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Diarrhea: Root Causes, Testing, and Treatment Strategies with Dr. Ilana Gurevich
Dr. Ben Weitz introduces the Rational Wellness Podcast episode on diarrhea and its complex differential diagnosis, featuring naturopathic gastroenterology specialist Dr. Ilana Gurevich. They discuss defining diarrhea using the Bristol Stool Chart and distinguishing acute from chronic cases, including when to investigate (about 4–5 days for new onset). Gurevich outlines an acute workup using LabCorp’s rapid GI Pathogen Profile PCR stool test, notes limitations and false positives, and explains her approach to chronic diarrhea evaluation, including GI-MAP with optional bile acid testing (OMX), pancreatic elastase and steatocrit for fat malabsorption, and assessment for SIBO/SIFO and H. pylori (emphasizing conventional confirmation and virulence factors). They cover bile acid malabsorption and treatment with bile acid sequestrants and fibers, exocrine pancreatic insufficiency and enzyme dosing, microscopic colitis requiring diagnostic colonoscopy biopsies and budesonide, carbohydrate malabsorption breath testing, hydrogen sulfide SIBO uncertainty, the role of stress/nervous system and motility, and supplement causes like excess magnesium or vitamin C.
00:59 Why Diarrhea Is Complex
02:39 Acute Loose Stool Workup
03:07 Fast PCR Stool Panel
04:47 Treating Blastocystis
07:46 Acute vs Chronic Timeline
08:49 Food Triggers and EPI
10:18 Testing Limits and False Positives
13:56 GI Map and Bile Acids
15:45 Bile Biome Explained
18:25 Bloating Points to SIBO
18:54 Provoking Stool Tests
20:25 Biofilm Protocol Details
23:19 Large Bowel Dysbiosis Targets
24:24 Small Bowel Workup and H pylori
26:12 Organic Acids Debate
26:44 Pancreatic Enzymes Trial
33:46 Microscopic Colitis Clues
37:15 Treating Microscopic Colitis
39:28 Sugar Intolerance Breath Tests
40:02 Hydrogen Sulfide SIBO
43:55 Food Sensitivity Panel Critique
45:11 Nervous System Bucket
46:21 Motility And Transit
48:11 Wrap Up And Where To Find
Dr. Ilana Gurevich is a naturopathic physician, who specializes in gastroenterology. She’s in Portland, Oregon and she’s the co-host of the excellent Turd Nerds podcast. She runs her practice out of OpenWellness PDX.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Dr. Weitz: If you’re looking for clinically useful insights, not wellness hype, then this is the place for you. Welcome to the Rational Wellness Podcast, the podcast for functional and integrative practitioners who want to practice with greater clarity and precision. I’m Dr. Ben Weitz, and each week, I sit down with the leading clinicians, researchers, and lab innovators to explore the science, lab testing, and clinical reasoning behind modern root cause medicine.
This is a show focused on practical, evidence-informed insights that you can actually use in patient care. Please subscribe to the Rational Wellness Podcast on Apple, Spotify, or YouTube. Please tell your friends and colleagues, and if you could give us a ratings and review on Apple or Spotify, we would certainly appreciate it.
Finally, to access the show notes and the full transcript, please go to my website, drweitz.com. Today, we’re going to talk about a symptom that’s incredibly common, often embarrassing to patients, and surprisingly complicated to diagnose and treat, and that is diarrhea. Diarrhea can be caused by something relatively simple, such as an acute bout of food poisoning, but chronic diarrhea can have a much more complicated differential diagnosis.
And in fact, as we’ve learned from the research on SIBO, a simple bout of acute infection can turn into SIBO and chronic conditions. the diagnosis of, of diarrhea can involve bile acid malabsorption, pancreatic insufficiency, celiac disease, IBD, microscopic colitis, SIBO, and a bunch of other things.
And so, we’re very fortunate to be joined by Dr. Ilana Gurevich to talk about the, this important topic. Dr. Ilana Gurevich is a naturopathic physician, specializes in gastroenterology. she’s in Portland, Oregon. She’s the co-host of the Turd Nerds podcast. She brings a particularly interesting perspective because she’s, at the intersection of conventional gastroenterology and functional and integrative medicine.
So Dr. Gurevich, thank you so much for joining us.
Dr. Gurevich: Thank you, Ben, for having me. I’m also… I’m looking at all the books behind your shoulder. And I’m like, well, our libraries might look almost identical.
I have to start by saying that since we scheduled this podcast, the last week I’ve had loose stools.
And I usually tend towards constipation.
Dr. Gurevich: So why don’t we start there? Why don’t we start there? because loose stool that onsets acutely kind of out of nowhere, the first thing you want to rule out is any kind of pathogenic agent. So that could be bacterial changes. That can also be protozoal or parasitic changes.
There is this test that I love. It’s actually become one of my favorite tests. It’s through LabCorp, and it’s called the GI Pathogen Profile, and I have no affiliation with LabCorp besides the fact that they make it very easy for me to use them in my office. but it’s called the GI Pathogenic Profile, and it’s a DNA PCR stool test.
The reason why I like it is because it turns over in three days. So, you know, any of our functional tests, you’re looking at multiple weeks before you get a result.
Dr. Weitz: You know, maybe 10 days for GI map.
Dr. Gurevich: I feel like for GI map, I’m seeing 10 business days, which is much more practically three weeks. So GI Pathogen Profile is always where I start.
It’s a really, really robust, big panel. You can drop off your stool, and it’s DNA PCR. I… Ben, I remember when, like, PCR testing was, like, thousands of dollars. You know what I mean? Like, it took forever to do. Only the labs, only the functional labs were really diving into it, or the research literature, and now it’s, like, so ubiquitously present.
Dr. Weitz: May- maybe LabCorp has a really high quality profile. I have to say my first inclination is to be skeptical of anything coming from LabCorp other than the traditional testing
Dr. Gurevich: So I like to start with a GI pathogen profile because it’s a fast turnaround. If they don’t find anything-
Dr. Weitz: what does that include?
Dr. Gurevich: Oh my God, like 21 different pathogens, bacterial, fungal, and protozoa parasitic.
Dr. Gurevich: not a lot of the, you know, questionable like, commensal protozoa, but it li- it like has Blastocystis homini and it has, Entamoeba histolytica, but it does not have like En- Entamoeba, The nano, what’s the-
Dr. Gurevich: I think it does ha- no, I think, I don’t think it has D. frag- fragilis.
Dr. Weitz: Yeah. So you’re, you’re a bit of an outlier, I would say, in the functional medicine world in seeing blastocysts, I think, as something that almost always needs to be treated
Dr. Gurevich: I, in my population, so, you know, people wait a long time to get to me, right?
They prob- I’m probably their fourth or fifth doctor who’s seeing them. If they’re walking into my office and they have blasto, I always am going to treat it. Right. I’m always going to treat it. And I’m going to treat it a little bit more aggressively because it doesn’t go away with, like, I’ve never seen it go away with herbs, and it doesn’t go away, in my experience, with shorter courses.
So I’ll use 21 to 30-day courses of antiprotazoal agents, and that’s when I can see their GI resolve, to be honest.
Dr. Weitz: And you like Alinia?
Dr. Gurevich: 500 milligrams twice a day for 21 to 30 days, and I, this is, well, you know, when I’m having my conversation with patients, I’m always like, “Okay, and, just a reminder, you are in a naturopathic office.
I’m not a conventional gastro.” And the reason why I say that is because I always like to dose it to cover both the full moon and the new moon, just because that is when parasites hatch. Like, that’s when they lay eggs, and that’s when they hatch. So I want a treatment that’s going to cover both of those [00:06:00] times, and I don’t have any data on that, but I have a lot of anecdotes and stories.
Dr. Weitz: We- as, as experienced clinicians, our experience matters.
Dr. Gurevich: true. True.
Dr. Weitz: And that’s one of the reasons why patients see us.
Dr. Gurevich: Yeah, totally. Totally.
Dr. Weitz: So when a patient walks into your office and says, “I have diarrhea,” you do this panel first? Or what i- w- what are some of the questions you’ll ask them to try to narrow down what some of the possible causes might be?
First of all, what is diarrhea? Totally. And are there different kinds of diarrhea? I mean, I’m sure some patients, what they mean by diarrhea is different than what somebody else means.
Dr. Gurevich: Okay, that’s a great place to start. So what is diarrhea? Generally, I will pull up a picture of the Bristol Stool Chart.
You know, we are- … doctors as well. Lots of, w- the one that I use in my office I love. It’s, like, for kids, so it describes the poops as food, which is very, patients love that and hate it. but so we’re looking at something that’s like a Bristol 5 mainly, definitely a Bristol 6, definitely a Bristol 7. So 5 is like- Small, soft chicken nuggets.
Six is like cow patties or gr– or, porridge. And seven is like gravy. So any of those, I’m going to be considering what could be causing it. That LabCorp panel, I only use for acute onset. I don’t use it for chronic, because that LabCorp panel is not going to find any chronic diarrhea, right? But if it’s like you, like something just drastically changed, you were always constipated, and now out of nowhere you’ve got diarrhea that’s going on for multiple days, and there’s no psychological trigger that you can attach it to, I think that’s a really good panel to rule out a
Dr. Weitz: bunch of- I could probably find all kinds of psychological triggers to attach it to.
Dr. Gurevich: Okay, well that’s the thing. That’s, that’s both. That’s when I’m talking,
Dr. Weitz: But that’s, that’s, that’s a, that’s for another day. Okay …
Dr. Gurevich: when I’m talking to patients, the first thing that I’m a- asking is it new or is it old, right? How, if it’s new, I want to- Right … rule out some things very quickly. If it’s old, it’s going to be a little bit of a different thing, ’cause you have to- Yes
look at different questions
Dr. Weitz: All right. so how many days in a row do patients have to have diarrhea before you say, “Oh, maybe there’s a problem”? Because as we know, stool consistency, it can change, you know, o- on a regular basis.
Dr. Gurevich: New onset, I want it here for four to five days. Okay. Mainly because a lot of acute infections will, like, resolve on their own.
If you’re not resolving by the five-day mark, I think I want to start looking.
Dr. Gurevich: Especially if you’re uncomfortable. Like, if you’re not resolving and in pain, I want to start looking.
Dr. Weitz: Right. And, so outside of that panel, what else do you start thinking about might be the possible causes, and how do you dec- decide which?
Dr. Gurevich: Yeah, where to go next.
Dr. Weitz: Where to go next.
Dr. Gurevich: So, you know, it’s a little bit, striated, right? Okay. first part is how acute, how chronic. Second question is how much tied to food. Like, is there certain foods that [00:09:00] religiously will cause diarrhea, and are you limiting your diet because you notice these foods are causing diarrhea?
And what I’m looking for in that case are the underlying conditions, which we can break down in a minute, is it could be a pancreatic insufficiency or an EPI that’s causing it. Like, literally you do not have enough enzymes to break down your food, and because it’s the, it’s not working up top where the enzymes get secreted, it’s all kind of flowing out of you too quickly.
Could it be y- the same thing but you’re not absorbing your fats
Dr. Weitz: or your- by the way, do you trust the, stool, pancreatic en- elastase, level? Is that how you determine it?
Dr. Gurevich: So the answer is yes and no. The pancreatic, it’s an exceptionally well-validated test. It’s such a g- it’s such a well-validated test that even if you’re taking enzymes, elastase is like a secondary marker, so you taking enzymes won’t change that test, which makes it a really valuable marker.
But the negative about that test is by the nature of having diarrhea- You have more water in your stool, right? And just [00:10:00] like when you’re cooking a soup, that can water down… The water in the stool can water down the results of the pancreatic elastase, so that number might look lower because of the water consistency in the stool than it actually is, and that’s where you get false positives, i.e.
lower values of your pancreatic elastase one enzyme.
Dr. Weitz: but doesn’t that also mean that you would get a less accurate stool test for pathogens or anything else?
Dr. Gurevich: So if you’re doing pathogen testing and you’re relying on PCR technology, you’re really… They’re doing… I mean, are they going, are they doing as many rounds and digging as deep as I want them to?
No. But, it does, like, give a pretty good… Like, it’s a, it’s like a big net. It’s not like a super, super small net. Like, I think we have better testing t- for super, super small nets. And honestly, one of the reasons why I started provoking my stool tests when I’m doing functional tests, which we can talk about, is because I want to, I want that net to get a little bit tighter and less porous.
But it’s not a bad super porous net. Can I [00:11:00] tell you a story about that test actually? I have a great story. Okay. So I had this patient come in, and she had started h- getting acute onset diarrhea. It had been going on for about three weeks unstoppable. And I was like, “You know, you’re here. It’s hasn’t changed.
It’s relatively new. Can we run this stool test?” Right? “Can we run that GI Pathogen Profile by LabCorp?” And so she sent out that test. That was the first thing I did. And, like, three days later, I get a call, first from LabCorp to say, “Hey, we have this result for cholo- Cholera vibrio.” So cholo- which by the way, I have in my 20, almost 20 years of practice, I have never seen cholera anything come up on a stool test ever.
So they were like, “We have this result for you from cholo- for cholera. This is a reportable condition. You have to report this to the state department, to the health department. We will also report it to the health department. But we have to give you the disclaimer that Cholera vibrio is found in, raw seafood, right?
And, in our agent, reaction agent, we use something [00:12:00] from otters.” This is very strange. Okay. “We use something from otters, and it’s com-” It’s- Yeah. “It’s completely possible that what we’re having is a increased magnification because of the replication of using PCR of this otter, and this might be a false positive.”
Dr. Gurevich: Yeah. so they were like, “What we recommend doing at this point is culturing to see if we can grow out the Cholera vibrio.”
Dr. Gurevich: We will send the sample over to my…” You know, I’m in Portland, Oregon, so Multnomah Health County got the sample, and I was like, “Yeah, start the process.” Then I had to call the patient and say, “This might be a false positive.
You’re going to get a call from the county health department.” I had to call the county health department. You know what I mean? Like, it’s all these… If you’re a doctor, you have to do all these things. And then three days later, maybe it was five days later, it was a complete false positive.
Dr. Gurevich: that’s the, that’s the n- Like, this is not a perfect test
Dr. Weitz: Yeah, I had a, I had that come up on a GI map, and the patient’s symptoms were, you know, kind of just typical chronic, not super [00:13:00] severe.
Dr. Gurevich: Yeah, right. I mean, like this is where having a clinician is valuable. Like
Dr. Weitz: if you- So do other stool testing companies use otters, whatever?
Dr. Gurevich: I think, yes, I think they do. Yeah. I th- I think when you’re using this piece here-
Dr. Weitz: Do the otters consent to this?
Dr. Weitz: Very- This is otter-ly ridiculous.
Dr. Gurevich: That is a good one.
Dr. Weitz: okay, I’m sorry.
Dr. Gurevich: so, with her, you know, that was a good acute onset. When it came up false positive, the next thing that I did was I ran a GI map. You know what I mean? I started her through the provocation cycle that I like to do to disrupt biofilms, and then I ran a GI map because I trust… I think the lab core test is good if it’s acute.
Right. Because it runs around in three days, and it finds a lot of things, and if it’s not acute, I think it misses it. I don’t think there’s enough magnifi- replication or magnification there in the process
Dr. Weitz: When you order the GI map in a patient that has [00:14:00] constipation, do you include the bile acids?
Dr. Gurevich: In a patient with constipation or diarrhea?
Dr. Weitz: Oh, diarrhea, diarrhea. Okay. Sorry. yeah, yeah.
Dr. Gurevich: I… Okay. So I
Dr. Weitz: have- As a, as a way to possibly, diagnose that bile acidosis?
Dr. Gurevich: Yes. So okay, that… The, it’s the Omax panel, right? It’s the Omax GI map, Omax map. Yes.
Dr. Weitz: Yeah, it’s an add-on to the GI map.
Dr. Gurevich: I do find it useful for diarrhea. I do. And one… So one of the things, I have a couple of patients where it was like, you know, the st- Okay, so in the, in a GI map, and I think US Biotech has it too, there’s this marker called a steatocrit, right?
And a steatocrit a- it’s a process called acid steatification, which basically like takes like a, hematocrit tube and lets the stool sit to see how much fat verse stool takes up, you know, in a, I think it’s like a mil, something like that. very, very well-validated test f- for, fat malabsorption. the problem with steatocrit is fat malabsorption can be caused by multiple reasons.
One is pancreatic [00:15:00] insufficiency, right? And they run- Right … the enzymes, but again, I said there’s a lot of false positives. the other reason is bile acid malabsorption. And so what that test does, one of the things I love about that test is it is really good at separating primary verse secondary, right?
If you have a panel, and I have seen these panels, where the primary bile acids are so damn, like over the top, this is a non-brainer. You know exactly how to treat that diarrhea, right? If it’s a se- if the secondary bile acids are over the top, but the primary are normal, it’s a little bit more nuanced, and then you have to get into the weeds about how the bile biome functions and how you can kind of target the bile biome.
One of the things that happens that’s really interesting about- Wait,
Dr. Weitz: wait a minute. What is the bile biome?
Dr. Gurevich: Oh. Oh, yeah, yeah. So bile acids are about to have a moment, right? I think, I think we’re just starting to like… It’s just starting to drip out. Bile, is… Oh my God, we are just starting to understand how [00:16:00] important bile is for all of our functions, digestive and more.
One of the things that bile does that we don’t even know how to quantify is it can change pharmaceuticals and supplements that you’re taking into what’s known as prodrugs. So it can take, like, this… There was a really, really interesting study. Andrea Macbeth, do you know Andrea, who owns ThenA?
Dr. Gurevich: So she knows how obsessed I am with GI stuff and diarrhea. She is just as obsessed as I am, if not more. so she sent me this really interesting article about mesalamine, right? Mesalamine is a nonsteroidal anti-inflammatory drug that we use for mild inflammatory bowel disease, and what she found is there was all of this study that found that for a subset of the population, mesalamine was a very effective drug.
And for a lot more of the population, it was kind of like a wah-wah. Like, it wasn’t very effective. And what they did is they did this study, like, way in the early 2000s that found that if you had the proper bile [00:17:00] makeup within your small intestine, that bile would bind to the coating agent of the mesalamine and actually change the activity of that drug, basically activate that drug so it had stronger anti-inflammatory effects.
But if you didn’t have the right makeup of bile, that drug didn’t work.
Dr. Gurevich: So this was a question that we had answered 20 years ago that we just, like, dropped the ball on, and then somebody refound that study and now they’re running new trials to see if we can actually make a new mesalamine drug that has this bile acid activation property.
You know what I mean? Like, that’s what bile can do.
Dr. Gurevich: So the… So when we’re looking at that OMX panel, or OMX panel, what we look at is we look at unconjugated versus conjugated, and when your bile gets conjugated, it’s either conjugated with taurine or glycine, right? And we can do… take that breakdown of that secondary bile acids to see if we need to support the patient with more of these building blocks to [00:18:00] help conjugate the bile acids.
Or if this is… This comes back to, like, a microbiome makeup where they just don’t have the right microbiome. So for diarrhea, I am adding in that OMX panel.
All right. So, what’s the next step after that? Right. You get the GI map back, and you’ve, you’ve done your analysis. What’s the next step?
Dr. Gurevich: So first, my first question that I’m going to ask even before I’m running any tests is, do you have bloating, right? Do you have bloating and do you have periumbilical pain?
Dr. Weitz: if they- And if they have bloating, you’re thinking SIBO?
Dr. Gurevich: I’m thinking SIBO, I’m thinking SIFO. I might be think- There… It’s going to be a small bowel-based diarrhea, right? Right. If they have any bloating, I’m going right up to, what’s the stomach doing, what’s the small bowel doing? If they’re not having any bloating, but they’re still having diarrhea, I’m going right to, we need to assess large bowel, right?
So that’s my next step is. So then I’m… Look, okay, can I quickly talk about provocation-
Dr. Gurevich: of microbial tests? So [00:19:00] I, w- the first thing I want to say is, I made this up. This is not based on any data. It is… I don’t want to, I don’t want anybody to go to hell. Lots of people don’t agree with what I’m doing.
Jason Hawrelak definitely doesn’t agree with what I’m doing. He said it very blatantly. I just made it up. But, you know, I got into studying biofilms, and I understand… The analogy that I give about biofilms is it’s like a house, right? Like, if you’re trying to take inventory of who is on a street, you can see all the people walking on the street, but that’s like a 10th of who is actually on the street.
Most people are in the buildings or in their homes, and rules change when you’re home, right? I might walk around naked at my house, but I will never walk around naked outside, right? Bacteria behaves differently when they’re at home. So if I’m running an expensive test to take inventory, I want to break down some of those walls so I can count who’s hiding behind the walls.
And so what I do is I give a biofilm-disrupting supplements at fairly high doses for 10 days. [00:20:00] 10% of people, it will fix all of their problems.
Dr. Weitz: So- The, you know, biofilms, very controversial. Do they even exist? If they do, you know, what are they like? what about mucus? I- I- That’s another thing that the bacteria can hide in, or is that really a biofilm?
What subs- what nutritional products actually break down biofilms? Can you use NAC, g- enzymes? Do we have to use, some more advanced products? What’s your favorite biofilm-busting product?
Dr. Gurevich: So I use several- Or
Dr. Gurevich: for my provocation, I… When I was making this up, I was like, you know who’s been talking about biofilms forever?
Dr. Weitz: Paul Anderson?
Dr. Gurevich: Well, this is even before… no, it’s probably not. It’s probably after Paul Anderson. Okay. But I was like, Lyme doctors have been talking about biofilms forever. Sure.
Dr. Gurevich: What do they use? They use a bunch of Interface Plus. So I use a bunch of Interface Plus.
Dr. Gurevich: Yeah, that’s it.
Three pills twice a day, empty stomach. I tell patients, “10% of people it fixes all your [00:21:00] problems.” It’s only 10% of people. 10% of people it makes everything worse. If it makes everything worse for two to three days in a row, it’s my fault. Collect your stool, I’ve obviously mobilized something. 80% of people feel nothing, and they’re just believing me that, uh, everything’s going to get better.
Dr. Weitz: what I do. So Interface Plus, three capsules twice a day for 10 days. Mm-hmm. Then they do the stool test.
Dr. Gurevich: Mm-hmm, that’s what I do. Yep.
Dr. Gurevich: I totally made it up. But I do th- I have enough patients and enough samples where they’ll run one, I won’t find anything, and then they’ll provoke, and now I’m finding something. Jason Hawrelak does say I am changing the microbiome by doing this, so he would say my test isn’t as accurate because I’m mobilizing it. So I just want to give you the other side of the coin. I, d- this is just something that I do that I made up
Dr. Weitz: I, Jason Hawrelak also doesn’t believe in treating,
What were we talking about? s- s- s-, Blasto … the parasite, that-
Dr. Gurevich: Yeah, that Blastocystis hominis,
Dr. Weitz: yeah. Yeah, Blastocystis, yeah. [00:22:00]
Dr. Gurevich: They, we all have different, lenses. We all have different- Yeah.
Dr. Weitz: Well, interesting. Okay.
Dr. Gurevich: So the, so then I’ll do my provocation with-
Dr. Gurevich: and then I’m starting to look at what-
Dr. Weitz: How did you come up with 10 days?
Dr. Gurevich: There’s… The, I’m, I’m, I’m making it up. There’re a bottle of
Dr. Weitz: 60 pills. just because, you know, the patient comes in, they want to get better. Yeah. You know, it’s going to, like as you said, it’s going to take a bu- a couple of weeks for stool tests to come back. Yeah. Now they gotta wait 10 more days.
Dr. Gurevich: there’s 60 pills in a small bottle.
Dr. Gurevich: That’s how I came up with 10 days.
Dr. Gurevich: I will also say I have been doing this now, I think I… Maybe eight years. So I’ve got a lot of experience, and I, you know, I have residents, I’ve trained clinicians. Like, this is a protocol that we have a lot of experience with, and it does for some people completely fix everything.
Interesting. And then for other people it really dam- I had, I’ve had one person, who of course was a practitioner, you know what I mean? Like, those are, [00:23:00] like, the most difficult people to treat. But I had one person who was, like, low dose e- MCAS-y, and me giving her the Interface Plus, two days of it, she went into such an MCAS flare.
I found a whole lot of stuff in her stool, but it took so much work to get her histamine back under control.
Dr. Gurevich: So it, yeah, I can definitely make things worse. So that’s what I do for… That’s my next thing, is then I’m going to look at large bowel stool assays, right? If there are protozoa there or parasites, no-brainer, I’m going to treat.
If there is more bacterial triggers, I’m looking for the bacteria that I generally associate with biofilms, like pseudomonas, like klebsiella, like proteus, like, like Proteus mirabilis is getting stuck in my brain ’cause Allison was just talking about a study for it yesterday. There’s a couple of more that I’m always going to go after.
Oh, Citrobacter’s another one that can be, like, biofilm, histamine-y. and then Morganella’s the last one that I’m going to… Morganella’s also another, like, it has a predisposition towards more [00:24:00] histamine production.
Dr. Weitz: So- What about staph and strep? Do they play a role in this?
Dr. Gurevich: I see staph and strep positive on virtually everybody.
Okay. I would never touch that with a more… Like, that would be our more standard dysbiosis treatments, you know? Like, herbal- Okay … treatments.
Dr. Gurevich: or fungus. Fungus is obnoxious.
Dr. Weitz: Now, you mentioned small bowel, and then you moved on. Did, do, did you need to look at small bowel, or does that come next?
Dr. Gurevich: So if they have predominantly bloating and periumbilical pain-
Dr. Gurevich: I’m going to start with a small bowel workup, right?
Dr. Gurevich: see, is it, do they fit a symptom picture of H. pylori, right? If they do, then I’m going to use a conventional lab to work up H. pylori. I think the functional labs l- di- like, diagnose it too early, and we’re treating a lot of people unnecessarily.
Okay. Do they have, they have SIBO, or do I need to do some fungal markers? So that
Dr. Weitz: would be- So you’re, you’re saying if you see H. pylori, slightly elevated on a GI map- That, may be, not warranted to treat at that time, especially if there’s not virulence [00:25:00] factors and it’s not really high
Dr. Gurevich: The virulence factors I’m always looking at, I care about cAgA and VacA the most.
Dr. Gurevich: I care about VirB and VirD a little bit less. but yes, I… If it, there’s no… If they’re not, if they don’t have an H. pylori life picture with that stabbing acute abdominal pain with eating, right? I’m not going to deal with H. pylori at all, I don’t think. and the only, the only asterisks that I have for that is I d- have enough good clinical experience where if skin is their biggest complaint, like if they’ve got acne or, like skin dermatitis, I have, there, I think there’s enough data, and I have seen enough good results treating H.
pylori for those pa- for that patient population.
Dr. Gurevich: But not for my chronic GI patients.
Dr. Gurevich: Which is what I treat almost exclusively. Right. You know, sometimes they’ll double with skin, but usually they’re coming into me to work up their GI.
Dr. Gurevich: So that’s two, right? So that’s, small bowel workup for what I think is dysbiotic- And
Dr. Weitz: small bowel workup is essentially a SIBO [00:26:00] breath test?
Dr. Gurevich: SIBO or SIFO, yeah. Like SIFO blood test. I like… I don’t like, but it’s the best option right now. Oh,
Dr. Weitz: for SIFO you like the antibody test, right?
Dr. Gurevich: It’s not great, but it’s something. It’s not great, but it’s something. Yeah.
Dr. Weitz: Organic acids?
Dr. Gurevich: I am only dipping my toe in organic acids. I’m sure that actually I would…
my guess is organic acids would be more useful. I’m not doing it enough.
Dr. Gurevich: But that’s a very… I think organic acids probably find fungus better and more reliably than blood.
Dr. Weitz: That’s what a lot of functional medicine practitioners feel. I wonder if it’s, you know, a lot of false positives, but…
Dr. Gurevich: That’s the other problem. Yep. Yep. okay, so that’s my first. Okay. And let’s say I get a low elastase or I get an elevated Ciatric or I have a whacked out OMEX panel I will trial people on pancreatic, you know, we call it, the pharmaceutical version is pancrelipase. The supplement version is [00:27:00] pancreatic enzymes.
There’s a couple of companies that make a protease, lipase, and amylase product. The pharmaceuticals are enteric coated, the supplements are not. The pharmaceuticals are thousands of dollars, but also may be free if you have good insurance. The supplements are $40 or- But
Dr. Weitz: the enteric coating is, you know, not necessarily good stuff
Dr. Gurevich: Right. Right, totally. I think it does come down to patient availability, patient desire. the ent- the positive about the enteric coated is because it’s pH balanced, we know where it starts dissolving, right? So we can, like a little bit, match it to how the body’s dripping out food.
Dr. Weitz: Yeah, but they tend to use some toxic substances and- Very toxic.
Dr. Gurevich: Yeah, totally. It totally kills the microbiome. The fat- the phthalates that are in there are not awesome.
Dr. Gurevich: so okay. So that’s… I will try that, right? If elastase is low, I will always at least trial enzymes. Because if en- Well,
Dr. Weitz: what about herbal bitters to try to stimulate their own enzymes?
Dr. Gurevich: I think it’s worth a try.
Okay. [00:28:00] What I usually do, what I usually do is I will try the stronger thing to get a yes or a no. Is this the problem? I give you enzymes, your symptoms are better. This is the problem. We have a yes. Okay, now can we start working through some of the other options to get your physiology to work better?
Dr. Weitz: By the way, how do you know how many enzymes?
You give them one, you give them two per meal, and then sometimes you think, “What if I gave them four?”
Dr. Gurevich: So according to the American College of Gastroenterology and the Cystic Fibrosis, Foundation, who is putting out most of the PERT, pancreatic enzyme replacement therapy, PERT, literature, you can go as high as 160,000 units.
160,000 units of lipase. Everything in the PERT therapy is based on lipase. And, for somebody that… Oh, God, I want to tell you this correctly. There’s a cutoff of under 180 pounds or over 180 pounds, and we max out at [00:29:00] 180 with over 180 pounds, and n- if not, we go up to 120. 120,000 units of lipase if you’re under
And what are some of the most typical nutritional, supplement, enzymes? How much lipase do they have in it? I want to say something like 5,000?
Dr. Gurevich: No, more. More?
Dr. Gurevich: 17… One of them… So Vital Nutrients has a product and Pure Encapsulations has a product, identical products. I think that Vital Nutrients has 17,500 per pill and Pure has 17,000 per pill or vice versa.
Definitely check me on th- that.
Dr. Gurevich: I will… So the, the pharmaceutical PERT therapy-
Dr. Weitz: So then you’re, you’re talking about eight or 10 capsules per meal.
Dr. Gurevich: Which is the other benefit of the pharmaceutical sometimes That’s the other benefit of the pharmaceuticals, yeah
Dr. Weitz: Do you ever start with one or two and work up to it?
Or y- you feel like you have to-
Dr. Gurevich: No, I feel like I… [00:30:00] So you, you know, things that cause, exocrine pancreatic insufficiency, so, you know, 15% of the mass of the pancreas does endocrine stuff, in- insulin. 85% of the mass of the pancreas do- does exocrine or digestion, right? If you’re talking about somebody who has an endocrine issue, especially like a type 2 diabetic, who probably has a larger body mass as well and insulin resistance, I’m going to want to rev up.
But if you’re talking about somebody who maybe, ’cause EPI and SIBO go hand in hand, and they’re like a little person who’s emaciated, they don’t… they, they need 25,000 units.
Dr. Gurevich: You know? Like, they might not need these crazy high doses. Right,
Dr. Gurevich: Okay, so EPI. I’ll go after that. bile acid malabsorption, super, super interesting, very, very, often missed, or d- we don’t pay attention to it.
So what happens? We have diarrhea, that is happening… W- so, hold on, let me, let me back up. The… [00:31:00] You start digestion, right? Your stomach starts digesting fats. It secretes this hormone called cholecystokinin, and, cholecystokinin knocks on the door of the gallbladder. It’s like, “Hey, fats are coming,” right?
So then the gallbladder dumps bile to start absorbing those fats. And what happens with bile is bile is hydrophobic and hydrophilic depending on if it’s a primary or a secondary bile acid, right? So the hydrophobic and hydrophilic bile attach to the fat and pull it apart, right? And then the digestive enzymes come in and start cutting up that fat to make it smaller and smaller and smaller.
If everything’s working the way it should, and you don’t have SIBO, or you don’t have small bowel Crohn’s, or you don’t have fast transit, that bile comes to the bottom of the small intestine, and right there it’s reabsorbed and recirculated. And this is one of the ways that primary bile acids become secondary bile acids, is pr- through the recertification…
circulation process. If that bile hits the large intestine, two things happen at the same time. One, it pulls a crap ton of water into the large intestine, and two, [00:32:00] it speeds up peristalsis. And then what you end up with is maybe the worst kind of torture in the whole world, which is bile dumping diarrhea.
You have no control. These are people who have bile a- bowel accidents. These are people that cannot control their bowel. I mean, it’s trul- it’s truly torture. And so for those people, again, I’m looking for a yes or a no. So I will often start them with pharmaceuticals, right? Do the bile acid sequestrants.
There’s three drugs, colesevelam, cholestyramine, and colestipol. They work a little bit differently. I will start them probably with a powdered cholestyramine, which is the oldest one, to see if I get rid of their diarrhea. If I do, amazing, I know what the problem is, and then I’m going to start working through some of my natural bile acid sequestrants, right?
Which for some people actually work better, but for some people don’t. That would include lecithin- Apple pectin, fibers, psyllium, like any binders can slow down the fat [00:33:00] malabsorption issue, and then they can have normal bowel movements again. And then I’m going to go back to be like, “Why?” Like, why is… What’s…
Can we go back to further underlying causes? For some people, the bile acid diarrhea is the primary cause, and for other people it’s not.
Dr. Weitz: So that- And sometimes there’s an underlying liver condition that makes them just pump out tons of bile.
Dr. Gurevich: Or there’s four underlying causes. One of the bummers about bile acid diarrhea, which I like the om- omics panel for, is there’s four underlying cau- causes.
Prometheus, which is a national lab, has d- has a panel that looks for two of the four underlying causes, but it’s the two less likely ones. So it’s not very useful to me, and it’s expensive.
Dr. Weitz: That’s not helpful.
Dr. Gurevich: No. So th- then I’m going to go after bile acid malabsorption. My third disease, which is what we were talking about before we started recording, my third disease that I’m always having in my brain is microscopic colitis.
And this is a thing [00:34:00] that I swear to God 10 years ago maybe I saw once, right? And now Five patients a week probably, if not more. Wow. I mean, it is much more common. It’s a tricky one to diagnose because there are no tests that we can look at for diagnosing it. You have to do a colonoscopy, right? And it’s not like if you’re getting your screening colonoscopy they’re going to find it, because they will not find it at all with a screening colonoscopy.
A screening colonoscopy basically is they’re g- the tube is all cleaned out, you know, you’ve done your prep. They’re going to go in and look for polyps. If they don’t see polyps, they’re going to say, “I’m coming right back out, I’ll see you later.” A diagnostic colonoscopy, they go in and they’re looking for polyps, but they’re also taking a chunk here, and a chunk here, and a chunk here, and they’re taking a lot of biopsies.
And, you know, grossly, or when they’re, when they have the scope in, nothing looks abnormal. It looks completely normal. But then they take those biopsies and they look at it under a microscope, and what they find is [00:35:00] microscopic inflammation. You can only see it from a biopsy under a microscope. And what happens is that microscopic inflammation is affecting the most common cause of the most common job of the large intestine, which is to absorb water.
So that’s why you… It’s non-bloody, non-mucussy, non-painful, Bristol 7 diarrhea. Sometimes it’s just once a day, sometimes it’s happening all day long, depending on severity. But l- I cannot tell… I had this one patient who I was working with him, working with him, GI map, this test, that test, and I was like, “Dude, I think you have microscopic colitis.
I’m pretty sure that’s what this is.” I sent him in to telagastro. He was like, “My naturopath says I have… She thinks I have microscopic colitis.” I think he heard the word naturopath and immediately, like, turned off his ears. He went in, this poor man had to prep. He’s been having nonstop diarrhea. He had to prep, and the dude did a screening colonoscopy.
He didn’t take a single biopsy, right? You need the biopsy to diagnose. I wish I had a Calprotectin. I
Dr. Weitz: [00:36:00] wish- let me, let me just jump in to try to help some people- All right … who might not be following the discussion in terms of the context. so, we have a set of severe gut conditions that we refer to as inflammatory bowel disease, and those include ulcerative colitis and Crohn’s disease.
And when you do a colonoscopy or an endoscopy, you see the lining of the intestines are red, swollen, u- ulcerations. It’s easy to see on a colonoscopy. And so when we talk about colitis, people often refer to ulcerative colitis. Now, you’re talking about this other condition, microscopic colitis, that if you do a scope, you don’t see anything until you do the biopsy.
Dr. Gurevich: Correct. And it’s not an IBD, but it’s also not an IBS. You know, irritable bowel syndrome is, like, completely functional. This is a functional disorder of the bowel, [00:37:00] right? But it is also an organic disorder. It’s, it’s in its own bucket. It’s in its own bucket. But it’s s- super common, and it’s one of those underlying causes of diarrhea that I feel like we are not paying enough attention to.
I also was… So let’s talk about how we treat, right?
Dr. Weitz: Yes. How do we treat microscopic colitis?
Dr. Gurevich: So I get calls a lot about microscopic colitis. conventional care will start them on a large, steroid called budesonide. Budesonide is a steroid that will dissolve depending on, you know, the formulation. The, so it’s a pharmaceutical, so it’s got all those phthalates that we were talking about earlier.
It will dissolve in different parts of the either bottom of the small bowel or, large bowel, and it is a large steroid, which means that 85% of it stays localized. 15% of it does go systemic, which means that 15% of that drug can cause that bone loss, that immune suppression, that affecting of the eyes, like all of those terrible risks, but it’s only 15% of it.
so what I’ll usually say [00:38:00] is, “Listen, let’s just start with that. Can we just try a three-month course of budesonide? For one time, if this fixes your problem, you might never have to drop money on seeing me. Just do it, right? Three months I’m not worried about it.” And some people are on it, and they’re right off of it, and they’re done, maybe for years However, there is a fairly high relapse rate.
And then the next thing conventional care does is they start looking at secondary medications like that bile acid sequestrant colestyramine or like mesalamine, a nonsteroidal anti-inflammatory. If they don’t respond to that, then they jump into biologics, right? So kind of similar trajectory, but not as intense as IBD at the moment.
Most, I’m betting in 10 years we’ll be treating it exactly like IBD, but I don’t know that right now. so that’s what they’ll do conventional. What I will do is I will then start looking at the large bowel because I have seen microscopic colitis present because of protozoa or parasites or microbiome issues or dietary food allergies.
You know, we… I don’t feel like we talk enough [00:39:00] about fructose malabsorption, sucrose intolerance, lactose intolerance. All of those can travel with some of these other GI disorders, and helping fix that could also help fix that, this GI disorder, right? I’m not saying that fructose intolerance is causing microscopic colitis, but I am saying that if you have microscopic colitis and fructose intolerance and you take the fructose intolerance piece of the picture out of it, your microscopic colitis might be a lot more tolerable.
Dr. Weitz: Do you have a test for lactose intolerance or some of these other intolerances?
Dr. Gurevich: So my answer is yes and. yes, I always offer it to patients because I love getting a yes or a no.
Dr. Weitz: But often- And you do the breath test?
Dr. Gurevich: Mm-hmm. I do the breath test, yeah. I’m using a Quintron machine. You know, I use the lab that I use.
and, a lot of patients just want to cut out lactose. Lactose is a little bit easier for them to cut out. Fructose and sucrose, malabsorption, those are a little bit more gray, so I do lean into testing for those a bit more.[00:40:00]
Dr. Weitz: And how often do you see that, hydrogen sulfide SIBO is playing a role in diarrhea?
Dr. Gurevich: You know, so I was just… Before we started recording, I was telling you that I just had Alison Siebecker on my podcast. Right. We… Our episodes are 30 minutes long, right? So I tr- we tracked her for four episodes, and we were just going over hydrogen sulfide, and she…
I was kind of pissed at the Trio Smart test, right? ‘Cause I was telling Alison, I’ve in all, you know, I… How long has this test been on? Like, 28… 2019, 2020? When did they release it? Do you remember?
Dr. Weitz: I, I don’t recall.
Dr. Gurevich: I feel like it was COVID times, ’cause I can remember being on, like, these meetings, sitting by myself in a room for the 100th day in a row.
so, but I have seen zero positive Trio Smarts. Zero. And Alison was just telling me Pimentel has released data that they’re treating it up with a lot lower ranges. And so I was like, well, maybe my problem with Trio… Maybe my problem with hydrogen sulfide is [00:41:00] that the ranges that they initially introduced to us were bunk, ’cause I’ve never seen a hydrogen sulfide over three, and I pro- I’m probably, like, I’m 100-plus tests into this.
I… Maybe even 200-plus. I don’t… Like, I tr- I do this a lot. Right … so my response with hydrogen sulfide is I think that maybe I’ve been missing it ’cause the ranges I’ve been instructed to look for w- are not accurate based on what Pimentel is saying now
Dr. Weitz: I, you know, he, I think he’s saying now that two, might, might, you might want to test C a positive at two.
Some people even talk about one and a half
Dr. Gurevich: W- exactly what Allison said yesterday. Yeah.
Dr. Weitz: I, you know, I asked him about the methane, and he’s sticking with 10.
Dr. Gurevich: Yeah. I, that’s… And y- the, you know, Quinton machines are just so reliable. I don’t know if the Trio Smart machines are as reliable. So I’m sticking to [00:42:00] 10, and I’m sticking with mainly Quinton machines So that’s where I’m landing.
Dr. Weitz: And then, and then, and then we got FoodMarble.
Dr. Gurevich: And then we’ve got, which also we went over at our episode yesterday.
Dr. Weitz: and they’re, yeah, I think in a year or so they’re going to be having a hydrogen sulfide version.
Dr. Gurevich: Well, yeah, we’ll see if they can match the technology. Yeah, and f- you know, my, FoodMarble is also very interesting technology.
I get concerned with any of my patients who are bordering on orthorexic. Sure. ‘Cause that would not be something that can make
Dr. Weitz: it- yeah, yeah.
Dr. Gurevich: Yeah. So yeah, I’m sticking with what I know. I believe it’s because I’m old, and now maybe inflexible.
Dr. Weitz: Do you, do you, do you think, so you’ve never seen hydrogen sulfide is what you’re saying?
Dr. Gurevich: Not, with a cutoff of three.
Dr. Weitz: never- Pimentel says 10%.
Dr. Gurevich: Not with a cutoff at… I can tell you 100% not with a cutoff of three.
Dr. Gurevich: In my, in my patient population.
Dr. Weitz: Right. I’ve only seen it a couple of times, so I felt the same way as you, that it’s not that common, [00:43:00] and Pimentel’s, it feels that it is.
Dr. Gurevich: So I’m, I’m curious to go back and look at some of my old Trio Smarts to see if a cutoff of one and a half or-
Dr. Weitz: Yeah, he’s actually been hinting that he thinks that hydrogen sulfide is playing a e- even bigger role. He didn’t quite tell me exactly what he means by that, but…
Dr. Gurevich: And not only that, but, you know, in the literature they’re only saying diarrhea, and Allison is saying 50/50, diarrhea/constipation.
Dr. Weitz: I asked, I asked Pimentel about that too, and he just doesn’t see that unless they have methane as well.
Dr. Gurevich: Right. So my answer is I think it’s a little bit too early for prime time.
Dr. Weitz: Right. All right, so where are we?
Dr. Gurevich: So we’ve done a lot. We’ve done microscopic colitis, we’ve done bile acid malabsorption- Right
we’ve done EPI, we’ve done treatments for all of those. we’ve done fructose malabsorption, sucrose malabsorption, and lactose. All of those are possible underlying causes.
Dr. Weitz: What about a big food sensitivity panel?
Dr. Gurevich: I hate those. [00:44:00] Okay, let me just give you the disclaimer that I always give. My pa- practice is 100% GI, right?
If you are waiting to see me and coming into my office, it’s because you have chronic GI complaints, right? That test is very, very good. Like, there is not a single person in my practice who does not have intestinal permeability, not a single person. I, for my practice, if I’m looking for an expensive way for me to tell them what they’re eating all the time, I run that panel.
I think that if you don’t have the chronic GI panel that I have, and you j- are dealing with more, like, primary care, family medicine type practice, that might be a very useful panel for you. For me, because of the nature of my patients, I find zero value in that. If I need to know what you’re eating, I’m just going to ask you what you’re eating.
Dr. Weitz: and you feel that patients have an inflamed gut, and trying to figure out what foods they’re reacting to is just not going to be accurate. Is that correct?
Dr. Gurevich: And it’s even worse than that, because generally they’ve already self-selected out of their food, right? So probably their diet is [00:45:00] already smaller than it should be, and maybe even smaller than what’s healthy, and now we’re going to run a panel and literally take away like 80% of what they’re eating.
I think that it could do harm. Right.
Dr. Gurevich: Okay, so then we go to my third big bucket, and my third big bucket is it’s not your GI, it’s probably your nervous system. You know what I mean? And that’s where we get back to your diarrhea, and maybe the- … of the stress, right? Because like, I, you… the minute I have a stressful event, I have to go to the bathroom.
And I also, like, I run constipated, you know what I mean? But the minute my nervous system turns on, I’m going to dump everything, which is physiologically exactly what happens. You know, your sympathetic nervous system is trying to lighten you up, and so it’s getting rid of extra weight, which is like stool in your bowels.
So the nervous system is probably as big of a bucket as the, you know, microbiome and the functional bucket, and so that’s what I’m also trying to differentiate. And if they’ll let me, then [00:46:00] I’ll work the nervous system at the same time, or I’ll help them, I’ll direct them towards working the nervous system at the hal- same time.
There is a lot of hesitancy by a subset of patients who know they’re not crazy, and then you’re asking them to also address their nervous system dysfunction, and they feel like you don’t believe them, but the nervous system is a pretty big bucket.
Dr. Weitz: Um, I just want to c- get some clarification about the, importance of motility and how we should think about this.
Now, it’s natural to think that if you have increased motility, that you’re going to have more stuff going through, it’s going to be m- more inclined towards diarrhea, and, and that if you have decreased motility, everything backs up and you have constipation. But theoretically, if the muscles in the gut are not contracting, then things can just flush right through, and you can actually get more diarrhea.
So when [00:47:00] is decreased motility cause more or less? How should we think about motility as related to diarrhea and constipation?
Dr. Gurevich: You know what the bummer is? My- Yes. My answer is yes. Yes, too much motility can cause problems. Yes, too little motility can cause problems. With too little motility, yes, it could be diarrhea, and yes, it could be constipation.
Okay. And unfortunately, the testing that we have to really work this up is slightly cost-prohibitive. You know, like, a smart pill would give us a lot of information. It’s very expensive technology at the moment. I think it’s coming. I think that probably, with technology advancements, smart pills are going to become much more available, and thanks to AI, we’re going to be able to answer a lot more questions.
But I think that’s probably five, maybe 10 years away. But yes, my answer is yes, all of that is true.
Dr. Weitz: So like a J-shaped curve.
Dr. Gurevich: Kinda, yeah. Yeah.
Dr. Weitz: All right. [00:48:00] do- what else? what haven’t we covered? Or do we cover it all?
Dr. Gurevich: I mean, I think that’s a pretty good starting point.
Dr. Weitz: Yeah, no, that’s pretty good.
Dr. Gurevich: I think that’s a pretty good starting point, and, you know, I think the take-home is, for me at least, you know what, like w- my take-home is it’s not just one thing, right? This presentation be, can be caused from a lot of different things, from functional GI disorders and IBS to actual IBDs, and what we did not touch on is how Crohn’s and UC can both present, how colorectal cancer can present.
You know, like all of those things, it could be organic, it could be functional, or it could be somewhere in the middle, and sometimes you get really good help from just your primary care or your gastro, and sometimes when you’re in this functional chronic space, they’re going to give you an SSRI or a tricyclic antidepressant, which by the way could be helpful, right?
And, uh, they’re going to say, “Go on,” and if you feel like something’s wrong, [00:49:00] maybe look at somebody who knows a, how to dig a little deeper.
Dr. Weitz: Yeah. The idea that stress and sympathetic nervous system stimulates, is, a, a diarrhea is, something that Pimentel has kind of pushed back from because for years everybody diagnosed IBS as just a nervous disorder.
It’s hysterical women, just give them an antidepressant, and blah, blah, blah, and, and kind of there’s an argument to be made that if you need to… You know, the sympathetic nervous system, we often think about the, zebra on the savanna. It has to run away from the lion, and there’s no time to have a bowel movement.
Dr. Gurevich: you know what I say about that? I always tell patients to do what I call the co- the common sense gut check. You know what I mean? Like, if you’re paying attention to your body and you… You know, and some people are really, really tuned in, like-
Dr. Gurevich: or too much or too… And some people have like, no, they don’t hear their body at all.
But, you know, if you’re seeing these [00:50:00] patterns, and one of your patterns is you s- you hear something, and you get a little anxious, and you have to have a diarrhea, there’s a nervous system. we’re one body. Right. It’s not like we’re exclusively a GI tract. Right. And in fact, our GI tract, our microbiome talks to our immune system.
It talks to our nervous system. It talks to the cells. You know what I mean? Like, it’s all connected, and it’s really, really convenient for all of these hyper-specialized clinicians who spe- like we have clinicians that specialize in, like, just the, you know, three bones in the ear. Like- … of course, both sides don’t see how it all works.
Dr. Gurevich: see a human, and it all plays a part.
Dr. Weitz: Right. By the way, one more, possible cause of diarrhea is taking too much magnesium.
Dr. Gurevich: Mm. Or vitamin C.
Dr. Weitz: Or vitamin C or both.
Dr. Gurevich: Yes. Yes, and if you’re having too much magne- if you’re having… I, we probably just only touched, like, the very tip of the iceberg.
Right. There’s, like, 2,000 other causes of diarrhea. buckets that I [00:51:00] think I talked about that often get missed. Right. So that’s why I want to talk about them.
Dr. Weitz: Great. Thank you so much again for another excellent podcast, and how can listeners get ahold of you?
Dr. Gurevich: so I h- you can listen to me on the Turd Nerds, Podcast.
Google says we’re not very classy by calling ourselves that, but we still love it. And then I will-
Dr. Weitz: Wait, wait, wait a minute. Google actually communicated with you?
Dr. Gurevich: That- they, Google said… ‘Cause we, you know, we’re, we’re, like, shooting back names. I, so I paired up with Dr. Rebecca Sand, who’s a naturopath, and Dr.
Amika Padia, who’s a functional medicine medical doctor, and the three of us literally just, like, sit in Dr. Sand’s closet, which now is a little bit nicer ’cause it’s our studio. And we just, talk GI. And, Google said it w- they, I can’t remember the word that they used, but basically they were like, “You sure you want to call yourselves that?”
And we were like, “Yes. We’re sure.”
Dr. Weitz: and are they w- i- do you have a shadow ban or something like that? Are they not, like-
Dr. Gurevich: I think if any of us were musical, we would take it on the road. But unfortunately- … none of us, we happen to have one small [00:52:00] gift, and that’s, like, it. We don’t have any interests or hobbies outside of-
Dr. Weitz: You need a Turd Nerd song
Dr. Gurevich: outside of medicine. We need a song, that’s true. and then I also, I’ve actually also, the other thing that I do for my h- side hustle is I teach practitioners how to inject and, like, reset the nervous system with injections. So I’ve taught up, I’ve teamed up with my cohost, Dr. Anne Hill, and we teach together, and we also have a podcast called The Point of Medicine. Oh. So basically I have no hobbies or skills besides those. and then on, you can find me at Open Wellness PDX, ’cause I’m in Portland, and that’s where I run my clinical practice out of, and I have residents, so you can get in quick. Or if you want to wait, you can wait.
Dr. Weitz: Excellent. Thank you so much.
Dr. Gurevich: Thank you, Ben. It’s always very, very fun. I want to say, I was talking to Allison Siebecker, and she was like, “I love doing Ben’s interviews because he asks the questions that, like, boils down everything to get the key factor.” Like, you can just tell how much research you do on these episodes. Which is why I love listening to you, so thank you.
Dr. Weitz: Thank you so much. Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a consultation for functional medicine. And I will talk to everybody next week
