The Melanie Avalon Podcast Episode #46 - Dr.  Will Cole

Dr. Will Cole, leading functional-medicine expert, consults people around the world via webcam at and locally in Pittsburgh, Pennsylvania. He specializes in clinically investigating underlying factors of chronic disease and customizing health programs for thyroid issues, autoimmune conditions, hormonal dysfunctions, digestive disorders, and brain problems. Dr. Cole was named one of the top fifty functional-medicine and integrative doctors in the nation and is a health expert for mindbodygreen and goop. Dr. Cole is the author of the book, The Inflammation Spectrum in which he explores how inflammation exists on a spectrum within the body, the various systems it can affect, and how you can discover your individual food triggers to overcome chronic inflammation. He is also the author of Ketotarian in which he melds the powerful benefits of a ketogenic diet with a plant-based one.


IG - @drwillcole
FB - @doctorwillcole
Twitter - @drwillcole


2:00 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

2:35 - Follow Melanie On Instagram To See The Latest Moments, Products, And #AllTheThings! @MelanieAvalon

2:40 -  Food Sense GuideGet Melanie's App To Tackle Your Food Sensitivities! Food Sense Includes A Searchable Catalogue Of 300+ Foods, Revealing Their Amine, Histamine, FODMAP,  Gluten, Glutamate, Lectin, Oxalate, Salicylate, Sulfite, And Thiol Status. Food Sense Also Includes Compound Overviews, Reactions To Look For, Lists Of Foods High And Low In Them, The Ability To Create Your Own Personal Lists, And More! 

3:30 - PREP DISH: Prep Dish Is An Awesome Meal Planning Service Which Sends You Weekly Grocery And Recipe Lists, So You Can Do All Your Meal Preparation At Once, And Be Good To Go For The Week! The Meals Are All Gluten Free Or Paleo, Which Is Fantastic If You're Already Doing So, But Also A Wonderful Way To "Try Out" Gluten Free Or Paleo With Delicious Meals, And No Feelings Of Restriction! Get A Free 2 Week Trial At Prepdish.Com/Melanieavalon

Ketotarian: The (Mostly) Plant-Based Plan to Burn Fat, Boost Your Energy, Crush Your Cravings, and Calm Inflammation: A Cookbook

The Inflammation Spectrum: Find Your Food Triggers and Reset Your System

7:00 - Will Cole's Personal Story

13:00 - Chronic Illness And COVID Response: Fear Of The Unknown

14:50 - What Is The Purpose Of Inflammation?

17:00 - The Cytokine Model of Cognitive Function: The Brain Is Not Immune Privileged 

18:15 - How The Inflammation Spectrum Manifests Today

19:45 - Where Does The Damage From Inflammation Come From? 

21:00 - Would We Have Autoimmune Conditions Without Inflammation? Did Hunter Gatherers Have Inflammation?

24:15 - Allergies Vs Sensitivities Vs Intolerances, Lab Testing, And Orthorexia 

29:30 - IGE Allergies

32:00 - Food Sense Guide

32:45 - The 3 Stages Of Autoimmunity: Silent, and Official

36:45 - BEAUTYCOUNTER: Non-Toxic Beauty Products Tested For Heavy Metals, Which Support Skin Health And Look Amazing! Shop At Beautycounter.Com/MelanieAvalon For Something Magical! For Exclusive Offers And Discounts, And More On The Science Of Skincare, Get On Melanie's Private Beauty Counter Email List At MelanieAvalon.Com/CleanBeauty!

38:40 - Type Of Autoimmune Conditions 

39:00 - Is It Ever Too Late?

42:10:  What Is The Purpose Of An Elimination Diet

45:40 - The  Inflammation Quiz

46:30 - Why Intuition Is Hard When Your Inflamed

48:55 - Toolboxes And Mantras

49:20 - Inflammation From Non-Food Factors

50:20 - Intermittent Fasting, Night Time Eating, Ritual Eating, And Digestion

55:15 - Grains: Does Everyone Need To Avoid Gluten?

57:35 - Is Dairy Always Inflammatory?

59:00 - Reintroducing: The Agency To Choose What You Want

1:00:55 - Lumen: Get $25 Off A Lumen Device At With The Code melanieavalon25 

1:02:30  - Herbs And Spices

1:04:20 - The Role Of Protein In Inflammation

1:05:30 - Very Low Protein Diets

1:06:15 - Macros In The Inflammation Spectrum (Keto, High Carb, Low Carb, Etc.)

1:07:15 - Ketotarian: The (Mostly) Plant-Based Plan to Burn Fat, Boost Your Energy, Crush Your Cravings, and Calm Inflammation: A Cookbook

1:07:30 - Novel Superfoods And Reacting To Supplements

1:09:40 - Anti-Inflammatories: Aspirin Vs Fish Oil, Etc.

1:13:55 - Food Fears When Reintroducing Foods 


Melanie Avalon:                      Hi friends. Welcome back to the show. I am so excited about the conversation that I am about to have. I have been long awaiting it. It is with the author of two really incredible books that I have thoroughly enjoyed. The first was Ketotarian. I'm sure a lot of my listeners are pretty familiar with that one, which was really unique in that it brought a plant-based approach to Keto. I found it extremely valuable. 

When I was introduced to the author who I have here today, Dr. Cole, originally, I was thinking, “Oh, he would do Ketotarian,” but he has a newer book, The Inflammation Spectrum: Find Your Food Triggers and Reset Your System, and friends, it is speaking... I don't know if that's a good thing that inflammation is one of my passions in life, but it is speaking to a topic that I just think is so important.

Honestly, when I saw the title, The Inflammation Spectrum, I was like, “Don't let your hopes get up,” because I wasn't sure if it would live up to, because normally what I do is I go through Google Scholar and I read all of these really intense studies. I was like, “I really hope that it really dives deep into what's going on with inflammatory conditions that we have today, and it 100% delivers on that but in a way that's very easy to read, very easy to understand. 

Then it gets even better. It has a whole protocol to follow and it brings in something that listeners know I'm obsessed with, which is the super-duper importance of mindset. It even has mantras you can use. I mean, this book is just such a wealth of knowledge and information, cannot recommend it enough. I'm here with Dr. Will Cole. Thank you for being here.

Dr. Will Cole:                           My goodness. Thank you so much. I appreciate the kind words. I'm excited to talk with you today.

Melanie Avalon:                      Really, really looking forward to this. For listeners, you are honestly a leading functional medicine expert in the country. You've been nominated one of the top 50 functional medicine in integrative doctors in the nation. You are a consultant and expert for Mindbodygreen, for Goop. You're just all over the place and yes, I'm really excited to dive deep into your book today. 

Dr. Will Cole:                           Thank you.

Melanie Avalon:                      To start things off though, before we get into the whole science and the health and all of that stuff, would you like to tell listeners a little bit about your own story and what brought you to where you are today with functional medicine health, and especially first the topic of Ketotarian and now the inflammation spectrum.

Dr. Will Cole:                           Yeah, sure. The books are really just an extension of my clinical practice. My heart and my passion, my focus, and my day job hasn't changed over the past 11 years. I run a functional medicine clinic online. It's a telehealth clinic. Since really the beginning of my career, I've just been doing webcam consultations and giving them a functional medicine perspective on their case. Ketotarian, it's just really a story of my food journey and then seeing the potential pitfalls of the conventional ketogenic diet and my approach to it in a cleaner way, a more nutrient dense whole foods way, hence Ketotarian and then same with inflammation spectrum. 

It's really just a ripple effect of my clinical experience and seeing the far-reaching implications of inflammation and all its insidious ways for people. How I came into the health space, I really grew up in a home that was... my parents were really interested in health and wellness and we're talking about the ‘80s and ‘90s in rural Pennsylvania, which is by no means an epicenter for wellness even today, but definitely wasn't in the ‘80s and ‘90s. I was the weird kid drinking adaptogenic tonics, and raw goat's milk and all those strange, healthy stuff from the ‘80s and ‘90s. 

It was definitely from the beginning I was in that world. My dad was a bodybuilder and like Mr. Pittsburgh and in actual health care as well. That was my formative years of looking at worldview of health and wellness. Then, I knew that I wanted to be formally trained in it. It wasn't just something that my mom did it or my dad did or my family did, but it was something that I really wanted to be academically trained in it as well so I went to an integrative school in Southern California at Southern California University of Health Sciences. 

Then I heard of a guy called [0:04:24 inaudible] and anybody that's listening will know that [00:04:27 inaudible], and still today is one of the leaders in functional medicine. He'd gone to my school. He was older than I was and that's how for me, honed in from integrative natural health care, alternative healthcare to specifically functional medicine. It just clicked for me. It was this beautiful amalgamation of the best of Western medicine, which is being evidence-based and running labs and looking at the data and then the best of alternative health, which is getting to the root cause, going upstream and actually dealing with these underlying components to why people feel the way that they do. 

I graduated from school knowing this is what I wanted to do and that's when the telehealth clinic, which I started literally, as soon as I graduated because I'd be talking about it online, writing about it in different States and countries. People would be like, “Okay, and that's me, talking about auto-Immunity like he knows what I'm talking about.” It hasn't changed. 

From 8:00 AM to 6:00 PM, Monday through the end of the week, that's what I'm doing, consulting people online. That's how I came to be all these years later. I know I look young, but I'm not that young guys, so that's what I do. 

Melanie Avalon:                      I love it so much. I have to tell you really quickly. I listened to your book on Audible and when you started talking, I was like, “That sounds so familiar.” Good job narrating by the way.

Dr. Will Cole:                           The inflammation spectrum?

Melanie Avalon:                      Yeah.

Dr. Will Cole:                           Yeah, because I didn't read Ketotarian, the publishers wanted this expert whatever reader to do it. I'm like, “I can read my own dang words. I know how to. I wrote this so I can read it.” I appreciate that. It was a lot of work. You think it would be easy, but it was difficult.

Melanie Avalon:                      I know. No, it is. I remember because I had self-produced audio books before and then when I released my book, traditionally with a publisher, I wanted to narrate it and they made me audition and then they only let me narrate the introduction, which was really funny but then I was like, “I know how much work goes into it.” It was the best of both worlds for me. I loved the narration. It was great. 

One more quick question that's really relevant to today. Since you do have the telehealth system set up, have you been, especially with COVID and everything, are you seeing a big influx with that?

Dr. Will Cole:                           Yeah, it's pretty much stayed the same. I mean, it's still the same. People… maybe a slight influx increase, but not really. It's pretty much stayed the same steady for the past couple of years. We're busy. We're very busy, but we keep a good doctor to patient ratio to provide quality care and we have case review meetings on a daily basis, making sure everybody's getting the top care that they need and I'm overseeing the cases and doing the consultation. 

It hasn't changed much, but our patients, it's interesting that my patient base is very, for the most part, very specific auto-immune. When I talk about in the book, it's this larger auto-immune inflammation spectrum, that's my people. Those people for the most part are very unchanged by a pandemic. They kind of, I find this very fascinating, that they for the most part are galvanized because they've gone through really serious health stuff and they have to live their life as almost like a pandemic in a personal level in many ways, because they don't go around amongst society doing all the things that everybody else is doing. 

When you're going through things like fatigue or flare ups in any way, you live a different life in a different lane. When the rest of the world is so shook by something like this, these people are so amazingly resilient and strong that I think that's why I haven't seen a major influx or increase the patients. It's just stayed the same because these people are like “Pandemic what?” Other than some people's jobs it's like for the most part, they're not really shaken by that. I find that fascinating, but it's really interesting to see.

Melanie Avalon:                      Oh, my goodness. Hearing you say that is resonating with me so much because my own personal story, the way I came to this whole podcast, the biohacking, the health theme was, struggling with my own. I started with digestive issues but my own chronic illness conditions and living with that has put me on this relentless search to just find answers and to find the practices that I can do every day to support my immune system, support my mindset. 

Because I think one of the hardest things with a chronic health issue and auto-immune conditions, things that is the fear of the unknown of not knowing if it's going to change. I think with COVID for people who haven't had that constant fear of the unknown about their health, that's what COVID is in a way. It's this fear of the unknown and not knowing if it's going to change, but it's not that it's funny that you say that, but literally when COVID happened, I was like, this is what…” Not this is what I feel like every day, but this is what I'm always working on and…

Dr. Will Cole:                           You've gone through it.

Melanie Avalon:                      Yeah, and when people are like, “Well, how should I change to support my immune system?” I'm like, “Just do all the things I've been talking about this whole time.” I even was Googling memes, auto-immune chronic illness COVID because I thought there'd be other people thinking this as well.

Dr. Will Cole:                           That's interesting. I definitely see it going on. I thought it was be like, “Oh, maybe one person.” The more, since the beginning of March, when everything went down, I've heard countless of the same stories over the past a couple months at this point.

Melanie Avalon:                      That's so interesting. I'm really thankful for the tools that I do have right now for this time, like meditation, the spiritual purpose, the diet that supports me so, all right. Well, I guess to start things off just with a broad picture approach, very large, simple, but not simple question. What is inflammation? Because it does serve a purpose. What is the purpose of inflammation and why does it so often go awry today?

Dr. Will Cole:                           Yeah, that's a good place to start. Inflammation, you're right. It is quite a nebulous term for many people, but the reality is, it is quite specific and it has real life applications on a daily basis. But inherently, it's not a bad thing. It's a product of our immune system. Imbalance, it's a wonder as part of the human immune system. Inflammation in check fights viruses, fights bacteria, heals our wounds, it's important for cellular health, cellular signaling and cell membrane function. It's important to have healthy modulating inflammation levels. 

The problem is when inflammation is thrown out of balance. It's this forest fire burning in perpetuity. That's really the issue. It's the Goldilocks principle, not too high, not too low, but just right. That Goldilocks homeostasis principle applies to our microbiome, we want bacterial, we need yeast and fungus, but we don't want to, overgrowths of it. We don't want deficiencies of it either. Same with our hormones. We don't want excess hormones. We don't want hormone deficiency. 

Same with our inflammation levels. We don't want high. We don't want too low, but just right when we need it. When there's a virus that comes through, you will need inflammation to fight it off into and to repair things but the problem is, inflammation is just so out of balance. In so many people it's burning too long, too high and that is really the commonality between just about every health problem under the sun. From auto immune conditions, which is most of my patients, to digestive problems, musculoskeletal issues, diabetes, heart disease, cancer, all our chronic inflammatory health problems to even when you look at the epidemic numbers of mental health issues. 

In the West we like to separate mental health from physical health, but the reality is it's not separate. Mental health is physical health and our brain is part of our body and there's physiological components to mental health issues and there's a whole field of research referred to as the cytokine model of cognitive function. Cytokines are proinflammatory cells. It's research looking at how inflammation is impacting how our  brains work or how inflammation is impacting mental health. 

The old view of the brain was that it was immune privileged, that it was the blood brain barrier, it was this nice casing around the brain and then  inflammation really was not a thing in the brain but now research has confirmed that actually wasn't the case at all. The brain is not immune privileged and that we have the microglial cells. The brain's immune  system where imbalanced, microglia cells help to clean up the dysfunctional cells. It's like a pruning of the brain to keep it nice and resilient and healthy. That's inflammation in check. 

Microglia cells out of  balance of the brain causes a cascade of neuro inflammation that's associated with a whole wide variety of neurological problems like anxiety and depression and fatigue and brain fog and neurological autoimmune issues like MS and Parkinson's and things like this. Inflammation is so important for people to realize. Because all those things I just mentioned, mental health issues, diabetes, auto-immune conditions alone, sadly is the majority of the human race at this  point to various degrees but it exists on a spectrum. 

From mild symptoms on one end of the inflammation spectrum, like maybe mild anxiousness, maybe some bloating, maybe some weight loss resistance on one end of the inflammation spectrum and then on the other end of the inflammation spectrum, it's the overt auto-immune disease or mental health issue or diabetes or something like that and then everything in between. 

This is really at the heart of my work, the heart of what I'm seeing on an hourly basis when I'm consulting patients online. While these numbers are sobering, as far as statistics are concerned, the other side of that coin is that these things are largely overcome able and healable, reversible, supportable things. But we have to know what we're up against to do something about it. Many people just have their head in the sand and they're not even asking questions because they're going about their life, because these are chronic problems. 

People can typically go to work, right? They can probably function on various levels on a day to day basis. They equate that with, “I’m all right,” or they'll say, “other than this problem and this problem and this problem, I'm in good health.” They somehow can put it on a box on a shelf and say, “Other than that, I'm in good health.” Well, these are all actually check engine lights that things aren't good, that you aren't healthy. We have to look at it to really determine and do something it. That's really what the book is. Is to educate people on this and more importantly, to give them tools so they can overcome these health issues.

Melanie Avalon:                      Some follow up questions to all of that. For listeners, for the inflammation process, just to clarify, because you spoke about how in check it's a good thing. When there is an inflammatory response in the body to a virus or bacteria, an allergen of food that you're reacting to, whatever it may be, the negative side effects and symptoms that you experience, are they directly from the compounds that are released by the body to fight the invader or are they from damage that occurs to the body from those compounds? Where is the actual symptoms and the damage occurring?

Dr. Will Cole:                           It's really both. When you're talking about acute inflammation, it's really a bit of both. The virus, for example, or any virus that you're talking about, it's going to have its own set of symptoms and that's going to be the person being sick, but let's say the fever or the inflammatory response is the immune system trying to fight it. That is, they're both things going on. There's the body's response to it and then the actual symptoms from the pathogen itself, whether that's bacterial or viral or or some other pathogen.

Melanie Avalon:                      Would it even be possible for us to have auto immune conditions if our body was never reacting inappropriately to something? On the historical timeline of humans, did Hunter Gatherers have auto-immune conditions at all or did it all start with modern agriculture? Do you think historically it was even a thing? I'm trying to have a mix the possibility of an autoimmune condition arise.

Dr. Will Cole:                           I don't know how far back there’s data for that, but I would say you can look at where the timeline that we do have data and you can't really ignore the fact that the numbers of autoimmune conditions are growing by leaps and bounds. Part of that is [0:16:52 inaudible] to better diagnostics and even today the auto-immune diseases are widely underdiagnosed, but even amongst the people that are the most skeptical within the auto-immune space will say, “Yes, these numbers are growing, Yes, we're seeing a problem”, there's really no argument in that the fact that we are seeing more and more of these auto immune mediated issues. 

I have no doubt that as science goes on and time goes on, we're going to find auto-immune components to many different inflammatory health problems that we don't know are auto-immune even today. Today there's over a hundred auto-immune diseases recognized in science and an additional 40 above that 100 that have an auto-immune component. I agree with you, it's this evolutionary mismatch between our genome, our DNA, which haven’t changed largely in 10,000 years yet the world has changed very dramatically in a very short period of time when you're putting that in context with the totality of human history. 

That's what researchers are looking at, is this epigenetic genetic mismatch that is growing. This chasm between the two are growing like never before and this is what's wakening these genetic predispositions that have been there for 10,000 years, but lie, it's sleep and slumber that are being triggered in a woken like never before, because of the onslaught of stressors that the immune system, that the DNA is under and that's awakening this immune inflammatory response. 

It's to say, I have… I really don't know. I don't know if we have any way of knowing if ancient times, how much the statistics of auto immunity, but I would say it's growing very rapidly in a very short period of time now. I would assume based off of the data we do have, it would be rare in the past. It wouldn't have been the epidemic that it is today, but it's definitely a problem and it's really a combination of factors. It's our food, it's our environment, it's stress, it's toxins. It's all of these epigenetic genetic mismatches that we need to address. 

These are things that I can measure on the lab as a functional medicine practitioner and find out what are these underlying drivers that's causing this molecular mimicry, this immune system to lose recognition of self and causing an overactivity against certain parts of the body.

Melanie Avalon:                      I mean, it's so fascinating. It's almost, I feel like it's one of the most tragic health issues we can experience because being able to identify self, it's really a friendly fire situation. I feel like it's the body trying to take care of itself and trying to be healthy and it just goes awry. Could you talk a little bit about the actual inflammatory response? Because I know there's a lot of confusion and you talk about this so beautifully and brilliantly in the book.

But there's a lot of confusion between the response the immune system can have when it comes to an allergy versus a food sensitivity versus a reaction and the difference between. I know listeners might get blood tests and they might get IgE versus IgM verses IgG. Would you like to put a little bit of clarity about what's going on there?

Dr. Will Cole:                           Sure. That's a sidebar in the inflammation spectrum because those words are oftentimes used flippantly interchangeably and it's not for any ill intent, but just, we're just throwing those words around very casually. The reality is when you have a sensitivity and an allergy, those are in effect immune mediated. An allergy is typically that immediate response because anaphylaxis. It's the food allergy that is immune mediated. Normally, really extreme, but you can have mild allergies too. There’s a whole allergy inflammatory spectrum there. 

Then sensitivities are immune mediated, just like allergies, but they're more of a delayed response, oftentimes less severe, but not always. Sometimes you can have more delayed reactions that are severe as well. Those are the immune mediated food reactivities. The third one is food intolerances. Sometimes food intolerances and food sensitivities are the ones used interchangeably and to be honest with you, sometimes food allergies is used interchangeably with the other two as well. 

The food intolerance is actually by its very definition is normally associated with an enzyme deficiency that's non-immune mediated. Lactose intolerance is a lack of lactase, the enzyme that breaks down lactose, the dairy sugar and then so on and so forth. There’s enzymatic deficiency. That's a non-immune mediated. Is it slightly semantics? Well maybe, but it's, if you're really looking at it, the problem that I see with this is that many people come to me, may be with the initial consultation they will Dropbox like the labs test us and we'll get the labs and they'll say to me, “Oh, I have an allergy.” 

Then they're removing foods from their diet based off of this proposed allergy that they have but what they are really think that they have it, but they think this analogy, but what really it is, is a food sensitivity or generally, a food reactivity as some people in the immune diagnostic world will call it. It's immune mediated, yes, like an allergy, but it's not an allergy. They think if they eat it, they're going to really get sick and die. Well, not really.

A lot of these food sensitivity testing, especially when you see multiple foods showing up higher, it's less to do about those foods and more to do with the intestinal permeability or the leaky gut syndrome that's causing the overreaction of that food. Not to say those tests are completely irrelevant, there is some relevance to them, but it's to me, from a functional medicine standpoint, my mind goes to, “Okay, what's actually causing the overreaction on those, on the lab to those foods in the first place?” Which is typically increased intestinal permeability. 

My goal would be to heal the underlying gut reaction and untangle that immune response in the first place. Because honestly, I've seen this many times, people go back and the next week on the lab, same lab, they'll see different foods being positive. What are you supposed to do? You're supposed to go and jump around and adjust your whole diet  based off a snapshot in time when you went to the lab at 7:00 AM on a Tuesday morning? No, it's really not very practical from a day to day, what do I eat for breakfast, lunch and dinner standpoint. 

I am not so much an advocate for those food sensitivity testing, especially for people using them at the beginning of their journey. I do think there's clinical relevance for them, for people that are longer into the journey. They've calmed things down. They've been working on dealing with the gastrointestinal health and then they maybe run a food sensitivity testing and they can see, “Oh, it's these three or four tests.” These three or four foods that they would never have known if they didn't run that lab.

We run labs like Cyrex has amazing data for that. But these labs should be used clinically when it's clinically relevant, when it's actually going to produce an action step that's going to benefit these people's lives and not just running labs for the sake of it. Biohacking is fantastic, but it should be used in context with actually benefiting, not just adding data for the sake of it. 

Then honestly, I think a lot of these food labs add to people's anxiety and stress, then it's like, they're like, “What the heck can I have?” All these foods are coming back red and yellow or positive and it's all the things that I eat. I can eat nothing but air and ice cubes and low lectin bark and goodwill, it's not good. Stressing about all this healthy food isn't good for your health either. I think it could be unintentionally for things like orthorexia or this disordered eating around healthy foods. These are the things I think too much about for my patients, but that's the difference between allergies, intolerances and sensitivities.

Melanie Avalon:                      I could not agree more. I also am the host of the Intermittent Fasting podcast and we often get questions about our recommendations for food sensitivity tests and everything you just said are my thoughts exactly. Especially because I think people, maybe they'll get a test when their gut is in a really good situation and it'll show that they don't react to many foods and then if their gut is not in a good situation, all of a sudden it seems like they have allergies or reactions to every food and it's like, “What's going on there?” 

I've also read about how they'll do the same samples to multiple labs and get different results and so it's like, “Okay.” One thing I say for listeners is, know your mindset and know how you react to this information and if you're the type that's going to get it and feel empowered and you will feel very positive from the information that you receive, then maybe, but if you're the type that's going to see it as a death sentence and doom and gloom, I'm just like, “Don't.” Just maybe don't.

Dr. Will Cole:                           Keep it simple.

Melanie Avalon:                      Yeah. Really quick brief follow-up. IgEs, are people typically born with those compared to the IgGs and IgMs?

Dr. Will Cole:                           No, I wouldn't say that at all. I would say that they typically are found early on in life and this of course, genetic predispositions for allergies and immune mediated to things like that but it's not entirely genetic. There is going to be some response going on in the microbiome or larger systemic immune response that causes IgE responses. But yes, there’s a genetic component for many of them, but that's not to say it's predestination and there's nothing they can do about it and there are allergies that are triggered later on in life too. It's not just childhood allergies as well. 

It's more than anything. It is the immune system and for allergies and sensitivities, and we need to say, “What is upstream to these? What's causing these and what can I do?” Because I've seen people with genetic predispositions for these immune mediated responses and they can dramatically improve the severity and the frequency of these flare ups by dealing with these upstream components that's causing the overreaction in the first place.

Melanie Avalon:                      Okay, I love that. The reason I was wondering about that is from the tests that I have done historically, my IgEs are very… it's a very small number and it's an environmental and food and it hasn't ever changed. It's always the same on all the tests on all the labs whereas IgM and IgG just seems to be all over the place. Now, I'm actually just thinking, if I use the correct terminology, I developed an app called Food Sense Guide and I refer to using it to tackle your food sensitivities and it compares 300 plus foods for their general levels of amines, histamine, salicylates, oxalates, lectins, gluten, FODMAP, nightshades, thiols and sulfites. Now you were talking and I was like, “Maybe this should be more called food reaction.”

Dr. Will Cole:                           I like it. Yeah. I mean, but you know what, like I said, part of it is semantics. People get it, it is a sensitivity. To me, I think more than anything, it’s people realizing there's a difference between allergies and these other reactivities. Allergy is a reactivity, but not every reactivity is allergy.

Melanie Avalon:                      All right. We're talking a lot about what can we do with this information and how can we make changes. Before going into the protocol that you discussed in the book, you also talk about autoimmunity and the stages of autoimmunity. One thing that I think I found so interesting was that first of all, there were a few really startling statistics. The amount of the system in the body that had to be destroyed to be qualified auto-immune was often very high. It wasn't until you lost 90% destruction of your adrenals that you qualified for an auto-immune disease for that. 

For listeners, what are the stages of autoimmunity and how long is this brewing before you finally get the official label of an autoimmune condition?

Dr. Will Cole:                           This is definitely near and dear to my heart. This is a lot of my patient base. There's three known, in functional medicine, the way that we recognize this. There's silent auto immunity on one end of the inflammation spectrum or auto-immune inflammation spectrum specific. Silent auto immunity and then stage two would be autoimmune reactivity, which is a lot of my patients or stage three, autoimmune disease. 

Autoimmune reactivity is where you're having symptoms that has autoimmune components that you would see positive autoimmune markers, but it doesn't fit all the criteria to be considered overtly an autoimmune disease by mainstream medicine and given ICD-10 code in the United States, at least, diagnosis code and given whatever appropriate action step conventionally. But the criteria, you mentioned Addison's disease or autoimmune adrenal disease, there has to be in effect 90% destruction of the adrenal glands before mainstream medicine will label it as Addison's disease. 

Similar numbers for the MS, with the myelin sheath or the Villi with celiac disease or ulcerative colitis, Crohn's disease. You look at all these inflammatory autoimmune problems. Research estimates, and I put this study in the book, but basically 4 to 10 years prior to that diagnosis, as when these things were brewing on the autoimmune inflammation spectrum. They didn't happen overnight. When someone's diagnosed with whatever interstitial cystitis or any other autoimmune condition you're talking about. It didn't happen the day before. It didn't start the day before. 

It happened on average 4 to 10 years prior and of course, there's exceptions to that, but for the most people, things were brewing on this inflammation spectrum for quite a bit and it's the reactionary approach to managing autoimmune conditions that a lot of people fall through the cracks of that conventional setting, which basically what happens when somebody is diagnosed with that autoimmune disease, what options are they given? 

They are given basically steroids or immunosuppressant biologics and that's basically it. Other than things like IVIg and some immune therapies, for the most part, they're giving steroids and biologics. That's the majority of people with auto immune disease and what they're given. Anybody on those drugs will tell you, the most part, it's no walk in the park. It’s no utopian solution now that they've been labeled with their disease, they have all the solutions in their hands. My question is, and the question that I'm posing to the reader and to people out there is wherever you're at on this autoimmune inflammation spectrum, or wherever you're at on the inflammation spectrum, what can you do today to start feeling better.

No matter if you're in autoimmune reactivity or autoimmune disease or in your silent autoimmunity and you just want to preserve your health and mitigate risk factors and just prevent all that stuff from happening? It's also important to know, we're talking about auto immunity now but you can have inflammation and not have autoimmunity. But all auto immunity is inflammatory. There's a lot of inflammatory problems that are not autoimmune in nature as well, but specifically to autoimmunity since that is a lot of my patients. That's obviously a good topic as well.

Melanie Avalon:                      I always really liked statements like that because they really make you rethink and reframe things. Sorry, I'm just thinking about that whole concept and then for listeners, I guess I think most listeners think they probably know what autoimmune conditions are, but I think there are a lot of conditions that people don't even really necessarily associate with autoimmunity that I didn't even until I was reading your book. Things like celiac disease. I think people don't really associate that with autoimmunity or pernicious anemia. 

There's so many conditions that can fall into this and it's very empowering like you said, to understand that there is this timeline in this progression. Is it ever too late to turn the boat around even if somebody finds himself in this third stage and they've got the label of the autoimmune condition, is there a chance to reverse things?

Dr. Will Cole:                           Absolutely. There's a chance. I mean, that's what I do workwise. For people that even don't have functional medicine doctors, there's so much tale and story and inspiration around people having agency over their wellness and reclaiming their life. There's a book that I haven't read fully, but I just know what the topic is. It's called The Other Side of Impossible and it's about, there are all these stories and friends of mine are in the book. 

I think Terry Wahls is in the book. She's of course reversed MS with and managing it and supporting it through functional medicine and food. There's other friends of mine in there too that have autoimmune conditions and then obviously, the countless of patients that I've seen over the years.  The body is just amazingly resilient and it never ceases to amaze me what the body's capable of doing. People that were counted as just this is your lot in life, there's nothing you can do and  just take this medication, see you in six months, basically, see you in a year even and because you're just in this maintenance phase of disease management, the body can overcome amazing things in many ways. 

My goal is to, as a functional medicine practitioner, what's the best we can get this person's health? How long have you been going through these health issues? What are they up against? What's realistic? But whether that's improving the body 50% or a hundred percent or anything in between, that's way better off than getting worse. That's really the question. To say that, is there hope for them? Absolutely. But does that mean everyone with autoimmune disease is going to be a hundred percent great and all, everyone's going to be in remission and nobody's going to have any symptoms because of functional medicine? 

No, that's not true, but it's a step in the right direction, whether that is a little incremental, whether that's major, whether it's complete resolution of your symptoms, it's still a step in the right direction.

Melanie Avalon:                      I love that so much. One of the sentences in the book that just has haunted me is where you, I don't know exactly what you said, I’m paraphrasing, but it was something about how oftentimes with conventional medicine patients go in and they'll say, yes, you have these symptoms, yes, you have this potential tendency to an autoimmune condition so come back in so many years and then we'll, you know, basically label you with the autoimmune condition. That's just such a helpless mindset. 

I know for me personally, my mom has autoimmune conditions and she's probably going to listen to this episode because I'm going to tell her, so hi mom. She often would say it's genetic, you inherit it. I've just always bristled against that idea because yes, I know genetic tendencies towards it, but I just think there's so much potential to even if it is a genetic tendency, the epigenetics, the environmental factors that the food you're eating, I think there's so much potential to turn the book around, to turn the book… To turn the boat around.

I'm so grateful for the work that you're doing. Practically turning the boat around to give some listeners some tools. One of the main things you do discuss in the inflammation spectrum is an elimination diet. I think elimination diets benefit so many people, but there is skepticism often from conventional medicine, like, what can that actually do? I think there’s a lot of fear or skepticism around elimination diets, because for a lot of reasons. One, people will think they're too restrictive. 

This idea, you mentioned it already, the idea of orthorexia, like it's not a healthy mindset and then there's also this idea, I think people think doing the elimination diet will make them more sensitive to foods after. Would to like to talk a little bit about the purpose of an elimination diet and how you work with that with patients?

Dr. Will Cole:                           Yeah, absolutely. To your earlier point, that statement of, well, basically we see an autoimmune condition way to your gut, bad enough for us to give you a medication. I wish that was not even… I wish that was hyperbole on my part, but I have heard that story so many times over the years so that they were told that what looks like lupus, there’s positive ANA. Basically, we don't have a medication for you now. Come back basically when you get worse.

Melanie Avalon:                      My mom, all the time growing up, she would say that. She'd be like, “Oh, they said that it looks like it might be lupus or this or that so just wait and see.” It's like, what?

Dr. Will Cole:                           Come back when you Plaquenil or something like it. Here's the deal with this, is that I actually have abhor the word elimination diet, because that's such a negatively charged thing. I mean using the word elimination in it. I completely, what my heart was at least, to break down that paradigm or break that old archaic perspective on elimination diets, and just give it a healthy facelift if you will. Because it's shifting the paradigm from, okay, this is what you're eliminating to all that stuff, but, shifting it to, this is not about eliminating foods. 

This is about eliminating feeling lousy. This is about eliminating inflammation. This is about eliminating fatigue. This is about eliminating disillusionment as to what's working for your body and what's not. The goal for me is to really just give your body time to center yourself, calm down, physiologically speaking, untangle these inflammatory reactivities till you really have insight and discernment on what's working for your body and what's not. 

Because feeling great is a place of freedom and knowing what works for your body is what I call in the book, food piece, having that freedom to know what's serving you and what's a saboteur. I agree with you. I think that there's a really a messed up dysfunctional way to do an elimination diet. There's a lot of conflicting information because there's a lot of different elimination diets out there. The Carnivores Diets, elimination diet, there's many other AIP is a type of elimination diet. GAPS is really type of elimination diet. 30’s is an elimination diet. 

I love a lot of these things, and these are all tools that people can do. The point is, just using the term elimination diet, there's so many ways to do it. What I wanted to teach in the inflammation spectrum is, let's take a functional medicine approach, a systematic, thoughtful evidence-based approach to find out what your body loves and what your body hates.

The book starts off with a quiz that's adapted from questions that I ask patients and then from there, they're going to get a track, two different versions of an elimination diet based off of where they're at on the inflammation spectrum and then they have a specific toolbox depending on their quiz score of things to focus on. If they're higher in the gut section, they're going to have gut supporters if higher and the hormonal section or the brain section or the musculoskeletal section, they're going to have different tools in their toolbox. That's the way that I wanted to do it. 

For anybody that's read the book, they'll know the ethos of the book is really not being punitive or obsessive or dogmatic about anything. This is really about finding out what your body loves and what your body hates because I'm actually a fan... It's a funny word of saying, I'm not a fan. I'm an advocate. I'm a proponent of intuitive eating. But when the body's in a state of inflammation and imbalance, there's a lot of noise in the body proverbially speaking. It's a lot of just chaos in the body and anybody going through that will tell you, “Yeah, it's pretty chaotic.” 

It’s hard to hear your intuition when there's so much noise going on in the form of  inflammation. Is it intuition or is it hungriness? Is it intuition or hormonal balance? Is it intuition or underlying microbiome issues? It's so hard to tell. It’s lack of discernment. But when you calm things down, settle things down, untangle those reactions, then you can hear the still small voice of your intuition and you know it, “Well, I feel so good eating those foods and I don't feel good eating those foods.” 

It's not being, “Oh my gosh, I can't have all those foods.” t's that, no, I love feeling better more  than I miss that food that made me feel really lousy. But you don't know that until you've calmed things down and actually know where your body truly needs so you can eat intuitively. I'm just using this tool at the beginning to get to a place of food peace, to get to the place of intuitive eating but believe me, anybody on the other side of the journey, when they're just starting out in the state of reaction and somewhere on the inflammation spectrum, they won't be able to eat intuitively because there's so much disorder in the body. 

They have to use this tool for a time, not forever, to calm things down, to center themselves, to know what actual intuitive eating looks like. 

Melanie Avalon:                      That made me so happy. That is exactly how I feel. I'm literally, I just think intuitive eating is ideally the way we should all be eating. That is the key but I think it's so hard for people to eat intuitively when their body's in a state where, like you said, they can't properly hear. They can't really hear what's the truth, because there's all this inflammation clouding things and then, a lot of foods like processed foods and things may feel intuitively good at the moment, but it's not really what's going on there. 

I think that's one of the biggest struggles. I think it's really sad because people, they want to be able to eat intuitively, but then they might feel like failures when they try, because they just can't find the foods that are working for them and if you're eating foods that aren't working for you at that moment, I think it's such a battle. One of my favorite things about the book is, you mentioned your toolboxes and you have these different toolboxes to address different areas where you might be experiencing inflammation. The brain, the digestive system, other areas, and you end every toolbox section with a mantra to tell yourself and I think there's so much power in there surrounding the mindsets. 

It's things like, for example, like  indigestion, you say, “I'm in perfect balance and I trust my gut.” I just thought it was really amazing. I'm so glad that you're coming from that mindset. I have some really random questions.

Dr. Will Cole:                           Can I touch on that real fast? If you don't mind.

Melanie Avalon:                      Please do. Oh, yeah.

Dr. Will Cole:                           The other component of the inflammation spectrum’s protocols in the book; it's not just about eliminating food. It's about focusing on the foods you can have, and it's all these non-food inflamers too. Because you could be eating super clean, but serving your body a big slice of stress every day and that's raising inflammation, or maybe it's a lack of sleep that's raising inflammation. In the book, you've obviously read it so you know, but for people who don’t know, there's multiple non-food and flavors to that. 

We're also working on over these weeks during the elimination phase to calm down inflammation in that way too because it's not just about what you're serving your body in the form of breakfast, lunch at dinner, what are you serving your spirit? What are you serving your mind? All of these things, from screen time to social media addiction to lack of sleep, blue light, all the research, looking at these other epigenetic modulators of our biochemistry will also bring inflammation levels up and thanks for bringing that up. I forgot to mention that.

Melanie Avalon:                      That was one of my other favorite things about the book. You went into the importance of the social aspect and the whole factor going on. One of the things I think is really profound is the inflammatory response to a meal if you're in a stress state. I wonder about the difference between the potential inflammatory response to a “healthy meal while in a stress state” compared to maybe a potentially more inflammatory meal, but in the context of no stress like a social with family, with friends, I just feel like all of the comprehensive factors are so important and I'm so glad you're providing that whole comprehensive picture. 

Dr. Will Cole:                           Yeah, it's so true. The state in which you eat the meal will produce the two completely different outcomes. You could have two of the exact same meals with two similar people and I've seen this so many times. It's similar cases where one person hates their food that they're eating. They're stressed. They're eating really fast, like at a toxic work environment and they have completely different response than someone that's eating with the sense of grace and lightness and enjoying and appreciative and thankful of their meal. 

It's so powerful. At that point, yeah, the food medicine is part of the puzzle, but it's not the totality of that puzzle. For them, their head space and their heart space is also influencing their biochemistry as well.

Melanie Avalon:                      One thing I wonder a lot about, because especially with intermittent fasting and eating meals and different eating windows, a lot of our listeners on the intermittent fasting podcast practice a one meal day situation where they're eating at night and there's so much research about Circadian rhythm and eating. I do think that's really important, but I also wonder if perhaps if a person's following an intermittent fasting pattern where, because they're eating at night, that's allowing them to eat after they've done all the work for the day and they have this almost ritual or this habit around their eating and that's how they can eat in a relaxed state and digest. 

I just feel like for that person, having that context in the eating might be an important factor to take into mind when looking at studies surrounding Circadian, rhythm and digestion. I think about that a lot, because I know when I eat earlier in the day, for me personally, I get stressed about it because I have work that I need to be doing and all of this stuff and I just find for me that context of the meal is so important. 

One thing you talk about in the book is you say to actually ask your body, “What do you want or do you want this food?” Have you found that to work for patients? If you ask yourself, “Do you want this food?” What reaction are you looking for in your body for whether or not you might react well to that food?

Dr. Will Cole:                           Yeah, and that, I think where you're talking about, I wrote that, it was towards the end of the book and it's when you start creating that intuitive eating pattern. You really are in sync and eat fully intuitively when you can really hear the still small voice of your intuition. That's not going to happen at the beginning. But when you get a rhythm of what works for your body, like women are exceptionally intuitive over men, generally speaking, and I just need more carbohydrates on these days of my cycle, around their ovulation, around their periods. 

They're naturally going for more clean carbs and fruits and sweet potatoes and rice and then the other days of their cycle they can go into maybe a moderate carb or lower carb state and they're just maintaining the metabolic flexibility because of intuition. That's what I meant there. Yeah, don't be so strict as far as this food dogma and like, “Oh, I can't have that,” but just go with the rhythms of your biochemistry. Go with the rhythm of what your body's truly saying. 

That's on the other side of it. That's once you have calmed inflammation levels. That's when you  calm your gut responses and you really can get to a place of awareness and conscious awareness with food. That's the goal. For some people, it's going to take weeks. For most people, it's going to take months to really get to that place but that's the goal.

Melanie Avalon:                      Glad you clarified that timeline. Prior to getting to that goal, the actual elimination diet protocol, you have a Core4 to Core8 foods to Elimin8. For listeners, you've got to get this book because it's all in there, taking the quiz, how to figure out if you should do the four or the eight, but say the potential of all eight is grains, dairy with lactose and casein, added sweeteners, inflammatory oils like legumes, nuts and seeds, eggs and nightshades. I refer listeners to your book to get all the details on all these individually. 

I was wondering if I could just ask some brief questions, I had about a few of them specifically. Grains, for example, I think people are very aware of the inflammatory potential of gluten and things like that. Do you think the… My co-host on the Intermittent Fasting podcast is very much a grain lover and a gluten lover, and I think a lot of people that eat these things and don't seem to experience any health benefits and maybe they do serve their body. 

I was just wondering what your stance is on grains versus gluten, and is there may be an aspect coming in with conventional farming in America and in glyphosate, versus people who go to Europe and say, “Oh, I can eat gluten and I was fine.” Gluten, do you think everybody should be eliminating it all the time? Can some people do well with grains and gluten?

Dr. Will Cole:                           I don't think everybody needs to eliminate it entirely, no. This is really the question that I'd like to explore in the book is bio-individuality. That's the heart of functional medicine and what I do consulting patients. If I hung my hat on one way of eating for everybody, I’d be proven wrong all day long. I had to keep an open mind. Intellectually, I had to keep flexible as far as my awareness of different variables to consider, because it's not so, I can't be so myopic and say, it's just one thing for everybody. 

For example, you mentioned the Core4 track and the Elimin8 track in the inflammation spectrum. The Core4 track are the four foods that are most likely to cause inflammation in most people. It's not going to cause the same type of inflammation in all people. It's really looking at bio-individuality that even these foods, they may work fine for one person, but not for the next person. The Core4 are the four foods that cause inflammation in most people. It's grains and dairy, third would be industrial seed oils, like you said, canola oil, vegetable oil, high Omega 6 industrial seed oils, and then fourth would be added sugar. 

I have a nuanced conversation about the types of grains like you said, gluten versus not gluten containing grains. Is it the hybridization, genetic modification of certain grains, is it the glyphosate spraying? These are variables to consider and everybody's biochemistry is going to interact in different ways to different degrees depending on the person and how much they're eating and how often they're eating it. Then same with dairy, is it beta A1 casein or beta A2 casein, and the goats versus the cow milk? 

We talk about each one, especially in the reintroduction and how to reintroduce these things from the, least likely to be problematic to the most likely to be problematic, based off of the data and clinical experience. Then obviously industrial seed oils and sugar are not really foods, even though probably some people would consider them foods, but they're more like additives to foods or ingredients in foods. 

But the Elimin8 track adds in the legumes. It's the Core4 plus four more or Elimin8. If you need meat think of a play on words, guys, I'm your guy, I wake up in the middle of the night and just think of how to like word things in books, but then you add the Core4 plus the night shades, the legumes and nuts and seeds and the eggs. All those foods are healthy enough foods, they're not the end of the world but everybody's going to react different in different ways. Like I do fine with eggs, somebody is not. I do fine maybe with rice maybe someone else doesn't. This is bio-individuality. This is functional medicine. That's what I look at with my patients. 

To your point with grains, I think all of those factors are something to take into consideration, glyphosate, hybridization of wheat and the overconsumption of it, and the preparation of it, like the soaking and sprouting versus the not. Those are all things. It's not just one thing, but on the reintroduction chapter, I am telling the reader, “Hey, if they want to try this back in, bring in the wheat, bring in the gluten containing bread, bring it in, see if your body loves it, see if it doesn't.” Because that will then give you feedback to know, is it worth it or not? 

If you love it, if you enjoy it and if it makes you feel good have at it. If you love it, but it makes you feel really lousy you have to take inventory and say, is it worth it or not? This is the whole conversation that I'm having with the reader at the end of the book, some people may determine, “Hey, if this doesn't make me feel good, but I'm going to eat it anyways,” but at least they have agency and know, is there a response they're going to get? 

They can have that adult decision, and that's what grace and lightness in wellness is all about, which is what the whole book's about. This is about them knowing what works for their body and what it doesn't, by having the freewill to choose what they want and not be bound by their hungriness and their insatiable cravings or their disillusionment as to what's working or what's not, that's the point of it. 

I'm fine with somebody who wants to have grains, and we talk about sourdough and the better versions of it, generally speaking, but there are people without a doubt that have wheat, that have grains that are fine and there's no negligible, you can't measure it on a lab, you don't notice it impacting their life in a negative way. I'm cool with it. I don't have an agenda other than that person feeling great.

Melanie Avalon:                      I love it so much. When I wrote my book, What When Why, and I had a guide to finding your “personal paleo diet,” but it was similar situation where it's like, you have to find what works for you. Because if I ever say that there's one diet for everyone, please let that never happen because it's just so individual. We just have to find what works for us. Rapid fire question related to that. Do you find that actually herbs and spices, people with autoimmune conditions can usually tolerate or what are your thoughts on that? Because I got a lot of questions from people about herbs and spices.

Dr. Will Cole:                           Nightshades are on that list in Elimin8, if I didn't say it, nightshades are on there. There are nightshade spices, and then seed-based spices like cumin, for example.

Melanie Avalon:                      Oh, true. I didn't think about it that way.

Dr. Will Cole:                           Yeah, so those can be problematic, but it would be the nightshade spices and the seed-based spices. Those are what we would consider gray areas spices. I differentiate that in the book, but for the most part, there's many amazing herbs and many amazing non-nightshade spices that could be good too. Later on in the book, there's a sidebar and I talk about, let's go through the system in the book and let's say, it gets you 80% better or 90% better, but you still got like 20, 30, 10%, whatever it is of improvements and you're stuck there. 

Maybe you need more time, and I mentioned that in the book, maybe repeat it and what has taken years to get to where you're at now is going to take time to recover. But, there are some people that need to go beyond the basics and that's where functional medicine comes in. We can run labs, we can be more thorough, we can take it to the next level, and there's only so much personalization I can get into one book. I can really talk to them as that as them. 

I talk about like the compounds that you mentioned in your food app, like the histamines in the salicylates and the oxalates and all these other things that we may need to take into consideration, but that's not to say everybody has to be worried about that stuff, No. But some people do need to be mindful of that stuff, and these are the things we can really take and put in specifics in the critical setting and see what that person needs to do.

Melanie Avalon:                      Thank you, I love that. Big question for you on protein, especially given the context of, not to say Ketotarian has to be low protein necessarily, but I think keto diets in particular are often high protein and I’m often contemplating the connection between protein and inflammation. First of all, the inflammatory response to foods, is it technically, always to the protein in that food, some sort of protein in that food?

Dr. Will Cole:                           Oftentimes, you're right. Oftentimes, it is some sort of protein, like the albumin in the egg white, the lectins in the plants, the casein in the dairy, the gluten. Oftentimes it's the protein, sometimes it's not. Sometimes it's the carbohydrates that can definitely cause reactions in some people. People have fructose intolerances that can cause inflammation or FODMAP intolerances or fiber reactions that can cause inflammation, but it is often times.

Melanie Avalon:                      Yeah, because for immune mediated, would that almost mandate that there would be some sort of protein aspect to it?

Dr. Will Cole:                           Yeah. Normally it is, and that's normally the molecular mimicry that's happening. It's some sort of food protein.

Melanie Avalon:                      For example, what are your thoughts on an almost low, I'm thinking of for example, like Kempner’s rice diet, where it was basically white rice, sugar, fruit and fruit juice and it radically improved health conditions. Do you think that was potentially the nature of just getting rid of the protein?

Dr. Will Cole:                           Yeah, I would definitely say that when you're mitigating a lot of variables, it can definitely produce a beneficial response for a time, but I ultimately want to be working with the underlying gut issues in the first place. While you're untangling those immune reactions and calming the system in general, you can get somebody's head above water, so to speak, and then start just really actively mend what's dysfunctional. 

You're right, I think with the Ketogenic diet, a lot of times people aren't mindful of the macronutrients specific to that, and that's not what I'm talking about in the inflammation spectrum. You could be keto, high carb, low carb, it really doesn't matter. It's, how do you do the best version of the way that you want to eat? What's the best looking Keto, what's the best-looking Carnivore, Adjacent diet, what's the best…  whatever you want to call it, it's fine because it works good for you. That's what the inflammation spectrum is about. 

But with Ketotarian, I was actually very specific about this because a true ketogenic diet is a high fat, moderate protein, low carbohydrate diet, but then it's about, okay, well, what is the best type of proteins to pick from? When someone's fat adapted, someone that's producing beta-hydroxybutyrate ketone that your body is endogenously making, actually ketosis is a very protein sparing diet. You actually don't need that much protein in it, and we're focusing on clean proteins, typically. Proteins that aren't going to cause so much reactions in people.

Melanie Avalon:                      Yeah. For listeners, definitely get Ketotarian as well for all of the science, and the more details there. One of the things you mentioned in the eight with night shades is alkaloids and also the idea of novel superfoods, potentially being more inflammatory. Is there more of a potential for an autoimmune response to, you call them these novel foods, foods that were maybe perhaps not a part of our mainstay diet? Do you think there's a potential issue for supplement forms of nutrients? 

I know your toolbox has provided a lot of supplements to use, to address specific issues, but are people with autoimmune conditions, do they have the potential to react negatively to supplements because it's a supplement form compared to a whole food? 

Dr. Will Cole:                            Oh yeah. I mean, it's a potential for sure. For all people that are higher on the inflammation spectrum, we typically will have them phase in supplements, very judiciously, very systematically, lean into it. Honestly, I say this in the book, maybe the person, the reader isn’t going to take any of the supplements. Maybe their body is so reactive, you don't need that for now. Just focus on the foods for now, and then you can slowly lean in as it's appropriate, based off of the toolbox. 

I don't actually want to bring that many variables and for somebody that's very reactive. Sometimes you just have to keep it really simple, to get things chilled out for a bit, and then you can lean into things later on. You don't have to do too much too soon because that's really, especially for people that are higher on the inflammation spectrum, that's not the most sustainable approach because it's going to be a lot of variables coming in and saying, well, what is it like what's working for you, what's  not, and you don't even know what's up and what's down. Sometimes you just have to take it low and slow and lean into it very systematically. 

Melanie Avalon:                       I love that so much because I think especially people struggling with reactions to food, autoimmune conditions, it can just be really overwhelming and a functionally minded practitioner might say, take all these supplements and another one might say, take these supplements. It can be very confusing for people. That's why I really love the approach that you offer to work through that. I could talk to you for hours, so I’m going to stop myself. I just have some really random, super fire questions that will haunt me if I don't ask you them. 

Is there a difference between compounds which modulate the immune system versus those which down regulate the immune response? For example, is there a different mechanism of action taking something like fish oil versus aspirin versus an herb that “modulates the immune system?” I don't really know how to ask it. Are you familiar with the work of Ray Peat? 

Dr. Will Cole:                           I am not, no. 

Melanie Avalon:                       He's a, well, I won't even go in that rabbit hole, but a lot of his work and his followers are actually not fans of fish oil supplementation, and Omega 3s for example, because of the potential inflammatory nature of polyunsaturated fats, even in the Omega 3 context. One thing I've read there is that even Omega 3s, for example, might just be turning off the immune response when we should actually have it. I'm not being clear at all on this question. I just want to know if there's a difference between modulating the immune system and turning it off versus down regulating?

Dr. Will Cole:                           I mean, there definitely is a difference. For example, adaptogens for the most part have a modulating effect, so cortisol could be high, it could be low. It could be volatility high and then low and sort of erratic with HPA axis response. You can quantify this on a urine-saliva test and look at the cortisol awakening response, and we measure this for labs and can see that specifically. In adaptogens, generally speaking, there's some nuanced stuff to this, but basically for the most part, it has a balancing effect to this and the research shows this and this is what it's also traditionally been used as. 

That is what I refer to it as a modulating effect on it, a balancing effect versus licorice root is going to raise it up. It's not so much balancing things out or modulating it, it is as stimulating that HPA axis. That's one difference. I don't know if that answers your question. There’re definitely different compounds, whether they're plant compounds or pharmaceutical compounds that are going to have a different response in someone's biochemistry, but then you also have to extrapolate that to your bio-individuality everybody's going to respond to that supplement. 

A lot of my patients say things like, “Well, whatever the known mechanism of action for a supplement is, my body has the opposite response to it.” That's true too, it’s like, you can read it in a textbook or understand all the science stuff, but it's like, “Oh no, actually I can tell you about a patient that has the opposite response from that because of bio-individuality.” That's would be my initial thought to what you said.

Melanie Avalon:                      How do you feel about aspirin? Is there potentially a place for taking an aspirin daily to keep inflammation down? Especially if somebody is at the beginning, if they're in a very high inflammatory state, do you think there's a benefit to taking pharmaceuticals to stop or calm the inflammation while they're beginning to implement these dietary practices? I often wonder that, especially with histamines, say you're going on a low histamine diet to address that. 

Is there a potential benefit to when you first start that beyond anti-histamines though in the beginning to keep things a little less damaging from the histamine load that you have at that moment, but yes aspirin because a lot of people will say, take an aspirin a day.

Dr. Will Cole:                           Yeah. There’s a place for it. I mean, we're not anti-medication in functional medicine. We just ask the question, what is your most effective option that causes you the least amount of side effects? For some people may be aspirin fits that criteria, it's a preventative thing, their doctor recommends it, it's really not causing any major problems. It’s like baby aspirin, just a small amount. It's really, maybe it's just not something to worry about honestly.

But aspirin, for example, historically where it came from, the Willow bark contains Salicin, which is a compound similar to aspirin. Maybe they want to just take a therapeutic dose of Willow bark or something like that or maybe it the aspirin. To me, yes, there's a place for those types of things even if it's like an over the counter drug, there’s sometimes a place for it. That's a conversation somebody can have with their doctor and see what is their most effective option that causes them the least amount of side effects.

Melanie Avalon:                      I love it and then for your patients, and for listeners and readers, when they do your protocol and they do get to the reintroduction phase and are testing new foods, how do you encourage them to not have food-fear about foods or about the reintroduction phase? Also is it okay, say that somebody does the elimination protocol actually finds that they really enjoy these foods? Can they “stay like that forever?” Is there a need to return to a broader range of foods?

Dr. Will Cole:                           That's a very good question. I do talk about that through the book because the foods we are focusing on in the, either the Core4 track is for removing the four foods for four weeks, in the Elimin8 track is removing the eight foods for eight weeks, and then we do reintroduction after for both. The foods we're focusing on during those either four weeks or eight weeks are very nutrient dense, very healing, very healthy, well balanced foods. If somebody wants to stay there and they enjoy the foods they're having and they don't miss anything they may just stay there, that's fine. 

I want people to have as much variety and flexibility and grace and lightness to their food as possible as the body will allow. Most people are going to want to try to reintroduce at least a few things, but by all means, they're not lacking nutrients if they are sticking with the plan in the book.

Melanie Avalon:                      Got you. Well, thank you so much. This has been absolutely incredible. Listeners, you’ve got to get this book. It's just absolutely amazing. This is really appropriate given everything the last question that I ask every single guest on this podcast, and it's just because I’m just realizing how important mindset is when it comes to everything. What is something that you're grateful for?

Dr. Will Cole:                           I'm grateful for my family. I'm grateful for a lot of things, but I'm definitely grateful for my kids and my wife and putting up with me. I'm obsessed with this health stuff and I talk about it too much and I'm busy with so much and I could not do it without them.

Melanie Avalon:                      I love it. Thank you so much, Dr. Cole. This has been absolutely amazing. We'll put links to the show notes for all of this. For listeners, by the way, these show notes will be at For listeners, how else can they best follow your work? Is there any other links or anything that you'd like to put out there?

Dr. Will Cole:                           Everything is at We offer a free phone or webcam, health evaluation, if people want a functional medicine perspective on their case. There's a lot of free content on the site, the links to Ketotarian and The Inflammation Spectrum are there too, and Instagram, if people want to connect with me on Instagram, I'm active there the most, it's @drwillcole, D-R-W-I-L-L-C-O-L-E. 

Melanie Avalon:                      Awesome. Well, thank you so much. This has been amazing. Do you have any other books in the works?

Dr. Will Cole:                           I am. This 2020 is meant to be. I can't speak on it yet, but it's going to be cool. It's going to be cool. I can't wait. I wish I could talk about it.

Melanie Avalon:                      Oh, kill me. Okay, this is great. We'll have to bring you back hopefully for that.

Dr. Will Cole:                           Yes. 2021. We’ll let this little pandemic and the election year pass and I'll be back in 2021.

Melanie Avalon:                      All right. Listeners stay tuned for that. That's wonderful. All right. I will talk to you then.


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