An AI app is helping diabetics count carbs with photos of their food – and major health care insurers are buying in

Alan Levine struggled for years to track what he ate. Even though he knew it would help him manage his Type 1 diabetes, he found food journaling and carbohydrate counting tedious. “I just wouldn’t do it that much, and I’d try to guess” how much insulin to take, he said in an interview.

Then in February a diabetes educator with the Saskatchewan Health Authority in Moose Jaw, near his home, suggested a new approach: photographing his food.

Using an artificial-intelligence-powered app called RxFood, the 62-year-old simply had to snap pictures of his food. The app would quickly generate an estimate of its carb, calorie, protein and fat levels. After three days, it produced a detailed report on his diet and offered daily tips to improve it.

Mr. Levine now uses RxFood every meal. It has made him more deliberate about eating fruits and vegetables, and now he thinks twice before going for seconds. His blood sugar count now tracks within the normal range about 70 per cent of the time – compared with 50 per cent before using RxFood.

“I’m so happy that it’s taken something that I didn’t do before and I’m doing it on a regular basis, which makes for better health care in the long run,” he said.

There are many apps for tracking what people eat. Few have what RxFood does: serious credentials, and the blessing of major health care players who are referring the app to diabetics.

It is backed by a dozen clinical studies that show people using RxFood have significantly improved the accuracy of their carb-counting efforts, reduced their glucose levels and saved time managing their diabetes by reducing the amount of time needed to monitor and record their food intake.

“We’ve been able to prove it’s as good as medication” that controls glucose levels, such as metformin, or other nutritional therapies, said Elizabeth Choi, chief executive officer of the Toronto company behind the app, RxFood Co.

That has helped turned 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 and revenues exceed $10-million, up fourfold in 18 months. RxFood has raised just $5-million in capital and is profitable.

RxFood has 500-plus customers including dietitians, health care systems such as Cleveland Clinic, regional health networks in Ontario, Quebec, Alberta and Saskatchewan, children’s hospitals in Toronto and Ottawa, and several hospitals in greater Toronto.

It has also pivoted its growth strategy since 2023 – at the behest of its two key investors, PointClickCare chairman Mike Wessinger and veteran technology executive Armughan Ahmad – to focus on private-sector clients, who typically pay the company and provide the app for free to their customers. Five Canadian insurers including GreenShield have signed on to offer RxFood to members. Sun Life Financial SLF-T is testing it on 100 people in the Philippines to help develop term insurance products for diabetics and others who would otherwise be uninsurable.

Walmart WMT-N offered RxFood to pharmacy customers at 55 stores last fall (users get access to food discounts in its stores), and after four months, 85 per cent rated it “useful” or very “useful.” “The scalability of the solution is very promising,” said Alex Hurd, vice-president of health with Walmart Canada.

Meanwhile, DexCom Inc. DXCM-Q, which makes a device for continuous glucose monitoring, offers access to the app to its customers. So far 6,000 have adopted it, enabling them to chart on RxFood how what they eat affects their glucose levels.

“The better you are at understanding the impact food has on your diabetes management, the better you are going to be from an overall health standpoint,” said André Côté, the Burnaby, B.C.-based general manager of DexCom Canada. He calls RxFood “an extremely powerful tool that is exceptionally easy to use for anybody that needs to be better at managing their diabetes.”

It’s not hard to see why insurers are signing up now. When RxFood first approached them, “they only cared about mental health,” said co-founder and chief medical officer Jeff Alfonsi. It was a tough sell. Then demand for Ozempic and other GLP-1 drugs for managing blood sugar skyrocketed. “All of a sudden they got what we’ve been trying to tell them” – that RxFood can deliver health and economic benefits.

After the app’s rollout last year, GreenShield determined use of RxFood could save employers and the health system $2,294 or more a year per user in health care and absenteeism costs. GreenShield plan members rate it 4.9 out of 5 on average and 80 per cent who have tried it still used it a month later.

“We were looking for a partner who would help us in programs where we have dietitians working with our members to help them get to a healthier, better place,” said Lucy Turowicz, senior vice-president of product and data with GreenShield. “Our dietitians feel like the report they get is incredibly actionable and accurate.”

And if Sun Life’s six-month Philippines test is a success, “this application could pretty much be right across the geographies in which we operate insurance businesses” said Chris Wei, Sun Life’s chief client and innovation officer. (RxFood doesn’t share personally identifiable information about users with employers or insurers but does provide aggregated, anonymized data on overall use.)

For RxFood’s co-founders, Ms. Choi and Dr. Alfonsi, the venture is personal. Both are graduates of University of Waterloo’s systems design engineering program who became friends when they worked in finance on Wall Street early in their careers. Dr. Alfonsi went on to study medicine and became a specialist in internal medicine and chronic diseases. Ms. Choi suffered from eating disorders during her school years.

A pivotal moment came after Ms. Choi opened a wine bar in Toronto in the early 2010s. A diabetic client asked for detailed nutrition information on the food served at a private event, explaining how hard it was for him to eat out. After talking with Dr. Alfonsi – who felt the medical system spent more effort treating the effects of metabolic diseases than addressing their root causes through better nutrition – the pair decided to build the app, initially to use at Toronto hospitals.

RxFood at first offered an array of ways for people to track their food on their phones, including typing what they ate, but a dietitian early on urged them to focus on taking pictures, saying that would appeal to young users. Mr. Ahmad and Mr. Wessinger agreed to invest after trying the app.

“I had no idea how bad my eating behaviours had been and what I was lacking in my nutrition” before trying RxFood, Mr. Ahmad said.

RxFood’s success comes from applying a familiar technology to a cumbersome task, making it more efficient and enjoyable. Photographing food has become a common activity for social media users. Now, for diabetics, it can also replace laborious food journaling and give them a pocket nutrition coach. The app not only provides immediate information on what users eat, but also daily tips like adding healthy proteins and fibre-rich foods such as lentils, kale or chia seeds to meals, plus recipes and articles on health.

RxFood also differs from other digital health-monitoring offerings by discouraging self-diagnosing, with a disclaimer stressing it is for education purposes and not meant to replace proper medical advice. It’s also not perfect, given the limitations on what a picture can definitively capture, although RxFood says its image-detection technology is 94-per-cent accurate. It does give users the option to manually edit amounts of ingredients. “It’s not 100-per-cent accurate but it’s pretty close,“ Mr. Levine said.

And while RxFood’s advice is not new, making it simple, immediate and action-oriented is key to tackling the biggest challenge: changing human behavior.

“Even minimal friction is enough of an excuse for people to basically not do something, and to be honest, humans are very good at denial,” Mr. Wei said. “A lot of this is realizing that we’re really taking on the challenge of behavioural change, which is not easy. RxFood has done the most difficult step, taking away the pain of having a log. They’ve made it fun and frictionless, but we still have a bit of an uphill climb to ensure our clients are consistently doing this.”

That’s a key focus for the intense, obsessive Ms. Choi, who is focused on making the app even simpler and friendlier to use with even fewer steps than users now take. The young company also needs to work with large customers to ensure they actively deploy it to members.

“Signing up a health plan and convincing them to use it is one step,” Mr. Wessinger said. “They need to take those early customers the next mile” to ensure greater engagement and continued use.

He thinks gamifying the app by adding rewards or perhaps creating community among users could help. “They have pretty good user adoption but it could be a lot higher. Why not drive deeper into health plans so they’re like, ‘We now have a digital alternative to Ozempic, we know how to promote it, we have more people on it, we can reduce our spend there, and we have people who are far healthier on the other side of this.’”