The Multi-Faceted World of GI Health, with Rashmi Advani

| Episode 42

There is a lot of different terminology surrounding weight-loss—overweight, obesity, BMI—but what does it all mean?

Today, we’re chatting with Dr. Rashmi Advani, a gastroenterology fellow with a sub interest in obesity medicine. She is sharing more about what an average day looks like as a gastroenterology fellow, the importance of healthcare access, and sharing some surprising facts and statistics surrounding GI health!

Click the play button above to listen to our conversation with Rashmi Advani.

Highlights from Today’s Episode

  • What an average day looks like for Dr. Advani
  • Surprising facts and stats that most people don’t know
  • Rashmi’s top tips for great colon health
  • How can people work with her
Colon Health Podcast with Dr. Dac and Ariel Bridges

About the Colon Health Podcast

Co-hosted by Dr. Dac Teoli and Ariel Bridges, the Colon Health Podcast features guest interviews with expert physicians, leading researchers, nutritional scientists, integrative health specialists, and other foremost experts in colon health.

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Episode Transcript

Ariel: Hello, and welcome back to another episode of “The Colon Health Podcast.” My name is Ariel Bridges and I am your host. And today I have Dr. Rashmi Advani with us today. How’s it going, Dr. Advani?

Dr. Advani: Hi, it’s going well. Thank you so much for having me on the podcast.

Ariel: Thank you so much for being here. Can you just start out by sharing with our audience exactly what it is that you do?

Dr. Advani: Yeah. Absolutely. First of all, this is such a great platform for people to listen in and understand a little bit about what we do and how we could help you on the other end listening to this. So, what I do, essentially, I am a gastroenterologist. I just graduated my gastroenterology fellowship just actually last week. So, the last three years, I’ve been essentially a gastroenterology fellow in New York, Long Island, New York at Stony Brook Hospital. Essentially, what I do in addition to that is I have some interest in obesity medicine, advanced endoscopy, which is the next stage of my career where I’ll be performing procedures that require more advanced tools and endoscopy. We do removal of certain cancers in the GI tract, and more invasive therapies, hiatal hernia repairs, endobariatrics, which is essentially primary weight loss therapies in the GI tract is another interest of mine and it’s something I’m going to be pursuing in the next year. Lots of interests.

I also spend a lot of time mentoring medical students, residents, my peers regarding the process into a GI fellowship and career moves and career directions for them. I’m a strong proponent for women in medicine. I have two platforms that I utilize to help, you know, promote the message and connect with my community, and to educate on many GI diseases that are commonly overlooked or not as appreciated. And really just providing the increased access to just knowledge about GI conditions that I think a lot of people may overlook on a day-to-day basis. So that’s where I am coming in to try to provide some sort of small contribution in whichever way I can.

Ariel: And on your recent graduation, that is so exciting.

Dr. Advani: Thank you so much. It’s been a long journey, medical school four years, and then, you know, you go into a residency, which is three years, and then this is another three years to be a subspecialist. So I chose gastroenterology.

Ariel: Yes. In case you missed it, we had another gastroenterology fellow on our podcast that did an excellent job of breaking down all of the different positions and roles within a medical team. I’ll link it down. It’s very interesting and helpful from a patient perspective. But Dr. Advani, I would love to hear a bit about your journey. We just chatted about it super briefly, but what led you to want to pursue this subspecialty?

Dr. Advani: That’s such a good question because I feel like the field of medicine compared to what it was even 10, 15, 20 years ago isn’t what we’re experiencing now. We’re seeing a lot more diseases that require subspecialty care and even sub-sub-specialty care because our knowledge is increasing about these various diseases. The path that actually led me here initially, when I was in medical school, I knew I wanted to do something where I could directly impact patient care. And I felt that doing things with my hands, I was very good with my hands. I was able to do certain procedures and have that direct effect on the patients I was taking care of. I knew that was what I was good at.

And then the other part of it was that GI diseases…the GI tract is probably one of the largest organs second to the skin of the body. And it spans all the way from your mouth to your anus. And from personal experience, what I have seen is that many people come in with these GI conditions or GI complaints, and really the GI tract has all of these connections to different various systems in the body. So, I found that very intriguing and something where I could still exercise my knowledge and basic internal medicine, but also provide not only direct therapy with procedures but also be able to connect them in very intricate ways. The GI tract is such an intriguing organ and has so many connections to the brain, to different other systems. It’s all one highway system, but it’s more than just the structural thing. So, I found this to be very, like, intellectually appealing. And also I feel like because there were so many GI complaints that this is where I could have the largest impact.

Ariel: Yeah. It’s so interesting that people are starting to get more in tune with their gut health and are wanting to learn more about it and realizing that they don’t have to settle for stomachaches when they eat certain foods or not having knowledge or understanding of what’s actually going on inside their body and knowing that there’s, wow, so many different things that could be going on with my body.

Dr. Advani: One hundred percent.

Ariel: And I’m curious to know too, with all of the subspecialties and interests that you have, can you just share what an average day might look like for you?

Dr, Advani: Sure. So, I think that average day varies based on what part of your training you are currently in. So, as a fellow in gastroenterology, we split our time essentially with inpatient GI consults. So, we’re primarily a consultant service. So, a patient usually gets admitted to a hospital, then if they have a GI complaint or GI issue, we’re consulted as a service and we provide our recommendation and/or procedures if it’s required. So, we do a bunch of inpatient consults, but also as the training years go along, you do more outpatient chronic GI care. So, you’re kind of getting a flavor of both, and as a gastroenterologist, which next year and the years after this you could really kind of operate in many different realms.

My average day, we take call, we hold onto the pager if there’s any emergencies overnight, we take care of them. And then on the outpatient side, we perform outpatient procedures for people who have your average colonoscopy or your endoscopy for various symptoms or conditions that we evaluate in the clinic or before. So, the field of gastroenterology, you could really get exposure to all different types and wherever your heart lies is where you can thrive in. So, some people just choose to be solely hospital-based. Some people choose to be private in the outside and the outpatient setting. Some people do a hybrid. Me, personally, I like both. So, I still have to figure out where my heart will ultimately reside, but it’s a good flavor, good mix of all types of exposures.

Ariel: Either think of it as one half that’s just entirely surgical like your colonoscopies, your endoscopies, all those types of things, any type of bariatric surgeries or people are on the other side where they’re like, “Yes, I have to see a doctor regularly for a condition that I have.” And I feel like people don’t understand that it’s a good blend depending on what your needs are.

Dr. Advani: Absolutely. It’s actually great to see it on our side because usually when we see patients in the clinic, we can do the appropriate workup and then tailor that to their symptoms. Like, if they need an endoscopy and I perform the endoscopy whichever time later I can correlate that I could be like, “Oh, this is what they were having in terms of symptoms. I need to do X, Y, and Z during my endoscopic evaluation. So, it definitely helps tailor my management to the individual.

Ariel: Yeah. And it sounds like it might be a little bit easier in terms of continuity of care as well.

Dr. Advani: Yeah. Especially in a large metropolitan area, there are a lot of gastroenterologists and a good bulk of that is outpatient chronic care. So, people who have chronic GI conditions, we could talk about inflammatory bowel disease, and IBS, and other types of conditions that really affect people on a day-to-day basis.

Ariel: So, with that in mind, what are some surprising facts or statistics that you think most people don’t know about in terms of GI and colon health?

Dr. Advani: That’s such a good question because I feel like that’s the crux of what I do on my platform. I constantly talk about things that people can do to be more aware about their symptoms. So, one of the major topics I do talk about is colon cancer. And for those listening to a colonoscopy, you know, based web podcast, this is a very important topic. Colonoscopy or colon cancer screening is really one of the major ways to screen for colon cancer and also to prevent colon cancer, which is essentially more or less 100% preventable. And what we’re seeing now in terms of trends is that the incidence of colon cancer is rising and it’s happening in even younger people. So, the most recent data that we’re seeing is that people who were born in 1990 have at least two times risk of developing colon cancer in their lifetime, compared to those born in 1950s. It is the third deadliest cancer in the United States.

It does affect predominantly…it can affect the entire population, 150,000 cases get diagnosed annually. That’s 150,000 people that could, you know, essentially have their cancer prevented just by getting screened beforehand or being aware of some symptoms that could be reflective of it. So, the reason why the screening guidelines have actually went down from 50 to 45 in the last year is because we’re seeing that colon cancer is presenting in, like, younger people. So, what do we do to try to mitigate that? And the mitigation strategy is to drop it by five years, even though you can even make the argument to start screening at an earlier age in certain populations like African Americans where, you know, that population is proportionately more affected by colon cancer. So, that’s one thing I would say with colon cancer.

You could also have no symptoms at all. A lot of people who have colon cancer, they have their colonoscopy and [inaudible 00:10:54] in their colon, and they don’t have any anemia, they don’t have any bleeding, they don’t have any abdominal pain. So, it’s always, even if you don’t have symptoms, you’re at the age of 45 and you don’t have any other preexisting conditions that would increase your risk, you know, you would talk to your GI doctor or any genetic conditions that you start at 45. And if you have no polyps, that’s amazing, then you basically don’t need a colonoscopy for another 10 years. That’s one thing I will say about colon cancer.

Another thing I think that’s important for people to start considering about their colon health is the diet that they’re taking in. And we talk about what increases risk of colon cancer overall. So, the common things that are common is smoking, alcohol use, but also it’s exposure to processed foods, red meat, people who take in less fruits or vegetables, less fiber in their diet. We’re seeing a trend in the risk of colon cancer in those people who fit that category.

I will also say one more thing without rambling too much, but stomach cancer. And stomach cancer, the incidence is going down. It’s about 1.5% down the last few years. That being said, people who have chronic upper GI complaints like you talk about reflux or, like, heartburn, even sometimes cough can be a presenting symptom of reflux, trouble swallowing, abdominal pain. These are all things that are not normal. I’m not saying that it is stomach cancer, but something is going on. Like, you know, you’re not supposed to feel like your quality of life is being affected and having all of these symptoms. So, with stomach cancer, in terms of risk, we talk about smoking, drinking, processed foods, red meat, things that are basically salted meat, that increases the risk of stomach cancer. Especially people who are Hispanic or African American or East Asians, they have a higher risk of stomach cancer.

And one of the things I will circle back to is I do have this sub-interest in obesity, and I think obesity or people being overweight or having a poor diet that leads to this. And obesity is not just a dietary, like, it’s a chronic condition that’s caused by so many different factors. But that in and of itself increases the risk of GI cancer. You talk about pancreatic cancer, GERD, esophageal cancer, stomach cancer, colon cancer. Obesity is a risk factor that has been demonstrated to increase the risk of all these cancers. So, those are all the little tidbits of information I would have to provide

Ariel: You said so many amazing things. And the first thing I wanted to touch on was would you mind providing some clarity for our listeners on the difference between being overweight and being obese? Are those the same things? I feel like there is a lot of confusion about terminology in that particular space.

Dr. Advani: Yeah. Absolutely. Those are such good questions. It’s actually like an actively studied topic because the concept of overweight versus morbidly obese is actually different for people who are not Asian and people who are Asian. So, it’s really the BMI cutoff is what we look at. And then there are also cutoffs for body fat percentage, but mainly the overriding definition is people who are overweight have a BMI of essentially less than 30. And then once you reach 30, you go from 30 to 40, you essentially are categorized into the obese category. And then once you’re over 40 of a BMI, you’re morbidly obese. And not only does your risk of cancers in the GI tract increase, but as the BMI rises, you can increase your risk for other things like heart disease and lung problems, sleep apnea. So, the treatment of GI conditions with regard to obesity it’s not just unifold, it’s multifold.

Ariel: It’s so interesting to me. I feel like there’s so many conversations these days about what you were saying. And I feel like I hear a lot of confusion about these terms and how BMI is being used to evaluate these conditions. So, thank you for explaining for the sake of our listeners who are maybe trying to gain some clarity and understanding about their personal situation and what kind of things they need to look out for.

Dr. Advani: Yeah. And if I may add, I think some people who may fit into the BMI category of obese might actually not be obese. Their body fat percentage might be lower. And that actually characterizes people who wouldn’t have that increased risk. Although, like, that much data is out on that subgroup of people but…And again, another thing I will say is that obesity, it’s not just dietary. There are so many factors like genetic, environmental, your metabolic rate, there are so many things that play into how likely someone is to suffer from obesity. There are a lot of ways to tackle something like that. And that’s why one of my interests is looking into that and being someone who is able to concomitantly treat GI conditions with obesity because I think that it all just ties in super well.

Ariel: That’s an excellent segue to my next question is, how can people work with you? They’re listening right now, they’re like, “Oh my goodness. I think Dr. Advani is exactly the person to help me navigate all of my GI issues that I’m having.” What’s the best way for people to get in touch with you to have you support them?

Dr. Advani: That’s also a very good question. Currently, my job description is in flux because I’m actually moving to California. I’m based in New York right now. So, my quest to provide the care I want to provide is just being intervened currently by another year of a subspecialty where I am going to be training for advanced therapeutic endoscopy and endobariatric. So, after that, I probably will be able to answer that question better, but I am someone that can be reached on my platform. If that’s something, like, I have people reaching out to me and asking me questions on there. Although I can’t really provide medical advice, I can at least point them in the right direction and provide some resources that might be helpful. But, yeah, working with me depends on where I end up settling, if it’s the West Coast or East Coast. So be on the lookout, maybe in the next six to eight months, I’ll probably be updating you all about that.

Ariel: And in the meantime, definitely check out all of her social platforms. I’m gonna link them down below, for so many…she touched on it earlier, but so many amazing, interesting facts and interesting videos and little digestible, easy-to-understand clips of all sorts of facts pertaining to GI health. I just saw a great one on some colon health-related topics just the other day. So, follow her in the meantime while she’s tackling this cross-country move. Wow.

Dr. Advani: It’s really exciting. I’m going to be working with Cedars-Sinai Medical Center in L.A.

Ariel: Oh, awesome.

Dr. Advani: Yeah. It’s a very robust…

Ariel: That’s exciting.

Dr. Advani: I know it’s super exciting and I know I’m gonna get the best of the best training and the support I need. And ultimately, really, like, the ultimate goal that I’m trying to achieve is providing better and efficient care for my patients and more, like, knowledgeable care, more accessible care. So, that’s something hopefully in the works.

Ariel: Yes. And something else that I want to comment on too that you mentioned earlier on in your introduction is your advocacy for women in medicine. And I’m also a huge proponent of that, especially minority women in medicine. So, I personally wanted to thank you for all of the amazing work you are doing to educate people and just push forward that advocacy because it’s so, so important.

Dr. Advani: Thank you so much. That actually means so much to me because it’s been a big part of, like, how I perceive GI care moving forward because I think, as physicians, we should do a good job providing the diversity that our patient population affords us, right? So, if you have one specific gender, you have one specific ethnic background as your physician and you have a patient who’s from a totally opposite background, and although I’m sure attempts are made to create that connection, I think there could be more connection and more trust-building when a patient is able to go to a physician of their choosing, gender, or ethnic background, or language. There’s so many factors.

And especially in gastroenterology and especially when I’m doing an advanced endoscopy where the percentage of women in the workforce in general GI is 15%. And when I’m currently doing, it’s even less, it’s about like 5%, maybe even less than that. And I think I’m overshooting with that percentage. But that just goes to show you that we have to do some work on our end to make sure that we’re providing that multi-faceted care to our patients. Not just providing the actual clinical side, but also the intangibles where, you know, we’re able to connect with them in different levels.

Ariel: Some of the differences that our ethnic and cultural backgrounds can influence our GI health in various ways. So being able to see a provider that takes and understands all of the implications of those things, I feel like will go such a long way in pushing the patient experience forward and having it not just be, like you said, just the medical…

Dr. Advani: The clinical medical side, right.

Ariel: Exactly. Just the clinical medical side. It’s so much more than just that.

Dr. Advani: I totally agree. And GI care is so multifaceted, and a lot of GI conditions, actually, there is a big connection between the mind and the gut, right? Like, I don’t know if you’ve ever heard people say like, “Oh, like when I get nervous, I get the runs or I go to the bathroom.” There’s this hormonal connection and there is a lot of data that’s coming out on this. Like the microbiome, we could really go into all these domains because that’s where, especially things that are not essentially structural, like, if it’s not cancer [inaudible 00:21:17] something structural in GI tract, but the person is still complaining of a lot of issues or complaints then, you know, we have to look into these other domains and try to see if we can help.

And I’ll give you an example, not particularly with this, but why it’s important to be diverse in our field and not just GI but other fields too. But specifically, I know I had a patient who told me that she would refuse to get a colonoscopy because where she currently was living there was no female gastroenterologist. This is before I even hopped onto social media and I was like, “Wow, this is not okay,” because someone isn’t getting the care…Even my mom, she wouldn’t see someone who isn’t female to…And these are very intimate areas that we enter, right, for lack of a better term. We’re doing colonoscopies, like, it’s a procedure, some people just feel more comfortable with a certain gender than the other.

Ariel: I think, especially with procedures like colonoscopies that can be so intimate, it really is so important for us to be able to provide patients the comfort that they need to pursue those things for their care. So, even something like making sure we can acknowledge something like a gender preference is so important.

Dr. Advani: Yeah, absolutely. And I’ll say this maybe million times over in multiple ways, but getting a colonoscopy is as important as getting your mammogram, getting your pap smear, getting your prostate exam, or checking your blood pressure, making sure you don’t have diabetes. These are all part of preventative care. So, it’s just one of the best ways that you could really just take control of your health.

Ariel: Ooh. Yes. And we love that. That’s the perfect note to end on. Dr. Advani, thank you so, so much, this was so many gems that you just sprinkled into our conversation today. Thank you so much.

Dr. Advani: Oh, it’s my absolute pleasure. I really hope that this message comes out wide and far and I’m always available as a resource for sure.

Ariel: Amazing. Everybody, be sure you check the show notes below for all of the links that we mentioned today. And as I always say at the end of the podcast, we all have colon. So, ask your questions, do your research and have a conversation. All right, we’ll see you next time on “The Colon Health Podcast.” Bye.

Dr. Advani: Bye. Thank you for having me.