Gladden longevity — Episode #53

Steve Reiter: Welcome to the Gladden Longevity Podcast with Dr. Jeffrey Gladden, MD, FACC, Founder and CEO of Gladden Longevity. On this show, we want to help you optimize your longevity, health, and human performance with impactful and actionable information by answering three questions: how good can we be? How do we make 100 the new 30? And how do we live well beyond 120?

I'm Steve Reiter. Dr. Gladden, we just had on Dr. Peter Kozlowski, who has written the book, Get the Func Out: Balance Your Hormones and Detox. We talked a lot about detoxing hormones. It was a great conversation between the two of you. We even got some questions for our subscriber version for those that are members of Age Hackers Plus.

Dr. Jeffrey Gladden: Yeah, we had some great Age Hackers Plus additional conversations for sure, but the conversation, in general, was terrific. Really, if you're sitting there wondering: "I'm lost in the morass of how do I balance my hormones? How do I deal with the toxic environment that I live in?". I think you're going to love this episode because we break this down.

Steve Reiter: It's practical.

Dr. Jeffrey Gladden: We get really not only granular, but we get really specific on what you can do today. Even if you have very practical information, what you can do today? If you have access to a functional doctor or you don't, these are things you're going to start to do and ways that you start to think about this. So, I thought it was a really interesting conversation, Steve.

Okay. Well, it's my pleasure to welcome Peter. Peter Kozlowski interesting last name, Peter. A really, a cool last name, quite honestly, but when I first saw it, it took me a minute to realize it was three syllables, and I hope I got that right, Kozlowski.

Dr. Peter Kozlowski: You got it. Great.

Dr. Jeffrey Gladden: Okay, good. Yeah, Peter's a really interesting gentleman who is an MD that's trained in functional medicine and has had a passion for that really from the early days of his training. I think one of the really important topics that we want to cover today is really this whole idea of hormone imbalance. I know the audience is aware that men go through andropause, and women go through menopause. Those are big life changes we all go through, puberty, but in between premenopausal or not even perimenopausal, but when we're in our prime, let's say, our bodies are exposed to a lot of toxins that impact hormones. You're probably aware of the fact that sperm counts have gone down dramatically across the population. Infertility is on the rise.

A lot of women struggle with things related to their hormones, even when they're in their what we'll call ‘normal reproductive years’. Then, of course, some of those same issues, of course, carry into the hormone replacement phase when people have gone through menopause or andropause. Now, they're looking at replacing hormones and getting back some of the hormonal pluses that occur with hormone replacement. That being said, we want to talk a little bit about the environment and how it's impacting us. So, Peter, welcome to the show. Appreciate you being here.

Dr. Peter Kozlowski: It's an honor. Thank you, guys. Thank you so much for having me.

Dr. Jeffrey Gladden: Yeah, absolutely. So, Peter, you've written a book, Get the Func Out, which is a catchy title. It's about really balancing your hormones and your detox. So, do you want to talk us through a little bit, how you got interested in this, what you were seeing, or just walk us through this a little bit?

Dr. Peter Kozlowski: Absolutely. So, I appreciate the intro, and I appreciate being here. So, in my experience being a family practice doctor who turned to functional medicine right at the beginning of my career, my goal with my patients has always been to help them determine the underlying cause of their issues. A lot of times, it's helping them identify the issue, and then they want to know why. Why did that underlying issue happen? So, the way I was taught functional medicine is there are five main areas that we look at. They are: food, gut health, hormone imbalance, environmental toxins, and mental, emotional, and spiritual health. So, those are the five umbrellas that I look for the most frequently.

I published a book two years ago, or a year ago, that was on gut health, and it's called Unfunc Your Gut. It's all about diet, gut health, and mental, emotional, and spiritual health. I never really thought I would write a second book, but I realized that I had topics left over that I hadn't addressed. So, the two topics that I had left over were hormones and toxins. For me, the connection was very obvious to, whereas a lot of people, they might look at it and think that that's a strange two subjects to combine together. But what I'm finding is that I can diagnose a hormonal imbalance in almost any one of my patients, and the five hormonal imbalances-

Dr. Jeffrey Gladden: Yeah, tell me about that. Let me just interrupt you for a second. So, you can diagnose a hormone imbalance just about on anybody that walks through the door. So, what are we saying here, just based on the symptoms, how they're feeling, the way they show up, the way they look or are you talking about specific testing that you're doing? What do you mean by that?

Dr. Peter Kozlowski: I mean, it's always a combination of symptoms and testing. So, the five that I focus on are: the thyroid, the adrenal glands, the pancreas, and insulin production, and then the reproductive hormones. So, for men, testosterone. For women, estrogen, progesterone, and testosterone. So, within those five areas, I can pretty much find an imbalance in one of them in all of my patients. The reason I say that is because, in my experience, if I can't find an insulin imbalance, a thyroid imbalance, or a reproductive hormone imbalance, I can always find some degree of an adrenal imbalance. To me, that's the mental, emotional, and spiritual component, which I have found to be the most important out of the five areas that I work with.

Dr. Jeffrey Gladden: Yeah, I agree. We would agree with that.

Dr. Peter Kozlowski: Yeah. The other things, in my opinion, are easy in regards to if you find a low thyroid if you find low T, if you find estrogen dominance, if I find lead or mercury or mold or dysbiosis or SIBO or food sensitivities, those things can be addressed through hormones, through supplements, through diet, through lifestyle changes. The stress and the mental, emotional, and spiritual part is the part that I have the most difficulty getting my patients to address.

My patients will frequently say: "Just give me the right supplement, give me the right diet, and everything will be fine." My feedback is usually: “It's not that easy.” We still need to address the underlying issues and traumas that started for most of us when we were young. So, that's where I say with pretty reasonable confidence that I can find a hormonal balance in anybody because usually, if I don't find one in the more common ones, then I can find an imbalance in the adrenal glands, typically.

Dr. Jeffrey Gladden: So, what you're trying to say is there's nobody actually normal out there. Is that what we're hearing? There's really nobody in good shape.

Dr. Peter Kozlowski: My belief is that we're all crazy and that we're either working on it or we're not. I'm more comfortable with someone that'll admit that they're crazy, that they are working on it, than someone that tells me that definitely, they're not. When a patient comes in to see me, they fill out 40 pages of intake paperwork before the visit, and there are two questions that I always look at first. They're in the middle of the paperwork, but it's a section on stress, and the first question says: "Do you have excess stress? Yes or no?" The second question says: "Can you handle it easily, or can you manage it easily? Yes or no?" So, when somebody answers ‘no, I don't have too much stress’, and ‘yes, I can manage it easily’, that to me is usually a red flag.

That's where I know that there's probably some degree of denial and that we have something to work on there. I've had a couple of patients over the years prove me wrong, but for the most part, I think that, especially over the last few years with the pandemic and all of that, I find very few people that aren't under more stress than they were or just don't want to deal with it. I personally get it. My story of how I got into functional medicine is actually alcohol recovery. So, I had a binge drinking problem, and I got sober and went through treatment.

The craziest part about treatment for me was that it had nothing to do with drinking. It was all about ‘why’. So, that's where I sat there and fought with my therapist and said: “I had the perfect childhood and everything was great.” Then it turned out that there was a lot of stuff that I was in denial about. So, it's my own personal story.

Dr. Jeffrey Gladden: That's a good point that you bring up here, which is that a lot of us live in denial. We don't really even understand what equilibrium is, right? Because we've normalized our dysfunction if you will, and we think we're calm when we're really not calm. You can get at that, of course, by measuring things like heart rate variability or some other metrics where you can actually get a feel for that. But it's so easy, as humans, to normalize what is and to think that we're okay. You even see this in the aging process. It's like: "No, I'm fine. I'm good, I'm good." But then when you get people feeling actually good again, it's like: "Oh, my God. I didn't realize I was that bad."

So, the same is true in mental health. Let's call it spiritual health or psychic health, and it's exactly the same way. So, I think you're highlighting the fact that a lot of people come in well intended, but probably to some extent, God bless them, agnostic to their own issues, if you will, just not sure they understand them. Yeah.

Dr. Peter Kozlowski: Yeah. I mean, I'm a first generation American. My parents are from Poland, so I was raised with the attitude of either surviving or not, of making enough money to put food on the table or not. Not talking about whether I was happy, sad, frustrated, or anxious. When I went to treatment at 27 or 28, I couldn't even name an emotion or a feeling. So, I had a long way to go. I mean, for all of us, it's different. 

I had to unpeel the layers and figure out that I was just very insecure and that I never felt good enough, and these are things I had to work through. That's what I'm always trying to encourage my patients, is to do that digging. I heard a definition of trauma once that ‘trauma is anything less than nurturing’. So, trauma could be something as simple as anything less than nurturing.

Dr. Jeffrey Gladden: Nurturing. Okay. Yeah. If you reflect on that for a second, ‘anything less than nurturing’ and that's going to comprise a high percentage of most people's experience, a very high percentage. Then it's a question of how do you go back and reclaim your birthright to be worthy, to be loved, to be safe? How do you go back and do that? That's work. It's work to get there. I've done a lot of it, and still, everything's in process, of course, but it's wonderful when you start to get some of those breakthroughs. I mean, I'm sure you've had breakthroughs in your own story here because you're sitting here today from a different perspective, right? Yeah.

Dr. Peter Kozlowski: Yeah. I mean for my own personal life, but my own experience just allowed me to even consider practicing functional medicine. I mean, when I started residency or medical school, I would've laughed in your face if you would've told me that I was going to be a functional medicine doctor. I was very traditionally minded and thought all the stuff I'm doing now was full of crap. It took my own life experience of getting honest and peeling back some of that to realize that there's more. The real magic happens when you really dig deep, but it's painful.

Dr. Jeffrey Gladden: Exactly. So, it's painful and exhilarating, but it takes courage, to your point, around the pain. I think it takes courage to dive into these things, and to be asking the right questions is really what it boils down to and not married to your particular answers and perspective at the moment. So, this is important. So, people come in, and they're toxic. So, they're toxic based on their own; we'll call it psychoemotional, spiritual health. That's one large area of toxicity, but now we live in an environment where there are lots of other toxins floating around. We've got EMFs everywhere. We've got 5G, and Wi-Fi. We're all being bombarded by all kinds of electromagnetic stuff, not to mention solar flares occasionally here and there.

Then we've got a world that's filled with man-made products that are also polluting the environment. So, when you were talking initially about making these diagnoses in virtually everyone, it sounded to me like you've got to have a fairly comprehensive set of testing that you're doing to see that, not just checking what's your testosterone level. It's got to be a much broader approach. So, do you want to walk us through what you think is an appropriate approach to people even understanding their own hormones? What kinds of tests should they be thinking about?

Dr. Peter Kozlowski: So, for me, a lot of it depends on the person, what their symptoms are, what their story is, age, sex, those things. So, I wouldn't do the same testing for everybody, but what I have seen is that the symptoms of adrenal fatigue can look exactly the same like the symptoms of a low thyroid, which can look like the symptoms of low testosterone. I can be totally convinced going into lab testing that someone has low testosterone. Then I test them, and the testosterone's fine, but their adrenal glands are imbalanced.

So, I do very much rely on testing. When it comes to the thyroid that's the most common autoimmune disease. It's the most common thing that people present with is a low thyroid. One of the things I get into in the book is just proper thyroid testing, from my experience. I don't feel that a TSH is enough. I assume your listeners also know that a TSH is not enough and that I rely on free T4 and free T3.

Dr. Jeffrey Gladden: So, yeah, let's just define TSH for a second. So, that's thyroid stimulating hormone. So, that's basically the brain telling the thyroid to make thyroid hormone and release it into the system. Thyroid stimulating hormone, if you will, comes from the pituitary. So, we're taught in medical school to look at the TSH. If the TSH is within a normal range, then the body's happy, and everything's hunky dory, but that's obviously a misnomer on many fronts. So, now you're breaking it down into T3 and T4 and free T3 and free T4, reverse T3, some of these different things. Do you want to walk us through a little bit of what you think is a little bit more adequate in terms of testing?

Dr. Peter Kozlowski: Yeah. My favorite analogy for the thyroid and the pituitary gland is thinking of it like the heat in your house or office, and your pituitary gland is the thermostat, and the thyroid is the heater. So, when I walk into the office, I put the temperature at 68 degrees. When the thermostat detects that the temperature has gone below that, it sends a signal to the heater to make heat. So, that's your pituitary gland; that's the thermostat. So, when the pituitary gland sees that there's not enough thyroid hormone, it sends TSH to the thyroid gland. The thyroid gland makes T4. T4 is converted to T3, and T3 is the main hormone that binds to cells all over your body.

So, in traditional medicine, we are taught, like you said, to test TSH, and that if it's high, that means that there's a lot of signal coming from the brain. So, the thyroid must be low. My experience is that is very frequently not the case. So, I have met and treated lots of patients who have a normal TSH but have a low T4 or a low T3 or both. I have treated patients that have a high TSH but they have normal thyroid function. I was just working with someone this morning, that their TSH was a little elevated. Their fertility doctor tried to put them on thyroid medicine, but we had their T4 and T3 levels, and they were towards the high end of normal. So, in my opinion, thyroid replacement was not the right thing in that situation.

Dr. Jeffrey Gladden: One of the things that we do in our practice also, which you may find interesting, is that we do genetic testing on DIO2, which is basically the brain's enzyme for converting T4 to T3 in the brain. The other thing that we do is we do resting metabolic rates on every patient because we've actually found that blood testing is also skittish, not only TSH but T3 and T4. So, by doing a resting metabolic rate, we can actually see: “Where is the metabolic set point, and are they hypothyroid?" So, we've found people that are clinically hypothyroid with low resting metabolic rates where the thyroid numbers all look good. So, we think that this is really an important adjunct piece.

Then the other thing, what we found is that with DIO2, if you're homozygous for DIO2 in the brain, you can have an 80% reduction in your ability to convert T4 to T3 in the brain, which is massive. So, when you look at brain fog, brain function, and you give these people Synthroid, they're not converting that in the brain. Systemically, even their resting metabolic rates will look normal. Their T3, T4, free T3, everything looks hunky dory, but their brain is still not happy. The only way you get at that is by doing genetic testing.

So, we have some people that are completely normal, but we'll actually give them Cytomel, which is pure T3, just to give the brain an extra boost for what it actually needs. We've seen concussions resolved. We've seen all kinds of things resolved with doing that approach. So, it is a complex scenario, and I think it's fairly poorly served by traditional medicine. Even functional medicine, I think, can fall short despite its best efforts. So, I think it's a critical, critical area. Yeah.

Dr. Peter Kozlowski: Yeah. That's testing that I haven't been doing, but I definitely want to look into it. That makes a lot of sense to me.

Dr. Jeffrey Gladden: Yeah, it's perfect. You'll be pleasantly surprised when you start to do it. It'll give you a new lens to look at all of it through. That's super helpful. Cool. So, then talk to us a little bit about environmental toxins and their impact on sex hormones, fertility, infertility, sperm counts, and all kinds of things. We've heard about plastics basically being feminizing for men. They're more estrogen equivalents, if you will, phytoestrogens, people eating lots of tofu and soy, and things like this. So, please walk us through that a little bit, what you're seeing, how you navigate that.

Dr. Peter Kozlowski: Yeah. You just triggered a thought that two days ago, I read an article that they found microplastics in the rain in New Zealand. I don't know if you've-

Dr. Jeffrey Gladden: I saw that.

Dr. Peter Kozlowski: ... seen that.

Dr. Jeffrey Gladden: Yeah, I've seen that.

Dr. Peter Kozlowski: When it's raining, it's raining down plastic on us, and they're finding that plastic in testes. So, when I do diagnose a hormonal imbalance, whether it's thyroid, adrenals, testosterone, estrogen, progesterone, or adrenals, my patients usually are happy but not satisfied all the way, and they want to know why it's happening. So, that's where I've tried to help them figure out the why. An area that I really got into that I was scared to get into, originally, was the branch of functional medicine called ‘environmental medicine’, which is basically looking at how all these things we’re being exposed to are affecting us. 

So, we're constantly being told that all these toxins that are in our water, in our air, in our food, and everything we touch or put on our skin are not a problem for us, but there's more research saying that maybe they are a problem for us. So, when I say toxins, I am talking about things like lead, mercury, mold, glyphosate, pesticides, herbicides, the things that are in makeup and deodorant, and just basically everything. In the introduction of my book, I go through my wife's daily routine of just from night to morning of going to bed, waking up, having breakfast, and playing with our dogs.

The plastic from the dog toys, the almond milk that's in her smoothie, the makeup she puts on, the hair straightening product she uses, if the router is too close to our bed, if you sleep with your phone, if you have mold in your house. We're not really taught to think of this stuff as potentially contributing to disease when you're taught from a traditional medicine standpoint. From a traditional medicine standpoint, we're taught basically of acute poisoning, like the kids in Flint, Michigan, where they changed the water supply, and they got full of lead, and they had acute neurologic symptoms.

The concept that we talk about in functional medicine is total toxic body burden, which is the lifetime accumulation of these different toxins. So, my argument is not that one of these toxins causes Hashimoto's and another one causes autism or whatever. My argument is that this lifetime of accumulation of these different toxins can eventually lead to disease. So, when we are exposed to these toxins, they try to get into our body through our lungs, through our gut, and through our skin. So, our first detox organs are the barriers to keep them out, but we are under this larger onslaught. Every year, there's more and more toxins, and so our mechanisms can't keep up. So, these toxins cross into our body.

Dr. Jeffrey Gladden: I think that's an interesting point that our bodies can't keep up. I will offer here, too, that different people have different capacities to detox.

Dr. Peter Kozlowski: Absolutely.

Dr. Jeffrey Gladden: Right? So, there are some people, when they get a whiff of gasoline, I mean, they're dizzy. I mean, they feel bad. There are other people that are like: "I could go to bed smelling gasoline, and I would be happy." So, it has to do with their ability to actually detox these substances. So, if you're listening to this as an audience member, it's important to realize that you may be sensitive to things that your partner is not or your kids are not, or your friends are not.

It doesn't mean that you're weird. It means that unless you've actually looked at the genetics of how you detox things, phase one, phase two, and then, of course, phase three is important as well, you really don't understand how to adequately equip yourself to be able to detox things better, as well as understanding what things you should be removing from your environment to keep you healthy too. So, yeah.

Dr. Peter Kozlowski: I describe it as our bucket, that we're all born with a bucket. Some of us have a very large bucket, and some of us have a very small bucket because you can have five people living in the same house or 10 houses on the same street. Everybody has the same exposure or roughly the same, and one person gets sick, and the other one doesn't, right? So, it's a little bit of the luck of the draw, I think, in regards to how big your bucket is and how much you can put in there before it leads to disease. I would also argue there's the component of nutrition. You can have great detox genetics, but if you're not feeding your detox pathways through your diet or if your gut is imbalanced and you're not digesting, then you're not absorbing. That's going to play a role as well.

Dr. Jeffrey Gladden: Absolutely.

Dr. Peter Kozlowski: Once those toxins get into phase one and phase two of detox, so when these toxins cross our gut, our lungs, our skin, these toxins are fat soluble. So, that means when they get into our bodies, we will store them. Every cell in our body is surrounded by a membrane, and those cell membranes have fat in them. So, arguably, these toxins could get stored in any cell in your body because they're fat-soluble. Well, lucky for us, the first place that our body sends those toxins is to the liver. So, that's what most people are familiar with as your detox organ, is the liver. So, you mentioned phase one and phase two of detox. What that is is changing the structure of those toxins to make them water-soluble. Once they go through phase one and phase two and they're now water soluble, we can then poop, pee, and sweat them out.

So, that is what detox is. If our liver is overwhelmed, if we don't have good detox genetics, if our exposure is too high, if our nutrition is not up to par, then the liver can't break down everything we're exposed to, and then they will look for places to start getting stored. So, they store in the thyroid; they store in the brain; they store in the cardiovascular system, in the immune system. All that, over time, can eventually lead those cells to start malfunctioning. So, if you have toxins stored in your testes or in your thyroid, they are creating inflammation in those cells, causing mitochondrial death, causing the cells to die and the organs to not work the same as they used to.

Dr. Jeffrey Gladden: Do you have a good way to measure the toxic burden of a client that comes into your office where you can give them a handle on, "Hey, here's your toxic burden. Here's where you are in terms of your bucket being filled up"? How do you go about that? I mean, anybody walking in off the street, since we're all exposed to things that we're unaware of, you must do some fairly comprehensive testing, I would think, to get a look at that, or how do you go about this?

Dr. Peter Kozlowski: So, the number one toxin that I would test anybody for are heavy metals.

Dr. Jeffrey Gladden: Why is that? Why heavy metals?

Dr. Peter Kozlowski: Because it's the most common one that I find. I don't need to hear anything in someone's exposure history that makes me focus that this person has a heavy metal issue.

Dr. Jeffrey Gladden: So, where are people getting these heavy metals from? Where are they coming from in their life? What do they have to be on the lookout for?

Dr. Peter Kozlowski: I live in Chicago. They used to make pipes from lead. So, lead can be in drinking water. They used to put lead in paint. So, it can be in the walls on your paint. It can be in food. Mercury is in the exhaust from coal-burning plants, so that can settle into our crops. Mercury also settles into the oceans, and the fish pick it up. So, when we're eating fish, we pick it up. Mercury's in vaccines. Mercury is in dental fillings. Two years ago, there was a study on organic Gerber baby food, and they found 200 or 400 times the amount of mercury in organic Gerber baby food in 2020. So, you imagine what that was like years ago?

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Yeah, this is an interesting thing. So, organic products are not necessarily protected from things that are in the air. The crop still has to grow someplace unless it's grown in a greenhouse or in a hydroponic environment. If it's an outside organic prop, it still has rain coming down on it with plastic in it. It still has the air coming by that's got mercury in the air from the coal-burning plant up the street or whatever it is or the fertilizer that was just dumped in the farm next door. So, I think it's just important for the audience to understand. It is really, really difficult. Unless you're going to live in a bubble and grow your food in a bubble to avoid these environmental toxins, it's just very, very difficult.

Dr. Peter Kozlowski: Yeah. I mean, even if your bubble is next door to a farm that's spraying glyphosate, that glyphosate gets into the ground, into the water, and that glyphosate can get into your crops. So, it really is, I think, in my opinion, unavoidable. So, a couple of patient stories, for example, that opened my eyes to this. I had a couple. They were both in their 60s, and they wanted to test for heavy metals. The husband grew up in Nigeria. The wife grew up in Chicago. When they did testing, we all thought that he would come back through the roof and she would come back normal or else lower. Well, it was the opposite. The woman that grew up in Chicago had sky-high levels, and the man that grew up in Nigeria didn't have anything.

So, that was one example of where I learned I need to just test everybody. Another thing that a lot of people that have gone down this road and hear a lot is if you've had mercury fillings, then you definitely have mercury in your body. That has not been my experience in testing people at all. I have had patients who have never had mercury fillings that have levels through the roof. I've had patients; for example, one of the greatest risks I've seen is people eating sushi three times a week or more are excreting tons of mercury.

Dr. Jeffrey Gladden: Yeah, agreed. Yeah, sushi, tuna, there's a lot of mercury-heavy fish out there.

Dr. Peter Kozlowski: There are. Yeah, tuna is the most popular and the worst one, probably. So, it's things like that where I've been taught by my patients that the highest levels I've ever seen of lead were in an airport mechanic from O'Hare. Lead used to be in airplane exhaust. I use pre and post-chelation testing for heavy metals. A normal reading is less than 1.2 for lead. My own level was 11. For me, I start treating when it hits ten or more. This airport mechanic had a level over 140. I still have never seen that before.

Dr. Jeffrey Gladden: The other thing is that when you're around exhaust fumes all the time, we find that people that live near highways also have a lot of exhaust gasoline breakdown products in their toxin profiles as well. You probably see that also. The point being it's very difficult. I have some people that are race car drivers, and the race cars, of course, have modified exhaust where they're not using catalytic converters because they're trying to get every last horsepower out of the engine. They stand around and warm these cars up, and these guys are breathing this exhaust. They come in with dramatically elevated levels. 

I've had guys change their warmup strategies. It's like: "No, I'm going to put the car over here, but I'm going to be over here, so I'm not breathing all that in." So, I think the point is that unless you've been tested, if you're listening, unless you've been tested, you really don't know. You just really don't know what you've been exposed to. A city is just really a cesspool, quite honestly, of stuff.

Dr. Peter Kozlowski: Yeah, I have always relied on the testing. I like to show people, objectively. So, I will do pre and post-chelation for heavy metals. I use mycotoxin testing for mold. I measure glyphosate in the urine, and then I use a toxin profile, which is basically what I call it as the non-metal toxin profile, which includes things like organ phosphate, flame retardants, the plastics, the beauty products, the gasoline additives, and all that stuff. So, in my experience, because the major way that we're excreting toxins is in the urine, in my experience, the urine testing has been the most beneficial for me to test people. So, I like to show you because if I'm talking about a bucket, I want to show you what's in that bucket.

So, those are the main tests that I personally use for toxin testing, but toxins can also be coming from your food. They could be coming from an imbalanced gut and things like dysbiosis or candida, or SIBO. So, there are other ways as well. This book is mostly focused on the environmental stuff, and I really believe in testing it. Mold is something that I don't test everybody for. My screening question, whether or not to test you for mold, is: “Have you ever lived or worked in a building that had water damage?” Because I, originally, was just asking people: “Have you had mold exposure?” Almost everybody says no. So, then when I started asking about water-damaged buildings, then I started hearing yes more often, and I started catching mold exposure. It's shockingly common.

Dr. Jeffrey Gladden: So, let's say you've had this testing done, and then let's say they're hormonally imbalanced. So, I assume that you're going to start by treating the toxicities, trying to eliminate the exposure, and then probably help facilitate the detox pathways. What are some of the things that you do to help your clients in this regard?

Dr. Peter Kozlowski: So, if I find both a hormonal imbalance and, let's say, lead or mold or both, I'm going to do something for the hormones. Frequently, that will be hormone replacement. So, if the thyroid is low, I will discuss options, whether it's Synthroid, Cytomel, both, or Armour, or a Nature-Throid, or a compounded thyroid. I want to get the person feeling better so they can detox. If a woman is very estrogen dominant, I will use progesterone replacement. We need progesterone to be able to detox. So, we need a functioning thyroid to detox. If a man has low testosterone, usually going on testosterone replacement will make them feel much better. That's part of my own story as well. 

I was diagnosed with low T at the age of 32. That was extremely shocking to me and actually upsetting, but it happened. I do think there was a connection with the lead that I found in my body. So, I will focus on getting someone feeling better by trying to balance out their hormones, but then at the same time, also helping them detox. So, depending on what toxin I find, I use different detox strategies.

Dr. Jeffrey Gladden: What are some of those?

Dr. Peter Kozlowski: If I find heavy metals, I like to use chelation therapy. I use oral chelation. My preferred drug of choice has usually been DMSA. There's DMPS and EDTA. There are different ways to go about chelation. I do get into my exact chelation strategy in the book. If it's mold, the most effective tool I've found is an infrared sauna because of the two-part effect. One is the sweating that helps the toxins come out, but there are also the infrared waves that help kill off some of the toxins. I use alpha-lipoic acid. There's actually a cholesterol medicine that I use called cholestyramine. So, not in everybody, but cholestyramine was designed from the traditional medicine standpoint as a bile acid sequestering.

So, what that means is your liver makes bile, and bile is secreted into the gallbladder and then into the small intestine. When the liver makes bile, it throws some of the detox toxins into that bile because then the bile gets into the intestine, and you poop it out. So, you get rid of the toxins. They've used this medication, cholestyramine, to not reabsorb bile. So, a normal process in your body as the stool is passing through, some bile will get reabsorbed. So, your liver doesn't have to make as much next time. Well, if that bile is reabsorbed and it's full of toxins, you are basically canceling out the detox effect.

So, by using a medication like cholestyramine, you can actually help someone detox because it's helping pull the bile out, which is full of toxins if that's what you're excreting. Many of my patients don't want to use that because it's a medication, and most of my patients are anti-medication, but I just thought that was a cool use of it. If I could pick just one supplement because sometimes I get asked: "What supplement would you use?" I don't like that question, but my favorite detox support is glutathione. I like a liposomal glutathione. I get into the pathways of phase one and phase two of detox and all the nutrients that are used.

Dr. Jeffrey Gladden: That's an important one. Glutathione is an important one because, remember, the genetics that really put people at risk for not being able to detox appropriately are related to their abilities to utilize glutathione in the first place. So, it's a logical place to go.

Dr. Peter Kozlowski: When you look at the nutrients used in phase one and phase two of detox, the only one that works on both pathways is glutathione. You need phase one and phase two to work together in order to detox properly. So, that's where I really like it for detox. I've found it to be very effective.

Dr. Jeffrey Gladden: We've also found sulforaphane to be very helpful to up-regulate detox pathways, which comes from broccoli and broccoli sprouts, but we're huge fans of sulforaphane, and we do sulforaphane with myrosinase, which activates the sulforaphane. So, we found that to be helpful and useful also.

Dr. Peter Kozlowski: I've had success with sulforaphane with autistic children in a part of my process of working with autistic families of autistic children. I've found it to be helpful in speech.

Dr. Jeffrey Gladden: They have detox issues also. They have detox issues, also. Yeah, cool. In the gut, there's beta-glucuronidase; also, I think that shows up. This can be an interesting problem because it'll cleave the glucose off of... You're talking about making fat-soluble toxins water-soluble. So, one of the ways the liver does that is to attach a glucose molecule to it, which of course, is water soluble. It gets excreted into the gut. Then there are E. coli in the gut that are making lots of beta-glucuronidase, and it cleaves off the sugar moiety or the sugar portion of that toxin compound that's now been targeted for excretion.

So, you end up reabsorbing the toxin. So, you end up in this circular thing. So, it's another important thing to measure when you're looking at the gut is looking at beta-glucuronidase and using calcium gluconate and things like that to help block that so you can bypass that. So, that's another piece that we've come across also.

Dr. Peter Kozlowski: I totally agree, and I have found that as well. For me, what I was taught in functional medicine from the beginning was to start with the gut, start with the gut, and start with the gut. So, when I started writing, my first book was on the gut. Many people argue that the gut needs to be healthy in order to detox at all because if you have any degree of a leaky gut, you're going to be getting in the way of detox anyway. So, for me, it depends on who I'm working with, what their history is, and what their testing shows. If I can, I'll do the testing, I'll test their toxins, and then we look at it together and decide what the right order of things is.

If someone comes to me and they're mostly focused on like IBS symptoms or gut symptoms, then we'll usually try to get the gut right and then look at toxins. If I have somebody that more is in the mechanic field or something like that, usually, I'll start with the environmental toxins. So, it's different for everybody, but I could definitely make the argument that getting your gut healed so you're not reabsorbing those toxins is the most important step, or at least the first step.

Dr. Jeffrey Gladden: Yeah, I agree. I agree with that. The way we were taught detox was phase one, phase two, and phase three, but I actually like to look at it as phase three, phase two, and phase one. The reason for that is that when you think about trying to move stuff out, you can augment, let's say, phase one detox, but a lot of phase one detox products are actually toxins in and of themselves. You can actually take something and make it more carcinogenic. You can make it more of a problem. So, if you're focused on: "Well, we're going to fix phase one first, and then we're going to fix phase two," you can actually end up completely backward from where you want to be. So, I start with phase three.

Let's make sure that the stool is working, that we're getting stuff out, that we don't have beta-glucuronidase, that the kidneys are working, that we've got them protected, that the skin is working. We've got the saunas. Let's clear the highways to get the stuff out. Now we'll actually start feeding more stuff into those highways that are opened up because you want to make sure you're open as you do this, as opposed to creating these log jams. 

In a detox protocol, you can make people worse because you're actually creating these intermediates that are actually more toxic than the thing that you're detoxing in the first place. So, as a listener listening to this, understand that this is a sophisticated approach, and you need to work with somebody that understands actually how to go about this.