Episode 77: How Crohn's and Ulcerative Colitis Are Wildly Different Than IBS

The terms inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) get used interchangeably, but as we’ll learn in this episode, they are wildly different diagnoses with very different treatment plans. 

Dr. Ilana Gurevich joins Andrea to talk about her own journey with Crohn’s disease, one of the main forms of IBD, what she commonly sees in her practice and how she marries conventional and functional medicine to achieve the best results for her patients. 

Dr. Gurevich is a naturopathic physician and acupuncturist who graduated from the National University of Natural Medicine in 2007 with her doctorate in naturopathic medicine, and in 2008 with her Master’s of oriental medicine. She is currently practicing out of two large integrative medical clinics in Portland and runs a very busy private practice specializing in treating inflammatory bowel disease as well as IBS, SIBO and other functional GI disorders.

Interested in learning more? Check out her collection of videos: https://www.naturopathicgastro.com/video/

Questions? Ideas? Email us at themicrobiomereport@biohmhealth.com or reach out on Instagram @DreEats or @BIOHMHealth. 

On This Episode, You’ll Learn: 

• What are IBD and IBS?
•  [1:58] IBD stands for Inflammatory Bowel Disease, which is classified as an organic disease. The illness state can be seen while looking at the origin of the intestines. When it comes to diagnosing and treating inflammatory bowel disease, imaging is commonly used. Some form of inflammatory process or ulcerations will be visible.
• [2:30] Another point to consider is that irritable bowel syndrome can occur alongside inflammatory bowel illness. IBS stands for Irritable Bowel Syndrome. Macroscopically or microscopically, you don’t see any pathology. However, the syndrome is still causing symptoms like gas, bloating, and pain.
• [4:24] IBS is frequently caused by IBD. Foodborne sickness, viral gastroenteritis, bacterial gastroenteritis, and parasite infection account for 60% of IBS cases. Infections like these can increase the risk of developing inflammatory bowel disease. And while the causal factors may be the same, they don't always end up in the same spot.
• Why Younger People are Afflicted More
• [5:32] There are two peaks. From the ages of 15 to 30, the first peak occurs. Between the ages of 55 and 75, the second peak occurs. You're going through a lot of hormonal changes during those two years of your existence. Hormones do play a role in modifying the microbiome, which can contribute to inflammation in the intestine.
• The Newly Discovered Organs
• [6:26] The microbiome is one of the organs that has recently been found. Depending on where you are in your cycle, something comes in and out of bloom within that organ. It aids in the detoxification of hormones throughout puberty, menopause, and andropause.
• The Rise of the Western Diet
• [8:24] Inflammatory bowel illness was nearly unheard of in third-world countries in the past. It was a disease that afflicted the developed world. In Pakistan, India, or China, IBD would never be seen. With IBD, we can see that it's a Western disorder linked to a Western diet. However, as the rest of the world adopts the Western diet, inflammatory bowel disease is on the rise all across the world. We used to believe that inflammatory bowel disease (IBD) was a condition that only existed in the Western world. Now, we consider a disease that has been linked to a Western diet.
• Warning Signs that Lead to a Diagnosis 
• [10:59] Prior to receiving a diagnosis, most people will experience a worsening of symptoms. And that awful feeling could last a long time. Ilana was 19 when she was diagnosed with Crohn's disease. But she developed it at 12 years old. She saw a total of five gastroenterologists before anyone could diagnose her with inflammatory bowel disease. There are sometimes, but not always, warning indicators for a diagnosis.
• [15:49] If you have a severe or even a moderate case of UC, you won't experience many systemic symptoms like fever. Because of the nature of the disease, IBD is more localized in the intestine.
• Is there a Cure for IBD?
• [18:23] Inflammatory Bowel Disease has no known cure. You can go into remission for a long time, but you can't cure yourself. Ilana  hasn't had any symptoms of Crohn's Disease in the last 25 years.
• The Types of Diet
• [20:33] Two diets have been thoroughly researched. The Specific Carbohydrate Diet, which is comparable to a Paleo diet, is the one we hear about the most. The diet consists primarily of protein and vegetables with no carbohydrates. The semi-vegetarian Crohn's diet, which is comparable to a macrobiotic diet, is another well-validated diet that demonstrates an equivalent amount of efficacy. A macrobiotic diet consists entirely of grains and is very different from a carbohydrate-specific diet. Both of them are demonstrating a lot of promise in terms of putting inflammatory bowel disease into remission and keeping it there.
• [21:45] You must first determine what your body enjoys and what makes it feel good, and then proceed from there. However, there are several elements that each of those diets have in common that any healthy diet should have: no processed sugar, white flour, or preservatives. They are as natural or unadulterated as possible.
• What Everyone Should Implement for Healing
• [23:26] Exercise is the first and most important. However, not everyone requires the same level of exertion. 
• [24:23] Start by determining the difference between Ulcerative Colitis and Crohn's disease before proceeding with treatment. Ulcerative Colitis is particularly receptive to probiotics, which is one of the most significant differences. Probiotics have been shown in numerous studies to help people achieve remission.
• Rectal Ozone
• [26:09] Ozone is a gas that is created by passing oxygen through an ozone generator or O3. The ozone generator electrocutes very stable molecules of oxygen, and 30% of it reforms as ozone.
• [26:51] The rectum is subsequently irritated with the extremely unstable gas. The amount used is determined by the location of the sickness. With rectal interpolation, three things happen at the same time. The first is that the ozone identifies any inflamed or damaged tissue within the intestine. It's also causing more harm. Apoptosis, or programmed cell death, is induced as a result of this.
• [27:41] At the same time, ozone enters the mitochondria. It supercharges the mitochondria, allowing them to generate at a higher rate. The third thing that will happen is that ozone will seek out a free radical. The O3 attaches to the O1, resulting in the formation of two O2 molecules. As a result, it works as a very quick anti-inflammatory.
• Ilana’s Goal in Treatments
• [31:06] For treatment, Ilana wants to see the numbers improving within a month. She wants improvement with the numbers and not symptoms. She says that it is very easy not to listen to symptoms because you want it to be better than it is. Symptoms are easier to control than getting some objective changes within the inflammatory state of the body. 
• The Options for Treatments
• [32:17] There are numerous natural remedies for inflammatory bowel disease that have been scientifically verified. It's reassuring to know that there are therapy alternatives that are either entirely holistic, naturopathic, or used in conjunction with standard treatments to improve the effectiveness of standard treatments and to establish and maintain remission.
• [33:23] There are options available to patients. It's either going the naturopathic or holistic route on its own or combining the two to provide the body with the nutrients it requires to feel happy and alive.

Mentioned On This Show:

• Dr. Ilana Gurevich’s videos: https://www.naturopathicgastro.com/video/
• BIOHM’s website (Promo Code: POD15)

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Transcript: 

Andrea Wien: Hey everyone. Just a quick housekeeping item before we get started today, the show is going to be moving to once monthly episodes again, for the next few months. We have some exciting projects in the work that are going to take some resources to get off the ground, so we are moving the show to once a month for the time being and shows will still be on Thursdays, so you will have a new Microbiome Report every Thursday of each month.

Welcome to The Microbiome Report powered by BIOHM Health. I am your host, Andrea Wien. And today my guest is Dr. Ilana Gurevich. Dr. Gurvich is a naturopathic physician and acupuncturist who runs a very busy private practice, specializing in treating inflammatory bowel disease, as well as IBS, SIBO, and other functional GI disorders. She lectures extensively and teaches about both conventional and natural treatments for GI conditions, including inflammatory bowel disease, SIBO, and IBS. She also supervises residents and consults with doctors about their most difficult GI cases. And she was nominated as one of Portland's top docs many times over. Today, I talk to her about the difference between IBD and IBS, including if IBS can cause IBD. We also chat about why IBD often affects young people, the pros and cons of pharmaceutical drugs, and whether it's possible to enter and stay in remission for many years using only natural remedies. Enjoy the show.

Dr. Gurvich welcome to the show.

Dr. Ilana Gurevich: Thank you so much for having me.

Andrea Wien: I think it's helpful to start this discussion with a definition of IBS and IBD and how they are different, because I do think that they get used sometimes interchangeably and would love to just get that out of the way and make sure we're all operating from the same plane.

Dr. Ilana Gurevich: Sure. That's actually a great question, so IBD stands for inflammatory bowel disease that word disease is super important because it means that when you look at the organ of the intestines, you can see the diseased state, right? When we're looking at working up an inflammatory bowel disease, we usually do that with some kind of imaging, either colonoscopy or endoscopy or some kind of MR enterography or CT enterography. And what you see is some kind of inflammatory process or ulcerations, so that falls under the category of organic disease. IBS stands for irritable bowel syndrome, and it's a syndrome because when you look at the organs, they can't find anything that's wrong with it, so macroscopically or microscopically, we're not seeing any pathology. However, the syndrome is still causing a lot of symptoms like gas, bloating, pain. And the other thing that can get a little bit confusing is you can definitely have an irritable bowel syndrome within an inflammatory bowel disease, so the best example of that is Crohn's disease, which is disease of the small or large intestine.

Crohn's disease can really occur anywhere from the mouth to the anus. But the majority of Crohn's disease, 80% of it, 80% of patients with Crohn's disease have some kind of infection or some kind of inflammation in the bottom of their small intestine. And with that inflammation in the bottom of the small intestine, what ends up happening quite frequently is you end up with a bacterial overgrowth or a fungal overgrowth within the small bowel, which is an IBS within the IBD. And what often happens with patients is, their physician or their gastroenterologist starts escalating care, so they're on like a non-steroidal anti-inflammatory and it's not working, and then they put them on a steroid, and then they add in a biologic, and maybe an immunosuppressant and it's not working because the problem is not the disease, it's the IBS that's causing all the symptoms.

Andrea Wien: So it's not that the IBS could turn into IBD. I think that's also something that I've heard in the past. Like I have these symptoms and if I don't get them under control that I could develop IBD, is there any correlation there between the two?

Dr. Ilana Gurevich: That's a really, really good question. The answer is not usually, but maybe, so let me just expand on that. Oftentimes IBS happens because of, so at this point we think probably 60% of IBS happens because of some kind of food born illness, be that a viral gastroenteritis, or a bacterial gastroenteritis, or some kind of parasitic infection, or something like that, right. And those same infections can upregulate the likelihood of developing inflammatory bowel disease, so it could be the same causative agents, but it doesn't frequently end up in the same place and sometimes it does, but it's less the rule than a minor occurrence.

Andrea Wien: Okay. Yeah, that makes sense. Now, when I was just doing some research for this episode, I learned that 3 million Americans have some form of diagnosed IBD and that the most common ages to get it is between 15 and 30, which was really shocking to me because usually we don't see progressive, very serious diseases in younger people, so do we know what some of the predominant root causes are or why younger people seem to be afflicted more?

Dr. Ilana Gurevich: There's two peaks. The first peak is that exact one that you found the 15 to 30, and then the second peak is like 55 to 75, right. And it's interesting because what's happening during those two parts of your life is you're going through a ton of hormonal changes. And so at 15, you're starting to go through puberty and at 50, you are starting to go through menopause. And so there is definitely a factor that hormones play a role in the changing of the microbiome, which then can lead to inflammation within the intestine. Recently, I don't know if you have been following this, but in the last like five years, they've discovered like three or four new organs in the body. Have you been following this?

Andrea Wien: Yes, but I'd love to just chat and like inform people on what you're talking about.

Dr. Ilana Gurevich: It's so interesting because you know, like an organ is an organ, right. We've been looking at the same organs since Da Vinci's time, but the answer is no, that's not true. One of the organs that they have recently discovered is called the microbiome, which you guys talk a lot about, this podcast is about it, so now they're calling that an organ. And within that organ, there's this thing called the estrobolome, right? And the estrobolome is basically this part of the microbiome that comes into bloom and out of bloom, depending on where you are with your cycle, and so it kind of helps detoxify hormones. And so all of those changes are happening right around the puberty time and also right around menopause and andropause. And so that is one of the theories of what's happening with inflammatory bowel disease.

If you look at what hormones do, some of them are a catabolic, some of them are anabolic, so some of them will cause the building process, and some of them will cause the breaking down process. And some of the female hormones, especially FSH and estrogen basically start this building process. And you know, that is what's happening with the inflammatory state is your big [inaudible 00:07:27] tissue that isn't healthy and it's more enlarged or inflamed.

Andrea Wien: We just did a whole episode actually on the estrobolome with Emily Sadri certified nurse midwife, so do we see in cases of IBD, higher levels of estrogen that hasn't been excreted from the body, is that part of it?

Dr. Ilana Gurevich: I don't know if anybody's looking, if we're completely honest.

Andrea Wien: Okay. Okay. That'd be an interesting place. I mean, if that is such a critical component of what might be happening there, right. And we start to see that higher levels of estrogen and beta glucuronidase are increased during flare ups or times when people are being diagnosed, then you can kind of work backwards, like, okay, where are we getting those phytoestrogens from the environment? And we don't have to go down this rabbit hole, but it's an interesting line of thought.

Dr. Ilana Gurevich: It's a super interesting rabbit hole because one of the things that we see with inflammatory bowel disease, so like in the very recent past, it was almost unheard of to have inflammatory bowel disease in third world countries. It was really a disease of the developed world, right? And so you would never see IBD in like Pakistan, or India, or China. Like really, we just wouldn't. And what we see is this was a Western disorder that was really associated with a Western diet. What's interesting is as the rest of the world continues to pick up our Western diet, now we have inflammatory bowel disease throughout the world that is on the rise.

The other thing that we see is when we bring people from countries that have no inflammatory bowel disease and we put them in the West, they develop inflammatory bowel disease equal to Westerners, right? What we used to think was a disease that we would only see from the Western world, now we think of a disease that we see that's associated with a Western diet. And what does that Western diet chock full of phytoestrogen, and xenobiotics, and pesticides, and herbicides and all the terrible things that destroy the organ of the microbiome.

Andrea Wien: It's interesting to me, because I have had some patients with IBD that their doctors have told them, it doesn't matter what you eat, that's not one of the root causes, which we can certainly get into diet. And I guess I'll take a step back, in the case of like an auto-immune disease or celiac. Typically you have three things that need to happen before someone is diagnosed, right? You need to have the gene, the genetic component to it. You need to have a stressor and you need to have leaky gut, so that is kind of the trifecta. When we start to see people who've been diagnosed with auto-immune, is there something similar in the case of IBD, where you have to have multiple components to create this perfect storm?

Dr. Ilana Gurevich: I would say they're exactly the same components.

Andrea Wien: Okay.

Dr. Ilana Gurevich: I mean, exact same process. You need something that has destroyed the microbiome. You need, not always, but you generally, there is often either some kind of pharmaceutical or some kind of foodborne illness that predisposes to the events. And I feel like the shock of the body, the hormonal change plays a big role.

Andrea Wien: In the case of an auto-immune disease, we know that we can test for antibodies early on. We can start to see warning signs far before we ever have a case where someone is diagnosed with an autoimmune disease, if we're looking. And when I was doing this research, I found that in the case of Crohn's, 70% of people might end up having surgery to have part of their bowel removed, which is just mind blowing to me. But do we have warning signs that lead up to a diagnosis typically?

Dr. Ilana Gurevich: I mean, yes and no. Yes, people will generally feel bad before they get diagnosed, right. And that feeling bad could be for a long time. Like my personal story is I was diagnosed with Crohn's disease when I was 19, but I was sick with it from the age of 12, you know? And I went to gastroenterologists to get to gastroenterologist, I think I saw five of them total before somebody would actually work me up for inflammatory bowel disease, so I had this seven year of not doing well before I got a diagnosis. However, I had a patient today who was sick for like six weeks.

Andrea Wien: Mm-hmm (affirmative).

Dr. Ilana Gurevich: You know what I mean? And so the answer is sometimes, but not always.

Andrea Wien: And if we do catch some of these symptoms early, is there a reversal that can happen? I guess this starts to get into the treatments, right. I think I've also had patients come to me, who've had a diagnosis like this, and they're really defeated by the idea of being on medication for life. And some of these medications have horrible side effects and maybe are necessary evils in the moment. I would love to just talk about that. Like when someone is diagnosed, because I'm sure if people are listening to this podcast, they have either been diagnosed or maybe they're down the path of looking for more answers, so if someone comes to you and says, I've just been diagnosed, my doctor wants me to go on these medications. What is your typical response?

Dr. Ilana Gurevich: I want to start with the fact that I don't treat a lot of kids and that's more for personal reasons. They just kind of break my heart, sick kids break my heart, so it's a very different conversation if you're a kid or if you're an adult, have I been doing this? My practice is probably 60% inflammatory bowel disease, 60 to 70% inflammatory bowel disease. And then the other 30 to 40% is other functional GI disorders like IBS, and SIBO, and SIFO, and all that. Do I know that we have a ton of tools starting from diet, and lifestyle interventions, and supplements, and herbs, and meditation, and exercise that can put inflammatory bowel disease into remission. Absolutely, I see that happening all of the time. But do I also know that some people are so sick that being alive at this time when we have some very effective tools that some have strong side effects, others don't so much that can put them into a remission.

Is it amazing that that is accessible to patients? Yes. And does it matter where you are in the state of your disease? Absolutely. I just had a consult with a new patient, who's going to get in to see one of my residents, I think Saturday. She got sick, four weeks later she's in the hospital they want to take out her colon, she is bleeding out and forming blood clots. You know what I mean? Like that is a patient who, if she can get a pharmaceutical that's going to get her out of there, that is amazing. Do the pharmaceuticals work? I mean, if you're going to look at it and you compare it to placebo, they are about 32% effective. If you would draw how much benefit you got from placebo and the remaining it's about 30%, 32%, right.

Are they always effective? No. Do they have side effects? Yes. If you're severe, would I always recommend doing both? Yes. I don't think any of the holistic stuff is going to hurt. I think it's only going to help and it's just going to make the rest of you feel better on top of making your GI feel better. And do I think that if you are a mild to moderate, it's worth taking a little bit of time and seeing if you can get yourself into remission naturally? Absolutely. Because, I see it working all the time. And there's risks to that, but if you're working with somebody who is able to navigate, understanding the risks are and understanding how to manage your symptoms and also tracking not only your symptoms, but tracking the objective findings of where your disease is. Do I think that you can absolutely get very, very good care and get into a remission with natural treatments? Yes. And do I think the drugs are the enemy? No, I think sometimes the drugs are just another part of the solution.

Andrea Wien: Well, it reminds me of a triage situation almost, if you have someone that has a severe case, we talk about oftentimes like functional medicine is great if you have gas, and constipation, and bloating, but if you break your arm, you still want the emergency room and potentially the surgery to replace the bone, you know? I think this could be a very similar analogy where it's the severity of the case depends on how many of the heavy hitters I guess, we need to bring in.

Dr. Ilana Gurevich: Absolutely, and they work so well together. If you were diagnosed with a severe presentation of disease, and severe is different for ulcerative colitis than it is for Crohn's. Like UC, even if you have a moderate UC, you're not having a ton of systemic issues, right. You're not having fevers, you're not having... Systemic like iritis, or uveitis, or some of the crazy, or joint issues. It's more localized in the intestine just because of the nature of how the disease presents. Crohn's by the nature of that disease, you begin with having more systemic issues, right? The difference between Crohn's and UC, is UC or ulcerative colitis is located within the intestine and it doesn't cross into the musculature of the intestinal wall to cross into the body, it really is just in the mucosa. With Crohn's disease the more progressive it is, the more it goes into that serosa, which is the muscle layer, which will cause more systemic issues, right? And it's honestly, one of the reasons why in many cases treating UC is a little bit easier than treating Crohn's.

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When we talk about people going into remission, is this a disease like celiac again is a good example. Like even though my celiac is under control, it's still an autoimmune disease, so my body is primed to respond to that whenever I have any exposure to gluten. In the situation of IBD, when we go into remission is that a cure or is this a disease that you have forever?

Dr. Ilana Gurevich: That's a very, very loaded question. If you ask the American College of Gastroenterology, or if you ask any Western doctor, the answer is there is no cure. There is no cure for inflammatory bowel disease. You can have a prolonged remission, but you cannot go into cure. Now, have I personally, knock on wood, had a prolonged remission myself for 25 years? Yes. Would I consider myself cured? I mean, I still think I'm primed. I think it's exactly like with celiac disease. My immune system can rev a little bit higher than somebody who has optimal health, but have I had issues with my Crohn's disease in 25 years? No, not really.

Andrea Wien: For your personal journey, did you do a combination of the natural healing and more of the pharmaceutical? Like what did your personal journey look like?

Dr. Ilana Gurevich: I did. I was finally diagnosed at age 19 and I was hospitalized and back then we didn't really have the amount of drugs that we have now. And so I started a non-steroidal anti-inflammatory, they were on the verge of putting me on an immunosuppressant, but they didn't. They did put me on really high steroids. And I also got in to see a naturopathic physician within two weeks of leaving the hospital. That naturopath saved my life, and not only gave me back my health, but he also put me on my life's path. And so initially for about five years, I took both the pharmaceuticals, which were pretty low side effect profile, and natural agents, and diet. And right now I really just manage the diet, that's all I have to do right now.

Andrea Wien: Okay, so let's get into diet because it can be very different I think, for people across the spectrum, when you're dealing with gut issues of what an ideal diet looks like. And maybe that's even a loaded question because sometimes a different diet is different for each person, so I would love to just hear your thoughts on where we start the conversation with diet?

Dr. Ilana Gurevich: There are two diets that are equally as well studied, right? The one that we hear about the most in the west is something called the Specific Carbohydrate Diet, which is similar to a paleo diet. And it was put out by Elaine Gottschall, I think in like the forties, so I think she wrote her book in the seventies, so that is literally, it's a paleo diet, really virtually no carbs, lots of protein and veggies, but the veggies are selective with no skins, no seeds, well cooked. The other diet that is equally as well validated and shows equal amount of efficacy is called for Crohn's disease at least is called the Semi-Vegetarian Crohn's Diet, right. Which is really similar to a macrobiotic diet, and a macrobiotic diet is all grains. You know what I mean? It's grains, it's tofu, it's beans. It is basically as far away from the Specific Carbohydrate Diet as you can get.

And both of them are showing a lot of [inaudible 00:21:36] for getting inflammatory bowel disease into a remission, and a prolonged remission. And so the response is, you are absolutely right when you say there is no one diet, you kind of have to see A, what your body likes and B, what makes your body feel good? And then go from there. There are however, a couple of things that both those diets have in common, that every healthy diet has in common. Which is there is no refined sugar, there is no refined white flour, there is no preservatives, as organic or as clean as possible with whatever you can do with your financial situation, so basically taking away the crap and leaving in either the protein and the vegetables, or the carbs and vegetables.

Andrea Wien: It's so interesting because when I think about this. And this is totally me theorizing, and I have no basis for scientific fact on this, but when you look at those two diets, it seems like they would work from two different mechanisms. Like the first diet of the more paleo style is really about giving the digestive system a time to rest, feeding it things that are easy to digest, easy to pass through. And the second one with more of the carbs, and the grains, and all of that is more so feeding the gut microbiome. And so maybe whatever they're producing in terms of postbiotics or metabolites is actually working to heal.

Dr. Ilana Gurevich: Mm-hmm (affirmative).

Andrea Wien: That would be like my reasoning of why those two things would work.

Dr. Ilana Gurevich: I think that is super, super solid reasoning. Super solid reasoning, I fully agree.

Andrea Wien: In the case of other healing modalities that you've mentioned outside of diet, what are some things, you kind of touched on it briefly, that you've seen to be most effective? Like if someone's going to come to you and say, okay, I'm doing the diet stuff. Like, what are the top three other things I should implement in my life to put myself on a healing path?

Dr. Ilana Gurevich: Okay, so I think the first and the most important is exercise and not everybody needs to exercise to the same amount of vigor but we now know, there was just a study that was published. I want to say like five or six months ago, that basically shows that exercise can improve the microbiome in a really solid way, right. And that's on top of the stress reduction that exercise offers, that's on top of the hormonal detoxification that exercise offers, so as a whole, I think exercise has to be part of the foundation. And what I will always tell patients is if we had a drug that can do what exercise could do, everybody would take it, because it really is that effective, so that's one. Then we start looking at, you know, there really is a difference between ulcerative colitis and Crohn's and how we move forward with treatments.

One of the biggest differences is ulcerative colitis is very, very responsive to probiotics. Study after study finds that different probiotics can bring UC into remission. However, that is not the finding with Crohn's disease. And this was a bummer. I had a patient come in and she was a Crohn's patient. And knee jerk reaction, let's start you on probiotics. And her husband happened to be a hospitalist. And he was like, probiotics are BS, like they just don't work. And so then I went in and I do what I always do when I'm trying to make my point. I start looking at the data to see, am I right? Where did I get this information from? And I was pretty shocked at how many studies have been done with probiotics in Crohn's disease. And how many of them showed efficacy, which was one, there was one type, which is Saccharomyces boulardii, it's a class two probiotic yeast.

And I think there was three or four studies that showed mild efficacy with Sacc boulardii initiating and maintaining a remission for Crohn's disease. With UC, I'm always thinking about probiotics. With Crohn's, I'm not so much. I might throw in S. boulardii, but it's not really where I'm starting. Another treatment that I find very useful that I do a lot of, but I think I'm one of the only ones, is I actually use a lot of rectal ozone with my inflammatory bowel disease patients. Do you know about ozone? Have you guys talked about that?

Andrea Wien: I am familiar with it, but I've never heard of rectal ozone and I don't think it's something most people have heard of, so I would love to just have you explain it.

Dr. Ilana Gurevich: It's amazing. Okay, so what ozone is, is it's a long story, but I'm going to get to a point. What ozone is, is it's a gas. The way that we make ozone is we take oxygen from an oxygen tank. Oxygen is O2, it's a very, very stable molecule. And we take that super stable molecule and we run it through an ozone generator. Ozone generator is known as O3, because what happens is that ozone generator basically electrocutes that super stable molecule of O2 oxygen, and about 30% of it will reform in the form of ozone or O3. O3 is super unstable, I always use the comparison of a husband, a wife, and a girlfriend. Nobody's happy in that situation, and it's not going to stay there for very long. And so then we take the super, super unstable gas, it's in that form for about 30 minutes.

And we insufflate that into the rectum and the amount that we do depends on where your disease is, but what's happening when we do that rectal insufflation is three things are happening simultaneously. The first thing that's happening is the ozone or that third electron, which is basically a free radical if we're honest. The ozone is finding any tissue within the intestine that's inflamed and damaged, and it's actually damaging it more. And that's important because what that does is that upregulates apoptosis or programmed cell death, so the body now sees that this tissue is inflamed and it kicks it off, right? That's the first thing that happens, and that happens for about six hours after we insufflate the ozone. Simultaneously, the ozone goes into the mitochondria, which is run on the electron transport chain, or again, a free radical or an electron. And it actually supercharges the mitochondria to produce in a faster speed, more tissue that just got sloughed off by the inflammatory process of the ozone.

And then the third thing that's happening simultaneously is that ozone will find a free radical. And what happens is the O3 finds the O1 and it makes two O2 molecules, so it actually acts as a very, very fast anti-inflammatory. I've been treating IBD pretty consistently for over 13 years, I use rectal ozone in a similar way that I would use a steroid. Generally I would start with rectal ozone. I start by getting some kind of baseline marker or their inflammatory state, beat out a calprotectin for UC or a test called the Crohn's monitor for Crohn's. And then we do a series of treatments. And then we take a break for about a week because we know that ozone is pro-inflammatory before it's anti-inflammatory.

And that's super important because if I catch that repeat sample too soon, it's going to be falsely more inflamed than what's actually happening in the tissue, so then we take a break and then we rerun these objective findings to see if I'm going in the right direction or not. And it doesn't always bring down inflammation. There are certain type of body types where they're already hyper producing free radicals. And so those people actually, they don't do really well with ozone, but I can usually get 60, 65% of people into a remission with ozone, and some other lifestyle modifications, or diet modifications.

Andrea Wien: That's so interesting. And is that all happening in office or are people doing that at home?

Dr. Ilana Gurevich: That's the bummer about ozone, that's the one bummer is you are tied to my office. Like you have to fill the bag and administer it into my office. However, we do rent out ozone machines to people, for people to bring home for that with them. And ozone machines are actually a lot cheaper than they used to be, like the ozone machines that we're carrying in the office are somewhere between 1500 and 3000. And now there's just more and more manufacturers of ozone machines, and so you can now buy your own home ozone machine for like 800, so the technology is becoming cheaper.

Andrea Wien: One, I think ozone itself is just becoming more readily available because I know we had Dr. Matt Kogan on who is a biological dentist. And when I visited his office, he gave me a little jar of ozone in a suspension of olive oil. And he said, just put this on whatever cut, scrape, kink or sore that happens to pop up. And it's like liquid gold, that stuff.

Dr. Ilana Gurevich: I'm betting that he did the same training that I did, which was many, many years ago. It's Frank Shallenberger is the medical doctor who puts on the ozone training. But yeah, it's just really effective a lot of the time.

Andrea Wien: In your case, if someone comes to you and they've just been diagnosed, and let's say they are a severe case, what is the timeframe that you're typically giving someone if they're doing multiple steps like this? And I know it varies patient to patient, but just as an aggregate, when people can start to expect to either feel better or be in remission?

Dr. Ilana Gurevich: Let's say we're doing ozone as a treatment, right? I will give it a month. I want to see numbers improving within a month. And that's really, really important to know. I want to see numbers improving, not symptoms. It is very, very easy to A, not listen to symptoms because you yourself want it to be better than it is. Like a lot of people who are coming to my office, they have a natural predisposition to not want to use drugs, right. And B, symptoms are easier to control than getting some kind of objective changes within the inflammatory state of the body, right? I want to see numbers that are showing me an improvement by about a month. Now, am I expecting complete remission at the end of the month? Not necessarily, no, that's not even the goal, but I want to see I'm on the right track. And if I'm not on the right track within a month then I want to change directions and circle back around.

Andrea Wien: Okay, that's helpful. Do you feel like there's anything else that we need to talk about in this to give people something to wrap their head around, or have we touched on enough in this episode to make you feel comfortable?

Dr. Ilana Gurevich: I mean, I really want to say that there are so many validated natural treatments for inflammatory bowel disease. It's really, if you are looking at the literature, there really is some comfort that you can have that we do have options to treat, in either a exclusively holistic or naturopathic way, or in conjunction with standard treatments to just improve how the standard treatments work, improve how your intestine works and be able to initiate and maintain remission. Like I do see that all of the time, I feel like... One of the things that I do is I train resonant physicians in my practice.

And these are brand new doctors, they've just graduated medical school, they don't have the thousands of patients in the hospital that medical doctor residents have. And going through and watching them see the power of the tools that we have, it is so empowering, like you have options, patients have options, either going a naturopathic or holistic way on its own or using it in conjunction. Where if you feed the body what it needs to be fed, you just feel alive. You just feel good, you're not suffering. And that is what makes my job so remarkably gratifying.

Andrea Wien: Well, you make such a good point that the body wants to heal itself and it knows how to do that, if we can give it the right tools and get out of the way.

Dr. Ilana Gurevich: Yep. And God knows being a human right now means we are actively putting up roadblocks in every single place because we don't remember how [inaudible 00:34:03] human.

Andrea Wien: Yes, this is so true. Okay. If people want to connect with you or learn more about what you do, see your website, do you take virtual patients or are you all in-office?

Dr. Ilana Gurevich: No, I was mainly in-office before COVID and now I'm all on the computer, it seems. I do absolutely work with people all around the country. It's a little bit of a different relationship because if you're not in the state of Oregon, then I can't prescribe, or I can't order any labs, unless you come to the office. But there's a lot of ways for patients to run their own labs. And as long as you have a physician there that's worth willing to work with us we can absolutely advise and recommend about where to go next, and I do, do that all the time.

And I also have residents who work under me and I supervise them. And so they're the touch point for the patients, and then the case gets reviewed through me and the whole team. But it's easier and a lot cheaper to get in with a resident. They can find me on naturopathicgastro.com. And that has a bunch of... Actually, I just posted on my website one hour talk all about rectal ozone and inflammatory bowel disease because it's this modality that's being underused for these patients in particular, because it's very effective for a lot of them.

Andrea Wien: And we'll certainly link to that. And if you could send over that talk, we would love to link to that in the show notes as well, so we'll put your website in there. Again, that's at BIOHMhealth.com/pages/podcast. Dr. Gurvich, thank you so much for the time today.

Dr. Ilana Gurevich: Thank you so much. By the way, you ask really good questions. Really, really well thought out good questions, so thank you.

Andrea Wien: Thank you so much, we appreciate that. We'll talk soon. Thanks so much for listening as always, you can visit BIOHMhealth.com/pages/podcast for all the show notes and BIOHM is B-I-O-H-M. And while you're there, don't forget, you can save 15% off with the code POD15. I'm Andrea Wien, and we'll catch you next time.

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