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 ?

9,925 Comments.

  1. Thoughts on xantham gum and guar gum? They are in a lot of products that are otherwise PHD complaint.

  2. Hi Paul,
    I am 41 and recently got a few tests done for the first time including lipid profile. My LDL has come at 160 (total at 230). I bought and read your book first time in 2013 and since then we switched to cooking with saturated fat at home (we do eat out but not very often). Also, we are vegetarians so our diet is high carb (we do eat eggs and dairy). What can I do to reduce LDL?
    Thanks.

    • Hi Pawan,

      The common causes of high LDL are (1) metabolic endotoxemia, i.e. too much entry of fragments of cell walls from dead gut bacteria into the body, possibly caused by poor gut barrier integrity and/or small intestinal bacterial overgrowth and/or inflammation in the gut from pathogenic microbes; (2) hypothyroidism or iodine or selenium deficiency — note both deficiencies are common on vegetarian diets, though eggs will help with selenium, and hypothyroidism can be treated by replacement thyroid hormone; (3) excess iron which can be relieved by donating blood.

      PHD eating, intermittent fasting, circadian rhythm entrainment, egg yolks, vinegar, and extracellular matrix (shellfish, bones/joints/tendon soups) will help with (1). Can you add shellfish or bone/joint/tendon stocks to your diet?

      Best, Paul

  3. Hi Paul,

    How long can fermented vegetables stay in the fridge without going bad? Should I go by the smell?

    Thanks

    • I’ve read indefinitely, but best within 1 year if fully submerged in brine. I ferment, and my suggestion for most is within 6 months unless you’re fine with them getting softer.

  4. Hi Paul,
    Any additional thoughts on OCD and anxiety? I have heard brain health comes 85% from gut health. I started a strong probiotic, but am wondering about additional diet changes or supplements.

    Also, where can I find thoughts on ingredients such as xantham gum, guar gum, lactic acid, etc.?
    Thanks,
    Sara

  5. Sooo appreciate this site–thank you! If you have time, would you please share your take on longer fasting (24hr up to 2 weeks). Have looked at Fung’s approach and since I am morbidly obese and have prediabetes, I’m wondering about the efficacy of combining PHD with longer fasting.

    Thanks!
    Connie

    • Hi Connie,

      Longer fasting may have some benefits, but I think the crucial thing is to set up a good daily rhythm that properly entrains circadian rhythms every day. Consistency is important. Try to finish eating as early as possible in the day, and don’t eat at all at night (only calorie-free beverages like water or herbal tea). Have a 12 hour night in which you get no blue or white light exposure, install two sets of lights in your home with orange bulbs for night use. Then, rigorously cut out omega-6 fats from your diet.

      An overnight 16 hour fast is perfect and something you should be able to do every day. Then, if you want to throw in occasional longer fasts, go for it.

      Best, Paul

  6. Any suggestions on substitutions for soy sauce? It compliments many Asian dishes so nicely, but I know we are supposed to avoid soy.

    • Hi Sara,
      Soy sauce is made from fermented soybeans, so not so bad.
      But wheat is also an ingredient.
      Tamari is a wheat/gluten free soy sauce. But confirm this on label before buying, as some inferior products may still include some wheat/gluten.

      Or, a soy free alternative you can try is Coconut Aminos… give it a google.

    • Soy or tamari sauce is fine. We’re not worried about soy proteins in the quantity you get in soy sauce.

      Best, Paul

  7. Paul,

    My sister in law is expecting a baby any day, and has been feeling dehydrated (also possibly associated with recently moving from Texas to the Southwest elevation about 4000 ft). The symptoms, dry sinus, mouth, and lungs haven’t been helped by drinking copious amounts of water. But, her OB prescribed 1 liter of saline in an IV, at her request, and it helped noticeably but only for two days.

    My question, do you have any idea why saline IV would help when drinking plain water (and some “Pedialyte”) didn’t? Can you think of any mineral waters or electrolyte drinks that might help her? She eats a typical American diet unfortunately (in spite of having received a copy of PHD as a gift two years ago), and is somewhat overweight but healthy otherwise. We are working encourage her to follow your recommendations in the book.

    Thanks,
    David

    • Hi David,

      In order to be hydrated, you need electrolytes (sodium and potassium primarily, also chlorine, iodine, and others may matter). If you don’t have the electrolytes in your body, any water you drink will be peed away, because the body has to maintain a fixed ratio of water to sodium and potassium. She should eat lots of fruits and vegetables (tomatoes, bananas) and some salt along with water. Try salted tomatoes.

      If she is low-carb, eating more carbs will also help.

      For weight loss, minimize omega-6 fats and entrain circadian rhythms are the two most important steps.

      Best, Paul

  8. Hello,
    I am reading your book for the very first time and I was wondering about your recommended dosage of safe starches. Are the weight units you mention (for example 2.7 pounds of sweet potatoes) supposed to be when the starches are cooked or raw. I’d really appreciate your help. Thanks so much. Kali from Germany

    • Hi Kali,

      That is “moist weight” or weight after gentle cooking. Harsh cooking dries out the starch and reduces the weight. Generally, boiling or steaming constitute gentle cooking. Weight after gentle cooking is usually the same as raw weight, except in the case of dehydrated foods like rice which gain water during cooking.

      Best, Paul

  9. Clare Boldurmaz

    Hi Paul,
    I hope I’m not being greedy here asking 3 questions! They’re just things that nutritionists have told me in the past so I thought I’d ask 🙂

    1) I was told it’s good to eat protein away from starchy carbs, and that not it’s good for the gut – I imagine that you would not agree with that as I don’t think I’ve seen references to it in the PHD diet?
    2) also from a nutritionist: vitamin C is important to have with iron source (i.e meat) for iron absorption. Is that the case, you may have mentioned in your book ?
    3) is it worth making your own fruit / veg juices for extra vitamin consumption? Have a juicer, trying to decide whether to keep it!

    Many thanks, as ever, so grateful for the time you give up to do this!

    Clare

    • Hi Clare,

      I don’t agree that protein and carb should be separated. Vitamin C helps iron absorption so if you are prone to iron deficiency anemia it’s good to combine them, but if your iron is normal then you don’t need to worry about it. There’s no advantage to juicing over simply eating vegetables. However if juicing enables you to eat vegetables, it could be beneficial. I personally find juicing to be more work.

      Best, Paul

  10. Hi Paul,

    My mother in law recently had brain surgery to clear a subdural hematoma. The neurosurgeons said that this often occurs in the elderly because of a loss of brain volume that puts stress on the veins in the dura which allows them to tear and bleed more easily. Are there any nutritional/supplemental steps that will slow or possibly reverse age related brain volume loss? Thank you!

    Nick

  11. Hi Paul,
    I’ve followed PHD for 4 years running and love it but have 2 main concerns based on my recent blood work that came back yesterday:

    1) Fasted Hemo A1C has never been tested before and is 5.8 (!)

    (note: Glucose is 84 (was 87))

    2) LDL is 122 (was 91 before starting PHD 4 yrs ago). (For reference my HDL is 82 (was 88) and total Chol is 214 (was 187).

    Last night I reread your chapters on lipids, and if I’m reading correctly, my LDL and HDL are good in your opinion? Or do they need to be tweaked? and how? I follow your apple, but I trim all my meats and use full fat milk and yogurt, but not much added fat. I have religiously eaten 3 eggs per day for 4 years. I’m inconsistent with bone broth and organ meats, but I eat ~ 1 lb wild salmon/wk. I eat TONS of veggies and fermented veg and foods daily. 4-8 oz animal meat in addition to the eggs, a cup of Greek yogurt and maybe 1+ oz of full fat cheese.

    The A1C is of greater concern though — this was quite a shock. I do eat ~1 lb sugary (berries, melon, tomatoes mainly, and an occasional banana, apple or fig but modest and rarely). I rarely eat even paleo type treats (just a few times per year) and the only time I eat honey is in them. I don’t add any sweeteners to my food. My main starches are white potatoes steamed in microwave (always reheated if batch cooked), winter squash like Kabocha, pumpkin, and Hubbard, less frequently a cassava tortilla and almost never white rice. I always add acid and/or sauerkraut juice and some Greek yogurt to my starch. If I’m guilty of something, it’s not eating enough pure fat. But I often sprinkle nuts or Feta cheese over my food, or eat a slice of avocado.

    What am I doing wrong? What should I change? I’m 60 and lean (5’4″ and 116 lb this morning). My main exercise is walking, with hills, 40-60 min per day.

    (BTW, only other minor changes in my bloodwork — Vit D has dropped a bit over 4 yrs — now 31 vs 41 before, so I’ll increase my Vit D to 4K IU and my RBC is a bit low at 3.7 (down from 4.1).)

    Thanks in advance!
    Susan

    • Hi Susan,

      5.8 is normal for Hemoglobin A1c. With your normal blood glucose, I wouldn’t be concerned at all. Some people have long-lived blood cells and get slightly more glycation than average for that reason. If you want to look at data, see the bottom panel of https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642750/figure/F3/. 5.8% is very close to the mortality minimum.

      Your LDL is great, I consider 130 mg/dl to be optimal. 91 mg/dl is immune suppressed. HDL of 82 is also great. See our series on the topic, http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

      You might try supplementing vitamin B12 and eating green leafy vegetables to help with the RBC count (also have your iron status checked, if you are iron deficient supplement iron and vitamin C). But it seems like you are in great health and worrying needlessly!

      Best, Paul

      • Paul,
        THANK YOU for taking the time to respond and for putting my fears to rest! That is great news!

        My LabCorp report said that 5.8 A1C was pre-diabetes level which is what got me worried. I guess this is a great example of how the lab normals are really off.

        On LDL, I’m glad that I understood your book correctly. When my LDL was 91, I’d been on a severe elimination diet for several months, eating no meat or fat, and had dropped down to 105 lbs, so my immunity was probably low indeed. I use to get colds many times per year, and the biggest change I’ve noticed on PHD over the past few years is that I don’t get colds anymore! And if I feel like I might be coming down with something or have been exposed, I’m able to brush it off overnight!

        I eat massive quantities of farm fresh greens of all types daily. But I might not be a good converter. My 23andme showed 2 types of methylation SNPs (one from each parent) so at one point I took a ton of the Seeking Health supps to address that, but it got too cumbersome.

        I don’t know if you would consider this iron deficient or not (LabCorp blood test range says normal):

        Iron 76
        Iron Saturation 26
        Ferritin, serum 96
        Vitamin B12 637
        Folate, serum 17.3

        I’ll try to be more consistent about liver and broth — I’ve fallen off that wagon of late. I take vitamin C, but may need more.

        Thanks again Paul!!!
        Susan

        • Hi Susan,

          Iron is normal, everything seems normal so I don’t know why your RBC count would be low. Maybe you need more aerobic exercise.

          I’m glad you don’t get colds any more! More evidence that everything is fine.

          Best, Paul

  12. Hi, Paul (and Susan above),

    Susan, I’m in almost exactly the same boat as you. I have been following PHD for years and have made great gains in a number of different areas. I had one minor setback of eczema during this time, but you (Paul) really helped me focus on a few areas and I eventually got better. So great!

    Like you, Susan, I recently had blood work. My doc wrote me today and said I need to correct my diet and/or go on a statin. Say what? I’m a healthy 48-year old woman who exercises regularly, eats PHD, doesn’t drink or smoke, and leads a pretty chill life. I do take thyroid medication daily, but that’s it. That said, my sleep is horrid (has been for decades) and I’m sure that contributes to any issues I have.

    I won’t bore you with all my lab work except for the two things Susan expressed concern with. My A1c is 5.6 (the highest it has ever been), but now I see I shouldn’t be concerned. My lipids, however, are:

    Total: 261
    Trig: 62
    HDL: 81
    LDL: 168

    I’m at a loss as to what to tell my doctor and/or how to correct my numbers. I feel I’m doing really well and don’t see a need for a statin. Paul, if you have any of your amazing suggestions, I’m all ears. Thanks for all you do! Laura

    • Hi Laura,

      Your triglycerides and HDL are perfect, so it’s just a matter of the high LDL. Common causes are iron excess and hypothyroidism. So I would start by getting an iron status test and if iron is high, donating blood; and considering whether you may be undertreating your hypothyroidism. Perhaps you would benefit from iodine supplementation, selenium occasionally, some T3 in your medication along with levothyroxine, or a higher dose. Be sure to eat at least 3 egg yolks per day, if not you should supplement inositol and phospholipids. If you have detailed lab values you could share them.

      Best, Paul

      • Thank you, Paul! You are truly amazing to answer our questions. I specifically went to get my thyroid labs and my doctor added on several other tests, too (Comp Metabolic, CBC, lipids, vitamin D, etc). Sadly, the lab forgot to add on my Free T3!

        I will look into getting an iron status test (though I’m usually low). Currently, I take a grain of generic NP Thyroid (a T3/T4 combo med) daily. (TSH 0.920 uIU/mL; Free T-4 0.78 ng/dL; Free T-3 ?)

        I was surprised to see my Vitamin D this low (32 ng/mL) so I will be increasing my supplementation.

        I eat two to three eggs daily and already take your supplements (including the iodine and eating nori daily). Perhaps the iron status test will be revealing.

        Thank you again for all your time and commitment to your readers. My husband jokes with me all the time by saying, “Well, what would your Dr. Jaminet say?”

        Many thanks, Laura

        • Hi Laura, the lab will still have your blood if you need them to run the T3 or FT3 test.
          The labs hang onto the samples in case they need to re run tests, or do add-ons.

          • Hi, Darrin. Unfortunately, my lab only keeps the blood for five days; they already disposed my samples. My doctor just wrote and said I could retest if I want or just wait another three to six months and test again. In the meantime, she wants me to eat a mostly vegetarian diet, no red meat or high fat dairy, and quinoa/brown rice. Argh!

          • Hi Darrin,
            FYI, I had the same experience as Laura. My lab screwed up my test and I had to go back for another blood draw. My doc checked with the lab first, and they’d already tossed my blood sample.
            Best,
            Susan

        • Hi Laura,
          After Paul responded to my post, I listened to an interesting podcast by Robb Wolf and Dave Feldman about lipids, and they echoed many of the same points that Paul has made here.
          Since then I’ve also heard back from the NP who works with my functional doc (Chris Kresser) and they say ditto to Paul’s comments about both lipids and blood sugar. The other marker she mentioned was my insulin which was very low (indicating excellent insulin sensitivity).
          All of this is making me realize (even more than before) that there are many people out there who are making bad changes in their diets and taking unnecessary meds because most doctors are relying on standard “normal ranges” on lab readings and not really understanding all of the complexities of nutrition science and their impact on markers.
          I’m so incredibly grateful to have people like Paul (and this community) and Chris’ team in my life and guiding me on the right course.
          Good luck with identifying the specific cause and fix of the LDL level, and keep us posted — I’ll be very interested in hearing about it.
          Best,
          Susan

          • Thank you so much for your response, Susan. I feel like you and I have such similar situations at the moment. I, too, am so grateful for Paul and the other commenter’s responses. I have learned a great deal on this site; however, this is the first time a physician has actually said she was “very concerned” about one of my labs. Makes me take pause and doubt everything I have learned over the years. I appreciate your feedback and will continue to educate myself and keep on keepin’ on. 😉 I will post my progress if it seems remotely interesting to anyone else. Take care, Laura

  13. Hi Paul, just to check – the supplements that Amazon recommends on your supplements page – are they recommended by you, or just brands that Amazon has picked out? I know getting the right brand is key 🙂

    Many thanks !

  14. Hi Paul,

    Any ideas on Keratosis Pilaris? Is it just genetic or something else is causing it? Any ways to get rid of it?

    Thanks

  15. Dear Paul,

    I hope you and the family are well and Angiex is going from strength to strength. I’ve been a faithful adherent of the perfect health diet for the past 7 years or so. This year I was diagnosed with a very rare cancer called Pseudomyxoma Peritonei. It’s a borderline malign cancer that originated in my appendix. It progresses very slowly and it’s quite possible I developed the condition c.10 years ago. Mercifully I was diagnosed quickly (it’s so rare it’s often misdiagnosed). I was operated on about a month ago in Basingstoke, UK which is I think one of the best places in the world to treat this particular condition and where they pioneered the application of what’s called the Sugarbaker technique to this kind of cancer (named after Dr Paul Sugarbaker). They have tremendous experience and carry out c.300 of these operations every year. It’s a huge operation – c.10 hrs- which involved the removal of my spleen, appendix, omentum, gallbladder and peritoneum. I’m now recovering but the good news is that my outlook is good in the sense they believe they removed everything, the histology revealed the tumour all to be low grade and I had no post op complications. It is not uncommon for the procedure to result in a complete cure of the condition. In fact the team told me that I had one of the fastest post op recoveries they had ever seen which they put down to my fitness (I’m a 50 yr old now) but I also explained the PHD and on the evidence of my recovery some of the medical staff were persuaded to buy your book! They were also very surprised I was able to cope with the chemo so well. They apply a heated chemo treatment in the operation itself but also subsequent to the op in the ICU unit you get 4 days of 24hr chemo being piped into your abdomen via abdominal drains. Normally people can only take a couple of days of this but I was able to do the full four – not from any greater personal courage on my part but just because whilst unpleasant I did not suffer from any of the really bad symptoms. One of the consultants was particularly surprised my bloods were so stable through the 4 day chemo treatment. I had a lot of people praying for me through this whole process.

    My question is what general advice you could give me now for a tweaked PHD diet given what I’ve been through and the loss of some of these organs. Once I’m fully recovered do you think it might be beneficial to engage in slightly more prolonged fasts for example? I’m not engaging in any fasts at the moment as I need to recover and it takes 3-6 months to do so. Once I am recovered though are there any slight modifications you would recommend or particular foods I could emphasize more? I know without a spleen and omentum my immunity is going to be a bit impaired. Is there any way I can tackle this vulnerability through diet?

    Best wishes,

    James

    • Dear James,

      So sorry that you lost so many organs. I always hate to hear that. I hope the cancer is gone forever, blessings to you.

      We’ve heard from many PHD readers who have undergone chemo that they tolerate it very well, so I’m not surprised you did well too. Based on Bruce Ames’s triage theory, it makes sense that detoxification pathways are the first to be lost during malnutrition, and therefore that a nourishing diet will help the body deal with toxins.

      I don’t have a lot of advice for you, I think you’ll have to experiment. I don’t think prolonged fasts (beyond our usual recommendation of 16 hours nightly) will have any special value, but circadian rhythm entrainment will be very important. With the loss of the gallbladder, bile flow will be altered and you could find oils harder to tolerate and/or a tendency to diarrhea. But I think you’ll find that only some tweaks are required. Be sure to optimize vitamins A and D for mucosal immunity and eat lots of extracellular matrix for wound healing. Soups/stews made with bones/joints and shellfish will help. This is especially important in the first few months.

      Best, Paul

  16. Hi Paul,

    I have hypothyroidism and I take levothyroxine daily. I want to try combining levothyroxine with some low dose T3 (I will discuss this with my doctor). I know you also recommend combining these two (I read comments from you here where you recommended it to other people).

    My question is, is it better to combine levothyroxine with synthetic T3 (like Cytomel), or with natural desiccated thyroid (like Armour)? Which one would you prefer?

    Thank you

    • Hi Gio,

      Either should work. Synthetic T3 may make it easier for you to control the dose. Some people feel they get better results with Armour. Either way it takes some experimentation to find the dose, but more experimentation and more care with the Armour.

      Best, Paul

  17. Hi Paul,

    I need your help!

    Firstly, thank you! Your PHD diet cured 13 weeks of mysterious chronic diarrhea – after which time the doctor said he had never seen such pink intestines of a woman my age!

    Secondly, by following your PHD diet as outlined, I was able to lose some nagging middle age weight – which worked just as you said it would! I am now a very trim 53 post menopausal woman – thanks to your science and generosity :). Unfortunately, I find it difficult to take excessive fats, MCT or Coconut Oil without diarrhea (eg even Avocado with my sardines and rice and kimchi goes straight through me) and I do not have access to Liver/ organ meats – so may not be getting sufficient there.

    HELP Required : I have had chronic insomnia for the last 9 months to the point at which a doctor & psychologist prescribed Ambien CR 6.25. I’ve had to take the medication for the last 5 months because otherwise I would have been a zombie – or worse. It is awful and I now suffer from DRY THROAT and DRY EYES – not sure if it’s the insomnia or the drugs?

    The insomnia started very mildly 10 years ago – at peri-menopause age 43 – and was considered apparently fairly typical. It only became chronic this year – 10 years along (meaning no sleep at all – just a maddening uncontrollable graphic film which played behind my eyes all night long). I suppose I recall it starting around the time of my 13 week chronic diarrhea 10 months ago in late January. I assumed all of the above disrupted my circadian rhythm and I have followed all the entrainment steps you have outlined. BUT SADLY… Still NO SLEEP.

    The only thing I have not done… is consumed the supplements you recommend since I can’t buy them in Asia. I have used a Vitamin B complex by Thorne #6, a Blackmores 1000mg of Vitamin C and Vitamin D. However, I know these will not be sufficient for overall health. I am now happy to buy them from Amazon and have them sent though!

    Other info: Blood work shows I have no estrogen which is normal for post menopause. I did use a Vagifem pessary to help build the lining in my uterus over a 31 day period then twice weekly for 8 weeks – also at the beginning of the year. I don’t know if this could have caused any insomnia either?

    Paul, I am at a loss. I feel like there is no hope in sight. Can you please ADVISE if anything obvious nutrition wise comes to mind?

    And PLEASE would you be so kind as to recommend the correct supplements I should be taking for a slim 53 year old woman with a fragile stomach (I once broke out in hives with an inferior B complex so can only take high quality supplements and not too many, only a few per day).

    THANKS IN ADVANCE – I really appreciate your help!
    With kindest regards,
    Rachel 🙂

    • Hi Rachel,

      There are a few clues in there to work with. Steatorrhea suggests a lack of bile: good nutrients for that are glycine, taurine or N-acetylcysteine, vitamin C, and egg yolks. Eat 3-5 egg yolks per day, maybe 2 with the white and the rest without. Buy glycine as a bulk powder and have 1/2 to 1 teaspoon (3-5 g) per day, preferably in the early evening with dessert. A mug of warm milk mixed with honey, glycine, and turmeric would make an excellent dessert. Taurine and N-acetylcysteine, 500 mg each per day, you can also buy as powders which are cheaper and which you would probably tolerate better than the capsules. Vitamin C get as tablets to avoid acid damage to your teeth. B-50 complex once a week is good. Along with the egg yolks get 2 tbsp apple cider vinegar per day, distributed in small amounts frequently through the day mixed with food and water. Also, supplement molybdenum occasionally, maybe once a week, and optimize copper and zinc per PHD. You need molybdenum, copper, and the choline from egg yolks to dispose of inflammatory amines which may keep you awake.

      Your microbiome (or an infection) may have prevented bile from being recycled leading to the diarrhea and inducing the deficiency. To help overcome this, and to reduce inflammation which is a cause of poor sleep, be sure to maintain good vitamin A and D status, per PHD recommendations. I recommend supplementing a little preformed A, eating lots of carrots, and supplementing D if you can’t get sun on bare skin.

      Dry eyes suggests a deficiency of carbs – are you eating enough? That can also cause insomnia. In general, a deficiency of carbs, protein, or some micronutrients can promote insomnia. Try to add more potatoes, rice, and fruit to your diet. As you get older appetite lessens and you need less fat and more carb and protein, proportionately.

      Also, add extracellular matrix to your diet, in the form of shellfish or soups/stews made with bones/joints/tendons.

      Circadian rhythm entrainment is critical for sleep. Have a 12 hour personal day year-round. Try this: In the first hour of day, get exercise, sunshine, and then eat a protein-dominant breakfast. Use 5000 K bright white lights indoors. Get more exercise in the afternoon. Make the mid-day meal your biggest, and stop eating an hour before the end of day. At the onset of night, wear blue-blocking glasses, shift to orange/amber lighting from white, use “night light” or f.lux on your computer and similar settings on your phone or tablets. Make sure you have no stress at night — move any stressful personal interactions to the next day in daytime hours.

      Finally, nutritionally, tend to electrolytes to prevent dehydration. Potassium from potatoes, bananas, tomatoes; adequate salt; a little iodine; enough calcium and magnesium. Be sure to supplement magnesium, it is crucial!

      That’s what I would start with.

      Best, Paul

      • Dear Paul
        THANK YOU SO MUCH!
        I really appreciate your kind and thoughtful reply.
        I will start on all of your recommendations immediately and revert back in 6 weeks to let you know how I’m getting on.
        I am currently taking Magnesium each night and eating rice, sweet potatoes, bananas, blueberries, mandarins, spinach and broccoli and some nuts at each meal together with a protein and kimchi or seaweed. However, perhaps I’m just not eating enough of the carbs as you suggest, and will increase these to see what happens. I’ll also purchase the supplements and follow your other sleep entrainment recommendations too.
        Paul, I am just so so grateful for your reply, thank you again for taking the time out of your incredibly busy world – much appreciated.
        Best wishes to you and your family and good luck with all the work – your research is really so exciting! Happy holidays,
        With kindest regards
        Rachel 🙂

  18. Paul,
    About six months ago, my sister was diagnosed with something called Dupuytren’s contracture. Prior to this, she had injured her right thumb – tore a ligament – and underwent a very painful prp treatment for that. At this point she has pain and inflammation in both hands. She has been told that there isn’t much that can be done for her. She is very discouraged. Do you have any ideas or suggestions that might help her? Any help you might be able to give would be greatly appreciated. Thank you.
    Mary

  19. Hi Paul,

    What do you think of Subclinical Hypothyroidism? Why would the TSH be high when the Free T4 and Free T3 levels are normal (not even on the low end of normal range)? And why is Levothyroxine prescribed in this case (to those with high TSH and normal T4 levels)? My condition was like this and my TSH normalized after starting Levothyroxine. I do not understand this.

    Thank you

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