then sort of go away and spend a day or two kind of rereading stuff and thinking, oh yeah, of course.
Dr Rupy: I find it humbling actually when uh because my hospital, there's a large focus on teaching, teaching medical students, teaching people during their training as well. So F1, F2 doctors. It's really humbling when they ask you a very simple question about how something works. And then you think you know in your head, but actually when you try and verbalize it, it's it it actually heightens to you, oh actually I don't understand how that works. And then it forces you to go back, do the reading and then you can see one, do one, teach one. That's what we're taught in medical school. And it really does work really well. And I love how illustrated this is. I mean, you know, you don't shy away from things like cytoplasm, cell membrane. And you told me about how you were trying to figure out how to explain blood pressure.
Dr Max Pemberton: Oh. See, this is the thing. Again, it was so interesting because you know, I just assumed uh you could you know, not to use too long words, but actually basically you could talk about concepts just as you would with an adult. And and of course, I mean so so ignorant of me because uh what was it so one of the pages for example is on the on blood vessels and the difference between obviously between veins and arteries. And you know, one of the main differences like functional differences is that the blood is under a lot of pressure in an artery and it's not under so much pressure in a vein, but actually you need to go against gravity. So you know, this is the issue and you've got the gravity kind of pulling it down particularly in things like your legs. So they're the kind of main differences and that kind of you know, they translate into structurally how they're different. So I then tried to explain this and then straight so you know, I wrote this very I thought very nice kind of straightforward explanation, sent it off and straight away my editor sent it back and went, no, because children at that age don't have a concept of pressure. And I was like, what what? How do you explain pressure without using the concept of pressure? It's a nightmare. It's actually very, really, really difficult. And we were, you know, and there was a section on the kind of skeleton and bones. And what I wanted the the children to kind of understand was that bones aren't kind of something boring and static, that they're dynamic and they're constantly changing and they're remodelling all the time. And actually they not just they're just to give us support, but also they serve a really important detoxifying uh sort of feature. And that's you know, if you have certain chemicals in your body that your body cannot get rid of, then it buries them deep in the bone and kind of like hides them. Um and you know, so actually they're incredibly functional and they serve this amazing, you know, purpose in our body. And so then I wrote about this and they were like, no, because the concept of chemicals is too hard for them at this age. And I was like, well how can I talk about chemicals without using the word chemicals? It's really hard. And I must you must have seen so many things like that. Like just hitting a wall like, okay, I've got to go really, really basic. But you know what, those things that you just mentioned there, I don't think a lot of the adult adult population would realize. Like they probably think of bone as something that's solid, something like stone without realizing it's full of vasculature. It is pivotal to a whole bunch of other processes in our body, calcium metabolism and you know, homeostasis and all that kind of stuff. Yeah. And I so I think, you know, I mean I'm just looking at the page now, the designer jeans example. Explaining jeans to kids. Come on.
Dr Max Pemberton: I know. And also I did it like as as it's on in the book, I wrote it like that. So the first kind of couple I was thinking, you know, what is a cell? And I was thinking, I I don't think I even know what a cell is anymore. You know, I thought I knew all this stuff and I really don't. But it was actually yeah, it was really sort of interesting trying to sort of strip it back. And actually I think it was quite useful for me as a doctor realizing, actually what words do I use? And I remember a long time ago, I was with a a patient and she was describing how she was, you know, very distressed and she had this kind of terminal condition. Um and you know, she'd had a heart attack and she was going to die at any point and stuff. And I was looking through the history and I thought this doesn't quite make sense. And and I was saying to her like, you know, but you have had a heart attack, but what makes it what makes you think that that's you're going to die now? I don't understand. You know, the cardiologist said you're fine, you've been discharged from hospital. She said, no, no, no, because they kept on saying it was acute. And I said, well, what do you mean? And she said, well, they were saying it's acute. Now in her mind, this is a woman kind of in her 60s. In her mind, acute meant terminal. So it was just a misunderstanding of the word. And I sat there thinking, God, all these people, all these doctors have been coming using this word repeatedly. And actually you it's no fault of your own. Actually they've just been failing to explain properly what that word actually means. So actually when I was writing this book, it sort of really gave me this really made me think even more about this again and again about, you know, the kind of the words, the vocabulary that we use, the assumptions we make about what people understand, what they don't understand.
Dr Rupy: That's a really good point. And you know, I I I try and use that tip quite a bit throughout um my sort of uh medical work, but also when I wrote my my two books, I actually had um lay people, so people who weren't uh clinically trained, who weren't medics or whatever, read the chapters and summarize it back to me because there's so much nuance and when you're trying to explain eating for skin disorders or eating for to prevent cancer and all these different things. And you never want to be misinterpreted, particularly on a public health level. You know, oh, this means this cures X, Y, Z. And that's why, you know, I I put a lot of effort into sending out the chapters before they got published, getting some feedback and getting them to explain, okay, what did you learn from this chapter? What was it this that you took away or was it this? And you know, getting that feedback to make sure that your message is being communicated properly.
Dr Max Pemberton: I think I think it tends to be GPs or people who've gone through GP training tend to be much better at that for my experience. It's often, not always, massive generalization. But it is sometimes uh hospital doctors. And I think it's because they live in such a it's such a closed world and you know, they interact with nurses who are experts and they know their kind of thing their area and they work with maybe dietitians who know their kind of thing. And so everybody's sort of talking with using the same vocabulary and it just you just assume that that world, you know, is is is out there as well. And I suppose GPs because you do lots more lone working, actually the main interactions you have is with patients. So actually there's not such an assumption of knowledge.
Dr Rupy: Yeah, we actually and not to blame hospital doctors at all because they're fantastic and some of them are fantastic communicators. But um sometimes when I work in primary care, I have to do undo a lot of misinformation that the patient has taken away from that consultation. So you know, uh after seeing an endocrinologist and they don't understand why their thyroid medication is changed, for example, I have to go really back to basics. Okay, this is what your thyroid does. This is why they've changed your medication. These are other things that you can do in your lifestyle to support all this other stuff and how it interacts with all the other medications because you know, they have very short consultation times as well, very much similar to what we have, like eight to nine minutes. So you know, for them, like you were saying, it's just completely normalized to just brush through thyroid like endocrinology issues and and just yeah, see as many patients as possible without really thinking about their understanding.
Dr Max Pemberton: And often the I suppose the kind of the sickest people end up kind of then going to see like the professor or something. And you know, they're often quite it's quite touching. They're often really sort of like, oh I'm seeing the consultant, I'm seeing the professor or whatever. And actually those people are often live in an even more rarified environment. And you know, they're kind of their area of expertise is incredibly honed down. So it becomes very difficult for them to understand. Um and I think that's really that's one of my sort of passionate things about you know kind of generalists within medicine and why they're so important is because they can stand back and give a much more holistic uh kind of view and it really helps the patient and sort of advocate for them and sort of you know, help them through that patient journey in a way that maybe the kind of really uber specialists would sort of struggle to.
Dr Rupy: Absolutely. And I think that's kind of the way I'm trying to get more people in specialisms to think. That's why culinary medicine like kind of skips through loads of different conditions and why food isn't just in the realm of specialist nutritionists and dietitians or even general practitioners. It's actually everyone's responsibility in the same way it's everyone's responsibility to bring up smoking cessation or screening or you know, all the other sorts of tools at a public health level. Um and I think that's a real, I mean, I have a bias here, but I really think food is the great leveller across different specialities and why everyone should be chatting a bit more about it and how this obviously very important to the human body as well. Um so what was the most difficult chapter to write?
Dr Max Pemberton: Well, I've just probably I actually you know I actually it was that. It was that. So I would say the page on male and female anatomy because obviously at the age of so it's pitched at around sort of the age of seven, seven to sort of 10. And actually at that age, it's it's it is a sensitive sort of topic to bring up. Um and and this is not a sex education book. You know, it's a book about the human body. But in it inevitably, you're we're talking about kind of form and function. And so we are inevitably talking about like what what those parts of your body do. So it was very difficult to kind of walk that fine line between explaining, you know, what what a penis does without going into the ins and outs of. It was very, very difficult to do that and to do it also in a kind of in a sensitive way that would appeal to kind of people from you know, all different backgrounds with kind of you know, you know, different kind of sensibilities. Um so I would say that took that took a lot of uh going to back and forth, lots of kind of talking to different people, sort of thinking like, you know, how how could I phrase this in a sort of an honest way. The other thing is you know, I didn't want to kind of brush over things.
Dr Rupy: I'm really glad that you didn't shy away from this because uh like just for the listener, you know, we have pictures of the vagina, ovaries, uterus. It's really, really important because a lot of adults don't understand the difference between these different places. So I uh parts of the body rather. I um I'm an ambassador for the Eve appeal and they uh a charity that essentially raises awareness of the five gynaecological cancers. And they've done some research uh about literacy of females and their anatomy and they don't know how to describe things like labia, vagina, etc. Um and that actually leads to a lot of embarrassment. There's a massive taboo subject taboo around going to the doctor and speaking about bleeding and pain and all these different things for fear of embarrassment and not being taken seriously. So actually, like we were saying, you're planting the seed very early in children to learn about their anatomy, understand how it actually works and why that's important later on in life as well.
Dr Max Pemberton: Yeah. And and I didn't I you know, I wanted it to be something about this is not anything to be ashamed of. This is you know, everybody's got this, you know, bits down there. It's kind of perfectly normal. And that you know, we shouldn't kind of shy away from having those conversations. And so it's kind of it was it was a very delicate, difficult line to walk. And you know, things like the illustration has got a sanitary towel and a tampon because I was like, you know, these aren't things that people should be ashamed of in any way. It's normal. And I wanted to kind of celebrate the fact, you know, there's a section about women's breasts saying they all come in all different sizes and shapes and that's normal and it's okay because you know, I wanted to try and get that message across, you know, before people, you know, before the children have kind of entered into puberty, they've already had that sort of seed planted that oh, you know, these are our bodies, they're normal and that's okay and you know, and it's okay to talk about them and stuff. And yeah, and certainly when I used to work a long time ago, I used to work in child psychiatry and you'd have some really heartbreaking conversations with children where you realize the level of ignorance um and the kind of shame attached to to their bodies. And and you know, they'd be like 14 year olds and you think, where's this come from? It was awful. I've got a friend of mine um is a beautician. She runs her own clinic and she frequently has to turn away um teenagers, like young young girls who are kind of 13, 14 because they've come because they want to be fully waxed because they're saying it's not natural and they don't want to do about it and they're very distressed. And she has to kind of take them aside and kind of explain that actually pubic hair is normal and it's okay. And then they're kind of saying, well no boys want to want to sleep with me. And it's kind of a part of a much more complex kind of socio-cultural situation. So I kind of wanted in a very small way to kind of be like sort of celebrating people's bodies and there's nothing to be ashamed of.
Dr Rupy: Well, I think this is in a very big way because I think that's a very sort of important topic to to raise. I mean, I did a little bit of um so I did psychiatry as part of my general practice training. What I did when I was in paediatrics, I was in um Brighton Medical School. Um uh we did some work at the Royal Alexandra. And um I remember having some patients uh who were as young as 11, maybe even younger than that coming in with eating disorders. They just wouldn't eat. And you know, the mother would be there, the father perhaps was travelling and that's why they were sort of like rebelling in a certain way and they just stopped eating. I literally had no idea and this is going back like seven or eight years ago. I had no idea that we could have eating disorders in the year in children, you know, and as young as you know, 10, nine. Um it it's incredible. This is something that you deal with this more.
Dr Max Pemberton: Yeah, so this is this is my area that I I work in. So I work in an eating disorder unit. Um and I I deal with adults or kind of teenagers transitioning into adult services and then adults. Um but there is yeah, there is a whole part of our service uh that deals with uh with children. Um and it's very difficult and part of it is kind of cultural and social. Um and the kind of influences that children pick up on around sort of you know, idealizing certain body shapes and so on and so on and kind of preoccupations around certain types of food and so on. Um but also there's a big psychological element. It's not simply just that. Um it's also a lot particularly in younger in younger people, um often about kind of ideas around control, um feeling you're very often out of control because of course one of the first things we learn as babies to control is the food that we eat. So it's often uh young younger people who feel out of control often regress back and then they then start to control the food they eat um as a way of kind of feeling more more in control around things in their life.
Dr Rupy: And do you think that that there's a rise of eating disorders uh in that particular age group as well? Or is it a case of greater sort of awareness from from a professional standpoint and um greater detection?
Dr Max Pemberton: So that's I mean that's something that that's a big a really, really good, very big question um that people have spent a lot of time trying to identify. Uh I think it's probably it is actually probably a bit of both. Um you know, I see I have a number of older patients, maybe in their sort of 40s and 50s, even into their 60s, um who have basically had an eating disorder their whole life often since childhood. And they will sit there and say, you know, I spent 10 years kind of in and out of just general hospital under paediatrics uh because there just wasn't that understanding then. Like when you think it wasn't until around sort of like 1978 I think it was that bulimia was first the phrase bulimia was first coined. So I mean it's it's actually very relatively recent um that we've even kind of had words and vocabulary properly to kind of understand eating disorders. Um so and you know, the first services are only about sort of 30 years old or so, sort of dedicated eating eating disorder services. So um so I think now, now that there's more and more awareness, obviously we then pick pick pick up more. Um whereas you know, years and years ago these people just seen paediatrics, failing to thrive clinics, you know, kind of uh not really receiving any psychiatric help. Um but I do also think that because of things like the rise in social media, increased kind of pressures on children and so on and so on. Um even down to things like and it's maybe quite controversial but things like atomization of the family. So kind of like family breakdown, we now don't have like you know our grandparents living next door as we maybe did do 50 years ago. Um you know, we don't have massive extended families with loads of aunties and uncles. So actually children, if your parents split up, that can be really catastrophic and you don't have anymore a kind of social network um that maybe they did 50, 100 years ago. Um and so I think it's probably a combination of lots of very different things um have kind of you know come together to to create this spike that we have we have definitely seen. It's probably not as much as we think it is because I think some of it's over detection or detection. Um but certainly there is there is a bit of a spike in increase.
Dr Rupy: You work in quite a diverse area, I'm assuming, right? So you're around uh Tottenham, Edmonton area. Um so do you think there's a bit of a taboo around uh people from ethnic backgrounds and coming forward with depression? Because I know certainly in the Indian culture, it's a very big taboo. And we we live in that perfect sort of environment where we have the extended family, the parents, the grandparents, etc. Um but with that also comes a bit of pressure as well. Uh and you know, to to go forward and actually go to your general practitioner or to go to anyone really and actually call for help is sort of looked down upon maybe.
Dr Max Pemberton: Definitely. Yeah, I mean absolutely. There's still a lot of stigma um within kind of Afro-Caribbean communities, within uh you know, Indian communities. Uh I do a lot of work um or lots of the patients we cover, uh the areas we cover have got a lot of Bangladeshi uh patients in and there's a massive, massive stigma um amongst them with regard to mental illness. It's like a massive thing. It's very, very difficult. And often it will be kind of somatized. So it will be kind of it will be physical symptoms. Um so lots of my colleagues that work in uh GI medicine, so gastrointestinal medicine will often see people kind of coming convinced they have some sort of, you know, bowel problem. And actually it's a manifestation of their distress, of their depression, of their anxiety. Um I mean it's a very sort of common I mean when I worked in A&E, you'd often get um patients from ethnic minorities would come in describing kind of all over body pain. And and there would be often like this often typically a kind of slightly older woman who would be there and she would just repeat it again and again all over body pain doctor, all over body pain. And and there would be the whole family would be around them. And I remember sort of because I did anthropology when I was at medical school and I remember sort of like thinking it's really interesting from an anthropological perspective how this this one person who maybe who feels kind of lost or forgotten within the family is now mobilized everybody around her and suddenly it's become quite powerful because of using using medicine and using this kind of you know, this manifestation whereas maybe if she was saying I feel depressed or I feel unloved or I feel anxious or whatever, um it wouldn't mobilize people in the same way.
Dr Rupy: I think that's a really interesting point because certainly from an A&E point of view, you need to like uh determine whether this is has got a psychological element to it before excluding anything like you know an organic cause. And we had a a friend of mine come on um who's a gastroenterologist and she specializes in functional uh gut disorders. So you know, functional dyspepsia, functional diarrhea, IBS is one of the biggest ones that everyone knows about. Um and how breathing could be one of the uh in one of the interventions that could help with a whole bunch of other things. And you think about breathing, the the fundamental thing that we do as humans um as well as eating. But uh um that has a plethora of effects on our physiology, you know, on our gut symptoms, on our um obviously oxygenation levels, our brain, volitional breathing is a part of like a meditative techniques and how that could have an impact on our psychology as well. I find it fascinating, but it's such a complicated topic because they'll often, you know, come in particularly as a general practitioner, convinced that this is a physical problem. And to even uh bring up the topic of it being perhaps related to stress or you know, um poor sleep or anything like that. It's it's a really, really difficult topic.
Dr Max Pemberton: Yeah, because because I think it feeds into the kind of this idea of like the stigma that that is attached to mental illness of like it's not real, it's all in the mind. These kind of sort of derogatory ideas around, you know, well, you know, I I want a proper illness. I don't want something that's kind of, you know, me just being a bit crazy. Um and it actually kind of feeds into that whole idea around mental illness isn't a real illness. Um and I feel very really strongly about that, really passionate about it. And of course, by the time patients have come to me, often they've already had a level of acceptance of it and they kind of understand it. Whereas I think it's very hard for GPs because they're often the ones that have to start that conversation. It's easier for me because you know, by the time they've got to see me, it's all been discussed. Whereas for GPs, they they have to broach it often and it's very very hard to do.
Dr Rupy: Yeah, it's a tough topic and plus, you know, you never want to be that uh practitioner whether you're in primary care or secondary care who misses something and misses something big. You know, there are lots of random symptoms associated with uh cancer and and even even your traditional sort of like cardiovascular issues, gut issues that they can present in multiple ways. Um and often detaching yourself from that as a practitioner is quite hard because of we're practicing quite litigation heavy medicine, I feel. Like it's defensive medicine.
Dr Max Pemberton: Very defensive.
Dr Rupy: Um we're sort of going the way of the Americans, I feel, which is a uh probably a bad way to go.
Dr Max Pemberton: Yeah. Well, I think it's sad because then it becomes not about the patient and it becomes about you not wanting to get sued. And that's kind of to me is quite that's not really how it should be.
Dr Rupy: It's quite upsetting though, isn't it? Yeah, yeah. Um but anyway. Let's not end on that topic. Let's think of something nice. Little bunnies or something. Let's talk about little rabbits.
Dr Max Pemberton: Actually one thing I did want to talk to you about um is social media and actually how you feel that um it it's impacting particularly on eating disorders, um orthorexia along with many terms is something that's recently been coined as the unhealthy obsession with healthy eating. Do you think there's a whole bunch of other sort of uh terms around like a similar uh sort of concept like orthorexia that we haven't yet to define and we haven't come across yet? Or do you think we kind of know what the triggers are and then we need to just get on with treating and identifying this?
Dr Rupy: I mean there is no doubt that social media does play a role. I mean there is just there is no doubt. And and you you sit in a clinic and I will have you know social media, Instagram gets brought up in my clinic probably you know a dozen times a day. Um so I mean there is no doubt that it's playing a role. There is a bigger question of but actually if it wasn't for social media, would it be there anyway? I guess or would it just be or is it just merely something that people are kind of kind of like hanging on to? Is it is it a hook? Would it be there anyway? Or is it or is it just that it's facilitating them? I suppose it's a way of putting it. Um and I don't know. I kind of I think it's easy. I suppose we all like doctors, everybody likes to think there's just one answer. We like you know, the bogey man. So we can go, oh it's social media. And I kind of think it's probably a bit more complicated than that, which is a really tedious answer and I'm really sorry. But I just kind of do. And I think that you know, I suppose what I don't like about uh social media is the way that it's removed from context. So we have had numerous patients within our service who have incredibly large social media followings. And they are posting about food and they have an eating disorder. They are not eating what they are posting. And we know that they are then you know binging on all sorts of things and making themselves sick and that they are really tormented, really overwhelmed by their eating disorder. And yet you look on their social media and you would have no clue and you would follow what they they are recommending. And I sit there thinking there is you know, it's almost like a kind of public health intervention that needs to happen to think say, actually nobody should be listening to these people because they are actually mentally unwell with regard to food. So you should not be taking their advice on food and they're not even doing what you think they're doing. They're not even following it. Um and it's really difficult and we've had lots of kind of ethical issues within our service of like, do we intervene? What do we do? How do we kind of protect the public from uh from this? Because actually, you know, it's they're they're promoting something that's not even real. Um and I suppose that's what I don't like about it. Um I don't like the fact that lots of people think it's normal for example to have a thigh gap, which is this kind of gap at the the top of your thighs. Um so when you have your legs closed, you can still see space through them. That is not normal. It is not it is it happens in a very small minority of people who just anatomically are variants. You know, they are as I say to my patient, they're just genetic freaks. And I mean that in a nice way, but they just are. And you are not. And that's okay. And you know, and and it's and I want them to sort of celebrate their body and yet they are constantly being bombarded with these images of kind of extraordinary people. And it's like sitting there watching Wimbledon and then beat yourself up because you can't play tennis like that. And it's like, yeah, but those people are extraordinary. You know, they are that is why they're on television doing Wimbledon. And actually if that if you're going to put that as where you're aiming for, you will inevitably be really disappointed. And that's how I feel about sort of social media is it kind of gives this very false impression of what life is like. It sets up unrealistic expectations. And I think that is the sad thing. And you know, what I want to see on social media is people going like sat here and eating three biscuits and stared out the window for an hour and had a photo of that because that is the reality of life. And not, you know, kind of everyone sort of skipping around in their latest kind of Gucci trainers and you know, kind of you know, it's just it's not real. And and that's what I kind of feel sad about and that's what I don't like about about social media. I do think there's positive things. I love the way that it kind of can connect people and people often from kind of very diverse communities kind of can learn more about one another and so on and so on. And uh you know, kind of people kind of in far-flung parts of the world can kind of get their news out and stuff. So I think there's loads of potential and loads of positive sides to it. But as always, unfortunately with human nature, there's also big negative things that come out.
Dr Rupy: Absolutely. Yeah. With any tool, I think there's definitely going to be negatives that come out. And I think there's so many parallels between uh an unhealthy obsession with healthy eating um and monetary attainment and wealth and you know, people posting pictures of them travelling all the time, these amazing exotic locations. Sometimes that can compound the feeling of inadequacy in yourself. And as a doctor as well, and this is speaking from a personal point of view, you know, being on social media and talking about healthy eating and how I want people to live healthy, happy lives using food and lifestyle. Um it puts me in a bit of a disposition because I want to reflect the normal tendencies of what I do when I go to A&E and that's why I'm always posting like the jelly babies that we have on like you know, um A&E wards and that kind of stuff. Um but I also want to educate people on why food is one of the most important health interventions. And in an era where everyone is scrutinizing exactly what you say, exactly how you say it, it's very hard to communicate a nuanced subject in 160 characters or a small comment post and stuff. And you've got to look at the totality of what people are are putting out there. Um and it's it's very hard. It's it's a a very aggressive uh place to be, I think social media sometimes.
Dr Max Pemberton: I mean that's part of the reason why I kind of don't really engage with social media particularly because I kind of feel, you know, obviously I'm very interested in other people's mental health. I'm also interested in my own mental health. And I sometimes find it's not a healthy place to be from a mental health perspective because you can feel very easily attacked or very inferior or you know, I I I quite like not being on social media. I'm on Twitter, which I very rarely sort of engage with particularly.
Dr Rupy: Twitter is pretty aggressive.
Dr Max Pemberton: I like it. But then but I would say I'm kind of quite passive on Twitter. So I I read stuff. So I read the news, but I've set my settings so that unless I follow somebody and they follow me, I can't see what they're saying now. So actually, you know, and that's so mostly it's kind of friends. In that might not be friends in real life. It might just be friends that I've made over Twitter. But but I like them enough that I want to hear what they're saying and they clearly like me enough that they want to hear what I'm saying. So that's fine. I don't mind that. But everybody else I don't see. So if anybody's kind of getting angry about getting angry to me or anything, I can't I can't see it.
Dr Rupy: That's why I'm going to do it. Didn't properly represent the female anatomy.
Dr Max Pemberton: But it's it's really interesting. And often people will take just one very small thing and they get very, very upset about it. And I just think, oh it's like that I you heard the new Taylor Swift song?
Dr Rupy: No, no, I haven't. I do like Taylor Swift, but.
Dr Max Pemberton: You need to calm down. And I kind of think it's about social media. And that's how I think about it. I'm just like, wow, everyone just needs to calm down. It's okay. Like, jeez. Let's all be happy.
Dr Rupy: Taylor Swift's great. She's pretty wise, isn't she?
Dr Max Pemberton: I love her. I tell you. I would marry her. He'd be devastated, but. I think she's I think she's underrated. I think she is. I would I would quite happily marry her.
Dr Rupy: I think she's I think the current one, this one is amazing.
Dr Max Pemberton: I can't believe I haven't heard it.
Dr Rupy: It's had 120 million uh listeners or something. I I just noticed it. I was listening to it on my way here.
Dr Max Pemberton: Really? Okay, well was it all you?
Dr Rupy: My favourite song is 22. I know it's it's hard for me to admit that, but I really like 22.
Dr Max Pemberton: It's very interesting to observe, I think, because even if you're trying to put out good content, um people will misinterpret that. And then that will just spiral out of control.
Dr Rupy: Almost like wilfully. This is what I think is interesting about it. It's almost like people want to be angry. And I and I think that I so I've tried to think about this from a psychiatry sort of point of view. And I think that actually a lot of people are very angry for a whole variety of complicated social reasons that actually sometimes the world is a really hard place. You know, even living in the UK in you know, 2019, it's still really hard for a lot of people and people for all for a variety of reasons feel very dispossessed, very disengaged, feel kind of society doesn't isn't offering them something and they have this kind of rage. And they are looking for somebody or something to direct it towards. And sometimes it happens to be you that sort of wanders in in front of that. Um and so I try to never particularly take it personally um when it does and I just kind of sit there and think I'm just going to be really happy. And I've got a couple of things that I do sort of very mindfully um to kind of keep myself really happy. And so one of them is.
Dr Rupy: Please tell.
Dr Max Pemberton: This is honestly it's really banal. But one of them and it really is honestly when I just think about it makes me kind of all relaxed is every Thursday, so on a Wednesday I have to stay up really, really late writing my column. And then on a Thursday I have a very, very busy day and it's very kind of complicated at work and I have a complex patient that I have to see in the morning. So I have an assessment slot. They've often been waiting for a very long time and it's kind of you know, it's it's it requires a lot of my thought. And then I have to then go and I do a I work for a day program. Uh so I have to go and do the ward round for that and everything's quite stressful. So kind of Wednesday into Thursday has been quite stressful. And so then on a Thursday evening, I leave work and I go to Sainsbury's home base. And I genuinely, I'm often followed by the security because I think they think, who is this guy? He's here every every Thursday evening for about three hours. And I walk around Sainsbury's home base and I almost always buy a house plant because I really love house plants and I've got two things in my life is that I really love house plants and I'm really bad at looking after house plants. So those two kind of combine.
Dr Rupy: The next system of my house plant collection.
Dr Max Pemberton: I'm not bad. I've got some very nice little pots. And then um and so so luckily just I think this sort of it coincides just enough that I kill plants at the same rate that I can kind of buy them at. So it kind of it's never quite a sort of jungle. It's like as I'm throwing one out once a week, I kind of bring one in. Um and so I'll kind of go around and I'll like often buy some house plants and I'll go and look outside and look at lawn mowers. I haven't got a garden, but I just like I like to look at the lawn mowers and just it's really sort of mindful and peaceful. It sounds a bit odd.
Dr Rupy: No, no, no. I totally understand that because when you're in that environment, I bet you can smell the smells of it at the moment of that sort of like uh the soil and the plants themselves and stuff. There's a really interesting, I've mentioned it so many times on the podcast. It's called your brain on nature. It's actually written by two psychiatrists. And it's basically all about um forest bathing. I think the Japanese art of forest bathing is called Shirin Yoku, I think it is. Um and you're essentially breathing in a lot of the volatile chemicals from the plants themselves that are naturally mood enhancing and anti-inflammatory. There's obviously the environment, the scenery that you're in as well, which is very relaxing. And there've been studies looking at uh the immune effects as well, like looking at natural killer cells, as well as your heart rate variability and all these different things that actually demonstrate, you know, walking in your park or walking through your home base.
Dr Max Pemberton: Do you know about this really fascinating study that was done in the 1970s in I think it's something like Pennsylvania State University State prison, something like this. It's somewhere like that. And um and and they the way just just randomly the way that the prison was built, half of the prisoners on one side looked out onto just literally a brick wall. There was nothing. And on the other half looked out over onto onto a park land. And some kind of you know, clever person thought, I wonder what the different rates of mental illness are of the people that have got all their windows looking out onto a brick wall versus onto a park. It's kind of it's a really one of those really classic famous um sort of studies. And I think there was a guy called Sam Evington who was this professor. I think he's still alive now. He's still a professor um of like general practice and stuff. I think he lives over in East London and he had this whole thing about kind of getting people to do gardening and stuff based on this study because it showed that the people who were looking out on the brick wall had a significantly higher rate of mental illness compared to those that were looking out onto greenery and grass and sort of nature. And so that's kind of how I feel when I go around Sainsbury's home base because I kind of like, you know, you go outside and there's like all these plants and I you know, and I don't even know a great deal about plants, but you can sit there thinking, oh wow, if I had a garden, I'd have this and this and this would look like and and it's all you know, like a little I don't know, it's very sort of meditative. And then um and then and then I go home with with my house plant that I buy and then thinking it's going to die soon.
Dr Rupy: I I I totally get that. And I think you know, there are some other studies looking at cognition as well after looking at an environment, an urban environment on the TV screen and uh a rural sort of lush green environment again on a TV screen and then they do some um some IQ based tests and stuff and they found that there was a significant difference in that just from that as well. So there's something almost like evolutionary based in how we are meant to interact with our environment and what impact that can have on our brain function as well. So from the human body to straight to eating disorders to walking around a home base. Um I think this is an amazing book. I can't wait for children all over the country to get this and parents as well. So um I really commend you for writing this and thank you so much for coming in. I really appreciate it.
Dr Max Pemberton: Thank you so much.
Dr Rupy: What a pleasure it was to chat and to cook for Dr Max. Like I said, you can check out the recipe on the Doctor's Kitchen YouTube channel. Make sure you check out Dr Max's book. All the socials and links are on thedoctorskitchen.com. And you can find all of this information and more at thedoctorskitchen.com. Subscribe to the newsletter for weekly science-based recipes, content and much more to help you live the healthiest, happiest life. Give us a five-star rating if you like this pod. It really does help spread the love and the message. Tweet us at doctors_kitchen, check out Instagram, YouTube, and of course, get a copy of Dr Max's book, The Marvellous Adventures of Being Human. See you next time.
