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. 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
    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
    12.2 H
    3.8-10.8 (Thousand/uL)

    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



    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:

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


  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.



  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.)


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