The Healthy Gut Podcast Episode 10

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the healthy gut podcast episode 10

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inflammatory bowel disease

Inflammatory Bowel Diseases can be painful, debilitating and embarrassing. They can render people feeling weak, fatigued and very unwell.

In today’s episode of The Healthy Gut podcast, Rebecca chats to Dr. Ilana Gurevich, a naturopathic doctor who specialises in working with people with with IBDs, SIBO and GI complaints about how she treats these conditions and can support them to live a healthier, happier life.

in today’s episode

In Episode 10 of The Healthy Gut Podcast, we discuss:

✓ Understanding what Inflammatory Bowel Diseases (IBDs) actually are including Crohn’s Disease, Ulcerative Colitis, Coeliac Disease, Microscopic Colitis and who is at risk of developing these diseases and why the age you develop it can alter the severity of your symptoms

✓ Understanding the symptoms associated with IBDs

✓  Why it can take so long to get a diagnosis with an IBD

✓ Understanding the increased risk of colon cancer with IBDs

✓ The link between IBDs and SIBO

✓ Why Dr. Gurevich tests for SIBO if there is small bowel involvement with an IBD

✓ Treatment options for IBDs and why Dr. Gurevich believes the severity of your treatment is dependent on the Gastroenterologists you have previously seen

✓  The role nutrition plays in the treatment of IBDs and which diet Dr. Gurevich uses and sees positive results with

✓  Why the quality of our food has such an influence on our health and why eating sick animals leads to sick humans

✓ Which fermented foods Dr Gurevich likes to use and when she advises you don’t use them

✓  New research pointing to the underlying cause of Crohn’s Disease

✓  The risks of leaving an IBD untreated

✓  The correlation of IBDs and mood/mental disorders such as anxiety and depression and vitamin and nutrient deficiencies

✓  The importance of getting to bed and being asleep before 11pm

✓  The future of IBD treatment

resources mentioned in today’s podcast

connect with dr ilana gurevich

Dr Ilana Gurevich

Dr. Ilana Gurevich is a naturopathic physician and acupuncturist who graduated from the National College of Natural Medicine in 2007 and 2008.   She is currently part owner of 2 large integrative medical clinics on both the east and west side of Portland.  Her practice is very specialised in treating Inflammatory Bowel disease as well as IBS and other GI disorders.

She uses individualized natural therapies to address the underlying cause of disease. She encourages her patients to take an active role in their own health care. Dr. Gurevich relies on a variety of natural modalities including Chinese and Western herbal medicine, acupuncture, nutritional supplements, homeopathy, hydrotherapy, and dietary education.

Dr. Gurevich was nominated as one of Portland Top Docs by the Portland Monthly in both 2014 and 2016. More information about Dr. Gurevich and her practice can be found at


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about the host

Rebecca Coomes

rebecca coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

Read more about Rebecca >>

podcast transcript

REBECCA: Welcome to the show.

DR. GUREVICH: Thank you so much for having me.

REBECCA: My pleasure. So we actually had the pleasure of meeting each other in person at the SIBO symposium in Portland which was great this June. And you actually came on to one of my little Facebook live videos and we did do a little of discussion about IBD. So this show is going to be all about IBDs and something that you specialize in. So I am really looking forward to really deep diving this topic with you.

I would like to start off with your story. Why have you ended up becoming a naturopathic physician and specializing with IBDs and SIBO as well? What took you to that path?

[1:49] DR. GUREVICH: When I was 12 I started being very sick. I had a lot of diarrhea, abdominal pain, difficulty gaining weight. At the age of 19, so 7 years later I was finally diagnosed with Crohn’s Disease which is one of the inflammatory diseases and I was very fortunate who was a physician; a psychiatrist was going through his midlife crisis. And instead of having an affair, buying a car, he discovered alternative medicine. And because of that process I went to see a naturopathic physician in Connecticut and he basically saved my life. And so when I walked in to see him I was on 60mg of Prednisone. I have just been hospitalized. I had a fever that wouldn’t break until they diagnosed me with Crohn’s. And after seeing Dr. Sensenig who was my naturopathic physician at that time, a year later I was the healthiest I had ever been. I was not cachexic. I wasn’t wasting away and I was actually living abroad. In Scotland, I was like I had energy and I was like partying and having a good time and I realized that for the first time in 7 years, for as long as I can remember, I was actually healthy. And there was something about that experience…

You know what really happened when I was in Scotland, I had a conversation with this man who was also a college student and he also had Crohn’s and he had been on a liquid only diet for the last 4 months because he was so flared and so out of control. And I remember getting off the phone with him my parents just happened to call the first time in like weeks and I started crying because I was like, “Oh my God I am going to get sick again. I am going to be as sick as this person.” And they were like, “you’ve never been this healthy. I literally can’t remember you ever being this healthy for the last 5 years, 7 years.” And that’s when I realized, “Oh my God, my naturopathic physician gave me a life.” Like I was dying and it was because of that i remember I came back from Scotland and rom traveling abroad in college and all of a sudden I knew exactly what I was going to do. And I had no idea what I was going to do before that.

[3:52] REBECCA: Wonderful. And so often it seems to be the case where it’s because of a person’s own journey that leads them to doing something with a career to help others.

[4:04] DR. GUREVICH: I am so grateful for it. The hardest time of life, I was the sickest I had ever been. But if it wasn’t for that experience, I don’t think I would fully understand the power that naturopathic medicine has to help people get well.

[4:17] REBECCA: Wonderful. I mean it’s not wonderful to be sick but it is wonderful that you now… you know it has led you to this path. You know the world is thankful for it and for you being out there treating other people. I would really love for you to just talk a little bit about what are inflammatory bowel diseases or IBDs as they can be abbreviated as…. What do they do to you? And all the rest.

[4:44] DR. GUREVICH: so there’s 2 maybe 3 names for bowel diseases. The first is Crohn’s disease. Crohn’s disease is an inflammation that can happen anywhere in your digestive system. So as high as your mouth, as low as your rectum and everywhere in the middle. Crohn’s disease also doesn’t have to be relegated to one area. If you are looking at some imaging of a Crohn’s disease bowel what you will see is what they call skip lesions and so there are like you can have parts of your large bowel affected and parts of your small bowel affected. Parts of your stomach affected. So it really is a disease that can affect the entire digestive tract. The majority of Crohn’s patients are affected at the bottom of the small bowel, in the area called the terminal ileum and their large bowel. The other big inflammatory bowel disease is ulcerative colitis. Ulcer colitis is just limited to the colon. Ulcerative colitis, it will start at the rectum and then go its way up to the bowel and it will never go in to the small bowel. It will only be in the large bowel.

Recently however, a lot of ulcerative colitis patients who are not progressing on treatments, they often suspect that it is Crohn’s disease as well. And then the other one, Celiac disease is another inflammatory bowel disease. That one is very specified about having gluten insensitivity and gluten allergy. And then there is a new one that is coming around called microscopic colitis. Microscopic colitis is when you do a colonoscopy and the colon looks completely normal. But then when you do biopsies of the colon and you look at it under a microscope, all of a sudden you are finding microscopic inflammation. And that is a relatively new condition or is being diagnosed much more widely.

[6:27] REBECCA: And what do these conditions do to you. It doesn’t sound like it’s much fun at all to have that digestive tract inflamed and compromised which is what is caused with these diseases.

[6:42] DR. GUREVICH: So if you have ulcerative colitis, a majority of symptoms are rectal bleeding and rectal pain. Those patients can have upwards 20 bowel movements a day. Very loose and lots of blood. Chron’s disease is a little bit more notorious for having pain. Crohn’s disease also has a lot of malabsorption which means that you can’t… because you’re small bowel what a majority of Crohn’s is all about that intestine… is all about absorbing nutrients and so if you have an inflammatory process in the small bowel that absorbs nutrients, you end up malnourished. And so a lot of Crohn’s patients, their biggest complaint is pain.

[7:19] REBECCA: do you find that there is one inflammatory bowel disease over another that is more prevalent or more common? Or are they about the same?

[7:29] DR. GUREVICH: I think it’s a good question. I don’t have the statistics on top of my head but I think they are relatively more similar. It is easier to diagnose ulcerative colitis because you can do it with a colonoscopy. If you have a disease in the small bowel and it is not just the bottom part of the small bowel, you have to have other means to find it. And what happens a lot of times with inflammatory bowel diseases is that they take a long time to get diagnosed because they don’t want to put you through invasive testing and they are always trying to put the blame on something else. “Oh it’s an allergy.” Or, “You know you are just tired or blablabla.” So it does often take multiple gastrointestinal visits before they will get diagnosed especially with kids.

[8:13] REBECCA: And what can these disease do to you? We have mentioned that there can be malabsorption but can they lead to anything more sinister?

[8:23] DR. GUREVICH: 100% you have and increased likelihood of having colon cancer if you have an inflammatory bowel disease. The quality of life when you are an inflammatory bowel disease patient in a big flare is terrible. I mean you literally, your whole life is taken over by worrying about your intestines. You know a lot of people, at least at my practice, we are only trying to control it with food. And it is almost maddening for them because sometimes food does an amazing job at controlling bowel disease. And other times it does nothing. But these patients will restrict themselves to death because they are hoping for any type of control.

[9:02] REBECCA: And what are the signs and symptoms of these diseases? You have talked about rectal bleeding with ulcerative colitis. If someone suspects that they have something like Crohn’s, what are some of the symptoms that they might be feeling?

[9:17] DR. GUREVICH: Abdominal pain, inability to gain weight, diarrhea, there is a small subset of Crohn’s with constipation, anemia definitely happens, fatigue is a big one. Sometimes dizziness because you are not absorbing iron. It’s really poor quality life.

[9:39] REBECCA: Yeah. And some of these symptoms sound very similar to SIBO which people that are listening to this podcast either have SIBO or have an interest in SIBO. So how can one tell the different between a condition like SIBO and Crohn’s. Is it literally that you just need to do the tests?

[10:02] DR. GUREVICH: That is a very tricky question. The first SIBO symposium which was I think 2011 or 2012, I presented a case on inflammatory bowel disease and SIBO. She was an inflammatory and bowel disease patient and it turned out we did everything to try and control her and her bowel disease and nothing worked. And then we tested her for SIBO and finally we were able to get her into complete control just by treating her SIBO. And when I presented this last time in 2016, again I presented about inflammatory bowel disease and SIBO and now all of a sudden there is preponderance of studies that is finding that there is actually a huge correlation between and inflammatory bowel disease.

Also, a study was just released I think 2 weeks ago that linked Crohn’s disease to 3 different bugs. One fungus and tow bacteria and they are overgrown within a Crohn’s GI. So the answer is, we are now starting to realize how much SIBO and inflammatory bowel disease have in common. A lot of times what happens with this Crohn’s patient is they will go to they are having bloating and they are having diarrhea and they are having pain and the doctor is looking for a Crohn’s flare. And then the doctor will start the medications that we have to treat inflammatory bowel disease. And these are hard hitting medications – steroids, biological agents with suppressed immune system. And these patients will not respond to these biologic medications or to these steroids. And if you go back and you actually test them for SIBO, they are actually in a SIBO flare and it is presenting like and IBD flare because it’s a lot of the same symptoms but it is actually a SIBO issue. And now there are studies that are linking that correlation which is brand new evidence.

[11:48] REBECCA: How interesting. And I guess if you are someone that has an IBD and I am wondering if someone is presenting with an IBD that your recommendation or advice when you speak and having a flare is – “Hey let’s test for SIBO if we haven’t already tested for it to see if this might be the underlying cause rather than your IBD causing you problems.”

[12:13] DR. GUREVICH: Now, what my baseline of treatment is have a patient come in and the first thing I’ll do is I figure out where exactly is their disease. Is it mainly large bowel centric like you see or some Crohn’s. It’s called Crohn’s colitis. Or is it like 80% of Crohn’s patients where it is mainly in the small bowel. If there is any small bowel involvements the first thing that I am going to do is test them for SIBO. If there is only large bowel involvement what I am going to do is I am actually going to do stool cultures to figure out what is growing within the intestine.

For a long time my working theory about inflammatory bowel disease has always been – this is a micro biome or there is something wrong with the functional cell of your intestine which happens to be external bacteria and that is why you are in this disease. Now the research is finally coming up with our naturopathic theories and proving them correct.

[13:05] REBECCA: So in terms of the way that you treat people with IBDs, how do you approach their treatment? Is it all about taking….is it all about their diet? Are you looking at pharmaceuticals or herbs? Is it lifestyle? What goes into treatment for you?

[13:23] DR. GUREVICH: The answer is all of those things. So the first thing you have to think about is how severe is their case? Is this a pretty mild case of inflammatory bowel disease that can relatively well controlled? Or are they basically dying in front of me and we need bigger guns? I am very very very pro using some of the bigger biologic pharmaceuticals if they can get into remission and they have no quality of life. If they are mild to moderate case, I think sometimes diet is enough. Or diet and supplementation for a series of years, I think can often times get people under complete control. It really depends on the person and the severity of their disease.

[14:02] REBECCA: And does it also depend on how long they have had the disease in terms of how invasive or mild the treatment needs to be?

[14:14] I feel like length has less to do with it than the gastroenterologist that they have seen.

So we have a medical system here in the pacific northwest called Kaiser. Kaiser is an HMO and so they are really big on saving money. So if you walk into a Kaiser office and you have a mild to moderate Crohn’s, Kaiser – the gastro is either going to do nothing or start you on a non-steroidal very cheap medication. If you walk into a private practice office and they have reimbursement for their biologic agents, I think you might be much more likely to start with a heavier hitting medication even if you haven’t had it for a long time. So in my experience, unfortunately there is no clear treatment. There are definitely recommendations for treatment and the recommendations for treatment are if you have a mild to moderate inflammatory bowel disease, start with the lower invasive medications and if that doesn’t work, step to the next one and then up to the next one. But that is not necessarily what is practiced at least not in the states right now.

[15:12] REBECCA: And I have had conversations with people who suffer from Crohn’s for instance and they are in a terrible state and they are Australians. And they have been told, there is nothing we can do about it, you don’t need to change or modify your diet, be prepared that we will probably have to do some invasive surgeries at some point… kind of like just deal with it. It just makes me so sad to see these people suffering terribly and there doesn’t seem to be a consistent approach to how to treat these diseases.

[15:46] DR. GUREVICH: I also think it is insane, insane that they are saying diet doesn’t matter. That to me it’s bewilderingly insane. If you were having and irritation on the skin because you are wearing a nickel belt, nobody would tell you to continue to wear that belt. Everybody would tell you, take off the belt and the irritation will go away.

I am not sure how the theory that diet doesn’t matter and inflammatory disease came up but it could not be further from the truth. And if you look at the studies, there are a lot of small studies on just dietary interventions with inflammatory bowel disease and what the studies find is about 70% of inflammatory bowel disease patients will do really really good on the specific carbohydrate diet which is like a paleo diet but slightly different and about 30% of people will do terrible on it. So there are definitely a lot of studies linking dietary interventions successfully to inflammatory bowel disease treatments. The problem is that these studies are generally really small. Eight people, thirty people, a hundred people. And when we are in a medical system that is ruled by big pharma where they have the money to fund these tens of thousands patient studies, we don’t look as seriously at small studies like what we have on dietary interventions. But the reality is, we also don’t need large studies for dietary intervention because our dietary interventions are not going to kill anybody like the biologic medications might.

[17:17] REBECCA: And what type of dietary modifications do you find work well with your patients.

[17:25] DR. GUREVICH: So generally where I start is with a diet called the specific carbohydrate diet. That diet is a monosaccharide based diet. Basically grains are out. Some fruits are out, sugars are out, honey is ok. Mainly it is a meat and vegetable based diet. Homemade yoghurt is a big part of that diet as well but if you are going to do any dairy it has to be aged. So there is no lactose or sugars still in there. The theory of that diet is very based on putting the right branching of sugars into your body and taking away things that we know to irritate like raw veggies, veggies with seeds, veggies with skins. All of that is not able to stay on the diet because it just is an irritant at least initially. And then as we get them under control, we generally increase the spectrum of what they can eat.

[18:17] REBECCA: And how long do you find that takes to get them in that first phase whether they are really restricting the diet through to perhaps maybe being a little bit more flexible or can they ever be fliexible with their diet?

[18:31] DR. GUREVICH: A hundred percent they can flexible in the long run. I think that it takes somewhere between…I have seen results as quick as 3 days and I have seen results take as long as 3 months.

[18:43] REBECCA: Sure. And can inflammatory bowel disease be cured? Is there a cure for them or once you’ve got it, do you have it for life?

[18:52] Dr. GUREVICH: that depends on who you are asking? Does a gastro think there is a cure for it? No. they said you are going to have inflammatory bowel disease for the rest of your life. In my experience, can you cure irritable bowel disease? Yes. Does it mean you are going to go back to living like a standard westerner, eating McDonalds and you’re… wheat gluten and dairy… I think you are going to have to make some dietary modifications. But I think that if you make those modifications and you get under control a hundred percent you can stay under control.

[19:25] REBECCA: is there research that is able to pinpoint what causes inflammatory bowel diseases?

[19:35] DR. GUREVICH: So that study just came out. Like literally a week ago. It’s kind of amazing. A week ago, they just published a study. I think it was in the British Journal of Medicine that found these three symbiotic bugs that are basically what they think now is the underlying of inflammatory bowel diseases. Or at least Crohn’s which is now the underlying cause of Crohn’s disease. It was Candida tropicalis is one strain of candida and I can’t remember what the two bacteria are. But basically they did a lot of cultures on a lot of Crohn’s patients and they found that these three bugs came up ubiquitously.

[20:12] REBECCA: That’s really exciting to think that they may be getting closer to understanding what is causing it an potentially being able to prevent it.

[20:23] DR. GUREVICH: My big question is, how is big pharma going to figure out a way to make a probiotic pill basically that they can charge thousands of hours for.

[20:32] REBECCA: Oh I know and it is so unfortunate I think that so much of our medical systems both in the States, here in Australia and other western countries are just so dictated by what the pharmaceutical companies can make money of or what they don’t make money of.

[20:49] DR. GUREVICH: Which is why I think dietary interventions are so incredible with GI disorders.

[20:56] REBECCA: Definitely. And even just from a symptomatic control perspective that modifying ones diet, if you can get your symptoms under control it may not be necessarily changing the core root of what is going on but if you can feel better you are going to be so much more likely to be willing and able to do more, to focus more on improving your health and moving forward rather than… no one wants to be kind of house bound or bathroom bound because they are just suffering so terribly from their condition.

[21:33] DR. GUREVICH: I fully believe if your symptoms are better because of choices that you are making, that means your disease is better. I think it’s that clear of a connection especially with GI disorders. Symptomatically, if you are symptomatically better, then what you are doing is working and that means you are doing the right thing.

[21:52] REBECCA: Definitely. And I think there is psychological component as well that when you do something it works, there is the positive reinforcement, it’s more likely to encourage you to do it again. So from a mental perspective, if you know something is progressing forward for you then you are happy to keep doing it.

[22:15] DR. GUREVICH: Totally.

REBECCA: Who is at risk of developing an IBD?

GUREVICH: So there are two phases when people are usually diagnosed. One is you know adolescence through your twenties. That is the biggest phase of diagnosis and then there is a second phase that is like 55 to 65 which is a slightly lower peak. Men and women area actually fairly equal. Maybe women are a little bit affected more than men. There is a little bit of genetic components. We used to think there is a genetic component. Now we think that actually has less to do with that. Like Ashkenazi Jews are one. I personally think my theory has always been, if you have a history of lots of antibiotic use, that’s a likelihood for getting Crohn’s because you are changing your microbiome.

[23:04] REBECCA: definitely. And I think overuse of antibiotics just has so much to answer for. We are just destroying our poor little microbiome with antibiotics coming at us from every direction. We are taking them orally. It’s in our meat. It’s just everywhere. No wonder we are suffering.

Are conditions like IBDs on the increase or are we just more aware of them now?

[23:28] DR. GUREVICH: I definitely think they are on the increase. I don’t have stats for you but I think the predominance of it has definitely increased in the last 30 years.

[23:38] REBECCA: And with these two groups of people when you see that you either get diagnosed with that in your teens or when you are on your sixties, are the diseases the same or are they presenting differently depending on what age you are when it presents?

[23:55] DR. GUREVICH: So I think that if you get it, if you are older, it’s usually a lot slower growing and it’s a lot less likely to be virulent. Like you are like less likely to have an obstruction. You know also, I definitely have a subset of patients who got diagnosed at 50 to 60 mainly because that is the recommendation to get your initial colonoscopy and they find it just randomly on colonoscopy. So I think if you are younger it is going to be, they are finding that… nobody does colonoscopies on younger patients. So you are doing really bad and they are really looking for it.

[24:34] REBECCA: Do you find as well that males or females are more likely to do something about it than the other? Like are woman more likely to do something about their condition than men or do you see that there is kind of an equal spread of both women and men coming through your practice?

[24:48] DR. GUREVICH: I think that women by their nature are more in tune with their bodies and more likely to act on it. That’s on my experience.

[24:54] REBECCA: And if you leave it unchecked and you just…if you are that person who is listening to this person who is saying, “Oh gosh yes, some of those symptoms sound like me but I just thought that was just life. And I know that you said that you are much greater risk of it ending up with colon cancer. Along with that are there any things that you can be doing to yourself that are making you worst by just putting your head in the sand and ignoring it?

[25:22] DR. GUREVICH: So all of those nutrient deficiencies could be very serious. Anemia for one could be extraordinarily serious. So I you are having rectal bleeding, you know rectal bleeding is happening higher in the intestine it’s not going to look like red blood but look like coffee grinds in your stool. And so if you are having bleeding, you might not even see that you are bleeding. So anemia is very serious. B12 deficiency is very serious. If you are not absorbing your minerals and your vitamins, then what is happening is…minerals and vitamins are basically enzymes that work in the body. So what that means is your body has a trillion different functions that happens every second and the co factors or the enzymes are the things that make that process go. So it is like you can’t just open the door. You have to stick the key to the door and turn the knob to open it. If you are not absorbing your nutrients then all of these bodily functions that your body needs to function are not happening. So the nutrient issues are a huge deal.

[26:27] REBECCA: And what does nutrient deficiency do to you? Like feeling fatigue… like how do you feel when you are not getting the nutrients you need?

[26:37] DR. GUREVICH: So fatigue is a big one. Brain fog is a big one. Easy bruising, easy bleeding, neuropathies or numbness and tingling could happen. With B12 anemias or pernicious anemias or B12 deficiencies, you can actually get psychiatric effects. You can get severe depressions, sever psychosis, electrolyte deficiencies which are about basically mineral deficiencies can cause dehydration. They can also cause psychosis. You know like these are… if it gets out of control these are big deals.

[27:06] REBECCA: And someone could be thinking, “Gosh I’ve got a mental disorder.” When in fact it could all be stemming from their gut but they are looking at where their output is which is they are feeling it in their mind.

[27:21] DR. GUREVICH: So the studies are really amazing about that. They are now doing extensive studies on locating specific bugs of probiotics which live in the GI that affect your mood. So one of the things that…I treat what I call psychiatry light. You know mild depression and anxiety and one of my most effective tools right now to treat it are using probiotics like lactobacillus rhamnosus which is super proven at this point to work for anxiety. Or streptococcus theophillus I think which has been linked to… a deficiency of that has been linked to depression. So we are now figuring out that the microbiome that gets affected in their GI is actually affecting our mood directly as well.

[28:07] REBECCA: And mental issues such as anxiety and depression are just so common for people with digestive disorders. I hear it a lot from people that I am talking to and I see it on forums and all the rests that anxiety and depression particularly are just prevalent in this community of people that are suffering.

GUREVICH: That’s what I see too.

REBECCA: Yeah. And I know that with my own journey… and I was never overly anxious or depressed but I definitely suffered my bouts of them. I don’t feel those things these days now that my gut is much better health than it used to be which is good. But it is a journey. I don’t think that I have now found the almighty elixir of health. I just feel that I am improved and I am progressing forward to wherever forward may be.

[29:09] DR. GUREVICH: I will tell you that elixir of health in my opinion comes down to moving your body and exercising, eating food that is high quality, high nutrient dense, high probiotic fermentation diverse, and surrounding yourself with community that you love. If those three things are doable I think that it probably fixes 80% of most diseases.

[29:34] REBECCA: It’s interesting you talked about that because as I came through my SIBO treatment and really that was just the beginning of my journey I have now discovered, I realized I had to address 5 key areas in my life and the first one was just awareness, I had to start getting aware with my body, just starting to listen to it. I’d ignored or masked the signals from my body for so many years with over the counter pharmaceuticals and prescription pharmaceuticals that I’d stop hearing what it was telling me. I had to deal with nutrition. I then had to look at my movement and I am one of those people that I am either lying on the couch and so sedentary or I am training for triathlon like there is kind of no in between for me and I had to really address how I moved.

My mindset paid an enormous role in my recovery and then my lifestyle. So the fifth piece being lifestyle like I had to do a lot of changes to start living in a way that supported health rather than hindering it. So things like sleep and stress levels and the people that I hung out with and all of that. Setting goals and intentions so that I actually stuck to my plans rather than falling over at the first hurdle that I came across. So I think addressing areas are really important. In terms of those 5 areas, as I call them now, the 5 key pillars to my health, are there any other points that you think are important to a journey to recovery?

[31:11] DR. GUREVICH: I really really want to stress what you said about sleep. Sleep for me, the way that I described it to patients… so I have a couple of things that all my patients have to do. One of them is 20 grams of protein for breakfast, for blood sugar regulation. The second one is being asleep before 11pm, being asleep before eleven. The Chinese have a lot of rules about a lot of things and one of their big rules I when different organs have different energy in them. So when the chi is at different organs to the body. And at 11 o’ clock at night, the chi goes into your wood organs which are your gall bladder and your liver. So what happens, I will tell people what time and they’ll say, “Yeah that’s exactly what happens.” What happens is you are laying on the couch dead to the world, exhausted, looking at your iPhone or looking on the internet or watching TV at like 9pm, 9:30pm, 10pm. 10:30pm, 11pm rolls around, all of a sudden you are like, have this crazy bout if energy and you are like organizing your closet by color or you are like replying to every email that you haven’t answered in the last three years. Because at that point your sleep or your chi is going into your wood organs your wood organs are the energy that it takes to grow a garden from seed. So you take a seed that has been hanging out for generations. And you throw it into the ground and it will literally breathe life into itself, force itself up through all of these dirt, double double double in size and now you’ve got enough tomatoes to fit the whole neighborhood.

If you are not asleep by 11pm, that energy that should be used to fix your body and everything you broke down all day long is now instead going to be used to pointlessly waste on the organization of whatever. And so my big rule to everybody is you have to be asleep by 11pm.

[32:57] REBECCA: I am laughing whilst you were saying that because I in the past have been so guilty of that person at 11 o’clock at night just almost manically doing things. I am going to this, I am doing that and then 2am rolls around and I am like, “I am so tired.” And 7am when I wake up rolls around and I am exhausted. So sleep for me is the eternal process in terms of me working on getting myself to bed early because I am such a night owl by nature. So if you are working with somebody like me who is notoriously up until midnight, 1am 2am, how do you get them to then change their habits to get into bed and asleep before 11pm?

[33:48] DR. GUREVICH: so do you know what my patients always say? They say, “I was on the phone texting somebody and I was like Dr. Gurevich is going to be mad at me because I am not asleep yet.” If you are asleep before 11pm, you wake up the next day and really the world is filled with butterflies and rainbows and flowers. You just feel so much more alive. And if you don’t, if you are up until 1am, 2am… so wood time is 11pm to 12am in the gall bladder or 1am to 3am in the liver if you are going to bed at 2 in the morning and then you are waking up at 7am, you know you are dragging the entire beginning of the day. You are not even getting going until 4pm or 5pm in the afternoon. And it’s really, it’s that awareness of your body and listening to what your body wants you to be doing that allows you to stay the habit of being in bed at a regular time.

[34:42] REBECCA: I find that since changing my sleep patterns and really really focusing on getting to bed, I now set alarms that start going off at 10 PM so that it’s my reminder to go to bed. So that I can get ready for bed, get into bed, read for a little bit, lights off and hopefully the plan is that I am asleep by 11pm and on the occasion now that I am up later than 11pm, I really feel it and it’s really interesting experience for me because I never went to bed before 11pm back in the day and now I really focus on being in bed early.

So it’s interesting. It’s really interesting to now just have that awareness piece like I feel it in my body. I feel my body saying, “Hey we don’t want to be doing this. We want to be asleep. We feel so much better when we are asleep.”

[35:33] DR. GUREVICH: I love that idea about setting alarms. I am going to use that with my patients. I love that idea.

I mean your body is supposed to be hydrated. Your body is supposed to sleep when I it’s dark and your body is supposed to eat quality food.

[35:49] REBECCA: It is and it feels so much better when you do it. When I travel or if I am away with work or something like that and I don’t eat the food that I normally eat, so my food these days is really…I focus on getting the best quality nutrition I can, so I buy these beautiful organic vegetables and fruits. I choose pasture fed meats. I choose good quality seafood, good quality dairy which I can tolerate a small amount of that. So everything is really high quality. I do pay for it but I am not spending any money on junk food. I just don’t buy any junk at all. But on the occasion where I am not in my kitchen and I am away from home, my gosh I really feel the difference in how my body feels when my nutrition changes. And when I… and if I have eaten out or somebody has cooked for me and they have used more processed food, wow! Like instantly I can feel the difference that that makes. And I never felt that before because my day to day previously was what I thought was very healthy but I was using foods… I was buying a lot of food from the supermarket that has been made in labs or big food production lines that came from packets. Whereas now there is virtually nothing in a packet in my food consumption.

[37:16] DR. GUREVICH: That is the difference when you are drinking water or poison. The other things is if you are eating a lot of processed foods, we know that the microbiome is going to… be the bacteria that those processed push are going to be not as healthy for you or not as beneficial as the bacteria that fermented foods push or that vegetables push or that pasture raised meats push literally are growing in your body. And you know you grow a new intestine about every three weeks. You literally regrow your intestine every three weeks. And so if you are feeding the bugs in your intestine that are constantly reproducing good quality nutrition that they benefit from, the new GI that you are building is going to be healthy and not inflamed and able to absorb nutrients and if you are feeding it crap then you end up with a crappy GI literally.

[38:08] REBECCA: what do you say to people when they say they can’t afford to eat good food and I hear this all the time and it does drive me a little bit crazy? What is your advice to people when they say, “I just can’t afford it, I can’t afford to go and buy fresh fruit and vegetables and good quality meats?

[38:25] DR. GUREVICH: You know, so buying bulk that is a big one for me. Buying in bulk is, it’s probably the easiest way to save money buying really good quality foods. You are buying beans in bulk and grains in bulk if you are eating grains and good quality organic stuff, a lot of it so that you get the bulk discount. Also, I am lucky enough to live in Portland where everybody has a yard. And literally, the Pacific Northwest is amazing because everything grows here. It is not very much work to do. Grow your own then dry it. I mean like these things are really doable. Also in America we have Costco. I don’t know if you guys have Costco in Australia.

[39:10] REBECCA: We do. It has come out.

GUREVICH: So Costco in the last two years or 5 years, Costco has actually become the largest supplier of organic foods and what they are doing right now is they are having a hard time finding farmers to feed the demand of their organic foods. So now they are giving farmers loans to convert their soil to organic soil. Costco has more of a supply. Costco has become an amazing player in the organic food world. They have no antibiotics in any of their meat. Most of their beef is now grass-fed. You have a ton of organic options. I am kind of shocked at my love of Costco and the high quality of their foods.

[39:51] REBECCA: I had no idea. I am so interested to hear that. That is wonderful to hear that such a big player in the food supply industry is actually taking steps to supplying better quality food for us.

[40:07] DR. GUREVICH: It’s revolutionary.

REBECCA: Yeah oh gosh! That is music to my ears. And some of things that I do and the tips and tricks that I give people when it comes to eating well but eating in a way that you can afford, I buy cheaper cuts of meat so I have my local butcher, my local fishmonger and then I now have this gorgeous company that is based here in Melbourne, Australia and they deliver fruits and vegetable boxes which are all organic. And I have actually done comparison and buying my vegetables from the supermarket versus buying a box of their produce, the supermarket produce is actually more expensive and it doesn’t taste nearly as good and it doesn’t last as long and quite often when I cut open something, I might cut open a red pepper and it’s all moldy on the inside from the supermarket. But the organic produce is just gorgeous. But I also do bulk cooking. So I will get cheaper cuts of meat that need to be slow cooked and pop in a pot with a bunch of vegetables, slow cook it then I divide it up, put it in the freezer. I’ve got really easy quick meals for those nights where I am busy running around and I know that all the ingredients in it are quality ingredients and I don’t have to grab for things. I don’t have to get take out or make bad food choices because I have already prepared my foods. So that’s a way that I keep my food costs down and much more affordable and still eat very good quality produce.

[41:45] DR. GUREVICH: I also, at this point my family buys a quarter of a cow. That is a hundred percent pasture raised and that is the red meat that we eat all year. I never eat red meat if I am in a restaurant. I just don’t trust the quality of their beef. But we will eat a quarter of a cow which actually ends up all the cuts about the same and they are pretty cheap. You just have to buy it all up front and have a chest freezer.

[42:08] REBECCA: Yep, definitely need a chest freezer. That’s one of my goals. I don’t have the space for a chest freezer at the moment. But that is one of my goals is to do that buy big side of animal and then that is my meat and I know the farmer, I know where it has come from. Before I got diagnosed with SIBO I spent 12 months working with the RSPCA which Australia’s leading animal welfare charity and I remember talking to the head inspector there about what she did in terms of buying ethically raised and humane animal products because you become very aware of animals once you have worked in an association/ organization like RSPCA. And she does that. She said, “You know I go to the farm and I meet the farmer and I see how their cattle are raised and I build a relationship with them and then I buy half a cow, half a lamb, half a pig, and that’s my meat.” For those that can do it, do it.

[43:11] DR. GUREVICH: It’s so delicious. I mean a hundred percent grass-fed animal that was fed a diversity of grass. Oh my God it’s like the most delicious meat you’ll taste. I literally cannot eat meat if it’s not coming out of my freezer. It’s that much of a difference.

[43:32] REBECCA: It really does show the difference at this point in time between Australia and the US. In Australia yes there are some grain fed cattle but we have great access to amazing cattle that has been pasture fed and finished here. And we are very lucky to have such good quality meat with the red meat that we eat anyway and neighbours across the ditch in New Zealand produce amazing lamb as well. So we are pretty spoilt here and when I do come to the States I really notice the difference in the quality of the animal proteins. It’s very very different for my pallet because I am just not used to eating grain-fed produce.

[44:19] DR. GUREVICH: That’s amazing. You should be so grateful. I did a bicycle trip, 2600 miles. Me and my husband biked five years ago and we were biking through cattle country in the US and we would see these cattle and they were sick. They had abscesses and oozing wounds. There was barely any grass. I mean it was awful. And you know when you have sick animals and you eat sick animals you get sick.

[44:49] REBECCA: We are lucky here. We’ve got a lot of land mass and there’s not many of us. There’s only about 21 million on this huge land of ours. So we are still, we’ve got a long way to go before hopefully we’ll never get there. We’re having these roaming land animals penned and fed grain. It just absolutely breaks my heart when I see that. We could talk for hours about our passion for food but I would love to talk a little more about how you work with Chinese medicine and obviously I guess more with what we consider more Western medicine in your approach. How do you combine those two worlds?

[45:34] DR. GUREVICH: Acupuncture is incredible for offering symptomatic relief. I mean really almost immediately. And so I use a lot of acupuncture. Almost every single one of my patients get needles put in because it will make them feel better. It will make them feel more relaxed for one but it can decrease that pressure and that spasm quality to their pain that they suffer in their GI. Also, it can help them build blood. Really for symptomatic relief acupuncture is amazing.

As far as naturopathic medicine, I feel like I am very very fortunate to treat the GI because I know anything that I give you in your mouth is going to get to the tissue that I wanted to get to in your intestines. I think that is really why I ended up focusing on the gut because if I give you something to take orally it’s going to take a long time to get to your heart and who knows if it will ever get there. Well whatever I give you orally into your mouth, I know it’s going to go to the organ I am trying to treat. And so I do a lot of anti-inflammatory medicines, probioitics, herbs, and they are able to get exactly where I want to go. The other thing that I use a lot of is actually ozone. Do you know about ozone at all?

[46:50] REBECCA: No, I haven’t heard of that.

GUREVICH: Ozone is a gas. So the way that ozone is made is we take an oxygen tank and we run it to an alternator which is basically electrocuting those oxygens and breaking down their bonds. So an oxygen is a very stable molecule at O2. Right? If we electrocute it then what happens is we are breaking up those bonds and about 15 to 20 percent of that gas will reform in O3. So three oxygens bound together instead of two. The analogy that I always use is a husband and wife and the girlfriend, nobody is happy in that situation. And so what happens is if you introduce ozone rectally to a patient that is having a lot of inflammation, what is happening in their body is that inflammatory state is shooting off a bunch of reactive oxygen species also called free radicals. And that is an O1. That is causing an inflammatory cascade locally on the tissue of the intestine because that single oxygen is also trying to bond. It also wants to be in a stable O2 bond. So if you introduce ozone rectally into a patient that is having a lot of inflammation, what is happening in their body is that inflammatory state is shooting off a bunch of reactive oxygens species also called free radicals. And that is an O1. That is causing an inflammatory cascade locally on the tissue of the intestines because that single oxygen is also trying to bond. It also wants to be in a stable O2 bond. So if you introduce ozone rectally into a patient who has a Crohn’s flare or UC flare that is pretty active. That reactive oxygen specie will bond with that 3rd ozone and everybody gets happy. It’s a very very strong anti-inflammatory that works very very quickly.

[48:19] REBECCA: That’s really interesting. I haven’t heard of that. I don’t know… I’d have to go and do some research to see if that is even available in Australia.

[48:28] DR. GUREVICH: I would be surprised if it wasn’t. I just don’t think it’s very broadcast.

REBECCA: And quite often is the case that you don’t know all these things until you go actively looking for them. But there are definitely treatment options that aren’t available in Australia that are commonly used in the US.

[48:45] DR. GUREVICH: That being said and ozonator is not very expensive to buy to administer yourself.

REBECCA: if you were to do it yourself how do you do it? How does it work?

[48:56] DR. GUREVICH: So what we do in the office, how we do it is we have patients fill bags. There’s this bag were this really stable plastic and they fill bag or we fill the bag for them and then they go into the bathroom and they administer it rectally. So here is the problem with rectal. It’s call rectal insepilation. The way your intestine works is its entire job is to push things down and out. You know you are trying to get a poop and what I having patients do is put things in and up. So the administration is not very comfortable. Usually what we see is an increase gas, an increase bloating because literally I am putting gas that is bloating into their intestines. And also some people might have a bowel movement and that’s really because the way the intestines knows that it needs to move the bowels is by stretch. And you know all that gas in there makes that stretch. So usually after the administration you are a little bit more uncomfortable, a little bit more gas, a little bit more bloating. But then the next day we see a pretty good decrease in their pain.

[50:02] REBECCA: That’s so interesting. I am going to go and do some reading about this because I have never heard of it. Wow that is interesting. And how long does it last? Like in terms of the… so you say that you see decrease in pain the following day, but does that last longer than one day? How often do you need to administer this?

[50:22] DR. GUREVICH: It depends on the acuteness of the flare. So there is a marker that we use a lot called a fecal calprotectin or a stool calprotectin which is looking at white blood cells within the stool. The higher that number, the more acute the flare. Normal is under 50. Borderline is between 50 and 120. So if you are at like 600, I am having you administer 3 times a week for like 3 weeks. If you are at a 120, maybe we will do once a week for like 4-6 weeks. You know we are always doing other things to reestablish the microbiome and to deal with inflammation and autoimmune response underneath. But that right now is my go to for acute flares.

[51:03] REBECCA: There you go. As they say, you learn something new every day and I have learned something new today with that. Thanks for sharing that with me. What does the future look like for inflammatory bowel disease in your opinion?

[51:19] DR. GUREVICH: I firmly believe that within the next 20 years, the way we are going to be treating inflammatory bowel disease is with a pill of probiotic. You know uber consolidated, very diverse probiotics. I think we are now… the more research we do on this condition, the more clear we are that this is a micro biome issue. This is a bacterial fungal issue that is growing in the intestines. All the more this week as compared to last week. And so I think the future of this medicine is getting some kind of biodiversity biome into the GI. My hope is as a culture, as we realized the dangers of antibiotic use, the use of it will decrease and therefore there will be less inflammatory bowel disease patients. But my theory is the way that we are going to end up clearing it up is by giving people high does good quality probiotics which is where fermented foods come in so practically right now.

[52:17] REBECCA: And just on fermented foods, what are the fermented foods that you like to or advise your patients to use?

GUREVICH: Lots of pickles, sauerkraut, kimchee, homemade yoghurt, mizzou, tempei, kambucha…. It’s kind of endless. I am sure you guys have that Westin Price Foundation. Do you guys have that in Australia?

[52:46] REBECCA: We know of them. I don’t know if they operate here but yeah they are known.

GUREVICH: Sally Fallon has this incredible book, Nourishing Traditions and it taught us all about how to make your own fermented foods and I mean that is how we should be eating as well.

[53:06] REBECCA: And that’s how we eat for a long time. We have just moved away from our fermented foods in more recent years in human evolution. Sally kept food safe. How we stored food. There are times when it is not advisable for someone to eat fermented foods.

GUREVICH: if they are really really acute I went them on a very very restrictive diet and I don’t use fermented food at that point. But as they are coming out of their acute flare, I think fermented foods are one of my cornerstones.

[53:59] REBECCA: I know when I was coming out of my active SIBO treatment and my naturopath and I were looking at expanding my foods from my limited foods. We started increasing, we started adding fermented foods and then just slowly increase and I started off with like a teaspoon of sauerkraut every few days and then just slowly upped it and I eat those foods all the time and I love them. They are great. It pays homage to some of the foods. My ancestry is French Dutch and English. Unless you are an aboriginal you’ve come from another land in Australia. So my ancestry is European and I pay homage to some of that gorgeous European food like sauerkraut. My Dutch ancestors are looking up from their graves going, “That’s what we use to eat.”

[54:38] DR. GUREVICH: It’s even more delicious now.

REBECCA: yeah. It’s been an absolute pleasure chatting to you today. Thank you so much for coming on to the healthy gut podcast. If people would like to connect with you, how can they find you?

GUREVICH: So, my website is and they can read a little bit more about me and they can get my contact that way.

REBECCA: Wonderful. It’s been a joy and it’s been so interesting learning more about inflammatory bowel disease and I hope that the listeners today have learned something as much as I have. So thank Dr. Ilana Gurevich for coming on to the show.

GUREVICH: Thank you Rebecca. This has been a lot of fun.

THG_PODCAST_POST_Episode 10 (1)

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