Gut Feelings

The anxiety of gut health apps, ZOE, and the culture of perpetual debunking. Words by James Greig.

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The Hater is a column dedicated to the art of hating. Each week, a different writer examines something they hate, or observes a trend of hating in the food world.

Past columns have included:

The TV Food Man, by Ruby Tandoh
Everybody Hates Norman’s, by Tom Usher
Rich People Peasantcore, by Sheena Patel
Gatekeeping Pubs, by Jimmy McIntosh
The Gallery Dinner, by Phoebe Cripps
STREETFOODZ and other atrocities, by Katie Mulkowski
Why I hate Americans talking about tacos in London, by Chloe-Rose Crabtree
Against Curation, by Jonathan Nunn
What is the point of the recipe box?, by Thea Everett
Against Culinary Cuckooism, by Luke Dunne
McLondon, by Robbie Armstrong
The biweekly British vs American food debate, by Niloufar Haidari
What is wrong with the London restaurant scene

This week’s Hater is James Greig

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Gut Feelings: The Anxiety of Gut Health Apps, by James Greig

The gut: simply too horrifying to contemplate

During the summer of 2018 – the best summer of my life – I lacerated the lining of my stomach by drinking too much lager. This experience led me to understand, for the first time, how indistinguishable mental and physical health can be. For months afterwards I was haunted by a broiling, ulcerous churn of acid in my gut, each rumble incurring a flash of terror that all the Gaviscon in the world could not dispel. I was scared that this situation would last forever, and that for the rest of my life every meal I enjoyed would bring with it swift and brutal punishment. My stomach turning against me felt like a moral judgement, the terms of which I accepted. In the end, I cut down on alcohol for long enough that my humours were rebalanced, but I still to this day respect the stomach as a formidable adversary. For that reason, I’d prefer never to think about it again. The complexity of the human gut – the fact that trillions of microscopic creatures live inside us, exerting an outsize influence on our brain chemistry and emotional lives – is simply too horrifying to contemplate. 

It is unfortunate for me, then, that gut health has recently become something of a cultural phenomenon, alongside an attendant preoccupation with the category of ‘ultra-processed foods’. This is partly due to genuine advances in understanding of the relationship between gut microbiomes (the bacteria which lives in our stomach) and a wide range of health conditions, including cancer, Alzheimer’s, anxiety and depression – it’s not just about gastrointestinal problems. Contemporary research has also shown that our gut health is heavily shaped by our environment, whether that’s through the prevalence of refined sugars and processed foods in our diets or the stress we experience in our lives. Gut health is therefore both a societal problem and, on an individual level, a new avenue through which we can optimise our bodies. 

These scientific advances seem to have captured the public imagination. There have been several books written about the gut in the last year alone, including Ultra-Processed People: Why Do We All Eat Stuff That Isn’t Food… And Why Can’t We Stop?; Dark Matter: The New Science of the Microbiome; and A Silent Fire: The Story of Inflammation, Diet and Disease. The food market has been flooded with new probiotic products, many of which promise more than they can deliver or cause more harm than good, while articles about gut health have become an enduring fixture of the lifestyle sections of broadsheet newspapers. On TikTok, meanwhile, #GutTok videos have amassed billions of views. The advice on offer ranges from the ineffective but harmless (no, coconut oil isn’t a magical panacea) to dodgy MLM schemes and outlandish claims about autism being caused by poor nutrition. Even more disturbing are the ranks of grown adults (mostly Americans) using the word ‘poop’. 

@mrguthealthYou’ll never guess… #guthealthmatters #guttok Gastroenteritis (food poisoning) is the biggest wrecker of gut health. Depending on the type of bacteria that infects you, up to 1 in 5 people will go on to develop long term complications. This is because the bacteria that cause food poisoning disrupt the microbiome, even more than antibiotics. These bacteria also spew out endotoxins which cause inflammation. One such toxin, CdtB, can lead to an autoimmune type of irritable bowel syndrome, for which there is currently no cure. Now you know why food hygiene is so important… and why I’d never drink raw milk! 🤢

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@thereneereina🤯🤯🤯 truly unbelievable how full of poop I must have been before. #viralvideo #viraltiktok #pooptok #guthealth #momtok #didyouknow

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According to the sociologist Richard Crawford, the concept of health promotion first properly took hold in the 1970s, along with modern wellness culture and holistic medicine. From then on, there were successive waves of expert advice about nutrition, many of which contradicted those which came before them. With each new paradigm-shifting study, our assumptions about food are revealed as hopelessly outdated and dangerously naive. Everything we think we know about food is wrong, just as it was wrong ten years ago and ten years before that. The gut-health trend is explicitly concerned with debunking these previous fads, yet in doing so what it really exposes is that expert advice is a slippery, contingent and unreliable thing. 

At the vanguard of this gut-health revolution is ZOE, an app, podcast and personalised nutrition service described by a spokesperson at the time of its launch as a food-based version of 23andMe. For the modest sum of £299.99 (followed by a monthly subscription fee), it provides its customers with at-home glucose monitoring, blood tests and stool sample analysis, then collates this data to provide a personalised regimen, where food items are ascribed a value out of 100. At the heart of the company’s philosophy is the rejection of standardised advice: we are all blessed with a unique stomach and no two individuals – not even identical twins – respond to food in the same way. Where hiring a personal nutritionist would once have been the preserve of millionaires and celebrities, ZOE is making this service accessible for the merely quite wealthy. 

Like many of its competitors in the age of body positivity, ZOE positions itself as being concerned with health rather than weight loss. The company was founded in 2017 by Tim Spector, a Professor of Genetic Epidemiology at King’s College London. In the early days of the pandemic, he launched a Covid symptom tracker app which turned into the ‘ZOE Health study’ – a related project which collates health data from volunteers in an effort to research diseases such as cancer and dementia, while also still tracking Covid infections. Much of what he has to say is laudable: he rejects calorie-counting, he encourages people to eat less meat (partly for environmental reasons), and he isn’t really promoting a moralising, censorious or ascetic approach to diet – part of the appeal of ZOE is that it grants permission to indulge in products such as red wine, cow’s milk or things containing saturated fats, which had all been deemed beyond the pale by a previous generation of experts. The problems which ZOE is working to address are real: in 2021, a survey carried out across 33 countries found that more than 40 per cent of respondents had some form of gastrointestinal problem. 

But there’s something about ZOE, along with the broader preoccupation with gut health, that I find troubling. The sheer specificity of it, the level of self-surveillance, management and monitoring that it demands, the expectation that we should achieve such a heightened level of expertise regarding our own bodies – none of this strikes me as realistic or desirable. While ZOE critiques calorie-counting, its programme seems to encourage more elaborate forms of restrictive eating, new taxonomies of good and bad food, and fresh opportunities for self-castigation. Where once you might have fretted over eating too many biscuits, now you can worry about failing to maximise the ‘microbial diversity’ in your gut.  Even the most mundane consumer choices are suddenly made fraught and high-stakes. The questions posed on ZOE’s website have the same urgent, neurotic tone as a late-night session spent googling symptoms: can turmeric supplements damage your liver? What’s the best natural sugar substitute? Are nuts bad for you? Should you be juicing your fruit and vegetables? Can bread be healthy? Is coffee healthy? Can alcohol be healthy? Did dinosaurs have gut bacteria? Is ultra-processed food hiding in your fridge? 

ZOE is one example of what academic Joseph Dumit has described as ‘the medicalisation of food’, where our diet is no longer judged solely in terms of taste or nutritional value, nor even as a means of gaining or losing weight, but as a form of preventative treatment – food becomes antidepressant, statin, insulin, and immune-system booster rolled into one. Because we have been besieged by forces trying to deceive us – the fad diets and outdated shibboleths which ZOE has set out to dispel – our intuition has been fatally compromised. Aiming to eat ‘healthily enough’ is no longer sufficient. Within this framework, we are always vulnerable and always at risk, regardless of whether we are currently unwell. According to Dumit, this means that ‘every choice of what to eat intersects with an anxious duty to be healthy’. 

It is true that we are always at risk of illness, just as it’s true that eating well can mitigate these risks (indeed, the available clinical data shows that ZOE is effective, at least in terms of making people feel better). But this manner of thinking about food breeds paranoia: we are ‘ultra-processed people’ living in a world which is trying to poison us, where cancer is lurking within even the most seemingly harmless of products, and the only means of escape is to retreat into ever more complex and specialised lifestyle regimes. I don’t think it’s a coincidence that the sudden preoccupation with gut health has emerged around the same time that the NHS is being eroded; in the absence of a secure safety net, a neurotic fixation on one’s health is understandable. But if our environment really is saturated with poisons, then bespoke services like ZOE are not a scalable solution but a form of private healthcare which will further entrench existing inequalities. If nutrition really is as important as the gut-health gurus claim, it needs to become something other than a niche hobby for the middle classes. 

Every once in a while my old nemesis – the gut – returns to haunt me, but I’ve never been tempted by apps like ZOE. I don’t believe that whatever health anxieties (or even symptoms) I have would be well-served by me becoming that fixated on the workings of my body. Ultimately, the most sophisticated stool sample analysis in the world cannot ward off ill-health and death forever. Even if we forgo processed foods and subsist entirely on pulses, seeds and kimchi, our cells can still turn against us at any moment – that is a terrifying and inescapable fact of being alive. As Barbara Ehrenreich writes in Natural Causes, a book about our attitudes towards wellness and death, ‘No matter how much effort we expend, not everything is potentially within our control, not even our own bodies and minds.’ I don’t think the popularity of ZOE is driven entirely by the fear of death, nor am I suggesting we swap out fibre for Freud. But coming to terms with the fundamental arbitrariness of our health seems just as important as achieving mastery over our gut flora. Having stared down my own mortality, I now feel at peace with my daily can of Diet Irn-Bru – microbial diversity be damned! 

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Credits

James Greig is a freelance writer and political editor at Dazed.

Vittles is edited by Jonathan Nunn, Rebecca May Johnson and Sharanya Deepak, and proofed and subedited by Sophie Whitehead.