Fasting With Intuition & Awareness - with Dr. Will Cole | The Empowering Neurologist EP. 113

Well, hello everyone. Welcome again to The Empowering Neurologist. I'm Dr. David Perlmutter. You know, fasting, time-restricted eating, caloric restriction— these are hot topics today, and with very good reason, because there are health benefits associated with these practices that have been looked at for decades. But, you know, the problem is how do you implement? What's it all about? And our guest today is Dr. Will Cole. His new book, Intuitive Fasting, really walks us through how to make this happen, how to make it user-friendly, and also explains why this is so important. It's an interview I've been looking forward to. Let me tell you a little bit more about Dr. Will Cole. Dr. Cole has been on our program multiple times, written other books, that we've been featuring as of late dealing with things like being a vegetarian but on a ketogenic diet, looking at how we can enhance our immune function or at least balance immune function. Now with intuitive fasting, how we can bring this notion of fasting, whether time-restricted eating or fasting per se, how can we make that available to people such that they can gain the benefits? Let me tell you a little more about him. He wrote the books that we've interviewed him about before called Ketotarian, and most recently he was on the program talking about The Inflammation Spectrum. The new book shows us how we can benefit from a, what he calls a flexible intermittent fasting program to gain metabolic flexibility and to finally find, as he describes it, food peace, meaning— you know, getting a place of satisfaction and being less so— less hypervigilant about the foods we eat and paying more attention to not so much what we eat, but when we eat and how we eat. We have seen Dr. Cole on multiple media experiences throughout the country. He's the host of the popular podcast Goop Fellas. And also Keto Talk. And the new podcast that he's on is The Art of Being Well. So let's just jump right in and talk to Dr. Will Cole. Well, hello, Dr. Cole. Welcome back to the program.

Hello, my friend. Thank you so much for having me. I'm excited that we're talking.

You're getting to be a regular. That's a good thing.

Oh, thank you. I'm honored and I love talking to you always.

So let's just jump in with both feet. What's all the excitement about fasting in general? Why, why are people just all over this right now?

I think people are looking for effective, easy, approachable, accessible ways to enhance their health. Specifically, I think fasting resonates with people because— 2 different reasons that come to mind. I think it's free, so I think that's appealing for people. 2, anybody can do it. You don't need equipment, you don't need supplements, you don't need a special diet necessarily to do it. I think there's something innate. I think there's something primal when it comes to fasting that resonates with many people.

Well, let's talk about the notion of intuitive fasting, that this is, I think, part of the hardware loaded in that, by virtue of the title, it's part of our intuition. Where do we get that from? How do you choose that as a title, and what's that theme all about?

Yeah, so when I put the title, there's a few reasons. One, as a writer and as an educator, a lot of my job, as you know, is educating patients and empowering them. And it was the prefix INT, that play on words of intermittent and intuitive. I thought, okay, visually it looks good, but it really was the conversation that I was more interested in. This seemingly paradoxical concept of how could fasting ever be intuitive? And then this whole conversation about intuitive eating, I think I really wanted to have a deeper conversation on what that means, like coming from a functional medicine perspective. I think some of the times there are a certain sect of people that they can eat intuitively, meaning they can more or less eat what they want. They don't have any major health problems, their blood sugar is stable. They have no sort of hangriness when it comes to cravings, etc. They're by no means the majority of the human race. And as a functional medicine practitioner, my day job is talking to people with different hormonal problems, blood sugar issues, inflammatory problems. It's— their cravings will drown out any intuition that's there. So I want people to have their— this sort of deep discernment or a grace and intuition when it comes to eating, but we have to show up for ourselves to actually have Metabolic flexibility, which you and I have talked about for years. Metabolic flexibility is fertile foundation for authentic intuitive eating, meaning we're just going to have proper hormonal signaling. We're going to have proper gut-brain axis communication, proper satiety signaling to truly know what our body loves and hates. The book is really a conversation and a roadmap to get to authentic intuitive eating and intuitive fasting because fasting won't be this arduous Punitive, dogmatic, where I have to grit my teeth to fast. It'll just be because we are fat-adapted, because we have metabolic flexibility, we can go longer without eating, not because we're willing it, just because we are more metabolically flexible. That's really the deeper conversation that I'm having about this concept.

I think you made a comment that we're getting back in touch with our instinctive pattern of eating. And what does that mean, instinctive versus choosing to be on a specific type of diet?

I want people to have proper signaling when it comes to their hormones as far as their ability to know what their body loves and what their body hates. And that happens on a physiological level. If somebody becomes more fat-adapted, more metabolically flexible, that's going to help with their instinctive knowing of I eat when I'm hungry, I can go longer without eating, I know my body needs a break from eating for a time, and just an awareness of how your body operates and how to check in with yourself to do things that make your health a bit better. But there's also a mental, emotional, spiritual, I think, side of things too, is that through times of fasting, specifically time-restricted feeding, I want people to use that as a mindfulness tool as well. Use food and use fasting as a mindfulness tool because so many people are divorced from even awareness when it comes to food or anything. They're just eating because that's what they do and they are not really conscious fully of why they're eating or what they're eating. I want to bring all of that awareness up to use fasting and food as a mindfulness tool.

You're bringing, I think, a conscious awareness to our eating, and that's a little different from instinctive. Instinctively, we would want to eat as much sugar as we possibly could. We have this instinctive desire for sweet, which allows us to make fat, which is a survival mechanism. In a sense, we're kind of getting away from our instincts and overriding that with what you just said. This conscious awareness of what we should be doing. So how do we then develop the intuition? How do we develop this program, if you will, that lets us know that we're on the right track?

I think there's 2 different tools. I think the flexible time-restricted feeding windows paired with a clean ketotarian diet, which is, you know, as you know, my made-up word for a clean ketogenic diet that's pescatarian keto, vegetarian keto, with vegan keto options too. Both of those are tools to support beta-hydroxybutyrate. Both intermittent fasting, time-restricted feeding, and the ketogenic diet done with ketotarian, they both support beta-hydroxybutyrate, which is a fuel for the body. It's fuel for the brain. It is also an epigenetic modulator. It lowers inflammation levels. It really repairs a lot of things that are not operating optimally in people. Pairing time-restricted feeding with ketotarian diet are 2 different tools that I explore throughout intuitive fasting for people to gain that metabolic flexibility. Because as they stabilize their blood sugar, as they lower inflammation levels, they'll have proper awareness to what fuels their body, and they'll have proper awareness of, of what their body truly needs, their intuition.

And they'll, they'll be in a better position to make good decisions. They'll be more tapped into their prefrontal cortex and away from It's more instinctual, you know, get the survival of the fattest kind of mentality. Just for our viewers, the thesis of Ketotarian, which I think was really very important, was, you know, there was this notion that to get into ketosis, you either had to be super aggressive about calorie restriction and fasting, et cetera, or you had to be eating, you know, all kinds of meat and fat day in and day out in order to get into ketosis. And you really challenged that really effectively. Yeah. indicating that you could be vegetarian and get into ketosis and reap the benefits of both. It really sets straight the notion that— this idea that going on a ketogenic diet is eating bacon all day and eating fat. You have these 5 benefits of intuitive fasting. Can we go through those one by one?

Sure. That chapter, let's go through the list. One is ketosis, this 4th macronutrient. Researchers refer to beta-hydroxybutyrate as the 4th macronutrient. We have proteins, fats, carbs, and ketones. It is one of the tools of fasting is tapping into this 4th macronutrient to not only fuel your body, which a lot of the energy-boosting benefits of fasting and the ketogenic diet has to do with the fact that beta-hydroxybutyrate is a fuel for the body. It improves, as you know, that BDNF, brain-derived neurotrophic factor, actually encouraging new neurons. It improves mitochondrial biogenesis. Making stronger, more resilient mitochondria, which is needed for cellular energy, and lowers the inflammation markers that I mentioned, or it downregulates the inflammatory cascades like NF-kappa-B and NLRP3 inflammasome. So it's this really amazing signaling molecule epigenetic modulator. So ketosis is one of them, but part of the second part of is in that chapter I talk about hormesis, which is one of the other components that makes fasting so effective. This concept of hormesis actually has its its origins with the king named Mithridates. Have you heard of this story before?

You talk about it in your book, but I have heard about it, how he was so fearful of being poisoned, so he worked his way up on the poison scale so that he was virtually— I hate to say immune, but developed a tolerance.

Exactly. His murderous mother. And if you know anything about royals, which I kind of am interested in history— I'm a history nerd when it comes to this stuff— as a royal, there are a lot of people murdering royals and a lot of family members murdered. It's quite horrible. I wouldn't want to be in their position. Anyways, this guy thought that his mom was going to kill him. Whether it's true or not, that's kind of the origins of it. Now, studies have come out over the hundreds of thousands— the thousands of years since then of how the dose makes the poison, basically, where you can do small or measured acts of stress on the body to make your body more resilient. Forms of hormesis on the body like fasting, like the ketogenic diet, like cold therapy, ice therapy, or sauna, or high-intensity interval training, or other types of exercise. It's stress for a period of time to make the body more resilient. The stem cell supporting activation pathways of fasting, the cellular resilience pathways, all has to do with the fact that fasting is a type of hormesis. Then the third component is autophagy. There's sort of the cellular recycling Cellular renewal pathways. And then the 5th is the fact that it's— it's all of these things, all of these things are lowering inflammation levels. And as you know this, but for people that don't know, I mean, inflammation is a commonality between just about every health problem under the sun. So autophagy, hormesis, ketosis all help to lower inflammation levels.

So what does it mean, time-restricted eating or intermittent fasting? What is the difference in those terms?

I think it's two sides of the same coin. I've heard you talk about this too, that it is true. When you look on PubMed, you look at the amount of studies that are out there, there are many. When they're referring to intermittent fasting, they're talking about a lot of different types of fasting. Time-restricted feeding is lumped into that larger fasting conversation because, from my perspective, it's like two sides of the same coin. Are we intermittently fasting or are we doing time-restricted feeding? Then there's different other forms of fasting as well. Time-restricted feeding is a specific break of eating or fasting, and we're eating within specific windows. So it's a subset, if you will, of intermittent fasting.

You mentioned autophagy, this recycling of damaged proteins, damaged organelles within the cell. What amount of intermittent fasting or time-restricted eating is necessary in humans to actually Fulfill that claim, to indicate that autophagy is going to be initiated by what you're talking about?

I think it depends on the baseline of what is— what we know that for someone to be keto-adapted or fat-adapted, their ability to produce ketones is going to vary depending on their baseline, where they're starting out, how much blood sugar dysregulation, how much inflammation, how much metabolic inflexibility or metabolic rigidity is going on. It could happen really quickly, a couple days for some people to really get metabolically flexible. It could take weeks for some people to troubleshoot and really work their way into this state of ketosis and start to upregulate and support these autophagy pathways or these more— these longevity pathways that researchers are exploring. But I would err on the side of— and that's something that I really explore in week 3 of the protocol— are these longer time-restricted feeding windows where it's an almost OMAD approach. OMAD is an acronym that stands for one meal a day. So I would say a 20 to 22-hour 72-hour fast and beyond is really what we are looking at as far as supporting these deeper autophagy pathways. But with that said, ketogenic diet and someone that does no time-restricted feeding, they're just in ketosis through the ketogenic diet, there is enough— it's logical to me to say that they are going to be supporting healthy autophagy pathways just through their food, just through eating and supporting long-term ketosis.

Well, I would— so you said it's logical for you to assume that, and I think it's logical to assume it as well. But, you know, there really isn't any human research that indicates specifically how long it takes to get to a place of autophagy when one is fasting. You know, it may be 3 or 4 days. We don't exactly know. But I would agree with you that it's logical to assume that once you're in ketosis, that likely you're stimulating that pathway. The point is we don't really have a biomarker for autophagy that's readily available, so We don't actually know. You talk about intermittent fasting along with a higher-fat diet, and I think, again, that is to support the ability to get into ketosis. As it relates to the brain, why do we want to do that?

Yeah, so I wanted to pair, because they both support beta-hydroxybutyrate, I wanted people to get some of the benefits of fasting without actually fasting, mimicking a lot of the same benefits of fasting. fasting while they're eating ketotarian. But it's also, as you mentioned, very satiating and stabilizing, so it's going to make their time-restricted feeding a lot easier because they're more satiated when they are eating, so it's going to be more effortless as they go into their fasting windows. But both— because both support beta-hydroxybutyrate, that is really good for the brain in many ways. As I mentioned, it supports BDNF, mitochondrial biogenesis, it lowers neuroinflammation, and our brain is predominantly fat. Working not just from a macronutrient standpoint, but the fact that it does support ketosis, those are 2 really important reasons from a brain-supporting side of things.

So much in modern weight loss science, if you will, which is certainly a very important consideration in modern times, is the notion that we are fat because we consume too many calories in versus the calories that we burn. And you bring up a really important point about eating. It's not necessarily calories in versus calories out, but when we eat as opposed to necessarily— obviously what we eat is important, true. Yeah. But you're talking about the notion of when we eat as being such an important and overlooked factor That is so relevant in terms of weight balance, for example, and inflammation and free radical-mediated stress.

Mm-hmm. Yeah, absolutely. And that's the, the opposite of what people think. People think when they hear fasting on face value, they're conflating that with chronic caloric restriction, and that's not the same thing. There are studies that show that people, especially with the deeper fasting windows, tend in studies tend to eat Mm-hmm. Slightly less, there's a slight caloric deficit, which does have its own merit on its own. But if you control for calories and you look at people that eat over a longer period of time versus a tighter window, same amount of calories, we can leverage the benefits of those time-restricted feeding windows. So it is, and we're not talking about anything extreme necessarily. In week 1, there's ample amount of evidence to show just something as simple as a 12:12 life, paired with a clean diet like ketotarian or any whole foods-based diet, is really beneficial. It's just going back to that adage of don't eat too late. Allow a couple of hours before bedtime to allow your body to repair through the night. I mean, your brain needs that amply, as you well know, but for people that are hearing this for the first time, your body is able to repair through the night, and if you're snacking really late at night, especially if you're snacking on foods that are very disruptive and inflammatory to the body, you're not giving your brain and your body the time to repair throughout the night. So a 12:12 time-restricted feeding window, which is the lightest one that we explore in the book in week 1, it's just priming and prepping people because you're eating a ketogenic diet with a 12:12. It's a nice segue into these deeper time-restricted feedings over the subsequent weeks.

You emphasize quite a bit about the importance of getting into ketosis and how health-supportive are the various ketone bodies. Focusing quite a bit on beta-hydroxybutyrate, and it begs the question I know many of our viewers would like to hear an answer to, and that is, what is the role of some of these exogenous either ketone precursors or the actual ketones themselves? What role do some of these now widely available commercial products have in amping up our ketosis and amping up all these, you know, really powerful pathways that you're talking about?

Hmm. So I don't use them personally. I get asked that question a lot from patients and people asking me what my thoughts are. I'm not against them. I think if someone wants to get a good quality source of it, there's so many things out there. Read the labels, make sure there's no added ingredients that you don't want to be having. But on face value, a good quality exogenous ketone has its place from an improvement of brain function because of the neuro— neuroprotective or the brain-boosting components that beta-hydroxybutyrate has, it would make sense to me that if somebody maybe has a long day at work or they want to perform optimally from a cognitive standpoint, having something like exogenous ketones is a tool that they could use. My perspective overall from a long-term, consistent, do I need to use it every day sort of thing, I would much prefer the person's body to produce it on their own, so have these endogenous exogenous, naturally produced ketones because you can raise blood ketone levels with exogenous ketones. And some companies will even say you don't have to change your diet at all, just take these exogenous ketones and it's going to help you. In theory, that's true, but the name of the game isn't just raising blood ketone levels. The name of the game is having healthy ketosis levels in the presence of normal blood sugar Lower inflammation levels. That is the true environment we are creating here with doing it and having your body produce it on its own. By just eating whatever you want and taking exogenous ketones, really, from a long-term health perspective, isn't the point.

Much of what is written about intermittent fasting and time-restricted eating has to do with letting us regain insulin sensitivity, how very, very important it is. And I have to admit that, you know, in the discussion of longevity and, for example, supplements and/or pharmaceuticals that might be looked upon as aids to longevity, which by and large have failed except for perhaps the rapamycin pathway, everything seems to ultimately funnel through the notion of glucose-insulin axis and control. But beyond reestablishing insulin sensitivity, which clearly what you're, you know, this idea of intermittent fasting time restricted eating can do. You talk about leptin. Can we just unpack leptin a little bit and why restoring leptin sensitivity is something we really want to try to achieve?

Yeah. It's something that I see on an hourly basis when I'm running labs and looking at people's cases. You see functionally elevated or lab-elevated, pathologically elevated leptin levels. Leptin is a hormone that our fat cells produce. Uh-huh. They're part of our endocrine system, and they're supposed to tell, in theory, the hypothalamic cells of the brain, the hypothalamus, to burn fat for fuel. But a lot of people have various degrees of leptin resistance. So you will see this on a lab by running and measuring serum leptin, blood leptin levels, and you will see high leptin, which is indicative of the endocrine— the fat cells actually having to secrete more to basically scream at the brain to burn us, burn Burn us for fuel, but the body is leptin resistant. It's a hormonal resistance pattern that makes it very difficult for people to lose weight. You could look at food and gain weight, or the people describe it like, I could do everything. I could live at the gym. I eat so good, and I can't lose weight. Invariably, many times you'll find higher leptin levels as being at least a major driver, not necessarily the only driver, but a part of that metabolic— Derangement or that metabolic inflexibility that we're trying to support and improve and overcome that. It's oftentimes associated with insulin resistance, so you'll oftentimes see those things hand in hand— high insulin, A1c, triglycerides are up, and high leptin. But I would say this, that I don't always see that. Sometimes I— well, the blood sugar looks fine, triglycerides look fine, A1c looks fine, and all the other markers in the metabolic blood sugar section look fine. Leptin is really high. There's other reasons of why leptin can be high, too, but getting healthy leptin levels, proper hormonal signaling, is one important part to overcoming weight loss resistance and becoming more metabolically flexible.

Leptin, like insulin, tell us to push ourselves away from the table, basically. Then what you're describing here is that we become resistant to that signal over time, and we don't know when it's time to quit eating. We've all been there, of course. And how interesting it is that fructose really is a powerful player as it relates to leptin resistance as well. Yeah. You had a bit of a discussion in the book, which I thought was really very timely, about NAD, and, you know, how this type of eating schedule can help with NAD levels And you even talked about NAD precursors. Maybe you could walk through NAD a little bit because I know that's a hot topic right now. I mean, people are real interested in NAD precursors.

Yeah, absolutely. So one of the pathways that researchers are exploring, these longevity or cellular vitality, cellular resilience, is the impact that fasting, time-restricted feeding, different fasting protocols has on supporting NAD levels, which is needed for cellular repair, cellular energy levels, And as we age, that depletes. So there are— most people know about NAD through taking like a special form of a B vitamin called nicotinamide riboside, which supports NAD levels, and that's why people are taking those. But fasting is another way to support NAD. So I think it's promising, and there's a lot of this emerging research that's coming out there. It's a promising tool to leverage the benefits, and it could explain in part these longevity benefits and anti-disease, anti-accelerated aging benefits that fasting has?

I would say that probably the latest, as it relates to longevity, unfortunately, the latest reports in rodents did not indicate extension of longevity. But I think there's a lot more to the story in terms of muscle activity, energetics, etc., related to NAD+, and not the least of which, the ability of sirtuins to do what they do, is NAD-dependent. And these days, I would say that there's plenty of discussion in terms of immune functionality, as even it relates to COVID, on the basis of NAD depletion or NAD availability, that with lower NAD levels that we see in some of the risk factors for bad COVID outcome, for example, obesity, hypertension, diabetes type 2, that seems to correlate with NAD levels. So,

you

know, So, my vote is to err on the side of doing this with either nicotinamide riboside, which has been shown to increase white blood cell levels in humans, versus nicotinamide mononucleotide, which is, you know, at least the one that David Sinclair is taking for reasons that have not been totally made clear by him, but he's a smart enough guy that I intend to listen to him, that's for sure. That said, who should not participate in intuitive fasting, if anyone?

The way that I advocate it in the book, it's a nuanced conversation and there's— born out of my clinical experience, there's adjustments and modifications for everybody throughout the book. It's not a one-size-fits-all approach. There's a lot of adjustments that I'm making because I've heard just about every, well, what if you're this? Or, what if you're that? In my clinical practice. I'm walking the reader through the book to say, if you're this, then adjust this. That's going to help people to fine-tune it. The measured, flexible nature of the book, it really is very accessible to just about everybody. The one caveat that I make in the book are people that have a past eating disorder or a current eating disorder. That's not to say they can't do it either. I just would recommend they work with their doctor, an eating disorder specialist. Right. Because, uh, I just think that's an appropriate way— route to go down it. But I— down— I would say this though, that I, I have seen countless of people over the years clinically, but also just hearing in the community, um, people that have struggled with eating disorders in the past, and when they do eat this way, they stabilize their blood sugar, they're lowering inflammation levels, they're supporting the gut-brain axis, all these things that you really want. They actually feel more in control and healthier relationship with food than they've ever felt. They don't feel out of control anymore because they feel better. So even though, like, on the surface you'd be like, okay, that's fasting, you shouldn't do that if you have an eating disorder. Well, yes, check with your doctor, check with your eating disorder specialist, but you're not ruled out from— this isn't for you anyways.

And diabetics?

That's another question I get. Should diabetics fast? Absolutely. They should check their blood sugar levels. They should talk to their doctor. And if they're injecting with Humalog or Levemir or Lantus, some injectable insulin, make sure you're testing for sure because you're going to have to adjust the amount of insulin you're injecting. But if you're testing appropriately, no, this is actually the point of it. You're gonna be gaining insulin sensitivity, so this is actually a good thing for your health. You just don't wanna be over-injecting insulin as your body's adjusting and getting healthier.

So I think that the point is, obviously, and you said it, that they need to be doing this with the guidance of their healthcare practitioner. I would ask our viewers to perhaps watch the interview I did with Dr. Sarah Hallberg Berg from Virtus Health on the actual reversal of type 2 diabetes by engaging people over a 1-year period of time in a ketogenic diet. Even we've done podcasts on treating type 1 diabetes with a ketogenic diet and allowing people to reduce their insulin dosages quite dramatically. Yeah. I would certainly say, again, that this is something that needs to be carried Under the direction, not just of your healthcare provider, but somebody who's really you know up to speed in terms of these dietary interventions. Because you know, with all due respect, that's not necessarily something you're going to find in an MD, for example. I know in medical school we received zero hours of education as it relates to nutrition, which is unfortunate, but that's the way it goes. So you do mention though in You talk in the book about the idea that there's actually an advantage that is conferred in people who are involved in intermittent fasting than when they're eating, that they're on a high-fat diet. And, you know, for so many people, the notion of a high-fat diet being good for them is challenging, having been exposed to what, you know, the mainstream has been telling them for decades in terms of dietary fat. So maybe you can Just help them understand a little bit as to why that might be a good choice.

Yeah, so it's definitely an important part, and I mention in the book that many of the studies done on fasting and time-restricted feeding is that you don't have to change your diet much at all. That had to have been done on a clinical side of things— sorry, from a scientific research side of things to see does the fast hold its own weight? Is the benefit coming from the fast or is it coming from the caloric deficit or is it coming from the weight change of diets? And what we know is that there are— you don't have to change much of what you eat by just adjusting your windows and giving your body more of a break from eating to have some of these insulin-sensitizing health benefits that I've talked about earlier. But with that said, I am not advocating for people to try to fast their way out of a poor diet. I think that we have to use food first and from there you can amplify the benefits of food as medicine and fasting as medicine by just adjusting the eating windows and doing these flexible time-restricted feeding windows. It makes your fast easier. It supports specifically because we're doing a high-fat, moderate protein, low carbohydrate Or ketogenic diet as it relates to ketotarian cyclically. We're not always in ketosis. We're doing clean carb cycling as well. That makes your fast a lot easier and it's mimicking fasting. You're supporting beta-hydroxybutyrate, this ketone body, even when you're eating food. I would say this. Because these time-restricted feeding windows are not— we're not talking about extended long fasts. You're going to be supported. You're going to want to be focusing on these healthy fats and a lower-carb approach to get into ketosis faster because you're not going to necessarily— if someone's the average American, not changing their diet, just doing time-restricted feeding, you're going to maybe see some benefits, but it's not going to be nearly what you can get by pairing it with this clean ketogenic way of eating.

What you did in your book, which is really very great, very helpful, is people who want to engage this type of therapy for themselves are a bit hung up on, you know, ratios of fat, carbohydrates, and protein. And you make— you really make it understandable and easy that they don't really need to sweat it that much. I mean, obviously, you don't want to be on a time-restricted eating program and then, you know, crash and burn at 6 PM because now, you know, you're able to eat and you're going to be eating the wrong foods. But, you know, within reason, you make it very Workable and user-friendly. Yes. The last topic I'd like to just touch upon is the notion of keto flu and the role that perhaps supplements might play in that. Maybe you can talk us— tell us what that means, and then, you know, we'll talk supplements, how they play into that, but also any other thoughts on supplements in terms of integrating supplements into this type of eating program.

Yeah. Keto flu happens when you go into any type of ketosis. It doesn't always happen. Not everybody's going to experience this, but either the ketogenic diet, types of intermittent fasting, if you're doing both, obviously, that could happen for some people. It's not going to last forever, and there's many different possible reasons why, but your metabolism's going through some major changes. Systemic cascade of things that are changing in your body, but that is taking somebody that's metabolically inflexible to various degrees and getting their metabolic flexibility. It's almost akin to if I've never done yoga before and I go to yoga class and I do an advanced yoga class, I'm going to feel— and I actually felt this before when it was me at one point— this is horribly unnatural. How does anyone do yoga? My body feels like it's going to break. It should never bend this way. I was doing the wrong class and I was doing too much too soon. The way that I'm doing— it doesn't mean yoga's not for me or working out's not for me. It just means that we need to lean into this appropriately and get the benefits of this. I almost see this as like a proverbial yoga class for your metabolism. We're starting off with that 12/12 and you're eating ample amounts of food. Even then, you could feel a little bit sore, so to speak, from that workout because you have never done it before. That doesn't mean it's bad. It doesn't mean it's not good for you. You just need your metabolism to adjust and your mitochondria has to start producing that prop— has learned to burn fat for fuel. Your gut microbiome is going through some major changes then too. So there could, in theory, if someone has dysbiosis or bacterial overgrowth or some die-off symptoms or Herxheimer responses, and your kindling is off the fire, if you were depending a lot on sugar and carbs for fuel and then you don't have that anymore— Yeah. I think you and I have joked about this term in the past, but this metabolic purgatory where the kindling's off the fire, all the sugar and garbage is off, and you're not fully fat-adapted yet, that can make you not feel so good either. Making sure you're eating ample amounts of foods during that time, and there's ways to mitigate this as well. I'm fasting right now. I'm doing an OMAD today, but I have this electrolyte solution. It's just water with— you can make it yourself just with some Himalayan sea salt. I put a recipe in the book, but there's also many supplements. I used a packet that someone sent me. So it's just a blend of electrolytes, which are sodium, magnesium, potassium, chloride in a solution that you are replenishing, that you can lose some when you're losing that water weight, you're losing that inflammation while you're fasting. And an electrolyte supplement can really help as your body's adjusting and making sure your electrolytes are balanced, because if that is one potential reason why somebody could be having the keto flu, making sure you're hydrated, Then making sure you are eating enough food when you are eating. Don't be hypocaloric. Make sure that you're well satiated. You can get your electrolytes from the foods you're having as well. Those are some things to think about if they do have keto flu, which symptoms can be achiness or more fatigue or just not feeling as good because your body is not used to this yet and you need to start to get that log on the fire, get that fat for fuel, which takes some time.

Yeah, and I would welcome it. I mean, I would say that if in fact you're challenged by it, it means that you've got work to do. I've been there myself plenty of times, and it means that, you know, you're shifting over, but your body's a little sluggish in adapting, keto-adapting, like you say. And I think your comment about electrolytes is actually very good. In my opinion, experience with others too, the biggest issue That people get into are deficiencies of electrolytes. As you develop these ketone bodies, they act as osmotic diuretics, meaning that you pee a lot, and you're peeing out a lot of your electrolytes— magnesium, potassium, and sodium. I use a product called LMNT. I don't mind saying so.

That's what I'm using, actually.

Pardon

me? That's what I'm using today.

Yeah, yeah. LMNT. LMNT.

I

love it. A great product. A lot of people find that just simply giving themselves back their electrolytes, their transition is is a lot easier. The other thing I find helpful in this discussion is continuous glucose monitoring. In other words, looking at your blood sugar and how it responds during the times that you're fasting. When you reintroduce foods, how does your blood sugar respond to you know the time restricted eating protocols? The various ones that you might try on and see what works best for you. So I use a CGM as well, and I use what's called Levels Health. to really look at that data and really give me good feedback. So, you know, I think there are a lot of hacks that perhaps our ancestors who either fasted because they thought it was good for them or fasted because they didn't have food, obviously didn't have access to. So these are things that we can take full advantage of these days, repleting our minerals, using products that allow that to happen, looking at our blood sugars either with continuous glucose monitoring or If you will, finger stick that's available to everyone. So, it does make it easier. But I think, again, to complement your book, it's all there for people. And it's well beyond a great starting place. I think you walk through how it's going to play out for people and what to expect. And I'm hopeful that more and more people are going to embrace this because it's really Really very powerful stuff. Why? Because it targets this fundamental final common pathway for all of our major chronic degenerative conditions, and that is inflammation brought upon us by issues like insulin resistance and elevated blood sugar. We don't have to have that. We have simple tools like intermittent fasting, time-restricted eating, to check that at the door and really realize better how Well

said. Yeah, it is something that I want people to lean into, and they don't— they don't realize that with just a few, few adjustments, it can wield a lot of influence over our biochemistry. So I'm excited for people to explore it for themselves.

Great. Well, Will, always good to see you. And God, you're cranking out the books. So I'm— I have to keep up with you, Dr.

Perlmutter.

Pardon me. Who knows what the next book is about? That's for sure. Anyway, great to see you. Thank you so much.

You too.

Okay, bye for now. Great interview, great information. And pay attention to this stuff because it's really an important way to regain connection with all the great stuff that our, our diets want to do for us, not just the foods we eat but when and how we eat. Really good information. Again, the book Intuitive Fasting, Dr. Will Cole. Thank you all for joining me today. I'll be back soon. Bye for now.