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The Melanie Avalon Biohacking Podcast Episode #169 - Dr. Peter Kozlowski "Doc Koz"

As a Functional Medicine MD, Dr. Peter Kozlowski uses a broad array of tools to find the source of the body’s dysfunction: he takes the time to listen to his patients and plots their history on a timeline, considering what makes them unique and co-creating with them a truly individualized care plan. A graduate of Family Medicine Residency, he has devoted his career to helping uncover the underlying cause of chronic disease through Functional Medicine. He trained with leaders in his field including Dr. Mark Hyman, Dr. Deepak Chopra, and Dr. Susan Blum. His bestselling health and diet book, Unfunc Your Gut, was named the winner of International Book Awards, and Fall 2022 brings us his much-awaited sequel, Get the Func Out: A Functional Guide to Balance Your Hormones and Detox. He serves patients in person and online via his Montana- and Chicago-based practices.



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Join Melanie's Facebook Group Clean Beauty And Safe Skincare With Melanie Avalon To Discuss And Learn About All The Things Clean Beauty, Beautycounter And Safe Skincare!

Get the Func Out: A Functional Medicine Guide to Balance Your Hormones and Detox

Unfunc Your Gut: A Functional Medicine Guide: Boost Your Immune System, Heal Your Gut, and Unlock Your Mental, Emotional and Spiritual Health

12:15 - Doc Koz's Personal journey

17:15 - Problems with Supplemental Testosterone

22:10 - Does Testosterone Effect Female Fertility?

25:50 - Excess Testosterone Converting to other hormones

28:40 - Supplementing Estrogen 

The Melanie Avalon Biohacking Podcast Episode #128 - Dr. Michael Platt

31:20 -Supplementing Progesterone

33:00 - oral supplementation

34:00 - Thyroid Medication

41:40 - Suppressed TSH

43:10 - how often should you retest?

45:15 - Testing with or without medication

48:00 - conflicts in approach across medical professionals

50:15 - finding what works

52:10 - reverse T3

54:45 - LOMI: Turn Your Kitchen Scraps Into Dirt, To Reduce Waste, Add Carbon Back To The Soil, And Support Sustainability! Get $50 Off Lomi At LOMI.COM/MELANIEAVALON With The Code MELANIEAVALON!

58:30 - 7 most important hormones

1:03:00 - DHEA

1:07:30 - Adrenal Fatigue

1:10:10 - Our Toxic Burden

1:18:15 - phase 1 and 2 liver detox

1:20:15 - toxicity tests

Your guide to safer personal care products

1:24:10 - Testing Beauty Products

1:28:00 LMNT: For Fasting Or Low-Carb Diets Electrolytes Are Key For Relieving Hunger, Cramps, Headaches, Tiredness, And Dizziness. With No Sugar, Artificial Ingredients, Coloring, And Only 2 Grams Of Carbs Per Packet, Try LMNT For Complete And Total Hydration. For A Limited Time Go To drinklmnt.com/melanieavalon To Get A Sample Pack With Any Purchase!

1:31:30 - Detox and chelation

1:38:00 - modified citrus pectin

1:42:50 - comparative testing levels

1:47:10 - medical cost of testing

1:50:10 - dosing  modified citrus pectin

1:51:10 - do vegetarian diets make a difference in toxic load?

1:56:05 - seeing improvement

1:56:10 - mold toxicity


Melanie Avalon: Hi, everybody, welcome back to the show. I am so incredibly excited about the conversation that I'm about to have. It is with a repeat guest and as you guys know, only the best of the best are repeat guests. So, I am so looking forward to this. I am back today with Doc Koz, Dr. Peter Kozlowski. He originally wrote a book called Unfunc Your Gut, A Functional Medicine Guide: Boost Your Immune System, Heal Your Gut, and Unlock Your Mental, Emotional and Spiritual Health. So, we aired that episode, I'm not sure when it was, quite a few months ago, I'll put a link to it in the show notes. And it was so incredible, I got so much amazing feedback about it. It was a really comprehensive look at, obviously, gut health and gut issues, which is something that so many people struggle with and it's a really valuable source just in how comprehensive it is, how much information it provides, and also just how motivating and encouraging it is. I really, really love that book, love that conversation. 

We are back today for Doc Koz's new book, I am equally excited about. It is called Get the Func Out, A Functional Medicine Guide to Balance Your Hormones and Detox. And oh, my goodness, friends. If you at all struggle with health issues, I mean, honestly of any sort. This is one of the most comprehensive books I have read on the topic of just getting to the bottom of why you're not feeling well, and just providing agency of just how to deal with it, there's-- I'm getting a little bit overwhelmed because there are so many things to talk about and I'm just going to have to say right up front just get the book because there's no way we can even remotely do it justice. So, just get it know it will be a really, really, a valuable resource in your life. But we will get to what we can get you in today's conversations. So, Doc Koz, thank you so much for coming back and being here.

Peter Kozlowski: It's such an honor, thank you for such an awesome intro. I'm so glad that people liked our first talk. And I'm even more excited about this book than the first one. I feel like having some experience as an author and just being a little more confident in my writing. I'm really excited to get this book on hormones and toxins out there.

Melanie Avalon: I am equally excited as well and I love reading it. And so, I will put a link like I said in the show notes to the first episode so people can definitely check that out. And you talked about your personal story in the beginning of that episode. But in today's episode, you talk about something specific in your personal story. I was wondering if you wanted to talk about it a little bit. You talk about a really interesting experience you had with your own fertility issues and hormonal issues surrounding that. Would you like to tell listeners a little bit about that?

Yeah, yeah, sure. Not Something I think I'd ever thought I'd openly talk about but that's life. So, my own hormonal-- and so this book is on hormones and toxins and I go over the thyroid, and the adrenal glands and the pancreas, and then reproductive hormones. And when it comes to reproductive hormones, I divide them up between male hormones and female hormones and some overlap, but for me, my story was about testosterone. And so, at the age of 32, I was diagnosed with low testosterone. And it kind of started-- I was in an abusive relationship in the past and was just coming out of that. And I was working with a doctor named Lisa Nagy, and she's an environmental medicine doctor, and I was telling her about my life. And she said, "Hey, I think you have low testosterone." And I was like, "What?" It was offensive. Honestly; I was pretty offended by it. But I humored her and I was like, "Fine, I'll do your test." And she started with urine testing, which I've now learned, I don't think that that's a very good test but the urine test said that I had "low T."

So, I followed up with a blood test and typically testosterone ranges for men between 200-1100 which is one of the things I really get into in the book is the psychotic ranges that we have, how could one guy be normal at 200 and another one at 1100? That's such a discrepancy. There's so much difference there. So, in general, the lab won't report your low testosterone below let's say 200, depends on the lab, but that's a rough value. So, I came in below that. It was one of the biggest shocks in my life. I mean, I said, I just I'm very competitive. I take things personally. So, for me it was a slap in the face that I had low testosterone, I processed it and I was like you know what it's better to know and that's an attitude I've taken with my patients this is like, sometimes the news we get sucks, but it's better to know and then be able to do something about it.

So, I was advised by this Doc to go on testosterone replacement, which I get into quite a bit in the book about what are the different options for testosterone replacement. My knowledge was that the best option was cream. And so, I was prescribed a testosterone cream that I applied twice a day. And I would say it took- that I'd say the biggest symptom that I had my whole life that I think I had "low T" I don't even know, maybe when I was 16, 17, I'm not really sure how long it went back. But for me, I've just always been really into sports. I love watching sports, but I love playing sports. I like working out. I grew up in the 90s in Chicago, so I thought I was going to be Michael Jordan, loved to play basketball. But I always felt I carried a little extra weight. I was never obese or overweight, but I just carried more weight than I thought I should for considering how much I exercised. And within probably four weeks of being on testosterone, my body started to get cut up. And when I do testosterone replacement when I did it for myself, when I do it for my patients, it's not I make the joke. It's not to be Barry Bonds, it's not to be this massive body builder type of physique.

But just to get to what an optimal level is. And in my opinion, when working with people with my own experience in optimal numbers around 800. Baseball players that are doing it to get huge contracts, and all the home runs they're probably a few 1000 their level, but just replacement to get to where you should be is around 800. So, I was applying cream and getting my levels to stay at 800. And like I said, my body started to change and when your body changes, you just feel better about everything. And so, my energy was better, my strength was better, sex drive was better, mood was better. I loved it. best years of my life was on testosterone replacement. Then I met my wife and we were talking about having a family. And in the back of my mind, I had a bad feeling about the testosterone I was on. But that's where it gets confusing because you would think the higher your testosterone, the better-- the more fertile you are. And that is the case when you're raising testosterone naturally. When you're taking some testosterone, it does the opposite.

So, when I did a sperm analysis, I had no sperm, just zero. And one of the worst days of my life without a doubt, I was like I can't believe what I did to myself, I was in a very, very, very dark place. I was embarrassed as a physician; I was embarrassed that just as a person I didn't know that I wasn't told and that I didn't look into it myself. And so, the reason it happens is because whether we're talking about the thyroid, the adrenal glands, testosterone for men, estrogen, and progesterone for women, our brain is the thermostat that sets our hormone levels and the brain sends signals to the different organs to make more hormones. So, when it comes to making testosterone, the signals that are made are called FSH and LH.

And so, you need these signals to be elevated. One tells you to make testosterone, the other one tells you to make sperm. When you're applying testosterone or injecting it or using pellets or whatever those signals from the brain are shut down. So, you don't make any FSH or LH because the brain is detecting that there's plenty of testosterone, so there's no need to turn on production. Well, the problem with that is that you need FSH to make sperm that's your sperm signal. So, for three years I had basically turned off my sperm signal. And in my first book and probably my biggest piece of advice for patients that I work with is to stay off the internet. Because there's just an overwhelming amount of information and sometimes you can go down some stuff that may not apply to you.

Well, when I started researching on the internet about my testosterone replacement and my loss of sperm production, there is a number of things out there that say many men may never make sperm again. So, naturally, I thought that would be me of course and convinced myself of that from reading the internet and this is even after I wrote my first book saying stay off the internet. So, I very much understand that that's the first place we go when we want answers. So, that was not the case for me. I became I'd say a mini expert or an expert in natural ways to boost sperm production, boost testosterone. Also, I used a medication called clomifene, which women may be familiar with if they've been through infertility themselves. Clomifene, some men use to make testosterone, for me I used it to make FSH and LH. I did a repeat test after six months of stopping my testosterone and I was still at zero. So, that panic got even worse. I was wow, this is really, I just messed up my body for life and then I did another test staying on the same routine of using clomifene and supplements and after 12 months, everything was back to normal.

So, I've been off of testosterone for a few years now. Once we're done having kids, I will definitely go back on it because I've never felt as good. But I am frequently over the years counseling men who come in and I'm diagnosing men with low testosterone, even younger than I was which was 32, I'm seeing in men in their mid to late 20s. But the first thing that I always do is counsel them about family planning and is family planning something you want to do? If it is then I highly recommend don't do testosterone replacement, even though I was lucky that I was able to reverse what I did. I would rather not take that risk with patients or at least let people know what the risk is. And if they want to take it, then it's up to them. But I think that's the gist of my major hormone story is my low testosterone leading to infertility, leading to a lot of mental, emotional, spiritual pain, but most things in my life falling down and figuring it out and getting back up.

Melanie Avalon: I have so many follow-up questions about this and I can only imagine that experience, especially that experience when you found out about it and feeling responsible like you did it to yourself because you had chosen to go on the supplementation. Is this a known thing?

Peter Kozlowski: It should be? I mean that's why I want to get my story out there. I don't think it is. I think most men that come to me for testosterone replacement when I tell them that they don't really know it. And it makes sense because in normal if your body is working normally, usually more testosterone means you're more fertile. So, it's just I don't know, to me it was common thinking well if I'm low testosterone, then I might be more infertile. So, if I go on it, it should get better. I don't know the answer honestly, I obviously went through medical school residency, functional medicine training, and I didn't think about it or part of me also though, I feel I chose not to think about it just because I was so happy with the results. And that's most of us, we don't really deal with an issue until we kind of have to. So, I think I partially chose to just not look into it. But it very, very, very, very much should be the first thing that any physician that's prescribing testosterone should talk about with their patient.

Melanie Avalon: Do all men react this way or do some still produce sperm?

Peter Kozlowski: No, not unless you take another medication. So, for example, what I've done with some men is that have very low testosterone that want to go on a replacement. I will put them on testosterone to get their levels up, but I will also put them on clomifene, which is a medication that causes you to make more FSH and LH. So, if you're on both, you can have high testosterone and you can also not lose your sperm production. But for those men that are being cautious, I would do a sperm analysis every few months and I would be checking in on their FSH and LH levels every few months to make sure that things are going as planned. I think that gets into probably more than I like to of messing with our biochemistry or biohacking as you would call it. I think we're playing with fire a little bit there doing two things at once, giving one and then giving-- it gets into a traditional medicine thing like here take this to feel better and then take this for the side effects that that's causing. So, that's something I try to avoid. But I've had a few men I've worked with choose to do that.

Melanie Avalon: And how often do women go on testosterone? And does it affect their fertility at all?

Peter Kozlowski: That's a good question. I don't think I've put any premenopausal woman on testosterone replacement. So, when I do testosterone replacement in women, it's usually post-menopause. But in theory, it should do the same thing, so in a woman you need FSH and LH, those same signals from the brain to make eggs and then for the eggs to be released, etc. And testosterone should turn off those signals. So, I would never want a woman of reproductive age unless she knows she's not having kids or doesn't want to have kids to go on testosterone replacement. Usually, on a lab test a woman's testosterone level is 10 to 40 roughly let's say, so much lower than they're like 200 to 1100 that a man should be at. I don't know that I've ever seen low testosterone in a premenopausal woman.

Melanie Avalon: You talk about in the book how it can actually become other things like DHT or even estrogen. How common is that? And do you see that in a lot of your patients?

Peter Kozlowski: Yes, that depends on factors how healthy is your body? What's your diet like? Is your body really inflamed? Are you eating the standard American diet? Is your body full of mold or heavy metals? Or do you have dysbiosis? Those are things that would cause testosterone to get converted into pathways that you don't necessarily want. I have a number of men that are taking basically some supplements that stop the conversion, usually the main one that men worry about is if you have too much testosterone, it's more likely that some of its going to be converted to estrogen. And as a man, you don't really want too much estrogen. One of the side effects of testosterone replacement, and I saw it once in one of my patients is breast growth and so I had a man that had some breast growth. And I think that was from the testosterone being converted to estrogen. So, that yes, if you're not-- and that gets into the whole thought process of functional medicine is that you should be looking at the person as a whole, and looking at their diet, looking at their gut, looking at the toxin levels, etc. Looking at all the hormones too because that's the hard part with hormones is.

Sometimes the symptoms of low thyroid look exactly like the symptoms of too much cortisol or the symptoms of low testosterone, or of estrogen dominance. So, the symptoms can really overlap. So, when I'm working with hormones, I like to look at all of them because I could be totally convinced somebody has a low thyroid, but it turns out to be something totally different. Because of things like that your testosterone could be converted to estrogen. These are all things that should be tested and you should work with a physician who has some experience with it that knows what labs to order and when? Probably like one of my most hated things out there are the hormone clinics. There are a lot of clinics out there that basically anybody who walks through the door is getting put on hormones. What makes me the maddest about that is, is that a lot of times those clinics are calling themselves functional medicine clinics. That is not at all, it's the opposite of functional medicine but by saying it's a functional medicine clinic, it's good for business. I think I wrote in the book and I always warn patients, if you're going to a clinic that all they want to do is hormones, that's not the right thing. That's the easy way to do things a lot of times for a practitioner, but that's not the right way to do things.

Melanie Avalon: Now, I'm just thinking because we're talking about how testosterone could convert to estrogen, you're talking about the negative feedback loop and supplementing hormones and how it affects our hormones. So, something like estrogen where people often deal with an overload. Does that mean if you supplement with estrogen, you actually could lower your body's endogenous estrogen production and actually lower your levels in the end if you went off of it?

Peter Kozlowski: Potentially, yeah. I mean that's always a concern when you're going to do to-- when you're going to do any hormone replacement, what are you telling the gland that should be making the hormone? And will it shut down long-term production of it? Now with me with putting women on hormones, I only use progesterone pre-menopause because the most common issue that I find is estrogen dominance. But the way I always describe that. So, that's a concern, like if you go on estrogen, you're going to tell the ovaries to stop making, if you go on testosterone, you're going to tell the testis to stop making it. I'm not putting anybody on it that isn't already very low. So, if you use me as an example, my level was under 200 going on it for three years, I mean my body's making it again on its own with some support, but I didn't really see any risk and I don't really care if my body can't. If I'm going to shut down my body's ability to make it in the long run because at the age of 32 it already wasn't. So, I was already kind of a lost cause in my opinion. But that is something to consider the long-term effect.

And that's why I don't like people that are too young to go on hormone replacement. There are so many factors that play a role and that's where when working with hormones, I would much rather wait till someone's past their reproductive years before we really start messing with the hormones and giving exogenous hormones and potentially suppressing the body's ability to make their own. It definitely does not come without risk of going on hormone replacement. The most common one that people know is thyroid, the most common autoimmune disease, Hashimoto's. And low thyroid is the most common thing that probably I see. I have seen people that needed to go on thyroid replacement and then through detoxing them, through getting their gut right, we've been able to get them off of thyroid hormone. But it's pretty rare, those stories are out there and they happen but once you go down the hormone replacement route, you're not really turning it around, you're not really going back.

Melanie Avalon: So, I did an episode all on progesterone with Dr. Michael Platt and he makes the case that you can't really over-supplement with progesterone and that it won't downregulate your body's production. And I've actually been using progesterone cream for years, I mean, years. Do you find issues with progesterone supplementation for women premenopausal?

Peter Kozlowski: I think the biggest thing that I would worry about is clotting risk, so sometimes women that go on progesterone can have an increased risk of clotting. So, you really have to get a family history and make sure that there's not really any history of clotting. That would be my biggest concern. I personally think you can overdo anything. As being someone in recovery. I know all about too much of anything is not good. So, I wouldn't say that me when this is just my opinion, obviously, there are different opinions. But for me, I'm always very careful like when I do progesterone replacement, I really prefer capsules. And I start at 50 milligrams most of the time with usually a maximum of 200. So, I always like to start with the lowest amount and then go up instead of like, I would rather start at 50 and give it a few months. And then if we need let's go up to 100 or 150 versus let's start at 200 and you have some side effects and then we have to go back down. I always go slow, and I'm cautious with it. But I know there's different ways to go about it.

Melanie Avalon: Those are oral capsules?

Peter Kozlowski: Mm-hmm.

Melanie Avalon: Okay, is there concern that it might be converted into something else in the liver? Or do you find that it works like that?

Peter Kozlowski: We get into the liver and how it detoxes and all of that in the book and anything that you take that gets across the gut lining in the first place that goes is to the liver. Progesterone, I can't think of anything that I would really worry about it being converted to unless there's just too much of it and your body can't break it down. So, if you're taking too much of it, I think it could be a problem. But I don't know of anything I don't worry about the conversion of it when I put a woman on it personally.

Melanie Avalon: So, I'm on thyroid medication. And I have been also for years actually by the same doctor that originally prescribed me the progesterone. And it's a situation where I've been on it for so long. When I first went on it, it really helped me a lot, especially with my constipation and GI issues. I've often thought I actually don't know if I need to be on it, but like it's been so long and it's been playing the levels it's just very confusing. So, when it comes to thyroid, I don't know the exact stats on thyroid medication and I don't remember if you have them in the book, but how many people are on thyroid medications, and how many people do think need to be and how many people do you think are on the incorrect dosage?

Peter Kozlowski: I think all those numbers are pretty high. I don't have exact statistics on and I have my patient population which people that come to me I'd probably say it's 25%, maybe more are on thyroid replacement of some sort. I think there are a ton of people being undiagnosed that should be diagnosed with thyroid with a low thyroid. And so, I definitely get into that and that's-- the first hormone that I wrote about was the thyroid because it is the most common. I think that the biggest issue with not enough people being diagnosed as low thyroid is the fact that traditional medicine is just relying on TSH levels. And the analogy that I love to understand whether we're talking about the signals from the brain to the testes or the signal from the brain to the thyroid, your pituitary gland is like your thermostat. And in Chicago or Montana the places that I live when winter is hitting, you set the temperature to 70 degrees. When the thermostat detects that the temperature has gone below 70 degrees, it sends a signal to the heater to turn it on, and you make heat until it's 70 degrees and then it shuts off again, the pituitary gland sets a number for the thyroid of how high your level should be. And if the levels go below that it releases TSH from the pituitary gland and it goes from the brain to the thyroid and tells you to make more thyroid.

So, if a TSH is elevated, we assume that the thyroid is low. The statistic on that I think probably 85% of regular doctors are just using that TSH value. For me having learned functional medicine, it drives me completely nuts because it's not an indicator at all of what your thyroid levels are and what I've seen over and over again is people who have a normal TSH so the level is normal. So, the doctor tells them they're fine. But they have constipation and they have low energy and their skin is dry and their hair's falling out. And they're reading all the symptoms of low thyroid online and they're like I have low thyroid, but the doctor won't order anything besides the TSH. And then they come to me and we order the free T4 levels, the free T3 levels and they come back low or they come back at the low end of normal. And I think getting into your question about what's the right level for people who should be on it. I don't believe in just using the lab values. So, if I tested someone and they're at the low end of T4 and they're at the low end of T3, but their energy is good, their hair is fine, they're moving their bowels every day, I wouldn't put them on thyroid replacement. Your symptoms you talked about in the presence of having a low thyroid, I would say yeah, let's go on thyroid replacement and see how you respond to it. And it sounds it was very good for you. But is it something that you need to stay on forever, the only way to find out is to try stopping it. And one of the things I talk about is my preferred method for testing if someone is on thyroid medicine.

So, many people are told by their doctors that if you're on thyroid medicine, when we are going to check your levels, don't take your medicine the day of the test. I do the opposite. I tell people to take their medicine and to get their levels drawn three to five hours after taking the medicine. So, if take your thyroid medicine at 6 AM, get your blood drawn between 9:00 and 11:00. That's because the medication has a half-life to where you need to take it every day because it goes away after a day. And I want to know what your levels. So, if you came to me and you were like "Hey, I want to know if I should still be taking this thyroid medicine?" I would say let's start with free T4, free T3 levels, TSH, thyroid antibodies if there have been any or if you haven't had them tested in a while. And let's see where you're at in the range. And if the range looks good and you're wanting to get off of it, I would say depending on what your doses and can I ask what medication you're taking?

Melanie Avalon: Right now, I'm on compounded NDT and compounded synthetic T3, so that my doc can specifically change the T3 levels.

Peter Kozlowski: Sure, and I assume you guys have gone up, you guys go down with the levels and I think that that's a good way to do it. I think the biggest thing that I do different is like at least in regular medicine, they start medications, and then they don't ever give you a game plan for coming off of them. It's just either we're going to add to it or we're going to change it. I've always operated with let's do as little as possible to get you feeling good. So, if your ranges look okay and you want to come off of it, then let's try lowering it. And that I think too is where functional medicine really- We try to be individualized and again I would never tell you or any patient like alright, well, your levels are getting too high. And so, you have to stop it unless they're getting really high, then I would say you have to stop it. But if they're at the high end, but you feel good, and you don't want to come off of it, you don't want to lower your dose, I wouldn't say you have to lower your dose. But the thyroid is very dynamic, it changes. I mean most people we can find a dose and they're steady on it, they take it every day, they're fine, but I have quite a few patients where every six months we're going up, and then the next we're going down, and it can jump around. So, it's definitely something that needs to be monitored for most people. But then also, a lot of people find their dose and they're able to just stick with it.

Melanie Avalon: I'm just so passionate about this topic because like you said, I think so, many people are misdiagnosed or not diagnosed and then so many have experience that the doctor just looking at the TSH. And then on top of that, I've had a few experiences in my history of being on thyroid medication where I really had a bad experience. At one point I was on T4 and T3, I'm not sure if it was NDT or compounded. But in any case, my doctor wanted to try to lower my reverse T3 that was high. So, she pulled me off of T4 and just put me on T3 and I literally felt I was dying; I think that that was much too- I think that was a dangerous switch to have made and then a more recent thing that happened and I'd be curious about your thoughts on this. This is a different doctor that I'm with now. My T3 was low, so she wanted to raise it, but she was worried about my TSH becoming suppressed, which I would love to hear your thoughts on suppressed TSH on thyroid medication. Literally what she did made no sense. She was like, "We got to lower your T4 to fix this and she was so concerned about keeping the TSH not suppressed." So, I sent her all of these studies on suppressed TSH levels and whether or not they correlated to issues if you're on medication. What are your thoughts on suppressed TSH on thyroid medication?

Peter Kozlowski: I worry in older people. I don't like to suppress TSH in my older patients. I think when you're younger, it's okay, but the older you get, I think that there are some studies out there that suggest that it can be a problem. So, that's where I'm careful is if I'm working with an older patient, I don't want their TSH to be too suppressed for younger people. How did your doctor respond to all the research you sent her?

Melanie Avalon: Well, a little caveat that I need to make, she didn't calculate it correctly because she was, we need to lower your NDT so that the T4 gets lowered. So, I can raise your T3 but the net difference, and this is why I just want to empower patients to have agency and looking at their lab work. The net difference was actually not raising my T3 because of how she was affecting my NDT kind of a bad example. It's interesting with the studies I sent I reached a very similar conclusion as you that possibly in older populations there might be an issue. I think I sent her so much stuff and then finally she was just-- she didn't really answer me. I think she was-- I don't know if she was embarrassed at me drilling her on the actual numbers, but she ultimately said okay, yes, we can do this and then retest which that's a question for you. How often do you retest because when I was with my other more holistic doctor, she was retesting much sooner like a month or so, but this doctor will wait like 3 or 6 months which seems a long time?

Peter Kozlowski: Yeah, definitely not. I don't wait that long. I mean if I'm not changing the dose, if everything's just status quo, then yeah, sure six months and maybe a year, but if I've changed someone's dose, I'm actually usually repeating somewhere between 3 and 6 weeks. It can be a pretty serious shock to the body and sometimes we don't know-- that's the hard part with practicing medicine as you don't know how somebody's going to respond. You trust what you've learned in the books and then you trust your experience with patients. But thyroid is something that can be dangerous if you overdo it. You can send someone into an arrhythmia. I've seen some crazy stories lately of patients going to emergency rooms being told to take thyroid medicine and just completely the wrong thing. Thyroid hormone the best way I think about it is just stimulating, it speeds things up and makes things grow. I'm always very cautious with it. So, whether I'm lowering someone's dose or whether I'm raising it. I'm changing your dose of medication I really don't want to go past a month to check in on how that change is happening. A lot of patients won't follow up because of the change that we made, they're happy with, so they don't go get their blood drawn, I can't force them to. But I would really prefer if I'm adjusting your dose to check in, I mean, maybe six weeks, but I definitely would not go longer than six weeks.

Melanie Avalon: Yeah, that actually happened to my grandfather, they put him on the wrong thyroid dose, it was way too high, and made him super hyperthyroid and it was a big issue. But okay, I got so excited when you started talking about testing after still taking the hormone or taking your medication, because I have thought about this for years, because everybody says, don't take your medication before the test. And that makes no sense to me, it literally makes zero sense logically, if we're testing to see what you're at on the medication, shouldn't you test when you're on medication?

Peter Kozlowski: Anytime that I'm saying something that goes against what everybody else is saying or, to me anything that I do with my patients it has to make sense to me. I have to be able to explain what I'm doing and why I'm doing it because I work with a lot of very smart people and they ask good questions, and they'll know if I'm full of shit or not. And so, I need to be able to explain things that I'm doing and I don't know where it came from for not testing or telling people to not take their medicine. If you're on thyroid replacement and we want to know how you're doing on it. Don't we want to see what your biologically available levels are after you've taken the medicine? I got actually really lucky-- my first practice when I left residency, I was actually in Destin, Florida. And I rented a space in this multi-facet clinic. And there was-- Destin is over by Eglin Air Force Base, so this military doc there, all he did was thyroid. I think he was doing it a little aggressively, he literally put everybody on thyroid, but me and him used to talk in the lunchroom or whatever and I was just really getting started. But he influenced me a lot with thyroid because that's literally all he did. So, he was pretty well versed in it. And so, I mean, this was literally when I started my career on my own. He's the one that was he's like listen, I only test my patients after they've taken their medicine 3 to 5 hours. I thought about what I had been taught or what we told people and I thought about what he was saying and I was like that makes a lot more sense to me. If you're taking it, we want to know what your levels are, how does it help to know what your levels are off of it? It that just doesn't make sense. So, yeah, I am glad that you agree and I can explain that to someone. I couldn't really explain to someone why I would want them to not take their medicine the day we're testing, how that medicine's working for them.

Melanie Avalon: It's so interesting to me because like you said, it's conventional practice. But then also like I've had two guests on the show that are very well known in this sphere and very involved with the thyroid, and they come from this functional approach. And they also say to not take it on the day of the test. And I've never-- not that I'm challenging them, I've never really challenged them on it because I'm like okay, I must just be wrong about this. So, this is very validating because I've just thought about this for a while the way I get around it is I actually take my thyroid medication at night anyways. So, I still get effective testing while on my normal schedule.

Peter Kozlowski: The one thing I would say about that there's a lot with anything-- you're going to get as you talk to a lot of very smart people all the time. There are two very, very smart people that have had very good success working with thyroid could take totally different approaches, that's okay. I mean, from the patient perspective my advice always is to go with who you trust, who sounds like they know what they're talking about, or who you've had success with. I was taught that if someone is going to test, just do the testing the same way every time. So, if your doctor is managing or you're doing okay. Every time you do the test, you don't take your medicine that's fine and you have some consistent values, but I mean, I've heard of the doctors don't tell their patients when I ask my patients when they come in with thyroid results, I'm like did you take your medicine or did you not? I don't remember. Did your doctor tell you what to do? No, they just gave me the lab order. That's a disaster, that's when you're getting into really malpractice or just not helping someone. But if you follow the same thing, I believe that there are different ways to go about doing the same thing, I think it's okay. Just to be aware "Hey, it's like I'm telling my patients, yes, take your medicine. No, don't take your medicine, just do it the same every time." So, even if they go to another doctor, they know what to say, yes, my doctor always had me take my medicine or no they didn't.

Melanie Avalon: Yeah, this is one reason I just love your work so much because you do a really good job of both providing a very extensive overview and your personal experience and perspective. But then also providing agency to people to work with other doctors and find what works for them. So, I super, super, appreciate that.

Peter Kozlowski: My favorite thing about this book we're talking about the lab values in the thyroid chapter specifically, I list all the thyroid tests. What are normal ranges? What are optimal ranges? How to interpret that?

Melanie Avalon: This was my- sorry I never interrupt. This was my favorite part, though, I was going to tell like you have this amazing, list of-- is this what you were talking about where it's like how a person's thyroid panel might present? And then what the root cause probably is related to that is that we were talking about? It's so helpful, sorry to interrupt you, it's so, great. Go ahead.

Peter Kozlowski: I can't wait to get either the hate mail from traditional doctors or just the excitement from patients. I think that in a lot of ways, people are going to be more educated than the provider that they're seeing, unfortunately, in how to look at their labs. So, I think a lot of people who read my book might end up getting fired by their doctors, but that's probably a good thing. In the end, if your doctor is not willing to work with you. But instead of just accepting that my doctor is just going to test my TSH and even though I have every symptom of low thyroid, people can use that chapter on the thyroid. I mean, there are charts of all the different labs and what's normal and what's optimal, and they can go into their doctor and be like no, like, this isn't right. And if their doctor is saying no, the only thing we need to test is TSH, then it's like alright, well, it's time to find a new doctor that is willing to at least test the T4 and the T3 levels.

Melanie Avalon: I was highlighting it and storing it. It's when you're reading something and you find this really nugget of gold, this is amazing. Do you ever test our T3, reverse T3? Does it inform your practice?

Peter Kozlowski: So, this is where I'm different than probably a lot of functional medicine people. I personally hate reverse T3 because what reverse T3 is that your thyroid gland makes T4, and T4 is converted peripherally to T3. And there is a number of factors that can cause the T4 to be converted to reverse T3. Reverse T3 is a form of T3 that is not active. So, it'll go and try to bind to cells and try to function like T3 but it doesn't. So, in theory if there's too much of it, it could almost make you have symptoms of low thyroid. Now, so, that's why a lot of-- most practitioners in my world are using it, they order reverse T3. For me, the reason why your reverse T3 would be elevated? Would be due to toxins, due to gut imbalances, due to your diet, due to a lack of sleep, due to stress. We're going to be working on all those things anyway. So, for me reverse T3 doesn't change my treatment plan and I'm all about ordering tests that will change my treatment plan. And I don't need to see a reverse T3 to test you for heavy metals like lead and mercury or if you've had a history of water-exposed buildings or water-damaged buildings, I'm going to test you for mold no matter what your reverse T3 says. So, I don't find it valuable and changing, the way people feel or my clinical outcomes are helping me decide what to order next. And again, that's a personal approach of mine. And that's my reasoning for why I take that approach but I know there are a lot of people out there that are really into thyroid that love the reverse T3 number.

Melanie Avalon: I've always just tested mine. I said I had that issue where it was sky high and that's what informed my doctor's change the medication which-- that the switch she made didn't really help me.

Peter Kozlowski: Yeah, that almost proved was my point a little bit too, they tried changing your regimen based on? Yeah, and it didn't work out well for you, that doesn't mean it doesn't work out well for everybody. But that validates what I'm saying, I guess.

Melanie Avalon: Yeah, so, another hormone-- because you have the seven most common impactful hormones that you talk about in the book, and one of the sections is cortisol, I know there is this question that haunts so many people about adrenal fatigue and is adrenal fatigue real. And you have your own perspective on adrenal fatigue? So, I would love to hear your thoughts on this mysterious adrenal fatigue.

Peter Kozlowski: Yeah. So, the Academy of Endocrinology, I don't know exactly what it's called, the group of endocrinologists basically have come out flat out and said like adrenal fatigue is not real. It's not a diagnosis, it's not something to test for, it's not real. Just so people know that aren't that familiar with it. That's what a traditional medicine doc-- traditional doctor is going to need. That's the viewpoint that will be coming from is that adrenal fatigue is not a real condition. The extreme position of functional medicine doctors that most people have severe adrenal fatigue and that's the primary thing that a lot of people that have gone to functional medicine practitioners have been told that they have adrenal fatigue and to take these supplements and it'll make everything better. I guess I fall somewhere in between in regards to-- I definitely think adrenal fatigue is a very real thing. I also think that basically every one of us has it. So, I think that everybody does have it.

But most people when they think of adrenal fatigue, they think of a flat cortisol curve. So, the best way to diagnose adrenal fatigue in my opinion is saliva cortisol testing and saliva cortisol testing basically means that you spit into a tube four times throughout the day, 7 AM, 11 AM, 3 PM, and 10 PM roughly. And for all of us, our cortisol starts the highest after waking up, and then it goes down in the middle of the day pretty rapidly, and then it smooths out or balances out the rest of the day, it consistently goes down until you go to bed, and then it pops back up in the morning. When most people who have read about adrenal fatigue or think they have it, they assume that their cortisol lines are going to be flat. So, in a "normal test," the cortisol curve would follow a bell curve starting high and going down. What most people think of when they think of adrenal fatigue, the lines would be totally flat, basically you're not making cortisol anymore. People think that their adrenal glands just completely have given up.

So, that's where I completely agree adrenal fatigue is a very, very, very real thing, but it's not as severe on labs as people think it is. So, some people argue there are three stages of adrenal fatigue. Some people argue there are four. To me, stage 1 would basically be is like you have 1 or 2 elevated or depressed cortisol levels. Stage 2 would be that you have a few of them imbalanced whether they're high or low. So, I personally would diagnose adrenal fatigue even if all your cortisol readings are high. So, that sounds weird, your cortisol is high, but I'm saying you have adrenal fatigue. To me, it just means that you're really activating your adrenal glands. So, they're going to be getting tired and you can't live your whole life with your cortisol being through the roof from morning to night. So, to me technically that's a form of maybe a better term for it is adrenal imbalance. Some people label it as stage 1 adrenal fatigue, but basically everybody-- the majority of people-- I don't know that it's not everybody, but the majority of people that I test for salivary cortisol are coming back imbalanced to some degree. So, that I guess is a little bit of my opinion on it. I think it's very, very real. And so, actually before I finish, the other thing that a salivary cortisol test looks at is DHEA levels and DHEA is a precursor to making androgens like estradiol, estrogen, progesterone, testosterone. We have one building block for our hormones and that is cholesterol. We turn cholesterol into cortisol, we turn it into DHEA, which then eventually becomes estradiol or testosterone, or progesterone, etc. So, we have what we say is one substrate that you have a limited amount of cholesterol to make all these different hormones.

But since there's a limited amount, if you're under chronic stress, the body will choose to make cortisol. So, it will make cortisol over all other hormones because that's your life or death. And if you're chronically stressed out, you've told your body that you're in a life-or-death situation, so you're trying to survive so you're making cortisol and you'll stop making the other hormones. So, for a man it could be that you're making less testosterone that definitely could have been part of my story. For a woman it could present as estrogen dominance, So, you're not making enough progesterone. So, on a saliva cortisol test, they also will give you the level of DHEA. And to me how I differentiate somebody who's under acute stress versus chronic stress, is either one of those people are going to have elevated cortisols. But then what I want to look at to determine whether it's acute or chronic is the DHEA levels. And if the DHEA levels are low that to me suggests that it's more chronic and they specifically term that cortisol steal and there are different reasons for stress. But because of chronic stress, cortisol is stealing away your ability to make other hormones.

So, I love adrenal gland testing for people that have read my first book, they know how passionate I am about mental, emotional, and spiritual health. I like to call the adrenal gland test my version of a stress test. So, your cardiologist or the emergency room uses a cardiac stress test to find out how your heart is doing. I use adrenal gland testing to see how well are you managing your mental, emotional, and spiritual health. So, I very, very, very much believe that adrenal fatigue is a thing but for most people it doesn't hit that last stage. So, that last stage would present as low DHEA and basically flat cortisol curves, where the-- Anybody that's seen an adrenal test would know what I'm talking about is that just the cortisol lines would be flat, So, that would be the last stage. And to me, that would be true, true adrenal fatigue where you're not making cortisol, the DHEA is low, and your adrenal glands are literally shot. I've done a lot of adrenal gland tests over the years, and I've only seen a true, true, true adrenal fatigue once and it was at an Environmental Medicine Clinic in Martha's Vineyard, where somebody was very, very toxic, environmentally toxic. So, their lines were flat and I've never seen it again. So, to me, people fall either between stage 1 and stage 2 of adrenal fatigue.

Melanie Avalon: You literally just answered my question. I was fascinated because you mentioned in the book that you've only seen it once. So, I was wondering what was going on with that person.

Peter Kozlowski: Toxins.

Melanie Avalon: One thing about the adrenals, I find it so fascinating, because like you said, on the one hand you have the official stance that adrenal fatigue is not real. Then you have really especially in the functional world, people thinking everything is adrenal fatigue and everybody's adrenals are just not working. Actually, the episode that's airing this week right now is with Ari Whitten, and he mentions in his book-- he talks about cortisol levels and how the actual data on cortisol levels, most people don't get a deficit of cortisol even if they're severely fatigued. It's not usually the case that you mentioned where there's literally not cortisol going on. So, I definitely think there's a reframe that needs to happen here for a lot of people.

Peter Kozlowski: Yeah, I think that the hard part is just that people read about adrenal fatigue, they have symptoms of it, so they just assume that their adrenal glands are totally shot and they're not- our bodies are very, very, very, very resilient. Despite how much we try to screw up our bodies, they are very- they fight hard to keep you going. So, yeah, that's definitely the word that I'm trying to get out there about adrenal fatigue is a- I do believe it's very real. But for the most part, it's not as bad as you can be made to believe. And the solution is really and this is my opinion is not supplements. One of the first patients I ever saw on my own, came to me, they had been working with a chiropractor, and the chiropractor had diagnosed them with adrenal fatigue, and sold them $3,000 worth of supplements, and said "Okay, you have adrenal fatigue and here buy all these supplements," I hate that also because I hate things that give functional medicine a bad name. There are very few things that supplements are the answer for especially $3,000 worth of them. It's a multifaceted approach. There are a lot of things that need to happen. To me, the real treatment for adrenal fatigue is to dig into what traumas I have. What stress do I have? What insecurities do I have? Etc, I think if you dig into that stuff, you can heal the adrenal glands without a single supplement.

Melanie Avalon: Yeah, I think that is so, so important because people really just go down the supplement approach to try and fix things rather than the holistic approach. So, now I think listeners, you can understand, we've just barely scratched the surface on everything that's in this book, and Get the Func Out about the hormones. So, you can learn so, so much about all of them and what may be going on in your body, so definitely, definitely check it out. Even you have a section on the pancreas and insulin for example and even a paradigm shift there you talk about how most people think about the pancreas, the main thing is insulin with food release, but really the majority of production for the pancreas is with pancreatic enzymes. So, just a lot of paradigm shifts there. So, stepping back a little bit . We went deep into these hormones and how they get off and imbalanced and what's happening. But so, chicken or egg, hormonal imbalances, are they causing health issues? Or is there underlying health issues that cause the hormonal imbalances? A huge part portion of the book is the role of toxins in our environment and mold and heavy metals. Is that always the root cause of hormonal imbalances? That was like some big vague questions. But yes, toxic burden? What is happening with toxic burden today with people?

Peter Kozlowski: Yeah, I would never say it's all just one thing. So, I would never say it's just toxins that are causing hormonal imbalances. But I do believe that the main reason we are seeing low testosterone in a 32-year-old like me when I was diagnosed or estrogen dominance in 16-year-olds or one of the things I get into is how early puberty is happening for boys and girls and I make the argument in the book that the main reason it's happening or that it's increasing at such a rapid rate is the rapid rate of toxins that are being added to our environment. Year after year, we're adding more stuff to our day-to-day lives and when toxins are present. So, I guess, to start with the basics, when we talk about toxins, there're things that are basically not naturally in our body. So, toxins can be in your food, toxins can be in the air, they could be in water. In the introduction of the book, I go through an example of my wife's routine of going to bed to waking up to all the most basic things that you would never think of where you would be being exposed to toxins. For example, I quote some studies on memory foam mattresses. So, they found over 80 different chemicals or toxins in memory foam mattresses and I'll never forget I bought a memory foam mattress. Then I think the next day I went to California for a conference on environmental medicine and I think the first lecture was about memory foam mattresses. And I was just I can't believe I have to throw this thing out now. Because I don't think about it. if I'm buying a mattress, I'm not thinking about how many toxins are in it and I'm not going to think about that until I find out well "Hey, wait a minute, why do I have low testosterone at such a young age? Well, why would it be happening? Well, maybe it's the 80 chemicals that I'm breathing while I'm sleeping when my immune system should be restoring and my liver should be regenerating and restoring and getting rid of all the crap that I was exposed to all day." Instead, I'm just breathing in all this new stuff.

So, there are any kind of substances that are foreign to our body, they've been putting more of them out there to make our lives easier, to make plastic, to make bottles to drink water out of, our furniture is covered in flame retardant. So, if there's a fire, your whole house doesn't burn down as fast. Sunscreen, I don't have a study to prove this but ever since I was younger started getting into functional medicine, I've always thought that one of the main reason skin cancer is so common it could have something to do with all the chemicals and toxins in sunscreen. I think the most shocking thing is for women with hair, beauty, makeup products. I've read different studies, but pretty consistently the average woman is exposed to 100 different chemicals before she's done getting ready for the day, that's not good. I mean at least we don't know if it's good because they never studied it. They never we're like "Okay, we're going to release a few trillion different chemicals into our environment but first let's study it for 40 years to see how humans are going to respond to it." It's like well, no, this makes your phone faster, this makes your food quicker, so let's do it and then we'll find out, we'll deal with the consequences later. 

So, there's been this rapid increase in all the stuff they're putting in our environment for 40, 50 years, this crazy chart that I wasn't allowed to put in the book. But there's a chart of comparing the use of glyphosate to the rates of autism. And basically, as you see the glyphosate use, which glyphosate is the main component of Roundup, which is one of the most famous toxins, but you see the rate of autism in the 1980s was one in a few 1000 to now it's less than one in 40 children. And obviously they won't let you do causation studies, I've met scientists from around the world that have some pretty crazy stories that we're trying to do studies on things like glyphosate and how their careers were attacked, or how they were basically taken out by the powers that be for doing that research. So, all we really have are correlation studies? Okay, 50 years ago, we had way fewer toxins, our rate of autism was way less. Now, the world is way more toxic and it's not just autism. And I'm not at all saying that just glyphosate or Roundup causes autism just stating correlation studies. But to me, it's during that time, it's all the different toxins have increased and our bodies have a limited capacity of detoxing. So, we can all get rid of a certain number of things a day. Let's say my body's ability is 100, I can get rid of 100 toxins a day. Well, in 1970, I would have been exposed to 10, there's no problem, 2022, I'm exposed to 1000 toxins every day, well, 900 are going to get built up.

Those could build for your entire life. And eventually the hard part with it is if you're being exposed to too much lead or too much mercury or too much mold. For the most part, you're not going to get symptoms, you're not going to know it, you're not going to feel it, you're not going to or the symptoms that you have, you'd never guessed that they were from some kind of toxin exposure. Usually, people don't know until it's too late, until they present with Hashimoto's or with lupus or with low testosterone, or with type 2 diabetes or type 1 diabetes that the toxins have already destroyed the organs and now it's being diagnosed as a disease. So, toxins I think are the biggest thing honestly that's being missed in medicine. I have my experience from working with patients of detoxing people. And I go into some patient studies and things that I've seen happen through getting the toxins out and it's pretty incredible. How big of a role they're playing. And just in general, just some more basics is basically toxins try to get into our body. They try to cross through our skin, they try to cross through our gut, and if you have a leaky gut, they're more likely to get in. They also try to get in through our lungs and your lungs make secretions that try to keep things out. You have cilia that try to push this stuff out. But again, due to the amount of stuff we're being exposed to, the toxins can cross across the skin, across the gut, through the lungs, and into the body.

Luckily for us, the first place that those toxins are sent are to your liver. And your liver is your most famous detox organ. Your liver what it does is this process called phase 1 and phase 2 of detox and what it does to those toxins is make them water soluble by nature, in nature those toxins are fat soluble. So, if your liver doesn't do anything, fat-soluble means that once they get in, they will stay there, they will get stored. So, we're very lucky that our bodies are designed that the first place the body takes those toxins is to the liver to break them down.

So, the liver breaks them down, they're water soluble and then you can pee, poop, and sweat them out. That's how you get them out. If you overwhelm the liver by just too many toxins where it can't keep up or all those detox processes that happen in the liver, you need vitamins and minerals for those processes to function. So, if your diet sucks, if you don't get enough nutrition, you can impair your body's ability to detox or if you just have too many toxins, your body can't keep up. So, they're going to get stored and they're going to build and they're going to build and eventually you're going to present at a doctor's office with some kind of disease that you didn't want to get when it could have been prevented just by testing. So, me personally I would start testing for toxins from the age of like 3. I think instead of most of the useless tests that your traditional doctor orders on your yearly visit, the number one test that I would do are your levels of heavy metals, your levels of glyphosate, the levels of mold, if you've been exposed to mold, I think that would be true preventative medicine in my opinion. So, another huge problem. I mean regular medicine has a lot of problems with testing for toxins or even acknowledging that toxins play a role in disease, the level of elevation doesn't correlate with symptoms. So, what that means is let's use-- we're going to use just totally arbitrary numbers.

But let's say lead, we're testing your levels of lead. And let's say normal is less than 2 and you test positive for 10 and another person tests positive for 50 and another person with 100. The person that had the level of 100 might feel totally fine. The person with a level of 10 might have autoimmune disease. And so that gets into again that we're all individuals and these toxins affect us differently. And regular medicine, they really want the standard okay, well, if your level was 10 then you get Hashimoto's. If your level was 50, then you get lupus, if it's 100, then you get diabetes it, unfortunately, doesn't-- or fortunately it doesn't work that when it comes to toxins. We all respond differently to them and somebody with a low level can feel, can have symptoms than somebody with much higher levels. So, that makes it a little difficult. I think.

Melanie Avalon: I am so passionate about all this. So, I'm just thrilled to hear you talk about this. And I was thinking about it. There's only one brand that I talk about on every single episode of every single podcast for both of my shows and its beauty counter and it's because they're addressing the skincare and makeup issue by creating products that are free of endocrine disruptors. Because if you-

Peter Kozlowski: Nice.

Melanie Avalon: Yeah, I'm obsessed with them, their founder of the company. She founded it because it was either her sister or her friend or somebody had fertility issues and a miscarriage. And she started doing research on toxins and their connection to fertility and realize that how big of an issue it was and how skincare and makeup, especially in the US, is one of the largest sources of exposure especially for women. It's so upsetting, in Europe, how they've banned over 1000 compounds from skincare and makeup in the US they've banned 11, which is ridiculous.

Peter Kozlowski: I think the craziest thing in writing my book was that basically, the FDA regulates all types of things or the government regulates all types of things. But basically, like beauty companies that are making skincare beauty products are basically told to regulate themselves. I mean it's not funny, but it's just insane.

Melanie Avalon: And the FDA has-- they have no power to call products off the shelves, which we've seen happen. There have been moments where I remember something happen with Claire's, like there'll be moments where they'll realize that there's some really toxic product, but nothing is done. The FDA literally can't pull products off the shelves and the I don't think they- if you go to the- sorry this makes me so upset. If you go to the government website, I think it's on the FDA, they have a section on testing basically for the safety of these products and why they don't test or regulate, and I just have to put a link in the show notes because it's something to the effect of-- I just have to find it-- it's basically they just say they don't really have time to sort of-- basically they're like well we don't really know it's a problem and we don't really have time to test this.

Peter Kozlowski: And we trust the companies that are making tons of money that are probably funding us to test it and that they're going to put safe products out there and not worry about products that are going to make them the most money. We're just going to trust that they care about people's health and safety.

Melanie Avalon: Yeah, it's a major issue. And you're talking about how the tests that are conducted for safety. And one of the issues there is that. So, if they do safety tests, they typically test the individual isolated one compound, they'll do it in vivo, super high amount, on a cell. It's not at all reflective of how, or they probably do low amounts, too. But it's not all reflective of how we're exposed to these chemicals daily, building up in our bloodstream, and it doesn't account for the cocktail effect, which is where chemicals interact with each other and become more toxic and it's just frustrating. This is my soapbox.

Peter Kozlowski: Yeah, I think that's probably if I could just get people to understand one thing about these toxins is, it's not just one, so it's not going to be just some chemical in your lipstick. It's the combination of all this stuff. I think the best example is glyphosate go from Roundup and that's one of the most famous toxins, but the main way that Monsanto got around saying glyphosate was safe at these levels, was by testing it alone. And Roundup is not just glyphosate, there is a ton of different chemicals in there and researchers that I've met now again from around the world, we're trying to scream like stop testing, stop doing these studies on just the glyphosate, we'll do it on the Roundup. And that's what our bodies have become as this mixture of Roundup, but we're throwing heavy metals, and we're throwing all the herbicides and insecticides, the pesticides, all this stuff, though organophosphates, the flame retardants, that stuff, all of that stuff is mixing, and it's sitting in your thyroid, and it's sitting in my testes and in your ovaries and accumulating in your nervous system. And then it's like well, why are so many people getting diagnosed with MS? Well, no, it's not glyphosate. It's not just lead. And they're getting away with this and just saying like well it's not lead specifically doesn't cause MS. And these are just random examples. But no, I'm not saying it's one thing either, I'm saying it's a combination of all these things that for the wrong person, for the unlucky person there's a reason that our immune systems are identifying our thyroid as an invader. Because these glands are getting full of all this junk and the body wants to help you, the body wants to get rid of that. So, I just love that's, that's the most important point. And it's not just one of these things. It's all of them in combination, this cocktail that we're getting from morning to night and even all night that some of our bodies just can't keep up with.

Melanie Avalon: And your mattress story, it's things we don't even think of. And I just have to-- I experienced a really intense toxic burden particularly with heavy metals, my blood mercury was over 30, which I interviewed Chris Shade at Quicksilver Scientific and he even worked with Tony Robbins with his heavy metal toxicity and when I told him that he was "Oh, you'd be on my wall of fame." I was like okay, it was bad. I again thought I was dying but I'm grateful for it because it really tuned me into the effect that toxins have and it really made me go into detox mode, but I remember I was trying to find a mattress and so legally mattresses have to have flame retardants. It is so hard to find a mattress with a natural flame retardant and I finally found one which I adore. I love it. It's called My Green Mattress I think but it's really funny because they use some sort of goat hair as the flame retardant that legally qualifies and when you first get it and they say this in interviews like it smells goats, and literally like the first night I was dreaming about-- I thought I was in a barn but it goes away after a few days, totally worth it.

But in any case, so I love how you talked about-- and I love you have a really extensive list in the book of all of these potential toxins, you're talking about with testing for toxins. I mean, clearly, we're not testing for all of these things that are in skincare and makeup because I highly doubt there are tests that are going to look at all of these compounds. But there are things you said with molds and mercury. So, when you find somebody with a high toxic burden, how do you go about that? With the heavy metals, I did do a lot of pharmaceutical chelation, which that's another soapbox for me now, because I think if I could go back I, I might have still done it because of how bad it was. But I would not have done it as aggressively and I would have paid big attention to remineralization.

Peter Kozlowski: Did you do IV or oral or?

Melanie Avalon: I did IV and I did a lot of pushes. So, I primarily did DMPS because I found-- I was reading all the studies on DMSA, EDTA, and DMPS. And trying to see which one pulled out the most Mercury with the least amount of collateral damage and it seemed to be DMPS. But I did all of them and I think I pulled out a lot of nutrients out of my body because I was so desperate. I was I got to get this mercury out especially with that over 30 blood tests.

Peter Kozlowski: Yeah, that's really high level.

Melanie Avalon: Yeah, so, how do you approach testing and chelation for heavy metals with your patients? And then also it's a two-part question, also things like mold.

Peter Kozlowski: Yeah, I would just comment, we can test some of those other toxins like the flame retardants, like some of the stuff that's in the bath and beauty products. It is a lab called the Great Plains Lab, which is one of my favorite labs to use and we call it the non-metal toxin profile.

Melanie Avalon: I got to get this.

Peter Kozlowski: Yeah, so you can test obviously there, I mean, I will never be able to keep up with the amount of stuff being added. But you can test some of it for sure. Those type of toxins are hard to catch even on that test, they seem to get out of our bodies faster. So, I don't see that many positive results despite how much we're being exposed. But heavy metals are the number one toxin that I would start with for anybody, I don't use blood testing, you have to have very significant exposure, blood, you can test in the stool, you can test hair, I use urine personally because that's where we get rid of the toxins. For somebody that you're suspecting like an acute toxicity, I would definitely do blood testing. But people that are coming to me are not ones with an acute toxicity. If they are they should be going to the emergency room.

So, I use pre- and post-chelation testing and what that means is that I get into it very deep in the book and how to do it. And that's another thing that patients could probably explain their practitioners how to do it after reading the book, but you do two tests on the same day, you wake up, you pee in a cup, and that's your pretest that measures your active exposure. Another probably most important thing that people should know when you're talking about toxins. Really the only thing that matters in detox, the first step, the last step, and the most important step is to stop exposure. If you don't stop exposure, you're never going to get rid of it. So, a pretest, it tells me whether or not someone's being actively exposed. An example I've seen a few times now is people eating sushi three times a week or more are actually testing positive for mercury on a pretest, which is crazy. The pretest measures the active exposure, and then what we really care about is how much is built up in your body. So, that's where I usually- the overwhelming majority, the time I use DMSA personally, and so, we give a dose of DMSA with 30 milligrams per kilogram and I give you that, how to calculate that in the book. That is something you would need a prescription for, so you can go to a supplement store or something and buy DMSA, it is a prescription. So, we calculate your dose, you take this medicine, and then you get this big orange jug and you collect your urine for six hours after taking the chelating medicine.

Melanie Avalon: I've done it so many times, like picturing the jug.

Peter Kozlowski: Yeah, so, in that jug, you're collecting the six hours of urine and what's happening is whatever chelating agent you used is pulling what's stored in your body out. And your post that's called your post-test, your post-test should look exactly like your pretest. The amount that you're excreting just at baseline should be the same as the amount that's stored. I very, very rarely see that. I mean most people do test positive, question is usually just how high. So, that's absolutely my preferred test, and really the only test that I'm personally doing for heavy metal toxicity. If someone tests positive, I prefer chelation therapy. So, I've taken a lot of people now through chelation therapy, I guess the main difference with what you did is I personally do oral chelation, So, I don't do IV, but I could definitely see why somebody would want to do IV if they were testing that high on blood testing. The main reason I do it is just a lighter form than the IV. The biggest side effect of chelating medicines is you mentioned that they don't just pull out the toxins, they can also pull out some vitamins and minerals. So, the biggest risk of chelation is that you could really deplete someone nutritionally if you don't do it properly. What I do is I put people on a regimen for a month of boosting all the vitamins and minerals that are needed for detox. So, I will load you up for a month and then chelate for four days and replenish for 10 days. Chelate for 4, replenish for 10. And I have my patients just cycling that 4 days on 10 days replenishing, 4 days on 10 days replenishing, So, we're boosting you for an entire month before we start and then we're replenishing you more than twice as long as we're depleting you.

Yeah, a lot of people I work with they don't want to take medications, they don't care how high their metals are. So, one of the things that I'm offering people more is called modified citrus pectin powder, I talk about it in the book. Pectin powder comes from citrus fruit peels. The word modified means that they have to modify that pectin powder in order to get it to cross your gut barrier otherwise you would just poop it out. But through the modification that they do it gets into your blood and then it works as a chelating medicine or chelating agent. That route is slower and chelation at itself takes a long time. For somebody with a low positive level it usually takes seven months. For some of the higher levels I've seen, it can take a couple of years doing it oral. In my experience, the pectin powder doesn't work as quickly and it's already a slow process. The thing I love about chelation is it is the only thing that I do that's 100% effective. It will work if you just follow-- if you just take the right stuff on the right days. So, that makes it easier right, then a lot of the stuff I do with treating someone's gut or etc. they are mold, you have to change all these things, these lifestyle things. With chelation, it really is just you got to remember what to take on what days. I think probably another hugely important point, I don't know what your experience has been, but in my patients, I don't see people get to a level of zero and that can be very frustrating for a lot of my patients, it's like they want to get their level all the way down to zero. I was an economics major in college and there's this law of diminishing returns that eventually too much of something, stops doing good and chelation in my experience follows that law of diminishing returns and so we're able to get people dramatically lower, but I've never seen anyone go to zero. So, in just a rough numbers analogy, lead normal less than 2. If you're over 10 or higher on a post-chelation test, I will probably recommend chelation with a goal of getting you somewhere between 3 to 5.

Ideally, it would be lower but that's just been my experience and I've had some of my patients take it to the extreme and I always think of a guy that found a rectal chelation program and so when I couldn't get him all the way down to zero he tried rectal chelation and it also didn't get them to zero and I just personally-- I don't know if there are doctors getting people down to zero, I haven't seen it, but I have seen dramatic changes, the patient's story that I go through in the book is I had a guy who was a truck driver who was on three blood pressure medications. And that's usually when regular medicine is crap, we don't know what to do, they're already on three there, you're maxed out. He had huge levels of lead and over the course of a year, we got them basically down to 3 let's say. And he got off of all three of his meds. He never told his cardiologist what he was doing but the cardiologist kept reducing his meds and was very proud that they were getting off the meds, I think and the patient believes that it probably was the chelation that got him off of the blood pressure meds.

Melanie Avalon: My experience with it, it's interesting because I know, you're saying how a lot of patients don't want to go the pharmaceutical route and I'm usually not about the pharmaceuticals, but I was like so in a dire mode, I was I'm just getting this out or doing whatever I can do and I was working with a doctor but it was more of a clinic-type situation, not the same as those hormone places that we're talking about but kind of I met with the doctor once, and then it was like I could do whatever I wanted. So, I just kept doing it. I just kept coming and getting IVs and getting pushes and that's why I think I went a little bit too intense. But I did know-- I knew I would never get to zero and interestingly the more I did it, especially after I started pulling out a lot of the mercury burden, I started pulling out because you list in your book all these different heavy metals, I started pulling out uranium and these other ones that are not as common.

And I think it was just because I was diving deeper and deeper and pulling more and more out. But a huge question I have for you about the challenge test and the urine test. And this is a similar question to the thing we're talking about with testing your thyroid and whether or not you're taking medication. So, in the urine test, when you get your results in a post-challenge situation, the printout you get assuming we're talking using the same company, which I feel there's a main company that does this. It's compared to-- I know you said in theory that pre and post should technically be the same. But when they give you the printout of your post-challenge results, they compare it to the population not challenged, it's compared to pre-challenge levels. Do you think that's misleading at all? Or do you know what I'm talking about?

Peter Kozlowski: Yeah, I guess the argument, there's the "How could you compare a post-test to somebody that didn't take anything that would pull the metals out?" Basically, you're comparing a test of giving someone a medication versus not. And that's not a fair comparison. My main argument is, is that our levels should be zero, they should be. We weren't really designed to have a bunch of lead or mercury in our body, or cesium or thallium, or uranium, or whatever. So, to me a baseline, I don't really need a comparative-- that's I guess if someone chooses to be well, my level of lead is 20 and I don't care, that's fine. That's not people that are working with me. I mean, people care and so to me the only thing that matters is that the number is elevated. And just using lead, I mean, I basically use a cut-off of 10. And if we're talking about the same lab, they present your results as a bar, and it could be in the green, yellow, or red and red at least with lead is right around 10. And that's usually where I start chelation therapy. But I don't even know if that's right. I mean I will offer somebody with a level of 7 treatment because I don't think that stuff should be in our body and with the results that I've seen with people over the years and how much it can change. Things like blood pressure, autoimmune diseases or fertility, I think it's worth a shot to get it out. There are definitely arguments from the traditional side of medicine against heavy metal testing or chelation. And that's one of them that you mentioned, but my counter to that is like that's fine if you don't care if your level's 15 grade, but most people would rather not, like why take the chance, we weren't designed to have this stuff sitting in our reproductive glands or in our nervous system or in our immune cells. But it's not for everybody so you can look at it how you want to, for me, I'm usually like a last resort for people that are just desperate, they're willing to try anything and we're very lucky to have a lot have really amazing results. The funniest thing I wrote it in the book, but in one of the main articles I found the argument from traditional doctors against heavy metal testing or chelation therapy is the cost.

Usually, I mean, prices can vary a little, they vary, but roughly let's say a heavy metal test is about $140 and DMSA can be expensive and DMSA the way it works, when you're buying it or ordering it, the more of it you buy, the cheaper it is. So, usually, when somebody does need DMSA for just the test, they might be paying like 50, 60 bucks, maybe a little more. When I'm actually putting somebody on chelation therapy, the price goes down dramatically because you're buying a lot more of it. But still, at the high end of costs, you're looking at probably after everything $1,000. And so that's their argument that it's like don't ever do heavy metal testing or chelation because it's so expensive. How many things in medicine cost $1,000 like labs charge Medicare $300 for a vitamin D test, while I was writing this book, they approved this Alzheimer's drug, which most-- it was literally 50-50 but a lot of people didn't even think it should be approved, but it was and this questionable drug that may or may not help people with dementia, the original price that they gave was $58,000 a year.

And then due to backlash and seeing people getting upset, they dropped the price to 25,000 a year. And that's-- People that develop dementia can live for a few years. So, that just another thing that's infuriating-- these arguments they make scaring people like "Oh, it's going to be so expensive," What is more expensive, chelating someone and decreasing their risk for developing dementia, or not doing it and then developing dementia and then spending $30,000 on this drug $10,000 on this drug, etc., it's the argument of cost and I know for a lot of people, I mean, it's not cheap, $1,000 for treatment is not cheap. But when you look at it relatively it can literally help you prevent things like high blood pressure and dementia and all these other hormone imbalances, etc. I don't get why insurance companies wouldn't want to get behind them and be like "Hey, this is going to save us countless, countless dollars."

Melanie Avalon: Yeah, it's such a valuable point, the whole system is just-- Ah there's a lot that can be done with it and I'll just do a little PSA for listeners because I really went down the rabbit hole with the mercury and the heavy metals. And mine actually was just from eating fish, I didn't have metal fillings. I didn't have acute exposure any other way. And one of the things I don't think people really realize because you don't see mercury, you don't see it in the fish. And I was always historically eating low mercury for that reason. And then I moved temporarily to California, and I was ah-- and I started exploring the world of different fish. And I was like "Oh, it can't be that bad to have a piece of swordfish." And then when I actually went and looked at the data, if you look at the charts of the mercury ranges, so if you take a piece of swordfish that's on the higher side of mercury and compare it to a piece of tilapia that's on the lower side. It can be as much as 300 times the amount of mercury in one piece of swordfish. Eating one piece of swordfish could be 300 pieces of tilapia. So, I think people just might not realize it's a big deal. When I go to restaurants and I see these things on the menu, I'm like don't order that fish because it can really have an effect. Quick question about citrus pectin, because I was taking that then and I recently got inspired to start taking it again. I'm going to interview Wendy Myers, and she talks about it at length. Does it need to be taken on an empty stomach? Or do you take it with food at all?

Peter Kozlowski: I would say on an empty stomach but I would probably confer with someone that's using it more. I don't use it that often. I mention it because some of my patients ask about it. But I have a lot more experience with actual chelation than citrus pectin powder is something I've just started using in the last year, So, I'm not the best resource for what exactly is the best way to take it whether fasting or with food, unfortunately.

Melanie Avalon: Okay, and then one other question, you pointed this out about an experience with your patients, which I've actually seen pop up in other people's books as well. And that's what levels do you see on people who are on primarily vegetarian, for example, eating lots of fruits and vegetables? How do you see that affect people's levels?

Peter Kozlowski: So, when you're talking about the different fish, I do have a chart in the book of what's the highest mercury, what's the lowest mercury fish, so people have that if they need it. But what I've seen in people that are more vegetarian diets or vegan diets, So, the other thing I would-- sorry before I get into that challenge you on is that it probably wasn't just the fish. You might have been born with a little bit of mercury because it crosses the placenta, they found it in organic Gerber baby food just like two or three years ago.

Melanie Avalon: And my mom had fillings historically.

Peter Kozlowski: There you go. It's in the air from coal-burning plants, so then that gets into the vegetarian, vegan thing is that once it's in the air, it drops into the soil, once it's in the soil, it can get in the crops, it can get in the animals eating crops that are growing out of the soil. So, that's why-- I would really there's literally nothing in your history, even if you had never eaten fish and you had never gotten mercury fillings, I still would test your mercury levels because it's literally everywhere. So, it's the only thing-- that heavy metals are probably the only thing that I would test besides maybe your gut health, your microbiome. I wouldn't really need to hear anything in your history that would sway me like yes, this person needs to be tested or no they don't. I would test anybody. With the type of diet that somebody's followed. In my experience, it doesn't make a huge difference and another thing that people have heard of mercury and mercury toxicity is the whole dental filling thing. I've also not really seen consistency in testing people. I have people that will come back through the roof with mercury levels and they've never had mercury fillings. I have people that have had seven, eight mercury fillings and they don't test positive. So, it's really hard in my experience to really pinpoint what was it in your lifestyle that caused you to have an elevation, I really would just argue it doesn't matter what diet you're following, where you've lived, what you're drinking, not drinking, etc. I would just test anybody that's basically to me if you're alive in 2022, I would test you.

Melanie Avalon: I think that's great to point out, so, awesome. Oh, so, the vegetarians and the fruits and veggies.

Peter Kozlowski: So, what I've found-- the two toxins that I've found a lot of are cesium and thallium, specifically and people eating more vegetarian, vegan diets and I learned that from I had a seven-year-old that his parents brought him for OCD-type behaviors. The child had been on the cleanest diet I'd ever heard of in my life basically had been following an AIP diet. And I mean, I was just blown away I even asked him I was like "What if you went to your friend's birthday and they had cheeseburgers or something?" He's like "No way, I would ask for vegetables." So, but we tested him and he tested through the roof with cesium and thallium. I did some digging into it talked to the lab. And where that's coming from is fruits and vegetables. Cesium and Thallium are radioactive, basically toxic metals that are used in the oil industry. And a lot what they're doing with getting oil out of the ground, there's a lot of water leftover. And that water is being purchased by farms that are going through droughts. So, if you think about California and the West Coast and all the droughts over the years, well the way that they're able to grow their crops is they're buying water that's left over from the oil industry that's full of cesium and thallium. And probably the scariest part for a lot of your listeners and a lot of people it would be that a farm could be called organic, even if it was watering their crops with water leftover from oil fracking or oil industry. So, those are the metals that I see particularly elevated in people that are really high vegetable intake specifically.

Melanie Avalon: It speaks to your original point about how you would just test everybody because it can be a problem for anybody. You mentioned how you don't necessarily see a correlation between people symptoms and the levels that they experience. Do you see a correlation within people like once people do get their levels down, does it tend to correlate to improvement in their health?

Peter Kozlowski: Yeah.

Melanie Avalon: So, it's just between people.

Peter Kozlowski: Yeah, and it depends on what disease or symptoms we're going into and why we've started detoxing, in my first book, I wrote about a woman that came to me for infertility, she had huge levels of mold, we got them out 3 months after she tested. So, mold is something that you can get totally down to zero, 3 months after testing totally negative, she got pregnant for the first time and has a young healthy baby boy now. The mold levels are something that we can get down to zero.

Melanie Avalon: You know what's interesting, I had mold toxicity for sure. When I moved out of my apartment in LA, I realized there was black mold everywhere, behind my bed, and the walls. And I just assumed it, I had it but I never actually test. I don't think I ever tested for mold pre and post.

Peter Kozlowski: So, we don't use pre and post, we use just straight-up urine mycotoxin testing, which is just a first-morning urine sample. And some practitioners are using glutathione to stimulate mycotoxin, in a similar way that I use DMSA. For me, I've just used a regular just the first-morning urine collection that specifically measures mycotoxins and that's what I use. So, to me, I don't use an agent that brings it out. Usually, if somebody has pretty serious exposure, we catch it.

Melanie Avalon: Okay, yeah, I was meaning I never tested pre me realizing I had, and then post, but that's very good to point out too, because people probably thought that's what I meant. While we have touched on a lot. So, for listeners, you've just got to get this book because I said, this only barely scratches the surface of everything in it. And it is such a valuable resource. And especially, I think, what would be really valuable for people-- Well, before that, are you still taking new patients?

Peter Kozlowski: Yeah, yeah, definitely.

Melanie Avalon: Okay, so, you're an option, obviously, but even if people don't work with you, it's a really great resource because you list the tests, and basically what you need to be discussing with your doctor and what you need to be looking for in order to really take charge of your health.

Peter Kozlowski: What medications to use, what supplements to use, dosing of supplements, what foods to eat, how to clean up your home, how to test what you are using? So yeah, I'm really pumped for people to read it and be able to use it as something to Get the Func Out, to get the hormone balanced, and to get the toxins out.

Melanie Avalon: Any other topics from the book that you wanted to touch on?

Peter Kozlowski: No, I think we hit a lot.

Melanie Avalon: Well, this has been so, so amazing. So, I don't know if you remember this from last time. But the last question that I always ask on the show and it's really appropriate, because we didn't go into this topic. But it is something that you touch on in this book, and in your first book as well that's the overwhelming importance of mindset. So, what is something that you're grateful for?

Peter Kozlowski: I am grateful just for an opportunity to help people for being introduced to functional medicine. I would have never dreamed that this is what I would be doing. So, I'm grateful that I randomly was introduced to this, and I followed it, and I've been able to help people change their lives and to truly heal. Because going into medicine, I think that the point for most of us is that you want to help people heal and then you go through extensive brainwashing from the pharmaceutical industry. And that's not to say that people are helped by pharmaceuticals. But there's also, the joy of seeing people heal without them and to figure out why they're sick and letting them heal. So, I would say grateful for just finding functional medicine and helping people have a different way to look at their health.

Melanie Avalon: Well, thank you so much for doing that because you're really doing amazing, incredible things and I said we aired the first episode and I think it helped so many people, I got so much amazing feedback, and I'm really, really, excited for people to get their hands on this book because it's just going to further all of that. So, thank you, thank you. How can people best get the book, follow your work, work with you if they want to? What are the links for all of that?

Peter Kozlowski: I'd say my website is the best spot. doc-koz.com D-O-C-K-O-Z.com. The books are available at Barnes & Noble, Amazon, your local small bookstore can order it, they're not going to have it in stock, probably, but they can get it pretty quickly. So, I would say my website for sure is going to have links to the books and to scheduling an appointment or to getting a hold of us. That's definitely the best way. And when it comes to finding the book, Get the Func Out. It's Func with a C, and that's for functional medicine.

Melanie Avalon: Oh, that just occurred to me. Okay, that's great.

Peter Kozlowski: We have t-shirts in my practice that said, we put the Func in functional medicine.

Melanie Avalon: I love that.

Peter Kozlowski: So, that's where Func came from. So, it's F-U-N-C. Yeah, I'm just really excited to get this out there. We got a lot of awesome feedback from the first book and I think that this one's better.

Melanie Avalon: Awesome. awesome. Well, thank you so much Doc-Koz, this has been so amazing. I will look forward to your future work. Do you think you'll be writing a book three in the future?

Peter Kozlowski: I don't know. Right now, I would say no. But I also, said no after the first one and then next thing, I'd written the second one. So, for now, no, but you never know.

Melanie Avalon: Exactly, that's how it goes. Well, thank you so much. This has been a true pleasure and hopefully, we can connect again in the future.

Peter Kozlowski: Sounds great. Thank you so much for having me.

Melanie Avalon: Thanks, bye.

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