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Ketotarian Diet with Dr. Will Cole
I’ve got an excellent guest that if you don’t know Dr. Will Cole, I don’t know where you’ve been. His book is out. Ketotarian is the name of the book and Dr. Cole along with yours truly was featured by Dr. Axe as one of the top 50 functional doctors in the world. You and I both know Dr. Josh Axe. It was an honor to be with those top 50 luminaries on there as well. You and I both know there were some great doctors that were not on that list. We’ll take it. You’re in Pennsylvania. You spent some training in LA and now you’re back in PA. Tell me some of your stories.
If you want to go way back, I grew up in a household that was into wellness before it was cool, before social media took pretty pictures of healthy foods. I was the kid in the countryside of Pennsylvania eating adaptogenic mushrooms, raw goat’s milk and strange foods that nobody else wanted. It was part of my upbringing. I owned it for myself as a teenager. It was not something that mom and dad made me do at home. It was something that I wanted to do myself and I owned it. My diet evolved at that time, learning about CAFOs, factory farming and a vegan diet. It was a conventional vegan diet. It was whole foods. It was real foods, but it was a vegan diet. It was a real food vegan diet. I ate that way for several years.
I noticed over that time my digestion wasn’t as good as it was. My energy was low and I knew I had to do something different to see different results. That coincided with my training in functional medicine at Southern California University of Health Sciences, which is an integrative school. I heard of a guy called Datis Kharrazian who had gone to my school, was older than I was. He was talking about this field of healthcare called functional medicine. I immersed myself in that and implemented the principles in the labs and the approach in my own life and then in my family’s life. All these years later, I predominantly have a virtual clinic, but 90% of my patients are done via webcam and giving people a functional medicine perspective on their case.
You’re lucky in that sense that you grew up that way. Kudos to your parents. I grew up eating McDonald’s cookies and cupcakes and only saw the light when I was 34 years old. Undoubtedly, I suffered a tremendous amount of damage in those 34 years and now it’s catch up time. Thank God for me meeting my wife and her opening up my eyes to all things health and wellness. My wife, like you, is a trained doctor of chiropractic as she says doctor of cause. What was your initial interest in going into chiropractic school?
My upbringing and noticing the different paradigm shift and seeing what that can do in somebody’s health. My dad is a Doctor of Chiropractic as well. I have seen the patients come through the doors and hearing the amazing stories as a young kid, hanging out at the clinic as a young kid and seeing the amazingness of it. That was an impression. I knew that I wanted to use my training in a more integrative medicine way. I thought being a Doctor of Chiropractic allowed me the leverage and the flexibility to do that. My school was an integrative school, an acupuncture oriental medicine school there as well. That’s the training I had. It was this confluence of medical doctors, Doctor of Chiropractic, naturopaths and oriental medicine doctors. That was a good foundation for my training in functional medicine because that’s what functional medicine is. It’s this integrative systems approach.
I like to think of chiropractic and then also the chiropractic lifestyle which I would say goes along with the Paleo lifestyle. We’ll talk about Ketotarian. It is about that whole lifestyle. When I met my wife, I thought all chiropractors looked like you and looked like my wife, super shape and they’re all in line with eating all organic. They’re eating animal products grass-fed and wild seafood and they’re doing all this amazing stuff. You meet chiropractors in the real world and like, “Not all of them follow that modality.” Maybe that speaks to your training as well that you tell me. Going through chiropractic school, how much was there an emphasis on nutrition and how much of your education came after you graduated?
My school was a little bit more I would say nutrition based because of the Oriental Medicine School, Acupuncture. It wasn’t progressive in the way that I look at nutrition now. For what it’s worth when you compare alternative medicine schools and chiropractic schools, mine was better than most because a lot of them are strict chiropractic adjustments only and they’re not bringing in the other side. It’s not so much of a focal point in the training where the doctors have to get more training afterward. If you’re comparing chiropractic training to medical school, even the worst chiropractic college is going to teach a lot more nutrition than the best medical school.
People that live in glass houses shouldn’t throw stones. I trained in a glass house, that’s for sure. I always tell people in my four years of medical school, three years of internal medicine, three years of cardiology, we didn’t talk about nutrition once. We didn’t talk about sleep once unless it was sleep apnea. We didn’t talk about the importance of the sun. We certainly didn’t talk about physical medicine even though I was trained as a DO. Believe me, and I’m sure the same thing for you, Dr. Will. If someone asks you now and they’re like, “I’m interested in medicine. Should I go to medical school?” What would you tell that person?
It depends on how they want to go about it and where they are. Most of my colleagues are conventionally trained. Most of my colleagues are MDs and after they’ve graduated, knowing not much through their training, they may have a personal interest and know through their own personal research. There are still, in our culture now, a cultural authority for medical doctors and DOs that I feel they can reach people than maybe other trained practitioners can’t make. It depends on the person and their journey and where they want to go with it. I see some amazing advancements in the conventional mainstream. The Cleveland Clinic has a functional medicine center now. Those guys are doing awesome stuff and they need to shake up the system and be a disruptor, something I couldn’t do. I’m not going to have that ability to do that coming from my outside of the mainstream world. It is up to the individual where they want to be. I see the benefits of both.
You’re not going to sell yourself short because you are a disruptor. You are changing the world. Your information is getting out there. Four years of medical school and three years of internal medicine for example, or family practice of seven years of pure brainwashing about pharmaceuticals and procedures. Hopefully, that person can continue to be saying, “It’s about nutrition. It’s about the lifestyle,” and then come out and have those advanced credentials. Seven years is a long time. Are you still vegan?Dieting is not about all the foods you can't have. It’s about loving your body enough to nourish it with good stuff. Click To Tweet
I left that part out. I evolved into this Ketotarian way of eating, which is still plant-centric. It’s more flexible in that way and it’s a high fat, lower carb way of eating that I put into my book in Ketotarian. It’s the way that I eat and I make a cyclical approach. I initially did longer times of ketosis and now I do about four to five days of the week I’ll be in ketosis then moderate my carbs from whole foods, increased fruits, sweet potatoes and things like that on the days that I’m cycling. I like the metabolic flexibility of that. Not everybody has that metabolic flexibility where longer-term ketosis makes more sense for them.
It is this plant-centric, clean, keto way of eating that I wanted to tell people the changes that I’ve seen in my own life, my patients’ lives. Hopefully, the audience can start implementing these principles in their life. What that looks like is you can be completely vegan keto. I wanted to give people a resource on how to do that in Ketotarian but there are three tracks. There’s vegan keto, vegetarian keto meaning I’m eating eggs and ghee, and then pescatarian keto so wild caught fish and shellfish. It’s all plant-centric, but it’s flexible in that way.
When you say flexible, sometimes when you’re going into ketosis, then you’re going to a high fat, a low carb that will be difficult. Since you’re limited on the plants in that phase, when you’re going into ketosis, but as you say, when you cycle out, now you’re going into more maybe sweet potatoes. I don’t know if you allow a little quinoa. I don’t know how far you go with things like brown rice or into beans. What about gluten? Does gluten fit anywhere in this plan whatsoever?
Ketotarian is completely grain free. During the initial eight weeks as I recommend in the book. They go for eight weeks mostly plant-based keto or entirely plant-based keto, depending on what your preference is or if you have any ethical or religious reasons to eat a certain way. There are over 81 different recipes they can pick how they want to eat but basically follow that eight weeks. It’s because I’ve seen clinically that takes at least eight weeks to create that metabolic flexibility of your body producing ample amounts of ketones to fuel the brain, fuel the metabolism, get the anti-inflammatory benefits of beta-hydroxybutyrate of the ketone. From there, I talk about different profiles of people where they may want to consider a cyclical approach, stay in ketosis or do ketosis seasonally. It’s giving people that flexibility to own it after that.
From there, to answer your question, they can bring in things like legumes, rice or quinoa after those initial eight weeks on the cycling days. That’s something that people can play around with. I give them ideas so they can own it for themselves instead of it being this one size fits all approach, which as we both know, that’s the antithesis of functional medicine. I wanted to bring those functional medicine principles in Ketotarian so they can play around with macros and different food choices. It’s all under this umbrella of being mostly plant-based keto.
Admittedly, I’ve seen the outside of your book. I’ve thumbed through it at whole foods. It’s a beautiful book. It’s loaded with recipes. It was done well. With my travels, wife, three children, I barely have time to read my text messages. Now you’re in the same thing. I was excited thinking, “I’m going to talk to him first, find out what the book’s all about and then go ahead and get the book and recommend it down afterward.” I’m sure you answer some of these questions in there. What about ketone test strips? Do we have to test to see if we’re in ketosis? Can we assume that when we cycle into a heavy, high fat, a low carb that our body is going to enter in?
I gave two different ways for people to go about it. I give a keeping it simple option and people want to go off of how they feel and see the health benefits. I also give the deeper dive approach. We know from a clinical standpoint to know for sure you’re in ketosis, you want to test, but not everybody wants to be that technical about it and they want to go off of how they feel. If they’re doing that for more of a lifestyle reason and not so much of managing certain health issues, losing weight or the insulin resistant, all of that stuff. I prefer for myself to keep it simple and go off of how I feel on. I gave some signs in your life if you’re noticing increased energy or if you are l losing weight, if you’re able to have less inflammation levels in your body and what that looks like.
There are some individual signs people don’t have to test for it, but two tests. The gold standard is blood. Similar to a glucometer, you test your finger, blood your finger and it measures beta-hydroxybutyrate. The other way I would recommend would be a breath meter. Ketonix is one brand, but there are other brands out there. That measures breath acetone, which can be directly correlated to beta-hydroxybutyrate. Urine strips aren’t dependable, especially long-term. If people want to use it at the beginning, it’s a cheaper approach, a more affordable approach in the short-term, they can do that. Longer term if they want to test, we might recommend blood and a breath meter.
What about a yay or nay on some of these ketone supplements? Yay or nay, and why?
Food is primary and you want to get your body into ketosis through foods. Your metabolism is getting better. The goal is not higher ketones. The goal is a healthy amount of ketone levels and nutritional ketosis and in the presence of lower glucose or normal glucose levels as well and lower normal insulin levels. If you’re not changing your foods and you have high insulin, high glucose and you’re taking a ketone supplement, will you get the brain benefits? You probably will. You will get the increase in cognitive function, sharper brain function, you will see that. That’s not the goal for Ketotarian. The goal is to use food as medicine and to have the whole package of the benefits which isn’t just producing ketones or having ketones in your blood from a ketone supplement. It’s also having normal insulin and glucose, which comes with food changes. If you get the food right, you can bring in good quality beta-hydroxybutyrate or a ketone supplement, exogenous ketone supplement and see amplification benefits of increased energy, increased brain function. It’s like the icing on the keto cake. Beyond food, not like the end all be all.True sustainable wellness flows from self-respect. Click To Tweet
What’s your take on intermittent fasting?
It’s definitely a tool that I talk a lot about in Ketotarian because what does it do? It produces ketosis. It amplifies ketosis. It’s both the cause and effect because the more fat adapted you are, the longer time you spend in ketosis, the more you’ll randomly intermittent fast because you’re not as hungry, you’re not angry, you’re more satiated and your blood sugar’s stable. I see it as both cause and effect of a fat adapted life, a state of being. There are different ways you can do it and we talk about time-restricted feeding and intermittent fasting and the way that you should do it as a way that works for your body.
I find that sometimes people get ahead of themselves and they do too much too soon with the fasting. They aren’t fully fat adapted and end up bingeing on some donuts because they’ve starved themselves all day. That’s not what we’re talking about here. You have to lean into it and it’s almost a natural byproduct of having a more stable blood sugar and insulin and you are less irritable and hangry. You don’t have to be snacking in between meals all day. You’ll randomly not eat breakfast in the morning and then you’ll break your fast at noon. It’s an effortless lifestyle approach, not this one size fits all dieting approach.
You mentioned the hangry thing and I always think back to some of my initial trials at intermittent fasting. On a Saturday night will be my last meal and I’d wake up Sunday and drink water all morning, afternoon. By the evening time my wife’s like, “Why don’t you eat something? You’re acting like a jerk.” I learned quickly. The more you do it, the more you get used to it and deal with things a little bit better. Intermittent fasting, especially in the beginning can be difficult when you’re under a lot of stress. It’s always best to do that on the weekend or on a day when you’re not working and you can chill, read a book, go for a walk, do some light activity and maybe catch a little movie or listening to some music. You’ve got twelve-year-old and a nine-year-old. What nutrition do we have them on? For strictly health benefits, I’m not talking about a child with epilepsy or something like that, but where does the idea of going into ketosis with a child?
I do not measure ketones on my kids that’s for sure. We don’t have to be worried about that. We don’t have to be managing ketones on that level and being mindful of that. We know we’re all born depending on ketones for energy. It’s needed for brain development. Babies are breastfed. They are producing ketones as needed for neurological development. Even if kids aren’t breastfed, MCT oil is added to the formula to provide healthy fats. My kids are older and they are living a lower carb to moderate carb, sometimes higher carb days. I would describe it as a mostly plant-based Paleo diet. That’s the way that they eat. There are times when there would be considered low carbo. I’m sure that there’d be days when they would be producing some ketones, but that’s not the main goal.
They’re my kids and I want to make nutrition effortless, grace-filled and have a lightness to it, which is what a lot of the things I talk about in Ketotarian. It’s not become overly obsessed about foods for adults especially that have years and years of dieting, shame and obsession about food. There’s a real problem of orthorexia in the wellness space and a never-ending vortex of conflicting information on Google. It’s stressing all these people out and they’re trying to do the right thing, but they don’t know what they should be doing. I see that in my clinic for my patients. I don’t want that for my kids.
This is what I do for a living, but I want to keep it simple and get to the basics for them so they don’t have to be stressed about food especially for my daughter. There’s so much bad information for girls about food. I teach them that this is the food that is going to make you feel great. This is not about all the foods you can’t have. This is about loving your body enough to nourish it with good stuff and let’s find ways that you can enjoy things similar to your friends but isn’t going to create many problems down the road. I’m trying my best, but that’s my approach to this.
For those young women, I’ve seen plenty of seventeen-year-old girls that come in with palpitations, skipped heartbeats and stuff like that come in for cardiology. I’m always cognizant of that about going into this deep Paleo rant about the foods they should be eating, knowing that there are many different layers to these young women. There are many different social pressures. You get into anorexia, bulimia and stuff like that. It gets into a slippery slope with that. The point you made is trying to encourage these young girls to love, honor and worship their body. It makes sense to put good nutrients into your body to take care of yourself. That’s great info.
I’m doing a chapter four for Mark Houston‘s textbook in integrative cardiology. Mark Houston is a huge leader in functional medicine. You and I were on that list somewhere, but Mark Houston was towards the top of the list. Even though it probably shouldn’t be ranked in order, but nonetheless, it was according to Axe. Houston says he’s writing a textbook in integrative cardiology. I write the chapter on Paleo nutrition. Even though I wrote a book called The Paleo Cardiologist, I came across a book from 1975 called The Stone Age Diet by Walter Voegtlin, who is a German gastroenterologist.
In my Paleo pyramid, the foundation is vegetables. Voegtlin, in his book, he’s done all the studies, all the research. It makes common sense. He’s a GI doc. It’s in 1975. Two-thirds of his recommendation, two-thirds of the diet are animal-based, animal seafood-based. He’s saying that it’s much easier to digest fats, much easier to digest some of these animal-based proteins and more difficult, especially raw vegetables. I’m reading that and I said, “We’ve all been told the foundation of the Paleo pyramid, the Keto pyramid, it’s all about vegetables.” This guy comes along and says that. I thought it was certainly interesting.
I utilize the carnivore protocol. I wrote a book called Ketotarian. It’s a plant-based ketogenic diet. My allegiance, as a functional medicine practitioner is what works for the individual. From the gastro, a gut health standpoint, I find that a lot of times people with these chronic gut issues, a carnivore protocol for a time is advantageous. I don’t see it as forever for them. Maybe you’re two-thirds or whatever the number is for these people with chronic gut problems, but they do have a problem with digesting vegetables.
If you have vegetables, we recommend having them soft, pureed, typically in bone broth for a while to even create some level of gut strength and fortitude where they can digest these plant proteins, fibers, lectins, phytates and all the issues they’re having problems with. I see the carnivore diet or carnivore light protocols as the ultimate elimination diet. You’re moving about everything and then you can start to reintroduce things. The problem is you’re looking at long-term health avoiding vegetables entirely or predominantly. I have concerns from a microbiome standpoint and from a restrictive standpoint. Most people won’t want to eat that way.
It’s the same thing with fruit. The fruit when you’re trying to get into ketosis and you’re going low carb, fruits are out. When you cycle out, you’re going to intake fruits. It’s going to be seasonal, preferably local and all that stuff.
I allow for lower fructose fruits like berries and citrus fruits, normally adding lemons or limes. Small amounts of fruit during those initial eight weeks. After that, if they want to cycle and add more fresh fruits, seasonal fruits, that’s good from an ancestral health standpoint. A lot of times our ancestors would have eaten that way. They were more in ketosis during the winter months and then moderate their carbs during the summer.
We covered everything that I needed to cover. Are there any last points you’d like to make or anything else maybe that you have with something else that we didn’t discuss that’s in the book that would be of interest?
The ethos of Ketotarian for me was this concept of loving your body enough to nourish it with good foods. There are a lot of ketogenic books out there and they cover great stuff. The science of it not only from Ketotarian, but I also wanted to give it a plant-based approach to the ketogenic diet. More than that, truly sustainable wellness flows from self-respect. Getting the macros right, eating these keto foods is one thing, but there are many people that have to get their head in the heart right first, the proverbial heart right first to make these healthy choices. I see many people sabotaging themselves because they haven’t got their relationship with their body or their relationship with food down. When they get that right, then all this other cool stuff, the nutrition stuff that we’re talking about tends to fall in the line more sustainably.
Thank you so much, Dr. Will Cole. We will catch you next time.
- Dr. Axe
- Datis Kharrazian
- Mark Houston
- The Paleo Cardiologist
- The Stone Age Diet
- Ketotarian on Amazon
- Ketotarian on Barnes & Noble
About Dr. Will Cole
Dr. Will Cole, leading functional-medicine expert, consults people around the world via webcam and locally in Pittsburgh. 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 50 functional-medicine and integrative doctors in the nation and is a health expert and course instructor for the world’s largest wellness brands such as mindbodygreen and goop.