Breakfast arrives sharp at 7am in square glass containers nestled in an insulated cloth bag. Inside, there is one portion each of potato rostis (imagine a mashup of hash browns and potato pancakes) with a fermented ranch dip, sautéed mushrooms, and a bottle containing a thick smoothie in which I detect a hint of papaya. Lunch arrives at noon, and it’s definitely more exciting: peri peri prawns, a roasted beetroot and orange salad, grilled broccoli with roasted almonds and a few crispy roasted crackers. Dinner at 7pm, the final meal of the day, is edamame curry, a small portion of coriander rice with pineapple raita, a generous portion of “egg keema” and an unexpected treat: banana nut bread.
This is not a list of meals from a stay at a wellness retreat. Earlier this month, I signed up for a week’s trial of Bengaluru-based nutrition startup LiveAltLife’s gut health meal plan, and this was the food that arrived at my doorstep on one of the days, even as the LiveAltLife app I had downloaded gave me updates on the meals, what they contained, and tips for storage and consumption (for instance, the ranch dip was supposed to be refrigerated if not consumed in an hour).
The startup, which formally launched in January, had been in beta testing mode for the past six months and claims that during this phase, hundreds of clients benefited from its 90-day curated health and nutrition programme, successfully reversing diseases like diabetes. The company claims that patients on its type 2 diabetes reversal programme, which costs ₹49,999 for the 30-day plan and ₹1.5 lakh for the 90-day plan, reduced their HbA1C (glycated haemoglobin test, which provides a picture of blood sugar control over two-three months) levels by 50%.
“Ninety days is a good start. You don’t have to stay on our plan forever. At some point you will be able to go back to a normal life, and with a better idea of how to manage the disease. Over 90 days, you learn more about the variety and taste of the food you can consume and realise it’s not that painful to follow this kind of diet. People think that once they are on diabetes medication, it is a losing battle, but we have shown that it is not so,” says Vivek Subramanyam, CEO of LiveAltLife. Like many entrepreneurs in the nutrition and health-tech space, he has battled his own demons in the health arena, having been diagnosed with type 2 diabetes five years ago. He is now off medication.
The idea that prevention is better than cure, and that nutrition plays a huge role in not only managing but also preventing disease, has taken root in the urban Indian psyche, especially after the year we have all had. The role of wellness and nutrition in daily life, and in building long-term health and immunity, has been impressed on us again and again over the past year, along with the fear of co-morbidities—lifestyle diseases such as diabetes, hypertension and chronic inflammation—that can exacerbate the effect of viral infections like covid-19.
The belief that you can avoid getting a lifestyle disease even if you are genetically predisposed to it, or that you can potentially reverse it or at least manage it better by making changes to what you eat, has found many takers. The boom in companies offering solutions for better nutrition and “nutraceuticals” in India is noticeable—especially in the past two years, with a growing number of startups catering to different layers of the preventive healthcare segment. From diagnostics to nutritional supplements, from healthy eating plans, prepared meals and superfood-led diets to nutrition that targets specific consumers like women and children, there is tremendous buzz in the sector, with investments of approximately $17 million (around ₹123 crore) in 2020, according to data for the nutraceuticals and health-tech sector from the analyst-led platform Tracxn. Two companies, Oziva and Yoga Bars, each attracted over $5 million in investment last year.
That certain diseases can be managed through a better diet and healthier lifestyle is not a new concept, says Manoj Chawla, consulting diabetologist at the Lina Diabetes Care & Mumbai Diabetes Research Centre. “But in the past decades, a faster pace of life led to a higher reliance on medication. That is changing now, with the availability of good nutritional products like meal replacements, high fibre protein shakes, flours that reduce glycemic variability (fluctuation in blood sugar levels). They are viable potential alternatives to medication, and I have seen patients who have managed to keep their sugars in control. At the same time, diet regimens have to be done in consultation with your doctor and while monitoring your medical parameters regularly, otherwise they may do more harm than good.”
LiveAltLife is not the only company gunning for better health through personalised healthcare. The level of personalisation reaches biohacking levels—an amorphous term encompassing everything from a simple blood-group type diet to optimising every part of the body through advanced implants and injections.
Nutrigenomics, focusing on how the food you eat interacts with your genetic makeup, falls somewhere on this spectrum, and has become an increasingly popular way of managing health and wellness globally. Ever since the human genome was mapped in 2003, companies around the world have tinkered with the idea of using an individual’s genome to deliver the best health solutions and outcomes. Vieroots, an Indian company launched last year, promises to do this through a tailored programme that includes personalised dietary, exercise and lifestyle modifications which, it claims, can not only help people manage their health better but even predict and prevent disease. Its proprietary AI-enabled app Eplimo (which stands for Epigenetic Lifestyle Modifications) uses data procured from a client through a combination of genetic and metabolic tests to create these programmes by testing for genetic predisposition to 200 health conditions, using epigenetic data to further refine them, claims the company. The ₹35,000 package includes the tests and medical report, a personalised lifestyle modification plan, and access to medical practitioners through the Eplimo app.
“Epigenetics”, a buzzy term in the healthcare sector today, is the “study of how your behaviours and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence,” according to the US Centers for Disease Control and Prevention (CDC).
Vieroots founder Sajeev Nair, a serial entrepreneur based in Kochi, Kerala, describes himself as a “wellness evangelist” who has been associated with the wellness industry through companies like Amway since 2003. He says he first became aware of the genetic factor in personalisation of healthcare after he underwent gene-testing for diseases in the US over 10 years ago, becoming convinced that wholesale health solutions are not the best. Nair uses the example of diets like keto and paleo, which have gone mainstream, to explain this. “While they seem relatively easy to adopt, there have been cases of people suffering damage to their kidneys, heart or general health because they adopted these diets without a proper study of their own metabolism and predisposition to disease,” he says. “What we do is, we tell people how their body will respond to particular nutrition and fitness plans. The same exercise which works for person A may not be good for person B,” says Nair.
Another example is the extremely common vitamin D deficiency among city dwellers. The common way to treat it is to prescribe supplements—indeed, at least 50% of the people you know are likely to be on these supplements—but Nair says they may not work for everyone. Genetically, he says, certain people have challenges absorbing nutrients, and in such cases, long periods of being on vitamin D pills can actually cause a build-up in the body, leading to vitamin D toxicity.
Despite the proliferation of diagnostic labs in Indian cities, both Nair and Subramanyam claim there are many diagnostic tools doctors don’t prescribe that can be important indicators of future disease. Nair mentions the “QT interval”, a period that can roughly be described as the time between two electrical impulses of the heart; a longer-than-normal QT interval is an indicator of degenerative heart disease. However, most hospital health-check packages include an ECG that can reveal the QT interval but don’t pay much attention to such fine markers unless they are absolutely off the charts.
Subramanyam, whose company also conducts elaborate diagnostic tests when a patient signs up for their 90-day plan, mentions that while most common health checks include blood glucose level tests like fasting blood glucose and HbA1c, they don’t check markers like the fasting insulin level, which indicates the level of insulin resistance in the body—insulin resistance, he explains, is what actually causes type 2 diabetes, not the lack of insulin production by the beta cells of the pancreas, as people commonly assume.
It is safe to say that never before have so many people been so invested in their health and nutrition, become so aware of a wide range of concepts like gut microbiome, chronic inflammation, superfoods, macrobiotics, and the effects of previously under-diagnosed health conditions like thyroid imbalances, PCOS (polycystic ovary syndrome), and insulin resistance—and been eager to address them. And while it’s not like protein shakes and vitamin supplements did not exist earlier, they are now delivering nutrition more efficiently—better in taste, more attractive to look at, and with fewer additives and preservatives.
From weight loss to wholesome health
A decade ago, obesity was seen as the all-encompassing problem, and weight loss the cure-all for health issues that had become endemic for urban citizens—dreaded “lifestyle” diseases. This idea led, in the 2000s, to a boom in weight-loss clinics, gyms and fitness centres and dietitians, and eventually, to the rise in popularity of diets like keto and paleo. Now, the focus has shifted to holistic health.
An Indian company that embodies this shift is Truweight, which has now reinvented itself as Possible. Truweight started life in 2012 as a company offering personalised weight-loss plans through diet and exercise. “Nutrition was a key piece, but seen as a part of the entire weight-loss journey. This changed over the past few years, with nutrition taking centre stage. We too realised that the customer had moved on from wanting passive weight loss to wanting to be more engaged with what they were eating and why. Over 80% of preventive healthcare is about nutrition, and the idea of ‘why treat diseases like diabetes with medication when it can be managed with diet’ has become more mainstream,” says Possible co-founder Megha More.
In January, the company pivoted to focus on nutrition and disease management and prevention after an infusion of fresh investment from high net-worth individuals such as actor Aishwarya Rai Bachchan. It now offers personalised diet programmes, with several recorded success stories of reversals of non-insulin dependent type 2 diabetes, thyroid imbalances and PCOS. Along with consultations with nutritionists and doctors, it provides video tutorials and courses, customised meal plans and superfood-led items on its e-commerce platform, from gluten-free grains to ready-to-cook items like quinoa-dal dosa mix, as well as proprietary foodstuffs like its Instant Hi Protein Meal, a ready-to-cook porridge mix with sunflower seeds, millets, pulses and oats.
“Being proactive is better than being reactive,” says Vaibhav Jaiswal, CEO and founder of Delhi-based digital marketing company Catalyst Web Trendz, who has been a Possible client since October. When we speak about his experience, weight loss isn’t the first thing Jaiswal mentions, although the 113kg executive has lost 11kg since the start of the plan. His HbA1C level, which was 8.8% in end-September, was 4.8% when he tested it on 15 January, and there has been a similar reduction in parameters like blood pressure and cholesterol levels. “They are all within the normal range now. And most importantly, I am feeling better, both mentally and physically,” says Jaiswal, who was suffering from severe anxiety, sleeplessness and lack of motivation through most of last year as he faced pandemic challenges to his business.
Making nutrition fun (and clean, and whole)
The nutraceuticals sector is also seeing substantial innovation in developing foods that not only claim to deliver the right balance of nutrients but do so in a more culturally rooted, holistic way. “Earlier, we were more focused on nutrition consultations and fitness coaching but we realised there was a gap in the market in terms of accessing clean, plant-based protein supplements that would contain other micronutrients as well. We realised we could either wait around for someone to make it or make it ourselves,” says Aarti Gill, co-founder of plant-based active nutrition brand Oziva, the only Indian company to get certification from the US-based Clean Label Project, which tests nutritional products for safety and efficacy.
But why do we need supplemental drinks and pills at all—isn’t the food we eat enough? Gill says it’s not that simple. For instance, vegetarians struggle to get enough omega-3 fatty acids into their diet because most of this is derived from fish. “People say flaxseeds kha lo (have flaxseeds). But how much flaxseed can you eat for the daily requirement? That’s where standardisation of nutrients in products like ours comes in. We measure the active ingredients in plant extracts, study the supporting ingredients we can add,” says Gill. The company’s R&D team is led by co-founder Mihir Gadani, who has a biotechnology background. They test the raw materials and the finished products.
“How many tablets will you eat in a day if you have multiple deficiencies like iron, calcium, vitamin D, vitamin B12?” asks Gill. This is what makes Oziva’s products, mostly nutritional powders one can consume as a drink, different from sports shakes and mass-produced protein drinks that contain ingredients like maltodextrin, sucralose and sugar substitutes like aspartame. These products are not just for “body builders”, as Gill puts it.
The innovation factor is also visible in another vital but neglected area of healthcare in India—women’s reproductive health. “Every month, women, who make up 50% of the population, go through hormonal changes that affect their period health, skin, hair, fitness and mental health, but till recently there were no good products for her. It pained us to see this hugely underserved market in the 21st century,” says Sheta Mittal, co-founder of Bengaluru-based &Me, which creates products on issues related to women’s health—from acne and urinary tract infections to PCOS and menopause.
&Me, founded in 2017, develops cookies, chocolate bars and teas that deliver key ingredients for specific life stages. Some of their most popular products are period teas and chocolates, which contain herbs like shatavari, ashwagandha and ashoka, as well as minerals like calcium, iron and magnesium and a host of vitamins.The company claims these help regularise the menstrual cycle, reduce cramps and bloating, and enhance energy levels and mood.
It is also, of course, much nicer to nibble on a dark chocolate bar or sip a cup of “period tea” than take pills. And that’s where a number of these new-age nutrition companies are winning over pharmaceutical companies, which haven’t innovated much in nutrition delivery—they rely on tablets and, at most, water-soluble powders that taste of nothing.
Sitting on my work desk right now is a blue and white striped bottle of Power Gummies —Vitamins for Gorgeous Hair and Nails. It looks like a jar of candy but actually contains a health supplement in the form of chewable (and frankly quite tasty) “gummies” containing vitamins A, E, C, B6, D3, B12, and Biotin (vitamin B7), minerals like zinc, iodine, as well as folic acid and choline. “According to the latest global nutrition trends, people want to shift to alternatives which are easy and fun to consume on the go while also being effective. The gummy alternative has proved to be a winner in terms of taste, interest, the fun element, durability, water retention, weather adaptability, composition and effectiveness. It is a high contributor to the nutraceutical business globally,” says Divij Bajaj, CEO and founder of Power Gummies, a Delhi-based brand.
“We have made nutrition very tasty and fun,” says Dhruv Bhushan, founder of Delhi-based Habbit Health and Nutrition, which launched last week with an array of nutrition shakes and drinks with high protein content, packaged in a fun, easy-to-consume format. Most Indians are protein-deficient, and this is one of the root causes of obesity and diabetes, believes Bhushan, because Indians, especially vegetarians, find it difficult to include sufficient amounts of protein in their diet and over-consume carbohydrates to satiate hunger. Habbit has also developed a range of low-calorie ice creams (the company claims each serving has fewer than 50 calories) in flavours like blueberry crumble, lychee blush, and salted caramel, and says it plans to launch “seriously healthy and seriously tasty” substitutes for most of the packaged food items that one sees on supermarket shelves.
"Clean" snacking options with no fine-print ingredients, where what you see is what you get, are also in shopping carts today. "Why do most brands hide their ingredient list, in microscopic font, at the back? As an obese person trying to eat healthy, I used to ask these questions everyday. I never got an answer, so I did my own research, and started The Whole Truth. Our purpose is make food so clean, we can declare every single ingredient that goes into it, upfront," Shashank Mehta, founder anc CEO, The Whole Truth, a packaged food company that is focusing on making protein bars in a variety of flavours that are better than dessert and have whole ingredients without preservatives and added flavours.
The fun part is not insignificant. After all, when we talk about prevention being better than cure, there is only so much motivation to commit to a serious health regimen involving multiple pills and tasteless powders, and new-age Indian nutrition companies seem to understand that making nutrition engaging is a huge opportunity. “India has woken up in this decade and realised that great nutrition management can help make a healthier country,” says Tushar Vashisht, CEO and co-founder of HealthifyMe, the big daddy of nutrition management startups in India. HealthifyMe is nearing a decade of its existence, with 20 million users worldwide, and Vashisht says the biggest growth in awareness and, consequently, solutions has come in the past three-four years. The pandemic has aided this awareness, leading to a huge leap in interest and demand for preventive healthcare. “Covid may end up saving more lives than it has taken,” adds Vashisht cheekily.