Innovative Nutrition Care: Dr. Piyali Chakraborty on Rethinking Chronic Disease Management

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Piyali Chakraborty, PhD, Co-Founder and CEO of Ashmi Health.

Dr. Chakraborty shares how her newborn son’s NICU stay and her research in personalized glycemic response led her to found Ashmi Health to improve nutrition care for diabetes and gestational diabetes in rural and underserved communities. She explains how Ashmi partners with community health workers and a photo-based app to predict glucose spikes, tailor practical food guidance based on real access, intervene earlier than standard care, and improve postpartum follow-up, with a long-term vision to support medical nutrition across chronic conditions.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-062626-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

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Hi, everyone. Welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights. Today's guest is someone who turned a deeply personal moment into a mission that could change how we manage chronic disease in this country. We have known that this happens so very often that individuals turn very challenging moments into opportunities that really affect change in positive ways, and that's what we're gonna be talking about today. Dr. Piali Chakraborty is the founder and CEO of Ashmi Health, a company rethinking how we deliver nutrition care to the people who need it most. But her journey did not start in a boardroom. It started in a NICU watching her newborn son struggle with low glucose levels while critical warning signs were missed. That experience, combined with a decade of research in food physics and personalized glycemic response, led her to ask a powerful question What if we could predict how food affects each individual and deliver that insight in a way that actually , reaches real patients in real time? Today, we're talking about diabetes, maternal health, and how technology, when designed thoughtfully, can close some of the biggest gaps in our healthcare system. Dr. Piyali Chakraborty. Piyali thank you so much for joining me today. Thank you, Jean. That was an amazing introduction. Thank you so much for having me today. Well deserved. So your journey into this work, as I mentioned in the introduction- Yeah ... it started in a deeply personal place with your son in NICU. So can you take us back to that moment and how it ultimately shaped the creation of Ashmi Health? Yeah. So my son was in the NICU for about a week for low blood glucose, and no parent wants to see their newborn in that condition, so it was obviously very traumatic for our family. And I was watching his tiny feet getting pricked like four or five times a day and him screaming, and all of that made me feel like, did I do something wrong during my pregnancy? Did I not eat the right foods or did I miss a sign? And I asked these questions to the doctor and they said, "No, it's fine. It happens." But that's the problem. It does happen. So when later, you know, all of this got over and I was looking, as a scientist, I always, you know, want to go back and look at papers and see this is a very common thing, like low blood glucose in newborns is quite a common thing. And a lot of times it could be traced back to the glucose fluctuations in the moms. And a lot of times moms have gestational diabetes, so the glucose fluctuations is still monitored. But I was never diagnosed with gestational diabetes, but I still felt really uncomfortable sensations in the third trimester where I had intense food cravings. I was feeling dizzy, I was feeling sick. Everyone told me that was normal. It happens. So I was thinking, you know, there is no monitoring system. The diagnosis of gestational diabetes happens only once or twice during pregnancy. There is no continuous monitoring. So even with the PhD and living in Boston, seeing one of the best OBGYNs, if that could happen to me, what about the millions of women who don't have access to this level of care? And at that point I'm from India. I've only been living in the US for five years now. So at that point, I was still thinking of India because we have huge rural population. We have real access to healthcare problem. But then last year, I was in Alabama for a health tech accelerator, and there I realized the problems are so similar. In the US, rural healthcare is just so fragmented, and women don't have access to OBGYN for miles. So many labor and delivery units and rural hospitals are closing down. So that kind of shaped where Ashmi is today, where we are focusing on diabetes, we are focusing on chronic conditions that need the right nutrition to manage, and we are focusing on underserved population that lack access to care. You are definitely in the right place in where you're focusing. It is really a population that needs the focus So you have this unique combination of a PhD in food technology and experience scaling behavior change at companies like Unilever. Yeah. How did those experiences come together to shape your approach to solving chronic disease? Yeah, and it is a very im- interesting combination. the PhD definitely, you know, gave me the foundation for science where I could learn about science, the glycemic differences or variations between individuals. But, you know, even with the PhD, there was always these underlying question that how do we apply it to people in a way that makes sense or it doesn't feel like a advice or guideline. So the PhD was still very much at the applied level, and the science is actually being applied in a food company. My PhD research has been applied already. Working in places like Unilever was amazing because I was work in, I was working in a Unilever in India, and it was in a rural part of India. And we were making these food products for the world, millions and millions of people, but even within the manufacturing unit, I realized that changing behavior related to food was so hard. People are just so deeply attached to their food habits, and they kind of see it as their identity. It is a critical part of culture, whichever country it might be. And that stayed with me. So now, you know, whenever I'm thinking of designing a technology or thinking of any application, I always assume it will be really hard, like adoption and adherence are the hardest things. So I think, of innovation in terms of how do we make a, an individual adopt or adhere to a specific nutrition guideline or a specific nutrition solution. And this is where the current technology has been helping a lot. Yeah. And I love that you have these experiences in India, and then you can bring them into the work that you're doing here. I think it makes it very relevant. Yeah, and it's just so similar. People across cultures, across countries essentially are very similar when it comes to food. Food is not just a thing to get done with, it is about having conversations, their social life how they meet friends, and how they get together as families. So anything telling them that You cannot do this," comes across as threat. Yes. Yeah. That is probably a human, a human- Yeah ... yeah. Yeah. We know that diabetes is a, over a $400 billion problem in the United States. Yeah. From your perspective, why has it become so widespread and such, has become such a difficult condition to control today? I think a lot has to do with our current food system. The ultra-processed foods are a big part of it. Before probably like, 50, 50, 60 years back, people were eating whole foods, and now it's just mostly processed foods, especially when you're talking of a population that is underserved. So when you have a scarcity in terms of resources, people would obviously value convenience and budget more than health. So these foods are engineered to ignore our hunger signals. They're designed to be fast, cheap, and it's just hard to stop eating. And then if you look from a lifestyle perspective, obviously, you know, our jobs have become more sedentary. We are sitting in one place. We are addicted to social media. We are not moving as much as we could, as we did before. So all of this obviously has contributed to diabetes, or even gestational diabetes has increased so much, so we are seeing more and more younger women getting gestational diabetes, and that leading down the line, that leading to type 2 diabetes. Yeah. it is huge. But maybe now we can move into nutrition because that is your area of expertise. And a lot of people think of food in terms of calories or carbohydrates. But your work focuses on food physics and the personalized glycemic response. So can you tell us what that means and why it is such a game changer for managing diabetes? Yeah. That's a really good question. So, When you talk of food physics as you said, we were really looking at f- like broadly we look at c- carbs, we look at macronutrients. Okay, this is how much carbs and proteins I do need to eat. We were looking at it very differently. We were looking at the physical aspects of food in terms of its particle size, its shape, its texture, which is like the physical sensations that happen when you put a food in the mouth. And we were looking at a bunch of liquids and seeing, okay, if we change its viscosity, we can change how it gets digested in the stomach or even earlier, like in the mouth. And we were incorporating very interesting viscosities that makes a person like that particular drink and it also enables the drink to be digested slower so that doesn't spike your b- blood glucose as fast. So let's say for a steel cut oat and an instant oat, it seems like they have the same nutrition content, but because the steel cut oat has a different particle size, has different physical attributes, so it would take much longer to be digested in the stomach, and that kind of slows down your spike in blood glucose. So these were all you know, really, cool scientific things that we were exploring in the lab And then when I went on to work as a scientist, we were looking at glycemic response of individuals where you can eat the same food, but within the same time, your spike in blood glucose would be very different. And this is-- I'm not talking of cookies. Even for foods like banana, which has sugar in it, you can have very dramatic differences between individuals because it, it's a combination of multiple factors, your gut microbiome, your stress, your sleep levels, and all of that. So we were looking at all of this and thinking, "How do we even apply this to individuals who, for example are still thinking, 'Okay, if I have a glass of juice, it means I'm having a fruit,' right?" So the rate at which the science has exploded in the nutrition space and how human beings have nutrition knowledge, it's not the same. There is a big gap, and I think that is the you know, power of technology today, where we can make very complicated concepts in nutrition or science make accessible in a way that it's applicable to your day-to-day life. It understands the constraints of day-to-day life, where you cannot always have steel-cut oats. Sometimes you have to have just sugary cereals. So I think the system should be designed in a way that considers the day-to-day constraints. Sounds very flexible, which I think people are looking for. Yeah. Yeah. So you s- you're starting with maternal health, particularly gestational diabetes. What is the current scope of that problem in the United States, and why is this such a critical window to intervene? So as I was mentioning earlier, gestational diabetes cases have increased in the past decade. So overall, it does affect about 10% of pregnancies. But if you look at rural America, the numbers are quite higher. The numbers are quite higher for women of color. Now, this is a really critical window because we are talking of the health of two people, so it's the mom and it's the baby, right? So if there is unmanaged glucose fluctuations during pregnancy, if you're not monitoring your glucose and not monitoring what you're eating, it is a serious threat to both the mom and baby. Both the mom and baby have a higher risk of having type 2 diabetes later in their life. So it is such an important time to actually intervene and see that- The gestational diabetes is managed. We are not-- right now, we are not in a stage where we can just eliminate gestational diabetes. Maybe down the line, we'll be able to have diagnostic tools that can pick it up much earlier or have intervention techniques that we can deploy much earlier. But right now, even management is a huge challenge, and that is what we're trying to do at Aashmi, where we come in at week twenty and help manage the condition so that it doesn't lead to a serious emergency while delivery, or it doesn't lead to type 2 diabetes down the line. That makes sense most definitely. A- and y- you, you have said that the issue isn't the science, it's the delivery, which I think most people sh- should say is a relief, right? So what's broken about how we currently deliver nutrition guidance? Because there is a lot of nutrition guidance out there. Oh. Some of it is very odd and probably incorrect. So w- what is broken about how we deliver this guidance, especially for rural and underserved populations? Yeah. I will just focus on the rural and underserved population, because overall, if you look at nutrition guidance, and even if you like, think of all the influencers giving wrong advice or all of that's a separate issue. But when it only comes to rural and underserved women, you are asking a mom, let's say, who has three jobs, a single mom, to calculate her calories for every meal. You're asking her to have salads regularly where maybe she's just has a very tiny window to cook for her whole family, and maybe she's just having the leftovers of her kids, or if she is diagnosed with a condition, a lot of times what happens in the rural health clinics is they just hand her a pamphlet, like a handout with all the information. And one is you expect her to understand all of that if, let's say, she has a fourth-grade literacy, and second, you expect her to understand and apply that to her day-to-day life, which I mentioned is quite hard. And then the biggest challenge is transportation. I was speaking to somebody from Arkansas the other day, and said that for us, getting the right nutrition is hard because of transportation problems. So let's say they don't have a car, or the grocery store is 30, 40 miles away. The closest store would be a gas station or a dollar store where you'll obviously not find lots of fresh foods and veggies. So there are so many logistical and economic and all these other challenges where just at the bare minimum, giving her a pamphlet and expecting her to understand what it means, it's really broken. We have to really get down to her level and look at her day-to-day life and see how how can we still provide her solutions that makes sense to her. So something that she can really implement, and it- it's not just another additional stressor of her life. Yeah, that's, burden reduction is really important. And I would really like to know now that we're talking about day-to-day- Choices for this mom. Walk us through what it looks like for this patient. So you said this is a, a mother in a rural community. So how does she actually interact with OSHMI, and how does it change her care day to day? Great. Yeah. So what happens now is the mom interacts through, to Ashmi through the community health workers. So these community health workers are very much involved in those particular communities, in those particular clinics. They already have a very good relationship with the mom. So the mom is not just getting like a digital app to use on her phone, which she might forget about. It's the community health worker deploying the app for her, teaching her how to use it. And how this particular technology works is, like she can use it on her iPad or she can use it on her laptop, whatever digital technology she uses. She can use it any of the devices. And the way it works is she can input her blood pressure or blood glucose data, and then once she's eating, she can take a picture of her food and the app will tell her how much of the glucose or blood pressure spike will happen if she eats the food. And then it would suggest food suggestions based on what she's eating on a day-to-day, because we have her pictures of her food, so we know what she likes, we know what she has access to, and we will keep suggesting those kind of foods that can be obtained through WIC or SNAP or foods that can be available in her nearest dollar store. So it's not technically probably the healthiest meal, but it is healthy for her standard if she's having just sweet tea for lunch and dinner. So we tell her about portion control. We tell her, "Okay, this is how it would make sense to you," through those particular images or through those nudges. And we're always keeping the community health worker in loop. So let's say if she has a spiked up blood glucose or a blood pressure, the community health worker is she gets a message and then she intervenes and makes sure that the mom is getting the right help. And eventually we also want to connect transportation and childcare to the app where let's say if she's cannot, she's not able to go to her doctor's appointment because she doesn't have childcare available, using the app, she can just let's say book a nanny or send her send the child to the nearest childcare center. Oh, that's really helpful. it, it's helpful in so many ways. That's amazing. Yeah. So I believe like, getting the right nutrition or even monitoring your health is not just it's not a problem. It's a combination of different problems, and if we cannot address all of the problems, I don't think we are ultimately helping the mom or the patient. Yeah. So I'm really interested and this is actually, this question is two parts. I'm very interested in a story, success story or example where Ashmi has already made a meaningful difference. So that's the first part of the question. The second part, where do you see this platform in the next five years? Yeah. I'm very excited to answer this question. First off, obviously we are early. We haven't have a huge, you know, a lot of success stories, but what was really interesting in the last pilot that we did is we could see significant improvement in stabilized glucose values. We caught spikes much earlier than the standard of care, so the community health worker could come in and say, "Hey, your lunch numbers have always been high. It's based, it's because of this is what you have been eating for lunch. Can we change this to this?" So we have made these interventions much earlier. We have also significantly, about 65%, improved postpartum appointment rates. So in a lot of these rural clinics, after delivery, the mom wouldn't go back to her postpartum appointment. Going back to that appointment is really important because after delivery, the first two years are critical. That is where a lot of these maternal mortality would happen, and they are preventable 80% of the time. So we want the mom to be connected to her healthcare team. So we have enabled that, and we are very happy with that. One thing that was really interesting was there was this clinic in Alabama. We were talking to the nurse and she looked at the app and said, "Hey, I want this for my dad who has diabetes and he has ice cream every day and he thinks that ice cream is not spiking up his glucose because he's not measuring glucose real time. If the app could tell him before he eats the ice cream that this is how your blood glucose would spike or once he takes a picture of the ice cream I know he's having ice cream every night so I can come in and say, 'Okay, you shouldn't be doing this,' that would be really helpful." And I think with that conversation, it indicated to us that we need to go broader, and that is what we have been you know, thinking about and working with quality and sides as well, where we are looking at chronic kidney condition, we are looking at diabetes management. So in the five, the next five, 10 years we really want to be the medical nutrition company for chronic conditions. Anything, any condition where nutrition is a core part of care, where we can provide the right intervention. But also more importantly, we should be able to remove every obstacle, whether it's cultural, logistical, or socioeconomic, that gets between a person and the right food choice for them. I love that. You're gonna help get, to help make sure that these individuals are plugged into the right food. It's like you are the go-between that food is medicine, and that's, I think, where the future really is for chronic disease management. Yeah. So just telling the person, "Do these," and then once that doesn't happen, it's always you know, we kind of say this, the person, it's the patient's fault because they did not follow these particular guidelines, or they were lazy, they did not do this. But I think we fail, most of the times we fail to understand the reasons behind the lack of adherence, the reasons behind lack of engagement, and I think this is what I really do want to understand. Like why, if something is not working, why is it not working, and how can we change that? Yeah. Love that. If people wanna find out more about Ashmi Health, how can they do that? You can email me at piyali@ashmihealth.com, or we can go to our website, www.Ashmihealth.com, and leave a message over there. Yeah, and I would encourage people to reach out. I've seen the platform, and it is absolutely fantastic, easy, and easy to use, and engaging. Piyali Chakraborty. Thank you so much for being with me today. Thank you so much, Jean. It was amazing talking to you.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

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