I am thrilled to have the opportunity to connect with Dr. Tim Spector today. He is a professor of genetic epidemiology at King's College, the director of the Twins UK study, a scientific cofounder at Zoe, and a leading researcher. He is also trained in rheumatology and epidemiology and is the author of Food for Life, his most recent book on nutrition and health.
In our conversation today, we unpack the new science on the role of the microbiome, the benefits of diverse food choices, and why Dr. Spector does not support superfoods. We dive into plant-material diversity, fiber, polyphenol-rich foods, fermented foods, and protein, and explore and explore issues surrounding bio-individuality specific to fiber, the impact of antibiotics, the Predict study, the Zoe program, and research on menopausal gut microbiomes. Dr. Spector explains why he does not believe in snacking, the value of digestive rest and intermittent fasting, and why lifestyle is a critical factor in menopause and beyond. We also get into some fascinating upcoming research.
I know you will love this insightful discussion with Dr. Spector.
IN THIS EPISODE YOU WILL LEARN:
What defines a healthy gut microbiome?
Dr. Spector explains the concept of the microbiome as a virtual organ
Why dietary diversity is essential
How fermented foods and plant-based proteins improve gut health
Some interesting research on research on how menopause affects the gut microbiome
Dr. Spector describes the holistic approach of the ZOE program
Why most snacks are unhealthy, and how extending the time between meals can improve gut health
Using intermittent fasting to rest the gut and improve overall health
How a poor night of sleep can alter food choices the following day
The interplay between exercise and gut health
Dr. Spector shares some ongoing research on the impact of coffee on the gut microbiome
“A healthy microbiome is about getting that right balance of the good guys and the bad guys- getting the right diversity and number of different species there.”
-Dr. Tim Spector
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Tim Spector
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve our health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[music]
[00:00:29] Today, I had the honor of connecting with Dr. Tim Spector. He's a Professor of Genetic Epidemiology at King's College, the Director of the TwinsUK study, Scientific Cofounder at ZOE, and one of the world's leading researchers. He's also trained in rheumatology and epidemiology and is the author of Food for Life, his latest book focusing on nutrition and health.
[00:00:52] Today, we spoke about the new science surrounding the role of the microbiome, the role of diversity and food choices, and why he's not a fan of superfoods, the importance of diversity of plant material, fiber, polyphenol-rich foods, ferments and protein, issues surrounding bio-individuality specific to fiber, the impact of antibiotics, the PREDICT study, the ZOE program, research on menopausal gut microbiomes, why he is not a fan of snacking and sees the value in digestive rest and intermittent fasting, and why lifestyle is so critically important at menopause and beyond. And lastly, some interesting research that is upcoming. I know you will love this conversation as much as I did recording it.
[00:01:45] Dr. Spector, it is a pleasure to have you on the podcast. Welcome to Everyday Wellness.
Dr. Tim Spector: [00:01:50] Great to be here.
Cynthia Thurlow: [00:01:51] I know that so much of your life's work is really devoted to the gut microbiome. And obviously, this podcast is very focused on helping women understand the changes that are occurring in our bodies as we are navigating perimenopause into menopause. But from your perspective, what helps define a healthy gut microbiome and why is this so important to set us up for success as we are navigating middle age and beyond?
Dr. Tim Spector: [00:02:17] Well, the whole study of the microbiome is a new science, so we're still finding our way. And it could be that what I'm telling you now is overturned in five years’ time, but we're moving in the right direction from total lack of knowledge, ignorance to more pleasant places. So, a healthy microbiome, which is the community of microbes living inside gut, I'm talking mainly about the lower intestine, the colon, it's about getting that right balance of the good guys and the bad guys. It's about getting the right diversity, the number of different species there, because we need to think of actually what this virtual organ does. It's all these different microbes, which are bacteria, fungi, viruses, parasites, are all actually working together, like they do in soil, like they do in the jungle or any environment, to compete for food and produce byproducts.
[00:03:15] And the main thing these microbes do are they're mini pharmacies. And I think if we start visualizing them in that way, it makes it a lot easier to work out what they do and how they go wrong or how they can help us. So, these mini pharmacies are converting the food we eat into other chemicals far more than our body can produce itself, and then sending those chemicals all throughout our body through receptors in our gut, whether it's the nerve endings directly or it's to the immune cells or directly chemicals that are going around the body. And they're in charge, really, of our immune system, which is the way we interact with our environment, which can be switched up or down. It can make you allergic or inflamed. It can calm down infections, and it can make you more efficient in fighting aging and fighting cancer.
[00:04:12] And some of these chemicals, we know, are also neurochemicals, so they can act directly or indirectly on the brain. And some people might have heard of things called serotonin, which the commonest, antidepressant drug Prozac, it was a serotonin acting drug. And there's another one called GABA, is made by microbes as well. And that people might have heard, remember, diazepam, Valium is how that works. So, this is just a taste of all the incredible things our gut microbes can do in terms of regulating, whether it's drugs, nerve, brain. And certainly, we know much more now than even five years ago about how important they are on the brain and our mood and our energy levels.
[00:04:53] And this is one of the big things that we see with our ZOE members that, when they start changing their diets with a gut friendly way, then mood and energy is the first thing that they notice. And that is not something that, as the medical profession has really cared about in the past. It's been generally ignored. So, I was pleasantly surprised. So, it does pretty much everything. We're just publishing a paper which should be out pretty soon. A new way of looking at the scoring system. People might know how to assess your gut microbiome is through a stool sample. And in the past, we just used the number of different species which we called the diversity index, which was a pretty good general guide. And generally, the more diseases you had, the worse it was.
[00:05:40] And we found that we have a better system now because we've got probably the largest database in the world now in the US and the UK combined, that tells us there are 50 good bugs and 50 bad bugs. And if you look at those in a ratio and you get that right, that's an even better predictor of gut health. So, that's what we're now using in our research, which is really cool. It actually changes quite quickly with diet and interventions. So, there's a lot of hope that we can use this gut microbiome now in a more quantitative way actually like a blood pressure reading to work out what we're going on.
[00:06:23] It's not very specific, it's not like going to identify certain diseases, and although some companies claim that, there's no evidence for that, but it gives you a pretty good idea of your immune health and your general well-being. But the nice thing is, unlike your genes, you can change it.
Cynthia Thurlow: [00:06:38] Well, and I think certainly when I was in my medical training over 20 years ago, the gut microbiome was not even something that was discussed. This really is the last 5 to10 years. And the more that I humbly learn about the gut microbiome and how impactful it is, especially on immune function, it starts to make a great deal of sense why this lifestyle piece is so critically important. You mentioned diet, and if I recall appropriately, you can get a 24-hour period of time where you change your nutritional patterns can have a profound net benefit on the gut microbiome.
[00:07:13] Now, when you're looking at the research, I would imagine some of the low-lying fruit are things like ultra-processed foods. But on the other hand, what is the research demonstrating in terms of what are the foods that you generally are recommending? Now, when I say recommending, this is again, very bio-individual. And I know that a lot of the testing and the work that you're doing is helping people identify what are the pieces of the puzzle that are unique to them. But what are the foods that you think for the most of the given population seem to be of benefit? Again, ultra processed foods, we know are not beneficial and could actually be harmful for many, many reasons. What are some of the foods that you feel like are important, essential, probably not looked upon as being so instrumental in supporting the gut microbiome?
[00:08:01] Well, I'm not one to so zoom in on superfoods, so I'm a real critic of that. So, everyone likes to have their superfood and their favorite food. I think if we talk about principles, and I think it makes it easier. So, there are a few principles about feeding your gut properly that allow you to then bring in lots of things into your diet, and it's about bringing more in, not taking them away. So, apart from ultra processed foods, which we can happily agree at all levels, and in the US, vastly overconsumed. Real food, this non-fake food, the general principle is go for diversity, eat lots of different things every week. And that is mainly about plants, eating lots of different plants, and mushrooms and fungi.
[00:08:52] After about 10 years of research, we've come to the idea that the number of different portions of plants you eat in a week is associated with your gut health. So, we've been championing with myself and my books and ZOE, the concept of 30 plants a week, which seems to ring a chord in people, because it's a fairly straightforward idea. And people forget that a plant is a nut and it's a seed, it's an herb, it's a spice, and it can also be a cup of coffee, because we forget that sometimes a lot of things we take for granted actually come from plants or fermented plants. That's one general principle. And if you do that, you're going to get lots of fiber, you're getting lots of diversity, lots of different nutrients, and it's like you're hedging your bets. You're just saying, “Well, I don't know exactly what I need. So, let's just get everything there and my microbes should be happy.” You're giving them the full buffet.
[00:09:48] And then the second principle is to eat the rainbow, which used to be an expression in nutrition quite a while ago, but no one knew why. I think they maybe thought it had vitamin C or something in it, but we now know that's a surrogate for containing these healthy chemicals that are defense chemicals called polyphenols. And these are used as energy by our gut microbes to invigorate themselves, have more children, produce more chemicals. And going along with the color, you tend to also get some bitter flavors in there. So, the darker the color-- the less beige it is, the more you're going to get these defense chemicals. That's why you get it in coffee beans, in dark chocolate, you get olive oil or red wine, seeds, all things that are slightly bitter to taste good for you. And they're good for your gut microbes.
[00:10:41] The third thing is eating more fermented foods. And in the US and the UK, we really eat hardly any fermented foods compared to other countries. And I think we're just rediscovering what we gave up when everything became in fridges and we stopped making things ourselves. So, studies have shown that if you have at least three portions a day of some fermented food, such as yogurt, cheese, kefir, kimchi, kombucha, kraut, miso, whatever, you're going to get a significant improvement in your immune system and your inflammatory responses. So that's the third pillar.
[00:11:23] And the other one is to really think about your protein intakes. We call it a protein pivot that you can switch from meat protein to high-quality plant protein, which also not only gives you sufficient protein, but also gives you all these other nutrients and the fiber we're lacking. Because the average American is not in a protein crisis, although the companies want them to believe they are, and they don't need a protein bar, but they do need fiber. So, 90-95% of Americans are not getting enough fiber. That's another reason to think about swapping your meat out for plant, proteins instead. And we're talking beans, legumes, chickpeas, lentils, that kind of stuff. So, they're the principles.
[00:12:10] And within that, you take your pick. And if you're going for diversity, then you may have a favorite, but you've got to mix it up and try and pick something new every time you go out to eat or you're in the deli and there's some strange thing you've not seen to eat before. It's probably going to do some of your thousands of species microbes some good. They might say, “Oh, that's interesting,” because that's got different chemicals in it.
Cynthia Thurlow: [00:12:31] Well, it's so interesting because if I recall properly, the average American consumes about five to six foods per week. They're so food monogamous. We say monogamy is a good concept, but, as it applies to food, we actually want things to be diverse. And the piece about fiber, which many people don't realize, when we're looking at that standard American diet, it's devoid of fiber because it's so highly processed. And if we look at ancestral diets, they were consuming 7500 g of fiber a day because they were actually directly eating the plants. What are your thoughts around people who state that when they eat a higher fiber diet, they get gaseous or bloating? Is that really a reflection of the lack of health of that gut microbiome that's driving some of those symptoms that they're experiencing?
Dr. Tim Spector: [00:13:18] Yeah, it's because they've let their gut microbiome degrade to such an extent that there's hardly any guys left there that have the experience of eating plants. So, the standard American diet of burger and fries or something similar or breakfast cereals is it never reaches the lower colon. So, it just gets absorbed in the small intestine gets into the bloodstream, sugar spikes. There's nothing going through to interest those gut microbes. So, those guys don't wait around forever. They often die out. So, when eventually someone says, “You know, you ought to eat some fiber, have some beans or something,” they overdo it, eat a large portion of these, and your microbes are overwhelmed. They can't break it down, and they go a bit crazy and they overferment.
[00:14:08] So, the key is to do this slowly, in small amounts and build it up. And when you do that, most nutritionists will tell you get a good result. And actually, many people say, “Well, I've already got bloating and constipation and problems. I don't want to make it worse.” Well, eventually it makes it much better. So, it's a question of having been patient and realizing all of these things we're talking about. It's not the six-week crash diet. This is about the rest of your life. It's about changing the way you think about food forever. And it's not about calories, it's not about fats. It's a different mindset. And this is what we're trying to do. That's a perfect example of just keep going back to a smaller portion and just work out what time you're fine, and then work from there. But give your microbes a chance, don't overwork them on day one. I think that's the key. And then, you'll be able to slowly rebuild them.
Cynthia Thurlow: [00:15:04] Well, and it's interesting because the experimented, the NF-1, five years ago, I was hospitalized for a ruptured appendix and ended up having six weeks of antifungals, antibiotics, completely depleted everything in my gut to get me through 13 days being hospitalized. And it took me a long time to be able to get back to eating more fibrous vegetables. I mean, it took 9 to 18 months, and it was very slowly. And when I say slowly, it was half a cup of a vegetable that was cooked, quite cooked. It was a small amount of, whether it was herbs or nuts or seeds. And over time, I'm now at a point where I've gotten back, granted it took quite a bit of time. But to your point, if you're listening and you're saying, “I just don't think I tolerate beans, nuts, legumes, etc.,” it may very well be that you need to do some foundational work before you start reintroducing these foods and understanding this is a marathon, not a race. I think so many of us were not very patient. And so, what ends up transpiring is that we overdo it. You have two cups of cruciferous vegetables, and then you’re miserable for two days because your body is like, “What is all of this?” But if you had maybe done a quarter cup, you might have done just fine.
Dr. Tim Spector: [00:16:16] Absolutely. Yes. And at the same time making sure that you’re getting enough water as well so you’re not too constipated. But it’s absolutely right. Antibiotics, very common in the US, lots of overuse of it. I mean, you obviously needed it, probably saved your life, but take them for as short a time as you can and realize there are these side effects and that it's really worth focusing on your diet for anyone taking antibiotics. At the moment, it's looking like diet is better than probiotics but in my opinion, for most cases, because we don't know yet what probiotics really to suggest. And this is where fermented foods, I think, really come into play and perhaps where our ancestors supplemented their own gut microbes with these ones that are in these foods. I mean, for those who don't know, they're essentially probiotics in real food.
[00:17:08] And you're getting all kinds of different strains in there, and they can assist in these situations where you're recovering from infections or antibiotics or some trauma to rebuild. So, I always advise my patients that they should be really upping the fermented foods anytime they're either ill or they're on antibiotics.
Cynthia Thurlow: [00:17:25] Yeah. And it's interesting because it certainly was a pivot for me because I think for so long, I would say to my patients, “Okay, you've been on antibiotics, appropriately dosed, appropriately utilized. And now, we are going to reincorporate some probiotics.” However, now I've completely pivoted, and I've been saying to people that the ferments, and it doesn't have to be a huge portion, but even if you have a tablespoon or two with your meals, it is going to be impactful. And one thing that I learned recently is there's a fermented plum paste that I've been finding for some of my patients they've been enjoying using along with miso. So, kind of like double the bang, if you will, of the probiotic rich foods.
[00:18:06] Now, I know that you've been doing some research around the net impact and the changes that are ongoing in premenopausal women, perimenopause and menopause. And what is the research demonstrating in terms of what is transpiring in the gut microbiome as women are navigating these significant hormonal shifts in middle age?
Dr. Tim Spector: [00:18:28] Well, we did the first ZOE study, which was called PREDICT back in 2020, and it was mainly women, but we noticed there was differences between women in the perimenopause and women who were younger, such that this study was giving 1000 people the identical foods, so it was an identical muffin in hospital conditions, either in mass general or in my hospitals in London. And the response was tenfold different between women for the same food, both for blood sugar and for the triglycerides in the blood. So, that was a bit of an eye opener.
[00:19:07] But then, we looked carefully at the menopausal status and the age of women and it turned out that peaks were 50% higher in perimenopausal women to women just one or two years earlier, even when you age, match them. So, we knew that given the same food, women were getting a greater blood response to that same food, which in part probably explains this whole idea of why, at certain times of life, women gain weight whilst eating the same food. And it's probably because the fat is hanging around more, the spike is higher, that's causing inflammation that has various changes on the rest of the immune system and the body and the gut microbes. And they feel hungrier as well, so may notice it, but they might be snacking slightly more or doing other things. And it's because the brain is saying, “I haven't really had enough to eat here,” being tricked by what's going on in the metabolism. So that was the first time anyone had really linked these diet changes to perimenopausal women.
[00:20:08] From that study, we then went and looked at thousands more women who've been doing the ZOE program and found the same general principles, but also looked at menopausal symptoms. And so, they again were correlated with the state of the gut microbiome so that the worse the state of the gut health, the more the symptoms and the peaks and everything would also relate to people who were spiking a lot, were also getting more the hot flashes and mood changes. And then, we followed a group of women who were doing the ZOE program, which is designed to reduce all those and improve the gut microbiome and those that adhered most of the program got immediate benefits for many of these symptoms as well.
[00:20:58] So, we think this is the first time that really, diet has been so strongly implicated in menopausal symptoms. And it's just never discussed with women. It's just all about, do you go on estrogen or not? Maybe there's some stalk about soybeans or not, but it's pretty primitive. And no one's thinking, “Well, maybe it's those high sugar, high fat foods that are causing these spikes and dips, and if we cut them out, then maybe you'll get rid of that brain fog, etc.” And all our data is showing that's true. And we've got over 50,000 perimenopausal women now.
[00:21:32] So, it's very exciting stuff as we're moving forward, and we're trying to work out which foods might fit with which symptoms and try and tailoring it that way. So, it's exciting research. I think it's empowering, because the first time women are able to do something about it, rather than just go to the doctor and ask for medicine.
Cynthia Thurlow: [00:21:51] Well, and it's so interesting to me because as someone that was traditionally allopathic trained and then moved on to do more functional integrative training, there was this negation of nutrition, the value of nutrition. And so, I love that the work that you're doing is so powerful because it allows women to be able to utilize and look at food differently, understanding what does-- the vasomotor symptoms or the hot flashes or the brain fog, what does that actually represent? Which is also understanding that our brains in our 60s, 70s, and beyond are made in our 40s and 50s, and how important it is.
[00:22:28] Will every woman transitioning from perimenopause and menopause have significant symptoms? No, not necessarily. But if you understand that a lot of those vasomotor symptoms are driven by blood sugar dysregulation and understanding that food choices that you're making can either contribute to those symptoms you're experiencing or can improve those symptoms is very, very empowering and helping women understand that we're losing insulin sensitivity as we have these sex hormone fluctuations, especially with estrogen signaling in particular.
[00:22:59] Now, I love that you're utilizing continuous glucose monitors or glucometers in your work. I think that this is the power, you call it the citizen scientist, but helping people understand the role of bio-individuality. Is that part of the ZOE program right now, utilizing continuous glucose monitors so that patients are able to monitor in real time what's going on with their blood sugar?
Dr. Tim Spector: [00:23:23] Yes, we certainly like these CGMs or continuous glucose monitors, but it's not the whole picture. I think you can't do everything with just a glucose monitor. That's why we've taken a more holistic view. But basically, the ZOE program starts with the testing phase, where you get a glucose monitor for two weeks. You get some of these standard meals so you can compare it to the hundreds of thousands of other women who've done the test. But we also have a blood suction device that takes blood three hours after a fatty meal so that we can see the level of fat that's still hanging around in the blood, because we think that's an even stronger marker of the inflammation that is caused after some of these meals. Some people get rid of it really fast. And others, it's still hanging around causing problems.
[00:24:07] And then finally, the third part of this is to get an assessment of the gut microbiome through metagenomic sequencing, which we use the state of the art academic platforms that allows people to then compare themselves with others of the same age and work out what journey they need to go on, how much further they need to improve their diversity or fiber or fermented foods. So, with those three things, they then get a score of every food that they scan or log on a phone app. And the idea is to keep those scores high, which means you're then avoiding the foods that, for you might give you particular sugar spikes or fat spikes, and improving your gut microbiome.
[00:24:56] And if you do that, we've shown in a big randomized controlled trial we published in Nature Medicine, compared to the US advice, which is mainly around eat more fruit, restrict calories and fats, that it does much better than that, and improves the gut health pretty rapidly as well. So, we've shown that this system works, which is a combination of personalization plus this whole concept of eating for your gut health. In those studies that work, then the menopausal symptoms are one of the first things to melt away. And this mood and energy particularly, are one of the first, biggest improvements we're seeing, which is great. So, it's more a holistic program, and it's not a one-off thing. So, it's an educational exercise. You do it for several months and carry on. And most people are signing up for a one-year, twelve-month plan, and then with a retest of the gut after that.
Cynthia Thurlow: [00:25:51] I think it's very exciting because I can't think of any other holistic modality that's looking at these particular pieces together in conjunction with the changes that we know are ongoing as we are navigating perimenopause and menopause. I know when I had Dr. Mary Claire on, who I know you've also had on your podcast, she talks about how our gut microbiomes in menopause seem to resemble men's. As we're making this transition, we're losing some keystone bacteria, losing some significant things that are unique about our gut microbiome prior to going into menopause. What are some of the standout things that you've been able to differentiate when we're looking at premenopausal women versus menopausal women in their gut microbiome composition?
Dr. Tim Spector: [00:26:37] Well, there isn't a consistent marker of it. So that's because the problem with this whole field is that we're all so different. If we were really close friends and we examined each other's microbes in our poop, we'd probably only have 20% of our microbes in common. And so, there's much more difference between individuals than there are, say, between the sexes. And this will change over our life course and due to our experience, or you'll still have the effects of those antibiotics or those antifungals. And so, teasing out, there isn't really a perimenopausal microbe that we can find consistently. There are general broad patterns. You get more proinflammatory microbes. These are microbes that you know will produce chemicals that can excite the immune system rather than dampen it down. You see changes like that.
[00:27:27] Many of these changes are microbes that no one's really heard of because we've got the latest secrecy equipment, which is great, but it means that they just have numbers and we don't know what they actually do. So, I think we mustn't jump to the conclusion that we can get suddenly a marker of someone's menopause. I mean, we are looking now in detail at some microbes that eat soy, for example. There's a whole group of these that we now realize depending on which microbes you've got, if you eat soy, some people will get a helpful estrogen like chemical and some people won't. And it just depends which microbes you've got. So, we, hopefully in the future, we'll be able to have a test that tells women there's no point in you eating lots of soybeans. It's not going to help the estrogen levels.
[00:28:23] And others say, yeah, this is really good for you. You tuck into that edamame. It's going to be fantastic. So again, as we learn more and we drill down into this, we'll see it. But most of our data so far has been quite cross sectional in very big numbers. So, we need more longitudinal data because of this complexity in a way, you're your own control. It's very difficult to match you with someone else. So, we see these broad shifts. We see the number of good bacteria dropping in that 10-year period and then stabilizing. But that's quite a big time, and it happens a long time before the actual periods stop. So, this is the other, as do often the symptoms. But medical profession still defines menopause as one year since the last period, which I think really is the worst. It's all over by then.
[00:29:09] You really need to get on with it and start much earlier. So, it is a fascinating area, and we think it's a combination of where you started from where you ended up, whether you've been taking extra estrogen replacement therapy or not, but all sorts of funny confounding factors.
Cynthia Thurlow: [00:29:27] I can imagine, because for listeners, there's such a broad significant relationship between the role of estrogen, and especially as women are navigating perimenopause and menopause. And if you look at the research on perimenopause, we have some of the most wild fluctuations in estrogen of our entire lives in that time period, 5 to 10 years preceding menopause, and then it starts to calm down quite a bit. But immune function and estrogen really do have this interplay that is quite significant. I think for so many individuals, we hear physicians and healthcare providers talking about the benefits of estrogen therapy for bone and brain and heart health without understanding that there's also this conferred benefit, that estrogen is very protective for immune function. And within the gut, helping to support specific keystone bacteria, improving or lessening our likelihood of developing small intestinal hyperpermeability, the health of the enterocytes, which are the cells aligning of small intestine.
[00:30:31] And I do agree with you that really, at the basis for whether it's perimenopause or menopause management, is really this lifestyle piece. And I love that you're really speaking to nutrition, because that is really the most important thing of all, because you cannot out widget a terrible diet. And unfortunately, at least here in the United States, I feel like we have really done ourselves a disservice, that we've been convinced that it's not worth our time to cook. And we go to the supermarket, and instead of shopping the perimeter, we're buying a lot of ultra processed foods, which are not supporting the health of our gut microbiome in a way that is beneficial long term.
Dr. Tim Spector: [00:31:09] And I think they're actually pro-inflammatory. And I think a lot of the symptoms that women are going through I used to be a rheumatologist. I used to see a lot of women autoimmune diseases, and with high inflammation levels, and it quite similar. This idea of the brain fog, the mood, the fatigue, or the energy, and low-level inflammation, we now know is being driven by the food you eat every day. It may not always be measurable in the bloodstream, but that's the common mechanism I'm seeing all the time. So, I think we're going to hear more and more about this.
[00:31:41] And that's why I think these holistic ideas that you're just trying to get everything to dampen that down, and then your body can get back to where it needs to be and your brain can free up. I think it's really important that we try and reduce it down to one little thing, or one food, or one chemical, or whatever. We just accept that inflammation pays as we know it does, from the disease. There's this huge role, and that food causes this low level of the same problem, and that if you cut that out, that's the first major step everyone can make.
Cynthia Thurlow: [00:32:15] Well, it's interesting, there's a program that I run, and just for a month, we do a whole 30, so that my patients will remove gluten, grains, dairy, soy, alcohol, sugar, and just for 30 days. And I'm oftentimes amazed at the reduction in symptoms just by-- And that's a broad generalization. But food can be the most powerful contributor to our health issues or not. And I think when I look at a broad schematic of patients in middle age, the ones that are oftentimes doing the best are the ones that are making the largest attempt to be conscientious about their diet. Do you have opinions about, in fact, I know that you do. What are your opinions on snacks?
Dr. Tim Spector: [00:32:56] Lots of opinions.
[laughter]
Cynthia Thurlow: [00:32:58] Yes. What are your opinions surrounding the concept of snacking, which unfortunately gets stressed a lot here in the United States, versus intermittent fasting, time restricted eating. And what is the research demonstrating for us in terms of eating less often and the benefits on the gut microbiome and the rest of our health?
Dr. Tim Spector: [00:33:15] We've looked at snacking in the ZOE data and most people snack unhealthily. So, 90% of snacks are pretty unhealthy. And so that process is causing extra sugar spikes and fat retention in the body that you wouldn't normally have. And, in the US, six or seven eating episodes a day is seen as quite normal. You may not go even overnight eight hours between eating is normal. We found that healthy snacks can actually still be healthy, though. So, you have some nuts or seeds or an apple. We found no evidence that was actually bad for you unless it's late at night. So, any snack late at night seemed to cause problems. And this is where it blends in with this idea of giving your gut a rest.
[00:34:11] So, even bad snacks at any time are bad and will actually make you hungrier. I think that's the other thing that we need to be absolutely blunt about. If you're having these foods, regardless of all other health rubbish, saying it's got extra protein, vitamin C, vitamin D, nonsense, it's going to make you even hungrier and cause inflammation. So, what you want to do is leave time overnight for your gut microbes to recover. We have these different teams. There’s a cleaning team comes out that cleans up your gut lining, which is crucial for your immune system, making it all fresh and ready for you to go when you're energized and you're going to be eating when you should eat, which is what our ancestors did, which is during working hours and probably not straight away in the morning.
[00:34:53] I spent a week with the Hadza tribe in Tanzania about 10 years ago, and they don't have a word for breakfast. And so, most humans are not naturally starving when they wake up. It's only the breakfast cereal companies that have made us ring that bell and say, “Oh, I must get my Cheerios or whatever before I leave the door.” So, extending that time of not eating to what our ancestors were doing makes absolute sense. And 14 hours, to me, seems to be the optimum time between efficiency and ability to carry it on long term. But probably anything over 12 is good.
[00:35:35] And we've done a study of 140,000 people who tried to do this intermittent fasting, and about a third found it easy. So, these are not selected people, this is just the general population. And a third found it easy and did it. About a third weren't quite so sure, dropped out or found it a bit tricky, and a third said it was impossible for them. So, I think you’ll also realize that we're all quite personalized in our snacking habits and that also some people are hungry in the mornings. I think they're the minority. But let's not be too rigid and say we should never have breakfast. Work out yourself what suits you and your metabolism. But I think most people can live very well on two good meals a day and make sure if you are having a snack, have it with your meal or just after your meal. So, it's one episode for your body to deal with, rather than your body and immune system having to deal with six or seven episodes. I think that's it.
[00:36:30] But the evidence-- It doesn't miraculously cause weight loss. I think that's a myth. It does help some people's mood. It does help some GI problems, so bloating and constipation seem to be helped by giving this rest of that and reflux and heartburn. But it probably just makes you think more about not eating snacks and rubbish food because you're saying, “Well, the way I do it is I try not to eat after 09:00 PM in the evening and wait till 11:00 AM in the morning to eat.” So, as you go to bed, the cookies are there. You say, “No, no, I'm not having them.” And it just breaks a few of these habits. So, if anyone's listening hasn't tried it, definitely give it a go. But don't beat yourself up if you find it really tough and it's not a deal breaker, but people who find it really helpful get great benefit.
Cynthia Thurlow: [00:37:22] Yeah. It's so interesting to me how many of my patients, when we even talk about digestive rest, just 12 hours, how that alone confers so much benefit. And I think we've gotten to a place as a culture where we're so hedonistic and everything is accessible all the time, that actually allowing our bodies to have an opportunity to actually get true intrinsic hunger as opposed to, “I'm bored,” or, “It's 08:00 in the morning, this is when I eat breakfast,” or, “I eat at 12,” or just acknowledging how your body's feeling.
[00:37:53] Over the summer, I've been doing intermittent fasting for almost 10 years and I decided to see how do I do with a wider feeding window, having maybe my first meal at 09:00 in the morning, my last meal at 5:00 or 6:00. And it's been interesting to see just with that degree of experimentation, it's something that everyone who's listening can certainly try to do. But eating less often, however, that looks for you, is so much more in alignment with way our bodies are designed to actually thrive. And I think also about their circadian biology, how we're more insulin sensitive earlier in the day than we are at night. How many people that wear trackable wear with data like Oura, Whoop bands, where they can actually track if they eat a late meal, what it actually does to their sleep quality, their blood sugar regulation, is really interesting. And so, to your point, that degree of digestive rest, however that manifests, I think, can be hugely impactful.
Dr. Tim Spector: [00:38:46] Yeah. In our study, actually, of the people that did it for the full three weeks and reported everything, a third chose to do early on. So, having breakfast and then finishing at about 06:00 PM. Two-thirds preferred the later one. And I think it's interesting because most of the study suggest the early one has slightly more benefit. But nearly everyone agreed that it's harder to maintain in your social life and have fun and eat with friends and family. So, I'm a big believer in enjoying food and not making it a punishment. And so, if there's a doubt between the two, then I go for the late one and make sure even if you don't do it every day, if you do it five days out of seven, and that lasts for years and years and years, that's much better than the really tough regimes.
Cynthia Thurlow: [00:39:36] Well, and I think you're very pragmatic, which I appreciate, because what we want is people to make sustainable change and be able to do it lifelong. And so, really meeting people where they are. Now, when we're looking at other lifestyle pieces that have a large net impact on the gut microbiome, I think a lot about sleep and exercise, what are some of the areas around the gut microbiome research that you're currently looking at to see--? What are some of the things that we can be doing and adjusting in terms of our lifestyle that can have a positive net impact on the gut microbiome?
Dr. Tim Spector: [00:40:08] With sleep and exercise, obviously very related, the three, if you put that with diet, they're all critical. People argue about which is more important. I think you and I are probably in the diet camp, but exercise probably comes up a pretty good second in terms of longevity. But in terms of day-to-day functioning, sleep is probably even more important. And we showed in our studies that we did log sleep in our published papers, and that a bad night's sleep changes your microbiome and changes your food choices the next day. So, we've all encountered this, right? You get three- or four-hour sleep, feel rotten, your brain is screaming, carbs at you, it's like, “Give me something. And now this is not the time to go on an intermittent fast, I need something.”
[00:40:55] So, there's something really hardwired about this. The brain keeps sending out the wrong signals to the body. And you have to try and override that, because once you get on that, you're on this cycle of spikes and troughs, and you feel even worse. So, they really are very closely linked. So, sleep and microbiome are quite easy to see, and you can see circadian changes. And when you deprive people of sleep, their microbiome changes. Microbes need sleep just like we do, and they like a circadian rhythm, they like steady patterns. Exercise has been harder to link with the gut microbiome in most of the academic papers we've seen and the work we've done, and it probably is that there's a bit of a different response.
[00:41:40] When we're doing the blood sugar studies, we found that some people’s blood sugar dropped when they exercised, and others went up. So, some people preferred running on an empty stomach and others preferred running on a full stomach. So, I think there's a huge area of personalization about how our body reacts, and it could be that we're designed as a race to be able to run away in all situations, whether we've just had breakfast or not. So at least some of the tribe will escape and others won't. [Cynthia laughs] I find it hard to explain in other terms why that is, but certainly exercise is important, but probably sleep has a bigger impact on the microbiome.
Cynthia Thurlow: [00:42:20] It's so interesting because I think about, obviously sleep is a non-negotiable, but even the circadian clocks that are in the digestive system is certainly very important how that impacts cortisol and melatonin and all these other players. But when I think about exercise, I think about if some ones just walking, yes, that can lower their blood sugar, maybe they’re doing strength training, but I think about high-intensity interval training or CrossFit, very intense exercise, I would imagine in some individuals you’re actually going to be depleting glycogen in order to facilitate the degree of intensity. And so again, very much a bio-individual perspective. What are you working on currently? What areas of research are you working on? Obviously, I know you are an academic and a practicing physician. What are you curious about? What areas that you're looking at right now for additional research?
Dr. Tim Spector: [00:43:15] Well, there's so many. I mean, we've just got a paper coming out of about a coffee microbe. It's the strongest association in nutrition and microbiome is between whether you drink coffee or not and whether you have this one microbe called Lawsonibacter. And if you're a coffee drinker, you've got four times the level of people who aren't. But in the US and the UK, everyone's got it, because coffee microbes are everywhere. People are breathing on you, kissing you, [Cynthia laughs] cuddling you, even if you're not a coffee drinker, right? Whereas other countries, it's not. So, there's this low level and it's hanging around. Do you drink coffee?
Cynthia Thurlow: [00:43:52] I am not a coffee drinker. I drink green tea.
Dr. Tim Spector: [00:43:54] You've probably got a tiny amount of this Lawsonibacter from all the other coffee drinkers around you. And it's just waiting to replicate when someone drops real coffee into it and then it explode to five times the amount. So, that was really quite cool. We did study of 30,000 people around different countries and that's really the start of our journey towards pinpointing foods that will trigger certain microbes. And once we've got that better, we can really pinpoint advice to people about, “You need to eat more of this, less of this,” etc. So, that's a really cool, fun one.
[00:44:27] We did something about a parasite in the microbes we published a couple of months ago. Usually, if you have a parasite in your gut, you're told to get rid of it by your doctor. But this one actually reduced your fat levels and your internal visceral fat, reduced your blood pressure and your lipid level. So, all our ancestors had it, but I think less than about 8% of Americans. We mustn't forget the other bugs in our gut microbiome, some of it which are like predators killing our nasty bacteria for us. So, that was really exciting.
[00:45:00] We've got a new scoring system, as I've mentioned, for the gut microbiome coming out. It's under review, so hopefully be out in a few weeks’ time, which could revolutionize the way we look at gut microbiome health, because everyone will have a nice, easy-to-understand score that changes.
[00:45:17] We've got a prebiotic mix, which we did a randomized trial on. We knew that this concept of eating more diversity was important, generally in epidemiology studies, but we wanted to do a trial to say, “Well, if we gave very small amounts of 30 plants to people every day, could that have a major impact?” And we didn't want to make them processed, so we just freeze dried them. And then there were six mushrooms in there, for example, and this is this what we call the Daily30, and we did this randomized trial against a dummy placebo arm of just breadcrumbs of the same size and a leading probiotic in 300 men and women. And we showed dramatic improvements in our prebiotic mix arm. The microbiome really improved rapidly within a few weeks, gut symptoms improved, mood, energy improved and the blood parameters. So, that's really exciting because we've been developing that for several years and we've rolled it out in the UK as a commercial product and it's doing incredibly well. And we're going to be rolling out in November in the US.
So just to do research, no other supplement lifestyle company does a randomized trial and then publishes in a top journal, it's quite risky, but we wanted to do that. So, we think this is going to have a huge impact because people are taking these chemicals. I don't know what you think of these powders. We won't name their names, but they're green and they're chemical and they've got about 80 ingredients in them. They’ve never done any trials on them. And many people get sick on them because they're not real food. Whereas this is real food, you add on top of your salads or your yogurt or whatever it is. I think we are setting a new standard in this area.
[00:47:05] So, they're just a few of the things that are going on. But we're the world's biggest database of gut health. I think the sky's the limit. We've published over 40 papers now and everyone wants to work on this database. So, I've never had such an exciting time as a scientist.
Cynthia Thurlow: [00:47:19] Well, I'm grateful for the work that you do. I mean, the gut microbiome is a real interest of mine, and certainly women in middle age as well. But the upcoming research is of tremendous interest as well.
Dr. Tim Spector: [00:47:33] Yeah, we will be looking-- I think I mentioned mood and energy, but I think I'd like to focus on people with menopausal symptoms to do a trial of those. And so, it'd be interesting to see if this Daily30 works as well as we think it does. People with menopausal symptoms, particularly on the mental, there's mood and energy ones the brain fog. I think that'd be interesting. Can you shift that just with a prebiotic that's tailored? I think that's going to be certainly-- I suspect we will, but can't yet prove it.
Cynthia Thurlow: [00:48:00] Well, it's so exciting. It's been such an honor to connect with you. Please let listeners know how to connect with you, listen to your amazing podcast or connect with you about the work that you do.
Dr. Tim Spector: [00:48:08] The podcast is Zoe Health & Nutrition, which comes out regularly. Good way to listen about the latest science of nutrition. My Instagram account is just @tim.spector where we post various ideas and themes. There's zoe.com, which is the website, and the other Instagram area where you get recipes, etc. And if you want to do the ZOE program, then you go to zoe.com and you can sign up at the moment everywhere in the US except for New York. So, you can get on and discover how you're getting on. But hopefully you'll be hearing more about us soon as we disseminate it. But interesting to hear how people get on, particularly with those menopausal symptoms.
Cynthia Thurlow: [00:48:52] Absolutely. Thank you again.
Dr. Tim Spector: [00:48:53] My pleasure.
Cynthia Thurlow: [00:48:57] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.
Commentaires