Zoe is the first in a wave of personalised nutrition programmes expected to hit the market that are based on the results of at-home blood, poo and even breath tests. Photo / Darrien Statton, Unsplash
OPINION:
Can the hottest new nutrition programme on the planet create the perfect diet for me? One that improves my health, boosts my energy and helps me lose weight by showing me the best foods for my unique biology?
That’s the premise of Zoe, the healthy-eating app based on innovative science that currently has a 230,000 waiting list in the UK. I’m eager to find out what all the hype is about, and whether Zoe can help me where so many other diets have failed.
Zoe launched in the US two years ago and in the UK earlier this year. If you sign up now you’ll have to wait until early next year to start the programme, but luckily for me I’ve been offered an early test drive.
My weight has fluctuated over the years, but after I had children the pounds piled on and now I’m at least two stone (12.7 kilograms) heavier than is good for my health.
Like many women my age (I’m almost 56), I’ve tried almost every fad diet you care to mention, from scoffing grapefruit every morning to ditching carbs to only eating foods with a low glycaemic index. Intermittent fasting? Let me count the ways… Most recently, I started reducing my calorie intake (again!) even though I know this doesn’t work for me (and fails most people in the long term).
Zoe is a personalised nutrition programme with a different approach. Co-founded by epidemiologist and nutrition expert Professor Tim Spector, Zoe’s goal is not to deliver weight loss per se, but improve participants’ long-term health.
But will it work for me?
After signing up, I’m sent a box of goodies through the post: my standardised test meals – muffins – a rather terrifying poo sample kit, a finger-prick blood test and a continuous glucose monitor (CGM).
First, I download the Zoe app and log in with my personal nutrition coach who will be on hand to help me throughout the programme. Then, I plug the glucose monitor into my arm and link it to another app (Zoe is heavy on gadgetry and tech). This will track my blood sugar levels and identify foods that cause them to rise and fall sharply.
Next, I do a finger-prick blood test to reveal how well my body handles fatty foods, including those muffins. And I collect a poo sample (using a paper “hammock” over the loo and a tiny scoop and vial), which will be scanned to identify “good” and “bad” microbes in my gut.
All this data will be fed into an algorithm to predict how my body responds to different foods. The idea is I can then reduce my intake of those that cause my blood sugar and fat levels to spike. This causes inflammation, which is linked to an array of health conditions including heart disease, cancer and obesity. I will also find out which foods I should eat more of so my good gut bugs flourish.
Five weeks later, my results are emailed to me in detailed PDFs totalling 100 pages. In short, though, I feel like I’ve failed my exams.
Going through my results with me over Zoom, Professor Spector tries to be reassuring. “Your blood sugar control is poor, but it’s better than mine,” he points out. “It’s slightly worse than average for your age group, so you’ve got to think about the carbs you’re eating because they will give you sugar peaks.”
The same applies to fats – my body doesn’t clear them from my bloodstream well. “Relative to your age, you’re just below average,” Spector says. “This means that six hours after eating a fatty meal you’ve still got slightly more fat circulating in your bloodstream than other people and this can cause inflammation.” The science is complex, but dietary inflammation can overwhelm your body’s normal healthy reaction to food, triggering a range of harmful responses that damage your arteries and immune system, make you hungry and gain weight. Although I consume lots of healthy food, I also overeat, and being overweight can cause inflammation. It’s a vicious cycle.
There’s better news on my gut microbiome, the complex system of trillions of microbes that plays a vital role in our physical and mental well-being. I have a high ratio of “good” to “bad” bugs. I develop recipes for a living and constantly cook with different ingredients, always from scratch; Spector says this probably accounts for my healthy gut bugs.
“You’re scoring above average here,” Spector says. “But you can improve it by another 25 per cent by doing some other things with your diet and lifestyle that would, over time, slowly improve your other scores as well.”
Zoe is a private company that helps fund Spector’s work on the Personalised Responses to Dietary Composition Trials (Predict). The largest nutrition research project in the world, it involves scientists from Harvard School of Public Health, Massachusetts General Hospital, Stanford University and King’s College London.
Predict data, combined with my test results and other information (including my age and medical history), are number-crunched in a process referred to as artificial intelligence. This allows scientists to anticipate how my body will respond to a vast range of foods.
The Zoe approach involves limiting my intake of foods that cause my blood sugar and fat levels to spike. I also need to eat more foods that encourage the growth of “good” bacteria in my gut, and those that suppress the “bad” bugs. To enable me to do this, every food is given a score out of 100, which is individual to me. For most people, leafy greens will score highly and ultra-processed sugary stuff poorly. But it’s the food in the middle that can vary significantly between individuals.
My aim is to log everything I eat and score an average of at least 50 points over the course of a day or week, eventually working up to 65 points or more.
Because I don’t process carbs well (which is not the case for 50 per cent of Zoe participants who score “good” or “excellent” for blood sugar control), I have to limit refined, starchy and sugary foods, which all score low for me: white bread, risotto, rice cakes and cereal bars can only be on the menu occasionally. Foods containing healthy fats – nuts, avocado and full-fat yoghurt, for example – are fine, but I need to space out my intake to give my body time to process them.
My “gut-boosting” foods include green leafy veg, salmon, trout and oranges. To suppress “bad” bugs, I need to limit single cream, chicken pie, burgers, chocolate bars, orange juice, salami and iced cakes. Red meat isn’t great for my gut health but not terrible either, I just shouldn’t eat it every day.
The real positive is that I don’t have to give up any food at all. Daily lessons on the Zoe app will teach me how to combine foods with low and high scores to cushion the impact of those that aren’t great for me. For example, eating sugary things together with good fats and/or fibre-rich foods can help “flatten” my blood sugar spikes. And if I consume a fatty meal, I should make sure that my next meal is low in fat to give my body time to process it.
For 10 weeks, I diligently strive to follow the programme, logging my meals and trying to keep my food scores high. Some days are easier than others. As a food writer, I’m invited to lots of events where there are delicious things to eat, and on day two (in June) I find myself enjoying Christmas dinner at Fortnum & Mason. It’s impossible to avoid low-scoring foods and I worry I’ve fallen off the Zoe wagon before I’ve even settled into it.
But Spector assures me Zoe isn’t an all-or-nothing approach. “The last thing I want people to do is to reduce their enjoyment of food,” he says. “If you go to a special event, enjoy yourself knowing that most of the time you’re doing the right thing.” With this in mind, I aim to score well most days and enjoy the occasional blowout.
Most empowering of all is learning how to combine foods to my biological advantage. For example, white bread is terrible for my blood sugar levels and gut health, so I should only eat toast with butter and jam, which scores 13, once in a while. But if I swap butter for peanut butter and jam for fresh raspberries, my score surges to 42. Add seeds and replace white bread with wholemeal, and this delicious snack shoots up to an “enjoy regularly” 60.
Most alcohol scores poorly for me (bad for my gut health) but red wine, which I love, is fine (62 points). If I fancy a gin and tonic, I can mitigate its effect slightly by nibbling olives or pistachios as I sip.
I think I can do this.
Zoe claims that after three months on the programme, 82 per cent of participants have more energy, 83 per cent don’t feel hungry and average weight loss is 4.3kg. After just 10 weeks, I’m delighted with my progress. I’ve dropped a stone in weight without ever feeling hungry, largely because I eat vastly more vegetables, nuts and seeds than before and they keep me full. Amazingly, I no longer crave sweet foods, I feel more energetic, have less brain fog, fewer mood swings, improved sleep and less joint pain.
Zoe is the first in a wave of personalised nutrition programmes expected to hit the market that harness cutting-edge science and technology. Expect more health and nutrition programmes that offer tailored diets based on the results of at-home blood, poo and even breath tests. Increasingly, programmes will be linked with supermarkets, which will help shoppers make healthier choices.
It certainly seems to have worked for me, at least in the short term. But some experts are cautious. Dr Stacey Lockyer, senior nutrition scientist at the British Nutrition Foundation, agrees personalised nutrition is an exciting new field of research. “Some people do find it easier to improve their diet in response to nutrition advice that is tailored to them,” she says. But it might be equally as effective to improve your diet with one-to-one nutrition advice that doesn’t require expensive tests and technology. “Many personalised nutrition programmes come at a very high cost and so aren’t accessible to everyone,” she says.
Dr Duane Mellor, senior lecturer at Aston Medical School, welcomes the fact that programmes like Zoe don’t focus on calories but on the broader nutritional benefits of food. But he worries that the data-crunching and technology underpinning such programmes removes a vital human element from the experience of eating.
“Developing a better relationship with food, learning about appetite and how our emotions can influence our food intake, eating intuitively and enjoying food within our appetite could be a healthier approach,” he says.
I consider Mellor’s words as I make a cake that I’ve discovered scores an “enjoy regularly” 68 points. It contains whole oranges, ground almonds and eggs, but also lots of sugar. Instinct tells me I shouldn’t enjoy it too regularly as I’d like to lose more weight. Perhaps I also need to think about what drives my desire for cake?
I wonder, too, whether, long term, I really want to log everything I eat and pay a significant monthly subscription for the app? The programme will be out of reach for people on tight budgets. It will also be difficult for people who can’t cook from scratch often and eat lots of ultra-processed (low scoring) food.
For the moment, however, I’m thrilled with the results Zoe has helped me achieve and I have no desire to stop following it now.
- The Zoe test kit is £259.99 (about NZ$518); then access to the app requires a subscription
The scores represent the way Sue’s body responds to individual foods.
High scores are good, low are bad, and she aims to average 50 points per item over the course of a week now, working up to 75 in future:
Kale: 100
Walnuts and pistachios: 99
Avocado: 95
Lentils: 94
Passionfruit: 89
Trout: 88
Cherries: 87
Eggs: 77
Red wine: 63
Porridge with whole milk and raspberries: 61
Wholewheat pasta: 53
Vegetable crisps: 46
Champagne: 36
Potato crisps: 35
White sourdough bread: 28
Salami: 0
White bread: 0
Sue’s weekly average: 61.8
New York Times: Mouth tape, melatonin, “worry journals” - do they actually help?