How I discovered I was pre-diabetic and dropped 3kg by personalising my diet with Zoe. Spoiler alert – white wine and potato chips out, red wine and okra chips in.
I’d been a steady weight for most of my adult life around 65-70Kg. That was till I hit menopause.
Then it rose to 71 then 72 then…74. At that point, I stopped looking.
A few months later, I threw out my entire wardrobe which no longer fitted. This was getting expensive.
I honestly didn’t recognise the person in the mirror anymore. Who was she?
The general diet and lifestyle I’d enjoyed for years didn’t seem to manage my weight anymore and I couldn’t understand why.
I was eating a rainbow of plants every day, quality proteins from all sources, probiotic dairy and sourdough bread, and nutrient-rich satiating grains like quinoa. I generally assigned alcohol to weekends, and didn’t have much of sweet tooth. One of my favourite foods were chips (air fried in extra virgin olive oil and sea salt), a weekly treat at the most. I exercised regularly. I didn’t eat ultra-processed foods or eat late at night, the most metabolically-unhelpful time to eat food. My book The 10 Hour Diet explains more about this.
What had menopause done to me? My diet and exercise (mainly gentle yoga, cycling, and dog walking) hadn’t changed either. Yet I had become the owner of two tyres – one around my middle and the other around my face. I didn’t understand why.
I felt as if the checks and balances of my body were no longer in place after menopause when your estrogen plummets, your periods stop, and your body behaves differently. I started to worry about developing other health issues triggered by the metabolically-dangerous fat accumulating around my middle.
Articles in the mainstream press where medics accused menopausal women of moving less and eating more as the cause of becoming barrel-shaped, frankly added insult to injury. Victim shaming at its worst. Recent research says our metabolism doesn’t slow down till our sixties
I started wondering if I had a slow thyroid. I checked it on Thriva and it looked ok.
And then I met Zoe, the app…
This is designed to help you manage your health, fronted by Professor Tim Spector. I first met Tim in 2016 when we were lone voices in the UK starting to talk about this strange thing called gut health. He had just launched the precursor to Zoe, called Map my Gut, and I had brought out my book The Gut Makeover. As a medical doctor, with, at that time, 700 scientific papers bearing his name, he was in a strong position to call out the outdated non-personalised nutrition advice in the mainstream at that time – eg eat low fat and counting calories. Zoe doesn’t encourage any of that.
I signed up and paid £400 for the 4-month subscription to Zoe. My goals were: 1) to try out this new health tech and see if it was a complementary approach I could weave into my own nutritional therapy gut health work with clients. 2) Could this help me lose the tyre? An outside tool to coach me along and personalise my diet using data about my own body and its responses to particular foods - interesting. Because let’s be frank, it’s hard to coach yourself however much knowledge you have.
My Zoe package consisted, roughly, of the following:
The tests
Poo
A poo test to see what types and patterns of bugs are living inside you which can impact many areas of your health from weight, mood, heart, immune system, and much more. Your microbiome, the billions of bugs living in your digestive tract cross talk with our hormones, brain chemicals, and almost every other a system of the body. Making sure that bacteria, and particular families of them, are flourishing nicely and sending positive vibes to the rest of your system is important. You put a small spatula of poo into a tube and pop it in a post box near you. Easy.
Blood fat
This gives information about how well your body metabolises fats. You have to prick your finger and squirt a blob onto a piece of blotting paper and pop that in the post too. I found that assignment messy and a bit complicated because you have to jump around and put your hand in hot water beforehand.
Continuous glucose monitor (CGM)
This is a plastic disc with a tiny metal spike that you punch into your arm with a spring lid. It’s almost painless. You stick a plaster on top and download an app to your phone. You then wave your phone over the plastic blob on your arm as often as you want, and you get readings on your phone about what is happening to your blood sugar levels eg up, down or static. The tiny spike senses how much sugar is cruising around your body and passes the info to your phone. You wear this for two weeks. You also have to do a muffin test to challenge your sugar response - where you eat 4 massive muffins which is like eating large portions of sawdust. There are a lot of instructions to follow but generally the app explains well.
Results
After you’ve sent off your tests and worn your continuous glucose monitor for a couple of weeks, the data is put into a computer and spits out personalised ratings for foods – on lists which appear on your Zoe app on your phone.
Zoe gives you personal scores from zero (don’t eat often) to 100 (do eat often) for foods so you know which ones are better choices for your individual health. As you can see from my personalised list here - many types of bread are not helpful to my health as many have low scores between zero and 8 out of 100.
My microbiome looked good – there were lots of different bugs in there and I scored a green “very high” diversity score putting me in the top 25% of people. This was a relief to see – eating all those flax seeds and variety in my diet had been worth the bother. Diversity is associated with good health, and you need to eat a wide variety of plants regularly to make your microbiome diverse and healthy.
However, my sugar handling scores were poor.
On the Zoe app, you see which foods are better for your individual physiology or not. The app produces scores out of 100 for each food. A score of 50 and above is shown in traffic light green and signifies you can eat these foods often. A score of between 0 and 49 is shown in the colour amber signifying they should only be enjoyed now and again. The closer the score is to 0 the darker the shade of amber.
Me as a case study
Here are some key findings about my particular body and what suits it best according to Zoe. My results motivated me to focus most on balancing my blood sugar levels, to take me out of what I suspected was the pre-diabetes zone. Within days of putting the continuous glucose monitor on I could see I was waking with higher than normal fasting blood sugar levels (I checked standard reference ranges for this). I worried that if I didn’t address this I could end up with type 2 diabetes. Both my mother and her mother developed this after menopause.
After menopause, estrogen levels drop dramatically and this can lead to some women’s bodies becoming insulin resistant or having impaired insulin sensitivity. It means that when you eat sugar, white carbs. or in some cases completely random foods personalised to you (as I found out), your blood sugar spikes, and this is followed by an insulin spike which aggressively stores fat around the middle of your body.
The results startled me and made me think that my high blood sugar readings were probably a cause of my central fat gain. Bringing my sugar levels, and consequently my fat-storage insulin levels down became my priority. I could see in real time that each time I ate any pastry or fruit (apart from berries which are low in sugar) my blood sugar reading went above 10 and out of reference range too high.
Remember, that Zoe is all about individualisation. In another person’s case it may have been that they weren’t eating enough variety and the microbiome needed the most help which in turn might improve mental health or heart health. The work you will do will be different from person to person and targeted to help your individual needs. Here are some examples of foods I personally needed to change.
Sourdough bread – 28/100 (amber). I started swapping this for keto bread full of flax seeds 87/100 (green). Instead of sending my blood sugar out of range like the sourdough, after the keto bread, my blood sugar levels stayed within reference range for hours.
To my surprise, the my whole list of different types of bread and flour indicated these foods would not be much good for my personal physiology.
The only flour/bread which appeared in green (therefore good for me to enjoy regularly) was gram flour (made from chickpeas). Plain white flour was a zero. Even brown bread was just a 3/100 – so not encouraged for me. I started mixing gram flour with regular wheat or spelt flour in quiches and cakes and my blood sugar stayed much more stable.
A blood sugar rise above 10 is out of range. About an hour after eating this home-made onion tart with spelt flour and then a tiny piece of ripe mango, my continuous glucose monitor app started beeping and showed the colour amber on this chart. This information taught me that this meal would not be a good choice for keeping my blood sugar stable in future.
In regard to grains, my favourite white sushi rice scored 3/100. Another disappointment.
At this point, I decided to invest in more continuous glucose monitors (CGMs) and wore them fortnightly on and off for the next three months (they only last a fortnight each). I ordered them directly from Freestyle Libre 2. They cost £50 each and gave me a better idea of how my blood sugar was doing in real time rather than just relying on the Zoe scores for guidance.
Timings and sequencing of foods
I started to play around with timings and order of eating foods to see if I could occasionally eat white rice or sourdough bread without my blood sugar rising so much.
I started to enjoy white rice – a small portion at the end of a main course, after the vegetables and protein rather than together and took a 10-minute walk afterwards. The order and the walk helped keep the blood sugar just about within range - on some occasions but sadly not all.
I found that a sourdough roll at breakfast had a much less pronounced impact on my blood sugar levels than if I ate it in the evenings. This is consistent with humans generally having better blood sugar control in the morning.
So what happened to my reaction to wine? I found that red wine before a meal seemed to keep my blood sugar level steady. However, white wine sent my blood sugar line racing high. In conclusion, I’m happy to have red wine in my life from now on rather than white. That sounds like a good way to live.
I found that potatoes (26/100) spiked my blood sugar dramatically. By swapping them with cauliflower or celeriac mash my blood sugar stayed fairly even. Try making a mash with cauliflower or celeriac with soy milk and some butter – it’s delicious. I started making okra (96/100) rolled in gram flour (56/100 made from chickpeas) instead of my beloved potato chips. Again, delicious and not spikers.
Results time…
I’m coming to the end of my four months with Zoe. I have not been logging my foods daily for the last few weeks – I find it repetitive and time-consuming and I am finding that the CGM gives me immediate results and guidance about how I am doing.
I’m using chickpea gram flour in baking and enjoying pasta made from red lentils (as they are high in protein and lead to less sugar spikes than when using regular white flour pasta ones). I make more curries with beans and black lentils. When eating meat I often stretch it with lentils or beans like in Mediterranean cooking – cheaper and healthier, and my blood sugar levels approve too. Also good for keeping my microbiome healthy.
I now mix chickpea flour into pastry to steady my blood sugar. The addition of the chickpea high-protein fibre-rich flour means I can enjoy pastry without it spiking my blood sugar out of range, and insulin, and driving fat storage around the middle of my body
The pros of doing Zoe
I started to pay attention more closely to what I eat and have learnt which foods to choose in my particular case, to keep my blood sugar levels within range.
I discovered I may have been pre-diabetic for some time. My fasting glucose levels were out of range on waking and were spiking high or our-of-range after eating when I started wearing the CGM . This information may partly explain the spare tyre accumulation. It is great to have food lists from Zoe that are personalised to help manage this.
I have discovered CGMs – and am using them with clients too. The Freestyle Libre 2 technology can be linked up to my computer so I can pop in and see how you and your blood sugar are doing and support you.
The cons
After quite a while using the CGM I realised you could set an alarm on it for when your blood sugar goes out of range (too low) - not just too high - which is what I initially had the alarm on for.
When I started using the low blood sugar alarm I realised my blood sugar was regularly dipping into the red each day and might have explained my low energy. But it wasn’t clear from the app what to do about low blood sugar episodes (because the app would give me low scores if I ate any white carbs to boost it).
I found daily logging a drag. I think realistically a month or two was my tolerance for doing this. Many foods and brands are still not in the Zoe database, so if you cook from scratch most of the time as I do, you are having to put in every ingredient or choose a supermarket version of said lasagne or curry instead which isn’t a real reflection of what you are eating. And although there is a section where you can put in recipes you use regularly, that is a big investment of your time too.
The fat handling was hard to understand. For example, the app promotes eating artisan cheeses for me, but when I ate them a message came up repeatedly warning me to watch my fat intake.
You are being coached by computer. I didn’t receive with enthusiasm the graphics high-fiving me or messages congratulating me. It felt weird. But on the good side, there are real people on the chat box you can ask questions to – response time is between a few hours and a few days.
There were also what felt like endless quizzes to educate you. I didn’t warm to this. Eg “What have you learned about blar-de-blar?” You enter a response and the computer congratulates you. I quickly found that if I just left the answer blank I still got congratulated.
There wasn’t a detailed-enough road map at the start revealing what you’d be doing on what weeks. The one sent in the initial box was nebulous and you never knew in advance what kind of actions you would need to focus on next.
Retesting isn’t currently offered at the end of your 4 months. It would be good to see how your microbiome or blood sugar handling scores are looking after the work.
Drum roll…where am I now?
My goals were to lose weight and learn about Zoe for my work.
I’m near the end of the 4 months.
I’m now 71kg and my blood sugar levels are steady and within healthy range most of the time (I know because I am still measuring on a CGM).
I have lost 3kg (about 6 pounds) slowly, and without having to give up red wine! The weight has mainly come off my face and waist. Weight gained during and after menopause is notoriously difficult to shift and finding the right point of leverage for the individual you are is important. I have to admit I eat less fruit nowadays because the sugar in it spikes my blood sugar so much. When I do eat it, say a kiwi, it’s at the end of a meal sliced and cloaked in sheep’s yogurt or organic soy milk with chia seeds and sprinkled in cacao nibs so I don’t get spiked. The protein and fat in the yogurt and seeds, slow down the sugar hit from the fruit and consequently the insulin fat-storage hit.
The tyre is coming down and I feel confident I can prevent the development of type 2 diabetes.
My story is a personal story and what you find out about you may be different to me. The best thing about #healthtech is that it can help you work out your Achilles heals and tweak your diet and lifestyle accordingly rather than employing guesswork. And because you are working on the right bits, eg blood sugar like me or lack of plant diversity in your diet if your microbiome isn’t diverse, you’d know where to focus your work.
2024 UPDATE: So how did I fare one-year after Zoe? What was the impact on my health and the way I was eating? Find out here.