Reader Feedback: A Roundup with My Reflections

We were very curious to see how readers would react to the new edition. Some of the reactions I think are interesting.

How Paleo is PHD? How PHD is Paleo?

One of my New Year’s resolutions is to do more on social media. Google+ has “communities” now and a few days ago I started a Perfect Health Dieters community just to see what it’s like. Paul Halliday, proprietor of Living in the Ice Age, left this note:

I bought your book since you were pointed out as someone who was more favourable about the role of carbs and very very much enjoyed the read.

My preconception about the PHD being a pro-carb diet were stopped in their tracks. In fact, the PHD is not a pro-carb diet at all. I read the book as very much a straight down the line paleo book with the inclusion that we need carbs to keep a number of basic bodily functions working as expected.

Two years ago it was totally shocking that a Paleo diet could include white rice (a grain! milled at that!), dairy, and other Neolithic foods. Now we’re “straight down the line paleo.”

In recent weeks, Robb Wolf has endorsed carbs and starches (part 1, part 2, part 3). Terms of our coinage, like “safe starches” and “supplemental foods” (meaning foods that one should eat on a regular schedule for their micronutrients, as people take supplements) have entered the Paleo vernacular. (See, for example, Mark Sisson’s recent post on supplemental foods.)

We couldn’t be happier about this. Not only is it progress toward better health, it is flattering to us.

I think the shift toward less restrictive diets speaks to the maturation of the ancestral health movement. Paleo is becoming a diet that is healthier, tastier, and more accessible and convenient to the general public; and gurus are following the evidence to more scientifically sound recommendations. That bodes well for our movement’s chances to become mainstream.

Responses to Our Obesity Ideas

A fair part of the new material in the book has to do with weight loss and obesity (see What’s New in the New Edition, 2: How to Lose Weight). I’m happy to see that a number of readers found the discussion illuminating.

Mark Lofquist, for instance, paraphrased an important observation from our book:

“Telling an obese person not to eat too much is as effective as telling a person with a cold not to cough too much.” (/paraphrased) -Dr Paul Jaminet

The original line can be found on page 176. Our position is that weight loss results from improved health combined with an energy deficit; eating less food generates an energy deficit but doesn’t necessarily improve health. In fact, if the previous diet was malnourishing, then eating less will make it more malnourishing and therefore will worsen health. The result will often be yo-yo weight regain and obesity that is more severe and intractable than before.

For effective weight loss, therefore, it’s inadequate to tell a person “Don’t eat too much.” You have to tell them how this may be accomplished in a healthful, satisfying way. This is what we try to do.

In fact, it’s best to focus on health first, and then the weight loss becomes easy. In an intelligent Amazon review, Navy87Guy notes:

I think it’s very telling that only a short chapter is actually devoted to the discussion of weight loss — because it is based upon all of the other principles that have already been outlined. The discussion in the weight loss chapter on the scientific origins of obesity is fascinating and sobering at the same time.

Great observation! Little needs to be said about weight loss once it has been explained how to be healthy. Good health leads to easy weight loss.

Have we succeeded in enabling weight loss? On Facebook, Henrik Johnsen shared some good news:

Today I can once again fit 3 pairs of pants that gave up wearing about 8 years ago. I’ve been losing weight steadily for the past 5 months by switching to Perfect Health Diet by Paul Jaminet and I’ve never eating so much fat and tasty food before in my life! Every meal’s a banquet! Thanks Paul! 😀

Kendal Lenton said:

Last week I decided to change my life, been eating great, and already down 8 lbs. Thank you Mark’s Daily Apple and Perfect Health Diet for helping me change my life.

Meanwhile, Laura at This Felicitous Life would like to lose a few pounds, but has been maintaining her weight. She has an idea that may fix that:

I’ve given it a lot of thought and done some scientific research and have come to a very cutting-edge hypothesis:

Maybe I should stop drinking 1/4 cup (or more) of heavy whipping cream in my coffee every day.

Heh. Yes, some people can lose weight eating whatever they want; just choosing healthy foods in the right proportions is enough. Others have to watch portion sizes or, as we discussed in Perfect Health Diet: Weight Loss Version, trim the fat.

It’s sad, but we can’t always have everything we want!

The Healer’s Perspective

One of my recent projects has been helping the Ancestral Health Society set up a new journal, the Journal of Evolution and Health. We have chosen a platform, are about to start editorial operations, and the first issue may appear as early as summer.

One goal of this journal is to document the successful health improvements that are often brought about by ancestral diets and lifestyles. Doctors and other clinicians are the best sources for that information, since they can see how multiple patients respond to the diet, and see negative as well as positive responses. To help bring Perfect Health Dieters and healers together in sufficient numbers to create a critical mass of knowledge, I’ve created a Healers page, and I invite healing professionals who would like to investigate the value of the Perfect Health Diet to list themselves there.

One medical doctor who has been recommending our book to patients is Dr. Shira Miller of The Integrative Center in Los Angeles. She wrote recently to say that “my patients are loving the book.”

Over at Amazon, Dr. Verne Weisberg says our book is “seriously important” and writes, “As a physician who treats obesity, I highly recommend that anyone looking to correct any of the multitude of ailments that stem from diet give careful consideration to what they have to say.”

I really liked the Amazon review from Denise Baxter, a certified health coach:

My clients are overjoyed with the changes they are experiencing in their bodies and their minds. They find their meals more enjoyable and easier to prepare. They appreciate being able to fix one meal for the entire family. One of my diabetics was able to lower her insulin yet again, and reduce her blood sugars even further by adding some safe starches. Although she had a great deal of trepidation about doing so, she loves the results.

This book is a gem and has answered many of my long standing questions. Paul and Shou-Ching Jaminet have made an enormous contribution with their many years of work. I will not be surprised to see their work make a significant difference in the health of our nation.

Other Amazon Reviews

R.U. Kidding-Me made me laugh:

As I read through this book there were quite a few what I like to call “Holy s*** moments” where I was so happy to read things that actually make sense.

In the end, even if you did not agree with or understand all of it, you emerge from this book like one does from a fog and you realize that you are definitely smarter than the person sitting next to you 🙂 Whoa! Mind blowing!!

Justin Sutherland:

Despite being full of research, the book is a pleasure to read and is easy to follow. I kept turning pages and saying to myself, “well, when you put it that way, of course!”

T., Quinton left a heartfelt review:

Although I wouldn’t wish illness on anyone, I’m grateful that the Jaminet’s were able to contribute immensely to society as a whole while conquering their own illnesses…. I have lost weight even though I’m not trying to, and am rarely hungry.

Navy87Guy has a complaint:

My only complaint is that they use the word “diet” in the title. While they use it in the academic sense (i.e., the foods that you habitually eat to provide sustenance), too many people only think of “diet” as a restriction in your food intake to promote weight loss. I prefer to think of the authors’ book as a “lifestyle”, rather than simply a prescription for changing your food intake. That view is reinforced by the holistic treatment of the impacts of circadian rhythm disruption on health – a fascinating chapter that probably could have as much impact on your overall health as your choice of food!

TMac had the same thought: “It pains me that the Jaminets decided to call their plan the Perfect Health Diet, rather than the Perfect Health Lifestyle.”

We liked G. Nesta’s comment:

When something just makes sense and seems right, you know it. I am basically back to the diet of my parents and grandparents who lived into their 80s and were active and happy their entire lives. This is my favorite diet/health book that i have read.

Our thanks to everyone who has left an Amazon review!

Vegetarian Concerns

I’m planning a post or series of posts looking at the healthfulness of vegetarian diets. Recently Beth, a vegetarian considering a switch, asked about T. Colin Campbell’s claim that protein causes cancer. Elyse L offered some good advice for former vegetarians considering PHD:

Many folks following PHD (and Paleo) are former vegetarians or vegans. For me, I started digging into all of the information out there pro and con and finally decided to just give it a try and see how I feel. For me, I had immediate relief from lethargy, allergies and arthritis. What’s the worst that can happen? Give it a few weeks and see how you feel. If you listen to your body it will tell you what’s best.

The commenters on Allison’s post

Allison’s tale of her ongoing recovery from panic disorder, OCD, and chronic fatigue brought fascinating comments from readers who are addressing similar chronic diseases.

Jennifer has benefited from homeopathy and PHD:

The Perfect Health diet helped me in many ways. I lost weight that I could never lose and improved my cognition and memory. I also felt more together and calmer than I ever had in my life but I still had panic attacks. I had certain triggers that couldn’t be erased. So when my daughter got PANDAS, I did a lot of research and read a lot of accounts of children being helped by homeopathy (I know….I hear the collective groans of disbelief)….. My daughter and I have been going to [a practitioner of the heilkunst method of homeopathy] once a month since September. Most of her issues have been completely resolved and I am completely panic free and my insomnia (which I had for over a year…could not sleep without drugs) is completely resolved. I have inner strength that I have never had and I sleep like a baby…. I know many people are skeptical about homeopathy or know little about it but I am proof that it works … I do credit the Perfect Health diet for allowing homeopathy to work as spectacularly as it has for me since I think my issues would remain chronic if I weren’t on an optimal diet.

We believe chronic infections are an under-recognized cause of disease, and Hunter’s wife illustrates that thesis. She benefited from antiviral treatments:

Allison, everything you describe sounds like you could be my wife Tiffany in another life!

A couple years ago Tiffany decided to stop taking birth control and her health took a turn for the worse as those hormones were apparently helping to keep her “functioning” all the previous years and she suddenly developed amenorrhea and hypothyroidism. Finding an endocrinologist who would actually agree that she was hypothyroid was impossible but we kept trying until she eventually progressed to be so bad that she was officially diagnosed but after trying many different thyroid medications, none ever helped her “feel” better and no one could find the cause of her thyroid issues. We finally came across an ad in the paper for a chiropractor who said he specialized in thyroid disorders and chronic fatigue syndrome so we went to see him and he ordered hundreds of blood tests looking for infections. In the end he diagnosed her with a chronic viral infection of Epstein-Barr Virus (mono) among a couple others and he told us that he has seen this in multiple patients and Epstein-Barr is always related to chronic fatigue and thyroid issues. Chiropractors cannot prescribe medicine in the state of Florida so he transferred her to a semi-retired infectious disease specialist who he had worked with for previous patients, Dr David Reifsnyder in Lakeland, FL. Dr Reifsnyder agreed that Epstein-Barr is the main cause of her hypothyroidism and chronic fatigue and told us how he has treated hundreds of patients for this throughout his career and that they always have active Epstein-Barr infections but that most doctors don’t know how to test and diagnose an active chronic Epstein-Barr infection, even before he could test for the virus he said that he discovered patients with these symptoms would respond to antiviral treatment, and that Tiffany would have to take antivirals daily for the next 2-4 years but that he was sure this would eventually clear up all of her issues, however recovery would be a slow process as her HPA axis recovered and got “back into sync”.

We noticed her improving almost immediately after starting the daily antivirals and it’s now almost 1 year later and she’s stopped taking antidepressants and just seems to have no desire to visit psychiatrists any more, something she had been doing for all of her adult life, I think they had tried putting her on every antidepressant possible over the years. She has also stopped taking thyroid medications and her body has normalized her thyroid levels on its own. She doesn’t have fatigue issues any more, she wakes up feeling more refreshed in the mornings and doesn’t want to sleep all day any more, she’s even started wanting to exercise and go jogging, something she enjoyed as a kid on the school track team but had given up as she got older and dealt with these issues. And after 1.5 years with a complete absense of her menstrual cycle her female sex hormones have normalized on their own and her regular menstrual cycle returned.

Jo had also suffered from panic disorder and other problems, but is doing better after getting antimicrobial treatment and eating PHD:

My life has been marked by fears – they literally dictated most of my choices. Finally, a diagnosis of autoimmunity that triggered an 8-year long search for remedies. I started addressing gut infections – gut imbalances and H.Pylori – then herpes viruses, then mono then, under Paul’s suggestion, I requested a course of fluconazole for a fungal skin condition that might actually be systemic. I saw improvements only when I addressed these infections together with a PHD compliant diet. The tics are still with me and are cyclical – which makes me think of some parasite I have not identified yet. But many other symptoms disappeared and for the first time I have a different perspective in life. In addition to infections I had several nutrient deficiencies – I was prone to break bones and hurt myself continuously, partly because of an anxious behavior and partly because of low vitamin D. I know very well what you mean about overcoming the memories and the habit of living life to cater fears. Plus, I spent so much time finding a psychological cause, torturing myself with any possible technique to train my mind…I wish I had known.

There is a great need for better diagnostic tools, better treatments, and more doctors who are willing to investigate and address chronic infectious conditions. But hopefully these stories will help move medicine in the right direction.

Last But Not Least

In my New Year’s Day post I quoted Jennifer Fulwiler to the effect that she was having a comfortable sixth pregnancy:

I have been following the PHD for this pregnancy. The results have been amazing. In fact, with all five of my previous pregnancies I had debilitating, severe morning sickness. On the PHD, I had almost none!…

[A]fter I had my fifth child I found myself tired, achy, and 35 pounds overweight. Thanks to the PHD I lost all the weight, and when the show was filmed, in my first trimester of pregnancy with my sixth child, I weighed the same as I did the day I got married, and felt better than I ever had in my life.

Fortune being fickle, soon afterward Jennifer experienced shortness of breath and checked into a hospital. Pregnancy is a risk factor for clotting, and Jennifer is homozygous for a mutation which leads to overproduction of Factor II (prothrombin). Her clotting disorder, which is shared by about 1 person in 10,000, was discovered during her second pregnancy when she suffered deep vein thrombosis. This time around the clotting caused pulmonary embolisms.

It’s impossible to know whether it contributed, but a few weeks before symptoms began Jennifer began taking a multivitamin with a number of coagulation-modulating ingredients. I may as well reiterate here for those trying to follow our diet without reading the new edition: One of the updated bits of advice is that we now recommend AGAINST taking a multivitamin, even in pregnancy.

Jennifer is at home and has resumed blogging, but I know she would appreciate prayers.

Leave a comment ?

53 Comments.

  1. Ah, yes, homeopathy. http://www.youtube.com/watch?v=kA6rUU0K9xE

    I suppose a placebo’s better than nothing, though.

    Anyway, I’m glad to see this positive reception of the new PHD, I’ve had nothing but great results!

    @Paul: Out of curiosity, what do you think is the best way to do some basic biology/biochemistry self-education outside of school? I think a basic understanding of the human body is necessary to avoid falling into the traps of veganism/atkins/breatharian/whatever the next dangerous diet will be.

    • Hi Anon,

      I don’t know. The smart alec answer would be to read our book. I think that’s a good start. The trouble is that biology is extremely complex and people have a tendency to get lost amid the trees and lose sight of the forest. Even top scientists do that. I don’t know what the solution is. The reason I suggest our book is that it is a high-level treatment where we try to show the forest.

    • You might want to look at MIT’s Open Courseware site: http://ocw.mit.edu/index.htm Also, Coursera has some interesting courses coming up in the Biology realm https://www.coursera.org/category/biology I’m currently enrolled in the Genetics and Evolution course there (offered through Duke University) and it’s fascinating. While these are obviously academic sources, it’s a far cry from having to be in school.

    • Another Coursera course that was not in the Bio section (it was in Physical and Earth Sciences) but looks good is Intro to Organic Chemistry https://www.coursera.org/course/orgchem1a I may sign up for that myself, if I can remember my Gen Chem from so long ago.

  2. Do the findings of Dr. Colin Campbell mean nothing? He claims that eating any animal products is injurious to our health. BTW, in view of mankind’s developing reconsideration of humane treatment of animals, it must be said that PHD is a step back from the movement toward this humane ideal in its promotion of the eating of animal products. A step backward from a human health standpoint and from that of the humane treatment of animals which will suffer due to the need to eat all these animal derived products the diet requires. It may be time to really read “The China Study.”

    • Colin Campbell “found” exactly what he set out to find, which was a platform for his personal agenda.

      • I have been watching a TV series Inside Natures Giants which is so interesting. Humans need to eat nutrient foods.

        • Nothing like an unfounded personal attack by someone who has no real insight into the story to clear things up! Let the world know, Todd S., how you have acquired this information (it better be good or you ought to withdraw the slanderous comment).

    • Hi Brian,

      I think they mean almost nothing, as they are not well-founded. If you follow the link to Beth’s question, you’ll see in my reply I link to a piece by Chris Masterjohn which thoroughly refutes Campbell’s animal-protein-causes-cancer claim. Other aspects of Campbell’s thought fare only a little better.

      PHD is hardly a step back from standard (non-vegetarian) diets, because we recommend the same amount of meat or fish that most people actually eat. Whatever quarrel you have with us, you have with the vast majority of the world’s people.

    • Brian- It may be time to really read The Perfect Health Diet. It explains how our body was designed to consume meat, along with other foods. It is actually a a step forward.

    • Brian,

      How can we hope to find a diet suitable from both a human health standpoint and the humane treatment of animals if we don’t first know what a healthy human diet truly is. That’s all PHD is trying to tell you here; what is the original optimal human diet. It’s a matter of hard fact that we’re only now getting a better grasp of. It just so happens the most healthful diet is probably not vegetarian.

      Even if your end goal due to personal convictions or empathy toward animals or the earth is to be vegetarian, don’t you want to know the truth about what is an optimal diet, so that you can approximate optimal health as much as possible through non-meat items? If PHD is a step back to you, you’re walking away from the truth.

  3. Paul

    I hope when you address the issue of vegetarianism, you distinguish between veganism vs even a lacto-vegetarian, which is worlds apart. I consider myself a PHD-er in spite of my choice to be a lacto-ovo vegetarian.

    Warm regards,
    Aravind

    • Hi Aravind,

      Yes! You can be a lacto-ovo vegetarian PHDer, because our diet is designed around being well nourished / getting the right amounts of nutrients, there are many food combinations that can deliver that.

      I think it would be very difficult to be a PHD vegan, however.

      Thanks, Aravind, important point.

      • Hi Paul, Could you implement a PHD type with specific ratios for vegan or for non “meat” eater.? As meat is a great and important source of fat, would you consider a lacto-vegetarian, or someone who eats fish as the only source of protein could follow a balanced PHD ? Should the carb ratio be more important as a valuable source of prot. ? Or moreover, the fat ratio should be more closely managed by adding tbsp (?) of fat (coconut oil, butter,or whatever..) Thanks for your answer ! Best, July

        • Hi July,

          Yes, you can hit all the PHD nutrient recommendations as a lacto-ovo vegetarian or as a pescetarian (fish only) eater.

          But I would suggest relaxing the carb recommendation, it makes it easier on vegetarians. A few extra carbs / less fats are not going to affect health much. Many centenarians eat 50% carb.

          • Paul, How can such a modified PHD be implemented ? Could you give us some example ?
            Is a pescetarian (I’m improving my english vocab. thanks to you :)) eating egg yolks concerned by adding extra carbs or is it only for lacto-ovo-veg.?
            You mention : many centenarians eat 50% carbs.So, would you say carbs could be recommended to such a level to live 110..? (Sorry, but As I have not read yet all the 45 pages of comments and Q/A of the blog, maybe you’ve answered it ..)

            Is there a reason why food is not the only recommended “health plan” you advise, as many centenarians did not have access to such recommended supp. . Do you think the supp recommended are to be taken all life long or could an improvement of health made them unuseful..?

            Thanks for your answer !
            Best, July

          • Hi July,

            As a pescetarian it’s pretty simple, you can eat fish or shellfish every day with no negative effects.

            For lacto-ovo vegetarians it’s more complicated.

            Our supplement recommendations are based on evidence drawn from the general population and are mainly based on mortality minimization, which means protection from cardiovascular disease and cancer. An improvement in health that diminishes the risk of those two diseases might favor other/lesser supplementation regimens. But there is a paucity of evidence to answer that.

      • Do you think that dietary creatine, carnitine, carnosine, and taurine from meat are important for being well-nourished? Lacto-ovo vegetarians despite not consuming processed meat, overcooked meat, meat in the context of a malnourishing diet (has a few downsides but are easily remedied) and being far more health-conscious than omnivores don’t have significantly lower total disease rates than the average omnnivore, who don’t have very desirable disease rates in the first place. But you are right, it’s a step up from veganism.

        Supplementation of these nutrients is generally beneficial, and vegetarians have lower levels of them in their bodies. I suppose one could supplement with them and PHD is pro supplementation when appropriate.

        • Hi Stabby,

          That is a question that is not easily answered. I do think supplementation is beneficial. But under what circumstances do you need to eat carnitine, or is it enough to get vitamin C which enables carnitine manufacture? These questions have to be answered empirically and I’m not sure we have solid data for most of them.

          I do think it is probably prudent for vegetarians to supplement a bit more than non-vegetarians.

          • True, I understand it’s not simple and there is a lot to consider; “how important?” questions need to be quantified. I’d say that they’re definitely helpful and desirable in the diet, but exactly what people should recommend or do about it has a quite elusive answer.

        • One thing to remember is that a good part of Indians has been lacto-vegetarian for 2500years. This is enough to create a basic set of policies for eating food, that is balanced.

          I would think that being sedentary as a vegetarian makes the diet unbalanced. It will work for a fairly active guy, as long as you eat enough dairy products. Ghee, Raw milk, and Yogurt are considered very important in a Vegetarian diet.

          That is the problem with the present Indian Vegetarian diet. Its difficult to get good ghee, very difficult to get good fresh raw milk. And many of us are sedentary.

  4. I know Stabby is just trying to goad me. I will take the bait. I supplement zinc-copper, selenium to name a few. I contend that in the absence of a specific pathology to be remediated, that the pareto principle suggests that NAD avoidance and compliance is the primary issue for the majority of people.

    • I wasn’t just trying to goad you, well maybe a little :p but I know your position for the most part. It’s an important question for Paul because he puts a lot of emphasis on nutrients and thinks that the discrepancy between vegan and lacto-ovo is significant, though not yet the discrepancy between meat-eating and non-meat-eating, which is understandable because it’s a very convoluted issue.

      Though I agree that good health by usual standards is compatible with not eating meat, we should still want to utilize as many advantages as we can that aren’t too much of a hassle. Sometimes some things are definitely a hassle, I don’t doubt that whatever the importance of meat is your culture is more important for you.

      Supplements can be a bit of a hassle, but tangible health benefits are the opposite of a hassle, that’s just a question that I would like to see answered and who better to contribute than P Jaminizzle? I’m not seeing it from the usual paleo gurus, but that’s probably because most of them think that the point is moot because 99% of self-identifying paleos eat truckloads of meat.

  5. No grains, no excess fructose, no excess omega-6 vis-a-vis vegetable oils, and problematic legumes (soy, peanuts) are the bang for the buck issues. YMMV.

  6. those google+ links do not seem to work.
    this one seemed to work,
    https://plus.google.com/communities/107159723317528697721

    could be they are only temporary tho…& keep changing?

  7. It seems unlikely that homeopathy had any real effect on Jennifer’s condition (beyond placebo effect, that is) since homeopathic remedies are typically diluted to the point that not a trace of the original substance remains. Is it possible that some additive was assisting in the recovery, or is it more likely the case that the diet improvements were solely responsible?

  8. Hey, Paul!

    Here’s another area you are making great strides for Paleo in: Uncovering fructose malabsorption problems.

    For some reason, many who adopt the paleo diet go crazy on fruit and avoid ‘safe starches’ like the plague. I was one of these.

    Since regaining my love of potatoes, and using PHD principles to tweak the perfect amount, I have decreased the amount of fruit I have been eating. These past several months, I have never felt better.

    Two weeks ago, our regular grocery store got in a huge load of pears. We bought a huge bag of all different types and started eating them. All of a sudden, I was gassed up and bloated–a condition I used to blame on ‘carbs’. I have also noticed periods of unexplained gassiness, bloating, stomach pains, that I now realize happened after excess consumption of fructose containing foods.

    Funny enough, the pear problem led me to this website: http://www.thefartingpear.com/index.php/foodsearch

    It’s a quick guide to the fructose content of foods.

    Fructose malabsoption seems to be a common enough problem that everybody experiencing symptoms of abdominal discomfort or bloating should explore. I see through a quick search that you have written extensively about it, but it wasn’t until I started eating a pound of potatoes a day that I was forced to give up some sugary fruit and finally put 2+2 togther to realize it was probably the high fructose content of my paleo diet that was causing me grief.

  9. Hi, my husband and I are keen to use your ideas and are processing your book. I have printed off the apple on a plate but have also adapted the diet plan with a shopping list for our convenience. I will try to attach this for your consideration. If not successful, please advise me of how I could email it to you. Thanks.
    PS Not in correct MS Word table format but you can get the idea
    PERFECT HEALTH DIET
    • About 1.4 kg of plant foods per day:
    o about 0.45 kg of white rice, potatoes, sweet potatoes, and taro;
    aAbout 0.45 kg of sugary in-ground vegetables (such as beets or carrots), fruits, and berries;
    o low-calorie vegetables to taste, including fermented vegetables and green leafy vegetables.
    o peas and green beans are fine.

    • 0.25 to 0.5 kg per day of meat or fish including organ meats
    o beef, lamb, goat
    o birds (especially duck and wild or naturally raised birds);
    o Shellfish and freshwater and marine fish.

    • Low omega-6 fats and oils from animal or tropical plant sources, to taste. Good sources include:
    o butter, sour cream, cream
    o coconut milk or oil
    o palm oil, palm kernel oil, olive oil, avocado oil, macadamia nut butter, almond butter, cashew butter

    • Acids to taste, especially citric acid (lemon juice, lime juice, orange juice, grapefruit juice), lactic acid from fermented or pickled vegetables, vinegars, tannic acids from wine, and tomatoes.

    • Broths or stocks made from animal bones and joints.

    • Snacks or desserts from our pleasure foods: fruits and berries, nuts, alcohol, chocolate, cream, and fructose-free sweeteners like dextrose or rice syrup.

    • Rice noodles, rice crackers, and the like are fine, as are gluten-free foods made from a mix of rice flour, potato starch, and tapioca starch.

    • Recommended foods for their micronutrients – liver, kidney, egg yolks, seaweeds, shellfish, fermented vegetables, and bone broths.

    NO GO
    NO cereal grains — wheat, barley, oats, corn — or foods made from them — bread, pasta, breakfast cereals, oatmeal.
    NO calorie-rich legumes. NO soy or peanuts.
    NO added sugar or high-fructose corn syrup. NO drinks with sugar.
    NO soybean oil, corn oil, safflower oil, sunflower oil, canola oil.
    SHOPPING LIST
    o white rice
    o potatoes & pumpkin
    o sweet potatoes & taro
    o onions, garlic, ginger, leeks
    o broccoli, cauliflower, zucchini
    o eggplant, mushrooms, shallots
    o ALL root vegetables
    o tomatoes, cucumber, capsicum
    o all fruit
    o berries
    o pickled vegetables
    o green leafy vegetables
    o green peas and beans
    o butter & sour cream
    o cheeses
    o milk & natural yoghurt
    o coconut milk or oil
    o olive oil
    o vinegars o rice syrup & almond meal
    o rice noodles, rice crackers
    o gluten-free foods – rice flour, potato starch, tapioca starch
    o MEAT- beef, lamb, pork
    o liver, kidney
    o eggs
    o seaweeds
    o shellfish
    o FISH – especially salmon, mackerel, sardines
    o POULTRY – duck, turkey, chicken
    o soup bones
    o coffee & teas
    o lemon, lime, orange, grapefruit
    o wine & beer
    o tree nuts
    o chocolate
    o ALL SPICES

    BREAKFAST LUNCH DINNER
    MON Boiled eggs & berries BIBIMBAP Red meat – slow cooked casserole, vegetables, rice
    TUE
    FASTING BIBIMBAP Fish – potatoes, vegetables or salad
    WED Rice & eggs Tuna, salad & rice crackers Poultry – sweet potato, vegetables or salad
    THU
    FASTING BIBIMBAP Red meat – BBQ potatoes, vegetables or salad
    FRI Yoghurt & berries Cheese, salad, boiled eggs Seafood – rice noodles, vegetables or salad
    SAT Eggs, mushrooms & tomatoes Rice paper rolls Whatever takes your fancy!!!
    SUN
    FASTING Omelette & salad Red meat – meatloaf, lasagne, sweet potato, vegetables or salad

    SNACKS – carrot/celery, fruit, nuts, pate, rye or rice crackers, olives, antipasto, hummus, vegetable dips, cheese
    DRINKS – water, tea, coffee, wine, beer
    TREATS – chocolate, GLUTEN-FREE / SUGAR-FREE desserts

  10. Scott Priestley

    Hi Paul,

    With your interest in infections as a root cause of many diseases, I thought you might find this reference interesting. It shows that pathogenic bacteria may contribute to development of obesity:

    http://www.nature.com/ismej/journal/vaop/ncurrent/full/ismej2012153a.html

    I’m enjoying reading the second edition of PHD and working to implement your approach for myself and my family.

    Best regards,

    Scott Priestley

  11. Hi Paul, I wonder if you could help me. I am very ill but not sure exactly what is going on. Are there any UK based companies you would recommend for medical tests, for things such as cortisol, vitamin status, thyroid, things like that? I am going to see my doctor but they are usually reluctant to order tests and I am happy to do it privately.

    Any help is much appreciated,
    thanks,
    PC.

  12. Hi Paul,
    You wrote that food sensitivities can sometimes be helpful in diagnosing certain health conditions. In my case fructose gives me digestive problems (gas and bloating). Do you know what health conditions that could be indicative of? I’m suspecting a fungal infection, but it might be something else too and I want to be more certain and rule out other possibilities in order to find a way to address the problem.
    Thanks in advance,
    Erik

    • Hi Erik,

      Fructose malabsorption is a very common problem — around 30% of people (http://en.wikipedia.org/wiki/Fructose_malabsorption).

      It is associated with gut dysbiosis / IBS and with celiac disease and other inflammatory food sensitivities. Also, some food toxins can induce it.

      It has too many possible causes to serve as a specific diagnostic tool. Anything that impairs digestion will make fructose available to microbes that can overgrow on it, causing symptoms.

      • Hi Paul,
        Thank you for your fast reply. I’m trying to find a way to be able to digest fructose properly again. I think a fungal infection might be causing my problems with fructose so I’ll try to treat that and see if it changes anything.
        I was wondering if you know any PHD success stories of people overcoming fructose digestion issues. Any kind of advice for addressing this problem would be greatly appreciated.

  13. Paul, I really enjoyed your first edition; in fact, it is the best book on diet and health I have ever read. How does the second edition differ? Thanks, George Ordal

  14. I started reading your book (and this blog) a while ago — very impressed with your scientific approach.

    I’m just not sure about your recommendation of rice. Your reasoning to be cautious of plant toxins, especially of grass seeds, is clear. Then you turn around and say, “well, rice is safe because statistics show no proven risks” Um, is this scientific? What if the stats were missing something?

    I am originally from Japan. I am no scientist, but I know a few things about the country’s eating habit and health. We ate large amount of rice (brown or white, occasionally mixed with other grains like barley) until about 1970, when we became more westernized (more meat, dairy, baked goods, sugar)

    Before, TB was a “national disease” So I couldn’t help noticing, on page 206, where you mention the relationship between wheat and V D receptor, and infectious diseases such as TB. We have believed that the decrease of TB is due to better medical care and overall better nutrition, but could it be that something in rice was causing the same problem that wheat seems to do?

    Rice has its lectins / plant proteins. On page 233, you say, “White rice: … All the antinutrition factors are proteins and all except phytin (phytate) are subject to heat denaturation.” If cooking makes plant proteins safe, other (gluten free) grains are fine, too, I guess? (Don’t we cook all grains?) Why only rice is deemed safe?

    On page 204, you write, “WGA, as well as other grain and legume lectins … have been shown to denude the small intestine of mucus … promote overgrowth of bacteria, including H pylori” So after all, lectin is not safe?

    This is interesting because another health issues in Japan has been stomach ulcer and cancer of digestive tract, such as stomach cancer, which is relatively rare in America. This, too, is decreasing in recent years as we eat less rice. So is rice lectin possibly contributing to the overgrowth of H pylori?

    Regarding Okinawa. Before WWII (in other words, when the current centenarians were young), they didn’t eat much rice. They couldn’t, because they are located right in the course of typhoons that ruin the crops just about when they are ready for harvest. So they grew sweet potatoes mostly. I heard that, in the old days, Okinawans diet was largely about sweet potatoes, supplemented with occasional pork (a few times a month, and yes, they ate the whole thing) and seafood. Vegetables were also readily available. Pretty similar to PHD except the rice, I guess.

    Please understand I am not anti-rice. Rather, I would like to think it safe, but I just don’t think your book clearly addresses some of the issues on this.

    • Hi Akemi,

      I like that you’re skeptical, but I think a lot of your questions would be answered if you followed the citations and read the literature referenced there.

      The reason we endorse rice is not that “statistic show no proven risks” (in fact, neither the word “statistics” nor the phrase “proven risks” appear in our book). It is the grain toxins that occur in rice have been well studied and are known to degrade during normal cooking of white rice. Wheat toxins, on the other hand, do not degrade in normal cooking.

      The stomach ulcers and cancers in East Asian have been attributed primarily to consumption of fermented foods, spicy foods, and high levels of iodine. It is not thought that rice contributes.

      I agree that tubers and corms are probably healthier than rice; they are certainly more nourishing. But diets should be convenient as well as healthy, and so we permit the consumption of any food that has some nutrients and lacks toxins, no matter whether other foods are more nourishing.

      • Diets using White Rice, or any carbohydrate grain with hulls removed, as a major carbohydrate source are actually very implicated in ulcer formation – as I have found to my detriment after following the Perfect Health Diet recommendations. See Peptic Ulcer – A NEW APPROACH TO ITS CAUSATION, PREVENTION, AND ARREST, BASED ON HUMAN EVOLUTION. by T.L Cleave. I think there is a lot of very good stuff in the PHD but I think you have got it wrong with the white rise. I have non h.pylori gastric ulcer which has developed on PHD diet although it was probably also influenced by using potato starch and inulin supplements – again carbohydrates with protein removed.

  15. Hi Paul & Shou-Ching – I am honoured to have been mentioned at the head of one of your posts. It has been very interesting to see how paleo has changed over such a short period – it is pushed by the community and then we look to certain named individuals to give it their blessing, so to speak. Look at how Mark Sissons does his “is it primal” posts and addresses certain foods.

    Your terms “safe starches” and “supplemental foods” are indeed very useful terms and it really is good to see them enter the paleo vocabulary.

    Supplemental foods is something very close to my heart. Why take pills and capsules when real food can provide for us? If our food is still lacking in whatever it is we need, seek a better resource. We are a resourceful species and with our most unbridled tool for communication, the internet, we should have no excuses.

    “Needs more fish …” has become my tagline. Really, it should be “Needs more from the sea …”

    I saw a comment, but blowed if I could find it now, about how Living in the Ice Age could be improved with a traditional recipe/method format. I’d like to address that …

    It’s not possible! I don’t weigh, measure or stick to recipes. I have never made the same thing twice, ever. I set out what I cook and try to piece it together (sometimes days later) for the blog. It is for inspiration, since my ingredients are not your ingredients. Adapting and changing is the key – take the inspiration and make real food.

    • Hi Paul,

      We have the same problem — we take lots of pictures when cooking but don’t weigh ingredients. So I know rough amounts eg “one medium onion” but nothing precisely.

      • Paul & Paul,

        I do my cooking the same way – never measure anything, just go with what feels right. The only time measuring accurately is really important is in baking floury things – cakes, pastries, souffles, meringues etc, and how much of that do we do?

        My theory is that not measuring – doing it by feel or thought, helps to connect you with what you are doing. Blindly following a recipe, down to the last cupful or teaspoon, does not lead one to think or experiment, or even adjust for local ingredients/conditions

        Paul H, you know my thoughts on your blog – the only thing that could really improve it is turn it into a book, so then I could give it alongside PHD as presents to my friends and family.

        • Your praise and support is much appreciated, Paul N – some day, we’ll get a book together. I do have a neat idea, but will need to pass it by the right publisher.

          • Richard Nikoley had written up something about how he published V2 of Free the animal – sounded like a less involved process than the conventional route.

  16. What kind of chocolate is safe?

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