Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

10,121 Comments.

  1. Hi Elyse,

    I think fungal infections or environmental mold are frequent causes of acne, so it may be that your shower mold is relevant.

    If it’s environmental, then a detox aid like charcoal would be helpful. If it’s an infection then NAC to support immunity and detox would be very important.

    It’s not easy to say why people become sensitive to particular plants. It has something to do with the nature of gut microbiome, but not enough research has been done to map particular sensitivities to particular gut flora.

    If you do see a doctor, then I would focus on discovering and addressing any thyroid issues, since it’s common to be hypothyroid with acne.

    • Thanks Paul, you’re a lifesaver. How long/often would you recommend taking charcoal (I do IF 14-17 hours with just coffee and coconut oil/butter, and I recall reading that you should take it then)?
      I plan to move in February so I truly hope things clear up in a new environment.

      • Hi Elyse,

        I would take maybe one tablet each morning during your fast, with a bit of oil, eg your coffee and coconut oil/butter would be perfect.

        You don’t need a lot, it’s just to help your body gradually clear toxins. Too much charcoal risks you becoming malnourished or upsetting gut flora.

  2. hi,
    earlier i asked about a coconut kefir drink i wanted to take for anti-candida probiotics.

    im just starting a candida diet and am a little bit concerned about some of the ingredients listed.
    what do you think?

    Coconut Milk (Coconut Cream, Water, Guar Gum, Xanthan Gum), Tapioca Dextrose, Chicory Root Extract (Inulin), Pectin, Calcium Phosphate, Lactic Acid (From Vegetable Source), Natural Flavors, Magnesium Phosphate, Carob Bean Gum, Citric Acid, Carrageenan, Dipotassium Phosphate, Vitamin B12 Live Active Cultures include: L. Bulgaricus, S. Thermophilus, L. Plantarum, L. Rhamnosus, L. Paracasei, Bif. Lactus, Bif. Bifidum, Bif. Animalis, Leuconostic Cremoris and L. Acidophilus.

  3. Michael corrison

    Do garlic and oregano oil and other natural anti-bacterials eliminate good bacteria as well?
    I posted early, I’m currently treating candida. If these do indeed kill natural bacteria, aren’t they just as harmful as ordinary antibiotics?

    • Yes, they do, but: (a) they’re significantly digested before they reach the colon, so they mainly act in the small intestine, where you don’t want many microbes; and (b) they’re not nearly as effective as antibiotics, so lots of good bacteria will survive.

      I wouldn’t worry about it.

  4. After taking up PHD one year ago, many things have gotten better.

    One thing that’s suddenly gotten worse is dental plaque. Within 3 months after starting PHD I have massive amounts of build up on my teeth.

    Have you ever heard of this happening? Do you know if one of the foods we added in (or removed) is a likely cause for dental plaque? I thought perhaps it was the acidic foods or perhaps dairy (butter).

    These are the changes I made when we switched over to PHD, everything else was already part of our whole foods diet.

    dropped legumes (beans) and grains (corn tortillas)

    started using coconut oil and butter

    added fermented food: kimchi, sauerkraut, pickles, acids like vinegar and lemon

    • Hi Mari,

      I’m happy to hear many things are better.

      What about other aspects of oral health: Are your teeth whiter or darker? Are the gums healthy or inflamed? No oral thrush or sores?

      It’s not uncommon to have negative effects when first adding fermented foods. There will be all sorts of microbes in them and if your body has an ecological niche available the foods can provide microbes that can grow in it. Overall, however, one hopes that probiotic species and your immune system will drive out pathogenic species over time and you’ll reach an improved equilibrium eating the fermented foods.

      So it’s mostly a matter of troubleshooting diet to try to see if we can shift the equilibrium.

      One question: is your mouth well watered with saliva? One possibility is inadvertent low-carb leading to a loss of saliva. Another cause of loss of saliva is dehydration or water retention due to low electrolytes: , low-salt, low-potassium.

      You should sweat, urinate, and generate saliva easily. I would address electrolytes first and potentially carbs second; electrolyte deficiencies are very common on low-carb diets and I would guess lack of saliva is the most likely cause.

      Vitamin A is an important oral immune molecule. Do you eat liver and egg yolks?

      Do you eat crunchy vegetables like carrots?

      Are you taking our recommended supplements?

      If it’s not carbs and electrolytes and if you’re taking our recommended supplements then give me an update and I’ll think over some possibilities.

      Best, Paul

    • Hi Mari,

      You might want to checkout http://www.drellie.com

      Here is her protocol:

      -CloSYS™ mouthwash. This is available at Walgreen’s.
      -Crest® Original Paste. Yes, regular paste. No whitening agents, tartar control additives, stannous fluoride, sodium monofluorophosphate, or triclosan.
      -Listerine® – the original. No plaque, tartar control, or whitening agents.
      -ACT® Anticavity Fluoride – again. The original not ACT Restore.
      -Xylitol.
      A good medium-soft regular toothbrush disinfected after every use.
      You can get the reasoning from her blog/book.

      Best,
      SC

  5. Green tea from Japan?
    A colleague just noticed the tag on my tea bag and remarked that green and white tea from Japan is radioactive, even though the government assures the public that it is safe.

    Anyone know anything about this?

    • Hi Dale,

      I think the tea-growing regions are in the southwest, the radioactivity is in the northeast and the prevailing winds blow it toward the Pacific, so I don’t believe Japanese tea has been much effected.

      I don’t guarantee it, but that’s my belief.

  6. Hi Paul

    I’ve been reading a lot about health, paleo and the lipid hypothesis lately and read your book/blog among many other (buletproofexec.com, chriskresser.com, marcsisson.com) and was stunned how the authorities might be misleading in what we should eat. So much it made me ask our main authority in food recommendation in Denmark about their skepticism about SaFa. After a month I got the answer that they in their coming evaluation still are going to recommend MuFa instead of SaFa. They gave me the following expert evaluation:

    http://www.ncbi.nlm.nih.gov/pubmed/21270379

    What is your take on this?

    Hope to hear from you

    Best regards

    Lars Asp Christensen

    • Hi Lars,

      Looking at that paper, the conclusion about SaFA being inferior to PUFA (they recognize it is not inferior to carbs) seems to be based on two citations, their 13 and 17.

      13 is the Mozaffarian meta-analysis which used a biased selection of studies, excluding studies with extremely negative results for PUFA (Rose Corn Oil, Sydney Diet-Heart) and taking the most pro-PUFA possible interpretation of the Finnish Mental Hospital study. See Chris Masterjohn’s discussion of this paper for more: http://www.westonaprice.org/blogs/cmasterjohn/2012/05/17/ajcn-publishes-a-new-pufa-study-that-should-make-us-long-for-the-old-days/.

      17 uses a totally worthless method: “The fall in serum cholesterol concentration was then calculated, assuming that this 1% reduction in saturated fat consumption was replaced with 0.5% monounsaturated and 0.5% polyunsaturated fats. The resulting reduction in cardiovascular and stroke deaths was then estimated, and a sensitivity analysis conducted.” In other words, they assume that LDL cholesterol causes heart disease in a mechanistic way and that if eating more PUFA lowers LDL, it must reduce deaths. This is false.

      There is one other citation bearing on the PUFA-SaFA issue, their 20, http://www.ncbi.nlm.nih.gov/pubmed/19641348, which I haven’t read yet but looks very weak from the abstract.

      We have a better analysis of the omega-6 vs SaFA studies in our book.

      Best, Paul

  7. Hi,

    You said kefir wouldn’t be the best drink for candida because of yeast… However, in an earlier post I noticed you said mushrooms were fine for those with candida- but isn’t that yeast to?

    • Hi Lucien,

      No, mushroom is not yeast. It is a fungus but not a yeast.

      • From Dom’s Kefir page: Candida albicans has never been isolated from kefir grains [as far as the author is aware at the time of writing]. Conditions make it quite difficult for this particular opportunistic yeast to flourish among the microflora of kefir grains and in kefir. Certain yeasts of kefir include Candida as part of the nomenclature [name]. These yeasts are not pathogenic yeasts as such, but are classified as Generally Regarded As Safe [GRAS]. Some yeast strains of kefir may have the potential to keep C. albicans in check in the host, for research has shown that certain yeast strains of kefir can colonize the gut, giving C. albicans competition for nutrients or good inhibition by some form of chemical action by yeasts, and or the Lactic acid bacteria [LAB] of kefir. Kefiran may also play an important role in this, for research has shown kefiran markedly antagonized the growth of C. albicans, including other strains of unfavourable fungi and bacteria.

        • Hi Kris,

          The concern is not pathogenic candida in the kefir – candida is a human parasite that is transmitted human-to-human – but that overloading the body with fungi will lead to gene exchange among fungal species and/or overload the anti-fungal immune response.

          I do think it’s possible that kefir may generate colonization with probiotic fungi that inhibit infection with pathogenic species. But in someone with an established fungal infection, it might aggravate the existing infection.

          So, tradeoffs. I don’t think much research has been done on these questions.

  8. Dear dr. Jaminet;

    What do you think the best probiotic is when dealing with candida?

  9. I’m a little but confused about the best ratio of protein-fats-carbs when on a candida diet.
    I’ve been paleo, so I’ve been eating a lot of fat- I cook every meal with lots of fat, and eat coconut oil/tallow from the container with a spoon.

    Is this advisable on a candida diet?

    When on a candida-paleo diet, should i keep cooking with fats and keeping fat intake high?

    • Hi Harry,

      My belief is that optimal is about 30% carb – 15% protein – 55% fat by calories.

      I think majority fat is good but not excessive fat. Food shouldn’t be oily.

      • thanks doctor.
        my confusion came from reading a few posts on candida forms about the 80/10/10 diet.
        many people there were saying how they tried the conventional higher fat, moderate carb candida diets without success, but when they switched to 80% fruit saw improvement within a few weeks
        what do you think of a fruit based 80/10/10 diet?

        • I don’t think that’s a good diet. Hard to believe it would be effective against Candida in the long run.

          • Dr. Graham argues (to vastly paraphrase) that candida proliferates in response to excess sugar in the blood stream, which itself is a result of insulin sensitivity. If you are diabetic (type II) the candida “rush” in to dispose of the excess sugar in the bloodstream. In this sense the candida are a survival mechanism, albeit with untoward side effects. Seems like an interesting argument to me.

          • Diabetes is certainly a risk factor for Candida, but I’d be surprised if diabetics with candida live longer than diabetics without.

  10. Hi Paul,

    I’ve posted recently about my treatment for epstein barr w/infusion C and valtrex. Symptoms include depression, brain fog, insomnia, blepharitis, coated tongue (not-candida), urinary frequency, sore throat w/granuloma on vocal chord, dry mouth.

    Turns out I also have Lyme, likely from a bite two years ago, as confirmed by immune tolerane test https://www.neurorelief.com/index.php?p=cms&cid=46

    My p100 late-state antigen is very high. Cytokines, however, are low and suggest perhaps that I’ve beaten the infection. Then again, as my doctor explains, it may just be that my immune system is suppressed.

    For now he has me on an herbal antimicrobial formula called A-L complex sold here (sorry no direct link): http://www.byronwhiteformulas.com/

    If I don’t improve over the next month, will begin triple course antibiotics (ceftin/azithromycin/metroindazole). Rest of the plan includes valtrex, IF, circadian rhythm, and per your posts and my doctor’s enthusiastic endorsement, low-dose naltrexone in the pm w/lithium in am.

    I am perfectly PHD compliant, supplements included. Any suggestions diet or otherwise? I’d been trying to keep protein to 50g/carbs to 150g but now am not so sure.

    Sorry for the repeat and in retrospect premature questions. And thanks you again. I’m certain that without your generous posting here, I’d have quit before ever identifying these infections.

    • Hi Shawn,

      It sounds like you have a good doctor. I don’t know enough to evaluate his treatment recommendations. I am glad you will try the LDN and lithium and other circadian rhythm tactics, I think those are effective and low-risk.

      Let me know how things go. I think moderate protein is probably best.

      • Thanks Paul. I do have a good doctor. As you’ve mentioned before, what’s most important is willingness to work w/the patient. I found him through metametrix actually, so that may be a good starting point for other PHDers.

        Also I’ll add that the compounding pharmacist warned me of a 1 in 4 rate of vivid dreams on LDN. I have not been disappointed to find that I’m one of the dreamers.

        Will provide an update, thanks again.

        • Paul,

          Wondering if coconut water kefir is okay or not if working on candida? I thought is was just kombucha that was a yeast base.

          Thanks,

          Jan

  11. thanks for your reply
    Sorry, just a quick follow up.

    i read so many conflicting things on candida- now im reading about this 80/10/10 diet, where people said they tried conventional candida diets that didnt work, but then tried a diet of mostly raw whole fruit and saw relatively immediate progress

    how could this be?

  12. Paul 2 questions,

    1. should I wait for the new book in Dec or buy now? Are they much different?

    2. I have been experimenting with a Ketogenic diet and using Ketostix my urine indicates I have been excreting Ketones now for 16 days. I have read that Ketostix care inaccurate but it seems they can give a false negative but rarely false positives. Can I rely on the positive readings to indicate I am burning mostly fat by now rather than glucose? Do I need to test my blood for Ketones to be sure?

  13. Hey Paul,

    Thanks for the book and all the great info! Can’t wait to get the updated version.

    I was wondering if you kneew of a multivitamin that covered all of your supplement recommendations. The only one that I’ve found is Mark Sisson’s “Damage Control Master Formula,” However it is a bit pricey.

    Mike

    • Hi Mike,

      No, I haven’t seen a multi I liked. I’m tempted to put one together myself.

      Best, Paul

      • That would be amazing!

      • I would be interested in that. I’ve looked all over for a multi that I like, but haven’t found one that I’m completely satisfied with. I know that one pill can’t contain all the supplements, but there’s no reason it couldn’t have the basic vitamins in the correct balance, plus the right amount of some of the minerals such as copper, chromium, a basic amount of iodine, and possibly a low dose of selenium. I would expect to need to supplement some things separately, such as magnesium due to its bulk, as well as an additional iodine if desired. But any reduction the number of separate items that I have to buy and take would be very helpful.

        • Hi Frank,

          The big issue to me is that a multi should supplement the diet, providing only those nutrients that the diet is lacking. And PHD is a fairly nourishing diet. So you don’t need a lot of the ingredients found in multis. And some of them, like manganese, it’s easy to overdose on.

          The commercial multis really focus on giving you 100% of the RDA of everything, which would make sense if the RDA was optimal and no one was eating food. But often the RDA isn’t optimal, so you may benefit from more; and people do eat food, so often you need less.

          • That’s why it would be amazing if you could somehow formulate a whole foods supp that only takes care of your recommended vitamins, but it’s so complicated because some vitamins do not interact with each other well and should be taken at different times and so on.

  14. Hi Paul,

    I wonder if you saw this:http://www.sciencedaily.com/releases/2012/10/121030062007.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+sciencedaily+(ScienceDaily:+Latest+Science+News)

    The study of course blames the sat fat content of the meal, but it doesn’t make much sense to me. Aside from the bread the meal is generally PHD/Paleo compliant. I wonder if the fast food/manufactured nature of the food somehow affected the markers they site?

    Lindsay

    • Hi Lindsay,

      I haven’t read the study yet. The first thing I would look at is whether the two meals were isocaloric. Also, this may have just been a comparison of a high omega-3 meal with a zero omega-3 meal in people who are omega-3 starved. But in general, the short-term (~1 hr) postprandial effects of a meal in people with metabolic syndrome are not an indication of the long-term effects. So you couldn’t infer much even if the study was well designed.

  15. Paul

    I got my metametrix stool test results. It says No Candida. It says I have parasite infection but taxonomy for parasite isunavailable 🙁
    How do I go about fighting it ? I am in India so there could be limitations and differences in what I can get here to tackle the issue

    Is there any diet or supplemental recommendation that can help me? Should I avoid dairy ?

    Thanks
    Koki

    • Hi Koki,

      I might try taking a tablespoon of bentonite clay and a glass of water during the daily fast. This may help clear cysts. Animals with parasitic infections often eat clay plus fibrous vegetables.

      Regular PHD should be a good diet for it. I’m not aware of any reason to avoid dairy.

      As far as more aggressive treatments, you’d have to consult a doctor. I know there are effective anti-parasitic drugs, but I don’t have personal knowledge of medical treatments.

    • Koki,

      One more thing.. As Paul mentioned, cysts could be the issue. I don’t know about India, but here in the states cysts in drinking water are pretty common. I got my city’s drinking water report and cysts are present. So, I got one of those water filters that you attach to the sink spout. Just be sure you get one that specifies the removal of cysts.

      Best,
      Lindsay

  16. Koki,

    For what it is worth I had the same results. No identifiable infection, no H. Pylori.. nothing besides a parasite with unknown taxonomy. Upon further research I read that it is likely just a parasite that is passing through the body. On some Metametrix interview I read it said that if the parasite was a helminth it would have showed specifically on the test. So, that means it is likely not hookworm, roundworm, etc. The other possible option is that it is a relatively rare parasite.. and unless you have spent time out of the country, in say the Amazon.. I doubt that is the case.

    Hope that helps!

    Best,
    Lindsay

  17. Hi Paul! I received MOST of my supplements that you recommend today. You generally recommended I take supplements with food. If I want to split up my supplements between my two meals (lunch and dinner), are there any of the supplements that are best AM, or best PM? Also, I did purchase Taurine since I think it might serve my brain health (Cyrex tests show gluten damage in brain, skin, thyroid).

    As always, I am grateful for your thoughts or advice.

  18. Thanks so much! Also, I just realized I accidentally purchased the Thorne Research Molybdenum Piccolinate which is your highest dose recommendation @ 1 mg. Do you think I should order the lowest dose and save this to work up to? I don’t know anything about Molybdenum, so a little nervous to take the highest dose. Love to hear your thoughts.

  19. Super! I’ll do that and thank you again.

  20. Hi Paul,

    In the supplement recs section it is mentioned that Dark chocolate should be eaten as desired.However, sometimes I find myself eating a lot more than I think is a healthy amount!

    I am 5’9 and 135 lbs; How often and how much should I be eating dark chocolate?

    Thanks,

    Lisa

    • Hi Lisa,

      Chocolate is not a dangerous food, but like all of our “pleasure foods” it should be a minority source of calories. Meals with safe starches, meats, etc should provide 80% of calories or so. But you could get 10% of calories from chocolate with no problem, I think, if you really wanted to. I would suspect that you would get tired of it before long if you did that.

  21. dear doctor-

    do you think extended fasting (3 days+) is good for candida?

    thanks!
    -john

  22. Hi Paul,

    I am wondering if you have specific advice for someone with depression. I followed the ketogenic diet recommended in the book for a while but recently saw your response to Kevin’s question in which you said that it is not necesarry to be in ketosis continually and intermittent fasting should be sufficient. I tried including 300 safe starch calories and about 50 from fruit,but after eating more carbs these past few days, I have been having an extremely hard time waking up in the morning again, it’s almost painful to get out of bed(Something that went away when I went ketogenic). I’m just a bit confused about what to do right now.

    Is there anything you would recommend? Could an infection be causing this?

    Thanks

    • Also, I have been fasting throught he morining, something I wasn’t doing when I was following the ketogenic diet.

      Thanks again

  23. Hi Paul,

    I think I have eczema on the top of my feet. I first had it on one foot and a couple of months ago, it appeared on the other foot. When I saw a regular MD for a wellness exam, he said it was not eczema. (but it it sure looks like eczema) He thought it was from an insect bite that I couldn’t stop itching, but when it appeared on the other foot, I knew he was wrong. I received all supplements you recommend except most of the “optionals” that arrived yesterday. The optionals I did order are: taurine and NAC. Anything else you can recommend or think of that would help? The itching is no fun.

    Thank you and so sorry for all of my questions.

    • Hi Dede,

      There may be a few tactics you can try to clarify what is going on:
      – An over the counter antifungal lotion like Lotrimin could test if it is a fungal infection.
      – An over the counter hydrocortisone cream to suppress immune function may clear symptoms and will clarify causes.
      – Sometimes sulfur helps, you could try an epsom salt bath. There are also anti-acne sulfur lotions.
      – Sometimes circulating toxins leads to skin effects in the feet if they collect there; taking extra salt, water, NAC, and taurine to support excretion can help, also elevating your feet.

      I would experiment a little and then maybe you can go back to your doctor with more information.

      Best, Paul

      • What would we do without you? 😀 Thank you! Such great ideas for investigation. I will try all of these suggestions individually. Unfortunately my MD is VERY old school and even dismissed my diagnosis of celiac from my naturopath (he doesn’t recognize Cyrex tests), so I have been struggling to find an MD in case I need medical intervention from the CD which has been my naturopath’s recommendation. But, so far, it’s been tough (Dallas, TX is not very progressive). So, your investigational trials are invaluable to me! Thank you again! Have a great weekend!

        • Hi Dede,

          Another possible cause of eczema is arachidonic acid deficiency, which can develop during chronic infections especially on low omega-6 diets. You could eat more egg yolks to test that.

          • Paul,

            How important do you believe it is to try and source eggs that are sourced from chickens that are not fed corn or soy?

            Thanks,
            Skip

          • Hi SC,

            It’s not essential, but if you can afford to patronize a farmer who lets chickens feed naturally (generally this will require heritage breeds) then the eggs will be a bit healthier. Sort of a nice-to-have-if-you-can-afford-it.

          • I have taken your advice and have added 3 egg yolks every day (raw and pastured) since early last week. On that WellnessFX blood panel, I did show under the electrolytes portion a 20 in CO2 in blood (flagged low and considered high risk). (all other electrolyest were in their optimal range. Is that related to the arachidonic acid deficiency perhaps? Again, I am such a novice with blood tests. Wellness FX ranges for high risk in blood CO2 are: 30.

          • Hi Dede,

            You might want to take some baking soda (sodium bicarbonate) to help alkalanize your blood a little. Also, eat more vegetables.

            If that doesn’t raise the CO2 levels, you could ask your doctor to investigate causes. Here’s an article mentioning a few possibilities: http://www.livestrong.com/article/208566-what-are-the-causes-of-low-carbon-dioxide-in-the-blood/.

          • So strange, my biggest goal with my mostly vegetarian diet before I switched to eating animal proteins and fats was to have my blood in an alkaline state. I drink fresh, raw vegetable juice every mid morning on an empty stomach, I have for about 2 years now. I have always thought that is very alkalizing. BUMMER! How much baking soda does one supplement, and I assume i mix it with water?

            Thank you again and again for the links, research and your tips.

          • Hi Dede,

            In that case you probably should disregard that advice.

            CO2 in air is bicarbonate (CO3) in the blood, so drinking bicarbonate will quickly increase blood levels. But you would like to find the cause and fix that, not just treat a symptom.

          • I just looked at my test my CO2 test from my blood panel in June (as a mostly veg), and indeed my number was higher (at 24 and in optimal range)…one thing I do know is I was eating A LOT more raw and cooked vegetables then. I struggle to find more vegetables to eat since I have been told to avoid nightshades. I do eat white potatoes now that you put my mind at ease with that tuber, but I still avoid tomatoes, peppers and eggplant. I wish I didn’t have to because I miss them! 🙂

          • I wonder if removing the skin and seeds of tomatoes and cooking them is enough to handle the solanine?

            Wikipedia even claims that tomatoes aren’t all that problematic: http://en.wikipedia.org/wiki/Solanine#Solanine_in_tomatoes

      • Hi Paul! I didn’t purchase Lotrimin last week. I decided to start the “testing” with the hydrocortisone since it was so inexpensive. I’ve used it only 3-4 times since last Friday and my rash that looks like eczema on top of my feet seems to be getting much better. When it wasn’t itching, it looked a little lighter than my skin and felt like rough leather. You can barely tell visually anymore and my skin is a lot softer where the rash is. Is this telling of anything, or should I still try the Lotrimin to continue to test to clarify causes?

        Thanks a million!

        • Hi Dede,

          It doesn’t tell you much, just that the immune system was causing the rash and suppressing immune response cures the rash.

          Open questions:
          – Was the immune response appropriate (ie to some sort of infection on the skin)?
          – Does it indicate immune activation from an infection elsewhere in the body? Eczema on the feet is suggestive of some kind of circulating toxins that collect in the feet if the circulation isn’t good enough to lift them against gravity.
          – Does it indicate an inflammatory state induced by some kind of nutritional balance, such as nutrient deficiencies or excesses? Omega-6 deficiency can cause eczema, for instance.

          I think it’s good to try to identify underlying causes, but it may not be easy to solve the riddle.

          • Not sure on any of those question; the eczema appeared about the time I started to investigate why I wasn’t feeling good anymore, which led to my (non digestive symptom) celiac diagnosis. What I will continue to do is stick to the PHD (MUCH less fat than what I was consuming LOL), and see how it goes. One thing I do notice in the last 2 days is I am feeling a little less fatigued, no cravings, and I stopped the weight gain (thanks to your advice on my fat intake!! 🙂

            Have a great weekend!

  24. Hi Paul, I have been looking at a lot of paleo diet cookbooks and I’m thinking that if I did that with the exception of leaving in the dairy you describe in the book and the rice it seems to be a good choice.Could you give me your thoughts on this? Also what is your take on Pecan oilfor cooking and almond meal for baking?
    Thanks, Syl

    • Hi Syl,

      Yes, Paleo recipes are generally PHD-compatible, and you can add ingredients to them.

      I would favor safe starches like rice flour, potato starch, and tapioca starch over almond meal (which is fine in moderation but you can overdo the nuts in baking).

      I would favor lower omega-6 oils like macadamia nut oil, beef tallow, clarified butter/ghee, and coconut oil over pecan oil.

      You can also work the other way — start from traditional/gourmet cookbooks and substitute PHD-approved ingredients like the safe starch flours for wheat flour.

      We are working on our own cookbook but that will take some time to finish.

      Best, Paul

  25. Michael corrison

    Hi Paul-

    How do you feel about coconut meat, coconut cream and coconut milk for those starting on a candida diet? Too much sugar?

    • Hi Michael,

      Well, you certainly don’t want sugar on a candida diet, but coconut meat/cream/milk don’t have much, so I think it should be fine. Check the quantities you plan to eat against the label (or nutritiondata.com) to see if they are delivering excessive amounts of sugar (> 8 g / 32 calories in a meal).

  26. Hi Dr Jaminet,

    I’m bothering you with a warfarin related question again. Both times I have been treated with it, I’ve gained an enormous amount of abdominal fat and bloat. My docs told me warfarin has nothing to do with this. But after the first 6 months of treatment, they took me off the warfarin. With VERY modest changes in diet and exercise, I went from 299 pounds to 240 (Previous to my DVT-PE weighed between 230-240) and lost ALL of the bloat and fat.

    I am on the med again after a second event. Fat and bloat are back, in spades. I’ve been incorporating PHD now. I’m lifting weights daily, very intensively. I walk for 20 – 50 minutes 3 to 4 times/wk. Most of my body is responding very well. But if you only looked at my belly, you’d think I ate and slept for a living! This is really frustrating and uncomfortable, so much so, that I am considering stopping warfarin altogether and taking my chances.

    Have you any advice for a guy who looks like an upside down question mark with legs?

    Thanks!

    • Hi David,

      First, yes, the warfarin can cause this. Vitamin K2 is an angiogenesis suppressor: http://www.ncbi.nlm.nih.gov/pubmed?term=vitamin%20k2%20angiogenesis. Warfarin blocks vitamin K action, removing this inhibition. Fat tissue is highly vascularized and in order for it to grow, it needs a tremendous amount of angiogenesis (I discussed this here: http://perfecthealthdiet.com/2011/06/thoughts-on-obesity-inspired-by-stephan/, scroll down to the pictures). I’ve also discussed how infection with certain adenoviruses can cause fat cells to want to multiply (http://perfecthealthdiet.com/2010/09/obesity-often-an-infectious-disease/).

      So a possible scenario is that you have an infection which makes your fat cells want to multiply, the only limiting factor is their ability to generate new blood vessels, and if vitamin K is removed then they can.

      Uncontrolled angiogenesis creates a lot of risks and is a major risk factor for cancer as well as other diseases, so I would not permit this situation to continue.

      One thing you can try is supplementing vitamin K2 along with the warfarin. That might relieve much of the effect.

      It’s up to you and your doctor to appraise the relative risks of continuing with warfarin. It may be that the condition the warfarin was meant to treat is better treated by diet, exercise, and lifestyle changes.

      Best, Paul

      • Hi Again Paul,

        I am grateful for the fantastic info that you take the time to provide to everyone. Unfortunately, I’ve had bad luck finding good medical care. Surprisingly, an experienced hematologist at a major research hospital in my area told that me that warfarin does not act on Vitamin K. I already knew that it did.

        I am reading up on Angiogenesis especially as it relates to tumors. I’ve learned that some cancers can contribute to hypercoagulability. I’ve been tested for other causes. All tests completed are negative except for Protein S Deficiency. But I haven’t been able to get the doc to retest to rule out a false positive.

        I started taking Vit K September. Along my 11-11.5 mg of warfarin/day, I alternate each day between 45 mcg and 90 mcg doses of Vit K. My INR has been stable around 2.7. There has been no visible or tactile impact on the fat/bloat problem.

        I’ve seen some research that says taking Vit K as high as 125mcg may be more effective. I may titrate up to or around that amount. Would my size (6’7”, 260 lb) suggest a higher dose of Vit K?

        Once again thank you. I now have some new directions to go in to research this situation.

        • Hi David,

          That dose of K2 would be a modest one even in someone not on warfarin, so it is likely that a higher dose would do some good.

          A few things to consider:

          High doses of vitamin K2 don’t strongly impact clotting time, at least in people not on warfarin, so you might consider much larger K2 doses like 5 mg MK-4 + 100 mcg MK-7.

          Also, I’d work on PHD/lifestyle/exercise etc to try to cure the CVD and any other condition that made them put you on warfarin.

          At some point you’ll have to decide which risk you choose to take. It seems like warfarin is not going to be a low-risk drug for you.

          • Paul,

            I have a lot to work with now. But I need clarification on the following:

            5 mg MK-4 + 100 mcg MK-7.

            Does the “+” indicate taking both the MK4 and MK7 together?

            Thank you!

          • Hi David,

            Yes, the idea is that our natural diet has a mix of both so conceivably it might be beneficial to take some of each. There’s no real evidence for that, it’s just an idea.

  27. Hello-

    New here. I have a question about a probiotic I’d like to take for candida.
    It’s called bio-k, and it’s very potent- 50 billion cfus of acidophilus and lacto-something ONLY.

    This is by far the highest concentration of acidophilus I’ve seen, so I’d very much like to take it.

    Problem is, it only comes in either dairy, soy or rice form, all of which I’d like to avoid.

    In addition, each serving has 4g of sugar, which I also know to avoid.

    Does this sound good for candida?

    • Hi Tommy,

      It’s worth a try. I don’t think those species are good at displacing candida, but maybe they’ll do you some good.

      4g of sugar is not a big deal. The bacteria need sugar to survive in the pill and may have eaten it by the time you swallow the pill. Also, the quantities of dairy, soy, or rice will be too small to matter. Here we favor dairy and rice over soy.

  28. Doctor Paul, have you heard of taking Saccharomyces boulardii to help with candida? whats your take?

    • Hi Todd,

      My take is it helps prevent new fungal infections from entering through the gut, but it won’t do much against an existing candida infection, and most candida infections are spread via the mouth or vagina nowadays anyway. But sometimes people think their problem is candida when it’s something else, and S. boulardii can help. The downside risk is that if you do have a severe fungal infection, adding fungal supplements increases the risk of fungemia. So I wouldn’t recommend it for immune-suppressed people or people with known systemic fungal infections.

  29. whose the best college football team in america?
    1. bama
    2.oregon
    3. k state
    4. notre dame

  30. I’m trying the supplements and the supplemental foods, and I have a question about broths: do you have to make your own, or is canned broth ok? If canned broth is ok, what type is best?

    • I am almost positive that Paul would say that you need to make your own to get full benefits. Almost as important is the fact that home-made tastes soooo much better. There is really no comparison. It’s also fun. You’ll find in the PHD/Ancestrial health community that homemade/slow cooked/prepared is always prefered.

    • I’ve never had a canned broth I like. Homemade broths taste great and I’m sure are much more nourishing. And they’re very easy, so why not?

      • It isn’t very easy for me and I often see many questions around the community about how to do it properly. Sourcing good bones. Multiple hours of cooking with occasional draining of liquid can be a challenge to work into some schedules. I’m not suggesting it isn’t possible or not a good idea … it just doesn’t seem very easy …

        • It does take some work to set up a supply chain and then experiment with cooking methods until you find one that works. But after that, it’s easy! 😀

        • Shou-Ching considers broth a foundational ingredient for our cooking. We make it fairly regularly now in a small pot with 3 bones cooked for just two hours, with bones re-used 3 to 5 times. Since it doesn’t need tending it isn’t a burden. We have some in preparation right now, and it smells good. The bones lose up to 50% of their weight after five cookings, 10 hours of total cooking time, so we know we’re getting the nutrients out.

        • I’ve found that making broth in a slow cooker isn’t difficult. I’ve put a simple broth recipe on my “10 minute meal” blog. Try it at <a hreg="http://10minutemeal.com/basics/bone-broth/"bone broth recipe."

  31. Hi Paul,

    Have you read/written anything about gluten sensitivity among Middle Eastern folk? I

    PS. I would like to also ask if sucrose is fine for sweetening tea?

    Thanks.

  32. Hi Paul, would gelatin consumption disrupt autophagy?
    Thanks,
    Jonathan

  33. Paul, I may have missed it if you responded to a previous query about coconut milk. Is it ok? I get mine form Amazon, supposedly organic and sugar free.

    http://www.amazon.com/Native-Forest-Organic-Classic-13-5-Ounce/dp/B001HTJ2BQ/ref=sr_1_1?s=grocery&ie=UTF8&qid=1351889879&sr=1-1&keywords=coconut+milk

  34. Hi Paul,

    In the book you say that 1/4 lb of white rice will provide 300-400 safe starch calories.

    Is that weight/calorie number for cooked rice or rice before cooking?

    • Hi Jackson, there was a typo in the book.
      1/4 lb of white rice will provide 300-400 safe starch calories…applies to uncooked rice, even though it says cooked in the book.

      See the errata for all the updates/changes here,
      http://perfecthealthdiet.com/errata-index/
      eg. for page 104,
      Book reads “rice has about 1300 calories per pound: thus, a quarter pound (100 g), or about 3/4 cup (180 ml) of cooked rice, will provide the daily 300-400 calories.”

      Correction reads “Uncooked rice has about 1300 to 1700 calories per pound, but rice absorbs a lot of water during cooking and cooked rice typically has only 500 to 600 calories per pound.
      Thus, a cup (180 ml/160 g) of cooked rice will provide about 200 carb calories, and several cups of cooked rice may be eaten per day.”

    • Thanks, Darrin.

      A pound of cooked white rice has about 500 carb calories.

      Cooking roughly triples the weight of the uncooked rice, due to water absorption, so that’s about the calories in 1/3 lb uncooked rice. So 1/4 lb uncooked would be about 375 calories.

  35. Hi Paul,

    Two Questions about Rice.

    1. PHD recommends 1 lb Safe Starch. For White Rice: What is considered a low amount, mid-range, and excessive?

    2. And because I’m horrible with measurements. 1 cup of water is 240 ml. So is 1 cup of *COOKED* White Rice equal to 240 ml? Or is it equal to a deck of cards?

    • Hi Monnyica,

      1. Well, is rice the only starch you’re eating that day? If so then 0.4 lb (after cooking would be a low amount, 0.8 lb mid-range, and 1.5 lb excessive. If not, then reduce those numbers proportionally.

      2. Yes, 1 cup of cooked white rice will fill a 240 ml container.

      • Hi Paul,

        Some Follow-up Questions. I’m looking at the PHD Apple Diagram…

        1a. Does Safe Starches include Veggies?

        1b. If yes, is Squash the only Veg that contains starch? Does Leafy Veggies contain starch? Is Banana the only Fruit that contains starch?

        2a. Is this correct: 1 lb Cooked White Rice = 2 cups Cooked White Rice?

        2b. Sorry for getting so technical, but just to clarify: 1 cup cooked White Rice is equal to 240 ml or 180 ml? Because in the above comment it says:

        “Thus, a cup (180 ml/160 g) of cooked rice will provide about 200 carb calories”

        • 1a No. Safe starches are listed on our diet page.

          1b You can look up vegetables at http://nutritiondata.com. “Starch” is listed as one of the types of carbohydrate. Starch is in many plants, but mainly in-ground tubers and corms and in grains.

          2a I think it’s about 2.5 cups.

          2b 1 cup is 237 ml.

  36. Hi Paul,

    I’ll try to keep this concise, but I am very lost as far as my health goes. I’m an 18 year old male suffering from acne and digestive issues.

    I have been strict low carb Paleo (no dairy, nuts, legumes, nightshades, and seeds) for a few months now. My acne has improved to about 90% clear, but I feel that I just need to rectify these lingering digestive issues to reach 100%.

    I can’t eat fruit without getting bloated and gassy. Within minutes I can feel my face itch and new inflamed acne is almost guaranteed.

    I do much better with starches and have for the past month upped my carb intake with sqaush and turnips. I am afraid to try white rice and sweet potatoes, since before they gave me problems.

    Upping the carbs has made me feel much better, however my tongue now has a white coating which is thick in the back. I also, sorry for being graphic, seem to have a male yeast infection that flares up with the higher carb intake. What can this be caused by? Candida?

    Adding in fermented foods and a probiotic seems to have helped me digest the upped carbs, however they seem to make me a little gassy.

    Is there any possibility of my thyroid causing some of my problems? I am very thin and I don’t seem to gain weight even on an excess of calories. My hands and feet also seem to be too cold.

    Is there tests you would recommend for me to have done in order to pinpoint the cause? I am looking into the Metametrix stool analysis however I am not sure I can get it done in NY.

    I have a lot of questions so I understand if you can’t answer them all, but your help is greatly appreciated!

    I’m looking forward to the updated version of your book but I would purchase the previous edition if it would help fix my issues.

    Thanks!

    • Hi Limak,

      The sensitivity to fruit indicates a small bowel infection – SIBO, maybe a fungal infection. Usually one cause of this is low stomach acid — this lets microbes in the mouth survive passage through the stomach so they can colonize the small intestine. You may have the same growth you see in your mouth in your small intestine.

      A start to addressing that would be to take betaine HCl with meals, to help increase stomach acid production. Also be sure to eat enough salt. You might ask your doctor to check you for H pylori (which suppresses stomach acid) and SIBO.

      The oral thrush is consistent with Candida or some other fungal infection.

      I would certainly take N-acetylcysteine which is helpful against a wide range of infections.

      Hypothyroidism generally occurs during such infections, so I’d be surprised if you didn’t have it. I’d try to start low-dose iodine and selenium supplementation as a path toward improving that. Your doctor can do thyroid tests and consider prescribing thyroid hormone.

      Optimizing vitamins A, D, and K2 is essential for immune function throughout the digestive tract. You may want to supplement D especially in the winter and maybe A also, perhaps via cod liver oil.

      I would try to find ways to get more carb calories with minimal symptoms. That will support immune function.

      It’s very important to support circadian rhythms for optimal immune function. Strategies are discussed in the Scribner edition of the book.

      The Metametrix test might be helpful but it sounds like your problems are higher in the digestive tract.

      Best, Paul

      • Thank you for the reply!

        I may be stretching this a little bit but can the fact that I swam in a heavily chlorinated pool everyday for 2 years have caused these acid issues? I remember that whenever I would accidentally take a gulp of the water I would get a very acidic feeling in my stomach/chest. The water in this pool was changed only every couple of months.

        How would I be able to eliminate the SIBO? I read that probiotics can possibly make my problem worse however I can’t say they have. Will a conventional doctor be able to test for SIBO and H. Pylori?

        I have actually been taking Betaine HCL and it has helped me a lot, however I have cut down a little bit since I started getting a warming in my chest area, which from what I’ve read is too much.

        I supplement 5k iu Vitamin D3 daily along with a capsule of Green Pastures CLO every day. I will start to eat liver once a week since I found a relatively cheap grass fed source.

        I will look into getting more carbs, but how would I counter my SIBO while doing this?

        Thanks again for the help, everything makes a little bit more sense now.

        • Hi Limak,

          I think it would be best if you saw a doctor. A more specific diagnosis would permit medical treatments.

          I’m not sure what swallowing chlorinated water does. If they rarely changed the water it could have carried a lot of germs and given you an infection.

          • Perhaps you should ask Peter Attia; he seems to know quite a bit about the risks involved in swimming.

  37. hi doc, thanks for your reply:

    i found the exact nutritional info for that bio-k drink.
    im a tad concerned it will affect my paleo/candida diet

    ingredients: Water Organic sprouted brown rice powder Organic evaporated cane juice Organic brown rice protein Nutritional yeast Organic carob bean gum Calcium citrate Natural falvours Pectin Active cultures of L. acidophilus + L. casei

    14g carbs, 4g sugar, 75 calories, 4g protein.

    what do you think?

    thanks!

  38. Hi Paul,

    How many grams of protein are in 100 protein calories?

    I haven’t been able to find this info and don’t think I really understand how to convert.

    Thank you,

    Jackson

    • 25 g. (4 calories per gram)

      • Ok, great.

        Another question- If I eat 3/4 lb of meat per day, how much fish would you recommend consuming per week to get a healthy dose of omega 3?

        Thanks again Paul

        • About 3/4 lb salmon per week is good. One day’s meat.

          • I’m glad this thread came up; I have gained 4 lbs. rather quickly (in 2 weeks), so I may not have my PHD plate “right”. I’m thin (5’6″ and weigh 119) and would like to stay that way. 😉 I have been eating 2 meals per day (one @ about 2:00, the other at 7PM-ish). I have done IF even since my days as a mostly vegetarian) with just fresh raw veg juice mid-mornings), which I still do. Before my juice, now, I do drink low mycotoxin coffee with 1 TBLSP MCT oil and 2.5 TBLSP. g.f. butter. My lunch is usually 4 oz. of a ruminant or fish, 1 cup of white rice or potatoes (I don’t have a scale yet), a salad with 1/2 avocado and some 2 TBLSP g.f. butter for cooking. Dinner looks very much the same but maybe a little more cooked veg and fat. In your opinion, am I eating too much of something? Thank you Paul.

          • Ooops, I forgot to list my 3 egg yolks per day I put in a g.f. whey smoothie, sometimes adding a ripe banana or a few berries.

          • Hi Dede,

            Well, the bulletproof coffee with 3.5 tbsp fat is 450 calories in one drink. It sounds like you’re eating too much fat/oil. Also your whey smoothie is a third meal in its own right. It sounds like you are eating the equivalent of four meals a day, calorie-wise.

            I would cut down the butter and oil and see how you do. And try to eat more regular food-based meals and less smoothies/coffee, eg mix the egg yolks in your rice with lunch/dinner.

            Also, I wouldn’t consider it intermittent fasting if you have 450 calories of fat along with veggies and maybe a smoothie in the morning.

            Best, Paul

          • Okay, that totally makes sense! I thought fat might be the culprit. Thank you again. Egg yolks in rice sound delicious by the way! I’ll try that today!

  39. Hi Paul,

    Regarding Garlic…

    1. Does Garlic kill the GOOD bacteria in our body? Or does it distinguish between the Good v.s. Bad Guys?
    2. Is there a time where we should avoid Garlic? For instance, a person with Leaky Gut, H. Pylori, Candida, SIBO, etc?
    3. Does 5 min of lightly steaming Garlic destroy the allicin?

    I also had another question up there (regarding Rice), if you have time to answer. Your replies are always appreciated!

    • Hi Monnyica,

      Garlic doesn’t distinguish between good and bad, but it’s only a mild antibiotic.

      Garlic can irritate the intestine so if your digestive tract is unhealthy it might be irritating.

      Allicin is maximized when raw garlic is exposed to air for a few minutes (mashed, cut). It is destroyed by heat. Not sure how much is left after 5 min steaming.

      • There is some great garlic info here:
        http://lpi.oregonstate.edu/infocenter/phytochemicals/garlic/

        When raw garlic cloves are crushed, chopped, or chewed, an enzyme known as alliinase is released. Alliinase catalyzes the formation of sulfenic acids from cysteine sulfoxides (figure 1). Sulfenic acids spontaneously react with each other to form unstable compounds called thiosulfinates. In the case of alliin, the resulting sulfenic acids react with each other to form a thiosulfinate known as allicin (half-life in crushed garlic at 23°C is 2.5 days). The formation of thiosulfinates is very rapid and has been found to be complete within 10-60 seconds of crushing garlic. Allicin breaks down in vitro to form a variety of fat-soluble organosulfur compounds (figure 2), including diallyl trisulfide (DATS), diallyl disulfide (DADS), and diallyl sulfide (DAS), or in the presence of oil or organic solvents, ajoene and vinyldithiins (2). Crushing garlic does not change its gamma-glutamylcysteine content. Water-soluble organosulfur compounds, such as S-allylcysteine, are formed from gamma-glutamylcysteines during long-term incubation of crushed garlic in aqueous solutions, as in the manufacture of aged garlic extracts.

        • Adverse effects of garlic:
          The most commonly reported adverse effects of oral ingestion of garlic and garlic supplements are breath and body odor (63, 120). Gastrointestinal symptoms have also been reported, including heartburn, abdominal pain, nausea, vomiting, flatulence, and diarrhea (121). The most serious adverse effects associated with oral garlic supplementation are related to uncontrolled bleeding. Several cases of serious postoperative or spontaneous bleeding associated with garlic supplementation have been reported in the medical literature (122-125). Garlic may trigger allergic responses in some individuals, including asthma in people with occupational exposure to garlic powder or dust (126). Exposure of the skin to garlic has been reported to cause contact dermatitis in some individuals (120, 127). More serious skin lesions, including blisters and burns, have also been reported with topical exposure to garlic for six or more hours.
          http://lpi.oregonstate.edu/infocenter/phytochemicals/garlic/

          Raw garlic juice has killed babies.

  40. Hi Paul,

    Although only a mild antibiotic, if Garlic does not distinguish between good and bad, and a person has Gut Dysbiosis… would it be best to avoid garlic (to save the good guys)? Or is it so mild it doesn’t make a difference?

    Also, how do you rank the antimicrobial strength of Coconut Oil, Cranberries, and Oregano Oil? Are any of these irritating to an unhealthy gut? Do any of these kill the good bacteria?

    • on a similar theme, olive leaf extract does look to be selective in reducing certain bacteria.
      (thanks to Mario Iwakura for posting this up the other day).
      http://www.ncbi.nlm.nih.gov/pubmed/19135874
      “Antimicrobial activity of commercial Olea europaea (olive) leaf extract”

      “In conclusion, olive leaf extract was not broad-spectrum in action, showing appreciable activity only against H. pylori, C. jejuni, S. aureus and MRSA.
      Given this specific activity, olive leaf extract may have a role in regulating the composition of the gastric flora by selectively reducing levels of H. pylori and C. jejuni.”

  41. Hello Dr. Jaminets,

    First of all I want to say thank you and great job on developing the PHD. I’ve been dabbling in paleo coming from a weight-loss/near-vegetarian perspective for about 2 years, and while I never trust any single source fully and take everything with a grain of salt, clearly your plan comes out as containing the most logical and sensible recommendations. My diet does not adhere to PHD 100% but it is closest to it than any other; some of the recommendations I was actually already following (like the macronutrient ratios) before finding out about this plan, but without a good foundation which the PHD provides and expands upon. Anyhow, hooking forward to the new edition.

    After reading (first edition) of your book, I have questions surrounding dairy fats. While almost every paleo authority seems to consider them a near-perfect source of fat, I have to join Travis Culp in my doubts about it (http://paleohacks.com/questions/40731/butter-and-heavy-cream-whats-the-deal-with-palmitic-acid-and-myristic-acid-we#axzz2BGYJfMm3). Yes, they are delicious, and I understand that epidemiologically they are associated with good health, but with the huge LDL numbers some people experience and various research specifically targetting palmitic acid in inflammation and insulin resistance, I’m left with the overall impression that dairy fat composition may be suboptimal for human adults. A better alternative to vegetable oils – absolutely – but gorging on butter and heavy cream still seems careless.

    Looking at the profile of animal fat like beef, eggs or lard (http://en.wikipedia.org/wiki/Animal_fat) – and more specifically, human adipose tissue – you clearly have almost no myristic acid, less palmitic acid and much more oleic acid compared to dairy fat (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596709/table/T0001/). As alluded to in your book, the myristic acid probably isn’t the concern so much because it simply doesn’t accumulate in tissues so it’s hard to quantify its need, and obviously coconut oil also contains a large fraction with few ill effects. But in dairy you clearly have a large trade-off of oleic acid for saturated fats and increased palmitic acid in particular compared to other animal fats.

    My question boils down to this: In your book your clearly and logically explain that human milk contains twice as many carbohydrates as adults need, because infants require them for fast brain development; but could it be that the same reasoning applies to its fat composition? As in, wouldn’t the dairy fatty acids be found in proportions specifically to support infant growth and may not reflect adult needs much or only partially? Personally I’ve always viewed milk as a growth food and I have trouble accepting the idea of too much butter because of this. And the way I understood it, palmitic acid is more likely to be used structurally in the body compared to oleic acid which contributes more to oxidation and energy (correct me if I’m wrong), which is in line with infant needs here rather than adult needs.

    For this reason, I’ve personally tried to balance out dairy fats with good sources of monounsaturated fats like macadamia or chocolate (I dislike olive oil) for the oleic acid especially; paleo eaters tend to consider them optional but in this context they seem necessary to me. This curiously coincides with your latest blog post about chocolate (if you consider stearic acid interchangeable with oleic acid, of course). Compounding this need is my continued desire to lose fat and the indications of palmitic acid possibly playing a role in obesity (gettingstronger.org/2011/11/obesity-starts-in-the-brain-2/).

    More and more it seems the discussion is moving away from saturated vs mono vs poly fats and rather toward the effects of individual fatty acids. I suppose what I’m looking for is a good analysis of dairy fat composition in this context versus other animals fats, which I’ve yet to find. I hope I’m not rehashing points you’ve already made elsewhere and I might have missed.

    Thank you again for all the research that you do.

  42. Hi John,

    I am also in the camp that dairy fats are extremely healthy.

    However, they do generate more oxidative stress than other fats and therefore their healthfulness is more dependent on good mineral status. High saturated fat intake will exacerbate a copper deficiency.

    Generally, I would take the high LDL on Paleo to indicate some combination of copper/iodine/selenium deficiency, or hypothyroidism. If dairy fat exacerbates it I would fix the underlying problem, not remove the dairy fats from the diet.

    However, you’re right, tissues do need saturated and monounsaturated fat in roughly equal proportions, so eating equal amounts of each will minimize any risk of something going harm. I tend to think the risk of a saturated fat excess is minimal, since saturated fats can be desaturated to be made into monounsaturated fats, and the body will preferentially burn whichever type is present in excess. But there’s something to what you say.

    I also agree about individual fatty acids having distinct effects.

    Best, Paul

    • Thank you, Dr. Jaminet; did not expect a reply on the same day!

      That is a further relief as I am now following the PHD recommendations for copper and soon iodine (unfortunately I hate seaweed). At the same time, curiously macadamia nuts and chocolate seem to be high in copper, so they seem doubly appropriate now. Maybe it would even confound results in self experimentation!

      I’ve resorted to trying to balance sat and mono fats explicitly specifically because of PHD philosophy. In your book an underlying theme is avoiding unnecessary conversion pathways between glucose and fat, to spare the liver of work. I simply figured that reasoning could probably be extrapolated to fat conversion as well; avoiding work for longevity. That said, I don’t know the biochemistry and if sat/mono fat conversion is truly harmless then I can accept that it may be for naught.

      • (where “conversion” = “conversion and/or substitution and “for naught” = “not of significance enough to be of concern”; bad wording, sorry)

  43. Hi Paul,

    I understand you do not suggest 12 tablespoons of coconut oil for Keto diet anymore. I am just trying to understand in more detail your protocol for it. The difference between PHD and Keto is only 200-300 carb calories. Do you suggest most of the fats to be monounsaturated on Keto as well? Does that mean more whey shakes and less red meat?
    I know bodybuilders do not do it for health reason specifically, but here is a nice write up for it. They recommend polyunsaturated fats to be the main source. “A ketogenic diet which utilizes a majority (60%) of polyunsaturated fatty acids versus saturated fatty acids has been proven superior. A diet high in polyunsaturated fatty acids induces a deeper ketosis in which levels of beta-hydroxybutyrate are significantly higher, and insulin sensitivity is increased. Since beta-hydroxybutyrate levels increase when a majority of dietary fats are polyunsaturated, it stands to reason that fat lipolysis and beta oxidation activity increase as well; so, in other words, you will rid yourself of fat more quickly and easily if a majority of your fat percentage comes from things like seeds, nuts, oils, and fatty fish. “

    • Paul has recommended supplementation of MCT oil, whose fat is saturated, on a ketogenic diet. Medium-chain triglycerides support ketone generation. I assume the change in his former recommendation of 12 tbsp coconut oil is due to the caloric inefficiency of eating so much coconut oil only for its partial MCT content; eating normally otherwise (including other, more nutritious saturated and monounsaturated fat sources characteristic of PHD), one would gain weight steadily.

    • Hi Steven,

      A ketogenic diet that was 60% PUFA would be a health disaster.

      MCT oil is the most ketogenic oil. These are shorter-chain saturated fats.

      I think about 4 tbsp MCT oil is sufficient, and 200 calories from safe starches is the minimum I would recommend for carbs.

      • Hi Paul,

        So it is basically eating normal PHD but going to 200 calories of carbs with 4tbsp of MCT oil? Is it still 15% protein?
        Do for example ground beef/butter have plenty of MCTs as well? or that is insignificant.
        If I only have coconut oil, would it still be ok to use 4tbsp of coconut oil instead of MCT?

        Thank you

        • Hi Steven,

          Yes, that’s right, it’s basically normal PHD but fewer carbs and extra MCT oil. Same amount of protein, or a bit more.

          No, beef and butter don’t have much MCTs. Butter is about 14%, beef close to zero. Coconut oil is 58%. MCT oil is 100%. So it would take extra coconut oil to have the same effect.

          • Hi Paul,

            I understand why for Keto you recommend MCT and coconut oil. And I guess the reason you do not really suggest taking spoons of olive oil is due to Omega 6s, but what do you think about Macademia Nut oil? Would it not be a bit healthier that coconut oil?

          • Hi Steven,

            No, I wouldn’t say macadamia nut oil is healthier than coconut oil. They’re both empty calories and both benign. In that sense they’re healthy components of a balanced diet, but like all foods you can overdo them.

          • Paul,

            Is there a reason macadamia nut oil is not listed as a low PUFA cooking oil recommendation?

            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.

            Thanks,
            Mark

          • Hi Mark,

            Sorry, just an oversight.

  44. Paul, what do you think about including a serving of salmon roe in ones diet 2-3x a week for vitamin d?

  45. H. Pylori
    So, I finished the 2 months of Thorne 734, to which I added Manuka Honey, mastic gum, and nearly daily broccoli.

    Took the breath test last week and still awaiting results; however, had “morning sickness” this morning and do remember I have struggled with that off and on for years, and it is said to be a common side effect of HP. I suspect I did not wipe it out. However, the stories I read about how sick the antibiotics make people, make me hesitant to invite that trouble. I need to work and cannot take several weeks off to wrestle with illness or the treatment.

    Amy King writes about what she did that netted her success, and most of it is doable for me, except no red meat and no rice. Chicken gives me joint pain, as do potatoes; so, managing without beef and rice sounds impossible. She even says that yogurt must be put on hold during treatment. Recent allergy tests indicate I shouldn’t eat eggs more than once a week. I do enjoy salmon but will surely abuse that if I try to eat it more than my usual twice a week.

    Amy’s blog about her H. Pylori experience is here: http://amyking.wordpress.com/2009/02/20/im-so-happy-i-have-h-pylori/

    • Hi Lana,

      Thanks for sharing Amy King’s story, very interesting. It’s good to hear that natural remedies can work.

      I’d be surprised if red meat was a problem for any reason except contributing to an iron excess; if you test your iron status and it is low-normal, then beef shouldn’t be a problem; if it is high, then donating blood should resolve the problem. I don’t think rice is a problem either.

      • Thanks, Paul. I’m packing for the Wise Traditions conference in Santa Clara, and will share a room. I think I’ll go back of the 734, because on that I felt pretty good. I read one of the comments on Amy’s blog indicating that the individual didn’t have troubling symptoms until trying to get rid of it. So, now I may have stirred things up. Uncomfortable stomach all day and just stopped the treatment a little over a week ago. Thanks again and again for your feedback. I may contact the Dr. E, whom Amy speaks of as having been a big help to her.

        Guess I won’t see you at the conference.

  46. Hi Paul,

    For Leafy Greens/Veggies (Swiss Chard, Collard Greens, Broccoli, Cabbage), what do you consider low-range, mid, and excessive amounts for daily intake? Also does excessive veggies cause Infrequent Bowel Movements?

    • Hi Monnyica,

      We don’t have any limits for leafy greens — eat as much as you like. The brassica vegetables however you have to be wary of because they have goitrogens and other toxic compounds that you can get too much of. In general it’s good to mix up your vegetables.

      I’m not aware of too many vegetables causing infrequent bowel movements. Often vegetables are recommended as an aid against constipation.

  47. Paul,

    Can you advise any specific diet/supplement recommendations for teen athletes that are dealing with Osgood Schlatter? Any input/recommendations would be appreciated.

    Thanks,
    SC

    • Hi SC,

      I’d recommend PHD with special attention to soups made from bone and joint broths (for calcium, phosphorus, and collagen) plus vitamin D, A, and K2 optimization. Supplement vitamin D until serum 25OHD is 40 ng/ml; supplement K2; and eat at least 3 egg yolks per day, plus colorful foods and green leafy vegetables and seafood for vitamin A. After that I’d supplement vitamin C, magnesium, and eat lots of potassium-rich vegetables like tomatoes and potatoes while getting a normal amount of salt.

      • Paul,

        Good info. Do you see any conflicts with compbining your above recommendations with the supplement Oscon below:

        Oscon is a specifically balanced formula of organically bound and clinically tested selenium contained within the cells of brewer’s yeast, Saccharomyces cerevisiae, and RRR-a-tocopherol, the most biologically active form of the vitamin E complex. In addition RRR-a-tocopherol is the natural form of vitamin E and the only a-tocopherol isomer found in nature. Each bottle contains 60 softgels, a 30 day supply. Rarely are more than two bottles needed, and often only one is sufficient. http://www.osgood-schlatter.com/product.html

      • Paul,

        “Supplement vitamin D until serum 25OHD is 40 ng/ml”

        How is this gauged/tested?

        Thanks,
        SC

        • Hi SC,

          Selenium and vitamin E are useful nutrients. I would limit selenium to 200 mcg/day.

          Serum 25OHD is a blood test that your doctor can order. Your teen will probably need to supplement vitamin D3 around 2500 IU per day through the winter to achieve optimal D levels, but midday sun exposure is also desirable.

  48. I’m shopping for herbal anti-fungals to help with candida, and i try to get the highest quality possible.
    However, many of them seem to have this one ingredient i se over and over-
    ‘magnesium stearate’
    what is this stuff? is it candida-diet safe? will it feed the candida, or is it unhealthy in any other way?

  49. Hi Paul,

    I have read about the importance of having a good percentage of fats in one’s diet. I had also listened to one of your interviews in which you were explaining the benefits. I would like to know what I can eat for breakfast everyday so that I can start my day with a healthy and fatty meal.

    Thanks.

    • Hi Abhi,

      First, if you’re doing intermittent fasting (16 hour fasting / 8 hour feeding) then your first meal might be at lunch. I usually have leftovers: rice, 3 egg yolks, leftover meat and vegetables, maybe vinegar and coconut milk.

      If you are not doing intermittent fasting and want a breakfast, good choices would be eggs and potatoes, or whole-fat yogurt and fruit.

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