It doesn't take an hour to fill in the food questionnaire on the app. About 10 minutes max. You've taken that too literally.
And they are testing their method against, say, typical NHS nutritional advice and support, which is negligible.
So your criticism is flawed here. They are setting out to prove their own product works, which is exactly what you describe in your post. They offer coaching, food tips, customer support and testing to those who can afford it. Roughly about the price of a gym membership (which is arguably a waste of time for many people). Can't see why they would be trialling something else. What are you suggesting?
Maybe the NHS or the government could provide more nutritional support to the nation and improve overall help instead?
The CGM, blood tests and gut tests are only relevant for that moment when they are taken, but there must be something said for the educational benefit. They make you think about your body, what you are eating and what is going on inside you. That allows you to make better informed decisions about your own diet and fitness.
Zoe has managed to push healthy eating of whole foods into the mainstream media in a way that was not happening before. They should be congratulated for that.
You seem to have a total downer on them and I've not seen anything constructive in your posts about an alternative method. Maybe I'm wrong though, so a point in the right direction would be helpful.
I'd sum up one point of this blog like this: they may have proved you lose slightly more weight with ZOE than if you do nothing. But they didn't prove that you lose more weight with ZOE's personalised advice than if you just eat what everyone recognises as a healthy diet, without paying for ZOE.
Since they didn't 'control' for a number of factors, like exercise, they also didn't prove that the people on ZOE lost 2 kg because they followed ZOE recommendations, or maybe they exercised more than the people who weren't on ZOE. And that is possible, because ZOE does encourage you to exercise.
And as you say, they are comparing people getting all the encouragement and support to change your lifestyle, to people not getting support. People who got support did better at losing weight, slightly. But that might only 'prove' that what works is to have lots of support and encouragement. It doesn't prove that what makes the difference is all ZOE's stuff about the unique gut microbiome and your supposedly personalised results, which is supposed to justify what you're paying for as opposed to other cheaper programmes and apps that do the same without the gut testing (etc).
That's exactly what their test doesn't prove.
Because maybe what actually is making the difference is to eat more veg, less meat and ultra-processed foods, and give people good support for lifestyle changes. Then people who can't afford to pay hundreds can also get healthy.
The point made around the quality of industry trials and the reliability of their findings is important. We should not simply dismiss findings just because they come from studies that have a funding conflict of interest. In fact, it is often the case that industry funding research are BETTER conducted than non-industry funding trials. The issue with them is that they are more often than not set up to favour the industry intervention. Think of it as a horse race - industry funding trials are more likely to be really well run/delivered, like the grand national or Kentucky derby. However, the industry intervention will be a thoroughbred horse but the competitor will be a three-legged donkey https://x.com/dnunan79/status/1751306845812134369
Readers might also be interested in others who have written about the ZOE programme and it's science: https://unherd.com/2023/10/we-need-to-talk-about-zoe/. In particular, caution over claims about the associations found using cross-sectional methods (as Nicola points out):
"“It’s a cross sectional [observational] study” he says, “which means that no claims of causation can be made.”"
"The design of the study, in other words, simply isn’t capable of telling whether any changes in the microbiome are a result of menopausal change. In fact, Dr Nunan says, “when the data for all microbiome species are compared, there is no statistical difference in pre and postmenopausal women. It’s only when you examine a subgroup of species that 8 out of 2,452 show a statistically significant difference.” Moreover, even when this happens, the study has not indicated what this means in real life. In other words, we do not know what impact this has for the ways that women metabolise food.""
In short, they had a 'control group' that didn't control all the variables, including some that we know can have an impact on changing health behaviours; giving it no credibility as a study or proof of anything.
I wish I'd known that before I spent hundreds on ZOE.
At the heart of their argument and rationale is a circle: between the foods you eat, the gut bugs you have, and your state of health. Their large PREDICT study showed a correlation between these. And that was interesting and I was very keen to get on the programme.
But where does the causality lie? If you eat healthy foods, you will encourage health-associated gut bugs, and you will also score better on many health markers. But are you scoring better on health because you ate the healthy foods or because you have healthy bugs? - It might not matter; but then you don't need to spend £300+ pounds to learn that eating healthy foods correlates with being healthy.
Their second important claim is that their testing gives you your unique profile and therefore unique advice, on presumably a unique diet that will make YOU healthy. - But if they claim that there are 50 'good bugs' and these good bugs are good for everybody, and we know what these microbes tastes and preferences are in foods; then even if our microbiome is unique in what we actually have now, the bugs that would be good for us are the same for everybody and therefore the foods we should eat to encourage them should be the same for everybody. - I wish I'd spotted this logical flaw earlier.
A wise, wry friend said, when I explained it to her, 'Yeah, but they're never going to tell you your unique profile means doughnuts are good for you and kale is bad.' I thought at the time she was missing the point, but she was hitting the nail on the head.
I, my husband, my sister, my best friend all did it at the same time. Vegetables and nuts were good for all of us and our gut bugs; ultra-processed foods, meat, refined starches, sugars, saturated fat were bad for us and our bugs. We didn't vary much. And overall I'd say the only variability that might make a difference is not about the gut bugs that is their big selling point; - it's how well your body deals with sugar and fat, and you can get tests for that from your GP. Your GP wouldn't (I assume) have the data to tell you how you score against ZOE's cohort, but I don't really need to know I'm at x% - I need to know if I have to change my diet based on standard, well-known parameters for being pre-diabetic etc.
While I was enrolled, I asked multiple times about the specificity of the food they were giving me in the app as 'gut boosters' and bad foods for MY UNIQUE gut bugs - since they are very specific. For example, apparently my ten worst foods for gut-bugs included chicken sausages, chicken soup, chicken pies. - Did that mean that pork sausages and beef pies or soups were okay? Probably not, as chicken was had a higher (good) score than pork or beef. Were these just generic stand-ins to say 'don't eat too many ultra-processed foods or meat'? - I didn't need to pay over £300 for that advice. So I asked how they determined which foods were good/bad for my microbiome and they never seemed to understand my exact question and just referred to the PREDICT study as having - allegedly - shown which foods the good gut bugs like.
I read that study multiple times; but it only shows you a correlation between certain microbes and a very broad categories of foods: e.g. 'vegetables', 'dairy', 'meat' and so on. If you read the study, which is free and in the public domain, then you will see that you need to eat vegetables, whole grains [etc] and less processed food, meat, alcohol [etc]... what is already recognised by most as a high-quality diet in order to have healthy gut bugs. I never found out what evidence they had for giving specific foods, vegetables or fruits higher or lower numerical scores, and the help staff were unable to explain.
They seem to trumpet a lot that they know exactly which foods encourage which microbes, and I do really fault them on this as a serious, culpable bit of misinformation or exaggeration; I can't see any published evidence for this. Not beyond the generic 'these microbes show up for vegetables, and those show up for meat. And the people with those microbes have higher cholesterol.' (But is that down to the microbes or the meat?
I wonder if they have *ever* published any data to show how diverse their dietary recommendations are between individuals. Now THAT would be an interesting study. Does anyone have a unique profile telling them doughnuts are good for their unique microbiome and kale is bad?
It doesn't take an hour to fill in the food questionnaire on the app. About 10 minutes max. You've taken that too literally.
And they are testing their method against, say, typical NHS nutritional advice and support, which is negligible.
So your criticism is flawed here. They are setting out to prove their own product works, which is exactly what you describe in your post. They offer coaching, food tips, customer support and testing to those who can afford it. Roughly about the price of a gym membership (which is arguably a waste of time for many people). Can't see why they would be trialling something else. What are you suggesting?
Maybe the NHS or the government could provide more nutritional support to the nation and improve overall help instead?
The CGM, blood tests and gut tests are only relevant for that moment when they are taken, but there must be something said for the educational benefit. They make you think about your body, what you are eating and what is going on inside you. That allows you to make better informed decisions about your own diet and fitness.
Zoe has managed to push healthy eating of whole foods into the mainstream media in a way that was not happening before. They should be congratulated for that.
You seem to have a total downer on them and I've not seen anything constructive in your posts about an alternative method. Maybe I'm wrong though, so a point in the right direction would be helpful.
I'd sum up one point of this blog like this: they may have proved you lose slightly more weight with ZOE than if you do nothing. But they didn't prove that you lose more weight with ZOE's personalised advice than if you just eat what everyone recognises as a healthy diet, without paying for ZOE.
Since they didn't 'control' for a number of factors, like exercise, they also didn't prove that the people on ZOE lost 2 kg because they followed ZOE recommendations, or maybe they exercised more than the people who weren't on ZOE. And that is possible, because ZOE does encourage you to exercise.
And as you say, they are comparing people getting all the encouragement and support to change your lifestyle, to people not getting support. People who got support did better at losing weight, slightly. But that might only 'prove' that what works is to have lots of support and encouragement. It doesn't prove that what makes the difference is all ZOE's stuff about the unique gut microbiome and your supposedly personalised results, which is supposed to justify what you're paying for as opposed to other cheaper programmes and apps that do the same without the gut testing (etc).
That's exactly what their test doesn't prove.
Because maybe what actually is making the difference is to eat more veg, less meat and ultra-processed foods, and give people good support for lifestyle changes. Then people who can't afford to pay hundreds can also get healthy.
Significant amounts of public money have been spent showing that “their own product works” in this case…
What public money?
Nicola on the money as per. And glad to see the catalogue of bias being put to good use (https://twitter.com/Catalogofbias).
The point made around the quality of industry trials and the reliability of their findings is important. We should not simply dismiss findings just because they come from studies that have a funding conflict of interest. In fact, it is often the case that industry funding research are BETTER conducted than non-industry funding trials. The issue with them is that they are more often than not set up to favour the industry intervention. Think of it as a horse race - industry funding trials are more likely to be really well run/delivered, like the grand national or Kentucky derby. However, the industry intervention will be a thoroughbred horse but the competitor will be a three-legged donkey https://x.com/dnunan79/status/1751306845812134369
Readers might also be interested in others who have written about the ZOE programme and it's science: https://unherd.com/2023/10/we-need-to-talk-about-zoe/. In particular, caution over claims about the associations found using cross-sectional methods (as Nicola points out):
"“It’s a cross sectional [observational] study” he says, “which means that no claims of causation can be made.”"
"The design of the study, in other words, simply isn’t capable of telling whether any changes in the microbiome are a result of menopausal change. In fact, Dr Nunan says, “when the data for all microbiome species are compared, there is no statistical difference in pre and postmenopausal women. It’s only when you examine a subgroup of species that 8 out of 2,452 show a statistically significant difference.” Moreover, even when this happens, the study has not indicated what this means in real life. In other words, we do not know what impact this has for the ways that women metabolise food.""
I can't work out if this is actually a grift, because there are so many "sober" studies that follow this model (ie, intensive intervention vs meh).
In short, they had a 'control group' that didn't control all the variables, including some that we know can have an impact on changing health behaviours; giving it no credibility as a study or proof of anything.
I wish I'd known that before I spent hundreds on ZOE.
At the heart of their argument and rationale is a circle: between the foods you eat, the gut bugs you have, and your state of health. Their large PREDICT study showed a correlation between these. And that was interesting and I was very keen to get on the programme.
But where does the causality lie? If you eat healthy foods, you will encourage health-associated gut bugs, and you will also score better on many health markers. But are you scoring better on health because you ate the healthy foods or because you have healthy bugs? - It might not matter; but then you don't need to spend £300+ pounds to learn that eating healthy foods correlates with being healthy.
Their second important claim is that their testing gives you your unique profile and therefore unique advice, on presumably a unique diet that will make YOU healthy. - But if they claim that there are 50 'good bugs' and these good bugs are good for everybody, and we know what these microbes tastes and preferences are in foods; then even if our microbiome is unique in what we actually have now, the bugs that would be good for us are the same for everybody and therefore the foods we should eat to encourage them should be the same for everybody. - I wish I'd spotted this logical flaw earlier.
A wise, wry friend said, when I explained it to her, 'Yeah, but they're never going to tell you your unique profile means doughnuts are good for you and kale is bad.' I thought at the time she was missing the point, but she was hitting the nail on the head.
I, my husband, my sister, my best friend all did it at the same time. Vegetables and nuts were good for all of us and our gut bugs; ultra-processed foods, meat, refined starches, sugars, saturated fat were bad for us and our bugs. We didn't vary much. And overall I'd say the only variability that might make a difference is not about the gut bugs that is their big selling point; - it's how well your body deals with sugar and fat, and you can get tests for that from your GP. Your GP wouldn't (I assume) have the data to tell you how you score against ZOE's cohort, but I don't really need to know I'm at x% - I need to know if I have to change my diet based on standard, well-known parameters for being pre-diabetic etc.
While I was enrolled, I asked multiple times about the specificity of the food they were giving me in the app as 'gut boosters' and bad foods for MY UNIQUE gut bugs - since they are very specific. For example, apparently my ten worst foods for gut-bugs included chicken sausages, chicken soup, chicken pies. - Did that mean that pork sausages and beef pies or soups were okay? Probably not, as chicken was had a higher (good) score than pork or beef. Were these just generic stand-ins to say 'don't eat too many ultra-processed foods or meat'? - I didn't need to pay over £300 for that advice. So I asked how they determined which foods were good/bad for my microbiome and they never seemed to understand my exact question and just referred to the PREDICT study as having - allegedly - shown which foods the good gut bugs like.
I read that study multiple times; but it only shows you a correlation between certain microbes and a very broad categories of foods: e.g. 'vegetables', 'dairy', 'meat' and so on. If you read the study, which is free and in the public domain, then you will see that you need to eat vegetables, whole grains [etc] and less processed food, meat, alcohol [etc]... what is already recognised by most as a high-quality diet in order to have healthy gut bugs. I never found out what evidence they had for giving specific foods, vegetables or fruits higher or lower numerical scores, and the help staff were unable to explain.
They seem to trumpet a lot that they know exactly which foods encourage which microbes, and I do really fault them on this as a serious, culpable bit of misinformation or exaggeration; I can't see any published evidence for this. Not beyond the generic 'these microbes show up for vegetables, and those show up for meat. And the people with those microbes have higher cholesterol.' (But is that down to the microbes or the meat?
I wonder if they have *ever* published any data to show how diverse their dietary recommendations are between individuals. Now THAT would be an interesting study. Does anyone have a unique profile telling them doughnuts are good for their unique microbiome and kale is bad?