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 ?

10,225 Comments.

  1. Thank you, Paul.

    Your response is very interesting. I always assumed I had some sort of autoimmune problem, perhaps resulting from a leaky gut. The possibility of a neurological problem had never occurred to me. I’ll read up on Dr. Oaklander and explore a ketogenic diet.

  2. Thank you so much, Paul, for the supplement suggestions for this annoying cough. I was looking at the detox formula you list here but I could not find Glutathione. You listed Vitamin C, Taurine and cholesterol from egg yolks in Parentheses. Are these the items that this Glutathoine contains. Can I find this product on your supplement list so that I can purchase it from your site? I don’t see it but maybe I’m missing something.
    Isa

  3. Hi Paul and Shou-Ching

    I have your book and am attempting to reconfigure the way I eat. It hasn’t been too difficult as I have always tried to eat healthy fresh foods as much as possible and exercise regularly. A recent scare with DCIS breast cancer has made me even more interested in what I eat, but also more cautious as I don’t want to make a change that may ultimately be dangerous. (I am 54)
    I have made a list of foods that I am hoping you might comment on – wondering if I should be removing them from my cupboards. I’m especially confused as to which foods are classified as legumes. Hopefully your other readers will find this helpful as well. Thanks so much for your blog and responses.
    Here is the list:

    almond milk
    whey powder

    coconut sugar
    coconut flour
    molasses

    chia
    ground flaxseed (often recommended for breast cancer due to the antiestrogenic properties/lignans)
    quinoa
    kasha
    bulgur
    canellini beans
    garbanzos – is anything like this at all allowed?
    split peas
    dal

    popcorn
    corn on the cob
    stone ground grits
    steel cut oats

    shellfish

    V

  4. Hi Paul!

    I have heard quite a bit about your diet in the past couple of months. I am quite interested to learn more as it has so much in common with what already I already lean toward. Doing this diet seems really doable in one sense, but I also do so well with practical examples of what it looks like. I am considering purchasing your book but was wondering if it gives some sample meal plans that help you to get going on this diet…

    Thanks!
    Kristy

  5. Hi Paul,

    I have two questions in regards to your carb recommendations. First, I notice that many people seem to have complaints towards a low carb diet, so why not recommend a more generous serving of carbs? I mean what is the benefit of limiting carbs to about 100grams versus having them at 200g where almost no one would have a problem?
    Second- do you think that if one were to attempt to follow your recommendations of eating approx. 100g carbohydrate a day that they should reduce that to about 50 or less for the first week or two while they become keto-adapted? I ask because I’ve noticed that on many failed attempts to follow this 100g intake, I always become hypoglycemic (or just develop every symptom of it–shaking, lightheaded, can’t concentrate) and disregard the carb intake as hokum– raising it to attenuate whatever symptoms the relative lack of them induced.
    I’m sure i made this too wordy and confused you, and myself, but hopefully some sort of legible picture was painted. Thank you again for wisdom =)

  6. This is not really a reply but a comment on the ‘good carbs’. I find that white rice does not agree with me, after several days ( once a day) of eating it it affects my sleep.. i.e. I get disturbing and very vivid dreams but potatoes have no adverse effect. However can you explain why two carbohydrates – potatoes and rice – which are not indigenous to europe turn out to be ‘good’ but wheat/oats/barley/rye which are indigenous are not good for us? It seems a little illogical.

  7. Happy holiday weekend, everyone. Poking around on the net today and found Kurt Harris, MD, at archevore.com. A reader wrote to ask him what he thought of Paul’s “safe carb,” stance and he seems to agree. A reader also asked him about an article he found describing research linking the consumption of rice to the alteration of human genes, causing an inhibition in the mechanism that keeps LDL in check. My LDL was always pretty high but no one worried because my HDL was at a healthy level. For years, lots of years I drank rice milk everyday.

    So, with the talk about paleo resulting in high LDL I wondered if this research was posted anywhere. Here’s a link to it.

    http://tinyurl.com/3gpnvst

    Hi Dale,

    I commented on that study here: http://perfecthealthdiet.com/?p=4949. See the first paragraphs under [2].

    The other thing I might have said is that the miRNAs in question have a fundamental role in plant biology — controlling transcription of proteins. So they are designed by evolution to help the plant, not for any effects on predators. That’s totally unlike the grain and legume toxins which we know are dangerous — those evolved for the sole purpose of poisoning mammals and protecting seeds from digestion. So, since the miRNA didn’t evolve to hurt us, there’s no special reason to think it does hurt us.

    The effect on LDL levels in humans is probably minimal. I certainly don’t think this is responsible for the phenomenon of high LDL on Paleo diets.

    Best, Paul

  8. Thanks, Paul. I should have used your search window to search without troubling you. I’ll try to do that in the future. Your work is so current, and reading 2 scientific papers a day indicates you’ve likely seen whatever I stumble on.

    On another topic — is it true that you and Shou-Ching have developed a PHD for canines? This video would suggest this to be the case. 🙂

    http://www.youtube.com/watch?v=7YmXdeRXqv8&sns=fb

  9. Hi Paul,

    My dad’s PA is giving several supplements. I thought I would ask you what you thought of them.

    RELAX MAX (for sleeping)contains: Magnesium 75mg, Inositol 2,000mg, L-Taurine 500 mg, GABA 100mg, L-Theanine 50mg

    SILVERCILLIN 50 mcg 2X a day
    IRON 50mg
    POLY-ZYM Enzymes 9 a day
    B-12 1,000mcg 3X a day

    He is taking them, but we are not really sure what they are doing, or if their doses are good.

    Thank you so much for your help and work!!!!!

  10. I bought your book at WAPF conv. in Dallas. Love it. Curious as to why you don’t recommend Cod Liver Oil, which is big on the WAPF list. Thank you.

  11. Hi Paul

    I wonder if anyone else finds that when opening the q @ a blog it obviously opens at the top and then you have to scroll down further and further each day to find the latest blogs at the end. Would it be easier if the blogs went in the other direction date-wise, with the latest one appearing at the top? It seems a minor issue compared to the fact that you, Paul, go to all the trouble of answering all our questions daily – which I find amazing and wonderful. However, just thought I would mention it.

    Kind regards
    Kay

  12. Hi Kay,
    Interestingly, when I click the link in my email, the O & A board opens at the end, to the email that contained the link.

  13. Hi Paul,
    Thanks so much for all your input on these pages.
    I was wondering if you have any insight on this… Two days ago I noticed a tiny white patch develop just near the inside of my eyebrow (it has a clear border and is noticeably lighter than skin around it). I think I have seen something like this before on my face years ago, but not since. This morning I woke up to another one (a little bigger, longer and thinner shape) on my chin (this one is a little less noticeable than the other).
    I just briefly googled to see what I could find… one possibility it said is either eczema or superficial yeast. I don’t know if I think it would be either of those though– the spots don’t seem dry at all and unless the yeast came from inside my body, I don’t see that possibility due to constant face-washing with Tom’s lavendar soap. I haven’t changed anything with regard to products so I generally am ruling out that idea.

    My thought is that maybe (I have no idea really) some dying bacteria are releasing some toxins? Or yeast from inside is surfacing for some reason? I have not had any yeast problems for many years (which surprises me since I’m diabetic, I might expect that high sugars lead to more yeast problems).

    Any thoughts on or experiences with those patches?

    Thanks so much!
    KH

  14. Hi Paul,

    I’m sure the answer to this question is somewhere amongst your many articles and information but I’m struggling to pinpoint it.

    Which form of gut dysbiosis, fungal or bacterial is more likely to result in issues digesting starch?

    I’ve been starch free for a long time, and battling chronic gut dysbiosis. Low carb gives me the most relief from symptoms, but doesn’t address the cause and I fear may result in additional problems.

    I understand reintroduction of starch to a low carb diet is likely to cause some temporary symptoms, as mentioned in your zero carb dangers series. The most prominent for me is crippling depression that effectively leaves me non functional. I’ve done up to a week so far before I had to stop on about 200g of starch a day. I have also tried white rice as it’s probably more benign to the gut but this rocks my blood sugars too much.

    Many thanks!

  15. I’m preparing to ditch most of my current principles with the Western Price Diet to go mainly Paleo.I will still consume my raw goat milk,raw cheese,organic produce.I’m very active.I’m a lettter carrier and i walk 6 miles 5 days a week.I have tried to increase my protein and fats and cut out my grains.But that leaves me still hungry.I consume alot of organic platains,organic white rice and organic potatoes.(organic white,sweet,) My diet is probably more Perfect Health Diet rather then Paleo.But since i’m so active is daly consumption of white rice and potatoes ok?Also is cooked organ meats/grassfed meats ok for daily consumption?i’ve been reading that raw is best but isn’t palatable for me.Thanks

    Hi Frankie,

    The more active you are, the more carbs you need, so as a letter carrier you should consume sufficient rice and potatoes. A good amount would be about a pound a day of safe starches like rice or potatoes (see our Food Plate).

    Cooked organ meats and grassfed meats are great. The only caution is that it’s possible to get too much liver. Once a week for liver is good.

    I favor cooked food.

    Best, Paul

  16. Frankie,

    Just curious, what are you doing that you consider to be inconsistent with Weston Price?

  17. Is it ok if i consume more then 1lb of safe starches.Since i’m so active.Also are organic sourdough rye and organic sprouted corn tortillas absolutely off limits?On a diet that consists of mainly grassfed meats,organic fruits,veggies,fermented veggies?

    Hi Frankie,

    Yes, it’s OK. Judge for yourself what quantity makes you feel best. Rye and corn are off-limits for our diet, because they aren’t toxin-free, but everyone has to make their own judgments about the balance between toxicity and taste/food preference that is best for them.

    Best, Paul

  18. Since my Adelle Davis days, I have been scrubbing tubers, but not peeling them. On this holiday weekend I have read that peeling removes a good bit of the toxins. It looks as though Paul and Shou-Ching’s french fries are unpeeled. I recall the story of the Colorado family during the depression who was able to get potatoes. Mom peeled and cooked them for the family and saved the uncooked peelings for making sandwiches for Dad to take to work. Eventually, all but Dad had scurvy. Real story, or poppycock? Don’t know.

    To peel or not to peel?

  19. Ellen,organic sprouted grains(properly prepared)are consistent with Traditional diets.Our ancestors have thrived on sprouted/fermented grains.The Indians would ferment rice and lentils to make dosas. Ethiopians would ferment bread.Europeans would make porridge.The WAP Diet allows organic/sprouted grains.But this is inconsistent with all paleo and all paleo-like diets.I have thrived well on the WAP Diet.But i don’t want to cause any digestive issues with my body that might show up later.I always thought from reading Sally Fallon’s cookbook called Nourishing Traditions that the practice of soaking/fermenting grains was 100% safe.If sprouting grains makes them more digestible and nutritious why are they so bad?Is the question i keep searching for.My Nauripath says that they are fine to eat,but i would still like to find out the reasoning. Today, alot of paleo foods contain toxins and antinutrients beacuse of the soil not being organic.The Romans thrived on grains and so did most of our ancestors but i don’t think it was the grains that contributed to their death.I guess it comes down to choice like everything else.I have never felt any ill effects from consuming organic sprouted grains.But that doesn’t mean that their safe.

  20. I eat my grassfed meats cooked.No pink inside.Is this doing harm to my body,even though i consume plenty of fermented veggies?

    Hi Frankie,

    As long as you use gentle cooking methods, cooking won’t do you any harm. Make sure you don’t blacken the surface, this makes a lot of toxins.

    Best, Paul

  21. Frankie,

    Well then basically you have not “ditched all the Weston Price principals” just doing a small variation on the same theme.

  22. Hi Paul and community,

    I read on one of the threads here about a poster commenting on a hydrogen breath test… are those fairly reliable? I had never heard of it and the only reason it caught my attention was that for the past several days I’ve been noticing what feels like extra air coming out of my throat. (It’s not burping, although at other times I have also been burping a little which I never used to do, but it seems like it’s air that I can’t/ shouldn’t breath in). I don’t know how to explain it but it’s very noticeable and I’ve never experienced this before. Does this likely mean there’s a bacterial problem in my small intestine? I went to hydrogentesting.com (Commonwealth Laboratories) and they offer various breath tests. Any thoughts?

    Also, these are the only things I can think of that I changed in my diet in the past week:
    – avoiding cow dairy (except butter); replaced with goat milk and goat cheese (not raw)
    – I bought glucose tablets to use for my low blood sugars (trying to get away from excess fructose), Dex 4 “Naturals” (no color added) Ingredients: Dextrose (D-glucose), cellulose, sterotex, citric acid, malic acid, natural orange flavor, ascorbid acid. (I had originally been eating fruit or raisins for lows, thinking that it’s healthier because I would be getting some nutrients and fiber, but I think there might be a problem with the fructose for me. I’m not certain.)

    In an online search I tried to find out where the glucose in these comes from. I could not find that info on their site, but on another site I discovered that it could come from corn and that in fact it’s probably a combination of glucose and fructose. But, I don’t even know what that implies for me. So… Paul, will you ever be doing a post on the different sugars, problems with them, fructose malabsorption, etc? I did already read the fructose toxicity post you have, maybe I’ll read it again to see what I can find out.

    This might be a dumb question, but… when I eat, for example, a glucose tablet, who gets fed first– my body or gut bacteria? Is there a fight for the food or how does that work? Sorry for soooo many questions…

    Thanks again so much! I really appreciate this site.
    KH

  23. Hi Paul,

    Just finished the book and loved it. I’ve made a few dietary changes and will stay the course to really see if it makes a difference.

    Question regarding kefir – I make water kefir with organic cane sugar, turbinado sugar, and blackstrap molases. I’ve read that sugary kefir grains (SKG) digest the glucose and leave the fructose behind. Do you think I should change to using a glucose based sugar like rice syrup to eliminate the fructose?

    Thanks!

    -Marc

    Hi Marc,

    I don’t know the answer to that, but I think it might be a good move. Why don’t you give it a try, and report back on the outcome?

    Best, Paul

  24. Hi as many others Ive tried Dr. Kruse Leptin Reset and had no success. I have Bulemia and during periods of stress it comes back full force. I am a full time college student working 3 days a week so needless to say I have a more than full schedule. I asked Dr. Kruse about my condition increasing in symptoms on the Leptin Reset and was advised to stop immediately of course due to my increased binging and purging and very very low depression. I was diagnosed with Lupus at 13 and am now 30. How much of my autoimmune and bulemia can be connected, if at all? Would a ketogenic diet be advised at all? Ive been paleo for two years and lost a lot of weight but it slowly came back with low mood, depression, stress, etc. I was low carb. What would you advise is the best approach? Thank you so much.

    Hi Amanda,

    Thanks for writing. It’s for cases like yours that we wrote our book. They’re difficult to cure which is why you need to try to get everything right, starting with diet and nutrition.

    First, some background. Depression and eating disorders are due to inflammatory alterations in the brain. Usually I think these are due to actual infections of the brain, but they can also occur due to infections elsewhere which lead to the import of inflammatory cytokines and sometimes toxins to the brain – thus a remote infection, usually in the gut, causes the brain inflammation.

    Lupus is said to be an autoimmune condition but autoimmunity generally arises from an underlying an infection which produces auto-antibodies due to ‘molecular mimickry.’ When the infection clears, the autoimmunity usually does too. Also, sometimes these diseases are misdiagnosed and there is no autoimmunity at all, just an infection. I’ve known cases of Lyme disease being misdiagnosed for years as lupus.

    Chronic infections usually are not infections by a single pathogen, but co-infections by multiple pathogens. This makes them difficult to diagnose, treat, and cure. Sometimes a single tick bite can deliver 5 different pathogens.

    Pathogens need nutrients too, so an excess of nutrients can promote their growth. This is why protein overfeeding as in Jack’s leptin reset can cause infections to flare a bit. If protein caused your symptoms to flare, then there’s a good chance that intermittent fasting and ketogenic dieting will calm them.

    The basic strategy which we advise in our book is (a) get diet and nutrition right, eating a nourishing diet that is in line with the body’s macronutrient needs – our food plate is a good summary; (b) work on diagnosis, in part by varying the diet to see how eg ketogenic diets affect the symptoms and in part by medical testing; and (c) when you know the pathogens, optimize the diet for them and take appropriate antimicrobial medicines.

    Ketogenic diets are therapeutic for bacterial and most viral infections. They can be damaging in the case of protozoal, fungal, and worm infections. So they have diagnostic value, and probably therapeutic value (since most brain infections are bacterial or viral), but you don’t know for sure. This is why it’s good to eat a healthy non-ketogenic diet first for a while, and supplement micronutrients appropriately, to optimize and stabilize your health first so that you can evaluate the effects.

    Often people have co-infections of bacteria and protozoa, eg Lyme with Babesia, so ketogenic diets can have mixed effects, good against part of the disease but bad against the other part.

    For diagnosis, you should fine a good chronic infectious disease (eg Lyme) doctor and get help with diagnosis and antimicrobial medicines. There are various blood tests that can be done to diagnose pathogens, and I also recommend gut profiling (http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology) since pathogens infecting the gut can also create systemic infections, also gut infections can have remote effects on the brain through toxins and inflammation.

    If diagnosis doesn’t find anything specific, then I would first test a ketogenic diet and then test antibiotics.

    You have to expect that this will be an experimental process that takes several years. It pays to go systematically and patiently, making one change at a time and giving it weeks or months to see its effects. You have to be a bit of a scientist and study your own disease carefully.

    Please keep me posted on your progress.

    Best, Paul

  25. Paul,

    I’m just curious about your thoughts on Co Enzyme Q10 or Ubiquinol as a beneficial supplement? I’ve heard much about this from other sources for cellular and heart health, but wanted your take on it if possible.

    Thanks!

    Mike

    Hi Mike,

    It’s an extremely important compound for good health, and essential for mitochondrial function, which is one reason why it’s dangerous to take statins (which suppress CoQ10 synthesis). Supplementing shouldn’t do any harm, but it’s not clear that supplemental CoQ10 will actually get to the mitochondria. So supplemental CoQ10 probably acts mainly as an anti-oxidant which might compensate for deficiencies in vitamin C, zinc, copper, selenium, sulfur / cysteine, vitamin E. However, in such cases it might both be cheaper and healthier to supplement with the elemental nutrients.

    I think it may be a beneficial supplement but I tend to favor the elemental nutrients and letting the body make what it needs of the rest. Research indicates that that is probably the best approach in regard to antioxidants / oxidation status.

    I would be most inclined to support CoQ10 supplementation in cases of gut dysbiosis, it might help protect gut cells from inflammation / oxidative stress.

    Best, Paul

  26. Terrific answer as usual, Paul! Thank you for the clarification.

  27. Paul,

    Thank you for your thorough answer to Amanda. My thoughts about my own diagnostic process are more organized now, as a result.

    Finding a sympathetic infectious disease doctor has turned out to be a no go. I have managed to get a stool test ordered via Metametrix, but expect that I will need blood tests next. Do you know if the blood tests for pathogens you talk about can be ordered online or otherwise obtained more or less directly by the patient? Is there a basic battery of tests you would suggest for someone who suspects chronic brain and/or gut infection but lacks a lead on specific pathogens? I would not know where to begin trying to identify what tests I might need when my symptoms are so non-specific (primarily mood issues, and thyroid/sex hormone deficiencies; gut symptoms resolved with diet.) Have done Paleo, then PHD, for a year; been on all your supps for past 2 months.

    Thank you immensely for any direction you can supply to those of us in the DIY diagnosis group (and I suspect that’s many of us).

    Hi Mal,

    I’m glad your gut symptoms have resolved. That’s a good start.

    I don’t feel I can advise on blood tests. They basically come in two types, tests of immune activity which are not specific for specific pathogens but differ depending on the class of pathogen, eg the response to fungi is totally different than the response to bacteria; and antibody tests. Antibody tests can be specific but they have high rates of false negatives (you can have the infection without antibodies) and false positives (you may have cleared the infection but the antibodies are still around). Thus it requires considerable judgment to decide what tests to order and to interpret them sensibly. This is best done by an experienced doctor who can examine you personally.

    I wish it were easier to find helpful doctors. I have heard that some doctors will do consultations with distant patients, eg Michael Powell (http://www.fmtlc.com/index.html) has been highly recommended by some chronic disease patients. He has more of a fibromyalgia focus.

    There is always the shotgun approach: experiment with ketogenic diets and antibiotics, and see if it helps. Sometimes it does, sometimes it doesn’t.

    Best, Paul

  28. Thank you so much Dr. Paul. I will do my best just bt following the regular diet first even though I need to lose weight. I feel just the regular diet alone might help in weight loss. I am going to try 50g in starches alone and not count low glycemic veggies at all. I will try the testing at a later time and see if diet works alone. Thank you again and i will definitely keep you posted. I have just felt like I have literally and slowly been going insane and extremely emotionally unstable at times and this has meant the world. Amanda

  29. Every afternoon my feet get extremely hot. They are hot to the touch and even get red and kind of swollen. This is very uncomfortable. Drinking a glass of wine makes it worse. Any ideas?

  30. Quick query..

    I am seeing my doc tomorrow to get my Vit D and TSH levels checked (as I do annually) and am just wondering if there are any other simple tests you think are beneficial that standard docs are likely to humor?

    Best,

    Lindsay

    Hi Lindsay,

    A lot of the standard things can have value. Lipid profiles (LDL, HDL, TC, trigs) are more useful than I realized in the past, they can diagnose various things. Liver enzymes, white blood cell counts, CRP, and anion gap are a few things I look at on my annual physical.

    I usually try to ask for one extra test and rotate it each year. Last year it was ferritin. Copper/ceruloplasmin would be another useful one. Just to see if I’m off in iron or copper or some other nutrient. Homocysteine would fall in that category, as a proxy for B12/B6 status.

    Best, Paul

  31. Ellen,yes i meant keep most of the WAP principals but cut the grains out completely.It’s definitely a challenge but i have been adapting well.I’m doing more good fats like avocados.And i use a very good whey protein caled One World Whey,mixed into raw goat milk.Alot of the whey protein on the market today are heated whch kills the nutrient ratios of the protein.This protein is 100% awesome.And it tastes like a milkshake.(No lie)It actually goes through a cooling process instead of a heated one which keeps all of the nutrients intact.I mainly use it for overall detoxification purposes since it supplys my body with glutathione.

  32. Hi Paul,

    I know you prefer rice syrup and stevia for sweetening….but what are your thoughts on molasses, which provides minerals; and raw honey, which provides natural antibiotics and wound healing? Sorry if this info is already posted, I searched but did not find.

    Thanks for all of your life-changing information!

    Sally

    Hi Sally,

    I would favor honey ahead of molasses, and keep the amounts small.

    Best, Paul

  33. Hello Paul & Community,

    I am wondering if anyone has had success with natural anti-fungal therapies? I (possibly brashly) told a friend that she could treat what she suspects to be a Candida issue without having to ask her doctor for anti-fungals… but now can’t seem to find anything on the site about treatments other than implementation of the diet and Diflucan. Thoughts?

    Thanks,

    Lindsay

    Hi Lindsay,

    I’ve been meaning to gather my thoughts on treating Candida into a post. In general, if you know you have a systemic Candida infection I think antifungal drugs are warranted. However, diet makes a big difference too. In general more vegetables / salads is a helpful antifungal step.

    Best, Paul

  34. Frankie,

    It takes a while to get used to no grain and work up a good collections of safe starch recipes. But if you like to cook you will find there is great variety available.

    An easy one is Chebe bread. I will post it in the recipe thread.

    Ellen

  35. Hi Dr. Jaminet,
    I just ordered your book from Amazon, and I read Dr. Mercola’s article about PHD. I have been suffering from severe throat pain for the last 4 years, which started when I gave birth to my third child and was put on heavy doses of antibiotics for an infection in my C-section incision. Ever since then, everything I eat makes my stomach and throat burn. I have taken allergy tests by numerous doctors, and a stool test by a chiropractor indicated I have Candida overgrowth. I have been eating Paleo for several months. I have been taking probiotics, and I incorporate fermented foods into my diet (sauerkraut, kombucha, coconut water kefir, etc.). The problem is when I eat fermented food, my throat feels worse. If I eat grains (which I’ve stopped doing), my throat hurts but not as bad. If I have severe Candida overgrowth, shouldn’t I feel better instead of worse when I eat fermented food? Or is something else going on? Thanks for your help and for all you do.

  36. I know Dr. Jaminet has mentioned that he plans to write a post on acne in the future, but in the meantime I’d love to know how others have managed their acne.

    I originally started eating Paleo, in part, because I read that it often helped people with their acne. Well I now eat PHD, but my acne hasn’t improved and has actually gotten worse. I’m a 25 year old woman, so it could be hormonal, but I’m thinking it is probably related to my gut since I’ve been having issues with that too (i.e. constipation). I’m taking all of the recommended supplements and have activated charcoal on order. I’ve also started eating fermented veggies on a regular basis (~1/4 cup/day with dinner). Any other recommendations out there? I’d love to know what has helped you.

  37. Hello,

    We are enjoying your book very much and are finding it very eye opening. We understand that plants in excess can be toxic; however, can there also be a detoxifying component of plants? We have read many positive comments from people advocating a “green drink.” For about a week and a half now, we have been making a drink with spinach, romaine, cucumber, parsley, mint, and occasionally some blueberries. We have also been adding in some Hawaiian Pure Spirulina Pacifica powder. What is your opinion on a drink like this and the need for Spirulina as well as Chlorella in the Perfect Health Diet?

    Also, you do not mention supplementing with Potassium. Is that because a person should get enough of it in your plan?

    Thank you very much for your book, blog, and website.

    Hi Jake,

    Plants can contribute to detoxification as well as provide toxins of their own. At what level of intake the balance shifts from beneficial to harmful is a judgment call; the evidence is not clear. So eat the amount of vegetables and spirulina/chlorella you feel appropriate.

    We recommend chlorella as a detox aid in some conditions, but have no specific recommendation for healthy people.

    We don’t mention potassium supplements because food is a better source. Too much potassium at once can be fatal, this is why potassium supplements are limited to 99 mg in the United States. That is tiny compared to daily needs. So we recommend getting ~2 lb plant food per day, roughly 1 lb from safe starches and 1 lb fruits and vegetables. That should provide sufficient potassium.

    Best, Paul

  38. Regarding iodine:
    Years and years ago, when the original paleo folks roamed the earth and buildings where caves, my high school biology teacher told us that since we lived on the west coast, not far from the sea (Los Angeles County), we got all the iodine we needed from plants that grow in the soil. She went on to say that excess iodine was the cause of many instances of acne, and that we should all go home and tell our mothers to stop buying iodized salt. I haven’t used it since. I do use sea salt, although, having been raised on salt-free foods (Dad had rheumatic heart disease), I likely don’t get much iodine from salt.

    Thoughts?

  39. Hi Paul,

    In your book, in the chapter on Omega 3 & 6 EFA’s, you state that ”essential’ means the body cannot manufacture these fats from other foods…..so must be obtained from the diet. It IMPLIES that they probably aren’t needed…if they were important, the body would have evolved a way to make them.’ This immediately reminded me of something that I read a few years ago about Vitamin C, probably from Linus Pauling. It said that humans and only one other species, gophers I think, are the only animals that don’t produce their own vitamin c. And that there is some evidence that we used to, but at some point along the evolutionary trail, we lost the ability to….which accounts for much human disease. This would contradict your premise about ‘essential’ nutrients. Do you have any thoughts on this?

    Sally

  40. Hi Paul,

    I have been on PHD + most supplements for a couple months and began the iodine protocol this week with 500mcg. I have some symptoms of hypothyroidism and my TSH is 3.44, with mid-range T4 and low normal T3.

    Thing is, I also would like to start trying to conceive asap. Do you know if it’s safe to ramp up iodine while pregnant or trying to conceive? I am concerned about detox. However, I’d really hate to lose 6 months (to get to 12.5mg) of fertility, as that side of things is a bit urgent as well.

    FWIW, a year ago I took ~1.25mg iodine/day and got what I guess are detox reactions – metallic taste in mouth and lump on roof of mouth. They went away when I stopped the iodine. A recent Hakala spot (not loading) test showed adequate iodine and no bromide toxicity but I’m not sure how reliable that type of test is.

    Many thanks to you and Shou-Ching for sharing your great minds. Your generosity is inspiring.

  41. Hi Paul,

    I understand you are busy, and appreciate you taking the time to answer so many questions. My husband and I love your and Shou-Ching’s book!

    I am only 28-years-old and for the last two years, my libido has been declining gradually, to the point of non-existence. My husband and I have a wonderful relationship, but this is a large problem. I have been to therapists, but something tells me it is diet related. Other symptoms of mine include: eczema, food/environmental allergies, low energy/motivation, minor depression.

    I had various blood tests in July and found:
    -free testosterone (direct) was .3pg/ml
    -DHEA was 236 ng/dL
    -Vitamin D was 22.7 ng/mL
    -B12 was 384pg/mL

    I was put on DHEA, Vitamin B12, 10,000iu of D3. My vitamin D3, B12, DHEA and testosterone levels all increased, but I never felt any difference.

    I also had a stool test done and it found that I had an overgrowth of Rhodotorula species.

    I have had difficulties with eating various foods, mostly dairy and sugar cane. A friend of mine who has Crohn’s disease, and who is also 28, has a low libido as well.

    Is there some connection here?

    Thanks so much for you time!

  42. Malarie, thank you for asking your question. I am in my early 30s and in the same boat as you. I’m looking forward to hearing Paul’s take on low libido and low testosterone in women our age. My T was <20 ng/dl while on VLC and again on higher carb PHD. Other sex hormones were normal. Insulin was <2 uIU/ml on VLC. BG is normal. I also had gut symptoms but those are mostly gone now and I've had no attendant improvement in libido, so I'm at a loss for how to approach solving this problem. Unfortunately, my doctors are at an even bigger loss, unless you count BHRT as a solution. Like you said, Mal, it's a big problem. And it gets very little attention in the Paleo world, I've found.

    One more question, Paul, if I may. Which gives a more accurate picture: serum or saliva testing of hormones?

    My thanks to anyone with thoughts about where to go from here.

  43. There are two respected companies that sell Deer Antler Velvet.(Suthrival,Sgn80.com)This could help your lack of libido.

  44. My apology.The company is called Surthrival

  45. Paul, Shou-Ching,
    Thank you for this absolutely amazing source of information. I have learned so much both from your book and the blog.
    I have realised lately that I have this strange reaction to iodine and I was wondering what you think might be causing it. If I ever try supplementing iodine even with as little as 120 mcg or eat fish for dinner I wake up between 3 and 5 the following night and can’t sleep for at least an hour. On other nights I sleep like a rock! I supplement with a multivitamin, selenium, magnesium, vitamin C and I have liver once a week. Would that be bromine/bromide detox reaction? I haven’t noticed any other symptoms. (By the way, I have Hashimoto’s and I take natural thyroid hormone for my hypothyroidism.) I am curious as to what is causing this reaction and what I could do to overcome it. I would like to supplement with iodine, but broken sleep really ruins my day…
    Thank you so much for your time!
    Anna

    Hi Anna,

    I’m puzzled but I know things like this can happen, I have heard of other cases of people with hypothyroidism having hypersensitivity to small doses of iodine.

    First, I’m assuming you supplement the iodine at night. If you take it in the morning do you get brain fog during the day? That would suggest that the sleeplessness is due to elevated immune activity.

    Iodine hypersensitivity can happen without Hashimoto’s, I suspect these cases indicate a nutrient deficiency in iodine and possibly some important cofactor. Do you also react to copper, iron, zinc, or B12? Bromine symptoms, I don’t know, do you have any symptoms on this list: http://www.breastcancerchoices.org/bromidedetoxsymptomsandstrategies.html?

    I guess I would just continue trying to improve nourishment with very low doses of iodine and experiment with other nutrients. Possibly you should get tested for iron and copper status. It sounds like seafood is a good way for you to work on your iodine tolerance.

    Best, Paul

  46. Hello Paul and also other posters on here who have problems with safe starches.

    I have tried long-cooked Japanese rice and also organic clear rice syrup to no avail – flare-up of AS symptoms. I think that my problem with rice syrup is probably the high maltose content, maltose being a dissacharide.

    I have autoimmune.I haven’t got any pathogenic bacteria or yeasts (recent stool analysis) so I assume that the difficulty is connected to leaky gut. I aim to heal this with GAPS so that I can then switch to PHD.

    I have in fact been doing GAPS most of the time for the last 10 months, apart from trying starch every now and then because I feel so dreadful on GAPS – light-headed, no energy, brain fog, insomnia, rapid pulse and palpitations. By definition, trying starch every now and then means that I’m not really doing GAPS properly.

    So I’d like to ask a couple of questions if you don’t mind.

    1. Is there a way of doing GAPS and feeling less unwell (pretty much incapacitated some days). I realise that you are not a proponent of GAPS, I’d just appreciate your thoughts.

    2. Fructose – I can calculate more easily using grammes rather than calories. Dr Mercola advocates no more than 15g of fruit, to allow for an extra 10g in other things, making his safe daily total 25g. I think that, for me, until my gut has healed, I need to not adhere to this too strictly but I would like to maximise glucose intake per gramme of fructose, so honey and grapes seem to be a reasonable way of doing this as they have a high glucose:fructose ratio.

    I am aware that you’re not a fan of either, but do you have any thoughts on it as a least worse strategy? Does your recommended glucose intake of 200-400 calories equate to about 100g of glucose? Unfortunately, this is impossible to get with fruit alone without totally busting the recommendation for safe fructose intake.

    I would go for glucose syrup but I think that the reason for this being prohibited on GAPS/SCD is that it is usually derived from corn and has many impurities. I have searched in vain for a fruit-based one and I imagine that such a product would be prohibitively expensive.

    Thank you Paul.

  47. Hi,

    How much meat per day do you reccomend for four year olds?

    Thank you,
    B

    Hi Bethany,

    A rough rule of thumb is that a 4 year old may eat 1500 calories per day, of which about 10% protein may be optimal, or 150 calories = 37 g per day. This would be the amount in 6 eggs or 1/4 to 1/3 lb meat per day.

    However, you can pretty much let children eat to their own tastes, protein is highly regulated so no child will voluntarily become protein deficient. So give them the opportunity to eat meat, fish, and eggs to taste, but let them stop when they want.

    Children typically do best on less protein and more carbs than adults, so don’t be surprised if your 4 year old’s taste differs from yours. The key thing is to make sure they are good quality food sources.

    Best, Paul

  48. Are Zojirushi rice cookers safe to use even though they are made with aluminum?Also are potato chips cooked in pork lard an acceptable snack?

    Hi Frankie,

    I believe the interior surface is anodized aluminum which should be safe as long as it retains its integrity (ie doesn’t get scratched or pitted).

    Potato chips cooked in lard are OK but cooked in coconut oil or clarified butter would be even better.

    Best, Paul

  49. Paul, What is your opinion about virgin vs. ‘refined organic’ coconut oil? I don’t care for the coconut taste of the virgin oil but have used the refined in mayonnaisse and frying, among other things. If you say virgin coconut oil only, I probably will just use olive oil and butter instead.

    Hi Mary,

    Refined coconut oil is fine. Use whichever you prefer. Coconut milk is fine too, for those who prefer it.

    Best, Paul

  50. paul, why is brown rice syrup recommended over dextrose (corn sugar)? my idea is that they are both glucose. thanks

    Hi Darius,

    They’re both acceptable. Brown rice is more tolerable than corn as an original food, but dextrose has fewer proteins remaining than brown rice syrup, so the dextrose might be better.

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