Episode #155: Unfunc Your Gut with Dr. Peter Kozlowski, MD

Why You Should Listen

In this episode, you will learn about how to boost your immune system, heal your gut, and unlock your mental, emotional, and spiritual health.

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About My Guest

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.  Currently he works with patients online and in person via his Chicago, Illinois and Bozeman, Montana based offices.   Dr. Kozlowski did his residency in Family Practice but started training in Functional Medicine as an intern.  He trained in the clinics with leaders in his field including Dr. Mark Hyman, Dr. Deepak Chopra, and Dr. Susan Blum.  His recently published book “Unfunc Your Gut” encapsulates his collaborative, patient-first healthcare approach which offers a blend of medical insight and the experiential wisdom of his own healing journey through addiction recovery.  Overall Doc Koz inspires us to seek and find real answers to "what's going on with my health?" and empowers readers with practical strategies to achieve true balance of body, mind, and spirit.  His expertise is in gut health, but he also works daily with food sensitivities, hormone imbalances, detoxing from toxic chemicals such as heavy metals and mold, and most importantly mental, emotional, and spiritual health. 

Key Takeaways

• Why are so many people experiencing issues with gut health?
• What are the 5 main areas to explore regardless of a diagnosis?
• What is the gut-brain connection? Can the mind change our microbiome?
• How often are tension or dysregulation within the nervous system a roadblock to recovery?
• How common is low stomach acid? What role do PPIs play in GI issues?
• How often do MCAS and histamine intolerance play a role?
• What impact do mold and mycotoxins have on gut health?
• What diets have been most helpful for his patients?
• What is the difference between food allergy and food sensitivity?
• How important is fiber for supporting the microbiome and detoxification?
• Can intermittent fasting support autophagy and detoxification?
• Does the presence of Clostridia always warrant treatment?
• How commonly do parasites play a role in complex, chronic GI issues?
• Is the treatment of SIBO about killing a bug, or is a broader, more holistic strategy needed?
• How is IBS different from or the same as SIBO?
• Could probiotics be contributors to SIBO?
• What is the role of estrogen dominance?
• What tools can be used to increase HRV?
• What interventions have been most helpful for supporting the mental, emotional, spiritual contributors to illness?

Connect With My Guest

https://Doc-Koz.com

Related Resources

Unfunc Your Gut

Interview Date

October 26, 2021

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections. 

[00:00:01.00] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:13.29] The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:34.11] Scott: Hello everyone, and welcome to episode number 155 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Peter Kozlowski, and the topic of the show is Unfunc Your Gut. 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. Currently, he works with patients online and in-person via his Chicago, Illinois and Bozeman, Montana-based offices.

Dr. Kozlowski did his residency in family practice but started training in functional medicine as an intern. He trained in the clinics with leaders in the field, including Dr. Mark Hyman, Dr. Deepak Chopra, and Dr. Susan Blum. His recently published book, Unfunc Your Gut, encapsulates his collaborative patient-first healthcare approach, which offers a blend of medical insight, and the experiential wisdom of his own healing journey through addiction recovery.

Overall, Dr. Koz inspires us to seek and find real answers to what's going on with my health and empowers readers with practical strategies to achieve true balance of body, mind, and spirit. His expertise is in gut health, but he also works daily with food sensitivities, hormone imbalances, detoxing from toxic chemicals such as heavy metals and mold, and most importantly, mental, emotional, and spiritual health.

Now, my interview with Dr. Peter Kozlowski.

The gut is so central to many chronic health conditions; I'm really excited today to learn about this important topic from Dr. Peter Kozlowski; thanks for being here today, Dr. Koz.

[00:02:29.26] Dr. Koz: It's an honor to be here; thank you very much for having me. 

[00:02:33.05] Scott: You bet. What was your personal experience that led you to doing the work you do today, to writing your new book “Unfunc Your Gut: A Functional Medicine Guide - Boost Your Immune System, Heal Your Gut, and Unlock Your Mental, Emotional, and Spiritual Health”?

[00:02:49.23] Dr. Koz: So the majority of medical doctors like me that go into functional medicine go into it because of a chronic health issue. That they try mainstream medicine to heal, and they don't get anywhere, or they get worse, so they search out alternatives.

I always looked at myself as like physically very healthy; I was born very blessed, I don't have any chronic health issues besides an issue with alcohol. So my issue was mental, emotional, and spiritual. I had no idea it was an issue until I was kind of told it was an issue, and then I learned that it was. My story is like I went into family medicine, residency, very traditional-minded.

My parents are both doctors; they were traditionally minded. Everybody I knew in med school was traditionally minded. I never even considered something like functional medicine; I thought it was like fake or not real.

Then during as an intern in residency, I took a break for six weeks and went to an inpatient treatment for alcohol and learned I had a problem with alcohol. The most interesting thing about that is that the treatment had nothing to do with alcohol; it was all about why. So that's where I was kind of introduced into the concept of underlying cause.

When I got back to residency, as a resident, you're taught by different doctors. So you're learning from different family practice doctors, different cardiologists, different surgeons, and everybody has a different kind of style. We had a doctor; his name is Dr. Bartra that would start every patient that was admitted to the hospital on a multi-vitamin and vitamin D.

We thought it was a joke; we made fun of him because we were like the interns; we had to write the orders. When I got back from my own treatment, I kind of just asked him; I was like, Dr. Bartra, why are you weird? Like why do you do this?

He took sat me down, and this is in the middle of night, and this is functional medicine, he showed me the website, and it looked interesting. As a resident, you're required to go to CME, I didn't really have any ideas of what I wanted to learn more about, so I was like, let me check this out.

Within the first hour of the first lecture, I just knew that I could never look at medicine the same. For something that I thought was going to be like hocus pocus, made up, was all taught from like a biochemistry, a physiology and anatomy level, and it just made sense. That was ten years ago, my first conference, and it's been a very interesting journey and a rewarding journey, and I couldn't imagine doing anything different.

[00:05:54.02] Scott: Beautiful, so your own personal pain has really become your purpose, your passion; I think that's amazing and fantastic.

It seems that so many people today that are dealing with a chronic illness, and even many that don't maybe know they have one or maybe they don't yet have one, are dealing with “Func’d up” guts. So what are some of the key contributors or reasons that gut health has become such a problem now?

[00:06:22.18] Dr. Koz: It's funny because Hippocrates, a few thousand years ago, said all disease begins in the gut. Basically, since he said that, everything we've done is damage our guts. So having risk for having a “func’d” gut is just being alive in 2021.

It starts with the way that we're delivered, so vaginal delivery versus C-section, breastfed versus formula-fed, diet, stress, trauma, antibiotics, anti-depressants, ibuprofen, Tylenol, our food supply, the processed foods, the chemicals in our foods.

The toxins in our homes and our mattresses, in our heating and air conditioning and our couches and our furniture and our toys, all of this stuff is just attacking our bodies, and the gut is the gateway into the body. So that's always like the most important thing that I like to teach people about the gut, is to think of it the inside of your gut tube is outside of your body.

If you swallow something and poop it out, it's never been in your body. So the gut's most important job to me is to decide what comes in and what stays out. It works like the skin, but the difference is the skin is three layers of multiple types of cells. The gut lining is a single layer of cells, very thin, and we don't treat it very well. So all this onslaught of all these things we're being exposed to day after day eventually damages our guts, that allows disease into the body.

[00:08:11.14] Scott: I guess maybe it would have been easier for me to ask in our modern world what things don't contribute to gut challenges because it seems like it's a pretty exhaustive list. In the book, you say that no matter what your diagnosis, there are five main areas to explore those being gut health, diet, hormones toxicity, and the mental, emotional, spiritual components.

So I'm wondering, in people that you work with, do these kinds of unfold in a common order when you're working with more complex chronic illness patients? Is it different for everyone? Where do you generally tend to start, or what foundation needs to be built first?

[00:08:49.22] Dr. Koz: Honestly, it varies in every person that I work with. The point of functional medicine is to like listen to someone's story, plot their story on a timeline, and kind of follow their life and see what things could have been contributing, when did disease start, etc.

If I had to generalize like if somebody's never done an elimination diet before, I wouldn't really have any reason to tell you to not do an elimination diet, so that's something that anybody could do. Then like estrogen dominance, as far as hormonal imbalance, estrogen dominance and thyroid disease are extremely prevalent.

So if I've got somebody with kind of those hormonal symptoms like fatigue, cold hands and feet, cold intolerance, weight gain, low energy, dry skin, then we might start with hormones. If I have somebody with gut issues, then that's kind of easy because that's my specialty, and have had a lot of success in helping people with their guts, toxins; for example, I had someone yesterday that two years ago developed an autoimmune condition of her skin, that basically kind of looks like a type of eczema or rash.

She'd been to everybody before she met me, so dermatologist, rheumatologist, primary care doctor. She doesn't really have any symptoms besides the autoimmune, so it's kind of like, well, where do we start? Well, the microbiome and the gut would be a great place.

But in her history, she works as a dialysis nurse, and the walls in her building are literally like crumbling due to water damage. To me, that triggers mold. So with her, we're starting with toxins. So it's kind of just, it depends on someone's story, sometimes people come to me, and they're like listen, I've been dealing with this for 30 years. I just want answers; every doctor's told me everything's normal, so just order all the testing.

Let's just do all of it, and let's figure out what things are contributing. So yes, it's it varies based on someone's history.

[00:11:11.03] Scott: We talk about the gut-brain connection, but the connection really is bi-directional. So I want to hear you talk a little bit about how our guts production of neurotransmitters impacts the brain, but also how the brain impacts the gut.

What are the connections there? And can we even potentially say that our mind our thoughts can actually influence our microbiome?

[00:11:34.28] Dr. Koz: Yes, absolutely, I think we can. Your gut, that tube that starts with the mouth and ends with the anus, is lined with its own nervous system called the enteric nervous system. There are somewhere between 100 and 500 million neurons in that nervous system. More than your central nervous system.

That nervous system is connected to your brain by the vagus nerve. We have 12 cranial nerves; they all have different functions, the vagus nerve runs from the brain down to the gut, heart, and lungs, and so it carries signals; that's basically the highway, that is the gut-brain connection.

It's become my passion, and I guess we'll start; the gut side of it to me is very easy, things like an imbalanced microbiome, food sensitivities, leaky gut, an inflamed gut can all trigger imbalances in your microbiome and in the function of your gut, and that can change the way you produce neurotransmitters.

There are some bacteria that you could have overgrowing your microbiome, like Clostridia, that could block dopamine production. So that's one of your neurotransmitters. But that part of it to me is easy because there's good testing, there are reliable treatment plans, and I think that that is very easy to deal with.

The mental, emotional, spiritual part to the gut is the difficult one, and that's where I get the roadblocks with my patients. So this is a spoiler alert for my book, but that's the secret to your gut health is the mental, emotional, and spiritual health. Every patient I meet, I try to stress that and teach that most people that come to me they're like, just give me the right diet, give me the right supplements, do the right testing, and everything will be fine. It won't be fine, and I know that because I'm a perfectionist and I can remember all the people that don't get better, and there's one overlying theme, and it's unresolved trauma, issues with relationships, etc.

So the reason the connection so the vagus nerve, the vagus nerve runs on your autonomic nervous system, your automatic. Which you don't think about it just functions as two responses, sympathetic and parasympathetic. Sympathetic is fight or flight; parasympathetic is rest and digest. Both are necessary and important for our survival, so they both need to turn on and off. Just like anything, too much of something is not good, and so when the sympathetic is activated, the fight-or-flight response.

The analogy is like I'm hiking in the mountains, and I see a grizzly bear, sympathetic is activated, the energy and blood go to my brain and muscles to survive. If I do survive and I'm sitting at the campsite, the campfire at the end of the night, I'm in rest and digest, parasympathetic is activated. So both responses were needed. I think one of the big problems we have today is the majority of us are living as if we're running from a bear 24/7.

We wake up, and the first thing we do is check our phone and email and texts and the news, and social media, and right away, our mind is telling our gut we don't need you today, right? Then you sit down for breakfast, and we don't have the energy to help you out today; we have to survive today. So when that happens, you don't make stomach acid.

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 activate the rest of your digestive enzymes, so things really fall apart. The small intestine, your gut lining gets leaky; that term leaky gut is when the barrier is lost.

Then you can actually suppress your microbiome, so you can shut down your probiotics from growing through chronically being stressed, and we can see that on a stool test, and we can also see like the kind of classic combo's suppressed microbiome and a low secretory IgA which is like the immune response in the gut. So if I see that on somebody's stool test, I can see that they've been stressed out for a long time.

[00:16:31.11] Scott: So this next question is kind of tied into that, but I'm going to ask it anyway because it might lead us in a slightly different direction. That is, a lot of the listeners of my podcast are dealing with chronic Lyme disease; one of the things that I see and certainly my own experience is it's commonly type A, overachiever, perfectionist.

Then once we become ill, we take that same approach and apply that to how we manage our recovery. Yet we just talked about the fact that really to heal to rest, digest, detoxify and heal that you really can't be in this sympathetic dominant state, that you need to be in a parasympathetic state.

So I'm wondering how often do you find that tension or dysregulation within the nervous system becomes a roadblock to recovery? And can a significant portion of our seemingly physical symptoms be driven from stress and sympathetic dominance?

[00:17:27.17] Dr. Koz: Yes. So yes, and a lot of symptoms can go away just through balancing out that sympathetic and parasympathetic response. I would say it is the roadblock in all of my patients who don't get better, and maybe there's things that I'm missing, and it doesn't happen that often, usually; we have a lot of success, and it doesn't usually take that long.

But for the people that are lingering and not getting better, the issues are coming back. To me, I always can see that the mental, emotional, spiritual part wasn't addressed the way it should have been. An example I have is a woman that was dealing with SIBO before she even met me. We started treating her SIBO; she got better.

She has some history in the health world, and her like life passion became health and listening to podcasts about health and reading blogs about health, and just all the health books. So when we had a visit the other day, she's asking me why the SIBO keeps coming back, and I said, and this is always a hard thing to tell patients because it can come off as it's not what they want to hear.

But I was like, what if you tried a month of no health information, right? Find a new hobby, listen to podcasts about something else. She had the response that I had when somebody told me not to drink for a month. I said, as someone that's in recovery, I feel like you can see other people that are struggling, and I do think that there's too much information online, and not all of us can handle it.

It can make us; I think that that's the number one reason why people don't heal. But it also makes sense because I think it's the most difficult thing to heal from. If you have SIBO or Candida or dysbiosis or lead or mold, that stuff is easy, like I said earlier. But if you've got trauma from childhood from not feeling good enough, it's going to be really difficult.

[00:19:49.01] Scott: It's interesting; I think we're going to touch on this a little bit later. But in some of the limbic system retraining work like Annie Hopper's work with DNRS, or the Dynamic Neural Retraining System, not looking at those types of things, health information and whatnot is actually a component of those programs and something that is important for them to be successful.

You mentioned a minute ago how stomach acid can be impacted by being in a sympathetic dominant state. So let's talk a little more about stomach acid; how common is it that people have low stomach acid, and that's contributing to their GI symptoms or their systemic symptoms.

Then talk to us a little about how we can maybe explore this using baking soda and HCl or hydrochloric acid challenges to see if maybe supplemental hydrochloric acid might be helpful. Then on the flip side, PPIs where we're taking things proton pump inhibitors to reduce stomach acid. Do you think that may actually be adding to the gut issues that people experience more so than helping to improve them?

[00:20:56.05] Dr. Koz: Good question. When a patient comes in to see me, and if on their medication list is a PPI, I forget everything else. I'm like, okay, our first goal is to get you off of this. So that's how strongly I feel about stomach acid. Like I mentioned the roles earlier, it's protein digestion; it's killing off all the bacteria and viruses and parasites that we're exposed to, it's vitamin and mineral absorption, and it prevents SIBO. The gut bacteria hate acid, so when it's deficient, they can overgrow into the small intestine. I think that over half of my patients have it. It is normal to have low stomach acid, it's a normal part of aging, but it's like 80 percent of people over 80 have low stomach acid. I am diagnosing it and treating it in like 13-year-olds and 20-year-olds, and 30-year-olds.

The overwhelming majority of the time, in my opinion, the cause is stress or trauma. It's that sympathetic response coming down the vagus nerve that's literally telling the stomach to stop working so to turn off the cells that make acid.

So I think it's extremely common, there's a really easy way to test yourself, and it's called the baking soda test. You mix a quarter teaspoon of baking soda into a few ounces of water, mix it up and drink it on an empty stomach. Baking soda is basic; your stomach should be acidic. When the base and the acid meet, it creates an explosion, and you present as gas, and you should start burping.

You should burp within three minutes; sometimes, we time up to five minutes. When I first heard about that test, I thought it was ridiculous. I was like; this sounds like a high school chemistry experiment. We're making a volcano, and it sounded like a joke. But it's actually been really reliable; I've used it with patients for a lot of years now.

If you don't burp or if we feel strongly that you have low acid, then the next step, as you mentioned, is supplementing hydrochloric acid. Hydrochloric acid comes in capsules that look like vitamin D or multivitamin whatever, like any other supplement. It is only supplemented before eating protein. So I tell people when they start just like meat, fish, eggs.

You take it, and then you eat. Somebody with normal stomach acid is going to get reflux because that you dropped in acid, your stomach's making acid, there's too much, and it burns in your throat, or it feels uncomfortable. So, in my opinion, it's not normal to tolerate HCl. If you can tolerate HCl, that means you're deficient, and the question then is how deficient.

Every two days, you try bumping the dose; you go from one to two, two to three as high as seven, until you get some discomfort. So let's say that happens after three, then your treatment dose is two. That whole, all of that I have outlined thoroughly in my book, along with like a plan of how to get off of a proton pump inhibitor if somebody's on one.

So in functional medicine, they kind of call it like the 5R program for healing the gut. The first R is remove, and that's removing food sensitivities and toxins and other things. The second R is replace, and that's assessing and aiding digestion if it needs to be. So it's a major thing. It's interesting because it's a polar opposite view of regular medicine, right?

The seventh most prescribed drug in America is an acid blocker; your local pharmacy has like an entire section of acid blockers. So for a lot of people, it can be kind of shocking to think about it differently, but time and time again, I've seen it work, and the symptoms are like the same.

So the symptoms of low stomach acid could be bloating, it could be indigestion, it could be heartburn, it could be fullness after eating, all the same, stuff that your regular doctor would tell you is too much stomach acid.

[00:25:36.10] Scott: What are some of the key tests that you might use to evaluate the gut, including the potential for leaky gut. But then also looking at the microbiome, what potential pathogens might be there? What imbalances? Where there may be deficiencies in certain types of beneficial flora? What are some of the tests that you use to evaluate the health of the gut?

[00:25:59.14] Dr. Koz: So there are three main tests that I would use for the health of the gut; the first one is a Comprehensive Stool Analysis which looks at what is growing in your microbiome. Do you have good bacteria, or do you have imbalanced bacteria, yeast, or parasites?

It assesses how well you're digesting, how inflamed your gut is, how well your gut bacteria are eating. So we get a lot; it's a picture of basically what's going on in the large intestine. The second test that I use frequently is an organic acids test, an OAT, that is, a urine test.

That is because the stool test is not great at identifying Candida overgrowth, which is very common; Candida tends to die in the stool. We measure the metabolites of Candida in the urine, and if they're elevated, then we'll treat it.

The other thing that the stool test is not great at differentiating is the Clostridia bacteria. Some Clostridia are good, some Clostridia are bad, and the oat helps us with that. So OAT has other things like your mitochondrial health and neurotransmitters and water-soluble vitamins and ketones.

So there's a bunch of other info, but as far as the gut perspective, that's why I order it. Then the third test would be a SIBO breath test. Sibo is the most common condition I treat, and it is diagnosed through a two hour breath test.

[00:27:30.18] Scott: Our listeners will be very familiar with mast cell activation syndrome, histamine intolerance. I'm wondering how often these play a role in your clinical work, working with people with complex conditions with GI issues.

In mast cell activation and histamine intolerance, what do you think of as some of the underlying triggers, and potentially some of the ways you might approach improving those situations.

[00:27:56.06] Dr. Koz: Histamine intolerance and mast cell activation is tough, so that's a tough one to work with. For the longest time, I was convinced that histamine intolerance is just undiagnosed SIBO because if you look at the low histamine diet, and you compare it to the low FODMAP diet, which is how we treat SIBO, they're very similar. So, anybody that I have that's suspecting a histamine intolerance, I'm going to test them for SIBO. I've been convinced that that's not always the case. A friend of mine, a nutritionist at Dr. Hyman's clinic, Maggie Ward, I've talked to her about this, and then I've seen it.

It's only been less than a handful of patients over the years. Where addressing SIBO didn't improve the symptoms of histamine intolerance, it's less than five. But there are those people that are like, we've tried everything, and they still can't tolerate them. The other area that I would look as an underlying cause would be toxins like mold and heavy metals.

So I'd always be searching for an underlying cause then, kind of trying to treat the histamine intolerance because, unfortunately, I haven't seen a treatment that's effective other than just avoiding histamine foods. So that's a tough one. But anybody dealing with that that hasn't been tested for SIBO or toxins, that's definitely a great place to check, to see if you can find a reason of why it's happening.

[00:29:43.27] Scott: Yes, that's very helpful. I tend to think of mast cell activation, as you pointed out, mold driven, parasites I think in some cases certainly can play a role there, and interestingly EMF exposure in many people. I think the more we're seeing people dealing with mast cell activation and this exponential increase of EMFs in our environment.

I know Dr. Theoharides talks about that, that even being around a cell phone can activate mast cells by ten times, which to me was kind of a shocking statistic that nobody really ever talks about. But it is interesting that the SIBO piece, obviously, it sounds like that's a very significant piece of this conversation as well.

[00:30:22.21] Dr. Koz: Yes, and that's a great point about the EMF and the mast cell activation. I mean, it's just trying to figure out what's underlying, right? Usually, we can find something.

[00:30:39.20] Scott: Some of my mentors over the years have suggested that the functional medicine approach of starting with the gut may no longer be the place to start, that maybe we need to first explore removing or resolving those things that are impacting the gut. So let's say mold and mycotoxins, for example.

Dr. Ann Corson, she says that mycotoxins in the gut are like throwing sparks on a silk scarf and that we need to address that issue before we start trying to do the more traditional functional medicine things to improve gut health.

So I'm wondering if you agree with that, that there are some things we want to explore first. What are some of the things that maybe we need to address before we start down the more standard functional medicine protocols for improving gut health?

[00:31:26.07] Dr. Koz: So I've never thrown sparks onto a silk scarf, but that sounds bad, that sounds like it could combust quickly. The patient that I told you that I worked with yesterday, where we went through her stuff, all she has is this autoimmune condition. In going through her history, mold came up to me.

It's not even that she knows, so a good screening test for mold, in my opinion, is not like do you have mold exposure? For me, the way I ask my patients is, do you live in or have you ever lived in or worked in a building that had water damage? Because to me, water damage equals mold.

So like with somebody like her, I'm definitely starting with toxins. I do think that there's a place to; there is definitely value in starting outside of the gut, specifically with toxins when we are looking at health. I mean, I've seen a number of people over the years where we've just gone at SIBO, and the whole time they had a mold problem, and they weren't getting better, and it was because there was mold.

So I think it just takes some kind of experience as a practitioner to kind of learn from your patients about where to start, but there's definitely value in starting other places sometimes.

[00:32:53.29] Scott: So let's dig then into the mold and mycotoxin conversation a little bit more. Wondering if you find the urine mycotoxin testing a tool that's helpful for evaluating that potential in your patients.

What are some of the ways that you find helpful for exploring the external environment and really looking at that possibility of mold as a contributor to health challenges? What are some of the things that maybe you would use to approach treatment in people that then have positive results either in their urine mycotoxin testing or in their environmental analysis?

[00:33:28.07] Dr. Koz: So I'm actually very pro mycotoxin testing. I use Great Plains lab, and I believe their mycotoxin testing has been, it's been five or six years that it's been out. I think I've been one of the top ordering doctors of it in the country, so I'm very pro mycotoxin testing.

My probably favorite patient story that I've had a lot of cool ones is a woman that had infertility issues. We tried everything; we did mycotoxin testing pretty soon after it actually came out. We detoxed her, she got out of the mold, and a few months later, she got pregnant, and now I see her and her boy.

So it's just kind of an amazing story of mold detox. So honestly, it's the second most common thing that I treat, I think, behind SIBO. So it goes SIBO and mold, and I've got a number of patients that have both, and to me, that's like the ultimate bad news, and those are usually the sickest people is when you have both SIBO and mold. But I tend to see it pretty commonly.

So I do like urine mycotoxin testing, the second most common source of mold mycotoxins is from food, and this is where I disagree with the people at great plains lab, is their policy is that patients don't need to follow any kind of special diet before the mycotoxin testing, because if there's going to be an elevation from food, it's going to be minimal.

I've always over the years told my patients to cut out moldy foods for a week before their tests. The biggest one or the hardest one, or the most common one is coffee; coffee is super moldy. But also foods like leftovers and fermented foods, mushrooms, so a lot of healthy foods are moldy. I just prefer to avoid any kind of false elevation in the test, and that's why I do that. So it's a huge problem, and it definitely needs to be addressed.

[00:35:49.03] Scott: I know Dr. Jill Crista; she shares your perspective there that pausing some of those foods that could be contributors is a good thing to do before the urine mycotoxin test. I personally do find them tremendously helpful as well. Wondering what your favorite tests are for helping your patient to explore their external environment.

[00:36:08.11] Dr. Koz: So my favorite test to explore the external environment is going to be the ERMI testing, which is testing for mold in the house. We test the dust, and you collect three grams of dust from the HVAC filter typically and send that off to the lab. We can a lot of times compare that test to your mycotoxin test and compare the two.

I've used a company called the Mold Pros, which can go anywhere in the country, and they'll come in and test for mycotoxins and all these different things in your house. They actually do remediation, which to me, there's a lot of controversy around. In that when I first started studying environmental medicine, the first thing that I learned is the only treatment for a moldy building is to knock it down.

If you talk to a mold remediator, they will tell you that you can remediate. I've seen both, but more times than not, people spending a lot of money on remediation and continuing to have mold. So the environmental pieces is really difficult, and I'd say there's probably controversy around all the different types of testing and which one's the best.

So the way I would approach it is if you have an elevation and mycotoxins in your urine, you have some kind of known history of water damage to where you're working or where you're living, I would get out of it. Like I tell people to move or find a new job.

[00:37:48.17] Scott: I want to talk a little more about some of the dietary strategies and how finding the right one really can be challenging my observation over the years, and that's primarily people dealing with Lyme and mold illness and so on.

Has been that the low histamine diet tends to be one that's quite helpful. You mentioned how that also has a lot of overlap with the low FODMAP diet, that can be helpful for SIBO as well. So what diets have emerged as kind of the top strategies in terms of those things that help your patients, any favorites? Then how do you match a diet to a patient?

[00:38:21.24] Dr. Koz: Yes, diet is a tough one. There are so many different types of diets, and different diets work for different people.

One of the things that I say is different than probably a lot of practitioners is I tell people to follow whatever diet is going to cause them the least amount of stress, and that's something I've seen a lot is with all these very restrictive diets that people get too stressed out about what they're eating, and it takes away any benefits from the healthy diet that they're trying to follow.

Because cortisol is released, cortisol suppresses your immune system, sugars released, and your dysbiotic situation that you're trying to work on is going to get worse. If I had to pick just one diet like I mentioned earlier as an elimination diet to identify food sensitivities.

That is something that I do once a year. Food sensitivities change over the course of time, so just because you're sensitive to something today doesn't mean you will be in six months. So I typically tell people to reintroduce foods every six months that they're missing to see if that sensitivity has been resolved.

The thing that I learned over the years is that I would have patients that got worse on an elimination diet. I couldn't make sense of why that was, and then we slowly kind of figured out that those are people with SIBO. Tip for most people when you go from your standard diet to an elimination diet, you're eating a lot more fermentable foods that are the favorite foods of your gut bacteria, and that can exacerbate SIBO.

So like the combo diet that I introduced in my book is an elimination diet that is also low FODMAP. If we suspect someone has couldn't, and we're waiting on test results. So those are ones that I would start with, but I mean, I work with patients that like swear that keto is the only way for them.

My best friend is a raw vegan. I've met carnivores now, and it really varies. I mean, I'm very specific when I'm treating a specific gut issue, but besides that, I'd rather just have you eating what makes you happy.

[00:40:44.16] Scott: In the book, you say that food sensitivities may actually be more deadly than food allergies. So talk to us a little bit about the distinction there.

[00:40:53.18] Dr. Koz: So when you have an allergy, your body, there's three kind of main reactions to food. You can be allergic, you can have celiac disease, and you could have a sensitivity.

Allergies in celiac are pretty easy to diagnose because they happen right after you eat the food, and there's reliable blood testing. So if I'm curious if you have celiac, or if you have a food allergy, I can send you to the lab, and we'll get a pretty accurate result. Food sensitivities are what I work with primarily, and they are due to IgG antibodies, which are your chronic antibodies.

So the reason that I think that food sensitivities are more deadly than allergies is because I could eat a bagel every day for breakfast and be sensitive to gluten and never figure it out. But I deal with chronic migraines or eczema, or joint issues, and I have no clue it's my bagel because I feel fine after eating it. So that reaction is delayed hours to days after the food. The second problem, and this is another one where there are definitely different opinions, is about the efficacy of food sensitivity testing. I personally, even though a lot of my mentors order that testing regularly, I've never ordered a food sensitivity test.

I have always prescribed a 21-day elimination diet with reintroduction. In my experience, the food sensitivity test is the best test for leaky gut. If you do a food sensitivity panel, and it comes back with a lot of low-level positives or foods that you've been eating for the last few months, that just tells me you have leaky gut.

The reason an elimination diet is 21 days because that's another thing I question. I was like, that sounds like a very made-up number, is because everything in your body has a half-life that's the clearance time. Lead, mercury, mold, tobacco, alcohol, your hormones, prescription meds, everything has a different clearance time.

The half-life of IgG antibodies is about 21 to 23 days. So if I had that bagel today, and I have 100 antibodies floating around against gluten. If I completely avoid it for the next 21 days, that immune response will cut in half to 50.

Then I eat it again, and the immune system has a very good memory. So if it remembers gluten as an invader, there will be an attack, and I will get inflammation. So systematically, I go through with people food by food, cutting them out all at once and then adding them back in.

[00:43:35.27] Scott: I want to talk a little bit about people that are what I would call universal reactors. Where maybe they're down to, you know, five foods is all they can eat. Actually been in contact with one person that was down to one food, and that one food was alligator.

So what I'm wondering is in people like that, that are really universal reactors, have very few foods. Is it about the food? Or is it fungal overgrowth? Parasitic overgrowth? Other dysbiosis combined with leaky gut, such that as you work on balancing the microbiome, work on improving their leaky gut, that a lot of those food reactions might then resolve?

[00:44:15.21] Dr. Koz: 100 percent. Somebody like that, I would really want to look at their gut and look at their toxin load. But the most important thing that I would want to do in the meantime, again, because I think that stuff is pretty easy, is to address the trauma they have around food.

If you've gotten to the point where you can only eat one thing, I'm not like a mental health expert besides my own story, but I'm pretty sure you have some trauma around food. If you don't start addressing that right away, then the leaky gut won't heal, so the issue won't heal.

Your dysbiosis or SIBO won't heal; it'll be more difficult to detox. So again, as someone that really kind of focuses on that mental, emotional, spiritual part, I would want to get somebody started right away on working through trauma around food as part of that healing process.

[00:45:09.26] Scott: What are some of the tools that you find most helpful for dealing with the intestinal hyperpermeability component?

[00:45:16.08] Dr. Koz: So leaky gut, the way that I approach it, the increased intestinal permeability. My approach is to get rid of what's causing it. So there are supplements that we can use, and in my opinion, the best one is glutamine at a very high dose. Five thousand milligrams three times a day. So that's something that I would use.

There are certain probiotics; there's evidence that says that they help heal the gut lining. Zinc, magnesium, fish oil, gamma-linolenic acid are things that could all be kind of anti-inflammatory or soothing. Aloe potentially.

But if you are taking those supplements to heal a leaky gut, but you're not working on the trauma, or you're not working on the dysbiosis, or you're still eating a food you're sensitive to, you're going to be spinning your wheels. Then once you do eliminate that cause, the gut lining could heal on its own, I think without any support. So to me, it's all about getting rid of what could be causing it.

[00:46:30.02] Scott: I completely agree that the mental, emotional contributors are significant in many of these conditions. But I wanted to talk a little bit about the limbic system as well. So I certainly have seen people that were down to five foods; they started doing something like Annie Hopper's DNRS, or Ashok Gupta's the Gupta Program to really work on rebooting or recalibrating the limbic system which can also be tied into mental, emotional traumas, but it can have other types of triggers like mold exposure or whole list of things that maybe aren't mental, emotional. So I'm wondering if you've explored limbic system retraining, and have you seen that as a tool that has helped your patients.

[00:47:10.08] Dr. Koz: That is not something that I've explored, and that's definitely something that I'm going to look into ASAP. So that's an area that I would love to learn way more about. 

[00:47:21.13] Scott: Let's talk about some of the macros, and so can too much protein be bad for us? Should we have higher levels of healthy fat? Then, where do you stand on the healthy omega-6 oil conversation?

I see so many people just blanket statement vilifying omega-6 seed oils, and yet, I personally love to have my hemp oil and my olive oil in my smoothie every morning and so on. So talk to us a little bit about the proteins, the fats; what are your thoughts on what should be kind of the ideal macros.

[00:47:54.09] Dr. Koz: So my approach is to eat 9 to 12 servings of vegetables and fruit a day. When you eat that many fruits and vegetables, so if I could give people just one dietary tip, it would be that is to eat 9 to 12 servings of vegetables and fruit a day.

When you eat that many, there's just not enough room for the other stuff. Then the rest of your diet will kind of balance out naturally. I don't particularly focus necessarily on you should have exactly this amount of protein, this amount of fat. I'm very pro fat; I'm very anti-sugar. I do like omega-6s; like I mentioned one earlier, gamma-linolenic acid from borage seed oil is something I use a lot in autoimmune or inflammatory skin conditions.

So I do support fats. I mean, for people that are trying to keep things simple, I'll use olive oil, coconut oil, avocado oil as some basics. You can obviously expand a little bit like the hemp oil like you like. So a little bit different approach from my perspective, and I really like that focus on the 9 to 12 servings of vegetables and fruit a day.

[00:49:16.06] Scott: I like that you bring out the sugar piece as well. In the book, you talk about the fact that it's not fat that makes us fat, but it's really the sugar that makes us fat and creates so many other complications. I want to talk a little bit about fiber.

So does fiber help with detoxification? You mentioned a lot of the toxicity that's involved in these scenarios, and what are some of your favorite fibers?

[00:49:40.06] Dr. Koz: Fiber is how your microbiome eats. So I'm very pro fiber; the issue for me is that the most common condition I work with is SIBO. So fiber will typically make someone with SIBO worse. It does definitely help you detox because what detox is, is converting fat-soluble toxins into water-soluble toxins. So the process of detox is making toxins water-soluble.

The way we then excrete them is in the urine, stool and sweat. So you need to be pooping regularly in order to detox properly. One of the best ways to poop regularly is to eat more fiber. Unless you have SIBO, especially like a methane positive SIBO, it could end up making you more constipated.

Favorites? I mean, I put like chia seeds into my smoothie. My favorite food is avocado, garlic, onions, bananas, artichokes, things like that. So yes, any kind of those vegetables or fruit are great sources of fiber, whole ancient grains.

[00:51:02.02] Scott: It's actually funny, Dr. Dietrich Klinghardt, who's one of my mentors, will say that people should juice and then give the juice to their children, and then for fiber, they should eat the leftover material from the process of juicing, right?

I don't know too many people that actually do that, but he says that it results in some pretty tremendous positive health shifts.

[00:51:25.03] Dr. Koz: My best friend, the raw vegan, he's a juicer, he's a big juicer. He would a lot of times turn the pulp leftover into like crackers. So he would like dehydrate them and eat it as crackers as a way to get fiber.

[00:51:40.05] Scott: Wow, very cool.

[00:51:41.12] Dr. Koz: It is a good strategy.

[00:51:42.28] Scott: So, talking a little bit more about toxicity. I wanted to talk about autophagy, intermittent fasting. Are you a proponent of intermittent fasting?

Do you see it providing benefits to your patients? And does the intermittent fasting then allow us to get into autophagy and essentially have our janitorial crew working more efficiently in support of that cleansing process or detoxification process?

[00:52:09.21] Dr. Koz: For the longest time, I was pretty against fasting; I didn't really see its benefits. I think part of that, looking back on it now, is like I never wanted to do it, I loved to eat, so I didn't really want to not eat.

But I also saw the majority of people that tried it with minimal results. So fortunately or unfortunately, the reason most people try it is for weight loss. There are so many other benefits of fasting. But the most people that I saw, they were doing 16-hour fasts.

So if dinner is at 6 p.m., breakfast would be at 10 a.m. the next day. The whole point of fasting is gluconeogenesis, to use stored glycogen to make energy when you're not eating. That process doesn't really ramp up to like hour number 20. So the 16 hour fast is not enough, and what I've done in my own life and with my patients is recommend 24 to 36-hour fasts, twice to three times a week.

I do it on Mondays and Fridays, but whatever schedule works. I do it for hormones; it boosts growth hormone and testosterone. It's one of the best effective things at increasing BDNF levels. So I like it for all those reasons, and it also is like mentally it's good for me. Like if I make it through a fast, I'm like, all right, that was tough, but I feel good about it. Like mentally, I think kind of gives me something like I had success around.

[00:53:49.24] Scott: For that 24 to 36 hour period, are you just having water?

[00:53:54.14] Dr. Koz: Yes. On my more difficult days, I don't know I'm moving around more, or I'm hungrier; I will have juices sometimes. I don't prescribe that to patients because that doesn't really qualify as fasting. I like coffee, so I will have black coffee or green tea as well.

[00:54:16.17] Scott: I want to talk a little bit about your work with children on the autism spectrum. Wondering how important the focus on the gut has been in those children and what are some of the key contributors that you observe in autism.

[00:54:30.05] Dr. Koz: Autism, it's kind of shocking for me to say, but our success rate in my practice has been 100% in regards to improving the health of autistic kids. I never would have dreamed that I could say that in my career, because from a regular medicine perspective, like as a regular family practice doctor.

If a family came in to me with an autistic child, I'd be just referring them out to all types of different people to try to get help, and it would be very overwhelming. Nowadays, like I look forward to it, I'm like, wow, there's going to be some awesome success here.

And it's a spectrum; I mean, I've had kids that went from just not speaking, not paying attention, headbanging to having full-out conversations with their parents, and playing and being in regular classes. So it's been pretty incredible. The approach that I take is the same that I take with an adult, and that is food sensitivities are very common.

So cleaning up the diet. Gut health, Clostridia overgrowth is the most common bacterial overgrowth I'll find in autistic children. Environmental toxins like mold and heavy metals. So it's all the same stuff just for a smaller person, and it's extremely effective with autistic kids.

[00:55:58.16] Scott: I actually like the way that you position that because I've always thought of the overlap between a child on the autism spectrum, an adult that has Lyme disease or chronic fatigue syndrome, or an older adult that has Alzheimer's, dementia.

I mean, there really is more similarity than difference; obviously, there are some nuances. But it is interesting that you observe that there's a lot of similar contributors to autism as what you see in your adult patients as well. I wanted to dig a little more into Clostridia, and so that is an issue that you say is common in children with autism.

But you also say that most Clostridia are beneficial. So how do we know when they're beneficial or not beneficial? Then can we address the not beneficial Clostridia with natural herbal type interventions, or is this a case where you need to use antibiotics?

[00:56:53.16] Dr. Koz: The best test, in my opinion, is a stool culture, but you have to order the stool culture-specific to Clostridia. My favorite lab for stool testing is Doctor's Data. Their regular comprehensive stool analysis just gives you the beneficial Clostridia.

If you pay for the extra profile that differentiates, then you get the dysbiotic versus the good Clostridia. Most of my patients are doing organic acid testing, and if I'm testing like a child or an adult, and the clostridium comes back positive on the oat, it's less specific than the stool test, but I will treat it.

Treatment, I have had success with natural, and the treatment that I've always used is Biocidin, which is a combination of a bunch of different herbs that kill bacteria. It's like an antibiotic that's mixed naturally. Clostridia forms spores, so we do something called pulse dosing.

So somebody with Clostridia, I'll put them on Biocidin three times a day for two weeks, and then every third day for two months. It's basically to kind of try to confuse those bacteria because they have very strong defense mechanisms. If they just see the same thing over and over again every day, they're going to develop resistance more quickly. I have used antibiotics like vancomycin if Biocidin fails in the past.

[00:58:30.20] Scott: You say that strengthening the microbiome is best done with fibers and also increasing short-chain fatty acids like butyrate.

Wondering if there are specific fibers we talked about that a little bit, but specific fibers or short-chain fatty acid products that are really supporting the microbiome, potentially even increasing the diversity of the microbiome. Then any specific prebiotics or probiotics on the market that you find consistently helpful for your patients.

[00:58:59.27] Dr. Koz: I try to do everything naturally through diet. If I do use pre or probiotic, I'm actually more pro-prebiotics. The two main ones that I use are inulin and arabinogalactan. Arabinogalactan is nice because it comes in capsules. Inulin, as far as my knowledge, it pretty much only comes in powder, so sometimes that could be kind of annoying to take.

So if somebody were to ask me like what should I take to kind of boost my microbiome, I would probably go with the prebiotic. But I would want to focus on fermented foods, and again the avocados, the bananas, greens, things like that.

Ancient grains, chia flax, hemp, I would want to be doing it through diet. And again, through eating 9 to 12 servings of vegetables and fruit a day, you're going to be getting that good fiber content. So supplementation, like I will use it in the short term if somebody has a really severe lack of good bacteria, or I'll use it as needed.

So the way I kind of teach my patients is if your diets balanced and you're getting lots of pre and probiotic foods, skip your probiotic. But let's say you're traveling or your diet is sucked that day, take your supplement.

[01:00:20.15] Scott: Some practitioners like Dr. Dietrich Klinghardt, Dr. Simon Yu, they talk about the importance of exploring parasites in people with chronic health challenges. It seems that there aren't very many good tests for really exploring parasites.

So I'm wondering if you feel that the tests that are available are good and exploring the possibility of parasites, or if there are times that you say you know what, let's just go ahead and empirically treat parasites in this person.

I know sometimes people will have negative parasite tests, and they actually see worms coming out in their stool. What are your thoughts on the role of parasites?

[01:00:56.04] Dr. Koz: This is another tough one, definitely controversy around this. So personally, I rely on my stool testing. If I really suspect somebody has parasites, then our typical stool analysis would be one day. But if we want to really rule out parasites, we will do a three-day stool collection.

I don't catch that many cases of parasites a year. I'd say probably around like five a year. The first time I did my own stool test, I had parasites, and so I definitely see them come back positive in stool tests, and I see improvement when we treat it. I know that there's a lot of doctors that say that it is not reliable, and you should just treat kind of like empirically.

I've never recommended a patient to do that, so I've always relied on my stool test. But I have patients that I'm like they'll show me the product because there are a lot of people selling products that are like, this is your perfect anti-parasite cleanse.

I get turned off by that because it doesn't seem objective, and it just seems like selling things which I've never liked; I've always liked to be objective and follow what my lab results tell me, and not doing the profit thing from selling supplements.

But I have patients that are like I've been following this doctor, all they talk about the parasites and that you can't catch them, and I want to try this parasite cleanse. So I'll look at it, and the majority of the time, I think 100% of the time I've never really thought that they would do harm.

So I'm like, listen, if you want to try this, I don't think it's going to do any harm, and just get back with me in six months and tell me if it worked. I can't think of anybody that was like, oh yes, that was the game-changer for me, that was the thing that I'm missing. An area that I might be wrong about, and I can accept that, but that's the way I approach it.

[01:02:49.08] Scott: Let's talk more about SIBO. I'm wondering if you see SIBO as primarily a bacterial overgrowth or SIFO as primarily a fungal overgrowth.

Or do you see other contributors that are more upstream such as the vagus nerve, the nervous system, the bile flow, things that are more the headwaters that need to be addressed before you can really bring longer-term resolution to the condition? And is resolving SIBO about killing a bug? Or is it about a broader, more holistic approach?

[01:03:21.23] Dr. Koz: Another great question. What is actually growing in the small intestine, to my knowledge, there's not a way to diagnose that because the current testing that I use is breath testing. Which basically, we are just giving you lactulose and measuring hydrogen and methane gases.

If you blow them out in the first two hours, that signifies fermentation. In two hours, that lactulose should not have made it to your large intestine, so there should not be any fermentation. So if there is, you assume that there's SIBO.

How to tell what's growing there? I don't know the answer to that. The thing that I've tried to do with my patients is to encourage them to also do a stool test and an organic acids test. If we do find dysbiotic bacteria or Candida, then we can assume that that might be overgrowing the small intestine as well.

Again, that's not perfect, but if it's overgrowing your large intestine, there's a chance it could be overgrowing your small intestine. So the treatment, I love the way that you said it. I do think it's very multifactorial, and it is; you have to make sure someone's digesting.

To me, the greatest reason that SIBO comes back, which is a very common thing, is unaddressed mental, emotional, spiritual health. Because when that trauma, when that vagus nerve, the sympathetic response when it shuts down your acid production, it shuts down the way that your pancreas is going to work, and the leakiness of your gut.

All of that stuff will allow SIBO to come back or take over. So I always support stomach acid if someone has failed like the baking soda test or has found that they needed HCl through testing. I'm always encouraging them to work on the mental, emotional, spiritual parts.

[01:05:20.04] Scott: I think that's great because I think that's something that's not talked about a lot in the SIBO treatment conversation. I do see many people that are on Rifaximin or Xifaxan, maybe doing the elemental diet, they feel better, but then the minute they stop, it seems like those things creep back in.

So I've always thought there are other components tying back in large part too to the nervous system and to that sympathetic dominance that you were talking about. It makes a lot of sense that the mental, emotional contributors to that would also be playing a significant role.

Talk to us a little bit about how IBS is different from SIBO. Are there significant overlaps? Is your exploration, root cause analysis and treatment more the same or more different?

[01:06:08.20] Dr. Koz: I don't know that I really believe IBS is a diagnosis. I believe it's kind of just like giving up on finding the underlying cause because we're kind of just like, well, we don't know. I find an overwhelming overlap between IBS and SIBO. So if somebody really comes in suspecting IBS, I'm going to look at SIBO.

But it could also be the other stuff we've talked about; IBS could be caused from food sensitivities, IBS could be caused from, like, a Candida or a bacteria or a parasite overgrowth. IBS could be caused by unaddressed trauma; IBS could be due to mold mycotoxins.

So I would very thoroughly go through all of those things and try to find an answer before just, I don't think I've ever told anybody that they have IBS. I don't think I've ever given anyone that diagnosis. 

[01:07:06.16] Scott: We know that SIBO is an overgrowth of bacteria. Some people say it's not necessarily pathogenic bacteria, but just an overgrowth of bacteria in the wrong place, in the small intestine.

I have spoken to some people that speculate that using lots of probiotics in supplements, where we're using a large number of copies of a small number of different types of organisms, could actually potentially be contributors to SIBO. I'm wondering if you think that that's a possibility.

[01:07:37.21] Dr. Koz: I've always thought that whenever I've thought that a patient had SIBO, the first thing I do is to stop their probiotic and to put them on a low FODMAP diet. I've had so many patients over the years that we do the initial visit, and I'll prescribe those two things, right?

Then usually probably test and treat them for low stomach acid. So let's say those three things, and we order the SIBO test. They come back in three weeks to go over the results because usually, it takes a couple of weeks to get the results, and they're completely better.

All we did was stop their probiotic, work on their mental, emotional, spiritual health and follow a low FODMAP diet. So when they come back in, even if their result is positive, I'm not going to be like, here, let's go on, antibiotics or an herbal treatment.

Like our goal has been obtained, your symptoms are gone; you've found the right path. It's something that I've also seen a lot of patients when I tell them I'm like for most people, and like if you just talk to your friends and you're like hey, I have gut issues, they're going to tell you eat more fiber and take a probiotic, right?

That is, in my opinion, the worst thing you can do for SIBO, which is the most common cause of gut issues, I think. When I tell people that, they're like, so you're telling, and they start crying. You're telling me everything I've been doing for the last three or five years has been backwards, and I'm like, yes, it's not your fault.

So that's been my experience. I know that there are doctors out there that are SIBO experts, that will use probiotics. For me, things need to make sense, and I can't make sense of how stimulating more bacteria to grow would benefit someone that the bacteria is overgrowing.

[01:09:36.12] Scott: Yes, it makes sense. Then a lot of times, the probiotics that people are using are actually histamine promoters. So if they're dealing with mast cell activation, sometimes that is even worse.

Fortunately, there are a few companies now that make probiotics that are histamine degraders and kind of consider that.

Wondering what your thoughts are about fecal microbiota transplants?  What has your experience been? I personally have not been very drawn to them, have been a little hesitant about the potential things that we don't know in someone else's biome and what that might mean to the person that's receiving that donor stool. Have you seen FMT helpful in your patient population?

[01:10:17.15] Dr. Koz: I've never used it and never really considered it. One reason is what you said is because we really don't know; it's too early on to really understand that. But your microbiome is so dependent on your diet and lifestyle.

So if we implant a healthy microbiome, but then you go to eating processed foods high in sugar three times a day, not exercising, being stressed out, you're going to damage whatever was transplanted. So I've more seen it from the traditional medicine standpoint, so people that are hospitalized with C-diff Clostridia difficile that they're keep getting diarrhea, it keeps coming back.

The microbiome transplant has been effective in those conditions. But if I'm just trying to address dysbiosis or SIBO or Candida or whatever, I wouldn't even consider the transplant, but maybe I should be, I don't know. I don't think we need it.

[01:11:22.20] Scott: Early on in our conversation, we talked about the five contributors that fill the bucket. I want to dig deeper into each one in our last few minutes together. So we've talked about diet, we've talked about gut health, let's talk a bit about hormones.

So talk to us about estrogen dominance; how common is that in your patients? Why does it happen? What can we do about it? Does estrogen dominance then tie back into the gut conversation?

[01:11:48.23] Dr. Koz: So estrogen dominance in my patient population and premenopausal women is probably around 75 percent of the women that I see. It's extremely common. Estrogen and progesterone are the two main female hormones. If we look at the cycle and the cycle is 28 days, the first 15 days, the woman's body makes estrogen and no progesterone.

In the second 15 days, the woman makes estrogen and progesterone. Estrogen dominance, in my experience, does not mean too much estrogen. It means not enough progesterone. So the balance is lost. So they're not making enough progesterone making them estrogen dominant.

It can present as heavy periods, imbalance periods, migraines, PMS, all these classic symptoms that women go to their OB or their family doctor and get put on birth control. You get put on birth control when you're 14 or 16 or whatever, and you stay on it until you get married and are ready to have a family, then you have kids, and then you're off of any kind of hormones, and you realize like holy cow, I'm horribly estrogen dominant.

The two biggest symptoms that I see, like the greatest relief in when we, the most extreme treatment is progesterone replacement in the second half of your cycle that is something that I've done frequently, incredibly reduced anxiety and improved sleep.

That's something I've seen in women where they're like I'm doing yoga, I'm doing meditation, I'm working with a therapist. I'm doing all these things for my mental, emotional, spiritual health, but I'm still incredibly anxious, I cry, I'm irritable, and that could just be hormonal imbalance.

We get their estrogen-progesterone balanced, and all those things that they're doing start working more effectively. The reason I think it's so common is, again, our environment; toxins destroy our hormones. I'm starting a second book, and the second book is going to be on hormones and toxins and the connection between the two.

They are endocrine disruptors, and toxins can be the dysbiotic bacteria in our gut. They can be stress; they can be fluorides and phthalates and lead and mercury and mold and glyphosate and all these things. We're just being EMFs like all these things we're just being bombarded with every day.

I see more and more young men with low testosterone, and like I said, I think probably 75 percent of premenopausal women I see estrogen dominant; I think it's our environment.

[01:14:42.12] Scott: Totally agree, yes. Actually, I'm interested in microplastics now as well; that seems to be another area that we're learning more about how much plastic exposure that we get and how that also disrupts a lot of the hormones.

Let's talk a little bit about the thyroid. So wondering how commonly do you find the thyroid needs to be supported? Are there cases where a downregulation of thyroid hormone could be a protective response or an intelligent adaptation from the body if we look at Dr. Bob Naviaux’s Cell Danger Response, for example?

Does low thyroid generally mean that supplemental thyroid is beneficial? Or can low thyroid be a sign that there's a bigger issue that needs to be addressed first, like an infection or a toxicant or mycotoxin, for example?

[01:15:31.12] Dr. Koz: I learned a lot about the thyroid from Dr. Susan Blum. She was one of my mentors. Her functional medicine book that she wrote a number of years ago, The Autoimmune Plan, I think, is one of the best functional medicine books. She treated her own Hashimoto's. The way she described the thyroid to me was the thyroid is like a sponge for toxins.

So all those things that we've talked about that can circulate in our bodies love to go to the thyroid. The general just the testing is controversial, right? In regular medicine. They're just ordering TSH in functional medicine. We're ordering free T4, free T3, thyroid antibodies, reverse T3.

I don't believe in treating people based on the numbers. I believe in treating people based on the symptoms, in combination with the numbers. So somebody that's got a like a low normal T3, and they do have like fatigue issues and brain fog and constipation, we might try to support their thyroid. If somebody comes back with those results and they don't have those symptoms, I'm not going to address it.

We don't all have the same perfect free T4 level or the same perfect free T3 level, like all of us is different. So I base it on somebody's history and symptoms. If somebody is really wanting to try like a low-dose thyroid replacement and they do have lower end labs, I will offer that to them to see if it helps.

For a lot of people, it's just been life-changing and amazing to get thyroid support. But I would always look at, and that's something where it depends on their other symptoms, but I might start with environmental toxins before the gut if somebody's got a thyroid issue, and thyroid issues are really common.

An interesting fact is like the number one condition that happens as a result of chronic low stomach acid is low thyroid. My theory on that is you need stomach acid to get vitamins and minerals out of your diet. Even if your diet's amazing, if you're not digesting, then you're not absorbing, and the thyroid and the immune system get stopped functioning normally.

[01:17:58.13] Scott: So extending then on that conversation, you say that toxins damage the immune system, the nervous system, the reproductive system. You highlight the value of walking for detoxification, which I completely agree with and think is really something that we don't put enough focus on.

Wondering what some of your favorite tools are for detoxification, and are there any particular binders or drainage remedies or organ support tools that you find helpful?

[01:18:26.15] Dr. Koz: It depends on the toxin. So for just general detoxing that you don't have a known toxin issue, I like sweating the best. I like exercise; I like drinking lots of water and eating fiber to make sure you're pooping every day. Yes, cheers.

So those are things that I would want anybody to be doing. When it comes to like a specific toxin, like, for example, mycotoxins. My favorite tool is infrared sauna. I worked with a doctor named Dr. Lisa Nagy, she's out of Martha's Vineyard. She trained with Dr. Bill Rae.

When I was there with her, we were measuring mycotoxins before and after sauna. After sauna, the excretion was elevated, pointing to increased excretion. If I could just pick one thing for people with a mold toxicity to do, it would be that probably, besides stopping exposure. If I could pick just like one supplement, I would pick liposomal glutathione as the body's master antioxidants.

So that I'm using whether I'm treating somebody with mold or heavy metals or some kind of phthalate or other issue or glyphosate, I really like glutathione. Binders, the one that I've used the most is GI Ddetox from the company that does Biocidin as well, and that's a combination of charcoal and clay.

In heavy metal detox, I use chelation, so I use oral chelation therapy, I use DMSA. Which is much stronger in a medication, and that needs to be done very slowly and safely.

[01:20:14.15] Scott: Yes, those are some excellent ideas. Actually had Dr. Lisa Nagy as a prior guest on the podcast here as well. Definitely very passionate and does some excellent work. When we talk about flight or freeze, more and more people look at HRV or heart rate variability as an indication of the autonomic nervous system's health.

This also ties back to the conversation around the vagus nerve. Wondering how HRV and the vagus nerve tie into the conversation and some of the best tools that you found that can measurably improve heart rate variability?

[01:20:50.12] Dr. Koz: Heart rate variability, I could argue, is like the key to your gut health because it's the way you can train your vagus nerve. Patrick Hanaway is, I think, one of the smartest people I've ever met, and he's the one that kind of really, kind of introduced me to heart rate variability. There's a lot of different tools now that are available that people can do it at home.

So I think the best one is the Heart Math Lab, you can order a device from them and a training course, and you download a program onto your computer, and you attach a monitor to your ear. There are other ones that you can attach to your phone, and you monitor your variability, and they have breathing exercises that you can see on the screen, how the breathing changes your heart rate variability.

So it's a really incredible tool that, because of all the technology now, is pretty accessible to anybody at home that I strongly recommend to most of my patients.

[01:21:50.05] Scott: You stress the importance of mental, emotional and spiritual health. My primary mentor, Dr. Dietrich Klinghardt, also puts these at the higher levels in his five levels of healing model.

Wondering what tools you find to be the most helpful interventions in these realms, and have you found things like EMDR or emotion code or family constellation therapy, or maybe even things like BrainTap or Frequency Specific Microcurrent helpful in this realm?

[01:22:20.03] Dr. Koz: EMDR has been amazing for my patients, especially if there's a history of trauma, which most of us have some degree of trauma. I've loved EMDR for my patients. There are so many, like you just mentioned, so many different modalities, and it's based on someone's history; unless it's like trauma, then I would really push them towards EMDR.

In my opinion, it's about finding what works for you, and exploring that and having to be honest. So I've recommended every patient I've ever met to work with a therapist while they're working with me. Therapists helped me kind of uncover what was underlying my trauma and helped me discover like where my issues come from.

Meditation, I like the app called Calm. I use prayer; I really like exercise; when I don't exercise for a few days, my mental, emotional, spiritual health kind of goes down the drain. So I would encourage anybody to try any one of those tools. If you try it for a couple of times, you're like; I don't think this is right for me, then try another one. To me, it's about finding that routine that works for you.

[01:23:34.19] Scott: Do you think that in some cases, the physical body may be following or taking a lead from or matching its level of health to the mental, emotional, spiritual body and that for some people, physical improvement might be elusive until they're working on those mental, emotional, spiritual levels?

[01:23:56.03] Dr. Koz: Yes, I think that. What I tell my patients also is like my job is to find the objective things, so my job is to look for hormone imbalances, dysbiosis, toxins, food sensitivities. Your job is to start working on the mental, emotional, spiritual sides.

I warn everybody; I'm like we might do all these tests, and everything might come back negative. In which case, especially if in their history, I can already see kind of trauma or stress or anxiety or whatever, then be like this is what I'm probably going to like diagnose you with, or encourage you that until that is addressed, I don't think that you will heal.

[01:24:43.23] Scott: In the back of your book, you have a number of recipes to make things easier, as changing the diet can often be overwhelming for people. Now I wish we could just pre-make some of those things and deliver them to my house.

Actually, that'd be really nice. So talk to us about the Koz plan recipes that you share in the book, and what potential diets are they supporting?

[01:25:03.19]Dr. Koz: I mean, everything in my book I wanted just to be a little bit different, and then kind of the rest of the functional medicine books. I think a cool thing about my recipes is that one of my patients wrote them.

She's a woman who came to me with rheumatoid arthritis that's been in remission for seven years now and really got into; I mean, it's basically been through diet. She was a chef by training, and so she always really liked recipes. So when I started writing a book, I was like, hey, will you write recipes, and also will you tell a little bit of your story?

So there's a little bit of her story in my book of what it was like to come in to see me. How she felt walking out of there, how overwhelmed she felt by changing her diet. So the recipes that she wrote are elimination diet-friendly. But because of the high frequency of SIBO that I see, there is a little blurb at the bottom of how to make those recipes low FODMAP.

Or some recipes are just not possible to make low FODMAP, so they're kind of just a no on the SIBO plan. So that's what the recipes are targeted at. I love the way they turned out, I've made all of them, and they're good to very good. I have heard the same from people who have read the book and are making the recipes.

[01:26:26.22] Scott: So talk to us a little bit more about your book, Unfunc Your Gut, where people can find it, where they can learn more about you. Are you taking new patients? Do you do telemedicine?

[01:26:37.03] Dr. Koz: Yes, thank you for sharing the book. The biggest thing I tell people about the book is you can find it if you spell it right, and it's spelled Unfunc with a C. In my practice, we had a saying that said we put the funk in functional medicine, and so that's where Unfunc came from. It is available on Amazon, in Barnes and Noble.

It will not be in stock at your local bookstore, but if you prefer to use your local bookstore, they can order it and have it within a few days. So it is available anywhere that you buy books. It is available on kindle. To get a hold of me, my website is doc-koz.com.

There's a phone number to my assistant Jasmine on there who is amazing; she is just phenomenal at answering people's questions, any kind of questions in regards to the functional medicine process. I do mostly telemedicine nowadays; I'm licensed in Illinois and Montana, those are the two states where I work. It's been interesting that I've found that our results are the same on zoom or on telemedicine as in office.

So that's a very good thing. I'm on social media now as Doc Koz and on Facebook Peter Kozlowski MD. My opinion is that our greatest job as practitioners is education, and an initial visit with me was usually one to two hours of education.

I put a lot of that into my book, and the feedback I've gotten from patients is that people that have read it, that haven't come to see me, they're like well when I went to go see a functional medicine doctor, I just felt really informed about the testing that they were going to order and what kind of plan.

Sometimes, they've known more than their practitioner if they kind of catch someone that's just starting their career. So I really tried to share as much information as I could in there and make it very easy to read.

[01:28:46.00] Scott: My last question is the same for every guest, and that is what are some of the key things you do on a daily basis in support of your own health?

[01:28:53.06] Dr. Koz: Yes, get good sleep. I go to bed at like 8:30 and get up somewhere around five usually. So sleep is really important to me. Exercise, I exercise usually five-six days a week, that's really important to me.

Every day I do a gratitude list with my wife. We list three things that we're grateful for. I work with a therapist for many periods of my life. I was going once a week; now, I'm down to once every few weeks. I try to meditate every day. I pray at night, and then I try to get my vegetables and fruit in. That works for me, but find what works for you, would be my advice. 

[01:29:41.25] Scott: This has been a great conversation. I love that we talked so much about the gut and that being the topic of your book. But that you brought in so many other components, so many other perspectives and really looked at it holistically, looking at things like mold and other infections and hydrochloric acid.

I think it's very holistic the way you've approached it. I would encourage people. Unfortunately, many people that I talked to are dealing with things like SIBO and gut issues; it just seems to be so incredibly common.

So I would encourage listeners to get a copy of your book Unfunc Your Gut and to benefit from all that you've put into it. Thank you so much for your time today and for sharing your wisdom with all of us.

[01:30:21.08] Dr. Koz: It's an honor to be here with you, and you are a great interviewer.

[01:30:25.01] Scott: Thanks, Dr. Koz, be well.

[01:30:26.24] To learn more about today's guest, visit Doc-Koz.com.

[01:30:38.11] Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or MeWe, you can find me there as BetterHealthGuy.

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Disclaimer

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.