🧠 Physician/Neuroscientist with 20+ years of experience in Healthcare & Life Sciences with Clinical Research, Digital Health, and Data Science expertise.

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DISCLAIMERS: The views expressed are my own and don't necessarily reflect those of my employers or other 3rd parties. Any health-related content shared is for informational and/or educational purposes only and should not be considered medical advice.

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Igor Korolev

Gastroenterologist | Medical Director, Oshi Health | LinkedIn Top Healthcare Management Voice | Forbes Health Contributor

I’m a board-certified gastroenterologist and the Founding Medical Director at Oshi Health, where I’ve had the privilege of helping shape and expand a virtual-first GI care model now serving patients in all 50 states. Working alongside an incredible team, I’ve contributed to building scalable clinical pathways for IBS, IBD, and other gut conditions—anchored in team-based care, empathy, and measurable outcomes.

With 28,000 + followers, I’m among the most followed gastroenterologists on LinkedIn, where I regularly share insights on topics including:

• IBS & the gut-brain connection — emotional triggers, stress, and personalized care
• Digital health innovation — virtual-first models, AI in GI, and wearable integration
• Colorectal cancer screening — rethinking pathways and improving early detection
• Reducing unnecessary testing — CTs, labs, and low-yield procedures in IBS
• Value-based gastroenterology — lower cost, better outcomes, patient experience
• Health plan integration — improving patient access to covered virtual GI care
• Microbiome & nutrition science — evidence-based takes on fiber, probiotics, and gut myths
• Healthcare system reform — tackling disparities, burnout, and reimbursement models
• Behavioral science in GI — the role of habit loops, psychology, and coaching in digestive health
• Virtual care leadership — insights from helping scale a 50-state GI operation

As a LinkedIn Top Voice, I collaborate across digital health, clinical care, and health plans to drive forward-thinking solutions in gastroenterology—without waste, and with humanity.

Let’s connect if you’re working at the intersection of GI, tech-enabled care, or value-based delivery models.

Michael Bass, M.D.

Most of us have taken antibiotics and moved on. This new Sweedish study says your gut hasn't.

A new Nature Medicine paper linked 8 years of prescription data to stool metagenomes from nearly 15,000 adults in Sweden.

The headline finding: a single course of clindamycin, fluoroquinolones, or flucloxacillin was still associated with changes in gut bacteria 4 to 8 years later. Not months. Years.

Clindamycin use within a year of sampling was tied to 47 fewer detected species on average. That's a massive hit to an ecosystem most patients assume bounces right back.

The species that increased after antibiotics included bacteria previously linked to higher BMI, elevated triglycerides, and type 2 diabetes risk. The ones that decreased were tied to lower inflammation and better metabolic health.

This matters because the gut microbiome isn't a bystander in human health. It regulates metabolism, immune function, and inflammation. When you wipe out key species with a broad-spectrum antibiotic, you're not just treating an infection. You're reshaping an organ system.

And the recovery isn't automatic. The fastest rebound happened in the first two years. After that, diversity plateaued well below baseline. Some species may never fully return.

We prescribe a 10-day course for a dental abscess and tell the patient they're done. But the disruption we triggered may still be measurable half a decade later.

If you've had a patient who "just hasn't been the same" since antibiotics a few years ago, this paper gives you a biological reason to take that seriously.
We can't undo the antibiotics we've already prescribed. But we can stop pretending the consequences end when the pill bottle runs out.

LinkedIn Top Voice | Gastroenterologist I Global Medical Director @ ViomeDx

The Gut doesn't Forget 

Something I see constantly in my GI practice, and it took me years to fully appreciate: most of the patients sitting across from me don’t have a GI problem. They have a lifestyle problem that finally showed up in their gut.

The story is almost always the same. Someone in their 40s or 50s comes in with bloating, reflux, irregular bowel habits, vague abdominal pain. They’ve had it for months. Maybe years. They want answers. They want a scope.

So we scope them. And we find… something. We almost always do. A hiatal hernia. Some gastritis. Diverticulosis. A polyp or two. The report looks official. The patient reads it and thinks, there it is. That’s what’s wrong with me.

Except it probably isn’t.

Those findings are background noise in most adults over 40. I could scope a room full of people who feel perfectly fine and find the same things. The hiatal hernia isn’t why you’re bloated. The diverticulosis isn’t why your bowels are unpredictable. But once the finding exists on paper, it becomes the story. And now we’re treating the report instead of the patient.

This is where GI medicine goes sideways more than I’d like to admit. We put someone on a PPI for reflux related to the hernia. Maybe a second one when the first doesn’t work. An antispasmodic. A low-FODMAP diet handed over on a photocopied sheet with no guidance. Six months later they’re on three medications, eating twelve foods, and feeling worse.

Meanwhile nobody addressed the actual problem. The ultra-processed diet. The fact that they sit for eleven hours a day. The stress they wear like a second skin. The sleep they’ve neglected for a decade. 

All this leading to a slow, steady erosion of microbial diversity that’s been compounding silently since their 30s.

The gut doesn’t fail overnight. It erodes. Barrier integrity weakens. Inflammatory tone rises. Motility shifts. The microbiome loses the diversity it needs to do its job. And for a long time none of that produces symptoms. The system compensates. Until one day it can’t. That day is when people call my office.

What frustrates me is how often the most effective intervention is the one that gets the least attention. Rebuilding the foundation: Real food, Fiber, Movement,
Sleep,Stress regulation. They are literally what the gut needs to function. 

They restore motility, feed beneficial microbes, lower visceral hypersensitivity, and repair barrier function.

But nobody takes that seriously when there’s a pill to try first. They take it very seriously six months later when the pills haven’t worked. And then they start to get better. Not necessarily because of anything I prescribed, but because they finally changed the inputs.

10 years into practcing, I’m convinced a good portion of functional GI complaints are predictable consequence of how someone has been living. And the treatment most of these patients need is the same thing that would have prevented the visit in the first place.

Everyone says AI will replace doctors. But the first thing physicians are actually using AI for? Reading the medical literature.

A new AMA survey shows more than 80% of physicians now use AI professionally. And the most common use isn’t diagnosis. It’s summarizing medical research and standards of care. That tells you something important about where medicine actually is right now.

The biggest bottleneck in healthcare isn’t intelligence. It’s bandwidth. Thousands of new papers publish every week. Guidelines constantly evolve. Biology keeps getting more complex. No physician can realistically read everything. 

So knowledge diffuses slowly through the system. Conferences, guidelines, word of mouth. Sometimes it takes years for a new insight to reach everyday clinical practice. I’ve seen it firsthand. A study changes how we should think about a condition, and five years later half the clinicians managing it haven’t read it yet.

AI changes that dynamic. Instead of reading 20 papers, a physician can read a two-minute synthesis. Instead of discovering a new mechanism years later at a conference, it can surface in clinical workflow the same week. That doesn’t replace physicians. It amplifies them.

Which is why most real-world physician AI use today looks nothing like the headlines,despite what the Silicon Valley tech- bros might be tweeting. 

It’s summarizing research, generating chart summaries, creating discharge instructions, reducing documentation burden. Not autonomous diagnosis. Not robot doctors.

Caitlin Owens highlighted this in a recent Axios Healthcare newsletter. AI’s earliest clinical adoption is largely about helping physicians manage information and administrative load, not replacing clinical judgment. That distinction matters more than most people realize.

Medicine isn’t moving toward autonomous doctors. It’s moving toward augmented cognition. Doctors still make the decisions. But AI helps them see patterns faster in an ocean of information that no human brain can process alone. And as biology gets more complex, that ability won’t just be nice to have. It’ll be essential.

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The most dangerous phrase in cancer screening right now might be “no cancer signal detected.”

Multi-cancer blood tests are having a moment. A single blood draw that claims to detect 50+ cancers sounds revolutionary. And maybe someday it will be. But the evidence is still catching up to the excitement.

There are now roughly 40 multi-cancer early detection tests in development or already on the market. Yet very few have been tested in randomized trials. And the first large trial results? They didn’t show a clear reduction in late-stage cancers. Which is the whole point. Finding cancer only matters if you’re finding it early enough to change outcomes.

Why is this so hard? Because early cancers are biologically quiet. Most current tests search for fragments of tumor DNA circulating in the bloodstream. The problem is that very small tumors often shed almost no DNA at all. The signal can be incredibly faint. You’re essentially trying to hear a whisper in a stadium.

That’s why researchers are exploring another layer of biology: RNA. 

RNA reflects what cells are actively doing, not just what mutations exist. Signals can appear earlier, even when tumor DNA is scarce. It can capture the body’s response to cancer, not just the tumor itself. And it provides insight into active biological pathways rather than static genetic changes.

None of this means DNA-based tests are wrong. But it highlights something important: detecting cancer early may require listening to more than one biological signal. DNA is probably part of the answer. It’s not the whole story.

Patients deserve innovation. But they also deserve evidence that it actually improves outcomes. Because “no cancer signal detected” only means something if the test was capable of detecting the signal in the first place.

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Kip West

The AI prescribing debate feels very different after you’ve cleared 40 refill requests in your inbox at the end of a clinic day.

Most people think prescribing is the clinical decision. Clinicians know the reality is everything wrapped around it. Prior auths, quantity limits, step therapy rules, plans that only cover 90 pills, missing labs, drug interaction checks, and the quiet liability of deciding what can safely go through and what needs a visit.

That’s why a recent The Washington Post  opinion criticizing Utah’s AI refill pilot with Doctronic caught my attention. Joseph Sakran , Johns Hopkins trauma surgeon and a medical researcher, argues that autonomous AI prescribing is moving forward on dangerously thin evidence.

His case is straightforward. The safety data rests largely on a single preprint on medRxiv that hasn’t been peer reviewed. The study authors hold equity in the company. The underlying data hasn’t been publicly shared.
They also point out that the widely cited 99.2% accuracy figure comes from urgent care encounters, not chronic medication renewals, which is what the Utah pilot is actually doing. Different context, different risk profile.

And they raise a fair concern about scale. Even a small error rate applied across thousands of prescriptions could affect vulnerable groups. Elderly patients, people on complex medication regimens, patients whose conditions have quietly changed since their last visit.

Those are legitimate concerns. But the authors also acknowledge something that gets lost in the headline debate. Medication renewals for stable chronic conditions are among the lowest-risk prescribing tasks in medicine.

If AI could safely handle routine renewals, it could free physicians to focus on the stuff that actually requires a doctor.

That tension is where the real conversation should be. Because the system clinicians are currently working in is already broken. 

Practices average nearly 40 prior authorizations per physician per week. Physicians and staff spend more than 13 hours weekly on them. Nearly 90% say prior auth contributes to burnout.

So I find myself in the middle on this one. I don’t want AI replacing clinical judgment. But I’m very open to AI reducing the administrative friction wrapped around routine prescribing. Stable medication renewals with guardrails and escalation paths? That’s not AI practicing medicine. That’s AI doing paperwork.

Those are two very different things. And until we can talk about them separately, this debate is going to keep going in circles.

Byron Crowe

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Maria Menounos’s story has a rare ending for pancreatic cancer. She lived.

She had persistent left upper abdominal pain and bloating that progressively worsened.

Endoscopy, colonoscopy, and CT scan were all normal despite ongoing symptoms.

A full-body MRI finally revealed a stage 2 pancreatic neuroendocrine tumor.

After the MRI found it, her doctors moved quickly. Surgery in early 2023. Part of her pancreas removed, her spleen removed, 17 lymph nodes taken out, an incidental fibroid removed. No chemotherapy or radiation because it was caught early enough to cut out completely.

The pathology confirmed a stage 2 pancreatic neuroendocrine tumor. Not the more aggressive pancreatic adenocarcinoma, but still a serious, potentially life-threatening disease. 

Today she’s cancer-free, on routine surveillance imaging, living a normal life, raising her daughter, and speaking publicly about early detection.

She doesn’t credit the system. She credits the decision to go beyond it. She’s said repeatedly that outside screening saved her life.

But we a know the perils of everyone getting a full body MRI.. incidental findings that require invasive follow up. Potentially leading to unnecessary complications and cost.

That’s the tension. Most patients don’t push that far. Most don’t get that extra scan. Most don’t catch it early. We don’t have population-level screening for pancreatic cancer. There’s no colonoscopy equivalent. No mammogram. For most people, the diagnosis comes with symptoms, and by then the window for curative surgery has usually closed.

So yes, Maria Menounos is doing well
 today. But her story isn’t reassuring for everyone else. She survived a disease that usually isn’t found in time because she found it before we typically do.

Her story should force us to ask why we still don’t have a reliable, accessible way to catch pancreatic cancer early for anyone.

The five foods a gastroenterologist actually eats to lower colon cancer risk. And the ones I tell every patient to cut.I sat down with gastroenterologist and innovator, Dr. Neil D. Parikh  on The Gut Doctor podcast to talk about diet and colon cancer. 

Eat more of these: Beans, lentils, oats, vegetables, and whole grains. These feed the good bacteria in your gut that produce butyrate, a compound that literally fuels and protects the cells lining your colon. 

Higher fiber intake is one of the most consistent dietary signals linked to lower colorectal cancer risk. It works.

Cut this: Processed meat. Bacon, hot dogs, sausage, deli meats. The World Health Organization classified processed meat as carcinogenic to humans with sufficient evidence for colorectal cancer specifically. Make it occasional, not daily.

It’s not just about the food itself. It’s about what the food does to the ecosystem inside your colon. Your diet shapes your bowel habits, your inflammatory response, and your gut microbiome. 

Those three things together determine whether your colon lining is in a state that fights abnormal cell growth or feeds it.

Colorectal cancer is now the leading cause of cancer death in people under 50. 

The prevention conversation shouldn’t start at age 45 with a colonoscopy. It should start at age 25 with your grocery list.

We go deep on fiber, processed meat, sugar-sweetened beverages, the microbiome, and what I actually tell patients in clinic.

Thanks for the conversation, Neil!

Open article: The Gut Doctor by podcasts.apple.com

Diet and Colon Cancer with Michael Bass, MD

Oxford just published a study that should end the “one perfect diet” debate. 1.8 million people. 9 prospective studies. 16 years of follow-up.

Yes, there was a real cancer-protection signal. Compared with meat eaters, pescatarians had lower risk of colorectal, breast, and kidney cancer. 

Vegetarians had lower risk of pancreatic, breast, prostate, and kidney cancer, plus multiple myeloma.

But here’s the part the diet tribes won’t post.
The protection was not universal. 

Vegetarians were not lower overall for colorectal cancer. Vegans showed a 40% higher colorectal cancer signal. In subsite analyses, vegans also had a higher rectal cancer signal. And vegetarians had nearly double the risk of esophageal squamous cell carcinoma.

Now before anyone turns that into ammunition, the vegan colorectal finding was based on only 93 cases. The authors explicitly say it should be interpreted cautiously. This is not an anti-vegan study. But it is an anti-dogma study.

The deeper lesson is the real story. A diet label is not a biological outcome. The paper itself says vegetarian diets are defined by what they exclude, not what they include. 

They can still be loaded with refined carbohydrates. And this study didn’t even have data on food processing or cooking methods. So we’re categorizing people by what they don’t eat and assuming that tells us something meaningful about their biology. It often doesn’t.

Two people can both call themselves plant-based and eat completely different foods, have completely different nutrient status, and get completely different results. I see it in clinic all the time. One person’s “plant-based” is lentils and vegetables. Another person’s is pasta and Oreos. Same label. Wildly different metabolic reality.

That’s why nutrition is not just about what you remove. It’s about what you replace it with. Nutrient sufficiency. Metabolic context. The actual person sitting in front of you. Not all foods are the best foods for everyone. 

And not every “healthy” diet protects every body the same way. The future is not diet ideology. It’s personalized nutrition.

Nom-meat dietary associated Lower Cancers 

Most people think memory loss starts in the brain. This paper suggests it might start in the gut.

Researchers took young mice and exposed them to the microbiome of older mice. Within weeks, their memory declined.They became indistinguishable from the older mice. Same behavior, same deficits, same cognitive profile.

Nothing changed in their brain directly. What changed was the signaling between the gut and the brain. One microbial species disrupted that circuit. And when it was removed, memory improved.

We’ve spent decades looking at the brain as the endpoint. Amyloid. Tau. Neurodegeneration. Billions of dollars in research. But what if we’ve been looking too late in the process? What if the signal is upstream? What if cognition is partly a reflection of how well we process internal biological information, not just what’s happening inside the skull?

Most of what we measure is static. Labs, imaging, snapshots of a single moment. But biology isn’t static. It’s dynamic, adaptive, constantly responding to inputs we barely track. And the gut sits right at the center of that feedback loop. Diet changes the microbes. Microbes change the metabolites. Metabolites change neural signaling. Neural signaling changes behavior. That’s not a hypothesis anymore. We’re watching it happen in real time in studies like this one.

We’re not just treating organs anymore. We’re starting to decode systems. And the gut-brain axis might be the most important system nobody told you to pay attention to.

This is a mouse model, and we’ve been burned before by gut-brain findings in rodents that didn’t translate to humans. But the direction is compelling enough that it deserves serious human studies, and for the first time we actually have the tools to do them.

Could the Gut hold the secret to Memory ?

Most of medicine is built on averages. But nobody is average. Give 100 people the exact same “healthy” bowl of oatmeal. Some will get steady energy and sustained focus. Others will spike their glucose like they just ate a candy bar. Same food. Completely different biology.

Why? Because the human body isn’t a simple machine. At any given moment there are roughly 100,000 chemical reactions happening inside you. And here’s the part most people don’t realize: only about half of those are driven by your own genes. The other half are driven by the microbes living in your gut.

For the past century, medicine tried to make sense of this complexity by studying large populations and treating the “average patient.” Average cholesterol targets. Average diet advice. Average treatment response. But no patient actually walks into my clinic as the average. They walk in as one person with one biology, one microbiome, one set of metabolic responses that belong only to them.

This gap between population medicine and individual biology is where some of the most interesting work in health science is happening right now. 

Momo Vuyisich  and Guruduth Banavar imagural podcast really hits a nerve. Just some of the topics they hit on:

-Identical foods can produce radically different metabolic responses in different people. 
-The microbiome runs a massive portion of the chemistry inside our bodies and most people have no idea. 
-Preventive health is still the exception in modern healthcare, not the rule. Chronic diseases that were rare a generation ago are now everywhere. 
-And understanding human biology at the individual level now requires computational scale that only AI can provide.

One line from the episode captured the whole shift: “Biology sets the table. AI serves the meal.”

Biology generates enormous complexity. AI may finally give us the tools to interpret it at the level of the individual, not the population. 

If you’re interested in where personalized medicine, microbiome science, and AI are heading, this conversation is worth your go time.

https://lnkd.in/eEGD6P55

Open video: Biology sets the table; AI serves the meal  |  Two PhDs on a Pod: Ep 1 on youtu.be

Biology sets the table; AI serves the meal  |  Two PhDs on a Pod: Ep 1

Bloating after every meal is one of the most common complaints I hear in clinic.
Healthy eaters get it. Junk food lovers get it. People on high-fiber diets get it.

For decades, we blamed gas and handed out simethicone. We were ignoring the real problem.

First things first. If your bloating came on suddenly, if you’re losing weight without trying, if there’s blood in your stool, or if you’re over 45 and this is new, you need a proper structural workup. That means blood work, imaging, and likely an endoscopy or colonoscopy to make sure nothing serious is hiding. Those red flags exist for a reason and they should never be brushed off. But once you’ve ruled out the scary stuff, the conversation changes completely.

Your gut has its own nervous system. Over 100 million nerve cells line your digestive tract, and they’re in constant conversation with your brain through a highway called the vagus nerve. When that communication breaks down, whether from stress, poor sleep, or illness, your gut slows down. Food sits longer than it should. 

And when food sits, bacteria feast on it. That fermentation produces gas, and that gas is what makes your belly feel like a balloon thirty minutes after lunch. The bloating isn’t just about what you ate. It’s about how your brain and gut are talking to each other.

Here’s where the microbiome comes in. Your gut contains trillions of bacteria, and the balance between them matters enormously. 

When bacteria that normally live in your colon migrate up into your small intestine, a condition called SIBO, they start fermenting food in the wrong location. Different bacterial species produce different gases. Some produce hydrogen. Some produce methane, which actually slows gut motility even further and creates a vicious cycle. A simple breath test can identify which pattern you have, and that pattern determines which treatment will actually work.

But killing the bacteria is only half the answer. If the brain-gut signaling problem that let them overgrow in the first place isn’t addressed, they come right back. 

Recurrence rates for SIBO are high precisely because most treatment plans ignore the nervous system. Stress reduction, vagal nerve stimulation, gut-directed behavioral therapy, and sometimes low-dose medications that calm the nerve pathways between your brain and gut can break the cycle. 

The bloating was never just about gas. It was about a communication breakdown between your brain, your nerves, and your microbiome all at once.

Novo Nordisk  just agreed to let hims & hers  distribute Wegovy and Ozempic through its platform and dropped the lawsuit it filed last month over compounded semaglutide. This isn’t a GLP-1 headline. It’s a preview of where telehealth is going next.

The first era of telehealth was about convenience. Fast visits, easy prescribing, consumer-friendly access. The next era will be judged on something much harder: can telehealth become a trusted distribution and care layer for complex chronic disease?

For years, telehealth has been underestimated as a lightweight front-end. Good for access, good for demand capture, good for meeting patients where they are. But this deal signals something bigger. Large pharma now sees digital care platforms as legitimate channels for branded therapy distribution. Not lead generators. 

Because once telehealth becomes a true distribution channel, the business model gets serious fast. It’s no longer about customer acquisition and conversion. It’s about clinical credibility, regulatory discipline, patient safety, adherence, supply continuity, and what happens after the prescription is written. 

Especially in obesity care, where anyone can build demand but very few can build durable care models. The companies writing scripts the fastest aren’t necessarily the ones that will survive this next phase.

There’s a second signal buried in this story too. Just days after U.S. regulators warned telehealth firms over misleading compounded GLP-1 advertising, one of the most visible players struck a deal around approved branded drugs instead. 

Telehealth is no longer disrupting healthcare from the outside. It’s being absorbed into the system itself. That creates more legitimacy and more accountability in the same move.

Your reflux might not be an acid problem. It might be a microbiome problem. And that changes everything about how you treat it.

Acid reflux that won’t quit is one of the most common reasons people end up in my office. Stress cases. Fit people. People who gave up coffee and spicy food years ago and still can’t sleep flat.

For decades we put everyone on a PPI and moved on. Mask the acid, next patient. But we were reshaping the gut microbiome without ever asking what was actually driving the symptoms.

First, the non-negotiable. If you’re having trouble swallowing, losing weight, vomiting blood, or your reflux started after 50, you need a scope. That’s not optional.
But most reflux patients don’t have those red flags. And for many of them, acid isn’t even the whole story.

Your esophagus has nerve endings that report sensations to your brain. Your brain decides how seriously to take them. In some people, that system gets recalibrated so normal amounts of reflux feel like their chest is on fire. It’s called visceral hypersensitivity.

The acid levels might be completely normal. 
But the volume on the signal is turned all the way up and the ecosystem underneath is off balance.

This is why some patients stay miserable on maximum-dose acid blockers with a perfectly clean scope. You can’t fix a signaling problem with acid suppression alone.

Long-term acid suppression changes the bacterial landscape of your stomach and upper gut. PPIs raise stomach pH, which lets bacteria that normally can’t survive in acid flourish.

Over time, that shift has been associated with C. diff, bacterial overgrowth, bloating, and impaired nutrient absorption. PPIs aren’t bad. They’re one of the most important drugs in GI. But using them for years without understanding why carries real consequences.

The right approach is figuring out what’s actually driving your symptoms. pH testing can measure exactly how much reflux is occurring and whether your symptoms even correlate with reflux events.

If the acid is controlled and you still feel terrible, the problem may be neural, microbial, mechanical, or all three. 

Neuromodulators can recalibrate sensitivity. Treating overgrowth can reduce the upward pressure keeping symptoms going. GI-focused cognitive behavioral therapy can break the catastrophizing loop.

And a conversation about whether you still need that PPI should happen at every single follow-up.

Nobody should be on a medication for years without someone asking why.

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