Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,


Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?


Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.


I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?


  1. Thanks. Yup, taking the vitamin K out of the nattokinase seems ridiculous.The reason usually given is that it antagonized anticoagulant drugs like warfarin. I guess they think that people may try combination approaches of prescription and natural clot-busting therapies and run into trouble..(or maybe they’re afraid that they won’t run into trouble and will instead be weaned from their expensive medications.

  2. George Henderson

    I think Michael has a point about dairy, some people will probably do better on PHD without it.
    I find, whereas wheat, corn, soy intolerance are non-negotiable, dairy intolerance is moderated or removed by other factors; high-fat diet, vitamin D, grape seed extact (binds to casien), probiotics.
    And it is brought back by exposure to other food toxins.
    Cheese is a convenient way to get some K2 and helps with cleaning and remineralising teeth.
    No other potentially toxic food is nearly as nutritious. Or as tasty.

  3. Hi Paul,
    I haven’t been able to thoroughly read through your blog or book yet but am wondering if you have a specific page devoted to SIBO. I’ve come across several posts where it is mentioned but never thoroughly discussed. I suspect I have SIBO and have likely had it for about 10 years.

    Here is a quick health history
    -around 9/10 years I became quite overweight
    -around 13 I started to lose the excess weight -even though I became a normal weight, I had abdominal distention – not bloating. It isn’t uncomfortable except it makes me very self-conscious
    -also developed mild acne around 13 years of age that never disappeared
    -I’ve tried several medicated face creams, antibiotics, and accutane (worked for a year)
    -also tried Loren Cordain’s dietary cure for acne which gave me gastrointestinal distress and an MRT food sensitivity diet
    -after the MRT diet, my skin was beautifully clear! But after a couple of weeks, the distention and acne returned
    – around 17 years I started eating low carb and eventually went to gluten-free low-carb
    -this eliminated seconds long “zone-out” periods I would have
    – I maintained this diet for a few years until about a year ago when I realized I could probably be classified as “orthorexic.” Plus, my acne has never totally disappeared and I started to develop new problems
    -about 3 years ago I started to get this chronic smell of old cheese after I ate something with dairy. I cut out dairy for a while and can now eat some dairy products without getting that smell
    -I’ve never had problems with constipation or diarrhea (unless I was sick)

    About a year ago I started developing a pimply rash (not itchy or uncomfortable) on the backs and top of my thighs. In addition, I started to chronically sneeze. I thought it might be allergies to a new dog (we had her for about 8 months) but the sneezing has persisted even after moving away. It gets so bad that I’ll wake up from an early stage of sleep with violent sneezing.

    I’ve recently started incorporating some safe starches in my diet and love it! I no longer have my after dinner carb cravings! I also don’t find it necessary to have chocolate (previously, I was a severe dark chocoholic). In fact, I now often prefer something like a strawberry cake over a chocolate cake. In an interview with Chris Kresser you recommended taking Bentonite Clay for fungal infections. I suspected I might have one so I started taking it. I didn’t notice major results until I stopped taking it. My distention became more pronounced after taking it (it had subsided a bit while taking the clay) and I realized that while on the clay, my underlying skin was nicer. Even my sister noticed the change after I stopped. I resumed taking it but this time around my distention is quite severe. I’ve also noticed in the past few years that I can only work out for about 20 minutes at a time. I can do light exercise (like walking) all day long but anything more intense and I’m quickly zapped. I’ve also tried some intermittent fasting (not eating till about noon) but find myself getting headaches. I know that I’m hypoglycemic and wonder if this is why.

    I’m working on dietary changes in line with your book (I need to purchase a scale so I can get a better idea of my macronutrient ratios) and already take vit. D. I’m leery about taking a multi-vitamin because several times I’ve noticed myself becoming moody a couple weeks after taking multi-vitamins.

    I don’t know what to do about the abdominal distension and the sneezing. The sneezing is becoming a real problem and I’d like some guidance. I’m only in mid-20’s and I’m worried about future problems. What do you recommend for the sneezing and distention?

  4. George Henderson

    in my case sneezing is definitely linked to dairy. On days I don’t eat dairy I don’t sneeze more than normal. It’s a delayed reaction (perfumes and dust are triggers, but dairy is the sensitiizer). Grape seed extract 200mg OPC caps have stopped it at present.
    The cheesy-smell factor suggests a sensitivity.
    In my case it is a lingering taste. I’ve found that intermittent fasting (8 hours eating, 16 hours fasting) eliminates residual taste sensations and cleanses the palate.

  5. George Henderson

    You should probably arrange IF so you’re not eating at night. for me, 10am – 6 pm is good.
    You are trying to strengthen circadian rhythms, so shoould probably keep it in time with those.

    • Thanks George,
      Maybe I’ll try eliminating dairy for a while again and in the meantime, try to heal my gut more so that I can tolerate it again. IF from 10-6 seems more “normal” to me so I’ll try that – hopefully I can avoid the headaches that way. I also find that I often get bad breath (I think its derived from my stomach because a simple teeth brushing doesn’t get rid of it) from some dairy. Has that ever happened to you?

      • I had that – i went to see a gastroenterologist who did an endoscopy and discovered that a value that shuts off the stomach opening when you swallow wasnt shutting so the smell of rotting food was coming up unabated, he gave me some pills to take which resulted in this trap door valve shutting normally and ive never had a reoccurance:

        The pharynx
        The pharynx, or throat, is a short, muscular tube extending about 5 inches (12.7 centimeters) from the mouth and nasal cavities to the esophagus and trachea (windpipe). It serves two separate systems: the digestive system (by allowing the passage of solid food and liquids) and the respiratory system (by allowing the passage of air).

        The esophagus
        The esophagus, sometimes referred to as the gullet, is the muscular tube connecting the pharynx and stomach. It is approximately 10 inches (25 centimeters) in length and 1 inch (2.5 centimeters) in diameter. In the thorax (area of the body between the neck and the abdomen), the esophagus lies behind the trachea. At the base of the esophagus, where it connects with the stomach, is a strong ring of muscle called the lower esophageal sphincter. Normally, this circular muscle is contracted, preventing contents in the stomach from moving back into the esophagus.

  6. George Henderson

    I’ve never had that feedback, but the babyish taste was annoying. Maybe it feeds some probiotic fermentation. But the IF has cleared it.
    I wonder about IF effects on microbiota composition…
    Opioid addicts sneeze when withdrawing. What if milk digestion opoids like BCM-7 and other casomorphins (or other prolamines) are endorphin antagonists in some people? Endorphins can be quite specific and not necessarily pain-related.

  7. Hi Paul,

    I emailed you a few days ago with childhood onset ulcerative colitis, migraines, and had a very slightly low platelet count (134-146) that the dr is “keeping an eye on”. One doc thought ITP might be lurking around. This spurred me on to make drastic changes, eg. gluten, darity and preservative free. Last test revealed a normal platelet count (150). When I was at my appointment, they did a whole battery of tests which I’m sure miss out on a lot of important information. One test in particular was the auto differential test, my lymph%auto was 16.8 with the standard range being 20.0 to 50.0. Do you have any idea what lymph auto is and what could this # indicate? I am guessing that my platelets were within the normal range, this is acceptable but if paltelets were not, what would it indicate? Also lymph absolute was 1.4 which seemed on the lowish end. Any thoughts?

  8. This is probably a lame question, but mixed with my happiness in finding the PHD is a nagging question..I’m a smart guy and have been looking into health improvement info for many years, but I only discovered PHD a couple of weeks ago by googling ‘diet for perfect health’.
    Maybe this is more of an observation than a question – it bugs me though that I hit on this almost by luck. It seems to me sometimes that whether you find good information or not depends on how adept you are a finding alternate phrasing for whatever question you have. People without good English skills are kind of out of luck…at my engineering job friends would ask me to find the most basic things for them on the web because they didn’t know how to search for it in writing.
    Maybe I’m making a big deal out of not much, but why didn’t a high-IQ guy like me, who reads tons of health info, find this 2 years ago when it first got out there? And how is it best made easier for people to find? How best to make quality material stand out from all the other data on the web?

    • Steve Reichard


      Having solved several serious health problems myself, unfortunately the brute-force method of reading and reading and reading is the best method I have found. It’s like a whale, who takes in tons of seawater, just to get at the tiniest of creatures.

      For example, I had a dry eye problem that caused me all-day pain and headache, roughly 50% of the days. No doctor could help me. No book helped me. Finally, after three years of researching it on the web, I ran across the solution, which was nothing more than a specific kind of over-the-counter eye drop that had a low-salt content.

      It’s sad that I had to work that hard to get an effective treatment, but that’s the reality of the state of medicine today. Hey, at least we have the internet – otherwise, the research would be ten times harder.

      I also think that most people don’t want to hear about people like Paul and Shou-Ching – they would rather believe what they’ve been indoctrinated with from organizations like the USDA, AMA, AHA, etc. Open-mindedness is truly a rare trait, and closed-minded people frustrate me to no end.

    • Perhaps because Google brings up the politically correct entries first and it takes the most creative phrasing to force it to come up with the information you require.

      I’ve been trying to figure out why I’ve been losing my hair for the past 60 years (starting in high school) and continuing unabated all these years … and believe me I’ve gone to every imaginable doctor and tried all kinds of topical treatments, supplements, etc.

      Alas the PHD and Paul’s recommended supplements, while wonderful and like others here I’d never go back, hasn’t helped the hair loss.

      It’s been the bane of my life.

      • Maybe hair loss isn’t a health issue. I always assumed it’s a genetic variation that isn’t amenable to any type of ‘cure’ until genetic tweaking becomes feasible.
        I’ve had my DNA analysed by 23andME and was going to suggest that to you, but as I recall they haven’t even found an SNP yet that controls baldness.

      • Sorry Erp, I didn’t even consider what gender you are, or that you may not be talking about male pattern baldness even if you’re male.

        • George Henderson

          Two things suggest themselves; 1) alopecia is a symptom of gluten sensitivity – so could other food toxins also cause it? Dairy can metabolise similarly in some people. Eggs might be another possibility. Unfortunately, there would be a time delay before results from any elimination.
          2) consider Chinese herbs – Fo Ti or He shou wu is used for hair loss. This supplies lecithin, pterostilbenes, OPCs. It may be that antioxidants can block the loss. There is a lot of cysteine in hair (cysteine supps are made from recycled human hair – true fact). When I started on NAC, selenium, manganese, zinc, C and E years ago my hair was obviously affected. Growth slowed down completely but hair didn’t get damaged even though it was hardly being replaced. If my hair had been sick to begin with, I wonder how this would have played out.

          • George Henderson

            Fo Ti forum which seems genuine:

          • George, you are so kind to take the time to answer me. I’m a 77 year old granny who has tried adding and eliminating every imaginable food and both internal and external remedies. My problem is neither alopecia nor male pattern baldness and at this point, it doesn’t matter except that I’d like to know what is causing it.

        • cronkser, don’t be sorry. I really appreciate your concern.

  9. George Henderson

    I got here because Paul posts opionions under all sorts of arcane headings of interest to people like you and I. Whether I actually knew I was reading part of the PDH the first few times I doubt.
    Claims like perfect health are easy to make, it’s the depth of the thought and diligence behind this blog that one needs to experience to make the name mean something.
    I find references to PHD and Paul Jaminet all through the Paleoblogosphere now, and imegaine it gets easier to find the PDH all the time.

    The Safe Starches “great carb schism” was an effective publicity stunt in this regard!

  10. Paul, anyone: What’s your view on the recent emerging buzz that the typical hunter-gatherer tribe eats only once a day? If humans can only absorb around 35g of protein at one time, this would mean that even H-Gs eating very high protein diets would ACTUALLY be on very low protein diets. This is huge no?

    • *light switches on* Ok I should let Paul answer first but I’m really stoked by this, it corroborates what the book says about protein needs being quite low.

      I found this paper that discussed protein fermentation by the colon (that 35g number you give is basically what the small intestine can absorb before the food reaches the colon) and it found that protein fermentation produced potential carcinogens that however fail to be carcinogenic: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518970/

      Presumably the body has protective measures against protein fermentation toxicity and if those fail that may result in increased cancer risk? Ergo don’t eat too much protein especially if it’s hard to digest?

      Hmmm, does that mean don’t eat a lot of cheese? Parmesan has 38% protein… :-/

      • Yes I’m STOKED too Wout, I’m like I little kid going “But, but, but….” I read this first in Loren Cordain’s new book — the one where he “softens” (does a U-turn) his stance on sat fat, and says he’s researching meal timings but that the emerging picture is “one meal a day” and “H-Gs have WISDOM built in.” Which I agree with because over time, the best practices emerge — tradition.

        I read somewhere that excess protein ends up being converted to fat??

        As I say Wout, Biochem is not my thing so maybe you can dig, and see what you can find out. I have posted this question ALL OVER the paleo eating internet 🙂

        I agree with you that it does lend credibility to the lower % protein on the PHD.

        Also, it suggests to me that grazers should eat only very small amounts of protein at each eating. But I’m getting way ahead there, I really don’t know WHAT this means yet 🙂

      • Wayne D Johnson aka Prouddaddy

        Your study was in rats, and I’m not sure that they handle protein the same way as humans. What I DO know is that we old folks had better hit the protein hard or become frail. Whereas you youngsters can stimulate muscle protein synthesis from a 20 gram serving, we need at least 40.

        I seem to remember that Kitavans eat twice a day with an occasional snack, but this wouldn’t be my first mis-remembrance.

    • It’s not true that humans can only absorb 35 g protein at one time.

      • Ah it’s so easy to get carried away on a light sprinkling of almost-facts 🙂

        So Paul, do you know of any limit in protein uptake from a single meal in a healthy adult? Perhaps the digestion slows down dynamically so more protein can be absorbed? It is correct that the colon doesn’t really do protein uptake, right?

        I found this study in short bowel patients that states that they managed to absorb up to 65g/day depending on small bowel length so presumably there is a limit unless I’m misreading. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774175/

        • I like your thinking Wout, that’s where I’m coming from. I read that for example, egg protein might be digested at 1g/hour. Don’t hold me to these figure, it’s just explanatory.

          No, if it’s all over once food hits the large bowel AND H-Gs only eat once a day???????? I smell a rat. Stuff is not adding up again.

        • Neat paper Wout. Yes, there must be a limit, but I haven’t investigated exactly where it is. I’m sure it’s higher than 35 g per meal. It is probably variable. It makes sense that we would take in a lot of protein when deficient, and refuse to take in toxic amounts, just as iron absorption decreases or increases depending on iron status.

  11. Hi,

    I wonder If someone have an idea to my problem: I startedt with the Paleo Diet, go to the perfect health diet and now eat Low carb high fat, avoiding Sugar, potatos, oil from plants, white flour at most times, eat more meet and butter and cream. Since this time (3 weeks) I suffer from a kind of diarrhoea only in the morning. I have no problems with less fat and less meet.

    • is the leaky bowel movement painful? do you just want it to go away? why not reduce your fat intake and see if that fixes it?

      • or take psyllium husks before bed to firm up stool

      • No it´s not painful, I only want to go it away, except its not a reason to concern

        New is, I become problems to avoid sugar; for weeks that wasn´t a problem, but now I can´t denie Cola or Cakes. Maybe I have to start again with starve a while

        • Ouch, every time I have a craving for sweet foods it’s because I didn’t eat enough real food… Are you eating enough? When I am still hungry at the end of a meal I eat more veggies and fat until I’m satisfied…

  12. Sherri Wilson

    Tried to look at your Good Friday Prayer…it disappeared.

  13. Paul, anyone: I came across this while researching optimal macro ratios. What amazed me was the consistency of human choices across all the sports featured. The macro ratios were remarkably consistent: around about 16% protein, 48% carb, 36% fat.


    Any thoughts?

    • Nice find, thank you. Hard to tell if they’re eating that way because it’s optimal or because everyone eats that way.

      • Yeah it’s the grain paradigm — the cereal/milk — sandwich — pizza/pasta diet 🙂 Lovin’ the book, so much cool stuff in there, I just wish there was something concrete about OMNIs. Don’t water soluble vs fat soluble vitamins give clues as to how much fruit and veg we need and therefore the amount of carbs? If we limit these things and replace with fat and white carbs are we not also swinging away from a net alkali load?

        • What are OMNIs?

          As for the vitamins, aren’t the available foods so varied across the world that it’s hard to say what “normal” intake of vitamins is supposed to be?

          As for the alkali load, a healthy body should be able to cope with any sort of input pH.

          I like to think of the body as a giant interconnected set of self-regulating systems. Pull a variable one way and three variables change to compensate. Pull a lot of variables in extreme directions (hello SAD and modern lifestyle!) and the system starts falling apart.

          I also like to think that PHD tries to optimize the variables we know about so all the self-regulating systems are in their normal operating range, in other words optimal as far as we know.

          • OMNIs are Optimal Macro Nutrients Intakes.

            “As for the alkali load, a healthy body should be able to cope with any sort of input pH.” Nah 🙂 This year, yes, for 5 years yes…. 20, 30, 50… no.

            “Pull a variable one way and three variables change to compensate.” Yes, in the short term, like pulling calcium out of your bones to compensate for an acid load. I agree re SAD, but if that is true, then it is also true to a lesser degree whenever the diet is sub-perfect.

            “I also like to think that PHD tries to optimize the variables we know about so all the self-regulating systems are in their normal operating range, in other words optimal as far as we know.”

            Yes that’s what it aims to do, but when I ran the numbers earlier today, based on Paul’s daily amounts on the “PHD on one page,” the water soluble vitamins were very low, protein was 26% despite me using the fattiest meat — lamb for the meat portion. Also fiber was only 15g. And as I said, the amounts of fruits allowed and veg entered as in the book, along with the amount of protein, would incur a net acid load.

            I’m just trying to see how PHD works in practice. What I REALLY need is the PERFECT DAY on the PERFECT HEALTH DIET — give me the numbers… e.g. breakfast, 2 eggs, 1 apple, 1oz nuts. Lunch 1oz salad leaves, 4oz tomatoes, 6oz roast lamb, 4oz sweet potatoes, 1 tbsp olive oil. Etc.

            Then there is no room for doubt and we can all see EXACTLY what PHD actually is. As it stand I have work to do to translate Paul’s data into food on my plate.

            Can we have a 2000 calorie reference diet for PHD that we can use as a template?

            I crunched the numbers this morning in about 20 mins… it shouldn’e be hard to do.

          • Hi Michael,

            Your food mix was close but a little light on plants – 3/4 lb safe starches, 3/4 pound other plants (mostly fruits) – we recommend 1 lb safe starches and 1+ lb vegetables for a similar carb intake but more plant food – and you had 1 lb meat plus 4 tbsp oil, which are on the high side a bit.

            Acid/alkali, all you have to do is come close and get enough minerals for buffers and you can urinate away enough acids or bases to be optimal. Since we don’t eat acidic grains and eat more plants than animals, the diet isn’t acidic anyway.

          • I’m confused Paul 🙂

            I had

            9 oz safe starch
            9 oz fruit
            8 oz veg (total 17oz fruit and veg)
            1 oz seaweed
            19.25 oz meat/seafood/eggs (oops)
            1 tbsp ea of butter, oilve oil, coconut oil, lard. (as per page 2)

            Could you give me the breakdown in the categories I have here please?

            I.e. 1. Safe starch, 2. fruit, 3. veg, 4. seaweed, 5. meat/seafood/eggs, 6. oils + fats. Oh and let’s have an extra one — 7. nuts/seeds 🙂

            Many thanks, much appreciated!

          • Hi Michael,

            The food list you sent me had 7 oz vegetable, total plant food 25 oz which is 1.56 pounds. It came to 400 carb calories which is at the bottom of our range, and 143 of them came from fruit which is a bit high, but more importantly you counted vegetable calories which we say not to do (because we are targeting usable glucose, and glucose is lost in digestion) … safe starches only provided 236 calories which is low, we want 400+ from there … If you had targeted 600 carb calories total, 400 from safe starches the other 200 from sugary higher-calorie plants (not vegetables), plus added in a pound of vegetables, and cut the meat down a bit, then the nutrient mix would have been more balanced.

          • Cool, so I want…

            400 calories safe starch
            200 calories fruit
            16 oz veg
            16 oz meat/seafood/eggs

            Is that right? How much oil/butter/fat and how much nuts?

            Thank you.

        • That’s pretty good. Fats, go by taste and appetite. Choose proportions that make food taste good, and eat to appetite.

          Since I don’t know precisely how many calories you need, I can’t prescribe a specific number of fat calories.

          • Excellent, thanks 🙂

          • Earlier you told Michael that 153 carb calories of fruit was “high.” But here you seem to say that 200 calories of fruit is “pretty good.”

            Don’t know what I’m missing. My morning smoothie comes to 166 carb calories and 209 calories. (Multiplying carbs on scale by 4 to get carb calories.)

            So, the 166 is high but the 209 is almost “pretty good”?

            Please help me sort this out.


          • Hi Pam,

            Fruit is OK but personally I’d favor a bit more diversity in sugary foods. We have beets pretty often for instance…. In terms of proportions, I think sugary plants should be around 1:2 to safe starches in terms of calories … So 200 sugary plant calories is a good match for 400 starch calories. … I probably should have said his first one was low in starches rather than high in fruit.

  14. That sounds about right for athletes. On days when I play 4-6 hours do competitive volleyball once or twice a week, I eat way more carbs. I’ve learned to do this since starting PHD – otherwise I get weak and sometimes nearly faint.

    • Hi Peter,

      The athletes macro ratios were the same as the general population…

      “The mean nutrient intakes of athletes compared with the general population are presented in Table 1 . Although energy intakes were higher for the athletes than
      for subjects of the CSFII-1985, the percentage of calories from carbohydrate, protein, and fat approximated the general US population.”

  15. George Henderson

    The athletes were healthy on those ratios.
    The rest of the population, not so much, maybe?
    After it, it was the general US population.

  16. Hi hope you can shed some insight,

    I follow a paleo style diet.

    my paleo diet is low carb say 50 carbs a day max.

    I do not eat a lot of saturated fat except virgin coconut oil, say max 1 big table spoon a day in meals.

    I do eat a handful of mix nuts each day mixed with sunflower seeds.Have done this for say 1 year ,I cut down a lot in the last month.

    hmm I wonder if the zinc content depleted the copper in me??? and raised LDl.

    My LDL is also elevated results below are all from lab tests,

    My ldl began to soar with my paleo style diet.which I started about a year ago.

    Before that my total cholesterol was 6.2, so hdl was low and trig high and ldl high, yes bad Ratios.

    it was something like this below ,

    Total Cholesterol: 6.2 mmol/L = 241.8 mg/dL

    LDL Cholesterol: 4. mmol/L = 156 mg/dL

    HDL Cholesterol: 1 mmol/L = 39 mg/dL

    Triglerides: 3 mmol/L = 267 mg/dL

    my vit d and b12 was low at this time so I started supplementation.It is okay now.

    over this period I lost circa 7 kilo, I am not overweight now.My BMi weight index is fine

    but it improved my HDl , and triglycerides.

    I am type 2 diabetic on diet only, no medication for it.Have been this way 4 years.

    I also have hypothyroidism, I take T4 and I also started taking T3 medication too 5 weeks ago, As my T3 was just a bit below the minimum range.

    After starting the T3 my total cholesterol has dropped circa 10 % mainly LDl but i would expect a greater drop as My T3 is in the max range now.
    and it ws jsut at minimum levels before.

    My diabetes is fairly well controlled ,as per results below,

    Blood results ##

    Below are Uk and USA readings

    cholesterol total 9.7 mmol USA 375. << this was 10.5 mmol before starting the T3

    triglycerides 1.03 91 USA

    hdl 1.59 USA 61

    LDL 7.6 USA USA 293

    Thyroid tests Tsh 0.11 range is 0.3 4.2
    Ft4 17.7 range is 12 -22
    Ft3 6.7 pmol range is 3.1- 6.8 pmol <<< see my t3 has raised with the t3 meds.

    Thyroid antibody test looks good so possibly no hashimitos ? but perhaps a conversion issue T4 to T3 ,

    tpo ab 7 range is 0 -35

    hb1ac 5.7 % range is 4.0 – 6.0

    new range 39.0 mmol range 20 -42

    Inflammation markers below ## seem to look good so not sure why the LDl is not clearing. unfortunately i have a long wait to get the results of my LDl sub fraction test, hopefully it is the large fluffy kind , but still it is way too high.

    Inflamation markers.

    crp <1 range 0-5
    ESR was 5 mm/hr range 1.0 10.0

    minerals vitamins''

    ferritin 75 ug/l range 14 -200

    vitamin B12 323g/ml range 200-660

    Magnesium 0.82 range mmol/l range 0.7- 1.0

    vitamin D 85 nmol divided by 2.5 = 34 ng USA

    I have been eating virgin coconut oil, a bit of salad,fish , free range meat etc when I can get it.


    B12 brazil nuts or selenium for my thyroid vit B complex fish oil , krill oil, magnesium all minerals chelated, vit C

    any ideas folks, I hoped the T3 medication would lower my LDl, nut alas , I have not prevailed.

    I get fibre from a big spoon of flax and a handfiul of nuts and seeds, but I can always increase this .

    Bowel movements are fine min twice daily. as I also have a good table spoon of greek yoghurt daily , it is high in fat % but I eat max 2 spoons daily ,frozen with berries.

    The fat is definitely not from food, not in the last 6 months anyway , even before that I did not eat much fat or butter only the fat on a couple of lamb chops.Or a spoon of butter on scrambld eggs.

    And I do not eat processed products meat or otherwise.

    Regarding visceral fat , no pot belly here , I am fairly slim now my BMI body mass index is 25 which is fine .

    At most I am 1-2 kilo overweight.

    hmm interstitial fat being dumped, but my weight loss was not drastic, and it has been stable for about 5 months.So in theory this is quite possible but seems unlikely imho. but its one to watch …

    I do have a little fat on my stomach but very little no six pack here
    liver enzymes tested

    Liver and renal tests below.

    renal and liver all tests come back in middle of lab ranges or just below, had these done a few times to check , nothing suspect here,unless there is something particular to check that would indicate increased cholesterol production.?

    liver tests show

    total proteins 76g/l range 60 -80

    albumin 48 range 35-50 TOTAL BILRUBIN 14 G/L range 0 -17 alt(GPT) 14 range 7 -35

    alkaline photophatase 50 range 40 -129

    gamma GT 17 range 0-60

    does anyone know if chelated minerals can be taken at once like copper /zinc /magnesium/chelated. Or do they compete ?

    any ideas ? I am kind of stuck

    thanks chessguy

  17. Hello everyone,

    I have a question that someone from here might able to answer. The question is about white rice.

    I have crohn’s colitis diagnosed in 2007.
    I’m eating paleo since 2009, low carb, sometimes autoimmun protocol, sometimes less strict. I’m also taking my medication. I was able to reach remission with diet + medication in 2009 until last december. Last summer and autumn I ate potatoes and sometimes dairy, ice-cream.

    Since december I went back to strict paleo and tried to fuel my workouts with fruits and I could not go back to remission, I had symptoms.

    Last week I decided to add white rice in my diet because if I can’t heal myself 100% at least I would like to fuel my workouts a bit better. I cut the fruit, introduced white rice and my symptoms fade away within a week. I can’t really understand this. Can someone make sense out of this story? If so, could you please explain it to me?

    Thanks in advance,


    • well, fruit is generally unripe and picked too soon. most fruit will not ripen off the vine. fruit has tons of fodmaps, which are very dangerous to and ibs/ibd sufferer. sugar alcohols, pectin, fibers, starches – all create digestive havoc.
      white rice, while it is still starchy, has most of the other plant poisons taken out in the refinement process. white rice congee has been used for ages as a digestive tonic. if you can eat white rice and feel fine, likely you were reacting to some other constituents in the fruit. it likely has nothing to do with sugar.

  18. I too am having difficulties translating the apple map into real meals for maintaining and losing body fat -can Paul give us some daily meal plans by meal period per day up to the desired 2000 calories.
    I’m a 54 yr old causasian male 5 foot 11 inches @ 79 kg trying to loose 10% body fat – I’ve been following the Primal Blue print since 2009 and your diet for 2 weeks now with good results!
    I currently follow this:
    Breakfast – coffee black & I tblspoon coconut oil
    Lunch – salmon 8 oz – 8 oz root veg & 8 oz yam & 4 oz butter
    Dinner – 8 oz veg & 8 oz meat

    Not sure why I’m not losing more body fat though
    Mark Sissons in his blog offers a daily meal plan by dishes and I reckon many of us would benefit from the same information I know it would help me a lot!
    Many thanks indeed

    • i’m not sure people really understand the correlations between calories, food quality, physiology and body fat percentages.
      as we age, so many physiological rates begin to slow down, in nature’s preparation for death. just one of these is growth hormone, which drastically effects how food is used and partitioned within the body.
      if you or i were hunter gatherers we would still have pretty fair body fat percentages, to keep us from dying in emergency situations.
      if you, at 54, really want to get even leaner, you have to not under eat, which causes stress, which causes fat gain. you have to optimize digestion and absorption of foods, any problems with digestion will cause excess estrogen uptake and conversion. you will probably also have to do some serious sweating and ramping up of your metabolism, using some combo of thyroid manipulating foods & supplements. plus sprinting, and other short, intense resistance training which is anabolic in nature.

    • Hi Richard,

      I think the level of animal foods is good, but for a weight loss diet you could cut down on the butter. Also, cutting down on the meat and add some eggs would help, choline is important for weight loss. Liver once a week would also help.

      I think you would benefit from more plant foods. Yams may be 230 calories/lb and carrots 200 so you are only around 200 calories carbs. We don’t count vegetables. It’s often easier to lose weight when you eat 400-600 carb calories. Try adding more potatoes, potassium rich veggies like tomatoes, some bone broth for calcium and use it to make a vegetable soup. Get a pound of potatoes/sweet potatoes/yams per day.

      If you’re still having trouble losing after those adjustments, then you either need to exercise more or reduce calories by cutting fat a bit further (eg, reduce the butter, use vinegar with a smaller amount of butter or coconut milk to flavor the yam).

    • Wow 4oz butter! That is like…92g fat and 813 calories right there.

      The trick for weight loss is to balance carb/prot and cut fat. Works like a charm.

      I agree we could do with a 2000 calorie reference diet to put PHD in the context of real food. I mean not many people know what 400 carb calories is. OK you say 1 lb safe starches but then the options become difficult to compute. Please can we have “the perfect diet” in terms of real food on the plate for a 2000 reference… pretty please 🙂

      • This is something Paul & Shou-Ching have plans to develop, as Paul has noted in many previous posts/comments. Right now, finishing the second edition of the book is priority 1.

        Meantime, online tools like fitday.com are useful for determining the number of calories per macronutrient in a meal. Just enter what a typical meal is for you, note the carb cals and adjust your food intake accordingly.

        • Thanks Bella I’m doing that. I will post it to flickr when it’s right.

        • 2000 cal ref diet on PHD, my best attempt 🙂


          1 lb of safe starch does not work to get anywhere near the right macros. Also, counting vegetables as fiber and therefore fat makes it impossible to work out real food.

          Also, 1 lb meat/fish/eggs also gets you nowhere near the 15/65/20 macros.

          The data as suggested by the apple map, even with only 12 ounces meat (mid-range) results in macros about 42% fat, 22% protein, and 36% carb (using veg as carb calories of course).

          Bottom line… I can’t make sense of this diet as real food. To get somewhere near the right macros, you need only about 11 oz safe starch and only 6 oz meat and 1 egg a whole lots of fat… 4 oz nuts and 2.5 oz of fat.

          I think this diet needs s very simple list of real food items and quantities that people can actually make some sense of like the list I gave above… you know, how much safe starch, how much fruit, how much veg, how much nuts/seeds, how much meat, how much fish. Even with this info, there’s works to do, but as it stands it’s impossible.

          • Paul: I don’t understand why we can’t have a diet sheet just simply like the one I did… a list of real food that adds up to 2000 calories, that has the correct food items that can simply be swapped out for other stuff in the same group on different days… like apple today, pear tomorrow. If I’m confused, I’m sure other people must be too, cos I ain’t dim 🙂 Cheers!

          • Paul, we need the macros as real food, so that the veg, when it becomes fat, ends up at 65%. But trying to get 65% would not work, cos then you’d end up with too much fat when the veg is converted to fat. Bottom line we need quantities of real food groups and a macro of prot/fat/carbs that ends up being right when the body does its thing. E.g. 15/50/35

          • Hi Michael,

            Thanks, we’ll work this up.

            Your calculator is counting dietary fiber as carbs — that’s wrong. Also counting vegetables — that’s wrong.

          • I’m very confused. I can’t figure out what fitday is doing to get 141g carb to 555 calories.

            I read fiber may have around 2 calories… but only the soluble fiber. And then there’s polypols which can range from 0.3 to 3 calories.

            Then I read 4 cals per gram is rounded up and it’s really 3.6 calories per gram???

            However I shake it up, I can’t get the numbers crunching right.

            Very, very confused. But if we have a reference diet of 2000 cals, then you could explain all about fiber, carbs, polypols, rounding, blah blah blah and then we can have a clear template. Folks with higher or lower calorie needs could simply use a factor and round off to get into the right ball park easily.

            Thanks 🙂

          • oh, so fitday has accurate data for my 6 oz. grass fed hanging tender steak? oh, so all meat is meat on fitday? oh, so this is ludicrous?

            this is only a slight exaggeration.

          • Hi Michael,

            Just an observation on your fitday example.

            PUFA is 9% and PHD PUFA is <4%. I'd think 4 oz of nuts/day (700 cal) is too many nuts. PHD recommends nuts as a snack. The problem I've seen is with PUFA=4%, Vitamin E is below RDA and PHD recommends to only get E from foods. Maybe Vitamin E RDA is not the right limit when eating PHD foods. I'm guessing magnesium, selenium, copper, and zinc will all come down a fair amount depending on what gets swapped in for the nuts. PHD recommended zinc:copper is 10-12:1 with copper 2-5 mg/day. Eating liver for copper and oysters for zinc are food options to get there, otherwise supplements are needed.


          • Wow thanks Mark, now we’re talkin’ The UK RDA for vitamin E is 4mg for men and 3mg for women…


            I live in the UK so I’ll def be alright with less nuts 🙂

            Thanks very much Mark… Maybe the PUFA and vit E gives us good clues and to the amount of nuts to eat optimally?

            And let’s not forget the one Brazil a day for selenium!

            Gonna get that perfect day nailed somehow 🙂

            Thanks again Mark.

          • Hi Michael,

            One example day is good and it’s also good to look at one week for a daily average.

            I recently entered a sample week 5/13-5/19. No nuts. Feel free to check it out:

            Darrin and I discussed it a bit on the Supplements page:

            breakfast: eggs/potato/spinach
            lunch: beef/sweet potato/cruciferous
            dinner: seafood/rice/leafy greens for dinner.
            Each meal with ~1T added fat (coconut oil, olive oil, butter) on ~500 cal/day starch.
            Works out to roughly 20/50/30 P/F/C where carbs include more than just starch.

            One more thing to consider to boost potassium is to choose higher potassium, lower fructose fruits like bananas and raspberries. For me, I might eat more potatoes instead of rice every day.


          • That’s perfect Mark, thanks!!! 🙂 I will study 🙂

        • Michael…..Golf Clap !
          Much appreciated for the FIT Day chart -and i agree with your challenge in getting the macros to work.

          Well im pleased im not the only one who is fining it hard to make head or tail of the % ages the apple plate drawing and relating it to three meals a day.
          When one looks at the calories and macros of the ‘perfect plate’ combo salmon dish Paul photographs advocates and x that by 3 then again its all out of whack. For goodness sakes cant someone simply translate the PHD plan into three meals a day so that we can then work our own variations.
          Mark Sissons does this on Primal Blue Print
          Veggie Omelette for bfst
          Big ass salad with about 4 oz fish and a few pinenuts for fat for lunch
          broccoli and a small 4 oz steak for dinner
          snacks are a handfull of blue berries and perhaps a handful of almonds.

          Can we not do something similar here.

          • FWIW, I’m not counting anything. For me the macros chapter is a good intro to the biochemistry behind digestion, and lays the groundwork for the toxicity.

            From there and the PHD Diet Apple Chart, I mostly remember:
            1. Eat a few handfuls of safe starches (I just now realized that cooked potatoes and cooked rice both are about 20% carb – makes bread at 50% carb look pretty bad)
            2. Meat/fish is good for you but you only need a smallish piece, anything more is basically luxury
            3. Eat as much good fats as you like
            4. Eat as much veggies as you like
            5. Ice cream is crucial to good health 😉

            Like many, I started out eating pretty low-carb Paleo. It really improved my fat metabolism (e.g. when running or just hunger management) and lowered my heart rate and increased my breath-holding-time, but I often had ketone breath and constipation.

            Since eating according to the PHD-derived rules above I hardly ever have ketone breath (or constipation after supplementing) even when skipping breakfast but I retain all of the advantages. I have washboard abs (well the top two at least but the rest are coming along), a flat tummy and generally lowering body fat (visually, not “measured”). I don’t really exercise but I do bounce around a lot, use a standing desk and when I take my bicycle to somewhere I go fast (maybe an hour total a week).

            I may be really far off 15/65/20 (or not, no idea) but for me the above is a successful macro ratio and easy to follow. Maybe I’m an outlier but in my opinion the book could be even more vague on the macro numbers. I think that macro ratios are very individual and the “to taste” modifier that is sprinkled around the PHD is really important.

          • I get to the right macro levels by:
            1. skipping breakfast or having something small (usually fruit and yogurt or cream or sometimes an omelet)
            2. eating lunch and dinner in portions you would find at a traditional restaurant. Not a Chili’s or Olive Garden or the Cheesecake factory, but a traditional restaurant that doesn’t oversize portions — a decent serving of meat or fish cooked in coconut oil with a gravy or sauce, a side of veggies, often with butter, and a smallish side of safe starch. Sometimes also a soup from bone broth.
            3. occasional snacks or deserts when desired (“pleasure foods” described in PHD), but don’t overdo it.
            I tracked the calories for a week or two. The protein was pretty much spot on. The carbs were a little high and the fats were a little low, but I’m sure if you took out vegetables from the equation, the ratios would have been right. Now I just do it by feel and because I’m eating enough carbs and protein and so much fat, which is satiating (and also eating nutritious, delicious food), I don’t get hungry or hunger is mild and not like it was when I was eating way too much sugar.
            So for me, it’s not that hard.
            But yes, sample menus would be helpful. Perhaps down the line, a website like fitday that excludes veggies from the carb count (and even tells you if what you are eating is acceptable on the diet – e.g., the website shows food in red if it has vegetable oil, and also tracks PUFA levels and highlights this in red if too high or ratio of omega-6 to omega-3 is too low) would be great. Probably would cost a ton of money and labor to set up, though.

          • Actually, I am misremembering – I was tracking macro nutrients on the PHD diet so I think I left out vegetables, per the book’s instruction. So total calorie count was probably slightly (but not very) lower than what I ate, but I didn’t care about calories because I was never very hungry so didn’t overeat. I think my ratios varied day to day but were just about right (sometimes as high as 30% carbs, rarely lower than what Paul recommends; sometimes fat only 50%, etc.). So I think the key is just don’t log vegetables, which will drive up your carb count, and you can use fitday or other sites to find out the ratio.

          • Wout… you’re making a lot of sense as usual, except the icecream bit 🙂

            David… yes exactly, we just need to know what to aim for when we enter stuff on fitday or nutritiondata. What’s the goal that will get us into the sweet spot of “perfection” 🙂

  19. Your response to my question is appreciated I forgot to mention that I do resistance training and sprinting 3 days a week however tour remarks really don’t help with regards my meal and calorific planning just reiterates what I have already said that yes I don’t understand the relationship so perhaps some meaningful specific meal plans could help if someone can illustrate thanks

  20. you have to optimize digestion and absorption of foods, any problems with digestion will cause excess estrogen uptake and conversion. you will probably also have to do some serious sweating and ramping up of your metabolism, using some combo of thyroid manipulating foods & supplements

    Thanks Darius
    Can you elaborate on this with specifics and meal ideas ? Thanks !

    • unfortunately, there is no one-size-fits-all specific plan for the human race. every person must do their own self experimentation based on their own results and symptoms. the internet is your friend.
      see, your meals that you posted look fine, but i have no way to tell if you are under-eating or over eating, if you are eating the best quality foods and types of foods for your specific genetics and digestive quirks.

      but let me tell you honestly that i think if this is your everyday meal plan then you are drastically under eating. skipping breakfast to drink some coffee with one measly tablespoon of coconut oil. organ meats, gelatin, and carbs are your friends. looks to me like you got caught in the leangains/intermittent fasting/mark sisson dietary stress camp.

    • Go with a salad for lunch and stew for dinner. I like a smoothie for breakfast — you could have an egg or two with it. All tasty foods and you can fit your macros around these easily.

      What’s your lean body mass?

      • a salad with what in it ?
        a stew with what in it ?
        a smoothie with what in it ?

        to arrive at the correct proportions…..please im not stupid ~

        • Hey R

          Welll…. that’s why I was asking about your LBM.

          I’m not sure how PHD translates to food right now, but it’s very similar to the Zone Diet. The Zone is pretty precise about portioning.

          I reckon if you are 20% fat now, you’d be needing about 19 blocks…

          I.e. 79 Kg x 0.8 = LBM = 63.2 x 2.2 = 139 lbs. x 0.8 activity factor = 111.2

          111.2/7 = blocks = 16. This sounds bob-on for you.


          112g protein
          144g carb
          48g fat

          That’s like… 16 oz meat, or 24 oz fish or 16 egg whites.

          And like… the equiv of 8 fruits.

          And like… 16 macadamia nuts.

          Look up Zone block sizes and get 16 prot, 16 carb and 16 fat, and that is a super-accurate way to start that fat falling off you while maintaining or even gaining lean mass.

          • “I reckon if you are 20% fat now, you’d be needing about 19 blocks”

            Sorry…. I meant 16 of course 🙂

        • I have…

          Banana/berry shake with protein powder, milk substitute like rice milk, celery/greens, and macadamias/walnuts/almonds.

          Lunch I have 4 oz lean meat or or 6 oz fish or 3 egg whites + one whole egg with 1 oz salad, 3 oz rice, tomatoes, peppers or leftover veg plus a dressing — about 0.5 oz olive oil + lemon.

          Dinner: This is foolproof tasty: Basically you cook everything in one pot. start by sauteing onions or garlic and then add stock/herbs and then add stuff depending on cooking time. There’s a HUGE range you can do with this method from risotto, stews, tagines etc. All just in the one pot. Delicious!

          • Oh… and a fruit starter before lunch and dinner. Sorry.

          • you’ve got to be kidding. ZONE blocks. seriously. dark ages bullhonky.

            if richard wants to be as lean as a fitness model, then he has to understand how difficult and specific fitness models’ food & lifestyle strategies are.

            richard is 54 with visible abs, if his photo is accurate. this is amazing and he has been some degree of lucky, via lifestyle and genetics.
            he can get even leaner if he wants, more ripped, whatever, but i am advocating taking a step back to look at the big picture.

            we are on the phd site, which is not the leangains/sisson/figure model diet site.

            i think richard’s goal is awesome, but when people start talking pseudo-science and eschewing the zone on the phd site, something is getting out of alignment.

  21. Thanks so much Michael 20% Body Fat is correct just had it measured ! Will follow those suggestions !! Much appreciated.
    GM Hotel ICON

    • You’re welcome Richard. That will get you ripped trust me. At these macros, your body eats its own fat with ease 🙂 Good luck!

  22. Anyone able to comment on the apparent connection between unfiltered (French press) coffee and LDL? Here’s a link to research:

    Then, ya gotta love the title of this one:

    I have only one cup a day, but still would like to do as little harm as possible, considering all the diet mistakes I have made over the years.

    • i think stressing out over your single cup of coffee everyday is actually the problem. the stress, not the coffee.
      if you wanted a viable, personal answer, you could stop the coffee for 60 days, and then see how you feel, tracking mood markers, etc. yes, it’s hard work, that no one can do for you.

      essentially, this one cup of coffee is a small rock, unless you are allergic and severely adrenal deficient. focus on the big rocks: adequate caloric/nutrient consumption, reducing stress & inflammation, adequate food quality (grass fed/pastured foods, some organ meats, etc), optimizing your personal digestion, having a pleasurably challenging life, etc.

      one could say that a large part of natural life is all about absorbing damage/harm and continuing on. that life is all about unknown consequences and compromises. this is just the way it is. if you want to be perfect, live till 150 and still be able to run marathons, maybe you need to look at that fairy tale closer, or support aubrey de grey’s research. all beliefs are valid until questioned deeply, right?

      • To clarify, I’m not stressing over my one cup. It’s just that rising LDL has been a frequent topic of discussion with regard to paleo and PHD. Having never heard of a connection between LDL and unfiltered coffee, I thought I would toss that hat in amongst the others. Besides, it’s an easy fix — just filter the stuff. My concern with this coffee connection is for family and friends who drink considerable amounts of it.

        With regard to fairy tales, they don’t interest me near as much as maintaining my independence. I achieved advanced degrees after I was well into what is generally thought to be retirement age, and continue to work full time at my profession. My parents and my brother struggled with “age-related” health issues before passing (my dad at 48 and my brother at 64) and I would like to avoid as many of those as possible, for the sake of my children, my personal comfort, as well as my independence. My mother lived to 82, but spent the last 30 of her years in pain and constantly declining health, which I also hope to avoid.

        I do appreciate your thoughts. You indicate a possible connection between LDL and mood. I had not read anything about that. Always something new here.

  23. I, personally, am getting quite depressed reading some of the above comments. Where are your heads? What happened to eating “food?” Paul has written a wonderfully helpful book. It’s full of science, but also full of common sense. He can’t possibly cover each and every circumstance of each of our lives – he can’t certainly answer each question we may have as to what we should eat at every meal.

    I, too, am tempted often to ask him what I should do. He’s been very kind to me and has advised me several times.

    But to ask him to make up meal plans? NO. He and his wife are very busy writing a cookbook which will be out I think next year and he has told us that. Let’s lay off and WAIT!!!! Surely it’s not too much to ask each one of us to go back – read the present book – and do our best to just eat food.

    For heaven sake you’re not going to die if you’re off a bit off in your ratios. You’re not going to die if your six-pack is a bit delayed in showing up. Take charge!!!!! I don’t want to sound harsh but from what I have read, we are all adults here. Please let’s act like grown ups.

    • Agreed, let’s go easy on Paul, especially at the moment given his comments here a few weeks back;
      “Given the timelines Scribner’s works under, the new manuscript has to be completed in June. This is an extremely tight deadline. We had plans for significant changes to the book in our second edition, and also plans for a separate book on obesity and weight loss. Weaving that material into the new Scribner’s edition, while also making the book more accessible to a popular audience but not lengthening it, is a big task.

      In order to produce the best possible book by the June deadline, I need to focus my energies solely on writing. Until the manuscript is complete, therefore, I will probably do little or no blogging.”

      • Ditto! For those that are relatively new to the site and book, please note the following comment from Paul around last year: “we look forward to a second edition. We aim for the perfect diet, but we know that we have not yet written the perfect book. To achieve excellence, an evolutionary process is usually required. We’re most grateful to all those who apply our ideas and help us refine them.” Thank you Paul and Shou-Ching for all you do!!

      • One would have thought that the feeddback and questions here on Paul’s Q&A would provide useful insights on what potential and current readers want to know. It will provide Paul a unique and competitive edge giving him actionable insights into the social and content experimentation of the diet and valuable marketing ideas. Reviews/commentary should be taken as being constructive and informative…..I for one am finding it difficult to plan real meals. Academics tend to get caught up in the theory and lose sight of the day to day integration of their theory into practice.

        • the thing with “real meals” is that they’re so personal and people tend to eat with their eyes or their brains, without taking the time to figure their own appetites and physiological needs.

          sometimes i am very hungry, but know that i really dont need to eat, sometimes its the opposite and i “force” myself to eat because i know i need it.

          meal sizes, and types of food vary wildly from person to person. sometimes i might just eat a steak, later on its ice cream with egg yolks and gelatin.

          in the morning i just need to get the protein in, and some fast carbs. you wont find that meal in any cookbook or trainer’s recommendations because people are so PC and try to play it safe.

          breakfast: rare steak and mexican coke with salt and lemon.

          lunch: salmon, fresh aoli, bamboo shoots, oj

          snack: oj & gelatin, salt
          snack 2: cream/sparkling water/sugar

          dinner: full fat high quality vanilla ice cream, pastured egg yolks, gelatin, salt

          • Darius – why are you so much eating sugar?? (mexican coke, sugar, oj). Not only PHD, but pretty much everyone agrees that stuff is not good for you.

          • darius,
            looks like you subscribe to some of the Ray Peat/Danny Roddy/Matt Stone school of thought/way of thinking.
            I too find myself gravitating in that direction.
            I would say i am becoming more & more open to sugar at the moment.
            And combine the PHD & Peat philosophies. More PHD then Peat at the moment. Increasing my sugars & salts seems to be improving (raising) by body temperature more then safe carbs alone.
            …Self-experimentation on-going…

          • hey david: sugar is only destructive in certain contexts. i too was once anti-sugar, until i learned and experimented. in this case, “everyone” is wrong, because “everyone” likes to create an ultimate villain to pin all blame on. saturated fats, sugar, the sun gives you cancer, etc.

            i experimented for the last 4 years as my mystery condition worsened, i went through every guru’s diet. paleo was a watershed moment, but many people including myself were disappointed with the post-honeymoon phase. my body cannot digest starches well, or fibers, most fodmaps. it’s just the way it is.

            hey Darrin, that’s where i was too. PHD was great, i needed/wanted the carbs, but the starches sat in my gut like cement. i do not know why this is, or why i contracted ibd/crohn’s-like symptoms after cleaning up my diet – went from SAD to vegan, to raw vegan, to paleo, to phd, to peat, over the course of 4 or so years. i don’t get the flu anymore, and my mind is much clearer, but my body is weaker/more sensitive, and i can only eat very limited food variety. super weird.
            docs don’t really help, wish i would’ve known before spending so much $ on them. even kresser, bless his soul, left too much to be desired. self-experimentation, research and judicious supplement use are all that remains. ha!

          • I see. Well, I’m no scientist, and maybe eating sugar is just, counter-intuitively, something that’s actually great for us. But I’m skeptical.

        • Ricardo:

          “One would have thought that the feeddback and questions here on Paul’s Q&A would provide useful insights on what potential and current readers want to know.”

          TOTALLY. There’s nothing like quality feedback and to see where your readers are tripping up to give insights in how to present and communicate info.


          Is that a big ask I wonder? Is that an unreasonable request?

          THE PROBLEM is that the recommended foods to not add up to the recommended macros. And so I cannot make sense of this diet.

          Now… if the macros are not the important thing… and reading between the lines, this seems to be the case, then why confuse people with advice that doesn’t add up? Paul talks about how the Kitavans are healthy eating high carb in the veggie section.

          SO… if nacros do not natter, then take them out of the equation. I will give a prize to anyone who can make a pound of animal foods and a pound of safe starch plus fruit and veg add up to 10/65/20.

          If one sees Paul as “Shepherd” leading the lost flock to dietary paradise then I understand why this is upsetting. But Paul does not see things like that. He calls his diet and book “an evolution.”

          As the hilarious Dr Oz/Gary Taubes thing shows, we are are LONG way off agreeing what is the best thing to eat.

          And yet, this is a conversation we MUST have. People are confused.

          All I want is to know how much starch, veg, fruit etc is a perfect day on the perfect health diet. The info as presented does not tell me that!! Is it too much to ask?

          • One “Evolution” it seems is Paul fat loss advice. In the book it says “no need to diet.” On the blog it’s “reduce fat in the diet.” OK evolution. If you see questions as attacks then you’ll get upset. No one is attacking. I love Paul, he is clearly an awesome human being. I am just asking questions.

          • The way to go is to present a perfect day on the Perfect Health Diet for a 2000 calorie reference. Then you have a crystal clear way of showing how the philosophy APPLIES, how people can make it work with REAL FOOD, and for looking at variations for weight loss (less fat), muscle gain (more protein), longevity (less protein), vegetarianism, etc.

          • I really don’t see the big deal here, Michael. The book suggests counting calories for a week or so get a feel for the recommendations. I think you would substantially comply with the recommendations by eating 55% fat instead of 65% on some days. But I guess you’ve come up with your own means of upping your calorie expenditure by posting a thousand times a day. (joking) Seriously, I’m glad Paul is going to offer meal plans or something analogous, but to me it is far more useful to understand what an ideal diet is and try to get as close as I can without obsessing over exact percentages. Seems to me like it’s far more important to get sufficient nutrients and avoid toxins than to get exact macronutrient percentages. I doubt, anyway, that anyone could consistently get them exact unless they always measured their food and ate the same thing every day. And I don’t think that’s what Paul is suggesting.

          • To be fair, David, I post because I don’t get a simple straight answer!

            For e.g.

            Starch 16oz +/- 3oz
            Fruit 3 +/- 1
            Animal foods 12 oz +/- 4 oz
            Veg — 16 oz +/- 8 oz
            Oils/added fat 2 tbsp +/- 1 tbsp
            Nuts/seeds 2 oz +/- 1 oz

            Right??????? Then I can work with it. And I will see that the macros don’t add up and then Paul can decide to do what he likes with that info.

            I TOTALLY get you about not stressing about macros. But, you see I need to be totally clear, not just for me, but because I am advising others what to eat. Wishy-washy doesn’t wash, if you see what I mean. I need total clarity.

          • Why not just tell your clients to read the book? Hahaha . . . Paul, can I get a commission?

      • Barbara, thankyouthankyouthankyouthankyouthankyou!

        I was about to stop reading this list, and you have restored my faith.

    • “Please let’s act like grown ups”

      Barbara ….What’s the one piece of advice you wish you’d been given in your mid-twenties?

      • Ricardo, the one piece of advice I wish I had been given when I was in my mid-twenties is this:


  24. Hello. I just came across your site, because I was doing a search for fungal infections and GAPS/SCD diet. My 10 year old daughter has been on the SCD diet. Her stomach went from being very bloated to much less so on the SCD diet…however, she suffered with terrible dandruff and occasional other skin patches that pink and rough. We decided to add a little millet, organic corn, amaranth, (even beans) etc…back into her diet because I had read someone saying that the SCD diet can be terrible for people with fungal infections. However, when we added a little carbs back in…her stomach came right back out (she looks very bloated again.). I have not purchased your book yet, but I was wondering if the problem could be corrected following the Perfect Health Diet. Do you think that a child can follow this diet? Can it correct both fungal and bacterial issues? Thank you.

    • Hi Holly,

      She has two problems, the gut dysbiosis/infection and the fungal infection. She needs some carbs so her immune system can fight the fungal infection. Try dextrose, rice syrup, or honey to see which causes the least bloating.

      Then get a stool test like the Metametrix microbial ecology test, and perhaps SIBO testing or H pylori. There should be something treatable.

      You might read our bowel disease series.

      Our diet will be pretty good but you’ll need some tweaking for a bit until the problems recede. The optimum for the bowel conditions is different than the optimum for the fungal infections.

      Best, Paul

      • Thank you so much for your quick response. A couple of quick questions. Once we get the results from the stool sample, would we treat the problem through a traditional doctor and prescription or through diet? Also, you mentioned your bowel disease series. Would this series instruct us according to our daughter’s issues? I do not see that on your website.

        Thank you.

        • Hi Holly,

          With a traditional doctor if you can. You might tweak the diet a bit based on stool test results, but not by much. However, sometimes treatments can make a huge difference after you diagnose the specific problem.

          Go to the Categories list and scroll down to the Diseases group, and find Bowel Diseases or Bowel Disorders.

          It won’t be specific to your daughter’s condition but many similar things are done for a wide array of bowel problems.

  25. This is for MICHAEL up above.

    Michael, the reason, perhaps, that you are not getting specific answers to your specific questions is because there are none. Are you not getting the message? No matter how many times you ask us/Paul to tell you what to eat, we/Paul will NOT tell you.

    Please stop asking. This is getting old fast.

    Read the book. Do your best to ballpark the ratios from Paul’s excellent recommendations. Then eat food.

    That’s it. If you don’t stop the foolishness we will all leave and re-gather at a secret blog and not tell you where we have gone!!!! 😉 We love you, Michael and we encourage you in your quest for the best health and happiness but can we move on?

    • It’s a very funny diet, that doesn’t tell one what to eat 🙂

      • But Michael for the millionth time – this is NOT a “diet” book. It is a “health” book. So it does NOT tell you what to eat. It guides you to what kinds of food to eat for good health. How you combine foods to achieve health in a variety of circumstances is also laid out. That should be enough to get you going on your quest.

  26. OK Barbara I will, although when I requested a 2000 calorie reference diet Paul, and I quote, said “Thanks, we’ll work this up.” Which I think means he’s gonna do one. So I am hoping 🙂

    Still… I already decided to do what you said and boil Paul’s data down to real food, and then I will post my perfect day on the PHD for those, like me, of whom there are quite a few it seems, who are struggling to make the advice practical.

    It won’t be 10/65/20 though, that is clear. I will do as you ask though Barbara, again, because you’re so nice, I can’t refuse 🙂

    I will be back with my “perfect day.”


    • Yeah, he’s definitely going to do it…

      WORK UP (verb)
      The verb WORK UP has 4 senses:

      1. form or accumulate steadily
      2. develop
      3. bolster or strengthen
      4. come up with

      Coool 🙂

    • Michael,

      I think you mean 15/65/20 (P/F/C), and those are just guidelines. The book doesn’t say you have to meet those percentages precisely. Read the section entitled, “The Perfect Health Diet in Brief”. Note that it doesn’t say you should have exactly one pound of safe starches, but rather up to one pound. Similarly it says one half to one pound of meat, fish and eggs. Again, those are just guidelines to help one approximate the macros without having to add everything up each day. Given those ranges, and the wide variety of foods in each category, I’m sure someone could come up with a day’s meals that would meet the ratios exactly, but why bother?

      Here’s what I’m having today, a pretty typical day for me:

      2 eggs (from pastured hens), cooked over-easy in Ghee
      2 chicken sausages (very lean, so cooked in a generous amount of coconut oil
      1/2 cup blueberries, with coconut milk poured over them. Sometimes I use cream (Kalona brand) instead

      Leftover braised beef short ribs
      Medium sweet potato with coconut oil

      Haven’t decided yet, but typically I’ll have: Some kind of meat – beef, chicken, or fish. If it’s a lean cut I’ll dress it with butter or coconut oil. Garlic butter sauce is a favorite topping
      White rice or potato with butter
      Green beans or brussel sprouts, sauteed in ghee
      Maybe a salad with olive oil and vinegar for dressing

      A lot of times I’ll have a sliced banana with either coconut milk or cream poured over it as a snack later in the evening. However, having ready several things recently that indicate it’s better to limit eating to a certain period of time, I’m thinking of moving this to earlier in the day or simply forgoing it. And in that vein, I may even go to just two meals a day.

      I’ve never measured and calculated my meals to see how close I am to 15/65/20, but I think I’m following the advice of the book reasonably well (and note that another important factor is what one doesn’t eat.

      • Thanks Frank, that’s very helpful. Yes, I meant 15/65/20. Incidentally, I’ve just been reading on Harvard website how the low-fat myth has to end. In the Q/A, they even say there’s no need to worry about fat as long as it’s good fat (although they promote PUFA and not SaFA).

        Is it just me, or is anyone else a bit miffed, that being health conscious, we have chowed all this fat-less, dry stuff for decades on the say-so of these diet experts, and now they say “OOPS.” They even say the low-fat stuff is causing us to binge and gain weight cos of the insulin spikes n all that!!! Grrrrr. 🙂 All that butter I missed out on cos of them!!

  27. Wonderful thanks 🙂

  28. Hello, I have PHD book and am sorting through info regarding fungal infections. I had an amalgam removed in Jan. (holistic dentist) and a bio feedback was done prior for a composition match plus a general scan, which showed fungus and gluten. Went gluten free and started on olive leaf extract and then developed skin breakouts around my eyes, and now my nostrils. Thought it was die off, as I have had sinusitis twice a yr for many yrs and used antibiotics for many yrs. Also had a stool culture done and it showed +4 geotrichum candidu and possible yeast. My eyes got so bad had to see Dr. and was given 5 day course of Prednisone and told to see dermatologist. It helped the “angry” red quite a bit but now the breakout is coming again. Have not taken Olive leaf for a month. I am looking for help on what to do for my skin. Am upping my carbs, chromium, kelp for iodine, iron (was anemic), copper, + daily multi. My body temp is low (97.3-97.7), which I know is not good to fight fungus. I would like some advice! Is it die off? Should I go see Dr. for anti-fungal med? Thanks!

    • Hi Susan, I’m a fellow dry eye sufferer; eyes flared up about four years ago following lasik and a bout of what was probably allergic conjuctivitis. I’ve tried steroid drops too, a whole month, as well as a month of antibiotic drops, all to no avail. Keeps me up many nights.

      I’m awaiting a stool test, which I expect to confirm fungus. So I have nothing helpful to offer yet save for sympathy. But I’m planning to see the doc for antifungal meds and will report back on my results.

      • Shawn, I’ve tried eye drops from the Similasan brand and found them to work pretty well. They have a formula specifically for conjunctivitis. While it’s true that these formulas are based on homeopathic recipes (which in general I don’t take much stock in) they do have the advantage of not containing chemicals like regular eye drops do which can shrink the eye’s blood vessels and potentially cause an undesireable rebound, angiogenic effect.
        The dry eye formula I used seemed to be of good quality and work well for occasional use, and seemed pretty safe. The conjunctivitis type might be worth a try.

        • For relief and stability while you’re addressing the root cause of the problem, of course.

        • I’ve used the Similasan drops but not systematically enough to evaluate. (I too was turned off by homeopathy.) Maybe I’ll give em another try. For now am using Oasis glycerine drops

      • Thanks Shawn..I did have conjunctivitis in Jan., most likely viral as the bacterial drops did nothing. This time it’s not the eye itself but the eyelid and all around the eye. Am right now trying to treat the dermatitis with iodine and vit E oil. Started last night and I think it is working some. I now believe the dematitis might be fungus on the skin, and not just die off symptoms. Iodine works very well on fungus I’ve been told. Cronkster – I am using Similasan drops also and I like them.

        • Hi Susan-I developed something very similar.The dermatologist said it was contact dermatitis(something outside the body to which I have an allergy).I reasoned that it may be stimulated by a food allergy because that could create a hair trigger to my immune system,and some previously benign contact could set off the reaction.It was dismissed offhand by the doctor,but thru eliminating suspected foods,I have found some foods to set it off.The rash will all but clear,and then somethings like grains,pasturized milk(even cultured),and chocolate,when added back in will exacerbate the rash.Maybe if you can calm the immune system thru a food elimination strategy.

    • That’s pretty much a diabetes-specific issue. Unfortunately, half of women over 65 have diabetes.

      • So this is due to glucolipotoxicity?

        Would you recommend any changes to the PHD for over-65 women with (borderline) diabetes?

        • No, I think reducing energy intake is much more important than the fatty acid profile of the diet.

          The one thing they might do is a temporary protein-sparing modified fast. But I think calorie-restricted PHD would work about as well.

  29. the problem with medical journalism (and studiies that ask people to report what they eat) is that they are both unreliable. No matter how much the authors “control” the study, people forget, or outright lie. And the differences reported (and the cohort studied) are quite small.

    • More importantly, what else did they eat? You can’t look solely at one food while ignoring the rest. To give an absurd example, does a diet that includes plenty of broccoli and arsenic tell us anything about the safety of broccoli?

  30. George Henderson

    If the “most fats” group consumed the extra fats in baked goods, which seems likely, there’s a confounding variable that may not have been controlled for.
    But here’s another interpretation; diet was self-reported. I predict that people who lie to minimize reporting of “unhealthy” foods are more competitive than people who report consumption honestly or exaggerate.
    In fact, in popular culture, people who exaggerate intake of “unhealthy” foods are often proud of their ignorance or seek to make a virtue of it.
    So reporting of “unhealthy” food intake is itself a sensitive marker of ambition and self-perceived intelligence, or even of how society has judged one’s intellect in the past.
    And these – ambition and confidence, as well as cognitive ability – are the qualities that are required to do well in intelligence tests.

  31. George Henderson

    I imagine that Homer Simpson might exaggerate his consumption of donuts, while Lisa Simpson might under-report hers.
    Under-reporting of “unhealthy” foods represents a desire to do well in the eyes of others, just as performing well in intelligence tests does.
    In fact, society already sees food choice as a kind of intelligence test.

    • I won’t belabor this George, because I know it’s off the point for this forum, but I think you’re making some unwarranted assumptions, for reasons I’m not sure about, concerning the personalities of people who do well on intelligence tests. Is it too simple and obvious to believe that they do well because they know the answers to the questions thereon?
      Your contributions about PHD, though, are excellent, and much appreciated by me.

  32. George Henderson

    And the people who “do well” on the food questionnaires are also the people who know the “right” answers to those questions.

  33. Hi Paul,

    The recent study linking early puberty to depression and anxiety in late teens fits my 18 year old daughter perfectly.

    The study mentions an enlarged pituitary gland. Is there anything in addition to following the PHD that may help offset an enlarged pituitary.




  34. Hi Paul

    I have read the book and as much of the blog as possible, so apologies if this has come up before. Are alfalfa sprouts toxic? Are fresh green beans vegetable or legume and therefore okay or toxic? Is organic maple syrup on a par with honey or less desirable? Also more than a modest amount of saturated fat does make me feel nauseous, especially coconut oil. I do have an inherited tendency to high total cholesterol, although it’s not so serious that it can’t be managed by lifestyle and diet. In my case is it prudent to watch saturated fats? I try to incorporate PHD as much as possible but am a bit confused about the fat issue for me. Olive oil seems to agree with me very well and I eat a lot of that. With thanks, L

    • Offloading Paul, hoping not to make any mistakes:

      – Sprouts are generally ok (although I don’t like them, they still taste bitter to me so presumably you should not eat them raw)
      – Green beans are fine
      – Real maple syrup is a fine pleasure food like honey, the darker kind will have more minerals
      – Try upping your coconut oil intake slowly so your uptake adapts? Not sure here. Saturated fats are safe except when you have chronic high blood sugar. (>140mg/dl)

      • Thanks Wout (and Frances)… and Michael the Chris Kesser link really helps to nail down my understanding of the cholesterol issue.

  35. Alfalfa sprouts are indeed nutritious but when raw, which is how most people would eat them, they contain high levels of L-canavanine, an amino acid. This has been known to cause lupus in susceptible people and to cause a relapse/flare up for people who already have lupus. I think, but I’m not sure, that other types of raw bean sprout may also contain L-canavanine at lower levels. So I would advise caution.

  36. Returned for the doc, still working with the Hasi’s and elevated lipids, but was interesting that she tested my serum B12 level and came back elevated @ >1999 pg/ml. She was a little perplexed….any input or ideas? Thanks Donna

  37. Hi Paul,

    I wonder if you will make any changes to your stance on fructose in the new book? I read this blog post by Stephan Guyenet and the linked-to interview which are very interesting.

    I’d say that this makes the toxicity curve of fructose a little clearer: Possible benefit on the low end (achievable by eating only fruit in sane amounts, no added sugar), proven toxicity at very high doses/energy intake and apparently not very conclusive evidence in between.

    The interview mentions that rat studies at 60% are hyperphysiological and also that humans have different fructose response than rats.

    I also found this blog post by Petro Dobromylskyj very interesting, detailing fructose uptake in the human body.

    • Hi Wout,

      Yes, I am revising fructose along those lines, it makes a clean benefits-toxicity curve. I think toxicity begins much earlier however.

      What was the post by Peter?

      • Oops I seem to have botched the HTML 🙂 It was his post on how the GLUT5 fructose transporter is found on cells all throughout the body.


        I really like this comment: I agree with a great deal of what Lustig has to say. But I find it hard to swallow an argument when certain easily disprovable biochemical statements are made. Saying that fructose uptake and its transporter are limited to the liver is disappointing. We have enough problems with misinformation on carbohydrate restriction from folks with carbophilia.

  38. George Henderson

    Health benefits of fructose?

  39. George Henderson

    If you want to know whether sugar is good for you, just ask a dentist.
    And remember: this is someone who thinks flouride isn’t toxic, and mercury isn’t that bad.

    • Hi George, the sugar being bad for teeth story…is that just a fallacy?

      • George Henderson

        Not at all; my point was that dentists have been in the habit of underestimating harm, so are more to be trusted when they do recognise it.

        • George Henderson

          It is certainly true, but the conventional explanation (bacterial acidity) is probably not the whole story; antinutrient effects preventing remineralization of teeth seem likely to me.
          In this regard, consider the links between osteoporosis and diabetes.

          • thx George,
            Your dentist comment caught my eye as i recently started adding sugar to my evening drink of decaf Tea.
            The sugar seems to be having positive effects on my quality of sleep.
            I am still experimenting with the ‘dose’ & type of sugar at the moment.
            Have been trying 100% glucose powder and coconut sugar in varying ratios and quantities.

  40. Paul and everyone –

    Any suggestions for my sister who is suffering from bile dumping sydrome three years after gallbladder removal? The dumping has been happening consistently since the surgery and she is pretty much housebound 3-7 days of the week due to diarrhea. Fruit and vegetables (especially lettuce) bring on the worst symptoms, and bagels with cream cheese are “safe.” She’s gained 50lbs in the past few years eating “safe” foods to avoid diarrhea.

    Her doctor told her taking statins (!) would likely alleviate symptoms but not cure the problem, and she’d have to take them for the rest of her life. She doesn’t want to. (The statin rec is unrelated to cholesterol – she has no cholesterol problem.)

    If anyone has any suggestions we’d both very much appreciate hearing them. She wants to avoid statins but also can’t live this way forever. Thanks in advance.

    • The obvious and standard treatment would be cholestyramine. http://en.wikipedia.org/wiki/Bile_acid_sequestrant. It’s prescription so she’ll have to go back to her doctor. In the meantime, activated charcoal might help.

      She should be careful to take the minimum dose possible. She doesn’t want it to lower her serum cholesterol. Ignore the dose on the label, it’ll be too much.

      • Thanks, Paul. Disturbing that the doctor didn’t even mention the “obvious and standard treatment.” I did suggest charcoal to her. Only issue was that she doesn’t know in advance what food/meal will set her off (though her diarrhea seems to happen most frequently between lunch and dinner) and I wasn’t sure if taking it in advance would help. And since I have experienced major constipation with charcoal, I was afraid that prophylactic dosing would result in the same for her. But our reasons for using charcoal are quite different, so perhaps she’ll have better results. And anyway, it may be the only reasonable option.

        Interestingly, she developed acne around the same time the dumping issues started. She was 46 at the time. Perhaps cholestyramine will help that too.

        Again, thank you!

  41. Love the PHD and try to follow, BUT do not understand your recommendation for Vit K2. You list 1 Mg. Is this correct or a misprint? Please advise.

    • You can start with 100 mcg/day MK-7 capsules, but vitamin K2 half-life in the body is about a week, so you can also take a larger dose once per week, or more for a higher dose.

      Life Extension makes a 1 mg MK4 / 100 mcg MK7 pill that is good for this dose.

      Then, higher doses may be therapeutic for some conditions, eg cancer. Japanese researchers have tested 45 mg/day as a therapy for liver cancer. So a step toward this would be to take the 1 mg dose daily.

  42. Dr. Jaminet,

    I know you wrote on the dangers of long term ZC diets, but what about short term ones. I’m doing one for a week and I’m already half way there. Any danger to a week long one? I don’t plan on doing it again or anything, but you’ve got me worried throwing around words like “gut cancers”. Thanks!


  43. Hi Paul,

    Book ordered, on the way, been going heavy into the blog in the meanwhile.

    Here’s my dilemma…I recently got back my lipid panel:
    TC: 248
    Tri: 238
    HDL: 43
    LDL: 157
    C/HDL: 5.8
    (I’m 40, 6 ft., 180 lbs. My glucose-fasting # is 103, fwiw)

    Most of these markers are higher than my last blood test, 2.5 years ago, thought my C/HDL ratio has declined and HDL count has increased.

    My doctor wants me to start taking statins but since I had previously been very sedentary and had never regulated various kinds of food (esp. carb-intake), I’m asking her to hold off for 3-6 months so I can first test out a radical diet/lifestyle change before resorting to a pharmaceutical intervention.

    To cut to the chase: I’m getting stuck on how to improve my cholesterol profile while still trying to stick the parameters of the diet. Specifically, every conventional guideline I’ve been told says “lower saturated fats” but this diet seems to urge more saturated fat. I get that conventional wisdom isn’t always to be trusted, but this one point seems so inherently contradictory, I’m having trouble accepting it as a prescribed goal. Other than that, I’m trying to follow the diet guidelines by cutting out as many toxic foods as possible, not overdoing it on the protein and allowing a modest amount of starchy carbs.

    On that note, and getting back to the saturated fat question: do you also recommend eating rice mixed with a saturated fat as a way to tamper the glucose spike?

    Your thoughts and input are highly appreciated.

    • Hi Oliver,

      Yes, the conventional wisdom is backwards. You need to cut polyunsaturated fat.

      Get omega-6 fats as low as you possibly can, and get carbs below 30% of calories. The combination will give you lower triglycerides and higher HDL, which is what you want.

      Re the rice, see our post “How to Avoid Hyperglycemic Toxicity” (try the google search box). Fats, vinegar, vegetables all help.

      • Thanks Paul. Definitely at work at dropping those O6 and raising O3. And I have no problems cutting polyunsaturated fats. I’m assuming monosaturated (namely avocado and olive) fats/oils are permissible?

      • Better question: how can I convince my doctor that I should be eating *more* saturated fats (which I rarely ate before)? (I’m half-joking asking this but only half)

        • Oliver – If I might jump in – before I read PHD and other books, I had the same mindset as you. But I think after you read PHD, you will believe, as counter-intuitive as it is, that the medical establishment has it completely backwards, as hard as that may to believe. Actually, more and more authorities are starting to accept that saturated fat is good for you. It appears to be a proposition backed by science, whereas the science that led to the low-fat recommendations is faulty. This blog has some discussions of the bad science that has gone into the conventional recommendations (there are some good posts on the china study, among others). Best of luck.

          • David: Thanks for your input. I hear what you’re saying. I’m a social scientist by profession and I certainly know how long it takes for schools of thought to shift; many never move from whatever foundational theoretical framework they were trained in and I can understand how my doctors, for example, would hew closely to the conventional wisdom.

        • First, get yourself convince. Second, try to convince your doctor. Third, get your health in your hands, specially if she keeps trying to statinize you (I would then look for another doctor).

          I would recommend first an easy summing up of events: See Big Fat Fiasco by Tom Naughton (his movie, Fat Head, is highly advisable too). Second, read Jaminets’ book, Barry Groves’ Trick to Treat, Gary Taubes’s Good Calories Bad Calories (this one I like the less, since bibliography isn’t reference right —you may locate the cites by name and year, though—). When you are convinced, you may borrow her one book.

          Best regards.

    • Oliver:

      To help you relax about Sat Fat n stuff, I think it’s wonderful to hear the same thing from more than one source. This is great…


      Yes, the “machine” is big, conservative, and slow to change. But you can read also, Gary Taubes and Michael Eades’ blogs too.

      On the Eades blog there’s a video about this recent study comparing Zone, Atkins, LEARN and Ornish. Atkins blood profiles were the BESY of all, although they we eating about 30% carbs and not being strict i.e. it wasn’t all lard and bacon 🙂

      I saw Dr Oz and G Taubes go head to head. Gary wouldn’t get his cholesterol checked because he insisted, it’s NOT a biomarker for heart disease.

      This whole thing about small dense LDL n stuff is new. The machine will take a while, prob a long while to catch up.

  44. Does anyone know how fitday calculates calories from carbs?

  45. Hi Paul —

    Ever since going the full PHD I’ve had a much stronger body odor — noticeable on my sheets, clothes, and me. I’ve been at 12.5mg iodine for the past year or so, but if anything stronger odor seems to be counter to other experiences on iodine (http://perfecthealthdiet.com/2011/02/therapy-and-life/comment-page-2/#comment-16805), so I don’t think I can blame that.

    I otherwise feel healthy, other than besting any deodorant out there. Any thoughts?

  46. Hi Paul! After finding my LDL-P numbers on a VLC diet to be very high, I started doing lots of research on the matter and came across your blog. And after chatting with a bunch of people I decided to buy your book. Well, I’ve just spent the last couple of hours reading and absorbing it.

    Before this week, I was SO SURE that a VLC ketogenic diet (>25 grams carbs) was the absolute best/healthiest diet. Of course, being obsessed with research, one tends to get tunnel vision. But I always try to keep an open mind. Your book is great so far and definitely challenges some of what I’ve come to believe strongly about low carb diets. The diet I’ve been on definitely relies very little on glucose and puts a stronger emphasis on glucose only by gluconeogenesis and essentially energy from fatty acids and ketones. But you are seriously making me reconsider this!

    My question is about Phinney and Volek’s research of ketoadaption. Their research suggest that a body that is adapted to fat metabolism and ketones (2-4 weeks minimum) can run just as well or better than a non ketoadapted body. But in order to reach a level of ketoadaption, one must stay in ketosis without breaks for at least a couple of weeks. In your book, I like that you outline the benefits of ketogenic diet days, but at least based on Phinney/Volek research, the body won’t know how to use the ketones as efficiently if you start and stop ketosis all the time. At least that is what their research suggests.

    I’m in no way refuting your writing, but I of course want to be thorough before making a big change to my diet (just as I was very thorough before I started a ketogenic diet). I like the benefits, or at least the perceived (maybe it’s placebo) benefits of being ketoadapted. I always seem to have energy, regardless of whether or not I was fasting. Will switching to 20% carbohydrates or more (even safe starches) completely get rid of this “constant supply of energy” from constant fat metabolism/ketone production?

    Also, you mention that people with ailments like alzheimers and diabetes should try to stay below 200 calories of safe starch/carbs to make it a ketogenic version of the perfect health diet. Are there many downfalls to doing this as opposed to the 600 calories from safe starch version? Would I probably still see my LDL-P (which is now >3000) being too high? Or is 200 cals enough to really make a change in your experience?

    Last question 🙂 And I am probably asking this prematurely since I haven’t finished reading your book yet, but what are the mechanisms for weight loss here? In a ketogenic diet, obviously more fat has to be oxidized in order to fuel the processes of breaking down protein, and in the process you get glucose and ketones. So if your body isn’t meeting the requirements for dietary fat to fuel these things, it uses body fat. The variable to lose weight is “Are you meeting your dietary fat requirements for the day?” I would assume it is still the same in a non ketogenic version of perfect health diet. But if your body doesn’t rely on gluconeogenesis as it’s primary fuel generator, how does it create energy from fat and REQUIRE fat (and resort to using body fat if deficient in oral fat load)?

    Sorry about all the questions! But you’ve really got me thinking today! I guess you could call that a success in your book 😀 (pun intended)

  47. This week a doc I went to for the Metametrix profile prescription told me the functional murmur I have had for as long as I remember did not sound functional, but rather like aortic stenosis. I’ve gone from “Oh he must be wrong,” to “Well, I don’t want a long protracted death, so spend the summer getting my affairs in order.”

    Echocardiogram scheduled for early next week. Is there anything anyone would suggest I do? Is this a result of the cal/mag/boron/mang/D3 I’ve taken to avoid the family osteoporosis? Didn’t know about K2 until a year ago.

  48. Hello Paul and all
    I’ve been on the diet for two months and taken the recommended supplements for the last six weeks.  I’ve roughly adhered to the food type ratios.  I suffer from fatigue and depression which gets worse at  certain times of my cycle, so I expect at 41 I am suffering from peri-menopause symptoms and hormonal.  

    I haven’t felt any better at all since starting the diet – I’ve given up dairy in the last two weeks in case I had a lactose or casein intolerance, but again no change – although it may be a bit too early to tell after 2 weeks?  I’ve had tests for diabetes, blood pressure, anaemia and the like, but no problems there.  

    Are any women experiencing similar and can anyone advise please?
    Many thanks

    • Hi Nessa,

      I would experiment with the diet a little. Try going lower carb, to the ketogenic version of our diet; if you remove carbs for a while do things get better? If you add in coconut oil or MCT oil does that help?

      These experiments have diagnostic value.

      Usually there is some form of gut dysbiosis or infection causing those symptoms. Fatigue indicates immune activity, depression inflammation. However, these are non-specific. It could be as simple as food allergies/sensitivities — usually there are more than one, once the gut is leaky many foods trigger immune reactions. Or it could be a gut dysbiosis or infection. Sometimes low-carb diets starve the pathogens and reduce the scale of the problem.

      Once you clarify the issue a little you should go to a doctor for diagnostic testing (eg stool test for gut pathogens, food sensitivity testing) to try to sort things out better.

      Best, Paul

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