Last Updated on October 9, 2025
This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!
Take $10 off your next order! Use promo code QUELL10 at check out — Get started HERE!
– – –
Could your “normal” bloating, fatigue, or skin rash actually be inflammatory bowel disease (IBD)? You might be surprised how often Crohn’s disease or ulcerative colitis are missed — especially when gut symptoms are subtle or completely silent.
Shockingly, a large number of people aren’t diagnosed with IBD until their 60s — not because they had digestive symptoms, but thanks to routine colonoscopy screenings. Others experience extra-intestinal signs in other areas of the body like psoriasis or vitiligo, long before a gut issue is suspected.
While inflammatory bowel disease goes unchecked, you can end up with nutrient depletions, anemia, brain fog, fatigue, anxiety, depression, thyroid issues, and even skin rashes like erythema nodosum, eczema, or psoriasis.
To make an important distinction, IBD (which consists of Crohn’s disease and/or ulcerative colitis) is not the same as irritable bowel syndrome (IBS). So do not confuse the two, as inflammatory bowel disease can have lifelong serious consequences.
Joining me to discuss inflammatory bowel disease, the symptoms of colon cancer, and whether or not there are dangers to having a colonoscopy screening is Dr. Ilana Gurevich, a board-certified naturopathic gastroenterologist and a fellow of the American Board of Naturopathic Gastroenterology. She graduated in 2007 with her doctorate in naturopathic medicine from NUNM.
Dr. Gurevich runs a gastroenterology-focused private practice in Portland, Oregon specializing in treating IBD, IBS, SIBO and other functional GI disorders. She is an educator who lectures about both conventional and natural treatments for gastrointestinal conditions, and is a mentor for physicians, helping them navigate complex GI disorders.
If you’ve felt ignored, gaslit, or confused by persistent health and gut issues that seemingly came out of nowhere, this episode is for you!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- Inflammatory bowel disease (IBD) vs. IBS — what’s the difference?
- Crohn’s disease versus Ulcerative colitis
- Surprising symptoms of colon cancer everyone should know
- Shocking link between chronic gut inflammation, anemia, nutrient deficiencies, fatigue, and brain fog
- Red flag skin signs of inflammatory bowel disease (IBD): psoriasis, pyoderma gangrenosum, erythema nodosum
- Which is better? Calprotectin verses colonoscopy screening
- Why you should never use a functional stool test to replace a colonoscopy
- Natural strategies to support inflammatory bowel disease
- Are biologic drugs necessary if you are diagnosed with inflammatory bowel disease?
Quotes
“The way I define a healthy digestive system is you think about your GI when you're hungry, and you think about your GI when you need to poop, and besides that, you don't think about your GI.”
“Psoriasis or vitiligo, and even a little bit less commonly alopecia, all of those can be tied to having IBD [inflammatory bowel disease].”
Links
Find Dr. Gurevich online
Healthy Skin Show ep. 304: Gut Microbiome Impact On Psoriasis w/ Dr. Fabrizio Galimberti
Healthy Skin Show ep. 217: Health Concerns Linked to Psoriasis (You SHOULD Know About)
401: With Skyrocking Rates of Inflammatory Bowel Disease (IBD), Colorectal Cancer… Is A Colonoscopy Screening BAD For Your Gut? w/ Dr. Ilana Gurevich {FULL TRANSCRIPT}
Jennifer Fugo (00:27.06)
Dr. Gurevich, I am so excited to have you back on the show to talk about inflammatory bowel disease (IBD). Thanks for joining me.
Dr. Ilana Gurevich (00:31.832)
Thank you so much for having me back. It was really fun the last time.
Jennifer Fugo (00:34.576)
I know, we got a chance to talk about fatty liver disease and all of that, which, I mean, is totally connected to the gut. And one topic, I mean, we're nearing 400 episodes, and I realized we have never once discussed inflammatory bowel disease, which obviously has manifestations not only in the skin, there's a lot of comorbidities, especially with psoriasis and IBD. Can we talk about what exactly is inflammatory bowel disease? Let's start there, let's start with kind of like a 101 overview.
Dr. Ilana Gurevich (01:14.158)
So whenever we're talking about GI conditions, there's this fork in the road. One fork is the organic condition, one fork is the functional. The organic condition means there is a change to the organ. Inflammatory bowel disease means there's a histological change, for Crohn's disease, anywhere from the mouth to the rectum, and for ulcerative colitis, only in the large bowel. So what that means is, when you go in and you bring a scope through the intestine, you will see that the tissue looks different. It looks inflamed, it looks ulcerated, it looks erythematous or red. It looks just angry. And those histological changes are different in Crohn's disease than it is in ulcerative colitis. When we're talking inflammatory bowel disease, it is just Crohn's disease and ulcerative colitis. Those are autoimmune conditions where you have organic changes to the bowels.
Jennifer Fugo (02:11.316)
And this is different from IBS, right? Because most people have heard of IBS. What do you think is the difference between IBS versus IBD?
Dr. Ilana Gurevich (02:21.278)
IBS takes that other turn. That is a functional GI disorder and significantly more common than IBD. So IBS, there's something, the organ isn't functioning the way it should. And you might feel gassy, bloated, abdominal pain, alternating diarrhea or constipation, but when they put a scope in there, they don't necessarily see any organic change.
Jennifer Fugo (02:46.26)
So could the symptoms, though, look really similar?
Dr. Ilana Gurevich (02:51.914)
Yes, and it's even more confusing because the other thing that you can have is you can have a diagnosed inflammatory bowel disease, but also an IBS component within your IBD. And the problem with that, and I am going to say, a lot of my population is that. The problem with having an IBS with an IBD is IBD is much more serious. IBD, you can lose blood, you can not absorb nutrients, you can have chronic inflammation. And your IBD might be completely controlled. You might be in what we call a histological remission, which means if they scope you, your bowels look normal, but you're still having the abdominal pain, the distension, the bloating, the discomfort, the alternating bowel movements. And because you have an IBD diagnosis, the gastro is going to say, this is IBD, so we should change your drug, we should increase the amount of drug that you're taking, we should add a second drug or a third drug. But the problem is not the IBD, it's the IBS functional aspect within the IBD.
And with Crohn's in particular, so the difference between, there are pretty significant differences between Crohn's disease and UC, one is where the disease could be found. Crohn's, anywhere from the mouth to the anus, UC, just large bowel. The other thing is, ulcerative colitis presents with ulcerations, so it's like an eating away of the membrane.
Jennifer Fugo (04:18.549)
Oh, wow.
Dr. Ilana Gurevich (04:35.167)
Crohn's can have ulcerations, but Crohn's has inflammation that's much longer or thicker. It goes to the serous aspect of the intestine, and so you can have inflammation with ulcerations within the inflammation. And you could be well controlled, but you're still feeling bad because the IBS is acting up.
Jennifer Fugo (04:39.552)
And with both of these conditions, the ulcerative colitis and Crohn's, I mean, there can be serious consequences, right? I know a gal from high school, I believe she had part of her intestine removed and I think she had Crohn's. Is that a potential consequence for both of these conditions?
Dr. Ilana Gurevich (05:03.136)
Yes, so it's tricky. So my answer is unfortunately if you have a moderate to severe, either UC or Crohn's, surgery might be your last option. They come for different reasons. Ulcerative colitis is labeled based on where the disease is. Is it just by the rectum, that's what's called proctitis, or is it the entire sigmoid, transverse, ascending colon, the whole thing? That would be pancolitis. If you have a severe pancolitis and you're having 10 to 15 bowel movements a day, you're bleeding, you're febrile, the treatment in the conventional world is to remove the colon, and they call that cure. Ulcerative colitis is only possible within the large bowel, if they remove the large bowel, look, you're cured. You have a different set of problems now, probably a secondary disease like pouchitis or something like that, but that's why you would get a surgery in UC. And generally in UC, because it starts from the rectum and works its way tangentially up the intestine, they don't ever take out a piece of it. Usually they just resect the whole thing.
Crohn's is different. Crohn's has what's known as skip lesions. So you have an area of inflammation, maybe attached to a completely healthy set of tissue, attached to another area of significant inflammation. They might cut that inflamed process or inflamed portion out, or, worst case scenario, that inflammation becomes so severe that you get an obstruction. So the swelling gets so bad that now you don't have an opening anymore. They might cut that out. The problem is that, what we see time and again, is Crohn's will restart acting up again exactly where they cut.
Jennifer Fugo (06:51.07)
Oh, wow. Really?
Dr. Ilana Gurevich (06:53.89)
Then you have patients going in for repeated bowel surgeries, and you're getting more adhesions, more scar tissue because they can't get the disease under control.
Jennifer Fugo (07:03.776)
So this obviously, and I don't bring this up to scare anybody, because obviously if you're dealing with this, if you're at the beginning of your journey, I think it's important to know that these can be really serious conditions. Because some individuals, correct, could end up with like an ostomy bag, is that right? Is that more common for UC when you have the whole colon removed?
Dr. Ilana Gurevich (07:26.07)
Not necessarily. So there's two ways to do a surgery. The most common way is to do the surgery in multiple parts where they do the resection, they cut out the damaged organ, and then you have an ostomy or a bag, and then they let that heal and then they go back in and they reattach the small intestine via pouch. And so that pouch is small intestine tissue originally, but it kind of begins acting like a large intestine. And so they do a J-pouch and they attach that to the rectum. So that's one reason why you would have a pouch. Crohn's, similar, but sometimes they can't reattach because of inflammation or tissue damage, and then those people end up with an ostomy.
Jennifer Fugo (08:04.234)
Okay, I mean, again, this is, I know my audience loves to hear about the gut, and this is something that I don't think gets talked about enough, because these are really serious conditions. How would they differ from something like diverticulitis? Is that a part of the IBD spectrum or is that something entirely different?
Dr. Ilana Gurevich (08:22.562)
Great question. That is something entirely different, and significantly more common. So, I don't know if you know, but the Western diet is kind of crappy. They literally call it the SAD diet.
Jennifer Fugo (08:36.288)
True, true.
Dr. Ilana Gurevich (08:38.19)
And so what happens when you eat a lot of Western foods, and this is a condition that we see more in Western countries, but it also might just be a normal variant. What happens with diverticulosis is your large intestine has these little pockets. The tissue changes and they have these little pockets. If those pockets are just hanging out, they're not causing an issue, you don't even know they're there. If those pockets get inflamed or infected, your life sucks. It is painful. You cannot eat. Anything that touches that tissue, which is stool all of the time, is gonna feel like razor blades are cutting your intestine.
There's ways to manage diverticulosis so you don't get into an itis flare. If you get into an itis flare, oftentimes, actually the best treatment and one of the ways you confirm if you're in a diverticulitis flare, is you just stop eating. So you give yourself complete digestive rest for 24 to 48 hours. And if you feel better, that actually tells you that's what's happening. And actually there's data that shows that complete digestive rest is as effective as antibiotics for treatment.
Jennifer Fugo (09:52.572)
Oh my gosh! Wow!
Dr. Ilana Gurevich (09:54.614)
If you stop eating for 24 hours and you're still in pain, then we start thinking about more severe interventions. For diverticulitis, or I'm sorry, to prevent diverticulitis, if you're in diverticulosis, the most important thing you can do is make sure you don't get constipated. Constipation is the factor that can make that little pocket, that's totally benign, that you don't know exists, turn into an intensely big fire of pain.
So my diverticulitis patients, always, they know how to prevent constipation at all costs. If they start feeling like they're getting constipated, they over-correct to prevent a flare. If you're in a flare, you stop eating for 24 hours, liquids only, and really just water only if you can. If it gets better, you know what you're talking about, you know what you're dealing with. If it doesn't get better, then you need a bigger workup. And also if the diverticulitis is so severe, that's another reason why they can resect the bowels, but then they usually take a small amount of where those pockets are.
Jennifer Fugo (10:57.952)
So what I'm hearing and what I'm kind of thinking, you just mentioned constipation. Is constipation, is diarrhea versus constipation kind of worse for these conditions, one versus the other?
Dr. Ilana Gurevich (11:14.188)
Yes and no, and they're both side effects of the conditions.
Jennifer Fugo (11:17.376)
True, true.
Dr. Ilana Gurevich (11:41.154)
The way I define a healthy digestive system is you think about your GI when you're hungry, and you think about your GI when you need to poop, and besides that, you don't think about your GI. It's doing its own thing, it's a different nervous system, you don't have to think to digest food. If you're spending a lot of time thinking, and feeling, and worrying about your GI, there's something not right. Hopefully it's just something functional, but it could also be something organic.
Jennifer Fugo (11:49.76)
Yeah. With these conditions, so specifically, if we go back to ulcerative colitis and Crohn's, with IBD, with these conditions, they can have extraintestinal manifestations or comorbidities. So basically outside of the GI tract, for those of you who are like, what's extraintestinal? What are some of the things that you've seen, or that are really common, that somebody who's watching this might not actually realize is a red flag to possibly be like, oh, something's going on in my gut that could be more serious than just some issues with IBS?
Dr. Ilana Gurevich (12:29.454)
So first things first, IBD, UC and Crohn's, are both autoimmune disorders. And autoimmune disorders do like to hang out together, so it's not uncommon to have more than one. Because this is the Healthy Skin podcast, let's start with skin.
Jennifer Fugo (12:44.192)
Sure, yeah.
Dr. Ilana Gurevich (12:59.528)
So it is not uncommon to have an overlap with either psoriasis or vitiligo, and even a little bit less commonly alopecia, all of those can be tied to having a base of IBD, or maybe more I want to say, because you have IBD you have a higher risk of having these autoimmune skin disorders as well. So that's one. For Crohn's disease, 80% of patients have disease in their terminal ilium or the end of their small intestine. The job of the small intestine is to reabsorb your nutrients. And so when you have an inflammatory process that's happening in the part of your body that's supposed to absorb nutrition, you end up with these nutrition deficiencies. And secondary to that, you can have a whole lot of fatigue, brain fog, anemias, B12 anemias, vitamin D anemias, iron deficiency anemias, that can all happen with inflammatory bowel disease.
Depending on severity, the other things that we see, is we see these really, really painful skin lesions, both erythema nodosum and pyoderma gangrenosum. Those are affiliated with IBD, especially severe IBD flares, and they are red, painful, hot, ulcerated lesions on the skin.
Jennifer Fugo (14:14.697)
Wow.
Dr. Ilana Gurevich (14:15.937)
They are not only associated with IBD, but if you're breaking out into these very painful rashes, you need to be thinking about inflammatory bowel disease as a possible underlying cause.
Jennifer Fugo (14:27.516)
Is it possible, this popped into my head, is it possible to have inflammatory bowel disease (IBD) but the symptoms within the GI tract are almost like silent? Where you might have a red flag someplace else, but in reality, and I've seen this with skin, where people's gut is a total mess, but they poop just fine, they have no GI symptoms, but there's like the gut microbiome is a mess, they're not absorbing nutrients, it's just showing up everywhere else. Is that possible with IBD?
Dr. Ilana Gurevich (14:58.445)
Yes. And one of the things, okay, so when we're diagnosing people with inflammatory bowel disease, there are these two peak curves when we're more likely to find them. The first is actually in adolescence, there's a peak, and so there's definitely a hormonal component through developing IBD. And I think that comes back to the estrabolome, which I'll talk about in a minute. So one of them is this adolescent peak, young adulthood, and the second is this menopausal, andropause peak in your 60s.
Jennifer Fugo (15:28.296)
Interesting.
Dr. Ilana Gurevich (15:28.848)
This population of in-your-60s diagnosis, it's often found on a screening colonoscopy. They have no symptoms at all, they just go in because their doctor tells them it's valuable to do a colonoscopy to make sure you don't have colorectal cancer. And when the gastro goes in there, they're like, what the hell is this mess? They take a biopsy and it's your inflammatory bowel disease.
Jennifer Fugo (15:45.918)
Wow, so wait, people are getting diagnosed in their 60s with inflammatory bowel disease from the colonoscopy screening.
Dr. Ilana Gurevich (15:57.934)
From the screening colonoscopy.
Jennifer Fugo (16:00.618)
Wow.
Dr. Ilana Gurevich (16:01.483)
A screening colonoscopy, they're literally, do I see a polyp? I'm taking the polyp, I'm not doing anything else.
Jennifer Fugo (16:06.836)
Right.
Dr. Ilana Gurevich (16:07.314)
But if they go in there and they're not seeing polyps, but they're seeing a whole lot of other things, they're gonna do a bunch of other things.
Jennifer Fugo (16:13.06)
Oh, wow. So at that point, if you don't have any symptoms, like let's say you don't have any gut symptoms, although to be fair, let's be honest, a lot of people think gut problems are normal, and we've normalized gas, and bloating, and all that stuff. But if, say, their symptoms are pretty minimal, at that point, do you basically have to start being treated as if, like you have to treat it similarly to somebody who does have significant symptoms?
Dr. Ilana Gurevich (16:45.952)
Unfortunately, symptoms are the least important part of this conversation.
Jennifer Fugo (16:50.345)
Really?
Dr. Ilana Gurevich (16:51.241)
It's kind of amazing, like you're lucky, you don't have symptoms, great, you're not in discomfort. But there's lots of things that are not happening physiologically because that inflammation is there, and lots of bad things that are happening because that inflammation is there, that the symptoms matter, but really what's much more important is the signs and then what else could go wrong.
Jennifer Fugo (17:14.964)
Can I just ask really quickly, does having inflammatory bowel disease (IBD) put you at greater risk for something like colorectal cancer, or any type of bowel cancer?
Dr. Ilana Gurevich (17:24.91)
Absolutely. Yes, it does. Yep.
Jennifer Fugo (17:26.74)
So this is something, because I just turned 45 and my doctor was like, hey, by the way, you're gonna have to go for your first colonoscopy screening. And I'm like, ugh.
Dr. Ilana Gurevich (17:39.018)
I just did mine, actually last Friday. We were supposed to record, but I was like, I can't, I'm doing my colonoscopy. It wasn’t bad, honestly.
Jennifer Fugo (17:42.846)
So do you, because you're a naturopathic doctor, what is your take on colonoscopies? Because I mean, listen, there's a lot of talk in this world, right, like about mammograms and all of this testing that is done in conventional medicine. You are an extremely knowledgeable practitioner. Do you think that it's too much, or do you think that it is worthwhile? Like what would you tell every person who's like me, in their 40s, getting ready, being told you have to do this? Do you think that it's worthwhile, is it overly disruptive?
Dr. Ilana Gurevich (18:20.718)
So five years ago, we would not be having this conversation because the recommendation would be to screen at 50, right? Why has the recommendation changed to screen at 50, from 50 to 45? Because colorectal cancer has gone like this. The reason why I turned 45 and immediately scheduled, is I have a friend, she's a naturopath just like I am, I've known her for 20+ years, she eats pristinely, she meditates, she exercises. She started having gas, bloating, distension. It got worse; she went in for her colonoscopy, mainly because it was her age. Stage four colorectal cancer.
Jennifer Fugo (18:59.484)
Oh my gosh.
Dr. Ilana Gurevich (19:00.75)
It's growing like this. And so that's the first thing that I want to say, is I don't think there's any controversy here. I don't think there's a big colonoscopy, you know, money thing behind it all.
Jennifer Fugo (19:12.608)
Right, okay.
Dr. Ilana Gurevich (19:19.342)
The other thing that we do have available, that is very, very well-researched, is a test called the Cologuard, that is basically, it's a stool test. They send you a kit to your house, you poop, you mix that poop with some preservative, you send it back to them, and that test is looking for blood and DNA fragments of cancer cells. And that test is very, very good at finding tumors that are over four millimeters large. So if you have a colorectal tumor in there and it's a little bit larger, the Cologuard will find it. If it's smaller, it might get missed, and the Cologuard is only effective if you're doing it every three years, no matter what.
So you don't have to do what I did, but I guess why I made my choice is colorectal cancer doesn't grow fast. So I went in and I had my colonoscopy. He didn't find anything at all, and so he said, come back in a decade. I literally do not need to think about it for 10 years. And so for me, that was the choice that I made.
Jennifer Fugo (20:18.73)
Can I ask you too, so we have all these functional stool tests, which obviously we can talk more about testing and things like that for inflammatory bowel disease (IBD), but I know that they're not necessarily screening for cancer, but do you think that something like a GI Map, or a GI Effects, or something like that could be helpful in at least telling you that there is a problem, or potential IBD or something like that present, where you would refer to a gastroenterologist?
Dr. Ilana Gurevich (20:49.13)
So there's a test on both of those called a calprotectin. A calprotectin is a stool test that looks at how many neutrophils or white blood cells are infiltrating the intestine, large bowel. For ulcerative colitis, the calprotectin is like 94% predictive, equal to colonoscopy.
Jennifer Fugo (21:10.324)
Wow.
Dr. Ilana Gurevich (21:21.84)
For Crohn's, it's somewhere between 30 to 82% predictive, depending on what clinical trial you look at. So does it tell us is there a problem with UC? Whenever I get a positive calprotectin back on any of the functional labs, I will reflex it to Quest or Labcorp, one of my hospitals.
Jennifer Fugo (21:28.232)
Right, 100%, yep.
Dr. Ilana Gurevich (21:29.341)
And if it's high then, then I'm going to say, okay, let's send you over to the gastro, let's see what's going on. However, is it screening for colorectal cancer? No, it's not looking at the DNA fragments that come with cancer. That is looking at function, that is a functional test. Why are you feeling bad? Not because you have an organic disease, because something's not functional. That's where those tests belong.
Jennifer Fugo (21:51.38)
Yeah. I think that's a helpful differentiation because we could, I have had some older clients who were like, no, no, no, I just did a GI Map or something, I don't feel like I need to go in. So this is really helpful for people to know that it can be helpful and possibly pinpointing. And let me tell you, I have a client who recently had a GI Map. She has confirmed through a colonoscopy, I don't remember which version, whether it's Crohn's or colitis, I don't remember because it just happened. And I mean, her GI Map is so off the wall.
And that's the thing, it can be helpful in pinpointing things, but I think that's where, as you suggested, when you start to see patterns that look, like your calprotectin is really high, there's a ton of occult blood, and I do want to talk about what that means. What is occult blood, what is the significance of that? You start seeing these things, you have to refer somebody to a GI doctor. You're not gonna fix that with digestive enzymes, you know? So let's talk a little bit about that. I think blood is one of the things that usually is motivating to people. If there's blood in the stool, all of a sudden they're like, they'll bear a lot of symptoms until they see that, and all of a sudden go, oh my. So can we talk about what happens if you see blood, versus what occult blood on a test is?
Dr. Ilana Gurevich (23:27.544)
So blood can come from a couple of places. The most common place you're getting bleeding is from a hemorrhoid. And there is no urgency with that type of blood. That type of blood usually appears on the toilet tissue when you wipe, very rarely does it appear in the toilet bowl. It will not make the whole bowl turn red. That's like, you have a little vein that's outpatching, that the stool irritated or cut when you're having a bowel movement, and then when you wipe, it's irritated and bleeding. So that is a different type of blood, and that usually I don't worry about.
And then the other type of blood that happens very commonly is they had eaten a beet or two a couple of days before, and then they see blood and then you get an urgent call. And it took me probably a year into practice to be like, did you eat beets? That's the first question.
Jennifer Fugo (24:13.45)
Did you eat beets? 100%.
Dr. Ilana Gurevich (24:15.97)
So that looks just like blood and you cannot differentiate it, that's beets. So that type of blood, I don't worry about hemorrhoidal blood. And you know, in Portland we have some amazing protocols, or Keesey treatments, where they can treat the hemorrhoids. A bigger deal is frank red blood that's filling up the toilet tissue or bleeding blood that's on the stool, streaking the stool.
Jennifer Fugo (24:33.805)
Oh, wow. Okay.
Dr. Ilana Gurevich (24:48.064)
That's not gonna be a hemorrhoid, that's some kind of other tissue inflammation or irritation that you're seeing, that could be a sign for something more serious. Then there's occult blood. Occult means hidden. What that's going to look like in the stool is like coffee grinds. It's flaking blood that happened higher up in the GI tract that has oxidized, or turned dark brown, and so in the stool, you're going to be seeing something that looks like like grinds of coffee. And that's even more concerning because then most likely there's a bleed somewhere higher up on the GI tract.
Jennifer Fugo (25:12.606)
And so is that a red flag?
Dr. Ilana Gurevich (25:15.522)
Yes. The big amount of blood in the toilet stool, I mean in the bowl, the streaking of blood, bowel movement after bowel movement after bowel movements, and then anything that looks like coffee grinds, is definitely warranted for a workup. And that workup can actually start by you just running a CBC and a ferritin, a complete blood count and a ferritin, because if you have that plus anemia, there's a little bit more urgency and they're also gonna get you in faster.
Jennifer Fugo (25:42.592)
So with these conditions, obviously some treatments include steroids, and there's a lot of biologic drugs out there now these days that are being used. I mean, it's amazing, some were found for IBD and now they're used for psoriasis, as an example. I mean, that is one of the easiest ways to see how the interaction is between those two particular conditions. And I actually see that quite a bit. Some individuals have interesting, where their skin is still reactive, but they're now in, quote-unquote, remission for whatever type of IBD they had.
So what are some things that you could use, or things you could consider, if you're not necessarily comfortable with meds? And I actually would love to know your opinion on using some of these meds because people have concerns, and they aren't sure which way to go, and then they're not sure whether they can do the meds with more integrative therapies. So as somebody who does this, you really straddle this whole world of being open to a lot of different things rather than, oh, you just have to take a pill or whatever. What options do people really have?
Dr. Ilana Gurevich (26:59.928)
So a lot, actually. I think when I, you know, I train residents, and we're all naturopaths, and so the MO is usually drugs are bad, and I don't agree with that MO, especially in the IBD world. In the IBD world, the disease is bad. The problem is the disease, it's not the drug. If the drug can put you in a remission and you can have your life back, what a gift. Because these people, their life is being stolen because it's surrounded by the toilet, they're in chronic pain, they have no energy, they're fatigued, it's rough to have an untreated inflammatory bowel disease. So I'm not opposed to the drugs. And do I even sometimes recommend steroids? Yeah, if I am seeing that that fire is about to rage, or is raging and they're not getting control, I am so grateful to have a steroid.
And do I have tools that are not pharmaceutical, that have randomized controlled trials and meta-analyses behind them, that show very effective control of IBD? Yeah, I have that too. There is never, I think honestly, I think my patients do a lot better than most because they have access. All of my patients have a conventional gastroenterologist. You don't want me to scope you, that's not the type of medicine I practice. Just as an aside, I did, when I was in naturopathic school, sit through one colonoscopy. I called my gastro, I said, can I observe, she got permission. I fainted during the colonoscopy. That poor woman was like, get an IV in her. I was like, I don't know, it a small room, and it was kind of smelly, and you know, the tube was making sounds, you don't want me doing the colonoscopy, right? You have a gastro to do that.
But are there a thousand functional tools, or herbal tools, or nutritional tools that we have that can help stabilize you or help your biologic work better? Or let's say, and a lot of my population falls under this category, the biologics don't work on you. Do I have other tools? Yes. Why would you ever just do one when you get better care doing everything together and having a team?
Jennifer Fugo (29:06.74)
What are some oddball things that either people haven't heard of or maybe are kind of like on the newer end of things? I think most people are also surprised about the use of immunoglobulins, oral immunoglobulins, even though that's been a treatment. It's considered what, a medical-grade food? It's been a treatment for a long time for IBD.
Dr. Ilana Gurevich (29:30.242)
So I will say there is a fork in the road between what you do for Crohn's and what you do for UC.
Jennifer Fugo (29:34.675)
Okay, fair enough.
Dr. Ilana Gurevich (30:00.256)
A lot of the dietary data is actually for Crohn's. We don't have the data for UC, but that doesn't mean it doesn't work. It just means that nobody has put together large data sets. So let's start with talking about food interventions. One of the most effective documented interventions that could be excessively effective at treating Crohn's is an elemental diet. So an elemental diet over four weeks is equal to a steroid to get into a clinical remission.
Jennifer Fugo (30:02.559)
Interesting. Wow.
Dr. Ilana Gurevich (30:03.326)
However, I mean, it's an elemental diet, it is borderline torture. So there is that. But for these patients, if you want to not take a pharmaceutical approach, and especially for the pediatric population, an elemental diet absolutely has data going back to the 1970s that it can effectively induce a remission similar to prednisone or steroids.
Jennifer Fugo (30:28.692)
And you're only doing the elemental diet. And that is the powders and such that, wow, that is a little rough.
Dr. Ilana Gurevich (30:35.444)
That you're drinking. It's rough, and there's data behind it. So if you're motivated and you want to avoid pharmaceuticals, that is a way to drastically reset the environment of the intestine. We don't have that data for ulcerative colitis, but we have case reports. So it might be a, the data that we have for ulcerative colitis is we show that if the patients go on an elemental diet prior to a bowel resection, they do better post-bowel resection, like they have less side effects. So that would be the food intervention for Crohn's.
For UC, which, the microbiome, the large trillions and trillions of bacteria in the large intestine, for UC, probiotics and fermented foods. I think last time I looked, there was something like 85 different randomized, double-blind, placebo-controlled trials on probiotics of all different classes, and like 95 of them showed benefits. So for UC, I'm like, okay, this is a no-brainer. Let's throw everybody in probiotics. For Crohn's, the research actually is not that good with probiotics. Something like only 42 or 45% show benefit with Crohn's and probiotics. So I'm not gonna have that conversation with Crohn's.
Other things that are amazing, amazing, amazing for UC is there's a herb called Indigo naturalis, or Quing-Dai, and that has three randomized controlled trials, one meta-analysis, showing 93% efficacy inducing and maintaining remission for UC.
Jennifer Fugo (32:08.757)
Wow.
Dr. Ilana Gurevich (32:10.754)
That's about what I see in practice. There is no drug that is gonna work as well as Quing-Dai. But, and there is a but, in the herbal pharmacopoeia, Indigo naturalis, or Quing-Dai, does have some pretty significant risks that are documented in the literature about, it's like 8% or 1%, I have to relook again. It can cause portal hypertension, which is an inflammation of the liver, and it can cause intussusception or telescoping of the intestine, which could be a surgical emergency if it doesn't resolve.
Jennifer Fugo (32:43.827)
Interesting.
Dr. Ilana Gurevich (32:47.418)
And I usually put my Indigo naturalis into a little bit more of a balanced Chinese herbal formula, so it's a little bit more tonifying to the middle burner, the GI tract. And so I feel lucky that I haven't seen that in my patient population, that might not mean anything except my time hasn't come up yet. But that is one of the most effective treatments.
And then I was just recently looking at another meta-analysis for Crohn's using Artemisia absintheum, for showing similar efficacy for Crohn's, but I haven't started using it with patients yet. I just literally read the meta-analysis. I was texting with Mark Davis, one of my IBD naturopath friends, and I was like, are you using this? He's like, yeah, I have great results. So I haven't started yet, but there's some interesting data on that.
Jennifer Fugo (33:32.608)
Impressive. Wow. And do you think, with both of these conditions, I usually, even if the client is in remission, but they're still having, like, for example, they come to me for skin problems. A lot of times there's issues with the gut microbiome. Do you feel that if you have these conditions, either any type of IBD, I even would argue there's probably something potentially going on with diverticulosis, do you think it's worthwhile to look at what's happening with what's living in the gut?
Dr. Ilana Gurevich (34:07.818)
So those functional tests, I am using a lot for my IBD patients, but I want them stabilized first. I don't start with, I want, if you're coming in and you're flaring, we need to find a treatment strategy to get you out of the flare because there's very significant risks, organic risks with that. Once we have you stabilized, the question is, how do we continue to build on what the biologics are doing, which is getting rid of that inflammation?
Jennifer Fugo (34:38.591)
Yeah.
Dr. Ilana Gurevich (34:43.684)
So that the rest of your life is more stable and we can prevent future flares. That's the sweet spot for the functional tests.
Jennifer Fugo (34:46.176)
And have you seen, if somebody does choose to go on a biologic and it gets them into remission, calms the flames, is it possible for people to get off of those meds at some point?
Dr. Ilana Gurevich (35:03.318)
You wanna know what's so funny, is I just was texting yesterday and I was like, I need to, I think that's gonna be the next talk that I write. Because I think that patients come to naturopaths because they wanna get off the drugs, and I think naturopaths, by our nature, wanna take them off the drugs. My view on it is, I mean, I'm never gonna talk you into getting off the drugs, right? If you are on the pharmaceuticals and you are having your life back, and you're not symptomatic, and you're not anemic, and you have energy. I'm like, wow, these drugs are amazing. Like, why would we stop this, you know? Some people still want to, and some people are on the drugs but they're not having remission, it's they're not working. That's a different conversation.
There was a large study that was released in 2014 that was looking at inflammatory bowel disease patients who took a drug holiday, so stopped using their medication, for any reason outside of developing antibodies against the drug. Like that's a thing that can happen, the drug stops working because you developed antibodies.
Jennifer Fugo (36:10.688)
Oh, so your body can produce antibodies to the medication. Wow, okay, that's good to know.
Dr. Ilana Gurevich (36:14.68)
To the drug. It’s a biologic, it's similar to your biology. 85% of them could restart the drug with efficacy. So, in the past, like way back early on, we had like one drug class, the TNF-alphas. For a long time there was one drug, Remicade, or infliximab, and then we added adalimumab, or Humira, and then Cimzia, and that was all you had. You had steroids, you had chemotherapeutic drugs like 6-MP or Imuran, and then you had the TNF-alphas. That's not true anymore. Now, I think we're at five or six different mechanism of action drugs that are different from the TNFs. But only five or six, not like a thousand.
So we have to be really good explaining to our patients that there's also a risk to getting off of these drugs, and that risk is right now you're stable, what's going to happen later? That being said, if my patients want, I don't treat kids, my patients are adults, they can make their own choices, I explain to them the risks. I like to see my patients in a clinical remission for three years.
Jennifer Fugo (37:31.776)
So three years before you would even want to, like feel comfortable even entertaining this conversation in a sense.
Dr. Ilana Gurevich (37:38.786)
That's what I do. Some people don't like that, but that's my preference. I want to be real damn clear you're stable. We're talking about the long run.
Jennifer Fugo (37:48.0)
Sure.
Dr. Ilana Gurevich (37:58.498)
This is not playing the short game. I don't want to pull you off your drug, you're happy for two months, and all your symptoms come coming back. You're stable for three years, and then we start where we start running a trough. So a trough is how much drug, like on the day that it's time for your next injection or your next infusion, how much drug is in your system the minute before we give you your next dose. So it should be when the drug is the lowest. Because if you have no drug in your system at that eight week mark, six week mark, I'm like, is the drug doing anything?
Jennifer Fugo (38:24.884)
That's a great question.
Dr. Ilana Gurevich (38:25.774)
If you have a lot of drug in your system, I'm going to say, well, why don't we try to space it out a little bit? Let's rerun a trough at 10 weeks. So there's all this nuance, but you have to know that there's a risk to making that choice.
Jennifer Fugo (38:42.794)
I really appreciate you for acknowledging this because I do feel, and I agree with you, that in the integrative, naturopathic, functional space, there's this bias. And you and I've talked about this. And I've talked about this with some of your colleagues, like Dr. Jenny Bennett and Dr. Allison Siebecker. There's this bias against using medication and this tendency at times, especially when somebody is, like in these instances, people are really sick, to just be like, oh, the medication is bad. But I think, like you pointed out, that there's pros and cons to both sides of the argument, right? Choosing to do the drug, and staying on it versus coming off of it.
And if you don't know the nuance to what could potentially go wrong coming off of it, and you're that what, 1%, 15%, whatever it is, where it goes wrong, I would bet that you would have wished you knew the other information. And maybe it would have changed your choice, maybe it wouldn't, but I do think that it's really important to maybe even, if you have somebody who's really super pro-integrative, sit down with your gastroenterologist and be like, let's hammer this out, we gotta talk it out, talk with your pharmacist, go online, do some reading. Really look at the hard pro and con of both options. Don't just assume the medication is a bad thing, because it could potentially offer you, I mean, like you said, there's this risk of cancer that comes along with that. Is it that if you are in an active state that the risk of cancer, bowel cancer, is increased with IBD, or if you go into remission is it still the same?
Dr. Ilana Gurevich (40:37.74)
So the problem is that you have this period of your life when you're not in a remission, where you are having active turnover of these cells because that's the nature of having the disease. And so because you go through this period of having active turnover, that's how cancers get started because they actively are turning over and not following the rules that they're supposed to be following.
Jennifer Fugo (40:56.72)
So I think this is a really good final question. For those of us who consider ourselves healthy, we're eating, like you said, your colleague, we're eating all the right foods, we're doing all the right things. What are the things, the sneaky things that you might ignore, blow off, explain away that could be red flags for either Crohn's or colitis, that if you experience this, you gotta talk to your doctor?
Dr. Ilna Gurevich (41:30.574)
So there's the scary, scary things, which I think you're gonna get alerted to right away. There's very rapid weight loss, there is rectal bleeding, there is a significant increase in frequency of bowel movements and consistency of bowel movements, frank blood and mucus within the stool, and you're having stools that are just blood and mucus, and pain. Any of those are like do not pass go, do not collect $200, go directly to the doctor, that is not right. Like you are not supposed to be in that much pain. You are not supposed to be having bowel movements of just blood or mucus. That's not okay.
There's often diarrhea, except when there's constipation. And I'm always shocked, I'm like, wait, wait, you have UC and you're constipated? like, I don't compute, you know, but that happens. Those chronic IBD patients can also have bouts of constipation. So any very rapid change of your bowel habits, that's a thing.
Jennifer Fugo (42:33.022)
Yeah, so that is something where you need to go speak with your doctor. I guess too, if this is, because I read all these articles online, they're like, I got diagnosed, or she got diagnosed with stage four cancer out of the blue, and this was the one symptom that she had that kept getting blown off. If you feel like the symptoms aren't resolving, but your doctor said it's no big deal, what would you say? Keep pushing?
Dr. Ilana Gurevich (42:59.212)
Yeah. Go get a second opinion. Imaging is expensive, and imaging is very valuable, especially in the inflammatory bowel disease world. The trick with imaging is, for IBD in particular, the best imaging to get is a MR enterography or a CT enterography, a CTE or an MRE. Those do use gadolinium, which is the dye. And there are risks to the dye, you know what I mean? Like we used to think it clears the system really quickly, now we find that it stores itself in the organs and in the brain, and it's not as safe as we once thought. So limiting that is important. And if it's not getting better, I mean, find somebody else.
Jennifer Fugo (43:46.506)
Yeah.
Dr. Ilana Gurevich (43:46.69)
You know, sometimes it's worth it. If you have an inner knowing, I think that we often, we live in a world right now where we think the only thing that's real is the physical body, right? And if I can't see it, if it's not on a blood test, it's not real. But I think we all know we're more energy than physical, and if there's a knowing, it's important to follow that knowing.
Jennifer Fugo (44:09.364)
And I would second that with if you had an inner knowing about your child, you wouldn't just blow it off. You would do it for your child, so why are you not willing to do it for yourself? We are worthy. We are worthy of that inner knowing and following through with it, just as much as we would do for another, whether it's our spouse, our parent, our child, whomever. I think we shouldn't deprioritize our own needs because this, as you shared, can be really, really serious. I just, thank you so much.
Dr. Ilana Gurevich (44:41.794)
Yeah, thank you.
Jennifer Fugo (44:42.431)
Thank you so much, Dr. Gurevich, for joining us today and sharing about inflammatory bowel disease. I feel like there's so many more things that we could dive into, but I think this is a really great starting point. And how can people find you?
Dr. Ilana Gurevich (44:54.312)
So I'm in Portland, Oregon, and I also see patients in Washington and California, licensed in all three states, and you can find me at Open Wellness PDX, which is what we’re called, openwellnesspdx.com.
Jennifer Fugo (45:07.398)
Awesome. And then you also have a podcast.
Dr. Ilana Gurevich (45:09.998)
I have two now actually. Thank you, right, I have a podcast. Okay, so I have two podcasts. The one, my first podcast is called The Turd Nerds, and I team up with Dr. Rebecca Sand and Dr. Ami Kapadia, who are, Dr. Sand’s a naturopath and Dr. Kapadia is a functional medicine medical doctor, and all we do is talk poop. And that one, we're like, I think we're hitting our 70th episode.
Jennifer Fugo (45:31.274)
Congratulations.
Dr. Ilana Gurevich (45:39.904)
And then I just launched a new one, because my other passion that I love more than anything else is neural therapy, which is a form of injection that resets the nervous system. And so I teamed up with Dr. Anne Hill, and we have a podcast called The Point of Medicine where we interview neural therapists around the world, because there's a lot of neural therapists in the rest of the world, and just talk about this incredible injection-based technique that resets the way the nervous system feels.
Jennifer Fugo (46:01.216)
Wow. That so awesome. Awesome. I'm so glad that people can find you and check out more about your work. And I look forward to having you back on the show. Thank you so much for setting the record straight, letting us all know, all of us 40-somethings and up, that the colonoscopy might actually be a helpful thing to detect early signs of colon cancer. Like we should probably, again, we have these conversations about is it really worth it or not? So I appreciate that perspective because not everything is this big bad wolf that we want it to be. Sometimes it can be life saving, and that is really good for us all to know. So thank you so much for joining us, and I hope you'll come back sometime.
Dr. Ilana Gurevich (46:41.432)
Thank you so much for having me. I appreciate always having these conversations.
