Going Deep Into the Microbiome Guest: Ilana Gurevich, ND, LAc MSOM
The contents of this presentation are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. This presentation does not provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Shivan: Dr. Ilana Gurevich is with me right now and that is a real treat, a huge honor. Here's why. Doctor Gurevich has contributed to the SIBO SOS community very generously over the past couple of years. She is the go-to for stool testing and for straight talk about parasites and common sense with an assertiveness for healing. She's a naturopath out of Portland, Oregon with a very busy practice there. And it's always illuminating to say the least. The very first conversation I ever had with her, I will never forget, and it was just like bells and whistles and a-ha moments where light bulbs were all going off. It was like fireworks around my head. My life has absolutely been improved by knowing her and this information that we're going to talk to you about right now. Hi, Ilana. Hi, Doctor Gurevich.
Dr. Gurevich: Hi. Thank you for having me.
Shivan: What can I say? I always love talking to you and always get inspired in a new action plan or a refinement of my action plan to heal my gut. So thank you. The microbiome and stool testing. Let's talk about it. Your favorite, I know this because we've talked, is GI-Map. So would you talk to everybody about why that is and what they can learn from it and how they can get it? And you're not paid by GI-Map by the way.
Dr. Gurevich: I have no affiliation, but I used their test a lot. So the reason why the GI Map is my favorite is mainly because of the fact that they are a DNA PCR lab. So how that looks different than a standard lab that you get from your MD, which is usually an open parasite test is, they take a stool test and with an O&P, you collect a little bit of your stool and you mix it into this
little container. And then the lab tech takes a drop of that stool and illuminates it 10,000 times and looks at 10 fields. And if they don't physically see above crawling, or if they don't see a egg of a bug, then they're going to call it a negative. DNA PCR is much newer technology. It's newer, but it's become significantly cheaper. And why I use the GI Map is because it's looking at
bacteria, fungus, viruses, parasites, protozoa, and worms. So that's really useful.
Plus, it gives me a bunch of functional GI tests. Tells me if your pancreas is working via in the last days. It tells me how much fat, how much fat you have in your stool. So that tells me another pancreas reading, or also a gallbladder bio reading. It tells me about your immune system in your GI. It tells me about if you're reacting strongly to gluten. It tells me if you're having blood in the stool, either from the upper GI or from the lower GI. It tells me if you have intestinal permeability or leaky gut. And it tells me if you have a calprotectin, which is a marker for intestinal permeability. So it's a really comprehensive test. It also has not bad insurance coverage. They're an out of network lab, but about 50% of insurances, the cost will be a $250 copay. And then you might get a bill for another $20, if insurance doesn't cover it. And I'm getting not bad insurance reimbursement. So it's a ton of information with the one stool sample. And it gives me a really good overview of what I should go after.
Shivan: You're getting a lot for the money there. So it's not an inexpensive test, but you're really getting a lot of information. I mean, this is what we're all trying to figure out. We're trying to figure out what is wrong? What needs to get better. And what I also like about it is, it's not a one trick pony, because then you can be like, the reason why it's this is because of this. I didn't even think of that. We all know about that from our own DIY and Dr. Google and trying to figure ourselves out. Thank goodness working with great practitioners too. And if you can't find some scour all these summits because they're here. So when it comes to the GI Map, you are going to find out all of that. Then within that, you just talked about parasites. So let's go there for just a second, because obviously the parasites are going to be affecting your microbiome and your gut. And there are so many people that have parasites that simply are in denial about it. Or even if they're not in denial about it, they'd be open to it. They've gotten a test and the test was negative from a mainstream lab.
Dr. Gurevich: So there was this great study that changed my whole understanding of parasites. It was a 2016 study and what it did is it took patients with known giardia. Those patients with known giardia, it send them to an ova and parasite test or an O&P sugar, salt stain, which is a more sensitive marker or immuno fluoroscopy or a DNAPCR test. And the findings were grossly different. And my numbers are not exactly correct with what
they’ve done, but up it's like a guesstimate I'm pretty close. I think in the O&P they found on average 17 cysts per sample. On the sugar salts they may have
found like 366, per sample. Immuno fluoroscopy they found 117,000 DNA sequences. And then in the DNA PCR they found 365,000 sequences per sample. So obviously if you have a known person with giardia, you're missing it and an O&P 98% of the time.
So an O&P what it tells you is not that you're actually negative. An O&P either says you're either positive definitively or you're not definitively positive, and you never get a negative from an O&P because it's such a not sensitive test. A DNA PCR is a much more sensitive task and so, that is always why I'm generally starting here. Just because this is a microbiome conversation, the other thing to remember is generally speaking, what protozoa and parasites do, and not always, sometimes protozoan parasites dig themselves into your intestine, but often times what parasites and protozoa do is they change the microbiome makeup to make the microbiome more hospitable to them than they are to you. And that causes a lot of your symptoms. If you have giardia, the problem is not so much the giardia, it's the microbiome makeup that the giardia is shunting your bowel into, that's giving you those symptoms.
And so that's why right now we have a lot of data about the microbiome, but we don't have a lot of explicit, this bug definitively does this, this bacteria causes this. And in fact, what we know about the microbiome right now is the body has all of these different webs of places to act. So if you have this subset of species, it might do one thing, but if you don't, a different subset of species is going to lead you that same outcome. And so the problem with just looking at sequencing your microbiome is, it's grossly different and it doesn't actually tell us what anything does. But that's not so true with looking at parasites and protozoa and worms. They definitively do things that change up the microbiome makeup, but also give you a lot of symptoms that present both like IBS and IBD with no underlying visualization of anything else looks like inflammatory bowel disease.
Shivan: This is why you're here. I just read something about psoriasis being linked to protozoa. Have you heard of this before?
Dr. Gurevich: So psoriasis is interesting because first of all, it's an autoimmune disease. And so, with any autoimmune diseases, you can have the immune system attacking part of your body that looks like a pathogen. Can you find increased parasites and protozoa with autoimmune diseases? Yes. Do giving yourself parasites and protozoa sometimes cure the autoimmune disease? Yes. It's called the, this old friend theory. This is where helminths come in because right now your body's attacking itself. And the theory is if you give them a pathogen to attack, then the attack will go away
from itself. But are we starting to find uses for all of these antiprotozoal medications that we never thought would treat things? Yes. And we're seeing that a lot in cancer research. Right now, one of the big lines of therapy with cancer research is looking at Albendazole and Bendazole, because what that drug does is it works for protozoan parasites, but they're like, look, it has these secondary cancer effects.
Shivan: That's exciting.
Dr. Gurevich: It's very interesting. Unfortunately, what happens is the drugs that were extraordinarily cheap out of nowhere overnight become exceptionally expensive.
Shivan: Can you say the names again more slowly my friend?
Dr. Gurevich: Bendazole and Albendazole. They're running some clinical trials right now with both of those drugs for cancer. It depends on how deep you want to go into the alternative medicine world, but there is definitely this subset of physicians who are treating stage 3, stage 4 cancer patients with a lot of these antiparasitic, antihelminth drugs with good success, which I think the pharmacology industry is starting to get ahold of. The best example for that is Doctor Simon Yu out of St. Louis, Missouri and Doctor Dietrich Klinghardt out of Seattle, Washington.
Shivan: I know Doctor Klinghardt's work. I will look into Doctor
Yu’s. Dr. Gurevich: Doctor Klinghardt learned from Doctor Yu.
Shivan: Got it. Love that. How do you get these parasites?
Dr. Gurevich: So it depends on where you live. The most obvious ways would be back country hiking, back country biking, drinking from streams without filtered water, international travel, especially to third world countries. Also, I feel I’ve become like the poster child for parasites, because I live in Portland, Oregon, and you can get it just from drinking tap water here. So you're not as immune as you think you are for parasites and protozoa. And oftentimes they are the underlying cause. I like to think of it as like this triangle. At the top of the triangle, you've got parasites and worms. At the bottom you've got microbiome and then the base is diets and it all comes down hill. And so if you have the parasite or protozoa or worm, it's going to affect everything down the line. So you're going to have microbiome issues and you're going to have digestion issues.
Shivan: If you want to get tested, GI-Map is a great way to go. It's very comprehensive, but then we have to talk about Parawellness because so many people don't know about it. Say it again.
Dr. Gurevich: You don't need a doctor's order for Parawellness.
Shivan: That's one of the reasons why I wanted to talk to you so we can share this is very empowering information with everybody, because you can do it yourself.
Dr. Gurevich: So he's a really interesting doc who put it together. He is out of Colorado, I think. And he was a primary care doc. And before that, when he was in the military, he was a microbiologist in the military. And so, he finished the military. He became a GP, ran a lab in his clinic. And then on his retirement, he just started running samples for his physician friends. And he decided, I don't want to deal with CLIA. I don't want to deal with the government. I'm going to start this membership and you can send me your stool and I'll assess it using an ova and parasite with a sugar, salt stain, so a more sensitive ova and parasite. But the thing that really makes his O&P more sensitive is he looks at every sample a thousand plus times. So yes, he's definitely still looking for a needle in a haystack, but he's looking way harder than any other lab tech through any standard lab.
Shivan: And then if he does find that you have something, he does treatment suggestions?
Dr. Gurevich: And it’s all herbal and I've had some patients do great with his protocols and some patients do mediocre with his protocols. But if we're honest, I've had some patients do great with my protocols and do mediocre with my protocols. His are all natural and so, that's the benefit of using him.
Shivan: I also think he does list the other pharmaceuticals that could work too.
Dr. Gurevich: He doesn’t like them.
Shivan: He doesn’t like them, okay. Well, you can also retest very affordably with him because you can then ask for a retest after you've done your treatment and he charges less for the retest, which is great. And they'll just retest the things that you just had before and then hopefully you've treated
well.
Dr. Gurevich: The other thing that he does, is if you find a worm in your stool, you can get a glass jar and fill it with alcohol to the very top and put the
warm in there and send it to him. And he'll tell you what it is, which is actually kind of amazing.
Shivan: That's unbelievable. I hope no one ever has to do that, but believe me, if you did, you'd want to know what was going on with this guy.
Dr. Gurevich: If it is a worm or if it's just a piece of your mucus membrane, that just looks like a worm that now you're convinced you have worms, because that happens a lot.
Shivan: I think it's the parawellness.com. He has a whole section there. It's Dr. d’Angelo, right?
Dr. Gurevich: Yep. That's him.
Shivan: That's him. So he has a whole section there where they show pictures of what people think are worms, but they're not. Like grapefruit pulp, like shredded cheese. It was wild. That looks like a worm. I would think that was a worm, but it's other things. So that is good news. That's the other side of this. Let's move on to one of your specialties, which is IBG. It's more serious than many of the IBS gut disorders that are out there. Can IBS, SIBO scenario turn into inflammatory bowel disease?
Dr. Gurevich: Great question. There is an increased likelihood that if you get diagnosed with IBS, you may get diagnosed with inflammatory bowel disease. What I'd say is probably even more important is, if you have inflammatory bowel disease, IBS can make your system symptoms appear worse. And so with that inflammatory bowel disease, the treatments that we use are pretty heavy hitters; steroids, biologics, immunosuppressants, bowel resection. It’s very intensive treatments. And if you are more and more symptomatic, there is a higher likelihood that they will escalate you through these really toxic treatments. Oftentimes what happens in that is they will have both IBS and IBD. The IBS goes ignored and they keep on escalating the IBD treatments, which are progressively more toxic and the underlying problem is the IBS. So where it's possible, it's just not common to move from IBS to IBD. It's like a 6% likelihood. It is excessively common to have IBS with your IBD. And if you don't treat the IBS, your IBD feels like it's getting worse, even though
sometimes your markers don't look worse.
Shivan: So could post-infectious IBS, meaning after food poisoning, your migrating motor complex, this peristalsis, antibody response is inhibiting your body's ability to process food and process your digestion in the small intestine. Are you saying that there's a connect the dots from post-infectious IBS to IBD?
Dr. Gurevich: Yes. And the other thing the other thing that can happen is the infection that originally caused the IBS, what happens is the body is trying to attack that infection and the infection looks similar to the mucus membrane of the GI. Now the body starts this autoimmune process to attack the lumen. So this infection started and then it continues to cascade and the immune system never gets the message to shut itself down. And then you start the inflammatory bowel disease process.
Shivan: Before we talk about ozone, I want to talk about homeopathy for a second. This is back to the protozoa and parasites, have you seen homeopathy work for that? Because I was just reading an article about that as well.
Dr. Gurevich: So I’m going to say, I am not a good homeopath. Do I refer to homeopaths? Yes. Do we have some really good ones in Portland? Yeah, we really do, but I'm not a good enough homeopath to say this is the thing. It’s a little bit too gentle. I'm like Chinese of my acupuncture style, not Japanese. Japanese is like, I'm so sorry. And Chinese is like, let's put the nails. I’m more likely to go there.
Shivan: The difference between Japanese, you just said, and Chinese. What's the deal with Korean?
Dr. Gurevich: Great question. I don't actually know.
Shivan: Because a friend of mine got into Korean acupuncture and just loved it. All right, more on that later. That's interesting. Ozone therapy, let's talk about that. How can that help our gut and our microbiome?
Dr. Gurevich: Super interesting therapy. So the way that ozone works is we take oxygen from an oxygen tank and we run it through an ozone generator that basically electrocutes that very solid O2 connection. And so about 20% of it reforms in the form of O3. If you're having an inflammatory process in your intestine, what's happening is you're getting reactive oxygen species or O1s are getting shot out as a byproduct of that inflammatory process. When you insert ozone into the intestinal mucosa, generally I do it with retro administration,
but you can also do it with drinking, like ozonated water. When you do that, that third electron binds with those reactive oxygen species and it completely acts as an anti-inflammatory quickly.
The other thing that happens is you're hyper oxygenating the bowels. Which means any bacteria that are anaerobic or hate oxygen because you're hyper oxygenating the environment, it seems to completely kill those bacteria. And so it seems to have a predisposition to leave healthy species and kill off pathogenic species. It's not a comfortable treatment, but it's a effective treatment, especially with inflammatory bowel disease. And I have used it
some with IBS and it has relatively good efficacy. I just often think it's too uncomfortable to start them on it.
Shivan: We know about IBS. It's a diagnosis of exclusion, so you don’t have this or that.
Dr. Gurevich: You don’t [inaudible] you don't have IBD. You don't have an organic change in your intestines that they can see when they go in with a scope or an MRI or a CT or anything like that.
Shivan: And it doesn't mean you don’t feel well obviously.
Dr. Gurevich: I'm going to say that people feel equally as bad, but you get more you don't get as much attention with IBS generally.
Shivan: That’s very true. Ulcerative colitis. What is that by comparison to IBD?
Dr. Gurevich: I think ulcerative colitis is an IBD. I think what you were thinking about is microscopic colitis.
Shivan: Yeah, just keep refining for us these definitions.
Dr. Gurevich: So you were thinking about microscopic colitis, which is neither an IBD. The two inflammatory bowel diseases or Crohn's disease and ulcerative colitis, but it's also not IBS. It's kind of its own thing. Microscopic colitis is when they do a colonoscopy. So microscopic colitis presents like crazy diarrhea. No such thing as constipation with microscopic colitis. A lot of bowel movements, they're all Bristol seven, very urgent. Somewhere between three and 20 a day. No blood, no mucus, just straight up Bristol seven diarrhea. And what happens is they do a colonoscopy and they do a biopsy like always. And they find that macroscopically with the scope where with inflammatory bowel disease, they could see ulcerations or inflammation, it
looks completely healthy with microscopic colitis.
But then when they look at it under a microscope, hence microscopic, there's a lot of inflammation localized within the lumen. And so, I do find ozone useful for microscopic colitis. A lot of my underlying thinking with microscopic colitis is protozoa, parasites, [inaudible] pancreas, insufficiency, and bile acid diarrhea. So something's going wrong in their upper GI, which is really presenting in the lower GI with diarrhea. And then sometimes food intolerance.
Shivan: All right, food intolerance. For food intolerance testing, what do you suggest?
Dr. Gurevich: I mean, the gold standard is elimination diet. I am very partial to the Carroll test, which is a naturopathic test which I have to say I'm very research oriented. Nothing makes me feel as comfortable as finding a clinical trial or a meta-analysis. There is no studies on Carroll tests. I just happened to use them clinically just because when my mentors said, and I do find good efficacy with them.
Shivan: Let's just backtrack for just a second. Would you just define the word lumen for people in case they're not familiar with it?
Dr. Gurevich: That's the GI tube.
Shivan: If someone is not near Portland, Oregon, and they're like, I have got to try this ozone therapy. It sounds amazing. It sounds like hope. How do we find that elsewhere?
Dr. Gurevich: So there's an organization called the American Academy of Ozone. They have a physician list. There are ozone docs probably in every state in the country. You can buy an ozone machine. I feel like they're cheaper than they used to be. And you can lower like rectal stuff like ulcerative proctitis, you can buy ozone suppositories. And so you take them rectally.
Shivan: That's interesting.
Dr. Gurevich: I do feel like ozone machines are way cheaper than they used to be.
Shivan: All right. And last but not least, let's talk about neural therapy. So spell it for us and explain what that is because it sounds like neurotherapy like your brain therapy, but it's not.
Dr. Gurevich: So neural therapy, N-E-U-R-A-L. It's a technique that comes out of Europe, mainly Germany, Switzerland, Spain. And then they use it a lot in Latin America. It's an injection based technique. That is the goal is to reset the nervous system intervention to different organs. And so, they use Procaine, which is the oldest local anesthetic. It is out of your system in 20 minutes. And what they do is they inject the ganglion or the nerve bundles that control a lot of the nerves further down to reestablish the nervous system intervention.
Shivan: So is it like flipping a switch? I just want to put it in a little bit of a different … because the way I’ve heard you explained it to me before it’s like
Dr. Gurevich: So why Procaine as opposed to Lidocaine or Novocaine or any of the better anesthetics? So Procaine is the only anesthetic that's hydrophilic
lipophobic. I'm going to explain, I promise. Which makes it a bad anesthetic. Most anesthetics are lipophilic hydrophobic, which means they like fat. So you inject, the substrate goes into the fat and it stays on the fat, nerves are all fat. So it blocks the innervation for the nerves. Procaine is the opposite. The reason it only lasts 20 minutes and the reason we don't use it as an anesthetic is because it prefers water to fat. But it is the perfect composition of sodium and potassium. So when you inject it, it finds that nerve bundle and it resets the innervation that to that nerve. So it turns the nerve back online.
The way that the nervous system works is, we've got the central nervous system from the brain and the spinal cord. Those nerves leave the body. The minute they're on the outside of the body, they become the peripheral or the autonomic nervous system. Then they go to the organs. Then they go to the skin. Then they go back to the organs and they go back to the CNS and go up to the brain. If you have chronic infection, chronic inflammation, a past surgery, a scar, anything like that, what happens is that, that rotation gets shut down. And so what happens to that rotation being shut down is that, your body, it’s blind, it's not getting information. So a lot of time, a lot of these chronic diseases, or especially chronic pain, happens because your nerves are not getting all the information and they literally shut down innervation to a bunch of the peripheral areas.
And so what neural therapy does, is it resets that innervation. And so the best way I can describe it, is it's like acupuncture on steroids. We find the area that's not working. We inject it with Procaine. Procaine, resets that nerve. And then that nerve starts firing. Sometimes it happens after one injection.
Sometimes you need more than one injection. It just helps the body work the way it's supposed to work.
Shivan: So I have had neural therapy and it's fascinating.It does put you in a parasympathetic state instantaneously. It's crazy. I hit my head on one of our taping trips and got neural therapy. I hit my head hard and I was like, I don't feel good. I was very swollen, definitely knocked the wind out of me. And I got the treatment. What would normally have taken me like 10 days to recover, took me three. That's a lot for me because I tend to inflame so much. So how does it work for inflammation?
Dr. Gurevich: I feel like the body's amazing. Naturalphysiology, the body is programmed to regrow and reheal itself. And when there is something that stands in the body's way, that's when things don't work and you get disease. You know what I mean? And so, if you can re-wake up the body and reestablish the nerve, innervation to go where it wants to go, the body knows what to do. So it just puts it back online. And the thing about the brain in particular is, it is literally all fat.
Shivan: Your brain’s fat, yeah.
Dr. Gurevich: And so, if you can get the body to bringthe nerves in there and do what it naturally is going to do, it's just going to heal itself. It is a really good tool to remind the body what it does naturally.
Shivan: So how can somebody find a neural therapypractitioner?
Dr. Gurevich: The American Academy of Neural Therapy.When in doubt, just put American Academy and you'll find it. The US organization is a growing organization, but they have a board now. They had a huge conference in January. The US is finally coming on board with neural therapy.
Shivan: For people who have diarrhea, constipation,especially if it's post infectious IBS, have you seen results from people when their nervous system or the nerves in the inside of their intestines, aren't working, have you seen neural therapy work there?
Dr. Gurevich: So yes and no. Just like everythingelse, is it the only thing? I've never seen it be the only thing. I have definitely seen it help as one of the things.
Shivan: We'll take it. All right. What else do you want everybody to know in this Microbiome Gut Rescue Summit about what we can do on a daily basis to feel better? People have come here because they're trying to improve their microbiome. They're trying to improve their health. They have gut issues. What is some wisdom from the pulpit there?
Dr. Gurevich: Microbiome and mood is a field thatwe are learning more and more about. And the reality is, we often think about our mood as being this thing that's really in our brain. And oftentimes, the way that the communication works between the brain and the GI is, 10% of information is going from the brain to the GI, but 90% of information is going from the GI up to the brain. And so we're often like this is making me anxious and that's making me anxious. And it's this person, it’s this situation. And oftentimes it's like, what's my GI doing? What did I eat yesterday that spun me out? If we start we start looking at it through, what's our body telling us and not so much a reaction to the mood, that's what we're starting to learn right now.
And where I would love to say, we know as a fact that it's this species that makes your mood better, or this species that makes your mood better. What we know definitively is, the microbiome that's in your GI makes a bunch of
neurotransmitters that go to your brain. And so, all you have to do is make sure you're moving your body on a regular basis to detoxify it and making sure you're putting good, clean, healthy food into your body. That right there, I do feel like fixes 60% of issues. That is something that everybody has control over. You can choose the food you put into your body. You can choose the quality of the food that you put into your body, and you can choose to move your body and live like a human, as opposed to living like a robot. And we live in an uncertain world and uncertain times on a good day. And it's amazing how just doing those very basic human things really has the ability to change your perspective.
Shivan: I appreciate your perspective. Thank you somuch. If you're attending this and you have seen a bunch of the other interviews, I know your head is probably spinning. If you just were clicking around and just popped in here and you're overwhelmed, I understand. Watch this recording a couple of times, take notes. Come back and revisit it. If you can afford to get it, get the transcripts so you can highlight, if not, that's fine. Here's your free session. But the thing is, is that Doctor Gurevich just gave you like a masterclass in gut health and what can go wrong and what you really need to be looking at, including parasites and protozoa. When I know so many people disavow that, their shame around it. Whatever the deal is up here, please get that checked
out because it mimics SIBO, SIBO, IBS. You talked about all the things that get eventually cleared up when that is taken care of. So that to me is one of my main calls to action here. Explore ozone, explore neural therapy and get moving.
