Dr Karan has an up-front discussion with the man who informed the nation about the most predictive, yet strange, symptom of Covid-19 in 2020; the loss of smell and taste... Epidemiologist Tim Spector created a reporting tool that is arguably the world’s largest ever citizen science experiment; the Covid Symptom Study app. First and foremost however, he's an epidemiologist. Dr Karan talks with Tim about how we can avoid future pandemics, how to prepare for cancer surgery and how to boost your gut microbiome.  



Tim is a Professor of Genetic Epidemiology at King's College London, he’s the director of the Twins UK study, and the co-founder at ZOE (which proved to be an invaluable tool to combat Covid-19). His knowledge and passion for epidemiology have benefited many people around the world – and could benefit YOU today! 



If you have a health-related question and want to get in touch, just head to TheReferralPod.com.



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This is the show where I bust myths, I talk to world-leading experts and scientists and generally interesting people to find out more about how we can improve our lives on a day-to-day basis and improve our happiness as well as our health.

Today I'm going to be talking to 1 of the first people in the world to pick up a really weird symptom of COVID, anosmia, a loss of smell.

He was instrumental in creating the COVID Symptom Tracker app, basically the largest citizen database of tracking symptoms of COVID.

And if you're wondering who this is, it's Tim Spector.

He's a professor of genetic epidemiology at King's College London.

He also founded the Twins Research Unit at King's College, where they basically look at twins and find out what we can learn about health in the general population.

He also co-founded the Zoe app, which was instrumental at picking up population symptoms when it comes to COVID.

Epidemiology is the holy grail of medicine.

To be honest, if epidemiology took off, I would be out of a job.

I don't want to necessarily operate on people because I'm already dealing with a condition that someone has before it's been prevented.

Epidemiology is looking for glitches in the matrix, patterns in the data to identify something before it even happens, like Minority Report with Tom Cruise, but science.

Now I promise you all the information will be applicable to you in your daily life.

Nobody says, before you start your immunotherapy, really we should be really boosting your gut microbes, pumping it for the 30 a day, the fermented foods, the polyphenols.

Tim is also going to be asking me a question of his own.

If there's 1 thing they taught you at medical school that you weren't taught,

And we've also got, if it ducks like a quack.

This is nothing to do with ducks, but it has plenty to do with quacks and all that nonsense quackery you hear about myths about medicine.

And probably some of these things you still believe to this day.

And up very shortly, we've got crowd science.

It's now your turn to take the floor and ask me any question you want.

If you wanna get in touch, contact me at thereferralpod.com.

What the health is going on in the world of medicine, science and health?

We leave traces of ourselves everywhere we go, just like snakes shed their skin, we shed hair, dead skin cells, we flush our urine and faecal matter down the drain into the environment, we cough, we spit, and half the population bleeds into the environment as well.

And all of that biological waste contains DNA.

This human DNA spillage can be accessed via the water, in the earth, and literally from thin air.

And the samples of DNA that they can get from the environment is strong enough and in high enough concentrations to literally match the individual it came from.

Now these free floating fragments of biological tissue, the eDNA or environmental DNA is typically used by scientists to track invasive species, trace diseases or even monitor biodiversity.

But it could be used for nefarious purposes in the future.

Like I said, the quality of the DNA that you can find there is so good you can even identify genetic mutations or even track a person's ancestry.

So realistically, harvesting this DNA from the environment could allow you to track specific people or even specific ethnic groups.

But let's not be so cynical and look at some of the beneficial opportunities.

There's potential for forensic use in criminal investigations.

You can literally go to a crime scene and catch the criminal's DNA from the air of the crime scene.

It could help archaeologists uncover these hidden archaeological sites from that hidden human DNA.

The 1 thing it does raise is an ethical issue about consent and privacy because currently there aren't any stringent laws about what you do with this eDNA.

AI, Artificial Intelligence, might save humanity.

You've probably heard lots of doom and gloom that AI is going to take your jobs, it's going to turn into Skynet and destroy all humans or worse, make them our slaves.

But actually, AI might be able to prevent the antibiotic apocalypse.

Now, it's not new information that we're running out of antibiotics that works against evolving strains of bacteria.

They're becoming cleverer, they're becoming more resistant to the antibiotics we have.

And eventually we might reach a stage where we've got loads of multi-drug resistant bacteria and even a small cut could kill us.

So as you can see, antimicrobial resistance is becoming humanity's greatest threat.

Worryingly, there's been fewer antibiotics discovered for several decades now as these superbugs become more and more commonplace.

So what the hell does AI have to do with any of this?

Well scientists have created a new AI that can create a new antibiotic to kill a deadly superbug.

So AI went through and searched through thousands of potential chemicals and found 1 that could be used to synthesize a brand new experimental antibiotic called Abaucin.

And this was used to target 1 of the most problematic species of bacteria we have, Acinetobacter baumannii.

You may have not heard about this, but it's 1 of the 3 superbugs that the World Health Organization, the WHO, has named as a genuine critical threat.

And it took AI just 90 minutes to sift through these thousands of chemicals to come up with that antibiotic which can target this strain of bacteria.

Now in lab experiments, they found that albalsin, this experimental antibiotic, could be used to treat this baumannii bacteria in mice.

And it was also able to counteract Acinetobacter baumannii from human patient samples.

As we know, there's a huge gulf between my studies and then human studies but this is very very promising.

Realistically we're looking at AI prescribed antibiotic by 2030 which isn't too far off.

Interestingly this experimental antibiotic doesn't work against any other species of bacteria, just A.

The precision of this experimental antibiotic means it's less likely that drug-resistant strains of bacteria will evolve, and it also means fewer side effects.

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Listen and follow wherever you get your podcasts.

Okay, that's What the health and all that news done.

Tim, thank you very much for joining me today.

And I understand you've already had 6 out of your 30 portions of fruit and veg already for the week.

And I've done my intermittent fasting as well.

But I mean, you, by trade, you're an epidemiologist.

You're a medical doctor, and you've gone into epidemiology.

And on the surface of it, it might not sound like a very hot specialty or a sexy specialty.

Is there anything that you've seen in the data, in the correlation on a national epidemiological scale that is so unbelievable and you've had a hard time convincing people that we need to pay attention to this.

Well, epidemiology comes and goes in favour.

It's either the most boring area of research, or it's the most exciting and important, like in COVID.

A bit of epidemiology that I don't think anyone's really noticed is the correlations between obesity and the percentage of ultra-processed foods that we're all eating.

No doubt in every single country in the world, there isn't a single country I've seen that's bucking that trend, that we can't blame the pandemic of obesity and diabetes and all the extra problems due to it, due to the rise of ultra-processed foods.

In the 70s we thought we're going to run out of food, they'll all be starving people.

And now it's gone way over the top and many more people are dying from obesity than are dying from hunger.

And you mentioned actually, epidemiology, obviously it's important in picking up these trends and population health.

And you mentioned it's sexy at certain points and it's never been sexier than from 2020 onwards when we were hit with the pandemic, the recurrent strains, different strains of COVID.

And you were 1 of the first to get the ZOE COVID symptom tracker app out there and picking up anosmia, which was a very strange symptom, which has previously been associated with viral, you know, upper respiratory tract illnesses.

But this is a quite an amazing thing to just pick up.

Why are suddenly people getting these weird perceptions in their taste and smell?

So what was that like, the days leading up to it and the sort of few weeks leading up after that as well?

I mean, I think those few months were the most exciting, adrenaline-fuelled, exhausting periods of my career.

The Zoe team, to remind people, built this app in 5 days.

And the government took about 6 months and then actually probably failed for their COVID track and trace app with a hundred times the budget and personnel.

And then because of social media, nothing else, no money backing, social media fueled this idea that people wanted to join something to help.

So suddenly we had millions of people on this app.

We didn't expect, we had no clue where anyone would look at it at all, right?

You know, we just launched it in a void and said, go for it.

Suddenly, we had millions of people on it and nothing, they were all telling us how important it was.

The 1 thing I'm concerned about increasingly is, you know, there's more than likely going to be future pandemics.

People might laugh at this, but since watching the HBO show, The Last of Us, where they've got this fungal pandemic, that is a legitimate concern that people have.

These infectious disease experts and epidemiologists have a concern that the next pandemic could be a fungal pandemic, because we don't have vaccines against fungi.

They're not plants, they're not humans, and they're strange things.

We have super bug fungi, which we don't have treatments against.

Is there anything on the data that you can see that helps you predict the next pandemic?

No, I don't have any brilliant insights into the next pandemic other than what is public knowledge.

And I think they play a key role in this gut community that we've got that, in a way, needs all the different species to play their role.

Just like in Yellowstone Park, you know, and we've...

Yeah, you know, we've discovered this new parasite in our guts that 1 in 4 people in the UK have.

And I think 7 out of 10 people in Asia have, and all our ancestors had, called blastocystis, which you might have heard of.

And it was associated with traveller's diarrhoea and you used to get rid of it.

Now it's a sign of absolutely good health.

We know it's like a fantastic predator inside our guts.

And we're eating microbes that are bad for our fat metabolism.

So this kills off competitive bad microbes, helps to reduce inflammation in the gut.

It helps to reduce inflammation in the gut, it reduces your blood lipid levels, actually reduces your visceral internal fat, and certainly in men at least, it reduces blood pressure through mechanisms we've got no clue about.

But it's probably acting like the lone wolf.

Well, you know the whole story of that Yellowstone park, that the whole ecosystem fell apart when they

Put the wolves back in, suddenly it's all restored again.

Now, we originally all had blastocystis, all our ancestors, all the old, and we've basically killed it off for reasons we're not sure why, because we've got 1, you know, only 25%.

The US, it's only 1 in 20 people have it, right?

That could be some interaction with an increased amount of ultra processed foods, a decreased amount of fibre, which is not providing the substrate for that bacteria to survive.

Yeah, and the US is the sort of the worst country in the planet and it's the best place to test what's going wrong with your health and your diet.

So what are some absolute must-haves of health that you've seen in terms of people's habits, that, you know, daily habits, small, sustainable habits that people have to have to have good health?

Well, humans, we're actually much more individual than we're led to believe.

And that's why we can inhabit all these different environments, live off different diets, have different lifestyles.

So very hard to summarize absolutely everything.

Not a 1 size fits all, but habits that in the majority will provide good health.

So the 2 pillars really are diet and exercise.

Diet side, long term, has to be good for the gut microbes.

So if you look at all the blue zones, and there's actually quite a variety of diets in there, but the thing they all have in common is they all have variety.

You know, coming back to the 30 plants a week.

They all have fiber and it's fresh ingredients, low in ultra-processed foods, and still doing exercise.

They haven't been confined to the armchair watching TV.

And that seems to be a universal side of what I see wherever you're looking around the world.

I mean, I find that often if I see patients in a clinic, you know, who've got gut issues or a number of things, 1 of the common questions I get is, should I have, you know, this supplement, that supplement?

And I think too often people disregard the very basics, the very pillars of health, which is optimizing sleep, ensuring a higher fiber diet.

So, arbitrarily maybe aiming for that 30 different types of plant foods a week, ensuring they have a good bowel routine, stress regulation, movement, so not necessarily lifting weights, but any sort of movement, even in old age, having social contacts.

And it's very difficult to almost un-brainwash people into thinking you first need to do these basics, but not paper over the cracks with XYZ supplement from your local health shop.

Every doctor knows, because that's the way we're trained to give the quick fix anyway, and doctors are really good about it.

So quick fix, can you give a tablet to the patient, get him out the surgery quickly.

And we're not taught about nutrition and going into detail, asking a history, particularly in a culture such as the UK and also the US, there is no great food culture.

So there's no real rules about food and people follow the latest trends.

And that's taken us to this disastrous place where, you know, we were told 20 years ago to avoid fats.

So we go to a supermarket, all you see is you can't buy a yogurt that doesn't have low fat and yet there's 0 evidence that there's any good for you and lots of evidence it's bad for you.

So 90% of the products people are seeing are actually bad for them, but they say they're good.

And people don't really know what a good diet is.

And we really need to educate everybody that, you know, a diet is reducing your ultra-processed foods, it's eating a variety of real foods, it's eating the rainbow, it's getting all those colours in because they've got the phytonutrients, the famous polyphenols, which are rocket fuel for your gut microbes and have all these antioxidant effects.

It's getting people back to the traditional idea of having fermented foods, which in the UK has been long forgotten.

It's had a slight resurgence in the last 12 months, 24 months, but yeah.

I mean, I know this because I've written 3 books on nutrition.

First time I've, you know, I would go and talk about kefir and kombucha and even to a room full of GPs only about 10 would ever heard of them.

You're prescribing all these newfangled things but actually it's a cornerstone of health.

Many of those countries that are doing well have fermented foods at the base of their diets as well.

So whether in the mountains in Greece, you might be making your own yogurt.

In Japan and Korea, they'd be having kimchis and misos, which, you know, and all these koji varieties and these tofus, all these fermented ones in India.

Brits and Americans, Australians and Canadians have completely lost any connection with that and see it as a rather freaky, weird thing to do, rather than as the magic health supplement.

So instead of taking these multivitamin supplements, which not only have been proven not to work in randomised controlled trials many times over, they are a complete distraction from people sorting out their diet.

I mean for me when I talk about supplements, you know a lot of people think, okay I can still take fish liver oil and all these things, but actually there is very little evidence to suggest that fish oil supplements actually do much, unless you're pregnant or you've got a recent heart issue or something like that, there is very little evidence and inconsistent evidence to suggest that even cod liver oil does anything except make your urine more expensive.

I mean, 99% of supplements, I say, have absolutely, have either been shown not to work or have no evidence because no one's ever bothered because they know it won't do anything.

So when you tell people exactly what you've been saying, 30 grams of fibre a day at least for an adult who doesn't have irritable bowel issues, maybe which fibre may be slightly contraindicated for in some cases.

So, I mean, a high amount of fibre, 30 different types of plants and vegetables on a weekly basis, which includes things like spices, coffee, nuts and seeds, which people traditionally don't think is plant food, but actually it does count, which helps you to rack it up.

Having the fermented compounds in your food, kefir, kombucha, sauerkraut, sourdough bread, all of these things.

When you say that and then you actually say, oh, these have got antioxidants, polyphenols, flavonoids, It sounds like when you actually advise someone, this is a real thing, it almost sounds like you're grifting them, but actually this is actual science and the real grift are things like probiotics.

The average person sitting at home thinking they need to drink their strawberry flavoured probiotic drink, it's like pissing in the wind.

With the trillions of bacteria we have, you're saying that this little drink, 1 size fits all for everyone, is going to work for everyone's microbiome, which is as unique as your fingerprint.

It was interesting because during COVID, we did do a test on a million people and said, we know how they'd co-affaired in COVID, the severity.

And we said, were you taking any supplements or probiotics?

Evidence was largely negative, except for females.

If they took vitamin D, they'd get slightly less reported, less severe.

Could be bias, it was observational study.

It didn't have effect in males, so I didn't really believe it that much.

Probiotics did affect males and females and did have a slight beneficial effect even when adjusted for everything else.

So I'm keeping an open mind on it, But listeners should be aware that most of the stuff they buy is either of low quality, the wrong microbe for their very individual gut microbiome, which I think is important.

It may be that once we start to personalise, we can really move this forward.

But there are definitely probiotics, you know, for like ABS that have been proven to work, definitely worth some people taking it, but always they're destined to fail in many people because they don't have the same community.

It's like using the same fertiliser in the Arctic and in the Sahara and in the Congo, you know, it's not going to work.

There is a species of bacteria that contains a gene encoding for an enzyme that only exists in the sushi eating population in Japan, where they've got a bacteroidis species of bacteria which is found in an American person's gut and a Japanese person's gut, but the key difference is at some point that species of bacteria in a native Japanese person has assimilated this cell wall digesting enzyme that usually digests red algae or the nori seaweed that you get in sushi.

Even though people eat sushi all over the world, I think for me, showing that these bacteria are almost evolving alongside us to help us to maximise the nutrients from food is fascinating to see.

More and more, now you've spoken about precision nutrition, we're appreciating that this microbiome, the community of viruses, archaea, fungi and bacteria that live inside us contribute more than just to gut health, but as you've demonstrated in studies, possibly even mood and dementia.

The sushi story is great because it does show you that we can adapt to, by using microbes, to eat new sources of food.

What I love about the microbiome, it's not like your genes, right?

All you can do is whinge about your parents with your genes, right?

Of all the things I've looked at, the least genetic.

It's all environmental factors which influence the microbiome.

Things you are doing in your daily life, so diet, exercise, interactions with, you know, early exposure to pets, for example, influence your autoimmune disease risk.

Yeah, and it's, you know, whether you live in cities or towns, whether you get rolled in the dirt, whether you, you know, are close to nature or not, how many courses of antibiotics you had, which is probably 1 of the major reasons we've lost so many microbes compared to tribes and groups that aren't exposed to antibiotics.

It's every time you get an infection you change it.

Stress, sleep, diseases, inflammation, you know, level of body fat.

All the drugs, at least 50% of drugs tested so far are interacting with your gut microbes.

So whether a drug works for you or not is going to be down to those gut microbes, particularly things like antidepressants.

And if you don't have those right microbes, or you have the wrong ones, it can switch it off.

I was a coordinator of 1 of the biggest melanoma trials of immunotherapy looking at microbiome and the conclusions of the study were that if you had a poor microbiome at the beginning of your treatment in that worst group, we did it with over 200 people, it was a massive, these people end stage cancer.

Look at 12 months immunotherapies, their last chance.

And if you're in that group with low, poor gut microbiome, once you adjusted for everything else, all other factors, you were twice as likely to fail your treatment and likely to not make it as someone who had a good healthy microbiome.

And nobody tells cancer patients about this.

When I'm doing a major surgery in big centres in the UK, which have access to CPET testing, where we do several weeks of pre-habilitation before surgery, where we make sure the patient stops smoking, exercises, maybe lift low weights if they can, generally improving their pre-morbid condition so the surgery will be more of a success, less complications, faster recovery, less pain, etc.

It sounds like this could be a component in the prehabilitation.

Well, totally with you on this, the cancer, people for having any chronic disease really, that involves the immune system, should be trained to do that.

And Often in cancer, things happen very fast.

So you know, you can understand why people get put on drugs without any time, because otherwise they're going to die.

But often it's been 3 years before they got the original tumor, and that's when they should have been told, you know, you got 3 years to get your immune system as good as you can possibly get it, that's gonna be double the effect of the drug, you know?

That's probably why we have such poor cancer rates in this country, because still eating ultra processed foods, et cetera.

All our foods are never tested on the gut microbiome.

So I think, you know, the future certainly, whether it's 5, 10, 15 years away, it looks like we are headed towards a future where the tiny passengers, you know, become front seat drivers.

And this is a really enlightening conversation.

I don't know what it is so I don't know what I'm getting myself into but Fire away.

If there's 1 thing that taught you at medical school that you weren't taught,

It's hard to narrow that down to 1 thing.

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Reboot Your Health with Professor Tim Spector