In this episode of The Scope Forward Show, Praveen Suthrum speaks with Cheryl Sew Hoy, Founder & CEO of Tiny Health, a microbiome testing company that’s redefining preventive care from pregnancy through infancy. Cheryl shares why the first 1,000 days are critical for lifelong gut health, how restoring beneficial microbes matters more than chasing pathogens, and why over 80,000 families are already turning to Tiny Health for answers. Functional medicine has embraced the microbiome faster than GI — but Cheryl makes the case that gastroenterologists are uniquely positioned to lead this revolution. The question is: will the GI community step up before it’s too late?*02:17 - A Founder’s Wake-Up CallCheryl’s journey began with her own C-section baby — realizing how birth mode, antibiotics, and maternal microbiomes shape a child’s lifelong health. This personal story launched Tiny Health.07:17 - 80,000 Families — Real-World ResultsTiny Health has already served tens of thousands. Parents are seeing their kids’ eczema, allergies, and gut issues improve after targeted interventions. The results are hard to ignore.10:09 - Traditional Tests Are Missing the PointStandard hospital stool panels chase pathogens. Tiny Health looks deeper — into beneficial functions like butyrate, GABA, and fiber digestion that actually sustain long-term gut health.30:29 - A Paradigm Shift: From Killing to RestoringMost of medicine (and even functional care) is built on killing pathogens. Cheryl flips the script: start by replenishing beneficial microbes, then address the bad actors if needed.32:01 - Functional Medicine Is Listening. GI Isn’t (Yet).Most adopters today are integrative and functional practitioners. GIs are still skeptical — but Cheryl’s message is clear: when families walk in with data that explains what’s happening, GI needs to lead the conversation, not dismiss it.34:23 - Science Is Catching Up, FastMetagenomic sequencing, functional markers, and AI-driven insights are transforming microbiome testing from “hype” to clinical reality. Evidence is mounting, especially in pediatrics.37:10 - Precision Medicine Is HereForget the daily “probiotic for everyone.” The future is testing first, then tailoring — the exact probiotic, prebiotic, or dietary shift each patient needs. That’s precision GI care.40:29 - The Longevity ConnectionMayo Clinic has already partnered with Tiny Health. Gut tests are moving into mainstream wellness and longevity clinics. Where will GI stand when patients start asking for them by name?44:27 - Infant Gut = Lifelong BlueprintThe first 1,000 days are destiny. Vaginal birth, breastfeeding, and parental microbiomes set the stage for allergies, asthma, and even chronic disease risk later in life.46:44 - A Call to Action for GastroenterologistsMicrobiome testing is no longer fringe. It’s an opportunity for GI to expand its scope, reclaim leadership in gut health, and guide patients with science-backed, personalized care.*#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift #microbiome

What happens when you combine a decade of science, a powerful entrepreneurial story, and two exponential waves—AI and digital biology?You get Geneoscopy.On the latest episode of The Scope Forward Show, I caught up with Dr. Erica Barnell—Co-founder and Chief Science Officer of Geneoscopy. If you don’t know Erica yet, you should. She and her team just raised $112 million in a tough VC environment. Their lead assay, ColoSense, is now the first FDA-approved, RNA-based, non-invasive diagnostic test for colorectal cancer and advanced adenomas.But this conversation went far beyond funding and FDA milestones.We talked about:How AI has replaced costly bioinformatics layers and transformed their R&DHow patients are being guided through diagnostics via smart automation (text, email, even Uber Health)What’s next in IBD precision diagnostics and biomarker innovationWhy AI is not “artificial” at all—and how to use it without fearWhy GI, like OB/GYN, is primed for disruptionThis wasn’t just a company update—it was a glimpse into the future of our entire field.We’re in a convergence era. Biology is becoming programmable. Intelligence is being digitized. And GI—if we lean in—has a front-row seat to reinvent itself.

In this compelling episode of The Scope Forward Show, Praveen Suthrum interviews Jeff Glueck, a tech entrepreneur best known for leading Foursquare and Travelocity, who has now turned his focus to healthcare. Jeff shares his deeply personal story that inspired the founding of Salvo Health — a virtual platform redefining chronic GI care by integrating traditional medicine with lifestyle and environmental health practices.Jeff discusses the fragmentation in GI follow-on care, the unrealistic expectations placed on patients post-diagnosis, and how Salvo aims to close these gaps. The conversation also dives into the role of private equity, the pressures on community GIs, and why collaboration — not bypassing — is key to healthcare innovation.🔹 Top Insights 01:24 - Childhood Seeds Can Shape the Future of HealthcareRaised by a conventionally trained physician father and a lifestyle medicine-inclined mother, Jeff Glueck saw both worlds early. Salvo Health is a direct synthesis of these influences—clinical rigor meets lifestyle-based prevention.03:38 - A Personal Tragedy Exposed the Learning Deficit in HealthcareAfter losing their first child to a preventable condition, Jeff asked: “Where is the data engine that learns from this?” The silence from the OB-GYN revealed a brutal truth: healthcare isn’t learning fast enough. That moment lit the fuse for Salvo.06:37 - Environmental Health Still Sits Outside the Clinical MainstreamWhen his newborn twins reacted to hospital-recommended products, Jeff and his wife discovered how everyday exposures are ignored in standard care. This gap led to MadeSafe.org—and a belief that chronic care must account for what surrounds the patient.09:57 - Gut Health Is the Access Point to Whole-Body CareSalvo chose GI not because it was trendy, but because the gut influences everything—metabolism, immunity, brain health. Starting with IBS, MASLD, and IBD, Salvo tackles the neglected zones of follow-on care.10:56 - Endoscopy-Centric Care Is Creating a Follow-Up VoidCommunity GIs are under relentless pressure to stay in the endoscopy suite. When 99% of scopes show no cancer, what happens to the chronically ill patients? Often, nothing. That’s the void Salvo stepped into.21:40 - Behavior Change Isn’t a Handout—It’s a ProcessTelling a MASLD patient to “lose 10% weight and come back in 6 months” doesn’t work. Without sustained support—coaching, digital monitoring, personalized food and psychology—those patients worsen. Salvo designs for that missing middle.27:55 - Doctor in the Cloud" Works Only If It Respects the GroundA digital center of excellence means little if it doesn’t integrate with real-world practices. Salvo’s model isn’t virtual vs. physical—it’s human + tech, layered thoughtfully.46:55 - Chronic GI Care Must Evolve Into Precision, Intelligence-Based SupportThe long arc of care needs to be reimagined—from episodic and procedural to continuous and insight-driven. Salvo Health is building this new engine—one that learns daily from patients and adapts in real time.#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift

Allied Digestive Health didn’t just grow—it transformed. COO Sap Sinha takes us behind the scenes of one of GI’s most effective private equity-backed MSOs. Learn how a digital-first mindset, thoughtful change management, and practical AI adoption are setting the new standard for gastroenterology.

Top Insights from interview: *06:05 - Middleware Matters: Build for Integration, Not IsolationInstead of relying on legacy platforms, ADH redesigned its tech foundation with open, modular systems that allow interoperability across workflows—from scheduling to billing to care coordination.07:30 - Don't Rehire—Rethink the ModelPost-COVID staffing challenges created the opportunity to fundamentally reimagine operations. Rather than rebuild the old structure, ADH merged human roles with automation to create a leaner, smarter model.14:37 - Cash First, Innovation FollowsADH began its transformation with revenue cycle automation—an area that directly impacts cash flow. This strategy built internal confidence and funded broader innovation.19:12 - The EMR Interface Is Becoming InvisibleDocumentation is shifting away from keyboards and templates toward real-time, intelligent capture. The clinician's experience is being reimagined—less typing, more presence.26:09 - Incentive Structures Must Evolve for Innovation to ScaleADH’s hybrid compensation model—balancing individual productivity with group success—enabled collective investment in future-ready initiatives.29:02 - AI Agents Are Already Enhancing Clinical OperationsADH uses AI-driven systems that proactively identify gaps in care and initiate outreach—ensuring patients return for needed visits, without burdening staff.33:22 - Change Management Is the Real Tech StackEvery operational upgrade included human considerations: trust-building, role evolution, and reskilling. Technology was introduced with empathy, not disruption.36:50 - The Org Chart of the Future Is Human-AI HybridADH is already moving toward a model where humans work side-by-side with digital assistants—handling everything from appointment scheduling to financial workflows. This shift enables smaller teams to do more, with higher precision.44:34 - GI Leaders Must See Beyond the Exam RoomSap urges GIs to expand their lens: understand the business, engage with systems thinking, and experiment boldly. The world is changing faster than most realize—and GI must not be left behind.

*

#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift

In this Scope Forward conversation, Praveen Suthrum speaks with Leo Grady, founder and CEO of Jona. Leo’s background sits at the intersection of healthcare AI and microbiome science — a rare combination that’s defining the future of gut health diagnostics.Their discussion explores why the microbiome is not a distant promise but clinically actionable today. They dig into why AI isn’t just a tool but a necessity to interpret the complex, rapidly expanding world of microbiome research. Leo breaks down how Jona’s platform creates a “digital twin” of the gut microbiome, simulating evidence-based interventions rather than offering general advice.Praveen and Leo also dive into why most existing microbiome companies miss the mark — often selling supplements rather than driving real clinical change — and how Jona was built to fill that gap with science at its core. The conversation closes with a look at why gastroenterology must — and is beginning to — take the lead in bringing microbiome research into everyday practice.Top Insights from the Conversation:

02:27 - The Microbiome Is Clinically Actionable — Today
Thousands of studies already link gut flora to chronic disease. Leo challenges the belief that it’s “too early” — arguing there’s sufficient evidence to act now, not a decade later.

03:57 - AI Is the Only Way to Navigate the Complexity
With 2,000+ new studies published monthly, no human can keep pace. Jona’s custom AI filters and interprets this tidal wave of research, making personal, evidence-based recommendations possible.

05:03 - Jona Builds a Digital Twin of the Gut
Jona sequences an individual’s microbiome and models how interventions — diet, supplements, medications — would alter it, based on interventional studies. It’s a simulation grounded in real, published science.

10:23 - Most Microbiome Startups Fall Short
Many existing companies sell the promise of gut health, but without scientific rigor. Jona was founded because Leo saw an opportunity to ground microbiome testing in solid evidence, especially for serious GI conditions.

15:45 - Business Model: AI-Powered Microbiome Insights

Jona sells precision gut tests, using AI to match microbiome data with clinical research—delivering evidence-based insights, not supplements.

22:19- Clinical Use of Microbiome Testing Must Be Evidence-Based

Jona’s recommendations — whether to change diet or introduce a probiotic — are directly tied to published research, with confidence scores that help clinicians weigh the strength of evidence.

26:43 - Jona’s AI as a Domain-Specific Language Model

Jona’s AI acts like a specialized LLM trained on microbiome literature—matching patient data to published studies and simulating outcomes. It doesn’t just read research; it reasons with it.

37:05- Gastroenterology Must Lead the Way — and It Is
While the microbiome has often been developed outside of GI, Praveen and Leo highlight how the field is shifting. GI physicians, with leaders like Dr. Lawrence Kosinski, are increasingly stepping up to shape the future of microbiome diagnostics and therapeutics.

#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift #microbiome

Countdown to AI Super Intelligence has begun

On Scope Forward, Matt Schwartz—Founder and CEO of Virgo—unveiled EndoML, a clinician-facing platform built on Virgo’s massive foundation model, EndoDINO. This isn’t just another AI update—it’s a turning point for gastroenterology.

With more than 2 million full-length endoscopy videos and a platform that lets any clinician train models using their own technique, Virgo’s trajectory signals a fundamental shift—from industry-led tools to clinician-owned AI.

This isn’t an update. It’s a wake-up call.

Matt lays out a bold vision: Imagine any endoscopist building a CADx system tuned to their own hands, their own diagnostic eye. Picture AI not as a separate assistant, but as an extension of the clinician—scaling personal expertise across teams, institutions, even continents. And what if the real bottleneck in AI for GI wasn’t regulatory, but data—and that hurdle is already behind us?

EndoML isn’t just a tool—it’s a scaffolding layer for AI-native medicine. If you're in GI and not exploring this shift, you may already be behind the exponential curve.

This interview made me feel both thrilled and uneasy—but that’s what happens when you realize the shift is already underway.

Top Insights:

01:55 - The World’s Largest Endoscopy Video Database
Virgo has captured over 2 million full-length HD endoscopy videos, with more than 1 million new procedures added annually. This massive dataset fuels the power of its AI.

03:14 - EndoML: AI for Every Endoscopist
EndoML lets clinicians upload, label, and train AI models using their own data—cutting down the training volume needed to build high-performance models.

05:52 - EndoDINO Enables Generalizability
Trained on 3.5 billion frames of real-world data, EndoDINO powers models that can generalize across diverse clinical environments.

26:42 -AI as an Extension of the Endoscopist
Clinicians can now train AI to reflect their personal technique—transforming AI into a mirror of their expertise and enabling scalable, high-fidelity clinical replication.

28: 01 - From AI Models to Autonomous Robots
As EndoML captures clinical intent and expertise, robotic endoscopy becomes viable—AI not just assisting, but eventually performing under oversight.

31:03 - The Exponential Fallacy: Why Most Will Miss the Curve
Matt highlights a recurring trap in tech: underestimating exponential growth. In GI, tools like EndoML are advancing faster than most realize.

37:03 - Humanoid Robots in GI? It’s Coming
With advances in robotics like Tesla Bot and Figure, GI procedures may one day be performed by humanoid robots—powered by clinician-trained AI.

39:25 -  The WTF Curve of Innovation
Your first reaction might be disbelief. But just past that “WTF” moment lies opportunity—for early adopters willing to lean in and shape the future.

46:40 - AI in GI Is Moving Faster Than You Think
From foundational models to clinical tools, AI’s pace in healthcare is accelerating. The gap isn’t technical—it’s mindset. Those who delay may be left behind.

*#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift

Dr. Neil Parikh, Chief Innovation Officer at Connecticut GI and Chair of the GI Alliance Innovation Committee, brings a refreshingly grounded perspective to the future of gastroenterology. For him, innovation isn’t research—it’s real-world feasibility. It’s pilot programs born from pain points like access, cost, and patient satisfaction. And it’s about using the scale and clinical volume of independent practices to drive meaningful change—shaping not just care delivery, but potentially the guidelines themselves.In this candid conversation, Dr. Parikh maps out where GI is headed: AI-powered triage and documentation, actionable microbiome data, non-invasive diagnostics, and the quiet revolution of food and alternative therapies. He also confronts uncomfortable truths—how procedural pressures limit innovation, why most ideas fail, and how listening to patients might be the most radical act of all.

*02:24 - Innovation Is Feasibility, Not Just ResearchDr. Parikh distinguishes innovation from academic research—it’s about pilots and practical implementation at scale within large independent practices.

04:11 - Pain Points Drive InnovationThe three main challenges—access, cost, and patient satisfaction—are core drivers of innovation in gastroenterology today.

05:31 - AI in Every Step of the GI WorkflowFrom pre-visit triage to in-room documentation and post-visit care coordination, AI is envisioned as a co-pilot in delivering efficient, real-time GI care.

08:56 - Image Recognition in Endoscopy Is Just the BeginningAI’s role in computer-aided detection (CADe) is evolving beyond polyps—towards liver, pancreas, and upper GI diagnostics.

09:34 - The Microbiome Will Become ActionableThe future lies not just in mapping gut flora but in personalizing interventions (diet, lifestyle) based on microbiome data—and gastroenterologists must lead this shift.

12:16 - The Future of GI Will Require Non-Invasive DiagnosticsLimited capacity for colonoscopies and rising costs necessitate non-invasive tools to triage and expand screening for cancers and chronic conditions.

21:49 - Innovation Needs Leadership That Sees Beyond RVUsFor roles like his to exist, organizational leaders must value long-term transformation over short-term productivity.

28:28 - Podcasts as an Innovation EngineDr. Parikh’s Gut Doctor podcast began as an internal education tool but evolved into a national platform.

31:18 - Dr. Parikh Integrates Food, Lifestyle, and Alternative Therapies into GI CareFrom yogurt to apple cider vinegar to adult coloring books, Dr. Parikh integrates low-risk, patient-driven solutions into mainstream GI care—with humility and openness.

42:07 - The Gut-Brain Axis Is Central to GI CareStress, sleep, and mental health directly affect GI function. Behavioral tools like CBT, mindfulness, and even “phone detox” are practical levers for healing.

47:06 - Physicians Still Want to See Patients—The System Doesn’t Let ThemContrary to perception, most GIs value patient interactions. However, systemic incentives push them toward procedures. Changing reimbursement models can rebalance the equation.

52:24 - Younger Physicians Need to Be Honest About Their GoalsTrainees often say what’s expected to secure jobs. Neil advises them to take time, be honest with themselves and their future employers to build meaningful careers.

*

#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift

A Tech-Startup and a GI Giant Just Redefined Clinical Research

What happens when the largest GI practice in the country partners with a digital-native startup?

You get more than scale. You get a radical redesign of how clinical research works—where trials no longer live on the sidelines of care, but at its very center.

On The Scope Forward Show, Dr. Jonathan Ng (Founder & CEO, Iterative Health) and Dr. Casey Chapman (CMO, GI Alliance) announced a first-of-its-kind alliance:
→ 80 research sites across the globe
→ A shared platform for trial execution at the point of care
→ And a vision to restore agency to physicians while unlocking equitable access for patients

“It’s not about trial volume. It’s about raising the standard of care through research.”
– Dr. Jonathan Ng

“If this was just about ROI, we wouldn’t be here. This is about building the future—with physicians, for patients.”
– Dr. Casey Chapman

This isn’t a financial partnership. It’s a systemic intervention—two years in the making—that breaks through recruitment bottlenecks, removes operational friction, and makes GI a launchpad for drug innovation.

I'm excited about this announcement because it signals a shift not just for the organizations involved but for GI at large.

Top 10 Highlights:

1. A Historic Alliance: The world’s largest GI research network is here—80 sites and growing.
2. Two Years in the Making: What started as “what if” became a deeply aligned mission.
3. Research Where Care Happens: Clinical trials integrated into community-based care.
4. Choosing a Startup: GI Alliance chose Iterative Health for their patient-first, flexible approach.
5. Beyond Tech: Iterative learned that tools alone can’t solve broken systems.
6. Focus on IBD & Liver: Targeting the conditions that matter most to real-world GI patients.
7. Success = Empowerment: The goal is a generation of research-empowered GIs.
8. Advice for Startups: Lead with listening, not just tech.
9. Why Scope Forward: A platform aligned with values of physician empowerment.
10. It Was Always About People: Partnership success came from shared priorities—not profit motives.

What happens when a data scientist with IBS meets a digital health operator scaling virtual GI care? You get more than an acquisition—you get a glimpse of where gastroenterology is headed.On this episode of The Scope Forward Show, Asaf Kraus (founder of Dieta Health) and Bill Snyder (founder & CEO of Cylinder Health) join me to announce Dieta’s acquisition. But we didn’t stop at the deal.We talked AI, clinical outcomes, and why digestive health—despite affecting millions—remains underrecognized in digital health. Cylinder has already served 100,000 patients. GI care represents a $136 billion market, mostly buried in fragmented smaller markets. That’s starting to change.Asaf’s journey—from Uber to founding Dieta—shows what happens when lived experience meets data science. Bill’s work at Cylinder is proof that virtual GI care can scale with rigor and stay grounded in patient outcomes.This conversation isn’t just about what just happened. It’s about what’s next—and who’s willing to build it.

*

Key takeaways:

01:41 - Acquisition announcement on The Scope Forward Show

Asaf explains that he deliberately chose Praveen’s platform because of its broad reach and innovation-focused GI community. He cites last year’s GI Mastermind Conclave as an example of how influential this community can be.

03:23- Dieta Health’s Origins

Asaf recounts how a personal bout with IBS during his time as a data scientist at Uber inspired him to apply data-driven personalization to GI care.

05:17 - Dieta’s AI Revolutionizes GI Diagnostics

Dieta ran four clinical trials and served 25,000 patients, confirming the viability of AI-based stool classification. Asaf references the trials to highlight that the solution is clinically grounded, not just theoretical.

06:53 - Cylinder’s Perspective and Asaf’s Motivation

Bill details how he has known Asaf for years and admired Dieta’s dedication to personalizing care.

10:52 - The Scale and Scope of Cylinder

Cylinder has already served 100,000 members with GI conditions and is on a rapid growth trajectory.

15:12 - Future of Gastroenterology and AI

Praveen asks both guests to imagine GI care a decade from now in light of recent AI leaps.

22:36 - Bill’s Background & Founding Cylinder

Bill traces his career from Humana (understanding the payer/provider landscape), then Virta Health (diabetes-focused) to eventually founding Cylinder in 2021.

25:27 - Fundraising for Cylinder

Bill clarifies how investors recognized GI’s massive, often-hidden market potential—buried in scattered claims data—and were drawn to Cylinder’s proven outcomes and cost-saving evidence, resulting in about $50 million in raised capital.

29:01 - Advice for entrepreneurs to fundraise in GI

Bill urges entrepreneurs to reveal GI’s large, underrecognized market, noting that scattered claims data masks its full cost.

32:19 - Bill’s Path to Success

Bill highlights two key enablers: first, educating the market on GI’s huge needs and second, strengthening partnerships with payers, employers, and providers.

35:14 - Cylinder Health's operational model

Cylinder’s two-pronged offering combines a core product (health coaches + dietitians) with a full-stack virtual clinic (gastroenterologists + lab/prescription services).

38:41 - How Cylinder differs from competitors

Cylinder commits to measurable outcomes, ROI, and patient satisfaction.

44:33 - Embracing Potential Disruption

When asked about AI advancements possibly surpassing human capabilities—thereby disrupting Cylinder’s model—Bill views it as an opportunity rather than a threat.

*

#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift

Dr. Brennan Spiegel, a physician, researcher, and author at the forefront of digital therapeutics, is challenging everything we know about gastroenterology. From virtual reality (VR) reshaping IBS treatment to AI rewriting the role of physicians, he sees the gut not just as an organ—but as an entire unexplored universe.In this conversation, he unpacks what the gut-brain axis is, why GIs are falling behind in microbiome research, and how gravity itself could be influencing gut health in ways we’ve never considered. He also dives into AI—how it’s extending human capabilities while simultaneously shrinking cognitive function, and what this means for the future of medicine.This isn’t just another conversation about the future of GI. It’s a wake-up call. Are we evolving with technology, or is technology evolving us? Let’s find out.*Virtual reality (VR) is transforming GI care – VR has been shown to alter cortisol levels, body temperature, and even immune responses, offering a new frontier for pain management and IBS treatment. The gut-brain-microbiome axis is real – The vagus nerve plays a critical role in two-way communication between the brain, gut, and microbiome, influencing motility, mood, and immune function. Startups, not GIs, are leading microbiome research – Despite its massive potential in GI, microbiome innovation is being driven by startups rather than physicians, creating a disconnect between research and clinical practice. Your gut is a universe – The microbiome is vast and largely unexplored, with a complexity comparable to the cosmos or human consciousness. Understanding it could shape the future of medicine.

The microbiome is central to total human health – With 90-95% of serotonin produced in the gut, the microbiome affects not just digestion but also mental health, immune function, and chronic disease. Gravity is shaping human health in ways we don’t realize – In his new book Pull, Dr. Spiegel introduces biogravitational medicine, explaining how conditions from IBS to depression may be linked to our relationship with gravity. AI knows you better than you know yourself – AI is not just replacing tasks—it’s reshaping human thought and behavior, raising concerns about our increasing reliance on digital intelligence. Human cognitive abilities are shrinking—just like our motor skills did with machines – Much like how automation reduced our physical activity, AI may cause us to lose skills like memory, navigation, and decision-making.

AI is both extending and shrinking the role of GIs – AI will enhance diagnostics, automation, and decision-making, but it will also reduce the need for traditional expertise in many areas, shifting physicians' roles. To stay relevant in the AI age, embrace technology but master human skills – The future of medicine will favor empathetic, wise, and adaptable physicians. AI won’t replace doctors, but doctors who use AI will replace those who don’t.*#digitalhealth #gastroenterology #thescopeforwardshow #nextservices #gi #future #ai #theshift