User login
What exactly is a healthy diet?
Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.
When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.
That is not something you should eat, he emphasizes.
“I really do believe though, that what crosses our lips and gets into our GI tract really underlies our entire health. It’s just that we don’t have enough information yet to know how we can coach people in telling them: eat this, not that,” he added.
In an interview, Dr. Ketover spoke more about the link between the gut microbiome and health, and the young patient who inspired him to become a GI physician.
Q: Why did you choose GI?
Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others.
Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing.
Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?
Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time.
Q: What role does diet play in improving the intestinal microbiome?
Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?
The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people.
Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.
I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.
It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.
How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
Q: What teacher or mentor had the greatest impact on you?
Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness.
Q: What would you do differently if you had a chance?
Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.
Q: What do you like to do in your free time?
Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.
Lightning Round
Texting or talking?
Texting, very efficient
Favorite city in U.S. besides the one you live in?
Waikiki, Honolulu
Favorite breakfast?
Pancakes
Place you most want to travel to?
Australia and New Zealand
Favorite junk food?
Pretzels and ice cream
Favorite season?
Summer
How many cups of coffee do you drink per day?
2-3
If you weren’t a gastroenterologist, what would you be?
Public policy writer
Who inspires you?
My wife
Best Halloween costume you ever wore?
Cowboy
Favorite type of music?
Classic rock
Favorite movie genre?
Science fiction, space exploration
Cat person or dog person?
Dog
Favorite sport?
Football — to watch
What song do you have to sing along with when you hear it?
Bohemian Rhapsody
Introvert or extrovert?
Introvert
Optimist or pessimist?
Optimist
What exactly is a healthy diet?
Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.
When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.
That is not something you should eat, he emphasizes.
“I really do believe though, that what crosses our lips and gets into our GI tract really underlies our entire health. It’s just that we don’t have enough information yet to know how we can coach people in telling them: eat this, not that,” he added.
In an interview, Dr. Ketover spoke more about the link between the gut microbiome and health, and the young patient who inspired him to become a GI physician.
Q: Why did you choose GI?
Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others.
Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing.
Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?
Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time.
Q: What role does diet play in improving the intestinal microbiome?
Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?
The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people.
Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.
I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.
It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.
How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
Q: What teacher or mentor had the greatest impact on you?
Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness.
Q: What would you do differently if you had a chance?
Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.
Q: What do you like to do in your free time?
Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.
Lightning Round
Texting or talking?
Texting, very efficient
Favorite city in U.S. besides the one you live in?
Waikiki, Honolulu
Favorite breakfast?
Pancakes
Place you most want to travel to?
Australia and New Zealand
Favorite junk food?
Pretzels and ice cream
Favorite season?
Summer
How many cups of coffee do you drink per day?
2-3
If you weren’t a gastroenterologist, what would you be?
Public policy writer
Who inspires you?
My wife
Best Halloween costume you ever wore?
Cowboy
Favorite type of music?
Classic rock
Favorite movie genre?
Science fiction, space exploration
Cat person or dog person?
Dog
Favorite sport?
Football — to watch
What song do you have to sing along with when you hear it?
Bohemian Rhapsody
Introvert or extrovert?
Introvert
Optimist or pessimist?
Optimist
What exactly is a healthy diet?
Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.
When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.
That is not something you should eat, he emphasizes.
“I really do believe though, that what crosses our lips and gets into our GI tract really underlies our entire health. It’s just that we don’t have enough information yet to know how we can coach people in telling them: eat this, not that,” he added.
In an interview, Dr. Ketover spoke more about the link between the gut microbiome and health, and the young patient who inspired him to become a GI physician.
Q: Why did you choose GI?
Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others.
Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing.
Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?
Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time.
Q: What role does diet play in improving the intestinal microbiome?
Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?
The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people.
Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.
I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.
It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.
How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
Q: What teacher or mentor had the greatest impact on you?
Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness.
Q: What would you do differently if you had a chance?
Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.
Q: What do you like to do in your free time?
Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.
Lightning Round
Texting or talking?
Texting, very efficient
Favorite city in U.S. besides the one you live in?
Waikiki, Honolulu
Favorite breakfast?
Pancakes
Place you most want to travel to?
Australia and New Zealand
Favorite junk food?
Pretzels and ice cream
Favorite season?
Summer
How many cups of coffee do you drink per day?
2-3
If you weren’t a gastroenterologist, what would you be?
Public policy writer
Who inspires you?
My wife
Best Halloween costume you ever wore?
Cowboy
Favorite type of music?
Classic rock
Favorite movie genre?
Science fiction, space exploration
Cat person or dog person?
Dog
Favorite sport?
Football — to watch
What song do you have to sing along with when you hear it?
Bohemian Rhapsody
Introvert or extrovert?
Introvert
Optimist or pessimist?
Optimist