Shivan Sarna talks with SIBO expert, Dr. Ilana Gurevich
Finding relief from your Small Intestine Bacterial Overgrowth (SIBO) symptoms is like putting together the pieces of a puzzle. Each one fits somewhere… the question is what order do you need to fit the pieces together, to come up with a complete picture?
Dr. Ilana Gurevich, a board-certified naturopathic physician and acupuncturist, is an expert in putting the puzzle together for SIBO treatment. Based on her years of experience, she knows what to start with, what to rule out, and what to continue with based on each patient’s individual findings.
Dr. Gurevich has had digestive problems all her life, too. Not only is she incredibly empathetic, but she’s also a very assertive healer. She’s totally no-nonsense, yet warm. Even when I get cynical, she restores my faith in the possibility of getting well. I think she’s an amazing doctor, and I am so glad I am able to introduce you to her.
Phase One: Herbal & Pharmaceutical Antibiotics
Before Dr. Gurevich can start phase one of SIBO treatment, she makes sure a new patient has done a SIBO breath test. This is serious business, and she doesn’t want to guess. This will reveal the extent of both methane levels and hydrogen levels – which is critical information in terms of what to do next from a practitioner’s perspective.
In phase one, Dr. Gurevich will prescribe her patient some kind of antibiotic; either herbal or pharmaceutical. The length of time can be two weeks or a month, depending on the patient and their initial response.
While Dr. Gurevich uses more pharmaceuticals like Rifaximin than herbals, she still relies upon herbals like allicin (which is the antibacterial compound in garlic – in this form it isn’t high FODMAP), Berberine, and Neem for their broad-spectrum applications.
Outside of antibiotics, with methane patients, Dr. Gurevich tends to have good results with a combination of Rifaximin and Neomycin.
Whether a pharmaceutical or herbal medicine, the medication prescribed is based on the individual patient profile.
During phase one, Dr. Gurevich generally refrains from recommending probiotics, which she saves for phases two and three.
Phase Two: SIBO Diet and Motility Aids (Prokinetics)
Phase two begins a new chapter that strictly focuses on diet and helping the motility of the small intestine. If inflammatory bowel disease is a factor, Dr. Gurevich may recommend the Specific Carbohydrate Diet (or SCD for short).
Alternatively, the SIBO Specific Diet or even the Paleo Diet may offer relief from nagging SIBO symptoms. After the issue of trigger foods has been narrowed down, (and they vary from patient to patient) the problem of poor motility can then be addressed.
There is an overwhelming number of choices with motility agents. Some of the more commonly prescribed pharmaceuticals are not available in the United States. FDA approval may be in the works for some of these, but for now that’s just an unverified rumor. One popular motility agent is a medication called Resolor, which is most often used in the half milligram to two milligram dosage.
In the herbal realm, there are many promising options to help with motility. One product trusted by Dr. Gurevich is MotilPro, which is a high dose ginger, 5HTP, and couple of other herbs. According to Dr. Gurevich, MotilPro works wonders, although some people can develop a tolerance to it, so breaks may be needed to keep the medicine’s efficacy.
Breaks are important, because they give your gut a “breather” and can act as a reset button to begin another round of therapy.
As an individual herb, Triphelia can be used, and even bitters, which you can find in your local liquor store.
Who knew that healing doesn’t have to come from just your local pharmacy!
Phase Three: Gastrointestinal Restore – It’s All About the “Silver Lining”
In a perfect world, your gut lining is tight – really tight. Within your GI tract, enterocytes cells (intestinal absorptive cells) get nutrients from two places:
first from the bloodstream, and also from the lumen (the interior of the small intestine).
Food comes down and enterocytes absorb what’s the most beneficial to them – just like internal sponges. It’s when you have intestinal permeability (leaky gut) these tight junctions are porous and inflamed.
To encourage a restored and healthier gut lining, Dr. Gurevich recommends a number of different supplements, including but not limited to:
- Resveratrol (a powerful plant phenol (antioxidant) found in grapes)
- Glutamine (a crucial amino acid)
- Colostrum (first milk from cows that has immune-boosting properties)
- Vitamin A (a cornerstone vitamin with protective functions)
- Zinc Carnosine (a chelate-combo that helps protect a healthy mucous lining)
The goal of Phase Three? That everything you’re now feeding your GI tract is helping to restore it to health and keep it that way.
And something you may not know (and sounds a little freaky, to be honest!):
You regrow a brand new intestine every three months. Most of your stool, believe it or not, is made up of old intestinal cells, not food.
Restoring that Friendly Bacteria: What About Probiotics?
As I mentioned earlier, probiotics are something that Dr. Gurevich recommends for either later Phase Two or Three. And what’s one of the best ways to introduce a probiotic in the healing process?
Make your own yogurt!
Now, homemade yogurt can be coconut or dairy, depending on your individual sensitivities. Homemade yogurt has a much higher probiotic content than commercially available brands you get at the supermarket (even if they say organic). All you need is a yogurt starter, milk of your choice, and a yogurt maker.
A simple recipe for making homemade yogurt?
Take two quarts of half and half (or other milk of your choice) and bring it to a boil. Let the half and half cool to room temperature, and then mix the cooled milk with yogurt starter in your yogurt maker like Yolife or similar products for 24 hours. If you can, add fresh fruit or raw honey to make it a really delicious treat.
Don’t Give Up!
Healing from SIBO is possible, but there is a learning curve. Give yourself the gifts of patience and grace, and know that even small progress is still progress.
Do you make homemade yogurt? What are ways you keep friendly bacteria happy in your gut?
20 thoughts on “The 3 key phases to SIBO healing with Dr. Gurevich”
1. If in past I had few times overgow of the Helicobacter pyroli…….does this mean I had too much acid or not enogh?
What to do to prevent it?
2. I can’t find it what to do to heal reflux? and painful belching. Is this forever? I practically sleep near in sitting position…but it is not enough ( even not eating 4 hours before sleep)..
I am desperate.
I feel your pain. I suffered with painful Gerd, but was successful weening myself off the PIPs ! Talk to your doctor about getting tested to find out if you have too much or too little acid. Not sure what you’ve tried. Dr. Siebecker recommends an easy home remedies; tsp. baking soda and 4 oz of water, also Golden Alka Seltzer. But it’s hard to say what to recommend for you without knowing your history. It’s best to discuss with your doctor. Hopefully, you’ll find the magic answer for you!
I meant PPI not PIPs.
SIBO SOS Team
I’ve done a breath test using glucose for hydrogen and methane which shows I have low hydrogen and higher methane readings concluding that I do have SIBO. However I’ve read that there is another test using lactulose that goes further into colon than glucose and wonder which one is the more reliable to use and why are there 2 different ones?
Currently, the 3-hour Lactulose test is the golden standard for diagnosing SIBO because of the transit time it takes to go thru the digestive system.
SIBO SOS Team
the breath test you took was 3 hours total if blowing into tubes? if so they probably used lactulos. Beware: treatment is different if you’re high hydrogen versus high methane, so be sure you know which. seems to me a Fodmap diet makes high methane problem worse. Just off top of my head from researching my own treatment.
What if you have nerve and motility issues from chronic Lyme disease? I have tried every single natural thing in book to overcome chronic constipation. Been on a very basic plant based diet of soft cooked veggies and soups. Nothing works!
Fiber, hebalmucil, Dr Schultz, vitc magnesium, juicing, you name it, I have tried to no avail. Forced to do daily enemas.
Out of desperation I am trying Linzess, which is working a bit but the effects are uneven, and instead of normal stool I get diarrhea even at lowest dose. Is this safe to take? Dies it dtop working sfter a while too?
I have been on no gluten, dairy, soy, corn, sugar for over 5 years.
Wow, that’s awful, Pepper. Sounds like you’re doing all the right things. Hopefully, you’re not trying to manage on your own and you have a practitioner helping you figure it out. Wish I had some other suggestions for you. Hang in there!
SIBO SOS Team
Sounds like just what I need. Help, help, help.
Does Dr Gurevich accept phone consult patients? My gastrointestinal doctor says he is familiar with Dr Siebecker and SIBO needs nothing but diet to cure.
Dr. Gurevich doesn’t do remote consults, darn it! I wish she did. Although diet plays a major role in managing the symptoms, your GI doc needs to determine the underlying cause of what created the SIBO, to begin with, before can cure it and often there is more than one underlying cause. Check out Dr. Siebecker’s Underlying Causes Masterclass of the website @ sibosos.com. You may want to refer it to your doctor too!
SIBO SOS Team
Watch out for neomycin, i had a patch teat and among other things I am allergic to it also bacitracin among other things
That’s awful. Thanks for sharing.
SIBO SOS Team
You left out one of the more important aids in healing SIBO- intermittent fasting- allowing 12-14 hours between dinner and the next meal (or between breakfast and dinner). This fasting protocol is a major factor in relieving IBS.
Yes. Thank you for mentioning. Meal spacing for some depends on other factors. Some treatment protocols make meals spacing more difficult. As Dr. Siebecker suggests, pick your most important symptom first.
I could not find a quick list of products for making yogurt when I clicked on the word “here” above. It went to the SIBO website with the many webinars that are being sold. So where do I find it please? Thanks.
Sorry, the copy was a bit confusing. The ingredients for the 24 hour yogurt are contained within the copy. It’s so easy. I use the Yogourmet brand that Dr. Gurevich recommends. I ordered thru Amazon.
SIBO SOS Tema
These seminars and articles are so helpful. Today, I’m in the process of doing the Hydrogen Breath Test to determine if I have SIBO. I believe that I have. The doctor who ordered this believes it a possibility due to my symptoms and the antacids I’ve been on for such a long time. I also have motility issues. I’m getting two different motility tests tomorrow and an endoscopy. Can SIBO cause motility problems?
Actually, motility problems can cause SIBO.
SIBO SOS Team
I should have added this also: Thank you for posting this–this is very helpful!
Thank you, Vicky! Glad you like the blog.
SIBO SOS Team
Quick question: Do you mean “triphala” instead of “triphelia”? It’s the ayurvedic formula of three Chinese fruits: amalaki, bibhitaki, and haritaki.
Great question, Vicky. I’m not sure. I’ll ask if anyone else knows?
SIBO SOS Team
YESSS ! IT is Triphala !