I'm about eight weeks in to my Zoe subscription, a personalised eating app which aims to improve your gut microbiome and hence your health. This week, for the first week, I hit all the targets in the different areas which contribute to healthy eating.
I wrote about starting Zoe here and earlier about the gut microbiome here.
The app is quite sophisticated, has thousands of foods in its database, combined with personal coaches, if you need or want one, and foods scored to your own personal biology through a set of tests that you do at the start of the programme.
There is a series of daily lessons or motivational activities which help you understand more about how to eat well and each week, on Sunday morning, you get a little rated summary of your previous week's logging (notice logging, not eating)!
This Sunday (29 October 2023), for the first time, I hit over 75: the threshold of excellent according to Zoe health scoring. So it's taken me about eight weeks to learn the algorithm how to eat well for my particular biology.
Here's the results from the weekly report:
This shot shows the overall score for the week at 77 (75 or over ranks as excellent). This is an average for the week. The days marked underneath show where I achieved more than 75 (highlighted in green) and the other days where I got a rank somewhere between 50 and 75 (a green ring). Plus the results for two of the indicators - the proportion of ultra-processed food logged through the week, and the total number of different plants (fresh, dried, canned and frozen) logged through the week.
I was pleased with this score as I had stayed in a hotel for two of the days and was travelling for the third. Hotel menus, in budget chains anyway, are not designed around eating for optimum health. In the first hotel, there was one meal that would have ranked as good or excellent. Most meals included chips and vegetables as a garnish, and the sides offered a house salad but no cooked vegetables.
The restaurant was fully booked in the second hotel - same budget chain, slightly better menu - so I got in 12,000 steps walking there and back to the nearest Indian restaurant where I was able to fulfil my obsession with plant-based foods - a sort of vampire in reverse. Even better, there was enough for a pack-up and this formed a picnic lunch the following day on the journey home. Just as well, as Marks and Spencers Food, even with its huge variety of salads of one sort or another, also managed to miss the mark.
I was pretty pleased with the results for these indicators: fibre up from 23 to 32, protein from 69 to 72 and lower quality fats down to below 15% of energy intake (channelling my inner Alan Freeman Pick of the Pops self there). It's taken a while to learn how to manage proteins and fats.
Again, I was especially pleased with these scores as I had been staying in hotels with the Full English option on the menu for breakfast. Bacon, especially a bacon sandwich, used to be my bête-noire when I first started eating a plant-based diet in my twenties, but now I'm older, it's the good old English banger - I love a pork sausage! I rarely buy them at home, but it's a small treat to have a single sausage when I stay in a hotel (also a slice of black pudding, ideally with a soft poached egg).
According to the Zoe tests at the beginning of this venture, I have poor blood fat control (nothing to feel bad about, it's my unique biology), and sausages come in as a 3 in my personal Zoe food scoring. However, no food is prohibited in Zoe and you can counter a blowout on breakfast pork sausage by adding other high scoring foods like mushrooms to the meal and eating more ascetic meals later in the day.
I found an interesting thing with the logging: if you started with the pork sausage and, in my case, a score of three, then added your other higher scoring foods (mushrooms, fresh grilled tomatoes, baked beans) you ended with a lower score than if you started with the other foods and threw the sausage in at the end. In one case, you're building from a low score, in the other you're decreasing an already high score. Hmm, interesting ...
It is interesting because I have had some qualms already about using this app. These fall into two categories:
- one is a general scepticism about self-tracking and how quickly this can fall into obsessiveness and a blindness that we may only be looking at one or two measures of a massively complex situation with many inter-related and not always easily measurable aspects.
- the other is to do with the Zoe app itself and that this is essentially a business with extensive funding sitting in the space between wellness, diet and health (a huge industry, bigger than the drugs industry); and, along with that, that the science on which it is based is a little fragile without much evidence for its claims.
One of the problems is about definition: thresholds and markers for disease, in diabetes for example, are highly contested by health experts and researchers. And in many cases, we have no definitions for the parameters for these markers in healthy individuals. There is no definition for healthy blood glucose levels and fluctuations in a system of homeostasis where levels are changing constantly, or for a healthy gut microbiome.
Another problem is about the tools that are used to measure some of these markers: researchers in controlled studies have found different readings in different tools for the same circumstances, and different readings in the same tool for the same dietary intake in different circumstances.
A lot of the results published on the Zoe website are anecdotal, observational responses in an internal unpublished survey with a very small sample of 450 people. The price of participating in the Zoe programme (estimated at £600 for a year) brings additional issues - results are from a population that can afford the app, rather than those who need it, and, the video below claims, from a young healthy population of "European background".
The video sets out some of the criticisms of the Zoe app including the lack of controlled blind testing and the unforeseen consequences of testing including increased health anxiety, over-monitoring and diagnosis and disease-mongering.
I've already found myself how you can game the AI by how you sequence logging foods and, to be blunt, when I buy the cinnamon bun twin-pack and eat it in one go with a large cappuccino, that doesn't get logged at all. Smoking cessation programmes already account for under-reporting, I wonder how the Zoe app manages gamification?
When I was first read about the gut microbiome research, I was very excited. It looked like there was potential to address many long term chronic conditions through changing what and how you ate. I was disappointed when it became a big business with extensive financial backing. How were the people who most needed this app going to get it.
I have my annual health check this month. It will be interesting to see whether there are any changes after ten-twelve weeks using the app. There are times when I get bored and just really want fish and chips!
