S2 Episode 2 - Functional Health Expert Dr Will Cole On Thriving Throughout Menopause


Dr Will Cole on what functional medicine is:

The first thing we do differently in functional medicine is that we interpret labs using a thinner reference range. People will know that when they get their labs, there's a number on that lab sheet and then there's a reference range that they're being compared to. This x to y interval. We get that reference range largely from a statistical bell curve average of people who go to labs. The typical people that go and get labs are people that are going through something - weight loss resistance, digestive problems, hair loss, inflammatory symptoms, anxiety, depression, brain fog, fatigue. The doctor runs the basic labs and they're told that everything looks normal, you must be depressed, take this antidepressant. Or you're just getting older. What they're unintentionally telling their patients, is that to have these symptoms, despite these “normal labs”, is that they’re like the other people with health problems that we're comparing you to. Just because something is common doesn't necessarily make it normal and comparing yourself to people with health problems is no way for you to find out why do you feel the way that you do. So we're looking at optimal not average in functional medicine. We want to compare you, where does vibrant wellness reside? Which typically is going to be a thinner range, within that larger reference range. That's the functional range, that's where we get our name. Where is your body functioning the best? So, if you're not there, can we get you there? And that's going to be our clinical objective there. The second thing is, we realize we're all different. So it's bio individuality and you could have a hundred people with the same set of symptoms, the same diagnosis code, but the underlying driver of it's completely different. So for fatigue, and being labeled with chronic fatigue syndrome, it's really not telling you why you have the problem. So my job is to figure out health history, context, labs, what's causing that? Instead of just labeling somebody with a description of terms. What's the root reason? So that's what I do. We use food as medicine, we use natural medicines, we use medications when needed. Another word for functional medicine is systems medicine or integrative medicine for really integrating the best of all worlds. 

Dr Will Cole on how he helped Gwyneth Paltrow:

I know her as one of my patients and friends that I've got to know over the years and she's passionate about health and wellness, so she's a really great friend in that way. But she's also a really great patient, she's very compliant. Not only myself, but my entire team. We love people that want to do what we say so we can get them better and she's top of the top, like as far as like whatever we say, she will do, and that's brilliant because we can actually get people better and she's seen great success in that. 

Dr Will Cole on how he measures inflammation and how he addresses it in the body:

So inflammation is a product of the immune system that fights out viruses. It's needed for humans to feel good. The problem is homeostasis. It's the Goldilocks principle, not too high, not too low, but just right. Many people have inflammation too high, for too long; chronic inflammation is the term for it. Chronic inflammation is associated with almost every health problem under the sun: hormonal problems, insulin resistance, autoimmune conditions, diabetes, even brain health issues. We quantify this through labs, and health history. The main inflammation tests are: High Sensitivity C Reactive Protein. We want hs-CRP to be above 1, it’s a surrogate lab for different interleukins, different types of inflammatory markers in the body, so it's a good way of gauging where inflammation levels are at. There's a lot of reasons why High Sensitivity C-Reactive Protein can be elevated. So it's non-specific but, it's a good way to look at that inflammation. Homocysteines another one, that has a lot of exciting research around it, it's an amino acid, again just like hs-CRP, it’s not inherently bad in low levels, but you don't want high levels of this because it's an aspect 1of methylation which you need for healthy hormones, detox pathways, healthy brain, healthy mood and regulating inflammation, so homocysteines should be brought down into something called methionine. Then you know we get a little bit more granular in functional medicine and will look at different gut-centric components to inflammation but looking at gut health because that's where 75% of your immune system is. Inflammation is a product of the immune system, so we look at things like calprotectin and lysosome, lactoferrin and we look at intestinal permeability, or leaky gut syndrome which can trigger inflammation levels. So I want to look at inflammation, quantify that, but then it's the commonality between all of these health problems, but what's driving the inflammation itself. So that's where it gets really interesting, where health history and further labs can really say okay inflammation is high, that's not good, but what's driving the inflammation? And that's where that's where my work begins.

Dr Will Cole on the more common perimenopause and menopause symptoms that your patients might present:

Perimenopause and menopause are a completely normal stage of life but people's experience of perimenopause and menopause are completely different. It's not it's not enough to say I have hot flashes, I have low libido, I have difficulty losing weight, I'm having hair changes, I'm having all of these symptoms, that's just normal. Well, if that was the case, then you would see every person with perimenopause having the same exact symptoms and we know that's not true. It could be a component obviously, you're going through a change of life and you're having hormonal changes. But the severity of the symptoms is a pointer that something is unstable and dysregulated, that can be stabilized and regulated. So we're going to see hormonal changes, that's normal, but the severity of what that persons going through, does not, should not, be normalized necessarily. There's a lot of things we can do to create a better resilience and a greater foundational stability. So perimenopause and menopause will come and go, but the person has an effortless grace filled like easy transition. Just that one factor of insulin resistance that I mentioned, is like gasoline on the fire for somebody going through perimenopause and menopause. Underlying gut problems, auto-immune problems, are gasoline on a fire for somebody going through perimenopause and menopause. So perimenopause and menopause in many ways for many people can be the straw that broke the camel's back. Indeed, that could be the tipping point because things were already very fragile, there was not a lot of resilience, and then, when that tipping point was made then it just set off a whole cascade of symptoms. So is it really the perimenopause or menopause that's the problem? Or were there other things that you actually do have agency over? Like you can't change if somebody's going through perimenopause. But you can change the core infrastructural things that are at play, that's causing the lack of resilience in the first place. So then on top of that you can support hormonal balance too. But what I’ve found with that is when we get those core factors looking really great, i.e. insulin resistance and lowering inflammation levels, improving gut health, improving metabolic flexibility, then perimenopause and menopause will be a walk through the park because it will be a change, it will be something to get used to, but it won't be as this violent storm that many people find themselves in. 

Dr Will Cole’s tips for insulin resistance or lowering inflammation:

The foods we're eating are foundational and even healthy foods. What works for one person may not be right for the next person. Just because something is better doesn't mean it's optimal for you. So I would start with looking at foods that can contribute to metabolic inflexibility. Every food we eat either feeds inflammation or fights it, there's no neutral food for your biochemistry. 

The foods most likely to impact your blood sugar negatively are what I call the Inflammatory Core Four. So these are the four food ingredients that are most likely to drive inflammation and mess up your blood sugar. Number one would be gluten containing grains. So things like wheat, rye, barley and spelt. You can have a nuanced opinion about this because I do actually. I think its what we've done to the grains more than the grains themselves, especially in the States, like in the UK and in Europe it's less likely to be problematic. It's the glyphosate's implication in what's going on there. But beyond glyphosates, it's the hybridization, the genetic modification of the grains. It's a different grain than it was thousands of years ago. Humans would have eaten these things typically in higher amounts during times of famine because they stored well. Now we’re feasting on famine foods all year around, it is out of alignment with our bio-chemistry, to always be consuming it and then on top of that, it's not prepared properly, it's genetically modified, hybridized. It's a confluence of factors, that's not the grain, but for the sake of simplicity look at gluten containing grains. Second would be added sugar. Really educate yourself on the labels and look at the grams of added sugar because there's things like Agave Nectar that sounds so natural but it's in fact quite highly-processed, high in fructose. Sugar with a lack of fiber is not good for your metabolism so look at those added sugars. The third would be industrial seed oils like canola oil, vegetable oil, soya oil. Again highly-processed out of the wholefood form and really can be disruptive to the microbum and pro-inflammatory, because of the balance of omegas 3, 6 and 9, which are these polyunsaturated fats. The modern western diet is very high and out of balance with omega 6s, which those polyunsaturated oils are high in omega 6. So those oils can work if you're eating lots of omega 3s and then you're not having so many of those package boxed foods with these industrial seed oils. The problem is people are having so much of the boxed stuff with the high omega 6 oils and not enough of the omega 3 which is from wild caught fish and seafood and things like that. The fourth would be conventional dairy. The problem is most people are just having straight up dairy milk where the cows are fed grains and not grass and then on top of that what we've done to the cows. So it's what we've done to the industry more than the cow itself, and that's why people tend to tolerate sheep cheeses and goat cheeses and goat milk over the cows because of the cross breeding of cows. So you'll see a lot of stores have cropping up these A2 milks and that's because they're from these Jersey cows and types of breeds that are still having the old casein that we would have evolved with as humans now most dairy has the beta A1 casein which is more inflammatory.  It really can be summarized by what researchers call a genetic epigenetic mismatch. Our genetics haven't changed in 10,000 years, but our world has changed very dramatically in such a finite period of time when you're looking at the context of the totality of human history. It's the evolutionary mismatch of what's driving this pro-inflammation issue. 

Dr Will Cole on HRT for women with perimenopausal symptoms:

I see it being a tool within the tool box for many people. We want to understand the bio terrain and the context of what's appropriate for that person. Sometimes it's the obvious easy thought like let's get some exogenous hormones in the system and it can be a game changing symptom relief for some people which is great and it should be monitored. Some of them can come with potential side effects, you want to be judicious and have it monitored by a doctor. A vast amount of people that are doing HRT aren't really seeing any benefits from it. It may take the edge off of it or they had a honeymoon period with it where it was good for a few weeks and then it went away and doesn't help any issues long term. My interest here from a diagnostic standpoint is to ask the question of what is contributing to that volatility? What's contributing to that tipping point that's causing these symptoms like hot flashes, or low sex drive, or sleep issues, or weight loss resistance, or anxiety, depression. What's driving that? And yes estrogen, progesterone, testosterone could be part of it. But I see many people that are teenagers, in their twenties, in their thirties, that are not perimenopausal, but when you run diagnostics on them, their hormones look perimenopausal, just like the perimenopausal person. They have the same sort of hormonal female symptoms that can mimic perimenopausal symptoms. So there's a lot of female hormonal problems going on that is always blamed to be perimenopausal and menopause. We can make perimenopause and menopause a lot more easy and enjoyable, when we deal with these underlying drivers. When the body stressed out, and I mean physiologically stressed, meaning underlying problems is stressful, chronic infections, it's stressful on the body, and psychological stress too, work and your relationships and unresolved trauma from the past, that's also stressful, that shifts the nervous system in more of a sympathetic fight or flight stressed state. Anybody's hormones are going to look not great when you're in that stressed state because hormones are like biochemical emails, so you can't expect hormones to be balanced and steady when somebody has those physiological and psychological stresses. When we start dealing with the physiological stress, just dealing with the psychological stressors, the hormones, the estrogen, progesterone, testosterone, could still be in the perimenopause and menopause range, but the person feels amazing. So let nature do what it's going to do, but if they feel amazing, there's not a need for HRT at that point. It still may be a tool within their tool box then because maybe they got 90% better but they still have this little inkling thing that they want to fix, so they try the bioidentical progesterone with their doctor. And when the person's health is better, their guts healthier, their inflammations levels are lower, their blood sugar is more balanced, then HRT may be a very, very effective tool within their tool box as the terrain is more bio available. You could be doing so much higher than what you should be which can create hormonal resistance and has whole load of other problems if it's done too much for your body and everybody is different or you may not be dosing enough. You want to look at lab data and symptoms, the subjective and the objective, to really see what's appropriate there. So I think it has its place, I think we just need to clean up how we're integrating this into people's lives. 

Dr Will Cole on alcohol consumption:

So pragmatically, as a clinician, I realize I'm not going to have a bunch of T-totalers as patients. If you're going to have this, have it rarely and go for the cleaner option for it. I don't want to demonize or shame anybody for their decisions but I want them to be informed and make the decision for themselves and just use take a mindful inventory of your health and say, is it serving me? I would say my experience is patients when you get them feeling really great, they like feeling great more than they thought they wanted something. It's a bad trade off having something that's going to dim your light and if they're going to choose to do it, they're going to choose to do it lot less often because they have more consciousness around it, a lot more intuition and mindfulness of what their body loves and what their body hates. And avoiding things that don't love you back isn't restrictive, its self respect. And nourishing your body with things that do love you back is a form of self respect. So it's that paradigm shift.  The research is clear alcohol is a neurotoxin. There's not a healthy amount of alcohol. The studies are pretty astounding, and really looking at even small amounts of alcohol are linked to brain damage, decreased size of brains, impacting nerve brain health and nervous system health. So it's not advised at all but if someone says no if I'm going to drink what would you recommend? Then I would say organic, biodynamic, regenerative wine that's low sugar as well or like hard kombucha or something like that. So that's my position on it.