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episode #199

Interview with Dr. Andrew Jenkinson: Why We Eat Too Much, Body Set Weight and Surgery for Weight Loss

November 2, 2022 in Podcast


This week I interviewed Bariatric surgeon, and best selling author of Why We Eat Too Much - Dr. Andrew Jenkinson!

In this episode, we discuss:
  •  How to get your body weight set point down
  •  What's wrong with calorie restriction?
  •  What is Leptin Resistance?
  •  Role insulin, stress and sleep play in weight loss
and his one tip to get your body back to what it once was!

Brian (0s):

Coming up on the Get Lean, Eat Clean podcast,

Andrew (4s):

You can say like the way set point of someone will alter as they alter a country or the food that they're exposed to. So I have a lot of patients who, a few patients who maybe when they move to America, they put on some weight and then when they moved back to London, they lose weight without, you know, any efforts.

Brian (25s):

Hello and welcome to the Get Lean E Clean podcast. I'm Brian Grn and I'm here to give you actionable tips to get your body back to what it once was, five, 10, even 15 years ago. Each week I'll give you an in-depth interview with a health expert from around the world to cut through the fluff and get you long-term sustainable results. This week I interviewed bariatric surgeon and best selling author of Why We Eat Too Much Dr. Andrew Jenkinson. We discussed how to get your body weight set point down, what's wrong with calorie restriction, what is leptin resistance, the roll insulin stress and sleep plane weight loss, and is one tip to get your body back to what it once was.

Brian (1m 6s):

Really enjoyed my interview with Dr. Jenkinson. I know you will too. Thanks so much for listening and enjoy the show. All right, welcome to the Get Lean E Clean podcast. My name is Brian Grn and I have Dr. Andrew Jenkinson to the show. Welcome.

Andrew (1m 22s):

Nice to be here Brian.

Brian (1m 23s):

Yeah, thanks for coming on all the way from London and I, I'm excited, heavy on and discuss your, your book. When did the book come out?

Andrew (1m 33s):

So it was published January, 2020, The hard back and then the paper back came out January, 2021 and yeah, it's pretty good. It became Amazon and Sunday Times bestseller.

Brian (1m 46s):

Excellent. And the title is Why We Eat Too Much The New Science of Appetite. So we'll, we'll definitely dive into the book, but maybe before we get in the book, perhaps give individuals, I know you're a general surgeon, you specialize in bariatric and laparoscopic procedures and perhaps how did you sort of go down this road and your interest in in getting into surgery and for weight loss and diabetes and things like that?

Andrew (2m 13s):

Yeah, so I was training up in, in general surgery, my sort of the end of my training was laparoscopic keyhole surgery and concentrated on upper gi. So basically stomach took all the stomach to stomach cancer surgery and then I sort of fell into the job because I'd already worked with a colleague who was doing bariatrics and he knew me and as normally happens he said that we're got a vacancy when I come for the interview. So I ended up being a bariatric surgeon without really having any formal bariatric training, but this is what happens like 20 years ago. And yeah, he sort of taught me up and I started doing gastric bypasses, gastric band sleep, gast hysterectomies.

Andrew (2m 54s):

And yeah, suddenly my room, my waiting room was full probably 80% full of people suffering with quite severe obesity. And the rest of the sort of practice, you know, gallbladder had any whatever was sort of sort of diluted away a little bit. And this is when I started to form a real interest in the disease, which is obesity. You know, why would these people come to see me and ask me to take their stomach out or bypass their stomach? So quite extreme surgery, right when conventional wisdom is, you know, well why don't you just go on a diet and go to the gym?

Brian (3m 30s):


Andrew (3m 30s):

So it got me thinking as, as someone who's from a relatively STEM family so doesn't have any, you know, subjective experience of you know, having to try lose way and things like that, it just, it intrigued me why so many people had such difficulties. And the thing that really struck me was, I mean this is, and this is sort of mentioned in the introduction to the book, the similarities in people's stories. I mean there was no collusion between people. I saw hundreds and hundreds and hunters of patients and they would, you know, all say, and they still do say to me today, yeah I can, I can lose weight on diet but I put it back on and then I end up even heavier than before the diet started.

Andrew (4m 11s):

And then a lot of them say, I think my metabolic rate is low. You know, don't think I burn as much as my rema or flatmates cause I don't eat it so much, but I'm suffering with a obesity and this guy's slim. Or a lot of them would say, you know, I think it's in the family, I think it's in genes. And again, looking at, you know, then when they come in with the family, you know, it's obviously there's something going on from a reedit basis. So I just looked into all of these areas and yeah, started to get really intrigued by, by the whole area, by the whole sort of field of weight regulation and obesity and that yeah. Stimulated the research for the book.

Brian (4m 50s):

Yeah. And I'm curious just as a bariatric surgeon, the people that came in and you did the surgery on, like what is the success rate for them in the future and, and to keep it off and to maintain, you know, where they wanna be as far as weight is concerned, Like is it pretty successful with this surgery?

Andrew (5m 10s):

Yeah, I mean basically I need to be coached that this is gonna reset their weight and we'll talk about, you know, the weight set point where people's weight is set without surgical intervention or serious lifestyle changes. So with a bariatric intervention, like a sleep hysterectomy or a acid bypass, their weight will reset for instance from, I dunno, an average of one 20 kilograms down to 75 80 kilograms within a year. If they then add in relatively simple and healthy lifestyle changes. So, you know, eating, you know, your own home prepared foods, not snacking between meals. Now looking after yourself sleeping, doing a little bit of exercise, all of these things then the weight ones go back on.

Andrew (5m 55s):

But a lot of surgeons don't. They just go for the operation. They say, okay, you're gonna be, you're gonna be cured. They still have bad habits and particularly the sleep hysterectomy procedure, you know, 15, 20% of people will put weight back on and yeah, feel a bit disappointed.

Brian (6m 12s):

Yeah, cuz I would imagine that that's the biggest obstacle is changing those habits that they, they've had through, through, you know, decades probably just doing the surgery isn't enough. They need to follow up and make sure that they're changing the, you know, making lifestyle changes.

Andrew (6m 27s):

This is actually, I've been commissioned by Penguin to write a second book, which is gonna be called How to Eat and In Brackets and Still Lose Weight. And that is gonna be concentrating on, you know, how people can change their eating and lifestyle habits, you know, how the brain works, you know, the dopamine reward system and you know, what process and you know, highly protest and you know, slightly addictive food does to our brains and our behaviors and sort of once we have that sort of understanding, being able to unpick it, you know, so that's the, the basis of the second book. I, and I think it's, this is what people, because the first book I, the end part of the first book, the, you know, section three concentrated on, you know, what lifestyle and dietary changes were required, but you know, it's not just being able to read a book, it's being able to change habits, which is really important.

Andrew (7m 23s):

So a lot of people would know what they're supposed to be doing, but it's these, we're we're basicallyum you know, we are, we're we are triggered by various environmental things and half the time we don't think about what we're doing. So I I find a whole sort of habit thing fascinating at the moment.

Brian (7m 41s):

Yeah, right. Like these habits that we're unconsciously doing every day and they just add up over time. And I always talk about like, yeah, you can have all the great information in the world and read all the books, but if you don't sort of have sort of a burden desire or a reason why you want to, to do, you know, lose weight or whatever, you know, get stronger. If you don't have a reason why that's really driving you, then it's probably not gonna be great. You know, you're not gonna have long term sustainability of that.

Andrew (8m 8s):

Yeah, I mean the first thing comes with I think understanding the issues. So understanding how your body and the environment works and, and then obviously wanting to change, but it's more, you have to be more than want to change. You have to have to almost change because you are educated about what the hell's happening to your body. You know, it's almost like you can be, you could do this thing successfully and still be a hundred til 20 kilograms. You, if you cracked it in your head and you wanna be that 80 kilogram person, you know, through, you know, lifestyle change or whatever, then you can be, but actually I'm not that, that's a bad example going from one 20 to 80 because that was the example of surgery.

Andrew (8m 49s):

When you get to that level of obesity, you do have other issues like lectin resistance, which is explained in the first book. But yeah, you can certainly lose a, a good proportion of your weight with lifestyle habit changes.

Brian (9m 2s):

Now you talk about body set weight and I remember reading a little bit, this was years ago, Dr. Jason Fung talks a lot about that as well. Yeah. So you touch on body set weight a lot and I was mentioning that Dr. Jason Fung while back talked about body set weight and ways to reduce that. A lot of times that is brought on by genetics, but how can individuals sort of, it's like the internal body temperature, right? Like how can they get their body set weight down to a place where they're more comfortable, where they want it to be?

Andrew (9m 36s):

So I mean, the first thing is to understand what the, I mean in the book it's, we term it weight set point. So every individual will have, you know, this weight set point that the part of the brain that's controls our appetite and metabolism, I how much energy we wanna take in and how much energy you wanna expand and how much energy we wanna store. This is your weight set point and it's sort of almost impossible to fight against that weight set point. So you can go to the gym and try and diet and whatever, or starve yourself, you know, calorie restrict. But the further you get away from your weight set points, either up or down, actually it's almost like a elasticated sort of spring.

Andrew (10m 22s):

The further you get away, the bigger the pull back and the weight setpoint. The in individual's weight setpoint is actually 75% determined by the genetics. So if you are from a family sufferer with problems, then you know, it's sort of preordained that you may suffer. But obviously you have to be combined that genetic predisposition with a probably a western food environment where there is a lot of sugar, refined carbohydrate and artificial, you know, other food special was particularly as mentioned in the book, which significantly affect the messaging, messaging within your brain, the hormonal, you know, homeostasis of your weight set points.

Andrew (11m 8s):

So basically talk about insulin three, six ratio causes all levels, these sort of thing. So the, the combination of your genetics and your environment determine your individual's weight set point. So for instance, you have, you know, a propensity to, to be from a heavy family, but actually you're in a environment where there is no western food trigger for that, you know, obesity, you'll be okay. But as soon as you move to an environment where, you know, so we western food and culture, you'll, you'll really struggle. And then the, the worst thing you can do is then start calorie restricting because you're then training your body to be metabolic and really efficient.

Andrew (11m 53s):

It's almost like saying, okay, we're in an environment where a famine comes along every six months, a severe famine, you know, where you're on, you know, eight or eight, 1000 calories a day maximum. You know, sometimes you're starving yourself even more. Your body not only will have a very efficient base on metabolism and based on metabolism is, you know, 70% of our total ex expanded energy, but also will want to store more fat as an insurance against further famines. So these people who, any lot of my patients are recurrent diets, they dieted for decades and the longer it goes on, they really, the more difficult it gets until the end of the road, they come to my clinic and say, Look, I gave up, take my stomach out, I hear it's good.

Andrew (12m 39s):

So that's the way set point. Okay. So we talk about genetics in combination with the environment and the environment affects it particularly with the food environment, with something called lectin resistance. So our body weight is normally controlled by this hormone called lectin. Lectin comes from our fat cells. So the more fat cells we have, the higher the lein than in our blood and it's almost like a signal to the hypothalamus, which is that part of the brain that controls raptor and and metabolism. So leptin level and you've learned is the signal to the hypothalamus of how much energy you're carrying.

Andrew (13m 20s):

You know, have you got two months supply or have you got two weeks supply? Do we need to go looking for food or we okay for a while? Are we in an environment where, you know, we keep having these famines over a few months, do we need to store a little bit more? So lectin that lectin signal, what will tell now it's almost like the analogy in the book is it's like the gas tank in your, the gas tank meter, sorry, in your car, leptin resistant comes about when the lectin level is high, but it's being blocked by two things. One is too much insulin. So the insulin and lectin know signal to the hyper performers are the same, they use the same receptor. So if you have high levels of be the lectin signal will not get through.

Andrew (14m 4s):

So you'll, the level of lein is high, but actually your hypers can't see it. The second thing that happens is as obesity is inflammatory condition releases something called tnfl for this causes hypothalamic inflammation as well against that dulls that left in signal. And the analogy in the book is you're driving along the highway going back to the gas tank meter analogy, driving along the highway and your gas tank meters hitting, hitting red. You think, oh god, I've gotta like stop, I'm gonna run out petrol panic, try and find the next petrol station start to fill up. When you fill up you realize it's full. You know, the problem is the gas tank meter making you feel as if it's empty.

Andrew (14m 46s):

And this is what left in resistance is so full blown obesity when we see people who are are, you know, double your size, trouble your size, particularly in America, people are really struggling. This is the disease. So their hypothalamus can't see any lein. It's seeing, it's seeing probably the same amount of lein as if you lost, you know, 10, 15 kilograms. It's actually seeing a really low amount of, of lein because it's being blocked by inflammation and insulin. So these people, people who suffer with no severe obesity are absolutely ravenous all the time because their leftin level is perceived to be low. The hypos thinks they're fading away and they have extremely low based on metabolism.

Andrew (15m 28s):

They're, they're again a, a response to perceived, you know, fat, fat deficiency and you know, a lack of food. So the, the symptoms that we think, sorry, the character, the characteristics that, you know, popular western culture thinks cause obesity, a being greedy and lazy are actually symptoms of the disease. Obesity, the disease, obesity causes you to be voraciously angry. And because it's embarrassing to in public, all these people bingeing eat in private, you know, and it also causes you to be really, really naked had on that the fact that you're carrying around, you know, like 200 pounds extra, it's like, it's a very sad disease.

Andrew (16m 16s):

It's not understood by many people including most doctors.

Brian (16m 21s):

So what, what would you say, you know, you talk about calorie restriction, obviously a lot of people, especially in the states, you know, believe in this in calories, in calories out approach, you know, and, and there's some, maybe there's some truth behind that to someone that's maybe metabolically healthy. But to someone who's, who's not and who's obese or a hundred, couple hundred pounds or whatever it is, overweight who has a sort of a rec metabolism, you know, like you mentioned calorie restriction can actually potentially wreck metabolism even more. So what steps would that, what would you say steps for that? I mean,

Andrew (17m 0s):

Calories in and calories are the ultimate, okay? So you can't argue the fact that if you can, you can throw someone into a prison center or concentration whatever and calorie restrict them force one to for treadmill whatever, they will lose weight. But when you are in a society where there is, you know, we're not prisoners, we can rest up if we want to or eat, if there's food available, you're then relying on the messages coming from the pipes and you can, you can fight against it for a while. You can try and calorie restrict to lose weight, but those signals will become stronger and stronger. And it's a little bit like trying to lose, you know, five pounds in weight through not drinking water.

Andrew (17m 45s):

You can probably do that after two or three days you will become quite dehydrated, but you're not gonna, that's not, that's not a way of losing weight because everyone knows that you are, again, the hydro found the first control center, you're gonna be voraciously, sorry, you're gonna be have a paring first. So you know, weight regulation from the calorie point of, from the fat storage point of view is the same. You know, it's like you, you can't just start your way out of it because there's signals coming from the hypothe. So sometimes as powerful as you know, if you try to lose weight ridiculously by, by dehydrating yourself. So the ultimate thing is to try and alter to the weight set point.

Andrew (18m 27s):

And you can only do that if you understand what the work set point is and that that sort of, you know, theory of, well actually born out with a lot of scientific research of it being actually quite significantly due to insulin but also inflammation and a little bit to do with the omega three six profile, which we may go onto later. Essential panty acids, we know, and you mentioned before we started this, this podcast that you'd had some sort of discussions about ketogenic dieting and things like that. We know ketogenic dieting, ketogenic diets work and they work because they significantly reduce the average amount of you have in your body.

Andrew (19m 8s):

And if you're suffering with obesity, certainly that leptin gets seen by the hackathons and sort of people easily will, if they're overweight they will easily lose weight with ketogenic diet. The problem is that it's really difficult to maintain a very low carbohydrate intake in society. A sort of take my hat off and congratulate people who can do it long term, but not many people can. My book sort of suggest that a better way of doing it is to try and go lowish carb, you know, try and get your carbohydrate levels, you know, first understand what the, what carbohydrates were, various different foods and then try and get, you know, your intake down to, I dunno, less than 180 then 60.

Andrew (19m 60s):

See if you do 60, I think keto is like 20 or 30 isn't that. But if you can go down and not have any side effects and be lowish carb, I think that's gonna have a really beneficial effect on your, your insulin signaling and it's gonna let, it's let him be seen.

Brian (20m 17s):

Yeah, yeah, I mean like I mentioned to you, I had just had a friendly debate between sort of a low carb camp, you know, you have a clinical keto approach where it's very low carb and then now you're starting to see that, you know, people aren't, the clinical keto approach is mainly for people with, you know, seizures and things like that. And so sometimes long term keto for some people can maybe even be harmful when it comes to hormones and once they sort of get their weight back in order, then they maybe can try tritrate, titrate those carbs up a little bit more.

Brian (20m 57s):

And, but when you talk about carbs, I mean it depends on which ones as well, right? They're not all created equal, but to someone that's not metabolically healthy, usually it's the things that they're eliminating, right? If they're, if they're getting their carbs from 300 carbs grams a day to a hundred, a lot of times they're gonna be eliminating the processed ones you'd hope. Yeah,

Andrew (21m 19s):

Exactly. Yeah, yeah, yeah, exactly. I mean, I'd sort of shied away a bit from the glycemic index, a way of looking at the carbs in food a the speed that the carbs goes into your blood in the book and introduce this thing of themic load of, of a food. So you know, the total amount of carbohydrate that is in, for instance the potato, you know, a slice of bread, et cetera, et cetera, to make people aware that that's, I think that's how you can get your, your total car load down and by definition your average insulin levels down over over 24 hour period for a long term long period of time.

Brian (22m 4s):

And what, what else would you say, you know, you talk about like metabolism, what are ways to maintain a healthy metabolism but also lose weight? I know you mentioned carbs. Are there any other ways that we can do that?

Andrew (22m 25s):

Yeah, I mean I think that the book doesn't really talk too much about exercise. It does mention a bit. I mean, I sort of say, you know, unless you have the time, you don't wanna really be training like an Olympic athlete. You're probably gonna injure yourself and you're gonna balloon again, you know, when when you can't do like 50 miles a week. So I still think, and it it's sort of just based on common sense. If you can do some vigorous activity for 30 minutes, you know, three times a week, this is what I tell my patients enough that you are like sweat so much, you need to have a shower that's gonna, you know, force your metabolism out because as you're losing weight, even if you're losing it because you weight set points being decreased because you've changed the type of food that you eat, you're still gonna get a decrease in a natural decrease in your basal metabolism.

Andrew (23m 19s):

But if you exercise regularly, you're gonna like force that back up a bit. We know exercise is great, not really just for expanding calories, but I think it's great because it improves insulin signaling. So if you do exercise regularly, it eventually works better and you don't need as much of it and it decreases the amount of cortisol that you, that you produce in corticol again is integral as explained as is explained in the book in like glucose and insulin signaling. So my perspective on, you know, the gym and exercise is you think you are running off the calories but probably you're gonna put those calories back in, in the juice bar what you're actually doing and obviously gyms do work cuz otherwise it wouldn't be thousands of them around things that are around.

Andrew (24m 8s):

But it's not because you are, you know, burning off those calories, particularly in the gym essentially. Cause you're making yourself metabolically much fitter so you don't need as much in insulin and cause levels are lower.

Brian (24m 19s):

Yeah, I agree. I mean, you know, they're always, the saying is you can't outwork a bad diet. I think there's a lot of truth behind that, but the benefits of exercise and putting on muscle, obviously like you said, you, you sort of have a better glucose tank, right? You can, you can, you're more insulin, you can become more insulin sensitive. And I also think too, one good habit can lead to other good habits, right? Like, you know, you start working out and then you're like, well maybe I should, you know, change some of the things that I eat and, and, and because that'll make me feel better and I'll be able to perform better in the gym. So I, I do think that like one good habit can lead to other and, and you can stack upon upon those habits.

Andrew (24m 60s):

I mean one of the things that's introduced in the book is this explanation of how dynamic our metabolism is. So as, as I mentioned before, and a lot of people aren't really aware, you know, the amount of energy you use before you move. So imagine just staying in bed all day and not actually even rolling over. So the amount of energy you used to heat your body, your heartbeat, the chemical reactions within your body, digestion, the immune system, all of these reactions just to keep a body ticking over breathing, things like that, right? 70%, 70% of my total energy expenditure, most of the rest is pottering around walking to work. You know, so that's sort of most of the rest.

Andrew (25m 41s):

And then literally maybe a couple of percent to 3%, maybe 5% if you go to the gym is, you know, active energy expenditure. So the, you know, and, and that's 70% of our total, you know, base energy expenditure is very dynamic. It can expand or decrease. And one of the examples in the book, and this has been, it's been researched quite a lot, but it's just not really out there unless you actually wanna look for it and it's not taught in medical school. So we would say, you know, if, and there's a lot of apps that wanna calculate your base on metabolism. So you'll put in your age, you know, you know your sexual weight, whatever, and it will say, okay, you're based on your average, based on metabolism is, and so be 1,600 kilos per day.

Andrew (26m 30s):

If you wanna lose weight, you've gotta get down, start just taking in thousand whatever. What the book highlights is, if you take a group of, for instance, a group of 10 people who look and, you know, look the same, the same age, same sex, same weight, same bmi, and you look at the highest metabolizer versus the lowest metabolizer of those group of 10 people, the difference in their metabolisms is over 700 kilo calories per day, which is the same as a 10 K run or you know, a large three course meal. And so this is why, and we all know people who, you know, they can eat rubbish and they never put weight on, right?

Andrew (27m 13s):

Cause that's because they, the guys have got the 10 K run just in their genes. That's like without going for a 10 k run, right? And you've got the other guys who have to go for a 10 K run in order to maintain their weight. And that metabolic variability is very dynamic. And I, I looked into how, you know, what, what is the mechanism from a physiological point of view where we can, you know, adapt energy expenditure up and down. It tends to be, as we've said before, if you'll carry a restricted, you know, you're going away from your weight set point, you're gonna get that pulled back based on metabolism is gonna collapse. If on the other hand you're overeating, which is what most people do in western society, actually quite often, you know, if we calculate how much weight the population should be putting on it should be putting on her a lot more than it actually is because our buddies are pulling us back from, you know, gain too much weight too, too fast.

Andrew (28m 8s):

So actually most people are over metabolizing and the mechanism is, and you have heard of this, the, the, the vital flights response, the sympathetic nervous system, you heard a little bit about that. So this is something where, you know, if we're scared by, you know, in the, in the old days, like an animal or line, you know, you're gonna like get freaked out stress

Brian (28m 33s):

Response, Yeah.

Andrew (28m 34s):

Start losing a lot of energy. You're gonna be like very, very strong. The glucose levels are gonna be up and you're gonna expand a lot of energy. You're gonna be able to, you're gonna be able to think really fast and stuff like that. And that's, so that's the sympathetic activation and then the parasympathetic activation. Parasympathetic activation is when you are just relaxed and chilled out and there's no threat and you're conserving energy. You can imagine just laying on the sofa now, just you hardly it's down, you're cold, whatever. There's quite a lot of evidence when they look at studies that have voluntarily starved people and they've lost 10% and then 20% of their weight and overeating experience where they're put on 10% and 20% of their weight.

Andrew (29m 19s):

And those studies show that it's the, it is the autonomic nervous system, so of sympathetic parasympathetic tone of, of someone that would change and alter, you know, the metabolism upwards or downwards. So people who are overeat have got increased sympathetic tone. And this is most people, which is a reason actually for most of the population in Western, but a lot of western population is suffering with high blood pressure. You know that when

Brian (29m 51s):

I was just gonna say, so you're saying

Andrew (29m 53s):

Effect of over metabolism, over metabolizing. So everyone has an increase who overeat in the west has an increased sympathetic tone because they're burning off more so that they don't put the weight on so that they can maintain, you know, not the body's actually trying to maintain their, their weight set points at that level despite them trying to like, you know, overeat. And so they, a lot of people have a, an increase sympathetic tone if you go to like the heart clinic, if you get a patient who's not dieting, you know they're gonna have high blood pressure, they're gonna have fast heart rate, that sort of thing, they're gonna be sweating all the time because the core temperature is high. But they're like obviously responding to that.

Andrew (30m 36s):

We know that the best treatment for high blood pressure is to kind rere restrict someone. And so this sort of fits in. So those studies really shown and highlighted the importance of what we thought was just due, due to, you know, a stress response. Actually the probably more important function of that autonomic nervous system response is metabolic regulation and keeping us at a level of the weight that our responses to be.

Brian (31m 5s):

Mm. So when you, when you talk regarding a stress response, are you saying that people are tend to like overeat due to just being stressed? Are you No,

Andrew (31m 19s):

I think that every, well obviously like the western, you know, societal stress is work, family, you know, whatever cause increased causes are, which will, you know, increase people's appetite and their weight and that's something that's just, we know it's similar to if you almost like living in the west is almost like a proxy drug. So if I started treating you with steroids, I put you on Prednisolone, you would in six months or three months be, you know, a stone heavier, you know, you try and fight it but you'll just be a stone heavier even if you're someone who able to maintain your weight for a long time.

Andrew (32m 1s):

Same thing happens with the western. So the cortisol stress response, you know, some people are gonna be quite sensitive to increasing courts level and that's gonna be one of the causes of their, their obesity. Right. What was your question again?

Brian (32m 13s):

No, I I was just saying if you were trying to draw a line between stress and weight gain.

Andrew (32m 19s):

Oh, overeating. Yeah, I mean the other thing we have is, you know, like we do have the food industry is, you know, it wants to make a profit, it wants to sell food, it wants to make food delicious and addictive and there are, you know, significant, you know, addictive elements in processed foods which will get you hooked basically like a drug. So that's another, you know, cause of overeating.

Brian (32m 42s):

Now you talk about

Andrew (32m 44s):

Figuring of habits by advertising, you know,

Brian (32m 47s):

Oh yeah, the holly payable processed foods and I, I know you always mentioned the west and you're in London is are the food habits where you're at just as bad as they are or they can't be here in the, in the, in the west. That's

Andrew (33m 3s):

Another interesting thing. So yeah, I mean you can say like the weight set point of someone will alter as they alter a country or food that they're exposed to. So I have a lot of patients who, a few patients who maybe when they move to America they put on some lights and then when we moved back to London they lose weight without, you know, any effort when they moved to, I don't know, UAE

Brian (33m 28s):

From just from a, yeah, just from a change in environment, right?

Andrew (33m 31s):

Yeah, just the quality of the food and you know, like we have a big problem with obesity in the UK but you know, when you go to America there's certainly a, a bigger problem and then when you look at the type of food that's available to the population, you realize why. And then you gotta bear in mind, you know, we see a lot of fat people around or obese people around, but you know, a lot of them are many of them hiding away.

Brian (33m 53s):

Yeah. And you talk about 75% of it being genetic, 25% being environment and you know, I guess to someone who, who is obese is that, can that be sort of a tough pill to swallow I guess? You know, like the fact that yeah,

Andrew (34m 12s):

But you know, the human race and all animals are very heterogeneous so they have, you know, differences in a genetic makeup in order to help them survive changes in the environment. You know, if we're an environment where certainly there was a true shortage, the people who have, you know, the genes that have, you know, efficient metabolisms, you know, can, can still weigh easily. These are guys that would survive, you know, you know, world catastrophe where there is not much food unfortunately we're in, you know, the other extreme where there is far too much, not only calories available, but also the type of food that's gonna cause these people to, to, to put weight on.

Andrew (34m 57s):

I think you just have to understand that, you know, you are, you are prone to weight gain if you eat bad foods. And in a way, and I say this to patients, you can look at it as a positive in that you know, that you have to eat healthly, you know, you have to eat, you know, mainly old fashioned foods, meat, fish,

Brian (35m 16s):

Vegetables, single single ingredient foods, little

Andrew (35m 19s):

Bit of, yeah, bit of exercise, you know, compared to the guy who was naturally slim might not eat very good and may not exercise actually from a metabolic standpoint, you know, he's not that healthy. He looks okay, right? But you know, at least you are forced if you want to be, you know, a regu relatively normal weight, you're forced to be healthy. So once they get that, you know, it's, it's, it's not so bad. But I mean the whole, the whole thing about like obesity being 75% preordained is from twin and adoption studies. So these have many different studies throughout lots of different countries where they look at identical twins that have been adopted by different parents, different families at birth.

Andrew (36m 10s):

So obviously they've got absolutely identical genetics and they found that there was a a 75% concordance with their weight. So if you're from a slim family, both, you know, both offspring are gonna be slim. Even if one's brought up in a, in an environment where you know there's bad food culture and you know, not much exercise, they're still gonna look like their sibling, which is sort of what you'd expect. They're gonna have the same color eyes and they're gonna be the height. So you would expect probably, you know, similar weight, obviously if you, if one is grows up in, you know, rural Africa and one grows up in New York, then they're gonna be different because one's not gonna be triggered.

Andrew (36m 51s):

But like if they're, if they're brought up in the same country where basically you are exposed to pretty much the same food, then they will be similar weight afterwards.

Brian (37m 3s):

And I know you touch on in the book a little bit, maybe we can talk about it as the omega-3 versus omega six fatty acids and, and how that could play a role in, in in weight gain.

Andrew (37m 13s):

Yeah, so I mean ratio, Yeah I mean we know about ketogenic dieting, we know about the, the importance of insulin signaling. But I think the other major important factor that, you know, western populations have become fat is this big change in our polyunsaturated fat acid profile on ourselves. So just to explain poly and saturated fatty acids or essential fatty acids like fat vitamins. So we can't, we can't make them, we can make pretty much everything. We can make cholesterol, we can make, you know, lots of things, lots of different types of fats but we can't make two types of fats and one is only omega the three and one is only the six and as I said, they like fat but we don't really understand like lipid metabolism very well yet we don't understand it like we understand you know, vitamin you the importance of different vitamins and what they do.

Andrew (38m 11s):

So this sort of area is, you know, formative research at the moment. But we do know that the ratio of omega three to O omega six on your cell, every single cell has got omega3 and omega six. It determines one how well insulin is gonna be into, into the and two the of inflammation around in the body when you go, sorry. So, and the two types of fatty acids are included in two different types of foods. So omega three is included in basically anything green leaf, you know, so and anything that's eaten grass and green leaves and plankton so

Brian (38m 59s):

So like oily fish, right? Fatty fish get high on omega. Yeah.

Andrew (39m 6s):

This is why you know, fish got so much three in them cuz they built well non farm fish, right? So natural fish, you know, sea fish because they planked him.

Brian (39m 16s):

That's a whole nother, that's a whole nother topic. All the farm fish and what and what they're eatings you know and

Andrew (39m 22s):

This is what yeah well there's two of them, the three six profile as well. Very importantly cuz yeah there is a big difference in the only the three profile of farm fish compared to the non-farm fish. And it's the same with meat from cattle that have eaten grass rather than than

Brian (39m 38s):

Corn soy.

Andrew (39m 40s):

So the O omega six on the other hand is found in seeds and we know that you know foods that have a lot of O omega three. So going back to the, you know the good, the good ones O omega three, they tend to oxidize really easily so they go off so can imagine fish going off within 24 hours if it's left out. You know, anything that goes off basically probably has got quite a lot of am omega3 in it cause it oxidize the am omega3 cause oxidization. But this is not good at all for you know, food that is being bought and sold by food manufacturers. They don't like food going off. They need food to be.

Brian (40m 18s):

When you say food going off, you mean like getting bad? Getting Yeah so

Andrew (40m 22s):

Yeah sell day. So there are two types of food that have and we got three and then we get six and we three is the good one for ourselves and then we get six is not so good and we get three is in fresh foods and then we get six tends to be in process foods am omega3 comes from any food you know that is grown from a plant grass has got a lot of am omega three leaves anything sort of associated with chlor? Yeah chlor chloroplasts. So plankton as well in the sea. So anything that eats plankton. So this is why fish have got high am omega three levels and you know, this oil is really good for us am omega six tends to be in seeds and, and nuts and that sort of thing.

Andrew (41m 10s):

It's almost like a winter type food but it's been used by the, you know, the, the food industry to produce vegetable oils. So natural oils and vegetable oils which we have sort of told is good for us. But actually when you look at the science, it's not so good. And food that you know, as I say is fresh tends to go off and it's not great for the food industry cause they make profits cause they can sell on self shelf for very long. Whereas food that can stay on the shelf for a year or six months or whatever tends to have all the am omega3 removed from it cause of with oxidized and a lot of am six oils and and stuff like that in there to preserve it. We know that if people are exposed to a western diet am wego three six ratio on their cells.

Andrew (41m 55s):

Cause these two fat acids are play an essential part in insulin signaling on ourselves. That ratio goes from so am wego three to am six ratio goes from between one to one and one to four not naturally to when you exposed to a western diet one to 20 to one to 30. So there's a massive dilution of the effect of O omega three on every cell, you know, in your body. And O omega three facilitates insulin messaging, so you don't need as much of it and also decreases inflammation. Whereas O omega six interferes with insulin signaling.

Andrew (42m 35s):

So you need more insulin and also incor increases in inflammation. So in an indirect way it it's almost like having a, yeah, a highly refined sugary diet, but actually it's because it makes your cells need more insulin because the insulin isn't functioning properly. So yeah, this is the reason that, you know, from a, when you look at the sort the data of populations exposed to Western diets, you know, they, as soon as they're exposed to western diet, they have a problem, you know, with obesity t and I think it's not just sugar and refin carbohydrates, I think it's the, then we get three six profile as well, which is why, you know, fast food, you know, it doesn't have to have a load sugar in, but if it's dripping with vegetable oil, it's gonna have a really me a detrimental effect on your metabolism and increase your weight step point.

Brian (43m 28s):

Yeah. And, and I know you talk I think a little bit in the book regarding, you know, cooking your own food. And I always touch on that on this podcast because you know, you can control what's going in it and you're, you don't have to cook in these vegetables when obviously these vegetables get heated. They get oxidized, they can cause inflammation as opposed to cooking in, I like to use ge, but you cook in tail even, you know, they

Andrew (43m 55s):

Can, we started on those saturated fat arguments. So there's a big section in the book on, you know, how that, you know, whole scare story of natural saturated fat in dairy products and you know, red meat causing, you know, ultimately heart disease. It doesn't, if you have this, you know, condition familial hypercholesterolemia, one in 500 people have that, you and you tend to really struggle, you know, in your forties you're dying from heart attacks and things like that. Yeah, you've gotta avoid saturated fats, but if you don't have that, you know, saturated fats are very neutral as far as, and we a three six profile, I was concerned they're not gonna cause obesity.

Andrew (44m 35s):

This is a, you know, it's got a terrible name fab, it doesn't make you fab people, but it doesn't, it's actually really good, you know, and you know, the developing people in the developing world and you know, the yeah, the non-western world understand the, you know, the nutritional value of saturated fat. This is why awful, you know, the in the inns of, of an animal are praised so much more than, you know, the meat are an animal, you know, we instinctively know that this food is good for us. So yeah, all of those studies that looked into the relationship between saturated fats, cholesterol levels, and levels of heart disease are explained in the book and, you know, they're unpicked and that, you know, that body of research is seriously flawed.

Andrew (45m 23s):

And when, you know, the food scientists started to tell us, look, you've gotta avoid saturated fat. We went into a diet of, you know, much more refined carbohydrates and the whole population became a beast. This was like in the early eighties. So yeah. Big epidemiological markup.

Brian (45m 41s):

Yeah. Yeah, yeah. And that's something that's, that gets talked about a ton in the states. I think more, a lot of people are understanding this, that doesn't mean the food manufacturers necessarily are changing their ways, but that's why it comes down to if you,

Andrew (45m 54s):

This is the problem. The problem is, you know, when something is so ingrained in a population, it's really difficult to, you know, get that, you know, get that out.

Brian (46m 3s):

Right. Oh, I know,

Andrew (46m 4s):

Like, and this, you know, when you go and have your juicy steak that you know, that's gonna fer up your arteries and this is how we think, you know, this is how you, you capture over's gonna think, you know, it's been, you know, hypnotized into this, you know, but it's not true. It's really good for

Brian (46m 22s):

You. Yeah. Now, I know we're coming up on, on about an hour here, but I just wanted to ask you one, one last question that I ask all my guests. If you would give, and you've given a lot of, we've gone through a lot of good tips, but if you were gonna give one tip to let's just say a middle-aged individual that was looking to, you know, get their bodies back to what it once was maybe 15, 20 years ago, what, what one tip would you give that individual

Andrew (46m 48s):

Like your lead a hundred years ago?

Brian (46m 52s):


Andrew (46m 53s):

So natural home prepared foods, you know, no takeaway, no processed foods, don't snack, people didn't use the snack. That's a bad habit. We got into two meals or three meals a day, you know.

Brian (47m 5s):

Yeah, yeah. Like in, in the seventies right. People would have three meals a day and now it's 6, 7, 8 meals.

Andrew (47m 13s):

Yeah, exactly. We're just totally constantly topping up our insulin levels and making ourselves fat. Yeah. So,

Brian (47m 21s):

Yeah, I like that. I like that. Well, thank you so much for coming on your book. Why we eat too Much, The New Signs of Appetite. I'll, I'll definitely put a link in the, in the show notes for that. And is there a good place for people to follow any, you know, any of your other things that you're doing maybe when your new book comes out?

Andrew (47m 41s):

Yeah, I'm on Twitter R as a a d Jenkins, So yeah, at a d Jenkinson one.

Brian (47m 51s):


Andrew (47m 53s):

But I'm not very active on it, but I've got a lot of historical stuff that I put in there, so, and when the new book comes out and yeah, whenever any translation comes out of this book up at the cover one, it's been translated into main languages, so. All good. Yeah.

Brian (48m 9s):

Excellent. Well, thank you so much for coming on the podcast. We, we, we got our times right? You, you being in London and me being in Chicago, so I appreciate all the knowledge and thanks again for coming on.

Andrew (48m 22s):

Thanks Brian. Brilliant. Thank you. Fantastic.

Brian (48m 26s):

Thanks for listening to the Get Lean Eat Clean podcast. I understand there are millions of other podcasts out there and you've chosen to listen to mine and I appreciate that. Check out the show notes@briangrn.com for everything that was mentioned in this episode. Feel free to subscribe to the podcast and share it with a friend or family member who's looking to get their body back to what it once was. Thanks again and have a great day.

Dr. Andrew Jenkinson

Andrew Jenkinson is a Consultant in Bariatric (weight loss) & General Surgery at the prestigious University College London Hospital, part of UCL.

He qualified from Southampton Medical School & soon afterwards was awarded the Fellowship of the Royal College of Surgeons. After completing a Master of Surgery thesis in Laparoscopic Surgery he moved to the Homerton Hospital in Hackney, helping to build it into the busiest bariatric unit in London. He has travelled the globe presenting his research & teaching bariatric surgery.


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