Navigating nutritional hygiene, with Glucare’s Ali Hashemi

Devina Divecha
[00:05 - 00:12] Welcome to Nourish by Spinneys, the podcast which promises to inspire you to eat well and live well. I'm Devina Divecha. 

Tiffany Eslick
[00:12 - 00:31] And I'm Tiffany Eslick. This is a space where we hope to nourish your heart and soul. On the show, we chat with leading players in the food community, from farmers to foodies, as well as health and well-being experts. It's all about engaging conversations and fresh ideas. And speaking of fresh ideas, Devina is getting a blood test today. 

Glucare Staff
[00:32 - 00:49] Hi, how are you? This is Hala from GluCare. We'll go over the process today. We'll start with the registration. Okay, and then we will go ahead with the blood test. After the blood test, we will meet, we'll go to meet the doctor. And then we will go ahead with the coaches, the dietician and ending it with the pharmacist. 

Devina Divecha
[00:49 - 01:06] So I visited GluCare, an integrated clinic in Jumeirah here in Dubai, which is incorporating technology into traditional diabetes care. And you feel it as soon as you enter, everything seems very slick and well designed. You almost don't really feel like you're going to get 
[01:06 - 01:25] tested. So what test did you do? Well, they did a full body check, which covered what seemed like everything from blood pressure to lipid profile. It was quick, though. It took about 20 minutes all through and we started off with my fasting sugar. 

Glucare Staff
So you're fasting today?

Devina Divecha
[01:27 - 01:31] Yes, I'm very hangry. Hungry and angry. Yeah, I'm just ready for food. 

Devina Divecha
[01:32 - 01:47] I definitely came across some machinery that I hadn't quite seen before. I also remember Francis, who was filming me at GluCare, joked about how they now had enough data to make a clone out of me. So this is the test to check for blood sugar level? 

Glucare Staff
[01:47 - 02:06] Yes, it will check your lipid profile, cholesterol, sugar, liver, kidneys, uric acid. The reports will be ready in 30 minutes. So after all the procedures, you will stay in the cafeteria. Once all the reports are ready, Dr. Yousef will call you from there to discuss all the 
[02:06 - 02:06] results. 

Tiffany Eslick
[02:07 - 02:23] Were you anxious about any of the results? 

Devina Divecha 
Not really. I mean, it had definitely been a couple of years since I'd done a proactive full body check like that. So actually, it helped me to see the progress I've made since the last one. And there was a decent bit of 
[02:23 - 02:42] progress, I should add. That's good to hear. I also caught up with GluCare's co-founder, Ali Hashemi, to learn about how they got started and some of the challenges with our lifestyles today, especially nutrition. So Ali has been in the industry for some time. His previous healthcare startup was acquired by Mubadala Healthcare in 2018. And his relationship with 
[02:42 - 02:44] diabetes is quite personal. 

Ali Hashemi
[02:44 - 03:05] My grandfather died of complications related to diabetes. He was a poorly controlled type 2 for a long time with a very, very strong sweet tooth. So I saw his behavior firsthand. So I carry the genetic predisposition. And I can get into it later. I actually became pre-diabetic myself. So I was a patient at my own clinic. My co-founder, Dr. Hassan Almarzouki, 
[03:06 - 03:22] his father was a poorly controlled diabetic. My wife's father is diabetic. So this is not a unique story. Every one of your audience is going to have a family member who is affected by metabolic dysfunction. The incidence of metabolic dysfunction in the US is now estimated 
[03:22 - 03:38] to be 70% to 80% of the total population. Wow. Yeah. In the UAE, the estimates now are that upwards of 20% to 25% of the population is already diabetic. Right. Okay. And upwards of 25% of the population is pre-diabetic, not including people who are already overweight 
[03:38 - 03:58] or obese, but not yet pre-diabetic. So you're easily talking about at least half the population. That's a lot. It's a lot. So it's a big problem. And so why did we tackle it? It's a combination of personal motivation, but it's also what's the biggest problem facing humanity and can 
[03:58 - 04:00] we actually take a shot at it? 

Devina Divecha
[04:01 - 04:05] So as I told you, I visited Glucare and I went through the whole journey. 

Ali Hashemi
[04:05 - 04:06] And we took your blood. 

Devina Divecha
[04:06 - 04:27] You took my blood. I just noticed how slick everything was and how efficient all the technology that your team used was. Can you talk a little bit more about that? Why was that so important to you to make sure you had technology that you do at Glucare and how has that helped 
[04:27 - 04:34] your patients? Because they were even telling me about the app that you get later on. I think that's just really interesting. 

Ali Hashemi
[04:34 - 04:52] So your experience coming into Glucare was not by accident. That was a very carefully crafted journey, which started with us visiting dozens of sites, buildings, and with our architects and so on to figure out, can we get the right patient flow? We didn't want our patients 
[04:52 - 05:09] to wait. We didn't want there to be bottlenecks. The flow had to be perfect because you want patient-centric care, which means that it shouldn't feel like a burden coming to receive care. So first and foremost, when you walk into Glucare, it's some combination of Apple Store 
[05:09 - 05:25] meets art gallery. It's designed not to feel like a medical clinic, although it is one. We wanted to feel like a place where you go to get healthy, not a place where you go to feel sick. That's first and foremost. But then secondly, the technology is there not for technology's sake. The technology 
[05:25 - 05:46] is there to, and I'm borrowing this from one of my team. My medical director actually framed it this way. The technology is there to give our humans superhuman abilities. In an interesting way, our technology, counterintuitively, makes our humans better at being human. So when 
[05:46 - 06:03] you sat with a doctor, I bet you probably noticed, first of all, how much time the doctor spent with you. Yes, I did. Yeah. Second, that the doctor wasn't distracted by the computer on his desk and typing stuff into the medical record and taking notes and all the stuff that you feel very obviously 
[06:03 - 06:19] in any other doctor visit. It doesn't happen because we've automated those tasks. Well, that's tech. Because ultimately, getting someone who's diabetic under control is not about the drugs. It's not about the devices. It's not about the lab tests or the cool gizmos. 
[06:20 - 06:38] It's about getting that person to live a better life sustainably, which is a very human problem. So it ultimately comes down to what is the relationship and the engagement between these humans. And at Glucare, you have not just the physician, an endocrinologist or a diabetologist 
[06:38 - 06:57] who's very highly trained, but you have a whole team behind them that you will not see anywhere else. And there's a reason for it. And that team consists of a diabetes educator, a nutritionist, a dietician, a health coach, and then all the other support staff that do everything else. The reason we do it is because when we built Glucare, we didn't build it as a 
[06:57 - 07:16] business. We built it as a sandbox, a lab to test. Like you guys have this kitchen here to help people learn how to cook. You built that kitchen as a showcase, as a lab, as a sandbox. We did the same. Glucare is actually a place where we tested our vision for this future of healthcare being 
[07:16 - 07:34] hybrid, machine plus human. Today, Glucare is among the best performing diabetes and metabolic health centers in the world in terms of the outcomes that we generate and so on. So again, it's not by accident. There was a very clear vision to use technology, architecture, even 
[07:34 - 07:55] wardrobe selection. You'll notice that our doctors are not walking around with stuffy suit and tie. Because why? It's not Halloween. You don't need to dress up your doctors. Doctors should be approachable. They should be human. Polo shirt just like I'm wearing with sneakers. There's no reason to dress up healthcare. You probably also notice that there's no desks 
[07:56 - 08:16] in any of the offices. We killed them. Why? Why should there be a desk? Like right now, you and I are sitting opposite a desk. This is a physical separation between two humans, which creates a dynamic that doesn't need to be there. We just replaced that with a very simple coffee shop style setup where you're sitting next to your physician together looking at all the data on that giant screen. 

Dr. Yusuf Said
[08:16 - 08:34] So, Ms. Devina, yes? Yes. Nice to meet you. Again, my name is Dr. Yusuf. I'm here the diabetologist and internal medicine specialist. So at the beginning, I will have some few questions and then we will do a body examination. And then after that, 
[08:34 - 08:46] I will show you all the results. Okay. Oh, on a big screen. Yes, exactly. Okay, great. Tell me a little bit about history. Any diseases known? 
Devina Divecha
No diabetes in the family. No. 
Dr. Yusuf Said
Okay. And are you taking any supplements?

Ali Hashemi
[08:46 - 09:04] It's designed to make you feel like you're part of the process. You're not being talked to. You're part of your own journey. We want you to get agency. We want you to take ownership over the outcome itself, right? Because that's how, that's the only way that you will 
[09:04 - 09:22] succeed. Yeah. You know, there's obviously a craze right now of a lot of people getting on diabetes medications that help with weight loss. And there's a huge debate around whether that's right or wrong. And, you know, we have some pretty strong views on how that should be done. And the punchline is it shouldn't be done just with drugs. There's a nutritional component, 
[09:22 - 09:32] which is why we're sitting and talking to you guys, right? Because food as an input is critical to that transformational journey. 

Devina Divecha
[09:32 - 09:39] So let's talk a little bit more about that around nutrition and its value when it comes to diabetes management or just generally looking after your health. 

Ali Hashemi
[09:39 - 09:55] Well, look, I want to challenge you on what is a drug and what is natural, because I think we need to broaden our perspective on those definitions. Food is a drug. Sugar is a drug. Alcohol is a drug, right? Anything that you put in your body 
[09:57 - 10:14] is creating an impact in some way. So I think we should probably think about a continuum, right? You know, obviously what you were referencing is drugs that come from pharmacies and get prescribed. Yeah. But in actual fact, I think we should probably think about it more broadly and say, 
[10:14 - 10:35] well, anything that we put in our bodies is going to have an effect. Yeah, that's true. Whether it's made in a pharma company's manufacturing plant or grown on a farm or worse in any of the many ultra highly processed food companies, right? So argument could be made that if you're really strict about not 
[10:35 - 10:53] wanting to put drugs in your body, then before you eliminate the diabetes drugs, you should first eliminate anything with high fructose corn syrup. So that conversation is a conversation that we try to have with our patients is around like, what is natural? Unless you're eating absolutely 
[10:53 - 11:09] whole foods off the farm that you have in your backyard, nothing is natural. Everything is processed. So that's an interesting thing to dive deep on because the definitions are not precise. And by the way, there's also nothing wrong with taking drugs that come out of a pharmacy, 
[11:10 - 11:28] like the GLPs. Some of them are compounds that mimic existing peptides in your body, and they're just enhancing your underlying metabolic processes. So there is a place for it. We're not a practice that is exclusionary. We don't say, oh, we're only going to do keto diets 
[11:28 - 11:45] and we're only going to make it vegan and we're only going to, you know, we don't do that. We say, okay, what are all the tools at our disposal? All of them, drugs, food, sleep, stress management, you know, exercise, whatever. Let's figure out for each patient on a hyper personalized basis, 
[11:45 - 12:04] what is the mix of approaches that makes the most sense? For some patients, whether it's driven by personal desire or by need, they don't want to have an injection. Fine, you go a path that doesn't include that. But for some patients, that injection really moves the needle, pardon the pun, on their 
[12:04 - 12:20] overall health. But the engagement with the nutritionist is central, right? Food hygiene is something that we all lack. Why do we lack food hygiene? Again, it gets back to the sort 
[12:20 - 12:36] of agency question. There's this, you know, now infamous example that I give in talks and stuff. So, you know, people talk about Ali's chocolate cake story. So I'll tell it to you, you know, and it's a very nice way to simplify it. You know, if I put your favorite dessert in front of you, 
[12:36 - 12:48] and mine happens to be my wife's, you know, chocolate cake that she makes from scratch. If I take that fresh out of the oven and cut you a nice slice and put it in front of you and, you know, put a nice cold glass of milk in front of you and then hand you a fork. 

Devina Divecha
[12:49 - 12:50] I'm going to attack the cake. 

Ali Hashemi
[12:50 - 12:54] You're going to attack the cake. But let me ask you a more interesting question. Right now is your mouth watering? 

Devina Divecha
[12:54 - 12:55] I'm thinking about cake. 

Ali Hashemi
[12:56 - 13:13] You are. There's no cake in front of you. With just words, I have actually elicited a neurotransmitter response in your brain, which has resulted in your mouth watering. And your audience now is also thinking the same thing, right? I've just over, you know, sound waves in a 
[13:13 - 13:33] podcast changed people's neurochemistry. Okay. So food is so powerful that just the description of it can change your neurochemistry. Okay. Now, if in the moment of giving you that hypothetical chocolate cake and handing you the fork, I asked you, hang on a second, Davina, before you eat it, 
[13:34 - 13:50] tell me what is the impact that that chocolate cake is going to, you know, what impact will that chocolate cake have on your metabolic health? What about all the chocolate cakes you've ever eaten? I don't know. Right. So food hygiene is not an easy thing to fix because we don't have 
[13:50 - 14:06] the underlying cause and effect data for the stuff that we put in our bodies. Yeah. We don't, we have no idea. So what do you rely on? Marketing claims by food companies on the packaging. You know, some people educate themselves enough to start looking at ingredients 
[14:06 - 14:21] and nutritional values, but even that is hard. It's hard for me. And I'm a professional in this domain. Like it's for the, for the regular, you know, parents of three kids trying to get a healthy lunch put together. It's not easy and it's time consuming and it's more expensive than just going 
[14:21 - 14:41] the prepackaged route too. And what confounds it further, what makes it more difficult is that no two people are the same. So you can have two people eating the identical meal and having a very different response to that meal. Right. I went through the journey myself. So I'd gotten 
[14:41 - 14:57] to a point a couple of years back where I was about 15 kilos heavier than I am today, maybe more. And, and I was pre-diabetic and I had a fatty liver and I had high cholesterol and I had high uric acid and things were just, you know, it was right after the COVID lockdowns. And so things 
[14:57 - 15:16] had gone sideways for me. And my journey of getting back on track started with putting a CGM on myself and analyzing my blood sugar every five minutes, continuously taking food logs diligently, understanding cause and effect, but then also experimenting with the foods that I was eating 
[15:17 - 15:34] to know how time of day impacted my response, order and combinations. So I could have the same food, the same, you know, rice, kebab and salad eaten at different times or eaten in different order, same meal, different response. 

Devina Divecha
[15:34 - 15:39] And that was what you were tracking. 

Ali Hashemi
[15:39 - 15:56] And I was tracking that, but I could only learn this stuff because I actually had the data. Without the CGM, you can't, you're just eating. Then I started looking at the same meal, same order, same time of day, eaten after a night of poor sleep. Right. Okay. Affected my blood sugar. 
[15:56 - 16:12] Same meal, same time, eaten on a day where I'm particularly stressed, different response. So you start to see how complex it can get. Yeah, of course. So what you want to do is help people on this journey of self-discovery. It's a skill, 
[16:12 - 16:31] like riding a bike. And it's a skill that once you learn it, stays with you. And it becomes a lifelong thing. Like you don't have to get obsessive about it. Some people become body hackers and go down the rabbit hole. I'm kind of one of those people, but you don't have to be that way. Just being mindful of the big picture in and of itself 
[16:31 - 16:34] is oftentimes enough to get really, really, really good results. 

Devina Divecha
[16:36 - 16:59] When we come back, we'll continue my conversation with Ali, where he tells me about how they're expanding the platform into other aspects of healthcare. And he's also got some tips on where to get started with your nutrition journey. Welcome back. You're listening to Nourish by Spinneys and my conversation with Ali Hashmi 
[16:59 - 17:11] of Glucare. What do you think those and the challenges are currently for people to, like you say, be more mindful of their food hygiene? What do you think is perhaps stopping them or scaring them? 

Ali Hashemi
[17:11 - 17:27] It's hard. It's work. It's hard to do the nutritional stuff because it takes effort, time, attention in a period of your life where you've got a full-time job, you've got three 
[17:27 - 17:44] kids, you've got to do school drop-off, you've got podcasts to go on, life gets in the way. So it's hard to fit it in. You have to be deliberate about that. Even things that you think are healthy. Like my wife became pre-diabetic at the same time as me. She's going to hate me for 
[17:44 - 18:01] telling the story yet again because everyone knows her all-brand and oatmeal story. So yeah, she was spiking. Her blood sugar was spiking every morning because she was eating a breakfast that she thought was healthy but turned out to spike her blood sugar. And it was all-brand with oat milk. 
[18:01 - 18:20] That's what she was having for breakfast almost every day. And it was spiking her blood sugar. So even things that you would think, oh yeah, absolutely, that's healthy. That's healthy. Yeah, okay. The nutritional piece also comes with a cost, a financial cost. Eating well costs more, 

Devina Divecha
[18:20 - 18:37] usually. Yeah. So for someone perhaps who's starting to think about their nutrition and how that plays a role in their blood sugar or their general health, I guess what tips or advice would you give them when they're starting out and just kind of trying to dip their toes to this brave new 

Ali Hashemi
[18:37 - 18:57] world? Yeah. So the good news is everyone can chart their own path and you don't have to get stressed out over it. You don't need to go all in and revolutionize your whole life. You can start baby steps. Something that I suggest to everyone is experience the magic of a CGM, the continuous 
[18:57 - 19:16] glucose monitor. And you might have seen it. People wear it either on their arms or on their abdomen. These are expensive devices. They're not cheap. The prices are coming down, but still, you'll spend, depends on which device, between, let's call it 500 derms to 1,500 derms per month 
[19:18 - 19:35] on the device. Now you don't have to use it forever. I would recommend using a CGM for a month and collect the data and misbehave, actually. That's what I did. Okay. That's what I did. When my medical director sat me down and said, Ali, we got to put a plan together to reverse 
[19:35 - 19:55] your prediabetes. I said, okay, I'm going to start by doing exactly the opposite of what you want me to do because I want to see the data. So I put on a CGM and then I started eating stuff that I haven't eaten in years. Snickers bars, full sugar Coca-Cola, you name it, I was eating it just to see how my body would react. Because those learnings you have forever. One thing I discovered was pineapple juice 
[19:55 - 20:14] for some reason, and actually pineapple slices on its own just absolutely went through my blood sugar through the ceiling. Oh, really? Okay. Things I didn't expect. And that would be different for different people? Yes, it's different for different people. It's different for the same person on different days of the week. There's variability, right? So I would start there, understand what 
[20:14 - 20:31] your baseline is, sit with the physician, put a plan together, and tell the doctor, candidly, here's my constraints. I'm a mom and I've got a full-time job and I've got three kids and I do these activities. And so realistically speaking, I'd like to start light. What does that 
[20:31 - 20:48] look like? You can make small incremental changes. It's 80-20. You might find that there is five particular foods out of all the stuff that you eat that cause the biggest spikes. And that just eliminating those five things, but keeping all the other stuff that you love, 
[20:48 - 21:07] makes a huge change in the way you feel and the way you're carrying your body around. So again, there's no one template solution. The template is just get started. It could be baby steps or it could be all in. We see patients all through. We have patients who come to us and say, 
[21:07 - 21:22] look, I don't want to do any of it. I'm not a techie person. I don't barely know how to use my iPhone. We have patients that are like, I like your doctors and I like the clinic and you're close to my house. And so that's why I'm here, but don't burden me with this stuff. Even those 
[21:22 - 21:41] patients get better because there's this thing called the Hawthorne effect, where just by virtue of someone knowing that you're observing them, makes them change their behavior. So look, I think there are as many solutions as there are people. The key is helping people find the solution that's 
[21:41 - 21:44] right for them. It's hard to do on your own. That's why we exist. 

Devina Divecha
[21:44 - 21:53] And what's next for Glucare? Do you have any plans for the brand or expansion or where do you see it going? 

Ali Hashemi
[21:53 - 22:11] Yeah. So we've gone beyond Glucare. So you've probably heard of brands called Metabolic, Zone.Health. So Glucare, we initially built it with a very specific focus on diabetes and disease. We quickly started to see a lot of healthy people come in and want support on a 
[22:11 - 22:32] weight loss program, which is not covered by insurance typically. And so we launched Zone. Zone is a dedicated, virtualized, behavioral change-oriented, medicated weight loss program. And then we launched also Metabolic, which is essentially the technology layer that powers 
[22:32 - 22:52] both Glucare and Zone. Once you start doing that, you start to be able to do other things very well. So when you have a diabetic population of men, many of those men will also experience low testosterone levels, erectile dysfunction issues. There's a lot of other 
[22:52 - 23:12] things that come along with diabetes. So we now have a full-time urologist on board to deal with men's sexual health. We've now launched a virtual testosterone replacement therapy program for our population, which is now open to everybody. Similarly for women's health, there's a relationship between polycystic ovary syndrome, PCOS, and metabolic dysfunction. So a 
[23:12 - 23:30] lot of our diabetic female patients have PCOS issues, which we then have a gynecologist come on board and help them with that. And so now you can do things around perimenopausal hormone replacement therapy and helping women on women's health issues. So Glucare is expanding beyond 
[23:30 - 23:46] just diabetes into, broadly speaking, primary care in many ways, because we're helping people with a broad range of issues that they're facing every day. And then there's a geographic expansion as well. So we're in discussions with mostly at government level to think about how do we take 
[23:46 - 24:04] everything that we've learned and then blow it up at national scale. So how do we go to your country and then build out a foundational new approach to metabolic health for the population, which becomes a mix of physical clinics plus all the tech plus all the other stuff. 

Devina Divecha
[24:04 - 24:05] Cool. That sounds great. 

Ali Hashemi
[24:05 - 24:07] Yeah. A lot of work. 

Devina Divecha
[24:07 - 24:15] Yeah. A lot of work. I have a question for you to round off this conversation. What is it that nourishes your soul? 

Ali Hashemi
[24:16 - 24:32] Easy answer. It has to be family. So I overinvest in during the 16-hour flights back to California to go spend time with the family. Also my kids and my wife. I don't do anything else. I basically 
[24:32 - 24:54] have work, which consumes a certain part of the day, and I have family. And everything else is secondary. So I think now that I'm a father of three, the soul-filling nourishment that I get is just seeing my kids evolve into real humans with real values and real opinions and all that 
[24:54 - 25:14] kind of stuff. So that's one thing on the personal side. On the professional side, look, I've already and sold a business. The question I get a lot is, why aren't you just hanging out on an island somewhere and just relaxing? Why are you working so hard? Because I took two days off after selling 
[25:14 - 25:34] the business and got a haircut and bought a pair of sunglasses, and that was my celebration, and got back to work. And I think on the professional side, it comes down to legacy and impact. My kids are going to Google me at some point, and I want what they see to be 
[25:35 - 25:50] a reflection of some value that I've been to society and to do that at scale. So if my Wikipedia page, which doesn't exist today, one day says Ali was a meaningful 
[25:51 - 26:10] contributor to the global war on metabolic dysfunction, there's nothing more fulfilling than that. When I have a diabetic patient that I... If I reverse somebody's prediabetes like I did for myself, well, if that person had gone on to 
[26:10 - 26:26] become full-blown, poorly controlled type 2 diabetes, they would have lived a decade less. All the memories that those 10 years will create, right? All the connections, all the contributions. So when we think about impact in health, that's one of the benefits 
[26:26 - 26:45] and the privileges of being an entrepreneur in healthcare is that, sure, you can sell a business, you make money and create commercial and economic value for yourself, but the double and triple bottom line around human and societal impact is massive. So yeah, there's that. 

Devina Divecha
[26:46 - 26:48] That was a great answer. Thank you. Yeah, my pleasure. 

Tiffany Eslick
[26:53 - 27:07] It's amazing to what extent food and ingredients can impact our health. And that's why at Spinneys, we spend so much time really assessing what we have in our stores and visit our partners to understand how they source their ingredients and their process on farming. 

Devina Divecha
[27:07 - 27:23] And it's also about transparency, right? We share our experiences from these trips with our customers. So you can read about it in our magazine, on our website at spinneys.com, as well as this podcast. This episode was brought to you by Spinneys and is hosted by me, 
[27:23 - 27:33] Devina Divecha and Tiffany Eslick. We're produced by Chirag Desai. You can find out more about Glucare on their website in our show notes and follow Spinneys on Instagram, Facebook and TikTok 

Tiffany Eslick
[27:33 - 27:38] for more. We'll be back in two weeks with our next episode, which will be all about cycling. 

Devina Divecha
[27:42 - 27:44] So what does saturation mean? 

Glucare Staff
[27:44 - 27:50] It's the oxygen that you are breathing in. So it's good. It should be 95 to 100. 

Devina Divecha
[27:50 - 27:52] Okay, I'm all right then. I'm saturated. 

Glucare Staff
[27:53 - 27:53] Yes, you are.