AI apps help diabetics count carbohydrates with food photos – and major health insurance companies buy

For years, Alan Levine struggled to track what he had eaten. He knew he could help him manage his Type 1 diabetes, but he discovered that food journaling and carbohydrates count boring. “I wouldn't do that much and I'll try to guess,” he said in an interview.

Then in February, a diabetes educator from the Saskatchewan Health Department in Moose Jaw, near his home, proposed a new approach to taking photos of his food.

Using an artificial intelligence-powered app called RXFood, the 62-year-old had to take a picture of his food. The app quickly generates estimates of carbohydrates, calories, protein and fat levels. Three days later, I produced a detailed report on his diet and provided daily tips on how to improve it.

Levine currently uses Rxfood for all her meals. It was more intentional about eating fruits and vegetables, and now he thinks twice before going for a few seconds. His blood sugar levels are tracked within normal ranges within about 70% of the time, compared to 50% before using RXFood.

“I'm so happy because it's something I haven't done before and I do it regularly. It's going to be better healthcare in the long run,” he said.

There are many apps for people to track what they eat. There's very little that RXFOOD does. A congratulations from serious qualifications and leading medical athletes who are referring the app to people living with diabetes.

It is supported by 12 clinical studies showing that people using RXFood have significantly improved the accuracy of their carbohydrate counting efforts, reduced glucose levels, and reduced the time required to monitor and record food intake.

“We were able to prove that it's as good as a drug,” such as Metformin and other nutritional therapies, which control glucose levels, “we managed to prove that it's just as good as a drug,” said Elizabeth Choi, CEO of the Toronto company behind the app.

This has transformed the 55-person company into one of Canada's most promising digital health startups. So far, 200,000 Canadians have downloaded and used the app, earnings exceeding $10 million, quadrupled in 18 months. RXFood raises just $5 million in capital and is profitable.

RXFood has over 500 customers including dietitians, health care systems such as Cleveland Clinic, the Community Health Network in Ontario, Quebec, Alberta and Saskatchewan, Children's Hospitals in Toronto and Ottawa, and several hospitals in Greater Toronto.

It also pivoted its growth strategy at the request of two major investors, Chair Mike Wessinger, and veteran technology executive Armughan Ahmad, since 2023. Five Canadian insurers, including Greenshield, have signed RXFood to offer members. Sun Life Financial SLF-T tests it with 100 people in the Philippines and helps develop term insurance products for people living with diabetes and those who otherwise do not get insured.

Walmart WMT-N provided RXFOOD to pharmacies at 55 stores last fall (users can access food discounts at stores), and four months later, 85% were rated “useful” or very “useful.” “The scalability of the solution is extremely promising,” said Alex Hurd, Vice President of Health at Walmart Canada.

Meanwhile, Dexcom Inc. DXCM-Q creates devices for continuous glucose monitoring and provides customers with access to the app. So far, 6,000 people have adopted it and you can chart how what you eat with RXFood affects your glucose levels.

“We've seen a lot of experience in the world,” said André Côté, general manager based in Burnaby at Dexcom Canada. He calls RXFood “a very powerful tool that's easy to use for anyone who needs to be good at managing diabetes.”

It's not hard to see why insurance companies are signing up now. When RXFood first approached them, “they only cared about their mental health,” said co-founder and chief medical officer Jeff Alfonsi. It was a huge selling point. Next, demand for Ozempic and other GLP-1 drugs to manage blood glucose spiked. “All of a sudden they got what we were trying to tell them” – that RXFood can bring health and economic benefits.

After rolling out the app last year, Greenshield determined that using RXFood could save employers and healthcare systems over 2,294 healthcare and absenteeism costs per user per year. Greenshield Plan Members continues to use 4.9 out of 5.9 on average and 80% of those who have tried it for a month.

“We are committed to providing a range of services that are important to us,” said Lucy Turowicz, Senior Vice President of Products and Data at Greenshield. “Our nutritionists find the reports they get are very practical and accurate.”

And if Sun Life's six-month Philippine testing is successful, “the application could be pretty much correct for the entire region where you run your insurance business,” says Chris Wei, Sun Life's Chief Client and Innovation Officer. (RXFood does not share any personally identifiable information about users with your employer or insurance company, but provides aggregated anonymized data about overall use.)

For RXFood co-founders Choi and Dr. Alfonsi, the venture is personal. Both were graduates of the University of Waterloo Systems Design Engineering Program and became friends when they won funds on Wall Street early in their careers. Dr. Alfonsi continued to study medicine and became an expert in internal medicine and chronic diseases. Choi suffered from an eating disorder during his school year.

A pivotal moment came after Choi opened a wine bar in Toronto in the early 2010s. The diabetic client asked for detailed nutritional information about the foods offered at private events and explained how difficult it can be to eat out. After talking to Dr. Alfonsi, who felt that the healthcare system had spent more effort in treating the effects of metabolic diseases than addressing the root cause through better nutrition, the pair first decided to build an app for use at Toronto Hospital.

Rxfood initially provided a way for people to track food on their phones. That included entering what they ate, but the nutritionist early on urged them to focus on taking photos, saying they would appeal to younger users. Ahmad and Wessinger agreed to invest after trying out the app.

Before trying RXFood, Ahmad said, “I didn't know how bad my diet was or what I lacked in nutrition.”

RXFood's success comes from applying familiar technology to tedious tasks, making it more efficient and enjoyable. Food photography has become a common activity for social media users. For those who currently live with diabetes, it can also replace the hassle of food journaling and give them a pocket nutrition coach. The app not only provides immediate information about what users eat, but also daily tips such as adding healthy protein and fiber-rich foods such as lentils, kale and chia seeds to your diet as well as adding health recipes and articles.

Also, RXFood is not intended to replace appropriate medical advice, emphasizing that, unlike other digital health monitoring offers, the disclaimer is for educational purposes, by blocking self-diagnosis. It also states that image detection technology is 94% accurate, but given the limitations of what a photograph can clearly capture, it is not perfect. Users will provide the option to manually edit the amount of ingredients. “It's not 100% accurate, but it's pretty close,” Levine said.

Also, while RXFood's advice is nothing new, it's key to tackling the biggest challenges that are simple, immediate and action-oriented. It is a change in human behavior.

“Even minimal friction is enough excuse for people not to basically do anything, and to be honest, humans are very good at denial,” Wei said. “A lot of this has noticed that we are actually taking on the challenge of changing our behavior. This is not easy. RXFood has taken the most difficult step. It's removing the pain of having a log.

This is an important focus for the intense and compulsive Ms Choi, who focuses on making the app even simpler and more friendly in even fewer steps than users currently take. Young companies should also work with large clients to ensure they are actively deploying to their members.

“Sign up for a health plan and persuade you to use it is one step,” Wessinger said. “They need to take these early customers to the next miles,” ensuring greater engagement and continued use.

He believes that apps can be wagered by adding rewards or perhaps creating a community among users. “They have pretty good user recruitment, but it can be much higher. “We now know how to promote it, we know how to promote it, we can reduce more people there, and we have far healthier people on the other side of this.”