EPI 238: How To Lower Inflammation In Your Body With Dr. Will Cole. Top Biomarkers + Tips On Food, Water, Air Purity, Personal Care Products, And More!

Welcome back to another episode of the Peak Performance Life podcast. Today, I am very excited to have a special guest that I've wanted to have on this podcast for a long time. His name is Dr. Will Cole, and he's a leading functional medicine expert who consults people around the world via webcam. And he started one of the first functional medicine telehealth centers in the world. He's been named one of the top 50 functional and integrative doctors in the nation. He specializes in clinically investigating underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders. He's very, very, very well versed in gut health, as well as brain problems. He's the host of the popular podcast called The Art of Being Well, and he's a New York Times bestselling author of Intuitive Fasting, Gut Feelings, which is his recent book, which is amazing. I can't wait to talk about it. Ketotarian and the Inflammation Spectrum. Dr. Cole, thank you so much for joining us. Thanks so much for having me, my friend. And can we nerd out now? Is it official? It's official, man. Let's do it. Let's start with maybe a little bit of background. How did you get into doing what you're doing today, opening one of the first, if not the first telehealth? Yeah. Yeah. So I grew up, I was, well, let's go way back. In the 80s and 90s, my dad was a bodybuilder at that time. And he, I thought it was normal to have your dad in, like lubed up with baby oil with, you know, turquoise Speedos. Speedos and my mom would be there with the camcorder, you know, getting the perfect poses and the, you know, all of that sort of world of bodybuilding. He owned a Gold's gym. He was in the health world. And, um, so that's not that all bodybuilding and fitness is healthy, quote unquote, but it's part of the conversation. And there are super healthy health, health conscious people within that community. And, um, we would shop at the local co-op and, and we'd get the raw milk at the farmers and put on, it was an honors basis. We just put the couple of dollars in to get the, draw our own raw milk from the local farm. It was not the industry that, that we know now, health and wellness. It was like the, you didn't have that many choices. It was the random granola at the co-op. It was the raw milk. It was the whatever, but that was how I grew up. So I grew up in that sort of, I would say different world as certainly for that time, even now would be considered pretty crunchy. And then I became a personal interest of mine as I got older. I really, looking back, you could call it biohacking. I didn't have the language back then, but I just, I'd used my paychecks from my job in high school to go and buy the latest superfoods or herbs or things that I heard about, read research about. And I just read a lot of books on these topics. And I wanted to be formally trained in health sciences. So I went to Southern California University of Health Sciences outside of Los Angeles, where there's DOs, MDs, DCs, acupuncturists, nurse practitioners, researchers, all kind of learning their own thing within health sciences. And I heard about a guy who had gone to my school. He was older than I was. His name was Datis Karazian, who's still one of the, I would say, early leading voices in functional medicine. And I knew, okay, it all made sense at that point. It wasn't this sort of larger health sciences. It was a specific field within health sciences of this both and not either or approach to health of really bringing in the best of Western medicine, which is being evidence based, very being familiar with the research that's out there. Diagnostics, like labs, I love labs, but really getting to the root cause and not just covering it up with pharmaceuticals and really looking at these emerging, like this cutting edge stuff that's in the scientific literature, but translating that stuff in the research into people's lives. That's what I wanted to do. So I moved back to Pennsylvania and a lot of people aren't in Western Pennsylvania in the woods. So I needed to figure out how could I, because I was early on talking about this stuff online. So I wrote a lot of articles. I love writing and I love talking about this stuff. So this was in 2009, 2010, talking about this stuff online a lot. So there would be people in different states and countries that we needed to figure out logistically how we could get the lab or the protocol or provide them the support and coaching and guidance that they needed. So we didn't have the language of telehealth back then. What we called it is a virtual functional medicine practice because that was the best that I could come up with. But so we just, that became everything that we did and it has not changed. And it's just over the years, 2009 to 2020, we'd already been doing it for 11 years and the pandemic happened and doctors had to figure out overnight how to figure this stuff out as far as telehealth is concerned. So we helped a lot of doctors figure out logistics during that time, but we'd already been doing it. So yeah, it's just one thing led to another really we haven't nothing's changed with my day job but the out like the ripple effects of it i have a podcast i write books about it i just can't shut up about functional medicine basically so that's in a nutshell the story and hopefully it wasn't two five minutes or less no that was great that was great and uh yeah i love when we talk about functional health i always like to remind the the listeners kind of like holistic health functional health is more along the lines of looking for what is the actual root cause of the issue, not like, oh, I have inflammation, I need to take a prescription anti-inflammatory or, you know, whatever the case may be. So I absolutely love it. I think, hopefully, we're making more of a push now to get to the root cause of issues. And I think more people are becoming aware. So I think it's really amazing what you're doing. Maybe we can start with what You've seen a lot of people, obviously, virtually over the years. What are some of the most common issues or mistakes that you're seeing kind of people make with their health? Well, I mean, we're faced with more complex health issues, I think, than ever before. I mean, part of it is just greater awareness and the internet connects people. Certainly, I think that people were going through similar stuff in the decades before and just unhurt. They didn't know. They were isolated. They didn't have access to information. but that paired with what researchers call an epigenetic genetic mismatch that our genetics haven't changed in 10 000 plus years as a species but yet our world has changed dramatically in such a finite period of time so when you're looking at the foods we're eating or foods we're not eating the nutrients we're taking in or the nutrients we're not taking in environmental toxins biotoxins which have always been there, but it's again, part of this confluence of factors, but things like bacteria, viruses, mold, parasites, if it was just that, it's not good. But then you have this perfect storm of variables with man-made environmental toxins like microplastics and forever chemicals and herbicides and pesticides and heavy metals. And then we have to look at the mental, emotional, spiritual factors of things like chronic stress and unresolved trauma and all the research around that. So it's this perfect storm of variables that are triggering genetic predispositions that have been around for thousands of years, but are being awoken like never before in human history because of what researchers call as this mismatch between genetics and epigenetics or our body and the world around us. And this chasm, we're living in a brave new world. So yeah, to answer your question, like what are people doing wrong or faced with? I think we have a lot of variables to contend with on an individual micro level and as a societal level as well of we are doing things. There's a lot of unintended and sometimes intended consequences with how we're living our life today. So we have to realize that we have to do something different to see something different. It's not just one thing. But if you had to say what people are doing wrong, I think it's just there. It starts with food. I guess we could start there. It does start with food and nutrition, most of the people that I know that I'm seeing from a clinical standpoint, they are eating better than most Americans. So they are doing better than most people in the Western world, but they're still struggling. So that's where we kind of come in to take it to the next level to say, yeah, you aren't eating fast food. You're still struggling, but what's going on here? And that's where these things are. Yes, we have agency over, but they're not like your meals. They're not like work out, eat less junk food. This is just when you talk about environmental toxins or underlying gut problems, it's because of our world, sadly. So we have to, I guess what they're not doing is maybe having, they need to know what they're up against to do something about it. I think that's the biggest thing is just increased awareness on these things that people settle for and just say, well, this is my lot in life. This is just who I am. And they make their symptoms part of their personality. if it can be reversed and optimized and healed, it's not your personality. So things like brain fog and fatigue, things like anxiety and depression, things like just body composition, trouble losing weight, fertility issues, digestive problems, these are not just you. Let's figure out what your body is telling you because all those things I just mentioned are proverbial check engine lights. You have to pay attention to the check engine light and then ask why is the check engine light on in the first place? what's underneath that metaphorical hood that's causing that problem in the first place. Yeah, yeah, that's very well put. And I'd love to get into maybe some of the tests that you think are important for people to run, maybe some of the important biomarkers as well. I mean, look, like you said, if the first thing is food, if someone's eating junk food all the time, sometimes you don't even realize that there are people who eat out a lot and don't realize that they're, you know, hey, I'm eating this healthy food, but maybe it's cooked in seed oils, right? And that's why I'm one of those annoying, I'm a waiter's worst nightmare. I'm like, hey, what oils are you using? Can you use olive oil or butter and make sure you don't use any seed oils and all that kind of stuff? But again, if you know you're doing okay and you're doing the normal things, there are still other people that have issues. And I've heard you say on other podcasts, like different genetics for different people might determine how much of a negative load, let's say, they can handle. But if, but so that's where kind of like some people might be able to deal with something and someone else might not. But yeah, and there's a whole combination of things such as stress and other things that go into it as well. But maybe let's start with what are some of the most important tests or markers or things that you would do on an incoming patient? So health history informs quite a bit, right? It's, you don't want to run labs for the sake of it, right? It's the sort of dock in the box sort of approach where it's like, yeah, well, these labs are maybe a good screening foundational. Obviously, there are foundational labs for everybody. But beyond the foundational labs for everybody, what are the specialized health history specific? What are the relevant labs to the individual? And that's where health history comes into play of looking at what are the stones that are most likely to have something underneath it per se. So if somebody doesn't have this issue at all, these labs aren't covered by insurance, some of the specialized labs. You don't want to run just labs for the sake of it. So I would say, let's talk about some of the foundational labs. And let me talk about the specialized ones. That could be things like environmental toxins, gut problem issues, comprehensive, more expanded hormonal tests. Those are some of the ones that you would want to run based on someone's health history. Now, you can make the argument that so many people are going through things that most people should be looking at these things at least periodically. And I think you probably could, but you want to make this practical and realistic for people. So that's where health history is so important. And so the, some of the foundational labs, I mean, one would be a set of labs really looking at inflammation. Inflammation is the common thread between all, pretty much every health problem, right? I mean, autoimmune problems, metabolic issues, even mental health issues, looking at things like anxiety and depression. So I would say, and these are all conventional tests too, which is nice. We run them for people around the world, but you could ask your local doctor for these labs too. So high sensitivity C protein HSCRP we want it to be under one in functional medicine So does the American Heart Association So does the CDC in the optimal zone Homocysteine is another conventional inflammation test In the conventional mainstream medicine world, they're running it typically from a cardiovascular risk factor standpoint, heart attack and stroke risks basically, which we look at that for that same reason. But it's more than that. There's research that shows that even suboptimal but still not outside of the lab's reference range levels of homocysteine above seven has been shown to act as a neurotoxin. It's associated with neuroinflammation or what's called increased blood-brain barrier permeability, the common term for it's leaky brain syndrome. But basically, it's a component to neuroinflammation for think brain fog, fatigue, mental anxiety, depression, or autoimmune, neurological autoimmune issues. It's shocking how many people have higher homocysteine levels. And that's an aspect of methylation, which is a big interconnected set of pathways that impact inflammation levels, hormone health, immune health, so many different things. So we look at genetic SNPs variants when it comes to that, like MTHFR and other methylation gene SNPs that are responsible for that. So there's always going to be this interplay, I guess, between genetics and epigenetics. Genetics are – I mean the analogy that's used here is genetics loads the gun, but epigenetics pulls the trigger. Our genes are the potential, but the way we live our life is either down-regulating or up-regulating, turning on or turning off these gene expressions. So homocysteine would be another thing that I would look at. It's an inflammation marker that we want to be below seven. Ferritin is another conventional test that it's very interesting, the information you can get with these basic tests. Ferritin is a biomarker for stored iron. So depending on if you're male or female, depending on if you're postmenopausal or you're cycling, there's different optimal ranges for these. But we want it to be at least 80 for most people. Most people are deficient in low iron, low ferritin, But then you'll get some people in these inflammatory storms where they have really high ferritin, which on the surface, you could say, okay, is it high iron overload? Is it hemochromatosis? Well, you have to put that in context. So you want to run a whole iron panel like serum iron, hemoglobin, hematogra, iron saturation. It's called the MC series, which is red blood cell measurements. The whole point being is ferritin can act as what's known as an acute phase reactant. In states of inflammation, you can see ferritin spike. So these conventional inflammation tests are very helpful to know, okay, where am I at on this inflammation spectrum? And certainly inflammation is more complex than just those three biomarkers. But if you're looking at some basic tests, I think that's a good start. I think metabolic health is tied into all of this for a lot of people. There's a UNC study that says upwards of 93% of the United States is metabolically unhealthy. So that's 7% of Americans are healthy. I mean, metabolically healthy. That's wild, right? So we want to look at things like fasting insulin. We want it under 9. We want fasting glucose or blood sugar to be under 90. We want the A1C to be under 5.6-ish. That's your three-month average of your blood sugar. We want triglycerides or circulating fat to be under 100. That's the metabolic Paul Revere. He didn't really say this if you know American history, but the British are coming. The British are coming. It's saying diabetes is coming. Diabetes is coming if triglycerides are above 100 because the body has all these brilliant compensatory mechanisms. It's trying to store triglycerides as – well, it's trying to store – let's say it this way, trying to store circulating fat or blood sugar in a way. How can the body get blood sugar down? and it's trying to figure out a way because that's toxic to the body. 93% of the United States is metabolic and healthy. They have higher blood sugar. So the body says, I need to get blood sugar down. Let's store it as circulating fat or triglycerides, fat around the midsection, weight loss resistance, and fat around the liver, fatty liver disease. You can measure these liver enzymes like AST, ALT, GGT. You'll see those suboptimal too because of this insulin resistance spectrum that many people find themselves on. So from there, you could expand into more niche immune tests or niche thyroid hormone full panels or female hormone panels and we do that. But if you're looking at, okay, I've never had labs ran. What should I look at? I would say statistically metabolic tests like I just mentioned, inflammation tests, and then the third category I would say nutrients. like looking at vitamin D, looking at magnesium, looking at iron, like I mentioned, looking at selenium, zinc, iodine. Those are really, if most Americans got those tests, there would be so much information to do something about it. And they're powerful modulators in how somebody feels. So yeah, it's, you know, if you can tell, I love labs. It's a fun part of my job. Yeah, that's really cool. I mean, a lot of people talk about triglycerides mainly in context of cholesterol and people thinking that, you know, cholesterol is going to cause the heart disease and all that kind of stuff. But it's interesting how you mentioned the high triglycerides, because that's something like there are people who, for example, myself, when I was, you know, very much keto, and I'm still very low carb, but I would have maybe higher total cholesterol numbers. But my triglycerides were really low, really, you know, really in good range. My fasting insulin was really good, all these other kinds of things. So that was one of the, this is kind of like one of the big debates is like about cholesterol right now, right? Like if you're eating a super healthy, low carb diet, but your cholesterol is high because you're eating healthy fats, you know, and things like that. Is that, is that really a concern or is inflammation? I've always said inflammation is the most important part of health. So I completely agree with you there. and like i look at health as like how can we lower inflammation in the body as much as possible um but yeah curious your thoughts on all that yeah i'm so glad you brought this up i'm so glad you brought this up because i was like oh i'm giving them too many labs it's gonna like they're gonna be overwhelmed but if i could add another thing it would be what's called a nuclear magnetic resonance test or nmr test it's what the fancy way they call it a sub-fractionation of the particles that carry cholesterol which is just it's looking at the context of that basic lipid panel, the context of that total cholesterol by itself. Okay, researchers estimate it's about 50% of people who have heart attacks and strokes have normal to low cholesterol. So it's like flipping a coin if that cholesterol above 200 is problematic or not. It could be a sign of something off, or it could not be. So there's so much, it's tied into the diet heart hypothesis, it's tied into really a lot of money, I think, but behind statin drug industry, which is a very, it's part of the orthodoxy. It's a central aspect of the way that we do healthcare. And it's tied into the diet heart hypothesis and federal institutions. It's wild, this specific topic. It's so tied to a lot of people's livelihood and industries. But it's really, it's failed a lot of people, right? It's really failed a lot of people. And so we would want to run a conventional test called the NMR test to look at the quality of the particles that carry cholesterol. So I agree with you in short, because it truly is inflammation that damages the particles that carry cholesterol. That's a problem. So it's like if someone's cholesterol is high, it's to me, it's another check engine light. If it's truly high, if it's above 250, right? it is a check engine light well why is the body causing the release of this because the liver is what's manufacturing this yes food influences a certain percentage of it some people in food influences a lot more than other people based on genetics but it is largely like blaming the fireman for the fire when you see total cholesterol being higher because the body's trying to actually repair oftentimes most of the time when you see high cholesterol it's for a reason the body's actually trying another compensatory mechanism to repair things that are damaged in part because of inflammation and things that cause inflammation. So when you're seeing the studies of microplastics in people's arteries, and then you have the plaque buildup and the high cholesterol and inflammatory response, the body is saying, I don't want microplastics in the arteries. So then we go and we say, no, we have to shove the cholesterol down with a statin drug versus realizing it's an environmental toxin causing an inflammatory response that's the problem in the first place so it's like and that's just one example but other environmental factors stress underlying gut problems which can impact lipid markers negatively it's multifactorial but there's a reason i guess the point of the saying this is that there's a reason why that cholesterol is behaving the way that it is so we would want to look at a few things triglycerides like i mentioned under 100. We want HDL or good cholesterol to be above 59. And then LDL, we want to make sure that the particles that are being, which is not LDL-C, it's LDL-P, the particle size of the LDL, what they call bad cholesterol, we want to be in pattern A, which is these fluffy, large, buoyant particles that carry cholesterol. These are analogous to cotton balls. They're protective, they're gentle, they're fluffy. That is very different than small dense LDL particles, which are the oxidized, rusted BB bullets that can potentially tear through arterial walls. So you could see that the context of the LDL particles really matters. And look, you can have oxidized, people can have oxidized HDL too. So even that sort of reductive oversimplified view of like HDL good, LDL bad, 200 above 200 bad, under 200 good. It's like, well, what's the context of it? Because you can have oxidized HDL. It's less likely to be oxidized, but it's possible. And you can have oxidized or unoxidized LDL. That paired with the homocysteine and C-reactive protein and the insulin and the A1C and the metabolic issues, you're going to get a really good picture on someone's metabolic health, which as I mentioned, 93% of Americans are going to be somewhere on this insulin resistance spectrum where they're not going to check all the, this is great box, let's do something about it. And I guess that's a bigger point here is that all of this stuff is largely healable and reversible and overcomable, but you have to do something different to see something different. And certainly there are genetics that make it more difficult in certain areas. Like some people have it really easy and they can reverse this stuff in a few months. For some people, it's going to be something they want to keep monitoring over time. But it is profoundly helpful for people to be proactive and not reactive with these cardiometabolic markers. Yeah, yeah, absolutely. And I think the sad part is kind of that I don't think your traditional doctor, when you go for your yearly physical or whatever, if you do get a blood test. I hear people say, oh, I go for my yearly checkup, I get my blood test, but they're not going that deep, right? They might give you the HDL, LDL, and maybe triglycerides if you're lucky, but they're really not going that deep into particles and doing these metabolic tests a lot of the time. So I think it's really important. And that's why I typically use like insidetracker.com or one of these kind of blood tests. Do you have one that's a favorite of yours or that you use? I mean, we use, or we, we run it ourselves through Quest or LabCorp, because that's one part that's typically offset through insurance. And we would bill, and then LabCorp or Quest would, um, bill the insurance. Like the labs would build the insurance, but we would fill out the requisition form. Um, but no, I love the director to consumer. I think inside tracker is doing very great things. Function health is doing really great things. So if somebody doesn't, but the, I'll say the problem with those, not, let's not say problems, because I know both of those guys, like they're doing great things. It's not a problem, but I think it's a starting point, but I see a lot of people get these direct to consumer labs and they still want a person to talk about it. Right. They still want to like that. And then they get paralysis of analysis and just stressed about all this data. So, you know, AI is going to probably be there at some point to like walk someone through it. But at this point, I wouldn't recommend using chat GPT for like, you know, AI for your, what you should do on the labs or even the context around these labs because not all of these are big deals. So I think that there something to be said for a human talking to another human about the science and art of wellness So I love the lab data because if someone gets inside tracker functional but typically what happens is they then reach out to us and say, I have these labs. Like, what do you make of it? Like, what's a big deal? What's not a big deal? What would you do about this? And sometimes these labs will show glimmerings of other things going on. So that's were like these specialized gut health tests, hormone tests, environmental toxin tests. Because if you see inflammation tests high, okay, that's important to know. But the bigger question is long term is like, what's causing the inflammation to be spiked in the first place? It could be food, but it may be an underlying gut problem or environmental toxin, or it may be stress or trauma. It may be a mental emotional thing. So that's where this sort of human, I think, experience comes in. And again, in another couple years, AI is going to probably be able to do that too. But at least where we're at right now, they still need us humans before they take us over. Yeah, I agree. I completely agree. And I think when the AI does, because people don't understand, people are sending me stuff all the time. Oh, AI said this or whatever. And it's like, well, what is the training data that's training that AI? Because there are a lot of BS blog articles out there on the internet that are just trying to get search engine optimization traffic from Google. So they're just, you know, stuffed with keywords and trying to get traffic to their website, but doesn't mean they're good articles. But if, if chat GPT might be reading that and taking that advice. So I agree, I think what's going to be better is when you make an AI version of yourself, Dr. Cole, for example, and then we can, you know, have you analyze based on all the data that you've uploaded and train, you know, the AI on versus some random training data that we don't even know what it is that they're training on. So yeah, completely agree with that. I do want to start to shift now into a lot of people listening. You know, we talked about lowering inflammation as being critically important. So why don't we maybe start there? Like, what are some steps that pretty much everyone regard? Like, I'm, I feel that I'm pretty healthy, but even still I'm every day, like, how can I lower inflammation in my body in a healthy way? And some things like maybe doing a hard workout might raise inflammation temporarily, but, you know, I mean, more chronic inflammation, what are some of the steps that you would that you would give as advice? Yeah, so I, it starts with food, like I mentioned, so I would, if I if you haven't already, really look at your relationship with what I would call the inflammatory core four, These are the four foods or food ingredients that are most likely to contribute or drive inflammation in people's body. So in no particular order, so don't come at me, people, in the comments. But that gluten-containing grains would be number one. So all of this is predicated on the research, in my opinion, on what explains why I would consider these to be the most inflammatory or some of the most inflammatory would be this concept of epigenetic, genetic mismatch. that our genes haven't changed in a long time. So what have we done to the grain supply? It's not the ancient biblical grain that people had that stored well during times of famine and it would help them to survive stored well, right? Famine. But now we're feasting on a famine food year round. So things like wheat, rye, barley spelt, oats can be cross-contaminated. And then on top of that, we've hybridized it. It's not the same grain. We've sprayed it with stuff. we're not properly preparing it we're not soaking and sprouting it and fermenting it and then we're over consuming it so it's there's a lot of context i guess to saying well gluten's bad well i want to look at the sort of larger reasons why and those reasons why are going to vary from person to person like maybe that one person has a really reaction to certain aspects of the plant versus the next person doesn't it's subject to the law of bio-individuality So what works for one person, even if it's a healthy food, may not work for the next person. So there are better for you versions to everything I'm about to say. But gluten containing grains is certainly no exception to that. Some people do fine with a sourdough, organic, ancient grain bread that has gluten. Some people still don't even respond well to those. So gluten would be number one. Number two would be industrial seed oils, which you mentioned. A little bit more controversial. It's been politicized. But I don't think it's actually that controversial. I think when you look at the animal studies, the in vitro studies, and then some human trials, looking at the omega-6 to 3 ratio, the modern Western diet is very over-consuming omega-6, not enough omega-3s. So the omega-3, 6, 9, these polyunsaturated fatty acids are really important. So I think you don't have to be bombastic and make hyperbolic, rage-baked content to say this is implicated. and the overconsumption of canola oil, vegetable oil, soybean oil is problematic because of its omega-6 content and not enough omega-3 content in the modern Western diet. And then on top of that, the oxidation that can happen, the rancidity of it because it's unstable, it's sensitive to light and heat and time, these seed oils, and the processing of it. They use hexane solvents and chemicals and things like that. So I would put industrial seed oils on the list. Now, if somebody has organic, cold pressed sunflower oil, and has it in the context of a nutrient dense, whole foods diet, I'm not worried about every seed oil under the sun. I think the context matters. Third would be added sugar, which most people you can get behind. It's a kumbaya moment for the nutrition world. It's not good. And there's a few of those. But even the nicer sounding euphemisms for the greenwashing within sugar. Become label literate. Look at the grams of added sugar on labels, things that are maybe okay in small amounts, but if they're not in their whole food form with fiber, it's going to be impacting your blood sugar a lot differently than that whole food sugar with fiber and all of the matrix of its whole food form. So things like agave nectar, it sounds so nice because it sounds like it's agave. There's picking that agave and squeezing it in my bottle and it's so natural. But the reality is it's still lacking fiber. And if it's in a pocket package processed food and it's still higher in fructose. So fructose and fruit, great. Fructose, even if it's not high fructose corn syrup, if it's agave nectar, it is still in excess amounts problematic. So become label literate and maybe do a sugar audit. How many grams of added sugar am I consuming in a day? Most Americans, most Westerners are doing too much. And the last would be dairy. Dairy, again, it's what we've done to the poor cow, not the dairy itself that's problematic. So if you look at ancient A2 dairy, the A2 is the dairy protein casein. Humans would have consumed that for a long time. Totally fine. We've crossbred cows. We have a new dairy protein on the block, beta A1 casein. And then on top of that, we've homogenized the milk, we've pasteurized the milk, we've feed cows grains, not grass. It's a shell of what it once was. So that's why you see more and more A2 dairy creeping up because certain breeds of cows still have the A2 dairy. Back to that mismatch. Our microbiome, our trillions of bacteria in our gut, our gastrointestinal system, our immune system recognizes the old stuff because it hasn't changed in thousands of years. So by decreasing that mismatch and eat more in alignment with what our ancestors would have consumed, our microbiome, our own immune system recognizes it. And then I could add a plus one to the core four. It would be alcohol. I mean, there's no healthy amount of alcohol. Healthiest amount of alcohol is none. They could bring up resveratrol all they want. There's better ways to get resveratrol. There's so many better ways to get resveratrol without neurotoxins involved. Now, I'm not a teetotaler puritan. If someone wants to choose to drink, then fine, informed consent, but don't fool yourself. It's not making it healthy. I'm a pragmatist. I think for our telehealth patients that want to drink occasionally, get organic, low alcohol, biodynamic, regenerative wine, and then have it occasionally. It can be a part of somebody's life and they could be just fine, but we have less wiggle room. I think for all of this stuff, we have less wiggle room because of our environment, our soil microbiome, and the way that we prepare food, right? And people bring up their grandma, great grandma, and say, well, she drank every day. We don't live in great grandma's world anymore. So if we were just up against the alcohol, okay, maybe it's not a big deal. But now the bucket's overflowing people. And yes, we do a lot to empty the bucket. That's my work. But it's just, we have less wiggle room. So the things that applied to previous generations aren't necessarily relevant today. Yeah, yeah. Those are really great points there. And it's one thing that I've kind of shifted to more lower carb. The more episodes of this podcast that I record, I feel like the lower and lower carb that I get, because it's just like one of the common themes that I hear over and over, like is that there's just so many benefits to being lower carb. and I guess there's different points where people consider as lower carb under 100 grams of carbs a day is it under 50 grams of carbs a day but what's your thought I mean in general it seems like a lot like step one is like eliminate gluten like kind of like what you said and that's a lot obviously mostly in carbs what you know what's your opinion on on carbs and kind of low carb versus high carb Can people do okay with two, 300 grams of carbs a day or have you seen that? Yeah. Again, less wiggle room, I think, because 93% of people are metabolically inflexible. So yeah, I mean, if you're super metabolically flexible and you have a high activity level, you could have higher carbs, certainly. And there are people that are athletes, there's people that are very active, they are very metabolically flexible, not insulin resistant at all, and they could have higher carbs in their whole food form. I think the quality of the carbs matters, right? To reduce – because you want to – fiber by its very definition is a carbohydrate. So if it's in its whole food form, are we talking about net carbs or total carbs? I think that someone should want to build metabolic flexibility over time so they can have whole food carbs that are fiber rich, which is great for the gut microbiome. So fruits, for example, and starchy vegetables, if someone's super strict, low carb long term, they may not need to be. Now, if somebody loves to eat that way, more power to them. I mean, we've utilized ketogenic and low carb protocols for decades. So it's something that I'm very, I love it as a tool within the toolbox to help rehabilitate somebody's insulin resistance, to lower inflammation levels, to build metabolic flexibility and deal with things like neuroinflammation too. It's a wonderful tool. I wrote Ketotarian in 2018 to talk about the sort of Mediterranean ketogenic way of eating, using things like avocados and olives and extra vitamin olive oil and fatty fish, these wonderful tools. But I use it as a tool. I use a ketogenic diet as a tool to build metabolic flexibility. And then it's a medicine, right? It's a medicine that's basically fasting, mimicking fasting without actually fasting because it's increasing beta-hydroxybutyrate, this ketone. That's the fourth macronutrient. We have protein, fats, carbs, and ketones. And it's an amazing tool to lower inflammation, to lower things like NF-kappa-B, these NRP3 inflammasomes, these pro-inflammation markers basically. Your body naturally does this when you tap into this state of ketosis, nutritional ketosis, which you can get through the ketogenic diet and fasting. And I would say both are part of this tool that we would want to be leaning into. But it's a medicine, right? Paracelsus, one of the fathers of medicine, he was known as the father of toxicology in Switzerland in the late 1400s, early 1500s. He called fasting the physician within, which I think is a beautiful way of putting it. And ketogenic diet is fasting mimicking. So it's this inner doctor to heal. But not everybody needs the same medicine in the same way. And there's going to come a time, especially for women, if they're inflamed and have metabolic issues, the ketogenic diet will be a great tool. And then even if it's cyclically around their cycle, which we would recommend for most people, but long-term, they may not need to. Long-term, they may moderate the carbs, which to your point, what is low carb beyond ketosis? I think under 150 grams of carbs in whole food form for most people is going to be where they are going to thrive. That's not the ketogenic range. I mean, that would be considered low to inching into moderating your carbs And if somebody is doing more high intensity workouts if they are more metabolically flexible if they are maybe going through whatever sort of health situation they may want to increase their carbs for a time But I think a cyclical approach, even a seasonal approach for some people, works really well. That's part of metabolic flexibility, the ability to burn both sugar and fat. So some people need to be in the ketogenic diet or lower carb long term because of genetics, because of an autoimmune issue. that's different but from a lifestyle standpoint i think use ketogenic for a while to heal and then find your carb sweet spot long term yeah yeah i think that's great advice and yeah absolutely i mean there's there's great carbs from berries and like you said fruits and starchy vegetables and things like that and i like that i've kind of i would say on an average day i'm probably 50 grams of carbs or less but there are certain days now i feel like i'm getting more in in a this is one of the benefits I think is like when you start eating clean and living really clean, you start to kind of intuitively feel like, oh, today I did leg day and, you know, I did a lot of squats and now I'm craving some, you know, sweet potato or something like that. So I'll have it that day. I'm not, but I think this is great stuff. You also mentioned about like microplastics and toxins in the environment. I think many people have heard, obviously don't drink plastic water bottles, especially if they've been sitting in the sun or anything like that. What are some other kind of of common things that you've seen where people could lower their exposure to toxins or microplastics? Well, I would look at every room in your house to make swaps as you can. And don't get overwhelmed. Like the caveat here is stressing about this stuff isn't good for your health either. So let's come into this with a sense of empowerment, being proactive, and not stressing anxiety. So I would say- And by the way, even when I do like the water bottle, like look, every once in a while, if I'm running out the door and I didn't have time to fill up my glass bottle and I grab a plastic water bottle, okay. Having one plastic water bottle once every two, three weeks is not going to kill you if you're doing things right the rest of the time. So I completely agree. Exactly. Because I think the problem that I find myself talking about is the sort of overcorrection that our community can get into where it's this orthorexic and it's not disordered eating or unhealthy food, but I think this is larger orthorexic spectrum of this hypervigilance. and it's like no we have to deal with stress and anxiety then maybe we're like the trauma that can be caused by this constant hyper vigilance so anyways it's still important to be like find a middle ground i guess is what i'm trying to say don't put your head in the sand don't be as super zealot obsessive compulsive either the middle ground is being informed making proper choices but not being coming obsessive so the middle ground for this is i think over time as you can afford to and want to swapping out your kitchen things that you use, kitchen utensils, kitchen appliances. So PFAS are very, these are forever chemicals, microplastics are in a lot of stuff. So to switch over your nonstick pans, like that's like a single scratch of a conventional nonstick pan can release over 9,000 PIFA particles. It is wild. And then over time as it degrades and you're using it and using it and using it, you're exposing these things to heat. So swap to PIFA free, PIFA's free, forever chemical free pots and pans. Do you have a favorite brand there? Do you have a favorite brand? Yes, I do. Carraway is great. Our place is great. And you can do cast iron skillets too, like cast iron as well. And then even things like toaster ovens and the other type of things, like when you're using plastics and the nonstick aspects of it, just be mindful of it and swap over to brands that are really doing better for you options out there because we know better now. And the other thing I would say is the personal care products. I mean, And that's why women are really exposed to so much more because they're using, on average, a lot more products on their skin and their hair compared to men. So really looking at using the Environmental Working Group, EWG.org. They have their Skin Deep initiative where they have a massive directory. And there are other apps that do this as well now. But just look at the rating and decide for yourself. Is this rated well? Does it have an ingredient that is a known carcinogen? and then you can make the argument, well, it's small amounts for these things. But we're talking about the cumulative effect over time and then all the other things you're exposed to. So if it was just that one small agreement, yeah, don't freak out about it. But it's not. It's this perfect storm of variables now. And the goal here is what do I have agency over? What can I make a swap for knowing I can't control everything but I need to do the best I can with what I have access to, with what's within my budget? then I need to give the rest to God and don't stress about this stuff. But that's why you can start looking at what we live in such a blessed time where, yeah, we're up against so much, but the flip side is we know more now than ever before. We have more options now more than ever before. And it's like Maya Angelou said, when you know better, you do better, hopefully. So again, that's where I'm coming at it from a, you know, intention standpoint. And so I think those are two things to start. And then a third is a big one, but it's still important here would be swapping clothes out, like getting natural materials as much as you can. Do I do it a hundred percent? No. But there's a lot of like, I shop a lot of H&M and there's a lot of brands that have organic cotton options and you can do wool and linen and cottons. And these are things that you could start swapping over, get organic when you can. And it doesn't have to be expensive, but it's just starting to swap over. Because I mean, things like yoga pants, like the conventional yoga pants that a lot of women wear, anything that's nonstick, anything that's sweat resistant, anything that is like that sort of material, probably going to be high in PIVA as if it's not claimed otherwise. So really educate yourself on clothing and the ingredients and chemicals that are used in a lot of clothing and then some basic stuff too. And then I'll wrap it up here, but air purifier in the home and getting it appropriate for the square footage and then a water purifier at home and make it appropriate, like lead filtering out what needs to be appropriate. We have telehealth patients measure, like get at home water tests to measure what is in their water. So you have a filter that's appropriately filtering what needs to be filtered out because you don't want a filter that's filtering out something else that you don't even have in your water. So you want to make sure that the filter is appropriate for what's in your water. There are local reports in your municipality. You can search online for the general municipality what levels are higher. but then what's happening from the municipality to your home is we don't know so that's why a home test is going to be beneficial here so that those are if people did that they'd minimize a lot of different environmental toxins oh that's really cool i want to do the home uh water test is there is there a home water test i can buy that you recommend or yes i don't know i'll have to tell ask my team it's a website but it's yeah i don't know the exact one that we recommend right now they're always changing in different biomarkers but I we could put it in the show notes I guess yeah that'd be great awesome yeah and yeah totally agree with the like I've actually started switching my wardrobe slowly to more like this is an organic shirt I'm wearing organic pants and boxers especially the boxers I think is probably one of the most important ones to to switch quickly as well I think this is going to be one of the biggest health trends and I think look people are going to say, well, I've been getting by with my other stuff for a long time. But I think as we start to just slowly start to get healthier and healthier, I think moving to the organic clothes. And yeah, there's a brand called Pact, a couple other brands out there that sell really cheap organic clothes there. Like you mentioned, the beauty care products, I think hopefully everyone by now has switched from an aluminum antiperspirant deodorant to a natural deodorant. I think people have been talking a lot about that over the years. That's kind of an easy switch. I wish I could get my teenage daughters to give up all their different scents and perfumes, but unfortunately, I can't win every battle. So I'll just do the best I can with everything else. Oh my gosh. I have a 16-year-old and daughter too, and I have a 19-year-old son. It's the same thing. I walked into her room the other day. I'm like, how did this contraband get past security? I don't know how this happened. Do you know who you are? But no, it's, yeah, it happens. It happens. They have Amazon and they're whatever. It's, it's, it's shocking to me sometimes, but yeah, we do the best we can as parents. Yeah. And, and, and, and, you know, opening the window sometimes getting fresh air. Like I think a lot of people like, you know, with my wife is cooking steak and the, and the whole house smells like steak. It's time to open the windows and the doors and get some fresh air. I think that's an easy thing that a lot of people miss and having the air purifier. So Dr. Cole, this has been amazing. Uh, where can people follow you, find you learn more, buy your books yeah thanks so much man uh everything's at dr will cole.com d-r-w-i-l-l-c-o-l-e.com the become a patient telehealth information's there the podcast the art of being well i have two episodes a week um the books there's tons of free resources like as i mentioned i've been writing for the past 16 years i'm updating old articles with new research so you can use the search engine there and type in anything you want there's 16 years worth of information there for people to dig into. That's great. And people can work with you, right? With your telehealth clinic. So people who want to get healthier, maybe they don't have a local doctor that they really like near them and they want to work with someone who's more functional and holistic and isn't just going to prescribe a statin if they see a certain number. I think that's amazing. Yeah. Thanks, man. It's fun work. It's positive. When people feel better, it's a positive thing. I love coming to work every day. Amazing. Well, Dr. Cole, thank you so much for everything you're doing and all the people that you're helping. And I hope we can do this again sometime. Thanks. Likewise. Thank you for listening. If you enjoyed this episode, it would really mean a lot to me if you would forward this episode along to any friends, family members, anyone that you think that would get value out of it and learn something important. The mission at Peak Performance is to help people prioritize and transform their health. And so if you think someone will get value, please, please, please do forward this episode along to them. Also, if you could please rate and review and subscribe on whatever podcast player you are listening to this on, we would greatly appreciate that as well. It means a lot. And I want to tell you about a couple of new products that we just released. 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