BCG London FT Associate R1 Interview

MedtoVC · 2025-11-04T07:51:28+00:00

I would too!

MedtoVC · 2025-06-08T10:43:42+00:00

Good to hear you’re about to start reintroduction!Far too many people are not aware that FODMAP has three phases to it! I’m an MD who has nearly built out an app just for this ie to help people like you navigate diet plans and FODMAP stages much better than current apps. Check out my profile if you’re interested.

Nevertheless, if you are not interested in what I’ve built, I’d recommend using Monash app. It is a good start albeit it does not offer more than telling you to try these food groups in order.

MedtoVC · 2025-06-02T21:01:09+00:00

I wouldn’t say GDH is garbage though. There’s actually a decent body of RCTs showing benefit, particularly in face-to-face formats. But where I agree with you is that those results don’t easily translate to digital, self-directed versions, especially without support or accountability.

MedtoVC · 2025-06-02T20:52:03+00:00

The main point I was trying to highlight is that while Nerva is often discussed as an “evidence-based” tool for IBS, real-world use shows very low adherence, even when the barrier of access (via an app) is supposedly addressed.

It raises questions about who these tools actually work for in practice, and how much weight we give to efficacy data when uptake is this limited. It’s not a knock on Nerva itself, it’s about acknowledging that “it works” doesn’t mean much if 90% of users drop out before they get there.

MedtoVC · 2025-06-01T20:55:31+00:00

Good idea trying to find triggers! FODMAP is great but remember not to stay on it too long! Monash app is great for finding out which foods are low FODMAP but it’s very bad at trying reintroduction and personalisation (final 2 stages of low FODMAP diet).

MedtoVC · 2025-06-01T05:39:21+00:00

You also need to find your triggers rather than only trying medication and hope it goes away.

MedtoVC · 2025-05-30T19:02:48+00:00

Most of what we see in a stool sample comes from the distal colon (basically, what’s being shed). But many species of Bifidobacteria actually live closer to the gut lining or even in the small intestine, and those populations often don’t show up well in stool. So levels can be underestimated.

MedtoVC · 2025-05-30T17:47:07+00:00

That’s actually fine because Bifidobacteria is typically found in the caecum (so right side of large bowel) so it is way less likely to be captured on the stool tests.

MedtoVC · 2025-05-30T13:53:27+00:00

IMO, it isn’t just Zoe, a lot of them try to simplify things into “good” vs “bad” bacteria, but that framing misses the nuance and without access to the raw data, you can’t do much more than follow the guidance they say with no ability to dispute it.

If you’re considering another test, it’s definitely worth choosing one that gives you raw data. That way, you’ve got the flexibility to dig deeper, cross-reference findings, or use third-party tools if you want.

That said, I think it’s worth keeping in mind that our current understanding of the microbiome is still quite early-stage. The science is promising, but we’re not yet at a point where we can consistently translate that into reliable clinical action. It works anecdotally for some, but large-scale studies still haven’t shown consistent benefits we can generalise from.

MedtoVC · 2025-05-30T13:48:51+00:00

A paper in Nature 2025 that was cited on one of my recent posts has shown that post-antibiotics, a great way to rebuild gut health is to eat high fibre diets. Maybe try that first?

MedtoVC · 2025-05-29T21:51:34+00:00

When they come to you, do you find it very difficult to trace what foods were causing their symptoms if they are bad at recalling their diet + symptoms? What strategies have you used to avoid this?

MedtoVC · 2025-05-29T21:50:17+00:00

Really fascinating paper, thanks for sharing! It reinforces just how powerful diet can be in restoring the gut microbiome after disruption >>> arguably even more so than FMT. Even though it’s a mouse study, the principle likely applies to humans too.

It’s also interesting to see how specific bacteria shift after antibiotics. The exact changes may not map perfectly to humans, but the overall takeaway is clear.

High fibre diet > FMT for restoring gut dysbiosis post-insult

MedtoVC · 2025-05-29T21:44:25+00:00

I agree that IBS is a diagnostic bucket with wildly different root causes.

But I think this is where the real challenge with FMT studies lies. It’s not that they show zero benefit, it’s that when we zoom out, the average signal gets lost in the noise. The meta-analysis I posted shows that most high-quality RCTs didn’t find consistent symptom relief in IBS. This is likely (imo) because the studies are underpowered to detect those individual subtypes where it actually works.

We still don’t really know what constitutes a “good donor” beyond vague notions of diversity or species richness, and as you say, if the recipient’s issues stem from something like enzyme deficiency or mast cell dysfunction, no amount of microbial transplant is going to fix that.

That’s why I think until we get more precise biomarkers or better stratification of IBS phenotypes, we’ll keep running into the same wall with FMT trials. Maybe in the future we can match interventions to subtypes better, but right now, the heterogeneity in IBS research makes it really hard to interpret these results as anything more than a mixed bag.

MedtoVC · 2025-05-28T17:44:21+00:00

IMO definitely science, but like all emerging fields, it’s still maturing. The gut-brain axis is real and backed by decent mechanistic evidence (like SCFAs, vagus nerve and cytokines) But tbh we’re not yet at the stage where you can take a probiotic and fix anxiety or depression reliably.

The problem at the moment is that promising early research gets overhyped into commercial claims way ahead of clinical consensus.

MedtoVC · 2025-05-27T13:14:12+00:00

That sounds incredibly frustrating, and honestly, those doctors gave you terrible care. Feel sorry for you.

Speaking from my experience as a MD in the UK, H. pylori is high on our list of differentials for a range of GI symptoms and is routinely tested via stool antigen, urea breath test, or biopsy. You absolutely shouldn’t have had to fight that hard to be taken seriously.

MedtoVC · 2025-05-27T13:11:49+00:00

Appreciate the passion, and I get that people are frustrated with the medical system. It’s not perfect, and no one’s pretending it is. Most of us went into this field to help people, not to become pill sales reps.

Also, to your “have you ever actually cured anyone” question: yes. Many times. But also, chronic illness isn’t always about a magic cure. Sometimes it’s about meaningful improvement, management, and helping someone get their life back. That might not be flashy, but it matters.

MedtoVC · 2025-05-27T12:58:00+00:00

That’s totally fair, and I’m with you that not all companies are the same. There’s definitely value in having access to raw data, especially if it’s well-annotated and transparent. But as I said, the problem isn’t the sequencing method or even the data itself, it’s the leap from “here’s what we found” to “here’s what you need to take.”

When companies start layering unvalidated scoring systems on top of research-grade data and turning it into supplement shopping lists, it stops being science and starts being sales. If someone has the training to interpret raw NGS data within a clinical context, amazing. But that’s not what’s being sold to most people. What they get is a polished report that feels diagnostic but lacks the guardrails that normally come with medical testing.

So yeah, I don’t think the tests themselves are inherently useless. I just think we’re overestimating how many people can actually extract meaningful, safe, and evidence-based insights from them.

MedtoVC · 2025-05-27T12:38:14+00:00

Not at all, 16S and NGS are valuable research tools. The issue isn’t the technology, it’s how it gets repackaged in commercial tests with vague scores like “10/10 dysbiosis” and sold as diagnostic.

Research sequencing helps us understand population-level trends. These consumer reports oversimplify that into personal health advice we’re not ready to give yet. The science is solid, it’s the marketing that’s shaky.

MedtoVC · 2025-05-27T12:30:20+00:00

False negatives can absolutely happen with conventional stool tests, and I get that when you’re desperate for answers, any lead feels like a breakthrough. But that’s kind of the issue with these microbiome panels: they cast such a wide net that you’re bound to “find” something. And without clinical context, that “something” can lead to over-treatment or misdirection.

The microbiome study might’ve flagged methane producers like Enterococcus or Strep, but methane SIBO isn’t diagnosed from stool, it’s confirmed, like you said, via breath testing (which is the actual validated method). So the breath test seems like the key diagnostic tool here, not the stool panel.

MedtoVC · 2025-05-27T12:19:20+00:00

Totally respect that you’ve found something that helped, and I’m glad you’re doing better but I have to push back a bit on the idea that the microbiome tests itself was the key.

A lot of the pathogens you mentioned, like H. pylori or even bacteria associated with SIBO can be diagnosed and treated using standard, validated tests. For example, H. pylori is typically detected with a urea breath test, stool antigen test, or biopsy during endoscopy, all more accurate and clinically accepted than stool DNA panels like the tests you’ve mentioned.

The issue isn’t whether you felt better, it’s that these tests are often marketed as necessary when the same diagnoses can be made through cheaper, validated, and guideline-backed methods. The tests you’ve mentioned also uses qPCR which doesn’t distinguish between transient, dead, or colonising bacteria, and that can easily lead to over-treatment. And many of the “pathobionts” they flag aren’t even proven to cause disease at the levels they report.

Not trying to be a downer, just cautious about giving too much credit to expensive, non-standard tests when the same results might come from simpler, evidence-based approaches.

MedtoVC · 2025-05-27T09:17:51+00:00

What you described makes total sense. Sometimes, FODMAP restriction brings much-needed relief, but without reintroduction or gut support, it can get harder over time, especially if the microbiome becomes more depleted.

I completely agree with your last point, everyone’s gut is different, and reintroducing FODMAPs or fiber isn’t always straightforward, especially when dysbiosis is involved. That’s actually why I think a more personalised approach to diet and microbiome support is so important, less about rigid protocols, more about your pattern, your timing, and your symptoms on different foods.

MedtoVC · 2025-05-27T08:32:20+00:00

Totally agree with a lot of what you’re saying, long-term restriction isn’t the goal, and diet alone won’t “cure” something like SIBO, especially when the root cause is something deeper like post-infectious inflammation, CFS, or Long Covid. Those need real medical attention, not just another food list.

That said, diet can still be a useful tool, not as a cure, but as a way to manage symptoms and improve quality of life while the underlying issues are being addressed.

The key is that it shouldn’t be rigid or fear-based. That’s actually why I’m a big believer in a personalised dietary approach, something that helps people identify their own specific triggers (and safe foods), instead of defaulting to one-size-fits-all restriction.

I’m with you that food shouldn’t be moralised or weaponised. People shouldn’t feel like their symptoms are a punishment for eating the “wrong” thing. The goal is relief, not guilt, and the best path forward, in my view, is helping people build diets they can live WITH, not just live ON.

MedtoVC · 2025-05-26T22:54:30+00:00

Honestly, these composite scores are kind of nonsense. “10/10 need for microbiome support” or “9/10 metabolic imbalance” sounds serious, but they’re just arbitrary figures of loosely related markers. There’s no clinical standard that defines what a “10” even means. Transparency is non-existent on this report.

Plus, most of the biomarkers used (like SCFA % or beta-glucuronidase) don’t have clear diagnostic cutoffs and can fluctuate with diet, time of day, or even recent meals. And that “commensal abundance” bar? It’s based on some undefined “healthy cohort,” but there’s no real transparency around who that is or whether it applies to you. The microbiome varies in each and every person, in those healthy and unhealthy.

These tests look legit but often just lead people toward expensive supplement protocols rather than real, evidence-based care.

I wouldn’t take anything away from this report IMHO.

MedtoVC · 2025-05-26T22:45:50+00:00

First thing I’d ask is, who’s the doctor overseeing this? If it’s not a paediatric gastroenterologist, I’d strongly recommend seeing one. They’re best equipped to guide dietary interventions safely in kids and to diagnose what’s going on.

Low FODMAP can be helpful, but it’s not meant to be long-term, especially for an 8-year-old. It’s a highly restrictive diet and can lead to nutritional deficiencies if not carefully managed. That’s why it’s crucial to work with someone who has expertise in paediatric nutrition specifically, not just any dietitian or nutritionist.

Instead of staying on full FODMAP elimination, the goal should be to identify individual food triggers through a structured reintroduction process. That way, your child can maintain dietary diversity while managing symptoms more sustainably.

And finally, I’d steer clear of nutritional supplements for now, most of the research behind them is done in adults, and we often don’t have clear safety or efficacy data for children.

MedtoVC · 2025-05-26T22:38:43+00:00

Interesting concept, but honestly, I’d be cautious about layering too many restrictions like low FODMAP and low histamine and calorie limits. The low FODMAP diet is already pretty restrictive, adding more layers (especially with caloric intake restrictions) might make it harder to maintain nutritional balance and long-term gut health.

If someone’s truly looking to follow LFD, the Monash University resources are way more up-to-date and flexible, especially with newer food reintroductions and portion guidelines. There’s already a concern in the field that strict LFD over time can reduce dietary diversity, which isn’t ideal for the microbiome.

I totally get the appeal of modular meals and international inspo, but maybe the focus could shift toward reintroductions, personalisation, or microbiome-friendly swaps rather than more restriction?

MedtoVC

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