Interview with Dr. Will Cole, Functional Medicine Expert on Inflammation and Gut Health

Some health conversations instantly make us rethink the way we look at symptoms, lab work, food, stress, and the whole idea of what it means to feel well. This is one of those conversations.

Dr. Thais Aliabadi and Mary Alice Haney sat down with Dr. Will Cole to talk about functional medicine, inflammation, gut health, insulin resistance, thyroid testing, stress physiology, and the practical tools that can actually move the needle. The biggest theme running through all of it was simple. We should not wait until disease is obvious and advanced before paying attention.

Instead, we can start asking better questions earlier. Why are we exhausted? Why is weight loss unusually hard? Why are periods irregular? Why are digestion, skin, mood, and energy all off at once? Why does standard blood work sometimes come back “normal” when we still feel far from our best?

Table of Contents

• Getting to the root cause
• Functional medicine versus conventional medicine
• Books, fasting, and personalized nutrition
• Gut health without the hype
• What a functional medicine intake looks like
• Essential lab tests and why they matter
• Why insulin resistance is such a big issue
• How Dr. Cole thinks about inflammation
• Stress, so-called adrenal fatigue, and nervous system health
• How people can work with Dr. Cole
• What we took away from this conversation
• FAQ

Getting to the root cause

How did we begin this conversation about functional medicine?

We began with origin story, because it explains a lot about the philosophy behind the work. Dr. Will Cole has been interested in health for as long as he can remember. He grew up around fitness culture, health food stores, supplements, and experimentation long before phrases like biohacking became mainstream.

That early curiosity eventually became formal training in integrative medicine and a career focused on helping people uncover why their bodies are struggling, not just what diagnosis label they may qualify for. Over time, he built a virtual practice before telehealth was even common language. The through line was always the same: figure out the underlying drivers of hormonal issues, autoimmune concerns, digestive problems, fatigue, and metabolic dysfunction.

That root-cause mindset is what makes functional medicine so appealing to people who have felt dismissed, rushed, or told that everything looks fine when they know something is not right.

What wellness tools does Dr. Cole believe actually help?

When asked which “biohacks” are worth paying attention to, he focused less on novelty and more on tools that support how the body is designed to function.

Among his favorites:

• Infrared sauna for circulation, mood support, lower inflammation, and support of detoxification pathways
• Cold exposure in measured amounts, not in excess, to help with inflammation and vagal tone
• Hyperbaric oxygen therapy for people dealing with brain fog, fatigue, and metabolic issues
• Ozone therapy in specific cases such as chronic infections, mold-related illness, or stubborn gut imbalances

His framing was helpful. These are not magic tricks. In many ways, they recreate the kind of environmental variability human beings were once exposed to more naturally. Hot and cold. Movement and recovery. Seasonal variation. Less comfort, more resilience.

That does not mean everybody needs every tool. It means the right tool, used at the right time, can support healing.

Functional medicine versus conventional medicine

What is the real difference between functional medicine and standard care?

The most practical difference came down to three things.

1. How labs are interpreted
2. How comprehensive the testing is
3. How personalized the treatment plan becomes

In conventional care, lab reference ranges are built from statistical averages. The problem is that average does not necessarily equal healthy. If much of the population is inflamed, sleep deprived, insulin resistant, stressed, and undernourished, then “normal” can still describe a body that is not functioning optimally.

Functional medicine often looks at narrower, more ideal ranges to catch dysfunction earlier. That matters because many chronic conditions build quietly over years before they cross the threshold into diagnosis.

The second difference is scope. Instead of looking only for overt disease, the approach may include a deeper look at gut health, microbiome balance, nutrient deficiencies, hormone patterns, inflammation markers, environmental toxin exposure, and the interplay between them.

The third difference is what happens after the testing. Rather than placing every person with the same diagnosis on the same basic path, the plan is built around bioindividuality. Two people can both have fatigue or insulin resistance and still need very different interventions.

This is one reason so many people with complex issues seek out additional support. It is also why blending good conventional medicine with a root-cause approach can be powerful. Preventive care matters. Early intervention matters. Listening matters.

For anyone navigating hormonal symptoms connected to insulin resistance, irregular cycles, acne, or excess hair growth, this overview on Polycystic Ovary Syndrome (PCOS) adds useful context about diagnosis, risks, and treatment options.

Books, fasting, and personalized nutrition

How do Dr. Cole’s books reflect his approach?

His books came out of repeated questions from patients. When enough people keep asking for help around the same topic, that usually means there is a wider need for education.

The titles map closely to his main areas of focus:

• Intuitive Fasting
• Gut Feelings
• Ketotarian
• The Inflammation Spectrum

Each tackles a major health issue through the same lens. Context matters. Personalization matters. Extremes are rarely the answer.

What does “intuitive fasting” actually mean?

The conversation around intermittent fasting is often too rigid. Some people act as if everyone should fast the same way. Others reject fasting entirely, especially for women. Dr. Cole’s view lands in the middle.

Fasting can be useful because it creates a mild stress that encourages resilience. But like any stressor, more is not always better. The dose matters.

For women especially, timing matters. He described fasting as something that should work with the menstrual cycle rather than against it. There may be times of the month when a woman can tolerate a longer fasting window and times when she should ease up or not fast at all.

He also emphasized that not all women respond the same way. A woman with PCOS and insulin resistance may benefit significantly from cyclical intermittent fasting, while a woman without those issues may need a gentler approach.

That nuance is important. We do not need another all-or-nothing food rule. We need strategies that fit physiology.

Gut health without the hype

Where should we start if we want to improve gut health?

The first principle was refreshing because it cuts through so much supplement marketing. Food comes first.

We cannot out-supplement a diet that is constantly working against us. Prebiotics, probiotics, postbiotics, and every other clever label in the gut-health world only make sense when the foundation is solid.

That means building meals around real foods that support microbial diversity, especially a variety of plant foods when tolerated. Fiber-rich foods feed beneficial bacteria, which then produce compounds that support gut and immune health.

But again, nuance matters. Someone with SIBO or significant gut irritation may not tolerate high-fiber foods right away. In that situation, pushing raw vegetables and huge salads can make things worse. Sometimes healing begins with temporarily reducing fiber, calming the gut, and slowly rebuilding tolerance over time.

He also highlighted polyphenol-rich foods such as extra virgin olive oil, green tea, and even coffee as helpful for the microbiome.

Are probiotics useful?

Yes, but they are not a substitute for nutrition. He likes high-quality, third-party tested spore-based probiotics in the right setting. The key is using supplements as support, not as a shortcut.

That distinction matters because gut health is now a crowded marketplace. It is easy to buy a bottle and hope for the best. It is harder, but much more effective, to ask whether we are eating in a way that our digestive system can realistically handle and benefit from.

What is a simple way to assess digestion before any test?

Start with bowel movements. Not glamorous, but very useful.

He gave a very practical benchmark. Ideally, we should have well-formed bowel movements two to three times a day. If we are chronically constipated, frequently loose, or passing tiny hard pellets, our body is giving us information.

These are not random inconveniences. They can signal microbiome imbalance, poor motility, inflammation, stress dysregulation, or other digestive dysfunction.

From there, additional testing may include stool analysis, blood work, or a SIBO breath test depending on the person’s symptoms and history.

What can help constipation if bowel movements are infrequent?

When the example came up of someone only having a couple of bowel movements a week, the answer was not a single fix. It was a layered approach.

That may include:

• Supporting motility
• Evaluating for dysbiosis or SIBO
• Increasing fiber only to the point of tolerance
• Using calming practices such as breathwork and meditation
• Considering magnesium support
• Trying probiotic-rich foods
• Bringing in healthy fats
• Using herbal support such as triphala

He also mentioned a morning mixture of apple cider vinegar with “the mother” plus extra virgin olive oil as something some people find supportive.

And importantly, medication review matters too. Some commonly used medications can contribute to constipation and should not be overlooked.

What a functional medicine intake looks like

What happens during an initial visit in Dr. Cole’s practice?

His clinic has always been virtual, but the depth of intake is what stands out. The first visit is long, often around ninety minutes, sometimes more depending on case complexity.

The goal is not to rush to a protocol. It is to understand the whole picture.

That includes detailed symptom history, timeline, lifestyle, stress, digestion, hormone patterns, cravings, sleep, and even small clues that many people have never been asked about before. He gave examples such as thinning of the outer third of the eyebrows, which can be associated with thyroid dysfunction, or strong cravings for salty foods, which may point the practitioner in a certain direction.

What we appreciated most in this part of the conversation was the emphasis on feeling heard. Real healing relationships begin there. People often know when something is wrong long before they have the data to prove it. Being listened to carefully is not a luxury. It is part of good medicine.

Essential lab tests and why they matter

Which tests does Dr. Cole consider especially important?

When asked for the top tests people should know about, he focused heavily on markers connected to blood sugar regulation, inflammation, thyroid health, and nutrient status. These are areas where subtle dysfunction can show up long before obvious disease.

Here are the main ones he highlighted:

• Fasting glucose, ideally under 90
• Hemoglobin A1C, ideally under 5.7
• Triglycerides, ideally under 100
• HDL cholesterol, with an optimal target around 59 or higher
• Advanced lipid panel such as NMR to look at particle size and insulin resistance context
• High-sensitivity C-reactive protein for inflammation, ideally under 1
• Homocysteine, ideally under 7
• Iron studies including ferritin, with ferritin ideally around 80 for female hormone health
• Full thyroid panel including TSH, free and total thyroid hormones
• Thyroid antibodies to assess for autoimmune thyroid disease such as Hashimoto’s

One striking point here was how often ferritin is far below ideal in women. Heavy periods, chronic stress, poor intake, and other factors can leave iron stores depleted in a way that affects energy, hair, mood, and hormone health.

Thyroid antibodies were another major point. Low thyroid function is often driven by autoimmunity, and if we only run a minimal thyroid panel, we can miss the autoimmune component entirely.

Why insulin resistance is such a big issue

Are we seeing more insulin resistance than ever?

Yes, and not just in adults. It is showing up across the age spectrum.

Dr. Cole noted that only a small minority of people in the United States are metabolically healthy. That means many people are somewhere on the spectrum of dysfunction, even if they have not yet been diagnosed with diabetes or cardiovascular disease.

This is exactly why catching subtle warning signs matters. Elevated fasting glucose, rising triglycerides, low HDL, and inflammatory markers can all tell us that the body is struggling long before something more dramatic happens.

Insulin resistance is particularly relevant in women’s health because it sits at the center of so many issues, including PCOS, weight loss resistance, fertility struggles, and chronic inflammation. If you want a patient-friendly look at how nutrition and movement can help, this guide to PCOS diet and exercise is a useful companion read.

How does he approach treatment for insulin resistance?

The plan starts with food, but it does not end there.

He looks at:

• Nutrition that supports stable blood sugar
• Gut health and the microbiome
• Supplemental support for glucose regulation and insulin sensitivity
• Inflammation reduction
• Environmental toxin burden
• Detoxification support where appropriate, including glutathione or related support

The main idea is that metabolic dysfunction is rarely caused by one thing. It is usually the combined effect of diet, stress, inactivity, sleep disruption, inflammation, and environmental burden. That is why the response often has to be comprehensive too.

How Dr. Cole thinks about inflammation

What are the main foods that can drive inflammation?

One of the most memorable frameworks from the conversation was what he calls the “inflammatory core four,” with an added fifth.

These are the foods or exposures he most often sees as problematic when the body is already in a state of dysregulation:

1. Industrial seed oils such as canola, soybean, and generic vegetable oils, especially in excess and in the context of low omega-3 intake
2. Added sugar, including “health halo” sweeteners that still create blood sugar disruption
3. Conventional dairy, particularly because of how modern processing has changed it
4. Gluten-heavy modern wheat products, not necessarily because the original food was inherently problematic for everyone, but because of overconsumption and how it has been altered, refined, and processed
5. Alcohol, which he bluntly described as having no truly healthy amount according to the research

His point was not that everyone must avoid all of these forever. It was that when the body is inflamed, certain inputs may be making recovery harder. Once resilience improves, some people can reintroduce certain foods in moderation.

That is a much saner message than extreme restriction. It is about boundaries, not fear.

What foods does he want people to eat more of?

He was clear here too. Do not get so caught up in cutting foods that we forget to build a nourishing plate.

He encourages people to emphasize:

• Adequate protein, with a rough minimum target of 100 grams a day for many adults
• Healthy fats such as extra virgin olive oil, wild-caught fish, grass-fed meats, and similar whole food sources
• Whole fruits, without unnecessary fear unless there is a specific short-term reason to limit them
• Fiber-rich carbohydrates as tolerated, especially once insulin sensitivity improves

His fruit comment was especially good. If a way of eating makes us afraid of a banana, something has probably gone too far. Fruit is not why modern metabolic disease is rampant.

That said, he did acknowledge that in active insulin resistance, temporarily moderating carbohydrates can help, as long as the larger goal is restoring flexibility and tolerance rather than creating lifelong food fear.

What if healthy foods still make us bloated?

Then the issue may not be the food itself. It may be that the gut is too irritated to handle it well right now.

For people with digestive distress, he often leans on softer cooked foods for a period of time. Think soups, stews, and broths rather than giant raw salads. This gives the digestive system a break while still providing nourishment.

Bone broth came up here too as one of his favorite supportive foods for a stressed, inflamed gut.

If fertility is part of the bigger picture, this discussion also connects well with the broader relationship between metabolic health and conception outlined here: does health impact fertility.

Stress, so-called adrenal fatigue, and nervous system health

How does Dr. Cole think about adrenal fatigue?

He reframed it in a helpful way. What many people call adrenal fatigue is often better understood as a brain and nervous system issue involving the communication between the hypothalamus, pituitary, and adrenal glands.

In other words, the adrenal glands are often responding to chronic signals from an overworked stress system. The real problem is not simply “tired adrenals.” It is a body stuck in survival mode.

That can look like:

• Feeling wired and tired
• Poor sleep
• Anxiety
• Exhaustion
• Hypervigilance
• Trouble recovering from normal life demands

He connected this strongly to poor vagal tone. The vagus nerve plays a major role in helping us shift into the calm, restorative state where digestion, repair, and recovery happen. When that system is underactive, we feel the effects everywhere.

What helps restore that balance?

The answer is not glamorous, but it is important.

• Consistent sleep support
• Breathwork
• Meditation
• Moments of stillness
• Healthier boundaries
• Reducing overload where possible
• Supporting gut health
• Tools like sauna or cold exposure when appropriate

This part of the discussion felt especially real because it acknowledged what many people already know. Most of us are not going to walk away from our responsibilities overnight. We need ways to move through real life with more resilience, not fantasies about escaping it.

Which supplements does he like for chronic stress?

He highlighted adaptogens as a useful category for supporting the stress response, especially when paired with lifestyle changes.

Some favorites included:

• Tulsi or holy basil
• Ashwagandha
• Lion’s mane
• Reishi

He also singled out magnesium as a major clinical needle mover. Many people are low in magnesium, especially under chronic stress, because they are using more than they are replenishing. He likes forms such as magnesium threonate for nervous system support and magnesium glycinate for overall calming support.

That point landed because it is practical. Sometimes the body is not failing us. Sometimes it is depleted.

How people can work with Dr. Cole

What does access to his practice look like?

His work is centered at drwillcole.com and through The Art of Being Well podcast. His clinic offers multiple paths depending on need and budget, including concierge-style one-on-one care as well as lower-cost group and hybrid models designed to make functional medicine more accessible.

That accessibility piece matters because root-cause care can feel out of reach for many people. The effort to create more entry points is an important part of the larger conversation about prevention and education.

He also shared something unexpectedly charming about his patient base. Many are nurses, teachers, engineers, and entrepreneurs. His theory was that they tend to love both data and problem solving. They want to understand the patterns, look at the numbers, and figure out what is actually going on.

Honestly, we get it.

What we took away from this conversation

If we had to sum it up, what stands out most?

A few big truths rose to the top.

• Symptoms are information, not inconveniences to ignore.
• Average lab ranges do not always reflect optimal health.
• Inflammation is not the enemy, but chronic dysregulated inflammation is.
• Gut health affects far more than digestion.
• Insulin resistance can begin years before diagnosis and influences many other conditions.
• Stress physiology is whole-body physiology.
• Personalization beats dogma every time.

Most of all, we were reminded that feeling unwell is not something we need to normalize just because it is common. Brain fog may be common. Weight loss resistance may be common. Constipation may be common. Hormonal chaos may be common. But common and normal are not the same thing.

There is a lot we can do when we start asking deeper questions.

FAQs

What is functional medicine?

Functional medicine is an approach that looks for the underlying causes of symptoms and chronic illness. It often uses more detailed history taking, more comprehensive lab testing, and personalized treatment plans focused on nutrition, lifestyle, supplements, and targeted therapies.

How is functional medicine different from conventional medicine?

The main differences discussed here were a stronger focus on prevention, narrower interpretation of lab ranges for optimal health, broader testing when needed, and more individualized treatment instead of a one-size-fits-all plan.

What are signs that gut health may be off?

Constipation, diarrhea, pellet-like stools, bloating, discomfort after meals, and irregular bowel habits can all be signs that the gut or microbiome needs attention. Dr. Cole emphasized that bowel movements are one of the most useful everyday indicators of digestive health.

What labs are important for inflammation and metabolic health?

Key tests mentioned included fasting glucose, A1C, triglycerides, HDL, advanced lipid testing such as NMR, high-sensitivity CRP, homocysteine, iron studies including ferritin, and a full thyroid panel with thyroid antibodies.

What foods are most associated with inflammation in this approach?

The main problem foods highlighted were industrial seed oils, added sugar, heavily processed conventional dairy, modern overprocessed gluten-heavy foods, and alcohol. The point was not permanent restriction for everyone, but being honest about which inputs may worsen inflammation when the body is already struggling.

Can intermittent fasting help women with PCOS?

It can, especially when done in a cyclical and personalized way. Dr. Cole noted that women with PCOS and insulin resistance may respond well to intermittent fasting, but the approach should take hormone status and menstrual cycle timing into account.

What helps with stress and so-called adrenal fatigue?

The conversation emphasized nervous system regulation through sleep, breathwork, meditation, recovery time, better boundaries, and targeted supplements such as adaptogens and magnesium. The goal is to help the body shift out of chronic fight-or-flight mode.

This article was created from the video Dr. Will Cole: Breaking Down Inflammation and The Functional Medicine Guide to Gut Health | SHE MD for Dr. Thais Aliabadi’s website.