Pam speaks with Sophie Smith, the founder of Nabta Health, about diabetes and women’s health. We also dive into gestational diabetes, and the relationship between Type 2 Diabetes, insulin resistance and PCOS.

Nabta Health is a disruptive healthcare technology company building a decentralised, woman-centric model of healthcare for emerging markets.

By combining the best of digital and traditional healthcare along clinical pathways to create a unique hybrid healthcare ecosystem, Nabta Health provides personalised, end-to-end support for women – from the acknowledgement of a specific health goal, through diagnosis, to holistic treatment options and beyond.

Sophie shares her background and how Nabta was founded, and gives us some special insights into women’s health.

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Sophie Smith is the Founder and CEO of Nabta Health, a hybrid healthcare platform for women providing personalised healthcare to women in emerging markets.

Prior to founding Nabta, Sophie worked for Accenture as a technology consultant and then founded several impact enterprises including myZindagi (a doctor-finding platform based in Pakistan) and Le Plastics (a plastic recycling company based in Sierra Leone). Sophie’s lifetime ambition is to make healthcare affordable and accessible for all women. Sophie read History at the University of Cambridge and completed an MBA with Quantic School of Business and Technology.

Nabta Health on Instagram: @nabtahealth

Nabta Health on Facebook: @NabtaHealth

Episode 14: Diabetes and Women’s Health with Sophie Smith

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Pam 0:02

Hello and welcome to Dia-Logue, the Diapoint podcast. I’m your host, Pam Durant. Today on the podcast, I’m interviewing Sophie Smith. She is the founder and CEO of Nabta Health, a hybrid healthcare platform for women providing personalized healthcare to all women in emerging markets. Prior to founding Nabta, Sophie worked for Accenture as a technology consultant. And then she founded several impact enterprises including myZindagi, a doctor finding platform based in Pakistan, and Le Plastics, a plastic recycling company based in Sierra Leone. Her lifetime ambition is to make health care affordable and accessible for all women, which is something about her that I really admire and something that I can say since meeting her a few years ago, that she has been working toward and she has been doing amazing. She also read history at the University of Cambridge, and she completed an MBA with Quantic School of Business and Technology. And I’m really excited to have her with us on the podcast today. She’s another one of those people that when I said to myself, I want to do a podcast. And she was also high up on the list to be interviewed. While her focus is on women’s health, there’s a lot more to women’s health that relates to diabetes and insulin resistance than you think. So this episode is good for all women, and also probably wouldn’t hurt men to listen in as well. Because it’s truly fascinating. The things that Sophie shares with us and discusses about hormones and insulin resistance, and so many other topics. So let’s get to the show.

Pam 1:54

Sophie, I want to thank you so much for joining me today. Welcome to the podcast. It’s really so wonderful to have you, you were another one of those people that I consider to be a trailblazer and a true leader in health care here in the UAE and in the region. And someone that I’ve definitely had on the list to join me for a podcast episode. So thank you so much for joining me.

Sophie Smith 2:20

My pleasure. Thanks for having me.

Pam 2:22

So let’s just jump right into it. How long have you been here? And how did you come to the UAE?

Sophie Smith 2:29

So I’ve been working in the UAE since 2011. At that time, I was still with Accenture. And we were doing kind of knowledge transfers for the VoIP system that we were implementing for an international bank. But I moved here in September 2016. And I actually moved with my husband for his job. He’s a commercial litigator. I had other companies in the UK, and in fact in other parts of the world. So I had set up a doctor finding appointment booking platform in Pakistan called myZindagi. I had just set up a plastic recycling company in Sierra Leone called Le Plastics that does waste plastics to bricks, tiles and roads. And I was pregnant. And when I arrived here, I was invited based on my kind of health tech consulting background to speak at a conference in Kuwait on diabetes, as it happens. And when I was there, I got chatting to the organizer. And we talked almost exclusively not about diabetes, in fact, but about the fact that I was pregnant. And about a month later, he sent me a whole load of stats on women’s health in the region. And they were pretty appalling. Yeah, 80% of breast cancers are diagnosed at stage four, which has a 27% five year survival rate as opposed to 99% at stage one or two. 40% of women across the region weren’t attending a single antenatal appointment, etc. And he asked me ‘do you want to do something for Women’s Health together?’ And I immediately said yes. I think I’d been looking for the business that I wanted to run, you know, for the next 30 – 40 years. And I said, give me a few months to hand over my existing business interests and also to have this baby. And then we can start work on Nabta and in fact, we started work on Nabta the day my son was due so the 21st of March 2017.

Pam 4:16

Wow. So that’s amazing and not surprising that you would start the day that your son was due because I’ve seen you come to meetings with, I think your second child, shortly after just a few days after that baby was born. And it really doesn’t stop you, like a lot of people take time off, which is good and also necessary and needed. But definitely your children come along for the ride with you. And I love that.

Sophie Smith 4:48

I think when you have a young company it is very much like another child and is as demanding, in many ways more demanding and you can’t you can’t leave it alone. You know, we’re still young enough that if I was to take, if I was to take a number of weeks off, there are things that wouldn’t move. We’ve just brought on board a really excellent Chief Operations Officer, and Medical Doctor in the UK by the name of Panna Morgan. But even with Panna, I think it’ll be a couple of years before I can step back, you know, an intake, the amount of times that I guess, kind of postpartum recovery would usually dictate, but I’ve been very lucky. I think my three babies have all been fairly accommodating. And when they’re little, you can transport them quite easily. I think the event you’re referring to actually is, and it was a Dubai Business Women’s Council panel. Elena was four days old. And my mother was sitting in the next door room with her keeping an eye on her. They weren’t actually they didn’t want me to come into the building with her. They said you have to wait in the reception. I said, Oh, please. You know, she’s really very little. And when I told them that she was four days old, they’re like, oh, we thought you meant you know, maybe she was six months old. They didn’t realize quite how tiny she actually was.

Pam 6:16

Yeah, I remember that day really well. And that was really amazing. And so that discussion, is that what got you interested in non-communicable diseases, or were you kind of looking to do something like this before?

Sophie Smith 6:31

So the non-communicable diseases part, that was actually the cementing of our idea and our identity around non-communicable disease, and empowering women in emerging markets to detect, diagnose and manage them. That’s actually Saba’s legacy. So my original co-founder was Moussad. And he stayed with the business for about 18 months until he had to step down as a co-founder for personal reasons. And then for the remainder of our kind of pre-commercialization R & D phase, we brought on board a third co-founder, Dr. Saba Alzabin who acts as our chief scientific officer. And going into the pre-commercialization phase of R & D, research and development, we had decided to build this hybrid healthcare model focused on kind of reimagining clinical pathways to support the detection, diagnosis and treatment of certain diseases. And our initial focus was on polycystic ovary syndrome, which is a hormonal imbalance responsible for about 70% of female infertility. And it was when we were kind of starting to build out this pathway that Saba said, ‘Well, you know, 80% of PCOS has an underlying metabolic component. And actually, a lot of hormonal imbalances and hormone related conditions and women have a metabolic component. Why don’t we focus on non-communicable diseases? And we can start by looking at some of the conditions that only affect women, such as polycystic ovary syndrome. But we can move from there, to looking at things like Type 2 Diabetes that affect the population in general, but affect women in a specific way. So that’s how the kind of NCD focus came about.

Pam 8:12

Amazing. And before I get into the diabetes discussion, how can you tell us more about your app? And how did that come about? I assume initially, it was to focus on the PCOS, or was it not?

Sophie Smith 8:26

Yes. So the app is our consumer interface. I think over time, it will likely change in terms of being the primary touch point. We’re at a funny point now where most companies that are technology enabled have a mobile app as the main consumer interface. But I think the prevalence of this kind of internet of things, and internet enabled devices is increasing. And actually a lot of the interfaces that we have with consumers, it’s very kind of concentrated into mobile phones at the moment. But it will start to become more dispersed. So if you want to book an appointment, you’ll typically use your phone to do it, which means that you’re very tied to your phone. But fast forward five years, you would probably book an appointment in your kitchen speaking to a voice enabled device like Alexa, or in your car speaking to another voice enabled device in your car. You’ll be able to do more things through technology that’s integrated in an invisible way into the environment as opposed to doing everything through your phone. So the Nabta app is our primary consumer touch point. What it is there for is for women to define their health goal with support from our little AI Powered Health assistant or care coordinator IA. And then our goal as a company is to provide women with the information and the access and the tools they need to achieve their goal with a focus on non-communicable disease and helping them understand how non-communicable diseases are affecting the goal. Because NCDs are predominantly lifestyle diseases, they come up time and time again as sort of stumbling blocks for women in the pursuit of specific goals. For example, if you are trying to conceive, and you have something like polycystic ovary syndrome, which is also, although not yet defined as such a non-communicable disease, you will likely find that there is a metabolic component to it. So, you will either be overweight or insulin resistant or pre diabetic or diabetic and that will be the underlying factor for your polycystic ovary syndrome. And so if you help women to address that factor, you will enable them not only to reverse or manage their PCOS, but stabilize their hormone profile, and ultimately, and hopefully fall pregnant without further intervention. The same thing for women who are struggling to lose weight, for example, if you have an NCD, or if you are struggling to lose weight, I should say it’s likely that you have some kind of non-communicable disease, some lifestyle disease that is preventing you from doing so. If you are struggling to recover postpartum, then potentially again, you have a kind of key deficiency, or hormonal imbalance that is tied to an NCD that is preventing you from recovering postpartum in a timely or structured or, you know, just kind of healthy manner. So whatever area of women’s health we look at, whether it’s health, fertility, pregnancy, postpartum, or menopause, NCDs, crop up time and time again, are the stumbling blocks. And so our app is there to help women address those in a goal oriented context.

Pam 11:56

That is amazing. The endocrine system never ceases to amaze me, because it really affects everything in the body and things that we never even thought about that were related, like insulin resistance, and other conditions. You know, we always hear about it in the context of heart disease and neuropathy and several other things, but we never truly hear about how it’s affecting the other parts of our body and particularly as women.

Sophie Smith 12:25

Yes, I agree. So we refer to the menstrual cycle as a women’s fifth vital sign, which is something that it’s increasingly being referred to as. It’s kind of a running joke but if you go to the doctor, or go to see the doctor for anything, pretty much the first question they ask you is, when was your last period? And the reason they do that is not because they’re just checking a box, your menstrual cycle is a very, very good indicator of whether you have any underlying health issues, any NCDs. For example, if you were, if you were overweight, and went into the doctor’s office, and they asked you, you know, when was your last menstrual cycle, you said, well, actually, it’s been about six months, or they happen very infrequently. What you’re actually telling your doctor is this: the fact of being overweight is affecting my cycle, there’s a very good chance that I am either pre diabetic or diabetic, or that I have a metabolic disorder that is affecting my cycle. If you go in and say, ‘You know what, I haven’t had a, I don’t think I’ve had a period for a couple of months now. But I have been getting like intermittent bleeding’, what you’re telling your doctor is, there’s a good chance that I have developed some sort of fibroids or polyps or cysts or something and, you know, structural, that could be a sign of oestrogen dominance, but is likely also disrupting my cycle. So you’re kind of like, eye roll, oh, well, it was here or I can’t remember or whatever response to what’s the day for last period or frankly wondering why on earth and doctors asking you that in the first place is. It’s actually telling the doctor a lot about your overall health. And I think we’ve ended up in a slightly funny place in society where a lot of women today will take hormonal forms of contraception as a way either to kind of mask or mitigate hormonal imbalances, or as a first line treatment for just about everything endocrine related. But the problem with that is that they lose visibility of their fifth vital sign, you know, for the period in our lives where we have a menstrual cycle, we have this window into our bodies, and how they work that men just don’t have it’s much harder to identify and a man, whether he’s pre diabetic, with women, it’s quite easy. And so I think, you know, for us educating women about the menstrual cycles and what menstrual health tells them about their overall health is really important. And you know, there’s an opportunity for a woman to see many things about herself that she might not otherwise see by looking inwards at her menstrual cycle.

Pam 15:16

That is truly fascinating. And it has me completely thinking differently about so many things. And you’re right, we’re in the West, we’re not really told that it means anything except you follow it or don’t follow it to get pregnant or not, we never were taught about it in the context of what it might be meaning for other things happening in our body. And then in some other parts of the world, people are still taught that it’s something to be ashamed of and they don’t talk about it at all.

Sophie Smith 15:48

In some cultures as it’s easy to see that, but I don’t know how in the West, it became like your menstrual cycle became something that was an inconvenience, or, you know, your period became something you know, that you just wanted to get rid of, I guess, you know, for a lot of women who suffer with things like endometriosis, or adenomyosis, where periods can be really very painful. Because when you shed tissue, you’re shedding tissue outside or from within the walls of your uterus, you know, and so women with heavy periods are excused for sure, in terms of wanting to avoid them, or not having to deal with them as frequently. But in terms of periods, in general, being an inconvenience, it feels like a rhetoric that’s been created by a mostly male dominated ecosystem that perceives the menstrual cycle as something inconvenient. Whereas you know, it is given the appropriate tools to manage a period so that, again, a period tells you so much, you know, for me, I’m always someone who’s suffered with irregular cycles. And we have a theory about a genetic mutation that causes a couple of other syndromes that could be linked to a genetic variant of PCOS. But I’ve always suffered from irregular cycles. And so the more regular my cycles are, the more I can deal with, and I guess sort of regulate them or get rid of the irregularity, the happier I feel, you know. It’s proof that I am maintaining my body in a good way, that I’m giving it the food that it needs, that I’m addressing the deficiencies that it has, that I’m not unwittingly consuming too much either refined carbohydrate, or kind of pure sugar. Yeah, it’s something that I celebrate. And I think there are parts of the world where, again menstrual cycles are celebrated in some tribes, in different parts of Africa, when a woman starts a period, she walks through the fields bleeding on them, because it’s a sign of good luck. And they believe that it will yield a good harvest. You know, that we’ve ended up in this position, where in many parts of the world, this sort of this vital sign of a woman is something that is to be ashamed or masked or treated as an inconvenience is honestly a little bit sad.

Pam 18:19

Yeah, I never I never thought of it in that context. I didn’t know that about certain tribes, either. That’s truly fascinating.

Sophie Smith 18:28

It’s cool, huh?

Pam 18:29

It is very cool. And in the same way that I say that I think your blood sugar number, if you have diabetes, is like an amazing health indicator. In the same way as you’re discussing menstruation. That’s also another indicator of if you are achieving optimal health. And it can be everything down to like you said, eating refined sugar. If you’re sleeping well, if you’re drinking, have enough water and do a lot of those basic things. It really, really does make a difference. And your app also helps you track and look for the signs correct?

Sophie Smith 19:06

That’s correct. So we have a logging system and activity logging system, it’s about to get a whole lot more intuitive. So by the end of the year, we’ll have completed integration with an API. So that’s an application programming interface called Thrive, which will allow us to sync data from over 300 wearable devices and apps. So rather than you having to kind of populate the Nabta app, with logs yourself, in order to see things in the context of your cycle and your goal, you will be able to sync whatever other devices and apps you use, and it will pull that information through again, that all of that will be done in a very transparent and person-led way. So we’re very strict about data privacy, about women controlling their health data and also understanding exactly what is happening with it. Like our job as a company is to empower women to make informed decisions about their health. And that means giving them the data and the tools and the ability to make these decisions, but not making them for them. So, you know, if women would like to sync information from their devices, and from specific devices, they can choose to do so. But it’s not something that we would do automatically and without asking them, but yes, the idea is to be able to give women a kind of coherent picture of what the decisions they make from a dietary and lifestyle perspective look like. Not only in the context of their goal, trying to lose weight, trying to fall pregnant, etc, in the context of their cycle, which is there in every mode of the app. And then also, in the context of any diagnosed conditions. Again, understanding that, you know, something like a decision for somebody with hypothyroidism in terms of consumption will look different to a decision for somebody with hyperprolactinemia, or, again, different to somebody with Type 2 Diabetes, for example.

Pam 21:10

Amazing, truly amazing. And moving on to the subject of diabetes. And when I think of women’s health, often, you know, typically, we end up thinking of gestational diabetes, but also women are quite affected by Type 2 Diabetes, and I don’t think people realize how much. I think a lot of people when they think of Type 2 Diabetes, sometimes they think of men more than women. But women also struggle with managing Type 2 Diabetes, would you care to comment on that in the context of women’s health?

Sophie Smith 21:47

Yeah, so I think all of these things are very related. You know, if you developed gestational diabetes, you increase your chances of them developing Type 2 by 50%. So GDX, and Type 2 are closely related, you also increase your children’s chance of developing Type 2 Diabetes later on in life. Now, how much of that is nature and how much of that is nurture ie, if you are regularly consuming, you know, more refined carbohydrate, when you’re pregnant, you’re likely to continue to do the same thing postpartum. And if you do that, and then you feed, you know, if your child then does the same thing, then they are likely to continue to do the same thing throughout the life, which is, which is a nurture thing rather than a nature thing. I don’t know if people really know at the moment, which one takes precedence. But I think, for us, there’s a kind of a natural flow and continuity in terms of conditions that we look at. So we started with polycystic ovary syndrome, because it’s the leading cause of infertility in women, because it has a huge underlying metabolic component. But also women with PCOS are much more likely to be high risk pregnancies. And that also includes being more likely to develop gestational diabetes twice as likely, in fact. So if we identify a woman with PCOS, when she’s trying to fall pregnant, then already we know that we will likely need to support her more during pregnancy with watching out for and then potentially managing GD, which means that we will then postpartum you know, have to again hand-hold her a little bit more and helping her to understand how to avoid developing Type 2. But there’s a link in a progression, I guess, in terms of not only a woman’s journey, but also the likelihood of these different entities cropping up at different points in her life. So gestational diabetes is actually the next clinical pathway that we are building. An activity that’s been led by our chief medical officer, Dr. Fadi Mirza. And so what we will attempt to do with gestational diabetes, firstly, as make sure that 100% of women complete an OGTT probably a one hour at 24 weeks’ gestation, or between 24 to 28 weeks, and then have quite a like a systematic set of things to do if she fails that first one hour test. And when I say fails, I mean that after one hour, her blood glucose and insulin levels have not returned to normal. So then if she didn’t, let’s say didn’t pass the one hour OGTT, we would then recommend a three hour OGTT, which gives you a much better idea of what exactly insulin and glucose levels are doing. After consuming a large amount of sugar, and then if she doesn’t pass it through our OGTT, then we would enter a kind of two week period of blood glucose monitoring where we would be taking at least four blood glucose readings every day, and providing her with lots of advice and support and, you know, access to nutritionists, endocrinologist etc. So that that during that kind of two week period, she can really understand you know, what’s going on with her body, what are the little lifestyle changes, she could make her there, you know, perhaps she shouldn’t, she should be introducing some more intermittent fasting where she’s not eating after a certain time of night or before certain time in the morning. And then if she doesn’t pass 75% of those blood glucose readings, we would refer her to a third party for more kind of hands on even more hands on support for the remainder of her pregnancy. So we again, as much as possible, this would happen at home, and on her own time. So these would not be OGTT. So, fasting blood glucose tests, where she has to go into a facility, they would be test kits that she would receive and do at home.

Pam 25:46

Hmm, beautiful. Yeah, for those listening OGTT test is the oral glucose tolerance test where those of us that have been pregnant before typically go to our doctor’s office to our OB, they give you that vile disgusting stuff to drink, and then you sit and you wait.

Sophie Smith 26:05

And it’s always orange, why is it always so orange?

Pam 26:07

Yeah, why is it orange? I never thought of that. I feel like I don’t remember if mine was orange or pink? Like pinkish orange that yeah, very bright color, really gross.

Sophie Smith 26:17

Make you feel like so that you’re about to drink something like a Fanta. But to alert you to the fact that it’s a high sugar drink.

Pam 26:27

But yeah, right. That’s very interesting. So now we need to study the psychological effects of that color. I really because of your margin, oh, that’s so interesting. And just because for anyone out there listening, if you do have a gestational diabetes diagnosis, please know that sometimes these things cannot be avoided, for whatever reason our bodies produce the amount of insulin they’re going to produce. But as Sophie’s pointed out, there are certain things that you can do with your lifestyle. Or if you need further support from your doctor to manage it. I think, depending on which doctor you go to, they may or may not give you a lot of detailed information about it. Some doctors are very, I hate to use the word complacent. But they’ll just say, oh, yeah, okay, you, you have this, just walk more, and watch what you eat. And while okay, that is good advice. But it’s not really detailed enough to always explain everything. And then I find women that do get a gestational diabetes diagnosis for especially the first time, you do have a high chance of having it again, after the first time you’re diagnosed. If you’re pregnant again, after you know, the very first time, it’s very scary, it’s very frightening. If I’ve met women that if they’ve had to inject insulin, it’s been terrifying for them to the point where they hired a home health nurse to help them do this. And there’s a lot of fear and confusion around it I think. So I think the first thing I want to say is that, you know, please don’t be scared. And if managed correctly, then your baby should not have any complications. Of course, if you don’t manage it, then that’s a different, different issue.

Sophie Smith 28:23

Yeah, so what’s interesting, actually, Pam, and you highlighted a really a really good thing, which is that the, again, I was catching myself saying if you fail this test, because that like pass and fail is, is unhelpful language when it comes to, I think anything parenthood related, but it’s the it’s the language used by doctors today. So it’s the if you say, you know, the doctor would say you have failed an OGTT, if your blood insulin and glucose levels are over a certain level when they when they record at the one hour point. But I think it’s potentially quite damaging language and something that should be changed. But yeah, it’s again, it’s one of these things. You can develop gestational diabetes at any point in your pregnancy. There’s an attempt to try and spot it earlier. So that more can be done to support women. But again, Pam, as you pointed out, for some women, no matter how, women who are perfectly healthy, who have normal hormonal profiles, normal blood glucose levels, normal insulin or, you know, will into levels pre pregnancy, will then will they those will start to unbalance themselves during pregnancy. And no matter how healthily you’re eating or living, you can still end up with gestational diabetes that doesn’t reverse, based on the lifestyle changes that you do or do not make. And so yeah, sometimes it does just require more I guess stricter hand holding. Interestingly, I have a question mark, myself about whether I developed it quite late on in both of my pregnancies with my boys. I definitely don’t think I developed it with my daughter. But towards both the end of my pregnancies with my boys, maybe around the 37 – 38 week mark, I would find in the evenings, particularly, that I became very thirsty. And then had quite a lot of amniotic fluid with both of them actually, when my waters ended up breaking, which is something that by that point, you’re kind of, unless there’s, they’re concerned about growth, you don’t have any more scans at that stage. So it’s not something that they would necessarily spot and then both were very large. So my first baby was 4.2 kilograms, which for a first baby, it’s quite heavy. My second son, and my third baby was five kilograms. He was a giant. And they asked me, you know, did you have gestational diabetes? And I said, Not that I’m aware of, but that actually, I do have a little bit of a question in my head, whether I might have developed it very late on. And it wasn’t from, like, there was nothing from a dietary perspective that I changed. And I was, I would always actually lose weight, even with the additional baby weight in the final trimester of pregnancy. So I think there’s, these things can be difficult to catch. But the most important thing is for women to be aware of them, to recognize the symptoms, to understand the risks, and then be able to make their decision accordingly.

Pam 31:39

That’s absolutely true. And drinking water is always one of the first signs of high blood sugar. So if you find that you are feeling really thirsty and have an unquenchable thirst, please highlight that to your doctor. I mean, even for my son, when he was diagnosed with Type 1, because it was in the month of August, I thought, Oh, it’s just because we’re in Dubai. And it’s really hot, but actually, it wasn’t. So any type of diabetes, if you’re drinking too much water, and you’re having to urinate more frequently, which again, when you’re pregnant, you have all this pressure around your bladder and everything anyway. So it’s hard to tell for sure. But always ask your doctor about that, ask for more information about it. And you mentioned about nature versus nurture. And I know that there’s a lot of studies, even to what’s happening in the womb, to children, and they’re looking, I listened to a presentation from a researcher from I think it was University of Colorado at a diabetes meeting several years ago. And they were looking to study what’s happening in the womb? And does that affect children or children that later become adults? And would they develop diabetes or not, you know, and like you said, if you do have gestational, then for some reason, that child may have a higher chance of developing or does have a higher chance of developing Type 2 later in life. But I think the thing that you highlighted that we need to be really careful of, and especially the medical community, because then it comes back to the mom blame thing again, right? Yeah, moms are always under scrutiny, like pass or fail, or, oh, you ate this or you ate that. And, you know, living healthy in general is going to help all of these conditions, not just the diabetes. So if you’re pregnant, or if you’re a mom, please know that. In so many cases, there’s often nothing that we can do to control our hormones. They sometimes have a mind of their own.

Sophie Smith 33:48

Yeah, I think also, just again, in this day and age, it’s very difficult, particularly somewhere here where you know, where people drive everywhere. Most of the kind of meetups and support networks, particularly for new mothers, are quite spread out. It’s difficult to find time to exercise regularly and you end up moving a lot less than you might do if you live somewhere with kind of continuous public transport links or where public transportation was something that everybody used, you know, where you might, you’d have maybe more women and a kind of a bigger support network in your immediate area as opposed to having to drive 15 – 20 minutes to get to wherever it was you needed to go. So I think yeah, it’s just I mean, we’ve spoken about it before and it was something that one of our advisors initially mentioned, that it’s very difficult these days to be accidentally well. People are not sick, but you can become accidentally unwell almost through no fault of your own just because of the demands that you have on your life. And again as a mother, in terms of carting children around and taking them to this activity and that activity and balancing that with usually quite a demanding work schedule. And, you know, not necessarily having the maternity leave that you would like, or you know, all these things, make it very difficult to be accidentally well, and so every person I would say, again, especially in a country, like the UAE, where you have to drive to get from place to place, anybody who manages to be fit and healthy, I mean, hats off to you, like, you’ve worked hard at that, that has not happened without effort.

Pam 35:40

Now, that’s really true. When I think of this last summer, we worked from Turkey, I didn’t necessarily have my regular workout routine, but I actually pretty much maintain my weight, but it was because I was having to walk and then there’s hills, it’s not flat either, right? And then when I came back here, and then you know, got even more deeper into my work, even though I felt like I was exercising more heavily, more regularly. All these things. I started to gain a couple kilos, and I think it was just because I didn’t have that general, kind of daily walking around to get things done in my life. And you’re so right, that can make a huge difference.

Sophie Smith 36:30

Yeah, so I developed insulin resistant polycystic ovary syndrome when I moved here, and I found out about it, because I was trying to conceive baby number two, I was using our little vaginal fertility monitor and realized that I wasn’t ovulating. So I went to see an OBGYN, got my diagnosis. And then I had to have a trigger shot to conceive Elena, between Elena and William, who’s number three, I made a lot of I would say small but significant lifestyle changes or dietary changes. And William, I conceived naturally and also for the first time. But I mean, again, little things, for example. And I would say three things, I now exclusively eat porridge with oat milk in the morning, because for me, that’s a low GI or glycemic index food. And cow’s milk can cause an inflammatory response in some people. So I find that I don’t cut it out of my diet completely, but I do limit my consumption of it. And that has helped. So I eat porridge with oat milk. I used to eat a lot of wraps. Wraps are one of these things that are sold as a healthy alternative to a sandwich. But actually wraps are full of refined carbohydrates and very calorific. And even if you get a whole meal, wrap, it’s quite densely packed, you know, you’d be much better off having a sandwich, so I cut wraps out of my diet. And I also started eating dinner with the children at five o’clock, and then basically didn’t eat anything after that. And it’s different for everybody. But for me, those three things have allowed me to manage my blood glucose levels much better. Over the day introducing what is effectively a kind of a period of intermittent fasting of about 12 or 14 hours helped a lot. But you know, every person is different. And there’s a very interesting study being done in the UK at the moment, that is looking at people’s metabolic response to different foodstuffs that they consume, and it starts, you are admitted to a facility for two, I think for an initial two week period, you get fed like very kind of nutritionally, I guess refined muffins, like little kind of food packs, three times a day your blood glucose levels are monitored continuously. And then after two weeks, you get sent home with a continuous blood glucose monitor, and just have to kind of record what you’re eating I think for further four to six weeks. And the one thing that they have realized is that every person responds to stuff that they give them in completely different ways. So for some people, you know, you give them peanut butter, and they’ll have a massive GI spike, other people you give them peanut butter and nothing. So working out what is best for your body, from a dietary lifestyle perspective was really important. Those were three things that worked for me.

Pam 37:14

Thank you for sharing that. I love that because at Diapoint we always say no two people with diabetes are alike. And it’s absolutely true that what works well for one person does not work for another. However, having said that, we could all eat probably a little more healthfully. And I find because my son is on a continuous glucose monitor being Type 1, when I feed him a more plant-based diet, his blood sugar is beautiful. He’s a teenager now. And so hormones have a lot to do with different blood sugars. And we had a few days where it was just being really stubborn. And I said, okay, we’re gonna go full on plant-based for his lunch and at school and different things for a few days and at home I’m typically cooking more plant-based. And then blood sugars went back to being really nice and in range. And then last night, he ate something that was not plant-based. And then there comes the insulin resistance. And also I find, and a lot of other people with diabetes, or parents with children with diabetes will observe this in their children, eating a really heavy dinner that has a lot of protein and fat, because your body has to break all of that down before it can digest the carbohydrates. Eating something like that at night is really hard on your body. And that can create a lot of insulin resistance. So eating it earlier, and then maybe going for a walk after or having whatever that heavier meal might be in the middle of the day, can do a lot for a lot of different people. So it’s all these little lifestyle changes. Sleep can also affect blood sugar. Actually, if you’re listening, and this is released in November, you should join the Diapoint challenge that we have going on in November because it’s all these small lifestyle changes and things that you can make, that you will see your outcomes improve no matter what the condition is that you’re managing, these are all basic things that all of us can do to make our bodies a little more healthy, as well as mental health as well. Even the smallest change can make a really big difference. So thank you for that.

Sophie Smith 41:57

I particularly think with children, you know, we don’t have any refined carbohydrates in our house and no white pasta, no white flour, no white bread, nothing white. And so even if we make something like cookies for the children, usually they have them. So they might have them with coconut oil. They have them with wholemeal flour, and things that are less likely to create a kind of a blood glucose level spike. And it’s really interesting to observe what happens now if they go to a party, for example. And they have something with refined carbohydrates. Firstly, they’ll often complain because they find them a little bit tasteless in comparison. You know, if you’re used to eating a kind of nutty wholemeal bread and then you get a slice of white bread, there’s a noticeable difference in taste. But they often there’s almost an immediate reaction in terms of their mood and behavior. My children become irritable and hyperactive and ratty if they eat things with refined carbohydrates in them because they’re just not used to them. But I think you know that that response is more stark because we do try to manage their consumption of refined carbohydrates in the house.

Pam 43:26

Yeah, we do the same and even find if Erin is out, like I gave this example to some people or I even mentioned it in a video at last Halloween, he was out with his friend, I’m like, okay, one day you go for it. And he ate some of the candy. And he gave the right amount of insulin and did really well managing his blood sugar, but he felt absolutely awful after, because he’s not used to having so much refined sugar. So it’s a matter of training them and they’re surrounded by a lot of kids that aren’t eating as healthily and suddenly, you know, kind of one of the beautiful things that’s come out of COVID is there’s less outside food coming in the school. Because for a while, I felt like doughnuts were coming in like every week. And that’s not the healthiest snack to have on a regular basis. So that makes such a big difference. I think maybe you and I can do a separate podcast about recipes for kids and different things.

Sophie Smith 44:28

Yeah, love to. Mirna Sabbagh is a really good person for healthy recipes for children on Instagram.

Pam 44:38

I’ll check her out. There’s quite a few actually. And we’re speaking with some of them at Diapoint because now, more and more people are realizing this fortunately, which I love. And more people are paying attention to what they eat and what they feed their children. So I’m really happy that people are paying attention to that. I don’t want to take up too much more of your time. But I just want to ask you a couple more questions before we go. So because you’ve worked in so many places and started businesses in other countries, what was it that led you to start your business here?

Sophie Smith 45:19

So for me, I mean, starting Nabta here, was initially a little bit accidental. But when we decided as it’s the place that I was, when we decided to register Nabta though, it became a more concrete decision to register here, as opposed to, for example, in another part of the Middle East, in Africa, even in South Asia. The UAE is pretty unique in terms of the blend of nationalities that you get here, there are over 200 nationalities, and they are fairly evenly distributed. If you go to the UK, you have terms like majority population and minority populations, because there are certain ethnicities in the UK that really are a minority. Whereas here, you’ve got a good number of people representing each nationality. And so if you want to look at the way that people from different parts of the world are affected by specific diseases, this is a good place to be. It’s also a part of the world where there’s a high prevalence of non-communicable disease. I think most of the GCC countries have diabetes rates among adults, have close to 25%. And more than half of all adults are overweight or obese. So again, if you are a company like ours that wants to build a platform capable of detecting, diagnosing and treating non-communicable diseases, this is a very good place to be.

Pam 47:05

I never thought of it in that context that you’re right. That’s one of the things that I think all of us that live here love about being here is all the different nationalities and things that we’re exposed to. But I never thought about it in the context of health care, or in the context of diabetes, which is quite fascinating.

Sophie Smith 47:24

Yeah, I think I mean, the UAE is, it’s also a fantastic place in terms of supporting startups and innovation in general. And I think increasingly, the UAE has aspirations to become two things, a hub for medical tourism, and also a hub for innovation in emerging markets. And so I think that, again, for us with our kind of Middle East, Africa, South Asia, focus, this is a very good place to be.

Pam 47:55

It certainly is, and we’re glad you’re here. If you don’t have the Nabta app, and you’re a female, diabetes or not, you definitely need to check this app out, you need to download it, use it, it can probably highlight many fascinating things about your health, that even if you’re very in touch with your health, and you think you’re being healthy. There is always room for improvement. And I really love this app, and what you’ve built. And like I mentioned, I’m really appreciative that you took the time out of your morning to speak with me, the work that you’re doing is so important, and so fascinating. But most importantly, it’s helping so many people, and it will continue to help many, many more people in the future, I’m sure of that. So thank you for that.

Sophie Smith 48:49

No, thank you for having me Pam. It was a great pleasure. And thank you for your support.

Pam 48:55

Always. I’ll always be one of your biggest fans.

Pam 48:59

So I learned so much today, despite being familiar with Nabta and their work. And some of the things that I’ve heard Sophie talk about at some of the meetings, I’ve seen her before, I still learn so much. There’s so much to know about the human body and about our own body as well as individuals. And Nabta, I think, is a beautiful use of technology that is very cutting edge and being useful and telling us information about our bodies that we didn’t know before. It’s not just tracking. It’s looking beyond just what’s being tracked and making suggestions for things that you might look into questions that you might ask your doctor or things that might allow you to change your lifestyle. So definitely check out the app. Menstrual cycle as a fifth vital sign, I never thought of it in this context. So that truly broke down a barrier to thinking that I had today which I really love. If you have any questions about Nabta or aren’t sure where to find it, we will put all of that in the show notes. So please have a look there to find the link to download Nabta, and their website to learn more about women’s health.

Pam 50:15

Today’s episode is brought to you by the Diapoint November challenge. I mentioned this during my discussion with Sophie. And it’s so true that some of the most basic things that we can do can really improve our health and also chronic conditions. This was created by Diapoint health coaches to create a comprehensive month long wellness journey to help you take control and reset your health during the month of November Diabetes Awareness Month. This challenge and the workbook that you get, it’s totally free. That’s right, free. It’s a beautiful handbook packed with information and inspiration and all kinds of worksheets to track your health goals and progress, a weekly email to keep you motivated, virtual Q & A that we’ll have throughout the month and also a chance to win free health coaching with a Diapoint Coach. So go to our website today. Check the show notes for the link. Visit our social media platforms and download your workbook today and participate. We look forward to seeing you at the challenge. If you’ve been enjoying the podcast and you don’t want to miss a future episode, please go to iTunes, Spotify or anywhere that you listen to podcasts and subscribe. Leave us a comment or leave us a review. It helps us to keep doing what we’re doing, or share it on social media or with a friend. Thank you so much. We really appreciate your support.

Show Notes and Links

Disclaimer: It should go without saying that the Diapoint podcast is not intended as or should not be used as personal medical advice. You will hear us interview medical experts and others, but please always always ask your qualified doctor, diabetes team or other expert about your health. What works for one person does not always work for another person. What you should always do when you discover any new health information is ask YOUR doctor about it. This information should empower you to have a discussion with your healthcare providers about it. Diapoint, our guests, sponsors and business partners are not here to replace that advice. Living a full, healthy life means taking the proper medical advice from your qualified physicians, diabetes team or other healthcare providers.

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