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 ?

9,730 Comments.

  1. Hi Paul,

    About a year and a half ago I started having a problem with constant bloating, burping and joint pain. I found your site and purchased your book (as an ebook before it was published).

    Since then I have pretty much followed your diet apart from 6 months in when I bought a blood glucose meter and had to remove most of the rice and potatoes.

    After around 9 months with no difference to my symptoms I had a stool analysis done and found I had geotrichum and candida tropicalis.

    I have tried many remedies, 1 week of water fast (burped all the way through, I realise now that it wouldn’t help a fungal infection), loads of bought and home made probiotics, azoles, nystatin, natural antifungals, 3 days of coconut oil fast (just cleared out my bowels) all to no effect.

    I don’t appear to have a problem with any particular food, all it does is change the flavour of the burps. The bloating is there all the time whether I have eaten or not.

    I’ve veered off your diet lately as I mostly eat raw food, raw milk and butter (on rice crackers), raw eggs, raw muscle meat(dehydrated at 35C), tinned sardines and occasional lightly cooked liver.

    The latest thing I am trying is lufenuron, which appears to be doing something, after the loading dose I am getting more joint pain and mild headaches.

    I wondered if you had any opinion on lufenuron and if this doesn’t work, any opinion on (I’m getting desparate here) tannic acid, peroxide and borax.

    Also since you say ketones feed fungi do think it’s worth upping my carbs and ignoring the blood sugar spikes until this is sorted.

    Thank you for the time you put into the blog.

    Merry Christmas to you and Shou-Ching.

    Hi Andy,

    I tried lufenuron briefly and it seemed to work, but then it became unavailable from inexpensive sources. It’s too bad the standard antifungals haven’t worked for you. It might be worth continuing whichever ones have minimal side effects.

    I would definitely not swallow peroxide or large quantities of borax or tannic acid. Injuring your gut would make things worse.

    I would eat green leafy vegetables (for nitrates), ev olive oil (for polyphenols), traditional herbs and spices (oregano and turmeric are good antifungals, there are many others), garlic, ginger, cranberries, and other foods with antifungal activity.

    I would eat fermented vegetables.

    The optimal amount of carbs is hard to say. Blood sugar spikes aren’t good but probably the infection is causing them. I would definitely try eating some carbs, but distribute them through the day (don’t fast), and combine them with fat, vinegar, and vegetables.

    Certain bacteria are good at fighting fungi, eg Bacillus subtilis. Some herbs are good antifungals, eg horopito.

    You have a tricky case. Please keep me posted.

    Best, Paul

  2. Andy,

    I am not Paul, and I have no experience with your specific infections, but I wanted to suggest that you experiment with HCl supplementation. Stomach acid is often decreased in those of us with gut problems, and bloating and belching can be symptoms of low HCl. It’s a very low risk, potentially high reward thing to experiment with.

    Good luck to you. I know how it feels to be desperate for answers.

  3. @SGW

    Already tried HCL, stomach acid seems ok, I only need to take 1 or 2 to feel burning.

    How would low stomach acid explain why I was still bloated when I didn’t eat for a week?

    Thanks anyway.

  4. Thank you for your advice about infant nutrition Paul, it is a great help and is so much appreciated.

  5. Hi Paul, thank you for your post re tapioca syrup and dextrose, only just spotted it.

    Merry Christmas to all.

  6. Any opinions on alleviating sore eyes? You guys probably read a lot. I guess eat a healthy diet and use reading glasses?

    Hi tam,

    I’m afraid I don’t recognize “sore eyes” as a medical condition. What do doctors call your condition?

    Best, Paul

  7. Hi Paul,

    I’ve noticed a fair amount of questions regarding the GAPS diet, and so I thought I’d add one. How exactly do you reconcile the fact that the gaps diet (and the precluding specific carb diet) recommends against potatoes as a source of carbs; both you and GAPS and SC diet creators are scientists, yet your ideology seems to vary quite a bit-not so much in the animal fat department though. Bit confusing as I have gut issues, one source says one thing and another says otherwise. Help!

    Hi Michael,

    You might look at my conversation with Judy Tsafrir for some background: http://perfecthealthdiet.com/?p=5198#4.

    Basically, our diet is designed to be optimally nourishing for the body as a whole, and to reshape the gut flora in a positive direction. If you have a healthy gut flora, you will be able to eat all the foods we recommend and our diet should improve the composition of the gut flora further over time.

    In bowel disorders, some of the foods we normally recommend are likely to prove troublesome. They will feed pathogens in the gut. So a restricted / modified diet is necessary. More emphasis is placed on re-shaping the gut flora by starving the pathogens and providing/supporting replacement flora; if necessary some nourishment may need to be sacrificed until the gut flora normalizes.

    GAPS and SCD embody a lot of lore about what restricted / modified diets are likely to work in most cases of bowel disease. Often, starches have to be restricted, because they commonly provide significant amounts of food to gut flora (and pathogens, if they are dominant).

    However, there is a tremendous diversity of pathogens, and it’s not necessarily the case that very low carb diets are optimal. Glucose is supportive of immune and gut function. Usually sugars are better than starches in colonic disorders, since they are absorbed in the small intestine and provide less food to colonic pathogens. However, I recommend glucose-only sugars, such as dextrose or rice syrup or tapioca syrup, rather than fructose-containing sugars like honey.

    In bowel disorders I tend to favor a systematic approach of diagnosing the gut pathogens with stool tests such as the Metametrix DNA GI Effects profile, treating the pathogens with specific antimicrobial drugs as well as providing replacement flora with probiotics and fermented foods (in extreme cases, fecal transplants), and modifying the diet to starve the pathogens and minimize symptoms. I think GAPS and SCD provide a lot of tips on how to achieve those last two steps, but you have to keep in mind that those tips are not universally applicable (maybe 90% applicable), and judge whether they are working in your case.

    In regard to potatoes specifically, I think they are excellent for feeding probiotic flora and clearing toxins, but can also feed pathogens. Thus, while the bowel dysbiosis is severe you may benefit from avoiding them, but should restore them in small quantities as things get better, so that they can nourish a population of beneficial flora. Over time, gradually increase the amount you eat. When you can eat them in large quantities, you are likely cured.

    Hope that helps!

    Best, Paul

  8. Hi Paul,

    There is a lot of contradicting information out there regarding vitamin A supplementation and cod liver oil during pregnancy. Can you share your opinion on this topic?

    I recently bought your book, and I notice that you recommend caution re: vitamin A supplementation, and I saw that you have a blog post that suggests that cod liver oil could be problematic for cancer patients. But what about for healthy (and pregnant) people?

    After much research, I had decided to go with Chris Kresser’s suggestion and I am taking fermented cod liver oil everyday (plus the multivitamin he recommends). Now, after reading your book, I am feeling nervous again about overdosing on vitamin A…. should I be worried?

    Best Regards,

    Hi Vanessa,

    First, I oppose taking fermented cod liver oil; I think the fermentation is all too likely to create toxic compounds from the fragile DHA and vitamin A. Oxidized DHA and vitamin A is especially dangerous, see this post: http://perfecthealthdiet.com/?p=3390 and the earlier posts it links to. I would rather take the freshest possible cod liver oil. If you do take it, get a bottled form that has been kept refrigerated and away from light.

    Second, I would keep supplemental vitamin A intake to <5000 IU/day and EPA+DHA to 1 g/day. This means, generally, at most 1 teaspoon per day of cod liver oil.

    I think it's important to get these nutrients, especially when pregnant, so I think 1 teaspoon of cod liver oil daily has a lot to recommend it if you don't eat foods for those nutrients. I'd just go with moderation.

    But dietary sources may be even better than cod liver oil. Egg yolks, liver, and salmon are excellent sources of vitamin A and fish oil, and provide a lot of other nutrients as well, so they would obviate the need for cod liver oil. If you eat those, then you have to consider whether the cod liver oil may be creating an excess.

    Best, Paul

    Vanessa

  9. Recently I mentioned “leaky gut syndrome” to a family member and she was shocked that such a thing is possible. I saw her today and she told me that a biochemist friend told her such a diagnosis is nonsense. If it were possible, people would have sepsis throughout their bodies. This woman and her husband have been drinking soy milk for years because cow’s milk gives them bloating and noisy gas attacks. She believes it is just their intolerance to dairy. This couple is in their 40’s and consume and defend the SAD. Paul, or anyone, is there documentation of a study that describes and proves that leaky gut is real? I have searched a bit, but find only those articles and videos by people who are hoping to sell a leaky gut cure.

    Hi Elaine,

    Yes, there’s plenty of evidence for leaky guts and for these having a causal role in autoimmune disorders and food intolerance.

    A good review is this from Anthony Fasano: Leaky Gut and Autoimmune Diseases, http://www.ncbi.nlm.nih.gov/pubmed/22109896.

    For specific data, here’s a recent paper on IBS and ulcerative colitis: Patients had 3-fold more leaky colons; constipation was associated with impaired absorption in the small intestine. http://www.ncbi.nlm.nih.gov/pubmed/22179430.

    I guess your relative’s biochemist friend is just ignorant of the literature. “Intestinal permeability” is the primary search term in Pubmed – 9171 hits – but “leaky gut” is a phrase that is coming into the biomedical lingo.

    Best, Paul

  10. Hi Elaine, funnily enough I have just had the results of a gut permeability (leaky gut) test and I do have some gut permeability – haven’t spoken to my practitioner yet to find out just how leaky it is. The test is a simple urine test.

    You swallow a solution of sugars I think, containing molecules of different sizes. Collect all urine for 6 hours and test it for the presence/absence of the different sized molecules. If the urine contains molecules that shouldn’t be able to get through the intestinal wall into the rest of the body that indicates leaky gut. If it doesn’t contain molecules that should have passed through this indicates some malabsorption.

    I think that leaky gut, like Candida, is one of those conditions that probably gets rather sloppily over-diagnosed by alternative practitioners but many symptoms are ubiquitous and there can be numerous causes so it’s worth having a test if there is a reliable one.

  11. Hi Paul,

    I had a very important question regarding calcium- specifically in regards to your recommendations to avoid supplementation. I understand that individuals who more or less favor a “paleo” perspective on diet, tend to prefer a kind of moderation (i.e. eat as much as you can get from food, don’t eat a stick of butter, but don’t eat a pot of potatoes either..etc). While this seems, as you say, prudent, my main contention and question is in aimed at those who are severely deficient–i.e. for instance someone with rampant tooth decay. It’s probably obvious that someone with healthy teeth and whatever else stick with moderate, food amounts, of minerals and vitamins; but what about someone grossly deficient, maybe megadoses are a wise choice? Also, through analysis of many indigenous peoples, i’ve noticed that all of them–with great dental health and the like– seem to have high intakes of calcium (even the kitavans managed to get 50-60% from foods and the rest from mineral waters–with content of up to 500mg/L). So how can, for instance, mineral water be a perfectly fine “supplemental food”, but man-made calcium products inferior and actual harmful (as you say in multiple posts on the blog)? I understand that there is a complex interplay of elements within each and every food/water substance, but after finding certain studies (e.g. http://www.ajcn.org/content/71/4/999.full) that suggest calcium (in mineral water) inhibits Parathyroid hormone and by the same mechanism, inhibit bone resorption, I am starting to think it’s the form of calcium that is the paramount factor in whether it will be beneficial or harmful. Also, just checking out one your citations from “Why You Shouldn’t Supplement Calcium” post (i.e. http://www.ncbi.nlm.nih.gov/pubmed/9092314?dopt=AbstractPlus), it seems to suggest a similar relationship.

    Apologies for the ramble but I was interested mainly in the health of my teeth, I understand there may be some complexity/uncertainty in regards to calcium supplementation, but would supplemental foods, such as mineral water, be something that I could consume freely-upwards to 1700mg, or even 2000mg calcium equivalent (a rough estimate of intake amounts by traditional peoples with pristine dental health-obviously through their food supply/water). Thanks for any insights on the matter!

    Hi Michael,

    Well, you certainly don’t want to be calcium deficient. I don’t have a problem with calcium supplementation – in fact we get supplemental calcium through our multivitamin, which has 200 mg. If you think you need more, then go ahead and take some.

    Just be sure that you are taking vitamin K2 and magnesium, and appropriate amounts of vitamins A and D, along with it.

    If you are “grossly deficient,” then it can take a long time to replenish calcium levels in the bones. However, I’m not sure “megadoses” are the optimal way to replenish those levels. Make sure D/A/K2/magnesium is good and then an elevated calcium supplementation for a time shouldn’t be an issue, but I wouldn’t go far beyond normal intakes. I think 1200 mg/day is OK, maybe as high as 2000 mg/day as you mention.

    Best, Paul

  12. I was recently introduced to your website and am very interested in beginning your program. I am however 6 weeks postpartum and am nursing twins. I am hypothyroid and take supplements, but other than my pre-natals and some extra vitamin D, I do no take anything else.

    Do you have any particular recommendations for me, or anything that should be modified? I currently follow a diet with many of the foods you list, but am consuming a lot of lactogenic foods which includes oats and brewers yeast. It’s very important to me to keep a good milk supply, so I do not want to do anything to endanger that. Thank you so much for your guidance with this. I am eager to get started!

    Hi Mel,

    Congrats on your twins!

    I don’t have special recommendations for you. Only very slight tweaks would be called for I think. You might take special care to get enough fish oil / omega-3, and get slightly less protein, slightly more starch and saturated fat, to support your babies. But really, eat our regular diet and follow your taste preferences and appetite. Your brain’s food reward system will give you a natural desire to eat the foods that are good for you; let it be your guide. Eat what tastes good to you. Don’t be afraid to eat starches or fats, but make sure the fats are low in omega-6. Butter is great.

    With hypothyroidism, you have to be especially careful about iodine. Deficiency is dangerous to the babies, yet adding iodine too quickly or without selenium can disturb your thyroid function. So supplement selenium (200 mcg/day) and a low dose of iodine (up to 500 mcg/day would be good I think).

    Magnesium is another extremely important mineral, and there is probably not enough in your prenatal due to its bulk. I would also take some vitamin C.

    So, for supplements I would recommend: your prenatal, vitamin D, selenium, iodine (low dose), magnesium, vitamin C. Also some vitamin K2.

    Best, Paul

  13. Paul,

    Many thanks for your book and blog as it has helped me lose 35 pounds and counting over the last 5 months, along with a general improvement in energy level and “evenness”. Extremely gratifying to find a way of eating which is sustainable, totally satisfying and results in natural weight loss. And, I have yet to add high intensity workouts to my normal morning and afternoon walks. I have been talking to anyone who has expressed interest as the potential of the diet is obviously tremendous!!

    I have one question which I think you’ve addressed somewhere, but I haven’t been able to relocate the information by searching your site. Would you please address why you recommend brown rice syrup over other sweeteners? I’ve been using it and I tolerate it fine, but I’ve been getting questions as to how it is different/better than honey and other sweeteners.

    Thank you again and best wishes in 2012 to you and Shou-Ching!!

    Regards,

    Brian P

    P.s. I strongly suspect PHD played a pivotal part in my wife getting pregnant naturally, just prior to starting her next round of IVF.

    Hi Brian,

    Congratulations to you and your wife! That’s fantastic about the baby! And it’s good to hear of your weight loss and improved mood and energy too.

    Re sweeteners, I think it’s desirable to avoid fructose, so that rules out table sugar, honey, and HFCS. For those with weight control issues I think it’s also desirable to avoid deceiving the food reward system of the brain by giving it calorie-free things that taste sweet. Both fructose and calorie-free sweeteners seem to promote obesity, so avoiding these two is especially important if you’re trying to lose weight.

    That leaves glucose- and galactose-based sugars as potential sweeteners. You can buy powdered dextrose, but rice syrup is a fairly natural and readily available source of sweet glucose-based sugars.

    I would prefer white rice syrup or tapioca syrup, but since those are not readily available, brown rice syrup will have to do.

    Best, Paul

  14. Helo Paul

    I have a bacterial and a fungal infection. how would you adress that?

    Hi AZ,

    Go to a doctor, use the tools of modern medicine to get a specific diagnosis (ie species identification), then get appropriate antimicrobial drugs that specifically target those pathogens. Support the treatment with a healthy diet and supplement program (esp vitamin D and related nutrients), as described in our book.

    Best, Paul

  15. I am a very busy public educator and, although well-intentioned, my diet is imperfect at best. I have relied, for some years now, on calcium citrate, magnesium, manganese, tri-boron,supplemental vitamin D, and separately, strontium citrate, all to help avoid the osteoporosis that crippled my mother and grandmother, and great grandmother. (I am female.) Now, I read in Paul’s book the devastation that such supplementation can cause. I do not consume much dairy, as it used to cause me joint pain. I am trying to add it back with small amounts of yogurt. I do juice an assortment of veggies every evening, including several leaves of lacinato kale, but I don’t believe this brings my dietary calcium/mag to the levels I need.

    Brain lesions? Really? This is one scary path. Is cutting calcium supplementation really what post-menopausal women should do?

    Hi Dale,

    You don’t give me doses, but those supplements should not be harmful in moderation. Too much manganese or calcium can be problematic. However, the main thing you need to avoid calcium problems is (a) magnesium and (b) vitamin K2 along with (c) vitamin D and A optimization. If you do those things, then supplemental calcium should not be all that dangerous, although I would still keep my intake in the physiologically normal range (ie 500 mg – 1000 mg from all sources). Also, I would get serum 25OHD levels tested to evaluate whether your D supplementation is excessive.

    For bone health, keeping omega-6 down and omega-3 up is a good idea; also keeping wheat intake down and safe starches up.

    Best, Paul

  16. Paul,

    I recently came across this article in the NYT Magazine: http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html

    If one follows a proper diet, does being overweight or obese previously make it harder to lose weight and keep it off?

    I don’t discount the experiences mentioned in the article, but I wonder if it’s because they were fat before, or if it’s because their current diet is still flawed.

    My father is overweight, yet my five siblings and I are all slim, ages 19-31, and none of us show signs of getting fat. I believe my father eats a moderate, though non-PHD diet. I’m wondering how much of his excess weight is due to diet and how much due to “inertia.” He ridicules my diet, and refuses to try a diet higher in saturated fats and lower in grain and sugar.

  17. Hi Paul/community,

    Just after some advice. Am just getting over what I believe is a yeast pathogen die off. I had some severe diahorrea and stabbing gut pain as well as fatigue and general malaise. I took charcoal tabs as well as Epsom baths and after a week the symptoms subsided.

    Since then things have been a lot better but my stools are very lose and show no sign of firming up. There is no sign of bleeding though which is good (I have UC). Any thoughts on how I can get things under control again. In the past die off experiences have always brought better health afterwards so I’m feeling positive and thinking it might be a case of letting things settle but I’d appreciate your thoughts.

  18. Hi Paul,

    Thank you so much for your reply to my comment last week, which I posted on the page of Jay Wrights weight loss journey (Type 1 diabetic, losing weight, doctor wants me on statins, etc…) I think I should have posted my comment on this page, so I’ll continue here. As for my weight loss, I did lose one more pound last week bringing me to 120.5, but I’m back up to 123.5, which I’m sure must be due to my breaking the diet over Christmas (I’m not allowing wheat at all, even though I was tempted, nope! but i did give in to sugar- too many hershey’s kisses!). Anyway, for the most part, I’m not too concerned with my weight, but I do want to try to make sure I’m doing whatever is best for my health. You asked about my supplements– so far I’ve only been taking Vitamin C (1000mg/day on most days; 5000-6000mg/day on days when I felt some kind of cold coming on or when my husband was sick) and 1000 IU of Vitamin D/ day (but not every day- I didnt want to get too much- ??). Randomly, maybe once a week, I take a pre-natal vitamin (only because I had them and that was serving as a sort of multivitamin for now). But I do need to go invest in a multivitamin. I am pretty sure I need the Vit D since my blood work from last year and also the year before showed very low levels:
    Vitamin D, 25-Hydroxy-
    Aug 2009: 36.2
    Sept 2010: 31.4

    I do have a few questions, and they are all over the place…

    1) I mentioned how, when my blood sugar drops, I usually eat raisins (I thought it would be better than candy) or whatever fruit is around. But I remember you talking about avoiding too much fructose. I can get glucose tablets to replace the raisins. As far as health goes, do you think they might be better? They should raise my blood sugar faster, which would be good because it would prevent me from accidentally going from hypoglycemia to hyperglycemia by eating too many raisins.

    2) What do you think about home Cholesterol tests? I wanted to buy one, but just wondered if you or anyone else has advice on these (accuracy, etc)?

    3) My triglycerides have always been low. Is this possibly bad? I’m sure there’s already info on your site about this somewhere… can you point me to it? Here were my levels:
    Aug 2009: 29 (lab test read, “**Verified by repeat analysis**” which I assume means they were surprised by the number?)
    Sept 2010: 26 (again lab test read, “**Verified by repeat analysis**”
    So, just wondering about that…

    4) Have you read any of the studies done on possible connection between Coxsackie B virus and Type 1 diabetes? I was wondering if there would be a way for me to test if I ever had the virus? I don’t remember where I read that, but I will look for it. Any thought on that?

    Again thank you so much for your time and all your efforts. I also wanted to ask about your book. If I go to Amazon directly from your site by the link you provided on the right, does that benefit you more than if I buy it any other way?

    Many thanks!
    KH

  19. Hello Paul

    What’s the connection between ketosis and Intermittent Fasting?…regarding brain bacterial infection?

    I’ve been trying alternating PHD-high carb (600 cal.) and IF because I have both bacterial and fungal infection. How would you schedule alternating between the two and for how long to do IF each time?

    and any good links for further reading/research?

    Thank You,
    AZ

  20. Hi Paul
    I am not sure I am posting in the right area – I am new to this site.
    Some months ago, after much reading, I stopped eating grains and added sugars – and already I am feeling better for it and lost some weight. Also for many years I have been using butter, coconut oil and olive oil and no other vegetable oils. Then, when I recently found your book (and subsequently your website)I was delighted as it added another layer of detailed knowledge which will allow me to refine my diet and work on any health issues. I am really grateful for all the incredible research you and Shou-Ching have put into this.

    However, I wondered if I could find some help with pulling together a flexible, simple “table” of foods, calories and calory types (carb calories, glucose calories, fat calories from protein and fat calories from protein-free foods etc etc) along with amounts to simplify daily meal planning and menus which I could amend as necessary for, say my weight. There must be a great variation in optimum calories according to personal weight. (I am female and weigh 65 Kgs (143 lbs) and would like to lose an additional 5 pounds, for instance).

    I have gone through the book on a first read. It is dense with information and I am now going back and making notes to try pull it together for my use – with a little difficulty at this early stage I have to admit (with a small added complication that we use kilojoules and kilograms here in Australia and have to convert from imperial, which of course is no big deal). I appreciate that you do summaries of calorie requiresments at the end of chapters but I am still struggling a bit with translating this exactly to my diet and personal requirements. If no one out there has felt the need for such a “table” then I am sure I can do one for myself with a bit more work. Perhaps I am just being lazy about this. Also I have not had time to catch up with all prior posts and comments, so may find something helpful there.

    I see you are planning a Cookbook and I look forward to that very much and hope it is not too far away. Could I request that it include a table/list of appropriate food values for reference and perhaps a meal planner as well. It would also be really helpful if you could add the conversions to metric in the recipes. All that would be a great help for newbies such as myself.

    Thank you and Shou-Ching for your incredible work which will help so many people to better health.
    Warm Regards
    Kay from Australia

  21. Thank you for your reply, Paul. I’m feeling somewhat calmer. 🙂 Years ago I took Twinlab’s Tri-Boron Plus, but decided to eliminate the calcium carbonate and rely on just calcium citrate, so set out to mimic the other ingredients in that product, as I seemed to have good bone density.
    The ingredients in that product were: per 500 mg of cal: magnesium = 250 mg; zinc = 7.5 mg; copper 250 = mcg; manganese = 2.5 mg

    The formula I have jury-rigged is: boron = 3 mg; chelated copper = 2.5 mg; zinc = 30 mg; manganese = 10 mg. These I take daily. Prior to Dallas I was trying to get 1000 to 1500 mg of cal and 500 to 750 of mag. Now I sort of shift around wondering what to do, so the cal/mag ranges from 600/300 a day to 1200/600 a day. I take 2100 mcg Vit K2 complex, and I do take a half tsp of FCLO after Dallas. Last summer my vit D was at the very lowest “okay” mark, so, at ND’s orders upped that to 5000 a day, now take only the FCLO.

    You pose interesting concerns about FCLO, however, so I’ll be thinking about that. Adding liver, brains, et al to my diet is going to be a hard sell. However, Sarah Pope (healthyhomeeconomist.com) suggests dicing raw liver, freezing, and popping the pieces like a pill, which I could do.

    But…daughter-in-law says that liver is a filter and filled with terribly toxic bad-for-you stuff. She’s very sweet and a proponent of SAD.

    Enjoying potatoes, but recall reading, just months ago, that to put a spoonful of spuds in my mouth is like taking a spoonful of white sugar. So, have to wonder at the mixed messages we get from so many sources.

    Have been wheat-free for 15 years, processed sugar-free (nearly) for much longer. Did fish oil to maintain omega 3, but now sticking with food. Got into trouble when a certain company changed the formula of their vit D to include safflower oil. Three weeks of crippling pain in thumbs, which got better as soon as I stopped the safflower oil laden caps. So sensitive to omega 6 now that I cannot tolerate any chicken and only a small amount of pork. I share this only because so many people think that osteoarthritis is inevitable. But, I’m not doing badly at all.

  22. Paul,

    do you think iron and/or iodine deficiency can cause high cholesterol? and or LDL

    my TC used to be quite low (160s) when i was on the “standard healthy” diet. HDL was 64, TG = 51. all good.

    my diet has been very close to PHD : moderately low C (25 – 30%) P ~ 15% (sigma = 4 – 7%), rest is fat (preferably SFA) for 1.5 years (+ almost gluten free except when i eat out). actually, i switched to “lacto-paleo” before discovering PHD.

    now my TC is 295. HDL = 88, CRP = 0.4; TG = 61.

    switching my diet cured my migraine, projectile vomiting (due to wheat); it also improved Raynauld syndrome & some mysterious joint pains + inflammation. i also feel much more energetic, less bloated, more cold resistant. i don’t need to loose weight so never go to very low carb.

    recently my ND just told me that i have mild hypothyroid” (TSH = 3.25, T3 & T4 are @ the low end of normal); i also have severely anemia (RBC low, iron is only 1/3 – 1/4 of normal).

    we were both very surprised, as there seem no typical symptoms. i don’t fatigue easily. if anything, i have been told i’m “hyper” all the time.
    i have only observed
    slightly thinning hair, dry skin, nails slightly brittle, vitilgo, eczema, mild depression.

    i suspect it may be an absorption issue since my stomach seems a little low. i used to eat sea vegetable much more often in Taiwan. now i hardly every eat it in US (Hubby does not like it so i don’t cook it)

    my diet is already quite clean. you think maybe my intake of iodine is not enough?

    have a great 2012,

    pam

    Hi Pam,

    Yes, iron and iodine deficiency can both cause hypothyroidism, and hypothyroidism can cause high LDL and high triglycerides.

    Your old serum cholesterol of 160s was too low. Optimal is 200-260. So you’re a bit high now. Not too worrisome, the hypothyroidism is what you need to focus on.

    Best, Paul

  23. Happy New Year Paul and Shou-Ching – I hope it brings all the happiness and good luck you deserve. I can’t thank you enough – your book, all the great articles on this site and your answers on this page have helped me more than you would believe. Everyone who finds this site is so lucky.

  24. I totally agree with that Francesca, and Happy New Year to all.

    Paul, what is your opinion of an article on Dr Mercola’s site about rice, potatoes, tomatoes, rye and barley producimg similar negative effects to those of wheat, due to the presence of “chitin-binding lectins.

    Thank you yet again, season’s greetings.

  25. In my previous post I see that in the components of the tri-boron I left out the boron, 1.5 mg per 500 mg of cal cit.

    I hope you and yours have a wonderful new year.

  26. Hi. I was discussing chocolate with a friend the other day. Now I always assumed dark chocolate (pure cocoa, no sugar) was in the same league as other plant foods, however my friend was saying how chocolate is particularly toxic and it’s a neuro stimulant so should be eaten very rarely.
    What do you think about this? I’m not addicted to chocolate and would happily cut it out of my diet, but every now and again I enjoy a piece of 99% dark chocolate, and am wondering if I would be better off completely avoiding it? Have you heard about the toxic effects of chocolate and can you shed any more light on this?

    thanks

    Hi Remo,

    I think chocolate in moderation is highly beneficial. Some of the studies supporting chocolate have been mentioned in Around the Web roundups.

    Best, Paul

  27. Paul, I forgot to paste the link to the Mercola article:

    http://articles.mercola.com/sites/articles/archive/2011/07/05/other-nonwheat-grains-can-also-hurt-your-health.aspx

    Hi Frances,

    Thanks for the link. Those lectins are only found in the roots and coleoptile (http://en.wikipedia.org/wiki/Coleoptile), not the grain, so they shouldn’t be in our food in any quantity.

    Best, Paul

  28. Hi Paul,

    In your book you label wheat as the most dangerous grain with corn as a close second. However, I note that Dr. Kurt Harris classes whole meal corn along with white rice as ‘reasonable sources of starch if tolerated.’

    What is the case against corn?

    Thanks and Happy New Year!

    Hi Martin,

    I think key points in the case against corn are presented in the book, however I would probably not be so harsh toward it if I were revising the book today. One factor maybe not mentioned in the book is that corn was relatively recently domesticated from a highly toxic plant, teosinte. Another factor is the high mortality in the Rose Corn Oil trial, another the fact that the toxins that cause pellagra are still not known and may be present in corn products. However, soy may be a more deserving candidate for the #2 spot. Hard to say which is #2. I’ll still stick with wheat at #1 however.

    Best, Paul

  29. Thank you for that Paul. It’s almost impossible to know what information is accurate or misleading and there’s so much of it about.

    Would you mind giving your opinion on another contentious area please, concerning Hashimoto’s thyroiditis and iodine, hope you don’t mind.

    1. Dr Kharrazian and Chris Kresser both advise that it is dangerous to supplement with iodine and eat seaweed in the case of Hashimoto’s (described as throwing gasoline on a fire). Do you know whether this applies if there is iodine deficiency?

    2. Testing for iodine deficiency: do you know whether the skin test (painting on iodine tincture and checking how long it takes to be absorbed)is accurate? Is the urine test more/less accurate?

    I’d be very grateful for your thoughts on this because the effects of experimenting could apparently be a bit unsafe.

    Also, do you know about an American herbalist, Ryan Drum, who specialises in treating throid problems and is a strong advocate of eating lots of seaweed, regardless of thyroid status
    (www.ryandrum.com).

    Thank you again.

    Hi Frances,

    Even in Hashimoto’s, I think it’s beneficial to supplement selenium and some iodine, but these are even more important in hypothyroidism due to deficiency.

    We discussed the issue of iodine in Hashimoto’s in two blog posts: Iodine and Hashimoto’s Thyroiditis, Part I, May 24, 2011, and Iodine and Hashimoto’s Thyroiditis, Part 2, May 26, 2011.

    Be sure to go very slowly with iodine. Start with 200 mcg selenium and 200-500 mcg iodine, then double the iodine dose once per month.

    I would trust the urine test a lot more than the skin test, but I’m not sure it’s all that accurate either.

    Re Ryan Drum, seaweed, especially kelp, can have a lot of contaminants, including bromine and heavy metals, so though it is a fine food in low doses I would get iodine from inorganic supplements like potassium iodide.

    Best, Paul

  30. Hi Paul,

    I just want to say thank you for answering all of these questions for everyone. It’s very admirable and apparent that you truly want to help people. I really appreciate it as I’m sure others do.

    1 quick question for you today:

    Can you please elaborate on the nutrient partitioning effects of more fats vs more carbohydrates in the diet from the standpoint of body composition? IE more muscle mass, less fat mass. The theory in your book about fat promoting muscle gain and muscle being the optimal storage mechanism for energy was intriguing, as well as the first time I’d heard that particular argument.

    I’d love to hear more about this, as I am a rock climber and ultimate leanness with a decent amount of muscle mass and strength is ideal.

    Thanks again!

    Mike

    Hi Mike,

    This is a complex issue, but in general for body composition I think 20-30% carbs is best for most people, 30-40% for elite athletes doing intense glycogen-depleting exercise.

    If you just want to be strong and recover from exercise quickly, and leanness is less important, you could go higher in carbs.

    Best, Paul

  31. Hi Paul

    Once again, thanks for your wonderful book and all the support I can see that you give to your readers -truly amazing. I could not be happier that I have found your book and website.

    Some time back I had two surgeries for breast cancer, followed by radiation and 5 years of the drug Tamoxifen. As a result I am keen to do whatever I can to optimise my health – and after much research I do feel I have now found the best possible way to do this through The Perfect Health Diet.

    I love the science base of your book and continue to re-read it to try to clarify and refine my diet.

    However, could I ask that you consider having someone produce a food and nutrition calculator/tracker based on your diet? There are a number of examples of this type of program out there such as the MyfitnessPal (iPad app for food and exercise tracking) but none are compatible with the Perfect Health Diet, as they are full of info on foods that are not acceptable, and focus on low fat etc. For example I could not find any meat that was not lean or fat trimmed in that particular tracker when I tried to test it out. I’m pretty sure they would not have coconut oil on it either!

    A Perfect Health Diet Calculator/tracker could list only appropriate foods for this diet, and give calories, protein, carb and fat quantities and percentages etc for each, along with appropriate ratios and details of PUFAs and so on. For instance, information for, say, breakfast could be selected from included food lists, and then based on what the tracker detailed about foods selected, decisions about what would be good choices for the rest of the day could be made to maintain a proper balance of all nutrition in the correct quantities and ratios in accordance with the diet. It would allow for a lot of tweaking of food selections as one went along.

    Suitable recipes could be added in due course as well.

    I know this could be a time consuming and costly exercise to set up, but I certainly would be more than happy to pay for such a program or app, and I think many people would also. It would be such a help to folk like myself who are new to this style eating, and eager to get it right for their health’s sake. As the word spreads about the tremendous benefits of the diet, I think more and more people would appreciate this kind of assistance.

    Would you consider this?

    Anyway, thanks again for all your inspiring work. I have just watched your full video interview with Dr Mercola and that was very informative as well.

    Warm regards
    Kay

    Hi Kay,

    I’m sorry to hear about your breast cancer but happy that you’ll be trying our diet!

    Your app idea is great. We don’t have immediate plans to make such an app; however, Shou-Ching and I are working on a cookbook, which will include meal plans and other aids. I will look into whether we can use some of that material to make an app, and whether we can provide the functionality you request.

    Best, Paul

  32. Paul,

    I recently started incorporating coconut oil into my diet. I was fine at first, having 1 tbsp in my morning cup of broth, but now whenever I cook anything in VCO, I immediately vomit.

    When I read other forums, some have said this is from doing too much too fast. Is it worth slowing down and trying again, or is my body not compliant?

    Jenn

    Hi Jenn,

    Coconut oil is not essential to the diet, so I would just avoid it for a time and then re-test it at some later date. I would though suggest an experiment with MCT oil to see if it is the shorter-chain fats that is causing the problem, as opposed to something specific to coconut oil. This might have diagnostic value.

    Best, Paul

  33. Hello Paul

    Thank you for your reply. I have just now been watching your interview on Youtube with Dr Mercola, about halfway through, it’s really interesting but I’ll have to finish it tomorrow. I thought that he was on the Dr Rosedale side of the argument but you appear to have won him round.

    Re the iodine, thank you for mentioning those other posts, I had spotted them. I’m interested in how it seems to be another controversial area. I think that the idea behind not supplementing iodine with Hashimoto’s is that iodine itself triggers antibody production. Dr K even suggests cutting out iodine-rich food such as fish, sea salt, egg yolks.

    Do you have an opinion on the idea that’s being discussed a lot on other forums that certain foods, rice included, are cross-reactive to produce a response similar to that of gluten?

    Thank you again for taking the time to answer all these questions.

    Hi Frances,

    Iodine is definitely risky in Hashimoto’s, if you do it without selenium or increase the dose too rapidly you can easily cause problems for yourself. I can understand why a doctor would not want to recommend it.

    But if it’s handled properly, I think you’ll improve your prognosis with iodine.

    I haven’t seen this idea that rice can produce a gluten-like response.

    Best, Paul

  34. Hi Paul

    Thank you for the positive response about the possible app.

    Just quick question as a new Perfect Health Diet follower. I have been in the habit of sometimes having a smoothie for breakfast when I did not feel like my usual eggs.

    I use full fat milk, whey protein concentrate, plain yoghurt, raspberries or blueberries and sometimes a small banana. I find these smoothies very satisfying and Dr Mercola is full of praise for the immune boosting and other health properties of whey protein.

    Now I wonder whether these smoothies are suitable to incorporate in the Perfect Health Diet. If you think they are, then I guess I would have to calculate the amount of protein, carbs etc and adjust my daily diet accordingly. (Oh for an app!).

    I would really appreciate your opinion on whey protein used like this.

    Kind regards
    Kay

    Hi Kay,

    The smoothies are fine. Enjoy!

    Best, Paul

  35. There was an article in ‘The West Australian’ on 31 December about a prem baby who weighed just 466g at birth and had taken part in a probiotics trial run by the University of WA’s Centre for Research and Education.

    “Preliminary findings from previous probiotics supplementation trials show babies born before 33 weeks gestation and weighing less than 1500g who are given probiotics have a better chance of survival and a shorter stay in hospital. Researchers do not know why these outcomes are occurring but believe the current study should help solve the mystery.”

    Do you think an eight month old who develops a rash after eating egg yolk, meat and some other foods, would benefit from probiotics? If so, how do we choose from the many probiotics in the fridge at the health shop? The solids she tolerates are potato, sweet potato, ghee, rice and diluted bone broth. She hasn’t yet had coconut oil, do you think it would be a good thing to try?

    Thanks so much for your help.

    Hi Francesca,

    Probiotics may often cause a mild infection for a few days. On the good side, they have a chance to fix the gut dysbiosis and resulting problems with food. An 8 month old is old enough to have enough immune function that I think the balance would favor trying probiotics.

    In general I would try to stick to Lactobacillus and Bifidobacterium cultures … I would recommend Lactobacillus reuteri as worth a try.

    I don’t have any reason for thinking coconut oil would be helpful. I wouldn’t object to it, in moderation.

    Best, Paul

  36. Hi Paul,
    Happy New year to you and Shou-Ching. I enjoyed the Mercola interview. Here are some questions.

    1. Is a ketogenic diet safe during pregnancy?

    2. Do you recommend the same supplements for pregnancy?
    (I am not pregnant, but may be in the future).

    3. Is there proof that supplements actually work and are beneficial? There seem to be be conflicting reports on this topic, most recently in the Rob Wolfe/Cordain podcast. Also, do you think some supplements are of higher quality than others? Are whole food supplements better than synthetic?

    4. What is the best way to measure fats and protein in doing a ketogenic diet? I want to start but am intimidated by this piece, ie. how do you know how much fat and how much protein is in a piece of meat?

    Also, how much fat should be eaten, and what are the best foods to get the fat from (aside from the oils and butter etc…).

    5. How long would it typically take on a ketogenic diet to feel or start to feel better?

    6. If a ketogenic diet works, must someone stay on it forever?

    7. I have been looking at your recipes and am curious why you use ingredients that are not part of PHD (ie. soy sauce (gluten and soy), miso (soy and sometimes gluten), and sweetened chocolate (sugar).

    8. Why are people out there thriving on other diets (ie. vegan diets) — like Scott Jurick for example, http://www.scottjurek.com/#/home/ who is an elite ultra marathon runner, and the healthiest guy I know. All this stuff is so confusing, especially since even in the paleo world, people can’t seem to agree on what is the optimal diet. Everywhere you turn it seems people are having positive results, but are doing such different things.

    9. Also, why is fish oil supplementation bad, but other supplements are good? Again confusion.

    10. Is white rice naturally white, or stripped of its outer coating?

    11. Are you worried about mercury content of fish? How to eat fish 3 times a week and not get mercury toxicity? Seems easier to do in the summer when the salmon are running. Although I guess sardines are low in toxic metals.

    12. What do you recommend for psoriasis?

    Ok, I could go on and on with questions…but I will stop there. Thank you.

    Hi JC,

    1. Ketones are safe, but a ketogenic diet will not be if ketone production is induced by starvation of carbs. If ketones are created by coconut oil consumption it should be OK.

    2. There are some minor differences, but basically nutrient needs are similar.

    3. We visit those topics from time to time. I do think supplements are beneficial, especially for key minerals. In a few nutrients the synthetic forms are not as good as the natural forms, eg folic acid/folate, vitamin E, carotenoids. But in most cases the synthetic forms are the same as the natural ones.

    4. It’s not really necessary to measure fats and proteins; if you measure, get appropriate amounts of short-chain fats (MCT oil, coconut oil) and carbs. Eat meats that are fatty enough to be moist (eg eggs, ribeye, salmon).

    5. You may not notice any immediate effects. The most likely thing you would notice is an improvement in mood. Ketogenic diets are generally therapeutic for neurological disorders, that’s really the reason to do them. But most neurological disorders require long recoveries.

    6. It depends on the reason. Certain genetic disorders may require lifelong adherence. Infections can generally be recovered from.

    7. Well, the dose makes the poison, so small doses of toxins are not too worrisome. We use gluten-free soy and miso.

    8. Thriving is a relative term. One thing to remember is that it’s possible to design a healthy vegetarian diet, just harder. One can get all the nutrients one needs, and avoid toxic foods, eating vegetarian and supplementing; indeed one can eat PHD macronutrient ratios from plant foods. But a vegetarian diet of grains, legumes, sugars, and vegetable oils would not be healthy.

    9. It’s not that fish oil supplementation is bad, it’s that freshness of fish oil is especially important, and fresh fish and shellfish are available as alternative sources.

    10. White rice is stripped of its bran, brown rice has the bran.

    11. Salmon and sardines are both low in mercury. It’s the hunter-fish at the top of the food chain, like swordfish, tuna, and shark, that collect mercury.

    12. Psoriasis – I would first make sure it is autoimmune psoriasis rather than some form of dermatitis, such as that caused by the fungi Malassezia (http://en.wikipedia.org/wiki/Pityrosporum) or allergies. You can do that by testing topical antifungals as well as hydrocortisone cream and allergen avoidance. Some key points in autoimmune disorders are to optimize vitamin D, to normalize micronutrition, to eliminate toxins especially allergens and adjuvants such as wheat, and to improve the gut flora.

    Best, Paul

  37. Thanks Paul for the fast and thorough reply.

    Scott Jurek eats brown rice and tempe, beans, soy, wheat, etc., no fish, no meat: no PHD. He races 135 miles on foot through the mountains, and wins. Any thoughts? We discuss diet and nutrition often, and it’s hard to argue with his approach. Mostly I feel confused with all the different information about diet and nutrition and as well, all the various iterations of paleo (high protein, low fat, no dairy, etc.) It’s difficult to sort through all of it. I appreciate all of your hard work and your sharing of knowledge. I am greatly enjoying the blog. Thanks again.

    Hi JC,

    Running burns a lot of carbs — typically 1000 calories/hour total with maybe 40% carbs. If he trains 2 hours a day he might burn 800 carb calories just for that, plus the usual 600 needed by a sedentary person. So he will be able to tolerate much more carbs than an ordinary person, and indeed eating the carbs will benefit his endurance running performance.

    Exercise is generally healthy and also increases food intake, improving micronutrient status.

    As for the effects of toxic foods, he’s only 28 years old. The effects of food toxins build up over decades.

    So I don’t see how his case proves the benefits of his diet. It may be a well adapted diet for endurance running performance, but it is not a good diet for long-term health.

    Best, Paul

  38. Hello Paul

    The information about white rice is on a number of autoimmune/thyroid forums, where presumably everybody has obvious gluten sensitivity/coeliac, leaky gut and other problems associated with autoimmune. I doubt whether it’s a problem for fully healthy people.

    Healing a leaky gut is a big issue for many people, especially those with autoimmune. GAPS and SCD advocate VLC but this also seems to cause other problems of its own,especially with thyroid I think. PHD explains this very elegantly.

    On the other hand, some people say that their Hashimoto’s improves on GAPS/SCD. It’s perplexing. Maybe they are the ones who get enough glucose from eating lots of fruit.

    Incidentally, do you have any idea why SCD prohibits pure glucose but allows fruit? It doesn’t make sense to me. Sorry, I know you’re not exactly the right person to ask.

    Hi Frances,

    Hashimoto’s is usually infectious in origin, possibly resulting from a inflammatory processes related to a gut infection. So anything that heals the gut has a chance to cure or improve the Hashimoto’s.

    Prohibiting pure glucose doesn’t make sense to me either.

    Best, Paul

  39. Hi Paul,

    I would like to thank you for all your work and wish you continuous success in the new year.

    What do you think is the best way of diagnosing coeliac in children?

    Although there are no gastrointestinal symptoms, I’m worried that they don’t absorb the minerals in food and multivitamins (they are short for their age, have teeth irregularities)
    Thank you.

    Hi Simona,

    As a practical matter, considering you are concerned about the impact of wheat on health and not only pure celiac disease, the best way is to remove wheat and see if things get better.

    Wheat contributes to rickets, so could be a factor even apart from celiac. Be sure to tend to vitamins D/A/K2 and C as well as minerals, and try to improve gut flora.

    Best, Paul

  40. @Kay Bowden

    My husband uses “myfitnesspal” on his Android phone. It has most of the things we eat and for those that it doesn’t have you’re able to manually enter them (and the data sticks around so you don’t have to do it each time). He’s also entered quite a few of the things we eat by simply scanning the barcode. While it isn’t geared towards PHD, it does show your macros (based on the food you’ve entered) and we use the macro breakdown in the book to make sure we’re getting what we need.

  41. Hi Paul. I purchased the recommended supplements through your Amazon link. I want to start off with your lowest dose recommendations. But it seems like each iodine and the magnesium tablet contain much more than what you recommend for a low dose. Would it be better to cut them up? I don’t have the bottle with me and it seems to be sold out on your site, but I think one pill of the prolamine iodine was over 3x your low recommendation. I don’t want to go too high with that stuff.

    Thanks,

    Ben

    Hi Ben,

    Thanks for purchasing through the site. Yes, you do want to start small with the iodine, and the prolamine iodine is meant to be an intermediate doses, not as a starting dose. I need to find a new starting pill for iodine.

    What I would do is cut the prolamine iodine tablets into eighths with a razor blade to start with. Do that for a month, then try quarters, then a month later halves.

    But it’s possible that even an eighth tablet may give some trouble. If this lasts more than a few days, then (a) take a multivitamin that has iodine, and eat seaweed for a while to try to start slow; and (b) look at all possible co-factors, including magnesium, zinc, copper, selenium, iron.

    Best, Paul

  42. Sheep Counteress

    Hi Paul,

    What do you think could be the cause of chronic swollen lymph nodes in the neck (tonsillar lymph nodes?)? I’ve had this issue for the past maybe 5 years. My primary doctor says it is “some sort of infection” but is not specific and doesn’t think it’s serious enough for further testing, probably because it wasn’t that bad on the visit I brought it up. It is pretty bad when I’m sick, which makes sense from an infection standpoint. But it’s also bad if I haven’t had a good night’s sleep – maybe depressed immunity?

    Recently, they are swollen for what seems like no reason at all. For reference, it doesn’t look like anything pathological; if you took just a face shot of me, it would look like I gained 20+ pounds. And the swollen nodes are definitely feelable under the jaw region.

    I know the swelling usually comes with a somewhat sore or dry throat, and drink more fluids when it happens. The only other related symptom that I can think of is chronic runny and sometimes stuffy nose, which I have had my whole life, and which change of diet has not substantially affected. According to these sites [http://www.thelymphnodes.com/swollen-lymph-node.php, http://www.thelymphnodes.com/tonsillar-lymph-nodes.php%5D, infectious causes can be throat infection or tonsillitis, which I imagine would be acute; or ear infection, which I don’t have. Other causes seem to be food allergies to peanuts, dairy, or wheat; these are not present in my PHD foods except for a tiny amount of butter.

    I had a blood test recently that showed nothing obviously strange in the WBC panel. Markers like blood lipids went from very good to stellar, which I credit to PHD.

    For a long time, I felt these swollen nodes to be mostly a cosmetic nuisance, but now I’m a little concerned. Am I missing some obvious – or less obvious – causes?

    Thanks very much for your time!

  43. @Ashley

    Thanks so much for that information. I looked at Myfitnesspal but obviously not closely enough to see that it can be usefully adapted for the PHD by manually entering some items.

    I appreciate your letting me know about this and I will go back and give it another go.

    It would be good if someone could design something specifically for PHD – but in the meantime Myfitnesspal will certainly be helpful.

    Kind regards
    Kay

  44. Friends,
    We are a North Bay Area 5 year old award-winning weekly health care radio program called Health Matters. We air Wednesdays 1-2 pm Pacific time and commonly share our hour with authors such as yourselves highlighting recent publications. We were shown briefly a copy of your book Perfect Health Diet and I am wondering if you are still in a promotional phase and might be willing to provide a media review copy and participate in a 50 minute interview on the text? For over 30 years our host has offered nutritional and oriental medicine services essentially of the same themes as our eyes noted in your book. What is immediately attractive to us is how you have formatted not just the text bodies but the idea flow. Your website also appears at first glance to be also a wonderful growing compendium I’d enjoy directing listeners to etc.
    So please let us know if any of the above might be possible for you. Thanking you in advance,

    Ned Hoke OMD, L.Ac.
    Host/Producer: Health Matters Radio
    166 West Napa St. , Sonoma, CA 95476
    ksvyhealth@gmail.com

    Hi Ned,

    Thanks, I’ve followed up privately.

    Best, Paul

  45. Hello Paul

    I’ve been trying safe starches again without success – inflammation and stiffness got worse.

    I’ve decided to stick with fruit and veg for glucose for now but want to minimise fructose intake so I’ve been trying to work out how much to eat of what fruits. I don’t seem to do well on bananas unfortunately.

    I think I’m being a bit dense here (glucose deficiency can be my excuse) because I’m finding it hard to calculate how much of certain fruits will yield the right amount of glucose, I think I’m getting muddled between the number of calories of glucose per pound of fruit and the number of grammes of glucose in the fruit.

    Also, would carrot juice be an ok source of glucose, maybe taken with coconut oil to slow absorption.

    BTW, I eat 2 portions of squash and a couploe of raw carrots every day and bits of me have gone a bit orange. I understand that this is supposed to be benign but do wonder whether it might be causing the liver to struggle.

    I’m planning to eat some liver once a week too. I know that beta-carotene in fruit and veg isn’t the same as eating Vit A, but is it possible to overload the liver with this much orange veg and liver once a week?

    Thnak you Paul.

    Hi Frances,

    I’m a bit puzzled at what’s causing your difficulties, it’s too bad bananas aren’t good either, they’re arguably the best fruit.

    Among the sugary foods carrots and beets are among the best. We’ve been having roast beets recently.

    You can also try upping the glucose:fructose ratio by adding rice syrup to your foods.

    If you’re low-carb you can assume the fructose converts to glucose and just count carb calories.

    I don’t think you’ll get too much vitamin A as long as you have liver only once a week. Your plan sounds good. The carotenoids that are turning you orange are pretty harmless as long as they’re from food, not supplements.

    Best, Paul

  46. Hi, Paul,

    thanks for the reply.

    now i know better about cholesterol; i wonder that was why i got month-long colds & flu when my TC was in “fabulously” 140s – 160s!

    for iron deficiency anemia, both my MD & ND suggest supplements; i’d rather not take it cause it may cause constipation + most seem to contain PUFA oil. 🙁

    my MD also suggests to have a gastroenterologist check my GI.

    FYI: i cook in cast iron pans. also i meant “stomach acid” low. stomach ulcers run in my family (i don’t seem to have any so far).

    a week ago, my ND told me to try Betain HCL. i found i could pop in 6 -7 without any discomfort! my stomach only starts to burn slightly @ 8 pills. this also has reduce a _LOT_ of sinus & itchy throat post meal, wow!

    anyway, i’ll try iodine & seaweed next.

    you’re probably right that after i take care of the iron & iodine, my TC would drop back to your optimal range.

    thanks for taking your time.

    pam

  47. paul, any ideas on a comprehensive leaky gut repair strategy? thanks

  48. Hey paul – quick question – What exactly is wrong with protein from plant sources? Is it a problem in the amino acid ratio?

    Hi remo,

    No, plant proteins tend to be high in toxins. In general the low-protein plant foods are safer.

    Best, Paul

  49. Hi Paul,

    I have a daughter leaving next week to teach in Dili, East Timor. Anti-malaria drugs are strongly recommended for all teachers.

    Twenty years ago my brother served as an Australian Volunteer Abroad in a small village in Indonesia for two years. He decided not to take the anti-malaria drugs and he didn’t contract malaria – just lucky, he now thinks.

    Do you know how harmful these drugs are and would you take the risk of not taking the drugs?

    My daughter has been following PHD for the last few months in a half-hearted way because of a hectic social life, but is now very keen to learn all about the diet in order to maintain her health in what seems likely to be difficult circumstances – she has been told that all meat and vegetables are frozen and people get sick often.

    I would really appreciate your opinion.

    Hi Francesca,

    Keeping in mind that I have no expertise on this question, my personal inclination would be take the drugs. Malaria can be a devastating disease. I know of many people who went to the tropics and came back with chronic diseases. My feeling is that doctors tend to recommend too little, not too much, in terms of infectious disease prevention and treatment. So if malaria prevention drugs are a standard recommendation, I would expect there is very good evidence for them.

    I would also advise your daughter to bring a very good water filter, to boil water if possible, to cook food thoroughly, and to wear shoes to avoid hookworm.

    Best, Paul

  50. Hi Paul,

    Another quick question… I don’t know if you have any information on this, but in any case I would greatly appreciate your perspective on this.

    My husband has been taking Coumadin (Warfarin) for maybe 20 years because of a mechanical heart valve that they put in when he was about 13 or 14 years old. I have not yet really looked into Warfarin much because I feel like I’m between a rock and a hard place with it. My desire would be to have him not taking Warfarin and to figure out how to achieve low clotting naturally (the reason for the Warfarin is to help ensure that a blood clot doesnt try to form on the plastic valve). But this is way way way out of my field of understanding, so I haven’t really tried to figure anything out, mostly because I’m afraid to choose or advise the wrong thing. I’ve just been reading about vitamin K2 on this site:
    http://wholehealthsource.blogspot.com/2008/06/vitamin-k2-menatetrenone-mk-4.html
    and this was the part that got me thinking once again about my husband’s Coumadin. (the artery calcification)

    “Rats fed warfarin, a drug that inhibits K2 recycling, develop arterial calcification. Feeding the rats K2 completely inhibits this effect. Mice lacking matrix Gla protein (MGP), a vitamin K-dependent protein that guards against arterial calcification, develop heavily calcified aortas and die prematurely. So the link between K2 and cardiovascular disease is a very strong one.”

    But, from what I understand, my husband is supposed to have a limited amount of foods and drinks that have high vitamin K because that would counterbalance the Coumadin. From what I understand, things like fresh garlic and ginger have some blood-thinning potential. We already eat those weekly (and of course he gets his blood checked monthly to make sure he’s in desired range) but I don’t know if they are actually doing the same thing as Coumadin. In any case, I still try to spread out the days that I cook with them because I worry about his blood getting too thin.

    I know this probably isn’t an easy one to answer since both possible extremes can be very dangerous– possible blood clot or blood that won’t clot enough. I just wonder what the possibility or probability is of blood clots forming on artificial valves. But, do you have any thoughts or any perspective on this? (Or anyone else out there?)

    Thank you so very much for all your time! Any thoughts at all would be greatly appreciated whenever you are able.

    God bless you both!
    KH

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