Show #2687
DIALOGUE edit
Intuitive Fasting
with Guest, Dr. Will Cole
Carl Lanore:
We're talking about intermittent fasting, time restricted feeding or what I like to call a more ancestral feeding pattern
Besides doing fantastic things increasing sirtuins and markers for better aging, balancing AMPK and mTOR, perhaps even quenching and removing senescent cells from the body; benefits you really don't see for years and years, intermittent fasting is becoming even more popular as people are seeing rapid changes in chronic disease states.
Still a lot of people have a hard time wrapping their head around it.
My guest Dr. Will Cole is one of the most sought after functional medicine experts today. With Telemedicine he services people around the globe, people with thyroid problems, autoimmune problems, and his approach is to find the insult, which is counter intuitive compared to the pharmaceutical model today.
Carl Lanore: [00:04:09]
I want to give credit to LIVon labs for making this episode possible. LIVon labs has been a sponsor of the show for many years. Cindy and Less Nachman are friends and I want to thank them so much for making this interview possible.
Dr. Will Cole: [00:05:00]
I think that more as time goes on and more studies are done, and we understand the pathogenesis of chronic inflammatory health issues we're going to find more autoimmune components to a lot of different health issues. Today I think there's upwards of a hundred different immune diseases and 40 additional health issues above that 100 that at least have an autoimmune component, but you're right. I mean, every year there's more and more autoimmune components that are discovered through things that we thought were just chronic inflammatory degenerative issues. The immune system actually is losing recognition of self and attacking certain aspects of the body.
It’s something that's sadly growing by leaps and bounds
Carl Lanore: [00:05:43]
The rise in leaky gut has become a lightning rod, right? Does all this stem back to the fact that things that should stay in the digestive track and be eliminated, are getting into the bloodstream because of a malfunction in the digestive process.
Dr. Will Cole: [00:06:17]
That's definitely one component of it. And for people to pontificate and say they don't believe quote unquote in intestinal permeability, this isn't a religion. There are hundreds and hundreds of studies on pub med looking at intestinal permeability.
Things are passing through the gut that shouldn't be able to pass through the gut and it's triggering, in some people this phenomenon, a Seminole event called molecular mimicry. It's this case of mistaken identity when the immune system thinks that the thyroid or the joints or the brain is a virus and attacks it.
I do see clinically other components to the triggering of auto immunity such as chronic infections, trauma that don't directly have to do with the gut but indirectly because all of that stuff will further perpetuate gut problems.
It's a confluence of factors and gut is a major part of it. Why? Because it's 75 to 80% of the immune systems in the microbiome. It's a piece of the puzzle
Carl Lanore: [00:07:28]
So let's talk about the book. Do we really need a book teaching people how to fast? That's a rhetorical question obviously,
Dr. Will Cole: [00:07:35]
I don't think that we need another book on fasting and that's why I wanted to write the book in the way that I did. It's a completely different part of the conversation that hasn't been told. There's a lot of great books about intermittent fasting, the science around it and the practical application of it. A lot of them were written by friends of mine, but I wanted to bring a more mindful approach to it where you don't have to be a type a biohacker though some of those are my patients as well. You don't have to be a health wellness rockstar to tap into these amazing things. I wanted to make it more accessible in the context of why we're doing these things; a conversation around having this mindful, flexible approach to intermittent fasting and the body's amazing abilities. The body’s healing capacity is profound if you allow a chance to do so. That's the conversation I'm having with my book Intuitive Fasting.
Carl Lanore: [00:08:37]
What does intuitive fasting mean and how's that different from what other people are talking about when they talk about intermittent fasting?
Dr. Will Cole: [00:08:48
It is paradoxical on purpose. I really wanted to make a point on the front end from a cover standpoint. Fasting will be anything but intuitive. When someone is metabolically inflexible or metabolically rigid they're stuck in sugar burning mode, they are hungry and have insatiable cravings. It's really a conversation coming from a functional medicine standpoint of metabolic flexibility.
I'm all for people eating mindfully and knowing their body and having agency over their health, but you actually have to show up for yourself first to create some metabolic flexibility, at least get it on its way. Calm inflammation levels, have proper blood sugar balance, become more fat-adapted.
At that point, fasting will be more mindful because you'll be in control of your food, not the other way around. You'll eat food because it's delicious and because it serves you. You will be able to go longer without eating and not feel it's some arduous restrictive thing. Because you're more fat-adapted, fasting will become intuitive just as eating becomes more intuitive when you’re metabolically flexible.
If you think about it, inflammation is noise in the body that blunts receptor sites signaling in the body so you don't even know what your body loves and hates. It's not just fasting for the sake of it. I'm actually having people use mindfulness practices when they are fasting and when they're eating to learn about their body. That's, that's an important part of my clinical practice and I wanted to share it.
Carl Lanore: [00:11:18]
There's a, a lack of understanding about mindfulness. There are numerous quality studies that show when people relax a bit before they endeavor their meal, get off their phone, don't read the back of the cereal box, their satiety increases. They, they seem to be able to control hunger for longer periods of time in between meals. But there's also a phenomenon if you sit down to a meal and you have a sense of angst, your body doesn't metabolize it well. The rest-and-digest phenomenon is legitimate
Dr. Will Cole: [00:12:32]
Absolutely. It's this bi-directional relationship between our thoughts and emotions and our physiology. You have to deal with both sides of the coin. If you're dealing with a toxic relationship or a stressful work environment, you're not getting enough sleep, you are endlessly scrolling on your phone with this FOMO inducing content, your body's mentally, emotionally stressed out that raises inflammation levels up. It's not going to make you feel good. It impacts your hormones and your gut health…Conversely underlying gut issues or hormonal imbalances, chronic inflammation will impact your thoughts and emotions. So that's two sides of the same coin.
I'm using fasting as meditation and also as a medicine. I think both of those things need to be brought into place for us to have sustainable health. If you start to at least, flex that mindfulness muscle, you create a space for you to learn about what works for your body and what doesn't. There will come this awesome tipping point for people where it's not this protocol anymore. I want people to have that paradigm shift. To reach that point where they realize It's not restrictive at all and you love feeling great more than you miss something that didn't make you feel great.
We're creating this awesome foundation of resilience and this center that they know they could pivot from but rarely do it because feeling great is so much more than the trade-off.
Beta hydroxybutyrate passes through the blood brain barrier, improves BDNF brain derived neurotropic factor. It's supporting neuroplasticity, it's supporting mitochondrial health. It's lowering neuroinflammation. The cognitive improvements, the brain supporting improvements are profound, but you have to put the work in.
Take somebody with tight hamstrings who has never done yoga before. They're not going to be good at it. You have to keep showing up to that practice to become more flexible. That's what intermittent fasting does, it expands and contracts the metabolism to become more flexible. Just like people that are really good at yoga, it's an art, it's like a rhythm, it's a practice that just happens more intuitively.
Carl Lanore: [00:16:12]
Dr. Daniel Lieberman came on my show a couple of times after writing “The Story of the Human Body. I feel that that book was a pivotal point for me in my journey and the journey of the show. One of the things he said was that culture drives evolution.
Dr. Will Cole: [00:17:26]
Yes, just titling my book intuitive fasting is triggering for a lot of people because the idea that fasting could be intuitive is just crazy to the modern thinker. Like we are bound by the next meal by the next snack, and it's just the way it is. Anything else is just seems like disordered eating. I would say the way that we're living our life as modern Americans is what's disordered and the chronic health problems speak for themselves. We are not living in alignment with our biochemistry. Like you speak so eloquently about this ancestral mismatch, this evolutionary mismatch, the epigenetic mismatch is at the heart of what researchers are exploring.
It's the driver of most chronic inflammatory problems autoimmune conditions being a component of it. It's the constructs of how we live our life. Just because something's common doesn't necessarily mean it's normal just because it’s the way that you've done it and your parents have done it doesn't mean you should settle.
Carl Lanore: [00:18:39]
The people who could use time restricted feeding or intuitive fasting the most, who are either diagnosed with type two diabetes and insulin resistance or undiagnosed, but have it; which I would venture to say is half the population in America today.
When we say heart disease is the number one killer that's a lie because you get heart disease because of insulin resistance. Reality is the number one reason for death today is insulin resistance, mismanagement, dismantlement of sugar and metabolic disorder.
The challenge is because they're already metabolically inflexible they have a hard time going three hours without a meal. They get the shakes, they start sweating. How do they embark on this journey and how does the book help them?
Dr. Will Cole: [00:19:46]
You're absolutely right and the statistic is 50%. Some studies show it over 50%. More than one out of two people have a massive blood sugar problem, or they're on this larger insulin resistant inflammation spectrum from mild weight loss resistance and fatigue and cravings, pre-diabetes, metabolic syndrome, PCOM, polycystic, ovarian syndrome for women and type two diabetes.
Those are all on the insulin resistance spectrum. So it's a lot of people and this is an amazing tool that could benefit most people in the United States and around the world. Going in just like that yoga analogy you don't want to go to an advanced yoga class when you're not very flexible and your hamstrings are tight, so you don’t quit. You just have to meet your body where it's at and that's what I'm advocating to people with intuitive fasting. You just don't want to rush into something when you're not ready for it. Week one in the protocol in intuitive fasting is what I call body reset fast, which is not very sexy, for the fasting aficionados out there, but the reality is for most of the world, that's going to be a good firm foundation.
It's just not eating too late at night. You have 12 hours to eat. 7:00 AM to 7:00 PM, 8:00 AM to 8:00 PM. It's just allowing them to allow a couple of hours to go in the evening after they stop eating dinner to allow their body to fast through the night until you break the fast at breakfast. We pair that with sort of a Mediterranean ketogenic diet that mimics the fasting and compliments the fast. So even when they're not fasting, they're supporting metabolic flexibility.
Carl Lanore: [00:21:42]
Good studies have come out recently that show that a low carbohydrate diet actually can restore and reverse brain health to its original status.
Dr. Will Cole: [00:22:38]
I think more and more people are waking up and realizing what they’re doing isn't working for them and they have to do something different to see something different. It’s not a system change, but an individual micro change. That's growing, that's changing some systems. Food industry is changing because they're innovating because people are waking up and want better options.
Carl Lanore: [00:24:14]
I know you specialize in working with people who have compromised thyroids and hormones in general. Your protocols indicate that you can balance hormones by using time restricted feeding, intuitive fasting. Is it adequate if someone needs to have some restoration in hormone levels.
Dr. Will Cole: [00:24:41]
With my patients we're looking at labs in the context of the specific aspects of the protocols that we need to be integrating into their lives, but for the sake of intuitive fasting, the first hormonal imbalance that I'm discussing in the book is insulin resistance, and then just almost directly proportional to that for most people is leptin resistance. The fact that we can modulate leptin in a positive way, lower insulin levels in a positive way and balance blood sugar. Those are two hormonal imbalances driven by receptor site blunting and receptor resistance patterns we are improving.
When you improve leptin and improve insulin, It's going to create a cascade of positive improvements across the board because you start lowering inflammation levels which improves sensitivity receptor site, proper hormonal signaling for a lot of different hormones, thyroid hormones, estrogen, progesterone, testosterone you're improving a lot of things throughout the body.
The other conversation that I'm having in the book is about progesterone and estrogen and thyroid hormone conversion. Using food as nutrition, food as medicine with intermittent fasting. These are all tools in the toolbox. I'm advocating doing time restricted feeding in a vacillating flexible sort of ebbing and flowing way.
We're leveraging the benefits of clean carbohydrates, like whole food carbohydrates, sweet potatoes and fruits and things like that to achieve some metabolic flexibility and lower insulin, lower leptin.
Women do better with a more cyclical approach. When they're cycling around the period around ovulation to actually leverage the benefits of supporting thyroid conversion and progesterone function. I think you can leverage the benefits of all these things in a way that works for you. And that's what I want people to explore.
Carl Lanore: [00:26:57]
The body is cyclical. The phenomenon of abundance and scarcity. It's fascinating. I never really thought about that.
My biggest frustration for about the past eight or nine years is the reluctance of doctors to check blood sugar and insulin, or even C-peptide at the same time. My argument is how much insulin is that person making to keep their blood sugar in that range?
How many people have come to you after a traditional physician told them, they’re fine. Then you find their blood sugar is 80, but their pancreas is pumping out gobs of insulin to keep it at 80. Does that happen often?
Dr. Will Cole: [00:30:32]
It happens all the time. I have a unique position to be able to see these labs on an hourly basis and all of my patients with few exceptions, are extremely compliant patients in the conventional setting. They've done everything their conventional doctors told them to do. They've really been great patients and they honestly have a great relationship with the conventional doctor, but they know that something's not being addressed. We are running labs looking at the full data, not just the basic labs, we're running C-peptide, we're looking at even a nuclear magnetic resonance test to look at the sub fractionation of these particles.
These things are being missed all the time. Research actually shows that by the time someone's diagnosed with a chronic disease, it's been about four to ten years brewing on this inflammation spectrum.
If you get to the point where your A1C is too high and you have all these problems - that didn't happen overnight. It happened over 10 years. So wherever you're at on that inflammation spectrum, do what can you do today to start moving the needle in a positive direction, instead of waiting for time to somehow fix it. It's not going to change until you do something different.
Carl Lanore: [00:31:57]
Isn't A1C an artificial metric if you will, because we assume that everyone’s red blood cells have a 90 day lifespan. Isn't it possible that metabolically deranged people, their red blood cells may turn over faster ?
Dr. Will Cole: [00:32:26] I
think it's one piece of the puzzle. It's never what I hang my hat on. It's interesting how many people, they don't even get the A1Cs run. They barely run anything unless the person's really begging for it.
They’re running just basic cholesterol, markers, serum, glucose, and that's it for most people. You're right. You cannot just base it off of one A1C. You want to look at the full pattern, put it into context. Looking at HDL, triglycerides is one way for us to see the if body converting that blood sugar into circulation or triglycerides.. People have triglycerides 150 -200 and above and there's no conversation about it until it's bad enough for them to give you a medication for it. This reactionary approach fails a lot of people because these things take time to degenerate to the point when they can give you the medications. I'm not just concerned with diagnosing a disease and matching it with the medication I'm concerned with what's going on with your health and how can we optimize it? A1C by itself is not very helpful. But if you put it into context with everything else, it can tell a story.
Carl Lanore: [00:33:45]
you just said something that's really intriguing to me and it's something I've always believed. When someone goes in with high triglycerides, the first thing the doctor tells them to do is cut out red meat, but they miss the fact that the glyceride portion of this word is a sugar bound to a fat. There's no discussion about cutting back on your carbs In the we have to manage your triglycerides approach. It's always fat cut back on your cheese and no more red meat.Ultimately the patient comes back and their triglycerides keep going higher because if you can't eat these things, you’ll eat more of these other things.
Dr. Will Cole: [00:34:30]
I see it all the time. It’s actually counterproductive on the lab standpoint. It's easy to make statements, but if you're actually tracking the data and labs improve, you know more or less the things that people have to do to get there.
Carl Lanore: [00:35:02]
We have a question from Robert Thompson on the A1C horizon: “how does a phlebotomy affect A1C? Lots of us in this audience donate blood for the beneficial things that does for us. Does phlebotomy play a role in A1C readings?
Dr. Will Cole: [00:35:19]
I haven't seen a considerable change when people that do that, I'm not a phlebotomist obviously, but I do have some patients with hemochromatosis that have to do it. I haven't seen it make a major negative or positive change. I'm sure it does something, but nothing that I know of specifically.
Dr. Will Cole: [00:36:13]
I think that's the, one of the amazing aspects of, of intermittent fasting and time restricted feeding and paired with a clean whole food space, ketogenic diet, I think which mimics fasting in many ways. If you look at the research of the ketogenic diet and intermittent fasting you're going to see a lot of the same mechanisms looked at because they're both supporting beta hydroxybutyrate, which is known in research as the fourth macro nutrient. We have protein fats, carbs and ketone bodies, and beta hydroxybutyrate is not just the way to burn fat, but also is a signaling molecule or an epigenetic modulator, meaning it does really cool things for our health.
Carl Lanore: [00:38:07]
What about chronic fatigue? I'm coming to the conclusion that chronic fatigue has more to do with insulin resistance than anything else. I'm also starting to think that different tissue becomes insulin resistant at different periods. We have this illusion that we're this monolith of tissue. We know there's a lot of people who are fairly lean, but have distended guts. And when you do DEXA scans on them, you find that they have a ton of visceral fat. So that means that the visceral fat is responding very differently to the rest of the tissue to insulin sensitivity. The same is true of people who develop insulin resistance of the brain, type three diabetes. We know that they develop dementia and so on. Is chronic fatigue, possibly one of the byproducts of insulin resistance that we should be addressing first that instead of giving people garbage drugs.
Dr. Will Cole: [00:39:27]
Yeah. I think it's something that should be explored as a component of it without a doubt. And it's not looked at, it's definitely not looked at. It’s usually just labeling someone and giving someone a diagnosis code of chronic fatigue syndrome. Anybody with CFS will tell you they are chronically fatigued, but why. Or fibromyalgia, you know you have pain. But why? These are just check engine lights in functional medicine. We know that something's wrong but what's underneath that proverbial hood that's driving that check engine light to be on in the first place. We don't just want to cover up the check engine light and say, see you in six months and create this artificial environment.
We want to actually know what's going on. What’s causing the problem in the first place. So that's what we can look at with labs. I get to see all these different labs from different perspective, from their vantage point. What are the pieces to the puzzle for people, with things like chronic fatigue syndrome and other different inflammatory problems? Insulin resistance is definitely a component for many people.
Interestingly I think the problem with things like chronic fatigue syndrome, like fibromyalgia and many other chronic health problems is what's underneath the hood for one person isn't necessarily underneath the hood for the next person. That's where you have to stay intellectually flexible and go out of your way as a clinician and figure it out, whatever it is, let's figure it out. We want to keep an open mind. Looking at things like chronic viral infections, mold and biotoxins, Lime and heavy metal issues. Also trauma, non physiological things that impact the physiology and hormone imbalance. Nutrient deficiencies, insulin resistance, low thyroid hormones and leptin issues. It’s typically a confluence of factors like a perfect storm. My job is to say, what are the components that make up your perfect storm? What are the pieces to your puzzle? And it's going to be different from person to person.
Carl Lanore: [00:41:41]
I want to talk about functional foods because you talk about using foods to enhance the effects of time restricted feeding. Give me an example of how you use foods to accelerate the benefits of your fasting?
Dr. Will Cole: [00:42:53]
I think that bringing in flexible, intermittent fasting, time compressed eating with nutrition specific food and reasons along with mindfulness practice really do enhance and take fasting to the next level. As a functional medicine practitioner, I would not advocate someone to fast their way out of a poor diet.
I would advocate you to eat foods that compliment the fast and vice versa. Focus on foods in specific ways, have a clean ketogenetic diet that's cyclical. Use it therapeutically to lower inflammation levels to become more fat adapted. Having more of a Mediterranean ketogenic diet is fast mimicking. Even when not fasting, it supports metabolic flexibility and and ketosis and all of these amazing benefits that I talked about earlier. It allows your fasting to be more flexible as well, since you're already supporting those pathways even when you're eating. It allows you to have to be as obsessive about the fast, you can be quite measured and flexible about it, and still get all the amazing benefits.
Some people do carb cyclically, around a heavy workout increasing starchy, tubers, like sweet potatoes, increasing more fruits. It's very measured stuff. We're only going to about 75 to 150 grams of carbohydrates still probably lower carb compared to most Americans.
Carl Lanore: [00:46:17]
We know that there are lots of phenotypes, some people are night people, some people y don't need the cues from food, people need a meal to get the body going in the morning.
Dr. Will Cole: [00:47:24]
Totally. In the fasting community it's always about “don't eat when you first wake up and break the fast” but to have your breakfast and move your eating window earlier in the day. works for many people. I don't think you need to follow these hard lines that you hear someone else is doing. Let it work with your day and how you feel. I want you to experiment and learn about your body and become more mindful about these things.
Carl Lanore: [00:48:18]
I'm a huge advocate of hormone replacement therapy once you're at an age where they're not coming back on their own. That being said, over the years, I've discovered that women who choose not to get on HRT (and I respect that choice) who have hot flashes, estrogen and progesterone have an effect on blood sugar management. What I've discovered is women who are choosing not to get on HRT, but are tired of the hot flashes that if they start to focus on managing blood sugar, going to a more low carb, their hot flashes go away.
If you look up hypoglycemia, the symptoms appear to be exactly like menopause. Hot flashes, anxiety, sleeplessness, sweating in the middle of the night. What are your thoughts about the role of fasting and the right kinds of foods in managing post-menopausal issues for women who don't want to get on HRT?
Dr. Will Cole: [00:49:39]
I get that question a lot. I think for perimenopausal menopausal and post-menopausal women fasting is a great tool to consider because of its blood sugar balancing effect, getting insulin signaling working well, lowering inflammation levels and gut health. Creating a calmer system and resilience reducing the highs and lows of volatility of hormonal change symptoms.
Carl Lanore: [00:50:56]
The Book
“Intuitive Fasting”
shrnetwork.biz/FAST
