A closer look at increasing access to care and education from a leading GI specialist and doctor
Salvo Health Clinical Advisory Board Member Dr. Mark Pimentel is on the frontlines of care and research, working with IBS and SIBO sufferers who are searching for relief and a diagnosis. Which is why his new book The Microbiome Connection is dedicated to dispelling misinformation about chronic gut conditions, while educating readers, both patients and doctors alike, about their gut health.
I recently sat down with Dr. Mark Pimentel. We talked about what readers can learn from his new book, how digital healthcare can elevate specialty care, and how Salvo Health is delivering better, comprehensive care for chronic conditions with Whole Self Science.
“I read your book, The Microbiome Connection. I definitely had to take multiple breaks, because I felt like I was absorbing so much valuable content, despite it only being 190, 195 pages. How is a patient who's educated in the differences between SIBO and IBS, and all the different types of testing and their bodies, able to make a better decision for themselves about their health? Especially in the moment with a doctor.”
“We've made some major discoveries over 20 years in changing this field. In the past, our understanding of IBS was that it was primarily due to some psychological event, which we now know is probably not the case. I'm not saying anxiety, depression aren't part of IBS, but that's probably not the major cause of IBS, but rather infection, food poisoning and bacteria are the cause. The problem is that doctors in some areas aren’t as up-to-date with new research on IBS.
And so the book, if the doctors buy it, it educates them about their patients and if the patients buy it, they can educate their doctor. We empower the patient within the first few chapters of the book, and then educate them about their microbiome.”
You talk a lot about barriers to getting help, managing your diagnosis and keeping up on different testing and treatments. The testing for IBS and SIBO are different, and the multi-pronged treatment approach for SIBO, might include more testing. Is there a sequence or algorithm of testing that you think is most cost efficient?
We've actually done the cost studies for some of these algorithms. If every doctor in Blue Cross, who had a patient who they suspected had a chronic gut condition—Let's say they're 30 years old, and they have some chronic diarrhea, did the new blood test for IBS—were able to identify IBS and get them on treatment within like, a few days, they would save Blue Cross hundreds of millions per year.
The biggest cost of IBS comes from the fact that the doctors don't believe their patients, and then they do the CT scan, an ultrasound, or a colonoscopy. All these costs stack up, but if you can identify IBS immediately, patients get the right care right away and that saves money.
The breath test that we use now for SIBO separates patients into three groups. And the three groups are treated very differently. For example, if your breath test indicates hydrogen, you get Rifaximin; if you're a methane, you get Rifaximin and Neomycin. And if the test shows hydrogen sulfide, the treatment would be different as well. And new algorithms will emerge in the next year that will be even more effective for the different subcategories.
Switching gears a little bit; The book clarifies that there's some outdated myths about IBS, especially about being a purely psychological condition. We know you don't recommend antidepressants, but how do you feel about gut-directed psychotherapies in general, like CBT? OR diaphragmatic breathing?
What doesn't hurt somebody, can help somebody. Some of these things are helpful, because mindfulness, cognitive behavioral therapy, and understanding your illness, doesn't hurt.
CBT is useful, if it helps the patient and helps ground them, makes them feel better, teaches them more about their symptoms, and gives them relief. That translates into improvement. But it's not a treatment for the microbiome, and the book focuses more on the microbiome.
Do you think CBT and these therapies help patients reduce symptoms, or do they find relief from symptoms through other pathways?
Relaxation will reduce your serotonin levels or change your serotonin levels. In the subset of the IBS patients that we study, a cognitive impact on gut health comes after diagnosis. The food poisoning comes first, then the anxiety and depression a year later. And whether it's the microbiome that's producing these neurotransmitter chemicals, changing serotonin production, and that is what is triggering the anxiety and depression, or whether it's the futility of the illness that's making them anxious and depressed, CBT is a useful coping tool.
You go into great detail about how some diets are just way too restrictive, and they're just not very easy to adopt in your life. Why is low fermentation eating a better option than those diets?
What’s unique about a low fermentation diet is that it can fit into different lifestyles.
One of the biggest things patients suffer with, is trying to live with chronic gut conditions. They're at the airport, they're scared to go on the plane in case they get diarrhea, or they're in their meeting with their boss, and everybody's at the table, and they have to get up and go to the bathroom. And then they don't come back for 20 minutes. They can't go on a date, because they don't know what's gonna happen. They're scared to eat, so they don't.
Low fermentation eating isn’t restrictive. You can go to a restaurant, and almost always you can find an item on the menu, where you don't have to talk to the waiter for 10 minutes to explain what to pick. And be embarrassed by that whole process in front of your friends, family, or colleagues. All this fear definitely makes you want to avoid eating, and that’s not life. And so low fermentation eating is a lifestyle diet, as well as a pathophysiology-based diet.
What’s the easiest aspect of low fermentation eating?
I like that you can find good options, whether you're vegetarian, or whether you're a meat lover when you’re eating low fermentation. Also, classics like a meat and potatoes dinner work just fine when it comes to low fermentation eating. Just get protein, carbohydrates, with a root vegetable on your plate.
Also, one of the things that people freak out about is when we say to eat white bread instead of whole wheat bread. They think of low-quality, mass-produced bagged bread. And I have to remind them that high quality bread can be white—French bread is white, Italian bread is white, and sourdough is white bread. And they’re all fine.
We're gonna switch gears and talk a little bit about your involvement with Salvo Health and the clinical advisory board. What do you believe digital healthcare can achieve that conventional healthcare is missing the mark on?
Patients tell me this all the time, but you see five doctors, and you get six different opinions. There shouldn’t be six different truths. Digital health offers the patient one platform, and one source of truth, but more attention.
In-person doctors also don't always believe what the patients are telling them, and make assumptions about condition severity based on appearance or age. In digital health, you can characterize and quantify the severity of that patient with evidence-based data without in-person assumptions. AI-based tools and digital health tools can also gather data that the patient isn’t able to accurately describe to the doctor.
How do you think digital healthcare has improved symptom management?
What patients need is affirmation and guidance along their journey. What digital healthcare apps like Salvo Health can do is provide continuous care, including the ability to track your journey or access to a care provider, that lifts the weight off of the patient, and gives them guideposts to handle their symptoms no matter their situation, no matter the factors that contribute to their gut health.
In terms of your decision to join the Clinical Advisory Board for Salvo Health, can you give us some context on how you decided to join us?
I think what I've learned over the years is because doctors aren’t always aligned on what to tell patients about their gut health, or as studied on chronic care, that there needs to be more outreach to patients. Sometimes, if clinicians are under-informed or under-resourced, it can get in the way of the patients getting beneficial health care. Salvo Health is this direct link to the patient, providing them directly with care, in a conscientious, continuous fashion, with a model of care, Whole Self Science, that syncs with the way I've always thought about healthcare.
I know that you've done extensive research and continue to do so. What do you hope, in terms of the narrative for people living with chronic gut conditions, is going to change from the current narrative?
I think we're seeing more and more challenges with access to care, and we’re seeing more and more challenges to, as well as opinions on how healthcare should be provided. I think the most important thing for the patient is to feel confident that somebody is actually helping them, continuously, and that a patient doesn’t get a five-minute appointment, five minutes of help, and then no help for two months, before their next five minute appointment. I think you can provide continuity, which is what I've understood Salvo Health to do, it’s only to the benefit of the patient and will change how healthcare operates.
Learn more about Salvo Health’s Clinical Advisory Board, composed of the nation’s leading gut health experts. And get a copy of The Microbiome Connection from Dr. Mark Pimentel to get a comprehensive review of IBS, SIBO, and how to manage symptoms with low fermentation eating.