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)


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,


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?


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.


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


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 ?


  1. Hi Paul,

    Reaching out for thoughts as you book previously helped me “solve” my digestion issues. For the last 6 months I’ve been experiencing ENT related issues and doctors I’ve seen so far only blame stress, which doesn’t help much.
    It started in Sept with stuffy nose/difficulty to breath with nose, although there was nothing inside. Then some weeks later I spit some blood that was in my mouth. This happened several time so it got me really anxious and went to the doctor. I did general blood test, radio of lumbs and sinuses, everything was ok. Still it generated a lot of stress and other issues started to appear: dry mouth, feeling of having something stuck in the throat (left side only), strange inflammation on tongue spreading around… I went to an ENT specialist that looked everywhere with the camera and said there was nothing wrong, he just told me to put salted water in the nose and eat candies to foster salivation. Went to the dentist that said the blood was coming from gums and indeed after descaling the blood in mouth almost completely disappeared. Then I started to have nasopharyngitys that wouldn’t heal, with blood in nose and even blood when I coughed once, something that never happened to me before. Again doctors said there was nothing to worry about and advise me to try and fix my stress issues instead. The doctor gave me rabeprazol in case inflamation was caused by acid reflux. It did not help at all but generated bloating, muscle tensions, eye and muscle shaking… (not sure it’s linked but started at the same time). Since then I did sophrology, hypnosis, went to the psy, take magnesium supplements. Just came back from 3 week holidays where I was not stressed at all, yet still the same throat issues when swallowing and the impression that it spreads with muscular problems in neck/shoulders/chest/jaw as well – everything only on the left side. To give you some background I’m 34 and lean, used to do a lot of allergies when I was a child, had IBS-like symptoms for almost 15yrs that I fixed around 3yrs ago with better eating (thanks to your book) and hypnopraxy, started boxing again in September (not sure it’s related but timing is the same), also had once muscle tensions problem in the neck/shoulder/head that could be fixed only with diazepam. Doctors just say it’s linked to stress whereas I believe there is something wrong somewhere, and stress might amplify symptoms and create toher ones (e.g. muscle tension). Any hint or thoughts would be much appreciated on where to look for and what version of PHD diet you would recommend to tackle this… thanks so much

    • Hi Julien,

      I’m not a doctor and acute issues like this really need to be diagnosed by a good doctor. So I would keep pressing on them.

      I would avoid boxing, as injury can promote infection, and also I’d worry about salt water in the nose. Salt water in the mouth is good as this normalizes pH and can help get rid of oral infections, but nasal washes may be risky based on the neti pot experience, https://www.cbsnews.com/news/is-it-safe-to-rinse-your-sinuses-with-a-neti-pot/.

      Here are some general principles that may help: Vitamin A and vitamin D are crucial for mucosal immunity, thus for sinus, earway, throat, lungs, and mouth immunity. Be sure to optimize these, take extra until you notice a difference, it’s probably not a coincidence that this came up in the winter. Supplement vitamin C at least 5 g/day, N-acetylcysteine, glycine. Optimize zinc and copper. Circadian rhythm entrainment, intermittent fasting.

      Best, Paul

      • Paul, thanks so much for taking the time to answer. I’ve book an appointment with another ENT specialist to dig further.

        Thanks a lot for general principles, will start ASAP and update if any improvement. 5g vitamin C does seem a lot compared to recommendations we usually get in France. Do you think I should continue magnesium intake? (was taking a supplement with magnesium/vitamins B/taurine but can switch to magnesium only).

        Thanks again for all your work and responsiveness.


        • I think magnesium daily and B vitamins at most weekly is better.

        • May not be related, but when I have dairy, I can’t breathe through my nose. Doesn’t help with all the other complications though.

          • Hi Helena, thanks. Don’t eat much dairy except old cheese, but will try to se if there is a link

        • Julien, in addition to Paul’s recommendations – you could try the following:

          You mentioned a history of allergies, IBS and now ENT issues. This could mean a defective mucosal layer as one of the factors leading to inflammation.

          For a few weeks try to eliminate eggs, organ meats, aged cheese and fermented vegetables BUT supplement with phosphatidylcholine. PC is the major phospholipid present in mucus. It creates a protective hydrophobic surface which is essential for mucosal defense. The richest food sources of choline are eggs and organ meats but ironically these are also most likely to cause reactions.

    • Nothing stresses me like being told, “It’s just stress.” Bless you, I hope you find the right doctor or other health practitioner. I have been playing with my own doses of magnesium for continued muscle tension and have found that I need more than “recommended,” and that I need the dosage spread out through the day, and I’m taking different varieties.

      And I put frankincense up my nose when inflamed. Hello, sorry for the TMI, but it helps. And frankincense topically is good for many other things I haven’t been able to heal.

      And I’ve read that kimchi has a particularly great effect on sinus health, so maybe you could try it. Can’t hurt.

      And the use of vitamin C at especially custom doses is a good thing to read/learn about. Listen to Dr. Robert Cathcart on youtube, for example. May you get the healing you need!

      • Hey St, thanks a lot for the input – will have a look to all of this. Just started magnesium glycinate, let’s see if that helps

  2. Paul,

    I have a nontoxic multinodular goiter. What would be your recommendation on healing this?


  3. Hi Paul,

    I was on ketogenic diet for about 18 months, and suddenly became very ill. I discovered an article on Mark’s Daily apple that quoted you on ketogenic diets and fungal infections. I have a history of both candida and mycoplasma. Wihin days of implementing the PHD and adding safe starches, I felt immediate relief (no more gas, bloating, day-long bouts of diarrhea, etc.) but after a few weeks on PHD, the symptoms have returned — I don’t eat any inflammatory foods (gluten, dairy, soy, etc.) Any insight as to why I got better, and now worse? I am beside myself — it seems as though everything I ate makes me sick.

    • Melancholy Aeon

      Hi Adrienne!

      So frustrating, right? Have you been tested for SIBO? This could explain your experience. Best wishes!

  4. Hi Paul,

    Manganese! My plasma manganese level has been pretty much drifting down since 2015 – last test below ref range. Not sure why. I have supplemented wisely over this time but not manganese specifically but periodically as part of a multi to see what happened. Other minerals low also. (Zinc mostly) I eat pretty much as your book states with some concessions. I guess I am asking in the case of low manganese (or any other low plasma readings) is it wise to just target they mineral?

  5. Hi Paul
    What do you think of organic sulfur / MSM powder as supplement ?

    Could it cause weight gain as reverse effect ?
    And if , why ?

    Thanks for your answer

  6. Hi Paul,

    I’ve been doing some general research into the endocannabinoid system and various effects of phyto cannabinoids. I know because cannabis is still a schedule 1 drug it’s hard to compile good research on it, but I was wondering what role you saw the endocannabinoid system playing in general health and what you thought cannabis’ potential might be as a way to regulate the endocannabinoid system.


    Nick T

  7. Paul,
    I found out recently that I’m deficient in both linoleic and gamma linolenic acid. Is this something to be concerned about? If so, what would you recommend as the best way to correct this? Thank you.

    • Hi Mary, It’s hard to be deficient in these. What’s the evidence? Do you have eczema? Best, Paul

      • I haven’t been diagnosed with eczema, but my skin is dry. I especially have trouble with the skin on my hands being dry and cracked. I had a fatty acids profile done (plasma) – which showed that I’m deficient in these two fatty acids (and very high in EPA and DHA). Thank you.

  8. Hi Paul,

    Is Choline in eggs in phosphatidylcholine form better and more bioavailable than Choline Bitartrate supplement? Or there is not much difference?


  9. Hi Paul,

    Is it not a good idea to take Zinc and Copper at the same time? I heard they will compete for absorption, does this prevent proper absorption of both? Should I take them at different times? Or it is not a big deal and it’s okay to take them together?


  10. hi Paul,

    I just got diagnosed with Leaky gut, Candida, disbiosis and celiac disease. I have severe problems with joint pain, migraines, digestive issues and so on. I’ve been given Nystatin, enzymes, acacia powder, liponic acid, butyrat and probiotics.

    I’ve been thinking about doing your special diet for healing the gut and exclude dairy, etc, but would it be enough just to do PHD? (tests showed no reaction to dairy)

    Is there anything I need to consider with the Candida? low sugar? How low? is there anything else I should think of? I want to make the most of the Nystatin treatment and get rid of the Candida.

    I would be so thankful for your input!

    kind regards

    • Hi Leni,

      Yes, start with PHD. That will fix many issues and clarify what remains. There’s probably no need to exclude dairy.

      With Candida, keys are optimization of vitamin A and D, getting 3 egg yolks per day and 2 tbsp vinegar, getting dietary acids like vitamin C, vinegar, and lemon juice, intermittent fasting, circadian rhythm entrainment, adequate carbs along PHD lines, bile acid supports e.g. taurine, glycine, N-acetylcysteine, vitamin C, and egg yolks. Eat a balanced diet, don’t try to go super low in sugar, do eat fruit but don’t eat processed foods with added sugar.

      Best, Paul

      • thank you so much for your reply! I’ll follow phd and the additional advice. I hope to check in again in a while with some good updates. 🙂

        • the Nystatin is making me very sick, is that common? My joint pain in through the roof and I feel very ill. is that a Candida die off or maybe a reaction to the medicine?

          • I don’t know, I have no experience with Nystatin. You should speak to the doctor who prescribed it.

            Best, Paul

          • ok I will. I read somewhere that you had Candida, how did you get rid if it?

          • Hi Leni,

            Diet and lifestyle. Drugs like fluconazole and nystatin didn’t help me, or what help they gave was balanced by negative effects. PHD and our lifestyle advice (intermittent fasting, circadian rhythm entrainment), with some points of emphasis nutritionally: vitamins A, D, and C, iodine, vegetables, 3 egg yolks per day, N-acetylcysteine, extracellular matrix, healthy acids like vinegar, zinc and copper, maybe chromium which is antifungal but usually not necessary. Ultimately your immune system plus beneficial bacteria are what beats fungal infections.

            Best, Paul

          • thank you again! so I can just follow the advice regarding the dose of the supplements and so on from your site? is n-acetylcysteine (and taurine, glycine) safe to take when having gastritis/inflammation? If I can’t make bone broth is gelatin ok as a substitute? … and where to get the vitamin A from? I have vitamin C and D already. what do you think of digestive enzymes? thank you again for your help, you have no idea how much it means.

  11. Paul, I just read something about vitamin C supplementation and would like your take on it. “ CAUTION: Always take Vitamin C with no fat in your stomach: studies have shown that Vitamin C supplements increase nitrosamine (a carcinogen) levels in the body with even 10% fat in the stomach. “


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