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.