Co-founder of ZOE - George Hadjigeorgiou, on understanding how food affects your body

George ,  great to see you again. Let’s start with the founding journey of Zoe.

Great to see you again, Kyriakos. The first thing to say about the story of Zoe is that the name Zoe is a Greek name. It comes from the Greek word “Zoe” ,  which means “life”. It’s synonymous with this vision we have of the world of people not being just alive and tagging along every day, but people living life and living life for longer with 10 extra healthy years of life ,  I’ll talk more about that. I think the story goes back to somewhere around 7–8 years ago. I had personally sold my last two companies and I was taking a break when I reconvened with my friend, Jonathan Wolf, whom I’ve known for 20 years ,  he’s my co-founder now.

We took a trip together. Through that trip, we discovered that we shared a common passion for health and around the role that nutritional lifestyle plays in our health. In my case, I had recently started doing more tests and I found that I had about half a kilo of fat in and around my organs. I was what people call “toffee”, which is thin outside, fat inside. I also had high cholesterol levels and I was a bit alarmed.

Was this a blood sample or through some other medium?

The fat was through a DEXA scan and the cholesterol levels were through a classic blood test. It was a personal interest ,  I was just reading. I had just taken a sabbatical. I was trying to get my life and my health back in order, so I tried to start to do different tests and I discovered I had this problem which I never knew anything about before. I went to the doctors and some of the best doctors in London.

The one thing that they gave me was a leaflet from the Heart Foundation about nutrition. I was quite surprised back then. I said, Okay, I have these problems and the only thing I get is a leaflet… I started researching and asking questions to myself about whether the advice in these leaflets was accurate. I saw there was advice about eggs being bad for your cholesterol. I remember my grandmother was telling me when I was a young kid in Greece ,  don’t eat eggs because they’re bad for your cholesterol.

I started researching and to my surprise, I found that this advice on eggs was based on just a few studies that happened decades ago.

One of these studies, for example, was a study in 1972 on just 12 men. Six of these 12 men had high cholesterol levels before the study began… Also, even more alarmingly, the study didn’t account for anything that these 12 people were eating during the study. They gave them eggs to eat to measure the impact of cholesterol, but they didn’t record or account in their analysis whether these people were drinking a lot of alcohol at the same time or eating bacon, etc.

That study came out with this big finding that cholesterol is very bad. Eggs are very bad for your cholesterol and whatnot. I started researching and I started reading. The more I was reading and the more I was approaching the problem from first principles, the more alarmed I was getting, and even more confused ,  and I was asking myself the question, could it be that everything we’ve been told about food was wrong?

Jonathan, my partner, had exactly the same journey and questions. He had a different problem in terms of sensitivities in his gut since his early 20s. At some point, we read Tim’s book, The Diet Myth, which is an incredible book. That opened my mind to this beautiful world of gut microbes. Up until that point, I was only associated with microbes as being these bad things. Actually, quite the contrary, these microbes form this wonderful ecosystem of bacteria that’s so beneficial for our health, for our immune system, and so forth.

We happened to see a talk about Tim Spector and the work that he’s been doing over the last 30 years on twins. Tim had a similar journey as well, and he’s been studying twins because twins are a perfect control group to do studies on. He was studying twins to understand the differences between nature and nurture towards health, different lifestyles, diseases towards obesity, etc. He discovered that although twins were identical in terms of the DNA, being exact clones of each other, they only shared a third of the bacteria in the gut, and that turned out to be a key reason why some of them had different paths in terms of the health that trajectory they were following, whether they were developing diseases, whether one of the two became thinner versus not. He actually focused research on the gut microbiome. The founding story was really around the three of us recognizing that we had a very common problem, which is we all had these different health concerns and we were not satisfied with the answer we were getting around the question, what should we individually do in terms of our lifestyle and malnutrition to be in control of our health?

We decided to solve this problem together, and I think the key innovation in what we try to do with Zoe, is to utilize an approach that up until that point, and maybe even today was quite revolutionary. I call this power to the people. What I mean by that is by giving the people the chance, the average consumer, to participate in what is already the largest ongoing study and data collection around nutrition, lifestyle, and the microbiome in the world, by getting people to get involved in that and by expanding the data set, we would be able to gather a lot of data and then develop great personalized health solutions to help everybody in the world extend the healthy years of life by giving them new personalized health insights and advice and even solutions to help them extend their healthy years of life.

That was the genesis of Zoe, and it builds upon a thesis and a belief we have that over the last 100 years, we’ve been able, as a society, to increase life expectancy by eradicating contagious diseases like tuberculosis and meningitis and whatnot. What has happened at the same time is a huge proliferation of lifestyle diseases like diabetes and heart disease.

Our belief is that most people in the world can extend their healthy years of life by taking aid. If they were able to take proactive, personalized actions around their health decades before this lifestyle disease arose. And that’s why we started Zoe ,  to give people this access, this power back, these keys to their health with this new innovative product, which is a personalized health coach that helps everyone extend their healthy years of life.

From my understanding of Zoe you were all about the underlying science first before building something small and getting it to the market. Could you expand a bit on that?

Yeah, I think that comes back to the values we had as founders. All of us in different ways, had some impact in our prior endeavors. One of the things that was really important for all of us was to have a real impact on the world and to do things in the right way, even if it was a hard way. From the very beginning, we said we really wanted to do something very innovative around science ,  we wanted to do real science.

That was one of the conditions for the team to join as well, and very rightly so. But that’s also what Jonathan and I want to do. Rather than start ,  and that’s six, seven years ago ,  by launching a product, getting a CGM (Continuous Glucose Monitor), and offering it to the market, we decided to go to the hospital, the actual hospital, St. Thomas Hospital. That’s where the company started ,  and to first license this amazing research that Tim has been doing on twins for 30 years and build upon it by launching what at that time was called Predict, now it’s called Predict One, which is this start of this ongoing study, this ongoing project to collect the largest amount of data around the microbiome, nutrition, lifestyle, et cetera, in the world, in order to collect the data set that allows us to understand how people respond differently to food, how people are different, how the lifestyles are different, and use a data set together with AI to be able to predict for any individual how any food, any way of eating, any way of eating and living impacts the health real-time.

That’s the reason I went back to the hospital, and I’ll share a funny story that I like to cite to show just how naive we were, particularly myself when we started an endeavor. We said, We’re going to do this study with 1,000 people, 700 of them, twins. Typically the studies were around 20 people because these are real intervention studies. In our case, it was a 14-day intervention study where we collected so much data from the DNA to the microbiome, people were wearing the CGM, and they were eating set meals for a number of days.

We had them in the hospital for a day to take blood through a catheter, through 10 or 11 different time points to measure insulin, to measure the triglycerides rise, and measure the glucose rise ,  metabolism. It’s a very intense study, typically done only on 20 people, if at all. In this case, we said 1,000. All the scientists thought we were crazy, and probably we were.

The funny story is that we had never done a clinical trial ourselves, ever. We asked the scientists what team we needed to build. They told us ,  “hey, guys, the first person you need to bring on board is a CRO.” John and I looked at each other and said CRO? Like Chief Revenue Officer? We have zero revenues. It’s only cost. What do you mean? Of course, they were talking about the people who used to be running these clinical trials and what are called CROs (Contract Research Organizations).

To cut a long story short, we interviewed a bunch of people, but we said to ourselves at the end of the interview ,  we can do better. I think that’s one of the interesting lessons in entrepreneurship or our naivety maybe as entrepreneurs when you approach a problem you don’t know anything about or an industry you know nothing about is that we think about the problem from first principles and by using our experience and approach in building startups, we treat the clinical study of that size as a startup and were able to complete it, I would say, at a fifth or sixth of the time it would have taken other people and probably at a tenth of the cost with many superior results than they would have gotten. This was a fun experience and that was the genesis of the approach.

From the very beginning, we said ,  “we’re going to do this clinical study, then we’re going to do a similar version of that.” We called it a semi-commercial product. It was a clinical study that was similar to the first one, a bit less intense, but at home here in the US. In that way, we proved that we can do the studies at home and, in effect, do the testing part of our product at home. That’s the evolution of the study and the product that goes from something that’s very intense to something less intense.

Very similar to how Tesla has developed the cars from way more expensive and complicated models to much simpler and less expensive ones.

How did people learn about Zoe in the beginning?

We started to develop our product around 2018–19. As we were starting to develop the product, a thing called COVID happened… It was March 2020 and we were still developing the product ,  we hadn’t launched yet. We started with the US when COVID happened and my co-founder, Tim Spector, had this wonderful idea. He said, All right, we’re utilizing this amazing approach where we collect data from people to give them great insights and advice based on breakthrough science.

This is like a moment in history that we may not see again. We need to help people. Why don’t we develop an app to study the symptoms people have of COVID so we can understand them and then help people to protect themselves, not get hospitalized, and not die. We thought it was a wonderful idea and something that was synonymous with the values and the approach we’re using in terms of having an impact on the world.

We put a small team together and in five days, and I’m sure our CTO remembers that he didn’t sleep for two nights in that period, we launched an app called the Zoe COVID Symptom Study, which was launched in the UK in March 26th, if I remember correctly.

After two days, it became viral. We had a million people after a day, two million after two days, in the end.

How did the app become viral?

It was a point in time when the world was in crisis. It was like people were hearing the news from Italy, people were dying. If you remember in Northern Italy, all the people were dying, unfortunately, and everybody was trying to figure out what was happening. People were very worried about their health. It was a way to give back to the people, to get people to contribute by recording their symptoms.

By recording the symptoms, we were able to study which symptoms were the ones that were leading to COVID-19, because then people would report whether they got COVID, whether they got hospitalized, and if they were able to complete that loop. They felt that by doing something, they could benefit the wider public, but also get back information that can help them protect and prevent themselves from getting COVID, dying, etc.

It was the right thing at the right time. We also had a sharing mechanism that people used to share. I remember people shared it on WhatsApp, Twitter, or Facebook. The wonderful thing is that this became the largest-ever community science project around COVID with more than five million contributors, mainly in the UK, a little bit in Sweden, and a little bit in the US.

It led to a number of breakthrough insights. This was the study and the app that substantiated scientifically first that nose-dyspnea, the lack of smell and taste was a key symptom of COVID, and that led a number of different governments, including the UK government, to put it on the official list of symptoms. It also was one of the few studies to study the efficacy of vaccines. We did this big study on vaccines where we could see how long the efficacy would last, depending on what vaccine you took, AstraZeneca, versus Pfizer, versus Moderna, and what sequence, and that led people to be able to know for how long the vaccine would last, and as a result, protect themselves at the time.

Now, of course, that’s all less relevant because we’ve gone to the other side of this. But back then, we feel very proud that not only contributed with insights, we contributed with new science and breakthroughs, but through our work, a number of different media took the news and the insights from our work, and published them in different parts of the world. People, particularly older people who are reading the news, were able to benefit from this insight ,  whether it be lack of smell or taste or the efficacy of the vaccines and get the comfort and the peace of mind that they know what they’re doing to protect themselves.

I always cite the example of my dad when he one day called me and said, Oh, I learned in this paper that the vaccines would last for five months, and so I need to be careful or I need to go and get another vaccine. I asked him to send me the article and it was an article that was based on our data. The knowledge that you have impacted human beings at that level with that peace of mind and confidence of what to do to protect yourself in different parts of the world is something that is wonderful and I think goes back to the impact that all three of us wanted to have when we started the company.

That’s what happened and that’s what led to Zoe, particularly in the UK, becoming a quite well-known brand based on something that we decided to do in the spur of the moment, pro bono, just to help.

As we see more and more wearables entering the market ,  what’s your approach to dealing with new data points and extracting value from this data at Zoe?

I believe over the medium term, we’re going to start integrating more and more data from different parts of our lifestyle and also from different systems together in order to develop more holistic insights and more holistic advice. I would say we’re in the early phases of that, not because this can happen today, but because I think the infrastructure, first of all, is quite disjointed. For example, getting your blood test when you go to a hospital or when you go to a doctor and then feeding through an API into your solution is quite disjointed today, so it requires a lot of work.

Some of the data points are newer in terms of understanding the impact. For example, I was wearing a 24/7 blood pressure monitor. You get some interesting data, but it’s not clear yet, for example, how your nutrition on a daily real-time basis impacts data. Also, I think we require a lot more work in terms of not only integrating these different data sources but also analyzing the insight you get out of them and then the impact.

So we are in the early phase of that. It’s always something that, strategically, is definitely something we’re thinking about because at the end of the day, if you go back to what you’re doing, we’re a personalized health course that provides you with the best-personalized health insights and the best advice around what to do and the solutions then to easily implement it.

The more data you have about a person, the more you understand where they are, but also you can understand where they’re going and provide much better insights and advice. So definitely something we’re thinking about a lot and something that I see is going to happen more and more. But I think the two key problems that people like yourselves are solving, but also others are around A, the infrastructure of getting the data together, and B, around the understanding of how these different data mean and to give actual insights and advice.

That’s why we’re playing very well because we’re running these huge clinical studies all the time as part of this ongoing study. We’re well-positioned to really start understanding the insights and generating advice.

What does the team at Zoe look like today and what are the most important things for entrepreneurs to know about team-building?

Let me start first with the culture and then I’ll talk about the team because we have been very intentional around culture. Culture for us is something we treat like a product. We think it’s our second product and probably the most important product because, with the right culture, you can build anything. We’ve been very intentional about culture from the very, very beginning. Culture, not in terms of the aspirations, but more importantly around the operating behaviors that we want to celebrate and also the operating behaviors that we don’t tolerate.

Culture is not only what you celebrate, but as importantly, what you don’t tolerate. As a result, that gave us a compass in terms of the types of people that we wanted to hire. Because the people together with you is what the culture is. The people and their actions that you celebrate and don’t tolerate are what create the culture ,  it’s what you do that creates the culture. We’ve been very intentional on that. We made mistakes along the way, as one does. I would say that if we are to describe the people, I would say it is ambitious.

People are ambitious, they want to create something that is great for the world. They are positive. We have this value called ‘positive diversity’, which is a wonderful value because we want diversity. We want different types of people, different types of thinkers, different types of backgrounds, but we want to bring them together in a positive way, in a way where one builds upon the other. There’s friction.

Friction is not bad, it’s good. But positive friction is even greater because in that way you can rub the rocks to create beautiful stones, as Steve Jobs used to say, and that’s the true nature of collaboration. We bring people who are positively diverse to try to collaborate, but in a way that has friction and has constructed this agreement and evolution to build something greater. This is a key part of our culture.

It’s quite honest, our culture. We’re very transparent. We say we’re transparent, especially when it’s hard. It’s easy to be transparent when it’s easy, but being transparent when it’s hard is what’s really important. We’re also quite big in diving deep, both in terms of the depth for our solutions and also ensuring that the scientific rigor is there because what we do is really important, and has to do with people’s health and people’s lives.

When you are in the health sector, you don’t realize that every word you put in the service, and every color in your app can impact people in a quite profound way. A health result that’s red versus orange, can have a big difference to people and people sometimes don’t underestimate how big of an impact it has. We’re diving deep to actually be able to take a customer-first approach and deliver something that is true to what we want to help our members achieve.

The last I would say is that it’s a fun culture. People like to hang out with each other and have fun. In general, I’m very proud of the team we’ve built. I think the team is very proud of the culture we built and it’s all part of an objective. We have a culture, which is to make Zoe an incredible place to be where people come and they’re empowered and motivated to do the best work of their lives.