fatty liver disease

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Did you know that non-alcoholic fatty liver disease (NAFLD) is the most common type of liver disease? (And it absolutely is tied to skin issues too!)

Fatty liver disease, also now referred to as metabolic dysfunction-associated liver disease, is the result of inflammation.

It is associated with other common health issues like high lipids, high blood sugar, metabolic syndrome, and autoimmune disease.

The good news is, in the early stages, when you’re just starting to show fatty liver signs (like elevated liver enzymes), fatty liver is reversible!

To share more valuable information about this liver disease, like fatty liver symptoms, how to get diagnosed, NAFLD treatment, and fatty liver diet, I’m joined by Dr. Ilana Gurevich.

Dr. Gurevich is a board-certified naturopathic gastroenterologist and a fellow of the American Board of Naturopathic Gastroenterology. She graduated from the in 2007 with her doctorate in naturopathic medicine from NUNM.

She 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.

Dr. Gurevich was nominated as a Top Doc by Portland Monthly in 2014, 2016, 2020, and 2021.  She was the recipient of the 2022 Borborygmus Lifetime Achievement Award by the GastroANP.

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In This Episode:

  • What is liver disease?
  • Non-alcoholic fatty liver disease (NAFLD): The most common liver disease
  • How inflammation causes non-alcoholic fatty liver disease (aka metabolic dysfunction-associated fatty liver disease)
  • How does high blood sugar affect liver cells?
  • Nervous system-liver connection
  • What causes fatty liver disease symptoms?
  • Microbiome-liver health connection
  • How is fatty liver disease diagnosed?
  • Who is at risk for fatty liver disease?
  • Fatty liver treatment options
  • Is drinking coffee or coffee enemas helpful for liver health?


“The liver…is the largest organ of detoxification, second to the skin. And because of that, everything is running through it, including all of the pesticides, toxins, immunological factors and everything else that we're exposed to on a daily basis. And in today's day and age, it's very, very easy to make that load on the liver too heavy. When that load on the liver is too heavy, you can get progressive liver disease.”

“Non-alcoholic fatty liver disease is the most common liver disease that's out there. And it is associated with a lot of other diseases…It is associated with high lipids. It is associated with high blood sugars and metabolic syndrome…There are factors of liver disease that tie into almost every autoimmune disease, and the sicker you are, the more weight that liver is carrying, so the more likely you are to have an inflammatory process of the liver.”


Find Dr. Gurevich online

Research: https://elifesciences.org/articles/44116

Turd Nerds Podcast

Healthy Skin Show ep. 282: Metabolic Dysfunction Disaster Fueling Skin Problems w/ Dr. Robert Lustig


Healthy Skin Show ep. 047: Will A Liver Detox Help My Skin Rashes?

Healthy Skin Show ep. 177: Liver Detox – Skin Rash Connection, Part 1

Healthy Skin Show ep. 186: Liver Detox – Skin Rash Connection, Part 2

Healthy Skin Show ep. 190: Liver Detox – Skin Rash Connection, Part 3

Healthy Skin Show ep. 242: When A Liver Detox Can Help Your Skin (And When It Can’t)


334: When Liver Detox Problems Become Fatty Liver Disease w/ Dr. Ilana Gurevich {FULL TRANSCRIPT}

Jennifer Fugo (00:20.786)

Thank you so much for being here, Dr. Gurevich. I'm so excited to have you today.

Dr. Ilana Gurevich (00:24.726)

Thank you so much for having me. I really love the podcast, I actually listen also.

Jennifer Fugo (00:28.062)

Awesome, I love to hear that. Well, I am glad that we were connected through some of our fan-favorite guest, Dr. Julie Greenberg. She's a good friend of yours. She put us together. So I'm glad that you could be here because I have been wanting, literally like almost dying, to talk about liver problems. This has been a big topic where I feel like people don't fully understand that this isn't just a detox problem. There are serious issues with your liver that can happen, especially with certain, even linked to certain skin conditions, that it seems like it's an educational piece missing. And so I'm so glad that we can talk about this today. So let's kick things off with what exactly is liver disease and are there, what are the stages that come along with this type of condition?

Dr. Ilana Gurevich (01:19.494)

So if you think about it, the liver is actually part of the enteric nervous system, so it's a digestive organ. It is actually the largest organ of detoxification in the whole body, and it's tied in with that whole system. It also has some exocrine functions, like it also has some functions where it's using digestion or aiding in digestion. The liver, however, is the largest organ of detoxification, second to the skin. And because of that, everything is running through it, including all of the pesticides, toxins, immunological factors and everything else that we're exposed to on a daily basis.

And in today's day and age, it's very, very easy to make that load on the liver too heavy. When that load on the liver is too heavy, you can get progressive liver disease. You first have a little bit of dysfunction, you can have some anatomical changes, and then you continue to progress to elevated liver enzymes. As those liver enzymes progress, that tells you there's a progression of inflammation and eventually it gets so severe that the liver stops functioning. When it's slowing down, it's functioning, that's called fibrosing. When it's stopping to function, that's called cirrhosis. And that is irreversible.

Jennifer Fugo (02:22.482)

So once we get to that final stage, you're basically stuck.

Dr. Ilana Gurevich (02:28.702)

It's got stuck makes it sound so much better than it is. You're very, very, very sick.

Jennifer Fugo (02:35.194)

And so that's why my feeling has been, we need to know what's going on in terms of where you are in this progression scale. So because we have a lot of listeners who have psoriasis and psoriasis has this interesting comorbidity with fatty liver problems, I think this is a big deal. So who exactly, like, are there any other people beyond those with psoriasis who may be at risk of having this type of progression and might not realize it?

Dr. Ilana Gurevich (03:06.046)

So non-alcoholic fatty liver disease is the most common liver disease that's out there. And it is associated with a lot of other diseases of the Western lifestyle. It is associated with high lipids. It is associated with high blood sugars and metabolic syndrome. It is associated with, you know, there are factors of liver disease that tie into almost every autoimmune disease, and the sicker you are, the more weight that liver is carrying, so the more likely you are to have an inflammatory process of the liver.

Jennifer Fugo (03:35.438)

And so if we do want to talk, because I think you make a really good point about the non-alcoholic fatty liver disease, which I noticed they're changing the name because a lot of times I'll have clients who will go to the doctor and they'll be like, oh, you have non-alcoholic fatty liver disease, but do you drink alcohol? You got to stop drinking alcohol. And they're like, I don't drink alcohol. I stopped that already. And so there's this weird association. Like they don't, it's almost like you don't know what to do with this condition. And they named it something that they're like, well, you don't drink alcohol, but you have this type of liver disease. So now they're renaming it to metabolic dysfunction-associated liver disease. So talk to us about that.

Dr. Ilana Gurevich (04:14.61)

That literally hits the nail on the head. That is exactly what it is. It is a secondary condition that happens when you're running an inflammatory systemic process like having high blood sugars, high blood sugar that's circulating and not controlled is just causing an inflammatory cascade. The liver is then carrying the majority of that burden. You know, at any given time, two-thirds of your bloodstream is actually sitting and getting processed within the liver, right?

Like the liver is like one of the biggest steps of detoxification in the body. And so because of that, you're carrying all this intense blood sugar that your body can't deal with. You're developing insulin resistance, which means that the sugar is there, the normal tool that you use to control for the sugar being there, isn't able to control for it because it reminds me of like, you know, when my kids, when I'm trying to like reign in my kids and I keep on saying the same thing again and again and again, and they're not doing anything.

Dr. Ilana Gurevich (05:04.822)

That's what insulin resistance is. You've got the insulin, your body is shooting out more and more and more insulin to try to control these rowdy, loud glucose molecules. And the glucose molecules are like, “ha ha, you can't stop me!” And so there's this resistance and the liver is carrying the weight of that. And initially what happens is the liver actually changes its composition. And then after that change has occurred and enough of the composition has changed, then we start seeing the markers on blood work, so then we start seeing the elevation of liver enzymes at that point. So first we have the anatomical change, and then we see the changes of liver enzymes.

Jennifer Fugo (05:43.054)

So are you saying, just to clarify, because I oftentimes think of just with diabetes or metabolic syndrome, where we have blood sugar issues that it's impact, I know it impacts our cells, but are you saying that there are also distinct changes that happen to your liver cells, because your blood sugar is high?

Dr. Ilana Gurevich (06:04.302)

Absolutely, and because your lipids are high, because you're not fully processing and recycling your fats. Remember, cholesterol is one of the most heavily controlled and recycled macronutrients in the whole body, right? Because of the bile cascade, bile is made in the liver and then it's shunted to the gallbladder, the gallbladder condenses it, and then both the liver and the gallbladder squeeze out bile to process the fat.

So you have a high-fatty meal, your stomach goes through a process of digestion and notices that fat, it regulates or it stimulates the liver and the gallbladder to secrete the bile. The bile then goes in and micellizes or breaks down those fats, and then at the end of the small intestine, that bile coming from both the liver and the gallbladder will recycle that cholesterol. If there is so much cholesterol coming into your body that your body can't keep up with it, that will also cause inflammation, which is also more of a toxic load on the liver.

So basically, what I'm saying is you cannot separate the nutritional and the dietary aspects from non-alcoholic fatty liver disease. It is one of the main causes.

Jennifer Fugo (07:07.634)

Okay, so it's really important then, if you are struggling with your liver, that is a clear sign, especially if you're headed towards this metabolic dysfunction-associated fatty liver disease, or you've been diagnosed with that, you do have to pay attention to what you eat and your fatty liver diet. You can't just assume a pill will fix this.

Dr. Ilana Gurevich (07:28.634)

And if we're honest, that is how we reverse this condition. You know, there's so many supportive aspects that we have in the naturopathic or functional medicine space that are really helpful for non-alcoholic fatty liver disease or metabolic fatty liver disease. But it's like, the foundation of everything that we do has to be based in treating your body well and giving it nutrition that it actually knows how to break down and utilize.

Jennifer Fugo (07:53.33)

And can I actually, I wanted to ask you something because this surprised me and I don't know why it did, but when I tell my clients this as well, they're also surprised, that the liver is actually governed by gastroenterology. It's like under that subset. Is there a specific reason that you have learned? Like, why is that?

Dr. Ilana Gurevich (08:14.006)

Great question. And this brings us into a whole big conversation about the nervous system and the enteric nervous system on its own. So the way I always describe the nervous system is, you've got your brain and spinal cord, right? And so that's the central nervous system. That's like the motherboard, even though technically we're not discovering there's a new motherboard, but that's a different conversation. So you've got the central nervous system, and then those nerves, they leave the central nervous system and they flare out. The minute they're outside of the spine, they're now called the peripheral nervous system.

That nervous system is both broken down to sympathetic, parasympathetic and enteric. Enteric means that there is an entire huge branch of the nervous system that only works on digestion, not just the intestine, all of the digestive organs. And that's super important because what we've learned doing a whole lot of animal studies is we can actually turn off the brain's conversation to the GI, but the GI will still be conversing with the brain. And so what we have is 90% of our nerves go from the GI to the brain, and only 10% of our nerves go from the brain to the GI.

Jennifer Fugo (09:18.03)

Wow, that's a big deal. Yeah, that's crazy. So basically, your gut is constantly communicating a ton of information up to your brain.

Dr. Ilana Gurevich (09:20.042)

It's crazy. It's a big deal.

Dr. Ilana Gurevich (09:32.242)

So we call the GI the second brain. I think if you look at how the nervous system is laid out, we should probably call it the brain. And we should probably call the brain the second brain.

Jennifer Fugo (09:43.034)

And so within all of this, because the liver is associated, I assume then is it innervated with these, this enteric?

Dr. Ilana Gurevich (09:51.414)

The enteric nervous system, correct.

Jennifer Fugo (09:52.354)

So that's why it's included in gastroenterology.

Dr. Ilana Gurevich (09:56.272)

Mm-hmm, correct.

Jennifer Fugo (10:06.806)

Okay. So if we're going to talk about non-alcoholic, well, so it was called and known as non-alcoholic fatty liver disease. What do you think are some of the reasons just from your own clinical experience, from research and whatnot, because everybody goes, we don't know. I feel like a lot of times there's a lot of shrugging of we don't know why this happens. What do you think causes fatty liver symptoms?

Dr. Ilana Gurevich (10:22.29)

I mean, if we're honest, I think we live in a world that is not set up for humans to be healthy. I mean, really, I think that this is a whole lot of lifestyle medicine. You know, the sedentary lifestyle, which causes us to gain excess weight, the lack of mobility, the lack of really moving your body, the food that we eat, the processed, the ultra-processed. This is a disease that only affects Western countries. We did not see this when people ate a diet that was more traditional to like, say what you eat in the blue zones or like whole food-based diets. This is a modern condition.

Jennifer Fugo (10:57.282)

And for people who end up with this type of condition, I have always thought there's possibly a gut connection to this, because obviously the gut microbiome, everything has an impact and everything, like all of these organisms, including us, produce waste. And from looking at the different waste products, there's some things that they produce like endotoxins, there's LPS or lipopolysaccharides, some organisms produce alcohol. Do you think that, or is it possible that the organisms and the way your microbiome is set up could potentially be contributing, on top of just the blood sugar issue that could be, like you said, lifestyle, dietary, etc, but could this be another component to fatty liver symptoms?

Dr. Ilana Gurevich (11:46.498)

There is no way that it is not. So I just, as you know, I have a podcast and one of my co-hosts, Dr. Sand, sent us a text today that just found that they found a microbiome connection to disc dysfunction of low back pain. Like they just found a microbiome connection to having degenerative disc disease. If we are seeing a microbiome connection to that, there is no way that we are not also seeing a microbiome connection to liver disease. There is no way.

And it is also exceptionally easy to extrapolate on what's happening because we have the microbiome changes that happen with eating an ultra-processed or processed food diet. We know about that. And so that is definitely gonna affect the way that the liver interacts with the rest of the digestive system.

Jennifer Fugo (12:29.754)

Yeah, and also too, the other piece for those with psoriasis is that there are eerie pictures of the microbiome between inflammatory bowel disease and psoriasis.

Dr. Ilana Gurevich (12:45.122)

And the drugs that we use in the inflammatory bowel disease space, they always start in the rheumatologic space. They always are used for rheumatologic disorders first, because people are actually more likely to get care. If they're not presentable or not feeling great to the outside world, they're more likely to get care. And so then they try those drugs in the psoriasis or psoriatic disease space. And then they always follow to the GI space, because it treats the same thing.

And you know, in Chinese medicine, we always think about the large intestine or the intestine in the skin is the same organ just inside out. You know, the tissue on the outside is the same tissue on the inside and they get affected by the same stuff.

Jennifer Fugo (13:28.762)

Interesting. So let's talk a little bit about how we get diagnosed with non-alcoholic fatty liver disease because I feel like this is a real struggle or uphill battle with my clients. Like I wish, sometimes I wish I listened to my dad and became a doctor, but here we are. So I struggle getting clients, especially those who have psoriasis where I have serious concern, they might have fatty liver disease symptoms like high hemoglobin A1Cs, elevated liver enzymes, there are issues, red flags, and I’m asking them please go back to your doctor to get checked for fatty liver or fibrosis, and they're being told it doesn't matter. And so does it matter to figure out your liver problems symptoms? And how do we even go about doing this?

Dr. Ilana Gurevich (14:15.09)

So the answer is, it is very reversible, depending on how progressed you are. If you are in the early stages of just forming some fatty liver or just having some fatty liver signs like elevation of liver enzymes, it is very, very reversible. All of us who are in the naturopathic or functional medicine space do this all day long. So it is very reversible if you catch it early enough. The more progressed it is, the more of an uphill battle it is, the more difficult or even impossible it is to reverse. So getting diagnosed is very important.

To make a diagnosis of fatty liver, you start by getting an ultrasound, an abdominal ultrasound, it's non-invasive. You don't have to do any, it's not like a colonoscopy prep or anything. You literally just go in and they put a little cold wand with some gel on your abdomen, and they can see if you have fatty changes. You also monitor your liver enzymes. If there is abnormality, then you have to go out, you have to continue to grade it, right? At that point, there's fibroscans that you can do that are more invasive, and that can give you a grade of degree of fibrosis. If you are pretty new on this diagnosis, you know, you're just having some slight fatty changes, we have lots to do to reverse it. If you're having progressive fibrosis or cirrhosis, it's a different conversation.

Jennifer Fugo (15:29.984)

And so with the liver enzymes, I definitely want people, well, I don't want people to feel like they have to look at their blood work and diagnose themselves. I do think that it's helpful for people, especially when you have a chronic illness, to get your blabs and start looking at certain things and monitor them because sometimes they go off-kilter, and your doctor might say it's fine and it gets overlooked for months on end before all of a sudden you start having a problem. What are we looking at here? Is it just AST, ALT?

Dr. Ilana Gurevich (16:03.682)

So the first thing that I want to say is there is actually no standardization of enzymes. There's no standardization for blood work. Let me back up. There's no standardization for blood work. The only lab values that we have a standardization for are labs that have drugs associated with them. So we have clear designation of what like hyperlipidemia is or hypertriglyceridemia is. Besides that, the lab values are set based on the mean population that walks into the lab.

And that's really important because I practice in Portland, Oregon. And so if I go into OHSU, they're going to flag liver enzymes at 50. But if I send them to Providence, they're going to flag liver enzymes at 35. So that's super important because if it has a flag on it, and like to the point where I had a patient who went to one Providence lab, and another Providence lab, and I have their Epic EHR pulled up in front of me, and they had a hemoglobin of 13 that's flagged, but then a hemoglobin of 12 that's not flagged because they went into two different Providence labs. So there's no standard, so it's really important when you're looking at liver enzymes to understand that you should really be using your practitioner's range and not so much the lab's range.

So the first thing that we're always going to look for is we're going to look for the AST and ALT. They are the most useful. They also will be on every panel. After you've had progression for a while, then the GGT will go up. And from there, we can, you know, at that point, it does make sense if the liver's enzymes are elevated. And sometimes liver enzymes just go elevated because you get exposed to something or you have a sickness or something like that. But if you see a trend of liver enzymes, again, over the course of, you know, four to six weeks and they haven't changed, now you're looking at a pattern. And so at that point, it makes sense to try to get some imaging done to see what the ultrasound looks like.

Jennifer Fugo (17:54.206)

So what is GGT? Because I was always taught that it's a really helpful enzyme when we start having those enzyme changes and then even with psoriasis, it can be helpful, and yet I've had clients that go back to like a dermatologist and they're like, I don't know what this is. I don't know even what to do with it.

Dr. Ilana Gurevich (18:20.106)

So basically, an elevation GGT can really just signalize that there are liver problems that are happening. It basically can tell us that there's something happening with either a bile duct obstruction or maybe there's excessive alcohol consumption. It just is a, so it's not the first liver enzyme to go up, but what it is, if there's been a progression of elevation of liver enzymes for a while, and the GGT gets pulled into it, at that point, you can assume that there is more longer-standing inflammation.

Jennifer Fugo (18:50.33)

Okay. And is there a point where you feel like with AST and ALT, there's like a red flag zone? The only reason I ask is I had a guest on earlier this year who was like, you know that they expanded and widened the acceptable range. So they're now allowing for people to end up with fatty liver disease, where really if you get past like the low 20s, now we’re headed toward this fatty liver issues. It was Dr. Robert Lustig. So he's an endocrinologist and he has concerns that our reference range is just way too high. So is there something that, do you kind of agree with that, if you're getting above the like maybe early to mid-20s that it's probably…?

Dr. Ilana Gurevich (19:37.09)

I think that's too low. I think that's too restrictive. My internal gauges go off when you're crossing 40, 45. My internal gauges really go off if you're in the 60s or 70s or hundreds. And then the other thing that's important is length of time. How long has it been elevated for? Is this something we've been seeing continuously for years because that shows a heavier weight on the liver? Or is this like, oh, it kind of goes in and out of normal ranges. It goes between your 30s and your 40s, but you get it back down. And so I don't think, I mean, where I agree with him is I think that our general population is getting sicker, right? And I think because our general population, and like children are getting sicker, you know what I mean? Like we see microbiomes of children that carry the same GI makeup of like really sick cancer patients. Like our whole population is getting sicker. So I do agree that they are widening the ranges. In my world, I am worried if you're hanging out above the 40s for a long time.

Jennifer Fugo (20:33.922)

Okay, that's helpful. That's a really helpful marker to share with people. So I also just wanted to underscore, you had mentioned about liver ultrasounds, and you were telling me something about them and why they're significant to do, between them and the enzymes. Can you just share with us why the liver ultrasound is so important?

Dr. Ilana Gurevich (20:56.754)

So the first thing that happens is the liver changes, right? So the first thing that happens is you start getting those fatty liver infiltrates. When you've had those fatty liver infiltrates that have progressed for a while, at that point and only at that point do you see the change of liver enzymes. Liver enzymes are not the first thing that gets elevated, they're just the easiest and cheapest to find. I will also say that if you're outside of the naturopathic or functional medicine space, your doctor is most likely not ordering comprehensive metabolic labs. They're ordering basic metabolic labs, which means that the entire stream of liver enzymes are not being run in a basic metabolic panel. You need that comprehensive metabolic panel. It is literally maybe 50 cents more. Why they don't run it stock, I'm not clear, but they're just generally screening for kidney disease and not liver disease. So an easy low-hanging fruit would be ask them to run a comprehensive metabolic panel instead of a basic. But the enzymes are not going to go high until there's been a change within the liver, and so that's why it's really important to get an image of it.

Jennifer Fugo (21:54.046)

So let's talk a little bit about fatty liver treatment options because I feel like, like you had said, if there's really no medication, and I feel like my awareness about the fact that there have been new medications, I think, approved very recently to treat this fibrosis progression. So what do you feel about fatty liver treatment? Can somebody just do a detox or a cleanse and get this reversed? Like what are our fatty liver treatment options here?

Dr. Ilana Gurevich (22:24.03)

So a cleanse is fine. I think it might help you feel good, and I think it resets your relationship to food. Is it gonna reset your liver? No, a two-week cleanse is not gonna reset your liver. An entire lifetime cleanse might actually do the trick, because for metabolic syndrome and metabolic fatty liver disease, getting your blood sugars under control is a must. Getting your lipids under control is a must. If we had a drug that can do what exercise can do, everybody would take it. I mean, the drug is that effective. So there's nothing that's gonna work as well as eating good quality, sustainable food that is rich in plant matter, especially, and mainly fruits and vegetables and good solid proteins. Nothing's gonna replace that. And for a lot of people, if you can stick to that lifestyle, that will reverse your non-alcoholic fatty liver disease.

If you can't, there are certain nutrients that work very, very well. My favorite one is actually alpha lipoic acid. Alpha lipoic acid is a really, really strong antioxidant. It's one of the key steps or key nutrients that we use in a bunch of our detoxification pathways. And what it does is it really helps, it goes directly to the liver, or one of the thousand things that it does is goes directly to the liver to just feed it and nourish it so it can work better, so it can carry the burden easier. I often think of like, you know, somebody who's weak isn't gonna be able to pick up as much load as like a bodybuilder. The alpha-lipoic-acid makes the liver stronger like a bodybuilder.

There's herbs, lots of herbs can be helpful that you drink on a regular basis. And I always go back to the bitter flavor because a lot of the liver herbs actually carry a bitter flavor. We have in our Western culture completely tried to abandon the bitter flavor to the cost of our health, but the bitter taste actually stimulates the detoxification process and stimulates the digestive process. So herbs like dandelion, herbs like milk thistle, herbs like artichoke, just bitter flavors are really, really good for cleaning out and helping your liver. And then, you know, nutrients like selenium and molybdenum and stuff like that can also push liver detox and just really strengthen the liver and give it more resilience.

Jennifer Fugo (24:33.978)

And so what about coffee in terms of liver detox? I hear people say coffee's bad for you. Then you have people that say, well, it's a bitter, it can be helpful. But then people load up on the sugar and all of the cream and everything in it, and maybe that's an issue, I don't know. And then they're trying to do the liver coffee enemas. And so is there any way that coffee could possibly be helpful, or do you think it's more harmful once you've gotten to the state where you've got actual fibrotic changes?

Dr. Ilana Gurevich (25:09.75)

That is a very, very good point that I think cannot be stated enough, which is there's coffee and then there's a Frappuccino. And those are two very, you know, a Frappuccino is basically a milkshake that's chock full of processed sugar and dairy, often not even real dairy, sometimes I guess, but not often. Coffee is a plant, especially that's organic. I'm a very, like, you know, what is food that is conventional? It is food that is doused in pesticides and herbicides. Pesticides and herbicides are basically antibiotics. So every time you eat food that is really chock full of pesticides and herbicides, like, you know, the Environmental Working Group has that great dirty dozen in the clean 15. You know, if you are eating food that's on the dirty dozen, you know, every time you are putting that food in your mouth, you're taking yet another antibiotic.

So there is that food, but then there is like food that is real, that is grown in the natural environment that is not chock full of pesticides and herbicides or fungicides. And that coffee is incredibly useful for that. And I think when you look at an aggregate view of the data on coffee, we land much more beneficial than harmful. Personally, coffee makes me crazy, so it's not good for me, but I'm an individual. On the aggregate, I do think it has a lot of benefits.

Jennifer Fugo (26:29.554)

And in terms of taking it orally versus “going up the other way”, because people will tell me, they're like, oh, I'm doing coffee enemas, so I'm detoxifying my liver. And I'm like…

Dr. Ilana Gurevich (26:42.198)

So, you know, I'm a naturopathic gastroenterologist. You know, like, all I work is with gastro patients, right? That's my entire practice. I am not a big fan of enemas. I'm not a big fan of colonics. You know, the microbiome of the large bowel really is, it's kind of like a neighborhood. You know, I live in Northeast Portland, and Northeast Portland is really different than Southwest Portland, which is a totally different vibe than Southeast Portland, right? These neighborhoods. And that's what your microbiome is made up of, of these niche little neighborhoods in all different areas.

If you are then flooding the area, by the way, in reverse, because you know, the large intestine’s supposed to go down, but you're flooding things up, you are moving this physiologic biofilm or these species that are not supposed to be higher up, higher up. I am generally not a big fan of using enemas unless it's like a worst-case scenario. If you are in the process of doing like an Ayurveda cleanse and you know, where they're doing the whole system of the herbs and the enemas, they use that medically for a short duration. I just don't generally recommend it to my patients.

Jennifer Fugo (27:42.994)

Fair enough. I appreciate that, because I also have always found it confusing why we're moving things in a direction that, your GI tract doesn't go that way. And in fact, if it does, usually it's unpleasant and we're not happy about it.

Dr. Ilana Gurevich (27:57.782)

Word. Yep.

Jennifer Fugo (27:59.966)

So I really appreciate you being here today and answering all these questions. I know that number one, you are taking patients. So you work specifically in gastroenterology. I also know you work with a lot of IBD patients. Is that correct?

Dr. Ilana Gurevich (28:15.27)

I was lucky or unlucky enough to be diagnosed with IBD myself at the age of 19. And I think I was sick for seven years before I was ever diagnosed. And I realized that a lot of my point of being on this earth right now is to be of service to that community. They are some of my favorite patients to work with and we have so many good tools to work in conjunction with, you know, other practitioners. And I am licensed in Oregon, Washington, and California. So I take those patients.

Jennifer Fugo (28:42.818)

Awesome. And you also have a great podcast. Can you tell us about that?

Dr. Ilana Gurevich (28:45.85)

I do, it's called the Turd Nerds. It is literally an integrative gastroenterology podcast. I team up with Dr. Rebecca Sand and Dr. Ami Kapadia. And what we do is discuss complex GI conditions from a naturopathic functional medicine lens. And so it really just gives you ideas of how your naturopath and your functional medicine docs are thinking, which is different than how conventional docs think.

Jennifer Fugo (29:13.374)

Awesome. And you can find that, by the way, on all podcast platforms. So we'll link up to all of this as well as all of your social media, website and everything, so it makes it really easy for everybody to find you. I just want to thank you so much for being here today and I hope I can have you come back sometime and maybe we can dive into some more like gut microbiome and gut issues because I always love talking about that too.

Dr. Ilana Gurevich (29:35.926)

I also want to thank you for having me. I also just want to just give, your talk at the GastroANP was so well put together. It was like such, we were, we left the conference early so we were listening to it on the car ride home and everybody kept on like shushing each other because we were just waiting to hear what you were gonna say. So I just want to say thank you. I really just enjoy listening to it and I found the podcast from there and I'm just loving the podcast. So thank you.

Jennifer Fugo (30:00.478)

Thank you. I appreciate that. I love it when we can connect and we can make this network bigger to help. Like you said, it's your mission to serve people and it's mine as well. Just a little different of a population, but there's definitely overlap and I love that we can put our brains together and help hopefully get people to answers and less suffering sooner and back to living and doing the really important things in life like being with their family and being the best mom or dad they can be, or whatever it is that is their calling in life. So I'm so grateful for you and I'm looking forward to the next conversation that we can have here on the show.

Dr. Ilana Gurevich (30:36.407)

Thank you so much.

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