SIBO and Inflammatory Bowel Disease (IBD) with Dr Ilana Gurevich

In today's episode Dr Nirala Jacobi is in conversation with Dr Ilana Gurevich on the topic of inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO). Dr Gurevich is a naturopathic physician and acupuncturist who graduated from the National University of Natural Medicine in 2007 and 2008. She is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland. Dr Gurevich also runs a very busy private practice specializing in treating inflammatory bowel disease as well as irritable bowel syndrome (IBS), SIBO and functional digestive disorders.

She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO. She is one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. Dr. Gurevich also acts as a mentor in the naturopathic community educating about GI disorders. She supervises residents and consults with physicians about their most difficult GI cases.

Dr. Gurevich was nominated as one of Portland Top Docs by the Portland Monthly in both 2014 and 2016.

Topics discussed include:

• How did Dr Gurevich come to specialise in IBD?
• How acute flares of IBD can be related to SIBO.
  • In relation to small bowel Crohn's and small bowel Ulcerative Colitis.
• Testing Dr Gurevich uses for IBD
  • Fecal calprotectin (before getting colonoscopy/gastroscopy)
    • Stool collection to test for leukocytes within the small bowel, giving an accurate sense for how much inflammation is in the intestine.
    • Useful for Crohn's and Colitis.
  • Colonoscopy
  • Gastroscopy
  • Comprehensive digestive stool analysis (CDSA) - Doctor's Data
  • GI Health Panel - DiagnosTechs
    • What kind of flora is in there?
    • Are there parasites, yeast, and assessing food breakdown?
  • ParaWellness Research - parasitologist
• Dr Jacobi uses Genova GI Effects for the PCR testing and microbiome assessment for anaerobes that could not previously be cultured out.
• Carroll Food Intolerance Testing
• Dr Gurevich's view of food allergy testing for IBD patients.
• Microscopic colitis - what is it? What is its main symptom?
  • Lymphocytic
  • Collagenous
  • Parallels with Coeliac Disease.
• Clinical pearl - if client is having greater than 10 bowel movements a day look into microscopic colitis and other possible conditions.
• How to use Budesonide (steroid) for a 3-5 month window, to address microscopic inflammation. Budesonide not as systemic as prednisone, and can be used concurrently to naturopathic care to continue to heal the intestine whilst client tapers off the Budesonide.
• Does microscopic colitis also show elevated fecal calprotectin?
• Diagnosing microscopic colitis with colonoscopy or sigmoidoscopy.
• How is ileocecal valve pressure associated with SIBO?
• IBD recalcitrant population and why they are more susceptible to SIBO.
• Bacterial translocation from the large bowel flora into the small bowel and how ileocecal valve scarring increases SIBO susceptibility.
• How to assess ileocecal valve pressure.
  • Colonoscopy (although not included with a standard colonoscopy).
  • 20% of people are found to have open ileocecal valves. Why?
• How else is the ileocecal valve scarred?
• Upcoming workshop in Australia - November 2018 - Dr Steven Sandberg-Lewis on physical exam skills of functional digestive disorders - how to free a stuck open or stuck closed ileocecal valve, the hiatal hernia manoeuvre, and a plethora of other techniques.
• Lower esophageal sphincter is part of the diaphragm - valvular relaxation treated with Buteyko Breathing.
• Does Dr Gurevich see much hydrogen sulfide dominant SIBO with IBD patients?
• Various assessment techniques for the complex hydrogen sulfide dominant SIBO.
  • uBiome
  • Genova GI Effects
  • Flatlining on a SIBO breath test
• The use of biologic agents in IBD as TNF Alpha inhibitors e.g. Remicade as an IV infusion, Humira as a subcutaneous injection, Cimzia (the only one safe in pregnancy).
• Biosimilars - generic biologics - about to be launched in the States.
• Upcoming course with Dr Gurevich for the natural treatment of IBD in 2018 via The SIBO Doctor Education Centre.
• The body has the potential to treat the biologic agent in the same way as it treats the intestine if the person has IBD - practitioners MUST fully educate the client of the risks of going on or off the biologic agent.
• What are the increased risks with use of biologic agents?
• Acute flare treatments that Dr Gurevich uses for Crohn's, Ulcerative Colitis, or both.
  • Rectal ozone - extremely anti-inflammatory and extremely fast acting.
  • Elemental diet - as effective as steroids.
  • Specific carbohydrate diet - SCD Intro included.
  • If no improvement then movement towards steroids to treat acutely.
• Maintenance treatments that Dr Gurevich uses for Crohn's, Ulcerative Colitis, or both.
  • Carroll test for dietary triggers
  • SIBO test for underlying cause
  • ParaWellness test for underlying cause
  • GI Lumen healing - seacure hydrolysed white fish protein, high dose resveratrol, glutamine, CBD and THC, colostrum, Physica GALT fortifier (Dr Gurevich's new favourite).
  • Always focus on digestive support - enzymes, hydrochloric acid, probiotics (e.g. saccharomyces boulardii for diarrhoea regulation), apple cider vinegar.
  • IV nutrition to help clients who have been ill for a very long time.
• Do parasites play a role in IBD?
• Dr Gurevich's experience with butyric acid enemas.
• Dr Gurevich's position on conventional antibiotics for IBD patients.

Resources

• Dr Ilana Gurevich
  • Portland, Oregon
  • Kwan Yin Healing Arts Centre
  • Phone consults available
• Dr Mark Pimentel
• Mim Beim - Buteyko Breathing Australia
• Buteyko Clinic International
• Greg Nigh - Hydrogen Sulfide Expert
• Dr Jason Hawrelak - Microbiome Expert and Founder of clinical tool - Probiotic Advisor
• Dr Mona Morstein - Diabetes expert
• Physica GALT fortifier

Testing discussed

• Fecal calprotectin
• Comprehensive digestive stool analysis (CDSA) - Doctor's Data
• GI Health Panel - DiagnosTechs
• ParaWellness Research
• Genova GI Effects
• Carroll Food Intolerance Testing
• uBiome

Upcoming courses (2018)

• November 2018, Australia - Dr Steven Sandberg-Lewis on physical exam skills of functional digestive disorders via the SIBO Doctor Education Centre.
• 2018, Digital - Dr Gurevich for the natural treatment of IBD via the SIBO Doctor Education Centre.