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 am unsure of the difference between yeast and bacterial cultures for making fermented foods. Do you mind elaborating? Thank you!

  2. Hi Paul,

    I’m addicted to this blog. Anyway.
    After coming off a typical American diet I started eating VLC, high protein. It was awesome for about 6 months, then I felt terrible (kidney trouble was the worst of it, and my stomach was always in knots, and i had adrenal issues) so I started PHD and felt great.
    I noticed that I seem to feel best when I eat 60% carb per meal, but in my mind it seems like too much. My health-conscious friends tell me I’ll get diabetes from eating so much white rice. I often worry about that too, but it seems I have the opposite problem – hypoglycemia.
    I never had this before, growing up or on VLC. I thought it would go away when I got over Candida but it didn’t. Of course right now I have parasites and a virus.
    I should be clear – I’m only hypoglycemic when I don’t eat enough carbs. This morning I had a lot more vegetables than I’d normally eat (sauerkraut and cooked string beans, plus some rice, and a bit of egg). In two hours I couldn’t focus on school because I was light headed. Should I be concerned about this dependance on carbs? Or I should I just accept I’m a ‘carb type’ and embrace it? Everyone around me says carbs are bad!
    Please be the voice of reason 🙂

    Blessings,
    Nora

    • Hi Nora,

      Well, first, are you sure you’re eating 60% carb? Remember the grams of carbs in white rice is much less than the weight of the rice, which is mostly water. To get 60% carbs from cooked rice your plate will be really dominated by the rice, and most people wouldn’t find it palatable.

      Infections in the small intestine are the #1 cause of poor regulation of blood glucose. Infections also increase your carb needs (though not to 60%) and if you fail to meet your carb needs risk of low blood sugar increases. So recovering from the infections is the important thing. Are you being treated for the parasites?

      I would eat the amount of carbs that makes you feel best for the time being, and try to heal your infections. Once they are cleared you should be able to tolerate a wider range of carb intakes. But I would double-check whether you are eating as many carbs as you think you are.

      Best, Paul

      • By small intestine infections, are you referring to things like SIBO etc?

        The only treatment i see mentioned is antibiotics and apparantley results aren’t lasting unfortunately.

  3. flu-like symptoms and iodine. i started low, then moved to 1 drop of lugals 2% a day. that’s supposed to be about 3mg of the iodine/potassium iodide mix. i stayed there for a few weeks and then went to 2 drops. then got flu-like symptoms and stopped. this has happened at least 2 times. maybe 3. enough that i know it’s no the flu.

    i don’t get sick that much. in fact i’d say my health is pretty good. but i’ve always been cold, sluggish, low energy, need a lot of sleep. i had lots of amalgams until about 3 years ago. drank lots of fluoridated water over time. and starting about 7 years ago started to have tingling…first in my hands and feet, then surface of my chest, and back of scalp.

    i would like to think that the iodine is detoxing me of halogens and heavy metals. i have read this. so i wonder if i should just stick with 1 drop for several months and then try going to 2 again.

    thx, for any ideas.

    • Hi cporro,

      That’s a very rapid increase in iodine dose. I usually recommend the following progression:

      225 mcg for one month
      450 mcg for one month
      900 mcg for one month then stay at 1 mg if that is your stopping point; or
      1.5 mg for one month
      3 mg for one month
      6 mg for one month

      So it would take 6 months to reach 2 drops of Lugol’s.

      More rapid progressions could lead to thyroid reactions. Also, you need to carefully optimize selenium status by eating beef/lamb, fish/shellfish, eggs, and kidneys, and/or supplementing selenium a few days a week.

      If it is detox, you can help by taking extra salt and water, and arranging sweat-inducing activity.

      I would try again but with lower doses and more carefully, starting at 225 mcg for a month.

      Best, Paul

      • thx paul. ok, i’ll reset with a lower dose. and add selenium back too. let you know how that goes. i failed to mention i have 99% removed wheat from my diet but eat other grains. not that i have a wheat problem. i just don’t think it’s good for people.

        • I’m going to start supplementing with iodine Paul, starting at 225 mcg. I don’t have any trustworthy lamb or beef sources where I am currently (asia), plus organ meats are really safe from other animals. Eggs are ok.

          How many mcg’s of Selenium do you recommend a day when supplementing with Iodine?

          Thanks

    • Hi cporro,
      I have a question for you. I have been on PHD for 4 months now. I have ulcerative colitis and severe migraines. Once cutting out gluten, I have had massively reduced headaches and fortunately the ulcerative colitis is under control. I had headaches Daily and now i currently have a headache once or twice a week. The specific headache I had which was tingling in my Lower skull and then would move upward throughout my head. I would then feel disconnected and have trouble forming words. This is no longer a problem for me an I am brain fog free. However about a year ago I started running and I started getting tingling and numbness in my toes of my left foot and then my right. I stopped running and am left with only tingling in my left few toes but I also have this tingling or strange sensation in my shoulder blades and in my chest. It feels like in my breasts (don’t know if you are female). This seems to be markedly reduced by acupuncture. Do you know hat this sensation is from? Aside from this and some anxiety occasionally I feel pretty amazing… Any help is appreciated.

      • hi lauren. I’m a man. i could give it a guess which is what i’ve done with my own symptoms. first what’s PHD?

        since i started having tingling (which is a surface, skin, type sensation) about 9 years ago i’ve had several suspects. first was mercury from amalgams. they are out now and i do feel better. i understand mercury takes a while to leave your body. then electromagnetic exposure. things like cell towers, wifi, actually a lot of things. muscle tension in my shoulders from working on a computer. but this did not explain the toes, chest, and back of head. aluminum or other toxins in deodorant. toxins in out water like fluoride and heavy metals. trouble is many things can cause tingling. over the years i’ve been trying different approaches.

        my theory now is i’ve built up some toxins in my system. heavy metals, halogens. and slowly i need to get the out.

        i’ve never had bad symptoms like you have. like trouble forming words. (i’ve never had a great memory) or bad headaches. but i think heavy metals and halogens can cause both. some claim iodine can cause the body to detox things like bromide which can cause brain fog. thus paul’s rec on salt loading for detox.

        i’d be interested in your full story we may be able to swap notes. my email is the user name here at the very popular search engine that begins with a g.

        • Hi Cporro,

          I was sitting in a meeting when I was writing my reply to you so maybe I was not clear. I believe the headaches I was describing and the disconnected feeling and difficulty speaking was tied to my gluten sensitivity. However, you raise an interesting point with the tingling, that I had never even considered. I know my amalgum fillings can’t be good for me …I’ll have to think about this. As far as my shoulder blades go, my sister occasionally has the same issue-I have a lot of anxiety in general but I don’t think that’s it. As for toes, I’ve been told it’s possibly due to gluten as well-we’ll see how my recovery goes in the next several months. In the mean time, I am sending in a hair sample to check if I have any issues with metal- just to mention, I don’t use regular deoderant, I use milk of magnesia-maybe this is a problem…
          What did you do with your fillings? and maybe root canals if you have any…
          I am happy to exchange stories further if you would like

          • oh yeah. gluten. i got that. probably no one should eat that stuff. my daughter is intolerant and so is my wife. i didn’t mention that because it seems you are already on that one. good.

            when i was looking into it most tests for mercury weren’t reliable. so be careful what you pay for. a simple urine test, as i recall, was meaningless. what you need to do is find the burden on your body not the amount you are getting rid of.

            if, IF, you decide to get amalgam replaced or root canals removed you need to find a dentist that knows his stuff. drilling an amalgam can releases a lot of mercury.

            i’d also look into your drinking water. there is public allusion that water is tested and we know whats in it. it is tested but only for a few things (and never at your site with your pipes etc). reverse osmosis or distillers remove flouride. charcoal does not.

            have you ever tied the tingling or it’s absence to a place?

            our pediatrician told me gluten takes around 3-4 months to get out of an adult’s system. the antibodies that is. i have done that and then some and still have tingles.

            all the things i’ve mentioned are real problems for some people. real show stopping problems. so it’s good to put them on the radar.

            anyway, email me and we can exchange numbers if you want to discuss in detail. i’m fascinated by peoples health and most of these off the radar issues.

        • Hi cporro,

          are you really sure about the sensitivity to electromagnetic exposure? Such a sensitivity has never been proven in the laboratory, while the test is in fact quite simple to set up and measure.

          I’m just pointing this out because it must be a real pain to avoid electromagnetic fields, especially when it may not actually be a problem.

          See also http://forums.randi.org/showthread.php?t=219259 for a discussion of the phenomenon.

          • hi wout.

            hey aren’t paul and shou-ching running this forum? where did i sign up? just kidding.

            yes, i am sure. i’ve been looking into EMF (electromagnetic fields) and health for 6 years. since my daughter was born. you are only skeptical (like most people) because you haven’t been presented with the full story.

            there are lots of accounts of emf shutting down peoples lives. i believe it’s sweden whose government recognizes hyperelectrosensitivy as a disability. Luxemburg recently lowered there public safety limits by an order of magnitude lower then ours. in fact Europe is way ahead of us on this. the science that has come out over the last few years keeps getting more damning.

            we still base our safety limits on the military’s thermal threshold (EMF can heat tissue) that came out of WWII. and some people argue that it should be based on wattage. but the newest stuff i’ve seen shows how cells are sensitive to very low wattages if the signal is erratic…like a cell phone.

            you have to consider that people have known about EMF impacting health for a long time. people living under power transmission lines and leukemia. pregnant mothers and electric blankets. hell, even your phone comes with a warning not to press it against your head while taking. seriously.

            So why all the controversy over this? you always get controversy when one side of the argument is a multi-billion dollar industry and the other side is the public and a few outlier professionals.

            anyway, if you do start looking into this a new story will emerge. i can’t cover it here. the point is the public should know EMF can effect your health.

            as far as avoiding it there are lots of ways to greatly minimize it but few ways to completely avoid it. the inverse square law would be my first line of defense.

            remember that the EMF we are using today can penetrate deep into your living tissue. living tissue is a very nuanced thing. it’s not engineering. it’s biology.

            oh, and many studies have found sensitivity. many other studies have found none. just check out that huge meta study…interphone. but it’s tricky. you have to read the studies you have to see who funded them and you have to know whose summarizing them for the public.

            how is is easy to set up a test for this? how long did it take science to conclusively say smoking was bad for people? we are talking about decades of EMF exposure from in utero to old age. btw there are studies showing people and cells immediately reacting to EMF. here is a dumbed down you tube version of one. there is a technical pdf for this also. http://www.youtube.com/watch?v=_EI9fZX4iww

            my wife says i need to work on tact while putting forward my “opinions”. no offense i hope. i have talked to a lot of people about this topic and the one thing i know is the public knows more about giant squid then EMF. 🙂

          • I am not sceptical about EMF, because I once worked cleaning electrical sub-stations, sweeping around big transformers and generators 8 hours a day.
            That stuff is powerfully toxic. I’ve worked with lindane, paraquat, and formaldehyde (not at the same time, thankfully) but concentrated EMF undermined my health the quickest, in the most blatant ways.
            Loss of peripheral and colour vision, the usual digestive and immune upsets, insomnia… I can well believe that some people become sensitized.
            The older workers seemed to tolerate it; I was vegetarian at the time, they liked their fatty meat and beer. Maybe there was some extra antioxidant protection going on in their case. And perhaps they had adapted in some way.

        • Hi cporro,

          I guess I deserved that 🙂 I’ll look into what you wrote and will contact you on email to continue the debate. Back to the PHD stuff 🙂

  4. Which of the protocols in your book would you recommend for someone who tests positive for (inactive) Epstein-Barr Virus? Since EBV is associated with many other conditions, it would seem that following your recommendations for chronic infections would be the way to go to keep it in check? In addition to avoiding overtraining and stress. What about IFing?

    • Hi Maria,

      I’ve tested positive for extremely active EBV, which I’ve been treating w/IV vitamin C and Valtrex for the past month. Today I retested my blood, and am anxious to see if the acute antibody titers have declined.

      Anyway, all of this is to say I’m also interested in the answers to your questions.

    • Hi Maria,

      Intermittent fasting, circadian rhythm enhancement (sunlight/sleep/exercise/meal timing/faces-sociability timing), vitamin D, and vitamin C (see http://perfecthealthdiet.com/2010/09/fighting-viral-infections-by-vitamin-c-at-bowel-tolerance/) would be my first suggestions. N-acetylcysteine, low-dose lithium, and lysine might help.

      Just to give an example of the state of the literature, this paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2199015/) looks at N-acetylcysteine during Epstein-Barr infection of B cells and shows that it inhibits one of the steps in infection. So it probably does some good.

      I would have to do a lot more research to design a specific protocol for Epstein-Barr, but these are some ideas for you.

      Best, Paul

  5. hi paul, been following for a long time but still fuzzy on the details about how to really go about figuring out which, if any, opportunistic organisms are problematic in the body. i mentioned before that my symptoms got worse when trying to go ketotic, a little better when adding starches and glucose, but a lot better when dropping starches in lieu of fruits and sucrose. now, i’m not 100% cured by any means, and i definitely notice a relationship between stress, immune function, and symptoms. my diet is so perfect it hurts, and now i’m at the point where it’s tweaking esoteric supplements and wondering what the next step is.

    • Hi Darius,

      It’s a good question. You may never know what organisms are infecting you. Diagnostic tools just aren’t that good, and the ones that we have, doctors won’t order because they don’t know what to do with the results.

      Since you notice a connection between stress, immune function, and symptoms, I would focus heavily on circadian rhythm strategies and immune enhancement. Daytime sun exposure and exercise, night-time dim lights and good sleep, coordinate meal times and faces-viewing/sociability with daylight as much as possible, try to get half an hour of outdoor daytime exercise per day at twice your normal heart rate.

      You also might consider low-dose naltrexone and low-dose lithium – lithium in the morning, naltrexone before bed.

      • nice response paul
        what dose and type of lithium? just so happens i have both types of lithium and ldn on hand to try out (again lol)
        where can i find good info on why lithium?

        • Hi Darius,

          I’ll blog about the lithium, but for now the dose will be on our supplement recommendations page and you can search pubmed for “lithium antiviral” or “lithium herpes” to get some links.

          • Paul, I will really look forward to your lithium post. I recently dabbled with it and was very impressed by the carbonate version, and the orotate to a lesser extent (I took very small doses of each over different intervals), but unfortunately I had the same incredible eruption of acne that I have with higher iodine doses. I think you mentioned elsewhere on this site that it aggravates your rosacea? It’s a shame lithium has some undesirable side effects, because based on my limited understanding and the Pubmed studies I’ve seen, it has impressive neuro-protective effects.

  6. I would love to be led to the link on what lithium is for? I take LDN for hashis and am not seeing much difference.

  7. Hi Paul,

    I was re-reading your link on high dose Vitamin C and was a little confused. Were you saying to be careful of higher doses with a viral infection or showing the benefits of high doses? I am taking Dr. Garry Gordon’s Bio Ener C drinkable, absorbable powder that gives me 4,000 mg a tsp with no problem to the stomach or bowel. I feel so much better on it and in 2 weeks a totally inflamed tricep feels great! Are there any side effects to that kind of dose? Again, the powder gives me no bowel problems and before I could only tolerate 500mg of Ester C without getting the runs.

    Thanks.

    Jan

  8. on the subject of fermented vegetables.
    Would a (good) store bought sauerkraut be okay, ie. does it still have all the good bacteria.

    I bought some sauerkraut (with carrot) the other day, it’s labelled as product of Poland with ‘no artificial colours, flavours or preservatives’.
    Ingredients: white cabbage 85%, carrot 15%, salt.

    • Hi Darrin,

      Depends on the quality of the production process. Often in store-bought versions they added sugar to the vegetables to speed up the fermentation, this lowers costs but the microbes aren’t as good. They should list the sugar in the ingredients though.

      • i’ll take that as a good sign, that sugar is not listed, on the particular product i bought.
        I think that if this brand did use sugar they would list it.
        As i also bought another product (same brand), which was more of a pickle i think, which did list sugar.
        In case you’re interested it was called ‘Lithuanian Salad’,
        ingredients: mixed vegetables 65% (white cabbage, carrots, cucumbers in brine, onion, red pepper), water, vinegar, salt, sugar.

    • I’m guessing that unless it has a preservative listed as an ingredient, it has cultures? Although one brand says they heat it at 175 degrees for 5 minutes when they’re done.

      • I recommend avoiding the store bought stuff! A lot of it is pasteurized (heated) to ensure if longevity. In the process the good bacteria are killed off! It’s basically dead cabbage.

        Stick to the home-made! Easy: cabbage and salt + time = goodness.

        • What if it says raw on the container though, or does anyone know if Bubbies is ok?

          • probably best to contact them directly.
            i did find the info below, supposedly from Bubbies, but it was not on their web site.
            “Our Pure Kosher Dills, Dill Relish, Pickled Green Tomatoes and Sauerkraut are all naturally fermented and cured in salt water brine using a lacto-fermentation process. These products contain live cultures and the enzymes that form from a natural fermentation.

            The Pure Kosher Dills, Dill Relish and Pickled Green Tomatoes are 100% raw; the Sauerkraut in the jars has been flash heated but not pasteurized.This means that the sauerkraut is neither pasteurized nor raw. Bubbies Sauerkraut is heated in a steam bath bottle wash after the product has been sealed in the jar, and this does not kill off all the cultures, but rather just some of them that are producing the bulk of the carbon dioxide gas at that stage of the fermentation.

            The hottest of the jars reach 130-140 degrees – no higher; the result is an approximate 10% decrease in culture content vs. a raw sample; but a product that will not continue to give off gas once sealed in the jar. Without the heating our Sauerkraut will continue to ferment in the refrigerator resulting in bulging lids, leaking jars and a big mess within the distribution to retailer to customer chain.”

          • Interesting, thank you. I’ve heard so much differing info on how long to ferment stuff to get the best out of it, anyone have one good source with recipes/ferment how to? Do fermenting times vary on type of vegetable?

          • Farmhouse Culture has raw krauts that I buy from Whole Foods and they taste amazing. Very small production! All organic!

          • Hi Elyse,

            http://perfecthealthdiet.com/2011/11/fermented-mixed-vegetables/

            Sugar and starch in the vegetable will speed up fermentation. Generally, less sugar and starch and longer ferments in a salty brine are better than fermenting sugary plants.

          • Everything you ever wanted to know about fermenting foods:

            The Art of Fermentation by Sandor Katz

            http://www.wildfermentation.com/

  9. Paul I just want to say something…the input you give on this page is SO appreciated. I can’t tell you how often I have felt hopeless when looking for help and have posted on a site looking for answers and never heard back…when I come here I know you take the time to answer and that you genuinely care and invest in each answer. I heard your podcast with Chris Kresser awhile ago and I know the strain of keeping up with all this can be tough…so I wanted you to know that while you are able…I appreciate you very much and I know many many others do as well. P.s. Your book is the book I recommend to my clients and I also give them the “apple chart” and it sits above my desk where they sign in for class. 😉 VERY helpful.

  10. Hello Dr. Jaminet,
    My family has been adopting your perfect health diet and have found many positive results from it. I had some blood tests run and I tested negative for ANA, had a sed rate of 2, a CRP of 1, but I did have a rheumatoid factor of 86. I am only 24 years old with no symptoms. I had it repeated several weeks later and it is still 80. Do you believe this could also be from a bacterial/viral condition? Have you found that coconut oil and your other diet recommendations have had a result on lowering a rheumatoid factor? No one in my family has rheumatoid arthritis or any autoimmune disease. I’d like to try a natural approach before I go in for more tests. With school I haven’t been as good about the diet as I had been previously. Any information you might have on rheumatoid factor and causes would be greatly appreciated. Thank you for all your work!

    • Hi Jay,

      I think creation of autoantibodies usually results from infections (sometimes from food compounds), and so a high rheumatoid factor would probably indicate some kind of infection. But not knowing what it is, I would say that our general diet is your best bet. If you had a diagnosis there might be ways to tweak the diet for greater effectiveness. Since you have no symptoms I wouldn’t do anything extreme. Even if the cause of the heightened rheumatoid factor reading has gone away, it can take six months for autoantibodies to fade away so I would give it time.

      I would just try to eat well, live well, get sunshine and exercise and good sleep, and see if the reading goes away.

      Best, Paul

  11. Hi Paul,

    I have been diagnosed with Chronic Prostatitis and was finally able to find that Chlamydia Trachmonitis is responsible. I have just read your book and I am trying to start the diet. Any recommendations you can give? I have read that NAC is used in Marshal Protocol. What do you think overall of Marshall Protocol? I have already took doxy for 30 days and then cipro for 21 and that did not resolve all the issues. Are there any specific antibiotic combinations.

    I also have Rosacea, and that could be Chlamydia Pn correct? How were you able to resolve it yourself?

    Thank you.

    • Hi Steven,

      NAC is great for Chlamydia. I do not agree with the Marshall Protocol treatment recommendations; I think you want to maintain normal vitamin D levels. Also, low-dose antibiotics aren’t necessarily best for acute infections.

      You can check out http://cpnhelp.org for a more aggressive combination antibiotic protocol with supplements. Your doctor should be the one advising you on what specific treatment regimen to follow.

      I associate rosacea with thyroid dysfunction, circadian rhythm disruption, low vitamin D, and fungal infections. I think NAC is helpful, as is vitamin D optimization, copper/chromium/selenium optimization, and thyroid improvement. Ask your doctor to look for evidence of subclinical hypothyroidism.

      Best, Paul

      • Hi Paul,

        I will check with the doctor regarding subclinical hypothyroidism. Pretty interesting about circadian rhythm disruption too. Awesome book and thank you for answering.

        I have just purchased as per your recommendations Source Naturals Life Minerals, it looks like they contain 200mcg of Selenium. Can I use this formula everyday for long time or would you suggest every other day?
        I assume if I take iodine I should probably take minerals everyday especially selenium. While taking selenium is it still too fast to start with 1mg of iodine?
        In terms of intermitten fasting and just overall taking Coconut oil. In your book you say approximately 500 extra calories should come from coconut oil. So that is about 4 tablespoons. Can I take them between meals and during that intermitten fasting? It will not simulate the bile release I assume in a fasted state?
        Due to the infection, would going like 200 carb calories a day for few months be beneficial? Is that about like a cup of rice or a big potatoe?
        How long can I take NAC? Is it too big of a pro oxidant to be taken on empty stomach?

        • Hi Steve,

          I wouldn’t do every day for selenium, you can easily get too much. Every other day should be OK, but it’s best to arrange to sweat frequently as that is an excretion pathway for excess selenium.

          I would suggest starting with 225 mcg iodine (or shellfish and seaweed first, then 225 mcg) and doubling the dose once per month.

          Are you trying to be on a ketogenic diet? Regular PHD is not 500 calories of coconut oil but < 5% of energy which is < 100 calories per day. You can take coconut oil whenever you want. Taking it during the fast is a weight loss trick. Low carb benefits you in some infections and works against you in others. I would start with 600 carb calories, let my health reach a plateau there, and then experiment with low carb. You can take NAC every day. It works better on an empty stomach.

          • Hi Paul,

            Yes I understand that but can I supplement my remaining calories all in coconut oil?
            Lets say on average I get 400 carbs, 400 protein and probably 400 fat calories. 3 more eggs will give me another 240. Is it ok for me to take lets say another 5 tablespoons of coconut oil to get the rest? I am just having hard time getting the rest of those calories.

          • Hi Steve,

            If you are well nourished besides and like the coconut oil, that’s fine, but sour cream on a potato or egg yolks in a potato soup would be equally good and (to me) more tasty. But whatever you like.

    • Bacteria in the bladder – UTIs- can irritate the prostate. There is a vicious cycle whereby the prostate limits the urinary flow so bacteria build up, inflaming the prostate more. Hibiscus flower in a strong infusion 2x daily can clear the bladder; mannose or cranberry extract are other options, but I find hibiscus cheap and effective.

  12. Ever think of using a tanning bed in winter, not just for vitamin D but MSH (melanocyte-stimulating hormone), which a mold infection reduces? http://www.survivingmold.com/docs/biotoxinpathway.pdf

    • Hi Tam,

      Yes, I’ve thought about it, but we don’t have a lot of space and I haven’t wanted to spend the money for a home one, and haven’t seriously looked into commercial ones. I did buy a reptile-aquarium UV lamp for my office lamp. Probably too low wattage to matter.

  13. I’m a little freaked out! Paul, or anyone who might know: I did a WellnessFX blood panel (blood drawn a few days ago while still VLC/high fat coming off GAPS), I have since incorporated more safe starch since Paul encouraged me to do so over the weekend (even based on my celiac disease).

    My last blood panels that you reviewed over the weekend were done in June while still vegetarian. Anyway, I’m concerned that my cholesterol jumped to 202, from 159. My LDL jumped to 94 (from 71), HDL: 94 from 79 and triglycerides jumped to 60 from 46. Wellness FX also did a test called VLDL-C which was 12, a LP (a) which was 9 and an APR B which was 83. Should I be worried? I have added a LOT of fat from grass fed butter, MCT oil, fatty grass fed ground beef/lamb to my diet since last month and added animal protein (all grass fed, etc. last July).

    Thank you!!

    • Hi Dede,

      Your new lipid numbers are much better than your old ones. Total cholesterol should be 200 to 240; LDL over 100; 94 HDL is great, high even; triglycerides should be low but 60 is low.

      You shouldn’t worry unless LDL gets over 140 or triglycerides get elevated.

      • Thank you, thank you, thank you Paul! I feel relieved now! 😀 Also, I will run another panel after about 4-6 months on PHD.

      • Paul, One more question if I may, I just re-checked my blood panel and one of the tests, Apo B which is listed in their LDL particles category measures protein in LDL and my result is an 83 which states I am in the red, or high risk category. Any concern?

        Thank you!

        • Hi Dede,

          ApoB is basically the number of LDL particles, as opposed to the amount of cholesterol in them. In general higher ApoB means your immune system will react quicker to pathogens or unhealthy foods. In people on bad diets this leads to excess inflammation. In people on good diets this might be a good thing. There’s not been enough research done to say.

          In any case, the places I look say a number of 83 is normal. For SpectraCell the normal range is 40-100, http://info.spectracell.com/default.aspx?Tag=Apo%20B. Medscape doctors say less than 130 is within the reference range, and less than 90 is very low risk for CHD: http://emedicine.medscape.com/article/2087335-overview. (Their presentation of this is screwy, and I doubt low ApoB is as good as they say, but they consider your levels low and indicative of low CVD risk.)

          You didn’t give me units or tell me if the number was flagged as too low or too high, but I think it’s consistent with your LDL which is a bit low but in the normal range. I wouldn’t worry about it.

          • I’m not sure what units are. Here are their ranges: high risk: over 80, moderate: 60-80 and optimal: under 60. My number is 83, which they considered too high.

          • Hi Dede,

            The fact that they don’t acknowledge that ApoB can be too low is enough to discredit their ranges. Probably had a vegan choosing the optimal range. I wouldn’t worry about it.

        • Wayne D Johnson aka Prouddaddy

          My lab gives the apoB reference range as 48-124. Mine is 104. Trade ya’!

  14. Paul, been following PHD along with supplementation and daily authophay-fast. I had a looooooong list of ailments and all seem to be improving! I’ll provide a full report once I’m sure it sticks.

    Due to immune issues, I’ve bee slowly titrating my iodine intake and I intend to keep going untill I hit around 50mg/day per your recomendation. However, I’m a little concerned that I’m not getting enough selenium. Mainly my sources are shrimp 1-2x per week, 4oz beef liver and 1 lb sardines/salmon per week. Should this be adequate or should I consider 2-3 brazil nuts per week as well?

    Thank you,
    Jonathn

    • Sorry Paul, I just read a post from you on just this topic from Oct 23. You mentioned that it may be a good idea to supplement selenium a couple times a week. I thought you were not in favor of this. Nevertheless, can you provide specifics on dose?

      Thanks again,
      Jonathan

    • Hi Jonathan,

      Just to be clear, I recommend 1 mg/day iodine for healthy people and higher doses are a possible therapeutic option in some diseases but resorting to them is a judgment call.

      I do think that if you are planning to go to high iodine doses then you need extra selenium. In addition to focusing all your meat on selenium rich sources (beef/lamb, seafood/shellfish, kidneys, eggs), you could take 2-3 Brazil nuts per day or supplement 200 mcg selenium several times per week.

      But be aware that the selenium content of food is highly variable depending on source.

  15. Just from my own experience, I think selenium is effective at reducing outbreaks of shingles and HHV type viruses, low Se is a factor in recurrence.
    Lymph nodes may be reacting to a combination of the virus plus a food allergen to which the virus/immune reaction is sensitizing. Similar to what happens when you drink milk when you have the flu.

  16. Thank you for your book.

    I was wondering if there was any way that a person could find out whether they were infected fungal(ly) or bacterial(ally)? And, am I correct in stating that for fungal, you would raise your carbs (600-700) and for bacterial, you would keep them about 200g?

    But my constant problem is: I have chronic insomnia. I go to sleep wonderfully, then wake-up, sometimes staying awake for a couple of hours. I am so deeply, deeply, exhausted and have been for so long. Any comments?

    Thank you soooo much in advance for any information.

    • Hi Stacey,

      It’s hard to tell until it becomes severe. Fungal infections will use give skin or mouth or vaginal manifestations.

      For fungal I would recommend 600 calories/day carbs or more if you’re active. For bacterial infections, 600 will often also be good but you can go lower.

      There are many causes of insomnia. Have you been eating our diet? I would suggest circadian rhythm therapies as a second step.

  17. I am/was doing the GAPS diet with my daughter (it seems to work for her) but that made my sleep worse–might that help explain anything? Will absolutely look into circadian rhythm therapies as well–thank you so much.

    I have somewhat large tonsils but not a lot of fungally-seeming things.

    Thank you so much.

    • Being too low carb can disturb sleep. Try eating some starches.

    • Hi Stacey do you have a hard time falling asleep or you wake up in the middle of the night for no reason?

      • JP: I go to sleep very well; I wake up and often can’t get back to sleep. Did look into circadian r. therapy–looks like some very good information.

        • Hi Stacey, sometimes we wake up during the night for no apparent reason because we don’t digest or food very well and our metabolism start working faster to digest the food. That would be interesting to see if you could have a better night of sleep if you either eat a smaller meal at dinner consisting of only raw food or fermented food and see if it helps or if you are eating a cooked meal maybe taking some digesting enzyme before the meal and Some Hydrochloric Acid after the meal. I know from reading Paul’s book he believe that Hydrochloric Acid is easily produce in the stomach if enough Salt is consume. But some other studies suggest that by the time you are 50 years old you produce about 23% of what you were producing at age 18 and by 74 you produce 0. So I would give it a try and see if it helps. If you do let me know if it helped.

  18. I just read this article: http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html?pagewanted=all&_r=0 which got me thinking about the importance of purpose and community to health. We of course place the greatest emphasis on diet, but it is articles like these that get me thinking that maybe how one lives is more important. Or better yet, whom one lives with.

    Personally, I have found that for the past 3 years I have lived in a new city that I have a much greater instance of body aches, head aches and general malaise than I did when I lived in an area with lots of friends and family. There are days that go by when I don’t see another person that I know. I only have seldom interactions with the few friends I do have in this town. I have also noticed that during times when family visits my mood is markedly increased and I don’t notice a tinge of body ache.

    With that said, the article points out that this particular group of long lived folks, the Ikarians, spend much of their time with others. From a diet perspective they’re less than “perfect,” considering they’re bean and gluten eating, very little meat eating, Heavy drinking folks. Yet they’re still living well into their 90s and maintain high levels of activity. So I wonder if it might be more healthy to just eat real food instead of obsessing over details and to surround yourself with a strong community.

    • Hi Lindsay,

      Great piece, thanks for the link.

      I agree, social interactions are extremely important to health. They are, along with light, exercise, and food, the major factors in setting circadian rhythms which seem to be extremely important in health.

      One of the common features of centenarians is they are sociable and maintain a circle of friends and daily social activities throughout life.

      Ikarians also get lots of sun, probably a fair amount of activity walking in the mountainous terrain, and do a lot of fasting in the Orthodox Christian tradition.

      My own health got worse when we moved my office into a poorly lit room that gets little sun. It took me a while to realize what had happened. Now I make a lot of effort to get bright lights and sun exposure during the day.

      We talk about these things in the new edition, but I’m looking forward to blogging more about them. I think longevity work is a great window into what’s really important for health.

      Best, Paul

    • Lindsay and Paul,

      I can’t agree anymore with your thoughts. I was reading a blog post from a lady on Ikaria. She was saying how festive the commmunity is. They party quite a bit… they drink a big glass of watered down wine (wine is most probably organically and locally grown) and then a glass of bone broth, then wine, then broth, etc. They party like this til sunrise. Not sure if it fits into the proper ‘circadian rhythms’ though ;o)

      On the power of quality relationships for health I HIGHLY recommend listening to this talk by the amazing Gabor Mate:

      http://www.youtube.com/watch?feature=player_embedded&v=MuZMSZ1_8o4#!

    • From a diet perspective they’re less than “perfect,” considering they’re bean and gluten eating, very little meat eating, Heavy drinking folks. Yet they’re still living well into their 90s and maintain high levels of activity. So I wonder if it might be more healthy to just eat real food instead of obsessing over details and to surround yourself with a strong community.

      Nicely said Lindsay and thanks for sharing.

      Also noting “low intake of saturated fats from meat and dairy” and “ate fish twice a week and meat five times a month” (pig,goat). No specific mention of eggs, organs, or both broth, but perhaps they ate head to tail … although that would mean pig organs.

      • They seem to have dairy fairly often, which is high in saturated fats.

        More importantly, this is a low omega-6 diet. Fish is very low in omega-6, goat is a ruminant very low in omega-6 like beef and lamb, and pigs like humans are low in omega-6 if naturally raised and fed.

        I think the low PUFA diet with omega-6/3 balance is very important for longevity.

        • Yes, good point, Paul. Not sure why the story indicated low dairy saturated fats, they do seem to drink a lot of goat milk.

          They seem to also eat a lot of olive oil, which is a recommended PHD oil, but I thought good to moderate due to PUFA. http://perfecthealthdiet.com/the-diet :

          The best cooking oils are coconut oil, clarified butter, and beef tallow; palm oil, lard, olive oil, and avocado oil are next best.

          Another observation from the photos is the missing teeth. I’d be interested in theories for the bone loss. I guess we don’t know the ages when the teeth are lost. My first thought was some sort of nutrient deficiency or maybe oral inflammation/infection. Or, is it considered normal aging. I recall from Weston A. Price’s Nutrition and Physical Degeneration that the traditional societies have healthy teeth without dentistry, so that makes me think that might be less of a factor.

          • It would be good to read more details – and to separate the eating habits of young and old. The article says LOTS of olive oil, the dairy is high-SFA. The health comparisons are with Americans – anyone would look good compared to SAD consumers!

  19. Hi Paul,

    I haven’t written in a while as I’ve been letting my body heal. 5 months into the PHD I am feeling better every week, but I worry that I am still missing some information that might keep me from healing completely. I suspected that candida was a major problem for me, but testing revealed only an imbalance in my bacteria (i am not doing anything for this); but no candida. I still think I have candida (on my tongue and some perianal itching). I still have geographic tongue that I think is telling of what’s going on internally-the tongue seems to be getting better very slowly each month. All other tests (thyroid is perfect) show me to be in good health except for the low ferritin-I had an blood test that revealed antibodies for h-pylori but a breath test was negative. So what I’m left is some tingling in my toes, back and chest (not constant), geographic tongue and low iron. Ulcerative colitis and asthma is in check. Last to mention, a blood test revealed high levels of a food sensitivity to egg whites. I think it was a 5 possibly. so now I’ve taken egg whites out of my diet as well-ugh, that was my favorite breakfast. I also added something called revive to my supplements. Am I just healing or am I missing something? Any guidance is truly appreciated.

    • Hi Lauren,

      Well, Candida is primarily an internal/intracellular pathogen rather than a gut pathogen so you could have it without anything showing on a stool profile.

      Geographic tongue could be leukoplakia from nutrient deficiencies, as well as Candida. Vitamin A is an important nutrient for that. I would eat at least 3 egg yolks a day.

      I would say that without a specific diagnosis, and with you saying you’re gradually healing and feeling better each week, it’s hard to recommend any major changes. Continue trying to optimize diet and nutrition and lifestyle until you plateau, then experiment carefully with things like NAC (for anti-candida, anti-bacteria) or other therapeutic steps.

      Best, Paul

      • Thanks Paul,

        For your support and hard work. I will heed your advice for sure and I look forward to seeing more improvements.

        I have my kids and my husband on PHD and even my parents and step mother are on board too! I have made them all read your book. I look forward to seeing seeing their progress as well. The proof is in the pudding. It has really changed my life.

        Thank you for everything!

  20. Hi Paul,

    I have left a comment and now I can not find it. What do you recommend for Chronic Prostatitis. I was finally able to diagnose Chlamydia Trachomatis. Any recommendations you can give? Also how are you dealing with Rosacea? Is it caused by Clamydia Pn?

    Thanks.

  21. Steve, I don’t know if you read my comment but I had a similar problem and recommend hibiscus flower tea to clear bacteria from the bladder and UT. This removes a major source of prostate irritation. Cheap, safe and pleasant to try.

  22. I have been doing the PHD for a year now and feel good but my moderate to severe psoriasis which I’ve had for more than ten years has not improved.

    I have been doing some reading and have found that some theorize that psoriasis is linked to chronic streptococci infection, and I read a paper from some Indian doctors that got excellent results treating psoriasis with azithromycin. They used 24 courses of 500 mg azithromycin daily for four days, then ten days of not antibiotic. So 24 four day courses of antibiotic followed by ten days off. 60% of their patients were 90%+ improved after a year.

    http://www.ncbi.nlm.nih.gov/pubmed/20299307

    Do you think I should try this course of treatment? Would you recommend modifying their program in any way? Thanks for any advice you can give me.

    • Hi Matt,

      I do think most such conditions are caused by infections. Whether strep is responsible in this case and azithro works, I don’t know. I think you have to take a guess and make a decision whether to try it.

      I’ll try to do some research on psoriasis at some point but I can’t promise to get to it any time soon.

      • But you think that trying an antibiotic approach as described above is a reasonable step? I actually had an acute strep infection earlier this year diagnosed by culture, which probably makes a a chronic strep infection more likely. I guess I’ll probably give it a try. Assuming I can persuade a doctor to prescribe it.

        Should I be taking any special supplements during the antibiotic treatment? A probiotic? Thanks again for your reply.

  23. Hi Paul,
    I wondered if you could do an article on dry/oily skin and sebum sometime? I acquired a persistent jock itch infection a few months after starting low carbing (no carb on your definition) and still haven’t got rid of all of it after several months. (Currently rotating different anti-fungal creams.) I have raised my carb intake noticeably, although I only realised recently how much rice/potatoes your recommendations imply if sticking to those sources so my previous quantities were maybe not sufficient (e.g. 1/2 pound of rice at lunch, 1 sweet potato in evening). I did notice that my skin got very dry low carbing and I’m used to having greasier rather than dryer skin.

    My assumption is that the sebum production is needed to combat skin infections, but obviously it can be too high, particularly in youngsters, so perhaps you could do something on how to increase or decrease sebum production as required? You suggest rice/potatoes (bananas?) as sources, do you think there is a place for less paleo sources like sugar/candy as a temporary measure? Does alcohol have an effect? What about omega 3/6 oils, do they boost or hinder sebum production? I’m sure you can think of more factors that might be relevant (meat consumption? dairy?) I see plenty of questions about acne on paleo blogs, but plenty of older people have dry skin, it would be good to see an article tackling this from both angles.

    Keep up the good work, looking forward to the new book.

  24. For those of us who have become interested in the role of infection in chronic illness, I found a video of a fascinating presentation on the role of bacterial infection causing autoimmune disease by Dr. Trevor Marshall. Apparantely, this is cutting edge stuff that we’ve only come to realize in the last 5 years or so due to our recent ability to decode the genome. It’s definetely a good watch or listen for fellow health dorks. Oh, he also discusses the role of vitamin d in some of his other videos.

    http://www.youtube.com/watch?v=MRx8eHBufHQ

  25. Hey Paul,

    This morning I felt the strong urge to urinate and when I went it took quite a bit of time. It happened for a short time around a year ago. I’m guessing it’s a symptom of an enlarged prostate. The only thing I can think that has changed is that I painted some iodine on my skin yesterday to see if I am deficient in it. What could this indicate in relation to the englarged prostate?

    Thanks

    • Hi Ron,

      Frequent or excessive urination is a symptom of hyperthyroidism. It could be the higher dose of iodine made you temporarily hyperthyroid. You could try painting the iodine regularly and see if your thyroid adapts, which it should do within a few weeks if it is healthy.

      I wouldn’t assume your prostate is enlarged. It’s more likely to be a hormonal effect.

      • Thanks for the reply Paul.

        That is really interesting, because I have been treated for HYPOthyroid…diagnosed not by tests, but by just symptoms by an open minded doctor.

        I’ve been on natural thyroid meds for a few months… havn’t been on them the last week or so as my med’s got delayed in the post.

        Now I’m confused! 😕 🙂

        • Sometimes thyroiditis can look like both hypothyroidism and hyperthyroidism — you can have nodules in the thyroid that produce excess thyroid hormone when iodine is available but have low thyroid hormone when it is scarce.

          I would keep a close eye on how you feel and try to understand what is going on. See if you are sensitive to shellfish and seaweed.

          • Paul,

            Whats your thoughts on using Iodine supplementation (starting off slowly like you recommend) for hypothyroidism? Is it dangerous?

            I hear some people (Brownstrein) say its safe and others say it’s dangerous.

          • Hi George,

            Well, they’re both right: it’s risky but can be beneficial.

            Personally, I favor careful iodine supplementation for hypothyroidism. I think the rewards outweigh the risks. Check out the posts in our hypothyroidism category, we’ve discussed this extensively.

  26. Hi Paul and Shou-Ching,

    I am wondering: Are there any health risks or problems with eating 10 oz. of canned tuna everyday?

    Are Mercury and other chemicals a concern?

    • Hi JC,

      Yes, mercury is a concern; tuna are at the top of the food chain.

      Chemicals in canning, like BPA and aluminum, are concerns.

      Canned tuna is mostly protein, so it’s nothing special from a nutritional perspective.

      It’s not a bad food, but in general fresh or frozen fish are preferable to canned fish, and fish lower on the food chain are preferable to fish higher.

      • Paul,

        What about the Selenium factor negating the harmful effects of mercury per Chris Kresser? http://chriskresser.com/the-truth-about-toxic-mercury-in-fish

        Dr. Nicholas Ralston: The types of fish that were consumed in the Faroes, I think they were between 50 and 100. But many of the types of fish that people think are worrisome, like various types of tuna. For some reason, tuna gets focused in on a lot, but almost all of the tuna that I have looked at have had values of around 200 positive. So rather than being adverse, the more tuna that’s consumed, yes, you are getting exposed to some mercury, but you’re getting 20 seleniums for every mercury, so the worst damage you can have is one mercury takes one selenium, so you’re still 19 to the good. So it’s just a small matter of just keeping track more carefully of how much mercury relative to selenium.

        • Hi SC,

          Well, it’s good news if true. I’m not sure how reliable the protection is, but it’s good to hear that selenium protects against mercury.

        • Paul, I’m getting all of my fish via canned sardines from wild planet(no bpa). Is this a good source or is frozen or “fresh” still better?

        • And there’s some question that the metals are not removed from the body by selenium/zinc …

          http://perfecthealthdiet.com/2010/07/the-china-study-evidence-for-the-perfect-health-diet/comment-page-1/#comment-54769

          Interesting idea about the SeHBV rating as a good way of examining the net health promoting or health adverse effects of different seafood. However, as someone commented there, selenium merely helps to offset oxidative damage from mercury, but it doesnt actually remove it from the body.

          • Mark,

            Not so sure about that. One recent trial in a mercury contaminated village in China showed an increase of mercury excretion after supplementing with 100 ug of selenium yast. Before supplementation both groups were excreting around 20 ng/mL of mercury in urine. After 90 days, control group continued excreting around 20 ng/mL, but selenium group increased to around 50 ng/mL. See:

            http://www.ncbi.nlm.nih.gov/pubmed/23033886

          • Paul,

            I wonder if selenium and zinc are being used to bind mercury and cadmium, if that means fish and shellfish provide less of selenium and zinc than other meats.

            i.e. Eat enough omega-3 rich fish sources and get selenium/zinc from non-seafood sources.

      • Does canned fish have less omega 3 than fresh or frozen?

        Money is tight for me and fresh or frozen fish isn’t always an option because of its cost. Any suggestions?

        Thank you

      • I’ve read that canned tuna is a smaller species and lower in mercury than the big tuna used for steaks. My concern would be – is it packed in soy oil? Does it still have its full omega 3 content?

  27. Paul:

    I am doing the GAPs diet for my 10-year old daughter. (I added the carbs back for myself as you suggested for the sleep issues–already better last night.) We have had amazing improvement with the GAPs, so I don’t want to abandon it, but there are still OCD symptoms that seem to persist no matter what.

    She takes ‘5htp’, instead of carbs, when she can’t sleep. Would carbs help her do you think?–with her sleep, yes, but with her OCD???

    If you did think there would be an improvement, would adding carbs (or whatever you might suggest) completely cancel out what the GAPs diet is doing and has accomplished for her? I mean, if you gave someone the GAPs diet with a little ‘safe starch’, then is it still the GAPs diet?–being it is so rigid?

    I am really confused at this point–I really need some help. I thank you so very much for any info. you can offer me.

    • Hi Stacey,

      The short answer is, I don’t know. We have had one reader who said her OCD went away on PHD, and it hadn’t gone away earlier on a very low-carb diet similar to GAPS. But that’s one case. I don’t know what causes OCD and I can’t say that our diet will fix it in other cases.

      I would recommend taking melatonin rather than 5HTP. It is safer. You can get time-release forms which should help her sleep. And yes, carbs would probably help her sleep.

      The only downside from carbs is if she has some sort of gut infection and the carbs would feed the gut pathogens. GAPS tries to starve colonic microbes of fiber. Starches always have fiber.

      What I would recommend is trying it. If she reacts badly to modest amounts of starch, then you can guess that she has an intestinal infection. Then what I would do is ask her doctor to do a stool test like the Metametrix Microbial Ecology profile to try to identify what her pathogen is. Sometimes it is an easily treatable infection.

      She might have to restrict carbs for a while, but I wouldn’t assume that that’s necessary without testing it.

  28. Interesting–thank you so much, I will start here. (As an aside, when I tried her on MCT oil for a bit, the OCD got much worse and I stopped it. Does this suggest anything to you?)

    • Hi Stacey,

      Well, one possibility is a protozoal or parasitic infection. Those will flare on a ketogenic diet.

      I’m sure there are other possibilities but I haven’t studied OCD enough to guess what they may be.

  29. In keeping with your emphasis on exercising daily in natural sunlight, I went for a walk after lunch today. Two questions:
    1) Are the benefits realized via a mechanism other than Vitamin D absorption? Only my hand, neck and face were exposed to sunlight.
    2) Any benefit to removing my glasses? When I was trying to conceive, I recall the advice to get sun exposure without glasses to allow sunlight to pass through Retina? Any merit to that?

    • personally i have noticed that some light on any skin is better than none at all, but, at least for a male, that sun on bare chest, belly, back, inner thighs, and groin region is really the best.
      also yes, any type of glasses does limit the benefits of sunlight. but again, something is better than nothing.

    • Hi Elyse,

      Yes, the benefits are partly sun on the skin (eg vitamin D and other photosensitive molecules), partly sun on the eyes (important for circadian rhythms), and partly activity (circadian rhythms).

      And yes, there is some benefit to removing glasses. The retina is sensitive to UV light and glasses block UV.

  30. Hi Paul,

    Using the Azimuth table http://aa.usno.navy.mil/data/docs/AltAz.php, Vit D is only obtainable from the sun at certain times of the year and it varies depending on where you live. This is according to Dr. Mercola who says if the reading is less than 50, no Vit D at best and potentially harmful sun rays, at worst.

    • Hi Cathryn,

      That’s a good question. Roughly speaking, at 40 degree north latitude, vitamin D production at the winter solstice is about 1/5 what it is at the spring or fall equinoxes and those are about 1/4 what they are at the summer solstice. So if 15 shirtless minutes in the summer would make enough D, an hour would be needed at the equinoxes and 5-6 hours would be needed in the dead of winter.

      I don’t know how many people go shirtless outdoors for 5 hours midwinter. So it’s reasonable to say we don’t make any D.

      • …which probably means that people of northern heritage have adapted to being without VitD for a few months. Not saying that it’s optimal, just that it won’t kill them right away.

        • Chris Kresser has some very interesting stuff to say on the Vitamin D subject here,
          http://chriskresser.com/the-latest-discoveries-in-evolutionary-biology-genetics-and-epigenetics
          here are just a few excerpts,

          “So let’s take a little closer look at each of those. Most of you know by now that vitamin D is produced by UV light from the sun acting on our skin, and of course, less is produced further from the equator where UV flux is lower. Now, since there is some vitamin D in fresh meat, hunter-gatherers in Europe may not have suffered from vitamin D deficiency. They could probably get by even with their darker skin. But as people moved north and adopted agriculture, which meant that they ate less meat, vitamin D deficiency would have developed, decreasing resistance to infection, causing rickets, and even increasing the risk of cancer. This is probably why natural selection favored mutations causing light skin, which allow for adequate vitamin D production in areas of the world where there’s not as much UV radiation.”

          “Most people are aware that sunlight helps the body create vitamin D. When we’re exposed to UVB light, the body converts cholesterol actually into vitamin D, which is another reason why lower isn’t always better with cholesterol. And the further north we get from the equator, as I said, the less UV light there is, especially during the winter months.

          And here’s an interesting side note, by the way: The next time you get your cholesterol checked, pay attention to what season it is because, because sunlight converts cholesterol to vitamin D, cholesterol levels tend to be higher in the winter months when there is less sunlight available to convert it. And I actually didn’t know that until fairly recently. So there’s a seasonal variation in cholesterol levels for that reason.”

          “And you might also be wondering how dark-skinned people produce enough vitamin D, and this actually involved another genetic adaptation, and dark-skinned people tend to be carriers of apolipoprotein E4. This is a single nucleotide polymorphism, or SNP, of the apolipoprotein E gene. And ApoE4 carriers have higher levels of LDL cholesterol than the more common ApoE3 and ApoE2 genotype. This means they have more cholesterol available for conversion of UV light to vitamin D, and carriers of ApoE4 can, in turn, compensate for limited ultraviolet light exposure. And sure enough, it’s not only people with darker skin that tend to be ApoE4 carriers, but that phenotype is also common in northern latitudes where exposure to UV light is low, like in Northern Europe. And this is yet another example of where a mutation that happened to prevent one thing from going wrong could have led to some undesirable consequences. So ApoE4 carriers have a higher risk of Alzheimer’s and dementia, and they have a higher risk of heart disease. And you know, the conventional view is that they have that higher risk because of higher levels of LDL, but actually the most recent research and our recent understanding of what causes both Alzheimer’s and heart disease suggests that the reason they have a higher risk is that ApoE4 carriers are more susceptible to oxidative damage and inflammation, and it’s the oxidation of the LDL particle that’s the common thread in both increased risk of heart disease and increased risk of Alzheimer’s and dementia. So this ApoE4 mutation that helps dark-skinned people produce vitamin D and also lighter-skinned people in northern latitudes produce enough vitamin D wouldn’t have been a problem in an environment where oxidative risk factors were low, like people weren’t smoking, they were getting plenty of exercise, their stress levels were managed, they weren’t eating a lot of omega-6 polyunsaturated fat that has the potential to oxidize. But in this modern world where the modern lifestyle is full of oxidative risk factors, then this ApoE4 mutation has a dark side. So I just find it fascinating. I mean, it’s like our genetic code is doing the best that it can to make us healthy and protect us from harm, but the lifestyle that we’re living keeps kind of throwing a monkey wrench in the plan.”

    • I don’t know if it’s true 100% but your body can’t make vitamin D if your shadow is taller than you are 💡

  31. Hi Paul,
    When I asked you questions the other day, I forgot to mention one other thing. When I had a rectal smear test, Entamoeba coli had an x under the column heading of cysts. Is this the same thing as SIBO? and are is there anything in particular I can do for it.

    As always, thanks!

  32. Hi Paul,
    I have recently bought some organic Yakon syrup after reading about its health benefits. Do you have an opinion on its worth as a alternative sweetener?
    Thankyou.

  33. Hello Paul,
    Since starting a paleolithic-type diet about a year and a half, ago, and having recently included some “safe starches,” I’m more or less chronicly constipated. Any thoughts as to best laxatives or other means to alleviate? How much water per day do you recommend?
    Many thanks,
    Richard

    • Hi Richard,

      http://perfecthealthdiet.com/category/disease/constipation/

      I would drink water to taste, but also eat water-rich foods. This is one advantage of, say, white rice and potatoes over the breads/crackers/etc that most people eat. Also, be sure to get enough salt to stay hydrated.

      • Paul,

        Thank you for your response. Consequently I visited your discusion on costipation and the remedies, all of which (as usual) makes great sense.

        Questions:

        How much salt do you recommend? I generally get between 850-950 mg Na, daily, except one day a week, 5 anchovies, giving me about 1800 mg for that day. Otherwise, my K/Na ratil is about 5 to 6/1.

        As to fats and costipation: I consume 1 tsp/day olive oil, 1 tsp/day coconut oil, 1 avocado, a pat of butter and some sat fat from salmon, chicken, beef- and about 1 tsp fish oil on days not eating salmon; sat fat is about 11-16% of calories. Sufficient?

        Many thanks, once again
        Richard

        • Hi Richard,

          Optimal sodium intake is about 3.7 g per day. Typically most will come from food and the rest from 1/2 to 3/4 tsp salt. Salt needs are increased on low-carb diets to about 1 tsp per day.

          If you are really getting only 900 mg daily, you are severely sodium deficient, but I doubt you get so little.

          I think you may be getting too much omega-3 if you are eating salmon and taking fish oil on other days. You don’t need fish oil every day, just eat salmon once a week. … That’s certainly sufficient fat to avoid constipation. But I would try to get less oil and more egg yolks for choline and phospholipids.

    • I’ve taken fiber for a few days (Konsyl). It seems to make things better for me.

  34. Hi Paul,

    How long can you be on the Ketogenic Diet? I decided to do PHD first and switch to Ketogenic after.
    Also the difference is on PHD it is around 400 calories of carbs and Keto you suggest 200. So the difference is only 50 grams of carbs. If that is the case then why on PHD you suggest only 2 tablespoons of coconut oil and on Keto it is around 12?
    It seems like a discrepancy in calories.

    • Hi Steven,

      Well, first the ketogenic diet isn’t a weight loss diet. It does tend to have more calories than a regular diet.

      It’s usually not necessary to take 12 tbsp coconut oil on the ketogenic diet. Some people might need that much to see an effect, but most people will have good results with less. Also, MCT oil is more ketogenic than coconut oil, so that would require fewer calories to create ketosis.

      If nothing goes wrong then it should be possible to be on the ketogenic diet indefinitely, but it is less robust to faults (eg, certain infections) than a diet with more carbs.

  35. Paul,

    I respect your work so much and I follow a similar plan to your PHD (I have the upper range of protein, 150g daily; then about 100 g carbs from fruit, honey, and/or white rice; then about 150 g fat for my calories needs). Another 50 g each whey protein and fruit sugars after a workout.

    Starting about 2 years ago, my mother and I who lived together began suffering from weird arthritis-like pains and general stiffness. Slowly, full-blown fibromyalgia began, as well as insomnia, coldness, fatigue, blood-shot eyes, dry hair and skin, and a chronic sore throat in my case. No bowel problems for either of us.

    Since we were (still are) both experiencing these symptoms together, we assumed our problem was environmental. So we moved out and did some inspection while living away. We eventually found that we had a rat-infestation (really bad in the crawl space), and mold and water damage, and a CO leaking water heater.

    So, fast-forward to now and we have gotten some better since moving out about 6 months ago, but we still have our symptoms, and our we’re just now noticing a sharp worsening of our symptoms now as the Seattle cold and rains have come with fall. For both of us, our symptoms predict rain.

    My question is, what should we do and what might we have? We’ve had blood tests revealing essentially perfect blood work (low CRP, ESR; no autoantibodies, no heavy metals, etc.). The only thing I think might be of significance is that my bilirubin is high (though my mom’s is not) and my white blood cells and neutrophils are always low (though, again, not so for my mom).

    We’re not sure if we might have chronic infection of some kind (I’ve read fungal infections can come after mold exposure), or if we are just broken from some kind of environmental toxicity.

    And advice or suggestions would be nice. One last tidbit, we are on a paleo diet for over two years before this all happened (and not a CR one or one too low in carbs.) I found your site and began following your plan about 6 months ago while searching for answers.

    I thank you in advance.

    • Hi Joseph,

      It goes without saying that I can’t diagnose your case, but here’s some ideas/opinions to consider.

      First, living with mold and water damage is a risk factor for fungal infections and also for a high burden of toxic fungal cell wall components. These can circulate for a long time as the excretion pathway is via the liver and bile and feces, but they can bind to bile and recirculate with it.

      For fungal infections, a good step is to supplement N-acetylcysteine (500 mg to 1 g per day) for glutathione production, and to take a charcoal tablet with some oil once per day during the daily fast to help excrete fungal cell wall components. Also for fungal infections copper and chromium are important supplements, not too much selenium but try to optimize it (say twice a week at 200 mcg along with some iodine).

      Some of your symptoms sound like hypothyroidism. Fungal infections are a common cause of hypothyroidism. I would get a thyroid panel done and you might relieve symptoms further by treating a subclinical hypothyroidism.

      For general immunity, circadian rhythm enhancement is very important. Daily physical activity, and bright sunlight (perhaps indoor UV lamp / sun lamp when it rains) exposure during the day is desirable. There are more circadian rhythm tips in our new book.

      I think chronic infections of some kind are the norm in fibromyalgia. The trouble is with diagnosis. If you don’t know what is causing the infection it is risky to try antibiotics.

      Since you’ve been improving I would continue to pursue tweaks and gradual improvement, with an emphasis on the circadian rhythm and anti-fungal tactics. Any diagnostic help you can get from your doctors would be good. I generally suggest the Metametrix stool profile as a reliable diagnostic tool. Not sure what the odds are that it will show anything, but if it does it will be actionable.

      Keep me posted on how things go.

      Best, Paul

  36. My apologies if this had been covered here or in the book, but I am having trouble finding the answer. On page 245 of PHD, you wrote that a low-protein diet is good for fighting C. pneumoniae and viruses. I have been dealing with reoccurring sinus and chest infections along with an inner ear virus for many months. Doctors have not been able to help me, so diet seems to be my only hope. What percentage should protein intake be to achieve this low-protein diet? Thanks in advance!

    • Hi Anna,

      I wouldn’t go low protein for respiratory tract infections. Try to get at least 15% protein. I would supplement NAC also for glutathione.

      For respiratory tract immunity it’s very important to get adequate vitamins A/D/K2. I would eat extra egg yolks (5 per day) and supplement vitamin D3 and K2. You might consider a source of extra A such as cod liver oil (not a version that has the A removed).

      Also, extra vitamin C and follow our general diet and supplement recommendations.

      You might ask your doctors to check iron status to make sure it is not abnormal.

      Let me know how it goes!

      Best, Paul

  37. Hurricane Sandy Approaches; meet Gabor Maté | Perfect Health Diet - pingback on October 28, 2012 at 10:04 am
  38. Hi Paul, I am 61yrs old and I have been on PHD for about one month now and I have been feeling good in a consistent way emotionally and physically. But today I don’t know what happened. I walked for about an hour and a half came home to prepare my noon meal of three eggs and rice (lots). Before eating my meal I checked my Blood Glucose and it was 72 and I could feel I needed to eat. Ten minutes after eating I felt very tired and laid down, later got up to take my Blood Glucose test again and I was so dizzy I could hardly walk. My BG was 101 one half hour after my meal. I decided to take my Blood Pressure and it was 82/40!! I have never seen my blood pressure so low. I tested my BG one hour after my meal and it was 132. But I am still dizzy and I wonder what it was that affected my BP. Was it the long walk? If you have any ideas please answer. I have been taking your recommended supplements. Is there anything that could be contributing to this? thanks again.

    • Hi Cris,

      That’s definitely a low fasting glucose and a very low blood pressure.

      The first thing I would look at is possible electrolyte deficiencies and dehydration. Are you getting enough salt? Potassium (tomatoes, potatoes, bananas)? Calcium (bone broth soups)? Drinking enough water?

      Put some salt on your fingertip and taste it. Does it taste good? Then eat some more and drink some water. When you no longer need salt, it won’t taste as good.

      When you are getting enough electrolytes and water, you should urinate regularly. Infrequent urination suggests a deficiency.

      If electrolytes and water don’t fix it then I would go see a doctor. Let me know how this comes out.

      Best, Paul

      • Well Paul, your suggestions fixed my problem of low blood pressure! I right away drank some broth and ate 1/2 teaspoon of salt, then ate a banana and supplemented with “no salt” which is potassium and drank lots of water. I started to feel better within a half hour. I will try and be more conscience of the electrolytes from now on. I can’t tell you how grateful I am that you replied so promptly, I was getting a little nervous.

  39. Dear Dr Jaminet;

    My name is Thomas Carney, I’m struggling with candida and acne..
    I’m 20 years old and trying to break into the entertainment industry,
    but I’m extremely mentally and physically hindered by what I believe
    to be candida. I’m at a loss as what to do next- I could really use
    your help

    After highschool, I embarked on a 2 year “suicide diet” of fast
    food, soda, candy, and pizza EVERY SINGLE DAY. It was literally
    nothing but junk food EVERYDAY- i think i maybe had 5 vegetables in
    the entire year of 2011.

    i slowly started to accumulate acne, although it was nothing too
    serious. however it was enough for me to try anti biotics, which i did
    intermittently over the course of a year and a half. id get a bottle
    of 28 pills, sometimes take them all, sometimes decide not to finish
    due to a nagging suspicious that maybe these arent great for my
    health. all in all i must have had over 100 pills, if not more, over
    the year, all while eating that terrible diet. i tried and failed
    going on a paleo diet, never going longer than 8 days (i noted
    improvement in acne in that 8 days.). i was 18/19 at the time do didnt
    really worry about it- always have time later.

    i noticed my physical and mental health slowly decline at this time,
    yet every test came back totally normal, and for the most part i still
    felt more or less ok.

    so 7 months ago i came to L.A, still with decent health and only
    moderately acne, planning to finally go paleo, finish a treatment of
    retin-a, and start my career.
    of course i didnt make the paleo switch, and keep binging on junk
    food. suddenly i realized i COULDNT stop, and was completely addicted
    to junk food. my acne started getting really bad at this time, and so
    in june, took another course of antibiotics. although i only had about
    18 of the 28, i think this is what finally did my system in
    completely. watching my acne get worse, i started an 8 day water fast
    on june 23th, and didnt feel to bad, although fighting off cravings. i
    gave in night 4 and had a candy bar and corn chis, but got mostly back
    on track and didnt have anything substantial to eat until the 8th day
    where i gave in and ordered an extra large pizza with large coke and
    chocolate sticks. at this point my acne had got really bad, and i had
    the pizza convinced it would be terrible the next day.

    shockingly, it wasnt- it had drastically improved overnight. i was
    shocked. i went home july 1st planning on doing a “rehab”, with mixed
    success. july was a yo-yo month- id fast for 3 days, break down and
    order pizza again. id fast for 4 days, break the fast, than binge on
    junk for a few days to “gain enough weight” for the next fast. i still
    probably ate a little better during this time than before, and i think
    its when i started eating probiotic greek yogurt. however, my skin
    stayed improved overall, although i stay had breakouts.

    finally in august i managed a 9 day water fast. my breakouts slowed
    down, and i finally broke the fast on day 10, although not on paleo
    foods- first thing i had was cornflakes. i then started eating a
    conventially healthy diet, mostly paleo but still with some “whole
    grains” and the occasional junk. i felt better, although still not
    quite as good as 2 years ago, and my skin was better, although not
    totally clear. i kept eating decently well for a while, but could
    never chain more than 7 consecutive days together without giving in to
    a junk food craving.

    i’ve noticed a curious affect where after eating very healthy id have
    breakouts, then id binge on junk and my skin would get very clear and
    id feel great, but only temporarily as it would get worse in the long
    run.

    in october i started a paleo diet with i kept for 12 days until a 2
    day weekend binge, which was last weekend. i got back on track monday,
    and started a water fast friday.

    so here i am now desperately trying to fix my candida, health, energy,
    and skin. im trying to find what the “perfect diet” would be for acne,
    candida, energy, and overall wellbeing.
    i always thought fasting and ketosis would be great for acne and
    candida alike, but i read your theory that ketosis wouldnt be
    beneficial for somebody on candida, as the candida can feed on the
    ketones. is this correct?
    i’ve read that people going low carb improve acne, and i want to avoid
    sugar as much as possible.
    im also concerned that probiotics, while essential for candida, may
    also cause acne breakouts.

    im reluctant to do anything that might make the acne worse, but also i
    know i have to eliminate the candida

    what should i do? whats my “perfect diet?” am i only making the
    candida worse by fasting and going ketosis paleo? how many carbs to do
    i need to stay out of ketosis?

    thank you very much,
    tom

    • Hi Tom,

      Well, first I think you should eat our diet. An urge to binge on Paleo sounds like you are too low carb. Try adopting our diet and eating in accord with our food plate.

      It’s very likely you do have some sort of chronic fungal infection, as it tends to produce acne/rosacea as a first symptom. In general, our diet, supplements, and circadian rhythm strategies are best for that, with two additions:
      – N-acetylcysteine, try two 500 mg capsules a day during your fast with a full glass of water.
      – fluconazole, if you can get a doctor to prescribe it.

      If you have low stomach acid try betaine HCl with meals. Chew your food to support digestion. Digestive enzymes, especially a formulation rich in carbohydrate digesting enzymes, may help also.

      That should do it, with a little patience. Be sure to get daily exercise and sun exposure, and eat a diverse mix of vegetables.

      Best, Paul

      • So am I correct to think fasting will actually make candida worse due to ketosis?

        Does ketosis activitely make candida worse, or just stalls recovery?

        I’m on day 4 of a water fast now and feel better, but obviously if I’m worsening the candida I don’t want to continue.

        Thanks!

        • Hi Tom,

          I think regular daily fasting of 16 hours (8 hour feeding window) is good, as it will support circadian rhythms, give the immune system time each day to work against starved microbes, but won’t starve the body / immune system of carbs or proteins to such a degree that immune function is impaired. Also it doesn’t create enough ketosis to favor eukaryotic pathogens.

          I think a four day fast is too much. Slow and steady will win this race. Usually after a four day fast, after you resume refeeding the infections come back as bad or worse than before. Immunity is impaired for days after refeeding begins.

          • Michael corrison

            ok, I’ve thought about trying an intermittent fasting schedule anyway. Sounds very doable.

            What about long term ketosis without fasting? If you eat ketosis daily, would that make candida worse as well?
            Sorry to beat a dead horse, I just need to be absolutely s

          • I don’t believe that continuous ketosis is optimal for Candida.

  40. hello-

    Awesome blog!
    I’m starting a full 3 month candida diet as seen on thecandidadiet.com, but I have a question about mushrooms.

    the candida diet says not to eat mushrooms as the yeast can feed the candida.
    i know a few excellent pre-made paleo places that send delicious pre-made paleo foods. however, many of the best dishes have mushrooms, so obviously i have to be careful since im just starting the diet.

    however, i thought mushroms where zero carb and zero sugar- isnt that wont candida feeds on? i thought yeast didnt feed on other yeast?

    what is the LEAST restrictive diet i can eat without delaying candida results?

    thanks!

  41. Doctor Paul, what are you thoughts on red cabbage for a stage 1 strict candida diet? While it’s a veggie, it seems a little high on a sugary side.
    Say I ate a whole head a day ( can exceed a pound) – is this too much sugar?

  42. Michael corrison

    Hi doc
    -what’s the most reliable lab test for systemic overgrowth of candida? I believe this might be my case.

    I’ve heard of the blood and stool test, which is best?

    • There’s no good test. I believe William Shaw of Great Plains labs recommend urinary organic acids testing: http://www.greatplainslaboratory.com/home/eng/full_oat.asp. You can try Metametrix Microbial Ecology stool profiling, but that only detects gut infections. Blood tests generally can’t detect systemic fungal infections until they are nearly fatal.

    • There’s a test for candida and other mold antibodies in the blood (igf or igg?). But that doesn’t necessarily mean you have it currently. Also cortisol and mmp9 can be high and msh low. There’s a new mycotoxin urine test. You might be noticeably less hungry after taking probiotics, and feel worse with more sugar.

  43. Hello!

    I am on a quest to conquer my candida once and for all- I am trying to build the best anti fungal diet possible.

    Yet I keep conflicting reports on carbs- some sites explicitly ban certain foods because they are too high in carbs, others claim going too low carb can be bad for candida to.

    What gives?

    P.s- not sure if you know, but your work is becoming very popular and widely discussed on paleo hacks . Com

    • Hi Belsin,

      Basically, carbs support anti-fungal immunity but can also feed candida. However, ketones can also feed candida but don’t support immunity.

      So for systemic infections — and candida is good at establishing internal systemic infections — a moderate carb intake is best to support immune function.

      For purely gut infections a low-carb diet would be best, but I’m not aware of fungi that can survive in the gut without being able to establish systemic infections also. Most human-adapted fungi either establish skin infections (Malassezia) or systemic infections (Candida, Cryptococcus) which can include mucocutaneous manifestations (oral thrush, gut, vagina, skin).

      So I don’t think the VLC-for-Candida argument works.

  44. Paul, do you still recommend a ketogenic diet for viral infections? I’m the guy with shingles that keeps bugging you with virus questions.

    Also, it seems that many of us are extremely interested in detecting and combating chronic/stealth infections. Will there be upcoming blog posts that we can look forward to which will go into more detail on this? Perhaps a PHD book/ebook in the future focusing on chronic infections?

    Jonathan

    • Hi Jonathan,

      It’s impossible to generalize about viruses. Ketogenic diets will help against some viruses but hurt against others. So we’d have to research specific germs.

      The safest thing would be to do regular PHD with intermittent fasting.

      Yes, I do plan to do a book/ebook about chronic infections eventually. It will be some time after the cookbook, maybe after some other projects too. In the meantime I’ll do research in blog posts.

      • Sounds good Paul, I’ll continue to faithfully follow PHD. I’m looking forward to the projects your working on. Thank you!

  45. Hi Paul,

    I have depression and have taken your advice to stick to a ketogenic diet with 200 starch calories per day. However, I have a very hard time eating the 12 TBSP of oil recommended per day. Would eating more fatty meat make up for less oil?

    Thanks,

    Kevin

  46. I have a question regarding probiotic drinks and foods.

    You read about greek yogurt a lot for candida as it’s rich in probiotics, but isn’t it very high in sugar? And I thought dairy was bad?

    I’ve found a coconut milk kefir with 8 grams sugar total per bottle (but only 2 billion strands.) 8 grams doesn’t like TOO much, but one never knows

    Is there a difference between the sugar you get in fruit, the sugar in vegetables, the sugar in yogurt, the sugar in coconut, and the sugars in junk foods?

    • also, would you trust greek yogurt from grocery stores? i have a nagging suspicion that your big name brands may not be as good as they claim to be.

      i also found a product of cultured coconut milk with all of these “other ingredients”
      maltrose, dextrose, types of gum, natural coconut flavorings”- what are these and can they be trusted?

      • Long-time reader, first time poster here. Caution: advice nowhere near expert.

        Andrew, the coconut milk kefir’s sugar content of 8 grams in a whole bottle doesn’t seem properly worrisome. Assuming it’s just added sucrose, 4 grams of fructose in something you’d presumably be eating infrequently seems tolerable to me.

        Superficially, the sugar in fruit, vegetables, and coconut is the same: sucrose (half glucose and half fructose, the former being healthful in moderation and the latter possibly toxic).

        Yogurt’s sugar is lactose, which I believe does not contain fructose but instead a combination glucose and galactose, which explains why dairy sugar is less sweet per gram than most other sugars.

        Most “junk foods” are sweet primarily because of high-fructose corn syrup, which tends to have a higher fructose-to-glucose ratio than sucrose (though the difference is small). The refined corn derivation of the sweetener may introduce toxins in addition to that from fructose, but these foods are invariably problematic for other reasons, like industrially baked wheat and high-omega-6 vegetable oils.

        Most people believe that sugar from whole foods is more healthful (or at least less unhealthful) than that found elsewhere. I recall skimming some evidence for this at least in the case of honey, but I don’t know how solid the evidence is for the benignness of fruit and vegetable sugar.

        Paul recommends limited fruit consumption to control fructose intake. Most vegetables have low sugar concentrations, so they are relatively safe.

        Lucie, I personally eat mainstream commercial greek yogurt (for the culturing, calcium, and protein). I just avoid large consumption because it’s probably from poorly raised cows.

        As for the ingredients you cite in the cultured coconut milk, they are unalarming. Maltose anad dextrose are glucose sweeteners. Most gums, like xanthan and guar, are pretty safe and are used for texture and emuslification, from the serious writing I’ve read on them. Natural coconut flavors should be fine.

  47. Real Food Eater

    What do you think of this article: http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html?pagewanted=7&ref=general&src=me. Do you think it is a coincidence that a lot of centenarian populations exist in the Mediterranean? Does lifestyle play a big role?

  48. Is goat cheese recommended for those in the very beginning stages of a candida diet?
    how long should one wait?

  49. Hi Paul and Shou-Ching,

    I have a hard time fasting through the morning.

    I have experimented with it in the past on a VLC Paleo diet and always woul end up hungry or preoccupied with food and have a hard time concentrating on work.

    Why might this be? Possibly an infection? Will supplementation help?

    Many Thanks,

    John

  50. Over the past few months I transitioned from the GAPs diet (strict candida low carb version for 7 months only meat/fat/veg) to your PHD diet and started eating more rice/potatoes. ACNE is one of my primary symptoms that I am using to gauge my progress. I stopped eating FODMAPs roughly a month ago, which seemed to help, and now I primarily eat tomatoes, cucumbers, bell peppers, lettuce, and ferments.

    I LOVE squash but it appears that I get larger, painful breakouts after I eat them and canned pumpkin gives me gas in larger amounts. Also, I have recently discovered quite a bit of mold hiding under the caulking in my shower just in case that’s relevant. My questions are: could the FODMAP/squash intolerance indicate a specific type of infection, can this heal simply by continuing PHD-am I just being impatient or am I not doing enough? I simply can not afford metametrix stool testing so I greatly appreciate your help!

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