In this episode of Functional Medicine Research, I interview naturopathic physician Dr. Ilana Gurevich on overcoming inflammatory bowel disease. We had a deep discussion about testing and treatment options for inflammatory bowel diseases including Crohn's disease and ulcerative colitis. We covered diagnostic testing, the pros and cons of stool test markers, probiotics, fiber, digestive enzymes and hydrochloric acid, gut healing nutrients, diets like the Specific Carbohydrate Diet, helminths, and much more. It was a pleasure to have Dr. Gurevich's expertise on inflammatory bowel disease.
Below is a transcript on How to Overcome Inflammatory Bowel Disease with Dr. Ilana Gurevich
Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research" I'm Dr. Hedberg, really looking forward to my conversation today with Dr. Ilana Gurevich. She is a naturopathic physician and acupuncturist. She graduated from the National University of Natural Medicine in 2007, with her doctorate in naturopathic medicine, and in 2008, with her masters of Oriental medicine. She is currently co-owner of two large integrated medical clinics, one in Northwest Portland and one in Northeast Portland.
She runs a very busy practice specializing in treating inflammatory bowel disease, which we'll be talking about today, as well as IBS, SIBO and other functional GI disorders. She lectures extensively and teaches about both conventional and natural treatments for gastrointestinal conditions, including inflammatory bowel disease, SIBO, and IBS. She's one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. Dr. Gurevich also acts as a mentor in the naturopathic community, educating and consulting with physicians about GI disorders. She supervises residents and consults with doctors about their most difficult GI cases. She was nominated as one of Portland's top docs by the Portland Monthly in 2014, 2016 and 2020. So Dr. Gurevich, thanks for coming on the show.
Dr. Gurevich: Thank you so much for having me.
Dr. Hedberg: Yeah. So this is gonna be really interesting. I've heard you talk before and I wanted to have you on because you're extremely a research-based, you know, scientifically sound. And of course, you have tremendous experience in inflammatory bowel and SIBO and IBS. So why don't we just lay some groundwork? And if you could just talk a little bit about what have you found to be the real causes, the triggers of inflammatory bowel in your patients?
Dr. Gurevich: You know, it is such a multifactorial disease. So with inflammatory bowel disease, there are these two peaks of when people generally get diagnosed. The first is, you know, adolescence, right around puberty to like the mid-30s or 40s. And then the second is menopause, andropause in your 60s, 70s, 80s. And those patients tend to get found a lot just on their basic screening colonoscopy.
And so, you know, because there are these bi-modal peaks of diagnosis, it really makes me think that one of the issues is hormonal changes that happen. And, you know, we're learning more and more recently about how hormones affect the GI, mainly using the estrobolome as an example, and then how the estrobolome affects how you conjugate or process your hormones. And so there's definitely a hormonal component.
Research is also exceptionally clear that diet is a huge component. You know, in parts of the world where they don't really see inflammatory bowel disease like Africa, like Asia, when people from those countries move to a Western civilization, they start getting diagnosed with inflammatory bowel disease equal to people of the West, which means that the way that we're eating is definitively changing our microbiome, which is then causing onset of inflammatory bowel disease.
What's interesting is the opposite now is also happening as we introduce the Western diet into more diverse countries that in the past were, you know, utilizing their own natural forms of eating as opposed to processed food. Now, those countries are seeing an upsurge in inflammatory bowel disease. And so the microbiome and us killing the microbiome or shunting it is definitely causing lots of changes that then upregulate the immune response in the intestine that's causing the onset of inflammatory bowel disease.
And then there's always the mental, emotional component. You know, the majority of your neuro-transmitters from your GI, from your brain are made in your GI and so the higher stress, the higher depression, the higher changes that happen. Then there's also an upregulation, not so much with diagnosis, but definitely with flares of disease. So I have a fair amount of patients, you know, I've been at this a while, and so patients are with me for a long time and we'll have them super, super well-controlled, and then they'll go through like one of the most stressful events of their lives and then all of a sudden, they'll go into yet another flare. So that's another thing.
And then my big thing is I will...it's pretty well-documented that antibiotics and certain antibiotics in particular will cause onset of an inflammatory bowel disease flare. And so antibiotics is the fourth big pillar that I'm always educating patients about. You know, my rule of thumb is you get an antibiotic if you go into the hospital. And if not, we have ways to treat you. And generally, using all of the natural tools that we have, I can get you out of whatever you need the antibiotic for so that you don't need an antibiotic so you won't go into a flare because I have just seen it so many times when they have an abscess or they need dental work or something like that and they end up getting a flare because of the antibiotics.
Dr. Hedberg: Yeah. I see that as well, emotional traumas triggering autoimmunity. And you mentioned moving from certain countries into the West. Do you think that, you know, things like intestinal parasites or just hygiene in general has any connection with that?
Dr. Gurevich: I really do. And I really, really do, especially because I'm looking at some of the research that we've done, that we've seen recently with helminths there's that one study that was done, I wanna feel like 10 years ago that was done in Argentina. Do you know the study I'm talking about?
Dr. Hedberg: I do.
Dr. Gurevich: Okay. So he was an MS doctor. And so when their entire economic system collapsed, so did a lot of their sewage system and stuff like that. And people used to come in with helminths that they were finding and all of a sudden, their MS was going into remission. And so, yeah, I definitely, you know, there's this whole theory called this old friend theory, which is we evolved with these parasites, protozoa and worms. And because of that, when our immune system is targeted at those parasites, protozoa and worms, it's not likely to target us. And I also wanna say, I have also seen the opposite be true, which is parasites, protozoa and worms could also be causing dysfunction because they are pathogenic species. And so I've definitely seen both happen.
Dr. Hedberg: And have you seen viruses as a player? This is a, you know, one of the real areas that I focus on and I'm interested in things like Epstein-Barr and other viruses like that. Have you seen that as well?
Dr. Gurevich: You know, I think just because of how hyper specialized my practice is, I don't focus on it as much. I'm also in a relatively large integrative clinic. So if people are coming in with that chronic-infection-like picture, then generally, I'll refer them over to one of my more infectious-disease-specialized colleagues. And so, you know, I feel like when we're talking about when patients are having both going on, and their GI is, you know, they're not in a flare, I usually take a back seat and let one of my colleagues really manage the infectious disease aspect of it.
Dr. Hedberg: Excellent. It sounds like you have a really great team where you work, so...
Dr. Gurevich: I'm exceptionally fortunate.
Dr. Hedberg: Yeah. So once you've established that someone has inflammatory bowel, let's talk a little bit about lab testing. I know you've done tremendous research on this, and I'm going to assume that you're gonna be doing stool testing on a lot of these patients and some of these markers are somewhat questionable. So why don't we just talk about some of these starting with pancreatic elastase? Have you found that that is a good marker, a good test?
Dr. Gurevich: So when you were talking about working up in inflammatory bowel disease patient, you are, you know, where I usually start with is, I usually start with actually not specialty labs, but just the regular standard Quest lab labs. And if it's an ulcerative colitis patient, I'm always, before I start any treatment, I'm always gonna get a baseline.
And the baseline for UC that's been most validated is a fecal calprotectin or a stool calprotectin. This is a stool test that I will say, I don't trust specialty labs. I've seen their values go up and down. And I have a theory about it. I don't know if my theory is correct. And so I'll always run a calprotectin through one of the standard labs. It's looking for white blood cells within the intestine.
When you have white blood cells in the intestine that means there's an inflammatory response. The number, depending on how high that calprotectin is, that tells us how much of a flare they're in. And it's something like 96% predictive for equal to a colonoscopy. So that's a really good test for the large intestine. It's less so a good test for the small intestine. Efficacy of calprotectin for the small bowel is somewhere between 30% and 90% effective, depending on what study you look at.
And so what I've done recently is I've pivoted away from stool testing for small bowel Crohn's patients to a blood test that's put out by Prometheus Labs.
