I am having to devote some time to other work so I will skip the usual science blogging this week in favor of a few administrative matters.
[1] Q&A Page: I’ve put up a page where readers can leave personal health questions. I will try to answer questions on this page, even though the answer will often have to be, “I don’t know.”
There are several advantages to collecting questions and answers on a single page:
- It makes it easier for readers to find questions that may be similar to their own, and to search past answers.
- It makes it easier for knowledgeable readers to contribute and improve upon my answers. We have doctors, scientists, and experienced patients among our readership, and their collective wisdom far exceeds my own.
- It establishes a permanent record of information, so that knowledge we generate in this community is not lost or forgotten.
With the creation of this page, I will no longer answer emails with personal health questions. I think it is more valuable to ask and answer questions publicly.
[2] Second Draft of the PHD Food Plate: On the “The Diet” page, you can see our new draft of the Perfect Health Diet food plate. We are grateful to all readers who gave us so many excellent comments on the first draft. The current version is much improved, thanks to all of you.
[3] Allan Balliett has Grass-Fed Beef: PHD reader and commenter Allan Balliett is a farmer and producer of grass-finished beef in Shepardstown, West Virginia. He distributes his beef in the Washington DC area, and would like to reach out to PHD readers. (In fact, he is delivering beef in the DC area this Saturday, and has 80 pounds still available.) If you’re in DC and would like to buy some locally produced grass-finished beef, consider giving Allan a try.
[4] Our Talk in York, Maine: Shou-Ching and I will speak to the Locavore Dinner, hosted by Denny and Aimee Perrin at the Wrap-Around Cottage, 254 Cider Hill Road, York, Maine, on Saturday September 17. Contact information may be found here. A pot-luck dinner starts at 5 pm; bring “a dish to share consisting of locally-sourced ingredients of animal and/or vegetable origins.” After dinner, I’ll give a talk describing our diet and the logic behind it.
via this link:
I have a personal health question for your Q and A page.
I’ve been following your diet since your book came out, the main change being the elimination of wheat and eating more fat. I took the NMR lipoprotein test before I started (last August) and again this August. I’m puzzled that my total LDL particles went up from 1700 to 2100 even though the small dense particles dropped from 830 to 700. Should I modify your diet? (I’m 68 and don’t have any significant health problems though heart disease seems to run in my family.)
I think the revised food plate is excellent. The shadow was an elegant solution to the Do Not Eat category.
Am also glad that you have the Q & A page up. I had been wanting something like this.
Is there a way that we can help add other exchanges from past posts?
I hope people will follow up and report back.
I really, really like the improved PHD “plate” … mad props!!
I really like the food plate. It gives you a good picture of amounts, dos and don’ts.
I also think the Q&A page is a great idea!! It makes think much more clear and will probably help to find answers to specifis questions when you have it all in one place.
Thanks a lot for all your effort!
Best,
Jen
Hi Peter,
I wouldn’t modify anything in response to an NMR lipoprotein test. No one knows how to interpret particle numbers, or what is optimal or what changes mean. Your changes may not even be significant, there is big variability test to test. See the recent Chris Masterjohn – Chris Kresser podcast.
In general, I think LDL particles are beneficial, but high LDL can indicate low T3 levels (eg due to insufficient carb consumption), nutrient deficiencies, or other issues. So I wouldn’t worry about the LDL specifically, but I would keep an eye out for other issues.
Hi Ellen,
I may try to recover a few “best of” comments from the past when I have time, but no guarantees. If people come back with links, that would help.
I also hope we hear back from people, that is the only way to learn from their experiences.
On the PHD Food Apple, where’s the spinach? Is it “colorful”?
Yes, green is colorful. To us anyway!
Hi Paul,
We’ve spoken before, I just need a few pointers about coconut milk and candida. Right now, I’m fighting what I’m pretty sure is a candida/yeast infection, but I’m afraid it’s not the only infection plaguing my health. Right now, the strategy against the yeast includes:
1. Protein restriction (1/2 pound of meat) with daily 16 hour intermittent fasting
2. 200-300 calorie coming from safe starches.
3. Plenty of antifungal herbs (oregano, thyme, curcumin
4. With every meal, probiotics coming from sauerkraut made using a starter (not anymore kefir, but a starter that uses as much bacterial strains as possible)
5. Supplements.
6. Fruit restriction to 2 pieces a day
So far, so good.
Question:
1. I’d love to include some coconut milk made from dried coconut during the daily fasts to mitigate autophagy (it’s possible to overdo it) and because its antibacterial and antifungal properties. The problem is that it is ketogenic. I don’t want to be feeding the yeast with ketones, so should I wait a little bit longer to include it in the diet? or is it a big no-no?
Thank you Paul, you’ve been a huge help and so far, the one who’s had the right answer to many problems. Keep up the great work.
Juan Camilo
Hi Juan,
You’re a little too low in carbs I think – what you’re eating is pretty much what we recommend as our ketogenic diet.
So I would add in the coconut milk / dried coconut but also add more carbs and reduce other fats. As long as you add carbs I think the coconut milk will be fine.
Hi Paul,
The new plate is great. It reflects how I am eating though my menu is less varied. I’m still learning how to add some variety while keeping the target plateaus in mind.
I read your recommendations for ‘erp’ since I am trying to lose fat (about 50lbs) and am a shorter female. I’ve been using Fitday.com to give me overall calories then I set my own protein/carb/fat goals. Carbs are generally anywhere from 200-400calories and same with protein. I always try to hit at least the 600 combines minimum. So my target calorie intake is around 1500 (500 cal deficit). Does this sound about right? Do you think it is better to have a little of the starch with each meal or is once a day ok?
I could probably just do 500 of each though I find I get full (HHB!) with what I am doing now.
Thank you,
Marcela
Hi Marcela,
It sounds like your diet is excellent. It’s great that you aren’t hungry, that is the key.
Since you are barely at the 600 carb+protein calorie minimum, I think you could consider shifting to slightly more carbs, same total calories.
I think it’s better to spread the starch out a little across meals, but you should do what you like.
Please keep me posted on your progress!
Best, Paul
Plate gets even better. One small, humble suggestion: make the lettering white in the Do Not Eat section, it’ll be more striking.
The PHD apple looks great. I like the do not eat foods as part of the shadow. That is clever. Overall, it reflects the PHD nicely. Great job!
Erik
I love the new graphic — putting chocolate at the top and the forbidden foods at the bottom in shade is genius.
Hi Paul,
A forum might be a nice way to organize Q&A into their own threads.
Thanks,
Mark
Hi Mark,
Yes, I’ve thought about a forum, but I figured baby steps are best.
Hi Paul,
I just ordered your book. I do have some questions while I wait to receive it.
I am a 52 year old female, 97 pounds. Obviously I don’ t need to lose weight, but I am trying to feel better. ( history of migraines and muscle and joint pain). Should I go carb free to start, or will that be unsafe considering my weight. (I’m 5’1″ by the way). Is wheat free the best way to start?
Sorry, forgot the other part of my question. I see rice is ok. What kind? Is Quinoa ok?
Hi Diana,
Do not go carb-free. We do not recommend that, even on ketogenic diets. See our “Zero-Carb Dangers” category, start from the oldest posts.
Yes, do go wheat-free. That is a great way to start. Also vegetable seed oil free. Those are the two most important changes.
We favor white rice. Re quinoa, see this post: http://perfecthealthdiet.com/?p=582.
As general guidance, I would start with our regular diet (400-600 carb calories per day, mainly from safe starches) and supplements, get used to that, then try the ketogenic diet, since that helps with migraines and the bacterial infections that are often the cause of joint pain. Since the ketogenic diet can either make you better or worse than the regular diet depending on the nature of your infections, it is good to stabilize your health on the regular diet before testing the ketogenic diet. Check out the “the diet” page for some guidance on the diet, especially the Food Plate.
Best, Paul
Already seed oil free! We use coconut oil and ghee for cooking and olive oil for salads.
Thanks so much….I can’t wait to read your book!
Hi Paul,
My partner and I have read the book and really loved it. The information was invaluable. I have already made the first major changes and converted to using coconut oil and milk; and have removed most of the gluten from our diet. There are still a few straggler gluten items that my partner is weaning himself off of. I have already noticed a difference. I have a couple of questions that I hope you can either answer or point me in the right direction:
I do not eat beef or pork; and hardly any chicken, but I do eat a lot of high omega 3 seafood (salmon, butterfish, etc.) and shellfish. I want to know can I still achieve the max benefits without eating the prescribed meats?
I noticed that my partner since eliminating all wheat products and the sugary drinks that his energy level is gotten really low. He seems to be very lathargic even after a night’s sleep. He does take a multi-vitamin, and adding more from your prescribed list. He works out regularly and could it be he isn’t getting enough “good carbs”? I would appreciate your feedback that could help him get his energy back?
Thanks in advance!
Jennifer
Hi Jennifer,
Seafood and shellfish are great. If you eat those, you don’t need other meats.
Your partner’s experience is often called “low carb flu” by Paleo people and can have diverse causes. He may be too low carb and need more rice. He may be malnourished in micronutrients and slow to make needed enzymes to adapt to the new metabolic pathways. Minerals and B vitamins may be important.
Usually this problem fixes itself in 2-4 weeks, especially if you add carbs and micronutrients. If it doesn’t, let me know, also keep an eye out for any low level infectious symptoms.
Best, Paul
I would like to inquire about tapioca starch/pearls and progesterone. I have found several articles about how yams/cassava contains natural progesterone. Actually, some African tribes seem to have extraordinarily high twinning rates because of eating cassava/tarot as a staple. On some websites, tapioca pudding is even recommended as a method to increase the likelihood for a twin pregnancy! For me, it is absolutely important not to eat food that might influence my hormonal situation at the moment. On the other hand I like to make deserts with tapioca. Do you know about the amount of progesterone that is contained in the pure starch? Is it relevant?
I thank you veray, very much!
I like your plate. It is well arranged & contained good vegetables, herbs, fruits, berries. Thanks for this sharing.
Hi Paul,
In the food plate, veal,and turkey are not mentionned as regular meat to eat. Is there a reason for this ..?
You also mention “lemon juice” a s regular acids to add throughall the day but do not recommend drinking fruit juices (too high in fructose..). Does this recommendation apply to lemon juice as regular beverage ?
Last but not least, I’d like to supplement with taurine, (for bile) , do you recommend it, and how much as a daily take ..? Thanks again, waiting for the next book in French ASAP ! 😉 Best,Maya
Hi Maya,
Veal and turkey are fine, the foods mentioned in the food plate are examples to illustrate the categories.
Lemon juice is encouraged. It’s fine to flavor water with lemon juice.
Yes, we do recommend taurine, but don’t have a preference for dose. The new book will recommend 500 mg once a week as a minimal dose, but if you have trouble digesting fats then take more.
Avoid beans, but eat a pound of meat per day???!!! I can’t believe any intelligent person would listen to these people.
Dear Paul, I have been doing a lot of research in the last 4 or 5 months as to the best way of eating that is sustainable in the long term. I am 44 yrs and I have had ocd most of my life and, going on 20 years I have had systematic thrush. I have tried to adher to Bees Natural Healing diet but I do have some concerns about it which I wont go into in detail here. I came across your web and there appears to be a lot of positive comments.
I intend to buy your book but I wont have it in time for the holiday season. I was wondering if there is anything you could tell me that might help me kick start your diet in the meantime?
Also, the PHD is high in fat, what is your view on 100% duck and goose fat? There is a lot of it around this time of year.
Kind regards
Maggie-Mai
Hi Maggie-Mai,
To get started, try to eat in accord with our food plate, and work hard to minimize omega-6 fats and stick to safe starches and whole foods. Home cooking is the best source of food. It takes time to alter one’s lifestyle so it’s OK to make changes gradually.
Duck and goose fat are great. Also eat some dairy fat and coconut milk or oil to help keep the omega-6 down.
Sorry Paul, me again, without knowing everything about PHD yet, im worried that lactose and fructose will have a negative impact on candida.
Kind regards, Maggie-Mai
Hi Maggie-Mai,
Well, our diet is low in both, so it shouldn’t be an issue.
You do need some carbs for immunity against Candida, so you don’t want to be extremely low-carb — just moderately low-carb.
Hi Paul,
This should be in the Reader Results page but I can’t get the page. The PHD has helped my whole family tremendously, but especially my sixteen year old granddaughter. She had frequent headaches and stomach aches since she was a toddler, at the age of seven a blood test showed that she was anaemic, had a TSH of 5.25mU/L, an FT3 level of 5.8mU/L and thyroid antibody levels consistent with auto-immune disease. She had no obvious signs of thyroid problems – she was always slim but had low self-esteem and struggled at school despite being an obviously intelligent child. At 14 the headaches became migraines and she was anxious and upset that she could never achieve the results needed to follow her dream of becoming an astro-physicist – she has had a passionate interest in astronomy from the age of about four.
We found the PHD almost two years ago and within a few days her headaches and stomach aches disappeared and her schoolwork improved tremendously. She said that before PHD she felt that her brain was in a fog and she couldn’t think properly. She is now achieving A’s in physics and chemistry and her dreams seem to be within reach.
Her TSH is now 2.81 mU/L, antibodies are within normal range and ferritin is 110 ug/L. She breaks the diet extremely rarely, not even for Christmas or birthdays, because even a bought smoothie caused a stomach ache and a headache. She loves Ris a la Mande and other recipes on your site.
Your diet has turned her life around and she is very grateful. Her only health problem is a terribly itchy scalp. She has had the problem for about two years and complains that it is now driving her insane. I developed the same problem at the same age and it drove me crazy for fifty years but since following PHD it has almost stopped itching. The itching followed exactly the same pattern for both of us – mainly in the crown area; perfectly healthy scalps; no dandruff; shiny healthy hair; we tried all possible hair products with no benefit yet washing with any hair product stops the itching for some hours.
She eats 4oz of liver a week, salmon once a week, and supplements Vit K2, magnesium and Vit C but she does not eat bone broth or fermented vegetables, Greek yoghurt is her only probiotic. She stopped having cod liver oil when she went on your diet and she goes back on the cod liver oil from time to time in desperation, becase it seems to ease the itching slightly, but not much and she worries that it isn’t good for her. She had eczema on her chest and back from a baby until she took cold liver oil at age 12. Her skin is now smooth but still becomes slightly itchy all over in our cold, dry winters. Her only other problem is icy cold feet, also developed like her grandmother at the age of fourteen.
My granddaughter has had almost miraculous improvements in her life from PHD so an itchy scalp doesn’t seem much of a problem but she is finding it very hard to cope with, especially when studying (which is most of her time) so we are hoping you can help.
Thank you for all your amazing work which has helped my family and so many others.
Hi Francesca,
It’s great to hear that your granddaughter is doing so much better. Astronomy is a highly competitive career choice so she’ll have to be at her best to succeed!
May I ask if she is eating 3 egg yolks a day? A deficiency of arachidonic acid may be in play, and the egg yolks would help and are important for nutrition generally.
She might also try zinc supplements, astaxanthin supplements and maybe another 4 ounces of duck/goose/pastured chicken liver in case the beef liver isn’t supplying enough A (you don’t want more than 4 ounces beef liver per week) because whatever may be depleting arachidonic acid will also deplete vitamin A. If zinc is deficient that would also lead to an excess of oxidative stress.
I would also have her supplement 225 mcg/day iodine as iodine deficiency might account for the cold feet.
It won’t hurt to adopt the other PHD recommendations — notably bone and joint stock and vitamin C — as well.
Best, Paul
Hi Paul,
Sorry to revive an old comment (if you get notified), and Francesca – sorry to hijack your comment! But google pointed me here and it is definitely on-topic so I thought I’d keep it organised.
I’m following the PHD quite closely; I’m getting 3 egg yolks a day, 4 oz of grass fed beef liver a week and supplementing C, Bs as per your recommendations, zinc, magnesium (dairy for calcium), iodine and selenium, getting plenty of sun. Yet I still suffer from mild dandruff and mild eczema/dermatitis on my fingers. The skin reaction isn’t like the eczema I had as a child however (resolved without diet changes before puberty) – it starts as small dots under the outer surface that eventually break the surface causing the skin to peel, which is painful if it gets bad but never itchy – my doctor has prescribed a corticosteroid that does stymie/reverse the problem when it appears (cyclical), but I try to avoid using it.
High/low carb seems to make no difference, neither does removing dairy (and it was no worse when consuming grains still either). I have removed cod liver oil as a supplement in case excess EPA was disrupting conversion of LA to AA – no apparent change.
However I work in a cafe and my hands are getting wet all day long – when I’m on holiday they definitely improve. My hair has gotten better (but not fixed) after removing shampoo/conditioner, and I was getting annoying pimples everyday until I stopped washing my face – which fixed that almost completely. So I’m just wondering if there is in fact a dietary factor or am I simply sensitive to physical irritants (short-sighted, childhood eczema and asthma, skin reactions to grasses, short stature, needed braces + adult teeth removed)?
I was hoping you would have some insight. Thank you so much for your time!
Kind Regards,
Adam
PS My only other thought was that I’m consuming liver in the form of freeze-dried capsules as I don’t have much time at all to cook and those that cook for me don’t want to eat liver (despite my suggestion) – is it possible the process degrades the Vit A or AA?
“astaxanthin supplements” is this a new one?
It’s a carotenoid and can supply antioxidant functions of vitamin A without providing its gene regulation effects (which you don’t want to get in excess). Astaxanthin often helps with skin symptoms.
Hi Paul,
Thank you so much, my granddaughter is only eating two egg yolks a day. I think you may be on to something about the vitamin A – my granddaughter and I both get tiny hard white lumps under the skin which disappear when we take cod liver oil; a few years ago I read somewhere that they occur in people who have trouble assimilating vitamin A. We will immediately try your recommendations.
I would also like to ask if you can recommend anything which may help with Dupuytren’s contracture. My hands are at the point of needing surgery. My mother had very severe Dupuytren’s which was not helped by successive operations; my four younger brothers all have it severely and have had many operations and my father had it slightly in one finger. It is supposed to be genetic yet no grandparents or great grandparents, aunties or uncles have it, while our immediate family has it so severely. Infection is not recognized as a cause but our family pattern seems to point to it.
Thank you so much for all your help, it is appreciated more than I can ever say.
Best regards,
Francesca
Francesca,
Google “Danny Roddy”. His dandruff/itchy scalp disappeared within several days after being on natural thyroid and vitamin A as per Ray Peat’s suggestion. Note that most thyroid experts recommend either ignoring TSH levels and going by basal temps alone, or recommend thyroid if TSH is over 1.5-2.0. Just a thought…
I realize this discussion is 3 years old but I wanted to reply in case anyone is searching Dupuytren’s and landing here like I was. Some postulate that Dupuytren’s contracture may be a chronic inflammatory disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798044/
It is characterised by an abnormal fibroblast proliferation and matrix deposition affecting the palmar fascia. It’s been described as acting like a cancer in it’s proliferation and speed, though noncancerous.
I have it on both hands. I also knuckle pads developing. And I have plantar fibromatosis. It’s frightening how many nodules I’ve developed in just 4 months. Very scary. And so little research, because it’s supposedly rare (though I know so many people with it).
I’m with you — I believe strongly that it’s an infection. My low LDL indicates infection somewhere. I’m working with a gastro right now getting stool samples, SIBO test, upper GI. I think one day we’ll learn this stems from the gut, like seemingly every other disease.
Meanwhile, I’m eating PHD, taking the supplements, practicing IF and circadian rhythm training.
Hi Sally,
Thanks for letting us know. Keep us posted on how you do. Low LDL is usually either an infection or anemia, so check iron status as well.
Best, Paul
Hey Paul,
I was hoping you could help me with something. Do you have any idea if dehydrated cassava is safe to consume? Does dehydration neutralize all of the toxins the same as boiling? I really want to know the answer to this question, but I cannot find definitive answers online. I would really appreciate the help! Great book, by the way. The diet has made a big difference in how I feel.