2021 Recap of GI + Tech

GI = gastro/gastroenterology/guts/gastrointestinal/got it?

Source: Rock Health

👀 GI is getting sexier for investors 👀

Investors are interested in the GI space, and this love affair started recently. GI moved from the 12th most funded speciality back in 2018 to the 6th most funded speciality in 2021. This makes sense as primary care companies have matured and investors, entrepreneurs, and companies are now looking into different markets.

GI TECH LANDSCAPE

Pt = patient

D2C = direct-to-consumer

B2B = business-to-business

I created this graphic to show some companies are interested in the D2C space on the left side and some only work with other businesses (usually employers or payors) on the right. This is certainly not comprehensive as the landscape is rapidly expanding, evolving, and changing.

Starting at the top left:

Oshi Health provides a patient service and, at the moment, is D2C. It's a complete telemedicine service for GI conditions providing a virtual GI doc, health coach and psychologist.

The number 30 represents 30 Madison, a company in a similar space as Ro and Hims/Hers. They have an on-demand platform to link reflux sufferers to a provider and the platform can then deliver generic heartburn medications to their doorstep. They expanded to include delivering probiotics, fiber, and magnesium. 

Top right:

There’s Bold Health out of London. Another telemedicine platform with a virtual GI doc, dietitians and psychologist available, and integrates digital therapeutics for IBS, IBD, and abdominal pain. Digital therapeutic is a software app that treats a specific condition. This could be stand alone or paired with medication. Pear Therapeutics also has a GI product in their pipeline.

metaME Health is also in the digital therapeutic space, specifically for IBS-associated abdominal pain. One of their products is FDA cleared as of 11/2021, according to their website.

Nutrimedy is a digital nutritional companion offering evidence-based and personalized clinical nutrition support across multiple medical conditions. The company has a gastroenterologist founder.

Vivante Health - All-in-one platform for employees with GI conditions. Sound familiar? Livongo did this for diabetes.

The bottom left:

ColonoscopyAssist - This website allows you to schedule an upper endoscopy or colonoscopy nationwide and provides the all-in price, leading the way in price transparency. Last I checked, a Manhattan surgical center was offering an endoscopy or colonoscopy for $1,075. It also has information on the performing gastroenterologist (active state license, how many years of experience, average endoscopies performed per month). And, it provides info on the facility where the procedure will be performed (accreditation, how many rooms and how many procedures are done per month).

Slingshot Health allows a patient to name their price for a procedure and a doctor in their area can accept or counter. Again, these companies avoid the problem of surprise billing. Slingshot is a peer-to-peer auction where true price discovery happens. 

Did this conjure up this memory?

What about the bottom quadrant? Who’s in the B2B data space? ALL companies, potentially. Health data is valuable to many different players.

What’s to come in 2022:

Further Consolidation of GI practice groups continues – a dominant GI-specific app will be born. A tech solution emerges to help with appointment reminders, prep questions and overall clinical workflow. All of it. Not in piecemeal fashion.

More niche GI digital health companies bloom - personalized care services blending genomics, microbiome, and lifestyle data to allow self-management and connection to virtual care when needed

Poop is good for business. Taking pictures of it. Analyzing it. We are only at the onset of understanding what the gut microbiome does and how it impacts our lives. 

New care models are born: Having a colonoscopy is a giant pain in the…  

I joke that one day we will soon be able to perform a colonoscopy in a Starbucks parking lot. Ok, maybe not a colonoscopy. However, how about seeing your gastroenterologist in a nearby parking lot?

*The Roving Scope is not a real company…yet

How to Prevent Inflammation in the Colon: Avoiding Colon Cancer

Colon cancer is near and dear to my heart. My mom was diagnosed with colon cancer and this really drove my desire to become a gastroenterologist. I knew my risk for getting colon cancer was now higher and I would need a colonoscopy earlier than usual. If you have a family member with colon cancer and want to decrease your risk with things YOU CAN CHANGE, read on:

Floss - How in the world is flossing connected to colon cancer? A bug called Fusobacterium nucleatum was found in actual colon cancer tumors. This bug doesn’t even usually live in the colon. Where does this bug usually live? In dental plaque. Yep, in our mouths. We can’t be sure yet if Fusobacterium actually causes colon cancer, but I’ll do my part to floss every day and get my teeth cleaned every 6 months.

Eat more fermentable fibers – These types of foods are gobbled up by the bugs in the colon, which then produce short chain fatty acids (SCFA). If you read anything about the microbiome, this buzzword comes up over and over again - short chain fatty acids. SCFAs help with regulating our immune system, supporting the growth of good bugs, and promoting an anti-inflammatory state. Where to find them? Oats, apples, apricots, cherries, oranges, carrots, banana, plantain, onion, garlic, leeks, onions, asparagus, just to name a few. Check out my Insta for a yummy plantain pancake recipe. 

Decrease red meat and processed meats - The data shows increased risk of colon cancer in populations who eat more red meat (beef, lamb, pork, veal, goat, venison) and processed meats (hot dogs) 

Regular exercise reduces your risk for colon cancer. Obesity, smoking and alcohol use all increase your risk for colon cancer.  These four really apply to many diseases, so not surprisingly they also apply to colon cancer risk.

Get the colonoscopy when advised to by your doctor -If you have family members with colon cancer, this is really the only way to get those polyps (growths that can turn into cancer) removed and prevent colon cancer. 

For those with family members with colon cancer, the guidelines are not straightforward as to when you have to start getting colonoscopies. It depends who in the family was diagnosed and how old they were. Ask your doctor where you stand. 

For those who are not at high risk for colon cancer (don’t have Crohn’s disease, ulcerative colitis, family/personal history of polyps/colon cancer, genetic syndromes called familial adenomatous polyposis (FAP) or Lynch syndrome/hereditary nonpolyposis colon cancer AKA HNPCC, or radiation to the belly) the American Cancer Society changed the age to start routine colon cancer screening to 45 in 2018 because of the rising rates of colon cancer seen in younger people.

Probiotics and Travel

I travel internationally at least once a year and recently it has been quite rough on my stomach. Despite following all of the usual precautions (don’t drink the tap water, don't eat raw foods, etc), I have fallen ill to traveler's diarrhea more times than I would like to admit. It is very difficult to control EVERYTHING when traveling. Electricity outages are frequent — this made me think of all of the refrigerators not keeping food from spoiling, if it is constantly being turned on and off. Eating out can become challenging. Spoons, forks, plates, cups may not be washed adequately and even prepping surfaces may not be cleaned sufficiently.

Diarrhea when traveling can affect up to 70% of travelers, so it is not a rare thing and I am certainly not alone. Bacterias really account for most of the cases of traveler's diarrhea. If you check out the CDC, there are generally 3 types of travel destinations in relation to traveler's diarrhea - countries that are low risk, intermediate risk and high risk. And clearly, 1 attack of traveler’s diarrhea doesn't necessarily prevent another attack from happening.

What is someone to do when traveling? I know when traveling my gut microbiome is put under pressure by the stress of traveling to a different time zone and the introduction of foreign bugs from contaminated food, so I wanted to review how probiotics can help with prevention.  Probiotics are thought to help either by changing the immune system or by directly attacking the bag bugs and/or their toxins. Generally, when looking for an appropriate probiotic strain and product to buy, I first look up research studies using probiotics to treat the specific condition I’m interested in (in this case - traveler's diarrhea). Once I find the studies, I look at the publication date and review how many people were included in the analysis.

The two biggest players in the probiotic space to prevent traveler's diarrhea are:

First place - Saccharomyces boulardii CNCM 1-745

Honorable mention -  L. rhamonosus GG

These two were studied as individual strains, not in combination with other strains. Most of the studies had participants take the individual probiotic strain 2-5 days before the trip and during the trip. 

Of course, speak to your healthcare provider before traveling to discuss all of your options to prevent traveler’s diarrhea

3 Tips to Have Great Poop

This is certainly not a sexy topic, but it needs to be discussed.

Avoid Waiting

Go to the bathroom when you feel the urge. Holding your poop is okay every now and then, but try to go when you feel the need. Peristalsis is a worm-like contraction that helps move feces down.  When the stool arrives at the bottom, nerves send a signal indicating the pressure in the rectum is increasing and, in turn, you feel ‘it’s time to go’. If you don’t relieve yourself, the colon can further extract fluid from the stool making it harder and drier. Hard/dry stool is not goal!

Do not sit for too long

Keep the phone and magazines outside of the bathroom to prevent prolonged sitting. Instagram feeds are very interesting, but do not let them distract you from the end goal! Evacuation should take 10 minutes or less. Prolonged sitting transfers pressure down to the anus. And, I must mention all of those germs you might transfer to your phone screen, if it is keeping you company…

Use a Stool (to have a good stool) or buy Squatty Potty

Put the stool underneath your feet while you are on the toilet. This changes your sitting position to a squatting position (knees high). In a squatting position, a muscle called the puborectalis relaxes and the colon is able to empty completely. This is genius and how humans had been pooping for ages before the creation of the porcelain throne.

How To Be Healthy on a Budget

Here are some tips to keep healthy on a budget:

Buy fruits and veggies when they are in season

If not, you are going to pay a premium for having strawberries flown in from far, far away. Food that hasn’t traveled a distance also tastes better. But, if you are having a craving for off-season produce, then…

Frozen fruits and veggies are A-ok

Frozen produce is picked at its peak ripeness and immediately frozen.  Also, frozen produce is usually already washed and cut. Win!

Download your supermarket app for coupons

Yes, even Whole Foods has some savings. I peruse the available coupons before I do my shopping.

Subscribe to Environmental Working Group (EWG) Dirty Dozen/Clean 15 when buying organic

It’s so expensive to buy everything organic, so stick to EWG’s list.

Buy inexpensive sources of protein

Canned wild-caught salmon, mackerel and sardines are some options for the carnivores. Beans, lentils, and chickpeas are some picks for the vegetarians.

Avoid the middle isles

Packaged/processed foods are housed in the middle isles and do not provide adequate nutrients. Replace candy bars with healthier counterparts from the outer aisles.

Buy in bulk at discount stores

For those who have the space, this can significantly help out with costs.

Eating healthy on a budget shouldn’t be so hard. Hope this helps ease you in!

How To Get Better Sleep

Why am I writing about sleep? This is supposed to be a gut blog! I am partial to the gut as it is notoriously known as the second brain (rightfully so as it contains more neurons than the spinal cord), but the upstairs brain needs a break.

Good sleep is just as important for optimal health as exercise and nutrition. And, the gut isn’t just an innocent bystander in the process. Our gut houses a microbiome, which consists of microorganisms that carry out special functions. The gut microbiome has the ability to produce important neurotransmitters that impact our sleep.

Sleep and our delicate microbiome are in a long-distance relationship; therefore, it is important to keep sleep hygiene in mind when thinking about gut health.

Here are some tips —beyond blackout shades — to help get some quality shut-eye:

Get out in the sun
Our sleep is affected by our exposure to natural light. Unfortunately, most of us spend far too much time indoors, even sometimes in a location without a window. Sunlight exposure for at least 30 minutes helps set our internal clock, the circadian rhythm, and suppresses our sleep hormone, melatonin. Generally, the best time to be the sun is in the early morning (6 am-8:30 am). If this isn’t possible and you find yourself stuck inside a building at work most days, then you should at least try to go outside during your lunch break.

Start to wind down
No phone, computer, or TV for at least 30 minutes before the Z’s. If you are brave, stretch it out and stop using devices 1 hour before bedtime. Blue light is emitted by these devices (even from your digital clock) and suppresses melatonin.

There are many blue light blocking products. I personally use f.lux on my computer. This is a free program that adjusts the lighting of the computer based on when the sun sets.

Eat better
The gut is responsible for more than 90% of the production of serotonin, an important substance in making melatonin. In order to feed our hard-working gut and keep the good organisms happy, it is important to eat indigestible fibers AKA plants.

For all those Margaret Wise Brown fans…good night stars, good night air, good night noises everywhere.

CES 2019: Review of Digital Health

WHY I WENT TO CES: 

CES = Consumer Electronic Show (giant conference for the latest and greatest tech)

Started in 1967….it’s been around for a long time

It has more than 180,000 attendees from 150 countries

VCR debuted in 1970… wow, we moved from that quickly. Though, I think my mom still has a VCR.

I specifically went to look at trends and to see if there’s a product that would be viable for a gastroenterology practice. I also follow healthcare tech + digital health and wanted to stay on top of the innovation in my field.

OVERALL TRENDS IN DIGITAL HEALTH:

1.           Make the user experience fun. 

People were very excited about the shiny TVs from Samsung and LG, but digital health was upping their game by making their products fun and interactive

For example, The Muse is an EEG device used for meditation – you hear peaceful weather when your mind is calm and stormy weather when your focus drifts off. You get points for how long you stay in the calm state. This let’s you compete with yourself or others.

Of note: Lots of sleep and meditation devices on the market = fierce competition

2.           Make the tech super helpful.  

Enter robot assistants. Samsung bot care is Wall E meets R2D2 attached with all sorts of sensors. It detects your breathing as you sleep. It takes your vitals (blood pressure and heart rate) when you touch it. It reminds you to take your medicine and detects falls. This would allow health care workers to remotely monitor patients.

Obstacle: People have to get used to robots in the home. For my Short Circuit fans, Johnny Five is very much alive and sleeping next to you.

3.           Disintermediation

Cut the middlemen and have a direct-to-consumer product. One of the digital health products, Foodmarble, works by analyzing hydrogen levels in the breath to determine if there are food intolerances or an overgrowth of bacteria. We use this test in GI already – it’s called the hydrogen breath test.

4.           Tech will make things easy

Everything is going wireless. There were devices that sit next to you, like a piece of furniture, and use radio frequency to measure your heart rate and breathing rate.

Obstacle: the devices need to have a good WiFi signal. Ever lose Wifi at home?

INTERESTING PRODUCTS UNRELATED TO DIGITAL HEALTH:

Intelligent connection of the Internet of Things (IoT) - everything in the home will be connected and will be smarter than you! It will be like having a personal assistant maintaining the affairs of the home - the frig can track and order any food product. Out of milk? Boom! It was already ordered before you had a chance to write it in the food-shopping notes section on your iPhone.

Proctor and Gamble came out with the Opte Precision Wand - a beauty wand that you run over your skin to detect darker spots and essentially prints over them.

Facial recognition being used in customer experience at SK-II (skincare line in Japan) stores– I had my face scanned to determine my skin age and make product recommendations.

WHAT WOULD I HAVE LIKED TO SEE IN THE WORLD OF DIGITAL HEALTH?

This won’t appear in 2020, but I foresee a home where we have the most intelligent IoTs tracking our health without doing or wearing anything extra. We live our normal lives without being disturbed. Our bed can detect how we slept. Our mirrors can use facial recognition to detect emotion. Our toothbrushes can detect gum disease. Our toilets can analyze our poop and determine what we need to eat. Maybe our floors can detect our blood pressure and pulse. Who knows? Remember, the VCR came out in 1970 and that was a big deal.