Angela Malik-Agarwal CA, founder of Planet Nourish, on transforming the treatment of diet-related conditions
By CA magazine
31 August 2022
One day Angela Malik-Agarwal CA took her mother to the dietitian and got a nasty surprise. She tells Ryan Herman what she learned there led her to combine her CA and her culinary skills with Planet Nourish
Last year, Diabetes UK issued a dire warning about the state of the nation’s health, predicting that, by 2030, 5.5 million Britons could be living with the condition. “Every diagnosis of diabetes is life-changing,” said Diabetes UK CEO, Chris Askew. “The relentlessness of the condition, and the ever-present fear of serious and life-altering complications is a lifelong reality for millions of families across the UK.”
Type 2 diabetes is a gateway to life-threatening problems such as heart attacks, kidney failure and strokes, as well as blindness. But for some communities the threat is far greater, with black and south Asian people being six times more likely to suffer from the condition. In part this is down to genetics, but another major factor is diet.
“Indians, for example, are ‘carbotarian’ – vegetarians who don’t get enough vegetables. We eat too much roti, too much rice, too much potato,” says Angela Malik-Agarwal CA, the founder and CEO of Planet Nourish.
Malik-Agarwal is on a mission to reverse this trend that has seen cases of diabetes grow exponentially. She has set herself the “big, hairy, audacious goal” of changing the health outcomes for one million people worldwide by 2030 through a combination of cooking, coaching and technology.
She warns that “750 million people worldwide are going to be diabetic by 2030. That’s just type 2 diabetes. It doesn’t include pre-diabetes. So Planet Nourish is building a prevention platform. We want to reach people earlier in their lives so they make adjustments to their diet that improve their health and wellbeing.
“Health authorities know that if you can get people by their late thirties, and you put them into the right programmes and essentially teach them how to redesign the plate, you are stopping them from getting diabetes, which is also a huge saving to economies.”
In the US, for example, 25% of the money in the healthcare system goes on treating people with diabetes, and the total economic cost, in treatment and lost productivity, rose by 60% in the 10 years from 2007 to 2017. A similar pattern is starting to emerge in the UK. “But governments alone can’t do this,” says Malik-Agarwal. “It needs companies like ourselves to step into the breach and, ultimately, provide mass healthcare.”
Wake-up call
Malik-Agarwal was first alerted to the issue when taking her mother to see a dietitian in 2018, following her diagnosis with a medical problem. “She ended up losing a lot of bodyweight because she was on a liquid diet,” she says. “I would go with her to see the dietitian up in Edinburgh. We were told she would have to add more protein and calories to her diet. Eat meat, fish, eggs, bone broth…
“My point to the dietitian was that my mum is a 72-year-old Hindi Punjabi vegetarian. She has never eaten meat, fish or eggs in her life and she wasn’t going to start now. So what could they do to design a menu which was in line with my parents’ ethnicity, culture and religion? What came back is that there was nothing tailored towards ethnicity when it came to dietary advice. Most health solutions are based on data from white populations.”
Malik-Agarwal set about devising a weekly menu for both parents. Her father’s blood sugar levels were higher than normal, which could have put him on a pathway towards type 2 diabetes. “I was teaching them about things like having nut butter on their roti, and plant proteins,” she says. “With small adaptations to their diets, within a year, my mother’s health had recovered and she was 90% back to pre-operative weight, while my dad was no longer diabetic. I thought if my family has this problem, then it’s a problem that others might experience.”
She pondered turning this into a business by bringing together the practical skills she had learned as a CA with her love of food and cookery. “I grew up in Edinburgh and my dad was a successful restaurateur who started up Indian restaurants across Scotland and Europe,” she says. “But he didn’t want my brother or me to have anything to do with the food industry. So my three choices were to become a doctor, a lawyer or an accountant. Guess which one I picked!
“I was a forensic accountant for KPMG. But when I turned 30 I pursued my passion and retrained as a professional chef. The first time I walked through the door at Leiths School of Food and Wine in 2002, I thought ‘I’m not weird any more. Everybody here is as obsessed with food as I am.’”
She had no need to leave her CA training at the kitchen door, however, becoming an adviser for supermarkets and catering operations and a consultant for new restaurants and chains. “The CA qualification has stood me in good stead,” she says. “You use terms like ‘equity finance’ and people take you seriously!”
Levelling the pitch
Then, in March 2020, Covid happened. “The whole conversation about inequity and health exploded globally,” says Malik-Agarwal. “And we saw Afro-Caribbeans and south Asians were disproportionately affected. And one of the reasons is these underlying conditions, such as type 2 diabetes, cardiovascular disease and obesity.
“Initially, my idea was to build a business where we were giving people culturally tailored advice around nutrition, health and wellbeing. I started to do a lot of ethnographic research. We went out into the communities and asked, how are people living? What are they cooking? What conditions are they concerned about? The number one concern was type 2 diabetes.”
That research also produced some fascinating insights around gender. “We did some work with the carbohydrate research department at Imperial College, London,” she explains. “Anecdotally, what came across is if a black or Asian woman develops a disease like type 2 diabetes, their long-term outcomes are worse, because the man in the family won’t eat adapted food. But if that man gets the disease, his outcomes are better because it’s his health on the line, so he will adapt his eating habits. So he’s less likely to end up on insulin as a consequence. Also, what I wasn’t aware of was just how genetically and culturally prevalent it is.” Indeed, according to Diabetes UK, people with close relatives who have the condition are more at risk. Worse still, while for white people the risk of developing diabetes increases significantly from the age of 40, for people from a south Asian background, the age threshold is just 25.
Picture of health
She adds: “Food is a celebration, and it’s a very important part of our culture. So people don’t engage when you start wagging your finger and saying, you can’t eat rice, you can’t eat roti, you can’t do this, you can’t do that. Then they will say, ‘Well, what do we eat?’
“We started to think about how we can create a tech solution to that problem. We learned early on that people love taking pictures and sharing their meals. There are two elements to this: number one is building vision technology. If you look at Google Vision, which can be used as a food recognition tool, it’s open source. So, if you take a photo of food, it recognises a strawberry, and it knows a sausage, and it provides a nutritional breakdown of that food. But it’s not been programmed for south Asian, Caribbean or Hispanic food. So there’s a huge opportunity within vision technology for us to educate people around what is dahl, what is dosa, what is roti?
“Imagine that one day you will be able to take a picture of a plate, and an app will know my age, my ethnicity, if I have type 2 diabetes – and when I take a picture it will suggest back to me, ‘One less roti, put more greens on the plate, add some tofu.’ It will suggest a recipe, a shopping list for me and my family.
“That’s one way we can use AI. The second part of the machine learning algorithm is: how many different sources of data can we take from one individual, or from thousands of individuals from different ethnicities? Can we work with insurance companies and build a predictive algorithm that will give you an overall health score, which insurance companies will use to decide premiums?”
For now, Malik-Agarwal is focused on improving the diet and health of south Asians, but she says the programme can be adapted for Afro-Caribbeans or the Hispanic community, which is potentially an enormous market in the US. She is also speaking and pitching to new investors and is keen to reach out to other CAs operating in similar markets.
“I do feel there’s great power in collaboration,” she concludes. “And what we’re creating is a blueprint for under-represented ethnicities globally, and for multiple diet-related conditions. My ambition is to provide equitable healthcare for all.”