Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,

A

Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?

G

Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.

Lupus

I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul

Depression


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?

9,718 Comments.

  1. Thank you so much for your quick and detailed reply. I will take all your advice and continue on. I can’t tell you how much I appreciate it and how motivated I am.

    You maybe onto something about inflammation. This was my
    SED RATE BY MODIFIED WESTERGREN on 8/3/2016
    22 mm/h
    Range < OR = 15 mm/h

    The RA didn't seem to concerned and said that I didn't have RA and that was that.

    This is blood work from 3/20/2017
    F CHOLESTEROL 147 (mg/dL)
    F HDL CHOLESTEROL 27 (mg/dL)
    F TRIGLYCERIDES 167 H <150 (mg/dL)

    My HDL cholesterol has been low going back to 2011 when I first learned of it.

    I had a comprehensive metabolic panel on 5/2/2017 everything was in range accept
    WHITE BLOOD CELL COUNT
    12.2 H
    3.8-10.8 (Thousand/uL)

    and
    ABSOLUTE NEUTROPHILS
    9382 H
    1500-7800 (cells/uL)

    I am told this is most likely the extreme amount of stress/anxiety I have been under over the last few months. Going back to the previous CMP before then on
    8/30/2016

    WHITE BLOOD CELL COUNT
    9.6

    ABSOLUTE NEUTROPHILS
    7133

    I know stress is really bad for Inflammation so I am trying to reduce that with exercise/meditation/healthy diet

    I do want to be positive though cause my health has improved a lot from PHD, I have lost weight, my sleep has been cut from 12 hours a night to an average of 9. I am on 1 high blood pressure medicine vs 2 previously. My depression is not as overwhelming. I do have sleep apnea and have been treated with cpap since 2013 and that is improving as well. So thank you again for giving me hope that Nutrition can drastically improve health and heal the body.

    Your book is so loaded with facts I think it is time for a second reading so I absorb everything and make sure I am following standard PHD. I have done a lot of reading and listening to health podcast online as well so sometimes I mix advice up or don't remember where I read it.

    I will take your advice and follow standard PHD lowering my fat intake and increasing my carbs. I have been eating 5 eggs every day but will go to 3. I have been taken the recommended supplements, I have raised my vitamin D from 26 to 40, Taurine seems to be the best at helping with fatigue. I take iodine and my thyroid is extremely healthy. Your advice on supplements has been extremely helpful as their is a tendency to overdue and take to many supplements so your guidelines on what to take weekly/daily have really helped. I havn't been able to will myself to eat liver yet but that's my next big step. I will take your advice and not be so low carb, I have been gluten free since January and only source of carbs are rice/ potatoes or gluten free products but it is very low under 60 grams most days. I will increase to 160 as recommended in PHD. I also need to increase and eat more of the recommended vegetables which has been the largest challenge. Now that the weather is increasing in the Northeast I will get more sun exposure as well.

    Thanks again for your advice and help.

    • Hi Patrick,

      Well, I would say you most likely have some kind of chronic infection. The WBC count of 12.2 is almost triple the number of 4.5 that would be seen in an infection-free person, and the SED rate indicates chronic inflammation as in the response to infection. Your cholesterol levels are alarmingly low. Total cholesterol should be 220 mg/dl, HDL should be 70 mg/dl, LDL should be 130 mg/dl. Your extremely depressed LDL and HDL levels suggest a possible eukaryotic pathogen, e.g. protozoal parasites such as cause malaria, Chagas disease, sleeping sickness, and many other diseases, mostly of tropical origin (did you travel in the tropics?). I think you should seek out an infectious disease doctor, ideally one who has experience with tropical diseases.

      Best, Paul

      • I have not traveled abroad or to a tropical area, . I will find a infectiois disease doctor asap. I live in your state MA so if you know a good one please let me know.

        • OK. Some other things to look at are gut dysbiosis or infections. You might want to ask for mebendazole as a routine de-worming step, this is routine in the tropics. Get iron status tested to check for anemia. I know you said your thyroid is fine but doctors underdiagnose thyroid issues. TSH should be 1.5-2.0 for most people, I would expect that it would be out of range for you with your other health problems.

          Best, Paul

          • Thank you I have an appointment in a few weeks with an infectious disease Doctor at a top hospital in Boston. My thyroid was checked on 3/21/17. Here are the numbers

            FREE THYROXINE 1.09 Range 0.61-1.72 (ng/dL)
            TSH 0.62
            Range 0.34-4.8 (u/IU/mL)

            So that range is lower than the 1.5-2.0 you mention.

            I really appreciate your help. I am around dogs a lot so maybe that could spread this type of thing?

          • Hi Patrick,

            OK. This is looking like hyperthyroidism which will bring down your cholesterol. I think you need to avoid iodine until the thyroid heals.

            Best, Paul

          • Yeah hard without all the information. So do you think it isn’t an infectious disease with those numbers? Just follow PHD and avoid Iodine and it should improve over time?

          • You have been really helpful so I will just list other blood work that give more information. The Perfect Health Diet has giving me a lot of hope.

            The other blood work from a few weeks ago out of range but not by much is

            Calcium 10.8 mg/dl (normal range 8.6 – 10.3)
            Albumin 5.2 g/dl (normal range 3.6 – 5.1)
            Protein, Total 8.3 (normal range 6.1-8.3)
            Ketones 1+

            In range but you asked.
            HEMOGLOBIN 16.2 (normal Range 13.2-17.1 g/dL)

            Any specific things I can do to improve my thyroid?
            Do you think this is more likely to be thyroid issue than infectious disease?

            Could my high WBC be because of extreme stress of being worried I am really sick and anxiety?

            Thanks again for all your help I really appreciate it.

          • Hi Patrick,

            I don’t think your high WBC count can be due to stress. I think you have an infection. The question is whether you have two issues, the infection causing the inflammatory response and hyperthyroidism causing low cholesterol, or one problem, the infection causing both. If the latter then the infection is more likely to be eukaryotic, probably a protozoa or worm.

            I think it’s very easy to be stressed and anxious when you are sick, and it is more likely the infection causing the stress and anxiety than the other way around.

            Best, Paul

          • Paul I just had a terrible realization. I have been using Clindamycin lotion and gel for the last two years for Hidradenitis suppurativa. I did not realize it was an antibiotic. My dermatoligst prescribed me both the lotion and gel Monthly so I would have plenty to use. Not sure if this changes things. Could this be the cause of a long lasting chronic infection? If this is the cause what can I do to heal.

          • Hi Patrick,

            The lotion might promote fungal skin infections. If you have a systemic fungal infection the extra fungal load would exacerbate that. You might be better off discontinuing the antibiotic lotion and instead using AOBiome’s Mother Dirt skin probiotic.

            Best, Paul

        • Patrick,
          Hidradenitis suppurativa may be an autoimmune disease. Many HS sufferers find that eliminating all nightshades from their diet eliminates the HS (though some other food might cause the problem). Nightshades include white potatoes, tomatoes, eggplant, chilies, and capsaicin-containing peppers such as paprika and cayenne; and paprika can sneak into lots of prepared foods.

          Searching on “Hidradenitis suppurativa
          nightshade” will produce lots of pages to check out. The best I found on a quick search was a Loren Cordain page:
          http://thepaleodiet.com/part-i-hidradenitis-suppurativa-and-the-paleo-diet/

          Hope this helps. If you’ve already been-there-done-that to no avail — nevermind!

          Pat

          • Thanks Paul I will keep you updated on progress and try the Mother Dirt Skin Probiotic. I really appreciate all your help and am staying hopeful that things will improve.

            Thanks MizPat I should try avoiding nightshades. I will say that my Hidradentis Suppurativa has improved with PHD and loosing weight but I can try that as well.

            I left my dermatologist last year. He put me on the Antibiotic Doxycycline the end of 2015 to treat my Hidradentis Suppurativa and they didn’t work. After 3 months I complained that I was having issues because of the antibiotics and said I stopped taken them. He just looked at me and said “That doesn’t surprise me antibiotics can wreck havoc on some people” I felt like saying thanks Doctor for letting me know the potential side effect ahead of time.

            After that he prescribed me Humira which fits in with your autoimmune thing. I went home did research and said no way am I taken Humira with all the potential side effects. It didn’t stop the specialty pharmacy from calling me over and over again trying to deliver it to my house which I had to refuse. That experience along with some others with doctors is what finally motivated me to take action myself and change my lifestyle, eat healthy and exercise more because I realized Doctor’s can’t always fix you and sometimes they can make things much much worse.

  2. Hey Paul,

    First of all, thank you for all your work, it has been of tremendous help to me and my family. I’ve been eating PHD for a few years now with about an 80% compliance rate. So about four out of every five meals will be PHD, but I’m a bit of a foodie so when there’s great pizza or sandwiches around I tend to cave. I take all the recommended supplements, but I have a hard time getting in 3 yolks a day. When I don’t I try to supplement choline. I also have a hard time entraining circadian rhythms. I’ve always been a night owl. I’ve never been diagnosed with delayed sleep phase disorder, but it greatly resembles what I deal with. Left to my own devices I will go to bed later and later each night. Mostly I keep it under control and end up falling asleep at about 3 am and waking up at 11am. I sleep in a completely darkened room. So it’s a somewhat regular sleep pattern but it’s just shifted later than most people’s. Generally my problem is in falling asleep and less so in staying asleep. Recently I had a run of time where I was consistently waking up too early and couldn’t manage to sleep more than five and a half hours. I reviewed the literature on your site and found Seth Roberts’ experiment with intermittent fasting and early waking. By no coincidence I had stopped intermittent fasting in the few months leading up to this problem. I started the 8/16 fasting protocol again and the early waking went away two days later. So I recently got my labs from my doctor and wanted to ask you about my sluggish thyroid:

    TSH: 2.0
    Total Cholesterol: 220
    LDL: 152
    HDL: 46
    Triglycerides: 110
    Non HDL, Chol, Calc: 174
    Vitamin D: 35 ng/Ml
    Glucose: 98 mg/Dl
    White Blood Cell Count: 6.47
    RBC: 5.09

    My question is, at what point with TSH does one start to suspect Hashimoto’s? Is it worth me getting tested for that, or should I just assume I need to up my seafood/seaweed consumption and wait for increased iodine to take care of my thyroid? My main hyper-thyroid symptom is that I sweat constantly under my arms (very annoying) but I’m also overweight. I weigh 220 and am 6’1”. I’ve also been considering slowly upping my iodine intake to 1mg a day from 225mcg but I know you don’t recommend that anymore. I feel like I’m so close to having really good PHD labs and am just looking for advice on what my next steps should be to correct my thyroid, which in turn should help me keep losing weight and shift my blood lipids towards the recommendations in your book. Thank you Paul! I hope Angiex is going well for you guys.

    Best,

    Nick

  3. Hi Paul, or other commenters in the metro-Boston area,

    Do you know of any restaurants in Cambridge, or more generally the metro-Boston area, that use only PHD-approved oils?

    (I’m asking specifically about oils because usually other problematic ingredients are relatively easier to notice, and thus avoid, from menu descriptions.)

    Best,
    -Eric

    • I think it’s almost impossible to find a restaurant anywhere that doesn’t use canola/rapeseed oil.

      However, we live in a small town in Scotland and our local Indian restaurant only cooks its curries in olive oil. Which I’m delighted about!

      You could ask for your meat/fish to be cooked in olive oil I guess if you said you were allergic to rapeseed oil although I haven’t tried this anywhere myself.

  4. Hi Paul,
    I was under a period of tremendous stress, out of town for work with long hours. Over 6 months, my BMI dropped from 24.5 to 23.5. I could barely get out of bed and I noticed some hair loss in the last month. My TSH number is usually around 1, it was .52 this time. The other labs seem to be decent, TC=180, HA1bc=5, FBG=83, Free T4=1, Free T3=3.3
    I’ll be de-stressing and leaving this work for my body to calm down. Can you explain what this lower TSH number means, is it better to be on the lower range for TSH and is there anything else I can do to stop/reverse the hair loss? Thank you.

  5. Hi Paul,

    I’m a bit confused by the math in the section titled “The Optimal Amount of Fiber” (page 165 of the book or at least of my edition thereof). You wrote:

    “Human breast milk provides 3 percent of energy as oligosaccharides, the milk equivalent of fiber… Most plant foods have about 8 to 10 grams of fiber per pound… To reach 3 percent of energy from fiber, [Americans] would have to eat 7 or 8 pounds of plant food per day. That’s a lot!”

    First of all, how did you get from 3% energy to ~70 grams of fiber? Am I wrong that fiber gives 1.5 calories per gram, which would give 3% energy = 60 calories = 40 grams of fiber?

    Second of all, does the “average PHD plant food” really only provides 8 to 10 grams of fiber per pound? For example, the 4 pounds of plant foods I ate today provided 62 grams of fiber, according to the USDA database. And I don’t think the collection of plant foods I ate today — sweet potato, taro, winter squash, banana, guava, spinach, watercress, shiitake mushrooms, oyster mushrooms, cauliflower, avocado, kimchi, nori seaweed, coconut milk, dark chocolate, macadamia nuts — was that abnormal for PHD.

    Anyway, if 3% of energy is 40 grams of fiber, and the average PHD plant food provides 15 grams of fiber per pound, that means 3% of energy would correspond to approximately 3 pounds of PHD plant foods on a 2000-calorie reference diet (as PHD recommends).

    Best,
    -Eric

    • Hi Eric,

      It does look like we made a simple arithmetic error. I must say though that it is gratifying that the theoretical claim that breast milk is a good guide to the evolutionary optimum diet seems to be well supported by your analysis … and that PHD dietary advice, arrived at for other reasons, may give the optimal amount of fiber!

      Best, Paul

      • Hi Paul,

        OK, great!

        On a similar topic, do you have any idea why breast milk contains so much pantothenic acid?

        Scaled to body weight, it’s the equivalent of 20 mg for a reference adult. By comparison, the average PHD animal food provides about 7 mg per pound (less if mostly muscle meats are eaten); and the average PHD plant food provides about 2 mg per pound. So to reach that level of intake on PHD, you’d need about 6 pounds of low-calorie vegetables (or “only” 3 pounds if vegetables high in pantothenic acid are preferred).

        Breast milk of all mammalian species, bird egg yolks, fish eggs, and royal jelly, are all quite rich in pantothenic acid — suggesting the explanation should be universal to the entire animal kingdom.

        Best,
        -Eric

        • ** the average PHD plant food provides about 1.5 mg per pound

        • Hi Eric,

          The pantothenic acid is for production of Coenzyme A. This is a required intermediate in fatty acid metabolism and in production of ketones. Ketones in babies are an essential pathway for lipids to get into the brain to support brain development, ketones are made in the liver and diffuse into the brain where they can serve as substrates for synthesis of fatty acids or cholesterol or other lipids to support brain growth. Also you have to augment the Coenzyme A pool as you grow, which is not important in adults. So the need for pantothenic acid is higher in babies than in adults.

          Brain growth is higher in humans than in animals, but body growth rate is lower (e.g. human neonates are growing in body weight at the same rate as weanling mice and rats, i.e. 8 week postnatal mice or 12 week postnatal rats), so the pantothenic acid requirement is elevated in all species.

          Best, Paul

  6. Hi Paul,

    In your book you mention about the body composition in percentage between the macro-nutrients. For muscle, its more than 50% fat. I see that all the cells have phospolipids for cell membranes, but where else would fat be present? any difference here between muscle cells and other cells in terms of the amount of fat and where it is present? I could not find reference links on this topic in the book. Am curious to see how fat is present, although it looks completely logic to me that muscle is a good storage of fat for energy..

    BR
    Naveen

    • Hi Naveen,

      You can follow references for the book here: http://perfecthealthdiet.com/notes/.

      One thing to keep in mind is that the body composition percentages in the book are in terms of calories, not weight. Fat has 9 calories per gram, protein 4, so 50% fat by calories corresponds to about 25% by weight.

      Since the meat we buy in stores is similar in calorie composition to human muscle, you can use that as a conceptual reference point.

      Note that muscle is lower in fat than the body as a whole, so while it is a good form of storage, one wouldn’t want to be too lean.

      Best, Paul

  7. About fasting, I read that in the morning you can take coffee or coconut oil, but cant find the quantity of coconut to take if we dont take coffee and its not in the fasting section of the book. Anyone?

  8. I recently read that you should add a small amount of baking soda with your apple cider vinegar and water to receive the full benefit. Is this true?

  9. Hi Paul I have a question. I’ve been on here a few times sharing my story. I’ve been PHD about 15 months. Since then I’ve lost about 30 pounds but I recently got street throat yesterday. My Dr took my blood pressure and it was 140/90 which was concerning to me. It does run in the family but because I feel so great I would never imagine my BP being that high. Especially after losing 30 pounds and having a wonderful workout schedule consisting of cardio and heavy weights. Any suggestions would be helpful. I know your blood pressure rises when sick but this number was concerning to me. It does run in my family.

    Bob

    • Hi Bob,

      140/90 is too high (110/70 or 100/60 would be better) but it’s hard to assess with one measurement taken when you are sick. BP can be highly variable. You might want to buy a blood pressure measurement kit and measure yourself periodically, these are about $10 if you can do it manually or $30 with digital measurement. Be sure that you are not dehydrated and are getting adequate water, salt, and potassium.

      Best, Paul

  10. Hi Paul,

    For people who take Choline supplements (I take 550 mg a day) instead of eggs, in addition to taking plain Choline Bitartrate, would you recommend taking a plain Inositol supplement (if so, what dose?), or would you prefer a Phospholipid complex supplement such as the one in the link below (if so, what dose?).

    https://www.amazon.com/Phophatidylethalnolamine-Phosphatidylinositol-Seeking-Health-Physician-Formulated/dp/B00SLVJ54M/ref=sr_1_1_a_it?ie=UTF8&qid=1498455121&sr=8-1&keywords=optimal+pc

    Thank you,
    John

    • Paul,

      I will ask again this way, I do not eat eggs and supplement 550 mg Choline (as bitartrate) daily, but I do eat 1/4 pound beef liver per week. Do you think the Phospholipids and Inositol provided by the beef liver is enough in my case? Or should I still supplement a Phospholipid complex and Inositol?

      If I should supplement Inositol, do you think 500 mg a day would be too much? How about supplementing 1500 mg Inositol once a week? Which approach would be optimal?

      Thank you

      • Hi John,

        I think food (egg yolks and liver) are the best source. If you want to replace the egg yolks with supplements, then a phospholipid complex would be best. You can also supplement choline and inositol, the amount of choline should be at least double the amount of inositol.

        Best, Paul

  11. Hi Paul

    I’m a little confused on iodine supplementation. I’ve gotten to 1mg daily on empty stomach in the morning. Should I be steadily increasing from here or just stay here? Thank you

    Bob

    • Hi Bob,

      Our updated recommendation is for 225 mcg/day iodine. So I would reduce supplementation, unless you have some strong therapeutic reason for taking 1 mg.

      Best, Paul

      • Hi Paul,

        Is there any page on your site with the full list of updated recommendations or views you’ve changed since PHD book was written? I’m a big fan of the book, but assume over time some of the evidence/suggestions would change. Thanks!

  12. Oh boy I hope I didn’t do any damage supplementing that much. I must have misunderstood something I read. I’ll cut back immediately.

    Thanks

    Bob

  13. Hi Paul,

    My mother has been swimming year-round for 90 minutes most days in an outdoor pool (heated in the winter), at a latitude similar to Boston.

    Is that too much direct sun exposure in the summer for someone of northern European descent — would it be better to wear sunscreen?

    Possibly relevant:

    (1) She stopped wearing sunscreen in the winter, and got progressively more tan as the seasons changed, but did not burn.

    (2) With that level of sun exposure in addition to about 4000 IU supplemental vitamin D, her blood levels are 40 ng/ml at the summer solstice.

    Thanks!
    -Eric

    • ** for 90 minutes at noontime

    • Hi Eric,

      I think 90 minutes will be just fine as long as she gets it consistently. If she is consistent then she should tan rather than burn which is the body’s natural regulatory mechanism. If she is inconsistent then she’ll be adapted to less exposure and the 90 minutes might lead to a burn and be too much.

      However, I’m not sure she should supplement 4000 IU in addition to the sunshine. There is an open issue about whether 40 ng/ml is optimal for everyone. She might check her 1,25D and calcium levels as well to make sure they are not high in the summer.

      Best, Paul

      • Hi Paul,

        Thanks! We checked her 1,25D and calcium levels; they were:

        1,25D: 31 pg/mL (reference range 18–72 pg/mL)

        Calcium: 9.3 mg/dL (reference range 8.6–10.4 mg/dL)

        Would you say that these numbers (together with her 40 ng/ml for 25OHD) indicate that supplementing 4000 IU in addition to the sunshine is a good idea?

        Thanks again!
        -Eric

        • Hi Eric,

          OK, great, those are normal so that relieves concern about an inadvertent overdose. Maybe the pool water is preventing her from forming vitamin D3. I guess supplementing 4000 IU/day appears to be safe for her, though I wonder if it might become too much if her lifestyle or nutritional status changes.

          Best, Paul

  14. Hi Paul, I’ve been following the PHD for a few years now, but one problem has plagued me over the time period (unsure if cause or correlation): much worse body odor and smell/discoloring of my clothes/bed sheets.

    Basically: I smell worse more quickly (previously I could “last” all day without issue). This seems to affect the clothes I wear and my sheets — the sheets and my pillow rapidly turn yellow after a few days/weeks of use, and develop their own odor. No washing method turns them back to original color (and the difference between “my” side and the other side of the bed is striking). My clothes seem to take on this new odor as well.

    My only thought is that this could be supplement related, but I’m not sure which or how. I take your basic daily supp reccomendations: copper, iodine, magnesium, K; and then your once-weekly B- and other complex, but that’s basically it.

    • Hi Dan,

      I would try AOBiome’s Mother Dirt skin probiotic, it’s highly effective at eliminating body odor. Many odors come from nitrogen compounds derived from protein, including ammonia. The AOBiome microbes remove those. It’s possible you’ve increased protein consumption in switching to PHD.

      The other likely pathway as you’ve guessed is oversupplementation leading to excretion of mineral wastes. Be sure that copper is balanced with zinc. Don’t supplement selenium. You might stop the Bs.

      Best, Paul

    • Hi Dan,

      Are you taking probiotics? Worsening body odor happened to me when I was taking them. It was like too much bacteria for my body to handle. I didn’t have discoloring.

  15. Hi Paul,

    You often write that it’s better to supplement B vitamins sparingly because they can be growth-factors for undesirable microbes.
    You have a post about niacin, NAD and infections, I suppose that you had it in mind when you write about this precaution. However, most of the information available says the opposite: niacinamide having antimicrobial activity. Same for riboflavin, and some metabolites of other B vitamins.

    Is the confusion related to having antimicrobial activity once they are already in the body being metabolized, contrary to first coming in contact with microbes in the gut?
    If so, what about transdermal administration?

    It’s quite nice that you still answer questions after such a long time!

  16. Hi Paul,
    I am desperately hoping you can help me. My 12 yo son had a hair test with an alarming amount of cadmium and double the typical amounts of mercury and aluminum. Do you have suggestions or can you direct me to safe detoxification information? We believe this started as a result of a root canal a few years ago for a broken tooth, we just found out bacteria had grown and his root never fully formed which allowed it to became systemic.

    Thank you in advance for any help you may be able to provide

  17. Elizabeth Houser

    My 10 year old and I started a month ago.Very favorable results, so far. trying to navigate gluten free . What is our feeling about browm rice flour, at this time??

  18. Hi Paul,

    Is moon light circadian rhythm disrupting?

    Thank you,
    John

    • Potentially yes. The question would be whether there are any benefits to having a lunar cycle of 28 days entrained by moonlight. Those might balance the disruption to the daily cycle from the full moon.

      Best, Paul

  19. Hi,

    Thank you so much for writing the book and providing this blog as a resource – it has helped guide our diet significantly! I have 2 questions:

    1. Have you guys seen any research or have any guidelines on storing/eating leftover food and whether that still retains most of its nutrients? We like to make a huge batch of salmon and eat it throughout the week, but not sure if that defeats the purpose. I’m also thinking about cutting up vegetables before the week and storing it in the fridge, so it’s easier to cook throughout the week.

    2. I’m Chinese, and we tend to eat a lot of pork. How would you rank pork among the meats – should we try to replace most of it with beef and fish instead?

    Thanks so much!

    • Hi Jenn,

      Leftover food does preserve most of its nutrients. The problem is with bacterial/microbial growth – any moldy or infected leftovers should be discarded. Smell leftover food before eating, and try to finish it within 3 days after cooking.

      Pork should be well-cooked to kill pathogens, and you should try to find a pastured pig for low omega-6 content. See the pork series, conclusion http://perfecthealthdiet.com/2012/02/the-trouble-with-pork-part-3-pathogens/, for more. A diversity of meats is a good idea, with some fish/shellfish, some birds, and some ruminants all providing useful diversification.

      Best, Paul

      • Thank you so much! That was helpful.

        Does pre cutting vegetables a few days before cooking them have any harms, e.g. Oxidation?

  20. Peter Silverman

    Since I follow a lot of the your suggestions from your book when it was self-published, I wonder if you’ve changed your mind about any of them.

  21. Hi!

    Reading your book, I notice you listed some foods on page 364, when describing the fasting practices of the Kitavens. You write that during the day, mangoes, breadfruit, bananas, and green coconut and their milk may be eaten while working.

    Does this mean that any of these foods will not break the fast during the fasting period?

    Thanks!

  22. Hi Paul,

    Are there any problems with dry-aged beef? If it’s okay, is the outer part okay to eat as well or it should be removed?

    Thank you,
    John

  23. Hi Paul,
    I have been on a strict PHD diet for three years. My HDL cholesterol is routinely very high at 115. Triglycerides and all other blood markers are excellent and I am in excellent physical health and active. I just read the results from a recent University of Copenhagen study which concluded that men with extremely high levels of HDL cholesterol have a 106% higher mortality rate than those with normal HDL. Should I be concerned?
    Thanks
    Denny

    • Hi Denny,

      It’s true that optimal HDL is 70-80, and higher values can indicate inflammation evoking an immune response. However, it can also indicate that your diet is too high in fat and too low in carbs, or too high in alcohol. I would try cutting back on alcohol and fat and adding carbs, and see what HDL does.

      Best, Paul

      • Thanks for the reply. I am a light drinker and only drink occasionally hence I can rule that out as a cause of the high HDL. I am a highly competitive endurance athlete and am 53 years old. The intermittent fasting combined with 55% healthy fats have allowed me to feel great in general and perform optimally during events without need for glucose replenishment.Just wondering if perhaps the high HDL sample people in the Copenhagen study could have been heavy drinkers or had other issues which may have lead to the conclusion that HDL corresponded to increased mortality?

  24. Just discovered your book and am excited to try this new lifestyle. Question for you. I’m 5′ tall and 120lbs. Just did 30 days of keto and just didn’t feel good on it. Thinking my body needs more carbs. My goal is to lose 15lbs more pounds. . If I understood the book correctly, to avoid any malnutrition, I should consume no less than 1300 calories- 500 calories in carbs, 300 calories in protein, and 500 calories from fats? That puts my macros as: carbs-38%, protein-39%, and fat-23%. Does this sound correct? Also, Am I correct then that once I meet my weight loss goal, I would switch to the 65/15/20 macros that is more typical of the PHD?
    Thank you for your help! 😀

    • Hi Ruby,

      I think rather than thinking in terms of macros, which most people have a hard time translating correctly to food, it’s best to follow our food plate for proportions and eat to appetite. For weight loss, cut down on added fats and oils (but don’t completely eliminate them); above all reduce omega-6 fats as much as possible. For weight maintenance optimize flavor. Be sure to do intermittent fasting and tend to circadian rhythms.

      Best, Paul

      • Ok thanks. Difficult to not track macros as that’s been my way for so long. But surely will try your recommendations. Circadian is tough as I’m a night shift worker. I do IF, my last food is at 11:30 pm, and then I start eating at 3:30pm next day. Not perfect, but it’s the best I can do for now.
        I am having a tough time finishing a meal since adding some carbs after doing keto. Feeling very full/bloated. I know I need to eat more to avoid nutritional imbalance but thinking it will just take time to get used to all the extra bulk in my diet. I don’t eat gluten/pastas/breads/grains, just added potatoes/sweet potatoes back in for now.

  25. Diet and immune system bias – fungal vs bacterial vs viral

    Paul – Wonder whether you are aware of any dietary/supplement hacks which might impact immune system effectiveness on three major categories of pathogen.

    I am very vulnerable to tinea pedis and tinea versicolor on abdomen. Topical anti-fungals will knock back any outbreaks, but it always comes back. So I have a theory that my immune system is less effective on fungi.

    FWIW, I have never noticed any obvious symptoms of systemic fungal infections (Candida, etc), but the common list of symptoms for this are awfully broad and vague, so who knows. Never did any labs aimed at this, but my overall health seems quite good.

    General background is I have followed PHD principles reasonably closely for 7-8 years, and most days IF in a ~6hr window. A few times each year I go VLC/keto for periods of 1-3 weeks. Recent years no supplementation.

    Not sure if it is relevant, but I do think it is likely I have a less than optimal gut flora – a year before before going PHD and losing 22kg, I went scrupulously GF (and remain so). This change in a matter of mere days permanently transformed a Bristol Stool index from decades at 6-7 to fairly consistent 3-5, so I suspect I was true celiac rather than simply gluten intolerant. (Though never did the labs on this either.) In any case, given this history, I would think it is a fair assumption that my gut flora has retained some degree of reduced diversity or other form of dysbiosis.

    In general, do you think some people’s immune system can be biased toward/away from one or another category of pathogen, and if so, any ways to modify this?

    Thanks!

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