Padma Vibhushan awardee Dr. Nageshwar Reddy on innovation, health, and the road ahead

Absolutely! When I received the Padma Bhushan, I was the first gastroenterologist to be awarded the honour, a significant recognition for the speciality. In fact, in the past 70 years, only 13 doctors have received the Padma Bhushan, and most of them were from Delhi, primarily from institutions like AIIMS, with the majority being cardiologists. This makes it even more meaningful that gastroenterology is now acknowledged at this level. Beyond personal recognition, I believe this award also highlights the broader contributions of the Asian Institute of Gastroenterology (AIG). Over the years, AIG has evolved into a multi-specialty institution. Our efforts during the COVID-19 pandemic, in particular, played a key role. For nearly two years, we focused entirely on COVID-19 — providing affordable healthcare, conducting extensive research, and publishing nearly 100 cutting-edge papers on topics like India’s unique COVID response, vaccine efficacy, and immunity patterns.

One of our most impactful contributions was authoring India’s first COVID-19 protocol book, which was distributed to over one lakh doctors nationwide. This book laid out structured guidelines for treatment and vaccination, helping streamline medical response during the crisis. In addition to research and treatment, public education was a major focus for us. There was widespread fear and misinformation, so we set up a COVID Studio — a dedicated podcast and video platform where our specialists provided daily updates and guidance on YouTube and television. Our efforts were widely recognised, with government officials frequently referencing our work. Unlike institutions directly under government jurisdiction, we took on this responsibility voluntarily, not as a financial venture but as a commitment to society. While the economic returns may not have been significant, the recognition and, more importantly, the satisfaction of having made a meaningful impact have been rewarding.

Over the past decade, your role in healthcare has expanded significantly. How do you reflect on this journey and its impact?

I was primarily a gastroenterologist and a researcher, leading a close-knit team of about 25-30 specialists a decade ago. We put gastroenterology on the map in India and gained global recognition for our research and innovative procedures. Since 2018, our focus has expanded beyond a single speciality. AIG has grown into a multi-speciality powerhouse with 500 consultants across fields like cardiology, neurology, and oncology. Managing such a diverse requires a different leadership approach.

Scaling up also meant dealing with new financial complexities. Running a hospital with 8,000 employees requires a different economic model than a smaller institution. I had to educate myself on large-scale finance and rely on experts to manage the shift. Today, our research projects involve crores, not lakhs, and our CSR initiatives have a much larger impact — for instance, last week, we donated a crore to PGI Chandigarh, where I trained. The journey has been more demanding but also deeply fulfilling.

A decade ago, when you revolutionised GI endoscopy, did you ever imagine that AI would become such a significant part of your work?

Not at all. In fact, until five years ago, I was sceptical about AI in medicine. I believed healthcare was solely about human intelligence, empathy, and direct patient interaction. I didn’t fully understand AI’s potential, and at the time, its role was mostly limited to computer vision, identifying lesions in images. As an experienced doctor, I thought that wasn’t necessary.  However, AI has evolved far beyond that. Today, we’re integrating large language models like ChatGPT into robotics, using AI-driven natural language processing for patient records, and even developing smart hospital beds that monitor vitals and adjust treatment in real-time.

One breakthrough is our AI-powered iSAVE system, which tracks patient data centrally and predicts medical emergencies hours in advance, allowing doctors to intervene before a crisis. As a result, we’ve nearly eliminated code blue alerts in our hospital, saving lives every day.

AI is also transforming hospital efficiency. For example, we used AI to redesign our pre-surgery process, reducing patient dropout rates and improving workflow. Even our AI-driven assistant, MIRA, handles routine patient queries, freeing up doctors’ time.  Initially, I doubted AI’s ability to bring compassion into medicine. However, recent studies show AI can be trained for empathetic responses — sometimes even outperforming tired doctors. Seeing its impact firsthand, I’m now a believer in AI’s role in healthcare, from improving diagnosis and efficiency to enhancing patient care and overall hospital management.

There’s a growing conversation about gut health. Is the gut the new heart?

The gut is more than just the new heart — it is the heart, brain, kidneys, and everything in between, influencing digestion, metabolism, brain function, and even heart disease. Once considered secondary to the heart and brain, the gut is now recognised as the body’s foundation. Its microbiome, made up of trillions of bacteria, outnumbers human genes by nearly 100 times and affects everything from weight management to mood regulation.

The gut bacteria process food, produce neurotransmitters like serotonin and dopamine, and impact energy levels. Active gut bacteria promote well-being, while imbalances can lead to lethargy and obesity. Recent research links gut bacteria to heart disease, with compounds like TMAO emerging as key risk factors. This suggests that gut health, rather than the heart alone, may be crucial in preventing cardiovascular issues.

The surge in gut health research is driven by technological advancements. Until recently, only 30% of gut bacteria could be cultured, as most are anaerobic and die upon oxygen exposure. Innovations like metagenomics, metatranscriptomics, and metabolomics have revolutionised our understanding, revealing vast differences in microbiomes across urban, rural, and tribal populations.

With rising cases of lactose intolerance and debates around dairy consumption, is milk becoming the new untouchable in modern diets? 

Milk has been a topic of debate, and increasingly, research suggests that consuming milk from another species may not be ideal for humans. Unlike human breast milk, which is specifically designed for infants and provides essential proteins and beneficial bacteria, cow’s milk is naturally formulated for calves, helping them grow rapidly in their early months.

Humans are the only species that consume milk from other species, which may not match nature’s design. Many adults lack the lactase enzyme required to digest lactose, leading to intolerance and gut issues. Additionally, cow’s milk proteins can trigger allergies in some individuals. While fermented dairy products like yoghurt reduce some of these concerns, the idea that milk is essential for human nutrition is now being re-evaluated.

Many scientists have extensively studied milk, including its effects on the body. A renowned Japanese researcher has recently uncovered the full range of milk’s side effects, along with its impact on the microbiome. His findings reveal that consuming milk alters the composition of gut bacteria, creating a microbiome significantly different from that of individuals who do not consume milk.

Why is there increasing emphasis on adult vaccination in healthcare today?

The COVID-19 pandemic increased awareness about adult vaccination, shifting the belief that vaccines are only for children. In response, our hospital established one of the country’s first adult vaccination centres. Key vaccines for adults include the influenza (flu) vaccine, especially crucial for those over 60. Since flu strains change yearly, a new vaccine is released every October. India follows the Southern Hemisphere version, while travellers to the US need the Northern Hemisphere variant. The shingles (herpes zoster) vaccine is vital for older adults and immune-compromised individuals, helping prevent a painful viral infection. The hepatitis B vaccine, long available, protects against liver complications, while the pneumococcal vaccine is recommended for the elderly and those undergoing surgeries to prevent severe infections.

A common misconception is that a universal cancer vaccine exists. While no vaccine directly prevents cancer, some, like the hepatitis B vaccine, lower liver cancer risk by preventing hepatitis-related complications.

As vitamin D deficiency becomes widely recognised and managed, why is there now a growing focus on magnesium deficiency?

While vitamin D deficiency remains a concern, awareness among doctors and the public has significantly increased, leading to widespread supplementation. The recent shift in focus toward magnesium is not because its deficiency has increased, but rather because improved testing and awareness have revealed its prevalence. Previously, magnesium levels were not routinely tested in many laboratories. However, with increased testing, a significant number of patients have been found to have magnesium deficiency due to various factors. This deficiency can lead to a range of issues, from mild symptoms to serious conditions such as cardiac and neurological problems. As a result, magnesium supplementation is now being recognised as an important aspect of overall health management.

How have advancements in cutting-edge technology improved treatment outcomes?

Medical advancements have dramatically improved treatment outcomes, particularly with minimally invasive procedures. For example, many of our treatments no longer rely on traditional endoscopy. A technique called POEM (Peroral Endoscopic Myotomy) allows us to treat achalasia — a condition where patients struggle to swallow — without surgery. This procedure has benefited numerous individuals. Similarly, we can now remove early-stage cancers endoscopically, eliminating the need for major surgery.

Another critical area of concern is Inflammatory Bowel Disease (IBD), which is rising sharply in India, much like it did in the West a century ago. We conducted a study in rural areas—published in The Lancet — and found a strong link between IBD and processed food consumption. Villages now have access to clean water, reducing infectious diseases, but even the smallest shops stock processed foods like chips, noodles, and hamburgers. These foods disrupt gut bacteria and contribute to rising health issues.

We strongly advocate against processed food and have urged the government to regulate fast food around schools, similar to liquor restrictions near colleges. Our research in schools, including government schools, revealed that 40% of children have high body fat, while in IT professionals, the figure is an alarming 80%. This is entirely diet-related.

Any concrete plans to address this?

We have secured a large government grant to conduct a nationwide study involving lakhs of people. This will help us gather data and push for strong advocacy, similar to campaigns against breast and liver cancer. Fatty liver disease is a growing epidemic, leading to cirrhosis and liver cancer — the highest rates of which are now seen in India. We see hundreds of liver cancer cases daily, all tracing back to poor lifestyle choices.

People often believe they can fix these issues with pills, but that’s a misconception. Many turn to drugs like Ozempic or Mounjaro (GLP-1 analogues) to manage obesity and fatty liver, but these are being misused. Prevention is key. A healthy lifestyle, exercise, and avoiding processed food can reverse these conditions naturally. Most people are unaware of these dangers, so public awareness is crucial. We are working towards large-scale advocacy, using media to educate people. Once our nationwide study is complete, we will have stronger data to push for policy changes. 

In an era of medical advancement, how important is it for young doctors to balance technology with empathy in patient care?

Training young doctors to balance technology with empathy is crucial. We mentor around 100 super-speciality DNB students each year, ensuring they not only develop technical skills but also embrace a culture of patient care over financial ambition. While skill development is structured through one of India’s best skill labs, instilling empathy requires a different approach. We have a mentorship system where each senior doctor guides a group of students, encouraging a culture that prioritises research, academics, and patient well-being over material gains. Unlike in corporate hospitals, where conversations often revolve around assets and salaries, our trainees discuss research papers and medical advancements. Shifting this mindset has been a challenge, but we have successfully cultivated an environment where young doctors focus on learning and compassionate care rather than financial comparisons.

Do you reflect on any societal issues beyond medicine?

One major concern is the shifting work ethic among young professionals across all fields, particularly in medicine. Many now seek a 9-to-5 lifestyle, prioritising material gains over the demanding, selfless commitment the profession traditionally requires. While work-life balance is important, as a developing country, we still need to work hard to progress.

Another key issue is women’s empowerment. At AIG, 56% of our 8,000 employees are women, and we actively encourage their growth in medicine. Stronger societies have empowered women while struggling nations often marginalise them. Respecting and uplifting women is essential for true progress. Lastly, increasing societal polarisation is concerning. While diverse beliefs should be respected, extreme divisions hinder harmony. A balanced, liberal approach is crucial for a progressive society.

Have you had a chance to celebrate the award announcement?

Awards are just by-products of our work — momentary and best forgotten. They bring brief happiness, but what truly matters is the work we do. I once asked a renowned endoscopy pioneer, a potential Nobel laureate, if he was disappointed about never winning. He simply noted that people rarely remember past winners. While recognition is nice, it brings happiness to our families, who sacrifice so much. I prefer quiet acknowledgment, gratitude, and moving forward.