Podcast: Play in new window | Download
When it comes to managing Crohn’s and colitis, finding innovative and effective treatments can feel like a never-ending quest.
Today’s episode is a game-changer, featuring the brilliant Dr. Ilana Gurevich, a board-certified naturopathic gastroenterologist who brings cutting-edge insights from her personal journey with Crohn’s Disease, to her years of experience guiding patients with digestive disorders. In this eye-opening conversation, Dr. Gurevich delves into little-known interventions that can make a profound difference in IBD care, from the mysterious world of biofilms to the surprising power of rectal ozone therapy.
Get ready to discover new approaches and feel empowered to take control of your gut health.
Three Things You’ll Learn in This Episode:
🌿 [00:04:15] What biofilms are, how they affect gut health, and Dr. Gurevich’s three-step treatment process for tackling them.
🌿 The benefits and applications of rectal ozone therapy for reducing IBD inflammation and supporting overall gut health.
🌿 Insights into a groundbreaking oral form of fecal microbiota transplant and how it can help manage IBD and dysbiosis.
Rate, Review and Subscribe on Apple Podcasts
Connect With Karyn:
Connect With Dr. Gurevich:
Links Mentioned in This Episode:
> > Take The Ultimate IBD Diet Decoder Quiz: Which Gut Healing Diet is Best for You?
> > Schedule Your FREE 30-Minute IBD Consultation with Karyn.
> >Join the Gut Love Community and Never Miss Out on Our Weekly Newsletter.
Episode Transcript
Karyn [00:00:01]:
Hey, Doctor Gurevich, welcome to the Tiki podcast. I am really over the moon excited to have you join us today.
Dr. Gurevich [00:00:07]:
I am very excited to be here. This is like one of my favorite topics.
Karyn [00:00:10]:
Oh, this is going to be great. So I want to talk with you because you have some of the most cutting edge ideas about IBD that I’ve ever heard. So I love talking with you, and I want to get into all of that because there’s so many different things that I think that my audience has never even heard of that we’re going to talk about today. But before we get to that, I want to start with your journey. So you are a naturopath, and out of all of the ways that you could have gone into medicine, that’s the one you chose. And then within naturopathy, you specialize in gut health. So my question for you is, why?
Dr. Gurevich [00:00:47]:
So I come from a long line of physicians. My grandparents were, three out of my four grandparents were doctors. My parents are doctors. The majority of my aunts and uncles are doctors. And my father was a psychiatrist. And he started going through his midlife crisis. And some people go through a midlife crisis by having an affair or buying a fast car. He discovered alternative medicine.
Dr. Gurevich [00:01:08]:
He discovered acupuncture, actually, he was addiction. He was board certified addicts in psychiatry, and he started realizing how powerful acupuncture was when the drugs weren’t working. And around that time, you know, I started getting very sick with my own health at around age twelve, I went to five different gastroenterologists between the age of twelve and 19. And my fifth gastroenterologist diagnosed me with Crohn’s disease. And it was, it just happened to be the perfect minute because my father was in acupuncture school and he was studying with this man who was also a naturopath. And so when I got hospitalized for Crohn’s disease, back then, we didn’t really have any drugs. You know, we had immunosuppressant drugs, we had steroids, and then we had methylamines, and I was hospitalized. When I got out of the hospital, I made two appointments.
Dr. Gurevich [00:01:53]:
One was doctor present, who at the time in New York City was the forefront Crohn’s disease physician. He actually studied with doctor Crone. And the other one was a Jim sensening. He was a naturopathic physician. And I went to see doctor present, and I sat in the waiting room for 2 hours and they had me get changed. And then I sat in the treatment room for another 2 hours, and he came in and he saw me for about 15 minutes. And then I went to see doctor Senzening, who was a naturopath, and I was on 60 milligrams of steroids at that point. I was really sick.
Dr. Gurevich [00:02:24]:
But doctor Sensenig was basically like, give me a year. If you give me a year, I can get your health back on track. And a year later, I was not cachexic. I was living abroad, I had energy, I was hanging out with people. And I met this person on the phone. One of my housemates in Scotland said, my friend has Crohn’s. And he was. I mean, he was on a liquid diet, on elemental diet for six months.
Dr. Gurevich [00:02:54]:
He was not thriving. And that’s when I realized, oh, naturopathic medicine works. And I think that is what I’m supposed to do with my life. And so I’m so grateful for that period of my life that was by far the hardest, but also got me on my life’s path.
Karyn [00:03:09]:
Yeah, yeah. So that’s why naturopathy, and that’s why gut health, personal experience, which is what brings so many of us to this side of medicine, doesn’t it?
Dr. Gurevich [00:03:21]:
Yep, it does. And it’s. You know, I never had a question, does it work? Like, I knew it worked. I lived how it worked.
Karyn [00:03:27]:
Right, right, yeah. And who better to hear it from than somebody who has experienced it? I don’t know about you, but when I work with people, they love to know that I have Crohn’s because there’s this connection that we have that they don’t have with their other providers.
Dr. Gurevich [00:03:40]:
Yep, yep.
Karyn [00:03:41]:
Yeah, yeah.
Dr. Gurevich [00:03:42]:
And, you know, also, like, they have time, you know, like, it’s really hard in medicine to have a physician who actually listens to you.
Karyn [00:03:50]:
Oh, yeah. Amen. Yeah, yeah. Well, you now have a podcast. It’s called the Turd nerds, and I will link to that in the show notes. But I was recently listening to your podcast, and there was a double episode on this thing called biofilms, and I had heard of it before, but never with relation to gut health. And so it really blew me away. And that’s when I said, oh, my gosh, I have to have you on the podcast.
Karyn [00:04:15]:
You have to talk about this, because most of the people listening this word is going to be completely new to them. And what I want to do is, you know, there’s so many people dealing with really chronic issues. They’re going from doctor to doctor. They’re trying different treatments. They’re not getting any better. And this could be the answer for them. So I want them to have that aha moment that I had. And you have this really cool way of explaining what a biofilm is.
Karyn [00:04:44]:
So can you talk to us about this, you know, from the perspective of somebody doesn’t even know what this word is, what is a biofilm?
Dr. Gurevich [00:04:51]:
Okay, that’s a great question. So there are, the first thing to start with is there are healthy physiologic, natural biofilms, right? And then there are scary, pathologic, bad biofilms. And so when I’m talking about biofilms, usually I’m talking about the bad ones, but they also are healthy and protective. The way I’d like to describe a biofilm is, you know, I think humans are a biofilm on the earth, right? So we live in these brick houses, and so when it’s blizzarding outside, we don’t really care because we have these walls around us that protect us from the elements. Bacteria, funguses, parasites, prozoa, viruses, phages, they all do the same thing. They come together and they make a decision in community, say this is where we want to build our city. And then what happens is the bacteria, which, you know, if we think about it, we usually think about bacteria like a single celled organism, right? Like you have urinary, you have some pain in your urine, you run a ua, they find e. Coli, they’re going to treat that bacteria that is a single celled organism, or that is a bacteria in the planktonic state, right? One little guy doing one little thing.
Dr. Gurevich [00:06:00]:
Bacteria are equally as comfortable in that planktonic state as they are in the biofilm state. The biofilm state means a bunch of variety of them come together and they make a choice to build a city, right? Then and there. And then they start building, and they almost hyper specialize and in a second become this crazy multicellular organism more complicated than the human being, right? And so they come together and they say, this is where we want to put our walls. And there are bacteria that are really good at building walls around the biofilm, right? And so then they build walls, and then they make, like, roads for sanitation and roads for nutrient delivery, and, like, they basically hyper specialize and start working together. The other way to kind of think about this is, you know, when you’re living in a building in New York City, which is where I grew up, you’ve got the people in the building, right? But then you’ve got the cockroaches and the mice and the rats and all of the other things that are also living in that building under the walls. That’s what happens with biofilms. And what happens is those biofilms protect the bacteria from the elements, which is your mouth or your gi tract or your skin. Plaque on your teeth is the most tangible explanation of a biofilm.
Dr. Gurevich [00:07:10]:
You know, you go to the hygienist and she, like, scrapes your teeth, and you have, like, airflow through your teeth, and then three weeks later, that airflow is gone because the bacteria rebuilt the walls to protect itself from the elements of your mouth. That’s a biofilm.
Karyn [00:07:26]:
Yeah, yeah, yeah. And so why are they hurting people with gut issues? Why is it specifically, I mean, I know there are other reasons why they’re harming people, but we’re going to focus on gut health here. So why are they harming people with gut issues? I know it has to do with antibiotic resistance. So talk us through that a little bit.
Dr. Gurevich [00:07:46]:
Okay, so the large intestine has more bacteria than all the cells of your entire body combined, the large intestine. Right. When bacteria gets together in that crowded state, they are gonna form a biofilm that is a physiologic or good biofilm. When you expose that much bacteria to the elements of our modern world. So that is pesticides, preservatives, processed food, processed sugars, antibiotics, you know, xenobiotics, like xenoestrogens, like all of the toxins, we end up killing off the good guys, right? We end up killing off our friends. This is what happens when you, like, hyper sterilize your house with bleach. Like, you’ve killed off all of the good guys, and everything that’s left is resistant to the antibiotics that you’re giving it regularly. When you have, now you have this crowded community of bad guys.
Dr. Gurevich [00:08:35]:
And so they’re going to build walls that are stronger, they’re going to build walls that are bigger. And so it’s going to make it harder for your natural immune system to, or your, you know, the body. The GI especially has a symbiotic relationship between the bacteria and the immune system. And if you wipe out the good guys, the guys that are left are making your environment just a bad neighborhood.
Karyn [00:08:57]:
Yeah, yeah. And from what I’ve read, they love a moist environment and a solid surface. And so your GI tract, right, that would be a good place for them to build up residence.
Dr. Gurevich [00:09:11]:
Your vagina.
Karyn [00:09:12]:
Yeah. Another place.
Dr. Gurevich [00:09:13]:
Your mouth. What else that is. Absolutely. So the fluid is really important because the fluid acts as kind of river systems through their, through their city communities. Right. So the river will flow through, and that’s how they do their detoxification, or that’s how they process their metabolites, is the water has to flow through. You know, in nature, we see biofilms all the time. Like in the river, a rock that’s slippery.
Dr. Gurevich [00:09:35]:
That’s slippery. That’s the biofilm. Or, you know, when you’re. When you have old copper pipes and they kind of get rusted out, right? That rust is a biofilm, right? That all of that, that gunk that builds up, that’s a pathologic biofilm, right? Like on the rock, it’s a little bit more of a physiologic biofilm, but it’s happening all the time. And as you change the microbiome, you change how the bacteria react and the virulence of the biofilm, for lack of a better word.
Karyn [00:10:03]:
Yeah. Yeah. So we know that Crohn’s disease, ulcerative colitis, these are chronic conditions. Would having this diagnosis be enough to say this is something that I should be concerned about? Or is it more like I have a co infection, like I have sibo, I have candida? And so that’s when I should start to become concerned. What is the chronic issue that should cause alarm bells to go off for us?
Dr. Gurevich [00:10:33]:
So the key word in that whole question is chronic. If you have a chronic condition, you do want to assume there’s at least a little bit of a biofilm component. And the trick. So the data on ulcerative colitis and biofilms is exceptionally clear. We know that there’s a huge link with ulcerative colitis and microbiome disturbances, significantly more clear than there is with Crohn’s. And we know that a lot of UC patients have a microbiome component to them. With Crohn’s, the data is not as clear, but I think that we can extrapolate to assume that there is also a biofilm component for those patients as well. I think with Crohn’s patients, you know, it’s not as easy to get to, because usually the disease is higher up, so you can’t take as much samples or data.
Dr. Gurevich [00:11:16]:
And it’s also, we’re not. Our technology is just getting started on being able to sequence the microbiome with a small intestine. The sequencing the microbiome of the large intestine is really easy. You poop in a cup, you got your large bowel, but you don’t have your small bowel there.
Karyn [00:11:29]:
I was going to ask you that because have you noticed that a lot of IBD research talks about UC instead of Crohn’s. That has to be the reason why.
Dr. Gurevich [00:11:37]:
It’S so much easier to study. It’s so much easier to study.
Karyn [00:11:39]:
But you think that that’s evolving?
Dr. Gurevich [00:11:42]:
I think that there’s a lot of new groups that are really trying to figure out how to sequence the microbiome in the small intestine. It is. I do not envy them. It is not easy to do because you have to, you know, basically, you have to have two scopes in there. If you’re really trying to get a good sample, you have to have a scope within a scope. And then that second scope is what comes in, takes the sample, pulls it out. But the first scope protects you from picking up any other flora. You know, if you’re doing a upper gi from the esophagus, from the mouth, if you’re doing a lower gi from the small intestine, it is not an easy thing to do.
Karyn [00:12:14]:
Yeah, yeah. But hopefully we’re getting there.
Dr. Gurevich [00:12:17]:
I mean, I believe in technology.
Karyn [00:12:19]:
Yeah, yeah, yeah. Okay, so let’s say you feel like, you know, you’ve been. You’re one of those people. You’re going from doctor to doctor. Things are not getting better. That word chronic is really resonating with you. You’re listening, and you’re saying, yes, me. Me.
Karyn [00:12:32]:
This sounds like me. Can you go to your doctor, your traditional doctor, and say, hey, doc, I feel like I have biofilms. What do I do about it? And here’s why I’m asking you this question, because I had never heard about biofilms until my son had chronic Lyme disease. And that was back in about 2015. And luckily we found a Lyme literate doctor, integrative medicine, you know, a whole functional approach. She was brilliant, and she was really helping him. She was treating his biofilms. So I’m so excited about this.
Karyn [00:13:05]:
I take this information to his pediatrician, who literally laughs me out of the office, calls me an irresponsible parent, and says that if I really wanted to help my son, I would take him to somebody who really knew what they were doing. Not a quack, as he called this doctor. That’s 2015. So if I think that this is an issue for me, if somebody listening thinks that this is an issue, can they now, have we advanced that far? Can they take this information to their doctor and say, hey, doc, can you test me for this? What’s going on with this? Can they use the word biofilm, or is it still just an unknown in the traditional doctor’s office.
Dr. Gurevich [00:13:39]:
So part of the problem is that the research world is really ahead of the medical world, and it takes a very long time for the medical community to change. So I can remember I was doing my training in naturopathic medical school in, you know, the early two thousands, and I got really excited about probiotics. I was like, probiotics? They’re amazing. And everybody was like, probiotics? It’s so boring. Like, eat yogurt, probiotics. You know what I mean? And now, ten years later, 15 years later, probably the microbiome is like the biggest thing in the whole world, you know what I mean? And so, do I think it’s coming? Yes. Do I think it’s there? No, I think the science is really clear on it, and I think if you do a literature search in Pubmed and you look for biofilms, hundreds of thousands of articles, do I think medicine’s there? No, I think it’s going to catch up, you know, I think it’s going to catch up in, like, ten years. So I think you really.
Dr. Gurevich [00:14:30]:
I mean, I don’t even think alternative medicine is there, you know, like, that’s interesting. So I. You know what I think about my practice? I’ve been treating patients for 17 years now, and there are, like, these pivotal moments in my practice where I’m like, oh, I was missing this whole group of patients. Like, that happened with Sibo, right? That also happened with me with biofilms. But I only learned about biofilms, like, five years ago, maybe doctor Paul Anderson was the one who really started doing the research on it and put it on the map, and I had, like, Lyme doctors knew about it, because Lyme was so complicated, and it’s the great mimicker, and it destroys everything. And so when I started looking at biofilms, the first thing that I did was talk to my Lyme literate doc friends and being like, what do you use? What do you. What are the herbs you’re using? What are the agents you’re using? But, like, I don’t even think it’s in alternative medicine yet, unless you’re in the Lyme community. I think it’s coming.
Dr. Gurevich [00:15:22]:
I think it’s dripping in. I think there’s a lot of interest, but I don’t think it’s not there yet.
Karyn [00:15:29]:
Yeah, yeah. So, yeah, so it’s not going to cut it. You’re not going to go to your doctor, and they’re not going to say, yes, this is what you do. I know it. Even though the research is there, which is so frustrating. But that is how it happens. They say it usually takes about 20 years for the research to catch up, but I feel like, if I remember correctly, that the biofilm research has actually been in, you know, circulation for. Since the eighties, maybe.
Dr. Gurevich [00:15:53]:
So in 1982, there were three papers on humans that had the word biofilm in it. If you look currently, I think I just looked in, like, the end of 2023, and there was something like 8000 papers being published every single year on biofilms. It is an upward trajectory. We are aware of it, and you will see it in medicine. Like, we study a lot of biofilms with surgical wounds that won’t heal. Like, we’re starting to see it there. I think that actually, the group that’s doing the most research on biofilms is the Department of Defense, because they’re starting to understand, seriously, because they’re starting to understand, they have a lot of chronic infections in that population, and they’re starting to understand that it is a biofilm.
Karyn [00:16:37]:
Issue with wound healing, with prosthetics, things like that. Oh, wow. So they’re the ones really advancing this.
Dr. Gurevich [00:16:44]:
Research at the moment. Yes.
Karyn [00:16:46]:
That’s really good to know.
Dr. Gurevich [00:16:47]:
Yeah.
Karyn [00:16:48]:
Interesting.
Dr. Gurevich [00:16:48]:
I mean, and then the other thing you need to. So one of the things we didn’t talk about is how it happens. Like, how does, how do biofilm formations happen? There is this function called quorum sensing, which is incredibly interesting. So what happens is you have, like, a hard area that’s surrounded by fluid and liquid, and bacteria will just kind of, like, hang out and propagate in that area. And when that bacteria gets to the area, it sends out this. It’s called an autoinducer molecule. It’s almost like a human. It’s like a conversation piece.
Dr. Gurevich [00:17:17]:
So let me back up even more. Bacteria, single celled organisms, there’s very few little ports where hormones can come in, but there’s two ports that are on every bacterial species. One is this auto inducer molecule that it’s a receptor for, an auto inducer molecule for other bacteria of its similar species. Right? So that’s like, people in China all speak Chinese, people in Spain all speak Spanish. Then there is this other molecule that every bacteria has that is this universal auto inducer language. Right? So it’s a hormone that every single bacteria releases that every other bacteria can understand. All species speak math. You know what I mean? It’s kind of like that.
Karyn [00:18:00]:
Isn’t that fascinating?
Dr. Gurevich [00:18:01]:
It’s fascinating, and I don’t think. I think I’m not using the right word. I think hormone is actually not the right word I should be using. I think autoinducer molecule would be more appropriate.
Karyn [00:18:09]:
Okay.
Dr. Gurevich [00:18:09]:
But, like, I think of it because it’s, like, out in the air and, okay, so a bunch of bacteria come together, and when there’s enough of them and there’s enough of those autoinducer molecules that are floating around, all of a sudden, as a community, they make a decision build. Right. And so then they come together and they build that decision making. That’s called quorum sensing. Right. Quorum sensing is the ability for every bacteria to speak the language of every other bacteria of its type. And so what’s happening right now is we are trying to make drugs that interfere with quorum sensing, which I love the theory behind that. I worry about it because that’s a universal language for all bacteria, and we know that bacteria is the foundation of humanity.
Dr. Gurevich [00:18:53]:
I mean.
Karyn [00:18:53]:
Oh, right. So it could have positive implications for breaking down biofilms, but negative implications for, well, just bacteria in general. What are they going to do when they can’t communicate with this universal language? That is a little bit concerning, and.
Dr. Gurevich [00:19:08]:
So it’s not there. Quorum sensing is both universal language and individual for the bacteria. The question is, can they come up with a targeted enough drug that blocks some of the quorum sensing for these particular bad guys, but doesn’t have downriver effects on everything else?
Karyn [00:19:23]:
Yeah, yeah, yeah, yeah.
Dr. Gurevich [00:19:24]:
It’s complicated.
Karyn [00:19:26]:
It really is complicated. It’ll be interesting to see if they can do that, because what will happen.
Dr. Gurevich [00:19:31]:
Is when there’s a drug out there that can do that, everybody’s going to be talking about biofilms.
Karyn [00:19:36]:
Yeah, exactly. Oh, you know it. You know it. Because that’s where the money is, right? That you, you know, pharmaceutical research up here, anything natural that’s less expensive down here, like we’re going to get ozone therapy. That’s one of those.
Dr. Gurevich [00:19:49]:
Yeah.
Karyn [00:19:50]:
Okay. So I just want to make sure that everyone is really clear on this so we know kind of what’s going on in the body, how it’s proliferating, how they’re communicating. But I know you mentioned the word chronic, like, what should I be looking for in my body? What should we be looking for? To say, you know, I really should think about this for myself. Besides the word chronic, what should we be looking for?
Dr. Gurevich [00:20:12]:
I honestly. Chronic otitis medium, chronic bacterial vaginosis, chronic candida, chronic gastritis, chronic ib’s, sibo, the word that we really are, it’s not, it takes a while to build those really strong walls to change how the bacteria builds biofilms. Right. And so really, if it’s been happening forever, and you’ve tried every treatment, if you have taken a lot of antibiotics to try to treat everything, then that’s when we get into trouble.
Karyn [00:20:43]:
Gotcha. Okay. Yeah. So that’s how, you know, if these things are happening, you’re not getting any better. This is where we really need to start thinking that a biofilm issue, and.
Dr. Gurevich [00:20:54]:
I’m never going to say it’s everything, you know, like, I think that the biofilm issue allows me to, you know, bring in and help this whole other group of patients that I just was not helping before. So I think it’s a piece of the puzzle. I am, you know, I’ve been at this too long to think that it’s the whole piece of the puzzle. But I do think that if you’re thinking about it and you’re treating it, other things become easier to treat most of the time.
Karyn [00:21:18]:
Yeah. Yeah. So typically with a patient, it’s not the first thing that you go to. You’ll try a bunch of things, and then if things aren’t getting better, you’ll think, ah, maybe we should start looking in this direction.
Dr. Gurevich [00:21:28]:
Or they come to me, you know, it takes a while to get in with me. So they come to me and they’ve seen, like, five other doctors, you know, four other functional medicine naturopaths. They’ve done all of the things. They have a long history of being on antibiotics or lots of pharmaceuticals. They live a lifestyle, I think, you know, we live a very antibacterial lifestyle.
Karyn [00:21:46]:
Yeah.
Dr. Gurevich [00:21:47]:
And that, I think, leads to disease. You know, I think the pendulum starting to swing on that. We’re starting to understand that all of that hyper sanitation that we’ve been, you know, obsessed with is causing more harm than good. But then I’m gonna be like, okay, we should, we should think about biofilms. And then the other thing that I’m gonna think about is there, I do run stool tests because, you know, I’m GI focused. That’s kind of exclusively what I do. I do run stool tests to see what’s in there. And I.
Dr. Gurevich [00:22:13]:
There’s just certain bad guys that I know I have to go after.
Karyn [00:22:16]:
Yeah, I want to get into that because that gets into testing. So if you suspect this and you’re doing testing, is it a stool test that you always look at? Is it the clinical picture? What? What? Yeah. What is your method of testing for this?
Dr. Gurevich [00:22:31]:
Both. So remember, there is no great way for me a clinician to work up the microbiome of the small intestine. Right. So then I’m looking for some chronicity there. If I’m doing all the treatments, I’ve done the testing, and they’re not responding to treatments or testing to the treatments that I’m doing, even though it matches the testing, I’m like, okay, either I’m treating the wrong thing, or I’m not treating it as precisely as I want to be as I need to. Right. So then I’ll think about biofilms there. If I’m looking at a large bowel patient, right, then I’ll do a microbiome workup.
Dr. Gurevich [00:22:59]:
And if I see a couple of key bad guys, I’m always going to go after biofilms. If I don’t see those key bad guys, but the symptom picture also fits, and I’m not getting anywhere. Then I’ll also go after biofilms and those I’m always looking for pseudomonas. We have a lot of research in pseudomonas, especially for surgical wounds. And so I’m always going to go after, if there’s an abundance of pseudomonas, I’m going to try to treat it. Klebsiella is another known biofilm creator. Provotella is another one. Proteus is another one.
Dr. Gurevich [00:23:29]:
So I’m kind of looking at the species that are coming back in the large intestine workup.
Karyn [00:23:33]:
Yeah. And those are bacteria. But we’re not just talking about bacteria here. Right. It could be a fungus, like a parasite, could be other things, too. Correct.
Dr. Gurevich [00:23:42]:
So fungi, I are very difficult. They’re more difficult to treat. You know, funguses are slow. They’re everywhere. Candida albicans, in particular, is known to make a fungal biofilm. And the fungal biofilm, the bacteria biofilm, they do kind of interact and do the same thing. So, yeah, that’s kind of what I’m.
Karyn [00:24:06]:
So you’re looking at all of those things?
Dr. Gurevich [00:24:07]:
Yeah.
Karyn [00:24:08]:
In a stool test, not a blood test, just to be clear.
Dr. Gurevich [00:24:12]:
Yep. Not. So.
Karyn [00:24:14]:
I mean, you’ll look at that in terms of global picture, but when you’re looking for this particular bacteria, you’re looking at their stool, correct?
Dr. Gurevich [00:24:22]:
Yes, yep, yep, yep. Correct.
Karyn [00:24:23]:
Just want to make sure. Okay, now let’s talk about treatment. And I know this is complicated. There’s a lot to it. And so I really want people to work with a. And I think we should coin this, if it’s not already a phrase. It should be biofilm. Literate doctor.
Karyn [00:24:39]:
Just like Lyme literate doctor. Biofilm literate doctors. So you’re working. I really feel like you should work with a biofilm literate doctor, but just at a high level. Can you talk us through what are some of the hallmarks of treatment? What is working to break these down?
Dr. Gurevich [00:24:56]:
That is tricky. That is tricky because, you know, so, I mean, let’s go back to Lyme disease. Like, Lyme docs have been treating biofilms. They’ve known about biofilms for like, a decade. They are, like, far ahead, far above, and advanced over the rest of us. Right. And what they were using back then is they used some chelator agents, like DMSA, dmps, EDTA. They used a lot of enzymes, and enzymes, I think, do have very good data behind them for breaking down biofilms.
Dr. Gurevich [00:25:26]:
Paul Anderson came on the scene, and he coined what he calls his bistio complex, which is probably what I’m most likely to use, which is a mixture of a chelator, DMSA, or dmps, depending on what your compounding pharmacy has. He also matches it with alpha lipoic acid. Right. When the bism. And then he adds in bismuth, some kind of bismuth species. So pepto Bismol, that’s bismuth subsalicate. Right? I’m using bismuth sub nitrate, because that’s what my compounding pharmacy can, hat can get. I think the best data that the v that the VA is studying is bismuth citrate, maybe.
Dr. Gurevich [00:26:02]:
Yeah. So the VA is studying a different.
Karyn [00:26:04]:
But that just means that different types of business are working, not just one. It’s just about what you can get.
Dr. Gurevich [00:26:09]:
Right.
Karyn [00:26:10]:
Okay.
Dr. Gurevich [00:26:10]:
And so, basically, when you combine the bismuth with a chelator and the alpha lipoic acid, they form this compound called a bis thiol complex. This bisthiol complex makes bismuth slightly safer. Bismuth is a really interesting substance because it goes back to, I mean, in chinese medicine, we talk about bismuth. In the classic ayurvedic text, they talk about bismuth. It’s a mineral. It’s everywhere. You know what I mean? It’s a very, that’s, that’s what pepto bismol is made out of. Um, and so we have a long history of using bismuth, and in short durations, it’s very, very safe, and in medium length durations, it’s probably safe.
Dr. Gurevich [00:26:47]:
And in the long term, it’s a little bit more toxic. Usually, all the toxicity that comes with bismuth, generally, if you discontinue it, it will get reversed, but it is definitely not. You don’t have free rein on it like you do with, like, magnesium or vitamin c. Right.
Karyn [00:27:00]:
Yeah. So it’s not something you’re using long term.
Dr. Gurevich [00:27:02]:
Right. But if you, if you put in this combination of this bis thiol complex, then it adds a little bit of safety to it, and you can use it for longer because the bismuth is larger, and so it’s less likely to get out of the GI tract.
Karyn [00:27:17]:
Okay, interesting. Like, through the, like, through the mucosal layer, like, like into the bloodstream.
Dr. Gurevich [00:27:24]:
Into the bloodstream, which is what you’re worried about. Yep.
Karyn [00:27:26]:
So that’s the main component of what you’re using to treat.
Dr. Gurevich [00:27:29]:
That’s one of the big things I do feel like for the GI, that one works really well. I also think enzymes are really helpful. And there is data that probiotics can act as an antibio film, or it can push your physiological by biofilms to regulate. And just as an aside, there’s absolutely, absolutely data that shows that if you have healthy physiologic biofilms, those actually act as protectors to actually shut down pathologic biofilms from growing. Right. So the better your microbiome is, the more robust and diverse your microbiome is in the GI, the more it’s actually to shut down the pathogenic biofilms.
Karyn [00:28:07]:
Interesting, interesting. Gotcha. And what about what role do antimicrobial herbs play in treatment?
Dr. Gurevich [00:28:14]:
So whenever I think about treating biofilms, I’m thinking about it in two levels. I think the reality is our antimicrobial treatments that we take orally are going to be great for planktonic bacteria, for those single celled organisms. That is also very true about antibiotics. When you have that urinary tract infection and you take that antibiotic, you’re getting rid of the planktonic bacteria biology.
Karyn [00:28:36]:
Single cell.
Dr. Gurevich [00:28:37]:
The single cell biofilms have different rules. Because of those walls. Antibiotics, both herbal and pharmaceutical, are a thousand times less likely to penetrate those walls to affect the bacteria that’s living in that planktonic state. The other thing about biofilms, I could literally just talk about the science of biofilms for like a month. Other thing that happens from biofilms is those plants. You know that bacteria very comfortably goes from single cell to multi cells, right? Planktonic to biofilm. When you give antibiotics for a planktonic bacteria and the planktonic bacteria has antibiotic resistance, right. It will go back to its biofilm community.
Dr. Gurevich [00:29:16]:
It will then spread the information of its antibiotic resistance to not just its species, but to the whole community. Also in the biofilm state, bacteria is not turning over as often as it turns out. It turns over in the planktonic state. So all of that antibiotic resistance is then going to this brand new generation of bacteria to then spread to the rest of the body. And so it, like antibiotics, if you’re not breaking down the biofilm first, your treatments are not necessarily getting where they need to go.
Karyn [00:29:53]:
Gotcha. Okay, so in terms of the antimicrobials, like, in terms of the herbals, not, not, not so effective.
Dr. Gurevich [00:30:02]:
Well, it’s more. Step one, break down the biofilm. Break down some of those, take down some of those walls. Step two, use your agents antibiotic, either herbal or pharmaceutical, to then change the microbiome. Step three, make sure you regrow a healthy, diverse microbiome.
Karyn [00:30:20]:
Okay. So it’s about getting, you know, the first step, using the bismuth complex first before you get to, you know, it’s basically, you have to do these things in order in order for them to work. Now, are you worried about antibiotic resistance with the herbals or the antibiotic that you’re using?
Dr. Gurevich [00:30:37]:
Not if we’re using whole herbs. You know, humans evolved, you know, so biofilms are about a trillion years old, and. Sorry, I should back up. Bacteria is a trillion years old. Humans in their natural state, about 200,000 years old. Right. We’ve been in this human form for 200,000 years. We have been using herbs for 200,000 years.
Dr. Gurevich [00:31:00]:
Right. Plant medicine is all we had. Also, plants to eat is all we had. And so I’m not worried about herbs because they have so many active constituents. And, you know, we don’t have a quote unquote clinical trial on them, but we’ve 200,000 years, like, that’s not that short of a trial to see safety and efficacy.
Karyn [00:31:19]:
Is there anybody that’s just top of mind right now that you’re thinking of so that people could really just relate to what it looks like to be treated for this? What, you know, any case studies you could share with us?
Dr. Gurevich [00:31:30]:
Well, I am always a lot more cautious with IVD people just because I feel like, you know, like, I think of it like a seesaw or teeter totter, and you can definitely do something that just, you know, spikes them right into a flare. Right. So I think that when I’m looking at going after biofilms with patients, I am not necessarily going to use the bismuth complex. You want to talk about ozone? Right? Can I talk about ozone.
Karyn [00:31:56]:
Yeah, let’s do it. Let’s talk about ozone.
Dr. Gurevich [00:31:59]:
Because ozone is one of these treatments that I.
Karyn [00:32:01]:
But remember, most people don’t even know what this is. So let’s just start at the beginning.
Dr. Gurevich [00:32:06]:
Okay. So ozone. Ozone is a very, very unstable gas. The way that you make ozone in the medical setting is you take oxygen through an oxygen generator, right? And you through. So you take ox, medical grade oxygen through an oxygen tank and you run it through an ozone generator. That ozone generator basically runs electricity every, depending on, you know what, gamma, you set it to every x amount of seconds and that will break down that really staple bond of oxygen, a husband and wife, and it will reform into the form of ozone. A husband, a wife and a girlfriend. It’s very unstable.
Karyn [00:32:39]:
I love the way you say that.
Dr. Gurevich [00:32:40]:
It’s not going to last for very long. It’s very unstable. You, at about 30 minutes, all of that ozone is now oxygen again. Right. And about 30% of whatever we put. And so the way that it works is we like hook a bag onto this ozone generator and that bag will fill with ozone. 30% of it will be ozone. The rest of it will be oxygen.
Dr. Gurevich [00:32:59]:
And then what I do is I take that very, very unstable gas and I have the patients go right into my bathroom in my clinic and administer themselves rectally. That ozone is doing three things at the same time. One, it’s actually pro inflammatory for the first 6 hours. So that third electron will go into the GI and it will kind of creepy claw all over and it will find any cell that’s inflamed or irritated. Right.
Karyn [00:33:30]:
And it’s getting way up there, correct?
Dr. Gurevich [00:33:31]:
Oh, depending on how much you’re putting in there. It is getting way up there.
Karyn [00:33:34]:
Yeah, yeah, yeah.
Dr. Gurevich [00:33:36]:
So it’ll find any cell that’s inflamed or irritated and it actually will irritate it more. That’s really important because what it, what happens is now the body can see how damaged that cell is and it just kicks it off. Right. So extrusion is what it’s called. It literally just kicks off that inflamed cell. But then that, that electron, that third ozone, you know, I don’t know if you remember, but in high school we learned about the electron transport chain or the Krebs cycle. That is flu fueled by an o one, a single oxygen unit. Right.
Dr. Gurevich [00:34:04]:
So that ozone, that single oxygen will then go into the mitochondria and like hyper speed up the prediction, the not prediction, the production of new cells. Right. So it’s gonna extrude, and then it’s gonna replace very quickly with healthy cells. With healthy cells, right.
Karyn [00:34:22]:
Yeah.
Dr. Gurevich [00:34:23]:
And then the other thing that that single electron is going to do is it’s going to act as an antimicrobial. Ozone is one of the antimicrobial, most antimicrobial species we have, and it acts as an antimicrobial. And anything that is anaerobic, it will end up dealing with, while also dealing with. So when you’re changing that environment, you’re also kind of penetrating that biofilm and breaking it down. So one of the ways that I think about treating inflammatory bowel disease patients is, you know, I’m as a clinician and as a natural medicine clinician, I don’t have lots of, like, I don’t have the comfort of these huge clinical trials to say, if I give 50,000 people this agent, they’re going to react, or 80% of them, or 40% of them are going to react in this way. So what I like to do is I like to be as scientific as I possibly can for my ulcer of colitis patients. A calprotectin is a very, very useful marker that tells me how many white blood cells are in the GI tract. Right.
Dr. Gurevich [00:35:20]:
So before I start, I’ll get a calprotectin, and then I’ll have them do ozone, you know, a couple of times a week, a few times a week, every other day, daily, depending on what’s happening. And then I always have them take a week off from ozone. The reason for that is because it’s pro inflammatory before it’s anti inflammatory. And I have seen those numbers be falsely elevated when I test too soon. So I’ll have them take a week off, and then we’ll rerun that calprotectin. Is this treatment working? Is the amount of white blood cells that are hanging out in their intestine because they have inflammation going down? If it is, then I’m going to say, let’s keep going. I want to get you into a stable remission. If it’s not, then I have to think about, am I not being aggressive enough, or do I need to change my treatments because ozone is not going to be one of the things that helps them.
Karyn [00:36:06]:
Yeah, yeah. So you’re using. You’re using various things. I mean, first of all, ozone is working on multiple levels because it’s working on inflammation. It’s turning over cells. So cell regeneration, it can break down biofilms. So what you’re saying is it has a wide application for a number of issues that people with Crohn’s and colitis are dealing with. And so maybe in a case you might use ozone over, like the bismuth complex.
Dr. Gurevich [00:36:35]:
I definitely feel like it’s safer to start with ozone over bismuth. It just, you know, so the side effects that come with ozone with rectal inseparlation of ozone is diarrhea, cramping and gas. Right. So the large intestine is supposed to squeeze and go down. And I am taking, depending on where their diseases and how severe their diseases, I am having them put in somewhere from 200 to 750 ccs of gas in their rectum. That’s going to be a lot of stretching, which means that most likely they’re going to have an urgent bowel movement, they might have some cramping, they’re going to feel bloated, they’re going to feel distended throughout the night, and by the next day, things are kind of going to come out and they will feel better. But I think it’s, I’ve done it.
Karyn [00:37:15]:
I can attest to it. It does a little uncomfortable, but then, yeah, you feel tons better.
Dr. Gurevich [00:37:20]:
And I’ve seen it stop bleeding. I’ve seen it get out of also infectious gastroenteritis. It’s very effective because of that antimicrobial, microbial aspect of it. And so that is where I’m generally going to start with an IBD patient, especially if they’re local there. Yeah, let’s say it doesn’t work. Let’s say I can’t get them out of this flare that they’re in, then I’m going to start thinking about, you know, layering in other tools that I have, and biofilm treatment is definitely one of those other tools.
Karyn [00:37:49]:
Gotcha. Gotcha. Now, let’s talk about FMT, just with a very specific question about it. So fecal microbiota transplant. So basically what they’re doing is they’re inserting healthy bacteria into the GI tract. So then it then proliferates more healthy bacteria. And so is this something, I feel like you mentioned earlier, something about using probiotics with biofilm. So is this something that would also be something that would break down biofilms as well as help, you know, repopulate the microbiome, help with inflammation, all of that? Is that something that would help with that?
Dr. Gurevich [00:38:30]:
The teeter totter that I was, the seesaw that I was talking about, FMT for a lot of patients will absolutely switch them into a physiologic state. Absolutely. But if you’re in the US, FMT is almost impossible to get at this point. They’ve. The. You know, the FDA was basically like, we don’t like the idea of stool transplants, also. A stool transplant, basically, that is an organ transplant. You know what I mean? Like, we do consider the microviome an organ at this point.
Karyn [00:38:55]:
Interesting.
Dr. Gurevich [00:38:55]:
And so the FDA was, like, the first drug company that can make us a drug that can get us very clean, very safe stool. We’re gonna shut down FMT because we don’t know what kind of infections are gonna spread. This is the same story about, like, hepatitis with blood transfusions and HIV with blood transfusions. We don’t know what we’re getting. We don’t even know to look for what we. You know, we only know what we know. And so in the US, it is currently very difficult to get FMT. It is available outside of the country, and there are still stool banks that are running.
Dr. Gurevich [00:39:24]:
But in the US, it’s more difficult to get an FMT transplant unless you have a known donor. If you have a known donor, it’s very. It’s vital that you screen that donor to death. And you work with a doctor who understands how to screen that donor to death, because we don’t know what you’re going to get exposed to until it’s too late.
Karyn [00:39:43]:
Okay. Which brings me to this recent advancement in FMT therapy, which is an oral. Sterile. Basically, it’s poop. Right? Sterile poop from this company called Thana. So I recently started taking this. Is this something that you are using a lot in your practice, and what are you seeing? You know, so I. Everybody, I hope you.
Karyn [00:40:07]:
I want to say this one more time. So this is like FMT, but it’s oral. So you’re taking it. You know, it’s a capsule that you just take by mouth. This is sterile poop. That is working pretty much like the components of FMT, right?
Dr. Gurevich [00:40:21]:
Okay. So, you know, when I’m using Fena, Thena is made. I do know both of the owners, the company, they are very, very smart naturopaths. They. So it’s very. It’s expensive, right? It’s not expensive as FMT. FMT is a thousand. This is in the hundreds.
Karyn [00:40:35]:
Yeah, yeah.
Dr. Gurevich [00:40:37]:
But. So I gave. I was at a board meeting with one of the owners or one of the founders of the company, and she gave us all a free bottle. And I was like, oh, I don’t need an organ transplant. I’m all set. And then I. For some reason, I went out to dinner and she, like, convinced me, so I started taking it. It was the craziest thing, so I started taking it.
Dr. Gurevich [00:40:55]:
And, you know, anybody who listens to the turn nerds knows all three of us suffer from constipation. Like, we are go getter. Like, the three of us never stop moving, you know, like, there’s not no time. And I was like, okay, I think Theta’s gonna really fix my bowel movements. And it didn’t. But what it did fix, which I did not see coming, was my sleep. I. When I started taking Theena, I was at first taking it at bedtime.
Dr. Gurevich [00:41:19]:
When I started taking Theena, I started. I did two things. I did, like, the Huberman lifestyle stuff, like the cold showers and exposing my. My eyes to sunlight and. And, like, moving right in the morning. And then I took Dana in my sleep. I was sleeping better than before I had kids. I was sleeping through the night.
Dr. Gurevich [00:41:34]:
I was having crazy dreams. I was so. Such a good sleep. And then I ran out of that.
Karyn [00:41:39]:
That doesn’t tell you the gut brain connection is real, right?
Dr. Gurevich [00:41:42]:
And then I ran out of Thana, but I kept on doing the Huberman stuff. And, you know, I’m in this huge transition. I’m opening up a new clinic, and my sleep got funny. And it probably had been, like, four months since I took Thena, and I was still doing the Huberman stuff, and I was like, oh, I bet it was the thana. And so what I do now is when I get through a period of where my stress overtakes my sleep, right. I’ll take, like, two weeks. I’ll pulse the thana, right. And it completely will reset my sleep cycle.
Dr. Gurevich [00:42:10]:
It’s like, so now I’m using it with my really, really complicated insomnia patients to see if I can reset their sleep cycles, and it’s working for a lot of them. And so. So that is where I’m seeing it be very beneficial. I am also absolutely using it with my chronic GI people.
Karyn [00:42:27]:
Like, you are?
Dr. Gurevich [00:42:28]:
I am. And, you know, I’m generally like. I start by selling it as a sleep supplement, and then people are like, yeah, but my poops are, like, amazing, huh?
Karyn [00:42:38]:
So for some people, it is fixing their poops. Is it more if you have loose stool? It’s bringing it back into formed, or is it working for constipated people, too?
Dr. Gurevich [00:42:47]:
I’ve seen it work for both.
Karyn [00:42:48]:
Both.
Dr. Gurevich [00:42:49]:
I’ve seen it work for both. It is one of those layers that we have in our arsenal that is really interesting and has good efficacy.
Karyn [00:42:59]:
Yeah. This is something I think. I mean, I had never heard of it. It’s very recently to me. So I think this is something most people haven’t heard of. So I will link it in the show notes so that people can look it up and do their own due diligence and see if it’s for them. But it is. This is not a probiotic.
Karyn [00:43:13]:
This is a postbiotic. Correct.
Dr. Gurevich [00:43:14]:
This is a postbiotic, and it is just basically sterilized stool. And I will also say, thana screens their donors to death like their stool don’t. So the way that the company started is Andrea Macbeth, who is one of the co founders, and her piper, her partner, were running a stool bank. They were treating exclusively c. Diff resistant patients who had failed standard treatment. And it became real clear that the FDA was going to shut it down the minute they could find a drug. And they were like, I wonder what would happen if we sterilize the poop. So they take human stool, and they run it through an autoclave.
Dr. Gurevich [00:43:51]:
It’s 100% sterile. There is nothing that is in there at all. And they encapsulate that. The capsules are white. Like, they’re not even brown. You know what I mean?
Karyn [00:44:00]:
The stuff inside is brown, though. And I know that because I had to start really small with it, because I can’t take a whole pill because I’m so sensitive. So I had to open it. And it’s brown. And it does smell a little like poop, I’m gonna be honest with you. Yes, it does.
Dr. Gurevich [00:44:15]:
Because I’m like, when they’re closed, I’m like, I think it smells kind of like green tea.
Karyn [00:44:19]:
Right? Like, you wouldn’t know. Yeah, but if you open it.
Dr. Gurevich [00:44:22]:
Yeah.
Karyn [00:44:22]:
And I even, I wondered to myself, because it’s so faint, that I had my son, I said, come smell this. He said, oh, yeah, that smells like poop.
Dr. Gurevich [00:44:30]:
Oh, okay.
Karyn [00:44:31]:
So interesting. You just turned off, but, like, you know, you can tell.
Dr. Gurevich [00:44:36]:
I think you just turned off, like, probably 20% of your audience.
Karyn [00:44:40]:
Oh, but it’s so good. It’s so good. Like, I’m loving it.
Dr. Gurevich [00:44:44]:
I. Yeah. What are you, what are you noticing?
Karyn [00:44:46]:
It has firmed up my stool.
Dr. Gurevich [00:44:48]:
Wow, that is something to say.
Karyn [00:44:50]:
Yeah. And that’s on just a small amount. I’m not even taking the whole thing because I have a particularly sensitive system, and I don’t need to take the full dose of anything. Plus, I’m thin, so, you know, so for me, I don’t usually need the full amount. So opening it up is, you know, taking less, and I’m still noticing that it’s helping.
Dr. Gurevich [00:45:07]:
Wow.
Karyn [00:45:07]:
That is the other thing I did notice. It’s interesting you mentioned sleep, because I’m having some kind of crazy dreams.
Dr. Gurevich [00:45:12]:
Okay. Absolutely crazy. Crazy. Take it in the morning. Take it in the morning.
Karyn [00:45:17]:
And I’m taking it right before I go to bed. So that.
Dr. Gurevich [00:45:19]:
Take it in the morning.
Karyn [00:45:19]:
I need to switch that.
Dr. Gurevich [00:45:20]:
Yeah.
Karyn [00:45:21]:
Interesting. Very interesting. Okay. I want to switch gears and ask you about something else, something that I noticed. I’ve been working with people who have IBD since 2010, and I mainly work with moms, women, and I noticed that their IBD shows up differently because I do have a few male clients I work with than men. I feel like it’s related to hormones, you know, like the start of your menstrual cycle, being pregnant after giving birth to the baby, menopause, these key hormonal fluctuations. Do you see in your practice, do you see IBD showing up different for women? And is it because of hormones? Like, what are you seeing there?
Dr. Gurevich [00:45:57]:
Do you know about the astrobalone? Have you heard about this?
Karyn [00:45:59]:
No.
Dr. Gurevich [00:46:01]:
So we’ve discovered a bunch of different organs in the last ten years. One of them is the microbiome. We classify that as an organ. The other one within the microbiome is this part of the microbiome called the astrobulone. Right. The astrobulone is the type of that bacteria that comes in and out of bloom depending on where you are in your cycle and so your strobe loan. So this whole inter organ within your organ will change around puberty, around pregnancy, every month, depending on where you are in your cycle and around menopause. Men do not.
Dr. Gurevich [00:46:31]:
Their. Their strobellone is much more static. I don’t actually even know if men have an astrobillon because I’m only talking about it in context of women. But it is important to know that that part, that organ is literally in flux. And so. Absolutely hormones can affect them. Absolutely. And, you know, one of the things that I’m always looking at for my patients is, like, is there a time of the month where you’re more triggered? Or, like, are you more likely to have a flare? Is it stress that flares you? Is it drugs that flare you? Is it your period that flares you? Like, what else happens? Because that zones me in to focus on the astrobalone.
Karyn [00:47:05]:
Interesting. Interesting. Yeah. Wow. That’s fascinating. I need to do more research about that. Okay, so there’s so many things we talked about today that I know that people aren’t going to hear about from their typical GI biofilms. We talked about rectal ozone therapy.
Karyn [00:47:20]:
We talked about fecal mycobriata transplant. We talked about this new post biotic that people are taking. If I’m, you know, I’m completely new and maybe I’m new, the people who are listening, they’re either new to IBD or they’re new to this idea that I want to move beyond medicine. Maybe I want to take medicine, but I want to do more. Or maybe I just want to get away from medicine completely. What would you say their first step? Like, let’s say they don’t really have access to a naturopath. What do you think their first steps should be? Something that’s going to move the needle. They’re going to see something right away.
Karyn [00:47:55]:
Would it be the kind of things we talked about today, or is it let’s dial in on food and like, what should they do first?
Dr. Gurevich [00:48:01]:
So the first thing I want to say about that is I personally don’t think that drugs are the bad guy. Right. You know, I think because of my nature of being a natural medicine provider, I see a lot of people who are convinced that the drugs are going to kill them. In my experience, I think the drugs absolutely have side effects, but I also think the drugs can be life saving. And I have seen people be able to, like, you know, I had a patient who, maybe she’s the one who introduced you to me also. She was like very involved in the online community and all the forums dealing with IBD. She was.
Karyn [00:48:31]:
Oh, right, yeah, yeah.
Dr. Gurevich [00:48:32]:
So she was so involved. And, you know, I got like so many referrals from her. And when she. When she came in to see me, she was about as close to a walking dead person as I had ever worked with. And we did a lot of work. You know, she had been resected. We did a lot of work on her microbiome. And I’ll still touch base with her.
Dr. Gurevich [00:48:50]:
She usually touch base with me like once or twice a year, but she’s like not involved at all because her microbiome is stable. Right. So it’s important, like, in my world, the solution is you having quality of life, so you’re not on those forums. And sometimes that’s the drugs. I am not opposed to the drugs. I think that there are some drugs that are safer and some drugs that are more dangerous. I would like to avoid the ones that are more dangerous as much as I can. And if all that works for you is the drug, let’s do that.
Dr. Gurevich [00:49:17]:
However, I think both of us know sometimes the drugs aren’t enough. Like, they take care of a small piece of it, but not everything in it, you know? Like, the drugs are not always the solution, and so if you need extra help, you’re always. The diet is the place to start, always. You know what I mean? Like, they’re food and, you know, start, like, real simple things. I was just. Yesterday, I actually had a patient come in, a new patient came in with a new diagnosis of inflammatory bowel disease, and we were talking about his diet, and his diet was chock full of processed food preservatives, food dyes, and gums. Right.
Karyn [00:49:54]:
You know where to start?
Dr. Gurevich [00:49:55]:
Yeah, I just pulled a study on it that was published in 2022, I think, in the Journal of Microbiology, that looked at what food dyes, gums, and preservatives do to your microbiome as one of the key agents that cause inflammatory bowel disease. That’s where I would start. Get rid of the ultra processed food, try to take the gums out of your diet, because we know that irritates your lumen, your gi lumen, and then, you know, make sure you’re eating a diet that’s pretty diverse and not processed. That’s where I would start there.
Karyn [00:50:25]:
Yeah, yeah. Yep. I like it. And then if you can get some sunlight, if you could get some movement, exercise, that’d be great, too.
Dr. Gurevich [00:50:32]:
You can decrease alcohol.
Karyn [00:50:35]:
Right, right, right. That is step one, which can. I love it. I love food because it can move the needle a lot. It may not fix everything, but it’s a quick win that you can just see right away. I really love that. Okay, so I don’t know if you’re gonna love this question, but I have to ask you, what. What is the future of IBD look like? What is on the horizon in terms of treatment? And do you see a cure in our future, in our near future?
Dr. Gurevich [00:51:02]:
I don’t think the medical community likes to use the word cure. So I’m gonna say that I have, you know, intimate experience with the medical community not liking that I use the word cure. So do I think that where research is going is more biologics that you can administer orally? I think that that is, you know, a chronic pharmaceutical that can keep you in remission is kind of where everything’s going. So that’s conventional. That’s, like, where the money is. I also think that we are at the same time, moving the needle in this, like, whole health, expanding health span. You know, we have those two opposite things. Happening at the same time.
Dr. Gurevich [00:51:39]:
And I put my money on, you know, what are the health span people doing? What are the longevity people doing? How do we. We have made our world toxic, and we’re starting to see the effects of that. And at this exact moment when it’s, like, the darkest, you know what I mean? We have this amazing light coming in to talk about just all the foundational things that we need to treat our bodies like humans. Right. That is happening right now. That is where I put my money. I will, you know, I’m also a huge believer in the human body, and, you know, being able to live a life where you are not polluting your body, and I think that’s what brings health. And so that’s what I would be paying attention to if I was, you know, new to this diagnosis.
Karyn [00:52:22]:
Yeah. Yeah. That makes complete sense. What we talk about here oftentimes is really kind of deep and heavy. And so I like to end on a lighter note with a lightning round so that we can just find out a little bit more about you, but keep it really light. Is that okay with you?
Dr. Gurevich [00:52:37]:
Yeah, I’m ready.
Karyn [00:52:38]:
Okay, here we go. So what is your favorite go to? Gut friendly snack.
Dr. Gurevich [00:52:43]:
Oh, kimchi.
Karyn [00:52:44]:
Kimchi. Oh, you gotta get those fermented foods in. Yeah.
Dr. Gurevich [00:52:48]:
Kimchi with nutritional yeast and, like, some mushroom salt. It’s very good.
Karyn [00:52:51]:
Yeah, love it. Okay. What is the number one supplement that you just cannot live without?
Dr. Gurevich [00:52:56]:
Glutamine. For sure. Any small valcrones patient. Glutamine.
Karyn [00:52:59]:
Glutamine. Okay. And being a doctor, going to a doctor, how do you advocate for yourself when you are the patient?
Dr. Gurevich [00:53:09]:
That’s like the hardest. You know, I honestly think the goal when you’re in the doctor’s office, you are. This is not the person who knows everything. This is not doctor knows best. You are utilizing that practitioner to give you opinion. That’s very educated and well informed. That may or may not be the key to you. That is the whole point of your doctor’s day.
Dr. Gurevich [00:53:29]:
This is a consultant that you’re bringing in that you may or may not utilize. There are treatments, yes.
Karyn [00:53:34]:
You cannot emphasize that enough. It’s so huge. So many people go and think, oh, but my doctor said, they are your consultant. They’re working for you. Oh, yes.
Dr. Gurevich [00:53:44]:
You can only know what they know. That’s it. Like, I only know what I know. I’m not having the pharmaceutical reps coming in and out of my office. Like, I’ve got my two. That for the drugs that I use, I’m having the nutritional people come into my office. They’re having the pharmaceutical people, they only know what they know, and the system is designed to keep them busy so they don’t, like, reach out and look for something that new or out of the box.
Karyn [00:54:05]:
Right, right. Exactly. What is one thing that you do on a regular basis to help you connect with yourself? Like something self care wise?
Dr. Gurevich [00:54:13]:
I’ve recently discovered orange theory.
Karyn [00:54:16]:
What is that?
Dr. Gurevich [00:54:17]:
Orange theory? It’s like.
Karyn [00:54:18]:
I don’t know this. Tell me.
Dr. Gurevich [00:54:19]:
Oh, my God, dude. They have. They have, like, hacked my psychology. It’s an exercise class, basically. It’s a mixture of cardio and weights, and it’s like, on a circuit. They kind of tell you what to do, but they blare, like fun music, and you’re, like, running and sweating and it’s. They have hacked my psychology.
Karyn [00:54:35]:
Do you have to go in person for this or can you get a nap?
Dr. Gurevich [00:54:38]:
I think you go in per. I don’t know. I only go in person. I’m not likely to show up unless I’m being.
Karyn [00:54:43]:
Yeah.
Dr. Gurevich [00:54:43]:
Like, holding me accountable. Yeah. I pay money. I’m gonna show up.
Karyn [00:54:46]:
Yeah. Right. Okay. What’s one thing that we’re all getting wrong about gut health, in your opinion?
Dr. Gurevich [00:54:53]:
I don’t think we’re focusing enough on fermented foods as we should be. And I think that one of the things that happens, especially in this community, that both you and I serve, is there is this, like, I want to limit. I want to limit. I’m on a limit. And then you’re on, like, the five foods, and none of them have nutritional value. I think what it comes down to is you need to, you know, get rid of the stuff that has the preservatives, the gums, the pesticides, and put in the fresh stuff so you can understand just how good whole nutrition makes you feel.
Karyn [00:55:20]:
Yeah. Because it makes a big difference, right? Yeah, yeah, yeah. Okay. If somebody says to you, do you have a good book recommendation? You know, when someone says that to you, what’s the one book that you feel like you recommend more than any others? And it doesn’t have to be gut health. It doesn’t even have to be health related. It could be anything. Of course it is. Knowing you, Doctor Gurvich.
Dr. Gurevich [00:55:37]:
So it’s actually called gut? It is. Her name is Alana something. I can’t remember. It is. And I listen to it. I didn’t read it. I listened to it.
Karyn [00:55:46]:
Yeah. Yeah.
Dr. Gurevich [00:55:47]:
First of all, she’s hysterical. Second of all, she builds and explains the Gi in these complicated, like, in these really simple ways for these complicated concepts, that actually puts a ton of humor in there. And it just like. It’s like. It reads like fiction, but it’s all about the function of the gi. It is, like, the best book ever. I love it.
Karyn [00:56:06]:
Okay. Oh, I haven’t ever read it. I’m gonna go get it.
Dr. Gurevich [00:56:08]:
You’re gonna love it.
Karyn [00:56:09]:
What’s your favorite travel destination?
Dr. Gurevich [00:56:14]:
I like to go visit my family.
Karyn [00:56:16]:
Yeah, no, no, we’re, like, tropical overseas or anything. Just home for your family? Yeah, yeah, yeah, yeah, yeah. And coffee or tea. And how do you take it?
Dr. Gurevich [00:56:25]:
Green tea. Coffee makes me crazy. Obviously, I have no limitation of energy. It gets a little bit too much for everybody if I get coffee, and I love. So I’ll buy loose leaf green tea, and then I’ll just refill it all day long until you get different a. You get caffeine, but also you get different layers of the antioxidants. And, you know, they say it’s anti carcinogenic, so it prevents cancer. We’ll see.
Dr. Gurevich [00:56:49]:
It just gives me the perfect amount of caffeine, and it also tastes delicious.
Karyn [00:56:53]:
Yeah, yeah, yeah. Love green tea. Okay, what’s your favorite way to unwind after a long day?
Dr. Gurevich [00:56:58]:
Oh, hanging out with my kids, and then I like to cook.
Karyn [00:57:02]:
You do? Yeah. Cooking with your kids. That would probably be perfect.
Dr. Gurevich [00:57:05]:
It’s really. And, I mean, I tell everybody I don’t have any hobbies. It’s like naturopathic gastroenterology and cooking. That’s it.
Karyn [00:57:11]:
Yeah, I love it. Okay, last question. So, the name of this podcast is the Cheeky podcast for moms with IBD. That’s my way of just having a little bit of fun with our illness, because I think you got to do that. So to me, being cheeky is being a little bit sassy, a little bit quirky, but a lot badass. So how are you cheeky in your life?
Dr. Gurevich [00:57:30]:
I feel like what I do every day, just showing up and slightly fighting the system.
Karyn [00:57:37]:
Yeah.
Dr. Gurevich [00:57:38]:
Which I believe in, but I also think is bullshit. I think that is what I do on a regular basis.
Karyn [00:57:44]:
Yes, yes.
Dr. Gurevich [00:57:45]:
I mean, like, you know, for us, you know, anybody who’s in alternative medicine, we’re not, like, I don’t get paid. I mean, I have some gastros that I work pretty intimately with, and there’s a couple groups that refer to me, and I refer to them, but really, we are talking to, like, the direct people who want other options besides just the system. And that is, like, not the easiest a lot of times.
Karyn [00:58:10]:
Yeah, yeah, yeah. Absolutely. I love it. Doctor Gurovich, thank you so much. I know we can find you on the Turd Nerds podcast, so everybody should go and download it, check it out. Where else can we find out about you?
Dr. Gurevich [00:58:22]:
So I’m moving clinics. My new website is open Wellnesspdx, and that will be where my new practice is, hopefully for the rest of my life.
Karyn [00:58:31]:
Yeah, you don’t want to make that move again.
Dr. Gurevich [00:58:33]:
No. Ever.
Karyn [00:58:34]:
Yeah, exactly. Doctor Ilana Gurevich, thank you so much. This has been such a wealth of amazing information. I know it’s going to mean so much to our listeners. So thank you for taking the time.
Dr. Gurevich [00:58:44]:
I also just want to say thank you for getting this information out there. Like, we live in a world where really good at information is really accessible, coming from experts who know what they’re doing. And you putting out something like this actually helps people take ownership of their own health, and that, I think, is the first step of feeling better.
Karyn [00:59:01]:
That is my goal, so. Yeah, absolutely. Thank you.
Dr. Gurevich [00:59:04]:
Okay. Thank you, honey. Bye.
Karyn [00:59:05]:
All right, bye.
