An Interview with Dr. Jessica R. Allegretti, MD, MPH

By Dr. Katie E. Golden, MD

At CMIT, we really value our opportunity to collaborate with talented clinicians from varied specialties and backgrounds. This diverse community of visionary researchers helps us move towards our goal of translating microbiome research into better treatment for patients. Dr. Jessica Allegretti is an inspiring example of a clinician who works passionately to improve the lives of those suffering from Inflammatory Bowel Disease (IBD), both through her direct care of complicated patients, as well as her research into the use of  Fecal Microbiota Transplantation (FMT). She currently works as a clinical gastroenterologist at Brigham & Women’s Hospital, where she founded the Fecal Microbiota Transplant (FMT) program and serves as its director. Sbe is also the lead investigator for multiple clinical trials. Her research focuses on understanding how FMT can positively impact the treatment of a variety of different conditions, and what we can learn from these trials about the contribution of the microbiome to human disease. I recently had the opportunity to chat with her and learn more about the origin of her interest in IBD. It is no surprise that she was warm, articulate, and a natural advocate for  both her patients and research field alike.

How did you choose the field of gastroenterology?

Jessica: Even before medical school, I knew that I wanted to take care of people with IBD. Growing up in Miami, among a strong Ashkenazi Jewish population, I knew several people suffering with IBD, so I have always had a particular interest in the disease. When I started medical school, I thought I wanted to be a colorectal surgeon. That all changed with I met Dr. Maria Abreu in medical school [a very well respected clinician and researcher in the field, and Chief of Gastroenterology at the University of Miami at the time]. She really inspired me. Every time we saw a patient, she would ask ‘What do we still not know about this patient? What do we have to do to find the answer? How could we design a research project that would answer that question?’ I loved the way her mind worked, and how she let her patients inspire her research projects.

Regarding your clinical work, what are some of the common challenges with treating IBD patients?

Jessica: The IBD population i treat is predominantly young patients, who are dealing with their disease while also navigating major life changes and milestones: school, career, marriage, starting a family. This disease impacts so many aspects of their lives and affects them in such a real, challenging way. The current treatment options are limited and have varied responses, and I really want to find a way to help improve their quality of life. This is part of the reason I also became a clinical trialist.

When did you first become interested in microbiome and Fecal Microbiota Transplantation (FMT) research?

Jessica: When I was in residency, I met an IBD patient who was unwilling to consider the recommended colectomy before trying FMT. This was over a decade ago, when FMT was still obscure and very few doctors were even using or studying it (and I certainly didn’t know anything about it). I was so curious about how she learned about this therapy. So I started researching it, and reached out to anyone I could to find out more about it. Thus ultimately transitioned into my fellowship work. When I started my fellowship at Brigham & Women’s Hospital, no one there was performing FMT, so I asked if I could start the program for C.diff patients. And they let me!

Much of your research focuses on exploring the use of FMT in a variety of different diseases, beyond IBD or gastrointestinal infections. What are some of the projects that your working on right now?

Jessica: We are just wrapping up the clinical trial for FMT in obesity. I am also continuing my work on the efficacy of FMT in Primary Sclerosing Cholangitis [a chronic and progressive autoinflammatory disease that affects the liver and biliary tract]. One of my main projects right now is helping IBD patients that are actively infected with C.diff. These patients are often very sick, and there is no consensus currently on how to treat them. Unfortunately, IBD patients are excluded from C.diff trials, and C.diff patients are excluded from IBD trials. This is, however, becoming an increasingly prevalent co-condition, and I really love working with these patients. They are challenging and complicated, but we don’t have a good answer for them yet. We are trying to understand the potential role of FMT in this specific patient population.

With your insight into the importance of our gut flora for overall health, do you live your own life any differently? In your food choices, or use of antibiotics?

Jessica: 100%! I tell everyone I know to avoid antibiotics that are prescribed unnecessarily. I have fortunately not been prescribed antibiotics in a long time, but I would avoid it if at all possible. With all the work I do with C.diff patients, I am sure I am colonized and would develop C.diff colitis for sure!

With my diet, I am a big believer in lots of fruits and vegetables, because we know fiber promotes a healthy microbiome. I also stick to a diet that is low in sugar and carbohydrates. It is a change I made for myself a long time ago, and noticed a huge improvement in my energy levels, sleep, and my skin. I would never push those dietary restrictions on my patients, and it’s not for everyone, but when they ask me about my diet, I am honest about the way I eat. I was actually recently in Rome for a conference, and I obviously was not going to pass up the delicious pasta there! But I also noticed that even a temporary return to a high carb diet meant I went right back to feeling terrible. When I came home and returned to my normal diet, the symptoms completely resolved.

What do you enjoy doing outside of work? (Does that even exist?)

Jessica: I love to cycle, which I do regularly. It feels good to do some form of physical activity every day. Another hobby that I really enjoy — and don’t laugh — is I am sort of an amateur makeup artist. (She laughs). Just like the way a lot of people take up painting, I really enjoy learning the creative ways you can paint a face. It’s not really about the makeup, it is more like an art form. It’s a great stress reliever at the end of the day, just to explore all the interesting things you can do with makeup. It is just like painting on a canvas, really. My husband thinks it’s crazy, but to me, it is just fun and relaxing.