Eleven Steps for Overcoming Alzheimer’s and Other Chronic Infectious Diseases

If Alzheimer’s is due to bacterial infection, as I suggested yesterday (http://perfecthealthdiet.com/?p=126), then it can be treated by diet, supplements, and antibiotics.

Here are eleven steps that can help defeat chronic bacterial infections, including the infections that cause Alzheimer’s. (Note:  I will justify each of these eleven steps, and cite to the scientific literature, in follow-up posts.)

1. Normalization of Vitamin D Levels.

Vitamin D is needed for the transcription of anti-microbial peptides, such as the cathelicidin LL-37 and beta-defensin, which are essential for defense against intracellular bacteria and viruses. Vitamin D deficiency is a risk factor for every chronic infection, and chronic infections tend to increase in frequency with latitude and progress most rapidly during the winter when vitamin D levels are low.  In general, a serum 25-hydroxyvitamin D3 level of 40 ng/ml (100 nmol/L in SI units) is a good target. (Some people, such as Dr. John Cannell of the Vitamin D Council, believe there may be benefits to higher levels, but this is speculative.)

2. Restriction of Carb Intake to 400 Calories Per Day.

Eating a carb-rich diet is doubly bad:  it increases blood glucose levels and triggers insulin release, both of which promote bacterial infections.

Intracellular parasitic bacteria need glucose or its glycolytic products to obtain energy. Abundant cellular glucose, caused by high blood glucose levels, enable them to reproduce and generate immune-impairing proteins more prolifically.

Insulin represses immune defenses against parasitic bacteria, by blocking production of antimicrobial peptides.

To keep both blood glucose and insulin levels low, carbohydrate consumption should be restricted to about 400 calories per day – the amount in 0.3 pounds of cooked white rice, or 1.3 pounds of sweet potatoes.

3. Restriction of Protein.

Eating minimal protein helps in two ways: it deprives bacteria of amino acids necessary for growth, like tryptophan; and it promotes autophagy, the primary means by which cells kill intracellular pathogens.

Indeed, the body’s primary defense mechanism against C. pneumoniae is tryptophan deprivation. This is why people with chronic brain infections have symptoms of serotonin deprivation, including depression, anxiety, insomnia, fatigue, impaired ability to concentrate, and low self-confidence. It’s important not to relieve this by tryptophan or 5-HTP supplementation, both of which promote bacterial growth. If symptoms are intolerable, selective serotonin reuptake inhibitor (SSRI) antidepressants, like Prozac, Paxil, or Zoloft, might be able to provide symptomatic relief. (NB: We neither recommend nor disparage these drugs.)

4. Intermittent Fasting

Autophagy is the garbage collection and recycling process of human cells.  When resources are scarce, cells turn on recycling programs and send garbage collectors known as lysosomes to engulf and digest junk proteins and damaged organelles, enabling re-use of their amino and fatty acids.

Autophagy is a key part of the immune defense against parasitic bacteria.  Lysosomes not only digest human junk, they seek out bacteria and digest them. 

Autophagy is strongly turned after about 16 hours of fasting. The longer one fasts, the more parasitic bacteria are destroyed in lysosomes.  Fasting is an easy way to improve the relative balance of power between your body and intracellular pathogens. Fasting strongly promotes autophagy in neurons, and is of therapeutic value for Alzheimer’s.

A simple strategy of intermittent fasting is to confine meals to an 8-hour window each day, thus engaging in a daily 16 hour fast.  On this strategy, one might eat only between noon and 8 pm.

5. Ketogenic Fasting.

Two dangers of fasting are that it can lead to loss of muscle tissue as protein is consumed to generate ketones and glucose, and that neurons may be put under stress by glucose deprivation.

Both dangers can be ameliorated by eating ketogenic fats during the fast.  “Ketogenic” means generative of ketone bodies. Ketone bodies, which are generated from fats or some proteins during fasting, are the only neuronal energy source that bacteria can’t steal. There is a large literature showing that high circulating ketone levels are neuroprotective, and ketogenic diets have been successfully tested as Alzheimer’s therapies.

The most ketogenic fats are the short- and medium-chain fats found abundantly in coconut oil. Taking plentiful fat calories from coconut oil, but no carb or protein calories and few other fats, can enable fasts to be extended substantially longer with minimal loss of muscle tissue or neuronal stress.

On a ketogenic fast, eliminate carbs and protein for a 36-hour period, from dinner one day to breakfast on the second day.  During the intervening day, eat no protein or carbs, but do eat as much coconut oil as you like.

There is no limit on how much coconut oil may be consumed – but 12 tablespoons per day would produce a surfeit of ketones. NB: Always drink plenty of water during a fast. We also drink coffee with plentiful heavy cream.

6. Elimination of Wheat and Other Grains. 

Wheat is a toxic food that interferes with immune defenses and impairs vitamin D function. It also generates antibodies to the thyroid, which damage the thyroid status and further impair immune function.

7. Elimination of Omega-6-Rich Oils and Inclusion of Omega-3-Rich Fish.

A diet that minimizes omega-6 content by replacing soybean oil, corn oil, canola oil, and other omega-6 rich oils with butter, coconut oil, and beef tallow, and gets adequate omega-3 fats by eating salmon or other cold-water fish, optimizes the immune defense against intracellular pathogens.

A high omega-6 and low omega-3 diet weakens immune defenses against intracellular pathogens and re-directs the immune system toward extracellular threats.

Note that the combination of carbohydrate, protein, and omega-6 fat restriction necessarily means that half or more of calories should be obtained from saturated and monounsaturated fats.  It is important not to have a saturated fat phobia if you want to escape or defeat Alzheimer’s!

8. Fructose Minimization.

Fructose is a toxin and is deprecated on the Perfect Health Diet. One of its worst features is that promotes infections. In mice, blood levels of endotoxin, a bacterial waste product, are higher on a fructose-rich diet than on any other diet.

Therefore, sugary foods like soft drinks should be eliminated.  Fruit and berries are OK in moderation.  We recommend no more than 2 portions of fruit and berries per day. Most carb calories should be obtained from starchy foods, like sweet potatoes or taro or white rice.

9. Melatonin supplementation. 

Whereas vitamin D is the “daylight hormone,” melatonin is the “hormone of darkness.”  It is generated during sleep, and is favored by darkness.  Even a little bit of light at night, like the LEDs of an alarm clock or streetlights shining through a window, can disrupt melatonin production.

Melatonin is extremely important, not least because it has powerful antibiotic effects.

To maximize melatonin production, everyone should sleep in a totally darkened room, with windows covered by opaque drapes and all lights extinguished and LCD or LED clocks turned face down.

Unfortunately, people with chronic bacterial infections will generally still be melatonin-deficient, for the same reason they are serotonin-deficient:  melatonin is derived from tryptophan and serotonin. Fortunately, melatonin is easily supplemented.

A melatonin tablet can be allowed to dissolve in the mouth just before bed. High doses will generally produce a deep sleep followed by early waking; this can be remedied by using time-release capsules, or by reducing the dose.

10. Selenium and Iodine Supplementation and Thyroid Normalization.

This is basic for good health in all contexts, but optimizing thyroid hormone levels and maintaining iodine and selenium status are especially important for anyone with an infection.

Both selenium and iodine are required for proper immune function. To get iodine, white blood cells will strip iodine from thyroid hormone; for this reason, people with chronic infections are often somewhat hypothyroid, as indicated by TSH levels above 1.5.

There are too many tricks and pitfalls to thyroid normalization to describe the whole issue here, but a good start is to eliminate wheat from the diet, and to obtain 200 mcg selenium and at least 400 mcg iodine per day. Do not get too much selenium as it is toxic.  Selenium and iodine may be obtained from foods:  two to three Brazil nuts a day for selenium, and seaweed for iodine.

11. Vitamin C and Glutathione or NAC Supplementation.

These are important for immune function. Vitamin C supplementation is an important safety precaution because infections greatly increase the rate of loss of vitamin C, and can generate tissue scurvy with devastating consequences.

Glutathione is destroyed by stomach acid. We recommend buying reduced glutathione and taking it with a full glass of water on an empty stomach, at least 2 hours after and 1 hour before taking food. Alternatively, N-acetylcysteine (NAC) and glycine-rich foods like gelatin may be taken to promote glutathione synthesis.

Conclusion

This is by no means an exhaustive list of dietary and nutritional steps that can help against chronic infections.  However, we believe these are the most powerful and important steps.

Alzheimer’s and other diseases caused by chronic bacterial infections – possibly including multiple sclerosis, Lyme disease, chronic fatigue syndromes, fibromyalgia, rheumatoid arthritis, and many others – are preventable, treatable, and often curable.  These dietary steps, along with appropriate antibiotic therapy, are keys to a cure.

Leave a comment ?

160 Comments.

  1. I think you are on to something, but it’s too complicated for me to follow on a surface level and I have neither the inclination nor aptitude to make a study of it as you have, nor do I know a doctor who would take any of it seriously.

    Do you know of anywhere in central Florida where such a physician could be found and will your book contain a section written for medical dummies to follow outlining suggested diet plans?

    Fasting sounds like something I could do, but coconut is one of the few foods I can’t tolerate. Even the smell of coconut is disagreeable. You say fasting, yet also say to have coffee with cream. Please define what you mean by fasting.

    Thanks so much.

    • erp – Unfortunately I don’t know doctors in Florida. Finding a good doctor is hard. Most doctors have a limited repertoire of diagnoses and prescriptions, and don’t like to innovate. Lyme doctors tend to be most familiar with these issues, but your best bet may be a general practitioner who knows you and knows you aren’t the sort who imagines ailments.

      I also despise coconut. Fortunately extra virgin coconut oil tastes far better than coconut. The kind I buy is here: http://www.amazon.com/gp/product/B001EO5Q64/

      As far as our book, yes, in our revisions this summer we’re trying to make the book accessible to “medical dummies”. One reason we’ve chosen to do a color book is so that we can have pictures of food, to illustrate what to eat. I hope to do some easier blog posts later too.

  2. Hi erp,

    Fasting is limited eating. I see a continuum:

    • One extreme is a total fast (no food, just water) is the most arduous and if sustained for a long time would cause starvation, malnourishment, and health damage.
    • The opposite extreme is a full-calorie diet optimized for fighting bacterial infections. That is basically the “ketogenic diet” that is in clinical use for epilepsy, brain cancer, and some other conditions. It is a low-carb, high-coconut-oil, high-fat diet. This diet could be eaten daily for a lifetime.

    Now imagine a partial fast that is halfway between these two. The partial fast aims to get just as much medical value per day as the total fast, by excluding the carbs and proteins that feed the bacteria, but includes useful fat calories and nutrients, so that the fast can be maintained for much longer.

    The Perfect Health Diet is more carb-rich and coconut-oil-poor than the ketogenic diet. This is not quite optimal for bacterial infections, but more fun to eat and healthier in other respects. To fight bacterial infections, I am suggesting living the Perfect Health Diet six days per week and a partial ketogenic fast 1 day per week. I think this is probably the optimal strategy, and easier and more pleasant than alternatives.

    I’ll respond to your other points in a second comment.

  3. It’s nice to know I’m not the only one who doesn’t like coconut. A couple of doctors did try to help. I had extensive tests for allergies (none showed up), also stopped wheat, gluten, corn, dairy, some other stuff … for months — no changes and an ENT tried a series of three different antibiotics for 21 days each, also no help.

    I’ll wait until your book is ready and then try to adapt to it.

    • Hi Paul:-) Hope you will notice my question.

      I have been fighting chronic viral infections forever, and I really need some help. I cant afford to lose weight, so can’t go low carb. But this suggestion you made for Erp may be very helpful.
      How would this one a week fast day look like? I am thinking low carb veggies, soups and fats like coconut fat, cream, butter? does that sound right? and should it be fairly low calorie as well? thnx!!!

  4. Yes, unfortunately this is not something that can normally be cured quickly. A good diet makes the cure much easier and quicker however.

  5. Per your post above: A melatonin tablet can be allowed to dissolve in the mouth just before bed. High doses will generally produce a deep sleep followed by early waking; this can be remedied by using time-release capsules, or by reducing the dose.

    What dosage do you recommend? They seem to come in from 3 mgs to 50 mgs capsules and will capsules do or must they be sublingual to be effective?

  6. Sorry, for the previous comment. I didn’t notice that the search came up with stuff other than melatonin which apparently comes in only 3 mg capsules. You recommend that they be dissolved rather than swallowed?

    • Hi erp. There are many doses of melatonin available. The best dose for me is in the 1 mg to 2.5 mg range. Anything higher and I wake up early. Source Naturals is a pretty good brand. If you search Amazon.com for “source naturals melatonin” you’ll see a variety of doses including 1 mg, 2.5 mg, 3 mg, and 5 mg. I’ve known Parkinson’s patients who took 20 mg every night.

      Yes, I do favor using brands intended to be taken sublingually, and letting them dissolve in your mouth. These brands work much better in my experience.

  7. You could try naturally refined coconut oil, known as 76 Degree Melt Coconut Oil. Spectrum sells it, but you can find it a lot cheaper from wholesalers, like soap making websites. It has no taste.

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  10. Paul,

    Here’s a question for you. In your book, you point out that glucose is metabolized by macrophages to form ROS, which helps to fight infections. On the other hand, glucose is the primary fuel source for bacteria, fungus and parasites. So it would seem that glucose can both worsen and improve chronic infections.

    I imagine your 400 calories from glucose recommendation takes this into account?

    • Hi Chris,

      Good question. Yes, the 400 calories does take that into account. At the same time, the 400 calorie recommendation is for the general (mostly healthy) population. In some diseases it is better to reduce the carb calories and add ketogenic short-chain fats from coconut oil.

      Let’s take healthy people first, who still have to balance these concerns in order to prevent disease. In order to deprive pathogens of glucose, you want to minimize average blood glucose levels over time (I’m speaking of body not gut infections here.) This does not necessarily occur at zero-carb intake, which tends to produce physiological insulin resistance and high fasting blood glucose. Since your body consumes ~500 calories glucose per day, you can eat up to that much with minimal elevation of blood glucose — perhaps even a lowering of average blood glucose, since fasting blood glucose will be lower.

      What really elevates average blood glucose is when you eat above ~600 carb calories, saturate glycogen stores, and have to use slower glucose disposal methods like fat conversion.

      Zero-carb diets risk glucose deprivation, with potentially severe effects. This is especially true in people with chronic infections, since immune utilization of glucose draws down glucose supplies.

      I think 400 carb calories, mostly from starch, is the optimum for healthy people and some diseased people.

      For some diseases, I suggest a “ketogenic variant” (“Herbivore Strategy diet” in the final version of the book). This reduces carb consumption but adds large amounts of coconut oil for easier production of ketones. This diet is especially important for infections of the brain and nervous system, since ketones provide an alternative energy substrate for neurons that bacteria can’t steal. In this case, depriving pathogens of glucose becomes a key therapeutic strategy. This same diet variant is also helpful for cancer and some genetic diseases that affect glucose metabolism.

      I think these two basic approaches are the optimal ones.

  11. Paul,

    Thanks for your quick response.

    Do you think the ketogenic variant is also ideal for gut infections? How many calories from glucose would be targeted with this approach?

  12. Hi Chris,

    Gut infections are more complicated, there’s less evidence to guide us, and the optimum probably varies depending on what part of the gut is affected.

    In infections of the small intestine, fat or protein digestion can damage the intestinal wall. For normal fat digestion, the small intestine senses the arrival of chyme from the stomach, injects bile to solubilize the fat and pancreatic juices for lipase and base to neutralize the acid. In small intestinal diseases, this coordination may not work properly and acid may damage the mucus-deprived intestinal lining and lipases may digest intestinal cells. All this goes to say that starches, digested easily through amylases beginning in the saliva, may be a safer source of calories in some small intestinal infections.

    At the same time, short-chain fats have antimicrobial properties and especially butyrate are healthful for colonocytes. So both higher carbs and higher coconut oil/butter may be desirable.

    It has to be said that gut infections are the most difficult to deal with, since the conflict between supporting the body and depriving the pathogens is impossible to work around. Some statements are easy, like you absolutely must eliminate fructose which benefits the pathogens but not the body.

    My tentative conclusion is that gut infections generally call for more glucose, not less. Intestinal and immune cells are relatively high glucose users, and under stress their glucose needs go up. Extracellular immunity, which is glucose and iodine dependent, is more important in the gut. Add in easier digestion, and I think there’s a lot to be said for starches like white rice in gut disease. Be sure to take high doses of iodine, which will have the effect of increasing glucose utilization.

    Combine the starch with high doses of coconut oil and you’ll still get some of the benefits of a ketogenic diet as well.

  13. Yes, I agree that gut infections are probably the most difficult to treat because of the inherent conflicts they present with.

    If we’d use 400 calories from glucose with a general infection, what’s your sense of how many we’d use with a gut infection?

    And what dose of iodine do you mean when you say “high”? Also curious to know your preferred method of supplementing with iodine. Obviously that’s a controversial issue. I’ve had my thyroid antibodies checked and they’re normal, so I’m not worried about any potential increase in autoimmune activity excess iodine.

    And by high doses of coconut oil, are we talking about 6-8 TBS?

  14. I’d say 400-600 calories is a good range for a gut infection for 6 days a week and then I’d add 1 day of ketogenic no-carb fasting.

    But it depends on the infection. Intracellular infections don’t benefit from extra glucose.

    I think 50 mg/day iodine is a good dose. Might take 3 months to work up to that. I use Iodoral tablets but kelp/kombu is fine, you just don’t know your dose as precisely. For understanding treatment effects I like pills better to document the dose, for a healthy person’s prophylaxis the kelp might be better.

    Coconut oil I would go even higher if you can stomach it. 6 fl oz = 12 tbsp would roughly replace ~200 calories glucose and seems a good level to me. I would keep glucose down to 400 calories if you use this much coconut oil.

    Understand, when I give these numbers I’m choosing numbers that maximize the anti-infective properties of the diet. Lower doses would still be helpful. Most people would be cured on a less extreme diet, and would enjoy a less strenous diet more. In clinical practice where compliance is the major issue I wouldn’t make such extreme recommendations. But since you are expert and highly motivated, I am using only biology as a criterion.

  15. Coconut oil I would go even higher if you can stomach it.

    Paul, one of your readers wrote about a benign (no smell) brand of coconut oil, but I can’t find where I recorded it.

    Do you remember it?

  16. Hi erp,

    Generally speaking, brands labeled “extra virgin organic” taste great, others are risky.

    I buy a Nutiva product because it’s the cheapest I’ve found that tastes great: http://www.amazon.com/Nutiva-Organic-Virgin-Coconut-54-Ounce/dp/B000GAT6NG/

    I tried Jarrow products. This one tastes good: http://www.amazon.com/Extra-Virgin-Coconut-Oil-Ounces/dp/B0009DXL9U/

    This one tastes lousy:
    http://www.amazon.com/Coconut-Oil-Organic-16-Ounces/dp/B0009DVI40/

    I think when it says “good for cooking” on the label they mean “not good for eating.”

  17. erp,

    I like the one sold by Green Pasture, who also sells the fermented cod liver oil and butter oil. It has an excellent taste, is priced reasonable, and is raw (cold-processed).

    http://www.greenpasture.org/retail/?t=products&p=products&a=display&i=1004

    Paul,

    Question for you. You mention that you drink coffee with cream and eat coconut oil during the ketogenic (36-hour) fast. Would you also do that during the 16-hour daily fast? It would seem much easier to get up to 12 TBS of coconut oil if you didn’t have to eat it all in 8 hours!

  18. Hi Chris,

    No, I just have the coffee and cream, no coconut oil, on the daily 16-hour fast, and 2 tbsp coconut oil with food in the other 8 hours.

    The 12 tbsp coconut oil is for a ketogenic diet with limited glucose. I’m not on that.

    But coconut oil is always welcome. There’s no harm in it. I could have some in my 16-hour fast if I wanted.

    Paul

  19. Right. I was thinking about it more in the context of this post, i.e. whether having coconut oil during the 16-hour fast would be appropriate for those attempting to treat a chronic infection.

  20. Yes. Sorry. The coconut oil reduces glucose utilization and that may free up some glucose for the immune system. It adds to the safety of the fast. That is most important in longer fasts, but with a bad infection could be beneficial in a 16-hour fast.

    Ketones can replace up to about 12 glucose calories per hour. That’s a significant amount of glucose on a long fast, not so much on a short fast.

    Liver glycogen is 70-100 grams, 300-400 calories, which is enough to provide glucose for ~16 hours. So there’s really little need for coconut oil on a 16-hour fast, if enough glucose is eaten during the 8-hour feeding window to restore liver glycogen stores.

    So the main benefit of coconut oil would probably be its antimicrobial activity in the gut, or in reducing liver glycogen depletion and enabling you to eat less glucose/starch during the feeding period.

  21. Chris, thanks for the tip.

  22. I’ve successfully put RA into remission using low dose, pulsing antibiotics, based on the work of the late rheumatologist Dr. Thomas McPherson Brown. I’ve been a low dose of Doxycycline, 100 mg, on MWF, for a little over two years now. My joints are no longer reminding me of my arthritis daily.

    For background reading, check out “The New Arthritis Breakthrough” by the late Henry Scammell. “Why Arthritis?” by researcher Harold Clark is good too.

    A few months before my arthritis reared its ugly head, I gave up gluten. In the last year, I’ve weaned myself off the myriad GF products such as GF cookies, bread & pasta. We’re buying meat from healthy animals a local farm. I’ve gotten reacquainted with butter, cream, and I avoid PUFAs like the plague.

    I’m keeping an eye on my fluctuating thyroid function, and fluctuating progesterone levels (I’m 47). Taking probiotics. Checking Vit. d levels.

    I’m sure all the positive changes have contributed to the remission, but I feel certain the low dose pulsing antibiotics got me over the hump.

    Thanks for all the good info.

  23. Dear Michelle,

    Thanks for sharing your story. C. pneumoniae is a known cause of arthritis, but it’s unclear what fraction of arthritis cases it causes. Many “rheumatoid” arthritis cases are probably actually “reactive” arthritis from chronic joint infections.

    Glad to hear you are healing!

    Best, Paul

  24. Thanks Paul,

    Yes, I had a panel of tests done at The Arthritis Research Center (www.tarci.net).

    The lab checked for strep, plus mycoplasma (M. hominis, M. fermentans, M. salivarium, & M. pneumonia), plus chlamydia (C. pneumoniae, & C. trachomatis).

    Ding! Stealth infections!

  25. Hi Michelle,

    May I ask which pathogens they found?

  26. Sure, Paul.

    On my baseline test, done within a month of the initial severe arthritic flare:

    M. hominis = titer 100

    The other 3 strains of mycoplasma were negative.

    Mycoplasma antigen (PCR) = positive

    C. pneumoniae = (IgM) = negative & (IgG) = positive

    C. trachomatis = (IgG) = positive

    ASO titer (strep) = negative

    My MD recommended I repeat the set of tests every six months to track progress. He explained that if the patient is making progress, subsequent test results will show the titers to mycoplasma will tend to rise, then fall, then clear to negative.

    For example, in a series of tests one might see M. Hominis go from 100 to 200 to 100 to negative. In addition, a strain that tested negative at the baseline, may turn positive as the immune system strengthens. For example, M. pneumoniae might go from negative to 100 to 200 to negative.

    He told me the mycoplasma antigen by PCR was important to do at the baseline, before starting antibiotics, as the immune system may be too weak. He said I might show negative to mycoplasma, but if the PCR is positive, then mycoplasma are a problem.

    He said I needed to run the ASO titer for strep because that would require a different antibiotic (amoxicillin). Brown discovered progress was impeded if strep was not dealt with. Tetracycline antibiotics will do the trick for mycoplasma & chlamydia.

    My understanding is that Brown felt one needed to start low and pulse the dose. Eventually, the body’s immune system can take over. Some people are able to drop the antibiotics, some need to stay on a maintenance dose, and others need to be on them for life. I’m still at 100 mg Doxy on MWF (with room to increase to 200 mg MWF).

    Back to my own tests…I was not able to financially swing follow up tests every six months, and since I was making progress, I didn’t feel it was a priority. I did do another test one year in to the protocol, but only the mycoplasma portion. It was negative across the board.

    Dr. Millicent Coker-Vann who is the director of The Arthritis Research Center (lab) is a valuable resource. She worked with both Brown & Clark.

    There is a patient support and advocacy group called The Roadback Foundation. At their site are references to research papers, plus an old video of Brown explaining the protocol.

    As I said in my original post, I think the Doxy worked magic, but I have no doubt the other changes (diet, hormones) I made significantly contributed to it’s success.

    I understand there’s controversy about stealth infections. Some say they are very difficult to treat, and one needs to throw the kitchen sink at them— high doses, daily dosing, rotating various antibiotics. My MD felt that many people were having trouble with stealth infections because they were over-treating. High, daily dosing makes the situation worse for many.

    When I questioned this, he reasoned that we can always raise the dose later, or switch up antibiotics later. As it turned out, I made progress on a small dose. It was slow going, but 2+ years later, I no longer worry about being crippled by arthritis.

  27. Hi,

    Just discovered your site and am finding it very informative.

    I’ve had mild chronic fatigue syndrome for about 30 years. I’ve been experimenting with dietary improvements. I now basically more or less following a Weston Price diet (no processed food, homemade probiotics, bone broth). I only have wheat if it’s a sourdough bread, but have reduced grains a lot.

    I have seen improvements in many minor things, but not in fatigue. I wanted to give the intermittant fasting / ketogenic diet a try, especially for my mild neurological symptoms.

    Are you going to post more explicit instructions about how to do this without causing damage? There seem to be a lot of tidbits of info in them comments but I’d like to make sure I don’t miss anything. Also, I’m wondering how to make the diet palatable. How does one ingest so much CO and live to tell the tale? 🙂

  28. Hi Melissa,

    Well, we try to give clear instructions in the book. The final version of the book, but not the early-draft e-book, has this material.

    Blog posts will present all the material sooner or later but it’s the nature of the beast for the information to be scattered. I write pretty long blog posts but there’s just not enough space to cover everything in one or a few posts. I think it’s reasonable to ask people to buy the book for an easy-to-follow exposition.

    Palatability is a problem on the ketogenic version of the diet. The regular version does not have that problem. Since everyone’s taste is a little different, ketogenic dieters may have to solve the palatability problem on their own! But my wife is the food expert in our team, maybe she’ll come up with ways to disguise the taste. If so we’ll present our ideas in blog posts and maybe in the free e-book we plan on meal ideas.

  29. Hi Paul,

    Thanks for the quick reply. I will definitely consider buying the book.

    Since this is an extreme diet, I guess the most important thing is how to try it without making yourself sicker. The rest is icing. (high fat icing)

  30. Hi Melissa,

    I don’t think you need to do the ketogenic diet for chronic fatigue syndrome. Just the regular Perfect Health Diet with intermittent fasting is excellent. You say you have neurological issues, the ketogenic diet could be helpful for those. Try some experimental ketogenic diet days, see what works for you.

    Best, Paul

  31. Melissa,

    I have a smoothie with 6 TBS of melted CO, kefir or yogurt and some fruit (usually berries, occasionally a peach). It’s an easy way to get your CO and it tastes great. Of course this wouldn’t work during the longer 36-hour fast day, but it’s great for the other days.

  32. Paul, great stuff. You talk about antibiotics in your three prong approach to overcoming Alzheimer’s, but it’s not listed in the 11 points. Is it in addition to these steps? Thanks.

  33. Thanks Chris. That’s helpful.

  34. Hi Poisonguy,

    Yes, antibiotics are in addition to the 11 dietary/nutritional steps. I think it is probably not possible to overcome Alzheimer’s without antibiotics, but at the same time the antibiotics won’t work well without the dietary and supplemental steps.

    I’m not going to give much advice about drugs, since that’s doctor’s turf, but we’ll probably give some case studies from time to time so you can see what antibiotics other people have used.

    Briefly, C. pneumoniae is the primary pathogen implicated in Alzheimer’s, and the drugs that have been most effective against it are (1) Doxycycline and (2) a macrolide that penetrates the brain, e.g. Azithromycin. These two can be augmented by occasional pulses of a cidal antibiotic, metronidazole or tinidazole. See http://www.davidwheldon.co.uk/ms-treatment1.html for more.

  35. The only part of this program I’m not completely sold on is the intermittent and ketogenic fasting. I’m convinced IF is part of our evolutionary heritage, and that it benefits the body in several ways. I’m also convinced that it’s therapeutically beneficial for certain people.

    I’m less certain, however, that it’s appropriate for those with hypoglycemic and reactive hypoglycemic tendencies – especially when accompanies (as is often the case) by cortisol dysregulation. Unfortunately, these are extremely common conditions in this day and age.

    When someone is hypoglycemic, the constant dips in blood sugar they experience stimulate secretion of cortisol and glucagon to bring blood sugar back up. If this happens repeatedly, cortisol levels are depleted and the body has to rely on epinephrine instead to raise blood sugar. Regular cortisol and epinephrine surges activate the sympathetic nervous system and cause a stress response, which, in addition to other negative effects, further dysregulates blood sugar. These people get trapped in a vicious cycle of dysglycemia and adrenal fatigue that wreaks havoc on the body and is difficult to get out of.

    I don’t recommend IF for this type of person. Instead, I recommend the opposite approach, which is to eat several small meals throughout the day. This prevents blood sugar from dropping and thus removes the need for cortisol and epinephrine to kick in.

    I don’t believe eating every two hours is “natural” from an evolutionary perspective. But we are so far from living in a way that’s natural in this day and age, that some people may need a different approach – at least until they can get back to homeostasis.

    I’m open to discussion about this, and I’d like to hear your thoughts.

  36. Hi Chris,

    This is a difficult issue and you’re right to be concerned about it.

    Fasting, ketogenic diets, and other therapeutic diets are confined to Step 4 of the book, are riskier than the regular diet. More things have the potential to go wrong, especially in people with damaged metabolisms. So they need special care.

    It would be nice if people with damaged metabolisms attempting high risk / high reward dietary approaches like these could do it under the supervision of smart medical advisors like yourself, who can help them troubleshoot problems. But that is not always possible.

    Regarding people with hypoglycemic tendencies. I agree that glycogen depletion is very dangerous and should be avoided. So fasting must be avoided or done with great care.

    On the other hand, ketones will be therapeutic and helpful to these people. Unlike long-chain fats, which have a complex lipase-and-carnitine-based transporter mechanism, and glucose, which also utilizes transporter systems to cross membranes, ketones are small water-soluble molecules that diffuse through the body and easily reach mitochondria. So they are very robust against failure; I’ve never heard of any disease that prevents metabolism of ketones, but there are diseases that damage both glucose and long-chain fat metabolism.

    Ketones substitute for glucose and so they radically reduce the rate of glucose withdrawal from the blood. This helps the liver maintain stable glucose levels.

    We always recommend that ketogenic diets be conducted with 200 calories starch and 400 calories protein, to prevent risk of glycogen depletion. We don’t favor the extreme low-carb, low-protein ketogenic diets that are often prescribed for epilepsy patients.

    With this dietary plan, I don’t think people need to eat many small meals. People are pretty good at sensing low blood glucose and I would tell them to take lots of coconut oil throughout the day and eat some starches, or bananas, whenever they sense low blood glucose. They should be familiar with indicators of glucose deprivation, like dry mouth.

    So I think one point this discussion reminds us of is that, although fasting and ketogenic diets may be adopted for similar reasons (e.g. to promote autophagy), they can be quite different in their risk profile and in which patients should adopt them.

    Best, Paul

  37. Great points, Paul.

    Perhaps if a hypoglycemic with a chronic infection wanted to follow this program, they’d be better off eating some CO during their 16-hour fast as well as during the 36-hour fast.

    If they do eat starches or a banana when they sense low blood sugar in between meals, they’d of course have to reduce them at meals. Otherwise they’d exceed the 400 calories of carbs. Say they have one medium banana at breakfast and a baked sweet potato between lunch and dinner. That’s 200 calories from carbs right there – half the daily allowance.

    Also, if they have a banana during their 16-hour fast (in the morning), wouldn’t that defeat the point of IF to some degree? Or are small amounts of starches and coffee with cream permissible because they have no protein, and protein restriction is what promotes autophagy?

  38. Yes, coconut oil is never out of place. We don’t count coconut oil as interrupting a fast, and it always makes a fast safer.

    I don’t think it’s necessary to advise people to reduce carbs in meals if they eat starches or bananas between meals to deal with an overt glucose deficiency. First, our upper limit on carbs is 600 calories, 400 is a target for most people not an upper limit. In any case glucose needs vary among people, fungal infections for instance increase glucose needs, and if someone is just barely relieving glucose deficiency with a few bananas, they can easily consume another 400 starch calories the rest of the day without saturating liver glycogen.

    If someone is glucose deprived and experiencing (say) dry mouth, the benefits of a banana or sweet potato are far greater than the benefits of a continued fast. And no, it wouldn’t necessarily defeat the purpose of the fast. The carbs might briefly elevate blood glucose but the liver would probably take them up fairly quickly.

    Rules of thumb like a 16-hour fast or 400 carb calories a day shouldn’t be religious observances, but guidelines that are adjusted to individual needs. People should listen to their body and if carb deprivation is inducing negative symptoms, they should adjust their carb intake upward and relieve the symptoms.

  39. Another way of putting this is that if someone has an overt glucose deficiency, it indicates he has made a mistake over the prior 24 hours. Bananas or starches are repairing that mistake and returning the person to where he should have been. Getting back to a healthy glucose status doesn’t imply that one should reduce future glucose intake, but rather that one needs to comply with glucose intake recommendations MORE closely because on reduced glucose intake one is vulnerable to deficiency.

  40. Paul,

    I’m glad you brought up the issue of individual variability, because I’d been meaning to ask you about that. I may have missed this in your book, but how much do the targets for protein and glucose need to be adjusted based on factors like body weight, metabolic rate, energy needs (i.e. relatively sedentary vs. extreme athlete)?

    Are you arguing that the main thing that should change in those cases is fat intake, and that protein and carb intake should be relatively stable across those different populations? In other words, should a very lean, active person with a fast metabolism be eating the same number of calories from protein and glucose as an overweight, sedentary person with a slow metabolism?

    It seems to me that these targets will have to vary, sometimes quite considerably, depending on individual needs. You’ve argued as much in your post above as it relates to disease states (i.e. those with fungal infections may need more glucose). But what about differences in physiology and metabolism?

  41. Hi Chris,

    Well, I have avoided that topic in the book because I think very few people fall outside our recommended ranges.

    Very few people need MORE carbs and protein than the upper ends of our ranges, 600 calories each. An elite Olympic swimmer like Michael Phelps burning 12,000 calories per day does, at least of carbs.

    For an elite athlete, but I would personally advise that (1) most calories be obtained from fats, including some coconut oil; (2) glucose consumption track expenditure, and therefore a reasonable carb calorie intake would be somewhere around 500 + 50-100 per hour of training, depending on how intense the training is; and (3) 600 protein calories is sufficient regardless of training intensity, though I’d bias it toward branched-chain and ketogenic amino acids such as leucine, maybe with a whey supplement, and glycine, probably from cooked collagen / gelatin.

    As I see it, only someone doing over an hour per day of intense athletic training would fall outside our carb range, and no one outside our protein range.

    The low end is where the major health risks lie, so that’s where I have more concern. The trouble here is that slight carb or protein deficiencies might build up insidiously over time, with no obvious symptoms at first.

    I’m planning a post on why so many Optimal Dieters, who eat ~100 carb calories per day, have come down with gastrointestinal cancers. This is what I mean about an insidious effect, probably due to glycoprotein deficiencies.

    This is why I make a hard lower bound of 200 carb calories and 600 carb+protein calories, even on ketogenic diets. This should be safe for all healthy people, if they follow our supplement plan, and nearly all diseased people.

    Are there some people for whom 200 carb calories may be insufficient? Probably. Possible reasons:
    – Infections, esp. gut infections because they can have the largest pathogen population and the largest stress on the immune system.
    – Advanced cancers.
    – Liver disease and/or vitamin deficiencies impairing capacity to convert protein to glucose/ketones.

    I largely use calorie counts rather than % of energy for carb and protein prescription, because that’s most accurate I think. Even people on fasts or severely calorie-restricted diets should try to avoid extended glucose or protein deficiencies.

    The physiology and metabolism differences – I think by far the most common problems are difficulties with glucose metabolism, sometimes with long-chain fat metabolism. For these I think the ketogenic diet covers it. I don’t think there are many pathologies that aren’t covered under the regular diet or a ketogenic variant.

    The difference between a lean and an obese person would show up mainly on calorie-restricted diets, since one has a large fat reserve and the other doesn’t, but since we don’t recommend stringent calorie restriction for any condition, it doesn’t matter for our diet.

    The difference between fast and slow metabolism also doesn’t really change our recommendations. A slow metabolism has difficulty burning fats, but in most cases mild glucose restriction and ketone/fat provision will induce the body to repair this metabolic deficit and multiply mitochondria, so keeping to our ranges would usually be therapeutic for the slow metabolism.

    Give me an example of a metabolic disorder that might force a person outside these ranges. Cancer is a possibility, but even there, mild glucose restriction and ketosis are therapeutic, so it would have to be very far advanced, many pounds of tumors, before you’d want to supply more than 600 calories carbs. Some diabetics do best below 200 carb calories, but they have to be very careful. If you have infections that are consuming over 400 calories glucose, call an ambulance and go to the hospital.

  42. Ah, somehow I missed the upper part of the ranges in your book. I was under the impression that 400 calories of glucose and 300 of protein were the targets, not the low end of a range. From what you’re saying now, it sounds like it’s more like the target is 400-600 calories of glucose and 300-600 calories of protein, with particular populations perhaps aiming toward one end of those ranges depending on their needs.

    Am I paraphrasing you correctly?

  43. Hi Chris,

    Yes, 400 and 300 are the targets for most sedentary people, also that’s what I personally aim for most days. 200 to 600 and 200 to 600 are the ranges, but if you want to test the low ends of ranges, you need 600 total in carbs plus protein. This is more clearly spelled out in the final version.

    Hitting the middle of the ranges is pretty close to optimal for most people, thus the 400-300 recommendation. For athletes, higher ends of the ranges are more appropriate. Low ends can be therapeutic in some conditions, e.g. ketogenic diets.

    People can pick a target for taste as well as for health/lifestyle. Some people don’t like carbs and some do. Anything in the range is near the optimum for health I think.

  44. Hi Paul,

    Whewn do you anticipate the final version of the book to be released?

    Is the PDF updated (a snapshot) as the final book version is revised or a fixed date version?

    Regards,

    WP

  45. Hi Winalot,

    As soon as possible!

    I keep getting interrupted with consulting work (my day job) and the blog has been busy. But we’re in the home stretch. I expect to submit the book to the printer next week, and get proofs soon after. Hopefully they won’t need changes and everything can be approved around the end of this month. If so, the book should become available in online retail outlets in October.

    No, the PDF is not revised. The PDF is the version from early June. PDF buyers will get the final book when it is available and the PDF will go away.

    Best, Paul

  46. I’ve been looking around for taro and sago and haven’t been able to find them anywhere. Anyone had any luck finding these in your local area?

  47. Hi Chris,

    Asian supermarkets almost always have both taro and sago.

    Our local BJ’s warehouse club started carrying taro lately. I would assume Costco and Sam’s Club also have them, and probably many regular supermarkets.

    Amazon has sago pearls: http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dgrocery&field-keywords=sago

    You can also get tapioca which is very similar: http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dgrocery&field-keywords=tapioca

  48. I purchased the ebook a couple of days ago. I’ve read it twice now. I’m really looking forwards to the published version.

    I’ve been on antibiotic treatment for Lyme and co-infections since February of this year (it’s a pulsing schedule, but I can’t say it’s low doses). I’ve also made a lot of changes in my diet (no processed foods, lots of homegrown vegetables, pro biotics, no gluten, etc..). After making the diet changes I noticed considerable improvement with many symptoms and most of my gut issues were resolved. Cognitive issues also greatly improved (no more calling home to ask for directions back to the house). And when I’m on “holiday” from the antibiotic treatment I can now stay awake all day.

    However, I cannot seem to shake the pain and stiffness I experience in one knee. (I’m trying to follow these guidelines with the help of fitday. I’m not doing so hot so far. You need a recipe sharing board!) Hoping giving this a shot will get the joints moving without pain once again.

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