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 ?

10,237 Comments.

  1. Hi Paul
    After being on the immune suppressent drug Neoral for 10 months to deal with severe Psoriasis (which btw my many diet changes would only temporarily be effective – I’d been trying for 4 years)
    I developed lung cancer stage 4, a listed side effect of the drug.

    Fortunately, if one can even use that word in this case, the cancer I got was the EGFR L858R mutation and I was spared having to have chemotherapy. Instead I was put on a drug called Tarceva which has been very effective so far. It’s only a month that I’m on it.
    It has it’s side effects as well…dry skin, rash, thin hair, heartburn and cough but none of the collateral damage of chemo.

    According to the oncologist I will have to be on it for the rest of my life…and it usually becomes ineffective in a year as the cancer builds up an immunity to it and returns in the form of a new mutation…which they do not have a medicine for.
    Having said that, there are those who have survived 4 to 5 years on it…as long as it’s been available…before the cancer returns. Very daunting prospect to live with.

    I know from my past experience that bread,
    gluten and sugar aggravates psoriasis and I eliminated them for years prior to my diagnosis. I even eliminated dairy. I continued not to eat them while I was on Neoral.

    After being diagnosed with cancer this December, I had the attitude that eating healthy had done nothing for me and being that I lost so much weight and the doctor begged me to make an effort to gain weight, I started eating bread and butter…tons of pasture butter…and put on some weight.
    But what I noticed was that after eating the bread I would get terrible heartburn and even have breathing issues.

    I started searching for a new way to eat, and came across your diet and started it this week. It’s so doable. Allowing diary and rice makes giving up grains so easy. I was also adding insult to injury by eating Oatmeal every morning!! Since starting your diet, no heartburn or breathing issues. It agrees with me.

    I’m enjoying the Perfect Health Diet and even decided to take your suggestion and order the Total Mins minus Iron and the Life Extension Selenium. I already take 10,000 mg of Vit D3 once a week and magnesium, zinc and folic acid every few days. Also a probiotic called Three Lac and 400 mg of resveratrol every few days as well as about 400mg of CoQ10 daily.

    I feel I get enough vitamins from the food I eat…lots of vegetables and berries and I never liked vitamins anyway. I thought that if i took vitamins (which were synthetic anyway) my body would forget how to extract them from the food I eat…maybe a foolish idea but it’s what I thought.

    I am wondering if there are any suggestions you could offer knowing what my condition is. Perhaps adding or even eliminating from what I mentioned above. I’m eating only grass-fed beef and dairy.

    I have a hard time accepting I will have to stay on this medication for the rest of my life and want to make every attempt to strengthen myself nutritionally so that maybe I can live without it at some point in the future.

    Hi minni,

    I would think you should be optimistic that you can beat the cancer. People get “proto-cancer” all the time but their immune system suppresses it; now that you’re off the immune suppression drugs, you can hope that your immune system will be able to suppress your cancer.

    We’ve written some general thoughts on diet for cancer patients here: http://perfecthealthdiet.com/?p=4739. Also, the book has a great deal of information about specific nutrients relevant to cancer. We have an index listing all the pages on which “cancer” is mentioned. Key supplements include selenium, iodine, vitamin D, and vitamin K2.

    Also, you may wish to read the whole “Cancer” category, look in the sidebar, it currently has 12 posts. You may also wish to Google HDAC inhibitors, many foods do that and they are good anti-cancer foods. Also, the book Anti-Cancer by David Servan-Schreiber is excellent.

    Circadian rhythm therapies are very helpful against cancer. It’s important to get sun exposure at mid-day, preferable with bare skin and bare eyes, preferably with exercise in a natural setting. Try to get a good night’s sleep, in a totally darkened room, leave enough time to wake naturally. You might read our category “Hypothyroidism” for some of our discussions of circadian rhythm therapies: http://perfecthealthdiet.com/?cat=49

    Psoriasis I believe is infectious in origin, so immune suppression is exactly the wrong thing to do. This is treating the symptoms rather than the disease. If you can discover and treat the underlying cause, it may help against cancer.

    Reducing omega-6 fat intake as much as possible is very important for cancer. Fish and shellfish should be your primary meats.

    I would do intermittent fasting. If you ever do start chemotherapy, try to fast during the chemo, and then eat extra and build up muscle during non-chemo periods.

    Best of luck and please keep me posted on your progress.

    Best, Paul

  2. Hi, Paul,

    there is a condense version of your diet (free pdf download)

    also your food plate jpg.

    could you make them “sticky” or on the side bar on the side

    (i’m trying to find them to send to my friends; easier than me standing on a soap box looking like a Food Cop!)

    thanks.

    Hi Pam,

    I’ve put a link to the free “Color Companion” which has the food plate, images, and other information, in the “Buy Our Book” box in the sidebar.

    Best, Paul

  3. >>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

    Doctors see nothing wrong. I just always have a little bit of eyestrain and can’t read for arbitrarily long periods without feeling it. More vitamin C I guess.

  4. Paul,

    wonderful! thanks.

    exactly what i was looking for
    —- a primer or a summary

    (as there’re plenty type A or ADD around here. ^_^

    then they can just explore should they be interested,

    stay healthy,

  5. Bill

    I know all about the Budwig protocol. who doesn’t? I don’t do flax oil.
    It’s not relevant for me or the question I was asking or the situation I am in.

    I’m sorry to see Paul didn’t find my question worthy of a response.

    Hi Minni,

    It’s not that it’s not worthy, I’m busy with some urgent projects and haven’t had time for comments. I will get to questions eventually.

    Best, Paul

  6. Hi Paul,
    I very much like your blog, recommended by Chris Kresser who I also think gives some excellent advice. My question is several-fold: I am confused about gluten in the form of traditional sourdough as I went strictly gluten free (from eating a half slice of bread a day and occasional oatmeal) for a couple of months and felt dreadful which I can only think was due to going too low-carb although I can’t imagine a half slice of bread has many carbs. My main problems were anxiety (partly as a result of anxiety over whether I should be gluten free or not as I feel it restricts my life so much and alienates me from the rest of my family – I have a history of eating disorders and in general try to avoid ‘all or nothing’ rules) and feeling tired, cold hands although I always have these in winter and tiredness could be due to busy life, young children etc, and intermittent constipation. Anyway, I have recently started eating a half slice of sourdough again, with eggs and butter and feel fine, better even. I have changed nothing else, I am generally lowish carb (slightly lower than PHD perhaps) though not VLC. I am now anxious about whether I should go gluten free again but increase safe starches (my mother has a little bit of arthritis, I have suffered from rosacea and canker sores in the past -both cleared up on a traditional WAPF diet with limited prepared grains such as sourdough – and have low bone density, a random collection of health issues!) I suppose my main question is how bad is gluten really? I have read Chris Masterjohn’s work and can’t help but think a little may not be too bad but I don’t want to risk poor health in the future for something that is not a big part of my diet, although psychologically I seem to have issues with giving it up entirely. Sorry for the long question, I know you are busy but sometimes I feel the anxiety over what and what not to eat will kill me far faster than any gluten ever will! All the best, keep up the good work.

    Hi Karen,

    Gluten is worse for some people than others. The trouble is that many of the effects are invisible so you can’t easily know if you’re being harmed by it. I think it’s best to stay away from it.

    So I would try rice and other safe starches to see if it’s the carbs you need. Another possibility is that you are sensitive to the opioid peptides in wheat, and have withdrawal symptoms. Chocolate and milk both have opioid properties, you might see if they improve your mood also. If it’s withdrawal symptoms they should go away in time.

    Constipation is a common low carb symptom. Cold hands could be Raynaud’s or hypothyroidism, and might be a sign of low-carb. I would just experiment with safe starches, gluten removal, and chocolate or dairy addition to see what works for you.

    Best, Paul

  7. Hi Paul,

    Would you recommend seaweed (as sushi) for babies nine months of age? Also, at this age would cheese and vegetables such as broccoli, cauliflower and green beans be OK? Are there any other foods you would suggest at this age when they need more chewable foods than banana, yoghurt, rice cooked in beef broth and root vegetables?

    Your previous advice has been greatly appreciated and the babies love their food and are healthy and happy.

  8. Hallo,
    sorry for my english, I am german. And I can´t find the right place for my illness…

    I suffered from endometriosis uteri (adenomyosis) and searching for ways to reduce pain and bleeding. Is the perfect health diet helpful? I have read another book written by a women who discover that her symptomes are reduced by avoid wheat (gluten) and eat less meat and more berries.

    Best regards
    Manuela

    Hi Manuela,

    My wife had endometriosis. I think vitamin D/A/K2 optimization are extremely important, as are collagen supports (eg vitamin C, cooked joint tissue eg ox tail or ox hoof soups), and antioxidants esp the minerals like selenium, zinc, and copper. Magnesium is always important, it helps prevent spasms. But really, our best advice is to follow the diet and nutritional advice in our book. The causes of these diseases are not known and so the best approach is to fix everything possible.

    Best, Paul

  9. Hi Paul,

    I haven’t been getting any answers to my questions, but I’ll try again……I’m not complaining, in fact, I think it’s amazing that you find time to answer what you do! And there is a wealth of information here, I really appreciate it.

    Any comment on the recent news about rice products….that they have been found to contain high amounts of arsenic due to to the soil they are grown in and their ability to absorb it from the ground? Rice cakes and avocado have become my favorite food!! And of course, all the rice pasta.

    Thank you in advance, Paul!

    Sally

    Hi Sally,

    I commented on the arsenic in rice bran issue here: http://perfecthealthdiet.com/?p=5231, #6.

    Best, Paul

  10. Hi Paul,
    there is so much talk about the omega 6: omega 3 ratio that I am very curious by what methods this is measured in the human body. Are there any blood markers from which it might be concluded? Or can you only tell for good when someone is dead and the fatty tissue can be analyzed? I wonder how the mechanism works: Is this like an acoount and each time I eat some salmon I increase my omega 3? Does it happen like this even when I am in energy balance and fatty acids are not likely to be stored? When omega 6/3 levels are checked and I drink a bottle of soybean oil afterwards do the markers (what ever they might be) change right away? And when am I back to normal? I know this might sound stupid and naive, but I have no clue how the whole system works! I am curious for your reply!

    Hi Iris,

    Yes, blood tests are the usual measure of tissue levels, sometimes adipose fat samples. Both measurements are discussed in our book. Food fats generally get incorporated into tissue and tissue fats get burned, so it is rather like a bank account (paycheck gets deposited, payments go out at other times). The long-chain omega-3 and omega-6 fats rarely get burned for energy, rather they get changed into other compounds via controlled (or uncontrolled) oxidation. This is why too much of them is a problem.

    Best, Paul

  11. Hi Paul
    Thanks for responding. I really appreciate it, especially since everything you mention resonates with me.

    When I was first diagnosed, I read the book Anti-Cancer by David Servan-Schreiber and got so much information from it.
    I was mostly concerned about supplementation and you’ve basically answered that question for me.

    I so wish I’d never used neoral for psoriasis…interesting that you think it’s infectious. My dermatologist believes it is inherited.
    My brother and father both have it on their forearms in a very mild form…where I get it the worst. My personal belief is that one might have a genetic predisposition for it but it is activated by stress and repressed anger…both of which I suffered from right before my first breakout.
    I never got it my whole life until I was 62 years old and went through a serious life drama/trauma.
    Then I got it on 70% of my body. Only my face was spared. That’s why I eventually went on Neoral. It was so out of control at that point.

    AS you say:
    “People get “proto-cancer” all the time but their immune system suppresses it; now that you’re off the immune suppression drugs, you can hope that your immune system will be able to suppress your cancer.”

    I think this too, but thought I was being naive.
    I stopped taking Neoral a few months prior to being diagnosed with lung cancer, but of course that was after the horse was through the gate and I’m sure my immune system was/is still compromised.
    I know Tarceva turns off the cancer cell by blocking a specific chemical pathway.
    If Tarceva can neutralize the cancer cells and there is no evidence of disease, I am hoping I can eventually stop taking it and have confidence that my own body, no longer on an immune suppressant and hopefully strengthened by good dietary habits, can pick up where Tarceva left off.

    Thanks again for the encouragement.

  12. Paul
    one more question..
    I read the cancer blog and noticed that you
    said cancer patients should take supplements but not anti-oxidants. Do you think I should
    continue with CoQ10?
    thanks

    Hi minni,

    I think it’s OK to take CoQ10 but not during chemo. Antioxidants will protect cancer cells against chemotherapy.

    Best, Paul

  13. Hello Paul,
    If you have time would you please respond to my question posted on the 17th of February?
    Thank you so much,
    Sofie
    the Netherlands

  14. Folks – You may have seen my name in earlier posts as ‘a friend of the blog.’ That I am. A friend of the blog and a strong supporter of Paul and the PHD. That said, I spoke with Paul a couple of days ago. He’s really busy right now and just can’t get to the blog. I believe, if we are all patient, he’ll be back to answering everyone’s questions as he used to do before it’s effectiveness and ease of adoption made the PHD so very popular.

    So, for the time being, hang in there, friends…

  15. Hi Paul,

    First off: I’ve read your book multiple times and use it and your blog as my health ‘bible’. Keep up the great work!

    Anyway, you may be the only one out there who can help me with my issue so thank you very much in advance for looking into my case: I’ve had mental issues (poor memory, lack of focus/concentration, lack of motivation, poor libido, ‘muted’ emotions, etc) for as long as I can remember. My shrink thinks I may have had a mild to medium depression since early childhood. Also, I have what I believe to be a so-called ‘persistent migraine aura without infarction’ (also referred to as ‘visual snow’) – I basically see things like on a TV with poor reception all the time (more annoying than debilitating). I have a strong feeling that these two issues are related. My physical shape however, especially after starting the Paleo diet, is pretty good and I generally look pretty healthy. I’m also able to work in my office job – even though I find my self in this mental fog all the time.

    Since first getting the diagnosis from my shrink, I’ve tried pretty much everything:
    – Paleo diet for the past 6 months
    – All the various supplements you recommend in your book
    – Mood enhancing supplements (St John’s Wort, 5-HTP, L-Tyrosine, L-Theanine, Taurine, etc)
    – Therapy (50+ sessions)
    – Neurofeedback
    – Yoga, meditation
    – Sports (running 2x a week)
    – I also saw any doctor I could think of (Neurologist, Ophthalmologist, GI, etc), had an MRI done, etc. Nothing.

    So, the weirdest thing for me has been that I noticed very little impact from any of these things. Sure, I lost like 25 pounds from going on Paleo but there was no significant mental improvement from the diet. Especially things like 5-HTP, L-Tyrosine, etc, which I had a lot of hope for, had no impact. If anything, they made me sleep worse (sleep, generally, is not refreshing for me). So in addition to having muted feelings, I seem to have a muted mental response to all these nutritional and therapeutic measures.

    In terms of medical history (I also share some similarities to yours – especially Accutane). Just to highlight a few potentially relevant ones:
    – Birth with aid of forceps
    – Lung infection at age 2 (was given antibiotics twice for that)
    – Various other rounds of antibiotics over the years (e.g. strep and acne)
    – Accutance (2x 3 months) and antibiotics at age 20 for acne (I’m 33 today).

    So could it be a chronic brain infection? Any doctor I ask that question just looks like I’ve completely lost my mind. You are obviously an expert on this issue. And if it is an infection, wouldn’t it show up on an MRI or have other noticeable negative physical impacts? And could it be causing the visual snow? I’ve read of people with lyme that had such visual ‘snow’ (depending on how long they had it they could treat it with a long course of antibiotics – like you suggest for chronic infections).

    Anyway, apologies for this very lengthy post. I just figured I’d give you the entire context. I would be eternally grateful if you could respond (I’d also be happy to pay you for your services if need be).

    Best,
    Adam

    Hi Adam,

    I wish I knew what to advise you, but I really don’t know what could be causing your symptoms.

    I think you have to experiment until you find something that influences them — for better or for worse, either way is a clue.

    You can experiment with low-carb ketogenic or even plant-free diets and see if that affects it. On the other extreme, a high carb diet.

    You can experiment with antibiotics.

    You can try various diagnostic methods; eg a stool test, or measures of immune function, such as circulating cytokine levels. This may need a cooperative doctor.

    I’m sorry to have so little to offer but there is nothing obvious to me about your symptoms.

    Best, Paul

  16. Hello Paul,
    i have been struggling with this…
    I am fructose intolerant, oaxalate sensitive, and suffer from severe candida and gut dysbiosis, and Chrohns. When on a keo diet, i drop so much weight and become very tired. My T3 is very low in recent blood work. But when I add carbs..safe carbs..my bloating and gut dysbiosis, i get severe constipation..
    How to I keep a safe balance with fructose intolerance, starch with gut dysbiosis?
    Thanks,kATE

    Hi Kate,

    You shouldn’t be on a ketogenic diet if you have Candida. Can you tolerate dextrose or other simple sugars? Pre-digested starches such as tapioca syrup or rice syrup may be OK for you.

    Find a carb source you can tolerate and then work on healing the gut dysbiosis. A stool test might help you identify pathogens with confidence, and support getting antimicrobial drugs from your doctor. Antifungals often work well against Candida, for instance.

    Best, Paul

  17. Hello Paul

    I’ve been on a paleo/PHD diet for quite some time now. My Health has been steadily improving. I still do a ton of research about health and diet etc Recently I came across “food combining principles” – I’m sure you’ve heard of it at some point or another. I want to know is it bogus or some macro nutrients don’t go well with others..?? Whats your opinion and the science behind this?

    Hi Johny,

    I think it’s bogus. There are a few macronutrient combinations I would avoid, like fructose and polyunsaturated fat, but for the most part healthy foods do just fine together.

    Best, Paul

  18. Jonny,
    while you await a response from Paul. just letting you know Paul has already answered similar queries which may be of interest to you.
    including one above, here;
    http://perfecthealthdiet.com/?page_id=4228&cpage=16#comment-41323

    & others here;
    https://www.google.com/search?hl=en&q=%22food+combining%22+site%3Aperfecthealthdiet.com&oq=%22food+combining%22+site%3Aperfecthealthdiet.com

  19. Johny,
    while you await a response from Paul. just letting you know Paul has already answered similar queries which may be helpful.
    including one above, here;
    http://perfecthealthdiet.com/?page_id=4228&cpage=16#comment-41323

    & others here;
    https://www.google.com/search?hl=en&q=%22food+combining%22+site%3Aperfecthealthdiet.com&oq=%22food+combining%22+site%3Aperfecthealthdiet.com

  20. Hello Kate

    I don’t have Paul’s knowledge but I am a bit in the same boat as you – somewhat stuck between a rock and a hard place.

    I’ve tried rice syrup etc and have come to the conclusion that starch causes me more problems than anything else.

    Dr Natasha Campbell-McBride has stated on the FAQ section of her website that most GAPS patients have some degree of fructose malabsorption and that that gets addressed when the gut has healed ie keep eating fruit anyway.

    There are obviously differences of opinion out there about the best strategy for healing leaky gut, but if it is the case that the gut can’t heal as long as you’re ingesting di- and poly-saccharides (GAPS) and also that the gut needs a certain amount of glucose to heal (PHD) then the options are dextrose (derived form corn) or fruit with as high a glucose to fructose ratio as possible.

    Unfortunately for me I don’t seem to tolerate bananas well and corn is by far my worst grain which makes me a bit wary of dextrose powder. So I am currently eating more fruit than previously as a way of getting more glucose.

    I also think that it may be necessry to have some tests and to get a personalised prescription for diet and supplements – I am waiting for a consultation with Chris Kresser.

    Good luck and please report back on your experiences, there are quite a few people in a similar situation.

  21. Hello Jonny

    I have tried most diets over the last 30 years, including food combining.

    I never found the theory convincing, as proteins and starches are digested in different parts of the gastric tract.

    I certainly felt no better on it overall. In fact, I lost a lot of weight unintentionally (I was already fairly thin), I think it played havoc with my blood sugar and I was permanently hungry.

    However, I did find that the principle of not mixing fruits with other foods worked for me and helped with bloating and discomfort, so I still do it.

    I also think that there is something in eating simpler meals with fewer components for people with digestive problems. So it might work for some people for that reason.

    And people who switch straight from SAD to FC would be eating more healthily in general, so it might work for them for that reason.

  22. Hello,

    Frances and Kate, I am in the same situation, it definitely is challenging to decide what to eat which doesnt feed pathogens, yet feeds my body. Frances, may I ask what fruits you do eat that are meeting your glucose needs? I also have issues with bananas and trying to decide what fruits to try. I actually can digest rice and potatoes better than bananas, but I am concerned with the GAPS assertion that my gut wont heal if i keep eating them. Thanks!

    Devi

  23. Hello Devi

    I’m still experimenting with fruit so I’m not claiming to have found a definitive solution and, needless to say, I am also not Paul, so I’m not dispensing advice.

    I am eating 2 pieces of fruit before breakfat, one before mid-morning snack and one before afternoon snack. Ideally I would be eating bananas and berries, as per Paul’s recommendations.

    As I’m not eating bananas I looked up the glucose:fructose ratio of different fruits.

    Having done this, I then proceeded to include an apple as one of my morning fruits, even though apples have more fructose than glucose. The reason is that I always feel well after eating an apple so I assume that they must have some beneficial ingredient.

    Also, because of the relatively high fructose content, apples are lower GL than some fruits, and I find that useful in my morning routine.

    My understanding of what Paul says about fructose in the book is that first thing in the morning may be the best time to consume fructose because the liver’s store of glycogen has been depleted overnight and so the fructose can be stored by the liver rather than converted to fat and thereby become toxic.

    The other fruits that I eat are blueberries or raspberries, kiwi fruit (readily available organically, relatively cheap and high vit C) and papaya (equal glucose:fructose, high potassium). Plums would be good from the glucose:fructose point of view but I’m not sure they agree with me so I stick to what does, even if not ideal in other respects.

    All of this still doesn’t come close to Paul’s recommended glucose intake but I think it’s the best I can manage right now.

    I haven’t got a sweet tooth at all and would prefer to eat less fruit as before ie 2 pieces first thing in the morning only. But since I started eating double that amount I think I have slightly more energy, my eyes are less dry and I’m not constipated.

    The fungal skin infection on my feet and bloating have not got any worse. Also, I’m not getting sugar cravings or feeling hypoglycaemic, so I assume it’s not disrupting my blood sugar.

  24. thanks Devi and frances for your insight, it definately is challenging!!
    Especially when I am trying very hard to gain weight!!
    I am on and off GAPS..I just drop so much and become depressed..look like a ghost..
    The hyperthyroid thing is tricky with the carbs, frcutose..
    I just want my gut to heal..and not have my thyroid suffer in the process!
    We are in this together!!

  25. Thank you Frances, this gives me some ideas. I’ll have to cook some of these though, I cant tolerate anything raw or fibrous–think I may try watermelon as well in the morning because its so high in fructose.

    Thanks again!

    Devi

  26. Thank you for your comments Kate and Devi.

    Devi,I’m not sure that I’ve quite understood your comment about watermelon, so just to clarify something about fruit in the morning, in case my previous post was a bit misleading:

    I eat an apple in the morning because I like apples, I feel well after eating them and I don’t get a sugar rush if I want to eat a couple of pieces of fruit together. But I eat it despite the fructose content, not because of it.

    If I’ve understood the book correctly,first thing in the morning may be the least harmful time to consume fructose.

    But there’s never really a good time – it would be better from PHD perspective if apples had more glucose and less fructose.

    Having said all that, I hope that you enjoy your fruit.

  27. Hi everyone,

    I’m writing in regards to the question by Nick on Feb 16- about the gallbladder flush. I wrote that my husband and I were going to try one of the variations of a gallbladder/liver flush yesterday and in fact we are (we chose a 2-day one, so we’re on day 2 now). I just wanted to share our results thus far. I don’t want to assume this is good or not good for anyone, I don’t really know, but this is our experience…

    Day 1- we ate only whole foods with no fat at all. (that was very hard and slightly depressing!) so some fruit for breakfast, for lunch steamed sweet potato and steamed beets, grated fresh beets with lemon juice with salt, some greens. dinner was white rice with lemon juice, cilantro and salt. it wasnt particularly fun– we both had a headache all day.
    A couple hours after dinner, we drank the olive oil/ lemon juice concoction (volume was a little over 2 c.!!!). we did half fresh squeezed lemon juice, half fresh squeezed grapefruit juice for the juice portion. the cleanse we chose said to do it in 15-min intervals. so about 1/2 c. at a time. then straight to bed, lying on right side.

    My husband did vomit about 2 hours later. About an hour after that when I woke up around 1am, I felt extrememly nauseous and in fact wanted to vomit to get rid of the feeling, but I never could. After about 40 min the nausea did go away and I went back to sleep.

    This morning, my husband passed at least 6 large bright green stones! The largest one is the size of a macadamia nut!! We were amazed! The others were about the size of a large peanut. Then it was my turn. And I passed several small and tiny green stones, the largest was about the size of a small spanish peanut maybe.

    Anyway, I don’t know if doing this is good for everyone, I did read several cautions, but after seeing our results I’m so glad we did it (well, we’re still doing it– today is sea salt water drinking, which flushes the intestines, so… probably more to come). Like someone above said, just make sure you research it before you try it (don’t do it if you’re sick or if you’re constipated, etc…). Also, there is a risk of a stone or stones getting stuck in the bile ducts.

    Just wanted to share our results– that we did have success! (and we didnt even have any symptoms, I just thought to try it after researching about it after seeing Nicks comment) I just can’t believe how huge that one stone was though!

    Paul– I dont know how you all feel about this kind of thing, so if it goes against PHD at all, of course you can erase this post. I wasnt sure…

    Thanks!
    KH

    Hi KH,

    I’m fine with gallbladder cleanses. If your husband is passing stones it’s clearly helping.

    Best, Paul

  28. Andrew,
    When are you taking your BP? A realistic BP measurement is taken after you are sitting in a chair resting for a few minutes, best done first thing in the morning. Everyone has variations in BP depending on recent activity, and your BP changes throughout the day. Actually all of your numbers look healthy. How old are you? What did you mean about the diastolic being 90 or higher? How high? And what were you doing right before you took it? I would be surprised if your BP didn’t drop after drinking wine and relaxing. It is normal for your pulse to go up a bit when your BP drops. Your heart has to pump a little harder to move the blood when your BP is lower.
    I don’t want to make you feel that I am minimizing your concerns, but you shouldn’t be concerned if your don’t “brighten” immediately with fasting. You may be overdoing the fasting, it’s a fine line, and you are fasting a LOT. I have been doing daily IF for 3 months, and in the beginning I noticed a great mental lift, but that did not seem as prominent over time, or maybe I just got used to a new “norm”. Sometimes I get really grumpy when I fast, sometimes not. It just sounds as if your are comparing your experience to that of others when maybe you should be paying attention to your own variations and what may lead to them. Sometimes I have a great result, sometimes not. Do you have specific symptoms that would make you think you are ill?

    Thanks Becky. BP measurements are a fairly standard average from rested seated position. I had just thought that was a huge drop. I’m 46, and the highest I’ve ever seen was probably about 155/105 or something like that… not in a resting state, and while at work in a jet! I’m just saying my avg daytime, seated, somewhat rested rate is about 130/80 and drops to about 110/55 after wine. Maybe things are changing with more carbs over last several weeks. Yesterday morning I was getting about 120/60.

    Not sure how long it should take to feel some changes after being low carb for a year. I just know I’ve felt kind blah for a while: fatigued, tired, not able to concentrate or focus on projects, and added a few extra pounds since Sep of last year.

    But it’s not like I was an extroverted, always happy, highly active and energetic before that. So that’s why I’m kind of looking at the infection angle as well. The 22 hr fasts where to maybe look at that and also get a handle on the extra pounds (kinda like the jaybird weight loss plan). Like he said, it just kind of fit my schedule. I was eating about 2k cal in about a 2 hr period. A bit much for me, so I kinda like the 8 hr window better.

    I know one of the VLC products is that you loose a lot of water weight at first… so I guess I’m gaining a lot back now. My urination is a lot more forceful, and I seem to be sweating a little more, don’t feel cold as much, hair is less grey, and outer 1/3 of eyebrows seem to be growing back. Weight is about the same, which is somewhat disappointing, but I think bf is 1-2% lower, so that’s good.

    So a lot of changes over the last month or so which makes it hard to gauge things: relationship loss, introduction of safe starch, more strict on no toxins (grains), PHD supplements… and first time in about 30 years being nicotine free.

    Patience…….

  29. Paul,

    Didn’t read the paper, but seems to support your findings from thyroid/Calpo series.

    He seems to say we’re Iodine deficient because our increased neolithic carb consumption drives increased T3 and a requirement for more iodine.

    So how much seaweed did Grok really get… especially if he didn’t have a beach house?

    I’m following the PHD supplement guidance. Taking kelp for 1g iodine for a month. Hope to increase toward 5g (slowly due to possible effects with chronic excezma/Atomic Dermatitis).

    Book is a little illusive, “There are additional benefits from higher doses of iodine, such as 12.5 mg/day or 50 mg/day. High-dose iodine is protective against infections and cancers.” And web site has low/moderate/high recommendations. So is one Iodoral/day a sound target?

    Nutrition, evolution and thyroid hormone levels – a link to iodine deficiency disorders?

    http://www.medical-hypotheses.com/article/S0306-9877%2804%2900169-0/abstract

    Abstract

    An increased iodine requirement as a result of significant changes in human nutrition rather than a decreased environmental iodine supply is suggested to represent the main cause of the iodine deficiency disorders (IDD). The pathomechanism proposed is based on the fact that serum concentrations of thyroid hormones, especially of trijodothyronine (T3), are dependent on the amount of dietary carbohydrate. High-carbohydrate diets are associated with significantly higher serum T3 concentrations, compared with very low-carbohydrate diets. While our Paleolithic ancestors subsisted on a very low carbohydrate/high protein diet, the agricultural revolution about 10,000 years ago brought about a significant increase in dietary carbohydrate. These nutritional changes have increased T3 levels significantly. Higher T3 levels are associated with an enhanced T3 production and an increased iodine requirement. The higher iodine requirement exceeds the availability of iodine from environmental sources in many regions of the world, resulting in the development of IDD.

  30. In the hopes that this will help some people get some answers soon and perhaps save Paul some time I am reposting here something that Peter C very helpfully said on another thread:

    … anybody who has a basic question like this, I recommend searching the site before asking. The best way to search is to use Google. Here’s an example searching for ‘rice’ and ‘arsenic’

    In the Google search box at Google.com type:
    rice arsenic site:perfecthealthdiet.com

    This can be used for any combination of words or a phrase

    Then my 2 cents:

    you can also use “control” and “F” to help you search for specific words as you scroll through a long list of comments.

    Just push “control” and “F” at the same time and a box will pop up on your screen, into which you type the word or phrase you are looking for. That word or phrase will then get highlighted.

    I just learned how to do this, so I thought maybe some of you might not know about it either. It’s hard not being a geek!

  31. Hi, Adam –

    I had not heard the term ‘persistent migraine aura without infarction’ before, but my doctor had told me that, while I was not having seizures, he thought my symptoms were from continuously experiencing the kind of aura that many experience before a seizure. My understanding is that seizures and migraine activity are both on the same continuum. Like you, I was experiencing poor memory, lack of focus/concentration, lack of motivation, etc. My problems started after experiencing a particularly bad bout of flu. Like you, I tried many approaches to deal with my problems.

    One of the things that helped me was finding a book called Reading By the Colors, by Helen Irlen. She was working with people who couldn’t read and with people with autism. She found out that many couldn’t see printed material the way most people do, but that everything fell into place for them if they placed a colored filter over the text. These filters are the same ones used over lighting for stages in theaters. Some of the people she worked with needed one color filter and some needed another. Her explanation is that some people’s brains react to some colors by being over stimulated. She eventually developed the concept to where people can go to an “Irlen Clinic” to be assessed for what particular color is most helpful, and also can get colored glasses and colored contact lenses.

    I was not having trouble reading per se, but had figured out that if I took a break from reading and working at the computer, my symptoms were less severe. The people at the Irlen Clinic suggested that I experiment to see whether different types of lighting affected my level of symptoms as well. While many people find fluorescent lighting intolerable, I discovered that cool white fluorescent lighting is the best light for me to read or use a computer in, and that if I want to keep my symptoms of brain fog etc, quiet, I need to keep all natural light out of the rooms where I use a computer or read. Anyone who is reluctant to spend the money on an evaluation at an Irlen clinic could get some sense of whether it would help them without spending much money. The preliminary evaluation consists of looking at printed material through one of ten colored sheets. When I looked through the color that was worst for me, I had a very visceral reaction. They said they often work with children who are non-verbal and it’s not unusual for the children to vomit when looking through the colors that are worst for them. So beginning to get a sense of which colors may work best is really a matter of trial and error. I was glad I met with the people at the Irlen clinic, but it’s also possible to purchase the selection of colored sheets from http://irlen.com/index.php?s=overlays or you could find a variety of colors to experiment with at a store supplying theaters.

    I tried getting colored glasses and found that they helped me be more comfortable when I had enough energy to leave my darkened apartment. Wearing a visor also helped. In MicroSoft Word, I can change the background color on the screen when I’m doing word processing and this helps tremendously. When my problems started I was using a CRT monitor. I tried an LCD monitor, but felt it did not help. More recently I got an LED monitor that is designed to conserve energy. One of its features allows me to turn down the brightness as far as I want. This is a big help.

    What helped the most? I found the colored glasses helpful, but the unfiltered light that came into my peripheral vision remained bothersome. When I finally got colored contact lenses through the Irlen Clinic, and wore them daily for a year, I experienced significant healing. By the end of that time, I became allergic to the fluid used to wash the lenses and decided not to get new ones. But the improvements that occurred during that year have stayed with me for what has been about 7 years now. I very rarely experience brain fog any more. Sometimes in June I feel like the light of the sun is unusually harsh and my symptoms flare a little. Read somewhere that some people experience something like SAD (seasonal affective disorder), but they have it only during the time of year with more daylight hours rather than less. I continue to be careful about reading and using a computer only in the light that is best for me, and still cannot just read or compute all day, but as I say, the vast majority of the time – no more brain fog!

  32. Hello
    I heve suffered from cervicalgia for two months.There ‘s arthrosis in my C5 C6 vertebrae.I can harly go to work.Can anybody here give me some advice ?

  33. Hi Debra,

    Thanks for your detailed comment and suggestions. I hadn’t heard of this concept before but will definitely look into it. However, I actually do have this ‘visual snow’ sensation all the time, even with my eyes closed. It is more noticeable in a darkened room or when looking at an object with just one (not too bright) color (e.g. a wall). Anyway, while the ‘visual snow’ is pretty annoying, it is bearable and the main reason I want to get rid of it is that I suspect it to be a symptom of something neurological – such as a chronic infection.

    Anyway, thanks again and I look forward to Paul’s comment on my case.

    Best,
    Daniel

  34. @Karen, you have a lot of symptoms that match hypothyroid. Are you addressing that?

    @Adam, I just listened to this podcast: http://www.robbwolf.com/2012/01/31/chris-kresser-migraines-iodine-omega-ratio-fibromyalgia-dysbiosis-vitamin-c-and-the-personal-paleo-code-paleo-solution-episode-117/ where Chris Kresser discusses migraines in the first question. Transcript is here: http://css.robbwolf.com/wp/wp-content/uploads/2012/01/Episode117-Transcript.pdf

    In particular he says “I’ve
    found that a low tyramine, histamine and arginine diet can be helpful.”

    Hope that helps you 🙂

  35. Hi Wout,

    Thanks for those links – I’ve listened to all of Chris’ podcasts but hadn’t heard his guest appearance on Robb’s show.

    Anyway, I’ll give it a try but given that my visual migraine is permanently occurring (btw, I actually don’t get headaches), I’m not sure how much impact this could have. I used to get these nasty acute visual migraines but haven’t had one in a year (I think mainly from change to paleo/phd type diet and stress reduction).

    Thanks again.

    Best,
    Adam D

  36. Hi Paul,

    can you give me advice on a dietary protocol for treating recurrent epididymo-orchitis? I had a really bad case of it years ago which resulted in inflammation so bad it ‘strangled’ my right testicle of blood, causing it to wither away to nearly nothing. According to follow up lab work, this dramatically impacted my testosterone levels, and my sperm number and quality dropped off so much it effectively made me infertile.
    All infection tests came back negative, and the ultrasound showed no sign of tumours. I was given antibiotics anyway, and the inflammation went away about a week later (after destroying my right testicle)
    I’m in the process of another flare up, on my remaining left testicle, and managing to limit the inflammation with high strength diclofenac, although it is still significant. Again, urine tests show no infection. I did a course of trimethoprim as a precaution but it did nothing.
    My GP is baffled, and thinks (by process of elimination) it could be ‘chemical epididymitis’, which is where a structural defect in my urinary tract is allowing urine from my bladder to flow back into my epididymis.
    This may have been caused by tearing in my groin from years of heavy powerlifting and olympic weightlifting i did. This makes sense, because the 1st time it happened i rushed through a heavy back squat session without voiding my bladder before hand, and this time it flared up immediately after doing several sets of high repetition pistol squats.
    Alcohol also seems to aggravate the inflammation and pain once the metabolites of the booze get into my bladder.

    I realise now that i will have to be teetotal for the rest of my life, and also probably give up any form of exercise that triggers significant core muscle exertion. That, combined with loss of fertility, and poor body composition from hormonal damage is quickly leading me to a state of depression.

    I’m thinking i need to basically keep my bladder as clean as possible for the rest of my life, and also eat a diet that is highly anti-inflammatory.
    My diet currently is moderate-carb paleo, with a small portion of raw cheese daily. I do eat a lot of raw and fermented foods, and im thinking that might not be a good idea.
    Can you give me any advice? Would a modified version of the PHD help?
    Thanks for your time

  37. Hi Paul,

    I’ve read and re-read the PHD book and find it to be the best hope for dietary advice and overall health. Thank you. I have a question on high blood glucose.

    I am 59 years old, with an athlete’s body (good muscle mass, very low body fat, resting pulse in 50s, beautiful blood lipid profile) with a “healthy” lifestyle. I have lifelong food allergies, hypothyroidism (diagnosed in 30s), migraines, minor digestive complaints and Candida-like symptoms. There is absolutely no history of diabetes in my family. I’ve been following the PHD for a couple of months and the benefits are compelling (and it was similar and more or less Paleo for over a year before) yet I continue to run blood sugars of between 100 and 110 fasting and typically over 150 post-prandial. (The issue was discovered four years ago by and NP, and now I’m monitoring.) Keto 7 DHEA, which I have taken for over a decade, helps normalize my thyroid (I’ve been taking desiccated supplements under medical supervision for many years) and it’s supposed to help with blood sugar control, also. I’ve been a heavy supplement-taker otherwise, too, although I’ve pared way down.

    Any thoughts on the high blood sugars, what could be the cause and what could be done?

  38. Hi Paul,

    I am using all the knowledge gained from your book. Before it I was already convinced that sugar was the biggest offender in a diet. Recently I am obsessed with the idea of buying a blood glucose meter as a tool to help me analyze the effect of my favorite dishes. I would like to think of it as a weapon for some weight loss but I am not sure how I should use it.

    I would appreciate some comments, links… maybe a future post? about how we could use a blood glucose meter to analyze our eating habits in order to optimize our diet for a healthy life and/or weight loss

    thanks!

  39. Lindsay Jane Grier

    Hello Paul

    I have recently finished reading your book… very exciting information. I formulate cosmetics in the natural and organic domain, which means that my oil phase in my creams is made up of vegetable oils. Should I be applying the same principle of vegetable oils low in omega-6 fats for application to the skin? Should I concentrate on using coconut oil, palm oil, cocoa butter, olive oil, avocado oil etc instead of safflower, evening primrose etc. If you have any opinion on this and recommend certain oils for the skin I would appreciate some feedback.

    All the best and thanks
    Lindsay

    Hi Lindsay,

    I’m not sure … the skin is a major site of polyunsaturated fat usage, and polyunsaturated fat oils are richer in vitamin E and other possibly useful fat-soluble nutrients. I’ve never used oil on my skin and I haven’t studied the literature here, or the experiences of others who have tried alternative oils. You probably know more about this than I do!

    Best, Paul

  40. Hi Paul,

    I recently got some bloodwork done and was wondering if you could help me understand the results so I can better discuss them with my doctor. Initially I got the blood work for reasons of fatigue and other hypothyroid symptoms. TC :160, hdl 28, Ldl 124, trigs:60, tsh: 2.74, free t3: 91, free t4: 9. I also had c-reactive protein at .9 (the range is <.8) and an albumin/globulin ratio of 2.2 (range is 1-2.1) and testosterone of 421 (range is 250 to 850) . Thank you very much for any time you can spare on this question.

    Hi Jonathan,

    HDL is extremely low, TC is low. One possible cause is infection with a eukaryotic pathogen, probably protozoal but could be fungal or a worm. You should discuss possibilities with your doctor. It is definitely not normal for HDL to be so low, especially on a Paleo diet.

    Best, Paul

  41. I know you’re busy as always, Paul, but I’ll throw my question in the queue 🙂

    When a person does the ketogenic version of PHD, with 200 carb calories, I am wondering if that number can be upped a bit by eating a few carbs prior to exercise. In posts on muscle building, you have suggested an extra 100 or so carb calories for each hour of exertion won’t hurt. Would the same advice apply to a ketogenic diet? I ask because I find the ketogenic diet to be a bit draining if coupled with intense aerobic exercise or weightlifting. Maybe I’ll just experiment and have a potato or banana before working out and see if I still feel “ketosis-like.”

    Thanks as always for being so generous with your time.

    Hi Thomas,

    Yes, you can up carbs by the amount you use in exercise. You can also increase carbs even more, and increase coconut oil/MCT oil at the same time. Experiment to find what works best for you.

    Best, Paul

  42. This is a question about the Budwig Diet and how it can be used with the Perfect Health Diet.

    Background: Last summer I was diagnosed with Stage 1 CLL. I’ve been eating more meats/fats and less carbs for a long time to stave off diabetes, etc. (I’m 67 years old) So when I heard about all the cancer diet approach (low fat, no meat, etc.) I ate nothing but rabbit food for awhile, and did not feel as well – I did add back some meat and my healthy coconut oil. But the one thing that saved me was the Budwig Diet – daily “meal” of 2/3 cup low fat cottage cheese blended with 6 tablespoons of flax seed oil (a lot of protein and good oil). That and other things on the natural “protocol” I’m on have helped against the cancer. Then I found the Perfect Health Diet! What revelation – I feel even better on it.

    My question: How does one figure in the oil and protein content of the cottage cheese (2/3 cup lowfat cottage cheese)? After reading your book, I assume that the amount of this oil is not a factor. But how much more protein do I need to eat at dinner? (I only eat lunch and dinner)
    Another question: It it very hard to find good cottage cheese where I live, but I’ve found some great Greek yogurt – but it has to be tripled, making it 2 cups of yogurt with the 6 tablespoons of flax seed oil. How would this factor into the protein for the day?

    Thank you.

  43. Hello,
    Does anyone have the link where Paul talks about how to do a safe keto diet? I found on the page he speaks about Hasimoto and the 2 children who had iron brain dysfunction.
    Also, how to implement a safe keto diet for a 4 year old child on the autistic spectrum with chrohns..GAPS intro caused alot of muscle wasting and weight loss
    Thanks,
    KATE

  44. I’m casein intolerant, so all dairy is out. Nuts cause extreme gas and bloating, even if soaked. Grains tend to cause gas and bloating, even rice. I’ve been off gluten for years, but even gluten-free products are a problem as far. Can you point me to some recommendations for how to work around these limitations in order to implement the diet?

    Many thanks.

  45. Hi, Michele
    There’s a type of work called Nambudripad’s Allergy Elimination Technique (NAET), which was developed by an MD who is also an acupuncturist. Many acupuncturists are trained in the work and it is highly effective. It’s likely that if you had the work done, you would be able to eat the foods you’ve mentioned without the adverse effects.

  46. Dear Paul,
    a few quickies (I hope 🙂
    – a high dose of Iodoral (4 tablets) gave me wonderful energy and mood, and for once I didn’t feel a bit like I’m driving with the hand brake on (despite T3-levels being corrected to the higher end of “normal” with meds (Naturethroid). Towards the evening I feltepy, and never felt jittery, palpitations etc. Do I understand you correctly; I should still start with a very low dose of Iodine, despite the lack of any ill effects from the high dose?

    -any dietary recommendations for the musculoskeletal system to avoid herniated discs, muscle pain, tendonitis etc? I’m thinking collagen, vitamin C, vitamin D, copper, sulphur.

    -the company selling the Metametrix test you recommend for stool analysis doesn’t give out their prices. How expensive is it? Id rather not have topay for an office visit with an otherwise unhelpful doc to find out. Can you give your readers some ballpark idea?

    Lastly, is thee some additional benefit to you if your readers buy books via the website? Id rather direct my patients her if that is the case. (I’m a phsyical therapist by profession and find that most of my patients are unaware of how.much dietary factors affect their symptom and therefore like to recommend your book and blog to them).
    All the best,
    Lilian

  47. @Kate – Paul answered your original question (that you posted on a different thread – “Ketogenic Diets 2”, I think). In his reply you’ll see that he doesn’t necessarily recommend a ketogenic diet for your child.

    FWIW, as someone who experienced muscle wasting and hypothyroid symptoms on GAPS, I agree with Paul’s suggestion to try to find a way to include glucose in your child’s diet. Adding glucose to my diet (when I switched from GAPS to PHD) has made a big improvement in my health.

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