Optimize Your Gut to Fight Disease With Tim Spector

29:38you don't know if it's trivial or it's really large. And I think that's the other sort of problem about extrapolating. 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, 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.

30:18Whether it failed or not, you're gonna write it up because it's important.

30:29So you're starting to develop this, you know, 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. 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.

31:17And she was linked with this group that had all worked with this, really the father of the microbiome, Jeff Gordon, who's based in St. Louis. And Rob Knight was another one of his protégés. 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, you know, 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.

32:02And so we got together and under the banner of the American Gut Project and did this and led to a paper where the UK, I think, provided about a third of the subject. So relatively, it was more popular in the UK given the population density. But together we did a great paper which outlined this. How many were in the study? There were about 11 ,000, I think it was, in the end. which doesn't sound much of the moment, but it was the biggest study done to date, clearly showed a link between nutritional eating habits, fiber and health and showed that these clusters that, you know, measures of gut health, which is then we used something called diversity.

33:00The 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. 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, it didn't matter whether you had a little bit of meat, a little bit of fish, you were vegan, vegetarian, whatever, your gut health was still optimal.

34:10And 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? 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 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, yes, it's nice to have, you know, the rich, colorful polyphenol rich foods.

35:08It's nice, you know, the fermented foods 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, you know, a really good way of communicating it also to the public about understanding why feed your gut microbes. You do it by eating right. And if you do that, you can't really have ultra processed food. It's very hard to get 30 plants. 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 because that project was like 2014, right?

35:54when 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? Well, it didn't have any of the public impact that it has now. So the newspaper - But they weren't like you're a nutter, like you've gone off the reservation. Well, I mean, there was awareness in 2014 people, it wasn't like, people were talking about the microbiome. There was an interest then. 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, that's how you get your money.

36:51and then it all comes crashing down again. And a lot of people thought that the microbiome was, you know, just a few years, flash in the pan, a few fancy mouse studies, you know, there's a few anecdotes of faecal transplants that were successful, it would all fall over. And most of my colleagues in the UK 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. And also the nutrition sort of profession didn't embrace it at all either.

37:36They 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 up until the time when I realized I wanted to do the next stage 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, getting money academically, I said, aha, this could be my big chance.

38:35But, you know, I'm warning you guys, you know, the science is very expensive and there's no quick results, you know, the way I want to do it. I don't want to 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. 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.

39:28That 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, you know, they competed high fat versus high carb diets and both did well, no winners or losers, but within the groups, massive differences. so and at the same time an israeli group had come out with with a study showing that cgms continuous glucose monitors were able to also predict responses to food so suddenly the idea was they had to combine the microbiome with these these these new devices on the market to suddenly have a quantitative way of really telling people how they respond to these foods.

40:42But 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 1 ,000 people, giving 1 ,000 people, mainly twins, because I still believe there was a genetic component then.

41:08who were studied at my hospital, St. Thomas' and a group were also studied in Mass General, given identical foods at the same time and then all their bloods studied, you know, 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 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 to that muffin at identical time of day in laboratory conditions.

42:08So 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 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 between people and how those certain variables that distinguish individuals can be valuable information in terms of how people respond to certain foods or don't.

43:13And 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 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 and you talk about this in your books, but what's really kind of empowering and fascinating about the microbiome is its mutability.

44:14Like when you look at genetics, you come with a, this is your DNA, this is your genetic makeup and you can say, well, 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 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.

44:55I've been finding genes. I've been telling everyone that it's all a genetic basis. 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'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, 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.

45:34And the only thing we could find different was their microbes. So the fact that, you know, other studies before us, 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. So I think suddenly, me personally, I was really energized to say, this is really important and that small changes to your nutrition can have massive effects 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 just as you would look after it like you would your heart.

46:24Right, and getting it right is hard. That's a big, hard problem, right? Well, we were starting from, yeah. It's a different, 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 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, realize that we know more than we do.

47:12And 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 British people have this parasite called blastocystis. And it's only in one in 20 Americans.

47:40And 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, you know, problems and whatever. You know, better, kill it, 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 is lower, and it's a sign of super good health.

48:14And so we're discovering that this parasite actually probably eats other microbes that are increasing your fat levels. So it's sort of, it's a sort of predator of other microbes that we still don't understand which ones and having this effect. So, and it turns out all our ancestors 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 Midwest America and California where healthier people are.

49:01It's a sign of healthy diets and healthy living. It's fascinating. This is just one element of all these, we know nothing about the fungi, the parasites, the viruses, the phages that are doing all this stuff as well. So we can't get ahead of ourselves. We could stick to the basics as we learn and understand that we've 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 because they're so good at crunching massive data sets and dealing with complexity at this kind of scale.

49:52Has 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. 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 what we think a healthy microbiome looks like in most people.

50:37So 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 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, if you're dealing with just hundreds of people, it's just, we have too much variation to be able to deal with it.

51:18Right, 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 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 other kind of things that are out there that are allowing you to run incredibly detailed experiments at a massive scale unprecedented in the history of science. Because Will and I were chatting the other day and he was telling me like, listen, And 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 that are very general and basic because you lack that level of detail and control.

52:26And 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 and again, like diagnostic tools. Yeah, no, 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 on 2 ,500 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 it's not just lost as it would be in any normal medical clinic or private facility or whatever.

53:26So it's all going back into a large database that 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, 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 the pandemic hit. and 2020. And obviously, everything, all our clinical studies stopped on the twins. And so, while cycling home in London, I had the idea of asking, repurposing the sort of Zoe app, which was based for nutrition, to understand COVID and get COVID symptoms, et cetera.

54:24So, it was a bit of a wild idea, but my colleagues, George and Jonathan loved it. The whole company loved it. And so in five days, we built this app, which went live, totally raw, full of bugs, you know, and thought it would flop, but at least we'd done our bit. And we had a million people downloaded in 24 hours. So one of the biggest sort of - How'd you manage that? Social media. Everyone shared it. So this is a great idea. It was the first day of the lockdown in the UK. And we launched 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 people wanted to unite to do something.

55:15And the government was useless. You couldn't go and see your doctor. 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 a questionnaire. Prove that wrong. You know, we had people in their 90s doing this. And it absolutely took off. And so it became the number one tool in the UK for knowing 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 variant.

56:03And so just in real time, we were seeing as people reported on the app, rather than old fashioned science of questionnaires and 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 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 a thing, right? It came out of that originally. Clinicians noted it in Italy. So they were saying, it's strange, I've got ENT people were saying, I think there seems something must be happening, but they couldn't tell, couldn't do a proper study.

56:56So 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 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 that I'm really proud of the team for doing, as well as the other symptoms. We found delirium in old people was a sign.

57:38Children 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 people could see around the world. We, there was COVID tongues. So people were sticking their tongues out, taking pictures, 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 to fill in a diet questionnaire in the US and UK and look to their severity of COVID they got a year later.

58:26And - 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 link with the immune system and nutrition. So this is all done at the speed of light. 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, there's still about 300 ,000 still logging daily. And we've, but we've, it's, 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.

59:15So we've got consent to study more than just COVID. And we've now using it to do other lifestyle factors. So we realized there's potential. And so we, for example, we've 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 gave them so they could fill this in and tell us how they were doing in terms of their mood, their sleep, their appetite,

59:59their weight and any other factors we wanted to 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, hand-picked volunteers from Stanford. I mean, what can you really extrapolate from that 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.

1:00:41And we're still writing up the paper, so I can't give you all the details, but it was super encouraging because the people that did manage to do that 10 hours reported all kinds of benefits on some of their GI health, many of them were less bloating, mood improved. And interestingly, appetite didn't go up because we're all told, well, if you... And there were differences between men and women, differences in different ages. But the fact where you could do this massive study at very little cost in such rapid time really means to me, this really is the future of how we can particularly do subjects that don't get the funding.

1:01:28You know, the sort of studies about who's gonna give you big money to do meditation 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? Fascinating the people, you know, because we're told like intermittent fasting works better if you do your fasting later at night.

1:02:21So you don't eat after 5 p.m. Right, right, right. 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 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? It's completely pointless if you can't stay on it long-term. So finding out that only about a quarter of people in the UK preferred to do their fasting late at night.

1:02:55I 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, they can 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. Like what's replicable and sustainable? Yeah, 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? 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 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.

1:04:11But well, actually, if I look at this, your deep sleep number increased or your REM went up or it went down. Yeah, I think that's the next phase. 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, either automatically or semi-manually some of these inputs and then rework some of this data. And we wanna also, So 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, can you personalize some of these lifestyle things?

1:04:54Well, 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. 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 feedback 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, a note saying, thank you.

1:05:35We published it in nature. You pray for God what it was. Thanks for your help. Now it's very much, you've done the study. People want to know how they got on, how they compared to other people. And it's, 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. Wouldn't have been possible. Yeah, the technology has to be robust enough, right? 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.

1:06:16And 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, and everything that's going on, you know, 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, you know, how close are we to kind of bridging that gap between our aspiration and what we're actually capable of providing the interested consumer.

1:07:06Yeah, there's plenty of critics 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. A fantastic example, that's right. So it's been a lot of rubbish. Yeah. But the new year of personalized nutrition, A, we've published peer review papers in Nature Medicine, high quality journals to show there are these big individual differences that are real.

1:07:48We have performed a randomized controlled trial of sort of unpersonized approaches, you know, standard US advice versus people doing the ZOE program who haven't unblinded the results, but I'm looking at it, I'm very confident they're gonna be good. So the randomized control trial is the best way to tell whether it's better than, you know, uniform advice. and I think the other reason is that as soon as something's personalised to you you're much more likely to believe it. I think that's what we've shown in all of these all these citizen science ideas that if you can make it, this is your response it's not just the average response.

1:08:41It's not like everybody who goes on this diet does well. We know that you respond to this, you will do it. 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. 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, yes, we won't be able to sort out all the problems.

1:09:23We're a long way from, I don't know, working out exactly how much protein every individual has because we don't have ways of measuring protein response in the body and things. But for glucose and for lipid levels and assessing how much those people need, I think we're doing a pretty good job now. And I think the studies will show that people feel better. Anecdotally, the people were saying they felt better and the randomized control 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, what's your mood and energy like when you change from say a high fat or a high low or 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.

1:10:29We're seeing that in everything we do is this report of I feel more energy. 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 well, you know this from running, you know? Yeah, of course, of course. Sports people do this by trial and error. But 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.

1:11:08One of the diagnostic tools that you're using for this is the continuous glucose monitor. And that, you know, I want to talk more broadly about metabolic health in general and how that relates to the microbiome. But with respect to CGMs, there's a lot of squabbling around that as 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 I believe that that comes 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.

1:12:01And there's kind of the whole like 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. 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, you know, 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 less than savory dietary habits because their sole focus is on and like flattening that curve.

1:12:52We agree on that. So, 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 and seeing how your body's reacting in real time, which is kind of, it's amazing really. 10 years ago, you wouldn't have dreamt this would be possible. And we think that within five years, most of the smartwatches might actually have some capability to do this as well. So, it's not going away. Like any new technology, it's going to be misused by some people or overused or overhyped, et cetera. And yeah, certainly for the type 1 diabetics, there was a time when they run out of supply, so they couldn't get it.

1:13:43Absolutely understand why they were angry. People just doing it for fun when they're risking. Right. you know, 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 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.

1:14:43So, we've shown there's a clear advantage even in normal people to having them as a sort of predictive tool. There are lots of ways of misusing them. I agree that if you don't have a clear program with it 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 100 % fat diet, like you're gonna have an awesome curve, right? It's gonna be flat. Exactly, you just put ice cream on everything, whatever it is, and you just cream on everything, you sort it out and clearly that's wrong.

1:15:29And that's why sitting 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, you know, we need a more holistic view of it rather than getting obsessed about that one increment of it because 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 it it is reasonable to use these and i think they are a great educational tool to show people that some of their common things they were eating like their standard sliced loaf bread, which they thought was super healthy is giving them this massive spike, which is what mine looks like if I ate supermarket bread.

1:16:44And certain fruits, for example, that they thought was super healthy. And like me, bananas, 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 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 got to think about your fats. You 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.

1:17:21That'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. 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, 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?

1:18:05These spikes in sugar and or triglycerides 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, pushing you towards pre-diabetes, et cetera. And that 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.

1:18:50So the idea is that if you can calm that down so you're not having as many of those spikes in the day, 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 are prone to these sugar spikes end up long-term with more diabetes and heart disease. So there are sort of links you can make epidemiologically. We also know that some of these big spikes, we showed there's something called a sugar dip.

1:19:39So one in three men, one in three women, one in four men, after a carby, say breakfast or lunch, three hours later, we'll have a dip below baseline. and you say, well, okay, that's not something to worry about. But 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. 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.

1:20:28So some people are even more susceptible than others. And what is the relationship between metabolic health and the microbiome? Like how does 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 2 diabetes, with obesity, with high blood pressure, with autoimmune disease, inflammation, all have low diversity microbes, 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.

1:21:29So it's a bit of a vicious circle. So the microbiome reacts to people with poor metabolic health end up getting unhealthy microbes. But we also know that having unhealthy microbes makes you more likely to also have poor metabolic health. 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 this is very clear associations and that you can improve metabolic health so dramatically in a lot of animal models by improving the microbes or things like fecal transplants in mice and things like this.

1:22:18So, 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, 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. They have species that actually thrive off, you know, the stressed cytokines and all these other stress hormones.

1:23:10and 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, but everything points to that that is the direction we should go in. 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 of the gut, just a fraction makes a big difference between it being beneficial or pro-inflammatory and itself producing more of the problems.

1:23:57That's fascinating. And as this continues to scale up, obviously you'll continue to learn more. Yeah, and Christopher Gardner, I know you're gonna be talking to him soon, 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 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.

1:24:49And yet most doctors never suggest these as treatments. They always reach for the prescription pad. Mm-hmm. It's amazing how fast that is too. Yeah, exactly. How mutable it really is. That was the surprising thing that it just, it was four weeks of intensive meal deliveries. So they knew, they were getting this stuff and then they had four weeks where they were just trying it on their own. But it was, the results really were very striking and that's what it had a really big impact. But no one had done those studies before, which is shocking as well. Right, right, right. Because we just said, oh, well, that's just yogurt.

1:25:29That'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 all a huge range of blood tests and microbe tests. 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 message about why, you know, medicine, why food really is medicine. And we should come back to that, you know, and not start saying, well, you have to be a nutter if you say that, you know. Did Hippocrates actually say that or is that apocryphal? We don't know. I haven't seen his original texts, but it's nice to think he would have said it.

1:26:12I like to believe that as well. The other kind of really exciting, interesting field where we're seeing a lot of exciting developments 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, but 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 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.

1:27:01And so that's why the immune system, aging 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, 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 defenses. And so, mortality rates were sort of 95 % and these drugs have really changed it. So, they've halved, doubled the survival rate in these particular conditions.

1:27:59It 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. and you want a really powerful immune response in order to fight that cancer for that drug to work. So, 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.

1:28:47These are people with terminal sort of metastatic cancer going through their immunotherapy. and saw how they did over a year. And it turned out the state 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, you know, 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 as tiny amount. If you know real difference between double your chances of success of reaching 12 months.

1:29:39Wow. 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's some hospitals like, I think it's Sloan Kettering,

1:30:15or MD Anderson 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. 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.

1:30:57And I think we're all gonna be storing microbiome when we think we're at our healthiest, it's 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 storing this stuff at our healthiest, right? So, 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, something 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.

1:31:43so I think we're going to 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 but if we can show how important it is in cancer So 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.

1:32:25And I get lots of complaints from patients saying - Because what is the rationale? 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 microbes but for the vast majority of people, most of the time these fermented foods could actually be saving their lives. So there's a lot of misinformation out there and that we need to get oncologists and doctors up to speed on this new area.

1:33:11And it's moving very fast, but fermented foods are really good for your immune system. And as far as I know that, they've never killed anybody who's got a few decent, some white cells. Yeah, so paint the picture of what the future in your mind looks like from a personalized 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? Like I'm imagining - How far in the future? Well, maybe like 10 years from now and 50 years from now, like I've had futurists on here.

1:34:05I'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 are, I think are really powerful in terms of catching things early on. 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. That's early treatment.

1:34:40Yeah, early treatment, right. 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 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, which is essentially killing us and giving half the population of the US make diabetes and obesity. And 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.

1:35:33And 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 have a negative effect on our microbiome. So, you know, I'd like to see a future where we're not just fighting an ever increasing number of diseases with expensive MRI scans. We actually gonna do something at a population epidemiology level to say, you know, these foods, they're like, they come to cigarettes in the 1970s, you know, that they should have health warnings on them, not health promotion benefits to say, this is healthy because it's got some vitamin D.

1:36:25Iron or whatever it is. Yeah, fortified with vitamin C or D or K. There should be a warning. If it comes with some health advice, it's bad for you. That would be a good sticker. So I'm really into prevention And I think we're going to 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 going to be moving towards this.

1:37:10They'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. 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, which is an emulsifier that will glue your microbes together and not other people's?

1:37:50Which artificial sweetener, if you have to have one, would you have? 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 is 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, 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.

1:38:39So that we realize this is an evolving science 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 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's even detected by the MRI scanner.

1:39:29And 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 in the new book. Yeah. I think this is definitely the future, but it's also understanding what the foods we're eating 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.

1:40:18And 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, you know, they're just, they're fake food. But because they have the right macronutrients on the label, they get a nice tick and we're poisoning ourselves. 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.

1:41:16So they are keeping muddying the water on it. So, the fact that they, you know, the companies, I 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 and that's totally clear like the example 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 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.

1:42:26So, smokescreen that we just need to get rid of and we need to start talking about quality of foods and what's whole food, you know, what's a whole plant food, not these foods that are made in a way to falsify real food. You know, 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, you know, we can go into the whole thing about why calorie counting diets fail the vast majority of people. It will work for a few weeks. then your body just readjusts and bounces back. Same way exercise for most people does the same because your body adapts to that exercise.

1:43:21We're not just furnaces, we're finely tuned machines that change. So these are concepts that have just stayed 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 smokescreen. Yeah, there's sort of an arms race also 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 and make it impossible to just have one.

1:44:26So 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 - I've got no, I don't really have a beef with foods 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 used to be low tar or low nicotine, therefore they're fine.

1:45:25Right, 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 all these foods are costing us. You know, so it's hundreds of billions of dollars a year just because of 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.

1:46:07And whereas anyone producing whole plants and fruits is not getting those same subsidies. Right. It's wrong. 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. So while we're all getting diabetes and becoming obese and dying of lifestyle illnesses. The country just won't be able to afford it. The healthcare system is broken. So it is, and it's a national security, 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.

1:46:50but perhaps we can pivot to a more optimistic or helpful conversation around like how to guide people towards those better choices. I mean, we all know more fruits and vegetables, not seeds, 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 what to invest in? 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.

1:47:33So things in cans. Many studies have shown that some canned tomatoes can have higher nutrient levels than fresh tomatoes, for example. you 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 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 really good for you.

1:48:23So that was a surprising finding that many of these products you can get out of season, frozen berries, for example, out of the freezer are really good for you. Nuts, there's nothing wrong with nuts as a snack and there's a big difference between some artificially created snacks, like, I don't know, things like Pringles, which have very little potato in them. They're actually made of all kinds of 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, 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.

1:49:18And 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 gonna eat more and more of them. So they might be cheaper, but they're made for a purpose so that you'll be overeating your family and you 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 ultra refined, have fiber, very little nutrients, get into your bloodstream quickly, don't fill you up.

1:50:03And they're just plain wrong. We weren't designed by evolution to eat them. And that, so to my mind, it's an educational way of thinking, 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, 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?

1:50:57Is 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 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 food that's wrapped in plastic? 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.

1:51:33Yeah, I mean, it is. I mean, you could 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 and the raw food movement has led a lot 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.

1:52:11And these polyphenols we talk about, these defense chemicals that are in all plants 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, I was like, 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.

1:52:52So 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 it. From an energy expenditure perspective. 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, and not be so obsessed with my prior beliefs. So structured 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.

1:53:36So a lot of these Mediterranean dishes which use olive oil and garlic and onions, 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 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 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.

1:54:25We 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 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, what's the ethical basis of that? Or 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.

1:55:15Sure. And it was a bit of an eye opener because it's quite hard often to balance these three things when you're making, you're going into a store and you want to buy something nice and you're trying to work out all of the, you know, 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 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, et cetera.

1:55:59So it makes obvious sense to cut that out. So I switched to oat milk, which, you know, I didn't mind the taste of it. It seemed quite good. But then I put a CGM on me while I was drinking oat milk and I saw it shoot up. 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.

1:56:47And, you know, are you going to get them from Mexico every week? 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 to read the book, to think about food in a very different way. Because the food choices we make every day 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 sort of product, food product that we buy that would kind of tally, like what is the carbon footprint of this?

1:57:44What went into the manufacturing and distribution of this? What was the amount of like water and acreage and all of that? And were animals killed in this? So it's impossible to put all that on the consumer and expect them to like really be able to make an informed decision, especially when And 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 that gives you an environmental index. And obviously the Zoe program is designed so that you get your general Zoe score.

1:58:32And I've got my scores in the book for various things, which is a combination of the three. But 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 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. It could, all the obscuring language around labeling, you think you're buying something that was grown in a certain way.

1:59:18And it most likely wasn't. And that opens up a conversation around a different, a different component of the microbiome, which is the sensitivity of our larger microbiome, not just to the foods that we're eating, but environmental toxins, the air that we breathe, 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 and have there been studies done to give us a real grounded scientific sense of the harm or lack of harm?

2:00:15Like what is the level of concern that we should have around that? Well, in researching the book, I mean, obviously, I looked at things like glyphosate and herbicides in particular 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 little vegetables or you eat breakfast cereal. We all have glyphosate coursing through our veins. 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.

2:00:59So everyone's exposed to some level. Because it's just blowing around in the wind from the neighboring farm and finds its way into the soil of the organic farm. And obviously, as I started to eat more plants, I got a bit more nervous about this because you don't get glyphosate on beef, for example, or meat. You get a whole bunch of other stuff. But you know, so it's, but you obviously compensate by eating lots of plants, the 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.

2:01:33So if you like oats, and I know Americans love their oatmeal in the morning, think it's a healthy food. 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 lymphomas and there have been some court cases on that. they've done some mouse studies that show that it does affect the gut microbiome because these chemicals were designed so they didn't affect human genes so they don't 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 due to glyphosates and the animal models have shown that they do produce abnormal chemicals.

2:02:51Now, 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 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 and can cause disruption in our gut microbes as well. And they're also enough. if you eat a lot of fish, you know, cause you think fish are healthy and I go into that in the book.

2:03:39You'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, nutritious, but they've got a lot of microplastic in them cause 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 good evidence that these pesticides, et cetera, are bad for newborn babies 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.

2:04:30is my advice. And unfortunately in most countries, it's still more expensive and that's a problem. 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 what's the most important food group to be organic versus conventional. But yeah, but your breakfast cereal in the US is one of the biggest sources. Well, you should just get rid of that.

2:05:11Exactly. Cross it off the list, right? I think we can agree. Have a health warning like a cigarette packet 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 a healthy microbiome, that having a robust and healthy microbiome is so crucial to so many facets of health 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, which are probiotics, et cetera.

2:06:13And 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, 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.

2:07:03Agreed. 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 have a poorer immune system. And so my worry about the carnivore diet is that it may work short term, they might feel better. Not everybody. I know some people who really can't tolerate those levels of meat or fats. And we know there's individual variations.

2:07:55There are some people who can tolerate it and for a short while will feel better, 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. You know, the average American has, you know, only half the microbial species of say that has a 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, their metabolism, et cetera, is gonna be used up.

2:08:43So whenever they have a problem, they're gonna 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. 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, exactly as they did.

2:09:25And, you know, I was filled up at about 10 o 'clock with baobab porridge, which is this just falls off the trees and you mash it up with a bit of water 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 ancient yams 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 for large periods of the year they'd be having no meat and most of their calories would come from the carbohydrates.

2:10:14And if there was 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. 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 Hatsa is for people that don't know, an African traditional hunter gatherer tribe that has been able for the most part to maintain their lifestyle and their traditions amidst a rapidly kind of encroaching developing world.

2:11:10And 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? 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 and pastoralists moving in. And of course, they've got all these researchers around them now.

2:11:55Right, everybody wants to study. I have a guy coming in tomorrow who went down and live with them also. Yes. for different reasons, but yeah. So yeah, I mean, 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 and calorie burning and all these amazing things that have gone counterintuitive to what we believe. We thought, in fact, they don't burn many more calories than we do and they're not running all the time either.

2:12:48And they're happier and they're more connected to their community and their neighbors and their family members. 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, and they die when they fall out of trees or they get hit by animals. 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?

2:13:23And they didn't have a word for breakfast. So this is, again, an invention of perhaps Kellogg's that we all have to have breakfast and otherwise we're not eating healthily. And so it is this last chance to see how we did evolve. I think they've been there for at least 15 ,000 years or in that similar sort of environment, which is where we're supposed to evolve from around the equator. So yeah, it's a pity, 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 I had. So the baobab, the yam, but one day, it was porcupine was on the menu.

2:14:15So, which is not something you get regularly and various other animals that had no idea what they were, they all got thrown on the barbecue. But we were surrounded by animals and dirt and they're the microbes as well. So I think part of this is also the environment that we've lost as we 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 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 cribs improved by about 30 % in diversity while I was there.

2:14:59But 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. Did you keep that culture though and store it for future proliferation? Yeah, I wouldn't have got through security.

2:15:20Yeah, 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, 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.

2:16:17diff, Clostridium difficile. You get recurrent diarrhea 30 times a day, usually caused by antibiotics, overuse. 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. It 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.

2:17:08Well, it does work in a proportion of people with ulcerative colitis, which is an autoimmune disease. So that's the other hope because there is at least one disease where I think it's about one in four or one in five people have remission. 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. It could be that the microbiome of the host, the person who's the sick person has to be so bad, there's literally nothing there in order for the new microbes to colonize and take over.

2:17:57And if it's too stable, 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, you know, the cure-all for everything. But the exceptions to this are in cancer 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.

2:18:41And a reasonable proportion of them were rescued. Wow. 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 and they don't quite know whether to get 10 donors and put them all in a, you know, a Magimix 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.

2:19:28But so I think cancer is the one area of the most hope and excitement. And going back to the idea, I think in the not too distant future, everyone's gonna be storing their stool sample, maybe to use when they have cancer treatment, give themselves the best chance. And storing up the people who've successfully fought off cancer against the odds and worked out what it is about those microbes 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.

2:20:08That a lot of people were doing this on the internet and had some very bad results. 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 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.

2:20:59We were talking about kombucha before the podcast or in these yogurts or these kefirs, 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. Yeah, I think the first one is I think to build a healthy gut microbiome, you've gotta get the diversity of plants in there as your number one. That's number one. If you don't eat plants, any amount of fermented food is gonna really help you because the probiotic microbes in the fermented food don't actually stay in your gut very long.

2:21:48They pass through. And as they're passing through, they stimulate the other microbes to produce helpful chemicals. We don't exactly understand that because, but we know that the microbes, for example, in kefir or yogurt, these lactobacilli, 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 these pharmacy idea. They're sort of boosting the pharmacy to produce those chemicals for you is the current idea of what they do.

2:22:34And 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 unless you get some exotic French ones, which are often illegal in the US because they're too dangerous. 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.

2:23:27And the difference with those foods is that they're also prebiotic 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.

2:23:55But how do you tell that? So, you want to study, so little and often is the rule. 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's 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. 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.

2:24:40Right. So it's dead. 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 gonna have a really long shelf life. and so you pick up a kombucha you want to see whether there's any sediment in the bottom is there something like a mini blob in there that's that could form and like and similarly 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 hasn't again make sure it hasn't been pasteurized even gently.

2:25:29And 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 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, it should, 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.

2:26:13Right, 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, 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.

2:26:52In 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 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 about a million people 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.

2:27:36Right, the omega-3, the D, what else did you look at? Like, cause there was a whole lot about like, if you're on D, you're gonna be in good shape. Vitamin C, garlic tablets,

2:27:49multivitamins, 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 actually no evidence that if you're healthy, probiotics prevent you getting disease. Okay, so for the healthy person to take them regularly, probiotic capsules or however you take them, no clear evidence for healthy normal people, they are useful.

2:28:35There'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. 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 that don't work at all, it's not totally consistent.

2:29:22And 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. 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. But I think we're in a stage now where we're moving to the second stage of probiotics. 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.

2:30:02But there are some new microbes like Acomantia, 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. And it's a very common feature in all the new microbiology we're seeing. So I think the next generation are gonna 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.

2:30:53Because 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, our human brains want that clear cut answer. Do this, don't do that. Yeah. Give me the tablet. And you're like, not so fast. Even with each one, like everything in this book, like 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 how many years did you spend writing this book? Six years. Yeah, so. I realized why no one else had done it.

2:31:30And 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, 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, if there are any kind of concrete, rules or recommendations for the person who's 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?

2:32:33Because at the end of the chapters, 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, what sits atop the kind of most important of those? Well, we've covered some of them. So obviously eating the rainbow is, 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, many bitter things are actually good. You know, one reason coffee's so healthy for you is it's got full of polyphenols and, you know, I recommend coffee over orange juice anytime as a health drink, should be in the health section.

2:33:23Dark chocolate's another surprising one. Cook with extra virgin olive oil rather than any other oil. don't believe all this nonsense about... Heating points. Yes, you go into that as well. The way you eat is also important. So we've talked about what to eat, but time restriction 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. 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.

2:34:13So I think that's an important part. So there's reducing the snacking time, less meals, giving yourself at least 12 hours overnight, 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. Just wait. Do like the Mediterranean countries. Just don't have snacks. Wait and have a proper meal. or make it a social good occasion, enjoy the food. And learn to try something new every week. You should be aiming something new as extra. So part of this 30 plants is to discover new things you haven't eaten and get your taste buds to try something new all the time and introduce that to your family and make food something exciting rather than a chore because we all get into these ruts in our choices.

2:35:25We 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. So I think it's all about an adventure, experimenting, find out whether you're someone who does well 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.

2:36:00Don't accept that everything's the same for everybody. And I think the more we can all experiment 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 because as an individual, it is the number one thing we can all do to save our planet. 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?

2:36:45And what is kind of on the near horizon for Zoe and the research that's going on there that has you excited? 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 - 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, you know, shake this up. So far, the study has been limited to a few weeks.

2:37:33And, you know, that's where I think I would, you know, if all the money in nutrition do that study, 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. Should they be worried about giving, we're trying to move towards giving people real-time advice about what they should be eating. 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.

2:38:31Because 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. So I think we're going to start doing these citizen science projects within the Zoe product so that we'd love several thousand people to start, you know, go on fermented foods for a month and see what the difference is. Others, intermittent fasting, all these lifestyle interventions, I think would be really exciting. And we want people to join in this big community.

2:39:11So there's a lot, there's so much stuff going on as well as feeding back these new insights 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 only have names yet. And so if we can harness them, they could be super powerful medicines as well. So yeah, there's sort of too much to, who I'm a kid in a sand pit, 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.

2:39:57Like if I was a young medical student, this would be where I would wanna 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. 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.

2:40:37Yeah, joinzoe.com. 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. Ah, there we go. 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 gonna fire him. No, he's nine out of 10, nine out of 10. He just needs to bring more sunshine to the venues when he listens. Yeah, good man, thank you. Well, come back again and share with me more about what's happening.

2:41:30I'm sure it's changing all the time, right? Oh yes. Yeah. Cheers, thanks, peace. plants.

2:41:48That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, 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 and the Plant Power Way, as well as 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.

2:42:33Supporting the sponsors who support the show 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 Kale Curtis. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake.

2:43:11Portraits by Davy Greenberg, graphic and social media assets courtesy of Daniel Solis, Dan Drake, and AJ Akpodiete. 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, plants. Namaste.

2:44:01Pure Dell