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. Hi Paul,
    Many thanks for your thoughts. I’ll try them they should help. I am still confused about bile salts – they help distroying bad bacteria but Metametrix GI guide told also giardia feeds on from bile salts and fat food.?!also some bacteria do that?

    I’m trying some fat for my leaky gut and UC but now I’m clueless. Alternative – does krill oil count as fat food? or generally oils? I guess animal fat is out of question. Pancreatic enzymes only without bile and HCl supplements shoud help?

    My dilemma is this – I have UC with constipation so cant get out but I also have to get rid of bad guys? My guess is putrefactive bacteria/supfhur like. Meat is not best choise but on a candida low carb diet what should we eat? Butyrate supps seems to help UC in any case?

    thank you, Paul

    • Great point about the bile salts and giardia. Yes, eukaryotic pathogens may benefit from them. I suggested them as a way to deal with constipation, but giardia taking them may be why giardia causes constipation. So bile salts are a mixed bag: they may aid the giardia, but at the same time if they help you digest fats they might benefit you.

      Krill oil, like fish oil, is rich in omega-3 fats.

      Why is animal fat out of the question? I would try to eat a balanced diet, to support immune function and healing.

      Meat is generally a nourishing, low-risk food. I would also try to get some quickly absorbed carbs — rice syrup on foods?

      Butyrate should be very good for you.

  2. Egg yolk consumption is purportedly dangerous:


    Can anyone find that study? I try not to be neurotic about every study that comes out, but I’d like to read this one because I love eggs.

    I wonder what other foods the subjects were eating. This kind of touches on a question I’ve been wondering about for a while. If a person ate a diet what was, say, 70% PHD compliant, but the other 30% was a typical American diet with bad carbs, vegetable oils, and sugars, is is possible that the otherwise healthful high saturated fat, high-cholesterol foods would have some sort of bad synergy with the bad carbs, vegetable oils, and sugars?

    • Hi Thomas,

      The high egg group had higher HDL, lower trigs, lower BMI, lower LDL, and were diagnosed with diabetes later in life than the low egg group. They didn’t measure health outcomes, only plaque area, and the high egg group had only 5% more plaque area despite more smoking and older age. They could just as easily have selected some of the other biomarkers to show that eggs are healthy.

      Add in the weaknesses of judging diet by food questionnaire, and I don’t think this is a study you want to pay much attention to.

  3. Hello community and Paul,

    I have a bad habit of giving out nutrition advice to my friends (only when asked). The reason I say it is bad is because it has, on occasion, come back to bite me..

    A friend of mine told me she was feeling really hungry during her intermittent fasts so I suggested she implement coconut oil or MCT oil. She did that for a few days and continually reported that it made her feel sleepy and groggy and “not really blurry eyed, but weird vision.. ” I didn’t pay much attention to this because fasting with the addition of MCT also makes me feel strange.. but then I was reading through some old comments and noticed that it is mentioned a few times that ketones are no bueno for fungal infections. So, I asked her if she had any history of yeast infections and whatever and sure enough she does and in the past week she had a flare up which she attributed to increased heat and exercise. So..

    Do fungal infections in fact benefit from ketones? And if so what is a girl who eats “clean,” while training for a fitness competition do without her coconut oil? Is it bad in all amounts of just in large doses? Also, has anyone else had success with treating mild/moderate fungal type infections? I realize this will lend itself to more nutritional advice, but I swear after this problem solving mission I am done! 😉

    Thank you!

    • Yes, systemic fungal infections benefit from ketones.

      You can eat coconut oil in moderate amounts, just be sure to eat sufficient carbs.

      I think the basic (non-ketogenic) PHD is great for fungal infections. Add more vegetables for greater efficacy.

    • antifungals – milk products, chocolate, coffee, spices like oregano, cinnamon, sage, ginger, olive oil
      probiotics (probably yogurt)
      potatoes and berries and other safe insoluble fiber to help clear out the toxins
      and feed the good bacteria
      frequent elimination and sweating/bathing
      sleeping in the dark
      lots of water

    • You don’t think a mild dying-off reaction could account for this?
      Sometimes eating a lot of fat at once affects my vision. Not as much or for as long as carbs used to, but there is a post prandial effect of lipid.
      Never noticed it with coconut oil on an empty stomach though.

      • This snippet of conversation reminds me of a question I have about the ‘die -off’ effects of coconut oil on candida (or other fungal pests.) Are crummy symptoms like those mentioned by Lindsay and George REALLY the result of dead and dying fungi? I hear this so often, but can/has anyone proven it? I sometimes think it’s one of those woowoo health ‘truths’.

        • Just imagine having a load of dead crap in your circulation. Maybe not just fungi. I think that calling it all Herxheimer is wrong as Herxheimer is a fever:
          (yeah, the page is “Health Truth” but the science history is sound.
          How would you prove it?
          I’ve reacted like that before to nystatin, to antibiotics, and to cononut. But I don’t anymore because there’s no candida to die off, or no excess (and I no longer need to take nystatin or antibiotics, which were causing bacteria to “die off”).
          So I consider it real, but perhaps sometimes used to excuse the effect of toxic treatments by woo-woos.

        • Die-off can be real, but the symptoms are not very specific: they result from circulating toxins, and you can get similar symptoms from environmental mold or many other causes.

          Most of the pathogen die-off toxins are excreted via the liver and bile, so taking charcoal or bentonite clay will help clear them. If these help it can support the idea of die-off.

          But in most people, there are no major systemic infections and the bulk of symptoms come from gut endotoxins and leaky gut and food sensitivities.

        • Susan,

          For me it is hard to say.. When one’s entire life is a big n=1 sometimes it is easy to get lost. Personally, I have been dealing with some kind of “infection,” for a few years or maybe my entire life. All I know is that most of my symptoms are triggered by stress.. so it makes it extremely complicated to treat. Anyhow, when I tried ketogenic style fasting I felt kooky.. my head was spinning, my eyesight was weird, I felt out of control and had a rapid heartbeat. So, I stopped doing that! About a week later I started taking high dose probiotics just to see if I would feel any major difference… and what do you know, I did! I felt instantly better, clearer, calmer, etc. But in addition I also became congested (which for me is uncommon), had a sore throat, increase in eye floaters, and a general mild itchiness all over. Much of these symptoms have subsided in the past 2 weeks, but some are still there in a mild form. Yesterday I began taking higher doses of Vit C (about 5 mg.), a different probiotic with different strains, 2 glasses of kombucha, and a higher dose of Iodine (by accident)… the itchiness increased and I could not sleep to save my life. So.. I think yes, much of this is “die-off,” but by what mechanism and to what extent I have no idea.

          • Kombucha and kefir have yeast.

          • I accept that die-off reactions are possible, but I have never seen proof that the indigestion I–or anyone else– get from coconut oil is indeed due to candida die-off. Lots of things upset my stomach and digestion–so maybe I just have a belly ache because my belly doesn’t like coconut oil. Just want to be clear–I know how easy it is to be mislead by medical ‘research’, and have become skeptical of everything I read.
            However, I very much enjoy this site–thanks to the Jaminets!

          • Oh, no.. I don’t think indigestion by coconut oil is a die off reaction either. My reaction to MCT oil is more cognitive in nature.

    • I am one who found that IF plus ketogenic diet with large amount of coconut
      Oil fed fungal infection. Am doing well now with non ketone and non IF PHD Which does include small amounts of coconut oil or coconut flakes. One of my favorite
      Anti fungal foods is a salad of raw grated carrots tossed with good olive oil and fresh lemon juice

  4. I am geting really thin, eating some more carbs now like rice, sweet potatoes, yams ect…but not all that hungry since not eating any grains. I have been off wheat, oats, rye, barley for years, but taking out the CORN, leagums(sugar snap peas)has seemed to really make me shrink. I am down to 100 lbs, I’m 5’4″……….I have always been thin, and very active, but this is kinda scarry. I am on a low dose of Natural Thyroid meds, and my TSH has been 1.50 to 1.25, also my FT4 has been low and my FT3 has been middle low. I feel like I have maybe too much T3 activty, but not seeing it on labs. My muscles are shrinking and am more tired. I read here that,many have had to lower their doses, I am on 1/2gn now so I have cut back from 3/4gn, I was getting really high FT3 with that. MAybe need to go to 1/4??
    Thanks for any in put. Laura

    • Hi Laura,

      Muscle shrinking and fatigue could be either hyperthyroidism or hypothyroidism. You mentioned FT3 was too high, so hyperthyroidism sounds more likely.

      You could go to the doctor for another thyroid panel, or try experimenting with dose yourself. You should be able to notice the difference fairly quickly.

  5. Paul,

    What do you think of a metametrix stool profile where all obligate and facultative predominant bacteria are in the 5th quintile, several around 9? I took a lot of probiotics recently as well as kefir and fermented food. A few months ago the values were low, but now they are too high! Is it better now than before? No opportunistic bacteria, h-pylori is gone and only have one unknown parasite (which metametrix does not consider important). I wonder what I should pay attention to now. Any clues would be very appreciated! Thanks


    • Hi Jo,

      I think you’ve done well to start eating fermented food, and now you need some time for your gut ecology to stabilize. I guess I would just try eating a healthy diet, and living a healthy lifestyle. Include some berries and green leafy vegetables and potatoes if possible to support a healthy flora.

      • Thank you, Paul! I’ll try little portions of berries and green leafy vegetables – no problem with potatoes but my body is super sensitive to fruits and green vegetables. I’ll report my progresses with the wonderful PHD!

  6. Hello. I am trying to wrap my head around why my newborn needs a hepatitis b vaccine. Any fact based opinions pro or con? The “best” response I have heard is he is not going to get it when he is older. Seems like the I as the parent would be controlling that. I know this might be outside the realms of this site but I figured it could not hurt to ask.
    Thank you for your time.


    • Hi Sophia,

      I’ve suspended your subscription. In case this occurs again, you should be able to find a link at the bottom of the comments page which will let you delete or suspend your subscription yourself.

      • I tried and received a message saying that I would soon receive another message with a link. I never received the second message. Also, the process seems cumbersome. But, thank you for your quick response. I couldn’t keep up with my Inbox.

  8. Please direct me to the way to.make bone broth safely that’s recently been mentioned

  9. Real Food Eater

    Hey Paul, do you have any suggestions for what to feed cats and dogs so they are eating a “Perfect Health Diet”? The ingredients on the typical cat and dog food bags do not look promising.

    • Feed your dogs and cats raw meat. There are many commercial brands selling beef, rabbit, lamb, venison, duck, chicken. They don’t need grains any more than you do and it is not natural for them to eat them. I greatly improved both my cats health by getting them off any commercial brands with grains. One of my cats is so sensitive she cannot tolerate something in the commercial products so I buy her ground meat and mix it with calcium (from the holistic vet).

    • I have not yet made the switch to raw, but I’m strongly considering it. I do feed grain free and also give my dog marrow bones 3x per week. I am working on a PHD for dogs, but need to do more research.

      This is a good article and also there are good links in the comments.


    • Yes, cats should eat mostly raw meat, a mix of muscle, organ meat, and fish and eggs. Milk is OK in moderation. Some bone broth would not be amiss either, but not too much.

      Dogs can eat some vegetables and fruit with a mix of cooked and raw meat/fish/eggs.

      • My dog has had thyroid issues (hair loss, flea sensitivity, emo behaviour, mastitis) on raw meat etc. which can be prevented completely by adding powdered kelp to feed and hence were soley due to low iodine. She likes kelp, raisins, prunes, but not other vegetables.
        She loves cheese and fat, even tallow, and fish or fish oil.

        • My cats love coconut oil (@George : great for thyroid status in cats and dogs,said a vet ? the same for human ??)and butter… Thay also love steamed green beans, and some winter squashes ! 🙂 They eat raw meat,especially chicken,turkey,liver and so on. I exclude pork that seems to make them badly ill and a little bit agressiv (?).

          • Does anyone have suggestions for a hyperthyroid cat? Our cat was diagnosed hyperthyroid last fall based on her bloodwork (they only did T4). Because I didn’t really want to jump straight to giving her medicine, I opted for the y/d catfood (for hyperthyroid cats) which basically lowers her T4 level by restricting iodine (it’s the only catfood with very low iodine). I never was quite sure if that was the right thing to do, but it did bring her T4 well within normal range. I just wonder if it was treating just a symptom instead of actually helping her heal. Anyway she won’t eat it anymore (she’s probably smart!) and I recently switched to a grain-free cat food which she likes. I’m not sure about raw because she’s older and very set in her ways, so switching from dry to raw might be impossible (she has always preferred dry over wet food).
            Any ideas or information?? I read the marksdailyapple link above and clicked on the one for cats, good articles.
            Maya- what does the coconut oil do for their thyroid?
            Thank you!

          • KH,

            I think is an error give your cat a low iodine catfood. Iodine is even a conventional treatment for hyperthyroidism:


            Since hyperthyroidism in cats is associated with polybrominated compounds, I think that lugol’s plus some selenium and sea salt in water/food is possible the best treatment:


            Hyperthyroidism in cats is also associated with chemicals in litter and canned food.

            owner of 4 cats.

          • Hi KH,

            Lithium is a good treatment for hyperthyroidism. Try 5 mg tablets. I would do that first, then try low dose iodine with Mario’s suggestions. I don’t think she should need selenium if she eats eggs/beef/shellfish.

          • We have a hyperthyroid cat and I have thought about trying the Abraham iodine protocol as suggested by Mario (I’m on it myself).

            It’s true that the iodine protocol can be very effective against hyperthyroidism in people. But it’s also true that one of the very few contraindications for the iodine protocol in people is the presence of functioning autonomous thyroid nodules.

            In this case, the iodine feeds the nodules and the problem of too much thyroid hormone only gets worse. And since the autonomous nodules don’t listen to TSH or other normal physiological controls, there’s no counterbalance. For this type of hyperthyroidism, iodine supplements cannot be used, as far as I understand. I believe all the well known doctors using the iodine protocol agree on this.

            According to my vet, in cats the typical hyperthyroidism is very similar to the functioning autonomous nodules in humans. So this might very well mean that iodine supplementation would only make things worse and could in fact be dangerous. This could be true even if the original cause for the problem was iodine deficiency and the related problem of bromine toxicity mentioned by Mario.

            This also might mean that the low-iodine cat food could be a good idea, despite the danger of starving the rest of the body for iodine. After all, hyperthyroidism is extremely dangerous, often deadly, to the cat and must be controlled by whatever means necessary. The conventional alternatives are chemotherapy drugs or radioactive iodine therapy, which aren’t so great either.

            So, based on what I know I’m not sure whether iodine supplements would be a good idea or not in a hyperthyroid cat. Certainly, I think if one wanted to try it extremely careful medical supervision and testing would be required to make sure the hyperthyroidism doesn’t flare and cause irreparable damage.

            We also have a hypothyroid greyhound, and I’ve seriously thought about trying the iodine protocol for her. Here, the concerns above would not apply, and my hesitation mainly concerns the lack of a proven track record of safety as with the iodine protocol in people. Not to mention freaking out my poor vet :-).

            Good luck with the kitty.

    • Thank you Mario and Paul for your suggestions!
      Any ideas how I can monitor her progress (aside from weekly or monthly vet visits for bloodwork). I can take her for bloodwork every few months but it’s so expensive so I can’t do it too often. Any signs I can watch for to see if the changes are helping or hurting?
      I hadn’t ever thought of the cat litter… right now she has very perfumy clumping cat litter which sometimes gives me a headache (I can’t imagine how the poor cat feels!). However, before this bag, I was buying cheap bags of clay only cat litter (no smell, nothing) and using that along with baking soda in her litter box. Does that seem safe, if I switch back to that instead?
      Also, if I try the added supplements you both mentioned, would it seem ok to stay with the new grain-free food that I just started her on (Merrick’s Before-Grain Chicken dry food)?
      Apart from the past bloodwork, she looks and seems to be doing well (her coat is a little shinier, a balding patch above her eye seems to be filling back in slowly and her BM looks normal).
      Paul, it looks like you and Shou-Ching might need to develop pet PHD for all of us animal lovers!
      Thanks again so much!

      • Here is a link to view the grain-free cat food I mentioned.
        Mario- what do you feed your cats generally?

      • I don’t think your current cat food has a significant implication with her hyperthyroidism. Perfumy litter on the other hand, is something to consider. Clay with baking soda would be a much safer option.

        You can monitor her progress measuring her weight and her heart rate (over 200 is considerated a sign of hyperthyroidism).

        • Hi KH,

          I do not know what’s the reason why coconut oil is recommended in thyroid problem for cats. Maybe because it enhances the metabolic rate ??

          Concerning food, I can only tell you from my experience : grain-free food has been a huge improvment in the overall condition of the pets I met.If you can’t prepare the food of your cat on your own,may I suggest you this brand :
          or this one (more affordable)

          Very interested concept, made with all raw ingredients, and slowly air_dried. A must !

          As Mario said,perfume and all synthetic adds from the litter or any other “synthetic” perfume in the house can be harmful for cats (as it is for us :). Maybe you can get in touch with some homeopath vet in your area, that could give you some tips to treat her gently. Cats do react extremely well with homepathic remedies.is
          Maybe you can try bovine colostrum (liquid form or powder form) is also usually used to reset and boost the immune system.

          Good luck for the kitty !! 😉

          • Thank you Maya for the links to raw cat foods– I’ll look into them. I’m not sure she will go for it, but I’ll check into it.
            You’re definitely right about finding a homeopathic vet– the vet we currently go to is well- meaning and a good vet, but very much by the book and not willing to try any other route with her. With the exception of her cat litter, we don’t use any synthetic scents (no air freshener or anything like that) and she always gets filtered water. In the past I made her cat litter at home with newspaper and baking soda, but stopped because I was worried about the ink dyes in the paper and because it was a little too time consuming for the amount that I made.
            Thanks again for your input! Very helpful!

            To Bill (above)– thank you for the info… a lot to think about now… I will research the autonomous nodules, but is that something they can test for or does it show up on X-ray or something?

            Thanks everyone for your input! Very very appreciated! 😀

          • “I will research the autonomous nodules, but is that something they can test for or does it show up on X-ray or something?”

            My impression is they don’t normally look for it specifically. Perhaps the vet schools do the advanced imaging tests the human endos do, but I don’t think it’s routine. My vet told me that in cats hyperthyroidism is generally of this type.

            Maybe there is experience out there somewhere of people trying the iodine protocol, or a feline version of it, for hyperthyroid cats under veterinary supervision. If so, we would know a lot more.

  10. Hi Paul,

    I was hoping to get your opinion on the Autoimmune Protocol of the Paleo diet. I suffer from psoriasis and have been following the protocol for the past few months with minimal progress. Do you think following such a strict protocol (basic paleo in addition to no eggs, grains, dairy, nuts/seeds or nightshades) is necessary for those with AI issues? Ive been able to handle it, but it is SO restrictive that it gets frustrating. Thank you!

    • Hi Marci,

      Although it’s called an “autoimmune protocol” it’s really a food sensitivity protocol. Often autoimmunity is caused by wheat so removing wheat can eliminate autoantibody production, but I’m not aware of wheat causing psoriasis.

      I would expect psoriasis to be more sensitive to omega-6 / omega-3 status and nutritional status.

  11. Where on this site do I go to look up a topic from the book (which is downstairs in my car!)? I’ve already copied the index and put it in the book.

  12. Hi Paul,
    Do you think it’s possible that broth could be “food” for some bacteria in the descending colon?. I’ve read here about sulphur bacteria.
    I have also CMV, yersinia, candida.

    It’ very curious everything good for many are not good for me and I’m thinking about different bacteria /pathogens. NOK broth, psyllium husk, linseed, okra, NAC ? they make my descending colon megabloating and no gases passed out!and of course constipation.

    I once tried colonics + krill oil + Bifido from Natren and things were better a little. No other probiotics except clean Achidophilus has helped me. I’ve heard there are bacteria/amoeba feeding also with probiotics.

    Have you got any info on that,
    Many thanks,

  13. Hi Paul, In your book Pottinger’s tests on cats showed they thrived on raw meat and did poorly on cooked meat. Would it be better to eat our meat raw?

    • Hi Marilyn,

      For humans, no; but taurine supplements might be worth considering, especially if you don’t eat meat rare. We have a more diverse diet than cats and are at less risk of nutritional deficiencies.

      • Thanks Paul. I am LOVING your book. It’s easy to do the diet when the science and reasoning are clear. I’m delighted not to be craving foods anymore.

  14. Will someone kindly tell me what “amp” means?

    • I don’t know. Where did you see it?

    • Catherine, I think I know what you’re talking about. For some reason when someone types the symbol for “and” it gets translated into some kind of computer talk and in the feed you get in your email, it says amp. The “amp” stands for ampersand which is what the ‘and’ symbol is called. Take a look and see if the word ‘amp’ always appears after the ampersand symbol.

      Is that what you’re talking about?

  15. I am reading the book and addicted to the Q&A’s. I have been trying to follow the PHD and still learning the new way to eat. I have not had any grains or sugar (only stevia), so I think I am on the right path. I can say I’m doing all the DONT’S but not doing all the DO’s… Not any organ meats yet (UGH). So far not missing bread or sugar. I feel a little anxious or nervous and really tired most of the day. I am sleeping good at night. Like I mentioned before, low thyroid take armor and I also take progesterone. I am taking most of the recommended supplements but was wondering your thoughts on pharma grade vitamins and minerals. Are they better? Also, I am not loosing any weight, can you give me suggestions on THAT. I assume my adrenals are off too. Any help would be greatly appreciated.

    • Hi Arlenena,

      If the anxiety began when you cut the grain and sugar, it’s possible you might be too low carb now. Try adding more rice and potatoes.

      One of the best things for adrenal-thyroid issues is to improve circadian rhythms. Get bright light and outdoor sunlight during the day, not much light at night. Get 10 minutes outdoor physical activity in the early morning and 10 minutes again in the afternoon or early evening.

      We are changing the supplement recommendations to remove the multivitamin and selenium, and add a B-50 complex once a week. Those changes might help.

      • Hi Paul,

        If you remove selenium from your supplement recommendations, it would be wise to remove Prolamine and Iodoral too.

        Since it would be a very bad idea to recommend a high dose iodine and rely only on diet as you only source of selenium.

        • Hi Mario,

          I think our foods (beef/shellfish/eggs) are rich enough in selenium to be safe, but perhaps I’ll put a note to eat some kidney once a week if taking higher doses of iodine.

          • There’s a problem with this reasoning. Some people don’t like or can’t eat shellfish, probably the best source of selenium (if the shellfish in question is low in mercury).

            And beef, eggs, kidney, brazilnuts and others “land” foods, depending where it come from, are not a reliable source of selenium. An example of this is this study comparing selenium status in brazilian japanese living in São Paulo and japanese living in Tokyo. Both selenium content in serum blood and in rice was much lower in São Paulo.


          • Yes, the variability in selenium is a big problem. But it works both ways, one can be poisoned by excess selenium in foods.

            That’s why kidneys are a good supplemental food, they concentrate selenium in all animals.

          • As an addition to what Mario said, supplementing selenium if you supplement iodine has the big advantage of having been thoroughly tested for safety with thousands of people under physician supervision in the Iodine Project. Doing the iodine without the selenium supplements hasn’t, to my knowledge.

            Of course Paul recommends far lower levels of iodine than the Iodine Project has used (12.5 mg–50mg+/day), so it could be that the need for selenium is also lower at the iodine doses he recommends. Or maybe not. I don’t know and I don’t think it’s been tested with thousands of people.

            The Iodine Project protocol also calls for magnesium, Vitamin C, and unrefined salt supplementation, and I believe all can be critical to successful and safe results.

  16. Hi Paul,

    I had a ferritin level of 12 and now 4 weeks of an iron supplement and I have shown no improvement. Is this not long enough? A doctor recommended taking vitamin C with it, have you heard of this?

    Also, my VITAMIN D,25-HYDROXY is 37. It says on the test that 30 – 80 is within the normal range, does this sound ok or a little low?

    Lastly, for hypothyroid issues you recommend 225 mcg iodine have I got this right?

    • Hi Lauren,

      Vitamin C improves iron absorption, so yes that is a good idea, especially if they’re taken together.

      You may also wish to eat heme-containing foods such as beef / organ meats, as heme iron may be better absorbed than supplemental forms. Search nutritiondata.com for the animal foods richest in iron.

      Your vitamin D level would be fine if the units are ng/ml, if they’re nmol/l then this is deficient. In nmol/l 100 should be the target. A reference range of 30 – 80 doesn’t sound right for either unit.

      Yes, for hypothyroidism I do think it’s prudent to take 225 mcg iodine (or more).

      • Thanks Paul,

        it said VITAMIN D,25-HYDROXY 37(my#) 30 – 80 ng/mL

        also, I wanted to know for TSH
        FREE T4 INDEX 2.98 1.95 – 5.90
        TSH 3RD GENERATION 1.96 0.34 – 5.60 uIU/mL
        these are my levels that all read normal. I seem to be having hypothyroid symptoms based on what I have read. I have a bunch a small things like slightly low platelets, reflux, ulcerative colitis, low ferritin, migraines, and I am just trying to figure out how it all fits together….
        I am much better on the PHD but I am working on fine tuning to keep myself healthy and flare up free

        • Hi Lauren,

          Both the D and thyroid levels are healthy. For D, 40 ng/ml is optimal. 37 is fine but you might want to measure again in winter to see how you’re doing then.

          It sounds like continuing to eat well and fixing the iron problem would be good first steps. One issue with iron supplementation is that iron may feed pathogens in the gut that are causing ulcerative colitis and reflux. There are not always perfect solutions, but usually you can make things better gradually.

          Best, Paul

          • Thanks a lot for your encouragement Paul. Yes I think time will help. I have 37 years of poor eating to undo so 10 weeks thus far is a good start. I am proud of myself for finding a good path and thankful to you for your intellect and your dedication to your readers.

  17. Paul

    I have 4 yr old and 1 yr old boys. They eat PHD 99% of the time except during parties and stuff they eat gluten. My 1 year old is slightly anemic. We eat only chicken, goat/lamb, fish n eggs. Red meat is big No. We eat lots of veggies n fruits too.
    Kindly advise if I should supplement them. If yes what is the safest dosage


    • Hi Koki,

      Why is red meat a big no? It is a good source of iron.

      I think food is better than supplements for iron. Organ meats like liver, heart, and kidneys, and clams and other shellfish, are great sources.

      • Paul

        Red meat is against our religious practice. In Hinduism Cow is considered very sacred. Hence if you can tell me other good ways to increase iron it will be great as my son n I are both slightly anemic.

        We are moving back to India soon so I am thinking of buying supplements from amazon thru ur website ( a lil token of respect for your great help to so many of us) before we move.Kindly let me know what will be your recommended supplements for my kids and me abd ofcourse the dosage if u can

        Paul is including fruits in smoothies or salads a bad idea. I have heard that digestion of fruit is very different from digesting other foods. Kindly advise

        Thanks a lot in advance

        • Hi Koki,

          Liver and shellfish (eg clams) are the best sources. Other organ meats with iron include giblets, spleen, heart, kidney. Seaweeds have a fair amount. Eggs have some.

          • Paul
            Just saw your updated supplement recs. thanks
            I am currently taking homeopathy medicines for candida n parasites. Is it fine if I take the metametrix stool test while on these medicines? Will that make the tests not so reliable? Kindly advise

          • Yes, it should be fine to take the test as long as you’re still having the symptoms that are leading you to get the test. In that case, the test should detect whatever pathogen is causing the symptoms even if you’re taking the medicines.

  18. Paul, can you tell me how exactly fat is stored in the body. I know excess calories that aren’t used up can lead to fat storage, but is it as simple as a calorie in/calorie out? Is it excess fat calories that are more likely to be stored because the body has a greater need for carbs and protein? How do food toxins actually become fat, according to your theory of obesity. Also, if I eat 20 carbs in a meal but I am sedentary for a couple of hours afterwards, will my body then store those carbs as fat because the glucose requirements for the brain have been met? How many carbs is too much at once, where there may be a spill over? Does glycemic index contribute to weight gain? How is insulin involved? I just want to know exactly how fat gets stored, but it has been difficult to find any straight answers.

    • Hi Carla,

      Food toxins don’t become fat, but they can impair the body from disposing of calories or increase appetite.

      It is mainly calorie in/calorie out, but what determines calories in (appetite) and calories out (activity/energy/temperature) are very complex. Many, many factors affect body weight.

      In healthy people, excess carbs are stored as glycogen, or converted to fat, or burned for energy. Healthy people can handle a one-day excess of over 3000 carb calories, which is more than most people will ever eat.

      The rest of your questions are too complex for a comment!

  19. Dear Paul, I’m curious what your take on gout is from the PHD perspective. I follow a strict PHD diet with carbs around 100-150g. However, I get gout attacks once every 2 months. According to my researchm, it seems that gout attacks occur when my uric acid is high and when my body is highly acidic. I don’t eat any sugar and my fructose consumption daily is probably less than 3g. I drink a teaspoon of baking soda before going to bed to keep my body from turning acidic. This has helped somewhat but I’m amazed how quickly my body turns acidic upon consuming meats (especially organ meats), bone broth soups and bacon. Once I do have an attack, I lay off of such items and stick to yams, sweet potatoes, rice and veggies, but I’d like to stay low-to moderate carb given my blood sugar issue. Any particular insight how best to be Paleo with gout? Thanks.

  20. Hi Paul,
    Could you give an advice for this : TSH level is higher than normal (4.025). The doc didn’t want to make further test for thyroid and does not think necessary to supplement in hormone.
    The symptoms are mixed : a little bit tired (less since I’ve been following PHD and get plenty of sleep) , but suffering from heat outside, never afraid of raw cold outside, constipation, skin is not dried at all,hair-loss but hair look healthy.. I’m a litle bit confused, and would appreciate your recommendations.

    FYI,I eat a lot of seaweeds and fish since about.. 10 years (meat only once a while because poorly digested). Could it come from hypophysis or from a nutrient deficiency (I suppose I do not suffer of a lack of iodine with all the fish and seaweeds on the diet ?! ). Thanks a lot, Best, Maya

    • Hi Maya,

      You do have several symptoms of hypothyroidism, and a TSH of 4 does indicate hypothyroidism in my view.

      The best thing would be to try supplementing levothyroxine to see if this relieves symptoms and thus verify you are hypothyroid. Too bad your doctor is uncooperative.

      Once you know you are hypothyroid, and what dose relieves it, it’s easier to test for nutritional deficiencies.

      I would also ask the doctor to test iron status (ferritin and transferritin saturation).

      And I would try to follow our updated supplement recommendations, including the supplemental foods.

  21. Hey Paul,

    My asian supermarket sells Organic Glutinous Black Rice. Is this PHD?
    They sell quite a lot of things I’m really skeptical about. But I’m guessing this is fine?

    Nora S

    • Hi Nora,

      It’s a heritage strain of grain whose toxicity profile hasn’t been studied. Shou-Ching and I eat it occasionally, a few times a year. It does have an interesting taste but I wouldn’t recommend it for daily eating.

  22. Hi Paul,

    Whats your view on Frozen shoulders, what’s the caues of it and what’s the best thing to do?

  23. Hi Paul

    I was diagnose with hypothyroidism over 10 years ago, I take levothyroxine 75grm currently, use to be higher. However I di not see a change a wondered if it can ce treated without medication?


    • Hi Carol,

      Levothyroxine does not treat hypothyroidism, it just replaces the thyroid hormone your thyroid isn’t producing.

      A healthy diet and lifestyle usually offers the best chance to cure hypothyroidism. Relieve nutrient deficiencies (esp iodine, selenium, copper, iron, vitamin C, vitamin D, magnesium) and eat nourishing, non-toxic, low-omega-6, low-sugar foods. Get daytime physical activity outdoors and good sleep in a darkened room at night.

  24. Hi Paul

    Thanks for getting back to me so quickly.

    The Doctors at my surgery (London) lead me to beleive that the tablets would help/aid in treatment.

    I have taken up zumba dancing exercise once per week, and try to walk most places. Could you kindly suggest a diet that I can follow? I try to drink water, herbal tea only (no sugar) juice, fruits and veg (moderation) rice A lot as I do like it suppose to pasta. Chicken, fish (salmon)

    Kind Regards

  25. I am of 100% Korean background, born in Korea, and ate mainly Korean food (with not so good Westernized food here and there) for the first five years of my life there, then spent my life in the Western World for most of my life.

    I am wondering out of curiosity if you think perhaps Eastern Asians in particular (Koreans, Japanese, etc) may feel best eating more carbohydrates? Low carb NEVER worked for me. It worked perhaps the one day I first tried it in my life, but even going on it for one day randomly during the year will cause me to go flabby, make my muscles go soft, and severely dehydrate my skin to the point that my fingertips are scarily cracked (and note, I was always of good and lean weight, but struggled with eating disorders then)!

    I also feel as if adding fats to my diet make me feel worse? My mom seems to have IBS triggered by fatty foods, and my dad has some interesting gut (mainly stomach) problems often triggered by insoluble fiber or fatty foods. I too have similar problems on my bad/stressful days or when I am extremely hungry. Vegetable oils are particularly the bad guys, but even safe fats can trigger me such as olive or sesame oils. Nuts are a no-no, although I don’t think the fats are the blame for the nuts. Fatty meats are okay sometimes and not okay other times for some random reason, and broths are fine but if my stomach was already triggered by something or is cramping from hunger then broths aggravate the pain. I know the PHD diet is mainly of fat, but could it be possible that some people should have fats in moderation and up carbs? Or could my gut be damaged by other toxins causing me to handle fats pretty poorly? The thing is, my body does like to have nourishing fats, but my gut doesn’t always feel comfortable eating fatty foods.

    • Hi Rosa,

      It’s fine to increase carbs if they make you feel better.

      Although our diet is half fat by calories, it doesn’t have a lot of fat visually. It is 2/3 to 3/4 plant foods by weight, and the rest is mostly meat, fish, and eggs. Fats are flavorings that make the plants and meats tasty. So one possibility is that you’re overestimating how many fats you should eat and underestimating how many carbs.

      Your experiences with fats are interesting. It does seem like the “bad fats” for you are the ones high in omega-6. Vegetable oils and sesame oil are high in omega-6. Many nuts are high in omega-6; try macadamia nuts which are low in omega-6 and see if they work better. Pure olive oil is about 15% omega-6, but in the US many supermarket olive oils are mixtures of 60% olive oil and 40% vegetable oil and are up to 30% omega-6. Supermarket pork may range up to 35% omega-6, similarly with chickens. If you handle beef and seafood better than pork, and coconut oil or butter better than other oils, and macadamia nuts better than other nuts, that would implicate omega-6 fats.

      The other possibility is a digestive issue. To test this you could try taking some ox bile with a fatty meal and see if that helps. If so, you might be deficient in vitamin C or taurine.

      Ultimately, you should eat the diet that makes you feel healthiest. I bet if you actually weighed foods and looked up their macronutrient totals, you’d find the diet that makes you feel best is PHD-like: by calories 50% fat, 35% carb, 15% protein, <4% omega-6 fat.

  26. Hi Paul,

    I have been following PHD for a couple of months and have lost 7 lbs. I weight 116 and 5’2. My question is about low back pain and the diet. I had a ruptured disc years ago and I corrected it with rest and eventually exercise. I cycle(not competitive)strength train, TRX, Band Resistant Work and walk. I gave up running years ago. I can go for months or years and have no problems and then it flairs up again. I would like to know if you feel diet can help correct this condition . I would appreciate any other suggestions that could help. Thank you.

    • Hi Judy,

      Diet generally does help nearly all conditions, but I have not heard any feedback from readers with ruptured discs, so I don’t know. I hope it will help. Please keep us posted how things go for you.

      Best, Paul

    • Discs alter their morphology when micro tears on the inside allow the very center of the disc to press outward, usually toward the back and spinal cord. That’s why they hurt so…they make direct contact with the cord. The ligamentous fibers that hold back the central gelatinous mass dry with age (dessicate) and there are several formulas on the market aimed at reversing this. We don’t know why they tend to dry but I imagine if it has a dietary connection then shifting to the PHD has to help. Consider a whole vitamin C molecule from food source, 10 mg/day from Standard Process.??

      • Would bone broths/collagen supplements help? My back doc said once the white blood cells eat the part of the disc that pops out, it doesn’t grow back.

        • Most discs don’t pop out. If they do it’s called sequestration…it’s rare and often requires surgery. Most ‘bulges’ on the other hand, retract in time and it takes many months for the ligamentous rings of the disc to repair as there is no vascularization of those areas. I would still ‘eat what you are’ to prevent aging (drying) of the disc with the PHD.

        • Broths made from bones and collagen from joint material (don’t buy supplements, they’re too expensive and no different than the joint material) are helpful for most such conditions. But how much improvement is possible after the fact, I don’t know.

  27. Hi Paul
    I have been on PHD for a year soon and got great results in overall health. There is one condition though which hasnt improved. I´ve had vitiligo since i was 18 and im 28 now. It was healed from my face completely after going PHD and using som gingko extract with sunlight, but on other areas some new spots have emerged. These are small compared to the progression of depigmentation during the standard gluten rich diet. Still as an autoimmune disease it “should?” be caused by gluten sensitivity and start to heal after this trigger is eliminated.

    I probably also have celiac disease even if i havent been tested. I weighted 55kg (which is underweight for a 180cm male) until switching to PHD. Now im at 63kg and feeling way better, even if i eat the same amount of food. Im gratefull for all the spot on advice you share. And this encourages me to ask if you might have any other advice i could try to get all of my pigment back? Is there another possible cause for vitiligo which is unaffected by diet? Or some tweaks or supplements in the diet that could encourage repigmentation?

    Just a remark for other people with the same condition: Gingko Bilboa worked for me only as a cream applied on the depigmented area. It had no effect when eaten.

    Thank you

    • Hi Olio,

      I don’t have much insight into vitiligo. It is supposed to be due to melanocyte death which may often be due to oxidative stress, perhaps brought on by an infection.

      I would try to optimize thyroid hormone levels and deal with any hypo or hyperthyroidism, including subclinical ones. I would follow our updated, not the original, supplement recs, and eat micronutrient rich foods. And I would do intermittent fasting and circadian rhythm enhancing strategies.

      It seems like a heartening sign that the spots on your face were healed, hopefully the rest will heal too.

      Best, Paul

  28. Hi, Paul. What amount would you recommend as a minimum fat intake for females following the weight loss version of PHD?

    • Hi Jay,

      I don’t think they need fat per se, except for some omega-3 from fish, but they need vitamins A/E/choline and other fat associated nutrients, which are hard to get without eating liver, egg yolks, etc. So minimum probably 500 calories fat, but as nutrient-rich foods, not extra oil.

      PS – Did you get my email?

  29. Dear Paul,

    I have been eating a very low carb (under 50 grams per day) diet for just under 2 years. Giving up grains (I imagine wheat, in particular,) has enabled me to get rid of daily, painful GERD that plagued me for decades. It also got rid of the bouts of diarrhea that were becoming more and more common. This has been great.

    In terms of weight loss, at first, appetite control was okay. Left to my own appetite, I would eat around 1700-2000 kcals per day. I easily lost 60 pounds this way, but then the weight loss stopped. I’ve been about 170 lbs for about a year now, and my appetite has also increased to annoying levels. Of course, this large appetite will not allow me to easily lose weight. I have found that eating good portions of protein helps to satisfy me, so I decided to try a Stillman style plan (all lean meats and eggs.) Here is what happened with that.

    1. During the first week, I felt satisfied at high protein levels, but, of course, fairly low kcal levels (around 1200 per day.) I lost 5 pounds.

    2. During week two, I started having cravings for more fat and also craving my favorite vegetables, broccoli and cauliflower. I crave those two vegetables no matter what I’m eating (an annoyance all its own,) so I figured that wasn’t so new. But, the fat cravings were terrible. I had to give in and have coconut oil.

    3. At some point, the hunger began to ramp up again, and I began to feel a lack of energy. I was eating around 200 grams protein per day to get my appetite satisfied. Between the low energy and the cravings, I had to give it up.

    I am a 48 year old non-menopausal woman. At 5’8″ and a fairly narrow build, 170 lbs is too much. I am still fat, and need to lose at least another 30 lbs. I am seeking your opinion on the best approach for someone like me. I need to find something that will allow me to get this appetite under control so that I can get my weight down. I noticed you had a similar weight loss issue. My only health issues are:

    1. I was diagnosed as “borderline diabetic” some years ago, but my blood sugars look good these days.

    2. I have occasional periods in which I’ll have esophageal spasms. They are quite painful, but no one knows the cause. It does not matter if I’ve had anything to eat or drink. Sometimes they come when I’ve had nothing to eat or drink but water. If you have any ideas about this, that would be great, too.

    Thanks so much for taking the time to address these question.

    • Hi LB,

      I think you’re malnourished, and that’s what causes the hunger.

      It’s not a good strategy to limit yourself to lean protein (although egg yolks make up for a lot of sins). It ends up creating many nutrient deficiencies.

      I would suggest switching to something more like PHD. Use the Google custom search box to search for weight loss version.

      I’m not sure what causes the esophageal spasms. Magnesium and other electrolytes are generally important for avoiding spasms. Do you get appropriate amounts of those?

      Best, Paul

      • Thank you, Paul. You aren’t the first person to suggest that I might be missing out on some nutrients leading to excessive hunger. I have been nervous about the idea of adding starches to my diet, but what have I got to lose? I haven’t been successful in the last third of my weight loss efforts at very low carb/high fat, nor with mainly protein. Perhaps this is just what I need. I am going to read the book in order to get the best grasp of the PHD plan. As far as magnesium, I take a chelated Mg supplement daily. I also get plenty of potassium and sodium from the salts I use on my foods. The spasms are a bit of a mystery, but fortunately, they don’t come often.

  30. Hi Paul,

    thanks for putting the new recommendations online! A practical question, do you really discard the egg-whites of those 3 yolks you eat daily?
    I find it such a waste, I always eat mine… I suppose that plays into me not getting 3 yolks daily 🙂

  31. Could anyone help me with the connection of coconut and fungal/yeast infections? I am fighting what I think is a pervasive yeast/fungal infection. Whenever I have any coconut products the symptoms get worse.

    I know that ketosis promotes yeast, and that coconut oil promotes ketosis. But I don’t think that that I’m in ketosis–I get between 150 and 200 grams of carbs a day, and plenty of (safe) starch.

    How and why does coconut promote fungus or yeast? Is this a likely connection?

    I cannot eat dairy, so coconut milk has been a staple for me, and I’m disappointed to see this link between coconut and yeast symptoms.

    Thank you to ANYONE who can help me with this. I really appreciate the insights of this blog and community!

    • Hi Katharine,

      Well, two possibilities. One is that you can generate ketones with any amount of carbs, if the liver has excess energy.

      The other is that if the yeast has access to oxygen, they can metabolize fats for energy. In a systemic Candida infection that may be the case, Candida is well adapted to human hosts.

      Do other fats also cause trouble? Do you tolerate ghee (clarified butter)?

      A third possibility is that you are allergic to coconut and this aggravates whatever else is going on.

      • I am heavily using coconut oil n milk too as I am off dairy. I am getting treated for candida too. Does coconut aggravate candida in everyone? Please advise

        • I think it would normally only aggravate Candida if taken in large doses or in combination with an excess of calories. Normal use in an ordinary diet should not aggravate Candida.

  32. I’ve been tested for coconut allergy–negative. (I know that tests are not reliable, but still…)

    Interesting to know about ketosis and fats. Other fats are better than coconut. But come to think of it, I may have felt better on days when I had less fat, period.

    I may try a strategy of high starch/high protein with little added fat. It’s tough to figure out what to eat at the moment! I am trying to improve an autoimmune condition, to fix my thryoid, and to fight a yeast infection at the same time.

    Thanks very much for your suggestions. I will try less fat overall and see what happens.

  33. Hi Paul!

    What do you think of using Luo Han Guo as a sweetener for someone who still has reactive hypoglycemia even from small amounts of dextrose or brown rice syrup eaten with lots of ghee & lemon juice?

    I eat plenty of safe starches in small doses throughout the day – always combined with fat & protein.

    The Luo Han Gao would just be an occasional sweeter for rice pudding.

    Thank you 🙂

    • Hi Andrea, I think it’s fine as a sweetener but it doesn’t provide glucose.

      Have you been checked out for gut infections?

      • That’s okay that it doesn’t provide glucose, I plan to add it to safe starches javascript:grin(‘:wink:’)

        I have been tested, yes. I’m still working on rebalancing my gut flora.

        I actually posted a few months ago so I’ll just give you a quick update now.

        I had both H.pylori and a parasite name Blastocystis Hominis. I was treated for both – with herbs as well as anti-parasitics and S.boulardii lyo. My latest Metametrix stool test came back all clear a few months ago…but I’m still struggling very much with gut issues — chronic constipation, stomach and intestinal pain, fatigue, mood changes directly following foods I’m sensitive to, nausea, acid reflux, difficulty digesting anything… and I continue to struggle with hypoglycemia.

        My GI specialist found chronic inflammation in my stomach but no villi blunting in small intestine (gluten free for 1.5 years). Tomorrow I’m scheduled for a colonoscopy – we’re looking for signs of Crohn’s.

        I’ve been eating a modified PHD and this has helped get some of the stomach pain under control. It’s helped tremendously with reducing bloating. The diet is one recommended by Chris Kresser – basically low FODMAP, no night shades, no dairy or eggs (which I cannot tolerate anyway).

        I also take RepairVite to help along the gut repair. I drink bone broth too but not too much or it make the constipation unbearable. I can manage it now with Magnesium Glycinate supplementation and homemade pickles (they’re low FODMAP).

        I hope that in the future I will be able to bring back high FODMAP foods, as well as eggs… dairy’s always been a problem.

        If not Crohn’s then it’s probably ‘just IBS’ – though the pain is scary to me…I hope to resolve it with the above protocol.

        Thanks again for the wonderful work & resources you provide. I hope you know how much of a positive difference you make javascript:grin(‘:grin:’); I’m grateful!

  34. I’ll be going for MRIs (with and without contrast) in a couple of days. What I’ve read about the contrast dye, with its link to a kidney fibrosis (NSF) and other unpleasant side effects, has me concerned. I’ve stopped all my usual supplements (d3, k2, Mg, kelp, b12, carnitine acid) just in case any of them would be detrimental. Maybe this is silly? Is there anything special I should be doing to prepare for these MRIs?

    • Hi Babs,

      I don’t know, but I would read the information from your doctor carefully.

      • Thanks for the reply. The doctor didn’t have any special preparation info for me and when I called the MRI center, they hadn’t even heard of the NSF risk with the contrast dye. Guess this is another instance of where the patient can only hope for the best and not to become a medicine-gone-wrong statistic.

  35. I am pregnant and think about supplement with fish oil (liquid) for Omega 3. All.products contain vitamin e as an antioxidant but from what I have learned vitamin e as a supplement is related to cancer. Is it harmful as found in fish oil? Thank you!

  36. Hi Katharine,
    You might want to consider also other pathogen besides candida. In my case for example I’ve had chronic giardia which causes many symptoms when I’m eating fats (any kind) especially coconut oil and butter. I’m also on no diary cause of that.
    Could be also something else – I also have yersinia and many times candida symptoms alternate with yersinia. please do consider also other pathogen also. candida wont come alone and having something else not yet discovered can make yourself very confused about treating candida.

    • This is incredibly useful. How do I test for giardia and yersinia? My doctors don’t seem to know and I’ve tested negative in a standard SIBO test. Can you let me know how you determined that you had these pathogens?

      Thanks so much!

  37. Hello Paul,

    You have greatly offered amazing advice to me before. I had Grave’s disease, radiation to treat, now I take armour. At your suggestion I recently starts supplementing with iodine. And I have read your info on iodine’s influence on building your immune system.

    I recently went to an allergist/immunologist who tested me for everything, but I was allergic to nothing. However she tested me, without my knowledge, to see if I had antibodies to streptachoccos because I had strep and got back to back sinus infections. So she said I didn’t create antibodies to strep or pneumonia. Which is interesting because if my husband and I get a cold, he is better in 3 days, mine will progress to my lungs, I get RADS and have to go back on inhalers or end up in the hospital. I am only 38, so it’s almost embarassing:)

    My questions are..can your immune system be that messed up to not create antibodies? What did I do to cause it to do this? Besides iodine, are there are things besides PHD (which I love) and iodine to strengthen my immune system, i am still having alot of trouble. I have a 3 year old, so I am hoping my defect isn’t heriditary.


    • Hi Patricia,

      I haven’t heard of people being unable to produce antibodies. I’ll have to ponder that one.

      • Paul,

        There are actual some people that don’t produce antibodies to the strep virus. I lookd it up after my doctor said that because I thought it sounded a bit far out for me! I mentioned it to my mother, she told me that my grandfather whom I never met died from rheumatic fever which was caused fom strep. Anyway, my doctor made me get a strep/pneumonia vaccine and I did stop getting as many sinus infections. I have no idea what strep has to do with sinuses! I was hoping you could tell me!


  38. I eat 2 soft scrambled eggs every morning with tomatoes and avocados. Is this not a good idea. I keep reading about egg yolks?

  39. Hello,

    Since experimenting with carbohydrate intake, I have noticed when I go too low, my heartbeat will beat very strongly along with the buzzed feeling of ketones being burned. I think it is hypoglycemia, however, I have been eating low carb for a couple months now. Energy levels are also fine when eating VLC, even when exercising. The heartbeat thing is very annoying, however my energy levels are good so I am wondering if it is not something that will go away. Do you think this is this something that I will in time adapt too, or should I just try to eat some safe starches at every meal to avoid this?

    BTW, love the website and information on here.


  40. Hiya Paul —

    I ordered the Metametrix GI Effects out of sheer curiosity, and it came back mostly in-line. The one outlier was my short-chain fatty acid section, which was flagged for low “Total SCFA.” (The percentage makeup showed low acetate, high everything else: butyrate/propionate/valerate.)

    I’m not sure what to make of it overall. If it’s directly applicable (uncertain) I have 1-2TB of coconut oil a day, otherwise am pretty clueless. Any thoughts?

    • Hi John,

      Coconut oil won’t increase those. Try adding some vinegar to your food. It reduces the glycemic index of starches, and supplies acetate to gut bacteria which helps increase butyrate production.

      • Thank you (as always) Paul.

        I’d seen Lucas’s post that you’d mentioned last year (www.lucastafur.com/2011/10/bifidobacteria-butyrate-and.html) and he’d indicated his skepticism of vinegar in the comments, but I will try. Thanks!

  41. Hi Paul,

    I was offered the option to get a really inexpensive C-Reactive Protein blood test. I am wondering if you think it is worth the time?


    • I don’t know. Are you sick? It can be nice to have a baseline to compare for the future, but the result of one test probably isn’t going to be actionable.

      • Nope, not that I know of.. But I am a sucker for blood work. Just wasn’t sure if the CRP test is truly only useful when suspected infection or disease is in question. I guess if I did get tested and had high readings I would know I am too inflamed (rather than thinking I am healthy).

  42. Hi Paul,

    I have many types of infections, fungal (thrush), viral (herpes) and i am also quite positive i have some sort of brain infection as i fit every symptom and i suffered a pretty big concussion about 6 years ago.

    I’ve been on PHD for about 14 months but am only now really getting on with treating the infections themselves, i was just wondering which i should go after first?

    The cognitive problems of the possible brain infection are what bother me the most but whenever i go on a ketogenic diet and eat anything more than 60g of coconut oil per day, i get really bad brain fog, i assume from the fungal infection.

    Should i just address the fungal issue first?

    Sorry to rehash an old question (I know i’ve read your answer somewhere but i just can’t find it)

    thanks for the brilliant book and all your great work!

    • Hi James,

      I would suggest getting a Metametrix stool profile and targeting whatever appears in the gut. That way you’ll know for sure what your target is and also improving the gut flora should help you tolerate more foods.

      In the meantime I’d also do circadian rhythm tactics to enhance immunity.

  43. I heard that is it disastrous to combine carbs and fat together in the same meal, because of the insulin response leading to fat storage. Is this true in certain contexts? Also if I eat a 500 calorie meal but I don’t plan to burn it off until later in the day will some get stored as fat if my glycogen stores are already full (say from breakfast)?

  44. Hi Katharine,
    Giardia and Yersinia was just in my case – you could have something different. I’ve discovered then by stool sample 7 tests till finding it(giardia)! and blood antigen for yersinia. I must say yersinia was a surprise and just a doctor’s previous case oriented us to do the test. In the same time we tested Campilobacter, E.Histolitica and something else. You have to be persistent with tests – many times they come out negative. In my country I’ve visited almost 14-15 doctors who send me regularly to psichiatrist because tests were negative all the time. I was persistent and now I have discovered like 5-6 pathogens including candida which made my condition. Also then I’ve discovered citomegalovirus. I’ve spend a lot of money did everything on my own cause medical system refused.

    Paul’s idea could be a good one – Metametrix if you afford besides do some blood test for antigens. In my experience they helped me at last to discovered but treatment was always antibiotics. For me it lasted 2 years to find out something because the tests were not properly performed. Example 5 endoscopy in 2 years didn’t reveiled H.pilory but a simple blood test did.
    Remember it’s just my experience you could have other stuff.Having more bugs could make you very confusing about symptoms.
    Hope this helps,

  45. Hi Paul,
    Have you heard about succesfull treatment of infections with natural antibiotics? I was give last year Cipro 3 times and now they recommend Augmentin 14 days for Yersinia and a probably strep. My stool sample 3 months ago showed almost no good bacteria and have also a lot of candida. I’m afraid they would lower my imunity again and increased my leaky gut.
    Of course this is not a medical advice 🙂
    Many thanks,

    • Hi David,

      I’m afraid I don’t know much about treatments. I leave that to doctors and naturopaths and alternative healers. Diet and biology are complex enough for me.

  46. Maybe some of you very smart people can help me understand something about insulin and the liver… I’ve been thinking and thinking on this and can’t quite figure it out. Anyway, just thought someone might chime in with any knowledge… I know this probably belongs in a diabetic forum somewhere, but I like this site so much and it’s full of you smart people!! 😉

    I was reading the info page that comes with my insulins (type 1 diabetic) which I’ve never really done before. Anyway, for both my fast acting insulin and my long acting insulin, the “Mechanism of Action” stated for the insulins is basically the same. They read, “Regulation of glucose metabolism is the primary activity of insulins and insulin analogs, including insulin lispro. Insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis, and enhance protein synthesis.”
    So, my question deals with the “inhibits hepatic glucose production” part.

    First off, in non-diabetics, does their insulin do that also? Or is this something specific to synthetic insulins? I definitely realize the plus side of this mechanism because it’s what allows my blood sugar to stay fairly normal all night while I sleep, versus my liver producing glucose unbeknownst to me while I sleep then waking up with a 250 blood sugar reading or something like that. But, on the other hand, wouldnt this be bad for the liver? Does this mean my glycogen stores don’t really ever get depleted unless I exercise for hours or something? And wouldn’t this mean that it would be hard for me to lose any extra fat? (never had a problem with this until about a month ago, I gained a layer of abdominal fat which I’ve never had before! it’s really strange and it makes me very sad. It happened pretty much right after I switched my long-acting insulin to a new brand, this is what started me looking into the insulins, then I came across the liver stuff… so many questions!!!)

    Also, saying that the synthetic insulin “inhibits hepatic glucose production” doesn’t necessarily mean its totally blocking it, I suppose. Maybe it just partially inhibits it??? It’s interesting to me though because whenever we go camping and hiking (like a 14 mile hike all day) almost certainly my blood sugar goes up that night (easily to 250) around 12 or 1am. But not every time, so I have a hard time figuring out exactly what to do besides set my alarm every few hours to check it. In those cases it would seem my liver must certainly be producing glucose overnight. I assume it means that I underate on those days so my body is burning its own fuel to make up the difference? On normal, non-intense exercise days, my nightly blood sugar is actually well within range and even goes a little low sometimes.

    Don’t worry, I’m not looking for medical advice, but my own thought is that I would like my body, including my liver, to operate as normally as possible. So, if my fears of the insulin “inhibiting hepatic glucose production” are warranted, I was thinking that maybe a few days a week I would not take the long acting and instead check my blood sugar like crazy to keep up with it if it starts to go high from liver glucose production (in an effort to let my glycogen stores become depleted). Is that right? I think that’s what I meant. It was just a thought, don’t worry, I know, I know… make sure I check my blood sugar constantly if i decide to do that.

    See, I really don’t have the whole picture, I’m sure I’m way off here… I just really really want to understand exactly how the liver and insulin affect each other and if my synthetic insulin is different from your own human insulin. Sorry to go on so long…

    Just to recap, in case I made my original point obscured by going into too many details, my main concern (in this post anyway) is the health of my liver, and that I want it to be operating as much like a non-diabetic as possible. (I’m not concerned with blood sugar levels in this post.)

    Anyone have some understanding of this area? Greatly appreciate any thoughts.

    • Hi KH,

      Yes, insulin does those things in everyone. It shifts peripheral metabolism away from fat toward carb and protein, especially carb, and controls blood glucose levels.

      In order to control blood glucose, it stops the liver from turning its stored glycogen into glucose which is released into the blood. When blood glucose is high you don’t want the liver adding more.

      The rise in blood glucose after an all-day hike is the same phenomenon as high morning blood glucose after the overnight fast. Eat less, exercise more, you stimulate the hormones that normally assure maintenance of normal blood glucose in a fast. Some of those manufacture glucose from protein, which is needed in a fast; normally insulin makes sure it is stored as glycogen, not released, but in a type I diabetic the insulin is missing. So you get high blood glucose, and need insulin to normalize it.

      • Thanks Paul, that makes sense. I was just concerned if the insulin I take is different in the way it works with the liver than normal human insulin. And I saw a case report which I didn’t completely understand (although it was with a type 2) where it seemed to show that insulin therapy caused his liver enzymes to skyrocket and then when they discontinued insulin therapy, his enzymes normalized. I don’t think that’s directly related to what I was trying to figure out, but it worried me a little since I don’t understand it all yet. I haven’t had elevated liver enzymes so far, so I suppose I don’t need to worry.
        As always, thank you for being so generous with your time and responses! 😀

        • The insulin is identical to natural insulin, the only difference is that it circulates systemically while insulin produced in the pancreas circulates in the liver first, is mostly taken up there, and only smaller amounts circulate in the blood. So natural insulin acts more strongly in the liver and less strongly in the blood.

  47. Everyone,

    I know this isn’t really a forum, but I figure enough people get email alerts that we sort of use it like one.. so I just wanted to put this question out there–Has anyone had any experience with diatomaceous earth for treatment of parasites or other human critters? I am just now hearing about it and am surprised it hasn’t come up sooner.


    • I have been wanting to put this out there too! Hope someone who has had some experience with it chimes in. It is also supposed to remove heavy metals and pesticides…..

    • I was also wondering about this after seeing silicon added to the supplement list: OPTIONAL: Silicon 5 mg. I know D.E. is primarily silica (Silica not silicon showed up when I was searching for supplements in amazon and allstarhealth). My understanding is that silica is the oxidized version of silicon.

  48. Paul, I love your book and your approach to health and wellness.

    SOme background…..I have a family history of alcoholism and depression as well as other mental disorders(grandfather was subjected to electro-shock therapy for schizophrenia, aunt is a horder and alcoholic, uncle has aspergers and alcoholic etc.).

    I have suffered from depression which has slowly worsened for over 6 years. I can’t remember the last time I had energy or mental clarity, I have zero self confidence, terrible self image, terrible guilt, zero motivation, I can’t make decisions(even simple ones), I isolate myself from friends and family, I studder and have trouble finding words and am forced to “ummmmm” and “uhhhhh” in between every word.

    On top of that, I have restless leg syndrome(I think there is a correlation with low dopamine) and a reocurring herpes virus (zoster/VZV).

    Although I’m not an alcoholic, I drink too much, 4-5 times a week, approximately 3 glasses of wine or 3-4 beers at a time. I’ve done this for approximately 8 years. I know I need to stop drinking at some point, but I am only able to experience some relief from my misery when I drink, this is the only time I feel good.

    I need to get well so that I can be the husband and father that my wife and daughter deserve. I don’t see how I can continue in this state for much longer.

    Paul, can you please provide some recomendations for my condition? THank you.


    • My restless legs stopped when I upped my magnesium supplements. I also take an epsom salt bath/soak about once a week.

      I am an anxious sort, and I too, used to drink a lot – similar to you. Two years ago I started a meditative practice, and being able to calm my anxiety helped a HUGE amount. The drinking slowed naturally, and my life-long nail biting stopped all by it’s self. It wasn’t until my nails got long enough to scratch me that I noticed that I’d stopped. I’d been a constant nail biter since childhood – my parents used to put bitter liquid on them to try to stop me, and now I LOVE highly bitter things. (Strange but true!)

      My brother is a recovered alcoholic – he used AA, and he lived with me while he was recovering. He went every day, and twice on Sunday for about 1 year. It really worked for him. He’s a stellar father now.


    • Hi Jonathan,

      Our diet, supplements, and circadian rhythm strategies are our general recommendation for all health problems, and I would recommend that you start with those. It is difficult to make suggestions about other possible causes until the diet is good and we see which symptoms clear up.

      I believe that many of them will improve with a good diet and nutrition and some daily exercise and sun exposure.

      Best, Paul

  49. Hi Paul,

    I thought it might be a good idea to try some fermentation. I made a mix of cabbage and other veggies. I also put in some little tiny bits of grape and apple, just a little, to sweeten it up because I was afraid it would be too pungent.
    But I was thinking about how wine is made using grapes. I didn’t put any yeast in the mixture, just some kefir. But they say grapes have yeast on their skin or something….
    My question is – is my ferment going to become alcoholic? I have Candida and I know I should not have alcohol but I didn’t think adding just a tiny bit of fruit would hurt. Its only been fermenting for one day. Should I stop it now? Wanted to see what you knew about this. Thanks!

    -Nora S

    • Hi Nora,

      Sugar in the ferment will generate yeast, salt and acid will generate bacteria. I favor creating a bacterial ferment.

      Having put some sugary fruits in, you should not let the ferment run as long as you would for a low-sugar ferment. Instead of ~2 weeks, maybe ~3 days. It should still be healthy to eat.

      I don’t think you need to seed it with kefir. There are natural microbes on all plants, you can let the ferment evolve naturally.

      As a general thing, if you have Candida, you should be seeking bacterially fermented foods rather than yeast-fermented foods. So I would avoid both the sugary fruits and the kefir in your next batch.

      Best, Paul

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