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Chronic Diarrhea: A Functional Medicine Approach w/ Dr. Ilana Gurevich Rational Wellness Podcast 483
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. 00:00 Podcast Intro 00:59 Why Diarrhea Is Complex 01:52 Meet Dr Gurevich 02:39 Acute Loose Stool Workup 03:07 Fast PCR Stool Panel 04:47 Treating Blastocystis 06:16 Defining Diarrhea 07:46 Acute vs Chronic Timeline 08:49 Food Triggers and EPI 10:18 Testing Limits and False Positives 11:03 Cholera PCR Story 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   25:46 SIBO SIFO Testing   26:12 Organic Acids Debate   26:44 Pancreatic Enzymes Trial 28:19 PERT Dosing Basics   30:40 Bile Acid Diarrhea     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.
Rational Wellness Podcast
https://www.drweitz.com
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