Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

9,730 Comments.

  1. I do not really trust The Vegans

  2. please for give my inability to do simple arithmetic, but i bought the prolamine iodine and it says the dose of iodine is 3mg. Is that equivalent to 225mcg?

    Thanks

  3. 1 mgm = 1000 mcg
    3mgm =3000 mcg

  4. Also, anyone have any thoughts on heavy periods and low ferritin #s. I am on an iron supplement as paul and the doc suggested but if the heavy period is contributing to the problem how can I stop this without birth control (which I won’t do)?
    I believe there is an underlying cause, but so far everything checks out…

  5. I sort of wonder if low Fe caused my Thyroid T4-3 conversion issue….
    Hypothyroidism causes heavy cycles, maybe you should check that?
    I feel that low carbing (ketosis for almost eight months) made me hit the wall.

  6. I haven’t tried it yet, but it seems like MCT oil would make a most excellent mayo.

  7. Hi Paul + everyone,

    What’s the best meal timing? Do circadian rhythms tell us anything? How long after waking is best to eat breakfast? Is a snack before bed good?

    • Michael, You might want to read Paul’s post about circadian rhythm. He talks about eating too. http://perfecthealthdiet.com/category/circadian-rhythm-therapy/

      • Thanks Connie, interesting. I’ve been digging… I have “The Circadian Prescription” by Sidney Macdonald Baker and he says that if you’re not hungry for breakfast, something is wrong! As always, the truth seems hard to pin down.

        • There’s a difference between being hungry and skipping breakfast 🙂
          I’m usually a little hungry in the morning but that goes away, especially if I drink coffee+cream/butter/coconut oil.

          • Thanks Wout, yeah coffee definitely delays hunger, being a stimulant 🙂 I’m hungry too, usually about an hour after waking. If we’re hungry we should eat no? Unless there is some evidence that eating breakfast is not natural, and somehow, the hunger is a mis-cue? We can certainly TRAIN our bodies to not want breakfast and not be hungry, but since Mr MacDonald literally wrote the book on it, he maybe right, who knows? Maybe the biggie is to have routine and be consistent, the body loves to know what’s coming.

          • Well I’m trying the 16 hour feeding window IF thing, so I skip breakfast on purpose.

            Depending on the severity of the feeling you could also say that hunger is either a hint (“ready when you are”) or a need (“FEED me NOAOAOAW”). I’m thinking that if it’s severe, you should eat and if it isn’t, eating is optional.

          • Maybe a hint of hunger means “Eat a little bit” rather than “Hit me with coffee” 🙂 How’s the IF going, and PHD in general. Feelin’ awesome?

          • I don’t have a problem sleeping, so can’t really say if Intermittent Fasting will help. But I do the 16 hour Intermittent Fasting with an 8 hour eating window and I’m not really hungry at breakfast time. I usually have a TBL coconut oil. When I first started, I really felt bad when I didn’t have the coconut oil. Now I’m usually okay if I skip it. So I get up at 8 am, sometimes do intervals on the recumbent bike, have my coconut oil, eat some raw carrots (per Ray Peat on an empty stomach) at 2 pm and eat lunch at 3 pm, snack at 6 pm and dinner between 9-10 pm. I really love the PHD and IF – it makes life easier in the morning and I’m not as anxious about food and if I eat a little later, I’m a little hungry but not starving and I’m not stressed out about it and can easily wait until I do eat. IF is so easy and painless! And of course I LOVE the PHD!

          • I often, but not always, have only coffee and cream and coconut oil for breakfast, and then eat at 1 pm and then again around 7 or 8 pm. I am usually not hungry. If I am particularly hungry I eat breakfast. For centuries people didn’t eat breakfast. It is not necessary. It is really a recent invention. In practice, IF is not very difficult, especially if you have an 8-hour eating window.

  8. Just curious what type of nuts you recommend? I know that Macadamia nuts have the highest level of MUFA’s of all nuts, but Walnuts have the highest level of Omega 3’s. And since we dont use Veggie oils in this diet I figure nut oils would be the best. But which one’s have the best flavor, and best ratio for the PHD?

  9. In my household Ketchup, BBQ sauce, are used on a regular basis.

    What kind of condiments do you use? Im curious.

    Since we cannot eat gluten, processed sugars, or refined fructose (HFCS) what do you recommend?

    • Caleb, I mostly use salt, butter or coconut oil if I need something extra on my vegetables, potatoes, kale chips, sweet potatoes and rice, but sometimes I eat them plain. I use mustard on my sardines. When I make meatloaf, I use a mixture of fire-roasted tomatoes and tomato paste for a topping. On my shrimp, I use hot cajun spice or melted butter or plain. Butter and coconut oil are so good! If I use soy sauce, I use the wheat-free kind. Just some ideas!

  10. Oh, I misundertood yr question earlier; some statins do cross blood brain barrier:
    “In 2003 an article cited 60 reported cases of memory impairment, most commonly with Zocor, less with Lipitor and only one case with Pravachol. Since Zocor is the most lipophilic (meaning most likely to get into the brain) and Pravachol is not lipophilic, this pattern is consistent with a relationship between statins and memory problems.”
    http://www.beforeyoutakethatpill.com/index.php/2010/06/20/do-statins-make-you-stupid/

  11. Given the importance of treating pathogens while minimizing the impact of antibiotics on microbiota, bromelain is worth a look: Bromelain may increase the amount of antibiotics absorbed by the body. In one clinical study, the combination of bromelain and amoxicillin raised the levels of amoxicillin in the blood. Also, some studies suggest that bromelain may increase the body’s absorption of tetracycline, another antibiotic. But results of other studies have been conflicting.

    I used bromelain with amoxil when I had pneumonia a few years ago and found it very effective; I needed half the antibiotic dose, which was great as I don’t tolerate amoxil well. Study results may have been conflicting because bromelian supps vary in potency, you want to maximize GDUs and use 500mg caps.

    “Potentiation of Antibiotics: Antibiotic potentiation is one of the primary uses of bromelain in several foreign countries. In humans, some undetermined activity of bromelain has been documented to increase blood and urine levels of antibiotics. [17-19]

    Combined bromelain and antibiotic therapy has been shown to be more effective than antibiotics alone in a variety of conditions including pneumonia, bronchitis, cutaneous staphylococcus infection, thrombophlebitis, cellulitis, pyelonephritis, perirectal and rectal abscesses, [20] and sinusitis. [21]”
    http://www.thorne.com/altmedrev/.fulltext/3/4/302.pdf

  12. Hi Paul,

    My wife and I have gone PHD and have been incorporating intermittent fasting for the last month or so. We feel great! We generally stop eating around 8pm, and she’ll start eating again around 11am, for me it’s usually around 1pm.

    I was wondering if you like the inclusion of coffee with butter and MCT or coconut oil during the AM hours (as advocated by Dave Asprey), or if the fat calories will break the fast and negate any HGH or other benefits?

    • Hi Marc,

      I don’t object to coffee and cream or coconut oil during the fast. There are pros and cons but either way of fasting is healthy, so it’s mainly a matter of personal preference. If you would get hungry otherwise, then I think the coffee and fat is helpful.

  13. Hi Paul,
    First of all thank you so much for your work. I have come across your website, when 3 months into following the GAPS/SCD diet, my level of thyroid hormone (I have Hashimoto’s)dropped. Reading your website, I learned that it could have been from the (unintentionally) low-card diet. I tried adding more vegetables and fruit – but it is hard for me to get enough carbs that way without getting a diarrhea from the fibre. I have a sensitive gut. I have since ordered your book and read that you recommend adding “safe starches.” I would like add some rice and sweet potatoes – I am really “craving” for them. But I have a history of GI problems–that’s why I started GAPS in the first place–and I worry about going against the GAPS/SCD approach of avoiding all starches. I am reading your book right now, and realize that you consider rice and taro and yams “safe” because they don’t have fructose…but GAPS/SCD diets advise avoiding all starch from grains and legumes, because they believe that compromised GIT has trouble digesting complex carbs. So, only simple carbs are allowed. I do not mean to question your research, but I am just afraid to lose what I have gained on GAPS. GAPS was was the first diet that allowed me to actually start gaining weight (I could not digest much of anything before, had with diarrhea for many years (which cleared out in the first week on GAPS). Could you be as kind as to share your opinion on this? Thank you very much. Natalia

    • Hi Natalia,

      Sometimes when you have a gut infection it pays to avoid a particular type of food; in some cases starches, in others fructose. But as the gut infection clears, then you can improve your diet by adding those foods back.

      I would try testing small amounts of potato to see how you handle it. If you handle it OK, keep eating it in small quantities so you can build up the population of beneficial bacteria that digest it.

      If you can’t tolerate the potatoes, then I would suggest getting a stool test to see if you have a treatable infection. The Metametrix microbial ecology profile is a good one.

      Sometimes the reason grains and legumes were intolerable was due to toxins or allergies/sensitivities. Our safe starches are largely free of such toxins/immunogens, so you might find they’re tolerable whereas bread etc are not.

      Give it a try and see how you do!

      Best, Paul

  14. Paul, what do you make of this study suggesting that high omega-6 levels in the blood correlates to lower risk of CHD?
    http://www.medpagetoday.com/Cardiology/Prevention/33660

    • Hi David,

      PUFA are fragile and oxidized/destroyed under oxidative stress, high endotoxin levels, and immune activity. So sick people will lose both omega-6 and omega-3. I think we would have to examine the links between plasma phospholipids, diet, and health status to really understand this correlation.

  15. Because the healthy people have less inflammation, omega-6 is not being broken down through Cox1 and Cox2, or peroxidized, as fast.
    The saturated fat in the blood could come from fat or carbohydrate.
    We know PUFA in the diet is essential; this doesn’t tell us how much is optimal.

  16. Can anyone guess why Kurt Harris would state
    “Maybe make sure you are not hypothyroid ONCE…”
    Comments section is closed on the posting but I find that curious and cannot think of a reason.
    Merci

  17. I found it in his comments back to someone in the
    “Jimmy Moore asks about ‘safe starches’ e-mail post on his blog. I am sure you remember all that!

    I was reading through anything I thought might be valuable regarding safe starches which I am completely sold on, but just to investigate other hypothyroid implications / possibilities.
    (I can’t find a search function on his blog)

  18. context:
    KGH:

    Like HDL and triglycerides in the Kitavans, which are “very bad” despite their absence of heart disease, other markers that are merely a sign of carbohydrate intake may also become more “bad” when you raise your starch intake.

    sdLDL may be such a marker, and probably is.

    I find the idea that your body makes sdLDL in order to burrow into your intima and kill you implausible – the Lipid hypothesis 4.0…

    I can’t and won’t comment on your specific case, except to say your health is your business.

    I personally would not monitor anything more than waist size and blood pressure and how I feel and make sure I don’t have diabetes. Maybe make sure you are not hypothyroid ONCE…
    ______

    • Hi Catherine,

      Ah. He’s saying that if you’re eating right then your health will take care of itself, so if you’re not hypothyroid at the start then you won’t be ever after, so you only need to measure it once if it comes back normal.

      If it came back hypothyroid, of course, you would have to monitor it.

      I think there’s little harm in monitoring your body. So the reward-risk ratio is highly favorable, even if the chance of developing hypothyroidism is low.

  19. thanks, yes my screen had eclipsed it.
    Oh, as in “Rule it Out”

  20. “euthyroid sick syndrome, a state of low T3 and high rT3, directly. ” (PJ)

    Are you working with the free T3/rT3 ratio, or absolute values?

  21. Paul and Shou-Ching, I have been following PHD for 8-9 months, with wonderful results across the board. The book has been a great influence on my thinking and lifestyle, and I look forward to the revised edition. So much thanks are due to you.

    I find very interesting your view that many, many ailments are probably related to low-grade, chronic infections, usually undetected or undetectable. In these pages, you often advise various ways to address suspected infections where commenters have symptoms or test results which suggests one or another type of infection.

    I think it is safe to assume that anyone who has followed the SAD for a long time, or just generally lived in our modern world, is probably host to a number of infectious pathogens which may be well established but not (yet) able to flourish to the point of producing obvious symptoms. Of course anyone following the PHD should experience improved immune function which should help to keep such threats in check. But is general healthy living and a PHD diet enough to enable the body to purge these threats entirely? Certainly not always so. Often the path out of trouble is not a simple reversal of the path in, but requires more decisive measures.

    I have been wondering whether there could be a benefit from a general anti-infection regimen, something more aggressive than regular consistent PHD eating, which could be administered once or from time to time, aimed at really getting rid of latent infections. Such an approach might even include a limited use antibiotics for a time, which would probably need to be followed with countermeasures to offset or repair any deleterious side effects.

    You often point out the differences between fungal vs bacterial vs viral infections, as well as intra- vs inter-cellular, so if there is any merit at all to my idea, it would probably need to be in fact a series of different campaigns.

    Personally, I am delighted with my own results on PHD, and unlike many of the commenters here I don’t notice currently any obvious symptoms which suggest a specific problem. That said, in the past I have suffered probable celiac – self diagnosed, after decades of the full range of celiac symptoms were 80% relieved immediate I went gluten free, and the remainder cleared after adopting PHD. Decades of probable gut permeability suggests that all kinds of nasties may have slipped thru the gates. I also had childhood spinal meningitis, occasional flare ups of Herpes II, one or two of Herpes zoster, multiple run-ins with third-world “travelers” GI infections, one bout of probable Epstein Barr, and who knows what else.

    Sorry to be verbose – in short, aside from PHD, do you see any benefit from occasional more aggressive temporary measures aimed at latent, non-symptomatic infections, (prophylactic is the wrong word here, preemptive is more like it), and if so, what might such a campaign entail ?

    • Hi MH,

      I think in general, antibiotics will do more harm than good in a healthy symptom-free person. Keep in mind that antibiotics don’t just affect gut bacteria, they impair mitochondria and can produce permanent tissue damage, eg “black thyroid” and bones from tetracyclines.

      Our new book expands the list of natural immune-enhancing steps you can take that are clearly healthy. So that’s what I would recommend.

      Congratulations on your improved health! We love to hear such stories.

      Best, Paul

  22. Hi Paul,

    One question about olive oil : in this post http://perfecthealthdiet.com/category/disease/cancer/
    is it right you emphasize extra_virgin olive oil ccunsomption rather than other fat sources ? Is it an easiest fat to digest, and could you explain moreover why olive oil is not really a major part of the fat source ? I particularly digest it well contrary to butter, (even clarified one) or any other animal fats.. 😕 Coconut oil is not everyday welcome (gallbladder ?) even if I love its taste. Can Olive oil be the main part of the PHD diet as it is mentionned in this post. Thanks in advance,Best Maya

    • As an added link to the previous question, http://www.livestrong.com/article/519649-coconut-oil-the-gallbladder/
      I’d like very much knowing your advice on this topic : gallbladder and coconut oil. 💡

      • Hi Maya,

        We support olive oil in general as part of the diet. For most people we think butter and coconut oil will be even better, but olive oil does have polyphenols which are thought to be protective against cancer. Yes, if you like olive oil best, you can make it your dominant oil. It’s PHD compliant.

        I think for gallstone prevention taking taurine and vitamin C supplements would be enough. It shouldn’t be necessary to avoid coconut oil or a high-fat diet.

  23. I have been on PHD for 2 months and definitely have been doing much better health wise. I have had reflux issues for a long time too and these issues don’t seem to get better. I the issue is with the valve or sphincter not opening and closing properly. I have a doctor, a good one and I have talked to him about some spasming in my stomach area below my ribs and feeling a raw pain in the pit of my stomach. I also have a lot of white stuff in the back of my throat. Symptoms subside when I take prilosec or nexium. I do not want to take these medicines long-term. when I take them I feel better, but when I go off them the symptoms return. I have been drinking some ginger and peppermint tea, which has been little help, but I am wondering if this problem can actually resolve itself through diet or if it is with me for the long term. I forgot to mention acupuncture has helped! Also, I am part of the world trade center monitoring program and this is an extremely prevalent problem amongst people in the program…any suggestions?

  24. OK, this is helpful. I just started iodine so maybe it will help! Any other suggestions are welcome thanks!

  25. Hi Paul,

    It looks like my 5 yr old nephew (not blood related) has been diagnosed with a fairly rare and unfortunate disease, Juvenile polyposis. At this point they are going to run some genetic tests to see if it was passed from one his parents, but it seems like it might be a new gene mutation. I have been digging through all the information I can find online, but most of it just talks about how rare the condition is and as far as a cure or treatment nothing more than yearly colonoscopies are recommended. So, my question is this–Aside from cutting out food toxins is there anything additional his parents can do in an effort to avoid colorectal cancer in his mid 30’s?

    Because this condition arises from a gene mutation am I correct in thinking that in order for the mutation to present there has to be an environmental trigger? And so then by lessening the triggers one can possibly silence the expression of the mutation? Or do I have that all wrong?

    Thanks for your thoughts.

    Lindsay

    • Hi Lindsay,

      I’m sorry to hear that. Poor guy.

      You might read our anti-cancer series (two posts). We’ll add material to that series as we get time. I would be sure to keep him optimized in vitamin D3 and K2 – he should supplement K2 – and give him a bit of iodine too, plus train him in eating a good diet.

      Best, Paul

  26. Hello,
    My 20-yr-old daughter and I began the PHD this summer, and have seen very positive results. However, she returns to dorm life in a few weeks, and we’re wondering how she can continue. She can’t afford the meal plans at the cafeteria, and has about $80 per week for groceries. She has access to a public kitchen about twice a week, and her dorm room has a microwave/small fridge. Do you have suggestions for a college student in this situation (in addition to taking 19 credit hours)? Thanks!

    • Ann,

      When I was taking classes full-time I tended to eat a lot of eggs, frozen organic veg, rice pasta, cheap cuts of meat like roasts, potatoes and inexpensive fruits like apples and oranges. If she only has a kitchen a few times a week maybe she could hard boil a bunch of eggs, and boil off tons of rice pasta (trader joes has great rice pasta and it is quite cheap), mix the pasta with butter or jarred organic sauce when back in her room, add to it some microwaved veg. Also, maybe invest in a slow cooker for her room that way she can cook up big pieces of meat and veg without the need for an oven. Hope that helps!

    • If she can boil 4-5 pounds of potatoes when she has access to the kitchen, those will last the next 3 days. She can warm them in the microwave when she eats them, eat with salt, vinegar, and butter or sour cream.

      Eggs are inexpensive, microwavable, and very important. Yogurt and fruit are good.

      I think she can manage, but it does take some creativity and maybe a willingness to eat foods repetitively.

  27. I was trying to convince a guy of the PHD and he says that he can’t eat eggs. They give him gas.

    I’ve never heard this before and had no response.

    Any thoughts?

    • Hi Jaybird,

      Eggs are a frequent source of food allergies in people who have leaky guts. In his case however it may be that he has gut bacteria good at metabolizing sulfur. I bet sulfur sources (eg Epsom salt) would give him even more trouble.

  28. Sulfur digesting bacteria?

    Egg white is a fairly common allergen.

  29. Paul,
    I bought one of the iodine tablets you recommend in your supplements tab. I know I am starting at 225mcg but since the tablets come in 3mgs can you recommend how small I should cut it up? Seems like a very small sliver of the 3mgs??
    thanks!

  30. Hey Paul,

    I just lost many hours on Art Ayer’s Cooling Inflammation site. My main take away is that he thinks everything is caused by chronic inflammation.. Which is fine, but it seems that he is staunchly against starch consumption. Here is one of the many examples of his railing against starches
    “Starch Is Inflammatory. Starchy foods should be treated like a fish. The starch should be pared away and discarded, like the fish gut and bones. (The guts and bones could actually be processed to make them nutritious. Not so with the starch. The starch should be fermented.) The potato skin should be eaten and the rest discarded, just as an aphid secretes as honey dew the extra sugar it sucks in from a plant leaf.”
    Really?! I couldn’t find anything on his site that explained how he suggests a highly active person fuel themselves, but it seems to me that he would be in strong favor of forcing yourself to burn fat as your main fuel source. Any insight into why his interpretation of the literature is that starch is made from the tears of the devil?

    As always.. thank you.

    • Just have to chime in: anyone can potentially react negatively to any food. U must self experiment continuously. I fuel myself with meats, some fruits, oj, shellfish, coconut stuff. No need for starch in my life but that doesn’t mean everyone will react negatively to it. Too many variables.

      • Darius,

        I agree with that. I don’t have problem with starches, but some do. My question is really why he thinks starch is so evil. I don’t get the sense that he thinks starch is bad because people react badly to it, but rather he thinks the rapid conversion to glucose is detrimental to overall health. That theory flies in the face of the “safe starches,” here at PHD. For someone like me that is extremely active this sort of statement is disconcerting.

        Lindsay

        • Why is it disconcerting? Bc some guy says it on the internet? 🙂 I get where you’re coming from but its better to have a framework of self experimentation, symptoms and results about yourself because theories don’t pay the rent.

    • Hi Lindsay,

      It is surprising that he says that, because his focus is on gut flora and resistant starch has a great record for promoting healthy flora.

      But, one can certainly have a dysbiosis in which starch becomes harmful.

  31. It is disconcerting because he happens to have a PhD in Molecular Biology and his emphasis is on carbohydrate or some such thing. Essentially I feel like a half wit when I am reading his blog and need someone smart to explain the dirty details 😉

    Further, I find it remarkable how much the “experts,” in the Paleo 4.0 world disagree. Not being a scientist myself I wonder how so many people can come to so many different conclusions. Perhaps my curiosity is futile.

    In the end I do agree that self experimentation is key, but it is nice to have a trusty compass.

  32. The disagreement lies in the unwanted reality that everyone responds differently to stimulus regardless of rat studies or textbook diagrams.
    I just smile, maintain uncertainty as the only constant, and keep eating my sugar to good results.

  33. I am wondering what the ideal way for may husband to eat would be. His kidneys are in question with creatinine that is too high. He has been told less protein but that concerns me because you have to make it up. That usually means higher carbs.
    Does this diet work well for someone like him? I am just becoming aware of your ideas. I in vestigated becuse UI like potatoes and get so mad when I hear how terrible they are and that one should never eat them.

  34. I have been having difficulty finding an iodine supplement with an easy to administer serving size. I found a liqui-kelp that is liquid. 6 drops is exactly 225mcg, is this a satisfactory one to use??

  35. Paul:
    What are your thoughts on eating a primarily
    raw food diet, as is recommended by many foodies
    through their books, blogs, and interviews…
    I am concerned about infections that could be
    activated by inadvertent consumption of same from
    eating raw food. Would love your thoughts…
    Am I being too conservative here?
    Linda

    • I do not favor a raw food diet (except for fruit and some vegetables) for exactly the reason you mention, infections. To eat raw meat you’d better know exactly where it came from and that the animal was healthy and that the meat is fresh. Supermarket food will never meet that standard. Sushi/sashimi can do it sometimes.

  36. Here’s a quote from a podcast with Chris Kresser and Matt LaLonde

    ” I found that that was a head-scratcher because you’ve got this, you know, the raw food vegan movement being very popular right now, and they’re talking about enzymes and this and that, and the research doesn’t support it.”

    there is a transcript. that quote is in the section about slow, low cooking. basically, cooking makes nutrients more bio available.

    http://chriskresser.com/rhr-what-science-really-says-about-the-paleo-diet-with-mat-lalonde

    • Yeah, the enzymes that can be good to supplement are not likely to be in raw plants or in any meat safe to eat raw.
      Read The Viral Storm by Nathan Wolfe before deciding to eat raw meat.
      There is scant science about plant enzymes. What there is, involves them doing things to the plants (i.e. ageing garlic, ripening fruit) that can be done better outside the gut. And often sped up by cooking.
      If we evolved to do anything to our food, it’s to cook most of it.

  37. Hi Paul,
    I was wondering if you can advice on my health issues.I’m from Eastern Europe here we don’t have functional or nathuropatic medicine – your site is great source of information but also shocking for me. I love your scientific approach.

    I’m now on a very low carb and I found many symptoms you describe as being a danger for me.
    Because of ilness I’ve lost my job onw year ago and many years of conventional testing showed nothing (5 endoscopy in 2 years => no H.pilory) just recently we discovered leaky gut and chronic infections: candida (believe it’s sitemic now) parasites(giardia especially, pinworms) citomegalovirus and EBV, H.Pilory (seems chronic now not able to have acid) and yearsinia enterocolitica (quite nasty). With Paleo diet I’m feeling better but very weak. I’m afraid taking magnesium or mineral or B complex cause of bacteria flare – e.g. yersinia seems to flourish in a Fe environment. Maybe transdermal are ok? if they contain also minerals do they reach the blood and gut when bacteria lives? Some probiotics made my condition worst except Acidophilus I guess. No fermented food or starch is ok. Grains are out of question with yeast and white flour. I’m am now stable somehow but not able to progress. But still very constipated. tried psyllium, linseed not ok for bacteria i guess.

    I am thinking about getting the Metametrix GI profile but can’t take antibiotics with all those bugs and candida. I would love to find a holistic or something really good. Doctors here believe this is a SF ilness in my head of course. Send me to psichiatrist and she advice to continue the searching and cure internal causes. Smart women.
    Adrenal fatigue by simptoms (blood test here ok), hipoglicemia and bacteremia feeling once several days.

    Could you be so kind to advice? I’ve read about antioxidants but don’t know how long should I take them, how much …and for constipation
    Many thanks,
    DavidF

    • Hi David,

      Eukaryotic pathogens like Candida and giardia benefit from very low carb diets, so I would certainly eat some carbs (aim for ~30%).

      I would take a B complex maybe once a week, not every day.

      Magnesium is important for you so I would take that. Definitely you want iron low. Avoid taking vitamin C with meals, that will promote iron absorption.

      I would check thyroid status just to be aware of what’s going on there – do you know your TSH?

      Hope that helps. Our general diet advice is my strongest recommendation.

  38. Paul, I know you say that fructose is bad and toxic to the body, but what I don’t understand is why a developing embryo, before it becomes a fetus, has fructose as its primary source of fuel. Another example is semen. From wikipedia: “The seminal vesicles produce a yellowish viscous fluid rich in fructose and other substances that makes up about 70% of human semen.” It apparenly has important functions in the body. I’m just curious what your thoughts are. Thanks.

  39. There’s a good risque joke in all this at the right time and place.
    Sperm doesn’t have to live long, in fact it’s better if it doesn’t. As for the fetus, I didn’t know that.
    But perhaps the ability to turn to glucose or fat with equal ease is an asset when the rate of growth is rapid. There is also an analogy with tumour growth, which also sees increased fructose uptake.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC39870/
    Fructose is probably a fertility signal for humans; with a 9 month gestation we want to deliver in spring or summer; if we fatten at ripening and windfall of fruits and nuts, when fructose (and PUFA) is high, the timing is just about right.

  40. I am on an elimination program to see which foods, if any, might be causing symptoms. This is the week that I am to add back foods, one per day, and note my reactions. This is proving to be very difficult because I can awaken in the morning to sneezing fits that last for as much as two hours. Extremely itchy eyes and constant need to blow my nose. I don’t think this is related to food, but really don’t know.

    I keep going back to the possible leaky gut/allergy connection. I have been gluten free for over 18 years and table sugar-free for twice that.

    Regarding bone broth, my intentions are good but I get discouraged when it doesn’t gel, tastes less than good, or when I just don’t want the mess to deal with. But now my allergies have been so terrible this past month that I am rededicating myself to a cup of bone broth three times a day.

    To that end, I searched online for some encouraging words connecting bone broth to eliminating allergies. There is plenty, including this article: http://www.thenourishinggourmet.com/2011/09/the-healing-power-of-broth.html

    I am sending it to you because the author, Kaayla Daniel, addresses the Fit for Life and Eat Right for Your Type diets. She believes that the issues these diets are designed to address can be better dealt with by adding bone broth to the daily diet. She provides her many sources.

    The article mentions lysine in bone broth, which is part of Pauling’s protocol for dissolving arterial plaque.

    No questions with that. Going to try using a stockpot in the oven for broth, as the crockpot is so cumbersome and nets me little for the energy I expend.

    Question regarding iodine: What have you to say of Edgar Cayce’s Atomidine? Label says it’s Iodine Trichloride with recommended dose being 1 drop in water, which provides 600 mcg.

    Thanks

    • Hi Lana, just a quick note regarding the bone broth: Having it three times a day may be a little too much of a good thing. See this case study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279073/

      As for the Atomidine, I couldn’t find anything I would trust regarding its merits and background. Regular Iodine supplements work just fine IMHO.

      • This is interesting, Wout. I had found that having too much of my home made bone broth gave me diarrhea and this was with it defatted. My Chinese medicine practitioners advised me not to have more than 2 large mugs a day. Now I use it mostly to cook my veggies in and I just drink whatever broth may be leftover from the cooking.

        • Yes … in the new book we recommend 3 bowls of bone broth per week … probably up to 7 would be OK, as long as they weren’t prepared with overlong cooking or lots of acid.

          • Paul and Wout,

            I believe you two may have solved a mystery for me! Three months ago I decided to do a 3 day fast and was drinking bone broth all day long that I kept boiling on the stove all day, as well. A day or so after the fast, I developed severe diarrhea and actually passed out from dehydration. Fortunately my husband caught me before I cracked my head. I seemed to have a fever and when it broke and I drank some water, I was okay, but I continued having broth every day and diarrhea to a lesser extent for a week before I saw my Chinese medicine guys and finally got it under control. I figured it must have been an intestinal virus, but I could not figure out how I would have gotten it. Now I suspect I may have had some sort of toxicity from the excess broth. In an attempt to make sure I was getting all my minerals (rather than take a pill) this turned into a classic case of thinking more is better. Tough way to learn that lesson again.

          • How big is a bowl, and how concentrated is the broth? I had the diarrhea from drinking too much last year, and it was also cooked very very long. And I didn’t skim.the fat. I want to do.it right this time.

          • darius, a bowl of broth is about 250 ml.
            There’s lots of ways to make broth.

            I get about 3litres of broth from one chicken carcass. (you can add some more wings or neck or even some meaty pieces if you want. I use a slow cooker on low setting, start it up after supper and it’s good to put it in jars after breakfast the next morning. Remove the fat after it’s cooled.

          • So I’m using grassfed beef bones. Id cook them on low for 8 or so hours… The bones must be thawed first in the fridge right?

          • When use beef bones, sometimes I roast the bones first. I use some meat too. I also add carrots,celery, onions, peppercorns, salt.

            There’s tons of really great recipes on the internet.

          • Just a note on bone broth as I have just made the best chicken broth yet. The key to getting the broth to gel is chicken feet. I just made a broth with about 1-2 pounds of feet, around 8, a few veg, lots of garlic cloves and let it simmer really low for about 6 hours. 24 hours later it has gelled completely.. so much so that it looks like brown jello. And delicious to boot.

  41. Hi Paul,

    I and my daughter and my 15 year old grandaughter eat 1 oz of raw grated liver in lemon juice for breakfast every day. We have been doing this for about four months and we all have more energy since we started eating it every day, previously I was eating four ounces of cooked liver per week. We buy it farmer direct, it is not certified organic but he uses no pesticides on his farm and it is grassfed. It has been frozen for two weeks before we eat it. You can’t taste the liver this way and I thought it would actually be better for you raw. Do you recommend that we stop eating raw liver? Thanks so much for your help.

    • Hi Francesca,

      I think cooked is safer, because there may be viruses or other germs in the raw liver. Even healthy people can have hepatitis viral infections for decades; I imagine the same is true of cows.

      Hepatitis E infects both pigs and humans, but I’m not aware of viruses that infect both cows and humans. So beef liver is much safer than pork liver. But it’s probably better not to chance it.

  42. There is also the question of unknown viruses, and viruses that are harmless but may one day interact with some new agent.
    The Viral Storm is a great read and has sold me on a) cooking meat b) getting professionals to do my killing and butchering. Without scaring me; it’s just that it makes sense. The author has quite a paleo perspective, has worked with Jared Diamond.

  43. Aww gee, I’m kindof worried and upset now. I developed a real taste for sushi/sashimi. (I stick almost exclusively with salmon) It’s one meal that I feel really good after I eat it. It seems like the perfect food…white rice mixed with vinegar, seaweed and fish.

    I have developed ulcerative colitis after starting this sushi habit. I can’t help but wonder if I’ve acquired a pathogen of some sort that has contributed to the destruction of my mucosal barrier.

    Thanks for the book title, George, I’m going to look into that and maybe get myself a stool test. That should show any pathogen overloads, right?

  44. From the logic of the book, fish are extremely unlikely to give humans viruses. Parasites and fevers maybe, but the closer it is (primates and pigs) the more likely a virus can jump. Fish really has minimal risk of being the next SARS or HIV source.
    Fish Flu is not on my radar yet… and cooked fish may be more risky for bacterial contamination than sushi.
    It (UC) might be the soy.

    • I wasn’t thinking virus, I’m concerned with the bacteria from the raw fish. UC seems to happen when the gut bacteria become unbalanced.

      It sounded to me like that book also discusses bacteria.

      Would you mind elaborating on your thoughts about soy? Can the hormonal disruption cause a bacterial imbalance or something?

  45. Hi Paul,
    Many thanks for your feedback – except you website I have never find this ideea with carbs for candida and giardia. Many protocols said for giardia low carbs low fat cause bile encourages giardia and low for candida.my problems is I also developed bacteria which feedbs on carbs.

    Paul I’ve been taking Mg before and it lowers my blood pressure but also I think some bacteria benefits from it. is it possible? what about transdermal oil of magnesium as an alternative?

    I also have UC (not so bad with paleo diet now) except constipation very taugh. I cant keep water in me and last stool is like hard pellets – only enema help now. I’ve read about butyrate and bifido can help along with krill oil? is it same to take these while having bacteria or candida?

    Blood test TSH 2.558 in normal range they said (I don’t believe tests here many years I was healthy acc to them). LH is 1.25 (lower limit is 1.14).
    but I believe my pituytary- adrenals- tyroid is messed up cause chronic infections.

    I have also a lot of symptoms of adrenals; need for salt, morning lethargy…
    Do you think I would benefits from iodine and adrenals support?

    Last one – should I take antioxidants for helping imunity – seems I cant fight with everything. also CMV seems to be reactivated.What can I do to help my imune system. Acupuncture?

    Many thanks Paul

    • Yes, magnesium is an ingredient in bacterial biofilms so it is possible that bacteria benefit from it.

      Have you read our constipation post? You may benefit from bile supports, eg vitamin C and taurine, maybe ox bile supplements with meals. Try also the other supplements, eg glutathione.

      A TSH of 2.558 indicates a low-level hypothyroidism. You would benefit from iodine and selenium rich foods, and perhaps from supplemental thyroid hormone. The hypothyroidism may be a major contributor to your constipation.

      I think circadian rhythm therapies are very important for immunity. Our new book discusses this. Try to get sunshine and activity during the day, dim lights and plenty of sleep at night.

  46. Hello Heidi,
    Could you tell what simptoms do you have as UC? Were you officialy diagnosed? Cause after colonoscopy they told me the same – UC with unknown cause and I am very constipated – my guess is due to pathogen agents. I already know I have candida and probably Enteroccocus or something. Unfortunately no conventional antibiotics for me 🙁 They already distroyed mucosal I’m feeling it cold and no mucus is there + inflamation. Gastro doctors here said its impossible 🙂 🙁
    What kind of test are you intend to do ? Metametrix?

    Many thanks,
    David

    • Hi Dave, My UC was diagnosed with biopsies during a colonoscopy. My symptoms are opposite to yours including bleeding for close to a year. (six months was waiting for the tests/diagnosis).
      I don’t have access to Metametrix (I’m not in the states) so I have to search for someone here who can help me, or get a passport and go to the US.

      In the meantime, I’m working away at drinking bone broth, taking probiotics and trying different eating strategies to look for clues and reducing symptoms.

      Before I took up the sushi eating habit, I had avoided starchy carbs because I had difficulty loosing weight. My appetite normalized and my face cleared up, so I thought I was on to something good with low carb. Now I’m not so sure.

      Good luck to you

  47. Hi Paul. I’m sure this is a pretty hackneyed topic by now, but what is your take on organic fruits and vegetables? Is it critical that I eat only organic, or is it OK to eat regular supermarket vegetables and fruits? I’m working with a budget, but I want to make the healthiest choices.

    • Hi Jason,

      No, I don’t think it’s critical to eat organic fruits and vegetables. But do wash them if they’re not organic.

      We have noticed that organic fruits and vegetables taste better and last longer. Supermarket plants go bad quickly.

  48. Iodine question—

    I should not have buried my iodine question in my allergy/bone broth ramblings.

    I would like some feedback from anyone who knows.

    Original question was: What have you to say of Edgar Cayce’s Atomidine? Label says it’s Iodine Trichloride with recommended dose being 1 drop in water, which provides 600 mcg.

    However, I have read that “this stuff” is “never to be taken internally!”

    Does anyone know about “this stuff”?

  49. Hi Paul,

    Can you comment/advise on my experiment idea please. First some history: I used to break out with very itchy pimples just before my period would start. When I went LC (avoided starchy carbs and most fruit) my face completely cleared. I then developed an auto immune skin condition that also ‘flares’ just before my period. Now I have developed ulcerative colitis which also flares during that part of my cycle. (Dr. is experimenting with med doses- 5ASA’s only at this point- no steroids)

    I’m thinking it’s possible that my bad gut bacteria are hormone dependant. (is this a possibility?) and that I should attempt to eat the ketogenic version of your diet for a few(?) days before my period starts.

    Is this dangerous in anyway? I actually do feel better (mood) when I added back ‘safe starches’, but I noticed I am also getting blemishes again.

    I will add that I went LC in an attempt to lose weight. I did lose a little but still had too large an appetite. Now with the ‘safe starches’ added in, I don’t have great appetite control, particularly at night.

    I will also add that I’m not taking the recommended supplements at this time because it seems that UC people can be really sensitive to additives in the supplements.

    • Hi Heidi,

      The menstrual dependence should be a strong clue, but I’m not knowledgeable enough to know how to interpret it.

      A little googling suggests that acne just before menstruation may result from excess androgens, as occurs in conditions like PCOS.

      Androgens can promote immune activity, promoting autoimmune conditions and maybe colitis: http://www.sciencedaily.com/releases/2010/01/100104135828.htm.

      So these might suggest you see an endocrinologist and see if androgens are high just before your period.

      An ehow site claims that menstrual colitis is due to prostaglandins promoting cramping/contractions (http://www.ehow.com/facts_5038557_menstrual-colitis-symptoms.html). If that’s the issue, then omega-6/omega-3 balance might be important, or perhaps some sort of oxidative stress that is producing excessive prostaglandins. Oxidatives stress stems from immune activity, returning us to the issue of androgens.

      Another possibility is a stool test or other diagnostic testing for SIBO. I associate difficulty regulating glucose and appetite with small bowel or pancreatic infections.

      These are just ideas, I really don’t know what is going on, but it seems like you have high levels of immune activity plus perhaps a hormonal imbalance.

      Best, Paul

      • I appreciate your generous (and diplomatic) reply, Paul. I guess I know why I’m not a scientist but at least I know when to ask questions 😯

        I will investigate this direction. Thanks.

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