Mark Divine 0:57

Yeah, it’s gonna be hard to keep it focused, because there’s so I mean, so much. We’re talking about functional health and gut health and nutrition and, you know, tying that to mental stability and emotional, you know, reactions. I mean, like, holy cow, there’s a lot there. And when you’re talking about the mind body, holistic connection, right? Well, why don’t we start with you a little bit about your background, where you’re from, how did you get kind of sucked down this path of functional medicine and get into gut feelings and your latest work on intuition/gut health?

 

Dr. Will Cole 1:30

Really began for me when I think of my fascination with nutrition and human health. It really began as a young kid. My first job was at finish line at the mall like selling tennis shoes at 16 years old. And I used my paycheck to go to the health food store or the local health food store and buy like the latest superfood I read about or like some herbs, some like micronutrient like it was like in hindsight, it would be like biohacking, but biohacking wasn’t a thing then. But it was just like me as a weird kid, that would just be fascinated about this stuff. And like how could it like impact how I felt human health and all that. So then that kind of evolved to me wanting to be formally trained in this. So I went to an integrative medicine school called Southern California University of Health Sciences, where there’s MDS and DEOs. And DCS and acupuncturist and oriental medicine doctors and nurse practitioners, all kind of learning their craft and being educated. And then that really honed in and focused my passion in functional medicine, specifically, because it really is marrying the best of both worlds. And it doesn’t have to be either or like Western medicine, which is like, quote, unquote, complementary to alternative medicine. It really can be the best of both. And being evidence based and running labs. I love data. I love spreadsheets. And I want to get to the root cause though I don’t want to just like cover up symptoms, I actually want to find what is your most effective option that causes you the least amount of side effects.

 

Mark Divine 2:55

What does functional medicine mean to you? Like not everyone really understands.

 

Dr. Will Cole 3:00

Certainly, yeah. So if I had to boil it down to what are the biggest differences to compare and contrast it between conventional medicine and functional medicine. First thing is we interpret labs using a thinner reference range. So anybody that’s listening to this, or watching this will know, hey, when I get my lab, there’s my number, and then there’s this extra y interval, we get that reference range, based largely on a statistical bell curve average of people who go to that lab. And you’ll see reference ranges may vary from lab to lab, there are some standardized biomarkers, but for the most part, they do vary. And they are not standardized. People that are predominantly going to labs are people that aren’t feeling the best. And that’s sort of the largest population that’s being looked at there. So a lot of people know intuitively heck, like something’s not right here, my fatigue, my weight loss resistance, my digestive problems, my hormonal symptoms, my inflammatory syndrome…Somethings off here, the doctor runs the basic labs with the best of intentions, and they’ll say, hey, these largely look good. Maybe you’re just depressed take, here’s an antidepressant, or you’re just stressed out, you’re just getting older, you’re just a new mom, like many new moms are told that. And what they’re unintentionally saying is, you’re a lot like the other people with health problems that we’re comparing you to. Comparing yourself to people that aren’t feeling so good is no way for you to find out why you feel the way that you do. 

So in functional medicine, we’re looking at optimal not average. So it’s the functional range. It’s where your body functions the best. So it’s a tighter interval within that larger reference range. So that’s the first thing that we do differently. We want more comprehensive labs based on health history. And we realized that something called Bio individuality, it’s we’re all different and there’s not going to be a cookie cutter, one size fits all approach to getting healthy. Yes, there’s some low hanging fruits for everybody. But there’s a lot of nuances a lot of context when you’re talking about many people’s health issues. So we have to look at both the mind and the body, something I’m really talking about in Gut Feelings, how it’s both and approach even within functional medicine, really need to be leaned into for these complex health issues. 

And by that I mean things like fatigue and hormonal problems and autoimmune problems and things like anxiety and depression. So those are my people, I want to figure out the pieces to their health puzzle to get them healthy. So we use food as medicine, we use herbal natural medicines, we use Mind Body practices, dealing with unresolved past trauma and chronic stress and strengthening the vagus nerve to regulate the nervous system. And medications when needed. I mean, to really be comprehensive, tailored tools, to what are the best tools in their toolbox? 

 

Mark Divine 5:37

Right? I love that. So lead with integrative health practices and, and habits and trill with the interventions through pharmacology or..

 

Dr. Will Cole 5:46

Yeah.

 

Mark Divine 5:47

Or west or surgery. Yeah, that makes a lot of sense. So it’s really functional health. Interesting. We even include the term medicine in there. And also like functional nutrition versus like a dietitian, right, who’s, there’s a very different kind of mindset there. I know some of your earlier work was around nutrition and fasting and ketogenic diet. Can we talk a little bit about those categories? So what is like best practices and the why behind periodic fasting or and or intermittent fasting? 

 

Dr. Will Cole 6:15

Yeah, and they’re still a part of my telehealth clinic for patients that need it? These are all tools within the toolbox. So when I have a conversation in book form. They’re just born out of countless conversations that I have with patients about how you use this, like, what is the context around this? So my first book was a conversation about okay, how do you use keto in a clean way? Because there’s the at the time it came out in 2018, there was a lot of this sort of like hashtag keto, like anything, as long as it was high fat and low carb was automatically healthy.

 

Mark Divine 6:47

Right.

 

Dr. Will Cole 6:47

Again, lacked nuance and context. So it’s more of a Mediterranean cyclical way, a flexible way to do the ketogenic diet that focused on nutrient density and bioavailability over just this sort of macronutrient obsession, and not to fear carbs, but how can you use carbs in a way that works for your body? And subsequently, even my previous book before Gut Feelings was called Intuitive Fasting was really a continuation of that conversation. It was about metabolic flexibility. And how can you use both a cyclical, flexible, whole foods based ketogenic diet and intermittent fasting, which are both, I mean, the ketogenic diet is fasting, mimicking.

 

Mark Divine 7:26

Right.

 

Dr. Will Cole 7:26

And intermittent fasting is obviously fasting. So it’s ways to train the metabolism to be more flexible, to tap into something called nutritional ketosis. If you’re doing fasting enough, and you’re eating the right way to maintain that metabolic state, it is tapping into something called beta hydroxy butyrate, which is known in the research as the fourth macronutrient, which I’m sure you’ve talked about. But there’s protein, fats and carbs and ketone bodies, which are not just a way to burn fat, which is what a lot of people really get in on keto about but it’s what’s known in the research as an epigenetic modulator, meaning it does really profound things on our body. And it modulates things like inflammation in a positive way, improving brain function in a positive way. So it’s a tool. Does everybody needs to be in ketosis? No. But cyclical times of ketosis for a lot of Americans that are really struggling with I mean, just looking at the statistics, the vast majority of Americans are struggling with some sort of insulin resistance, metabolic issues, inflammatory problems. Well, what is the research saying? This is a potential tool to lean into, to learn about to consider to talk with your doctor about if you want to see how you can leverage and level up your life. So that’s how I see it. And I patients that fast and don’t fast I have patients that do high carb and low carb and cyclical high and low carb. So there’s a lot of bio individuality in these conversations, but they’re important tools with a lot of exciting science behind it. 

 

Mark Divine 5:52

Right, wow man just threw out a lot there. I first heard the term metabolic flexibility from the OG in the field Mark Sisson.

 

Dr. Will Cole 8:59

Yeah.

 

Mark Divine 9:00

Who you are familiar with. And then and I first learned about ketogenic kind of thinking from another OG Rob Wolfe is a good friend of mine, who did a lot of work in the Paleo arena, which is cursorily, like, ketogenic becoming a fad. So from my understanding, it just seems kind of common sense that human beings really require metabolic flexibility, because that’s how we were for 1000s of years, right? You know, seasonal fruits and vegetables, seasonal droughts and lack of food, lack of meat during certain areas, and so are times of the year or periods of your life because of different changes or moving or migration. And so you just had to basically or the human body got trained to be flexible and actually became more resilient that way. Then fast forward to the modern culture. Were this high carb diet and fast food and everything is available all the time. And you’re not eating different things at different times of the year and you’re not you know, forcing yourself to go without to restrict yourself. Then your body is going to respond negatively to that, right. And so we’re seeing that as inflammation and obesity and all that kind of stuff. It just seems kind of obvious, right? 

 

Dr. Will Cole 10:08

Yeah. 

 

Mark Divine 10:08

So why are we so late to the game kind of figuring this out? 

 

Dr. Will Cole 10:12

Yeah. It’s like a collective remembering, right? It’s I think I see that so many ways, like what we call the ketogenic diet, or intermittent fasting or answers is just called life. Like there’s no like, randomized control trial, there’s no like podcast about it, or like some like fancy book. It’s just like, hey, this is how we evolved. And you look at exactly what the researchers are looking at from an ancestral health perspective, it’s what they call an evolutionary mismatch, or an epigenetic genetic mismatch. And our genetics, most of them 99% of them are so haven’t changed in 10,000 plus years. Same with our microbiome, which we co evolved with. So if all the trillions of bacteria in our gut haven’t changed, predominantly, if we our own body hasn’t changed very much over 10,000 years, we have to look at this evolutionary mismatch. And that explains so much of what’s ailing us as a culture on so many levels, not just a physical health standpoint, but even just like a cultural standpoint of how we even interact with other human beings. It is disordered, to say the least.

 

Mark Divine 11:15

Yeah, 100%. So in simplest terms as possible without the sciency stuff, what are like the top three or four best practices for this idea of creating metabolic flexibility through intermittent fasting and through ketosis or creating ketosis? 

 

Dr. Will Cole 11:29

Sure. First, I would say focus on whole foods, right? Nutrient density, and let’s just say bioavailable nutrient density, meaning what your body can use of foods that are high in nutrients, that’s first and foremost, and primary right. From there, you can leverage the benefits of how you’re feeling your body. So I think for I would rather somebody just start there, like if you’re eating the standard Western diet, or if you make way more allowances in your life, and you know, those foods don’t love you back. Like I wouldn’t necessarily even start with a ketogenic diet or a cyclical ketogenic diet, I would start with just clean up your food that you’re eating, some people want to go zero to 60. And then metabolism and the mitochondria and the microbiome, the brain is just not ready for that. And then they crash and burn. And it’s not sustainable. 

And there’s a lot of sort of this sort of diet culture creeping into nutrition and wellness. Which is then to antithetical to sustainable wellness. So I’d rather someone just start with the basics, remove, like decrease the amount of processed sugar they’re having, decrease the amount of industrial seed oils, they’re consuming, like canola oil, vegetable oil, soybean oil. Iincrease fiber rich vegetables and fruits and clean protein like wild caught fish, grass fed beef, poultry, and plant based options to if you’re more plant based, and healthy fats like avocados, olives, coconut, like just really focus on that alone. 

And then from there, based on your goals based on what you want to experiment with, based on your health, you can experiment with how macronutrients make you feel. And macronutrients are protein, fats, and carbs. So all those foods that just mentioned have different varying degrees of those, right. And so really look at breakfast, lunch, and dinner and snack and how you’re feeling yourself. So start with whole foods. And then from there, a ketogenic diet is higher fat, moderate protein, lower carb. Now, you can be in ketosis with higher protein, but for the most part, the research is really looking at keeping mTOR lower the mammalian or mechanistic target of rapamycin, which is the pro growth that we need cyclically, right? We need to build muscle and, and be healthy. So there’s a time in place ancestrally, for mTOR, to be high, but the kind of the longevity benefits a lot of the anti aging benefits around ketogenic diet and fasting is around autophagy and mTOR being low, autophagy being high and mTOR being low. So in short, too high of protein can impact mTOR negatively, which kind of decreases some of the potential benefits the longevity benefits of both of these practices. So that a lot of the carnivore diet, people don’t necessarily look at protein moderation, but they could still be in ketosis. So that’s kind of a different conversation. Not everybody has to be that specific about it. You can kind of just focus on carbs keep it super simple, keep it intuitive, but it’s going to be depending on your metabolic flexibility meaning how much of a sugar burner you are and how much how fat adapted you actually are. Genetics play a part of that, your health like baseline like where are you at right now plays a part in that. So anywhere between like there’s like stricter ketogenic diet is less than 25 grams of carbs to, I have a little bit more of a flexible approach as long as it’s coming from fiber rich vegetables etc. We go to 50 ish grams of carbs or less. And then some really metabolically flexible people can go to 7500 grams and still have low levels of ketones, when they test ketones. And how you test that is typically the gold standard is via blood. So you would measure beta hydroxy butyrate, similar to glucometer. But you’d measure beta hydroxy butyrate through a little blood prick on your finger. But there’s breath meters, there’s urine stuff, but for you to measure different proxy biomarkers to. So that’s in a nutshell, what it looks like and like some initial first steps.

 

Mark Divine 15:24

Okay, so in terms of a, you know, let’s say you’re working with a client and you say, okay, Mark, I’ve tested you and you know, we’re going to give you 75 grams of carbs, and then X amount of protein and fat, and you’re going to eat between these hours for the intermittent fasting in these quantities, what would that look like? 

 

Dr. Will Cole 15:42

So I mean, it’s, I really advocate for my patients to have an intuitive with component to this, and not…have it work with their schedule, have it work with how they feel, I don’t want them to become obsessive or Orthorexic about this kind of stuff. And every day is different to like, what’s my schedule look like? Maybe I’m doing something different the weekends. So I like all of that. Like the nuts and bolts the granular like protocol stuff is secondary to somebody that headspace around these things. Because like stressing about fasting isn’t good for your health, like stressing about healthy foods isn’t good for your health. 

So what it could look like I’ll say what it looks like for me. I will typically do about a 16 to 18 hour fast. I’m not militant about it, I will typically break my fast somewhere between 10am and noon. Sometimes a little bit later, I’ll do an occasional omad, one meal a day, very occasionally. And then on the weekends, I’ll typically open it up and do like a 14 or even a 12-12. Like I’m basically my eating window is between 8pm and 8pm or 7am 7pm. So that’s sort of the vacillating ebbing and flowing that I think people should explore with and how they feel. And the analogy that I used in intuitive fasting, my last book before this one is is it’s like a proverbial yoga classroom metabolism and you’re not always going to be doing like the deeper like vinyasa, hip openers or whatever. You’re gonna sometimes be doing the just chilling out of the end where they call it savasana. Or what they call yoga nidra. Sometimes you just chilling out and that’s like the expanding and contracting eating and fasting Windows is really what true metabolic flexibility is. I’m finding some people in this specially in the Keto world, the lower carb world, the fasting world, they always think more is better than they become so Orthorexic about the lack of loose open opening their eating window like oh my god, it’s a failure, like anything that could potentially lower ketones is therefore seen as bad. 

That’s not true. If you want to be a good sugar burner, still, you can’t just always be burning ketones. Look, some people feel better with burning higher ketones, so I don’t want to diss on them either. Because I have some patients that have neurological issues or autoimmune problems. When they do lighten up on the ketones. They don’t feel as good. So there’s a lot of bio individuality with how you use this tool within the toolbox or if you should use it at all. 

 

Mark Divine 18:03

Right. Do you recommend kind of seasonality and I think you kind of said that, but it may be also customized or individualized. But you know, during the summertime when people are more active and spending more outside time getting more sunlight. Maybe they need more carb more sugar, you know?

 

Dr. Will Cole 18:17

I love that. Yeah, that’s honestly most people. I would advocate that, that’s how I talk about it in Ketotarian and Intuitive Fasting, is to do a seasonal ketoterian meaning a Mediterranean ketogenic diet, that’s cyclical, it can be cyclical, I mean, I have some menstruating women do it just around their menstrual cycle. During the days of their cycle, they are increasing their clean carbs every month, and then for someone that is postmenopausal or a man they are doing it more seasonally with the with nature. So I think that’s a brilliant move and what it looks like if someone’s doing clean carb offs are like moderating their carbs. You’re just decreasing the fat really you’re decreasing the fat keeping protein solid, any and increasing carbs. And that looks like if you want to get specific on the grams, I normally would shoot depending on their activity level, depending on their health. It’s about 75 grams to a 150 grams coming from things like fruits, more fruits, seasonal fruits, sweet potatoes, tubers, starchy vegetables, stuff like that. 

 

Mark Divine 19:22

Yeah. And how about proteins and fats compared to that? 

 

Dr. Will Cole  19:26

Yeah, so I mean, protein. If you’re looking at the true definition of the ketogenic diet, the typical advice is going to be about 15 to 30 grams of, I’m sorry, 15 to 30% of your diet coming from protein. The quality of the protein matters, right? I mean, not so much, I think reductive conversations around protein. It’s the essential amino acids that we need to be more mindful of and making sure we’re getting this essential amino acids throughout the day and the timing works for you from a satiety standpoint, muscle building standpoint, energy production standpoint. 

So that’s a whole different conversation. But fats like anywhere between I mean, you can moderate fat pretty good. On the lower side, people think it’s like more fat is always the best. I have patients that can’t do that they have maybe no gallbladder or they have some fat malabsorption issues, digestive problems when they increase fats too much. So it can be as low as 50% of your caloric intake can come from fat. And then from there, you can increase based on your tolerance. You know, 75-65-75% is probably the more classic ketogenic diet, but you definitely have some wiggle room there based on your body. 

 

Mark Divine 20:35

That’s amazing. So 50 to 75% of your caloric intake from fat.

 

Dr. Will Cole 20:39

Which is the quality of the fat matters, right? It’s..

 

Mark Divine 20:42

Of course, yeah. 

 

Dr. Will Cole  20:43

What, what is it coming from avocados? Fish? 

 

Mark Divine 20:46

Yeah. 

 

Dr. Will Cole  20:46

Or is it coming from, you know, trans fats or what, whatever some processed it canola oil. It’s, it’s not the same thing. It’s not going to behave the same to the human body. 

 

Mark Divine 20:56

Yeah. yeah. Interesting. I’ve always found it difficult to kind of judge that, especially if you’re eating, you know, like fish, because fish has a high concentration of fat and protein in it. 

 

Dr. Will Cole 21:06

So how you Yeah, it’s not perfect science when you’re looking at that, because every cut of meat is going to be different. So again, back to like that, can we just keep it intuitive? Can we just be in the ballpark if we want to because we track macros and calories for people who need to do it. But at the end of the day, we’re talking about ballpark like the average serving, it’s not like the exact kind of like whatever sardines, you’re talking about, right? Anchovies, or wild caught fish or grass fed beef. It’s gonna be a mixture of both depending on the cut and sourcing of it. So we’re around that window, give or take a few grams and percentages, you’re gonna vary. But that’s where experiment, experimentation getting weeks and months under your belt of experimenting with these things is important. Because there is sort of an intuitive second nature about it over time where you don’t have to be super like, alright, count every gram, every combination of macronutrients, you kind of more or less know, these are the foods that made me feel the best. 

 

Mark Divine 22:03

Yeah, totally. That’s why I was never a fan of the zone diet, because it’s just like largely unsustainable for most people to be that rigid and weighing and measuring and whatnot. Because you know, as you know, the best diet or nutritional plan is the one that is actually adhere to.

 

Dr. Will Cole  22:18  

Yeah, exactly. 100%.

 

Mark Divine 22:21

If it is rigid and it sucks, you’re not going to do it. 

 

Dr. Will Cole 22:23

Exactly. 

 

Mark Divine 22:25

Since you’re talking about nutrients, I want to talk about micronutrients, and supplementation. So, you know, the general prevailing wisdom is that you should supplement because the quality of the nutrients in the food has gone down so much over the years, because the nutrients been sucked out of the soils and blah, blah, blah. What are your thoughts? Because some people, especially in functional medicine are like, You know what, actually, supplementation is not doing you any good, because even the supplements are not, their  just washing through your system, the bioavailability sucks, and you’re wasting your money. Where’s your take on this? 

 

Dr. Will Cole 22:56

Yeah, I think the truth oftentimes is somewhere in the middle. It’s like what supplements we talking about? Who are we talking about taking it? And then what’s the dosage of it? And then for how long like sometimes when you’re talking about significant nutrient deficiencies, if we’re talking about micronutrients, there’s a certain level based on labs that you may get to the point where you don’t have to be on the dosage or the amount or even beyond on a regular basis. Yes, it’s true. I think there’s enough data to show that nutrient quality, the health of the soil isn’t what it used to be. 

We know that it’s impacting the environment, and it’s impacting the human health, the soil microbiome is impacting our environment, as well as it’s intimately connected to our own gut microbiome. So yes, I know that, in theory and we have people on supplements based on labs, but I have to say, food is still first.

 

Mark Divine 23:48

Right.

 

Dr. Will Cole 23:48

Like, yeah, you, you still can make amazing waves on labs, with food alone. So you’re gonna get every nutrient across the board, like vitamin D is a good example. Like, you’re not going to get ample amounts of vitamin D from foods, you can get some from fish and ghee, and mushrooms and things like that, but you’re not going to, it’s the sunshine vitamin so that you really can get it from being outside within reason, too. But that’s one of those numbers that more isn’t always better. It’s a fat soluble vitamin. But to get to an optimal level, unless you’re like living in Miami, walking around in a loincloth, like 11 months a year, you’re Vitamin D is probably not going to bewhere you wan it to be because of this evolutionary mismatch thing. So there’s some within reason, there’s some people that have methylation gene variants. And here’s the variable to think about in the case for supplementation. It’s the stress, the toxic burden, the evolutionary mismatch that I find with patients, many of them it depletes a lot of the nutrients basically, it’s the body’s spending more than it’s taking in from food alone. So I think that’s a variable beyond just the soil and like the food, nutrient density and bioavailability. It’s what is that? The stress the body’s under?

 

Mark Divine 25:06

Yeah.

 

Dr. Will Cole 25:06

And I think I see that with magnesium, the body’s under stress, like you’re just like spending all your body’s just like trying to spend just to maintain some regulation. See that with methyl donors like B vitamins to the body is stressed the body uses B vitamins to maintain that. So there is a certain level of like, once you regulate your nervous system, calm stress, get back into nature, and then focus on nutrient dense foods over time, I find that my patients requirements for supplementation goes down with time. So that’s something to think about too. 

 

Mark Divine 25:35

Is there any risk of over supplementing? 

 

Dr. Will Cole 25:38

Absolutely. Oh, yeah. I mean, the vast, I love these people, I love them. There’s no shame whatsoever. But I’m like, normally not someone’s first rodeo. And they’re talking about health and nutrition. They’ve seen a lot of good conventional doctors, they’ve seen a lot of good functional medicine and natural minded doctors quote-unquote. But then they just accumulate over time, all the supplements that like this doctor says, or they’ve heard out on this podcast, or they read this book, and they’re left with this massive supplement graveyard. And they just like, with the best of intentions, like I don’t know, what’s helping me anymore. And I look at the list and yeah, they all make sense. Like in theory, I know the research around it. I know that the data around it, but it’s like, do you have to be on all of that stuff? And there’s a lot of variables to consider to know even what is the needle mover for you. 

So part of my job for many of my telehealth patients just like editing it down, like what are the most effective needle movers for you? It’s probably not 40 supplements, it’s probably a lot lower than that. If we focus on food, and we focus on absorption, right? I mean, gut health is a major part of that, right? We aren’t just what we eat, and supplement with we are what we absorb, and I see many people’s like if we get their gut health improved and lower inflammation level. So on a cellular level, they can absorb nutrients, that also decreases the requirements because that’s higher for higher doses or supplementation.

 

Mark Divine 27:00

Right. Well, that’s fascinating. So um, in the same vein of supplementation, there’s a few more things I want to talk about. One is so pro and prebiotics, since you just mentioned gut health and biome health, what’s the state of affairs there? And do we need to be you know, supplementing with a pro and what’s the difference in a pro and a prebiotic?

 

Dr. Will Cole 27:18

So a prebiotic is in effect fiber, you know, it’s resistant starch and some sort of fiber inulin something like this, right? That is you can get it from food, prebiotics, for the most part, you should be predominantly getting it from food. Now is there a place for psyllium husk for some people or inulin for some people, resistant starch for some people, adding that like supplementing with that it’s like they come from food, right? But you’re getting it in the form of powder and you’re adding it to your breakfast, lunch and dinner, you’re adding it to smoothies, or like whisking it and water or something like that. From a microbiome diversity, and a gut health standpoint, there’s some merit for that, and I do recommend it to some of our patients. But predominantly, it’s coming from the meals, it’s coming from their actual breakfast, lunch and dinner from vegetables and other fiber rich foods, um like fruits. The probiotics are, let me just say the soup. The prebiotics are food for the microbiome. The microbiome eats what we eat. The prebiotics are food for the microbiome and they digest ferment these prebiotics or fibers, and ferment the prebiotics and make something called short chain fatty acids, which are end products of bacterial fermentation. So one of those short chain fatty acids is called butyrate. It is actually related biochemically to beta hydroxy butyrate, that ketone that I talked about earlier. So endogenously, naturally, your body makes something similar to a ketone without even being in ketosis just because you’re eating a wide variety of healthy foods that include fiber, which has similar benefits. Butyrate, has anti inflammatory benefits, has brain supporting benefits, it has immune supporting benefits and digestive supporting benefits. So just keep that in mind for people. But the probiotics are the bacteria right, there the beneficial microbes that are within the microbiome or should be in the microbiome. And so the most common one are things like Lactobacillus, and different types of Lactobacillus or Bifidobacterium, and different types of Bifidobacterium. Because they’re the two classes of colony forming units are the most well researched in the scientific literature. But then there’s many other types of probiotics out there, all with so much exciting research. It’s just a matter of how effective are they to humans taking them? And what’s the viability of the probiotics because, has to get to the stomach and the stomach acid, that some of them can be dead on arrival, which meaning like they’re not even surviving the survivability of it’s pretty low. So you want to make sure you’re vetting it getting it from a lab that’s reputable within the space that has third party testing to see the survivability of the probiotics to make sure you’re I’ve been getting a benefit from it. I think these can be tools for people both candy, but I go back to food. 

I think if you can get good variety of fiber, get some maybe probiotic rich foods like kimchi or kombucha or sauerkraut or kefers. I would say that’s first and then the probiotics, key probiotics can be beneficial tools. I’ve seen it for many patients be beneficial tools. But it’s like, filling in the gaps. It’s not like a massive, you need this. Everybody needs this. I think it can be a tool within the toolbox, but it’s not the toolbox. 

 

Mark Divine 30:36

What about if you just, you know, take a two week trip to Egypt, or you know, Africa and you know, you’ve completely changed or killed everything in your life from that trip? Is a rationale to kind of supplement after that? 

 

Dr. Will Cole 30:49

The answer is certainly Yeah, if you and also like rounds of antibiotics, right? It’s like if you are if you’re sick, or if you feel rundown, if you had to go on antibiotic, there’s a place for food first, but also having some probiotics within reason to support bacterial diversity, but the mechanism of action for probiotics, it’s less like grass seed, like many people think, Okay, I have this gut garden. Which that’s true, you do. But the probiotics aren’t like little grass seeds, and you grow the good microbes, they more influenced the, the economy of the microbiome, they encourage other beneficial microbes. 

 

Mark Divine 31:27

Okay.

 

Dr. Will Cole 31:28

So if you’re low in this, and then taking this, that’s not always the benefit, it’s more or less, does this probiotic encourage the regulation of other microbes to be strong? And sort of this crosstalk? I think, between microbes, this communication between them, that seems to be the mechanism of action, and why its people can have benefits from probiotics. 

 

Mark Divine 31:51

Right. Cool. I want to get into the relationship between the biome and intuition and feelings. But two more things on supplements, because the last one relationship between amino acids as a supplementation and also the new kind of rage around peptides? And what are your What are your feelings on both?

 

Dr. Will Cole 32:10

Amino acids, I think I hate to be redundant on this. I think if you’re getting enough from food, you don’t really need essential amino acid supplements, the only way you would really know that for a time like almost as like a little n of one experiment, a little mindfulness experiment, maybe tracking in something like chronometer or My Fitness Pal or something like that, to kind of look at the what are the eight or so essential amino acids? What are you getting throughout the day, from your meals, and you may be shocked to find that some of those essential amino acids meeting fewer you have to get them from food, your body is not able to produce this on its own. And obviously, you’re going to have to get it from your meals. Many people are thinking they’re getting the protein grams, because that’s what’s on the label of the, you know, thing that they’re buying. But it’s the what is it the type of amino acids, the building blocks to proteins and their body? Is it what they need or not? So I would say that’s the only way to really know if you want to get granular on it on the types of amino acid you’re getting, because they’re not all the same. The second thing is, I do find that essential amino acids can be helpful for people that are not getting enough from their food. And it’s something convenient that they can have throughout the day. And they kind of takes the guesswork out of it, you know, you’re just having a little bit more throughout the day. And you know, you’re kind of filling in any nutritional gaps that you may be having. Or if they have a specific goal, they’re struggling with maybe fatigue or brain fog, or having trouble building muscle, maybe the requirements are going to be a little bit higher for a time. And you lean on that, you know, once twice a day or so. That’s typically the clinical usage of how I use essential amino acids for our patients. And then peptides. peptides are another thing that we use for some patients too. You know, it depends on the accessibility of it. And you know, is it legal in certain areas like it’s there’s definitely, this is an up and coming space within the nutrition world. But when they’re clinically appropriate in the right setting, they can be a great tool to we typically see it the most in the research and with our patients in the modulation of inflammation. That’s how we typically would utilize peptides as a tool within the toolbox not as like this panacea, magic bullet. But yes, they can be a great tool. And for some people, I’ll be honest, like some people, we integrate peptides in their protocol. And it’s not a massive needle mover. And for some people it really is. So there’s a lot of but you can say that about anything. So I don’t want people to like it somehow viafied I think in certain spaces, it’s like that’s it like that’s the next thing. Sometimes it’s not always the new thing. And the next thing sometimes it’s just staying consistent with the thing we already have.

 

Mark Divine 34:58

Right.

 

Dr. Will Cole 34:58

So it’s always a balancing act for me to not just add to that supplement graveyard when I’m trying to like whittle that down. 

 

Mark Divine 35:05

I agree with that get the whole system back in balance instead of keep chasing, you know…

 

Dr. Will Cole 35:10

Yeah.

 

Mark Divine 35:10

The next new thing that’s going to be easier or the boost or the edge. 

 

Dr. Will Cole 35:16

Yeah.

 

Mark Divine3 5:17

I love that. Alright, so, so let’s talk use the term shameflation. I think it’s something like that, right? 

 

Dr. Will Cole 35:23

Shameflammation. Shameflammation. Yeah. 

 

Mark Divine 35:26

What is this? So just, let’s dive in. What is the relationship between the gut and emotions and feelings? And you even related to trauma and shame? I think it’s fascinating. 

 

Dr. Will Cole 35:37

Yeah, it’s huge within a we and then telehealth clinic to help people recover, and heal and get to where they need to be. You know, obviously, in functional medicine, we deal a lot with nutrition and wellness and the physiological stuff, right? How can we move the needle, using food and nutrition and supplementation and biohacking and things like peptides? You know, I mean, these physiological things that impact things like inflammation, and impact healing and impact gut health, but it’s just one side of the coin and really with Gut Feelings is my newest book. It’s really just as all the other books have been born out of these conversations, and just seeing there’s two sides of this conversation, when you’re talking about you feeling your best no matter what you’re going through. And I deal with these aficionados, like they are the Type A, they’re very erudite. They’re well read, they know more than most doctors do about health. And that’s like being nice. Like they’re extremely smart people that are have all done all the things, right. They just like live and breathe this stuff, right. But they’re still stuck at these complex things. So I’m used to beyond the basic stuff, where we run labs, we look at the data and we get that data looking great.

 

Mark Divine 36:53

Right.

 

Dr. Will Cole 36:54

So their complex, they’re not cut and dry. There’s a lot of variability about that. And I can be proven wrong, I would be proven wrong all day long. If I hung my hat on, like, this is the protocol for everybody to do all day long. Because it’s like, okay, I can’t think of a caveat for that. And a caveat for that. And exception for that, or, oh, I remember that person. It didn’t work for them on that one. So it was a lot of variability. And the point being is, on the gut, and the feeling side of it, the physiological and the mental, emotional, spiritual side of it. They both are important. And we need to realize we can’t hang our hat on one. And I think for a lot of our patients, when they’re meeting us, they’re expecting me to say okay, this is the nutrition protocol. This is the supplement protocol. This is the biohacking protocol. Yes, we do all that stuff. 

But they’re surprised when I’m talking to them about unresolved trauma, and childhood experiences, or their job or their marriage and their relationship with work. These are complex things that are less prescriptive, it’s easy for me to say this is the macros, this is the like milligrams, this is the grams of this stuff, we do that. But these sort of nebulous things on the feeling side of gut feelings are really important, because we know, you know, that concept that I talk about in the book, shameflammation, how does what are we not just feeding our body? What are we feeding our head and our heart because that influences our physiology? And the thoughts we think the words we say, our experiences that we have and had are the books that fill up that silly library that is our body. And it is complex. It’s not easy, but it’s something that I really want to delve into to teach people these practices that how a lot of exciting science around it, how can we modulate the gut brain axis, the guts, the second brain. And where 75% of the immune system resides, ie inflammation, calming that? How can we modulate it from a different vantage point.

 

Mark Divine 38:50

Right.

 

Dr. Will Cole 38:51

Because I see people that clean up their diet, take all those supplements are doing all the right things, they are better off than they would be if they weren’t doing those things. But they’re stuck at this stubborn plateau. They know there’s a missing piece of the health puzzle. Yes, there may be some nutritional things we need to lean into. And we do that. But oftentimes, it’s the feeling stuff that hasn’t been looked at or looked at in the bigger they are almost gaslighting themselves to realize, they’re not realizing the importance of the role that it’s playing in their health today. 

 

Mark Divine 39:20

Right.

 

Dr. Will Cole 39:20

That’s kind of what the conversation I’m having. 

 

Mark Divine 39:22

I like that. And it’s a two way interactive street, right? So you know, that flawed or negative or traumatic patterns of mental emotional patterns will affect the biome or the body, right? Causing some sort of imbalance or inflammation, which then will trigger, right, subconsciously or just through that kind of gut brain connection, negative emotions and thoughts. 

 

Dr. Will Cole 39:46

Yeah.

 

Mark Divine 39:47

So it’s like, chicken or the egg. So you got to kind of attack them from both angles.  

 

Dr. Will Cole 39:50

Both sides, yeah. Because the studies that show that people with PTSD, for example, have changes in their microbiome. So what came first the chicken and the egg? Well, it looks like the some studies at least with using PTSD as it as example, will modulate the microbiome, meaning certain microbes will shift. But we also know that it’s a causative in other studies that lower levels of different Bifidobacterium, and lactobacillus are associated with things like anxiety and depression. So it is a bit, it’s a bidirectional crosstalk between the microbes and our mood. And not just the microbes in the mood, but also the microbes and inflammation levels. 

So it is complex, but but if you don’t have to know necessarily what is the chicken and what is the egg. Even though some, some people want to know, they want to know, very, very detailed, tell me where this came from. But then we’ll figure out how best to to our abilities. But ultimately, for most of us, it doesn’t really matter, because you really just have to start to untangle and support both sides of this coin. 

 

Mark Divine 40:50

Right. What I found in my work, I don’t do the nutritional piece. But people are stuck in such a state of hyper arousal, that oftentimes if we could just get the arousal control with proper breathing effect, no effective breathing, and stress management techniques and some somatic movement and massage even. And then starting to work on the diet, because now they can start making better decisions. So they start working on the nutrition, then suddenly, the biome comes back in. And then you can go deeper and work on some of the trauma.

 

Dr. Will Cole 41:16

100%. And that’s exactly what I get to talk about in the book. There’s a protocol that I adapted from protocols that we lean into, for our telehealth patients that are really, largely most of them are strengthening that vagus nerve that getting them out of the hyper arousal state that hyper vigilant state, to I mean, when you’re struggling with poor vagal tone, that is going to impact how you feel you’re going to feel wired and tired, anxious, exhausted, inflamed, brain foggy, dysregulated blood sugar, and dysregulated mood and all of that stuff. What we can do through some of the practices that you just mentioned, like breath work, like somatic practices, like EMDR when you need to, and you’re getting out in nature I talk about in the book, like the research around you forest bathing, Shinrin Yoku in Japan and South Korea. Of how it again, our ancestors would just call it life, but we have to call it…

 

Mark Divine 42:03

They would be laughing at that term.

 

Dr. Will Cole  42:06  

Like, Oh, you mean my back my back room? 

 

Mark Divine 42:09

Where we work.

 

Dr. Will Cole  42:10 

You mean my bedroom? So it’s, yeah, but that’s where we’re at right now society, a collective remembering of what our ancestors would already have done intuitively and had to do. 

 

Mark Divine 42:22

That’s awesome. We’re gonna wrap this up here. But someone’s listening, going, Wow, man, you guys covered a lot of territory really quickly. But based upon your new book, Gut Feeling like what’s the process? Where do I start? 

 

Dr. Will Cole 42:32

So I just really show them what I’ve seen clinically in the gut side, and the feeling side, and the science between both. And then I really wanted to go hard around I think this toxic tribalism within our culture, because I think about this stuff too much, but like the existential result of individuals with dysregulated systems, and then like, okay, how does it impact your family? How does it impact how they treat the other people on social media? How does that impact our government? How does it impact geopolitical thing? There’s a lot of dysfunction.

As above, so below,

 

Mark Divine  43:11 

Yeah, I love that the biome of the United States is way out of whack. 

 

Dr. Will Cole 43:15

Absolutely. And it’s so true, we are a part of nature that the physical soil microbiome, there’s climate change going on. And from an environmental standpoint, there’s physiological climate change in the form of chronic inflammation, and a lot of it has to do with our microbiome. So it’s absolutely intimately connected in how people are acting, because they’re so hyper vigilant and so reactive, and so tribal, which, in many ways our world is, you know, we have blessings within our world, we live in a very safe world, most of us do better than in many ways. But we are paying the price of modernity in some ways. To me, it’s like, how can we have the best of both worlds, right, like the best of modernity, we’re talking to people around the world right now. But also like, how can we maybe decrease that chasm between genetics and epigenetics and regulate our nervous system, and live in this modern world, but in a more sane way, a more way, a way that has healthier boundaries with things like technology, and modernity? So it’s really a conversation around that culturally. And I think this sort of either or reductive conversation around Western medicine versus Functional medicine, and really just teaching people the statistics about what’s going on there. And also about I talked in the book about toxic diet culture and what I would say equally toxic anti diet culture, and this body positivity movement, and just how both really are messing a lot of people up and confusing people when it comes to food and wellness in their body. So that’s all I somehow did that all in one book. And then I teach people how to like regulate the nervous system, so they’re less miserable.

 

Mark Divine 44:50

Right. Yeah, we magnify the extremes and glorify that and then and then those extremes, you know, try to get crammed as the norm and it doesn’t work right. Everyone’s out of balance.

I have one question. I promised my stepdaughter, Catherine Divine that I would ask, but it kind of ties to what’s happening in our culture, and it’s about parasites, right? So it’s not it feels like we have a parasitic culture. But let’s take that to like the biome what what is the effect of of getting, you know, the parasite in a biome and, and what can it do? And how do you get rid of it? How do you know if you have it? 

 

Dr. Will Cole 45:22

Yeah, so labs would be helpful. I mean, there’s no perfect lab out there, right. And microbiome testing is always changing and evolving and becoming more advanced and more specific. So, but we won the best labs we have access to in science, diagnostic science today. And that can be helpful. Sometimes you need a biofilm disruptor prior to collecting the microbiome test, because things can be like lurking in the body and not fully clearing out and all labs not just stool tests, blood labs, urine saliva testing, hair testing, they’re all snapshots in time, so you can miss things. So sometimes you have to click multiple times even catch something. But a biofilm disruptor like serrapeptase, or something like that can help clear this stuff out. So you can get a better snapshot. But even then, you know, it’s sometimes they can go missing. And these are the complex things that we have to face with patients and figure out, they are part of the microbiome. They’re not all bad. Like you can have protozoan, like pastahominess, and other things that are classified as parasites, and we measure them on labs. And sometimes they’re asymptomatic, meaning they’re not causing any acute digestive symptoms. But they are also can be a component to that kind of the landscape of dysbiotic function in the microbiome, meaning that there’s a lot of bacterial overgrowth, a lot of protozoan overgrowth, a lot of maybe yeast and fungal overgrowth, we deal a lot with people that have SIBO, small intestinal bacterial overgrowth. So I don’t necessarily always see the parasite, if we see it on the lab as like, that is the boogeyman, like that is the problem. It’s more of the context of the lab and saying, Well, if this is overgrowing, there’s probably a lot of things over growing, and it’s probably a larger dysregulation of the gut brain access. 

So a lot of times these people have decreased migrating motor complex, which has to do with the gut brain connection, where a lot of things are overgrowing these weeds or overgrowing, in this gut garden, where it is contributing to inflammation, but it’s not just one thing that’s the problem. Now, look, there are acute parasitic issues, which is a bit different, right? But we’re talking about these functional issues where we’re seeing some parasites, but it’s part of a larger problem of why the bio train, if you will, like what is the lack of resilience, and the balance of the microbiome and how it’s contributing to their symptoms. So you don’t necessarily have to have extreme acute digestive symptoms, to have overgrowth. 

So some of these things, whether it’s bacteria, or yeast, or a parasite, that could be causing neurological symptoms or causing triggering an autoimmune problem, because it’s an irritant to the immune system. In some and in some people, I would say this, some people are more sensitive than other people. If you have people that have different methylation gene variants, or people that have different HLA gene variants, its impacts how inflammation, response to inflammation response in the body. Some people are just on a bio individual level more sensitive to these dysbiotic or imbalances of microbiome. So I think there’s there’s a lot of nuance and context to that conversation. 

I think with social media and parasites. There’s a lot of these like parasite cleanses and like everything’s parasites, just like with the Medical Medium, you know, he’s like, everything’s Epstein Barr Virus, I think, yick. It’s like, probably want to tone it down a little bit. And it’s like, yes, it’s a problem for some people. Yes, we should and delegitimize people that have those real problems, but it’s not like the magic bullet for everybody either. 

 

Mark Divine 48:44

Yeah, that makes sense. And is that how you get rid of a parasite, a cleanse, generally?

 

Dr. Will Cole 48:49

As the anti parasitics, which herbal anti parasitics oftentimes can also have antimicrobial and antifungal benefits too. meaning it’s like a broad spectrum sort of pruning, if you will, of the microbiome that supports bacterial and overall microbiome balance. So things like Wormwood, which is an appropriate name there, but it can folic acid, oregano, powder argo, cat’s claw. These things can be some considerations. And then we typically bring the biofilm disruptors in like serrapeptase and binders like diatomaceous earth to light activated charcoal, things like that. So that’s some examples of things we do. And then look, there’s a place for maybe the probiotic to help with as you’re on the anti antibiotics bringing some good support. And you can also supplement with the post biotic that I mentioned earlier, the butyrate, the short chain fatty acid, you can supplement with that too, which has some compelling data, and then different herbs that can be supportive of the mucosal barrier, like something called DGL, which is the cluster has a native type of licorice and you can get marshmallow root and glutamine and different enzymes can also be helpful in this circumstance as well. 

 

Mark Divine 50:05

Yeah. You said earlier that, um, the gut is responsible for the use of 65 or somewhat like high percent of your immune capacity. 

 

Dr. Will Cole 50:13

75%. Yeah, say I see really what the world would call immunocompromised people, or like reactive systems that have had a history of different flare ups from different viruses and some from medications and things like that. The best thing that any one of us could have done is getting metabolically flexible and working on your gut health.

 

Mark Divine 50:37

Right.

 

Dr. Will Cole 50:37

Like that is the best insurance policy you could have ever had. 

 

Mark Divine 50:42

All right, Dr. Cole, thanks so much, man. This has been fascinating. We covered just a mountain of information. I really appreciate you the depth and scope of your work. And..

 

Dr. Will Cole 50:51

Thank you so much.

 

Mark Divine 50:52

Gut Feelings, is the book is out. I assume it’s out on Amazon or wherever. 

 

Dr. Will Cole 50:56

Yeah, I’m hearing this. But yeah, it’s definitely for preorder definitely coming out really soon. I’d probably I comes out March 21. You definitely were right here. So yeah. 

 

Mark Divine 50:05

And where to folks learn more about you or if they wanted to reach out to you? 

 

Dr. Will Cole 51:09

Yeah, everything’s that DrWillCole.com. That’s Dr. W i l l C o l e.com. The links to the telehealth center are there, becoming new patient like all our new patient options? Are there? The book like for Gut Feelings, you can order that there, and my podcast The Art of Being Well, the links to the podcast as well.

 

Mark Divine 51:27

Awesome. We’ll put all this stuff in the show notes. Thanks a lot. Well, I really appreciate you and appreciate your time. 

 

Dr. Will Cole 51:32

Likewise. Thanks for having me.

 

Mark Divine  51:34  

I tell you that was a fascinating discussion with Dr. Cole. Holy cow did we cover a lot of information, keto diet, as well as metabolic flexibility and fasting and peptides and amino acids and supplements and parasites even. So we covered a lot of territory. Fascinating discussion. Thank you, Dr. Cole. Show Notes are up on MarkDivine.com website, as well as the YouTube videos in our YouTube channel. You can find me on Twitter at Mark Divine and on Instagram @Real Mark Divine, as well as Facebook or my LinkedIn account. My newsletter Divine Inspiration comes out every Tuesday morning, where I have show notes for the week’s podcast, I have my blog, I have a book I’m reading. I have a habit or practice to do and some other interesting things that come across my desk. So go to MarkDivine.com and subscribe and share it with your friends. Thanks to my terrific team, Geoff Haskell and Jason Sanderson and Catherine Divine, who helped produce this show, and bring incredible guests like Dr. Cole to you every week. 

Reviews and ratings are very helpful. So if you haven’t done so, please consider doing so, wherever you listen to this podcast. It helps keep us at the top of the ratings and gives us incentive to keep going. Thanks for being part of the change you want to see in the world. Thanks for your support of the Mark Divine Show. Thanks for doing the work. You make the world a better place. Do that one person one day at a time. Till next time, Hooyah!

 

Transcribed by Catherine and https://otter.ai