The Rich Roll Podcast - Optimize Your Gut to Fight Disease With Tim Spector

Episode Date: May 22, 2023

As Hippocrates said, food is medicine. But what food specifically for which person? Under what particular circumstances? And when? Thanks to some astonishing breakthroughs in medical technology, scie...ntists are at the threshold of prescribing food to sidestep disease, predict diagnostic outcomes, promote longevity, and enhance well-being on a highly individuated basis. The era of personalized medicine is upon us. And at the tip of this revolution is today’s guest, Dr. Tim Spector. Arguably the world’s leading authority on the cutting edge of microbiome research, Tim is a globally-renowned epidemiologist and geneticist. He is also the bestselling author of several books, including The Diet Myth, Spoon Fed, and his latest work, Food for Life, an in-depth, scientific breakdown of what and when to eat, and ways we can all improve our own personal nutrition. This is a fascinating conversation that will leave you reframing the importance diet plays in your life—and what the near future holds for better health for all. Show notes + MORE Watch on Youtube Newsletter Sign-Up Today’s Sponsors: Seed: seed.com/richroll ROKA:  http://www.roka.com/ Squarespace: Squarespace.com/RichRoll  Caldera Lab: http://calderalab.com/richroll SriMu: http://srimu.com/rrp

Transcript
Discussion (0)
Starting point is 00:00:00 The Rich Roll Podcast. The whole of nutrition advice had been so muddled and confused. It's not about, you know, that one thing that you do or you don't do. It's about the holistic view. What can you get on your plate? If three quarters of it's filled with a giant steak, there's not much room for your plants. Food is medicine. We are now at the threshold to prescribe foods to sidestep disease, predict diagnostic outcomes, and enhance well-being on a highly individuated basis.
Starting point is 00:00:42 And at the pointy tip of this revolution is today's guest, Dr. Tim Spector. Professor Tim Spector. Professor Spector. Medical professor, Tim Spector. Many consider you to be the leading expert on gut health and diet. Tim is a globally renowned epidemiologist, geneticist, and author.
Starting point is 00:00:59 Microbes are these microscopic organisms that builds this community in your gut. Only recently we've discovered are like mini pharmacies. Awarded the distinction of Order of the British Empire. Tim is also the bestselling author of several books, including The Diet Myth. And his latest, Food for Life, is an in-depth scientific breakdown on what to eat, when and why to improve our own personal nutrition. In this episode, we expand upon my many past conversations
Starting point is 00:01:25 about the microbiome. We talk about the importance of plant diversity in one's diet. We talk about the environmental implications of food systems and consumer food choices, the future of food, microbiome science, and plenty more. Before we dive in, let's acknowledge the awesome organizations that make this show possible.
Starting point is 00:01:42 awesome organizations that make this show possible. We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because unfortunately, not all treatment resources adhere to ethical practices. It's a real problem, a problem I'm now happy and proud to share has been solved by the people at recovery.com,
Starting point is 00:02:32 who created an online support portal designed to guide, to support, and empower you to find the ideal level of care tailored to your personal needs. They've partnered with the best global behavioral health providers to cover the full spectrum of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Plus, you can read reviews from former patients to help you decide.
Starting point is 00:03:08 Whether you're a busy exec, a parent of a struggling teen, or battling addiction yourself, I feel you. I empathize with you. I really do. And they have treatment options for you. Life in recovery is wonderful, and recovery.com is your partner in starting that journey. When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com.
Starting point is 00:03:52 Okay. Right now, let's get into it with Dr. Tim Spector. This one is appointment listening. Enjoy. Well, Tim, it's a delight to have you here today. Thank you for coming. As I mentioned to you a few minutes ago, I've had the privilege and the pleasure of hosting many conversations about the microbiome, about gut health over the years, including the good Dr. B, Will Bolzewicz, friend of the podcast, who's sitting right over there right now, who accompanied you. But today is a particular honor because as Dr. B insisted I make clear, you truly are the world's leading authority in this field at the cutting edge of all this fascinating emerging science that's creating a new way of learning about how our bodies work,
Starting point is 00:04:38 how they operate in the world. And it's very exciting. So not only are you somebody who's innovating new research, you are also pioneering this fascinating field that I wanna learn more about that we're calling citizen science, which we're gonna get into. But I think the best place to begin
Starting point is 00:04:58 is just to understand what got you interested in this field, kind of the origin story behind this and kind of defining our terms with respect to, you know, what we're talking about when we're talking about gut health in the microbiome. Okay, well, it's great pleasure to be here. Big fan of the podcast. So very excited.
Starting point is 00:05:18 And my journey has been a bit of a long one. So I- We got time. Plenty of time. Okay, so, cause I'm old so that's what makes makes one's career longer um i started life as a doctor went to medical school and got interested in epidemiology which is a study of populations uh but there was no real jobs in that so I trained as a rheumatologist studying bones and joints and made my way up training and that in London in medical schools and on the way I did a
Starting point is 00:05:56 master's in epidemiology that was still interested in that side of why diseases happen in populations this sort of detective in me that wanted to find out why things happen and i when i did my um three years research and my thesis in in that whole area and it was only really after in about 30 years ago that I changed tack from purely rheumatology and I started what's called the Twins UK project, which was setting up this twin volunteer system across the UK, which now has 15,000 twins in it and has been running out for 30 years. So that was the largest of its kind in the world, where we were intensively looking at these twins as they were getting older
Starting point is 00:06:53 and looking at a whole range of disease. And obviously started with bones and joints, which at the time no one knew much about. And the whole idea of the twin study was this nature of inertia debate. And it was a really cool time to be doing that because many of the diseases we thought were purely due to aging, for example,
Starting point is 00:07:16 ended up having a big genetic component. And many things that we thought were genetic ended up not being particularly genetic. So we found that back pain was three times more genetic than breast cancer. Interesting. And also to interject here, the state of science with respect
Starting point is 00:07:37 to what we understood about genetics in 1992 is very different than it is today. Yeah, it's hard to believe how much our opinions have changed and how, you know, the scientists and doctors of the time have had these fixed views about everything was degenerative. It was just everything was wear and tear. And your body just wore out. And that was a common thing for anything to do with aging.
Starting point is 00:08:02 And the idea there were these big differences between people really wasn't really considered so it it was really quite exciting to be able to write these pivotal papers to disprove a lot of you know clinical nonsense that had been talked about and and why some disease were given more priority than others because they're more exciting, they're sexy diseases. Others were sort of dull aging diseases. So that was the time we were living. And it was also just as the genetic revolution was starting. So we were starting at gene markers, et cetera.
Starting point is 00:08:39 But it took the first 10 years was really convincing people that there was a genetic component to common diseases. Up to that point, really only been the rare ones that people had focused on or the sort of exciting ones. So that was a cool time. And I came out of my little field of osteoporosis and arthritis and back pain into all the other common chronic disease of aging.
Starting point is 00:09:07 And that led us to publish all kinds of fascinating work and made me realize that if you had a model that worked, you might as well study all the interesting stuff you can, not be stuck in a specialty like most of my colleagues remain. So from what I understand, I mean, obviously, when you're studying twins, it's fascinating to see a difference in outcomes
Starting point is 00:09:32 between two different people that share the same genetic makeup and then trying to figure out like why those, what's driving that differential, right? What aspect of their nurturing or their environment is compelling one to become ill and the other one to remain healthy? But was there some sort of epiphany along the way
Starting point is 00:09:57 that triggered this fascination that led you into the microbiome? Or how did that kind of evolve out of studying these pairs over so many years? Well, I think I eventually got out of my system that everything was genetic. So I was telling everyone everything's genetic. It turns out that 50% is the, of every,
Starting point is 00:10:19 you name any disease, 50% roughly is genetic. And that got a bit dull. It's not a very satisfying answer. No, it wasn't. And it was useful because we then went on to find genes. But as it turned out, they weren't that useful either, other than maybe for long-term drug targets and things. But for me, I started looking more closely
Starting point is 00:10:43 at why identical twins who were basic genetic clones and lived the first 18 years of their life completely together ended up often dying of different diseases so the aging process was different there was no real genetic base of longevity it was very small one would die of cancer the other one wouldn't one would get autoimmune disease the other one wouldn't one be depressed one wouldn't so i was suddenly intrigued why we were seeing this when you know all the previous stuff was showing it was quite it seemed to be genetic and yet the identical twins which this perfect model of these it's like you know all of us have this shadow person that can be doing
Starting point is 00:11:25 in a living in a different environment to us uh what happens to them it's like your own little controlled study and so i was fascinated by this and i was then determined to try and look and see what were those factors was it gene mutations that were different between them don't know that wasn't the case I looked at something called epigenetics, which is where you can switch genes on and off with chemical signals. Did that for a few years. Only small differences
Starting point is 00:11:52 that couldn't really explain these big effects. And it was then, it was about, yeah, 2000, about just over, you know, 11 years ago that I came across the microbiome and said, let's test this in twins. And that was really epiphany because I found that identical twins had very different microbes.
Starting point is 00:12:15 And it was the first time in 20 odd years of studying them that I'd found something really different in identical twins. And suddenly i said wow that's that's kind of that is really cool because why should they be different and yet if they are different that could explain why we we all get different diseases slightly what we thought was randomly because of this whole new organ in our bodies that is behaving very differently in all of us
Starting point is 00:12:47 and essentially producing lots of different chemicals. So I think it was an aha moment, both for realizing what we thought was this randomness of disease, but importantly also changed my perception about how food works as well and why in a way the whole of nutrition advice had been so muddled and confused
Starting point is 00:13:13 and seemingly with poor science because we'd assumed everyone behaves the same. Once that food goes into you, it's gonna behave the same way in everybody. And suddenly knowing that even identical twins, they only share maybe a quarter of their microbes,
Starting point is 00:13:30 means that in response to the same food, they're all going to respond very differently. So that was the theoretical moment when I said, aha, this could be really interesting. I'm going to spend,
Starting point is 00:13:41 you know, the next at least decade working on this rather than all these other areas, which I could work on to try and get to the bottom of it. Cause I think it can be much bigger than just looking at a few microbes. Right, so it is quite a watershed moment or a paradigm shift to realize
Starting point is 00:13:58 or to kind of reflect upon this conventional perspective, which is our genetic makeup is what differentiates us. And it becomes this predictor of a variety of things. But in reality, the genetic differences, like we're much more genetically similar than we are different, right? And that's a very set number of variables. It's still incredibly complex,
Starting point is 00:14:23 but it feels very simplistic in comparison to the diversity of the microbiome and understanding that maybe a better way to look at it is through the differences in these trillions of microbes that are dramatically different from one individual to the next, irrespective of similarities in their genetic makeup. Like, and using that as a lens
Starting point is 00:14:49 and then trying to sort of wend that or tie that to certain outcomes as a predictor seems like an impossible not to untie because of the infinite number of variables involved. Yeah, it's sort of mind boggling the complexity of it. But I think it's becoming clear that, yes, there are lots of different strains and microbes and trillions of them.
Starting point is 00:15:19 But the thing that does bind them in common is they are essentially mini pharmacies. They are taking a food as their sort of consumables and pumping out all kinds of chemicals that are unique to us and our system and in completely in different amounts. And so there is a certain amount of redundancy in these microbes,
Starting point is 00:15:43 but the difference, and I think that the key difference is not so much the microbe, but the products they make, the chemicals. And that's the essential, for me, the big difference is understanding food and nutrition, not as macronutrients or these rather old fashioned ways of looking at it, but in chemicals,
Starting point is 00:16:06 that we are converting one set of chemicals as food by our microbes into these other chemicals which have massive effects on our immune system, our brains and our bodies and our health. And I think as complex as the microbiome is, it can be simplified by understanding those chemicals and this whole science of metabolomics, which is a study of studying these metabolites.
Starting point is 00:16:33 So I don't think it's an impossible scenario at all. And luckily, because of the genetic revolution, we have the tools now to measure our microbiome incredibly accurately and actually uncover 75, 80% of the microbes that are in there, which is pretty, you know, we wouldn't have believed that possible.
Starting point is 00:16:57 Yeah, yeah, yeah, that's unbelievable. 10 years ago, and the cost has come down from $5,000 a sample to less than $100 a sample in 10 years. So it's been an incredible journey. And, you know, we're just really scraping the surface of what we know about these things, but they have huge potential in all kinds of areas, not just in nutrition, but in pharmacy and fighting disease and everything else because of this, all these incredible chemicals
Starting point is 00:17:28 they're producing all the time that we co-evolved with. So before we even go any further, it would probably be good to just define what you mean when you say the microbiome, like what are we talking about specifically? In general terms, the microbiome is the term we use for the community of microbes, microorganisms that live in our bodies. And we generally refer to the 99% that live in our lower intestine, our colon. And the microbiome really refers to the genes of those
Starting point is 00:17:58 microbes, should technically be called the microbiota, But we just use them as microbiome because I'm not fussy about words and everyone now understands that. So there are some dispute about how many there are, but there are certainly trillions, maybe 100 trillion or so, roughly the same numbers of cells in our body. Most of them are the ones we know about are bacteria, but there are also these other related species called archaea,
Starting point is 00:18:29 and there are fungi and yeasts, and there are viruses, five times as many viruses as bacteria that feed off them called phages, which also have a role in health. And there are even parasites that virtually all of us have to some extent in our guts and some of which turn out to be beneficial as well so it's this whole community a bit like an ecosystem that is living within us and it best considers a virtual organ stick them all together they weigh about two kilograms same as your brain and they're basically as i said these mini pharmacies pumping out chemicals which send
Starting point is 00:19:10 signals all over a body but particularly to all the immune cells the majority of which are immune cells are actually lining our gut and so they interact with those immune cells on a constant basis, signaling whether to be aggressive or be passive and modifying them, tuning them up and down. That helps fight aging, helps fight cancer, sorts out allergies, et cetera, et cetera, fights infections. And they also produce lots of chemicals that might go to our brain,
Starting point is 00:19:43 responsible for serotonins and many other pathways in the brain as well. So it affects our mood and obviously our metabolism and how we digest food amongst others. Right, like so many things, right? Infinite things. But this idea that our immune system really resides in our gut is kind of a shocking revelation. Like I always understood that our immune system really resides in our gut is kind of a shocking revelation.
Starting point is 00:20:05 Like I always understood that our immune system originates in our bone marrow. And this is where we're producing all these cells. Yeah, this is why, yeah, this is. And why is it that we didn't begin to really even put these pieces together in a methodical way until, I don't know, the early 2000s. Like, it seems like you kind of got into this around 2011, right?
Starting point is 00:20:31 Like this is all extremely recent because prior to that conventional wisdom was sort of like, you know, we gotta get rid of parasites and all this stuff. These are plaguing the human body. And at some point somebody figured out like, actually we're living symbiotically with all of this. And this is crucial to every facet of health. And we're still, it feels like in the very early beginning
Starting point is 00:20:56 stages of trying to understand the true and vast implications of this incredibly complex system. I think it was medical hubris that says that, our powerful drugs can get rid of this incredibly complex system. I think it was medical hubris that says that, our powerful drugs can get rid of this stuff. We're fighting the West, the world. We know that microbes have killed lots of people in history, infectious diseases were vitally important. We survived them.
Starting point is 00:21:19 Therefore, we can beat them and antibiotics, sterilizing creams, keeping people away from dirt. This is the way we're gonna conquer our sort of our fears. And I think it was a blind spot to realize that the gut health really was important. And for so long just regarded that the intestine is a tube to get rid of toxins.
Starting point is 00:21:45 Right. And that's it's only- Absorb nutrients and- Some people still believe that, right? But you know, particularly the toxin bit, but the not realizing it had such major implications as a vital organ for us. And I think it was, you know, few people guessed at it.
Starting point is 00:22:03 And even the, you know, you go back to the days of 100 years ago, Metchinkoff and Pasteur talking about yogurt. They thought it worked because it deputrified the body, you know, got rid of those toxins. They couldn't still imagine that it was feeding other microbes inside there. So I think we just had a blind spot to it. Some people believe the ancient Indian art,
Starting point is 00:22:28 you know, understood the sort of core of the gut to health. And so ancient Chinese and ancient Indian did know, but of course they couldn't see these microorganisms, couldn't grow them. And this has been part of the problem. Medical science just couldn't see them until genetics came along. And so over the course of the 30 years
Starting point is 00:22:52 under which the Twins UK research has been ongoing, there's been like a thousand research papers that have come out of this. What are some of the revelations that have emanated out of looking at twins through this lens? Oh, it's hard to pick highlights. Because there was some revelations at the time, they might seem rather dull now.
Starting point is 00:23:16 Like I was saying, back pain is highly genetic. Might not surprise people now to say, but other ones were, one of the first to look at fat distribution was highly genetic. So whether when you put on weight, whether you accumulate it in your belly or your bum, really strongly genetic. And you can see that in families. It's sort of obvious.
Starting point is 00:23:42 We showed for the first time that cataract wasn't just was something you inherited as well um we looked at um early risk factors for melanoma found that because everyone talks about melanoma they're always talking about sunshine which is a really overrated risk factor for melanoma, it's actually highly heritable about whether you have these lots of moles. You have light skin and lots of moles, much stronger genetics than anything else. And so you can divide people into those groups.
Starting point is 00:24:17 And twin studies helped us with that. And we did some fun stuff. We found sense of humor wasn't particularly genetic. Political views were. So your right-wing views or your left-wing views have got a strong heritable basis. Interesting. As does belief in God have a heritable basis.
Starting point is 00:24:42 So there's nearly anything that you can quantify, you can study in this way, if you can quantify it reliably and get the similar answer. So it allowed us to look at sexuality as well. And we were the first to look at the genetics of female sexuality. And so you can study any personality or trait in that way, as well as things like the microbiome, epigenetics, which, you know, again, has some genetic influences, and even things like vitamins. So people are always talking about, oh, my vitamin D level is low. Well, we were the first to show
Starting point is 00:25:26 how that was strongly heritable and that there are certain genes. So 50% of the differences between say our vitamin D levels are gonna be due to differences in our genes. So what's normal for you, isn't gonna be normal for me. And how does epigenetics play into that? From my understanding, epigenetics basically means the potential for genetic expression.
Starting point is 00:25:51 And also this idea that we're kind of storing genetic information passed on from our ancestors that is perhaps latent, but given the right set of circumstances could be expressed. Like how, you know, that seems like a sticky wicket and very complicated to kind of understand. And there's a certain aspect of it that's sort of mystical in terms of like the inheritance of like ancestral trauma and things like that. Like how does that play into how you think about this and study populations?
Starting point is 00:26:27 Well, I wrote a book about this called Identically Different, which nobody read, but I think it was a great book, but you know, as often the way. And went into a bit of this and a bit theorizing about it. And it's been called soft inheritance. So it's an inheritance. We think it's an evolutionary adaptation that allows in times of stress or famine or some emotional stress to just switch the genes on or off in a way that takes you on a different path to some extent. And the general belief is that
Starting point is 00:27:06 it takes so long to change your genes normally that your whole family would have been wiped out by that time you'd made that switch. But if this allows you to, I don't know, there's a temperature change so it allows you to switch so you gain more weight or just the fact that your family might all be switching their genes so that
Starting point is 00:27:26 they end up more different so they're not all going to be wiped out by the same environmental stress or infective agent makes some sort of sense so but it just lasts for a couple of generations and then fizzles out so in when i was looking at, I did interview lots of identical twins who went through stress, for example. And it was quite remarkable that, say, a very major family breakup or something when the teenage twins, one, for example, responded by overeating and got very obese and the other one had an eating disorder and ended with anorexia.
Starting point is 00:28:05 So they were acting in response to a stress, but very differently, probably because in theory, the genes were switched and doing something. But there was something in our evolution that allows us to have these switches and make you depressed or happy and these things. So I think in response to stress, it does make some sense.
Starting point is 00:28:29 And there are lots of stories about after the war, Dutch hunger famines, whole populations having these stresses, which for several generations had effect on their mental health or others due to these change in genes. So it's a lovely, it's a nice theory, but it's been really hard to prove it in humans. Mice, it sort of works quite well as often the case.
Starting point is 00:28:55 And you can change mouse hair color, for example, just by giving them different vitamins and things, switching them epigenetically or giving them alcohol or whatever. Can't do that in humans. It's gotta be so frustrating to see, amazing kind of dramatic results in mice studies and not be able to replicate that in humans.
Starting point is 00:29:14 I mean, that seems to be kind of like the recurring theme across all areas of science. Millions of scientists have been frustrated. That's why I didn't get that Nobel prize. You know, humans just don't behave like mice. It's very annoying. Right, and the mice studies are what, you know, generate a lot of hyperbolic headlines
Starting point is 00:29:33 in terms of breakthroughs. They still do. It creates a lot of consumer confusion. And they still do. And it's similar in the microbiome. It's not very, it's not different. And there were, you there were some misleading studies in the early days of the microbiome
Starting point is 00:29:47 that just exaggerated the potential effects in humans. So I think they were accurate, but from mouse studies, you can't really get an idea of the scale of the effect in humans. You don't know if it's trivial or it's really large. And I think that's the other sort of problem about extrapolating.
Starting point is 00:30:09 And, you know, we're not rodents and we have very different lives and we eat different things. And so, yeah, more and more, you know, we realized that a lot of these mouse studies were flawed. And of course you can do unlimited number of mouse studies. You know, you got labs, well-funded labs,
Starting point is 00:30:29 they can afford to slaughter thousands of mice and they don't necessarily report every experiment they do. Right. And that's the other problem, which human trials, they take so long to do. You know, whether it failed or not, you're going to write it up because it's important. So you're starting to develop this, you know,
Starting point is 00:30:57 growing sense that the microbiome is playing a much more crucial role than previously imagined. And this sort of leads you into the American gut project and the British gut project. So talk a little bit about like how that came together and what that was all about and kind of what you discovered as a result of that.
Starting point is 00:31:21 Well, so when back in 2011, there was no one really doing microbiome research in the UK and most of it was going on in the US. So I got in touch with a colleague who I met at a meeting, Ruth Lay in Cornell, and we did all the microbiome testing in her lab there. And she was linked with this group that had all worked with this, really the father of the microbiome, Jeff Gordon, and who based in St. Louis. And Rob Knight was another one of his proteges.
Starting point is 00:31:58 And he learned that I was really interested in this. I was doing the big twin study and told me about his project, which he just started, the American Gut Project, which was a citizen science project getting Americans to sign up, basically donate money
Starting point is 00:32:16 in order to pay for their own microbiome testing. And I said, I was really keen on doing this in the UK and I think we could, you know, British public were up for this as well. And so we got together and under the banner of the American Gut Project
Starting point is 00:32:33 and did this and led to a paper where the UK Inc. provided about a third of the subject. So relatively, it was more popular in the UK given the population density and uh but together we did a great paper um which how many were in that how many were in the study there were about um 11 000 i think it was in the end um which doesn't sound much at the moment but it will it was the biggest study done to date. Clearly showed a link between nutritional eating habits, fiber, and health,
Starting point is 00:33:20 and showed that these clusters, that, you know, measures of gut health, which is then we used something called diversity. The more diverse the species, the healthier you were and the less likely you were to obese or have diabetes. And so this was common to the British and the American populations. American populations tend to still be, they were slightly heavier, slightly less diverse microbes compared to the British. But the key bit of that paper was it was the one that found that 30 plants a week was the sweet spot for maximum diversity.
Starting point is 00:33:56 And that study still hasn't sort of been bettered many years later. And it's been a bit of a mantra for me in the books that I write for the public about trying to educate people about what to eat. And I think what was really important about the study is that it showed as long as you ate 30 types of plant and that's including nuts and seeds and to some extent, herb mixes and spices,
Starting point is 00:34:24 it didn't matter whether you had a little bit of meat, a little bit of fish, nuts and seeds and to some extent, herb mixes and spices. It didn't matter whether you had a little bit of meat, little bit of fish, you were vegan, vegetarian, whatever, your gut health was still optimal. And I think that still resonates with me that it's not about that one thing that you do or you don't do, it's about the holistic view of that. What can you get on your plate?
Starting point is 00:34:48 Clearly, if you've got a big, if three quarters of it's filled with a giant steak, there's not much room for your plants. Right, so the top level rule just being diversity of plant life in your diet on the most consistent basis possible is producing the diversity in that gut microbiome ecology that is going to be,
Starting point is 00:35:11 you know, the sort of front lines of keeping you healthy. Yeah, and it's a nice simple rule that means you don't have to be too strict about anything else because if that's your number one rule, then everything, you know, follow, yes, it's nice to have, you know, the rich, colorful polyphenol rich foods. It's nice, you know, the fermented foods,
Starting point is 00:35:35 we know are good as well, avoiding ultra processed foods, et cetera. But that to me is still number one. And I think that's been a good, a really good way of communicating it also to the public about understanding why I feed your gut microbes, you do it by eating right. And if you do that,
Starting point is 00:35:59 you can't really have ultra processed food. It's very hard to get- You're crowding it out. Yeah, you're crowding it out. Yeah, you're crowding it out. Yeah, I mean, and it's an easy rule to follow. It's flexible, it's doable. It's easy to wrap your head around what that means. And it's withstood the test of time
Starting point is 00:36:16 because that project was like 2014, right? When you were doing that. So I'm curious about how that was received at the time. Like we're all talking about the microbiome now. Was that the case back then? How are your colleagues sort of receiving this pivot in your career and this focus on this new science at a time where this was just emerging?
Starting point is 00:36:40 Well, it didn't have any of the public impact that it has now. So the newspaper- They weren't like you're a nutter, like you've gone off the reservation. Well, I mean, there was- People were saying- There was awareness in 2014, people,
Starting point is 00:36:55 it wasn't like, you know, people were talking about the microbiome. There was an interest then, not like now. There was, but a lot of people thought it was a passing fad that like a lot of these new science, as soon as something comes up, a lot of grants follow it, money goes there. It's hyped up because you write a grant to hype it up.
Starting point is 00:37:14 That's how you get your money. And then it all comes crashing down again. And a lot of people thought that the microbiome was just a few years, flash in the pan, a few fancy mouse studies, you know, there's a few anecdotes of fecal transplants that were successful, it would all fall over. And most of my colleagues in the UK
Starting point is 00:37:35 were not keen on it at all. And so the countries varied about whether they supported it or not. And the UK certainly didn't. And that's because a few powerful people in science just said, this isn't going to work. It's rubbish. We've got to stick with genetics. It's the only way.
Starting point is 00:37:51 And also the nutrition sort of profession didn't embrace it at all either. They felt threatened by it and didn't approach it. So pretty much on my own doing this, often with US collaborators or overseas collaborators and getting maybe commercial money. And we used the citizen science funding actually to get a lot of our work done, where we asked the public to actually pay for our research. And that really got it going. So that was really where we were, you know, up until the time when I realized I wanted to do the next stage.
Starting point is 00:38:39 And I was giving a talk about the microbiome. And that's when I met these two guys came up to me and said, we'd like to form a company. And with all the trouble I'd been getting money academically, I said, aha, this could be my big chance. But I'm warning you guys, the science is very expensive
Starting point is 00:39:05 and there's no quick results the way I wanna do it. I don't wanna do a marketing led project with smiling MDs and a stethoscope on the front page. It's gotta be serious science. It's gonna cost you several million before we get going. So I thought I'd never see them again, but they came back a few weeks later with the money. And so that's where the company Zoe was born.
Starting point is 00:39:31 Right, and the kind of operating principle behind that and the studies that you wanted to pursue were what specifically at that time? Well, we wanted to really test the idea that you could use the microbiome and other blood tests to personalize food choices and nutrition. That there was sufficient variability between people that you could use that to predict everyone's response. And so give people a real idea of what they should be eating. And came out of this idea that, you know, there isn't one single diet that suits everybody. And all these studies like that of Christopher Gardner, the diet fit study where they competed high fat versus high carb diets
Starting point is 00:40:30 and both did well, no winners or losers, but within the groups, massive differences. And at the same time, an Israeli group had come out with a study showing that CGMs, continuous glucose monitors, were able to also predict responses to food. So suddenly the idea was there to combine the microbiome with these new devices on the market
Starting point is 00:41:01 to suddenly have a quantitative way of really telling people how they respond to these foods. But the only way to do that wasn't in theory was to actually do a really big experiment to prove it and see if it worked so it was a big gamble at the time but luckily managed to convince these guys it needed to be done and the study was a thousand people giving a thousand people mainly twins because i still believe there was a genetic component then um who were um studied uh at my hospital st thomas's and and a group were also studied in Mass General, given identical foods at the same time, and then all their bloods studied,
Starting point is 00:41:50 and work up for 24 hours and then for two weeks onwards. And it was that experiment, which was the largest of its kind, that really was the basis for everything else we've done since then. And that was the PREDICT study. Right. And that gave us the nextDICT study. Right. And that, you know, that as well,
Starting point is 00:42:07 that gave us the next revelations, if you like. So having known that the microbiome was different between people, there were two other big aha moments there when we first looked at the data. One was when you give people an identical muffin, there was at least a tenfold difference between normal people's response in sugar and insulin
Starting point is 00:42:28 to that muffin at identical time of day in laboratory conditions. So that was, well, pretty amazing. There was also a tenfold difference in their triglycerides, their blood fat levels, six hours after that meal. So everyone clears fat at a very different rate. And up to that point, no one had ever thought to even look
Starting point is 00:42:50 because we only take fasting levels, which aren't very informative. And that really meant that we had the basis of a big enough variation to build algorithms to predict how people would do based on those sort of baseline standard tests. Right. So it provides this like sort of starting base to try to begin to understand the nature of personalized nutrition and lifestyle habits and the variations, you know, between people and how those, certain variables that distinguish individuals
Starting point is 00:43:31 can be valuable information in terms of how people respond to certain foods or don't. And when you start to scale that up with massive data sets, you can extrapolate from that valuable information to provide solid guidelines in terms of do's and don'ts. So that gets into the sort of citizen science aspect of the conversation that I wanna get into, but there were so many things in what you just said
Starting point is 00:44:00 that I wanna tease out gradually. The first being just the realization that gut health, the microbiome in so many ways holds this key to unlock so many things that have befuddled scientists for so long. And there are a few things as complicated as nutrition. And certainly it's something that is so hotly debated and it appears that it's so difficult to arrive at any kind of consensus around,
Starting point is 00:44:29 and you talk about this in your books. But what's really kind of empowering and fascinating about the microbiome is its mutability. Like when you look at genetics, you come with a, this is your DNA, this is your genetic makeup. And you can say, well, you know, my dad got this or my grandfather got this. I have a genetic predisposition to this. And perhaps there's some mutability around the epigenetic piece, but there's not that much that we can do about it. But with the microbiome, there is this mutability, right? And trying to understand
Starting point is 00:45:02 how to kind of maneuver around that, you know, mutability and right? And trying to understand how to kind of maneuver around that mutability and kind of push it in certain directions becomes the vanguard of this whole new kind of horizon of science and discovery. Yeah, I mean, for me, it was a revelation because I was a geneticist. I've been finding genes. I've been telling everyone that it's all a genetic basis.
Starting point is 00:45:24 Just blame your parents for everything, right? You're eating crow now. And hope that, as you said, take this magic potion to tweak your epigenetics and you might, you've got a chance of doing it. But it was a pretty depressing talk. And I was sort of getting myself down a bit about it. And so it was so empowering really to realize that yeah we're you know
Starting point is 00:45:48 identical twins have very different microbes and they respond differently to the same foods you know we had these identical twins one would have a good fat response the other a bad fat response and the only thing we could find different was their microbes. So the fact that, you know, other studies before us, you know, this study, some out of UCSF had shown just by changing from vegan to meat eating diets in four or five days, you can switch your gut microbes. You can do this stuff in a few days. So unimaginable to change your genes in that way.
Starting point is 00:46:24 So I think suddenly, you know, me personally, in a few days. So unimaginable to change your genes in that way. So I think suddenly, you know, me personally, I was really energized to say this is really important and that small changes to your nutrition can have massive effects, you know, via your gut microbiome if we get it right. And so everyone needs to know much more about gut health and the microbiome and treat it, you know,
Starting point is 00:46:46 just as you would look after it like you would your heart. Right, and getting it right is hard. That's a big, hard problem, right? Well, we were starting from, yeah, a very fair base. Yeah, it's like this, I feel like you're kind of cresting this hill where for many years, it's been about trying to understand the nature
Starting point is 00:47:07 and the complexity and just the general landscape in which the microbiome operates. And now we're in this kind of transitory period where it's about applying that understanding into kind of tangible protocols or means of diagnosis and recommended therapies. Yeah, no, it's tough. And I think we mustn't, again,
Starting point is 00:47:35 realize that we know more than we do. And so we are just at the tip of this discovery. The microbiome sequencing is just getting to the point now where we're discovering all kinds of new elements to our gut microbiome. Like, you know, we've discovered this parasite. There's in one in four, you know, one in four British people have this parasite
Starting point is 00:47:58 called blastocystis. And it's only in one in 20 Americans. And if you have it, if you went to see your GP, he'd probably say, look it up and say, okay, we've got to get rid of this guy. You know, it's been shown to cause diarrhea and bloody problems and whatever. You know, better kill it.
Starting point is 00:48:19 Let's get it out. But it turns out that if you've got it, you are healthier, you're skinnier, you've got less visceral fat, your blood lipid levels are lower, your blood pressure's lower, and it's a sign of super good health. And so we're discovering that this parasite
Starting point is 00:48:43 actually probably eats other microbes that are increasing your fat levels. So it's sort of- Wow. It's a sort of predator of other microbes that we still don't understand which ones and having this effect. And it turns out all our ancestors
Starting point is 00:49:00 had this blastocystis parasite. And if you look at all the data, whether it's modern day, you know, hunter gatherers or most third world countries, 100% of the populations have blastocystis and modern living has wiped it out. And, you know, we even see big differences between, you know, Midwest America and California.
Starting point is 00:49:24 There's, you know, where healthier people are. It's a sign of healthy diets and healthy living. It's fascinating. This is just one element of all these, you know, we know nothing about the fungi, the parasites, the viruses, the phages that are doing all this stuff as well. So let's, you know, we can't get ahead of ourselves. We've got to stick to the basics as we learn
Starting point is 00:49:46 and understand that, you know, we're all got different makeups and different bugs inside us that could be doing different things. Right, the insane complexity of all of it seems like a perfect dynamic for introducing the tools of, the emerging tools of artificial intelligence
Starting point is 00:50:10 because they're so good at crunching massive data sets and dealing with complexity at this kind of scale. Has there been any inroads with these kind of emergent tools and how they might apply to this field? Well, we think we've just about got to the level. So we've now got, we've been looking at our latest paper at 50,000 stool samples from the US and the UK, people who've taken the ZOE tests.
Starting point is 00:50:37 And with those numbers, that's where you start to get this real power. And so we're just starting that journey now to try and understand it and link that with the health outcomes. But in a way, we're doing this on a small level with our studies at the moment that's allowed us to work out
Starting point is 00:50:57 what we think a healthy microbiome looks like in most people. So what's the sort of key ingredients of a healthy microbiome, which has been quite elusive. So we've got a list of good and bad microbes that's getting bigger and bigger that we find if you get that ratio right, that's associated with all these good health outcomes
Starting point is 00:51:21 and associated with these healthy foods as well. So it's the link between the foods, the microbes and the health outcomes. Right, right, right, right. But you need these big data sets, like we did in genetics before you really start to get the clues out that, you know,
Starting point is 00:51:38 if you're dealing with just hundreds of people, it's just, we have too much variation to be able to deal with it. Right, and those big data sets, introduces this idea of citizen science. And I wanna get to personalized nutrition, but I don't think we can really talk about that until we kind of discuss the impact
Starting point is 00:52:00 and the potential impact of what this whole emerging world of citizen science is and the kind of advent of these technologies by dint of Zoe and, you know, other kind of things that are out there that are allowing you to run, you know, incredible, incredibly detailed experiments at a massive scale
Starting point is 00:52:25 unprecedented in the history of science. Because, you know, Will and I were chatting the other day and he was telling me like, listen, in testing or in science, historically, you can have a small population of people that you kind of control and you can get very detailed information out of them, or you have population studies
Starting point is 00:52:45 that are very general and basic because you lack that level of detail and control. And now because of these technology platforms and in particular what Zoe is doing, you can get both, you can get the best of both, right? Which opens up a whole new world of kind of data analytics and the power of the results that you're seeing to create predictive outcomes
Starting point is 00:53:10 and again, like diagnostic tools. Yeah, and I think it's a real game changer in science because in a very short period of time, we've built up the largest microbiome database in the world. We're now doing microbiome sequencing in the world we're now uh doing you know microbiome sequencing on two and a half thousand people a week and doubling that very soon because in a way people are paying for those tests themselves and they're all signing consent forms to say they agree to share that data for science so that, you know, it's not just lost
Starting point is 00:53:45 as it would be in any normal medical clinic or private facility or whatever. So it's all going back into a large database that we, you know, we've published, I think Zoe's published like 40 papers now on this kind of data. So it is a whole new phase, I think, of science. So rather than waiting five years to get a NIH grant or so slow,
Starting point is 00:54:11 you can do this in real time and get these results back. And I think my eyes were open to this. You know, we'd started Zoe, but then a pandemic hit and um 2020 and obviously everything all our clinical studies stopped on the twins and so while cycling home from in london i had the idea of uh asking repurposing the the sort of zo app, which was based for nutrition, to understand COVID and get COVID symptoms, et cetera. So it was a bit of a wild idea, but my colleagues, George and Jonathan, loved it.
Starting point is 00:54:56 The whole company loved it. And so in five days, we built this app, which went live, totally raw, full of bugs, and thought it would flop, but at least we'd done our bit. And we had a million people downloaded it in 24 hours. Wow. So one of the biggest sort of health outcomes. How'd you manage that? Social media.
Starting point is 00:55:18 Everyone shared it, said this is a great idea. It was the first day of the lockdown in the UK. And we launched it a week later in the US. And within two weeks, we had 2 million and then we eventually got to 4 million people using this app at a time when there was, people wanted to unite to do something. And the government was useless. You couldn't go and see your doctor. You know, you were told to stay at home. You couldn't go and see your doctor.
Starting point is 00:55:46 You know, you were told to stay at home. You couldn't get tested. So it just struck a chord. And we were told no one over 60 is going to use an app, right? That was the other thing they say, well, you know, technology is not for oldies, you know. You've got to send them a web page or you know or a questionnaire prove that wrong you know we had people in their 90s doing this um and it it absolutely took off
Starting point is 00:56:13 and so it became the number one tool in the uk for knowing out where outbreaks were happening and what was going on and we learned also what the new symptoms were which were not what we were told from the original chinese uh variant and so just in real time we were seeing uh as people reported on the app rather than old-fashioned science of questionnaires and you know waiting a year to validate the paper and whatever in real time, we got a system worked out with the team at Zoe so that we knew that loss of smell, for example, was being reported by a third of people
Starting point is 00:56:55 who had all these other symptoms of COVID or tested positive. Right, so that's the origin of how it was determined that loss of smell was the thing, right? It came out of that originally. Clinicians noted it in Italy. So they were saying, it's strange, I've got, you know, ENT people were saying, I think this seems,
Starting point is 00:57:17 something must be happening here, but they couldn't tell, couldn't do a proper study. So it was a combination of having that real data in millions of people. And we presented it and, you know, suddenly WHO and all these other countries around the world changed their criteria. It was the UK was the slowest to change, but interestingly, because they hadn't done the study themselves. But that was that was a wake-up call about how fast this new way of doing science with new technology with apps citizen scientists working together could do so much and we did lots of other stuff um that i'm really really proud of the team for
Starting point is 00:57:57 doing as well as the other symptoms we found delirium in old people was a sign. Children got very different symptoms. We looked at skin. We asked people to send pictures of their skin rashes with COVID. I think we got 30,000 pictures. Wow. And she formed an Atlas that, you know, people could see around the world.
Starting point is 00:58:19 We, there was COVID tongue. So people were sticking their tongues out, taking pictures, you know, and suddenly people felt engaged for the first time they were doing something. And I think it was really important. We did a study that would have taken, you know, $5 million and five years to do where we asked a million people
Starting point is 00:58:40 to fill in a diet questionnaire in the US and UK and look to their severity of COVID they got, you know, a year later. And with that data, we clearly showed that diet quality was one of the biggest factors in determining how you were likely to die or to stay in hospital, have really serious COVID, a link with the immune system and nutrition. So this is all done at the speed of light.
Starting point is 00:59:12 We were writing papers in a few days. Yeah, shocking. I mean, so 4 million people, how many people are on the app now? We have about, still about 300,000 still logging daily. And we've, but we've, so it's three years on now. It's obviously come down from the millions that were doing it. But we've repositioned it into a health study app.
Starting point is 00:59:40 So we've got consent to study more than just COVID. And we're now using it to do other lifestyle factors. So we realize its potential. And so we, for example, have just finished a study on intermittent fasting. So we've got 140,000 people to agree to change their method of eating to eat in a time-restricted eating window of 10 hours and we repurposed the app and and gave them so they could fill this in and tell us how they were doing in terms of their mood their sleep their appetite appetite, their weight, any other factors we wanted to,
Starting point is 01:00:27 and got this launch really fast. And amazingly, most people, and they could do the fasting whenever they wanted. So we were also looking, it's a way of looking at not just does it work, but how practical is this? Because you have these tiny studies done on 10 people, handpicked volunteers from Stanford.
Starting point is 01:00:47 I mean, what can you really extrapolate from that? They're not generalizable. That's meaningful. So it was really cool to see how many people managed to do it. And I think it was about 80% or something managed to do it for at least three weeks, at least five or six days a week of just eating in a 10-hour window and
Starting point is 01:01:06 you know we're still writing up the paper so i can't give you all the um the details but it was super encouraging because the people that did manage to do that 10 hours you know reported all kinds of benefits on some of their gi health, you know, many of them were less bloating, mood improved. And interestingly, appetite didn't go up because we were told, well, if you... And there were differences between men and women, differences in different ages. But the fact we could do this massive study
Starting point is 01:01:38 at very little cost in such rapid time really means, for me, this really is the future of how we can particularly do subjects that don't get the funding. You know, the sort of studies about who's gonna give you big money to do meditation
Starting point is 01:01:58 or yoga or five minutes exercise or going to bed earlier or, you know, cutting back on alcohol or, you know, just seeing what are the practical cold showers, you know, who knows, you know, these things. You get, you know, you get the aficionados who tell you, yes, you know, the dedicated gurus say, if you do this, it always works, all anecdote. What about the real, you know, the person on the street? How good, useful is it for them? How easy is it to do?
Starting point is 01:02:35 Fascinating that people, you know, because we're told like intermittent fasting works better if you do your fasting later at night. So you don't eat after say 5 p.m. Yeah, like that 10 hour window, when is that 10 hour window? And what are the age of these people? And what are the foods that they are eating
Starting point is 01:02:55 when they break their fast? There's all kinds of variables. And then beyond that, there's adherence issues. And are these people even being honest with what they're reporting? None of these things are useful if you can't adhere. It's like diets, right? Completely pointless if you can't stay on it long-term.
Starting point is 01:03:11 So finding out that only about a quarter of people in the UK prefer to do their fasting late at night, I have an early meal and then most people, it was easier in their lifestyle to like delay or skip breakfast. And that's just really useful to know that saying, well, actually for most people, even if it's not quite as good biologically,
Starting point is 01:03:37 they can keep probably keep that going for years. So it's much better rather than this purist idea that this is the only thing that people should do. What's replicable and sustainable. And if you do that, then are you eating it? You're probably eating dinner at six or seven as opposed to 10 at night. And what's the implications of that?
Starting point is 01:03:57 But the real power it seems comes in when you layer on top of that, all kinds of other sort of biometrics from heart rate variability, the glucose monitor that's showing how you're metabolizing your food, resting heart rate, metabolic rate, all these things with these kind of devices now
Starting point is 01:04:22 that all establish a matrix of variables that you can then compare and contrast to draw a more kind of intelligent conclusion from just, I feel better or I slept better. But well, actually, if I look at this, you were your deep sleep number increased or your REM went up or it went down. Yeah, I think that's the next phase.
Starting point is 01:04:43 That's the next phase, I think, is to, having shown this works at a sort of crude level, is to try and get people to input, you know, either automatically or semi-manually some of these inputs and then rework some of this data. And we want to also, with people doing the paid Zoe program, Also, with people doing the paid Zoe program, also start having some of these interventions as well. So that every wave of different week might do a different intervention. So we can actually see, well,
Starting point is 01:05:15 can you personalize some of these lifestyle things? Well, can you predict who's gonna do better? Is there a certain cold shower person? Is there a certain early fasting person? Can you predict who they are as well? So I think the more you can combine these things together with these interventions as opposed to just observation, the more you can do it.
Starting point is 01:05:38 And everything we've seen is people are super willing to take part. Even if they've been paying money, they like the idea of being in these large experiments as long as you give them you feed back the data so in the past researchers like myself have been grabbing all the information you can and then five years later you get a little you know a note saying thank you we published it in nature you know you pray for God what it was right thanks for your help. Now it's very much, you've done the study, people want to know how they got on,
Starting point is 01:06:10 how they compared to other people. And this is what we have to start to do much better than we've done in the past. But I think it's really exciting. I wish we'd discovered this 20 years ago. Well, these things happen when- Wouldn't have been possible. Yeah, the technology has to be robust enough, right?
Starting point is 01:06:28 And to your point, we are at the very beginning of this. I mean, I think there's privacy concerns, there's other kind of issues that need to be kind of properly navigated, but it is exciting. And I think it answers a critical question that I'm sure gets posed to you from your critics around like, okay, so you're making these breakthroughs and you're trying to understand, you're understanding better what's happening with the microbiome, et cetera,
Starting point is 01:06:59 and everything that's going on, you know, on your platform, but like, why does this matter? going on on your platform, but like, why does this matter? Like, how are we translating this into anything actionable? Like what is the reality of personalized medicine versus the promise or the hype? And how close are we to kind of bridging that gap between our aspiration and what we're actually capable of providing the interested consumer. Yeah, there's certainly plenty of critics
Starting point is 01:07:32 of personalized nutrition, which is what we're into as opposed to medicine. I mean, because that's in a way the personalized medicine has been discussed before, particularly with regard to genetics and genetic testing and things like that, and selecting drugs on a basis of those things. Remember the blood type diet? Yeah, exactly.
Starting point is 01:07:52 That was a fantastic example, that's right. So there's been a lot of rubbish. But the new era of personalized nutrition, A, we've published peer reviewreviewed papers in Nature Medicine, high-quality journals to show there are these big individual differences that are real. We have performed a randomized controlled trial of unpersonalized approaches,
Starting point is 01:08:22 standard US advice versus people doing the Zoe program. Unblinded the results, but I'm looking at it. I'm very confident they're going to be good. So the randomized controlled trial is the best way to tell whether it's better than, you know, uniform advice. to tell whether it's better than uniform advice. And I think the other reason is that as soon as something's personalized to you, you're much more likely to take, believe it. I think that's what we've shown in all of these,
Starting point is 01:08:59 all these citizen science ideas, that if you can make it, this is your response. It's not just the average response. It's not like everybody, you know, who goes on this diet does well. We know that you respond to this. You will do it.
Starting point is 01:09:14 So your adherence to it is much more likely. Your level of belief is so much higher. And if that's backed up by science, then I think, you know, it's inevitable. It's going to happen.
Starting point is 01:09:29 So these critics, yes, we need to do these big studies. We need to do the randomized controlled trials. These critics are generally, you know, hanging on to the past and old style nutrition and they will be dropping off. This is absolutely the future. And I think, you know, yes, we won't be able to sort out all the future. And I think, you know, yes, we won't be able to sort out all the problems. You know, we're a long way from, I don't know, working out exactly how much protein every individual has
Starting point is 01:09:55 because we don't have ways of measuring protein response in the body and things. But, you know, for glucose and for lipid levels and assessing how much those people need, I think we're doing a pretty good job now. So, and, you know, I think the studies will show that people feel better. Anecdotally, the people were saying they felt better
Starting point is 01:10:22 and the randomized controlled trials actually are saying the same thing. And I think the bit we've always been forgotten about nutrition, which we didn't know, is things like energy. It's never really been asked before in nutrition trials, you know, what's your mood and energy like when you change from say a high fat or a high low
Starting point is 01:10:42 or, you know, whatever it is, you switch around to something that suits you and you don't get these spikes in your sugar or you don't get this, your triglycerides hanging around your body which means you get less inflammation. We're seeing that in everything we do is this report of I feel more energy.
Starting point is 01:10:59 Right. And I think that's really important. So it's not just about weight and the sort of external stuff. It's finding out what foods make you feel good. And you know this from running. Yeah, of course, of course. People do this by trial and error.
Starting point is 01:11:17 That the average non-sports person has to rely on other tricks to do it and may not have thought about it in the same way as a performance athlete. One of the diagnostic tools that you're using for this is the continuous glucose monitor. And that, you know, I wanna talk more broadly about metabolic health in general
Starting point is 01:11:44 and how that relates to the microbiome. But with respect to CGMs, there's a lot of squabbling around that as well. There's a certain kind of subset of the type one diabetic community that seems unhappy with the fact that this is available to consumers more broadly. And, you know, I believe that that comes
Starting point is 01:12:04 from perhaps an affordability or access perspective. There's another kind of contingent of people who don't like it because they think that an undue fixation on CGM metrics alone paints an incomplete picture of what you should or should not be eating, et cetera. And there's kind of the whole biohacker community around it that's drawing conclusions that aren't necessarily completely solid because of an over-reliance on that variable over kind of a matrix of complimentary value.
Starting point is 01:12:43 So can you talk a little bit about the benefits and perhaps the limitations of the use of a CGM? Like I've used it, I found it to be super interesting. I drew a lot of kind of non-intuitive conclusions about my lifestyle habits and certain foods that were contributing to spikes and valleys, et cetera. But I think without adequate education, it's very easy for a consumer to perhaps adopt
Starting point is 01:13:11 less than savory dietary habits because their sole focus is on like flattening that curve. We agree on that. So, you know, for anyone who hasn't tried it, they are an amazing educational tool about how your body works. Okay, so it's like you suddenly do this amazing science experiment on yourself
Starting point is 01:13:32 and seeing how your body's reacting in real time, which is kind of, you know, it's amazing really. 10 years ago, you wouldn't have dreamt this would be possible. And we think that within five years, you know, most of the smartwatches might actually have some capability to do this as well. So it's not going away. Like any new technology,
Starting point is 01:13:54 it's gonna be misused by some people or overused or overhyped, et cetera. And yeah, certainly for the type one diabetics, there was a time when they were run out out of supply so they couldn't get it and I absolutely understand why they were angry people just doing it for fun when they're risking
Starting point is 01:14:13 fatal hypos without them so they're incredibly useful but they are a complaint against Zoe was that they weren't very reliable. We did a study where we gave 300 users one on each arm and looked at those, and they worked out really pretty well
Starting point is 01:14:38 for the purposes we're using it. We've also looked at whether you know compared to standard blood tests they are do they add anything to just taking a baseline blood sugar and insulin level and a hba1c and by looking at over your two weeks your time in range and the very glycemic variability, you can predict who's unwell or not better than those baseline tests. So we've shown there's a clear advantage, even in normal people, to having them as a predictive tool. There are lots of ways of misusing them. I agree that if you don't have a clear program with it
Starting point is 01:15:23 that puts it into some context, you would, you know, using it just as a toy, you reach some wrong conclusions. And one of the common ones is that the only way to eat is to have a completely flat. Right. You eat a hundred percent fat diet. Like you're going to have an awesome curve, right? It's going gonna be flat. Exactly, you just put ice cream on everything or whatever it is and you know, you just cream on everything, you sort it out. And clearly that's wrong.
Starting point is 01:15:53 And that's why something with Zoe, we see it's just one of these three tests really. It's one part of your score is your glycemic score, but we need to know how you handle fats. And that's why the Zoe test has a blood spot and your six hour triglyceride test, see how much is hanging around. And of course your gut microbes and those,
Starting point is 01:16:18 you know, we need a more holistic view of it rather than getting obsessed about that one increment of it because you have to if you are going to control your blood spikes for sugar you've got to make sure that you're not giving yourself too much fats you're tipping that so your your fats hang around the blood you're going to get atherosclerosis and inflammation and also the foods you're eating are also good for your gut microbes. So if you have a more holistic view of it, then I think it is reasonable to use these. And I think they are a great educational tool to show people that some of the common things
Starting point is 01:16:56 they were eating, like their standard sliced loaf bread, which they thought was super healthy, is giving them this massive spike, what mine looks like if I had supermarket bread. And certain fruits, for example, that they thought was super healthy and like me, you know, bananas, you know, which I used to take as my standard every single day fruit, not particularly good for me. I think these are things that are useful because they start making
Starting point is 01:17:25 you think about food in a different way and i think but out of context i think they can be dangerous to some people but if you think about it you also can think about your fats you've got to think about how good that food is for your gut microbes and accept that you will all yeah you can still have some sugar spikes every now and again. It's normal, that's physiology. Let's not get obsessed about it. But seeing it in real time is kind of cool. And that's a glimpse, I think, of the future.
Starting point is 01:17:54 You know, someone will invent a lipid test in real time and it'd be on your watch soon. So you'll be able to see how these- Right, all of these different readings about what's happening in real time within your body. I think it's inevitable. Which is interesting and fascinating. But like a real basic question here is like,
Starting point is 01:18:11 why should we care about this? Like we see, let's say you have a CGM, you see your blood glucose go up, it goes down. Why is this important? What is metabolic health? And why should we be paying attention to this in the first place? These spikes in sugar and or triglycerides
Starting point is 01:18:34 are part of normal physiology. So, our body's designed to do that way. But if there's too many of them and the spikes are too prolonged, you either get a buildup of... So the sugar spikes will create rise in insulin, which can start getting insulin resistance, and long-term you might end up more likely to get diabetes,
Starting point is 01:18:58 pushing you towards pre-diabetes, et cetera. And the buildup in triglycerides are particularly related to inflammation. You get inflammation in the blood vessels. Over time, that stress builds up, and again, heart disease and other metabolic problems. So the idea is that if you can calm that down so you're not having as many of those spikes in a day,
Starting point is 01:19:22 then your inflammation levels are lower. And we've shown that they are related to blood inflammation markers. You will reduce your risk of many common chronic diseases, most of which are related to some extent to what we call chronic inflammation, this sort of low-level stress in the body. And other studies have shown that people who have um are prone to these sugar spikes end up long term with more diabetes and heart disease so there are there are sort of links you can make epidemiologically we also know that some of these big spikes we showed
Starting point is 01:20:01 there's something called a sugar dip so one in one in three men one in three women one in four uh men after a carby say breakfast or or lunch three hours later we'll have a dip below baseline and you say okay that's not to worry about but we we followed a large number of these people and it turns out they report being more tired. They don't know what their result, they were blind to their result. They were more tired, they were more hungry and they overate by about 300 calories that day.
Starting point is 01:20:39 So these sugar dips, which you get from highly refined foods and carbs, are actually making you overeat as well. So they over time will make you gain much more weight than someone who's not having these dips. So some people are even more susceptible than others. And what is the relationship between metabolic health and the microbiome?
Starting point is 01:20:59 Like how does a robust, healthy microbiome in turn a robust, healthy microbiome in turn help you maintain a healthy metabolic sort of profile? We don't know is the true answer, but we do know that all the epidemiology studies show that people with poor metabolic health, so with type two diabetes, with obesity, with high blood pressure, with autoimmune disease, inflammation, all have low diversity microbes,
Starting point is 01:21:35 poor ratios of good to bad bugs. So there's a clear association there. And then you can do studies in mice to show a cause effect relationship of these sort of inflammatory microbes that are maybe producing chemicals that are making the whole problem worse so it's a bit of a vicious circle so the microbiome reacts to people with poor metabolic health end up getting unhealthier microbes. But we also know that having unhealthy microbes makes you more likely to also have poor metabolic health.
Starting point is 01:22:10 So it's both cause and effect relationships. So we don't understand exactly how they do all this. There's so many chemicals involved, so many microbes involved that we don't yet know the details, but we do know that there's these very clear associations and that you can improve metabolic health sort of dramatically in a lot of animal models by improving the microbes
Starting point is 01:22:38 or things like fecal transplants in mice and things like this. Right, so in other words, if you are getting indicia that you're having some level of insulin resistance, the immediate kind of first thing to do would be to make sure that you're getting 30 varieties of plants in your diet,
Starting point is 01:22:59 like improving the quality of your microbiome, which in turn may have some positive impact on buttressing against that insulin sensitivity. Is that a leap or is that? No, I think that's general for most of the chronic diseases that are raised to inflammation. So yes, we know that people who have poor metabolic health have pro-inflammatory microbes.
Starting point is 01:23:26 They have species that actually thrive off, you know, the stressed cytokines and all these other stress hormones. And if you can change those and get some of the good guys in there instead and drive down the bad ones, you can reduce some of the impact of those diseases. So these haven't been studied in big enough nutritional trials yet,
Starting point is 01:23:51 but everything points to that is the direction we should going in it. So far for most of these diseases, they don't seem to be very specific microbes that are involved. It's more the general community is all changed. So it's just the environment has just shifted. And it could be something subtle just by changing the pH
Starting point is 01:24:12 of the gut, just a fraction makes a big difference between it being beneficial or pro-inflammatory and itself producing more of the problems. That's fascinating. And as this continues to scale up, obviously you'll continue to learn more. Yeah, and Christopher Gardner, I know you're probably gonna be talking to him soon,
Starting point is 01:24:35 did a really neat study where gave intensive amounts of fermented foods to volunteers and looked at their inflammation and immune levels over the next few weeks. And they showed one arm was given just fiber and the other one was given fermented foods. And both groups improved to some extent, but the one that had the biggest immune impact
Starting point is 01:25:01 and reduced inflammation was the fermented foods group. So we know we can change in just a few weeks, quite a lot of these basic mechanisms that are important to so many chronic diseases. And yet most doctors never suggest these as treatments. They always reach for the prescription pad. It's amazing how fast that is too. Yeah, exactly.
Starting point is 01:25:26 How mutable it really is. That was the surprising thing that it just, it was four weeks of intensive meal deliveries. So they knew, you know, they were getting this stuff and then they had four weeks where they were just trying it on their own, but it was, you know, the results really were very striking and that's what it had a really big impact,
Starting point is 01:25:48 but no one had done those studies before, which is shocking as well. Cause we've just said, oh, well, that's just yogurt. That's not real treatment. You know, that's hippie stuff. You know, we don't believe in that, but these, you know, luckily they did a huge range of blood tests and microbe tests.
Starting point is 01:26:06 So yeah, in a few weeks you can really change your gut health and influence disease. And I think that's the message and this whole mess about why medicine, why food really is medicine. And we should come back to that, not start saying, well, you have to be a nutter if you say that.
Starting point is 01:26:24 Yeah. Did Hippocrates you say that, you know? Did Hippocrates actually say that or is that apocryphal? We don't know. I haven't seen his original text, so, but it's nice to think he would have said it. I like to believe that as well. The other kind of really exciting, interesting field where we're seeing a lot of exciting developments
Starting point is 01:26:46 is at the intersection of the microbiome and cancer research, right? So explain a little bit about what's going on with that, specifically with respect to melanoma and to some extent, even lymphoma, right? Yeah, well, it all comes down to this new approach to cancer, which is to realize that it's actually an immune problem rather than a sort of mutation problem,
Starting point is 01:27:17 because we're all getting micro cancers all the time. And our immune system, if it's healthy, is picking them off before they get too big. And so that's why the immune system, ageing and cancer have got this sort of close link. We've never really realized how important it was until these immunotherapy drugs come along, these so-called checkpoint inhibitors,
Starting point is 01:27:41 which have been sort of game changers for many people with some of these solid tumors, particularly melanoma, but to a lesser extent, kidney and lung and some prostate, that you're using these drugs to boost the immune system to attack the cancer cell and get round its defences. And so mortality rates were sort of 95% and these drugs have really changed it.
Starting point is 01:28:16 So they've halved, doubled the survival rate in these particular conditions. It doesn't affect most cancers, but these ones. And what we've seen is that there were some early studies showing that the microbiome might have a role in this and that the state of the microbiome was important because it was interacting, because as I mentioned, how important it is for the immune system.
Starting point is 01:28:46 And you want a really powerful immune response in order to fight that cancer for that drug to work. So there are a few early studies of this suggesting this might be the case. And we got together with a UK charity and got a consortium of other cancer centers in the UK and the Netherlands and we got several hundred melanoma cases end stage these are people with terminal sort of metastatic cancer going through their immunotherapy and saw how they did over a year and it turned out that the state
Starting point is 01:29:22 of their gut microbiome at the beginning was one of the biggest predictors of whether they would survive or not. And as expected, it was the good to bad ratio, loss of diversity. And we also looked at their diets and it was the lack of fiber and positive aspects of those that followed more Mediterranean diet had like double the rate of success of survival. And these figures aren't trivial. It's not a tiny amount. If real difference between double your chances of success of reaching 12 months.
Starting point is 01:30:04 Wow. And yet, how many patients know the importance of this? Yeah, it's interesting. How many oncologists discuss diet in such a powerful way? And there's been some studies for chemotherapy haven't been very clear or very large, which is where you just sort of try and kill all the cells. And there are some hospitals like, I think it's Sloan Kettering or MD Anderson,
Starting point is 01:30:41 where they actually, if you're going through chemotherapy, they will take a sample of your gut microbiome and they'll store it in freezers. You have your chemotherapy, then they give it back to you as a booster. And so, and they've got data that improves survival as well. So you- I mean, that makes perfect sense.
Starting point is 01:30:59 It's common, I mean, you're saying, it's immediately what I thought of, like no matter how robust and great your microbiome is, if you're going into chemo or radiation, it's gonna get obliterated, right? So to culture it and be able to supplement or kind of have a way of repairing that as you go along would seem to be kind of crucial and obvious.
Starting point is 01:31:22 Yeah, and I think we're all gonna be storing microbiome when we think we're at our healthiest, which is always hard to know. Yeah, well, trust me, I'm gonna get into fecal transplants. Like we, yeah, we should all, we should have banks where we're, where we're storing this stuff at our healthiest, right?
Starting point is 01:31:39 So, you know, when we face some kind of crisis, we have the ability to kind of turbocharge our microbiome and in turn our immune system so that we can meet whatever we're facing in the best way. And as you said, there's some other examples in lymphoma, some called CART therapy is very complicated using T cells. And the microbiome again is proving crucial in those lymphoma just like a type of leukemia.
Starting point is 01:32:08 So I think we're gonna see more and more of this. And I think the cancer area is one that the public can really relate to. And this might be finally the barrier that gets it across to the medical profession how important diet is and gut health because medics are still not being taught anything about this whole area and nutrition is still sidelined as a minor thing.
Starting point is 01:32:34 But if we can show how important it is in cancer, then hopefully everyone will be convinced and the word will get out. But cancer patients are traditionally told to avoid fermented foods, right? They are, yeah, they certainly are in many places. And I get lots of complaints from patients saying- Because what is the rationale?
Starting point is 01:32:56 I think it comes to the days when at some point in chemotherapy, you are very vulnerable to infections. And so you have very few white cells to fight infection. And so they're worried about introducing bugs. And obviously, at that nadir in your treatment, you don't want to be given large amounts of micros. But for the vast majority of people, most of the time,
Starting point is 01:33:22 these fermented foods could actually be saving their lives so there's a lot of misinformation out there and that um we need to you know get oncologists and and doctors up to speed on on this this new area and it's moving very fast but fermented foods are really good for your immune system and as far far as I know that, you know, they've never killed anybody who isn't, who's got a few, you know, decent white, some white cells. Yeah, so paint the picture of what the future in your mind looks like from a personalized
Starting point is 01:33:58 medicine perspective and a diagnostic and treatment perspective when you're able to perform, really dialed in specific citizen science and data crunching to create really powerful tools to treat better in a more bespoke way. I mean, what does that look like? And you did, like I'm imagining how far in the future. Well I'm imagining- How far in the future are we talking? Well, maybe like 10 years from now and 50 years from now.
Starting point is 01:34:28 Like I've had futurists on here. I've heard, like I think what's happening in terms of- I can't go beyond 10 years, I'm sorry. Well, like there's a lot of interesting breakthroughs and developments in scanning and early detection and all of these things that I think are really powerful in terms of catching things early on. Like so much of what we perish from is avoidable and all of these things that I think are really powerful in terms of catching things early on.
Starting point is 01:34:49 Like so much of what we perish from is avoidable if we could have caught it earlier. And kind of the technology is getting to a point where we're gonna be able to detect these things so early on that we can deal with them in a really facile manner before they become problematic. But- That's early treatment. Yeah, early know, before they become problematic. But that's early treatment. Yeah, early treatment, right.
Starting point is 01:35:07 And what you're talking about is just another piece in that broader puzzle in terms of like where medicine and healthcare are heading, but you know, what does it look like from what you're seeing? Well, I'd love to see more about prevention rather than sort of early treatment and reverse the major threat to the Western world, which is our poor diet,
Starting point is 01:35:35 which is essentially killing us and giving half the population of the US, you know, diabetes and obesity. It's an insane statistic. And so, you know, ultra processed food is the number one killer in this. And the studies are clearly linking ultra processed foods and microbiome dysfunction.
Starting point is 01:35:58 And we've just let it happen. You know, we just let all these chemicals come into our food system without a proper testing. And the science is now showing that many of these emulsifiers that glue stuffed food together, the artificial sweeteners, the sugar alcohols, all these things that you see in ultra processed foods
Starting point is 01:36:19 have a negative effect on our microbiome. So, you know, I'd like to see a future where we're not just fighting and ever increasing number of diseases with expensive MRI scans. We actually gonna do something at a population epidemiology level to say, these foods they're like, they couldn't have cigarettes in the 1970s.
Starting point is 01:36:41 They should have health warnings on them, not health promotion benefits to say, this is healthy because it's got some vitamin D. Iron or whatever it is. Yeah, fortified with vitamin C or D or K. There should be a warning that says, if it comes with some health advice, it's bad for you. That would be a good sticker um so i'm i'm really into
Starting point is 01:37:07 prevention and i think we're gonna we're gonna see that the tools for you know rather than trusting in doctors that individuals are empowered to do this themselves i think this is the way it's going to happen and we've seen already you know how these devices are changing people's lives just in the last few years. The glucose monitor, there'll be the lipid monitor. We know all the major smartwatch manufacturers are moving towards this. They'll have laser devices that will be able to pick up different blood measures in you in real time. These will be fed back through algorithms in your phone. measures in you in real time. These will be fed back through algorithms in your phone.
Starting point is 01:37:53 And, you know, the vision of companies like Zoe is to also tell people not only what's happening to their body in real time, but what they're eating in real time. So with the complexity of the ultra processed food, it's very hard to know what you're actually eating. How bad is it? How many of these chemicals are bad for you? Are you the one in three people that reacts to carrageenan, you know, which is an emulsifier that will glue your microbes together but not other people's? You know, which artificial suena, if you have to have one, you know, would you have?
Starting point is 01:38:19 This level of personalization can only be so complicated. You need apps and advice to be able to do it, to guide you through it. So I think we'll be using these devices to find our way through the food jungle, point us to say what ideally we should be eating, keep us logged about how well are we doing in our 30 plants a week,
Starting point is 01:38:44 hints of new things to try and telling us when we should be taking our exercise relative to where our last night's sleep was. Everything should be optimized, but also not just making us robots, but making us more intelligent, more educated about what we're doing so that we realize this is an evolving science
Starting point is 01:39:08 and if everyone is part of a giant citizen science project, then everyone benefits. And I think that's my vision of the future is that we will have this sort of benevolent companies. There'll be a group of people who can pay for all these tools, but that information will pass to the people that can't pay for them. And they will get predicted scores that are free
Starting point is 01:39:33 and we'll move to a time when this is possible. So realizing that, you know, as we talk about cancer, yes, you can have an MRI scan that can detect that cancer early, but wouldn't you be better to know how to boost your immune system so that your immune cells do it, beat that cancer before it seemed detected
Starting point is 01:39:53 by the MRI scanner. And rather than rely upon the food pyramid, that's the result of a political process to have a personalized food pyramid that is specific to you and you alone, which is what you talk about it in the new book. I think this is definitely the future, but it's also understanding what the foods we're eating
Starting point is 01:40:15 and moving away from this old fashioned idea of calories. Well, let's talk about that. Like it's a good segue into the new book, but let's bust a few diet myths, right? Like macros, calorie counting, like come at me. Like I know you got a lot to say about this kind of thing. They exist, but you know, their importance has been massively hyped.
Starting point is 01:40:43 And the idea you can describe food by calories and by macronutrients has been exploited to the nth degree by the food companies. And that's why they can sell us all these products with these health claims on them. When we know they're rotten, they're artificial, they're fake food. But because they have the right macronutrients on the label, they get a nice tick and we're poisoning ourselves.
Starting point is 01:41:14 So I think, you know, we haven't really changed in 100 years our basic concept of how to discuss nutrition properly. And we're only just starting to get into this discussion of what ultra-processed food is and the different levels of food processing, which the food industry doesn't want us to discuss because the last thing they want is some definition that they would have to apply to.
Starting point is 01:41:40 So they are keeping muddying the water on it. So the fact that they, keeping money in the water on it so the the fact that they you know the companies um you know discuss this in the book you know love the idea of calories they love calorie things on menus and they're describing food by its as if you can tell if it's food good or bad by its calorie count and its fat content. It's complete nonsense. There is no real correlation. And there are good and bad fats and there is good and bad calories, foods. You know, we need to be focusing on the quality of food.
Starting point is 01:42:16 And that's totally clear. Like the example I gave you in the Zoe study of people giving an identical calorie muffin. I gave you in the Zoe study of people giving an identical calorie muffin. And some people react to that in a very different way and get a sugar dip and will overeat by 300 calories later in the day. Others won't. If you describe food purely in terms of that, all calories are equal.
Starting point is 01:42:42 And you just gave everyone these bad, bad foods, you wouldn't know that this is what this effect they're having on mood and energy and everything else. So smoke screen that we just need to get rid of and we need to start talking about quality of foods and what's whole food, what's a whole plant food, not these foods that are made
Starting point is 01:43:02 in a way to falsify real food. They're designed to reformulate actual food using fake ingredients, extracts. And I think that's, you know, no one denies that calories exist, but we can go into the whole thing about why calorie counting diets fail the vast majority of people.
Starting point is 01:43:31 It will work for a few weeks, then your body just readjusts and bounces back the same way. Exercise for most people does the same because your body adapts to that exercise. We're not just furnaces, we're finely tuned machines that change. So these are concepts that have just stayed
Starting point is 01:43:54 because of the market, the force of the calorie counting diet market, the force of the food industry trying to sell us worse and worse food with more and more health claims. And I think the science is now out there to show how sort of irrelevant they are and how they are just a smoke screen. Yeah, there's sort of an arms race also,
Starting point is 01:44:19 because as the public becomes increasingly more and more aware of the ills of ultra processed foods, at the same time, the giant conglomerate food companies are getting better and better and better at dialing in palatability and the addictive nature of these foods with the exact recipe or combination of salt, sugar, and fat to kind of light up the dopamine centers
Starting point is 01:44:48 and make it impossible to just have one. So it creates this sort of compulsive relationship with foods we know are not good for us. And yet we find ourselves powerless to deny, right? So education takes us to a certain place and human frailty and weakness accounts for the rest. So it's sticky to like- Well, I've got no, I don't really have a beef with foods
Starting point is 01:45:17 that are obviously unhealthy, but super tasty, right? But when something is wrapped up in all this healthy packaging and is sold to you as a healthy, low calorie, low fat alternative, that's criminal. It's like dressing up cigarettes as healthy because they're low in, like it used to be low tar or low nicotine. Therefore they're fine.
Starting point is 01:45:49 Right, yeah, that's sort of the tobacco company version of greenwashing. It makes us just feel a little bit better about that purchase, you know, making that purchase. Exactly, so, you know, let's have, we're not gonna get rid of them, but let's have them with health warnings. Let's have them with a tax that reflects the huge burden on the taxpayer that
Starting point is 01:46:12 all these foods are costing us. So it's hundreds of billions of dollars a year just because we're eating these foods. And why should the taxpayer be basically paying for all this when the food companies are making all the money? And they're getting massive subsidies to do it. And whereas anyone producing whole plants and fruits is not getting those same subsidies. Right. It's wrong.
Starting point is 01:46:39 Right. I mean, I agree with you completely, but then it becomes a question of political will and kind of penetrating the battalion of lobbyists who are very invested in the status quo. Yeah, most countries have this problem. While we're all getting diabetes and becoming obese and dying of chronic lifestyle illnesses.
Starting point is 01:46:57 There will be a point when the country just won't be able to afford it. The healthcare system is broken. So it becomes a national security issue, honestly. Like it's a really huge problem and yet it continues to persist and metastasize, which is disturbing, but perhaps we can, you know, pivot to a more optimistic or helpful conversation around
Starting point is 01:47:22 like how to guide people towards those better choices. I mean, we all know more fruits and vegetables, nuts, seeds, you know, that's the kind of thumbnail. But for the conscious consumer who's just going to the supermarket and shopping for their family and is on some level of budget, what are some of the kind of guiding principles about what to avoid and, you avoid and what to invest in?
Starting point is 01:47:46 Well, there's a lot to avoid. But in writing the book, there were some surprising findings that I found that things that are relatively cheap aren't always unhealthy. So things in cans. many studies have shown that some canned tomatoes can have higher nutrient levels than fresh tomatoes for example get a can of beans they're just as healthy as getting your dried beans and doing them yourself And they're often extremely cheap, really good source of protein. Most frozen vegetables and berries are also highly nutritious and really good for you and cost virtually nothing.
Starting point is 01:48:34 So we tend to think of anything frozen or in cans or in packaging is all the same. But it's absolutely not true. As long as the source, it doesn't have an artificial source in it, it's gonna be true as long as the source it is it doesn't have you know an artificial source in it it's going to be really good for you so that that was a surprising finding for many of these these products you can get out of season frozen berries for example out of the freezer really good for you um nuts and you know there's nothing wrong with nuts as a snack. And there's a big difference
Starting point is 01:49:06 between some artificially created snacks, like, I don't know, you know, things like Pringles, which have very little potato in them. They're actually made of all kinds of a composite of other things versus some artisan potato chips that you can get that only have potato and olive oil or sunflower oil. So there are some surprising ones in there,
Starting point is 01:49:31 but unfortunately, the vast majority of ready meals that you buy have large lists of ingredients in them that you wouldn't find in your home. And they're the ones that will cause you problems. They will make you overeat and they will be bad for your gut microbes. And I think that's a really important educational message that needs to get out there is that it's not about the fat. It's not about the calories. It's the fact they have this really harmful effect on your immune system and you're going to eat more and more of them so they might be cheaper but you're gonna they're made for a purpose so that you'll be overeating your family and you
Starting point is 01:50:12 will put on weight and have all these other diseases so i think it's this education about what's wrong with certain foods that are you know ultra refined have no fiber, very little nutrients, get into your bloodstream quickly, don't fill you up. And they're just plain wrong. We weren't designed by evolution to eat them. Right. And that, so to my mind, it's an educational way of thinking,
Starting point is 01:50:39 but realizing there are some things that look quite similar that actually are still very good for people, but they're not eating. Yeah, your dietary perspective and recommendations, although very plant focused and kind of plant centric are not ideologically sort of driven and they're not super strict in that regard. They're more like,
Starting point is 01:51:03 this is what looks like the science supports and this is what I'm advising you to do and not do. And an added wrinkle on top of that that I found really interesting in the book is addressing not only how the food is prepared, like, have you cooked it? Is it better to eat raw? Or this is stuff I've thought about often, like, should I eat this vegetable raw or is it better cooked? Is it better, like, have you cooked it? Is it better to eat raw? Or this is stuff I've thought about often,
Starting point is 01:51:25 like, should I eat this vegetable raw or is it better cooked? Is it better to light? What happens if you overcook it? Am I destroying all the nutrients in it? And then also, how is the food packaged? What is the impact of, you know, food that's wrapped in plastic?
Starting point is 01:51:41 And particularly if you end up like heating that food up while it's in the plastic and you kind of address all of these, which I think are kind of common questions we all think about, but maybe don't pay enough attention about. So can you kind of unravel some of that? Well, it's a lot to unravel.
Starting point is 01:51:58 Yeah, I mean, there's, it is. I mean, you can read the book, but like maybe some sort of general principles around that. Yeah, well, I think a little bit comes down to understanding a bit more about the structure of food and cooking changes the structure of food. So yeah, there was a common misconception that raw food is better for you
Starting point is 01:52:17 and the raw food movement is a little of this. But all the science suggests that actually lightly cooking food is the optimal. So lightly steaming your food breaks down the structures, allows the nutrients to come out without destroying some of these vitamins and nutrients. And these polyphenols we talk about, these defense chemicals that are in all plants
Starting point is 01:52:42 that are really rocket fuel for our gut microbes that are really what we should all be trying to get more of that definitely aren't in ultra processed foods. So understanding the structure of food and how you're cooking is really important. Understanding that freezing stuff, even microwaving is fine. Before I researched the book,
Starting point is 01:53:02 I was, oh, I'd got rid of my microwave. I thought this is terrible. But it turns out that actually it doesn't destroy nutrients in any way. It's actually good and it's much better for the planet. So in terms of the energy used, if you say a baked potato in a microwave, it's much more efficient for climate change to use.
Starting point is 01:53:25 From an energy expenditure perspective. It may not taste as good. I still struggle with the idea of like having a microwave, but go ahead. Well, I was like you, you know. But in a way, having researched the book, I've said, well, if I care about the planet, I should use both of these tools, you know,
Starting point is 01:53:43 and not be so obsessed with my prior beliefs. So structure of food's important. How you cook it's important. What you cook it with. So just combining foods together will change their nutrient value as well. So a lot of these Mediterranean dishes which use olive oil and garlic and onions,
Starting point is 01:54:06 you know, collectively, they actually produce many more healthy chemicals together than they do when you have them alone. Chopping up your garlic 10 minutes before you use it actually trebles the amount of these really beneficial nutrients in the garlic that otherwise would get broken down. So all these kind of funny, weird stuff about structure of food
Starting point is 01:54:32 is useful for people to know in everyday life about how to cook things. Obviously, cooking stuff close to plastics, and you've alluded to some of this, you know, the problem of microplastics is something we should be aware of. We don't really know enough about it except there's lots, far too much plastic around and so limiting the plastic that's close to our food
Starting point is 01:54:57 is also important. And I think the other thing I realized is that no one had really written a book before that looks at all the different food groups and first takes health, then takes the ethics. So, you know, were animals, you know, injured? What's the ethical basis of that? Or what's a lot of,
Starting point is 01:55:27 there's a lot of new stuff about child slave labor, for example, chocolate and coffee and various other tropical things that we need to be aware of. But also finally, the big other area is the environment. Sure. And it was a bit of an eye opener because it's quite hard often to balance
Starting point is 01:55:45 these three things when you're making, you're going into a store and you wanna buy something nice and you're trying to work out all of, to get all three perfectly aligned at the same time is kind of tough. And so, particularly when it comes to something like artificial milks. So I found that really interesting because I'd experimented with cutting out dairy milk
Starting point is 01:56:12 and the main reason for me to cut out dairy is because of its harmful effect on the planet when you calculate how many cows and methane and land use, etc. So it makes obvious sense to cut that out. So I switched to oat milk, which I didn't mind the taste of, it seemed quite good. But then I put a CGM on me while I was drinking oat milk and I saw it shoot up.
Starting point is 01:56:36 So suddenly I've swapped what was this reasonably healthy fat, mild sugar mixture for a much higher sugar, much more refined product, meant that if I was having regular oat milk, for me, it'd be bad. Other people might be fine, but that would be better for the planet if we all switched to oat milk. But it would probably cause more, have some disease consequences as well. So there are lots of examples of how tough it is to balance some of these things. And, you know, are you going to get them from Mexico every week?
Starting point is 01:57:16 Are you going to, how do you freeze them enough? And where do you get the nuts from? So it starts to ask a lot of questions. We don't have all the answers, but I think it made me think, and I want people who read the book to think about food in a very different way because the food choices we make every day
Starting point is 01:57:36 are the most important choices we make for our health and probably also for the planet. Yeah, 100%. I mean, every purchase of food that you make is a vote for the world that will be, right? So it would be great if there was some kind of metric or carbon score or some numerical value that we could attribute to each food product that we, sort of product, food product that we buy
Starting point is 01:58:06 that would kind of tally, like, what is the carbon footprint of this? You know, what went into the manufacturing and distribution of this? You know, what was the amount of like water and acreage and, you know, all of that. And, you know, were animals killed in this? Or like, you know, so it's impossible to put all that on the consumer
Starting point is 01:58:27 and expect them to like really be able to make an informed decision, especially when the larger food companies are doing their best to obscure any kind of transparency around that. Well, there are academics who have produced scores and we're working with them at Zoe and we do have a sort of beta score for all the common foods
Starting point is 01:58:47 that gives you an environmental index. And obviously the Zoe program is designed so that you get your general Zoe score. And I've got my scores in the book for various things, which is a combination of the three. So we're thinking sometime in the near future of adding in that fourth score which would be the environmental impact score so that people who wanted to prioritize environment above health or have it as a major factor could actually have that but it is so complicated it would need it does need algorithms and an app you can't
Starting point is 01:59:21 it is so complicated. It does need algorithms and an app. You can't retain all of this stuff in your head knowing if that avocado comes from Mexico or it came from California, what's the difference? And also labeling is not reliable. All the obscurant language around labeling, you think you're buying something
Starting point is 01:59:41 that was grown in a certain way and it most likely wasn't. And that opens up a conversation around, you know, a different, you know, a different component of the microbiome, which is the sensitivity of our, you know, larger microbiome, not just to the foods that we're eating, but to environmental toxins, the air that we breathe,
Starting point is 02:00:05 the personal care products that we use, skin cream, shampoos, et cetera, and not for nothing, the pesticides that find their way onto the foods that we're eating, that we're not even aware we're consuming, whether we're washing them or not. And there's a spectrum of harm associated with that. But how do you think about that?
Starting point is 02:00:29 And have there been studies done to give us a real grounded scientific sense of the harm or lack of harm? Like what is the level of concern that we should have around that? Well, in researching the book, I mean, obviously looked at things like glyphosate and herbicides in particular,
Starting point is 02:00:53 because I was wanting to look at exposures that nearly everyone has had. And the problem with this kind of study, it's pretty hard to find people who haven't been exposed because whether you live in a rural area and there's lots of spraying around you or you eat a lot of vegetables or you eat breakfast cereal. We all have glyphosate coursing through our veins.
Starting point is 02:01:12 All of us have glyphosate. And yes, the studies have shown that if you have organic food, it has a fifth of the glyphosate levels of non-organic food, but you're still getting some. So everyone's exposed to some level. Because it's just blowing around in the wind from the neighboring farm and finds its way
Starting point is 02:01:30 into the soil of the organic farm. And obviously as I start to eat more plants, I get a bit more nervous about this because you don't get glyphosate on beef, for example, or, you know, or meat. You get a whole bunch of other stuff. But you know, so it's, but you obviously compensate by, you're eating lots of plants and vegetables, think you're, so it's, but you obviously compensate by eating lots of plants
Starting point is 02:01:46 and vegetables, think you're doing the right thing. But if it's not organic, you are actually ingesting more glyphosate. And I certainly realize there are also certain types of plant where you get many more. So if you like oats, and I know Americans love their oatmeal in the morning, think it's a healthy food.
Starting point is 02:02:07 It has really high levels of glyphosate when the people have tested breakfast cereals because oats and rye, to dry them out, they'd spray it out as a way of harvesting it quicker. So used for different purposes. So I have a real problem with something that we're ingesting every single day of our lives, what effect that has on our bodies now the science isn't the epidemiology isn't conclusive there's a suggestion it increases
Starting point is 02:02:32 lymphomas and there are some there have been some court cases on that um they've done some mouse studies that show that uh it does affect the gut microbiome because these chemicals were designed so they didn't affect human genes. So they're not supposed to interact with human genes, but they're supposed to kill plant genes and as collateral damage, they take out quite a few of our microbial genes as well. So we are seeing disruption in the gut microbiome
Starting point is 02:03:08 due to glyphosates. And animal models have shown that they do produce abnormal chemicals. Now, that's really all we know at the moment. So there's nothing definitive, but it's sufficient to worry about. And there have been epidemiology studies, such as one in France,
Starting point is 02:03:25 where they compared a group of people having organic foods regularly versus non-organic foods and found big differences in cancer and mortality levels over the next 10 years. So there's enough for me to worry about. I'm also worried about microplastics. I think we don't understand that. And we do know that they do get into our gut
Starting point is 02:03:52 and can cause disruption in our gut microbes as well. And they're also enough if you eat a lot of fish, because you think fish are healthy and they go into that in the book. You're gonna be eating. And if you go to a nice non-sentient fish like mussels and say, okay, I can eat those. They're great, they're really healthy and nutritious,
Starting point is 02:04:15 but they've got a lot of microplastic in them because they suck it out of the sea. So we're sort of screwing up our planet slowly. So all these good things we're having a problem with. But so, you know, I think there is pretty clear evidence that these pesticides, et cetera, and are bad for newborn babies
Starting point is 02:04:38 and pregnant women and increase, they've done some small scale studies. Evidence for the whole population isn't yet definite, but certainly if you can afford it, then definitely go organic is my advice. And unfortunately in most countries, it's still more expensive and that's a problem.
Starting point is 02:05:02 But I do worry about that. But having said that, it's still better to eat vegetables and not worry about the pesticides than not eat the vegetables and the fruits. Yeah, and you can go to the environmental working groups list of the dirty dozen. There's a spectrum of harm with respect to that. If you're budget conscious about
Starting point is 02:05:23 what's the most important food group to be organic versus conventional. But yeah, but for your breakfast cereal in the US is one of the biggest sources. Well, you should just get rid of that. Exactly. Cross it off the list. We can agree. Have a health warning like a cigarette packet
Starting point is 02:05:41 and then say, yeah, if you have this at your own risk, you can't sue us if you get cancer. What is your thoughts? A big piece of, let me preface this by saying, I think the scientific consensus is pretty clear that if you want, that you want a healthy microbiome, that having a robust and healthy microbiome is so crucial to so many facets of health.
Starting point is 02:06:05 And we're only, and that the level of that relationship and importance is only growing as more science is coming out. And a key component to maintaining the robustness of that ecology is a diversity of plants in your diet. You talked about 30 plants a week, eating a diet that's high in fiber, that is high in prebiotics and fermented foods,
Starting point is 02:06:34 which are probiotics, et cetera. And with that, what is your response to this growing enthusiasm around what's being called the carnivore diet, which is a diet that is, if not exclusively meat, is almost entirely meat-based. There's a lot of people, particularly on the internet, who are espousing the benefits of that,
Starting point is 02:07:00 saying how much better they feel, how it helped them resolve whatever kind of chronic ailment they had. And this seems to be more than a fad at the moment. Like there's a lot of people who are very enthusiastically sharing their anecdotal experience with this. Well, the good side of it is generally these people are not having ultra processed foods.
Starting point is 02:07:28 Agreed. So they are doing some good in that. Where, and I also get people saying, I've been on a carnivore diet for two years, I feel great. What are you talking about? You need all these plants. We do know that people who don't eat plants, a variety of plants, have less diverse gut microbes. Their microbial health is generally poor, which means they will
Starting point is 02:07:57 have a poorer immune system. And so my worry about the carnivore diet is that it may work short term, they might feel better. And not everybody, I know some people who really can't tolerate those levels of meat or fats. And we know there's individual variations. There are some people who can tolerate it and for a short while will feel better,
Starting point is 02:08:25 might lose weight, might feel they're getting, you know, they're feeling stronger, et cetera. And I think that's genuine. But long-term, they're gonna be causing harm to their system, their immune system, because they're not nourishing those gut microbes. They're, you know, the average American has,
Starting point is 02:08:42 you know, only half the microbial species of say that Hadza hunter ancestors through antibiotics, through poor foods, through ultra processed foods, et cetera, et cetera. So they're gonna be denuding that even more. And so that means their armory of chemicals that they can use to fight infections, to help negotiate their energy balance,
Starting point is 02:09:05 their metabolism, et cetera, is going to be used up. So whenever they have a problem, they're going to be in trouble. They just won't have the tools to be able to deal with it and have an immune system that I think is going to be wanting for most people. I'm not saying there are some rare individuals who might be able to get by for longer than others without this problem. In general, it's a problem. And I think the other misconception is this is what our ancestors ate.
Starting point is 02:09:32 I mean, I spent a week with the Hadza tribe about five or six years ago and saw firsthand what these hunter-gatherers in Tanzania, what they actually eat. And, you know, I ate exactly as they did. And, you know, I was filled up at about 10 o'clock with baobab porridge, which is this, it just falls off the trees and you mash it up with a bit of water.
Starting point is 02:10:01 And that's your huge high fiber mass. You can't stop farting after that. You know, you're just so full of fiber. You're eating berries. Then at lunchtime, you'd have, the women would dig up tubers, which are like, you know, ancient yams,
Starting point is 02:10:20 like a sort of form of sweet potato. And that would be lunch. And then the guys would go out and do a bit of hunting. And on top of that, they would bring back some meat if they found any. But the large periods of the year, they'd be having no meat. And most of their calories would come from the carbohydrates.
Starting point is 02:10:39 And if there's honey around, they didn't want meat. They just went for the honey. They stopped hunting completely. They just satiated themselves on the honey. So people have a very different perception of what our ancestors were actually doing. And the majority of their food was plant-based and carbohydrate-based. It wasn't a high protein, high fat diet.
Starting point is 02:11:07 And they have the healthiest gut microbes. They don't get chronic diseases. They never get cancer. All these things that we've now developed as part of the West. So the Hatha is, for people that don't know, an African traditional hunter-gatherer tribe that has been able for the most part
Starting point is 02:11:27 to maintain their lifestyle and their traditions amidst a rapidly kind of encroaching developing world. And they have the most robust microbiomes because they have a very robust environment and extremely diverse amount of plant life on which they sort of persist and exist, right? But it feels like there's a deadline on that. I don't know, when were you there?
Starting point is 02:11:57 Like the world is encroaching on them, right? And some of their traditions are beginning to erode and their dietary habits are starting to kind of shift as a result of that. Yeah. Which is awful. The area they're in is getting squashed by people cutting down trees around them
Starting point is 02:12:13 and pastoralists moving in. And of course, they've got all these researchers around them now. Right, everybody wants to study. I have a guy coming in tomorrow who went down and lived with them also. Yes. For, everybody wants to study. I have a guy coming in tomorrow who went down and lived with them also. Yes. For different reasons, but yeah.
Starting point is 02:12:28 So yeah, I mean, you know, hopefully they will survive a bit longer, but they're sort of running out of room. And they are the last true hunter gatherer tribe really in Africa. And, but I think it's really important we do learn the lessons from them. And we've learned so much about sleep and exercise
Starting point is 02:12:52 and calorie burning and all these amazing things that have gone counterintuitive to what we believed. In fact, they don't burn many more calories than we do. And, you know, and they're not, you know, they're not running all the time either, you know. And they're happier and they're more connected to their community and their neighbors and their family members.
Starting point is 02:13:19 And I think for the most part, anybody I know that's had any contact with them said, you know, basically they're doing it a lot better than we are. Exactly. And you don't see obesity, you don't see diabetes, you know, and they die when they fall out of trees or they get hit by animals.
Starting point is 02:13:35 So, you know, it's not, they don't live to ripe old age, but they don't really have a concept of age. And it was just interesting. And, you know, it was fascinating to see them. You know, I asked them, when do you have breakfast? And they didn't have a concept of age. And it was just interesting. And, you know, it was fascinating to see them. You know, I asked them, when do you have breakfast? And they didn't have a word for breakfast. So this is, again, you know, an invention of perhaps Kellogg's that we all have to have breakfast.
Starting point is 02:13:56 And otherwise, you know, we're not eating healthily. And so, you know, it is this last chance to see how we did evolve. I think they've been there for, you know, at least 15,000 years or in that similar sort of environment, which is, you know, where we're supposed to evolve from, you know, around the equator. So, yeah, it's a pity.
Starting point is 02:14:22 But, yeah, we've learned a lot from them. I certainly did. My microbes actually- You tested before and after, right? Yeah, and I was eating everything they had. So the baobab, the yam, but one day it was porcupine was on the menu. So, you know, which is not something you get regularly and various other animals that I had no idea what they were, but they all got thrown on the menu. So, you know, which is not something you get regularly and various other animals
Starting point is 02:14:45 that had no idea what they were, but they all got thrown on the barbecue. But you were surrounded by animals and dirt and they're the microbes as well. So I think part of this
Starting point is 02:14:57 is also the environment that we've lost as we've moved into cities, everything's sterile. You know, we're not, we need to go back to hugging trees and getting back to nature. And that's why gardeners have better microbes
Starting point is 02:15:11 than non-gardeners. You know, I think we also realize it's external as well as what we eat as well is important. But yeah, my microbes improved by about 30% in diversity while I was there. But when I got back on airplane food on the way back, by the time I got back to London, it had gone straight back to where it was.
Starting point is 02:15:31 Did you keep that culture though and store it for future proliferation? Yeah, I wouldn't have got through security. Yeah, I mean, that conjures up the next thing, which is the future of fecal transplants. Like it does seem like there's something interesting there. Like if you can, the more we learn about the microbiome and the more we figure out how to kind of cultivate a very bespoke ecology for a particular individual,
Starting point is 02:16:13 the idea of these fecal transplants seems to be a really good idea. I think it's a great idea. But I would say that the hope and hype we had 10 years ago hasn't played out as much as I would have hoped. It is the number one treatment for a couple of conditions, mainly really bad infections and something called recurrent C. diff, clostridium difficile. You get recurrent diarrhea 30 times a day, usually caused by antibiotics overuse.
Starting point is 02:16:50 That is 90% of the time cured by a single transfusion of a healthy donor stool sample. But there are not many other conditions where it's shown to be nearly as effective. And the early hope that it would be a cure for obesity has been shown to be false. So you can't take someone's skinny feces and put them into an obese person and make them skinny.
Starting point is 02:17:22 Doesn't work. But isn't there, there's some indicia around cravings though, isn't there with this or no? There are autoimmune diseases. Well, it does work in a proportion of people with ulcerative colitis, which is an autoimmune disease. So that's the other hope because there's at least one disease where I think it's about one in four or one in five people have remission.
Starting point is 02:17:48 So it's like there's no sign of the disease after it, which is pretty much as good as the drugs, the medicines, the immunotherapies that they're given, which is pretty good. But it doesn't work for other related conditions. Other autoimmune conditions doesn't seem to work nearly as well so we don't really understand what it is and it it could be that you know the microbiome of the host the person who's you know the sick person has to be so bad there's actually nothing there in order for the new microbes to colonize and take over and if it's too stable
Starting point is 02:18:24 it's really hard to gain a hold. Plus the fact we haven't matched up the donor and the recipient very well. And we don't know what the magic factors are. So I think there's still time to do it, but I think it's not looking as hopeful as it was perhaps 10 years ago to be the cure-all for everything. But the exceptions to this are in cancer,
Starting point is 02:18:48 where they've done a couple of cases of people who survived metastatic melanoma, responded very well to immunotherapy, and they took their stool sample, and they gave that to people who'd failed immunotherapy and were about to die. And a reasonable proportion of them were rescued. Wow.
Starting point is 02:19:10 So there could be very specific cases for people who have very bad microbes where they just need that extra shot to improve them. So I think we're still finding our way and trying to get around this idea that because we're so different, it's very hard to come up with a sort of one size fits all solution.
Starting point is 02:19:33 And they don't quite know whether to get 10 donors and put them all in a Magi-Mix and serve up that soup or they should be specifically looking for certain microbes or you should be artificially producing these fecal transplants. And there are trials going, many trials going on artificially to look at it. But so I think cancer is the one area
Starting point is 02:19:56 of the most hope and excitement. And going back to the idea, I think in the not too distant future, everyone's going to be storing their stool sample, maybe to use when they have cancer treatment, give themselves the best chance. And storing up the people who successfully fought off cancer against the odds and worked out what it is about those microbes
Starting point is 02:20:20 that are so good at helping that person's immune system. Yeah, that's interesting. Yeah, it's a nuanced game as we say, but I think we were misled because a lot of people thought it was a cure for obesity. Right. That a lot of people were doing this on the internet and had some very bad results.
Starting point is 02:20:42 Another source of confusion surrounds the importance or lack thereof of fermented foods. We talked about the 30 plants a week thing. I think there's a lot of people who think as long as I'm getting some fermented foods in my diet on some kind of regular basis, I don't have to worry as much about the 30 plants a week
Starting point is 02:21:07 or the diversity of the foods that I'm eating. How important is the fermented food piece? And then on top of that, how do we know that the kind of cultures, the fermented cultures that are in these foods are actually efficacious? We were talking about kombucha before the podcast or in these yogurts or these kefir's,
Starting point is 02:21:29 it'll say, it has this and that in it, but what is the pasteurization process? Like do these cultures persist through the manufacturing and distribution process of these foods such that they have any kind of viability once they're consumed. So lots of questions there. I think the first one is I think to build a healthy gut microbiome, you've got to get the diversity of plants in there as your number one. That's number one.
Starting point is 02:22:00 If you don't eat plants, I don't think any amount of fermented food is going to really help you because the probiotic microbes in the fermented food don't actually stay in your gut very long. They pass through. And as they're passing through, they stimulate the other microbes to produce helpful chemicals. We don't exactly understand that because, to produce helpful chemicals. We don't exactly understand that but we know that the microbes, for example, in kefir or yogurt, these lactobacilli,
Starting point is 02:22:32 they're designed to live in milk and yogurt, not in your intestine long-term. So they pass through and they have to have a sort of collateral effect on that environment. They just, for reasons we don't still understand, they make them produce better chemicals. We discussed this pharmacy idea.
Starting point is 02:22:52 They're sort of boosting the pharmacy to produce those chemicals for you is the current idea of what they do. And obviously the greater the diversity of the microbes that are doing that, the better your chance of it working. That's why kefir has more microbes than yogurt, perhaps 10 times more different species. It's a more complex fermented food. And cheese, you know, often has only two or three microbial species. And as you get some exotic French ones, which often illegal in the US because they're too dangerous.
Starting point is 02:23:35 And then you've got things like kimchi where the fermented food is, you've got the microbes which are eating the cabbage and the garlic and the chilies. And there may be 30 different microbes in there, including yeast and fungi. And the difference with those foods is that they're also prebiotic
Starting point is 02:23:58 because you're also eating the plants that are nourishing the microbes. So they will probably hang around a bit longer than say just your kefir or your yogurt or your cheese ones. So, and the kombuchas are similarly complex, often between 10 and 30 different microbe species. But how do you tell that? So you want to study, so little and often is the rule.
Starting point is 02:24:26 So there's no point having a big once a week feast. You want to have a small little shots. And I think the study is suggesting that if you can get three small portions a day, that's probably pretty ideal of different types of these fermented foods. And how do you tell what the best products are? It's really difficult.
Starting point is 02:24:48 We were discussing kombuchas and I was in a store with Will. We were looking at some of these range, great range of kombuchas in California, but some of them just at the bottom, just say, oh, gently pasteurized. Right. So it's dead.
Starting point is 02:25:07 So probably if it's a little use, although there is some evidence, there are some microbes that do work when they're pasteurized, but I don't think these ones have been proven to work. And so checking whether it's been pasteurized, checking the date, how long its shelf life is. If it's live, it's not going the date how long its shelf life is if it's if it's live it's not going to have a really long shelf life and so you pick up a kombucha you want to see whether there's
Starting point is 02:25:31 any sediment in the bottom is there something like a mini blob in there that's that could form and like and similarly um other products if you're taking kimchi or sauerkraut, make sure it's not in vinegar. It's actually live and it says live microbes on it. Again, make sure it hasn't been pasteurized even gently. And the ultimate test is probably to try some of these, either get a brand you really know and can trust. And if you don't know them, test them. You can take the sediment of a kombucha
Starting point is 02:26:07 and if you put that into a bit of tea and sugar and leave it for a week, you'll know whether it's real or not. Similarly, if you take the end of a kefir, if it's live, you pour it into a glass of milk, within 24 hours, that should have turned into kefir. So there are ways of actually doing your own little practical experiments to work this out. But it's a real problem for the consumer at the moment. There isn't anything to protect you.
Starting point is 02:26:38 Right. Like the consumer shouldn't have to do that, you know, to figure this out. Like we shouldn't have to run our own experiments to validate whatever's on a label or isn't. And beware of artificial sweeteners as well in a lot of these products, because we know they're harmful for the gut microbes as well. So you're doing some good and some bad. You might have to put up with a little bit of sugar,
Starting point is 02:27:00 not too sweet, rather than having artificial chemicals, which will have a negative effect on the gut microbes. And what about a proper probiotic, not as a replacement for a healthy, robust, diverse diet, but as something as sort of a cherry on top? In the book, there's a study that you talk about with respect to COVID and kind of outcomes around, you know, populations that were on a probiotic
Starting point is 02:27:29 versus not on a probiotic. So where's your thinking around that? Because there's also a lot of confusion and there's a wide spectrum of products out there. And I think a lot of consumers struggle to kind of make sense of that world. Yeah, to cover the COVID stuff first, we did a, again, a survey of consumers struggle to kind of make sense of that world. Yeah, to cover the COVID stuff first, we did, again, a survey of about a million people
Starting point is 02:27:48 and looked at their COVID outcomes and whether we're taking vitamin supplements or probiotics. And virtually none of the vitamin supplements had a consistent effect on preventing COVID. Right, the omega-3, the D, what else did you look at? Like, because there was a whole lot about like, if you're on D, you're gonna be in good shape. Vitamin C, garlic tablets, multivitamins.
Starting point is 02:28:14 But the one that looked like it had the biggest effect was actually regular use of probiotics. This was an observational study. So it's full of potential biases and flaws, but for someone in gut health, I'm biased to say, well, that looked like a good result for me. Right, I'll put that one in the book. But a few years ago, we did a meta-analysis for the British Medical Journal and looked at all the evidence for probiotics. And there's absolutely no evidence
Starting point is 02:28:45 that if you're healthy probiotics prevent you getting disease okay so for the healthy person to take them regularly probiotic capsules or or however you take them uh no clear evidence for healthy normal people they are useful there's some evidence that in neonates, early young children and the elderly, they can be beneficial. So there's some randomized trials that show they are, some are good in preventing infections or other problems. They also are shown to work in, if you have, for example, some GI infections, in balance, they do work. There's some evidence they work in mild depression in randomized controlled trials.
Starting point is 02:29:32 So there are a few examples where, and this irritable bowel syndrome is another common, there's some evidence they work a bit in these conditions. Now, many people don't work at all. It's not totally consistent. And a lot of this is probably because each probiotic is different. They're protected by patents, so they can't be used by other companies.
Starting point is 02:29:58 And our individual microbes are very different as well. So it's not surprising there's this big difference. So although we can say that many of these conditions, probiotics work, I can't say which one you should take because the studies have included lots of different ones. So it's, but I think we're in a stage now where we're moving to the second stage of probiotics.
Starting point is 02:30:19 There's some exciting ones that have come out of this new science because all these ones are very old, we're talking about, all the ones you see out there. But there are some new microbes like Accomansia, for example, is a bug that has been shown to reduce blood glucose levels in trials and actually works just as well dead as it does alive.
Starting point is 02:30:45 And it's a very common feature in all the new microbiology we're seeing. So I think the next generation are going to be much better and much more designed for human health than these old ones, which have just been around on some company's shelf with a patent for a long time. So I'm not giving you a very clear answer, but I think it's, I still think you're much better off taking your probiotics as food than as supplements.
Starting point is 02:31:18 Yeah, of course. Because you're getting a bigger mix. Yeah, of course, of course. And I appreciate the kind of respect for the complexity and nuance of all of this. Like, you know, our human brains want that clear cut answer. Do this, don't do that. Yeah. Give me the top.
Starting point is 02:31:34 And you're like, ah, not so fast. You know, even with each one, like everything in this book, like, you know, there is that layer of complexity that I think when you read it, you begin to understand like why it's so hard to even tackle this subject to begin with. Like you, how many years did you spend writing this book? Six years.
Starting point is 02:31:53 Yeah, so. I realized why no one else had done it. And it's almost in this day and age, a courageous act to like dip your toe into the world of nutrition and make a statement, you know, because, you know, it is so difficult to provide kind of any actionable, you know, guidelines around it because the science is, you know,
Starting point is 02:32:16 is in many ways so inconclusive and there's so many variables that come into play, like, you know, in terms of, and the personalization, you know, aspect of it that is emerging that makes it even harder to say, you should do this and not do this, right? But we do have to end this podcast. So maybe we could do that with,
Starting point is 02:32:36 if there are any kind of concrete, you know, rules or recommendations for the person who's, you know, brand new to the idea of the microbiome even being a thing and who's grappling with the idea of making healthier choices for themselves, beyond the 30 kind of plants a week, what are some other principles that you could share? Because at the end of the chapters,
Starting point is 02:33:01 you do kind of like bullet point, like here's some kind of clear takeaways that I think would be helpful. So top of mind, you know, what sits atop the kind of most important of those? Well, we've covered some of them. So obviously eating the rainbow is, you know, the colors are there for a reason and they're actually really good. So don't eat beige. Don't eat beige. Yeah, go colorful. That's the title of this podcast. Go bitter.
Starting point is 02:33:31 Many bitter things are actually good. One reason coffee's so healthy for you is it's got full of polyphenols and I recommend coffee over orange juice anytime as a health drink. It should be in the health section. Dark chocolate's another surprising one. Cook with extra virgin olive oil rather than any other oil. Don't believe all this nonsense about-
Starting point is 02:33:56 Heating points. Yes, all that stuff, that's all rubbish. The way you eat is also important. So we've talked about what to eat, but time-restricted eating we've discussed. We didn't discuss that actually has a really big benefit on your gut microbes. So all the studies show that if you leave a big gap overnight, so your gut is rested just as the hunter-gatherer tribes did.
Starting point is 02:34:27 They're not nibbling snack bars or protein bars at night. They're resting just as they're sleeping, giving that full circadian rhythm, real chance to real synchronize. So I think that's an important part. So there's reducing the snacking time, less meals, giving yourself at least 12 hours overnight,
Starting point is 02:34:49 ideally 14 is a good way for your gut to repair itself and enhance. Eating more slowly. We all eat too fast. I think one in five American meals are consumed in the car. It's difficult to have a leisurely meal in the car um just you know wait do like the mediterranean countries you know just don't have snacks wait and have a proper meal you know make it a social good occasion enjoy the food um and uh you know learn to try something new every uh every week you should be
Starting point is 02:35:29 aiming something something new as extra so part of this 30 plants is to discover new things you haven't eaten and you know get your taste buds to try something something new all the time and introduce that to your family and make make food something exciting rather than a chore because we all get into these ruts in our choices. We find something we like and we think it's healthy. We have the same thing. Well, our microbes don't like that. They like to be tested all the time.
Starting point is 02:35:58 So I think it's all about an adventure, experimenting, find out whether you're someone who does well, you know, with this long overnight fast and not snacking or whether you are someone who does need to eat. There are different people. Are you an early morning person, a late morning person? Try skipping breakfast. Try changing your breakfast for, you know, from a high carb one to a high fat one. See how you feel. Try and just think about how your body's working. Don't accept that everything's the same for everybody. And I think the more we can all experiment
Starting point is 02:36:31 and understand our bodies, the better we get to understand food and live with it. And always think about your food. Now, again, in these food choices, if you care about the planet, really think about those food choices you're making. Cause as an individual, it is the number one thing we can all do to save our planet.
Starting point is 02:36:52 Beautifully put, I really appreciate it. Final thing before I let you go, would be around the kind of science that you would like to see being performed right now. Like what is the study that hasn't been done yet that you feel is most important to be conducted? And what is kind of on the near horizon for Zoe and the research that's going on there that has you excited?
Starting point is 02:37:21 Well, in general, the study that will never be done would be a massive randomized control trial of ultra processed food against real food and pay people to do this. Why can't we do that? Because- Who's gonna fund it? Who's gonna fund it and-
Starting point is 02:37:39 We already know the answer though. Irrationally, the ethics board would probably say it's unethical to randomize one arm to the American diet and the other arm to a healthy diet. But that's what we need to shake this up. So far, the study has been limited to a few weeks. And that's where I think I would, if all the money in nutrition do that study,
Starting point is 02:38:06 that would change our system and show how bad it is for us. The Zoe studies are, it's evolving all the time and introducing all kinds of new features and giving people personalized feedbacks on whether they're dippers or not. You know, should they be worried about giving, we're trying to move towards giving people real-time advice about what they should be eating.
Starting point is 02:38:37 We are just starting retesting. So this is a really exciting time. People can see if they've reduced their sugar peaks and their fat peaks and they improve their gut microbiome, what does it look like on retest and how their gut microbes are tested and the results are looking really good on that.
Starting point is 02:38:56 Because no one's managed to do that yet so far. And so using the gut microbiome is a pretty good sort of like a dental checkup that you go to every six months or so to say, how am I doing? When I'm experimenting, it's quite hard to know. I think we're going to start doing these citizen science projects within the Zoe product so that we'd love several thousand people
Starting point is 02:39:21 to start, you know, go on fermented foods for a month and see what the difference is. Others got intermittent fasting. All these lifestyle interventions, I think would be really exciting. And we want people to join in this big community. So there's a lot, there's so much stuff going on as well as feeding back these new insights
Starting point is 02:39:40 into the microbiome. Maybe getting some of those microbes as new probiotics and prebiotics because they've never been discovered before, but they have really big effects. In our data now, we see these huge effects of these microbes that don't even have names yet. And so if we can harness them,
Starting point is 02:40:01 they could be super powerful medicines as well. So yeah, there's sort of too much to, I'm a kid in a sandpit, but it's full of toys and it's a fantastic time to be doing science. Yeah, yeah, well, I can tell it lights you up and it's a really fascinating new kind of emerging field. Like if I was a young medical student, this would be where I would wanna, you know,
Starting point is 02:40:28 be focusing on right now because you're at the very beginning of something that clearly is only gonna grow and become kind of more integral to all aspects of human health and planetary health too. So it's really exciting. And I think the work you're doing is really important. It's inspiring.
Starting point is 02:40:48 And it was great to talk to you today. So thank you. Appreciate it. It's been fun. Yeah, it was good. If you wanna learn more, pick up Tim's book, "'Food for Life, The New Science of Eating Well." You can check out the Zoe app. Joinzoe.com. Yeah, joinzoe.com.
Starting point is 02:41:04 And any other places you wanna direct viewers and listeners? Follow me on Instagram. People still do that. They still do. I think they still do. You're not on TikTok? I wouldn't admit to it. There we go.
Starting point is 02:41:24 No, no, I'm not on TikTok, I can't. I haven't got the patience or technology for that. Yeah, how's Dr. B doing? Is he doing a good job? Should we give him a review right now while he's sitting right here? Yeah, no, he's- You gonna fire him? No, he's nine out of 10, nine out of 10.
Starting point is 02:41:42 He just needs to bring more sunshine to the venues when he lives. Yeah, good, man. Thank you. Well, come back again and share with me more about what's happening. I'm sure it's changing all the time, right? Oh, yes.
Starting point is 02:41:57 Yeah. Cheers. Thanks. Peace. Play it. plants. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest,
Starting point is 02:42:21 including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, as well as podcast merch, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify and on YouTube and leave a review and or comment. Supporting the sponsors who support the show
Starting point is 02:43:00 is also important and appreciated. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful. And finally, for podcast updates, special offers on books, the meal planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg,
Starting point is 02:43:38 graphic and social media assets courtesy of Daniel Solis, Dan Drake, and AJ Akpodiete. courtesy of Daniel Solis, Dan Drake, and AJ Akpodiate. Thank you, Georgia Whaley, for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace.
Starting point is 02:44:01 Plants. Namaste.

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.