Curing Arthritis and Depression with Diet and Antibiotics

Most chronic diseases are considered incurable. But if cures are rare, it may only be because doctors and patients rarely try the proper dietary and antibiotic therapies.

Two smart commenters who figured out how to make progress against their own chronic diseases refute the notion that disease progression is inevitable.

Arthritis

First, Michelle cured her arthritis with diet and antibiotics:

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.

I noted that many if not all cases of arthritis are caused by infections, with C. pneumoniae probably the most common agent, and Michelle replied:

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!

Michelle’s infections included M. hominis, C. pneumoniae, and C. trachomatis. It’s quite common to have multiple infections, even in the general (“healthy”) population as we noted in this post. So it’s no surprise there was more than one.

Michelle’s doctor recommended low-dose doxycycline (100 mg three days a week), which took 2+ years to cure the arthritis. She might have been cured quicker with a larger dose. As she describes the issue:

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.

Dosage is a tricky issue.

  • Higher levels of antibiotics are more likely to denude the gut of probiotic bacteria, and populate it with pathogenic species that shelter from the antibiotics in biofilms, or with fungi that are immune to the antibiotics. The loss of probiotic species in the gut can lead to new infections; immune cells go to the gut to fight pathogens there, get infected themselves, and then go to joints to fight infections there, and spread their pathogens into the joints. Thus, there is a potential to add new pathogens to the joint infection, compounding the arthritis.
  • On the other hand, lower levels may be insufficient to clear the infection, or may take inordinately long to do so. If the duration of antibiotics is longer, gut problems may be as severe on low antibiotics as on high.

My own prejudice is “go as fast as you can but no faster,” but clinical experience will teach us the best course in different diseases. In more severe diseases – multiple sclerosis, for instance – low-dose monotherapies have no chance and high-dose combination protocols are needed.

The potential for antibiotics to backfire is why you want to adopt all the dietary and nutritional steps first (in our book Steps 1, 2, and 3), then pursue antibiotics and therapeutic diets (Step 4 in the final version).

Depression

Second, Winalot has made progress against depression and suicidal tendencies by eating a ketogenic diet:

I’m zero-carb as I’ve found Ketosis has greatly reduced my depression / suicidal tendencies, however I do worry that this might not be “healthy”.

You mentioned “some mental health and neurological disorders, may benefit from very low-carb “ketogenic” diets” and I was wondering if there’s any more advice you can give on finding that sweet spot?

Ketosis hasn’t cured me, I still have bad days and take SSRI’s but it’s certainly better than boatloading carbs for “serotonin” like I used to.

It’s very smart of Winalot to have found the ketogenic diet. A ketogenic diet has two major benefits for infectious brain diseases:

  1. Ketones induce neuronal autophagy, which means they upregulate the primary intracellular immune defense mechanism against bacterial infections.
  2. Ketones are neuroprotective. One mechanism: They are an alternative energy substrate for neurons. Bacteria steal pyruvate and other glycolytic products for their own energy metabolism, depriving neurons of their main energy source and inducing the cognitive symptoms of hypoglycemia in the brain. But bacteria cannot consume ketones. If ketones are supplied, neurons do not starve. Starvation is probably the main cause of neuronal death in many of these diseases. If you don’t wan’t to suffer the shrinking brain that is so common in Alzheimer’s, multiple sclerosis, and other infectious brain diseases, a ketogenic diet is prudent.

Winalot asked for a “sweet spot” and I gave the following advice:

In general, I recommend 200 starch calories a day. This will not prevent generation of ketones if you take a lot of ketogenic short-chain fats and will protect you against glycoprotein deficiencies leading to bowel cancers and other nasty long-term side effects, not to mention impaired immunity against extracellular pathogens.

This should be accompanied by a boatload of coconut oil for those ketogenic fats. I suggest about 1500 calories / 6 fluid ounces / 12 tbsp coconut oil per day. This sounds like a lot, I know, but it is therapeutic.

Also, get 400 protein calories per day. This is higher than our normal protein recommendation.

Finally, I highly recommend antibiotics, since I believe bacterial infections of the brain (leading to tryptophan sequestration by interferon-gamma and IDO) are far and away the most likely cause of your depression and serotonin deficiency. I would start by assuming this is C. pneumoniae, the most common brain pathogen, and take the Wheldon protocol antibiotics. You can find a good guide at http://cpnhelp.org.

Tryptophan sequestration is a primary intracellular defense against bacterial infections, and bacterial theft of tryptophan from serotonin also tends to denude infected cells of serotonin. We regard serotonin deficiency symptoms as prima facie evidence for a bacterial infection of the brain. C. pneumoniae is the most common bacterial pathogen in the brain, so antibiotic strategies that are proven against C. pneumoniae are a good place to start against depression.

Doxycycline is a good first antibiotic; it enters the brain well and is active against C. pneumoniae. The response to doxycycline also has diagnostic value. If you don’t have an infection, usually there is no obvious effect to the antibiotic. If you do, there are usually clear effects, either good or bad:

  • Good, because doxycycline is a protein synthesis inhibitor and will slow down bacterial activities that may be damaging you, including tryptophan theft. You may experience euphoria for a few days, followed by richer emotions and relieved depression.
  • Bad, because it may produce either toxicity effects from bacterial die-off (endotoxins and porphyrins) or other side effects. For instance, C. pneumoniae inhibits apoptosis (cell death) of immune cells, and inhibition of protein synthesis will stop this and may be followed by the immediate suicide of most white blood cells. This sudden drop in white blood cell count could lead to a surge in fungal or other infections, lasting several weeks until new white blood cells can be manufactured.

If you notice such effects, continue the doxycycline, but modulate doses so that the bad effects are not too severe. Other antibiotics can be added in combination once the bad effects are modest.

Conclusion

The thesis of this blog is that most chronic diseases can be cured in a two-part process:

  1. Good diet and nutrition should be used to eliminate toxicity syndromes and empower the immune system.
  2. Antibiotics can then be brought to bear against entrenched infections to work a cure.

Diet and nutrition should be the first step. A good diet will clarify symptoms and help diagnose pathogens; minimize antibiotic doses and duration needed for a cure; and minimize die-off effects from bacterial endotoxins and porphyrins during antibiotic treatment.

It’s great to hear from people who are making progress against their diseases. Hopefully, our book and blog can generate many more such cases. Abundant cures will do more than billions in research funding to teach doctors and scientists how to treat these diseases.

Leave a comment ?

102 Comments.

  1. Hi Paul,
    I’m a first time visitor to your blog. WOW-knock my socks off. I’m just an average american who doesn’t really understand all the science stuff but I will pick up your book and hope I can understand it . I’m starting to read blogs that say things that most of the world says are crazy talk–statins are bad?? Carbs are bad? Fats are good? Actually, it all makes my head hurt bc I don’t know what to believe.

    I’ve suffered from serious depression for 20 years–almost whole adult life. I thought I was all radical for getting my vit d levels checked (were 21) bc most of my docs and friends don’t buy all this and just prescribe medicine. Early on, I tried every manner of medication and some would help for a year or two, but nothing long term. THen they all had major side effects too.

    So now I want to try diet, but I am so afraid of doing something like this. I bake with coconut oil, but I don’t like the taste of it. I cannot imagine putting a tablespoon in my mouth. So that’s a hurdle not sure how to get over.

    Also, when you say high fat meat, do you mean I go to the grocery store and buy beef w/ the most fat in it?

    ANd as for the antibiotic. I think my doc will think I’m nuts if I tell her there is a possibility my depression is from a virus.

    I looked at your supplements too and I don’t see a fish oil? Is that on purpose?

    Thank you for being out there. I keep reading and learning a little bit here and there.

  2. Nevermind on the fish oil question….I see you address it in your diet page. I do eat (frozen) wild alaskan salmon at least once every week.

  3. Hi Adele,

    Welcome! Glad to have you with us. I hope you will find our book easy to understand. There is science in it but it’s mostly pitched a bit easier than the blog.

    I do think diet, antimicrobial medicines, and lifestyle changes (eg sunlight, sleep) are critical to overcoming depression. You might want to listen to my podcast with Chris Kresser to come out this Tuesday, depression came up.

    You don’t need a lot of coconut oil unless you are trying a ketogenic diet, which I do think is worth a test at some point. I would try the regular diet for a while, get comfortable with the foods and supplements, and then try a more ketogenic diet. If you don’t like coconut oil, you can try MCT oil which is tasteless.

    High fat meats have a moist texture, lean meats have a dry texture. So salmon, many cuts of beef (we like ribeye), chicken wings, pork bellies are example of fatty meats; cod, chicken breast, and pork loin are examples of lean meats.

    Re antibiotics, try the dietary steps first, then look at antimicrobials. They are experimental. Unfortunately a lot of doctors don’t want to experiment any more, but cross that bridge when you come to it.

    Re the fish oil, I think our very first post discussed why we favor fish over the capsules.

    Feel free to ask questions at any time, and please keep me posted on your progress. We like to learn from our readers’ experiences.

    Best, Paul

  4. Hi Dr. Jaminet,

    I’ve had low to mid grade depression for about 6 years (I’m 27). Do you have any advice on how to get the antibiotic prescriptions? Should I just tell my doc I want to test doxycycline to see if it has any effect? How were you able to get your antibiotics? Would requesting a test for C. Pneumonia be of any use?

    I was unable to sleep at night until I started taking tryptophan, so I think I likely have a seretonin deficiency. After reading your other posts about tryptophan I have switched to melatonin.

    I have had a head cold for the past few days (sneezing, coughing, nasal congestion) and it seems that my low mood has improved during it and I also slept better the last couple of nights I’ve had it. I wonder if that is any indication of a possible brain infection causing my low mood (possibly higher body temp from the cold killing bacteria?). I could just be imagining it.

    Also I want to congratulate you on a great book. I bought the kindle version on Amazon.
    Thanks
    Atticus

  5. Hi Atticus,

    A positive response to melatonin is consistent with a brain infection but it doesn’t necessarily indicate it. It is only a piece of the jigsaw puzzle of evidence.

    I don’t think the C pn diagnostic test is that useful. The test only looks for antibodies. Antibodies often disappear maybe 10 years after infection, but the infection can still persist and spread to the brain much later than that. Also, 70% of people are antibody positive for C pn, but very few of them have brain infections. So either a positive or negative result may not be meaningful. Many other pathogens could also cause depression.

    I think a stool test is more useful, as it is much more precise – it looks at actual DNA of what’s present there now, so if it’s positive you know you have something and will benefit by treating it. I often recommend this one: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology.

    I would follow a highly nourishing diet – basically our diet. It’s important to do that first before starting antimicrobial treatment.

    Then intermittent fasting is a good step. The fast is neuroprotective, so fasting 16 hours daily is a good way to help against a diverse range of possible causes of depression. Take a tablespoon of coconut oil or MCT oil during the fast if you ever feel hungry or down.

    Re antibiotics, it’s hard to get doctors to give prescriptions for non-standard diagnoses. I was helped because I had other evidence of bacterial infections elsewhere. You have to do your best to persuade your doctor. Yes, I think experimental testing of antibiotics is desirable (after a good diet has been adopted and you’ve stabilized on that).

    Best, Paul

  6. So Paul, so you think doxy would be the place to start??
    Atticus, if you live in an area where there are md’s who “think outside the box”, you could try to bring them information on infectious diseases. Try people who have found a fp doctor who treast rheumatoid arthritis as an infection. I know it is hard to find, but there are doctors out there. Keep us posted. I love this thread and I <3 the Jaminets!!

  7. Hi Adele,

    I do think doxy is a good place to start, because it is relatively benign toward gut flora.

  8. @Atticus,

    I think Paul has mentioned the website cpnhelp.org before, which is about C. pneumoniae. Many of the users at that site swear by the “NAC test,” which consists of taking 2.4 grams of N-Acetyl Cysteine for a little while. Apparently, an adverse reaction to the NAC test that consists of a runny nose and headaches is supposed to be an indication of a CPN infection. Take this with a grain of salt as I’m just repeating what I’ve heard over there- I have no scientific knowledge beyond knowing what H2O stands for. If you go over to that site and search the forums you’ll find a bunch of discussions on it.

    I pursued the antibiotics path in addressing a suspected brain infection. I had to discontinue the AB after a little while due to an unfortunate side effect, but may try again soon. For what it’s worth, melatonin has been enormously beneficial to me (I had a couple of head injuries when younger and such people often have melatonin deficiencies), far and away the supplement that is most helpful to me. That and 16 hour fasts every day have really helped me improve. I don’t know if that will help you too, but good luck.

  9. You’re spot-on, Paul (may I call you that?)! I just returned from a book club meeting where we discussed The Perfect Health Diet at length. I have to say, I am most fascinated by the chapter focused on chronic disease and infection!

    I am a living testament to the power of diet and “immuno- warfare”, if you will (a.ka. antibiotic therapy). I muddled through 32 years of life on this drug or that, all in the hopes of ending my “not-so in love affair” with Juvenile Rheumatoid Arthritis (RA). I was diagnosed at age 3 after a bout with what doctors thought to be a cold virus, and that which followed was years upon years of aspirin (24 chewables daily, to be exact), gold salts, NSAIDs and DMARDs. Ugh!

    Since beginning to uncover secrets of old three years ago, I have eaten a Weston Price, biblical, Paleo-ish diet and dabbled in various and asunder supplements. This part of my new-found health journey yielded results good enough to keep me off prescription meds, but something was still lurking in my body causing imbalances, hiding out in my joints and other deep, dark places.

    Thank God for my integrative MD…He ordered Metametrix testing, and lo and behold, found parasitic and fungal infections (imagine that, right?). I reluctantly gave in and started rounds of Flagyl (antibiotic) and Nystatin (antifungal), along with Primal Defense Ultra probiotics and a much lower carb/no sugar diet. The results have been nothing short of WOW!

    I can sometimes feel the anger welling up inside me when I think of the years of my life this degenerative disease has robbed me of. But as quickly as the feeling comes, it fades when I’m reminded that I wouldn’t be enrolled in a Naturopathic Doctor program now. Moreover, my passion in life certainly wouldn’t be helping others with chronic, degenerative diseases if it hadn’t been for those nasty bugs that attacked that little three year old girl many years ago.

    Thank you kindly for joining the crusade and bringing your diet and this life-restoring information to light. May the Immuno-warfare games begin!

  10. You’re spot-on, Paul (may I call you that?)! I just returned from a book club meeting where we discussed The Perfect Health Diet at length. I have to say, I am most fascinated by the chapter focused on chronic disease and infection!

    I am a living testament to the power of diet and “immuno- warfare”, if you will (a.ka. antibiotic therapy). I muddled through 32 years of life on this drug or that, all in the hopes of ending my “not-so in love affair” with Juvenile Rheumatoid Arthritis (RA). I was diagnosed at age 3 after a bout with what doctors thought to be a cold virus, and that which followed was years upon years of aspirin (24 chewables daily, to be exact), gold salts, NSAIDs and DMARDs. Ugh!

    Since beginning to uncover secrets of old three years ago, I have eaten a Weston Price, biblical, Paleo-ish diet and dabbled in various and asunder supplements. This part of my new-found health journey yielded results good enough to keep me off prescription meds, but something was still lurking in my body causing imbalances, hiding out in my joints and other deep, dark places.

    Thank God for my integrative MD…He ordered Metametrix testing, and lo and behold, found parasitic and fungal infections (imagine that, right?). I reluctantly gave in and started rounds of Flagyl (antibiotic) and Nystatin (antifungal), along with Primal Defense Ultra probiotics and a much lower carb/no sugar diet. The results have been nothing short of WOW!

    I can sometimes feel the anger welling up inside me when I think of the years of my life this degenerative disease has robbed me of. But as quickly as the feeling comes, it fades when I’m reminded that I wouldn’t be enrolled in a Naturopathic Doctor program now. Moreover, my passion in life certainly wouldn’t be helping others with chronic, degenerative diseases if it hadn’t been for those nasty bugs that attacked that little three year old girl many years ago.

    Thank you kindly for joining the crusade and bringing your diet and this life-restoring information to light. Let the Immuno-warfare games begin, and may the odds be ever in your favor!

  11. Hello Paul,

    I’ve always suffered from depression since I was a child. A month ago I started a ketogenic diet, and after 3 days, it was like the lights turned on in my brain. I was suddenly calm, energetic and happy for seemingly no reason. However, the feeling only lasted a couple days, before I was back to my previous self. I am still on the diet and I do experience a couple random burst of mental energy, but they dont last long… I am completely puzzled.

    Have you ever heard of a similar case? What would be your advice?

    Thanks!

    • Hi Jim,

      I have no idea why it stopped working. Maybe a loss of substrates for utilizing ketones? You might try experimenting with branched chain amino acid supplementation, lemon juice, and a bit more carbs, with extra MCT oil to create more ketones. Also perhaps B vitamins.

  12. Paul,
    Just found a doc who is testing for Lyme and other chronic bacterial infections. He has identified C.pneumoniae, and just started me on azithromycin (he chose azithromycin because it causes less sun-sensitivity than doxy). Concerning ketogenic fasting and dieting, would you recommend either during antibiotic therapy?
    Thanks for all you do.

  13. Hi Paul,

    Sorry if a similar question has already been answered. My doctor has put me in a course of oral antibiotics to take care of an MRSA skin infection.

    Any suggestions for a protocol to reduce/recover from gut flora damage?

  14. If toxins from dying bacteria are a concern, would not adding charcoal to your diet help mitigate this issue? If the bacteria are in the gut, put charcoal in the gut with them. Dietary charcoal is an ancient treatment. Even monkeys in India were found to be sneaking into the village and stealing charcoal. It allowed them to eat certain plants during times of drought and food scarcity that they would otherwise not touch.

  15. Hi, Paul and greetings from Finland!

    Thanks for the great book!

    This thing that Atticus was writing about… I experience the same thing when having a cold. Improved mood and almost euphoria. What’s that all about? Doctors here (Finland) don’t recognise or see any connection with these things…
    My mood has improved from beeing on ketogenic diet, but the improvement that the headcold brings is phenomenal!!!

    “I have had a head cold for the past few days (sneezing, coughing, nasal congestion) and it seems that my low mood has improved during it and I also slept better the last couple of nights I’ve had it. I wonder if that is any indication of a possible brain infection causing my low mood (possibly higher body temp from the cold killing bacteria?). I could just be imagining it.”

    What’s this about?

    • Hi Sakari,

      Very interesting experience. The body has multiple types of immune response and when it upregulates one it downregulates another. You seem to have a chronically high immune response of one kind and it impairs your mood. When you get a cold, the immune response shifts to a different threat and the cytokines etc that were depressing you disappear and your mood improves.

      I would have to do more research to guess what specifically is going on, but this could have a bit of diagnostic value both for the cold and the cause of the chronic immune response.

  16. Hi Paul!

    Thanks for the quick answer.

    Yes I agree it´s very interesting. I started noticing the connection between moods and colds when I was on sertralin for my low to mid grade depression. And what happened then was that, every time the dosage was altered I got a cold. A very mild one I have to say.

    And then when I stopped taking the medicine all together I got a 2 months lasting nasal cavity infection (or what´s it called…) and at the same time the, I guess, classical “brainzapp”-symptoms from the withdrawal. I joked to the people around me that I bet these symptoms and the infection will disappear at the same time. And then they did. The brainzapps continued a bit longer, but they were almost unnoticeable then.

    By the way… I haven´t had a serious infection in many years. Excluding the one I mentioned before. So it might be that the chronically high immune response is keeping me somewhat “healthy” but at the same time there´s something else that´s harming me and causes the high immune response?

    Or something like that…?

    Thanks again for what your are doing. I admire your wonderfully scientific approach to everything. There are sadly so many scientist who have some other goal than the truth. I´m a firm believer that we must adapt our ways to what is true and not the other way around no matter what the truth is.
    …even if it´s something as “crazy” as eating according to the evolutionary guidelines! 😆

    • Hi Sakari,

      That’s another plausible insight. People with allergies are less likely to get cancer, the allergic immune response is more vigilant against cancer. Could be something similar with you.

  17. Hello Paul —

    I am writing because I have extremely dry skin. It doesn’t flake off, but basically I can go without a bath for a long time and still the skin is dry. I am on hypothyroid meds (combination of Synthroid and Armour) for longstanding Hashimoto’s — I’m not well enough to do IF but I try to follow other PHD recommendations.

    Also the dryness seems to occur in winter (I live in Florida, where we usually have humidity, except in winter!). Is there anything I can do to tweak PHD to help my skin? Thanks for any suggestions you might have —

    • Hi Kathy,

      I don’t know what’s behind it but the first thing I would try is getting extra of nutrients important for skin health, especially vitamin A (extra liver / chicken liver) and vitamin C and bone/joint broth. Vitamin K2 and optimization of D levels should accompany the extra A.

  18. Joseph Hartmann

    Have you ever been tested for lyme?

  19. John Henderson

    Hi Paul,

    What are the best ways that one can test for brain infections directly or indirectly?

    I’ve have some mild depression, irritability, anxiety, have trouble dealing with stressful situations, etc.

    Its challenging figuring out what could be contributing to it on a physical level (infection, neurotransmitter defiencies, etc).

    From your experience,what place could methylation imbalances and pyroluria have in psychological symptoms?

    Thanks, John H.

  20. Hi Paul,
    I have ankylosing spondylitis. I just ordered your book from ebay. I’m very strict diet/lifestyle-wise and will hopefully become finely tuned through ThePHD. It has been a while since this post and a lot has gone on since. FMT’s, SBO’s, and refined tuning of IF’ing, circ ryth, ketogenic diets etc. It was recommended that I go on the wheldon protocol by my naturopath. My AS came JUST after my contraction of C. trachomatis. Made sense to go on an ABP to me but there are very reputable sources arguing in favor of each side. For or against ABP? If you were in my shoes, what would you do? In your opinion, is it possible to manage AS solely through lifestyle and dietary health with the inclusion of adding beneficial bacteria through fermented veg etc.? I have a script for doxy 300 mg per day. I saw you mention that taking 100mg doxy to see how one reacts might be a good idea. Do you still think that is a sensible approach?
    I feel that I’m closing in on the management of my condition. Please please try to help me fill in the blanks. I am NOT expecting a magic pill and will not be deterred by taste or temporary discomfort.
    Thanks for making your knowledge public and for spreading hope to people who really need it!
    Rog

  21. Wow, I didn’t know this was a thing.

    I recently went to my GP because I’d had crushing fatigue for about three weeks. She noticed enlarged lymph nodes and some other stuff and sent me home with a prescription for a z-pack. On day 3 of the z-pack I felt ON TOP OF THE WORLD!!! And now that I’m done with it I’m tired again (albeit less tired) and pretty depressed again.

    I had no idea depression could be linked to infection. I’ve dealt with mild depression on and off since I was a kid.

  22. Hi Paul,

    I would love to know if your theories have developed in the years since this blog post was written, and if you have further explored treatment for chronic infections (in addition to the dietary and supplement strategies you outline in your book and on this website).

    I’ve experienced significant and amazing, but not long-lasting, improvements following transitions from vegetarianism to a GAPS-type diet, and then from GAPS to your PHD. Both times, I was ecstatic about the positive impact on my mood…and so disappointed that the improvement didn’t seem to “stick.” I wonder if a significant improvement followed by a regression could indicate an infectious origin of my “moods” (i.e. die-off followed by overgrowth of pathogens).

    Thanks for all that you do! I wish you would open a clinic, and I could bring my whole family to see you. 🙂

    Regards,
    Sarabeth

    • Hi Sarabeth,

      We emphasize the importance of intermittent fasting and circadian rhythm entrainment more now. Mood is heavily impacted by gut flora and you might find probiotics and additional fiber (vegetables, resistant starch) helpful. Get lots of bone/joint material, liver, egg yolks, and seafood too.

  23. Hi Paul,
    I have Lupus with very a very high ANA titer, and I never used to get head colds or the flu, I’m thinking because my immune system is on overdrive. My doctor prescribed me 100mg of doxy twice a day because of an eye condition related to rosacea. I’ve been on it for a month or so, but the strange thing is, I’ve had a chronic cough, runny nose, and sore throat since staring it. Could this be a herx reaction? Is it possible that I do have C. Pnemoniae and it’s getting out of my system? I’m a little concerned I’m doing more harm, however my joints do feel a bit better. I do follow the PHD as much as possible, but could do better at eliminating more sugar.
    Thank you for all of the information you put out there!!
    Sandy

  24. Paul, Could you recommend a doctor that would be in the Greensboro NC area that would think along the lines of antibiotic treatment. My concern is inflammatory arthritis. Thanks

  25. Hello,

    Can someone please recommend a functional medicine practitioner who would treat my friend for depression.
    Thanks,
    Jim

  26. Hi Paul. Would you say most cases of RA could be cured by antibiotics and diet? Would that also go for other autoimmune diseases like lupus? I have a sister with RA and a grandson with lupus.

  27. Paul,
    What do you think about this info? I fast till at least noon six days a week.

    Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial.
    Jakubowicz D1, Wainstein J2, Ahren B3, Landau Z2, Bar-Dayan Y2, Froy O4.
    Author information

    Abstract
    OBJECTIVE:
    Skipping breakfast has been consistently associated with high HbA1c and postprandial hyperglycemia (PPHG) in patients with type 2 diabetes. Our aim was to explore the effect of skipping breakfast on glycemia after a subsequent isocaloric (700 kcal) lunch and dinner.
    RESEARCH DESIGN AND METHODS:
    In a crossover design, 22 patients with diabetes with a mean diabetes duration of 8.4 ± 0.7 years, age 56.9 ± 1.0 years, BMI 28.2 ± 0.6 kg/m(2), and HbA1c 7.7 ± 0.1% (61 ± 0.8 mmol/mol) were randomly assigned to two test days: one day with breakfast, lunch, and dinner (YesB) and another with lunch and dinner but no breakfast (NoB). Postprandial plasma glucose, insulin, C-peptide, free fatty acids (FFA), glucagon, and intact glucagon-like peptide-1 (iGLP-1) were assessed.
    RESULTS:
    Compared with YesB, lunch area under the curves for 0-180 min (AUC0-180) for plasma glucose, FFA, and glucagon were 36.8, 41.1, and 14.8% higher, respectively, whereas the AUC0-180 for insulin and iGLP-1 were 17% and 19% lower, respectively, on the NoB day (P < 0.0001). Similarly, dinner AUC0-180 for glucose, FFA, and glucagon were 26.6, 29.6, and 11.5% higher, respectively, and AUC0-180 for insulin and iGLP-1 were 7.9% and 16.5% lower on the NoB day compared with the YesB day (P < 0.0001). Furthermore, insulin peak was delayed 30 min after lunch and dinner on the NoB day compared with the YesB day.
    CONCLUSIONS:
    Skipping breakfast increases PPHG after lunch and dinner in association with lower iGLP-1 and impaired insulin response. This study shows a long-term influence of breakfast on glucose regulation that persists throughout the day. Breakfast consumption could be a successful strategy for reduction of PPHG in type 2 diabetes.
    © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  28. Hello Paul,

    I’ve been trying to implement this advice for healing depression but I am noticing that whenever I start consuming MCT Oil my stool becomes quite light in color. I don’t exactly know what this means but it seems to go away when I stop consuming the oil.

    Do you have any advice for how I can/should proceed? I am considering giving the zero-carb version a test run to see if I can get results from that. Or would antibiotics be a better next step?

    Thank you Paul, your book has helped me so much.

    • Hi Joshua,

      Is light-colored stool a problem? I would try nutrients for bile acids, especially taurine in the morning, glycine in the evening, and vitamin C and egg yolks; plus 1 tbsp apple cider vinegar per day.

      Best, Paul

      • Thank you Paul,

        I was under the impression that it indicated a bile issue and something I should avoid. Perhaps I was misguided. Thank you for the advice, I will try it.

  29. Hello again Paul,

    I didn’t mention it the first time because I thought it had gone away, but the MCT Oil is without a doubt inducing diarrhea even in doses as low as 1 tablespoon. Is this just something uncomfortable that I should move through? I generally had IBS symptoms that improved significantly on the PHD, and these symptoms had stopped.

    I cannot tell if it is anxiety or not, but since I started experimenting with the oil I feel like my depression has had much more (and stronger) ups and downs than usual.

    I also recently had my TSH tested at 2.14, so I will also focus on Iodine and Selenium. Not sure if a MCV of 79.8L is particularly bad, but that was out of range.

    Thanks, Josh

  30. Hello once again Paul,

    Your book has been such a great resource for diet and you’ve been quite helpful in responding to my specific questions I wanted to ask one more.

    Feel free to respond to the gist of what I am writing as I am sure you are quite busy.

    I have been implementing a <20g carb ketogenic diet for approaching 6 full days now, but I haven't really noticed any changes. I've lost a little weight, my energy is a bit more stable, and on the keto urine strips it is showing moderate – large amounts of ketones.

    Have I spent enough time in the diet to see the benefits for depression, or is this a suggestion that this may not be the right place to be looking for me? (Perhaps not an infection in my case?) I am asking now because I am experiencing something I can only describe as a moving numbness mostly in my feet and lower legs but shifts around between left and right sides and other places. Presumably electrolyte related but it's making me anxious to return to the PHD, which I quite enjoy 🙂 .

    And like you've elaborated clearly, there are a significant amount of issues with such low carb diets. My experience with depression is long term but generally moderate, but I have very little to near 0 aggression and my experience does sound quite a bit different from how you've described yours. Especially because mine was early onset and my family has a history of bipolar and trauma events. (As opposed to your late onset with no description of adverse childhood experiences.)

    I am primarily asking on the point of infection. If I have reason to think it is not infection related I will probably try SSRIs. One interesting path of origin seems to be (permanent?) brain changes caused by early childhood stress and trauma. My inability to remember my childhood may also point in this direction.

    Sorry for the long message, but thank you so much for the help Paul. Your work has made a huge difference in my life.

    • Hi Joshua,

      I would say that a ketogenic diet, if it is going to work well for you, should show results quickly, within a week (if you are doing it properly). So if it hasn’t helped then I wouldn’t stick with it.

      The ketogenic diet would be most effective against certain bacterial infections; it doesn’t help against many others. So I wouldn’t say that you can rule out all infections just from this experience.

      Best, Paul

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