Unfunc Your Gut with Dr. Peter Kozlowski: Rational Wellness Podcast 221
Podcast: Play in new window | Download | Embed
Dr. Peter Kozlowski speaks about How to Unfunc Your Gut with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
5:00 The gut is so important for our overall health because as Hippocrates told us 3,000 years ago, that all disease begins in the gut. A lot of things that we do in modern life is damaging to the gut, including EMFs from our phones, stress, our food supply, toxins in the environment, antibiotics, meds, etc. One of the most important things about the gut is that it is the barrier to keep things out that might harm us, so leaky gut is so problematic. Once you get inflammation in the body, it can go anywhere and that’s why you get different symptoms when people get SIBO or candida or gluten sensitivity. We also have 3 to 5 lbs of bacteria living in our microbiome and these bacteria interact with our genes and they help to keep us healthy. We are mostly bacteria.
8:23 Dr. Kozlowski in his book Unfunc Your Gut discusses the important role that mental, emotional and spiritual health play in our gut health. Your nervous system talks to your gut through the vagus nerve. This is largely through our autonomic nervous system and we tend to be very sympathetic nervous system dominant. The more we can activate our parasympathetic nervous system through meditation, therapy, heart rate variability, gratitude, acupuncture, breathing, the better your gut is going to function.
19:40 Food sensitivities. Dr. Kozlowski does not find food sensitivity tests helpful since what typically comes out as a positive is based on what foods they have been eating for the last few months. Most people who show multiple food sensitivities have open gap junctions, ie. leaky gut. He prefers to place patients on a 21 day elimination diet that eliminates at least gluten, dairy, soy, corn, eggs, and sugar. On a full elimination diet, he will also cut out beef, pork, shellfish, processed meats, and coffee. After 21 days, the eliminated foods will be reintroduced one by one. Foods that they still can’t tolerate, they should work on improving their gut health and then test those foods back in 6 months.
28:14 The healthiest diet for longevity is some version of the Mediterranean diet. Dr. Kozlowski recommends that people eat 9-12 servings of vegetables and fruits per day and a serving is 1 cup raw or 1/2 cup cooked. In our standard American diet we don’t eat many vegetables. In our typical breakfast of pancakes, bacon, breakfast sandwiches, cereal, etc. we typically don’t eat any vegetables. And then lunch is pizza or hotdogs or sandwiches, no vegetables again. And then perhaps there’s a side of broccoli at dinner. So we’re eating one to three servings of vegetables instead of 9-12 servings of vegetables and fruits per day that he recommends. We should definitely avoid sugar, processed foods, and processed vegetable oils in our diet.
31:25 The microbiome. When you don’t take care of your garden, weeds grow and this happens with our microbiome. Antibiotics are the easiest way to screw up your microbiome and one round of broad spectrum antibiotics can wipe out half your microbiome. And then weeds take over your garden, which is dysbiosis. Dr. Kozlowski prefers to do a stool test and urine testing to see what might be overgrown or out of balance in your microbiome. It is a bad strategy to give probiotics to patients with SIBO or dysbiosis or candida, since you need to pull out the weeds first before trying to grow back the healthy bacteria. This is typically done through taking herbs like grapefruit seed extract or uva ursi or silver or berberine or oil of oregano or caprylic acid or garlic, or you can use the elemental diet to starve the dysbiotic bacteria. Dr. Kozlowski likes to order the stool test from Doctor’s Data, which tells you which natural products will likely be effective against whatever is overgrown in your gut. He often uses combination supplements such as FC-Cidal, Dysbiocide, and A.D.P. from Biotics Research or Candibactin AR and BR from Metagenics. He also likes to use Biocidin, which has the longest research behind it. If the gut lining is inflamed, Dr. Kozlowski will use L-glutamine 5 gm 3 times per day. He may use high dose fish oil or GLA. He may recommend HCL, digestive enzymes, and/or ox bile. They may need gall bladder support. His favorite SIBO protocol involves taking the herbs two weeks on, one week off for a total of nine weeks. For re-growing the microbiome, Dr. Kozlowski prefers to use prebiotics like Arabinogalactan or inulin and prebiotic foods like banana, asparagus, and artichokes rather than taking probiotics.
Dr. Peter Kozlowski is a medical doctor who transitioned to Functional Medicine as an intern in medical school. He has trained with leaders in the Functional Medicine field, including Dr. Mark Hyman and Dr. Deepak Chopra. Dr. Kozlowski’s unique take on gut health is described in his new book, Unfunc Your Gut.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today, our topic is gut health with Dr. Peter Kozlowski. Dr. Peter Kozlowski, he will give his unique take on gut health as described in his new book, Unfunc Your Gut. Dr. Kozlowski started out as a family practice MD, but transitioned to functional medicine as an intern. He has trained with leaders in the functional medicine field, including Dr. Mark Hyman and Dr. Deepak Chopra. Dr. Kozlowski, thank you so much for joining us today.
Dr. Kozlowski: It’s an honor. Thank you for having me.
Dr. Weitz: Good. Good. Good. So you’re speaking to us from Montana. How are things in Montana right now?
Dr. Kozlowski: I think we’re on like day number 20 over 90 degrees. So, hotter than normal here.
Dr. Weitz: Yeah. But climate change doesn’t exist.
Dr. Kozlowski: Yeah.
Dr. Weitz: So since you started off as a functional medicine MD, how did you find your way to functional medicine?
Dr. Kozlowski: Completely randomly. I just tell people that I got lucky. The majority of practitioners that I know in the functional medicine world usually got into it because they got sick themselves and they tried the traditional route and they couldn’t get better, so they found functional medicine and then decided to use that in their practice. For me, I was an intern in family practice residency. And as an intern or as a resident, you do different rotations every month. So one month we focus on clinics, outpatient, inpatient, cardiology, OB/GYN, and you’re constantly being trained by different physicians. And when you’re on the inpatient service, every week, there’s somebody new that teaches you.
And we had one doctor that every patient that was hospitalized, he would put them on a multi-vitamin and vitamin D. And we, as residents, thought it was ridiculous and used to make fun of him that he would make us write those kinds of orders because nobody else did it and we just didn’t get it. So I was working with him on… It was a Sunday night at like 2:00 AM and we had some downtime and I just asked him, I was like, “Why are you weird? Why are you different?” And he’s like, “I’m studying something called functional medicine.” And I was like, “What is that?” And he took me to the IFM website and it just took off from there. I looked at it, I was like, “This looks pretty interesting.” They require you to go do CME during residency. So I was like, “Why not go check this out?” And within the first hour of the first conference, I just couldn’t look at medicine the same. It was all taught from a science, biochemistry, a physiology level. I couldn’t really argue with it, and it just made sense to me.
And then another thing was, at this conference, there was doctors that were from every profession from chiropractic, acupuncture, ophthalmology, cardiology, neurology, and they’re all here. And I was like… I didn’t get it. I was like, “What are you guys doing here?” And they were like, “This is the future of medicine.” And I heard that over and over and over. So I left that conference and just really with my brain overloaded, but I was like, “I’m going to slowly focus my career on this.” And I continued throughout residency to go to conference, to work on my certification and got invited to do away rotation. So I left residency for like a month at a time to go work with some of the leaders in the field, and I would just follow them around. And it wasn’t just the doctors. I would follow around the staff, the nutritionist, the health coach, the life coach, because everything was new to me. It was a completely different approach than I had learned in residency. So I was learning from everybody and I just took notes. And when I graduated, I started my own practice and I’ve been out on my own for seven years now.
Dr. Weitz: Cool. So why is the gut so important to our overall health?
Dr. Kozlowski: Yeah. So Hippocrates said it 3,000 years ago, right? All disease begins in the gut. And what I always tell people is, basically, since he said that, everything we’ve done is pretty damaging to the gut. With our phones, with stress, with what we’ve done to our food supply, our environment, antibiotics, meds, all of that stuff is damaging our gut. But the reason, the true reason that it’s the key to our health is, in my opinion, because the gut is the gateway into your body. So when we say gut, it’s a long tube that starts with the mouth and ends with the anus, and it has openings on both ends, so it’s literally just a tube. And the inside of that tube is actually considered outside of your body. So if you swallow something and poop it out, it’s never been in your body. So to me, the gut’s most important job besides digesting and absorbing is to decide what comes in and what stays out. So that’s where a lot of people have heard of this term, leaky gut. That’s pretty much exactly what it means. When your gut’s leaky, the junctions are wide open and anything that’s passing through your gut tube can pass into your body. Now it’s fair game, it’s in your blood, and the blood goes everywhere. So you could take a hundred patients with SIBO, candida, gluten sensitivity, and they all have different symptoms because the inflammation is in the body and it can go anywhere. That, I think is the biggest reason. And then the secondary one is your microbiome, is that we all have three to five pounds of bacteria growing on the inside of the large intestine, the last part of your gut. And that bacteria constantly talks to us. We, as humans have about 23,000 genes. They’ve found over 20 million bacterial genes in our gut. So one of my favorite T-shirts that I have says, “Mostly microbe,” that we’re mostly bacteria. And those bacteria, they develop, they start when we’re born and then we can either keep them healthy through our diet and lifestyle or we can damage them through our diet and lifestyle. So those are the two reasons why the gut is the key to your health.
Dr. Weitz: Yeah. I certainly know all about the importance of the microbiome and there’s incredible amount of research going on. But one thing I always find interesting is there are people who do not have a colon, they had Crohn’s disease or ulcerative colitis, and they had their colon cut out. And yet they continue to thrive, probably not ideally, but I’m always amazed about that.
Dr. Kozlowski: Yeah. I think it just proves the point of how resilient our bodies are, right? I assume if your large intestine gets cut out, your microbiome just starts to grow at the end of your small intestine and your body adjusts.
Dr. Weitz: Yeah. I don’t know. It’s a question we need to answer one of these days. So in your book, Unfunc Your Gut, in the beginning, you talk about stress, which is really important and often not talked about. So how does our mental, emotional, and spiritual health play, or what factor does that play in our gut health?
Dr. Kozlowski: So, spoiler alert, that’s the big secret that I reveal in the book is that your mental, emotional, spiritual health is the most important component. And that I learned through my own story, but more in my… I learned it from my patients because one of my faults is that I’m a perfectionist. So I don’t really think about the patients that get better, I only focus on the ones that didn’t. And trying to figure out why could I put 10 people on a CBO Protocol and half get better and half don’t. And what I started to see over and over, it was usually their mental, emotional, spiritual health, which other terms are anxiety, depression, trauma. To me, I like mental, emotional, spiritual health. But this, just like everything else in functional medicine, and there’s science behind it; and the main reason, anatomically, why that is because your gut, that tube is surrounded by a nervous system called the enteric nervous system. There’s 200-250 million neurons in that nervous system, more than in your brain or spinal cord or anywhere else. That nervous system talks to your gut, but then it also sends signals to your brain and your brain sends signals to your gut. So that whole gut-brain connection that people talk about, it’s between the two nervous systems; your central and your enteric. Those systems are connected by the vagus nerve, that’s one of your cranial nerves. And this is where the mental, emotional, spiritual component comes in.
Your vagus nerve runs on your autonomic nervous system, which is your automatic nervous system, which is divided into two responses; sympathetic and parasympathetic. Sympathetic is fight-or-flight. So that is hiking in Montana, you see a bear and you want to escape, all the blood goes to your muscles and brain to try to figure out how to get away. Then when you’re sitting by the campfire, you go into parasympathetic and you rest and digest your food. People right now, nowadays, are living as if they’re running from a bear 24/7. We wake up, we go straight to our phone, we check our email, our texts, we check the news, we sit down for breakfast, we’re reading our phone or watching the news. And so we’re just constantly activating that sympathetic nervous system, which is sending signals down your vagus nerve to your gut to tell you to not digest, to not absorb. It shuts down your gut bacteria. So that is the connection. So the more that someone can activate their parasympathetic nervous system through things like meditation, therapy, heart rate variability, gratitude, acupuncture, there is a lot of ways to do it, just breathing, the better your gut is going to function. And then treating something like candida or dysbiosis or SIBO is much easier.
Dr. Weitz: Yeah. Actually, this is a device that uses vibrations and it helps get you into a parasympathetic mode as well.
Dr. Kozlowski: Oh, excellent.
Dr. Weitz: Yeah. Yeah.
Dr. Kozlowski: What’s it called?
Dr. Weitz: The Apollo.
Dr. Kozlowski: Okay. I’ll take a look at that.
Dr. Weitz: Yeah. So what do we do about how stress, our mental, emotional spiritual health affects our gut health? You just hinted at it by saying we got to get out of being in sympathetic mode all the time, but what else do we do? If your emotional health is affecting your gut health, what can you do?
Dr. Kozlowski: Yeah, the first step is just admitting there’s a problem. My own personal story is I’m in recovery and I used alcohol as a coping mechanism, and so that’s where I learned mental, emotional, spiritual health personally. But what I’ve seen over and over is, as someone who’s spent a long time in denial, usually, you can see it in other people, and so I see it in my patients. And just having the first… Like I said, the first step is just admitting like, “Okay, maybe my relationship with my parents or with my spouse or my kids or my job could be having a role in my health.” And once you know that, you can’t really un-know it. And even though it’s the most important part of health, it’s the most difficult one for me to help someone with because it’s not what I was trained in. I learned it from my own story, but-
Dr. Weitz: Interesting. I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. This is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. This device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, get into a deeper meditative state, even to help you sleep, and there’s even a mode to help you wake up. This all occurs through the scientific use of subtle vibrations.
For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.
Dr. Kozlowski: Every patient that I meet, I encourage them to work with a therapist while they’re working with me.
Dr. Weitz: Okay.
Dr. Kozlowski: And therapy was a huge part for me to uncover why did I need to use alcohol to deal with my feelings and emotions? And the analogy is like peeling back the layers of an onion. And over time, you just get deeper and deeper and figuring out what’s underlying that. And so that takes… I mean, it’s hard. It’s not easy, so I get why people don’t want to do it. It would be a lot easier to just find the right supplements to take or find the right procedure or treatment, whatever. This is the real work. And for most people, it starts when we’re children. Trauma is… I have the best definition I’ve heard of trauma, is trauma is anything less than nurturing. And for a lot of us, it could be your parents working two jobs or working and not being around. And then that can start making you feel like you’re not good enough, and then that affects your gut, and then you start having abdominal symptoms. And then by the time you come into my office, you’re in your 30s, 40s, 50s and there’s autoimmune disease. And it started with something as simple as just being uncomfortable in your own skin, which shut down your gut.
So then the good thing about mental, emotional, spiritual health is there are so many different modalities to use, and it’s about exploring and finding which one works for you. For me, exercise is a big one. I feel much better when I exercise. I do a gratitude list every day with my wife. We usually take a walk in the evening and we always do three things that we’re grateful for. Building connections, helping others, these are things that work for me, but then there’s meditation, prayer. So it’s about exploring what is the right combo for you.
Dr. Weitz: Yeah, it’s interesting. I think that there’s a tendency for… When dealing with patients with some of these gut disorders that are not really structural, these functional gut disorders like SIBO and IBS, over the years, because it’s been difficult to get quantitative tests that really show what’s wrong. Typically, if you have a patient with IBS, a traditional gastroenterologist is going to do a colonoscope or an endoscope or a CAT scan, you’re not going to see anything.
Dr. Kozlowski: Never.
Dr. Weitz: So it’s difficult to see the exact structural reasons for why they’re having the problem. So, for many years, patients with IBS were dismissed as basically having an emotional disorder and given antidepressants and things like that. So there’s, I think, a tendency to try really hard to focus on the physical causes for these conditions. And maybe we’ve gone too far and forgotten that there really are emotional and stress-related issues that affect the gut.
Dr. Kozlowski: Yeah, I agree. And I think that there’s just a balance because for the… I mean, a lot of patients that have been diagnosed with IBS that come through with me and we do testing, the most common thing that I find is SIBO, an intestinal overgrowth of your small intestine, or dysbiosis or candida or low stomach acid, leaky gut. And treating those things, to me, I think we have good testing now so there’s tests for all of those conditions, and then there’s treatment plans that work. I guess my point of my book was just, if that’s not working, if you’ve had the right testing, you’ve had a good treatment plan and it’s still not getting better, in my experience, usually, it’s been the mental, emotional, spiritual health that was the big thing that was missed.
Dr. Weitz: Right. Let’s talk about food sensitivities.
Dr. Kozlowski: Yeah.
Dr. Weitz: To begin with, why do so many people seem to have a lot of food sensitivities these days?
Dr. Kozlowski: I think it’s mostly because of what we’ve done to our food supply. Most of the food that we eat is not in the form that it started, that it was created as. It started with the hybridization of wheat in the 1960s. Right now, over 90% of soy and corn are genetically modified in the United States. Cows don’t eat grass. They are put in pens and fed hay and other things. So we’ve changed the proteins of the majority of the foods that we eat, but we never tested how that would affect human beings. And that is, I think, the biggest reason why food sensitivities are increasing at the rate that they are.
Dr. Weitz: Now, there’s lots of sophisticated lab tests to measure food sensitivities that look at IgG, IgM, IgA. Companies like Cyrex, [inaudible 00:20:53] have very sophisticated food sensitivity testing. But you say in your book that you don’t feel like these tests are helpful.
Dr. Kozlowski: Yeah. And my experience has been that those tests are helpful for diagnosing leaky gut. And when someone does those… The majority of people that do those tests, it’s typically a log of what they’ve been eating for the last few months. Because if your gap junctions in your gut are open, then those proteins from those foods are going to be getting into your blood and you’re more likely to create an immune response against them. To me, the gold standard that I’ve always used is an elimination diet, which is 21 days of cutting out the biggest offending foods and then reintroducing them one by one. And that’s another thing that is science-based. And when you have a sensitivity, you create IgG antibodies. Everything in your body has a half-life. So if you smoke cigarettes, if you take prescription meds, if you drink alcohol, everything has a different half-life, or your hormones, toxins. The half-life of IgG antibodies is around 21 days. So let’s say I react to gluten and I had a bagel for breakfast today, and I have 100 antibodies floating around; if I don’t have any gluten for the next 21 days, that antibody count will drop in half to 50. When I eat it again on day 22, if my immune system has identified it as an invader, it will attack and create inflammation which can present as symptoms like a headache, abdominal pain, a rash, acne, joint pain, it can present anywhere. So, to me, the best way that I’ve found to diagnose sensitivities, the most reliable, is you cut out the foods and then you add them back in one by one, every two days.
Dr. Weitz: Now, there’s different versions of the elimination diet. Some people recommend cutting out two foods or six foods or 10 foods. Which foods do you recommend cutting out?
Dr. Kozlowski: So typically, the top five or six offenders are gluten, dairy, soy, corn, eggs, and sugar. In a “full elimination diet”, we also cut out beef, pork, shellfish, processed meats, coffee. And I think there might be one more that I’m missing. I have it listed, the full list in the book. So I really believe in meeting patients where they’re at. There are some people where if all you’re ready to cut out is your energy drink, that’s better than nothing, right? And if you’re just ready to cut out gluten, I’d rather have you do that than try to do a full elimination diet and quit after a day because you’re going nuts.
Dr. Weitz: Right.
Dr. Kozlowski: One of the things that I think has happened in our field is that there’s so many restrictive diets out there and there’s so much information out there that’s like, “You have to be paleo or you have to be keto or vegan or Mediterranean.”
To me, I and my patients think I’m nuts, I tell them, I’d rather have you eating fast food if it doesn’t stress you out. If you’re so worried about eating the perfect meal, it’s not going to help. You’re going to shut down your digestion, your cortisol is going to elevate, and you’re not going to get the benefits from that meal. And that’s okay. Like right now, you might not be ready for an elimination diet, but a year from now, you might be.
Dr. Weitz: [inaudible 00:24:38] is when they layer one diet on top of the other.
Dr. Kozlowski: Right.
Dr. Weitz: So they’re following their paleo diet, and then they eliminate high-FODMAP foods, and then they eliminate histamine foods.
Dr. Kozlowski: Yeah. Right. Then there’s like three things you can eat.
Dr. Weitz: Right.
Dr. Kozlowski: I’ve seen that a lot with the sensitivity testing too. People come in, they’ve had the testing and they’re eating like six foods. I believe in a candida diet, a low-FODMAP diet, elimination diet, but in short-term. Right? Some of those diets are too stressful to do long-term.
Dr. Weitz: Yeah. Short-term to get rid of symptoms, to help get your condition on the road to healing.
Dr. Kozlowski: Exactly.
Dr. Weitz: But long-term, you’re going to end up with nutritional deficiencies.
Dr. Kozlowski: Right. Yeah, absolutely.
Dr. Weitz: So you have patients cut out all these foods for 21 days. And then how often do they put food back and how long do they wait for? How many times a day do they need to eat it?
Dr. Kozlowski: Yeah. We’re starting an elimination diet challenge on August 1st on social media, on my Instagram and Facebook. So I’m going to be posting… In my book, we have over 50 recipes to help people, but we’re going to be posting recipes, answering questions, and just hopefully making it easier for people to do. The way that I approach it is you reintroduce the food, one food at a time, three times that day. So day 22, you introduce, let’s say, gluten three times. You don’t add anything else new. You wait, day 23. If nothing’s happened in those two days, then you start the next food. So we’re doing every two days. A classic reaction to dairy is like, everything’s fine on day 22. But day 23, you wake up and your face is broken out in acne or something. So, we do one food every two days, three servings on that day. If you have a reaction, you wait until the reaction’s gone to start the next food. For some people, it could be a couple of days. I’ve seen it be a week. And you use a tracking journal, which we have a copy of, and you just write down what happened. And the symptoms, if you went into an elimination diet because of migraines, when you have dairy and you react to it, you might get joint pain. You might not get the exact symptom that you’re looking for, but it still means it’s inflaming your body.
Dr. Weitz: If somebody has a pretty strong reaction to gluten, will you have them try it again in the future or will you just say, “Just avoid gluten?”
Dr. Kozlowski: Yeah. I tell people to try it again. What I tell them is to Unfunc their gut, get their gut right, and then try again in about six months. I mean, it can change. I’ve seen it change. What you’re sensitive to, you might not be sensitive to in the future. So my advice always is to try, especially if you’re missing the food… You meet a lot of people that are like, “I don’t care about gluten. I don’t ever want to eat it again.” And they’re fine. But then, I think more people are like, “Well, when can I eat this again?” So I always encourage trying.
Dr. Weitz: Sure. So what’s the healthiest diet for most people to follow for longevity?
Dr. Kozlowski: I keep it very, very simple. I give two main goals. The most evidence, what I’ve seen is behind the Mediterranean diet. But to keep things simple, what I encourage people to do is to eat 9-12 servings of vegetables and fruit a day. And if you’re eating that… A serving is a cup raw or a half-cup cooked. And if you’re eating that many vegetables and fruit in a day, there’s not room for the other stuff. You’re full from everything else. And so, in our standard American diet, our typical breakfast of pancakes, bacon, breakfast sandwiches, all this stuff, cereal, we don’t eat any vegetables. And then lunch is pizza or hotdogs or sandwiches, no vegetables again. And then there’s a side of broccoli at dinner. So we’re eating one to three probably, the average American. Whereas I encourage people to shoot for 9-12.
So I think that’s an easy… I mean, it’s not easy for people to do, but it’s easy to remember like, “Okay, if I’m going to try to eat well, what should I do?” And it’s just like, “Increase that intake of natural vegetables and fruit.” And then I think that everybody should do an elimination diet because you might not even have symptoms right now, but you might be sensitive to some things. Besides the Mediterranean diet, that’s what I would recommend for people. But I’ve met people that they swear by vegan, they swear by paleo, they swear by keto. That’s fine. I don’t tell people, “No. If that’s working for you, you have to stop it because I believe in something else.”
Dr. Weitz: Right. So in terms of prevention of cancer and cardiovascular disease, what do you think are some of the things to focus on? What foods or food groups or macronutrients, what should we reduce or avoid for most people?
Dr. Kozlowski: Sugar.
Dr. Weitz: Sugar.
Dr. Kozlowski: Yeah. You just cut out sugar, it’ll take you a long, long way.
Dr. Weitz: [inaudible 00:30:42].
Dr. Kozlowski: And then processed foods and saturated foods.
Dr. Weitz: Okay.
Dr. Kozlowski: Yeah.
Dr. Weitz: What do you mean? Saturated fat? Is that what you mean?
Dr. Kozlowski: Yeah. Yes. Yeah.
Dr. Weitz: Okay. Lots of controversy over what causes heart disease. Does saturated fat really cause heart disease? Does it raise your LDL Why? How does saturated fat do that?
Dr. Kozlowski: Sorry. So I misspoke. Yeah, I agree with you. So it’s like the trans fats, the fats that are in fast food and in French fries and the processed vegetable oils and canola oils and all that stuff.
Dr. Weitz: Right. Okay. Can you talk about the microbiome and what’s the best way to test for it, and what do we do to optimize our microbiome?
Dr. Kozlowski: Yeah. Your microbiome, the analogy that I really like is it’s like your own garden, like your garden at home. And so, in that analogy, the probiotics are the plants of your garden. Fibers and good sugars are the fertilizer of your garden. But what happens when you don’t take care of your garden is weeds grow, right? And that’s what happens in our guts. And that’s where you can get dysbiosis, candida, SIBO, those things. So I think the best way to screw up your microbiome is antibiotics because antibiotics are tablets that were designed to kill bacteria. And where do you put them typically? In a tube that has five pounds of bacteria in it. So just taking antibiotics once can wipe out up to half of your microbiome. And then if half your garden is wiped out, what happens? Weeds start to take over, right? And we’re being exposed to all these different weeds every day, all the time. And if your garden’s empty, those weeds see this fertile soil and will take over. So antibiotics are a big thing. A microbiome in general, because of that analogy, even though I’m known for gut health, I don’t typically start probiotics. I prefer to do it through food.
Probiotics, there’s a lot of discussion of do they actually stay in your gut? Where do they get broken down? How long do the effects last? But also, if there’s weeds overgrowing in your garden, you wouldn’t go to the nursery and buy more plants, right? You would pull the weeds out. And so pulling the weeds out is, in my experience, done through stool and urine-testing to identify what’s growing in there, and then treating that to make sure it goes away, and then focusing on pre and probiotic foods. The other thing that’s happened to me is the most common condition that I treat is SIBO, and that’s when your microbiome, which should be living in your large intestine, is now living in your small intestine. And your small intestine is where you should be absorbing your nutrients and digesting some food, should not be covered in bacteria. So it’s bacteria overgrowing. And if you have SIBO and you start a probiotic, you can actually get worse because you’re feeding the problem. And in our general society, if you tell someone you’ve got abdominal pain, they’re going to tell you to eat more fiber and take a probiotic, which for a lot of people works but if it doesn’t and you’re feeling worse, that could be a sign that you have SIBO. So, stool testing, a stool analysis tells us what’s growing in your garden, how inflamed your gut is, how well your gut bacteria eat, do you have parasites?
Dr. Weitz: I’d like to interrupt this fascinating discussion we’re having for another few minutes to tell you about another really exciting product that has changed my life and the life of my family, especially as it pertains to getting good quality sleep. It’s something called the chiliPAD, C-H-I-L-I-P-A-D. It can be found at the website chilisleep.com, which is C-H-I-L-I-S-L-E-E-P dot com.
So, this product involves a water-cooled mattress pad that goes underneath your sheets and helps you maintain a constant temperature at night. If you’ve ever gotten woken up because temperature has changed, typically gets warmer, this product will maintain your body at a very even temperature, and it tends to promote uninterrupted quality deep and REM sleep, which is super important for healing and for overall health.
If you go to chilisleep.com and you use the affiliate code, Weitz20, that’s my last name, W-E-I-T-Z, 20. You’ll get 20% off a chiliPAD. So, check it out and let’s get back to this discussion.
Dr. Weitz: So, Peter, what do you use to treat dysbiosis or bacterial overgrowth?
Dr. Kozlowski: Yeah, it varies in everybody. The three options typically are antibiotics, which I usually try to push people away from just due to all the side effects; a natural herbal approach, which I’ll talk a little bit more about; and then a third, and I call it the nuclear option, is an elemental diet, a liquid diet for two or three weeks. That’s usually… I’ve only used in either people that can’t get an ulcerative colitis under control or people that have failed treatment with SIBO multiple times, I’ll try that. I’ve had a few patients over the years that have just started with an elemental diet, but that’s pretty rare because it’s so difficult. But when it comes to the herbal approach, so if you do a stool analysis and they find dysbiotic bacteria, they’ll do sensitivity testing. So they’ll tell you that whatever species is growing inside you reacts, responds to grapefruit seed extract or uva ursi or silver or berberine or oil of oregano. So if you have that information, you can really target your treatment because you’ll see resistant patterns on there.
Dr. Weitz: Yeah. Some of the stool-test companies do and others don’t. What stool tests do you usually order?
Dr. Kozlowski: Majority of the time I use Doctor’s Data.
Dr. Weitz: Okay.
Dr. Kozlowski: Because I’ve just found they always test more herbs than anybody else. So I like to see the resistance and sensitivity patterns. And my experience is that they seem to be better at catching candida and yeast overgrowth than other labs that I’ve used. So I like Doctor’s Data a lot.
Dr. Weitz: I think a lot of us are using other stool tests that don’t necessarily test those. So if you don’t have those, how do you decide what herbs to use?
Dr. Kozlowski: It’s a shotgun approach. So you can pick the herbs that are the most effective, and that’s some of that list, oil of oregano, uva ursi, silver, grapefruit seed extract, caprylic acid, garlic. These are all things that you can use. And when I’m treating, let’s say, SIBO, which with SIBO, through breath testing, you can get a yes or no answer. “Yes, you have it.” “No, you don’t.” But you have no clue what’s overgrowing. So you don’t know if that’s probiotics overgrowing, you don’t know if that’s yeast overgrowing, you don’t know if it’s dysbiosis growing. So that’s a situation where we’re definitely using a shotgun approach. We’re just doing a broad spectrum.
Dr. Weitz: Well, a little bit, because if it’s methane, you know it’s archaea. If it’s hydrogen-
Dr. Kozlowski: That’s true.
Dr. Weitz: It’s likely different organisms. And now we have the hydrogen sulfide, which some say it’s the type of organisms that are involved in that.
Dr. Kozlowski: So when I’m treating those, I typically use a supplement from Biotics Research, FC-Cidal, Dysbiocide, and A.D.P. That combination of the three, that I’ve used for the last few years, mostly. Metagenics makes a combo product called CandiBactin.
Dr. Weitz: [inaudible 00:39:41].
Dr. Kozlowski: Yep, exactly. And then Biocidin, I think has the longest research behind it, or at least I’ve used that one the longest. And right now, just with all the things going on in the world, so many things are backordered, so it’s just trying to figure out what’s available and trying that.
Dr. Weitz: Yeah.
Dr. Kozlowski: Stuff.
Dr. Weitz: Yep. Yep. Yep. So, besides herbal antimicrobials, what else will you use?
Dr. Kozlowski: So, for dysbiosis, if somebody’s gut lining looks very inflamed, then I might do things to calm the gut lining, and my favorite is glutamine.
Dr. Weitz: Okay.
Dr. Kozlowski: High dose. Five grams, three times a day. Sometimes just anti-inflammatories like high-dose fish oil or gamma-linolenic acid (GLA), omega-6. So sometimes I’ll do some stuff like that. If somebody we suspect or they have low stomach acid, I will put them on hydrochloric acid. Sometimes we’ll use pancreatic or digestive enzymes, ox bile, gallbladder support. So those are the main things I think that I use.
Dr. Weitz: Okay. And do you go through phases of treatment or?
Dr. Kozlowski: Usually, my SIBO most common treatment plan is nine weeks where it’s two weeks on, one week off, and you cycle that three times.
Dr. Weitz: Okay. With the same herbs each time?
Dr. Kozlowski: Mm-hmm (affirmative). Yeah. There’s been times where I’ve tried to use different ones because one of the concerns is if you use the same stuff over and over, there’s obviously resistance. So you can definitely try to cycle it. But no, typically, I’ll use… At least through the first time through, right? In the first two or three months that we’re trying, then I’ll stick to the same regimen and then either repeat testing or talk to the person and see if they’re not really getting better, then we need to adjust something.
Dr. Weitz: Right.
Dr. Kozlowski: I always try to take the path of least resistance. So usually, whatever’s going to be the easiest, let’s try that first, assuming the symptoms are not severe. Instead of just throwing everything all at once. It can be overwhelming, I think.
Dr. Weitz: Right. So let’s say you have a SIBO patient, you do the nine weeks of herbs. Is treatment done then?
Dr. Kozlowski: If they’re better. It depends. If their symptoms have gone away, which happens many times, it’s great, and they move on. And then the next phase is reintroducing the higher FODMAPs because I do like people to stay on a low-FODMAP diet during SIBO treatment. The interesting thing I’ve found with people that have recovered from SIBO is frequently you’ll hear that there’s one food that they just can’t tolerate. And it’s always different. Every person tells me something different. So it’s just adding them back in the higher FODMAPs and making sure that your body doesn’t react to those still.
Dr. Weitz: I know Dr. Pimentel will put the patients on a promotility, prokinetic after he uses antibiotics, to decrease the likelihood that it’ll come back because there’s a whole motility focus. Some natural practitioners will use natural prokinetics.
Dr. Kozlowski: Absolutely. Yeah, I definitely agree with that, with the motility activators. I’ve found to be, to me, more important is to make sure the patient’s digesting, that their stomach acid is sufficient because to me, that’s the key, that’s what kills off the bacteria. So if you’re not making enough stomach acid, then that’s a pretty high recurrence rate for SIBO.
Dr. Weitz: So how do you know if you’re not making enough stomach acid?
Dr. Kozlowski: There’s two ways to test that I’ve found to be reliable. And the first one to me, when I first heard about it, I laughed. I thought it sounded kind of ridiculous. It’s called the baking soda test where you mix a quarter teaspoon of baking soda and a few ounces of water, drink it on an empty stomach. Baking soda is basic, your stomach should be acidic. When the bass and the acid meet, it creates an explosion which presents as gas and you start burping, which you should burp in the first three to five minutes. So when I first heard of that, I was like, “This sounds like a high school chemistry experiment. This sounds ridiculous.” But I’ve actually found it to be pretty reliable. If people don’t burp, then it usually means they don’t have enough acid.
And then the second step is actually supplementing hydrochloric acid. I outline the whole protocol in the book, but you start with one capsule, but you only take it before eating protein. So I tell people in the beginning, just with meat, fish, eggs, your bigger proteins. Definitely not with a smoothie. But you start with one and you take it and then you eat.
A normal reaction would be to get some heartburn, to get some discomfort because you dropped in acid, your stomach’s making acid, there’s too much and it refluxes. An abnormal response to that is to not feel anything or to feel better, that’s a marker that you have low acid. And then the question is how bad is it? So every two days, we increase the dose from one to two, two to three, until you get some heartburn or discomfort. And let’s say that happens after you took three, then your dose is two. And that’s what I would have you on.
And the most common question that I get is, “Well, how long am I going to be on this?” And to me, it usually depends. What I tell people is it depends on the underlying cause. With majority of people that I’ve seen, the biggest cause of low stomach acid besides aging is our stress and the sympathetic nervous system. So if that’s activated, you’re shutting down your acid production. So when your parasympathetic gets activated, then you’ll start making more. And then let’s say you’ve been on two capsules; all of a sudden, you take it one day and it kind of burns, you know it’s time to cut back or come off of it.
Dr. Weitz: And you don’t like to use probiotics. You use what? Fermented foods?
Dr. Kozlowski: For stimulating the microbiome?
Dr. Weitz: Yeah.
Dr. Kozlowski: Yeah. I prefer focusing on pre and probiotics and foods. So fermented foods, sauerkraut, things like that, dairy or dairy alternatives, and then prebiotics. I believe more in prebiotics, so things like banana, asparagus, artichokes, things like that, that are going to feed your microbiome. And to me, if you’re going to supplement one, I usually actually go with prebiotics just to stimulate your bacteria to grow. I can’t say that I don’t ever use them. In general, supplements I think should be supplements. And so what I tell people frequently is if you’re traveling or if your diet sucks that day, you didn’t have anything fermented, then take a probiotic. But if your diet is strong, then you don’t need it, in my opinion.
Dr. Weitz: What’s your favorite prebiotic product?
Dr. Kozlowski: Arabinogalactan or inulin? Inulin is typically in a powder. Arabinogalactan comes in capsules and powder, so sometimes that’s easier. If you take your pre and probiotic together, they call it a symbiotic. So those are the two big ones that I would use.
Dr. Weitz: Okay. I think that’s pretty much a wrap, Dr. Kozlowski. Have final thoughts you want to leave our viewers and listeners?
Dr. Kozlowski: No, thank you very much for having me. And if I can give one piece of advice, it is to stay in the present moment. There is an ancient philosopher that said anxiety is worrying about the future, depression is worrying about the past, so what’s the best treatment is the present moment. And I think so much of our lives are taking us out of the present moment, so the best thing you can do is to get back into it and your gut will heal and then all the protocols or supplements or whatever you need to treat whatever’s going on will be much more effective.
Dr. Weitz: That’s great. How can listeners and viewers find out more about you, your book, et cetera?
Dr. Kozlowski: Yeah. So my book, Unfunc Your Gut, with a C, Unfunc with a C, you can get it anywhere on Amazon, Barnes & Noble, your local bookstores, so it’s pretty available. To contact me or to learn more about me, doc-koz.com, D-O-C dash K-O-Z dot-com. And I’m on Instagram and Facebook. On Instagram, it’s @doc_koz. And on Facebook, it’s just Peter Kozlowski M.D., which I’ve gotten more active lately and just sharing stuff there.
Dr. Weitz: Great. Thanks, doc.
Dr. Kozlowski: Yeah. Thank you.
Dr. Weitz: Thank you listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take… I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111. And take one of the few openings we have now for an individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.
Leave a ReplyWant to join the discussion?
Feel free to contribute!