The Melanie Avalon Biohacking Podcast Episode #143 - Dr. Peter Kozlowski

TRANSCRIPT

Melanie Avalon: Hi, friends, welcome back to the show. I am so incredibly excited about the conversation that I am about to have. It is about a topic that you guys know is, I was going to say near and dear to my heart, near and dear to my gut, and near and dear to many of the audience as well. Oh, my goodness, so, I read 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. It's by Dr. Peter Kozlowski. I said it. But he goes by Dr. Koz. And friends, wow, I read this book and it pretty much touched on so many things, so many topics surrounding the gut and our overall health that I personally have experienced for years. We're talking things like SIBO, the role of mindset, food sensitivities, stress, immunity, FODMAPs, so many things. And then, it's a very comprehensive picture. It dives deep into the science, but it's also super approachable. I am just really, really excited to have today's conversation and dive deep into all of that. So, Dr. Koz, thank you so much for being here.

Peter Kozlowski: Thank you. That's the funnest, best intro I've gotten. So, I'm very honored. I'm glad you enjoyed the book and I'm definitely excited to talk about it.

Melanie Avalon: It was just a list of keywords that light me up. Not because they make me happy so much, but just things like FODMAPs, I think about all the time. And I was in the SIBO, oh, my goodness, I was in the SIBO rabbit hole, black hole for years. I'm really, really excited to talk about that, because your approach to it was very enlightening and a lot more comprehensive than most of the sources that I come across. There's just so much that we can talk about. To start things off, you are a functional medicine practitioner. Would you like to tell listeners a little bit about your personal story? I'm super curious, what made you so interested in gut health in particular and what led you to what you're doing today?

Peter Kozlowski: Yeah. If you would have told me, I'd be a functional medicine doctor, when I started medical school or even a residency, I would have laughed at your face honestly. I would have never dreamed that this is what I'd be doing. My story is, I'm a first generation American. My parents were from Poland. They were both doctors in Poland and moved to the States about a year before I was born. Medicine was always in my blood. My grandpa, my aunts, uncles, there're a lot of doctors in our family and it was something that I always wanted to do. When I was coming out of high school and going into undergrad, I would say that I didn't have my priorities set straight, I went to Arizona State University, basically, because of palm walk and all the palm trees they had there and really learned how to party there. It was during my junior year, Playboy came out with their rankings of top party schools and number one was Arizona State. I called my dad to tell him how excited I was and he just said in his Polish accent, "I wish you would have told me you were the number one study school." I tried premed, but classes were on Friday mornings and Thursday night was a big night to go out. So, I switched to a business degree, because business school was closed on Fridays. 

During my senior year, my best girlfriend got diagnosed with lupus. She went on spring break, she came back with a rash, and not feeling well, and her health deteriorated. Over the course of two months, she passed away one week after we graduated. During that time, I didn't know what I-- My parents really wanted me to go to more school, I didn't really know what I wanted to do, but during that experience, I just felt really helpless. I wanted to help her and there was nothing I could do. I was reading medical books about lupus and it seemed totally fine. It was going to be an issue that would go into remission, and she would have a long healthy life, and for whatever reasons hers accelerated faster than anybody I've ever seen in my life. That motivated me to go into medical school. I went to medical school, I got into a family practice residency. 

The one thing that maintained for me was the partying. It was very much like a work hard, play hard. When we learned about alcoholism in medical school, I answered yes to all the CAGE Questionnaires, but I thought it was funny and a joke. I never thought I had a problem with alcohol. I just really enjoyed drinking and would lose control sometimes. I tried to stop when I got into residency. As soon as I tried to stop, I knew I had a problem. I had no idea how to deal with life. Like I said, I never would have thought of myself as an alcoholic, because I had everything going for me that I didn't really have anything bad besides, I couldn't stop drinking. I ended up going to a treatment program. While I was in residency, I took a break and I went to a treatment program for six weeks. It was all professional. It was all doctors, and lawyers, and businesspeople, and I was shocked by the people that were there. It wasn't people that were under a bridge. That experience was all about the root cause. So, we never really talked about drinking, we talked about why. 

For me, I had a lot of unknown childhood trauma just from never feeling good enough from being an immigrant, from feeling like I didn't fit in. I created this story in my head that I just didn't fit in, I wasn't good enough, and so, when I found alcohol that cured all those symptoms. That was a big thing. Because when they were telling me trauma, I was like, "I don't have trauma." Yeah, our lives were difficult in the beginning, but I had everything I ever wanted. Since then, the best definition, I've learned of trauma is, trauma is anything less than nurturing. I was very unnurturing to myself. That opened me up. When I got back to residency, one of my attending doctors, Dr. Batra would-- Every time a patient was hospitalized, as family medicine residents, we do different rotations. We study cardiology, we study pediatrics, we do OB, we do outpatient, we do inpatient. We do all these different things. We're trained by different doctors, who have different styles. Every patient that we worked on with him, he would start them on a multivitamin and vitamin D. We thought it was a joke. We made fun of him, we would complain that he would waste our time to write those orders, because we as the interns were doing the scutwork of doing the orders. 

After I finished my treatment and it was in the middle of the night on a Sunday on call, I was just asked them and we were together and I was like, "Dr. Batra, why are you weird? What are you doing?" He told me, "I'm studying something called functional medicine." He explained that as root cause medicine getting at the underlying issue of why people are sick. Having been through, what I just went through it made a lot of sense to me. I signed up for an IFM conference, the AFMCP. Within the first hour, I knew that my career and my life would probably never be the same. I thought a lot of it was going to be just made up not real things that don't make sense. But it was all based in anatomy, biochemistry, physiology. I left that first week just wondering why nobody was teaching this to me during traditional medical school or residency. The other thing that happened at that conference is, I was pretty much the youngest person there in my career. I was still an intern in residency and there were cardiologists and ophthalmologists, and neurosurgeons, all these people there, that for me, I was again like, "What are you guys doing here? Why are you guys studying this?" Everybody I met was telling me like, "This is the future of medicine. This is what you should focus your career on." 

I did and I decided to get certified and trained as fast as I could as a resident. I was very aggressive in talking to other doctors and I ended up getting to leave my residency program and do away rotations with Dr. Susan Blum in New York, at Dr. Mark Hyman's clinic in Lenox, Massachusetts, and Dr. Deepak Chopra center in Carlsbad, California. I would leave, and go there for a few weeks at a time, and just follow everybody, and follow the doctors, the nurses, the receptionists, and health coaches, life coaches, and I was learning from everybody. When I finished residency, I started my own practice and that was seven years ago. So, I've been in private practice since, and practicing and loving functional medicine, but never ever would have dreamed that this is where I would end up. 

Melanie Avalon: Wow, that is such a story with so many things to touch on. That is really, really haunting and sad about your girlfriend. Have you worked with patients now who have lupus?

Peter Kozlowski: Yeah, and that are in remission off of meds.

Melanie Avalon: Wow. That's incredible. So many things to touch on. I read your book probably a few months ago and the quote about trauma is anything less than nurturing stuck with me and I forgot where I had read it. It's been popping up in my head, and I've been sharing it with people, and I was like, "Where did I read this?" And then, I was revisiting the notes to prep for our interview today, I was like, "Oh, that's where it was." So, question about that, because I really like how you did explore the role of trauma in your book and how it affects people's health today. You talk about the different types of traumas and you talk about how people often disregard it like you just mentioned. I was wondering if you could talk a little bit more about that. And also, how does it compare to stress, for example? What is the difference between trauma and stress?

Peter Kozlowski: Yeah, it's a very difficult world. I feel to fully explain the different labels. Because there're the terms like anxiety, depression, stress, trauma. There're the diagnoses like bipolar and things like that. The term that I learned from the Institute of Functional Medicine was mental, emotional, and spiritual health, the way I try to describe it. But what I've noticed over the years, it's very difficult to bring up with patients, because I can't tell you how many times people have looked at me across the desk and been like, "So, you're telling me I'm crazy." I usually say yes, but don't take it personally, because I think we're all crazy, there are those of us that are working on it and those of us that are not. To me, it's just a product of being alive in 2021. It's not easy, whether it's social media, or whether it's breaking news, or whether it's the pressures of having to respond to emails, texts, and phone calls everything immediately. This information overload that people would get-- If you start searching for answers, you can go down so many different rabbit holes. That's a great thing, because my practice wouldn't exist without the internet and people searching for issues about their health and looking for alternatives. But I've also seen the overindulgence into reading all the health articles, and blogs, and all this stuff completely kill people.

I've had two patients now in wheelchairs that there's no diagnoseable reason that besides to me just the stress that they can't let go of. I guess, I don't really care what term people put on it, whether it's trauma or stress. One of the things that I talk about is, trauma, when it is the more significant type, somebody that's been through war or a severe car accident, that is worse, but it's almost easier to deal with, because you can accept it. If you were to tell your friends like, "Hey, I have trauma, because I got in a horrific car accident." People would be like, "Oh, my-- They'd feel bad for you. Then, when I looked at people and I was like, "Hey, I have a drinking problem and it's from trauma. I'm never feeling good enough." People are just like, "Get your stuff together." So that I think-- And I've seen that in so many patients and it's basically like the more together one's life is like married, kids, financially secure, go on vacations, etc., the harder it is to accept that there's something underlying. So, I guess, I don't have a great word for it other than it's just dealing with the things that we deal with in life.

Melanie Avalon: I could not agree more. The internet rabbit holes can be so intense, especially when I got a diagnosis of SIBO, it just consumed me. I would just research for hours and hours every single night and then, I would go in these support groups on Facebook, which can be really wonderful. But it's hard to have a healthy relationship, especially when you're struggling with some health issue and you don't know exactly what it is. It's hard to have a healthy relationship with going about researching it yourself. How do you recommend that your patients, like, do you tell them, just stay off the internet or what do you recommend for people having a healthy relationship with taking agency of their health conditions, but not also getting into this mode of complete fear with self-diagnosis?

Peter Kozlowski: The advice that I try to give people is two things. One is to find a practitioner you trust, whether that's an MD, whether that's a natural path, a chiropractor, a health coach, a life coach, whoever you trust. You can honestly say, I trust what this person is going to try to help me with. Then, go to that person if you do have questions. And then, the second thing is, every time you want to get on the internet and read about something, try meditating instead and see what happens with your health. I could tell you, for people that are really, really wrapped up in it, my patients, a lot of them can't get out of it. To me, I see it as addiction. I see it like alcoholic. I couldn't stop drinking and I see it in my patients, not a lot, but in get off the internet, stop searching and just focus on your mental, emotional, and spiritual health. It was like two weeks ago I had a patient where I gave her a goal. I was like, "For the next month, don't go on anything health related." Her response, the way she was in her chair was the way that that I responded when somebody told me to stop drinking. I see that, because I've been through it for-- I think that's why I'm so sensitive to it, because I've lived it. 

It's hard. Anything that we're addicted to and I do think it's a type of addiction. It's really hard to stop that. I guess, the greatest thing that I learned about recovery is like, "I can't do it alone and everything else in my life, I've done alone, I sat down, I wrote my own book, I edited it with my publisher, I started functional medicine practice, I got through medical school." Everything in my life happens, because I work at it. But the more I tried to control recovery, the worse it got. For me, having to admit like, "Okay, I need help" was extremely difficult. It took a number of years honestly. Getting support -that's where it's hard, because you can get support from people in Facebook groups or social media groups like that, where there is positive stuff. There are people that can help, but the more support someone can have to let go of that stuff having a practitioner they can trust, I think the easier it'll be. Again, it actually to me, recovery starts with acceptance, admitting there's a problem and that was another thing that took me a very, very long time. So, just even being honest with yourself like, "Hey, I think that I'm spending too much time reading about these health issues and I don't think it's helping me." It's just like some people can drink two glasses of wine like you and feel good and not want the 10th one like I would want. It's getting that support, admitting it's an issue, those are just the first baby steps, even though, they're huge steps in making progress. 

Melanie Avalon: I don't remember, again, where I read this, but I did read at one point that, when you experience something that could potentially be seen as a traumatic event that it was the level of support you have during that event that tends to determine whether or not you get PTSD from it and I thought that was really, really interesting. Diving deeper into the gut-brain connection, so, our mental health and everything that you just talked about, how does it literally, physically on a biological level affect our gut? You talk in the book a lot about the ENS and how it relates to even, I think vagal nerve cells in our brain. Can you tell listeners a little bit about the gut-brain connection? Even if it seems it's just all in our head, it can have very real effects on our gut health.

Peter Kozlowski: Yeah, absolutely. This as another recovery thing is like, I like to keep things very simple. I think health is overcomplicated to a bit. It's obviously a very complex thing, but it helps for me, at least to keep things simple. The gut-brain connection is your vagus nerve. The way this whole system works is, is your gut, the tube that runs from the mouth to the anus is surrounded by your ENS like you mentioned, the enteric nervous system. That nervous system has somewhere between 200 and 500 million neurons in it more than like your brain does. That nervous system doesn't operate alone. It's connected to your brain by the vagus nerve. We have 12 cranial nerves, and they all have different functions, and it's always a big deal, at least through anatomy class learning all the nerves and where they run. But the vagus nerve, number 10 runs from the brain to the gut. It also goes to the heart and lungs. This is a highway that is carrying information from your brain to your gut, and then, from your gut to your brain. This nerve runs on your autonomic nervous system, which is your automatic nervous system. It's happening without you thinking about it. The autonomic nervous system is functioning without your direct conscious thought. 

It either can be in sympathetic response or parasympathetic response. Sympathetic is fight or flight. Parasympathetic is rest and digest. The analogy I give now that I live in Montana is, sympathetic is, I'm out hiking in the mountains, and there's a grizzly bear, my sympathetic nervous system is activated. The blood and energy go to my brain and muscles to survive, to escape and let's say I do escape and I'm sitting by the campfire at the end of the night having a meal that I'm relaxed, I'm in parasympathetic. The energy is going to my gut to digest food. Specifically, some of the things that happen with that sympathetic response is you shut down your stomach acid production. When you don't make stomach acid, you don't digest protein, you don't get vitamins and minerals out of your food, you don't kill off the nasty bacteria and viruses we're being exposed to. You need stomach acid. The number one way, a natural way that it gets low is through aging, 80% of people over 80. The most common way that at least from the traditional medical standpoint that it's low is medications, the seventh most prescribed drug in America is an acid blocker. There's entire like-- if you walked into your local pharmacy, there's usually an entire aisle of acid blocking drug options. 

To me, in my practice, what I see it the most is stress. When that sympathetic nervous system is activated, your body doesn't want to waste energy digesting food. That would not be a good way to survive. Our bodies are incredible at survival and figuring out the best way to do that, so, one of them is not expending energy when you're trying to escape from a wild animal. People nowadays are living as if they're running from a bear 24/7. We wake up, and we check our phone, and the first thing we do email, texts, breaking news, and right away, the mind is telling the gut like, "Okay, we don't need you today. We're in a survival day." And so, stomach acid is shut down. If your stomach acid is shut down, your pancreas is what helps digest the rest of food, fats, carbs, and whatever proteins leftover, your pancreatic enzymes need stomach acid to be activated. Your whole digestion is shot. A big key word that we talk about in functional medicine is leaky gut. But when you are stressed out, your gut becomes leakier. That's the effects on your stomach, your small intestine, and then, last part is your large intestine, which is where the microbiome should live the three to five pounds of bacteria, and you literally shut down your good bacteria, your probiotics from growing. So, I warn my patients, because the mental, emotional, spiritual part, the trauma part, whatever you want to call it is the one area that most people put up a huge red stop sign and tell me to F off and just figure out the right diet, figure out the right supplements. But I warn them. I'm like, "I can see how stressed out you are in your microbiome."

There're three specific probiotics on a stool analysis, Lactobacillus, Bifidobacterium, and Enterococcus that won't grow out on a culture when somebody's under chronic stress. There's also your gut is where the majority of your immune system is. There's a specific marker called Secretory IgA that we measure in the stool to look at the immune response. If that number is also suppressed, that the immune response is shut down, that's another marker to me in the gut that this person has been under chronic stress. Basically, your entire gut is shut down by that fight or flight response by the trauma, by the stress, or anxiety, or work issues, or relationship issues, children, whatever, that shuts down the gut. In my experience, for most of us it starts when we're kids. We start shutting down the gut due to undiagnosed trauma and that could present as disease when someone's eight years old or I have people that come into my office that they're 60 years old, and they've just been filling their bucket, and filling it. But it all started when their gut got leaky and their digestion stopped due to trauma when they were kids.

Melanie Avalon: I practice intermittent fasting and the way I do it, I do one meal a day. I just eat in the evening. I know it has a lot of physical health benefits. But I think, honestly, at least now, my favorite thing about it is that it allows me to eat every night. Eating for me is like a ritual, and it allows me to eat, and be completely disconnected from all of these stressors and things that I might have been experiencing during the day compared to when I was eating during the day and it's more hectic. I really, really appreciate that aspect of it. So, I think that's really important. I liked how you said in the book, when you first started intermittent fasting, you realized you weren't doing it enough or long enough?

Peter Kozlowski: Yeah, what I had seen, what I learned, and the majority of patients that I worked with, most of them were on a 16-hour regimen of 16 hours of fasting. I think one of the problems with fasting is that the majority of people are only doing it for weight loss. What I learnt-- I wasn't a fan of it, to be honest. I'm not really seeing results from this. I don't feel it's a very effective tool. And then, at one of our international IFM conferences annual, there's an annual conference every year that's on a different subject. A couple years ago, there was a few lectures on intermittent fasting. One of the doctors was just talking about the whole point of intermittent fasting is to get to gluconeogenesis in the liver, where you're using up stored sugar, your body turns food into energy after you eat it and it stores the excess. In case, again, because our bodies are amazing and they've figured out how to survive, they've set that up in case there's a period, where food is not available, so, your body can make energy from what it has stored. The problem with our standard American diet, the SAD diet is we've built up way too many reserves. But that process of gluconeogenesis doesn't really get going till hour number 20. I think that's why I wasn't having very much success with 16-hour fasts. Since those, it's been a couple of years. Myself, I do 24 hours twice a week, usually Mondays and Fridays. That's what I try to get my patients to do. I do it for the hormonal benefits personally and I do think for mental health like you were saying. When I finish a fast, I just feel good about myself like I accomplished something. So, I know that there's a lot of different ways that people do it and recommend it, the 24 to 36 hours, two to three times a week is what I've seen the most success in my patients.

Melanie Avalon: We get a lot of questions about fasting, obviously, on the intermittent fasting podcast and that is something I think that a lot of people experience. They're doing like a 16:8 and they might need to do just a little bit more to start experiencing the health benefits. So, going back to what you were talking about with the HCl, so, how often do you have patients use supplemental HCl and/or digestive enzymes?

Peter Kozlowski: HCl, very frequently, I don't know if I'd say probably at least, half of my patients, because I think most people are coming to me because of gut issues and it usually starts when your digestion goes wrong. I am frequently telling people to evaluate for it. A test that I wrote about in the book is the baking soda test, which I thought was hilarious when I first learned it. It sounded like a high school chemistry experiment to me and I was just like, "This can't be real." But it's actually shockingly pretty reliable. What it is, is just drinking a quarter teaspoon of baking soda into a few ounces of water and drinking on an empty stomach and your stomach should be acidic, the baking soda is basic when a base and an acid meet, it creates an explosion, which presents as gas and you should start burping. It's like making that volcano as a kid. Then, if someone does fail that test, I usually have them do it a few times, not just once. Then, I will use a HCl supplement. The majority of patients can tolerate it just fine. I give the regimen in the book of how to titrate up to figure out what your right dose is. 

Some people are on it for a few weeks, some people are on it for years. I think, to me, the greatest factor, because people are like, "Well, what am I going to be able to get off of this?" To me and the majority of people that I'm working with, the cause is the trauma or the stress. My answer is like, "Once this gets better, then your stomach acid will also improve." I don't use pancreatic enzymes as much. If I do, it's on a stool analysis. One of the results that we get is pancreatic elastase levels, which is a marker of how well your pancreas is working. I haven't seen it correlate clinically that every patient, who has a low pancreatic enzyme notice anything from a pancreatic supplement and I've had people, where even if their numbers were normal on the stool test and we're still trying different things. We'll try it and it's helpful to them. But for example, just yesterday, I had a guy, who is not tolerating the HCl and we switched him to a digestive enzyme. So, my preference is usually HCl, just because again, I see more success and results with it, but I will sometimes use pancreatic support.

Melanie Avalon: Do you do an HCl pepsin blend or just HCl? 

Peter Kozlowski: Usually, pepsin. I feel it's pretty rare to find HCl just on its own. It's frequently like pepsin and gentian root. But usually, it's a combination of things.

Melanie Avalon: You're right. It's normally always combined with pepsin. But speaking to me being the crazy rabbit hole researcher, tangent girl, I definitely went through a period, I went to isolate everything. So, I found like the HCl that was just HCl and I was like-- I don't know. It's probably, because I read something online about, I don't know, the ratio to pepsin. 

Peter Kozlowski: I have some patients. I could send your way to help find that, because I don't have found it myself.

Melanie Avalon: Oh, that HCl, only one? I can send it to you. Yeah, there was one brand. Random question. You're speaking about all these tests that you try. Do you treat more the tests, or the patient, or both, or is one more important than the other?

Peter Kozlowski: Yeah, that's a great question. I am very, very, very much treating the person. I think is a product of the information online is, I work with a lot of people who just really, really want to optimize their labs. Their whole decision making is basically like, "When my B12 level gets to 800, when my vitamin D gets to 75 or 80, then, everything will be good." Or, "When my microbiome looks perfect on a stool test, then, my issues will go away." In my experience, again, it doesn't work like that. I think a good example of that is repeat SIBO testing. A lot of patients are like, "Well, you put me on the SIBO treatment plan and what's the retesting process?" And SIBO is one of the few things that I don't recommend retesting. I don't do it unless someone really wants to do it, because there's this population of people that will still come back positive. But to me, the way I've always approached in my career is like, my answer is, I only like to order tests that are going to change our treatment plan. 

Let's say, you had SIBO, you had symptoms, we treat it, it goes away, and you're feeling great, and then, your SIBO test repeat comes back positive. I personally wouldn't put you on a treatment plan again, like, where are we going to get, what's the point? The counter of that is, if we did a treatment plan, and it's been a couple months, and you're still not better, I don't need to repeat the test to see that we need to keep treating you, we need to keep figuring this out. That's one example. Another big one is hormones. I started writing a second book and the first half of its going to be about hormones and the second half is going to be about toxins and basically, how the two are connected. Hormones is something specifically one of the most common things I work with is estrogen dominance in pre-menopausal women, when the estrogen-progesterone ratio is imbalanced. 

Again, there's certain numbers that we look for, when we test progesterone, but especially, with hormones, I really like to listen to the symptoms, because they've created these normal ranges that are based on population studies. Because my free T3 might be three and I feel great. Yours might be 3.1 and still not good enough for you. To me, I think it's really important to listen to the person, and make a decision based on a combination of the lab result, and how they're feeling.

Melanie Avalon: For listeners, SIBO, small intestine or intestinal bacterial overgrowth and I would love to dive a little bit into that. My personal experience with SIBO was, I didn't perceive having intense gut issues until I got food poisoning around 2014, I think. It was really bad. I have loose bowel movements for a week and had a colonoscopy actually that resolved the diarrhea, but the GI doc diagnosed me with SIBO. I believe I did a breath test around that time as well. Maybe we can talk about the breath testing. What's interesting, I went on rifaximin, so that's the antibiotic bits often prescribed and it supposedly targets the SIBO in the small intestine preferentially. After rifaximin, so, prior to that, I didn't experience upper GI distress after eating, but it did something to me, where ever since then, I started getting bloated after meals, I would feel food was just sitting in me, and that's when I entered the rabbit hole of doing all the things. Since then, because that was quite a few years ago, it's been an ongoing thing. Now, I pretty much follow and we can talk more about this a little bit later, but I follow a little FODMAP diet and I found the things that work for me and I don’t really-- I got exacerbated at one point, where I was like, "I'm over this. I'm not going to try to treat my SIBO anymore and stopped thinking about it in a way." I know just from the hours and hours I've spent on online forums with people, who have been diagnosed with SIBO that there is so much confusion, so much concern, so much worry, misunderstandings. You talk in your book about many reasons that it's actually often underdiagnosed today. So, that was rambling and all over the place. I guess, to start for diagnosing it, the tests like the methane, the hydrogen, I should have pulled up my test. I think my initial test, I had no hydrogen and a little bit of methane.

Peter Kozlowski: For me, I would have never treated you with rifaximin with that profile. What a SIBO test is, it's called a two-hour breath test and it's a challenge to us. It's really cool, the way they came up with this. But you drink a solution of lactulose, like a little shot of lactulose, which is a sugar and one of the favorite foods of the gut bacteria. I guess, probably, the most important thing to understand is your gut bacteria are alive, they need to eat to stay alive, they eat via an anaerobic process. That means without oxygen. When they eat, it creates gas. For a normal healthy person, if you eat a meal that's high in fiber and FODMAP foods and you get gassy, I don't think that's a bad thing. That's just a sign that your gut bacteria are eating. Maybe they're eating a little too much, but that's how they eat. That's where the concept of a breath test came from, because the first few parts of your gut do not have enough bacteria present to ferment that lactulose. Your gut, the tube starts with the mouth, then, things go through the esophagus, then, into the stomach, and then, into the small intestine, which is 20 feet long. So, that's within two hours. If you swallow something, that's how long it's passing through to get through those parts of your gut. 

For a breath test, we're measuring hydrogen and methane gases in every 20 minutes. In those two hours, you shouldn't blow out any gas, because you don't have gut bacteria present to ferment. If you start blowing out gas, the sooner it happens, the higher up the bacteria probably are. So, that's a SIBO test and it's very much a yes or no thing. It doesn't tell us what is overgrowing your small intestine. One of the ways I tried to figure that out is with the stool analysis seeing what's going on in your large intestine. We can assume that probably whatever is growing in the large intestine is also growing in the small intestine. You can either be hydrogen positive, or you could be methane positive, or you could be both. In my practice, I'd say, I don't know, it's probably 75% to 90% of people are either methane positive or both. And that's not good, because for whatever reason, the methane-positive SIBO, it just means there's a certain bacteria present that are making methane gas are more difficult to treat than somebody that is just hydrogen positive. 

Specifically, like rifaximin, I think it's a great antibiotic for somebody that's hydrogen positive. A cool thing that I learned about rifaximin is that, A, it's not absorbed into your body and then, B, is they've done studies and it's gone by the time it makes it to your large intestine. It's all used up exactly, where it's supposed to be. 99% of meds or 99.9 even are designed to be broken down by your gut and then, absorbed into your body and then, they go to your joints, or your eyes, or your ears, or whatever, but rifaximin just stays in the gut tube. I try to discourage my patients that are methane positive from using rifaximin. If we do, then, sometimes, I will add an antibiotic called neomycin that is supposed to help with the methane-producing bacteria. I have had people that works, but a lot of people, it doesn't. The second approach that I use is an herbal approach, which is a broad-based approach with using natural antibiotics. So, herbs, nutritional supplements that kill gut bacteria, I will use that for people that are methane positive. 

Melanie Avalon: I totally forgot about that. I did the neomycin with it, but yeah, I was methane positive, but not hydrogen. Because that was a long time ago and it's been a while since I've been researching it. Have they updated that test at all? Just because I know there was a lot of debate about false positives or false negatives.

Peter Kozlowski: I think one of the things they've changed over the years is, they used to put a statistic on theirs, where they would add the total of hydrogen and methane, and try to make a diagnosis off of that. But I feel that's been thrown to the side or at least I don't use that, because it's questionable about how accurate that really is. But other than that, I do feel the two-hour lactulose SIBO test is pretty reliable.

Melanie Avalon: The natural antimicrobials that you use, do you use a blend, do you find one more potent than the others? I know for me, the ones I use the most were oregano and allicin. What are your favorites?

Peter Kozlowski: That's interesting with the allicin, I try not to use that, because that comes from garlic and garlic is one of the favorite foods of gut bacteria. I've definitely seen people use it and, in the beginning, when I was treating SIBO, I used it myself, but I don't know that it was the right thing. I typically now for a number of years now, I've used a blend from a company called Biotics Research. The three products are ADP, which is oregano oil, and then, they have Dysbiocide and FC-Cidal, which are their own proprietary blends. There're probably 10 different herbs in there that they've studied. When I first started my career, I used Biocidin. I feel that's the most famous one. I've used, typically, when I'm treating just straight dysbiosis. So, an imbalance in the large intestine. I do use straight just herbs like oregano oil, berberine, caprylic acid, silver, grapefruit seed extract, those are some of the main ones. Sometimes, I'll do that with SIBO, but usually, I'm using a blend. There's also a blend from Metagenics called CandiBactin that I've seen work, but I've used the Biotics Research brands for a number of years now and we have really good success with that.

Melanie Avalon: Interesting about berberine, so, I've recently started taking berberine not for anything in the gut, but to see its effect on my blood sugar levels, especially while wearing a CGM. Interestingly, I know some people report GI distress with berberine, but I've actually found that it's had a nice effect on my gut, which I wasn't anticipating. I've kept it in for just the benefits overall with everything.

Peter Kozlowski: There might have been something imbalanced in your microbiome that it's helping with.

Melanie Avalon: How do you feel about probiotics and prebiotics for people with or without SIBO?

Peter Kozlowski: My approach is to always take patients that have SIBO off of probiotics and I don't use them to treat SIBO, because the whole point of a probiotic is to grow more bacteria in your gut. That's the last thing that we want to do when somebody has SIBO. I don't use them for SIBO. It's interesting. One of the things I've seen over the years too, is, when you're in just regular culture outside the functional medicine world and you tell someone, you have gut issues, a frequent response is like, "Eat more fiber and take a probiotic," which is the worst thing you can do for SIBO. I have had handfuls of people that have cried in my office, because they're like, "You see, you're telling me everything I've been doing for the last few years is totally backwards." Many of them, the answer is yes. I've seen a number of people that we do the SIBO tests at the first visit, and then, we follow up in three or four weeks to go over the results. And during that time, we put them on a low FODMAP diet, we stopped their probiotic, we put them on HCl, and they're all the way better, and, they're feeling amazing. They get the positive SIBO results, but I recommend them not to do any treatment, because the treatment already worked. So, that's definitely one of the things that I wanted to get out there. 

It's hard. It just anything in the functional medicine world, you can find people that have a different opinion. I have heard of people that are considered SIBO experts like putting their patients on probiotics. Things have to like make sense to me. I have to be able to conceptualize it and I can't really make sense of how a probiotic would help an overgrowth of your microbiome. I don't use them in SIBO treatment and I don't really recommend people to take them blindly without doing a stool analysis to see what's going on in there. Maybe, I could share that analogy, because that's also people are usually shocked. They're like, "You're a gut doctor, but you don't really like probiotics." I do use them for sure. If I'm treating Candida, or a bacterial dysbiosis, or just a dysbiosis due to not enough good bacteria, I'll definitely use probiotics. But the analogy that I like that is your microbiome is like your own garden and the probiotics are the plants of your garden, fiber and FODMAPs are the fertilizer of your garden. But if your garden at home, if you don't take care of it, if you spray it with weed killers, the plants will die or if you don't feed them, they will die and weeds will take over. That's what dysbiosis is and that's when you have imbalance bacteria or yeast like Candida or parasites. 

If weeds were overgrowing your garden, is your first step to go to the nursery and buy more plants? No. You have to pull the weeds out. That's essentially what you're doing by just taking a probiotic without really knowing what's going on in there or if your gut garden is full of weeds, there's not really room for that probiotic to help you out. I have an unfair advantage, because I can order stool testing on anybody I work with. The average person can order a reliable stool test without a doctor. So, that's definitely a factor in it. I get why people try it, but that's my experience with probiotics.

Melanie Avalon: Also speaking to the fiber, a question I'm haunted by and I've asked this recently to a lot of gut health experts I had on Dr. Tim Spector, who runs the ZOE program and then, last week, I was interviewing Dr. Neal Barnard. I've been asking all of them-- I'm very curious if you can actually grow certain species if you don't have them anymore. In particular with fiber, there was a really cool study that came out pretty recently, it was in Cell. I don't know if you saw it. They took people and they gave them either a high-fiber diet or they gave them a fermented foods diet to see the effect on their gut health. Did you see this? 

Peter Kozlowski: No.

Melanie Avalon: Oh, I'll send it to you. It's really, really fascinating, because what they found-- The people on the fiber diet did not increase the affirmative foods and the people on the fermented foods diet did not increase their fiber. The benefits were pretty overwhelmingly in the fermented foods group. The fiber group didn't really experience the benefits with the immune system and things that they thought that they would see. But for those who did within the fiber group, it seemed to depend on their initial gut bacteria status. So, if they had a good gut, the fiber could probably help. But if they didn't, it did not, compared to the fermented foods group where across the board, it tended to improve things. I'll send it to you.

Peter Kozlowski: That's super interesting. To me, it makes sense. The example like Dr. Mercola did where he studied his own homemade sauerkraut versus a store brand like the amounts of bacteria that are created naturally from that. I always like to use a combination of pre and probiotics. They call it like a symbiotic when you're taking the bacteria with the food for the bacteria. That's a great study and the results make sense to me for sure.

Melanie Avalon: Also, for listeners, there'll be a full transcript and links to everything in the show notes. Something else all within this world, and we've touched on it a few times now, and it's something I'm a little bit obsessed with, and that is FODMAPs. I actually-- I'll have to send you. I created an app called Food Sense Guide. I created it because when I was in the rabbit holes, [giggles] I was looking up all of these different compounds that I thought I might be reacting to. FODMAPs, lectins, glutens, oxalate, salicylates, thiols, and there were all these different lists, but there was never one comprehensive source that compared everything for foods altogether. I first made a guide. You and I are very similar. We just like do, we just go for it. We just make things. I first made a guide, and I put it online, and it was so popular. Oh, my goodness, people were just obsessed with it. I turned it into an app. I just looked it up. Right now, it's number 11 on the iTunes store for food and drink apps. It has FODMAPs. I was wondering if you could tell listeners a little bit about what FODMAPs are. I do really well on a low FODMAP diet and one of the questions that haunts me and will probably haunt me as long as I'm doing this is, is it okay to perpetually exist in a diet world of low FODMAP foods? So, what are FODMAPs?

Peter Kozlowski: Do you want my honest answer to your question? [laughs] 

Melanie Avalon: I do. [giggles] 

Peter Kozlowski: I don't think it's a good long-term diet.

Melanie Avalon: I thought you're going to say that. Yeah.

Peter Kozlowski: Yeah. Because at the end of the day, I'm a gut microbiome person. Starving the gut microbiome for too long of a time, I don't think is a good thing. I think one thing, though, that I very, very much believe and I've learned from my patients is, not to assume that everybody's going to respond the same way. My best friend is a raw vegan. I tried that. I couldn't really last more than a day. I've worked with people that are carnivores, or keto, or pescetarian, or all these different diets. Different things work for different people. I don't discount that. If you were coming to me and you were telling me like, "The only way I feel good is on this low FODMAP diet." I'd probably tell you to keep going with it, because is it helping if you are trying to feed your microbiome, but you don't feel good? I use it as a very short-term diet. I like to just implement it typically, while someone we're treating their SIBO and then, we stop it, and we start reintroducing FODMAPs as soon as we can. 

My experience with working with people over the years is that, usually, every patient is a little bit different at the beginning of treatment and at the end of treatment in regards to what foods do they react to. You'll meet SIBO patients that can eat like a pile of garlic and feel fine. And then, you'll meet people that can look at garlic and get sick. It's very different is what I've seen over the years. The symptoms are very different, the tolerance of foods is very different, but the general principle behind it is to starve those bacteria, because like we said earlier, if they don't eat, they die and that's a good thing when you have SIBO, you want them to die. So, I'm more of a proponent of a short-term, low-FODMAP diet, but more so doing what makes you feel good.

Melanie Avalon: The Part 2 project I always want to do, but I don't know if it would be speaking to over diagnosing and getting too granular with things. They don't ever really often separate out. For listeners, FODMAP stands for-- Oh goodness. Every letter stands for a different compound. They're normally all just lumped together as FODMAPs. Is there any benefit or does it help at all to isolate the type of FODMAP that you will have problem with or do they all go together?

Peter Kozlowski: It's a mouthful, its fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. I guess, I don't go that deep into figuring out exactly what group people are reacting to. When usually, so, let's say, someone's doing an herbal treatment with me, which is typically nine weeks, I tell them to start reintroducing foods as soon as they're feeling better. In some people that could be after a week and some people it takes longer than the nine weeks. And usually, what people find is, they'll find a food or two that just doesn't work for them. The specific foods are to me very individualized. I don't know if it matters so much on the exact group, maybe it does. But usually, in my experience, when we get rid of the SIBO, usually people can tolerate most of those foods, again.

Melanie Avalon: Okay, gotcha. It's so interesting how individual it is. Speaking to the garlic, for example, that doesn't bother me at all, besides the fact that it makes me smell like garlic, which is so sad, because I love it. But other things will just like, I can't even touch like artichokes, for example.

Peter Kozlowski: An interesting thing that I've seen now over the years is, having worked with a lot of people with SIBO and there're certain people, not many that just don't get better, can't get better, or they'll follow this pattern of, they get better, and then, they get worse, and then, they get better and worse. We're cycling this and we're just focusing on the SIBO. But what I find a lot of times in those type of people is either a mold mycotoxin issue or a heavy metal buildup. Some kind of toxicity, which to me like a chronic untreated trauma is another form of toxicity. So, that's something that if it's been a couple of runs and we're still just spinning our wheels, we're kind of getting better, we don't, I like to take a deep dive into toxins and frequently, we find something there. 

Melanie Avalon: Yes. When I first got the SIBO diagnosis, the apartment I was living in. When I moved out of it, I realized that there was black mold everywhere behind my bed. And then, I got tested shortly thereafter for heavy metals and my blood Mercury was over 30, which is not good. So, I was like, "Oh, okay." There was a lot of things going on. It's really important, I think, for the comprehensive picture. Not the same thing as FODMAPs, but also a dietary approach that people can do, and that you talk about, and you also talk about how to decide which one to do, an elimination diet. How do you handle elimination diets with your patients?

Peter Kozlowski: That's usually the overwhelming majority of the time. The first step for somebody when they start functional medicine is identifying food sensitivities and that's the whole point of an elimination diet. It is a diagnostic test. It is not like a weight loss diet or anything else like that. It is strictly a test to see what foods you are reacting to. When you react to food, your body has three main responses. You can have a food allergy, you can have celiac disease, and you can have a sensitivity. They're all caused by different antibodies. Allergies are due to IgE antibodies, celiac is IgA antibodies, and food sensitivities is IgG antibodies. I always say that allergies and celiac are really easy to work with, because there's good testing. If we're curious, if you have any of those conditions, you get blood drawn, you can do skin testing, you can get a biopsy of your colon, and we can diagnose those conditions really easily. Those types of reactions also happen very quickly. If there's a child allergic to peanuts and they have peanuts, they can go into anaphylaxis very quickly. 

Then, another big thing is that the traditional medical community accepts those diagnosis. They get behind that, whereas sensitivities as the overwhelming majority of what I work with and they are caused by IgG antibodies, which are your chronic antibodies. They are delayed hours to days. What that means is, let's say, I'm sensitive to gluten, and I have a bagel every day for breakfast, and I feel totally fine. I get through my morning and I feel great. But I'm dealing with a chronic eczema condition and I get migraines. I'm having this bagel every day and I have no clue the bagel's making me sick, because the reaction's not happening after I eat the food. And then, I go to my doctor, I get put on pills for the eczema, and creams, and migraine meds, and I keep eating the bagel, and the issues keep coming back, and then, the issues can change. They can go to different areas. Inflammation can spread to other areas. Because of it, their reaction is delayed, in my opinion, there's not reliable food sensitivity testing. There're a lot of companies out there that offer it. I've never ordered one of those in my career. There are IgG food panels that can-- they test over 200 foods. I've had a lot of patients come in with those results that they did prior to meeting me. There'll be foods on there that say they're sensitive to that the people have never eaten their entire life. It's typically just a log of what you've been eating for the last few months. 

To me, the diagnostic way to do it is a 21-day elimination with a food-by-food reintroduction. You cutout the biggest offending foods and then, you add them back in one by one using a tracking journal. My biggest question that I had when I learned about an elimination diet was, why is it 21 days? That sounds a very made-up number to me. But it's based on science. Everything in your body has a half-life. If you drink alcohol, if you take prescription meds, your hormones, toxins, everything has a clearance time. That's called its half-life. The half-life of IgG antibodies is about 21 days. If I had that bagel and I have hundred antibodies right now, if I completely avoided gluten for 21 days, my immune response will cut in half to 50. I eat it again on day 22 and the immune system has a great memory. If it sees the glutens back, it'll attack and I'll get symptoms. Systematically, you go through food-by-food and figure out what you're reacting to. The top foods are gluten, dairy, soy, corn, eggs, sugar. Those are my top six. Other foods, we cut out are beef, chocolate, coffee, peanuts, pork, processed meats, shellfish. It's a lot of stuff to cutout. 

Most people, they see that list and they're like, "That's everything that I eat." That's why we put recipes on our book. And nowadays, it's so easy to get recipes, especially that are sensitive to your food restrictions. There're lots of things you can still eat like dairy alternatives, and fish, and fruits, and game meats, and whole grains, and oils, and lagoons, chicken, seeds, vegetables, there's all types of stuff you can eat. It's just relearning how to do it that. That's an elimination diet. The reason we do it is to diagnose food sensitivities. Because the symptoms of food sensitivities can be anything. You can have infertility, you could have depression, you can have headaches, blurry vision, rashes, abdominal issues, reflux, it could be anything. If you look at that list of foods, it's basically, a list of the top foods that scientists have been messing with, whether it's through hybridization, or genetic modification, or all the spraying of chemicals, all those proteins look different than they used to. Our bodies are seeing the proteins that look different. So, it feels an inappropriate response, because someone's getting sick, but at the same time, your immune system knows what's going. It's seeing this as a bad thing and it's trying to get rid of it.

Melanie Avalon: I was just about to ask, why did certain foods become more likely for people to react to than others? What do you think is happening with shellfish? Is there a certain compound in there that people react to?

Peter Kozlowski: I think that they're just picking up all the crap that's in our water. Our oceans are filthy, and our seas are filthy, and I think it's just the toxic load for such small little organisms. Shellfish are on the list. I haven't seen many people. I'm not even sure if I can think of one that I've seen in my practice that had a sensitivity. You'll see very frequently an allergy. As far as the sensitivity, I'd have to think about it. But I don't know that I've actually seen anybody with a shellfish allergy. But I think it's because of the toxicity of our seas.

Melanie Avalon: Some questions about the celiac test. I actually, just recently got both a blood test and a gut biopsy for it. But the thing is, I've been gluten free for-- I've been seeing myself as being gluten free for probably a decade. I'm sure maybe it slipped in somewhere.

Peter Kozlowski: I assume your testing was negative.

Melanie Avalon: It was, although, my further granular question about that is, for example, the value, the celiac reflexive panel IgA, the range is 68 to 408 and my value is 206. I'm just wondering, like, that qualifies as a negative. But if you're having the response, that's halfway up to where it could be positive or for example, the tissue transglutaminase IgA was 3 with the range being 0 to 3. Why is it not black or white? Wouldn't it be either yes or no, on or off?

Peter Kozlowski: What it couldn't be with you is that, your numbers are so low, because you haven't touched the gluten. And technically, those numbers are pretty high for someone that hasn't eaten gluten in 10 years.

Melanie Avalon: That's what I was wondering. Yeah.

Peter Kozlowski: Yeah. It's impossible to prove, but I just wonder, I guess, one way you could try it and might not be comfortable is, just go heavy on gluten for a year and then do the test, again. It might be a miserable year, but that might get you the answer. Yeah. For somebody that's been gluten free, I don't know that and I don't think I would really even order the testing just because I don't think it would really tell us anything. But food sensitivities are so common that if you're having an IgG reaction to gluten, then, it doesn't really matter. You need to keep it out. So, whether you're allergic, or celiac, or not, if you're sensitive at the end of the day, you probably shouldn't be eating it.

Melanie Avalon: My GI doc, she actually said that, she was like, "Well, you could do-- go on gluten." She's like, "But there's really probably no point, because if you're just going to say gluten free anyways," but she ordered it just to see if maybe it was sneaking in somewhere and it would show up as positive. I just find it interesting that I just don't understand why it wouldn't be all or none for anybody as far as the reference range.

Peter Kozlowski: You mean, either 0 or else? 

Melanie Avalon: Yeah. Because you have the antibody, doesn't that mean that at some point your body was making that antibody?

Peter Kozlowski: Right. I see what you're saying. I think because that your body makes like IgA and these proteins for other reasons, that could be just why it's showing up as a little bit of a positive. That's what I would assume. But I see where you're going with that. I guess, that probably comes from just them doing studies to try to figure out a normal range and they probably never saw a significant amount of people that had 0. So, they just have to through data assume that zero is not a realistic number for people, unless every single person's reacting to gluten and we don't know. But I don't think that's the case.

Melanie Avalon: Yeah, I have to think about this more. Also, random question. They did an x ray and told me, "I have a twisty colon." Is this a thing? I haven't researched it, because I was like, I don't want to go down that rabbit hole. But is that anything that people with gut issues experience problems with?

Peter Kozlowski: I don't really know what that means.

Melanie Avalon: Okay. [laughs] It was diagnosed. I was like, "Oh, no, another label." [laughs] 

Peter Kozlowski: Yeah. The labels are tough. Your small intestine is super twisty, your large intestine is pretty, I guess, almost a rectangle almost. It goes basically up on the right side of your stomach up to basically your ribcage and then, it crosses over to the left side, and then, it goes down, and then, out through the anus. It's not twisty, I guess, like the small intestine, but that could just be seeing gas patterns. I've never really heard of radiologist's report, a colon as being twisty.

Melanie Avalon: I know. I was like, "Oh, no." I think it is a functional, like an actual thing. Because I mentioned it on my other podcast and I had some listeners reach out to me and say they had had that diagnosis as well. One listener actually reached out and said that she had surgery on it and that it completely got rid of all of her gut issues. I was like, "Oh, wow." [giggles] But surgery, I don't know. Surgery is very daunting thing to me, but that was really surprising to me. So, yeah, twisty colon.

Peter Kozlowski: Yeah. I don't even know what they'd be doing, untwisting your colon like unwrapping it?

Melanie Avalon: I don't know. Yeah, so, that was very interesting. One other thing that you've mentioned a few times, Candida. Do you treat that differently and do you ever use pharmaceuticals for that? I know, I went through, I did a few rounds of fluconazole that one point I was on Nystatin for a long time. I had a doctor tell me that, you could pretty much just be on Nystatin for life that stayed in the gut and really didn't have negative side effects. I'm not on it now, but I know you talk in the book about people, who think they have Candida and they're on these like anti-Candida diets and they won't eat anything. And you talk about your experience with patients and changing that paradigm a little bit for some people. So, what are your thoughts on Candida/Candida? I never know how to say it. 

Peter Kozlowski: I don't know how to say it, either. I usually say Candida, but I don't know if that's right. Technically, English is not my first language. I learned Polish first. I'm not the right person for pronunciation, but let's go with Candida. I think people know what we're talking about. My preferred treatment I'd say is Nystatin statin that I agree. There're people that it sounds you've heard these people that argue that like, "Nystatin is safer than ibuprofen and should probably be an over-the-counter medication." I would never want to keep anybody on anything forever. I frequently say, I work a lot with children specifically on the autism spectrum disorder, but other issues as well in kids. For whatever reason, Candida seems to be more difficult to get rid of in kids. Usually, I have kids on Nystatin much longer, maybe six months instead of usually I put adults on three.

I can think of one patient that I worked with that we treated her, and my goal was always to get off of everything, like, treat as short as possible, and then, get back to normal. But the only way that she could feel normal is on Nystatin. Since I do feel like it's safe, again, that's where my attitude is like, "The goal is to feel better. So, if this is working for you and it's not causing harm, then, Let's keep it going." A lot of the people I work with are just like so anti-medication. They're like, "I don't care if this is safe. I don't want to be on any meds at all." That's not an option. Caprylic acid, grapefruit seed extract or in my experience, berberine, oregano oil are really good at getting rid of Candida. It is rare to show up on a stool analysis. The best way to test for it in my opinion is arabinose levels in the urine and there're multiple labs that do that kind of testing. Arabinose is a breakdown marker of Candida. If you've got a bunch of the breakdown of it, we can assume that you have it in your body. 

The amazing thing about, when it shows up in a stool test, which I just got one before we started of an individual, who had Candida and his stool culture, the lab did sensitivity testing on it. His is susceptible to Nystatin, his is susceptible to like fluconazole, his is susceptible to berberine, caprylic acid, uva ursi, grapefruit seed extract. That's easy for treatment, because we know what kills, what's going on inside that person. When it's only in the urine, then, we're taking more of that shotgun approach. In the beginning of my career, I used Diflucan more, now I'd say it's pretty rare, because it is a strong med. I try to avoid it, but I still use it from time to time. Diflucan or fluconazole are the same thing.

Melanie Avalon: Yeah. You're talking about patients, who are very anti medication. I prefer not to have medication if I can, but if I can, I go really crazy with it as well. I always get it compounded. I remember I got my Nystatin compounded with vitamin C as the filler. So, I was like, "Well, I'll just turn this into the best version of Nystatin that it can be." Well, I want it.

Peter Kozlowski: I've had it compounded into syrups for kids, because kids, they can't swallow it, but that's impressive the way you had it done.

Melanie Avalon: Because I'm on thyroid medication. I get it compounded with vitamin C as well. I pretty much always get vitamin C as the filler, which works well. 

Peter Kozlowski: That to me would be a reason to stay off gluten is just thyroid. The thyroid receptors, gluten can get in them and block your thyroid from working. So, rarely do I ever tell anybody like, "You can't eat this forever. You have to keep this food out." But I do encourage people with thyroid issues to keep out gluten.

Melanie Avalon: The thyroid has been a struggle trying to figure that out. Have you heard of SF722 Thorne? It's 10, I'm just looking at the label, 10-undecenoic acid. People swear by it. They say it's better than the caprylic acid. I briefly experimented with it.

Peter Kozlowski: And success, or no? 

Melanie Avalon: Yeah. mm-hmm. It might be something to look into. 

Peter Kozlowski: Yeah, absolutely. 

Melanie Avalon: But yes, so, oh, my goodness, we have touched on so many different things. Is there anything else within that you think is important to discuss as far as your approach to your patients, and helping people unfunc their gut, and just address their health issues in general?

Peter Kozlowski: I think that it doesn't have to-- like I said earlier, health doesn't have to be so complicated. It can be difficult to find a practitioner you trust. A lot of people in my world are up charging their tests. They're really focus and the way they make money is by selling supplements. If you're working with someone that's just convincing you that supplements are the answer, that's pretty much a traditional medical approach is just take supplements instead of meds to fix the issue. In my book I wrote, I feel to try to educate people and the feedback I've gotten from people, who haven't worked with me, but read my book is like, "I read your book and then, I saw a functional medicine doctor, and I just felt so much more prepared for the visit." A lot of times, they almost will no more than the person if they've just started in the functional medicine world, which is something that happened to me. When I was early on my career, I went straight from residency into private practice, which I don't know any doctors that do. You usually train with someone, you learn from somebody. I just went out there and figured it out on my own. But one of the big things I learned, the big ways I learned over the first few years was from my patients, because I was still coming from a very traditional training and I was working with people that had been working in the alternative medicine world for 20, 30, 50 years. He knew a lot more than me about a lot of different things. I always have been open to learning from my patients. But yeah, I would say, parting words would be is, at the end of the day, the core of the functional medicine matrix and at the core of health is mental, emotional, spiritual health. As someone that's worked with a lot of people with their gut health, I can promise like, "If that's not the focus and if that doesn't get figured out, the gut usually won't heal."

Melanie Avalon: Yeah, I cannot agree more and I really, really loved that aspect of your book and that made me think of one more really random question, two parts to it. Because you're talking about IgGs and then, staying in the body, can they be stored in fat cells? My question about that is, if people lose weight, for example, could they release them later and experience issues later? And then, to tie it into what you're just talking about, which is why I thought about it, do you think we can store things in our fat like trauma or other things? And then, when people lose weight, they might actually experience things-- issues?

Peter Kozlowski: Yeah, I do. I think we definitely store those things in our body. Whether it's in the tissues or in the fat, the answer specifically about IgG antibodies, I would say, I don't know the answer to that for sure and that's also something I learned in my careers to say, I don't know when I don't know. Because of the 21-day half-life and the fact that we eliminate things after four to five half-lives, I guess, if they did get stored in the tissues, then, we wouldn't be eliminating them. I don't know, but I do think that a lot of things can be released when we do start losing weight than the body has to deal with, especially the faster the weight loss is, the more likely that is to happen. 

Melanie Avalon: Yeah, I think it can happen for a lot of people. And especially, I think when people are losing weight with intermittent fasting, for example, because then they're in a fasted state and I think they'd be more in tune in a way to feeling those toxins release, but it's all very interesting.

Peter Kozlowski: I think for somebody that's losing weight too, they're just more focused on their health. They're going to be feeling things that they probably were feeling before, but they just didn't pay attention to them. So, when you do start focusing on your health, those things can come out.

Melanie Avalon: Well, this is perfect, because the last question that I ask every single guest on this show, it's something related to it. Everything that you're just talking about and it's, what is something that you're grateful for?

Peter Kozlowski: Ah, I do a gratitude list every day with my wife. We always do three things we're grateful for. I would say, I'm grateful for making the move to Montana, because I'm looking out onto the mountains right now. I got my ski pass for the season. So, I get to live out my dream of being a ski bum, at least in the afternoons after I'm done working. I'm from Chicago. I was born and raised there, and then, made the move for my own mental health to just be more in nature and not in the grind. I'm grateful for looking out into the mountains right now. 

Melanie Avalon: When did you move?

Peter Kozlowski: Last December. It's been about a year.

Melanie Avalon: Oh, wow. I've heard it's just absolutely beautiful, just gorgeous up there.

Peter Kozlowski: It's the best. I feel like nature in the mountains.

Melanie Avalon: Yeah. Well, I do. I do. [giggles] Well, thank you so much, Dr. Koz. This has been absolutely amazing. For listeners, you've got to get this book if you at all struggle with gut issues and even if you don't, it's a very comprehensive view of everything that's going on in your body. And like Dr. Koz was saying, it's a really, really helpful resource for engaging with your personal practitioner, and just having that knowledge base to know how to-- questions to ask, and what to test, and things like that. So, again, the book is Unfunc Your Gut. We'll put a link to it in the show notes, where there will also be a transcript and links to everything that we talked about. Anything that you'd like to put out there for listeners? How can they best follow your work and can they work with you? Are you accepting patients?

Peter Kozlowski: Yeah. I'm definitely accepting patients, mostly working via telemedicine, which we found to be just as effective as in person. Since the book came out, I have gotten on social media, which I was not, but I am now @doc_koz. I'm trying to be more active on there. But my website for people that have questions or want to work with me is a great place to get a hold of us, my assistant Jasmine, she's absolutely amazing, answers the phone, and just helps everybody with any of their questions. Yeah, if somebody wants to get, I think probably most of your listeners have already started on the functional medicine journey or on the healing journey, but I think my book "Unfunc Your Gut" can help that journey.

Melanie Avalon: Awesome. Well, thank you so much. This was absolutely wonderful. I cannot thank you enough for everything that you're doing. We need-- I just wish all doctors had your mindset and your approach. But I really, really appreciate everything that you're doing and I look forward to talking with you more in the future.

Peter Kozlowski: Sounds great. Thank you so much.

Melanie Avalon: Thanks. Bye.

Peter Kozlowski: Bye.