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Dr. Jeff Alfonsi and Elizabeth Choi



The story of RxFood begins not in a medical school, or a hospital, but within the rigorous academic halls of the University of Waterloo's System Design Engineering program. It was here that Dr. Jeff Alfonsi and Elizabeth Choi, along with their peers, were challenged to tackle complex problems through interdisciplinary approaches. They became fast friends and their scholastic foundation in engineering would later prove instrumental in their approach to healthcare.


A Nutritional Journey Wrought with Meaning


Growing up as a Korean girl in an immigrant family in Canada, Elizabeth Choi, the CEO of RxFood, was deeply influenced by the cultural emphasis on appearance. Annual visits to Korea heightened her awareness of these pressures, as she observed the societal expectations to be as thin as possible. These experiences sowed seeds of self-doubt and led Elizabeth down the path of an eating disorder that began in high school and persisted through her university years at the University of Waterloo. Despite the severity of her condition, which necessitated hospitalization and a comprehensive care team, Elizabeth continued her engineering studies, driven by a relentless work ethic and the desire to not let her struggles define her academic and professional ambitions.


Elizabeth's struggles had brought her into close contact with the realms of dietetics and nutrition, albeit in a context marked by personal turmoil. Despite these challenges, she persevered, completing her engineering degree while navigating the complexities of her health. Her personal experiences endowed her with a profound understanding of the gaps in nutritional guidance and support, fueling her desire to effect meaningful change.


A Confluence of Skills: The Renaissance Man's Balancing Act


At the heart of Jeff’s story is his unique ability to navigate and contribute to vastly different fields with equal skill. Initially setting his sights on a career in medicine, Jeff faced the setback of not being accepted into medical school. This challenge led him to explore an alternative path on Wall Street. 


Serendipitously, after graduating from the University of Waterloo, Jeff and Elizabeth spent time on Wall Street with the same investment bank. Elizabeth worked in US fixed income trading and emerging market foreign exchange and Jeff was a fixed income trader for the US government bonds and swaps desk.  Given their university friendship, and the fact that they had moved to New York City not knowing many people, they grew close.


Deciding to reapply to medical school, Jeff left his finance career behind, embarking on his medical journey just before the 2008 financial crisis - a timing he considers fortunate. Throughout his medical education and residency in Toronto, Jeff maintained a keen interest in the intersection of technology and healthcare, a passion that aligned perfectly with Elizabeth's vision for RxFood. This blend of medical knowledge, engineering acumen, and financial industry experience provided Jeff with a unique perspective on healthcare innovation, ultimately leading to the creation of a platform designed to transform nutritional care and support for individuals with dietary needs related to health conditions.


From Concept to Clinical Impact


During Jeff’s medical school residency, Elizabeth eventually left banking to start her genuine pursuit towards her passion in innovation.  Given her entrepreneurial spirit, she found herself as the creator of a wine bar, which became the unlikely crucible for the birth of RxFood.  It was in this endeavor where Elizabeth encountered a client, Kale Boehmer, whose persistent inquiries about food ingredients and preparation methods initially perplexed her.  Kale lives with type 1 diabetes and needed detailed nutritional information to manage his condition effectively. The interaction was a pivotal moment for Elizabeth, sparking a realization about the universal need for accessible and accurate nutritional information, not just for individuals with specific health conditions but for everyone. It was also poignant and pivotal for Elizabeth, in light of her own challenging history with nutrition.  


Elizabeth reached out to Jeff because she knew he had a knack for coding and was in the midst of his clinical training.  “She came to me because I was in residency and could code apps, and I was the person that she could talk to first in healthcare," Jeff explains.  They began to conceptualize a platform that could simplify nutritional management for individuals with chronic conditions. Their collaboration led to the development of a minimum viable product that could recognize food items and assist in nutritional management.


The true test of their innovation came with a research study at the Hospital for Sick Children (SickKids) in Toronto. Under the guidance of a supportive mentor and the clinical care team, the study aimed to evaluate the accuracy, usability and clinical impact of their solution. The results were promising: users not only improved their ability to manage diabetes through carb counting but also learned a skill that had a tangible impact on their health outcomes, comparable to medication. This success marked a pivotal moment for Jeff and Elizabeth, solidifying the value of their innovation. 


RxFood: Pioneering Precision in Nutritional Assessment


At the core of RxFood's differentiation is its response to the outdated and rudimentary processes that currently dominate dietary assessments. Traditional methods, often reliant on self-reported data and paper records, are fraught with inaccuracies and inefficiencies. "Most of the time, people are writing on a piece of paper what they ate and giving that to their clinician," Jeff explains, highlighting the inherent limitations and guesswork involved in such approaches.


The primary challenge in primary care and dietetic consultations often revolves around the limited time available for patient interactions and the scarcity of access to dietitians for many patients. RxFood addresses these issues head-on by streamlining the dietary assessment process. Traditionally, dietitians spend a substantial portion of consultation time gathering basic dietary information, a task that becomes more cumbersome and less accurate through remote consultations. RxFood's dietary assessment tool preempts this process, allowing dietitians to review a patient's dietary habits in advance of the consultation. This efficiency shift enables dietitians to "have more meaningful conversations" focused on actionable recommendations rather than spending precious time gathering data. RxFood also addresses dietitian shortages in a number of areas, thereby enabling clinicians to provide more accessible and timely care to a larger number of people.   


RxFood introduces a paradigm shift by digitizing and quantifying dietary data, which enables more detailed trend analysis and outcomes prediction. This is particularly revolutionary in settings like bariatric clinics, where accurate dietary histories are critical to pre-operative assessments. By replacing paper records with digital inputs, RxFood not only streamlines the process but also enhances the quality of the data collected.


RxFood's technology allows for the capture and analysis of food intake through photographs, providing detailed reports that integrate seamlessly into clinical practice and can be trended over time. This approach not only quantifies dietary intake but also educates both clinicians and patients. Unlike many nutrition apps that overwhelm users with raw data, RxFood focuses on contextualizing the information. "What types of proteins are you having and from what foods, what types of fiber, how much, and what kind of fats are you having?" Jeff points out, emphasizing the importance of understanding the nuances of nutrition.


A distinguishing feature of RxFood is its commitment to continuous improvement and accuracy. With a team of dietitians constantly refining the database and incorporating automated safety checks, RxFood ensures that its assessments remain precise and reliable. This commitment to learning and adaptation sets RxFood apart, making it not just a tool for assessment but a partner in the journey towards better health and nutrition.


Key Challenges 


One of the most significant obstacles in the development of RxFood was perfecting the food recognition technology. This challenge was not merely about recognizing a wide array of foods but doing so with the precision required to support dietary management effectively. "Recognition is an ongoing challenge," Jeff admits, highlighting the difficulty in maintaining accuracy as the database needs to accommodate new ethnic foods, variations of products, and unique combinations. Ensuring the platform's ability to meet these demands required continuous refinement and innovation. Despite these hurdles, RxFood has made substantial progress, transforming what was once a major challenge into a manageable aspect of the platform's development.


Another significant challenge stemmed from the need to alter entrenched clinical practices. Transitioning from traditional, paper-based dietary assessments to a digital, photo-based approach necessitated a shift in how both clinicians and patients approached dietary logging and analysis. "There was a bit of that kind of change management that happened," Jeff reflects, emphasizing the effort required to educate users on the platform's benefits and operation. This process involved not only teaching users how to utilize the new tool but also helping them understand how to interpret and apply the data it provided within the context of clinical care.


Addressing these challenges was no small feat and required a multi-faceted approach. The solution lay in improving the platform's user experience (UX) and developing comprehensive documentation and content to guide users. These enhancements played a crucial role in making the application's benefits more apparent and its operation more intuitive. This focus on user-centric design and support has been instrumental in overcoming initial resistance and integrating RxFood into the daily routines of clinicians and patients alike.


The Proof Is In The Pudding 


RxFood has notably advanced diabetes management, evidenced by a study that showed a significant 0.8% drop in Hemoglobin A1C levels, an improvement comparable to the effects of some medications. This was achieved through teaching patients carbohydrate counting, enhancing their ability to manage diabetes and lighten their disease burden. Patients have acknowledged that RxFood is reducing their burden and helping them to more effectively manage diabetes by understanding their carbs, which underscores RxFood's practical impact.


Additionally, RxFood has been effective in primary care for reversing early-stage diabetes or pre-diabetes by fostering direct dietary changes, with some patients even returning to normal A1C levels. Its utility extends beyond diabetes into areas like obesity, mental health, inflammatory bowel disease, and oncology nutrition, showcasing its versatility in preventive and therapeutic nutrition.


RxFood's commitment to research, including collaborations with Queen's University on mental health and McMaster University on inflammatory bowel disease, highlights the platform's wide-ranging potential. These studies aim to show how dietary interventions can aid recovery, prevent complications, and enhance quality of life, affirming the platform's role in addressing various health challenges through nutrition.


The Shifting Landscape: An Explosion of GLP-1 Agonists


RxFood's integration into the treatment and management pathways for patients undergoing GLP-1 receptor agonist therapy highlights a critical aspect of holistic care. "We do a lot of work with obesity clinics, weight management clinics, and diabetes clinics," Jeff explains, indicating these are the primary indications for GLP-1 usage. RxFood's role extends beyond mere dietary tracking; it facilitates a nuanced understanding of a patient's nutritional intake before and after initiating GLP-1 therapy. This approach allows for a comprehensive assessment of potential nutritional deficiencies, muscle loss, and bone health, which are critical considerations given the known side effects of GLP-1 medications.


One of the most innovative aspects of RxFood's application in this context is the baseline dietary assessment conducted prior to starting GLP-1 therapy. By evaluating key nutritional parameters such as protein, calcium, and vitamin D intake, RxFood enables healthcare providers to monitor and address any nutritional deficiencies that may arise during treatment. "Every six months, we repeat the dietary assessment...and we are monitoring people at risk of nutritional deficiencies, muscle loss and bone loss," Jeff notes, underscoring the platform's role in proactive patient management.


Moreover, RxFood serves a dual purpose by offering a preventative tool that may obviate the need for GLP-1 therapy in some patients. By providing practical ways to improve diet quality and lifestyle, RxFood empowers individuals to potentially meet their health goals through non-pharmacological means. This aspect of RxFood's application is particularly compelling, as it emphasizes the importance of dietary and lifestyle interventions in managing conditions like obesity and diabetes, alongside or even in lieu of medication.


Mentors Along the Journey


The journey of RxFood has been significantly shaped by key relationships and collaborations. Dr Dante Morra's mentorship not only guided Jeff through his medical education but also nurtured his entrepreneurial aspirations, laying a foundational stone for RxFood. The inception of the organization was notably influenced by Kale Boehmer, whose firsthand experience with diabetes and insights into its daily management challenges enriched the project's development, serving as the initial spark for RxFood's vision.


The collaboration with Diabetes Canada proved crucial, lending RxFood enhanced credibility and visibility within the healthcare sector. Advocacy for incorporating RxFood into diabetes management practices exemplifies the power of having champions within established health organizations to facilitate the integration of innovative solutions.


Dr. Mark Palmer's pivotal role as the principal investigator of RxFood's inaugural study at SickKids, alongside his expertise in diabetes care, provided essential clinical oversight and research rigor. This not only validated RxFood's approach but also established its clinical credibility. Furthermore, Mike Kessel, CEO of Cleveland Clinic Canada, offered invaluable healthcare leadership and strategic guidance, assisting RxFood in navigating the healthcare industry's complexities.


The collective support from various leaders underscores the importance of a diverse ecosystem in advancing health tech innovations. Their unique contributions, ranging from user experience insights to research, advocacy, and strategic partnerships, have been instrumental in propelling RxFood from concept to reality, highlighting the collaborative effort required to transform healthcare through technology.


Vision for the Future


Elizabeth and Jeff envision RxFood transforming the integration of nutrition into healthcare and daily life, aiming for a holistic approach where personalized nutrition and technology-driven guidance are commonplace. They believe in the power of personalization and engagement to change health behaviors, especially in how food is perceived and consumed, moving beyond diet management to a lifestyle embraced through actionable insights and convenience.


Central to their strategy is the "food as medicine" concept, advocating for nutrition as a fundamental component of wellness. RxFood plans to connect dietary advice directly to grocery shopping, simplifying healthy eating while incentivizing better food choices through discounts on healthier options. This strategy not only aims to make nutritious eating more accessible but also embeds it into routine decision-making.


The incorporation of advanced technologies like wearables and continuous glucose monitors into the RxFood platform is crucial for providing real-time health metrics and personalized dietary suggestions. Furthermore, applying artificial intelligence to analyze user data promises highly customized health and nutrition guidance, moving beyond generic advice to support individual health goals and conditions.


This ambitious vision positions RxFood at the forefront of health tech, aiming to revolutionize personal health management by making personalized nutrition and lifestyle adjustments an achievable reality for its users. Through strategic integration of technology and a deep understanding of dietary impact, RxFood is poised to redefine health engagement and empowerment.

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