As a doctor and co-founder of diabetes clinic GluCare.Health, you wouldn’t think Ali Hashemi would be one of the many silent cases of pre-diabetes walking around Dubai. However, that is exactly what happened.
Ali joins Livehealthy editorial director Ann Marie McQueen to talk all about Zone.Health, his new metabolic program that is powered by coaching, tracking, and revolutionary new diabetic drugs.
He explains why pre-diabetes can be reversed, the importance of tracking blood sugar levels, and how his company are planning on shaking up the health insurance industry.
What is Zone.Health?
To put it simply, Zone Health is a medicated weight loss program. It’s not for people who are diabetic but to be eligible you must have a BMI (body mass index) of over 30, or a BMI over 27 and at least one comorbidity, too. Maybe that’s pre-diabetes, cardiovascular issue or high cholesterol.
Those who are not eligible can be treated with a non-medicated behavioral therapy approach to weight loss, too.
We can help anybody who is struggling to lose weight, or keep it off. For a lot of people, losing weight is the easy part, but keeping it off is hard or near on impossible. I myself found this.
Why did you decide to lose weight?
When I was in medical school, I probably spent more time in a gym than I did in my books. I was super fit, and probably had a body fat percentage of less than 10 percent. But then I moved to Dubai, became a professional and developed a serious work-life imbalance. Getting married and having kids brings its own new set of challenges. The six-pack became barely a one-pack but it happened over a long period of time so I didn’t notice. Until one day I was like, “Wow, I am not the same person I used to be.”
The trigger for me wasn’t that I had gained a lot of weight. It was that I became pre-diabetic and the irony was that it happened when I was also in the middle of opening GluCare.Health, which is now the world’s most advanced diabetes center. In the middle of launching that in May 2021, my wife and I both found out we were pre-diabetic.
We have a lab at the clinic so I test myself all the time. I caught it when my fasting blood sugar started to pass the threshold.
My grandfather died of complications related to diabetes. He was a poorly controlled diabetic for many years. My co-founder, Dr. Hassan, also has a father who is diabetic. So for both of us, it is a very personal topic. For me, my motivation was that I wanted to get myself back to having good metabolic health.
What pushed you from being overweight to pre-diabetic?
I was one of those guys that was heavier than they should be, but I carried it well and I still played soccer twice a week.
It lead to me getting injured on the soccer pitch and I underwent two major surgeries. I ruptured my ACL (anterior cruciate ligament) in my knee joint because I was too heavy. But I was active so I think the pre-diabetes was a manifestation of my underlying genetics.
It also happened during the pandemic when all of us were less active than we normally were and eating takeouts a lot. So I think it was a culmination of a lot of factors. It was a perfect storm.
We were stressed too…
Very stressed. It was a crazy period of time. I think all of us suffered in a lot of different ways, including with metabolic dysfunction. Most folks probably just don’t know it yet.
We send medical teams to screen every employee at big companies. It’s shocking, the amount of pre-diabetes that we’re seeing.
Obesity is something you can see immediately but pre-diabetes isn’t. Sometimes a person isn’t obese at all. My wife is slim and she was pre-diabetic at the same time as me. We had different journeys, but we both totally reversed our pre-diabetes in 90 days. I lost weight because I was taking Ozempic, which is is an extraordinarily powerful drug.
Zone. Health was built on the back of my own experience. Since then, we’ve treated a couple of 100 patients.
What is the difference between insulin resistance and pre-diabetes?
Medical knowledge on these conditions is evolving very rapidly. There’s a lot of good content about them on social media and there’s a lot of less good stuff. It’s hard for someone who’s not medically trained to tell the difference.
There’s a couple of ways to determine whether someone is pre-diabetic.
One is based on Hemoglobin A1c, which is measuring your average blood sugar saturation. An average of below 5.7 percent is considered normal, between 5.7 and 6.5 is considered pre-diabetic, above 6.5 is considered diabetic and above 7 is considered poorly controlled diabetic. If you look at the entire population of diabetics in the UAE, 75 percent of them are poorly controlled. That’s where the damage is being done.
The other definition for pre-diabetes is a more instant test that looks at your fasting blood sugar. You come to the clinic without having had any food or caffeine for at least eight hours, and if your blood sugar’s over 100, we consider that a marker for pre-diabetes.
Insulin resistance is more a description of how well-tuned your metabolic system is. For instance, you could have a nice shiny sports car, but if you haven’t had regular tune-ups done on the engine, it’s not going to run well.
You can think of insulin resistance as a gradual dysfunction in how your body reacts to the presence of blood sugar. The ultimate endpoint of metabolic dysfunction can be pre-diabetes, diabetes or obesity. It’s all just different results of metabolic dysfunction.
What causes pre-diabetes?
The medical community is still learning about this.
We know that sleep, glucose and stress hormones are central to so many conditions. They’re actually all important and that’s what makes it so much more challenging to account for all these different variables.
There’s a new revolution in medicine driven by data that is collected through wearable devices like Dexcom, Abbott or FreeStyle Libre. They are continuous glucose monitoring (CGM) systems that read your blood sugar every five minutes. They record your connected pump, pen, photos of your food, your step count, your sleep and your heart rate. They are producing dozens of new sets of digital data.
The problem is no one’s equipped to actually make sense of it all.
Let’s say you’re an educated patient who understands that sleep, stress and food are related. So you buy an Apple Watch and track your sleep for three months and then go to your doctor. But the doctor has no idea how to interpret this new data and they also don’t have the time to sift through it all either.
How do you use the data collected?
Yes. But we are trying to make it more accessible, not just to patients, but also to doctors.
I remember something our medical director commented on recently. He said: “Every day I come to the office, I feel like Superman. The data and the insights that I can access gives me superhuman abilities. I’m able to achieve outcomes with my patients that I’d never be able to do before. We’re changing the way people lead their lives and our outcomes are among the best in the world.”
The data it is out there it’s just not being contextualized and used properly. We call it a medicated weight loss program but Zone.Health is really us holding your hand and walking you through your own data.
How many people do you know who have stuck with these tracking platforms for more than six months? I think if you don’t know what to do with the results, your engagement levels drop off.
There’s certainly a lot of virtue signaling that comes along with these devices too. But we’re a medical practice so we come at it from a totally different angle. We’re very outcome driven.
I want to see long-term sustainable behavior change. I don’t want to see you lose 10 kilos and then gain it back. That’s as damaging as having the weight in the first place.
How were you treated for pre-diabetes?
As I said, I was overweight and she wasn’t. But both of us had a predisposition. My wife’s father is diabetic and my grandfather was diabetic.
If we had gone to a doctor or any health care professional, I would not have faulted them for coming to the natural conclusion that we were pre-diabetic for the same reason. Because it’s the pandemic, we’re living in the same house, and therefore probably eating the same food and not moving enough.
The treatment would most likely be the same too. Like do keto or cut out carbs. Usually, whenever you try to lose weight, it’s something out of the ordinary that you have to do. You have to cut out certain categories of foods or you have to go to the extreme and do intermittent fasting. But this is because the people giving those recommendations are also blind. They are just guessing that intermittent fasting will work because it worked for someone else.
But GlucCare actually looks at the data. In our case, my wife and I started wearing CGMs. I think everyone at some point in life should experience the power of the data that comes from a CGM even if just for a couple of weeks. It’s so informative.
Not a lot of my colleagues in the medical profession agree with that because CGMs are only given to insulin-dependent diabetics. But we use it very broadly because it’s very powerful. For instance, my wife found out very quickly that her blood sugar was spiking a lot every single morning after breakfast. Her blood sugar was fine at night but she’d have breakfast and boom. She was having All-Bran in oat milk thinking that it was super healthy and a great way to start my day.
So we very quickly identified one of the core reasons why her blood sugar was out of control.
My experience was totally different. My blood sugar was consistently high all night which meant that my insulin levels were high all night and my body was just storing fat. So I had to look at what I was eating at night time.
What was making your blood sugar spike?
That was a journey of discovery. The timing of what I’m eating, the composition of what I’m eating, and so on. I’m Iranian and one of the foods that we like to eat is this meal called chelow kebab which is basically a mountain of rice, two skewers of meat, and a serving of vegetables. Actually, if you think about it, it’s a well-composed and balanced meal. You’ve got carbs, fat, and protein and you’ve got your fiber. I started to mess around with the parts of the meal to see how it impacted the data. You can only do this if you are wearing a CGM.
For example, one day I would just eat the rice, and, as expected, my blood sugar boomed. Next day, I would eat the whole meal together and my blood sugar spike wasn’t as high. Then I ate it in the opposite order to how I normally do. I had the vegetables first, then the meat and then the rice. It was the same food, calories and macros but again my blood sugar changed. My mind was blown.
Our understanding of human physiology and metabolic function is still evolving. I still don’t understand it fully and I work in the industry, so I don’t know how a normal person is meant to. It’s hard. Zone.Health helps you navigate your own data and make super insightful discoveries.
For a month, I actually misbehaved. I wore a CGM and ate all kinds of garbage. I was drinking full sugar Coke, having Snickers bars, pineapple juice, different fruits and I was just testing my body to see how I reacted to different things. When you learn the cause and effect, you carry that learning with you forever. There are certain foods that I just cut out.
What did you cut out?
Pineapples. For whatever reason, my blood sugar absolutely spikes when I have a pineapple.
I experimented with combinations of food, the order I ate it, the timing of it and exercise. For instance if taking a brisk walk after I ate or being well-rested made a difference.
Not everyone has the ability to explore that data. That’s what we bring to our customers. We help people find a path that is sustainable.
For example, as I mentioned my co-founder’s father has been a poorly controlled diabetic for 20 years. He’s already had amputations and multiple health conditions. His condition has never improved. With an older person like that who is set in their ways, we call them a resistant diabetic.
They’re resistant to change because they think it’s God’s will for them to be that way. So they just want to enjoy life and go whenever they go. So shouldn’t tell them to do this, or don’t do that. People have been telling them the same thing for 20 years so why would they listen to you? Instead we don’t tell them to change, we just tell them to collect the data.
Then, when they come back, we can look at which foods or habits are causing their spikes and ask them to stick to the ones that don’t. It’s a way of changing human behavior without making patients uncomfortable or asking them to do things that we know they’re not going to do.
It’s always different things for different people?
Yes, everyone’s metabolic systems are different. It’s so fascinating.
My problem was also portion control. My wife is a bit more diligent about what she puts on her plate. She makes the most delicious food so I just used to eat until the point that I was going to explode.
That’s one of the reasons why Ozempic is such a powerful drug. We’ve been using it ever since we opened. But, after Elon Musk tweeted that he lost a bunch of weight on it, Kim Kardashian lost half her body weight on it and Eminem included Ozempic in one his songs, it was suddenly out of stock. We couldn’t even get it for our diabetics because people were going and buying it off the shelf and medicating themselves.
Is it harmful to self medicate Ozempic?
Very. Firstly because of dosage control. There is a science and a protocol around taking patients up a particular dosage and then lowering it. Some people have been ramping it up too quickly and getting really severe side effects that they can’t deal with. Or some people hit their target weight, stop taking it, and their cravings come back. But we’ve learned from these patterns and tweaked our protocols to combat this.
It seems like all of Hollywood is on Ozempic. It’s all over my TikTok feed. You can get it in pharmacies and we all know you can walk into a doctors and somehow get a prescription for something you don’t actually need. That’s a problem with our regulations. GPs also want to keep their patients happy, so they are tempted to just give them what they want. Unfortunately that’s happening a lot.
The other challenge is how much these drugs cost. They’re expensive and they cost four times as much in the US as they do here in the UAE. You’ll spend $10,000 in six months on these drugs. Even if it helps you lose 10 kilo, chances are that if you haven’t learnt anything about food, diet, exercise, and sleep, you’ll rebound once you come off it and waste all that money.
It’s super important for this drug to be delivered and consumed within a program of behavioral change and data. The patient needs to learns why and how they can keep the weight off.
How does Ozempic make you feel?
It was invented by Novo Nordisk, one of the big pharmaceutical companies, as a diabetes drug that really targets your insulin sensitivity, which is at the core of your metabolic engine. It’s like tuning the engine of the car, and that’s important for diabetics.
However, there are a couple of unanticipated side effects to it that affect people in different degrees.
It appears to affect your appetite control center in your brain. It kills your cravings and appetite. When I was on it I would go the entire day without ever thinking of food. It was as if it didn’t exist and I didn’t need it anymore. It was super weird.
It also affects the speed at which your stomach empties, so you get full a lot faster, and you stay full a lot longer. So I’d sit down with a plate of food, eat half of it and then it was like I couldn’t physically eat any more.
I’ve talked to a lot of patients and not feeling hungry is very common. That was great for me because I snacked a lot, and I overate a lot. It tackled those two things head-on.
There was a bit of nausea and discomfort and I was tired a lot because I wasn’t eating. It’s almost like forced caloric restriction. Because at the end of the day, losing weight ultimately is about eating less. But the main benefit of the drug, in addition to the caloric restriction, is the calibration of your metabolic chain.
How long should you take it for?
Some people stay on it forever because they’re afraid of what will happen when they stop. That shouldn’t be the case. Ideally, you want a limited time using the drug, and then the behavioral change part will take over as the long-term and sustainable part of the treatment. It’s too expensive to do it forever.
The cost of the drug in the UAE is anywhere between Dh1,200 to Dh1,300 for Ozempic, all the way up to Dh1,700 a month for Mounjaro. In the US, it’s about three to four times that. So $1,400, $1,500 a month. That will add up.
What we try to do is we start patients off with a month of just data analysis. We start that learning journey and help the patient understand why and when their blood sugar is spiking. Because once you go on the drug, your blood sugar will flatline. We then gradually take that patient up to a tolerable dose and then titrate it down under supervision.
So pre-diabetes is reversible?
Pre-diabetes is entirely reversible. With the right support and the right intervention, it can be reversed really quickly. We reverse most of our pre-diabetics in three months.
Part of the problem is the insurance companies. No one is tackling pre-diabetes because it’s not profitable to do so. However, diabetics are really profitable patients.
Every insurance plan includes an annual diabetes screen that is fully paid for. But no one knows this because the insurance companies generally don’t tell people about it. They don’t want people to find out they are pre-diabetic because then they have to spend the money on treating them.
I’m now 47. Had I not reversed my pre-diabetes and lost all this weight, with almost 100 percent certainty, I would have eventually progressed and become a diabetic. The difference in lifetime costs is $500,000 when comparing a diabetic to a non-diabetic.
But by investing a few thousand dollars in CGM drugs and the therapies, I saved a hundred times that.
Our long-term vision is to change the system and make the insurance industry think about things differently.
For more information about Zone.Health, find them on the web or Instagram.
