ZOE's best health tips of 2024 - Part 1
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Welcome to Zoe, Science and Nutrition, where world-leading scientists explain how their research can improve your health. Thanks for tuning in to this very special episode of Zoe, Science and Nutrition, where we're taking a look back over 2024. In fact, it's a two-parter. There were just so many amazing insights this year. We had an incredible lineup of guests throughout the year who shared with us a huge range of actionable tips on improving our nutrition and our gut health.

And a lot of what we learned this year surprised me. Like the beverage you're probably drinking every day that we thought was bad for us. Turns out it can actually be beneficial. Or that what counts as a plant is actually so much more than just fruit and vegetables. Not to mention the really important topic that until very recently was taboo and made our celebrity guest emotional. I know I learned a lot from that one. That's coming up at the end of the episode. So make sure you stick around.

With January around the corner, a lot of us are thinking about making some positive changes. But new habits can be really hard to stick to. I know my yearly resolution of giving up the dark chocolate after dinner always falls by the wayside before Valentine's Day. That's why we took a deep dive into this very topic. How to build healthy eating habits in a meaningful and sustainable way.

And I got to chat with the brilliant James Clear, author of the number one New York Times bestseller, Atomic Habits. We're also joined by Dr. Federica Amati, our head nutritionist here at Zoe.

So it's mostly about how you structure your environment. And I think a simple question to hold in the back of your mind, just like think about one habit that you're trying to build. Maybe it's a certain type of food you're hoping to eat more of, or, you know, something you're hoping to do. Maybe you just want to cook more meals or something like that. And then walk into the rooms where you spend most of your time each day at your kitchen, your living room, your bedroom, look around those rooms and just ask yourself, what is this space designed to encourage? What behaviors are obvious here? What

What behaviors are easy here? And, you know, if you walk into one person's house and the chips and the cookies and snacks are on the counter and visible and easy to get to, and you walk into another person's house and those things are either tucked away, maybe some of them already have been in the house or they're, you know, on the highest shelf in the back of the pantry and they're harder to get to. And they've got, you know, a piece of fruit out on the counter. That really struck me that our environment is crucial in building new habits.

Another key tip is to start out small by asking yourself what you'd be most likely to stick to on a tough day. One of the most common challenges with building new habits is that people bite off more than they can chew. You know, they decide to try to do too much. And this is, I have made this mistake more times than I can count. So, you know, it is something that is very natural to do. I think particularly for ambitious people, there's kind of this conversation in their head where they sit down and they start thinking about the changes they're going to make.

And then the assumption in the back of their mind, even if they don't state it explicitly, is, man, you know, like, what could I do if I really got going? Like, what would peak performance look like for me? You know, if I was like really on my game and like living my best days, if I really have my habits dialed in, what could I achieve? And I think when you're in that mindset, which is great, it's great to be hopeful and dream about where you could go. It's also really easy to end up doing too much. Oh, well, I'm going to change five, six, seven habits at the same time. And

Rather than asking yourself, what could I do on my best day? I actually think the place to start is by asking, what can I stick to even on the bad days?

And that becomes your baseline. That becomes the new habit that you try to get established. And once you establish that, then you can start to feel successful and feel like you're moving forward. You gain some progress and a feeling of momentum. And then great. Now you're showing up each day and there's all kinds of things that you can do from there. And so does that mean your guidance is in general, don't try and like make this massive change all at once, but think about this more as a series of like smaller habit changes step by step. And is that-

And is that what the sort of the science shows is more successful? So I think there, let me give you two examples that will probably help clarify. So the first one, this is just a really simple tactic. I think a very actionable thing that you can use for building better habits. I call it the two minute rule. And it just says, take whatever habit you're trying to build and you scale it down to something that takes two minutes or less to do. So read 30 books a year becomes read one page or do yoga four days a week becomes take out my yoga mat.

One thing I was left wondering, along with many of our listeners, is how long does it actually take to form a solid new habit? So this is a very common question. How many days does it take to become a habit? And so on. You'll hear 21 days, 28 days, 30 days, 90 days. I don't know. There's all kinds of stuff that people say.

The answer is it depends. There was a study that shows that on average, it takes about 66 days to build a habit. So that's a common number you'll see floating around now. People with science says it takes 66 days. But if you actually read the study, the range is quite wide. So something pretty easy like drinking a glass of water might only take a couple weeks. Something more difficult like going for a run after work every day might take seven or eight or nine months.

And even that I don't think tells the story very cleanly because you can imagine one person who wants to build the habit of going for a run after work, who lives with people who nobody is working out and nobody's interested in that. And it kind of goes against the friction of that group. And then another person who lives with all athletes that are excited about working out and they just need to join their friends to do it. Obviously, these are two different circumstances. And so it's going to depend.

But I think the real answer, the honest answer to how long does it take to build a habit is forever. Because if you stop doing it, it's no longer a habit. And what I'm trying to get people to realize with that answer is that we often think about our habits as this finish line to be crossed, but they're not a finish line to be crossed. It's a lifestyle to be lived. For many of us who are parents, we're also thinking about how to help our kids build healthy habits.

And James had some tips there too. First thing is model the behavior that you want to see. To ask somebody else to do something and then to not do it yourself, like your kids are almost always going to imitate your behavior more than they listen to your words. And so if you want them to act a certain way, then you should try to set the standard as well. People often play to the standard that you set, not the one that you request. And so like, how can you showcase that?

Another example related to healthy eating and perhaps to kids. Let's say you want to get your kids to eat more greens or eat more salads. I just talked to a woman who she wanted to get in the habit of making a salad for lunch every day. And when she started eating,

At first, she had this idea in her mind that it had to be like pure and perfect, that if it wasn't like a perfectly healthy salad, then it wasn't worth it for her to do it. And then she shifted to this idea of like, what would it be like if it was fun? And so she tried to make each salad bowl like a party and she would put little toppings on it. And she even some days she would even like crumble up potato chips and put them on or whatever. But it made the habit enjoyable. And then once she got to the point where she was actually having a salad 90% of the days,

There are all kinds of ways to improve that and to optimize it because she's actually showing up and eating it every day. And so I think you can take a similar sort of approach, whether it's with yourself or with your kids and whether it's an eating habit or something else. What would it look like if this was fun? Let's start there, get the habit established, and then we can optimize and improve it from there. What would it look like if this was fun?

For me, that seems such a light, encouraging place to end our chat with James and definitely makes my new resolution for 2025, which again is to try and cut down on that dark chocolate after dinner, seem much more attainable.

If you're also thinking about a change you might want to make in 2025, let's take a look back at one of the year's most popular episodes for some inspiration. Legendary chef Hugh Fearnley Whittingstall and my ZOE co-founder, Professor Tim Spector, are encouraging everyone to eat more plants. More specifically, to eat 30 plants a week. It's believed that eating 30 plants a week could lower cancer risk and help you live more healthy years.

To me, it sounded like a lot of plants and potentially really expensive. But our guests for this episode helped me understand it could be neither. Hugh's first key point was that plants are not just fruits and vegetables.

Absolutely, that's right. Fruit and vegetables being a fantastically important and indeed delicious and useful group of plants, but there's much more to it than that. I think it's really one of the things I've really enjoyed doing in the book is exploring the store cupboard and reminding people that there's lots of really great plant ingredients there.

whole plant ingredients, you know, not processed, but that come from the store cupboard. So I'm thinking of nuts, seeds, spices, pulses, these kind of things. They all count. At least Tim assures me that they all count. And this is what has been the basis of my most recent exploration of what I think is a really excellent way of eating. Encouragingly, pretty much all the plants that we consume have some benefit on health.

That's firstly because they contain a lot of fiber. And we know that total fiber is very important. Magic figure is for every five grams of fiber, you're going to reduce your overall risk of mortality by about 14%.

When you say reduce your chance of mortality for regular people listening, that's just like reduce your chance of dying by 14%. Correct. Yes. So you reduce your risk of dying by around a sixth, just by five grams of fiber and that

Just to put it into context, the average US person has about 15 grams of fiber. So just increasing from 15 grams to 20 grams will give you this improvement in your lifespan. But also because plants contain polyphenols, which interact with our body and specifically our immune system, helping to regulate our brains, our behavior and more. Tim and Hugh had some tips on choosing plants based on their polyphenol content.

Tim, can I just clarify? So you're saying if you're looking at a vegetable in a store, this is the way you figure out whether a vegetable has more polyphenols? Yes. I didn't know any of this before I started researching my book 10 years ago, so I don't expect most people to know. No, it's not really taught. It's the shape, the color, and then the taste, if you can nibble a bit in the greengrocers, which you may not be able to. They're all clues as to the polyphenol count.

So the more bitter and strong, if the leaves are loose, interestingly, that means they've had less protections from structurally. So they have to be tougher and have more chemicals in them.

if we can avoid it, we shouldn't discard the outer leaves of the lettuce and the cabbage. They often have very tender white middles, which are effectively blanched. I always think of that in terms of they've been prevented from photosynthesizing in the heart of the plant, which is often why the middle of the plant is sweeter and why traditionally you actually tie up celery and endives and things like that because you want that white, slightly sweeter heart from a flavor point of view, but from a

different flavour point of view and health point of view those greener more open outer leaves have probably got more going on in them in terms of polyphenols just as they've probably got more bitter flavours

which now we might try and cultivate that taste because we know it's good for us. Therefore, let's enjoy the bitterness of those plants and sort of find a way to relish it. I mean, from a chef's point of view, we traditionally have, and a lot of us still do, including myself from time to time, we get very, very excited about animal protein, about meat and fish, and we make a massive fuss of it. We obsess over how we're going to marinate it or get the skin crispy or get the crackling. And once you've

obsessed over those ingredients. You haven't got a lot of time left to think about the plant or the veg, which does then become the bit on the side. So we have to recognize that they're slightly tyrannical ingredients, meat and fish. I'm still an omnivore. I enjoy them both.

But we've got to just put them on one side from time to time and then focus on making plants delicious, which turns out not to be hard at all. Not least because from the plant kingdom, you've got the greatest variety of textures and flavors and aromas, far greater than you could ever get from the world of animal protein. I mean, a pork chop is different from a chicken drumstick.

but it's not nearly as different as a walnut and a peach or a leek and a strawberry. You know, these plants are really different from each other. And from the point of view of flavor and just being excited in the kitchen, we've got to remind ourselves of that often. And

That's why a great variety of plant ingredients coming into the kitchen is exciting. We shouldn't see it as just, this is what we all should be doing now for our health. It's what we ought to want to do because it brings so much flavor and excitement into the kitchen and onto our plates. So not only are plants vital for our health...

With a little imagination, they can be the main attraction on our plate. But where does this number 30 come from? We showed that the people with the healthiest gut microbes, which we define by diversity, sort of different types of species, were eating the most variety of plants. And this came out at around 30. So we saw big changes in the good gut microbes that have been associated with good cardiometabolic health.

and reductions in those microbes that have been shown to be related to poor health and poor diets. So we also showed improvements in mood and energy and reduction in hunger.

and a number of other parameters. So it was really exciting to see how we take this epidemiological concept, which is just based on observational data, and then do a randomized control trial that had such convincing results. For anyone who thinks it sounds challenging to eat 30 plants a week, like I did initially, it's less difficult than you might think.

Don't worry that we're sending you off to buy lots of expensive obscure plant ingredients that you haven't heard of, don't know what to do with and might not like. The first thing is to remind yourself that there are many, many, dozens, maybe over a hundred plants that actually you already like. You're going, really? Yes, there really, really are. And that's why I've done a big plant list in my book. And there's over 200 plants on the list.

And with the possible exception of the idea that put a couple of seaweeds there, because I think it's a really interesting ingredient. But every other plant on that list, you've heard of it. I promise you, you've heard of it. You've heard of the spices and the herbs and all the main vegetables. You've heard of the pulses, the nuts and the seeds. With a lot of them, you might not have put them in your cooking for quite a while just because of the habit you're in. The first thing is to remind yourself there's lots of plants out there that you already like.

Some of them might be in your kitchen cupboard already. Being able to put together plants-only meals, I think it's really important for omnivores as well as people who choose a vegan or vegetarian approach. We do not need meat and fish on our plate every single day. And Hugh, is that almost like your first tip to say like,

It's okay to have a dinner that doesn't have any meat in it and that suddenly opens things up. Yeah, not just okay, but important to do that pretty regularly and to feel comfortable with ingredients in your kitchen that you can make delicious meals that your family is going to enjoy without putting meat and fish in them all the time.

And I think that there are some, there's a whole bunch of ingredients that are really useful for doing that. I always have lots of tins of different pulses in my store cupboard, not baked beans in tomato sauce, but different types of white bean, black bean, chickpeas, lentils,

I have dried versions as well, particularly lentils because they cook so quickly. But you want things to be easy and cracking open a tin of beans and adding them to a big stew with lots of other lovely flavors, tomatoes, chilies, spices and herbs add depth of flavor to a lot of these dishes that make them really very, very enjoyable.

Hugh left us with some quick, easy ways to pack more plants into your meals. Like a homemade trail mix with nuts and seeds. A delicious butter bean hummus. And garlic butter on greens. Especially handy for those picky younger eaters. Do make sure you go back and listen to the full episode to get all those great cooking tips. One of our most fascinating episodes this year was about dementia. It's something I know has affected so many families out there, including my own.

And I really wanted to hear how we can put emerging science into action on this topic. So I spoke to dementia expert Claire Steeves. She's a medical doctor, a professor of aging and health, and head of the Department of Twin Research and Genetic Epidemiology at King's College London.

So dementia is actually an umbrella term. So lots of different things actually fit into that term of dementia. But if we want to sort of classify it, it's a condition that involves cognitive function, so thinking and learning and memory, more than one domain of it, which is altered in somebody. That's altered to such a degree that it then causes a problem in day-to-day living and that it's gradually progressive over time.

and needs to have been around for longer than a six-month period at the very least. And actually, most people who get diagnosed with dementia have probably had some symptoms going back for maybe years. For me, the million-dollar question was, can our lifestyle or even diet have any impact on our risk of getting dementia?

Let's start with me. So, you know, I'm someone in my late 40s. I really want to make sure that I don't have dementia. Give me the advice. If I was walking into your clinic, tell me what you would be saying that I should be doing in order to try and make sure I never had to come back to your clinic in, you know, 20 years. So actually what I realistically say to patients is,

It's about getting as many different colors of fruit and vegetables into your diet as possible and making sure that you're getting good plant-based fats into the diet. Because the brain is hugely metabolically active. It needs a lot of nutrients. And we know that a wide variety of plant-based nutrients is really important for brain health. And I talk about colors because actually there's evidence that flavonoids

are really key phytonutrients for brain development. It may be because you're changing the microbiome because there's such a thing as a gut-brain axis. You know, there's quite a number of studies now showing Mediterranean diet helps to improve

cognitive health. So that there is real evidence of the Mediterranean, like changing this, this isn't just like something, because doctors always say you should eat more healthily, right? And everyone's like, yeah, yeah, yeah. There's real scientific studies that show that switching to this Mediterranean diet, which is high in the things you're describing and low in like the more traditional Western diet of meats and like white bread and all the rest of it, like that actually has an effect on dementia. Yeah. And then you, so you've just mentioned the other thing, which is

meats and white bread, yeah? So we know that there's a relationship between vascular health

And brain health. And vascular health means? The blood vessels within your body and your heart. That's because one of the other types of dementia we haven't really talked about is a vascular dementia. And often there's a combination, actually, of vascular factors that then bring on those other processes like Alzheimer's. So if you're eating a diet that's good for your heart, basically, and that's also going to be good for your brain.

Yeah, it's going to be good for your brain and it's going to put backwards the balance of things that are going on in your brain that might relate to Alzheimer's. So if you can change your diet in a sustainable way, it really can reduce your risk of dementia. What we also learned in this episode is that exercise is key.

So probably the most evidence is around resistance training exercise for overall frailty and so on. Then, you know, for cardiovascular fitness, there's aerobic exercise. I'm one of your patients. I'm not very physically active. What would you be telling me that I should do that can really make a difference? Walking.

Walking. I think you need to get out and do walking 45 minutes at least three times a week. And that will really make a difference. If I'm not doing that, that will really make a difference. So that, I think, again, is amazing. Claire, I think you were like, well, it seems sort of obvious. But again, I think many people...

listening to this grew up with the assumption there is nothing you can do about your dementia. It's just literally a consequence of getting older. And you're saying actually if you went for a walk three times a week, compared to just not doing that, you're going to make a really significant reduction in the risk. It is rather extraordinary. For me, one of our more intriguing episodes this year was about coffee. Something you probably have at least one cup of every day and contains the world's most popular psychoactive drug, caffeine.

But could coffee actually be healthy? I chatted with renowned coffee expert James Hoffman, who's the best-selling author of How to Make the Best Coffee at Home, along with our very own Tim Spector. For many years, we thought coffee was bad for us because short-term, it increases your heart rate, increases your blood pressure. For decades, people said this is a rather dangerous thing to be having. Don't do too much of it. You're going to have a heart attack. Then they started doing some proper studies and have shown that you actually...

Based on over 25 studies, you can now see a reduction of about 25% in your risk of a heart attack or heart disease. So then you're saying, why would that be? Something that's short-term, slightly stressing your system is actually long-term good for you. And I think it's seeing coffee as this whole, coffee as this fermented plant,

that has microbes acting on it, has hundreds, if not thousands of chemicals produced from it. And it's probably a combination of all those things that gives it this health benefit, such as the fiber in it. And we used to not think of coffee as a fiber-rich product.

But we now know that broadly you can get about 1.5 grams of fiber out of a cup, which means if you're having three cups a day, that's 4.5 to 5 grams of fiber, which is a quarter of your daily fiber intake in the UK and the U.S.

I always find it extraordinary because I always somehow in my mind think about fiber as being like this roughage that you can't... Like bran. Like bran, exactly. Or like, you know, the stuff that my grandmother, you know, might stir into a glass of water. Yeah, and two cups of coffee is more than a banana in terms of fiber. So this drink that has been demonized as harmful could actually be quite beneficial. Tim explains some exciting new research to do with a mysterious sounding microbe. Exactly. It's like a forensic test.

Rather than doing questionnaires, you just take a bit of that stool sample, you extract the DNA, and you find this microbe called Lawsonobacter, named after Dr. Lawson. And it is inevitably linked to the consumption of coffee. And we found that it then produces...

these chemicals that through the fermentation process that turn out to be really healthy for us and have been shown to reduce blood pressure and reduce blood sugar. Tim and James left us with a couple of tips to guide our coffee consumption. Firstly, give the instant coffee a miss as it's pretty low in these helpful polyphenols. And secondly, do go for decaf if you want to skip the buzz as you'll still get most of the health benefits.

Another wonder food product we dealt into this year was olive oil. Incredibly, it regulates blood sugar, helps with weight management and prevents long-term disease. For this episode, Tim and I met with olive oil expert Elizabeth Berger. She's the founder of Frantoi, which works with growers and millers across Italy to harvest exceptional extra virgin olive oils.

There haven't been any large-scale long-term studies until 2018 when they did something called the PREDIMED study. It was randomized but not blinded because they were delivering large amounts of olive oil to 7,000 Spaniards, large amounts of mixed nuts to another group, another group that were just giving the standard Mediterranean meals. And they followed them up for six years.

And this was the best study that had been done and clearly showed that the olive oil group had these really significant reductions in heart disease and strokes and breast cancer. So, Tim, I just want to be clear, like the drug intervention in this study over six years was literally just got sent bottles of olive oil. And the people who got sent bottles of olive oil were

actually had lower levels of strokes and things like this? And heart disease, yes. Sounds crazy, right? And breast cancer and some signs they were getting, you know, less brain dysfunction leading to dementia. So it...

And it was an amazing study because it was huge logistic exercise to keep people stocked up with this. And they were giving them the equivalent of about four tablespoons a day, which actually is not far off some levels you'd have in bits of grease, for example, which would be seen as quite normal, but 100 times more than you'd get in the UK or the US, where we're only really drinking one bottle of olive oil a year as opposed to one every two days.

in many Mediterranean countries.

So this, I think, was a fairly pivotal study, but there have been other ones since in the US showing it's not just a Spanish thing because they were sponsored by the olive oil industry and Spain does have a slight interest in promoting it. They're the biggest producer in the world. But in the US, the cohort studies comparing olive oil drinkers against non-olive oil have found virtually the same results. So I think we're now very confident that drinking extra amounts

of olive oil and particularly extra virgin olive oil

Has these major benefits, but it's not just the fats so the epidemiology study Which has measured things like fat levels? Changing suggests that it's actually the polyphenols These we've mentioned these before a number of podcasts these defense chemicals in the plant and this time in in the olive fruit that are conveying the benefits to the body and

because they are the key antioxidants. They are the ones that nourish our gut microbes. And they're in huge numbers in olive oil compared to other foods. You can sort of see how if anyone's had olives or olive oil, there's some similarity. And it's because of those defense chemicals in your mouth that are

as well as defending the plant, end up nourishing our gut microbes and perhaps helping our immune systems to then fight disease and aging and all the stresses of life in the cells. And is the level of polyphenols in olive oil very high compared both to other oils but I guess also to other plants that I might eat?

There are 36 known polyphenols in extra virgin olive oil. And I guess if you would compare that to coconut oil, for example, there are six.

So it's a much more complex mix of polyphenols that you're getting in extra virgin olive oil. And for example, one of those polyphenols is oleacanthal. It's the polyphenol that gives a slight burn in your throat when you're tasting really, really decisive extra virgin olive oil, so peppery olive oil. And oleacanthal exists naturally in olives. It's one of the components in ibuprofen, for example. So it shows us

that it's an incredible natural anti-inflammatory. Extra virgin olive oil is probably one of the best sources of polyphenols you can get. It's certainly in any oil that we drink normally, but it's also related to the quality. So the higher the quality...

the greater the concentration and diversity of polyphenols in it, which I think is a really important message. And the lower your quality gets diluted and you don't get nearly the same benefits.

But a really important point here is that how you buy, store and cook with olive oil really matters in order to get these benefits. So the process is that the olive oil is produced and then it then typically naturally decants. So it takes a little bit of time where the sediment falls to the bottom. You then have a choice as a producer whether you filter or you don't filter. In terms of super high quality, you would wish for a light filtration of your oil. And there's a reason for that because...

An unfiltered oil, and I'm sure that this is one of those myths that's out there, that an unfiltered olive oil is really great because you see it in those lovely clear bottles and it's got that lovely cloudy look to it. Must be real. Must be the real deal. It's actually not. That's actually not great for a couple of reasons. One, you shouldn't have your olive oil in clear glass because it will change.

change its quality. So you're looking for dark glass as the very, very best format for extra virgin olive oil. But the other thing is that that sediment that is in suspension in the olive oil will actually start to oxidize the oil with time. So anything that needs to be shipped, we have to think about these things. If something's being shipped globally, it does need to be stable. And so a light filtration won't change the quality at all. It will actually enhance the quality because it'll give it a little bit of

stability in terms of shipping. So to confirm, if you see a bottle of olive oil that sort of says it's unfiltered and has some sediment in, which I've definitely seen and always thought that looks pretty cool and very authentic. Actually, that's like a complete no-no. Don't buy that because basically that sediment will have been continuing to react with the olive oil and I'm going to lose sort of the health properties we're talking about. Exactly right.

Keep your olive oil somewhere where the temperature is steady, like a cupboard. A key question that a lot of people have is can you cook with olive oil? Will that affect its health benefits? So if you're starting with a good quality olive oil, you're still going to end with something that is stable, not causing problems, has still got plenty of polyphenols. But if you cook with it, you're not getting...

the same benefits as you would if you're having it on a salad or you're having it over your fish once you've cooked it. Exactly. And so therefore, if you've got a very high quality olive oil, you may prefer to keep that as a raw ingredient rather than cooking with it. But the benefit as well, whilst the polyphenols might be dropping down when you heat them in the olive oil,

they will improve the nutritional content of the ingredients that you're cooking. So let's say, for example, that you roasted some carrots with extra virgin olive oil. It will improve the nutritional content of the carrot.

Not just decrease the level of polyphenols from the olive oil. So there is an upside. So there's no question that you should be using it to cook with. I'm coming away just even more reinforced with this idea that olive oil is really great for my health and I should be trying to have more of it. Could both of you maybe share a tip on an unexpected way to incorporate olive oil so that we can get more of it each day? I would replace olive

butter at every step of the way with extra virgin olive oil because I think it's an extremely good thing to do for your health but also for the flavor. And so I would start with breakfast. So on your toast, if you like marmalade on toast, try to put a little bit of olive oil underneath your marmalade. It's wonderful. Yeah.

it's uplifting, you know, it makes you feel brighter in the morning. If you make granola, make it with olive oil. And if you favour sweet things at breakfast time and you perhaps, I don't know, make a cake of some sorts, certainly as they do in Italy and the Mediterranean, then, you know, make it with olive oil because it'll make a moister cake, it'll hold for a few more days and you're just upping the level of olive oil in your diet.

Agreeing with most of those, certainly really I hardly use butter at all. I just reach for the olive oil every time.

And finally, for part one in our whistle-stop tour of 2024 Zoe episodes, I took a step back and we had someone very special take over the microphone. This is Davina McCall and I'm in the driving seat today and I'm going to tell you why. You see, there's a stage of life that every single woman goes through and it's not spoken about much,

Your mum probably didn't tell you about it. Your teacher never taught a class on it, that's for sure. But let me tell you something. If you've not been through this stage of your life already, it's coming for you. So I suggest you prepare yourself. For way too long, we've kept quiet about the menopause, the onset, the symptoms, the treatments. But those days are over. Today, we are shouting from the rooftops.

So back in 2022, I published my book, Menopausing. What I really wanted to do was change the way that society perceived and saw us as midlife women. And I wanted to share what I learned with you today.

I'm joined by my friend, Dr. Sarah Berry. She's a professor at King's College London and chief scientist at Zoe. And she's just led a new study about how diet affects menopause symptoms. And Jonathan's here as well. There's two really important reasons that Jonathan's here. Obviously, he asks really good questions, but also because we need men on side. We really, really need men on side.

all the allies we can get to hear us, help us, support us. So, thank you. Did you think you were going crazy when you were first in perimenopause? Yes. When you first started having perimenopausal symptoms, did you realize what they were? No. Okay, we're going to come back to that. Sarah,

Can you suffer severe symptoms from menopause without hot flashes or disturbed sleep? Yes. Does menopause increase your risk of many chronic diseases? Yes. Can the right diet significantly reduce menopause symptoms? Yes. And Davina, you get a whole sentence for this. You're lucky I don't get the sentence. What's the biggest myth that you hear about menopause?

women lose significance, importance, you become invisible, you are dried up, and life is over after menopause. And it's not. Davina went on to share her own personal journey through menopause and hormone replacement. And I really urge you to go back and listen to that episode in full because it's truly incredible. Then Davina and Sarah had a fascinating discussion about menopause symptoms.

What's really important is to remember there's more than about 50 symptoms and it varies from one individual to the other. It varies the time course of the symptoms, the duration of the symptoms, the intensity of the symptoms.

And that's because oestrogen receptors are all over our body and it's oestrogen that declines mainly in the menopause. So that's the primary reason we start to have all of these experiences. We have oestrogen receptors throughout the body. It affects things like our hunger, our energy, our mood, as well as our heart health, our muscles, our bones, etc. So once you have this decline in oestrogen, which is what happens in the menopause,

That's why you can have so many varied types of symptoms. And I think what's interesting is what you described, Davina, is this fluctuation of symptoms. And this is really interesting as well, because I think a lot of people think, okay, you hit 51, which is the average age of menopause. Suddenly you've gone from premenopausal, you're postmenopausal, that's it.

But there's this whole phase before, which we know, which we call the perimenopause, which is where your oestrogen levels, as well as some other hormones, start to change. But you don't just have this beautiful, gradual decline in oestrogen so that your body slowly just learns to handle it.

It's like this crazy roller coaster. And Sarah, just to make sure I've understood that right, because I think I was definitely brought up with this idea that basically you hit menopause, everything is completely normal until then, and then you stop having periods and it's all over, but you're describing this long sort of perimenopause period where...

You're saying almost from day to day, the level of this estrogen is all over the place and that that is therefore what explains the description that Davina is talking about, about suddenly having the night sweats and then just switching off three days later. Yeah, absolutely. So menopause is the point at which it is a year after your last menstruation, so your last period.

But leading up to that, you have these fluctuations, these peaks and troughs in oestrogen. It can last from two years to five years on average, but for some people it can last up to 10 years. And it's that phase that's particularly troublesome in terms of all of these symptoms.

Can I ask you something? So lots of women talk about taking blood tests to see if they're perimenopausal or not, but that doesn't work, does it? Because if your estrogen is going up and down and up and down in a day, like you're not going to know. Absolutely. And I think this is a huge waste of money, a huge waste of resources. And again, it's one of those myths that's like so frustrating when people say, oh, I've had my hormones checked and they're fine. It's like, okay, they were fine at that point in time, but what about tonight or what about tomorrow? So

So as well as feeling rubbish with all of the symptoms,

Also, it actually impacts your health. It impacts your risk of many chronic diseases, such as your chances of getting type 2 diabetes, cardiovascular disease risk, etc. And that, again, goes back to the function of oestrogen. Like I said earlier, the oestrogen impacts nearly every cell in our body. And so it impacts all of the different kind of mechanisms and processes involved in the development of different diseases. Menopause has been this taboo topic.

And it was also really underfunded in terms of the research. So Sarah shared some of her brilliant research into menopause symptoms that she's been working on here at Zoe. And what really shocked me actually, Jonathan, is that 99.8% of our peri- and post-menopause women reported having one symptom or more.

That's not what I thought that you were going to say. I thought you'd have more people not having any symptoms. No. Obviously, what symptoms they have are hugely variable. So we asked them questions about 20 different symptoms.

and we asked them about for each of these symptoms, how severe were they on a scale of one to five? What we found was that 66% of this group had 12 or more symptoms. And again, that really, really surprised me. And what I found interesting is, because this is the first time we also looked at the severity of the symptoms, the symptoms that were most common, which was sleep, irritability, weren't actually the symptoms that people reported as being most severe.

So we often think about the irritability or the sleepers being the ones that have the biggest burden. But actually, it was the other factors that caused actually the most burden to their life or really impacted them. And this was weight gain. This was change in their metabolism. Loss of libido, going back to your point, was something that... It's really important. Although it was less prevalent, so less people had that as a symptom, it was what they said was the most...

impactful and then fatigue. People are saying that's just like one of the biggest problems having the kind of fatigue symptoms and they have the impact there every day. What we also learned in this episode is that hormone replacement therapy is safe and beneficial for most people but it doesn't always completely get rid of symptoms so a holistic approach can be helpful.

I'd really like to talk about sort of diet and other lifestyle changes and whether these can impact symptoms, whether or not you're on hormone therapy. I have to say that five years ago, so we were already into Zoe, I would have thought that reducing menopause symptoms with diet and what we're doing at Zoe sounded like crazy. But Sarah, this is an area that's been a really big focus and interest of you. So we've ended up doing all of this study and you've just released this big new study. Yeah.

Can you tell us what you found and maybe explain what it is? Yeah, well, I would say start by saying I would have agreed with you based on what little evidence there is about diet and menopause that diet can't do anything, particularly because of all these crazy claims out there about supplements, about, you know, there's silver bullets, whatever, that it will cure all of this. Yeah.

But we looked at this, we put it to the test in our Zoe Predict cohort. And so we followed 5,000 women over a period of up to about 20 weeks. And these were perimenopausal women who had signed up to take part in the Zoe membership program.

So these are women who we did various tests to look at their metabolic health, their microbiome, and then deliver personalized advice to them based on some of these tests, but also based on their health history, where they are now with their diet, their lifestyle, etc.,

And we asked them loads of questions about their health, the baseline and their symptoms. And then we followed them up over this period of, you know, it was between about 18 to and beyond 20 weeks. And then we asked them at the end about their symptoms, about how many symptoms they had, about the severity of the symptoms.

And what we found was around a 34% reduction in overall menopause symptom burdens. This is taking into account the number of symptoms and also the severity of the symptoms by following a healthier diet. And actually, when we looked into the details of the dietary changes, we weren't actually seeing huge, huge changes in people's diet quality. And I think that, to me, Jonathan, is what's most important. We are actually seeing relatively small shifts, but very meaningful shifts,

And even just when people were having small shifts, we still saw a huge impact. And we saw, of course, so many different symptoms. I mean, talk about falling in love with you guys, like with all of my heart, because nobody... Oh, I've got to stop. But sometimes... Oh, sorry. Sometimes it feels like nobody helps us.

Honestly, and it's like when somebody does go, no, we see you and we've got your back and we're going to do some work on it.

It was so upsetting. You think, we're all going through this thing and no one's helping. And this is something, it's not just medicine. This is something that literally every single woman could do. And a 34% reduction, it's ridiculous. That's over a third. Yeah. And we see that, you know, I'm not a hugger, but I'm going to have to give you a hug now. Yeah.

know what I mean? Yeah, so I think as scientists, what we always want to do is look at our own results, but we want to look at them together with the bigger picture because there are other people doing research in this area. It's not only us. I'm very proud of what we're doing because we have the resources to do it at a scale that allows us to look at an individual level what's going on

But there's many other studies that are also being run now, although it's slower than it should have been. And collectively, what this research is showing is that following an overall healthier dietary pattern, a Mediterranean-style pattern, as we often call it, can improve health.

reduce your symptoms, as well as it will help improve some of these risk factors, you know, that we talked about, social disease, your blood lipids, your blood pressure, etc. So the kind of fundamental principles that are here are reducing your heavily processed unhealthy foods, these ultra-processed style of foods. So your very heavily processed red meats, for example, reducing refined carbohydrates, you know, your pasta, your rice, your white bread,

But as Zoe, we're always about what can you add in rather than what you have to take away. And so the great news is that where we see the biggest benefit is actually by what you're adding in. So adding in unprocessed plant-based foods. So fruits, vegetables, pulses, whole grains, oily fish. If you're not vegetarian, having a decent amount of healthy oils because we know that will help with many of these diseases.

disease risk factors, but also could help with the symptoms as part of this overall healthier diet. So there you have it. Some really actionable tips you can carry with you into the new year. From replacing butter with olive oil to eating 30 plants a week. If someone in your life is trying to make healthy nutrition changes, why not share this episode with them?