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. Hi Paul, thanks for your insight an dposts on here.

    I’m wondering if you have an dieas if there is anything(chronis infectios say) that might underly near life long hypotension? Someone dear to me complains of needing to eat frequently to stave off ow bp. She has raynaud’s secondary to limited scelerderma,

    She’s leans, eats PHD stylee (I bought her the book lol) so it’s a matter of convenience not of weight per se, and it would be interesting if you have any insight…

    Cheers,

    Michael.

    • Hi Michael,

      I wouldn’t be surprised if a chronic infection contributes to her issues. Scleroderma is thought to be genetic but no mutations have ever been identified to cause it.

      Since scleroderma leads to a loss of vessel walls, it could contribute to hypotension. The blood vessels have to contract in rhythm with the heartbeat to return blood properly and maintain blood pressure. Scleroderma could interfere with that.

      Electrolyte imbalances or deficiencies can contribute to low blood pressure. She should get sufficient salt, water, potassium (tomatoes, potatoes, bananas are good sources), calcium and phosphorus (bone broth), magnesium, and low-dose lithium (our new supplement recs). Also, lots of vitamin K2 to help prevent calcification of arteries.

      So I don’t have definite ideas, but I think general principles should help. If she has any other symptoms they might be clues to whether a chronic infection is present.

      • Thanks again. She has plenty of salt and potatoes, some bananas and dates so mineral intake generally high.
        Very prone to stress though, tends to ‘push too far’ many times, fatigues/gets exhausted. Taking anti-depressants for the last five years.

        If there is some sort of chronic infection, how do you think it could be identified or ruled out? People live with all sorts of pathogent stuff as I think you’ve written somewhere in the past.

        One further question- do you think vit k2 is particularly important for someone like her?

        PS I apologise for my atrocious typing in the last post…

        • Michael,

          She does not have hypothyroidism? All these symptoms are associated to it.

          In hypothyroidism, at first, because of low heart rate and dificultity in retain sodium, there is hypotension. If not treated, some develop hypertension, because low thyroid hormones causes hardening of the arteries.

        • Hi Michael,

          Mario’s point about hypothyroidism is a good one.

          Also, some antidepressants cause low blood pressure, notably the tricyclic antidepressants. http://www.mayoclinic.com/health/low-blood-pressure/DS00590/DSECTION=causes

          It is difficult to diagnose and treat chronic infections, because medicine and the pharmaceutical industry just haven’t invested any effort in this. But there can be big payoffs to achieving diagnosis and treatment.

          Yes, I think vitamin K2 is important.

  2. do you think beef labeled “grass fed” from stores like whole foods, fresh and easy, and trader joes is actually grass finished to, like you get when ordering directly from ranches?

  3. There are numerous study’s that indicate that fat in the diet damages endothelial function. Some vary the effect depending on whether it’s fish oil. But numerous ones say all fat causes damage. If you do a search on the internet for dietary fat and endothelial dysfunction you will find the research. How does this line up with the perfect health diet recommendations? I am really confused about what to eat.

    • Hi John,

      Fat generates stress on endothelial cells under conditions of (a) oxidative stress generated during energy excess or immune activity, and (b) deficiencies in zinc, copper, or selenium. Energy excess occurs primarily in people with metabolic syndrome, which is unfortunately all too common these days. Copper deficiency is extremely common, and selenium is also a common deficiency. Copper deficiency prevents zinc-copper superoxide dismutase from protecting the endothelial cells from extracellular reactive oxygen species.

      I think PHD cures both metabolic syndrome and mineral deficiencies, so it shouldn’t be an issue.

  4. To Paul or anyone one else who would like to comment,

    What is your tale on occasional use of stevia? I occasionally use an egg white powder for a quick shake in the morning and one of the ingredients is stevia for sweetness. Where does this fall within the PHD if at all? Thank you!

    Melissa

  5. Hi Paul,

    I have a few questions. I have been on PHD for about 4 months after pretty strict paleo and initially GAPS for leaky gut. The addition of rice, white potatoes and eating nuts (soaked and dehydrated) has led to recent gut issues returning…constipation, food sensitivities, poor digestion. In doing some additional reading, I found that rice, even white rice has lectins that are similar in action to the lectins in wheat. Also, the potato as a nightshade, even peeled and cooked, should be avoided along with other nightshades. Should I remove those lectins, no rice or potatoes? I have stopped nuts already and feel better, so nuts are out! I don’t eat any other grains, no soy, corn, dairy and I’ve stopped eggs recently to try and figure out what is giving me problems.

    How do you feel about using organic wild rice for the holidays? Is that an ok one time substitute for traditional stuffing? Does it have way more toxins because it’s dark?

    Last one, is coconut water kefir a good alternative to dairy kefir, as far a candida control or is all kefir not good?

    Thanks. Cant wait for your new book!

    Jan

    • Hi Jan,

      I doubt your issues are with rice lectins or nightshade toxins, which are scarce in potato tubers (they are found in potato fruits and leaves). Rather it’s more likely that the carbs or resistant starch fiber are bothering you by feeding a gut infection.

      The best course, I think, is diagnostic: stool tests like the Metametrix microbial ecology profile are good at detecting colonic infections.

      In the meantime, you might experiment to find which carb sources you tolerate best. If the problem is isolated to colon, so that fiber causes the biggest problem, then eating simple sugars like dextrose or honey may give you some carbs without exciting symptoms. (GAPS is designed on this principle.) You do need carbs for gut health and immune function, but you want to find the ones that cause minimal symptoms.

      Wild rice (http://en.wikipedia.org/wiki/Wild_rice) is actually a totally different genus from domesticated rice, and its toxicity profile is not known. So I personally avoid it, on the general principle that grains are likely to be bad.

      I would think dairy kefir would be better than coconut kefir (since coconut water is high in fructose and you may not want fructose-metabolizing microbes), but I don’t really know. I would tend to favor yogurt over kefir if you have a Candida infection.

      Best, Paul

      • Thanks Paul. I’m going to have to do the Metametrix test. I found it through my med labs.com no dr required…except what do I do with the results? I’ve not found a dr who knows what I’m talking about with leaky gut much less interpreting those results. My GP takes notes when I come in because she learns so much. Yikes! Any suggestions would be appreciated. 🙂

        • Hi Jan,

          Well, the hope is that it identifies some pathogen or pattern that is treatable, or that it at least excludes possibilities and helps guide you toward a successful treatment plan.

          I think the test results are fairly self explanatory and if the diagnosis is clear then your doctors will know what to do.

      • since both honey & fructose was mentioned, be aware that the amount of fructose & glucose/fructose ratio will vary greatly in honey.
        Sugar contents (fructose, glucose, maltose, sucrose) will vary between honeys. one article i read tested different honeys with fructose varying between 27.5g & 52.4 g/100g.

        Iy f you are after a low fructose honey, then pick a natural honey that looks solid & crystallized (not runny).

        some more info here,
        https://rirdc.infoservices.com.au/items/05-027 (free download)

        http://www.countryrubes.com/images/Honey_Crystallization.pdf

  6. I have been wanting to make bone broth for a while now and just not sure how to make it….. Can somebody please guide me with exact instructions. I also need to know exactly what to ask for at the meat market. Thank you in advance for any advice and help.

    • Hi arlenena,

      You want beef bones for soup, preferably large bones with marrow inside and some joint material attached. They have to be cut to expose the marrow. It’s OK to have meat attached.

      (You can also buy meat that has bones in it, like short ribs, eat the meat and then save the bones for re-use in making soups.)

      Alternatively you can get more gelatinous parts like ox hooves, ox tail, or chicken feet for use in making a soup.

      Add clean water, simmer the bones briefly (maybe 30 minutes) until you’ve drawn out blood and other impurities, and discard the first batch of water and add new fresh water. Then simmer for a few hours. At this point meat and marrow should have fallen off the bones; if not you should be able to pull them off easily. Leave the marrow and meat in the soup and take out the bones and set them aside for re-use. Make a soup or pho out of the meaty/fatty broth.

      On re-use of the bones, add a bit of acid (vinegar works). This time the broth won’t have much fat or meat, but will have collagen and calcium and phosphorus, and will make a tasty stock for soup.

  7. Hi Paul,

    Are calcium supplements recommended if I don’t take bone broth? If so, what form and dosage of calcium should I take? Thanks in advance.

    • Hi Lewis,

      I’d rather recommend dairy and green leafy vegetables, but you can supplement. A minimal PHD diet without dairy or bone broth may have 300-400 mg calcium per day and optimal is about 700 mg/day. So you could supplement up to 300 mg/day.

  8. Hi Paul,

    I think you have said before that you try to stay away from discussion of hormones, but I wonder if you might be able to guide me to a good source for such information.

    I have, since turning 30, been having occasional cyclical breast pain and swelling. It seems to only occur when stressed.. which I assume is due to cortisol/progesterone relationship. Do you know anything about this topic at all? Most information I can find is pretty lame and recommends super obvious things like get exercise, try not be stressed, etc. Also, the dietary recs seem pretty baseless i.e., caffeine avoidance, low fat dieting, vit e.

    I had my hormones tested last month at cycle day 21 and the numbers seemed pretty good aside from low testosterone.

    Any advice on dietary tweaks, supplements or gurus? I tried to wade through the deep ocean that is Ray Peat’s website, but I found most of his articles extremely hard to interpret.

    Thank you,

    Lindsay

  9. I feel like I always post follow-ups to initial questions… my apologies. But I forgot to mention that the only non-prescritption recommendations I have found on science based sites is for the use of flax seeds. Can you comment on your thoughts on flax?

    Thanks again,

    Lindsay

    • Hi Lindsay,

      I’m afraid I don’t know much about hormonal problems, nor about cyclical breast pain; nor even any gurus. Perhaps one of the female doctors, like Cate Shanahan or Lauren Noel, would be able to direct you somewhere.

      Re flax, I think it is fine. However, be aware that it contains very high amounts of lignans, which are a kind of phytoestrogen that block estrogen activity. It may be for the lignans, not the omega-3, that they are recommending flax.

  10. Hi Doctors,

    Are there any safe starches other than Potatoes, yams, taro and white rice?

    Thanks,
    Jackson

    • I haven’t heard it mentioned specifically in the PHD but I eat a lot of butternut squash. Found out about it on a bodybuilding forum and it’s delicious. I think (hope) it’s PHD-approved.

    • Hi Jackson,

      Any commonly eaten in-ground root, tuber, rhizome, or corm is a safe starch; also the squashes although they are not very calorie dense and some are sugary. Among above ground starchy plants, sago is one, unripe plantains, tapioca which is from cassava. Just a few ideas.

      • A propos: Have you had the opportunity to form an opinion on Maelán Fontes’ talk, specifically his remarks about rice mRNA ?

  11. Hi Paul, I have been following a paleo diet for about 2 weeks and I have been getting lightheaded ness and sinus pressure with a feeling of losing my balance. I have been eating eggs, I was thinking an allergy or am I lacking something in my diet? I did not have allergies before and I would eat eggs about once or twice a week. I’m also following lunch and dinner menus for Paleo. I would appreciate any thoughts. Thank you very much, Syl

    • Well, eggs are a common food sensitivity so you might try eliminating egg whites (eat egg yolks only) or eliminating eggs entirely. Remove them and bring them back and see if the symptoms follow the food.

      Also, if you follow PHD I think there will be lower risks of nutrient deficiencies that might compound whatever is going on.

  12. Thanks for your fast reply, I will try elminating eggs. Syl

  13. Paul, you posted a nice piece on the wonders of chocolate, but as I understand it, a lot of commercial chocolate is “dutched”: treated with alkali which destroys most of the flavanols. Can you recommend a vareiey/brand that avoids this issue?

    And what about the added sugar?

    • Hi David,

      Well, added sugar is not good, but if you get dark chocolate and don’t go overboard I think the dose of sugar is small.

      As I understand it, dutching reduces the flavanol content by maybe 60% (http://en.wikipedia.org/wiki/Dutch_process_chocolate), and since we don’t know what the optimal dose is — it could be 10 g/day or 30 g/day, in the vicinity of what people actually eat if you eat a small block of dark chocolate daily — a factor of 2-3 reduction in flavanol content probably doesn’t affect the healthfulness much. Anytime you’re close to an optimum, changes don’t have much impact.

      So I personally wouldn’t worry about dutching, and haven’t looked into how to get non-dutched chocolate.

      However, on the chocolate post Chris B mentioned that Ghirardelli sells a non-dutch cocoa powder (http://perfecthealthdiet.com/2012/11/chocolate-what-is-the-optimal-dose/comment-page-1/#comment-97103). I’m sure you can find many others. You might ask at Whole Foods or a chocolate store.

      • We buy Rapunzel organic, unprocessed, non-alkaline cocoa powder from Amazon. Good for smoothies, cooking, baking, etc. Whole Foods sells it, as well. 🙂

  14. Hi Paul.
    I make a pancake for breakfast which includes a dessert spoon each of psyllium husks and oatbran an egg and a dob of Quark. Would you consider that to be a healthy alternative to bread. Or not?
    Cheers Fran

    • Hi Fran,

      It is healthier than bread, but still not quite PHD-approved. I would rather recommend vegetables and fiber-rich safe starches like potatoes as sources of fiber, as opposed to supplemental fiber like psyllium husks, and we support white rice but not oats, although oats are healthier than wheat.

      If the pancake is made with a wheat flour then we would be even more strongly opposed.

      A similar PHD breakfast might be rice pudding / kheer with egg and Quark (if Quark is the cheese, http://en.wikipedia.org/wiki/Quark_%28cheese%29).

  15. Thanks Paul.If I substituted rice flour instead of pyllium/oatbran would that be PHD approved. i also top it with vegetables or something similar. Avocado /tomato etc.

  16. 😛 Ta

  17. Paul, what do you think about Lecithin, how many table spoons a day would you recommend?

    • Each tablespoon (7.5 grams) of lecithin granules contains about 1700 mg of phosphatidyl choline, 1000 mg of phosphatidyl inositol, and about 2,200 mg of essential fatty acids as linoleic acid. It also contains the valuable fish-oil-like, omega-3 linolenic acid.

    • Hi Steven,

      I think it’s a good supplement. If you follow our 3 daily egg yolks plus weekly liver recommendation you shouldn’t need it, but I have no objection to it.

      A half tablespoon per day would be sufficient.

      • I thought lecithin was soy based, is that a concern?

        • Yes, if the amounts consumed are large (tablespoons). But since the toxins in soy are mostly proteins, and this is oil, I think up to a half tablespoon per day would be fine. If the fats are 50% omega-6 and a tablespoon has 120 calories, a half tablespoon would have 30 calories omega-6 or 1.5% of energy, which is significant but not necessarily toxicity-inducing.

          • Paul,

            But Choline is not the only benefit of Lecithin. I thought it might be very beneficial on a high fat diet. This is what I found on it. It is also a major component of myelin, which insulates the nerves, brain tissue, and bile. lecithin lowers cholesterol, prevents gallstones, and increases the absorption of dietary fats and fat soluble vitamins.
            Is the reason you do not recommend it in large amounts due to having already 3 eggs a day?

          • Hi Steven,

            I think the egg yolks and liver should supply enough for good health of the various nutrients that lecithin also supplies. Taking extra makes sense as a temporary measure to relieve a deficiency, or to support a pregnancy, but you could also increase egg yolks to 6 per day for the same effect.

            So I don’t think lecithin is necessary if you eat egg yolks and liver, but it’s also not dangerous for the most part. But if you are seeking perfection then I wouldn’t overdo it. I think a half tablespoon per day is as high as I would recommend, and eat some egg yolks and liver.

        • Say Paul, Steven indicated “granules” as opposed to oil. Granules aren’t as calorie dense per tablespoon, not sure all what’s different.

          Steven may be referring to something along these lines:
          http://www.swansonvitamins.com/swanson-premium-pure-lecithin-granules-non-gmo-16-oz-454-grams-granules

  18. o no- just cheated big on candida diet. im on day 17, went out for dinner after wedding assumed one day wouldnt do anything- had coke, pizza, ice cream, etc…did i just go back to square one??
    if i went home and gobbled down some goldenseal and probiotics, cold i nuetralize the effects?

    • I don’t think the goldenseal and probiotics would’ve neutralized the effects Bob.
      If you have proccessed stuff like coke, pizza, icecream, etc and expect to have a successful result overcoming a gut infection/bacteria overgrowth then you’re just dreaming.

      If I was in your shoes I would’ve just had ONE of those things (coke, icecream, pizza) in a SMALL amount to reduced the negative effects of it. But to be honest, you’re best off just giving 100% and not touching any of it at all.

      Well done on being on day 17 though. If you want icecream, have a look on this site for a home-made icecream recipe which will probably be ok for you to eat with your current diet.

      Good luck

  19. Hi Paul,
    I have been on a paleo diet for about 2 weeks after easing into it for a week prior. I had a lipid profile done one week ago and my total cholesterol was 307, Hdl was 76, Triglycerides were 55 and LDL was 220. These #s seem pretty high and they are similiar to the profile I had when I tried the Atkins diet in Aug 2011,(total cholesterol-323, Hdl-81, Trig-64,&LDl-229. At that time I went to eating Oatmeal and lowfat and had it checked in Aug 2011 and the #s had dropped to total Cholesterol-231,Hdl-77,Trig-52,&LDL-144. I thought maybe it was because I was not buying whole foods and eggs from cage free chickens when I was on the Atkiins diet. But on the Paleo diet I am only using whole foods and eggs from cage free hens that have omega 3. I read labels and buy from whole food co-op. Could you give me your thoughts on this? I’ve read that Paleo brings your cholesterol down. I have lost 5 lbs and my energy level was up until I experienced light headedness and off balance as I asked you about earlier. I will be trying no eggs to see if its an allergy, is it possible my cholesterol has anything to do with this?
    Many thanks, Syl

    • Hi Syl,

      This is a common problem which we’ve discussed a number of times under the heading “High LDL on Paleo” (really on low-carb diets). You can read the cholesterol category for more.

      Basically, it results from hypothyroidism or mineral deficiencies (copper or iodine usually), exacerbated by being too low carb and thus the body needing to conserve glucose.

      So eat more carbs and take our recommended supplements & supplemental foods (in this case, beef or lamb liver, shellfish, and seaweed) to eliminate mineral deficiencies, and if the problem persists then get treated for any subclinical hypothyroidism.

      Best, Paul

  20. Hi Paul, just wanted to let you know that after approximately 2 months on PHD and taking the recommended supplements, my restless leg syndrome has completely disappeared. I was a bit hesitant at first to believe it could be true, but it’s been a few weeks now so I can say it’s officially gone. This is something I remember having since I was a young child, maybe 6 or 7 so it’s pretty neat to resolve the issue through diet. Well, next on the list is perennial rhinitis. I hope it starts to resolve itself soon as well.
    Thanks for your tireless research and devotion to helping those with health challenges. We all appreciate your hard work.
    Jonathan

    • Awesome Jonathan, congratulations! 😛

      Real Food is the answer, no douubt about it!

      I remember when I started eating real food and dropping the processed food, especially sugar and hydrogenated oil, out of my diet my chronic blepharitis/horrible stye problem went away completely. I wonder what the eye doctor who said the condition is ‘incurable’ would say?

    • That’s great news Jonathan! Thanks for the report!

      For the rhinitis you might try NAC supplements.

      Best, Paul

  21. I have been very happy with the results i have received by following the perfect diet. I am hypothyroid… i have a question concerning sorghum flour..please can you explain if this is a safe flour to use on occasion ….for combining with rice and almond flours?…
    thank you in advance…Laura

    • Hi Laura,

      I’m glad to hear of your success!

      In general we’re skeptical of grains until they’ve been proved safe, and I don’t think sorghum is safe.

      Of course, infrequent use is unlikely to produce problems, but I would recommend using a safe starch like potato starch or tapioca starch to mix with rice flour and almond flour. Usually potato starch makes a good mix.

  22. I have been very happy with the results from following the perfect diet. I am hypothyroid..need to loose weight and am finding success. My question is concern sorghum flour…it is included in a flour mix that includes rice flour and is used to make bread…is this acceptable for on occasion to eat bread made with this ingredient?
    thank you…

  23. Hi,
    I read your book last year and I found it very interesting and helpful. I do have some questions. Do you think it matters how you combine the 3 macro nutrients? Should you avoid eating fat at the same meal as carbs? Or as long as you stick to the recommended daily intakes, is it irrelevant if you eat fat while spiking insulin, in terms of weight gain that is?

    Also, do you think it makes a difference when you eat most of the carboydrate (or fat and protein) if you are trying to improve sleep, or do you try to eat basically the same ratios at each meal over the course of a day? Thanks for sharing your wonderful research.

  24. Hi Paul,
    I just thought of another question. What do you think of using dextrose as a sweeter, in something like rice pudding. It’s basically pure glucose. The rice eventually becomes pure glucose when you break it down, so would this not just be like eating more rice in the end?

    • Hi Olga,

      I do support dextrose as a sweetener.

      • Hi Paul,
        Thanks for the speedy replies. I had come to those conclusions already, but just wanted to make sure. One other question that I have been wondering about lately, is about milk. I have always been told that milk will interfere with mineral absorption in the meal in which it is consumed. I wonder about this, because for most of the first year of life, babies consume almost exclusively milk and yet are able to double, maybe triple their blood volume, and grow considerably. If milk make it difficult to absorb minerals, how can this be??? Is it different for adults, or is this just another myth, which goes away when you consume full fat milk? Thanks again.

        • Hi Olga,

          I think milk is fine. It does have lactoferrin which is an antimicrobial iron chelator, but that is generally good for us. You’re right, it doesn’t prevent us from getting mineral nutrients.

          • Hi Paul,
            Do you think there is anything wrong with eating a typical low carb diet during breakfast and lunch, and then eating most or even all of your glucose at dinner, thereby causing only one insulin spike rather than 3? I’m just wondering if this would help with sleep and weight loss. The odd time that it has worked out this way, by accident, I have slept better.

          • Hi Olga,

            No, I don’t think that’s wrong. Many people find that carbs late in the day helps them sleep better.

            Just be sure to eat the carbs with acids, fat, and vegetables: http://perfecthealthdiet.com/2011/10/how-to-minimize-hyperglycemic-toxicity/

          • Thanks Paul!
            Am I correct to assume that as long as I keep to around 100 g of carbohydrate per day that I should continue to keep my triglyceride level as low as it has been on a very low carb diet, or at least close to it?

          • Hi Olga,

            Yes, I think any well nourishing diet with less than 150 g carb per day will produce low triglycerides.

          • Hi Paul,
            Is there a minimum amount of glucose required to spike insulin, or do you get a relative spike,ie. tiny amount of glucose small insulin spike, more glucose, more insulin, etc? Is there a level of glucose (say 10 g) below which insulin is not released?

            Also, when you do spike insulin, and it takes 4 hours to come back to baseline, what happens if you consume more glucose in that time. Do you release more insulin, or is the amount floating around in your vasculature enough to deal with the newly introduced glucose? Thanks again. I’m a working mom of two, and being able to ask you the questions rather than researching myself is allowing me more time to sleep :grin:!

          • Hi Paul,
            I just read that you are releasing another edition of PHD. Will the new edition have an index? I have read the original twice, but it would have been useful to have an index to look for information quickly. Thanks again for your exellent work.

          • Hi Olga,

            Yes, the new edition does have an index!

          • Hi Paul,
            I’m always confused when it’s suggested that half the calories should come from fat. What if you have fat to loose, shouldn’t some of the calories come from stored fat? So if you have excess fat, should you eat the 600 calories of glucose/protein and then eat only as much fat as is necessary to keep insulin spikes down?

            Is there a minimum amount of glucose required to spike insulin, or do you get a relative spike,ie. tiny amount of glucose small insulin spike, more glucose, more insulin, etc? Is there a level of glucose (say 10 g) below which insulin is not released?

            Also, when you do spike insulin, and it takes 4 hours to come back to baseline, what happens if you consume more glucose in that time. Do you release more insulin, or is the amount floating around in your vasculature enough to deal with the newly introduced glucose? Thanks again.

          • Hi Olga,

            Yes, if you have fat to lose then trim the fat a bit: http://perfecthealthdiet.com/2011/02/perfect-health-diet-weight-loss-version/

            Eating any carbs or protein will cause insulin to be released. This is fine. Eating more than 30% carbs starts to risk problems with glucose disposal if there are other causes of metabolic disorders.

          • Hi Paul:

            Does rabbit starvation only a danger when someone is under a certain weight? If you have weight to loose and you’re eating lots of protein, lower carb (herbivore strategy), but limiting fat for weight loss, would rabbit starvation not be unlikely if you have fat stores to draw from?

          • This occurred to me to, Olga. Rabbit sickness in the literature seems to be a product of lean meat eaten by lean people in lean times.

          • Hi Olga,

            Yes, if you have fat available to burn then very high protein intakes will leave excess protein unabsorbed and left for gut bacteria to utilize. They’ll produce toxins with it that can be quite dangerous, and you’ll have very smelly stool, but it won’t lead to death, whereas rabbit starvation in a lean person can be fatal.

          • Does this apply to 100g of protein and 50g of glucose, or only protein in excess of 200+grams?

          • 100 g of protein is OK. It won’t do you harm.

  25. Dear Paul and Shou-Ching,
    I’ve been on the PHD for three months now, after following the GAPS diet for a short while, on which I felt terrible: I had extremely low energy and strong food cravings on it (I was binging on honey, dried fruit and nuts all the time). I have been feeling a lot better and much more satisfied since I’ve started following the PHD. But I still suffer from the following health problems: -very stuffed nose making me unable to fall/stay asleep at night. -very low energy (especially for a 21-year old guy). -dandruff, which I’m quite sure is some sort of fungus. -rash on my chest, back and face sometimes, which might also be fungal because I usually suffer from it when my dandruff get worse. -genital candiasis. -cravings for sweets. -blurry vision: I’ve had great vision all my life, until last year in the course of six months it got very blurry all of a sudden. Close reading is still fine, but I’m no longer able to read signs/screens from a distance. –fructose give me many digestive problems (gas, bloating, etc.)

    All these issues make me suspect a fungal infection to be the likely cause for most, if not all of my problems, also because of my problems digesting sugar/fructose, would you agree? In order to heal from it I’ve started taking all the PHD recommended supplements plus NAC and activated charcoal, eating around 600 carb-calories a day mainly from potatoes (for potassium) and eating anti-fungal foods like turmeric, oregano, thyme, spinach, cranberries, beetroot juice and olive oil instead of coconut oil.
    Do you recommend taking anti-fungal medicines like Nystatin, Diflucan or Fluconazole or would it be better to stick to natural methods? Do they have any harmful effects (e.g. kill beneficial fungi in the gut aswell)? And if you do recommend them which one would be the best?

    I hope you can give me some advice for my issues. I want to thank you very much for all your work. Reading your book and following PHD has already improved my life greatly and I hope that it might help me overcome these remaining issues too!

      • you know, for some reason the import of any products containing Xylitol in to Australia is prohibited.

        No US site will permit shipment.

        The weird thing is that products containing xylitol are available here (in Australia) in the shops?

        • There is an Xlear site in Australia. http://www.naturallysweet.com.au However, the Therapeutic Goods Administration decided to classify the Xlear Nasal Wash as a medical device. Xlear Australia therefore, unfortunately, decided not to import the product from the United States and it is no longer available in Australia.

          On a side note, the company states that Xylitol is effective against Candida. http://www.naturallysweet.com.au/xylitol-faqs/#answer%2028
          Xylitol has been shown to be effective in inhibiting Candida Albicans, a serious systemic yeast problem, and other harmful gut bacteria including H. Pylori, implicated in periodontal disease, bad breath, gastric and duodenal ulcers, and even stomach cancer.

          • that’s funny that it mentions h.pylori.
            that’s my current pet project, researching ‘natural’ ways to eradicate/limit h.pylori in the stomach.
            a few of the things that have come up that i am looking in to are;
            – olive leaf extract.
            – iodine.
            – manuka honey.
            – find ways to raise low stomach acid to normal levels, ie. betaine hcl, increase metabolism to normal if low (slowing of the body’s basal metabolic rate associated with hypothyroidism may cause low stomach acid).

            it looks like h.pylori thrives in low stomach acid (& does not thrive when stomach acid levels are normal).
            And low stomach acid is “A symptom of Helicobacter pylori infection which neutralizes and decreases secretion of gastric acid to aid its survival in the stomach”
            http://en.wikipedia.org/wiki/Achlorhydria#Causes

            So h.pylori itself will lower stomach acid, allowing it to thrive, looks like a vicious cycle.

    • Hi Erik,

      It does sound very much like a systemic fungal infection. I do recommend medicines especially diflucan/fluconazole (these are the same) which has helped me. They do have side effects of course, especially in the liver, maybe kidneys, so you have to support them with glutathione and salt and fluids and bile support for detox. NAC I’ve also found to be very helpful as an antifungal supplement. The antifungal foods are good, most important is to eat a diversity of vegetables including green leafy vegetables.

      I would go to an opthalmalogist to see if they can explain the blurry vision.

      Also ketoconazole shampoos or lotions may help with the dandruff/skin fungal infection which is probably Malassezia. (The internal infection will be a different species.)

      The rash may not be a skin fungal infection, it could be the immune system getting over-active due to stimulation by circulating fungal cell wall components like beta-glucans and causing a dermatitis rash like you might get from rubbing moist skin or contact with nickel. You could test this by trying whether an anti-fungal lotion helps. If not, and if hydrocortisone creams do, it is probably a dermatitis. It still would likely be caused fundamentally by the internal fungal infection.

      The low energy is probably some combination of hypothyroidism and immune activity. Infectious fungi seem to flourish in the thyroid and commonly cause thyroiditis.

      When your nose is stuffed, is it due to mucus in the sinuses, or are your lymph nodes swollen?

      Best, Paul

      • Hi Paul,
        Thank you for your fast reply! It’s already a great relief for me to have found the likely underlying cause of my problems. I will follow your recommendations and see how it works out for me.
        When my nose is stuffed it’s not so much due to mucus in the sinuses, but rather due to swelling of my nasal mucosa. For this reason most of the home remedies that I’ve tried (nasal rinse, hot steam, etc.) don’t work for me, because they’re mainly aimed at loosening excessive mucus in the sinuses. My lymph nodes seem normal, at least not particularly swollen.

        I’m supplementing 500mg NAC daily, do you think it would be helpful to increase the dose? What would be the maximum helpful dose for NAC?
        And one more question about vinegar and lemon juice. I’ve read lots of confusing and contradicting information on the helpfulness of lemon juice and vinegar for fungal infections. Some say “avoid vinegars and take lemon juice” and others say “take vinegars and avoid lemon juice”. Some say fungal infections like and acid environment and others say they like an alkaline environment. I’ve gotten so confused that in the end I’ve decided to just avoid lemon juice and vinegar altogether. Do you know the answer to this?
        Thanks again for all your help. I’ll definitely let you know how it works out for me.

        Hi SC,
        Thank you for the links. Very interesting! I’ll definitely try the nose spray if dietary changes don’t solve my sinus issues.

        • Hi Erik, I would try asap. Most health food stores carry so you can get right away rather than waiting for an online order. I think it works that well. I think it will likely bring some relief immediately and if you are able to later deal with the underlying issues with diet, so much the better. If you try let me/us know how it goes.

        • Hi Erik,

          I would experiment with various doses of NAC to see first if it is helping you. Lots of people with chronic infections go as high as 3 g per day. I personally would take about 1 g per day, but I have no idea if that is optimal. Probably not. You could take a bit of glycine with it.

          Vinegar is acidifying and lemon juice alkalinizing, but I doubt that matters much. Supply minerals and salt and the body will manage acidity just fine, you’ll only change the pH of the urine. Both vinegar and citric acid are healthy and I eat some of each. You can follow your taste.

      • ketoconazole also has a possible side effect which may be handy for some

        http://en.wikipedia.org/wiki/Ketoconazole#Hair_loss

    • Hello anyone who knows,

      If fungal infection is an issue, should coconut oil be avoided? I thought it was anti-fungal. If so, no wonder I’m not healing I have it all the time!

    • I’m actually working on trying to get a night’s sleep without waking up incredibly thirsty in the middle of the night. I think I need more carbs/sodium/water.

  26. Paul,

    During my intermittent fast I drink hot water with 1-2 tbsp of coconut oil. I typically use with some fresh squeezed lime juice. Since I use 1 small key lime per cup as it is more convenient than lemon juice for me. Is using lime vs lemon juice more or less advantageous?

    Thanks,
    SC

  27. Paul,

    When you treated with fluconazole, how long and how much did you take? How did you know when the problem was gone? Is it prudent to always keep candida control or maintenance in place to prevent return?

    For me, I’m not sure if I have candida or not. I dealt with it years ago when I had symptoms. But I do have thyroid problems and gut/digestion issues. Wondering if I should just do a course of fluconazole? If I do the Metametrix test will candida show up? Any thoughts?

    • Hi Jan,

      When to stop is a tricky issue, because if you treat only until symptoms are gone the infection will still be there and it can grow back. Repeated cycles of inadequate treatment may help it develop resistance to fluconazole.

      For instance, the Medscape page for coccidioidomycosis suggests fluconazole at a dose of 400-800 mg/day (high) for a minimum of six months. (http://emedicine.medscape.com/article/215978-treatment#aw2aab6b6b2). This is for severe cases, often immune compromised.

      Less threatening fungal infections are usually undiagnosed and untreated. So there isn’t necessarily a universal standard of practice for these.

      I will save my personal case for later discussion on the blog, but I think if you’re unsure whether you have a systemic fungal infection, a reasonable course would be to try fluconazole at a lower dose (say 150 mg per day or even a few times a week) and see if it makes a difference. I saw clear benefits at these doses, and they pose less risk to liver and kidneys. Duration is an open question but it may be prudent to use it for a long duration to minimize the chance of a return.

      Since fungal infections can be systemic, they needn’t show up in a gut profile. But if they do show up, that would be a strong indicator.

      I suspect fungal infections may be a very common cause of thyroid problems.

  28. Hi Paul
    If one cheats on the candida diet one day with lots of forbidden foods, is it back to square zero if you immediately resume a clean diet again?

    Thank you

    • Hi Bob,

      I don’t know what the Candida diet is. But I don’t see how any single day of bad dieting could set you back to square zero. Diets have cumulative effects over months and years.

  29. Dear Doctor Jaminet;

    You say you don’t like extended water fasting for candida, yet I’ve read many anecdotal accounts of success using this method.

    Why do you say no to water fasting for candida, or am I misunderstanding your position?

    Thank you very much,
    TC

    • Hi Tommy,

      Candida can live just fine intracellularly and systemically and can live on fats and protein and other things floating around in the blood. It doesn’t need dietary sugar. It can live on circulating ketones and fats. So if you really have Candida, a water fast will not work.

      However, if you have a bacterial infection of the gut, then fasting can be an excellent strategy. So if it is bacterial problem misdiagnosed as candida, then a water fast may work.

      • Alright, that’s interesting- so definitely won’t incorporate fasting into my long term candida plan.

        However, fasting does give me much temporary relief of many symptoms, and I enjoy it anyway- so does fasting actually make candida WORSE, or is it simply a net effect zero? Say 6 weeks in I do a 5 day fast – am I simply losing 5 days, or am I back peddling?

        • Just do daily intermittent fasting — 16-18 hour fasts. That will work even better against Candida, and most other pathogens.

          You can backpeddle with a 5-day fast.

          This is discussed in detail in the new edition of the book.

  30. Hi Paul:
    My husband and I have been on a low carb diet for about 10 years now. After reading your book, I wonder if we have been eating way too much protein. I have shifted this towards more fat now. Out of curiosity, what are the symptoms of eating too much protein? My husband still has lingering symptoms of restless legs, insomnia and nocturnal polyuria. I was wondering if these could be due to the body trying to clear excess protein break down products. Thanks.

    • Hi Olga,

      Well, it’s possible excess protein could be contributing to your husband’s symptoms although that probably isn’t the only or main factor. The biggest issue is that the excess protein will be metabolized either by gut bacteria (since the intestine fails to absorb toxic amounts) or the body, and the leftover nitrogens generate compounds called amines (http://en.wikipedia.org/wiki/Amine) many of which are toxic. So there will be a high toxin load that is unnecessary because a higher carb lower protein diet would not generate them.

      Re restless legs, I am not sure what causes it but we have had reports that PHD can cure restless legs. One today in fact: see Jonathan, http://perfecthealthdiet.com/q-a/comment-page-40/#comment-97838.

      Insomnia can also be a number of things, for instance immune activity will keep you awake, lack of carbs can keep you awake, hormonal maladjustments or disrupted circadian rhythms, so again it is difficult to name the cause in any one case but usually PHD will improve sleep quality.

      Polyuria often indicates either kidney issues or hormonal issues due to thyroid or adrenal issues. The causes can often be diagnosed by a doctor and may be treatable. However, high toxin loads from excess protein would contribute to a need to urinate to excrete the toxins, and could also cause kidney damage that would also contribute to it. But there are many other possible causes of polyuria, so again I can’t say for sure it’s the protein.

      Diseases and disorders have many causes, and usually it’s easy to just eat in a perfect healthy way (the goal of PHD) and let the problems recede than to try to understand exactly what was causing what.

      Some fraction of excess protein will fail to be absorbed and will be utilized by gut bacteria. They generate a number of toxic compounds when they metabolize protein.

  31. Hi Paul,

    I’m reordering my Vit K2, which has been an MK-7, but I was thinking that you suggested MK4? I’m having a hard time finding that. What do you suggest? Thank you!

  32. Paul, would supplements such as NAC, Carnitine, D-Ribose taken during 16-hour fast diminish autophagy? Thanks.

  33. Hi Paul,

    Sometimes I experience a warm acidic feeling within the stomach area.

    I tried the Baking Soda Test twice, once in the AM, once in the PM. I drank a mixture of 1/4 tsp Baking Soda in 240 ml room temp Water.

    Result: No burps. Does this highly indicate Low Stomach Acid? Perhaps I did not use enough Baking Soda?

    • I’m afraid I don’t know, Monnyica. I’m not familiar with the baking soda test.

      The way I would test for low stomach acid is supplement with betaine hydrochloride at a meal. If you digest the meal better, you’re probably low in stomach acid.

      • I have a similar question…I get this acidic feeling a lot too but more in my mid throat/upper chest area. I have Braggs apple cider vinegar with my meal at least once a day and occasionally take 1 HCL, I can’t tell if these things make it worse or not. Sometimes the sensation doesn’t come about until I drink water (between meals only) strangely enough. Also, I drink warm lemon water 30 minutes before my dinner…would it be better to do it at a different time? I’m confused about all of this acid/alkaline stuff and how to tell which it is.

  34. Hi Paul, My husband is a little concerned about taking all of the supplements recommended that are from metals (molybdenum, chromium, vanadium, et. al) since he is suspicious of heavy metal over exposure. He is about to do a Metametrix test to see if there is a problem. Do you have any advice or thoughts to his supplementing your recommendations with this concern? Since receiving the supplements early last week, he is only taking the vitamins (B, C, K-2, etc.) and magnesium. I do have him taking Taurine when he has a cocktail which seems to help him sleep through the night.

    Thank you.

    • Hi Dede,

      Well, skip the vanadium but molybdenum and chromium are essential minerals, and molybdenum in particular is quite rare in the environment, so it’s extremely unlikely he’d be high in that. But he should do what makes him comfortable, it’s not likely that these are major factors in his health, the supplements are mainly precautionary.

      Interesting about the taurine-alcohol-sleep connection. I see that is discussed here: http://drlwilson.com/Articles/TAURINE.HTM.

      • Oh great! Thank you! He feels much better about the supplements now! 🙂

        The article you linked is the one I stumbled upon coincidentally. I tried the Taurine a few times at bedtime after he had a cocktail or two, and it helped him.

  35. hi doctor, sorry just one quick follow up from above about the fasting question
    definitely won’t incorporate fasting into my long term candida plan.
    However, fasting does give me much temporary relief of many symptoms, and I enjoy it anyway- so does fasting actually make candida WORSE, or is it simply a net effect zero? Say 6 weeks in I do a 5 day fast, or start with a fast – am I simply losing 5 days, or am I back peddling?

  36. Hello doctor;

    I’m looking for anti-fungals for candida, but most seem to contain Magnesium Stearate.
    Is this ok to take?

    thanks!

  37. Dr paul, is it true that one must rotate anti-fungals ever 5 days when treating candida?

  38. Hi Paul,

    I buy farmed Oysters (medium sized, without the shells). This may be gross but I eat around the poop because I assumed it’s harmful. But I read that another commenter ate her newborn’s poop to fix her gut problem.

    So is it safe and even beneficial to eat the oyster poop? Or does it negatively affect the gut flora, especially since it’s farm-raised?

    • I doubt it’s healthful to eat it. Oyster digestive tracts have some bacteria that aren’t good for us, like cholera. This is why eating raw oysters can sometimes cause food poisoning. I haven’t heard of oyster poop being a health food.

      • Good to know, thanks Paul! Is it okay to eat the whole oyster, poop and all, when it is cooked (steamed 10 min)? Or best to avoid the poop even when cooked?

      • In Aldous Huxley’s novel “After Many A Summer”, bacteria from fish guts are a longevity elixer.
        Huxley also wrote about concepts equivalent to probiotics, prebiotics, and enteric coatings in “Antic Hay”, 1923.

  39. Paul, what do you think of CLA supplementation?(Conjugated Linoleic Acid)

    • I think since we support ruminant meats and dairy so strongly, it shouldn’t be necessary to supplement CLA to obtain their benefits.

      • In fact there are studies showing CLA supplements have the opposite effect from CLA in food, basically acting like trans fats, because either there is another isomer present in the product that isn’t in ruminant fat, or the CLA effect is hormetic and unnaturally high doses are not better.

  40. I’ve noticed something interesting that ma

    im trying to do a very strict candida diet, paleo with elements of PHD, anti fungals, probiotics, etc.

    doing this makes me feel AWFUL- brain fog, leg pain, no energy, depression, severe digestive symptoms etc.

    however whenever i break this diet with a junk food binge, which usually happens once every 2-3 weeks and lasts for 1-2 days, i immediately feel completely better…my symptoms vanish, i get incredible energy, i feel like lifting weights and running, cognition on fire, abdominal pains vanish, etc.

    whats going on here? shouldnt these binges make the candida feel much much worse after 2 weeks of very clean eating?

    i suspect this effect either strongely suggests a major case of candida overgrowth ,or strongly suggests not having candida overgrowth at all

    • CJ,

      I am no expert, but I thought I would offer my two cents. I would suspect that you might have underlying digestive problems if eating whole foods makes you feel worse. Junk food is generally extremely easy to digest and the energy is nearly immediate. I think the energy surge from eating junk is pretty standard.

      If I were you I would focus on continuing the probiotic supplementation, adding fermented foods, maybe adding more easily digestible safe starch like white rice and see if that helps. Try and steer clear of veg, fruits, and other things that are hard to digest, but otherwise stick to “clean eating,” and see if that makes a difference.

      I think that if you find that does not help, the other possibility is that monitoring your diet and eating clean is causing you some sort of emotional stress. Then when you find freedom in junk food you feel momentary bliss. I find that dieting and stressing about the details of everything I put in my mouth stresses me out so much as to be counterintuitive. Does that make sense? You might want to try Sean Croxton’s approach and “JERF (just eat real food).”

      Good luck,

      Lindsay

      • Hi CJ,
        It happened the same for me…i went very low carbs very paleo very everything and i couldn’t barely stand on my feet.
        Paul suggested to increase carbs a bit and supplements and it worked better.
        some cooked pumpkin and wild rice more.

        i’ve done further than that and experienced more just to see what’s happening – eat some bread and coffee. although not very ok they seem to add more power and help a little with my mood.

        I have bacteria, candida and parasites also. maybe they are starving too much 🙂 on paleo or PHD. kitting.

        I think Paul has a point with malnutrition from very paleo, very everything.
        Dave

    • … also, what type of strict candida diet are you following? If it is the kind that severely limits starch that might be contributing to the problem. You can search this site for information on anti-fungal diets. You do need some starch… which goes back to my suggestion of easily digestible white rice. Also, if you are eating a lot of coconut oil, that could be feeding the fungus.

    • Hi CJ,

      Lindsay’s observations are great.

      I would say most likely your “very strict candida diet” is missing something important. Any restrictive diet carries that risk. See the anecdote I recently discussed from Chris Kresser about the fellow who was being treated for health problems with a restrictive diet and felt awful, but cured himself with beer and pizza. His diet was so restrictive he was starving himself, and once he quit controlling his diet and ate more food, his health problems went away.

      I can’t know what you’re doing but keep in mind that antifungals are toxins and consume the liver’s and gut’s resources; probiotics and bacteria that the gut and immune system need to manage, costing resources; and your “very strict” diet is probably restricted in a number of things.

      So my advice would be to stop doing six things (candida diet, Paleo, elements of PHD, antifungals, probiotics, and whatever the etc is) and try to just do PHD for a while, eating a normal amount of food and never being hungry. Then if you still have signs of infection, look to a doctor to treat them.

      Best, Paul

    • Brain fog could also be a sign of immunity at work. There’s nothing wrong with pacing yourself.

  41. Hi Paul,

    Quick question.. what do you know about Melanoma? A friend of mine is at extremely high risk (fair skin, many moles, etc) and recently had a scare. I am wondering, aside from vit D supplementation if you know of any specific preventative measures. Every Derm she has seen has mainly just advised her to bathe in sunscreen, but that advice seems so insane to me.

    Thanks for your time,

    Lindsay

    • Hi Lindsay,

      Generally speaking, PHD is an excellent anti-cancer diet, melanoma included. Our cancer category has further information, and I have some more posts on cancer planned.

      It is very desirable to get sunshine, which protects against melanoma, but very important not to get sunburn. So she should limit sun exposure on any given summer day, but get as much sun as she can in fall, winter, and spring (assuming she’s at mid-latitudes as in most of US).

      Vitamin K2, selenium, and iodine are other important anti-cancer supplements.

      Most important for cancer are circadian rhythm strategies. Those are discussed in our new book.

      Best, Paul

      • Thanks for your reply. For some reason I was thinking Melanoma was different… It seems like most studies I could find in PubMed were non-conclusive and that Melanoma confounded the research world a bit. I’ll pass along the advice!

  42. Hi Paul,
    I’m wondering what you think about drinking green smoothies with fruit and greens blended. I rotate fruits and greens weekly and sometimes add ingredients such as brazil nuts, gelatin and chia seed. I’ve done a search on your site to spare you from having to repeat yourself, but nothing related seems to come up.
    Also I’m curious to hear your view on drinking raw green juices first thing in the morning.
    Thanks to you and your wife for your supportive, educational work!

    • Hi Jeanette,

      I’m not opposed to green smoothies, in fact many people find them a helpful way to eat more vegetables, but we personally just eat vegetables directly. Also, the benefits of higher vegetable intake aren’t well established — it’s clear that healthier people eat more vegetables, but it’s not clear that eating more vegetables makes you healthier — so there isn’t a really strong reason for me to push people toward making green smoothies. That’s why I haven’t blogged about it.

  43. Thank you for all your information!

    A little over 2 years ago, I started to have multiple days of spotting premenstrually, onset of multiple small cavities, and fatigue during the second half of my cycle. After several months, I saw my doctor, and she found that my T3 was slightly low and my vitamin D level was also low. Female hormones were in range. I made an effort to increase the seaweed in my diet, increased my D3 supplement, and went from more WAP-type eating (what I had done for 2 years) to more PHD. I felt better after a few months, but not 100%. The doctor then recommended vitamin C supplementation (2gr) believing that my adrenals needed help. I was still nursing my youngest and was not going to be able to take herbs/other supplements yet. My cholesterol was in the low 200’s, with an HDL of 92 and triglycerides in the 30’s.

    The vitamin C helped a bit for a few months. I can’t remember why I stopped taking it, but I did.

    I was still having an extreme response to physical activity. If I did any heavier-than-usual activity, I would feel sick (swollen glands, fatigue) in a disproportionate way. Also, my cycles became increasingly heavier and more painful, and I started to develop palpitations. I had been taking some lugol’s occasionally, if I felt I had not eaten enough seaweed, but nothing drastic (a drop of 2% in water occasionally). After a non-significant month on a heart event monitor, I went to see a naturopath.

    My D level was 44, and t3 was in range. Markers of inflammation and auto-immune issues were ok (CRP under 1, negative ANA, no antibodies to thyroid). My salivary cortisol showed some disregulation (lower in the morning and higher at night than it should be). Also, my CD57 was a 44 (although Labcorp Lyme Western Blot was fully negative). I live in a tick-endemic state and have had exposure to ticks in the past which raised the question of lyme. She sent for a Western Blot at Igenex. I had a positive IgG. BUT…I had one dose of Lymerix in 2001, before it was pulled from the market. My result may be complicated by that since the positive hinged on band 31, which corresponds to protein in the vaccine. From the only research I can find, immunity waned quickly for most people on 3 doses of Lymerix, but perhaps my case is different.

    For now, I am on herbs for adrenal support and to help with my cycle, along with vitamin C/B complex/D3 and a PHD/WAP influenced moderate carb diet. The naturopath is also checking me for heavy metals since I recently had my amalgams removed (through a holistic dentist using protection protocols). She is tabling the lyme question for now, mostly since I do not have cognitive symptoms, but is open to me doing a one month anti-microbial course to assess my response.

    Overall, I feel better than 2 years ago, but I still have trouble doing yardwork without feeling horrid for a few days after. I used to do martial arts six days a week and be able to do 3 day all-day camps without issue. I am about 5’6″, 125 lbs, and am mildly active as a stay at home mom who tends a small homestead, but trying to lift weights, do karate, walk more than a couple of times a week seem beyond me right now. I would like to go back to doing regular physical exercise. My attempts to ramp up slowly have not really worked.

    I feel as if I am *mostly* healthy but something is holding me back from my optimal. If you have any thoughts, I’d appreciate them.

    • Hi Tania,

      It’s a difficult case. The low CD57 lymphocyte count is consistent with chronic Lyme (http://www.ncbi.nlm.nih.gov/pubmed/11222912) but probably other infections too. CD57 appears in highly differentiated T lymphocytes including senescent lymphocytes (http://www.ncbi.nlm.nih.gov/pubmed/21576928), and probably some pathogens benefit by keeping T cells in an undifferentiated state.

      However, many infections increase the CD57 population, including cytomegalovirus and hep C.

      There’s this, which links exercise to the loss of lymphocytes: http://www.ncbi.nlm.nih.gov/pubmed/19816709. It suggests you might try supplementing NAC / glutathione and vitamin C. These are safe when nursing. I would also try our recommended minerals — copper (liver), selenium (kidney), magnesium especially. In fact you might try rigorously following PHD including our supplemental foods and supplements for a while. That would help exclude possibilities.

      Your triglycerides are low which could indicate some form of malnutrition (reducing triglyceride synthesis) or hyperthyroidism (increasing clearance). I would take bile supports like taurine and vitamin C and eat 3 egg yolks a day at least. Check your thyroid numbers to make sure they weren’t too high. Supplementing lithium might help if they are.

      Best, Paul

      • Thanks for the quick response.
        Regarding the diet recommendations, I eat 2-3 eggs a day and currently take 1 gram of vitamin C (powdered and naturally sourced supplement). I eat liver once a month or so, a couple of brazil nuts and servings of fish a couple of times a week, and eat fermented buckwheat once a week or so. It isn’t as much copper, selenium, and magnesium as you recommend though, so I can watch that more carefully. I have in the past, but have recently slacked.

        As for the PHD diet, I eat pastured beef, lamb, wild caught fish, along with pork and chicken once a week (and we ate things like hocks, trotters, heart, liver as available). Pastured eggs daily. Home-cooked bone broth is regular feature in our house (multiple times a week) since we eat soups almost daily. We eat mostly root veggies, tubers, starchy veggies along with a significant amount of green veggies (all organic) and a small amount of fruit (mostly berries). We eat white rice once a week or so, and fermented buckwheat once a week. I use pastured ghee and pastured butter daily, along with coconut oil, and small amounts of olive oil for salads and home soaked nuts like almonds and macadamia. I consume about one serving of raw pastured dairy a day, and eat germinated/fermented legumes maybe twice a month. Almost no sweetener (well, there is that sugar in my 87% Taza chocolate, but I only have a few chips a day). I ferment my own veggies and eat those a few times a week. Mostly PHD, with a few forays into WAP-land.

        About a year ago I tried to hit about 65% fat, but I didn’t feel that great. Lower carb doesn’t seem to work for me either. If I had to guess, I naturally gravitate to about 45% fat, 30% carbs, 25% protein and I eat a significant amount every day (maybe 1800-low 2000 calories).

        My last thyroid results from August were
        tsh 1.49 uIU/mL (down from 2ish Jan 2011)
        t4 9.0 ug/dL (range 4.5-12.0)
        t3 uptake 31% (range 24-39)
        Free thyroxine index 2.8 (range 1.2-4.9)
        t3 79 ng/dL(range 71-180)
        which seem ok?

        Digestively, I think I am ok, but I have wondered about my food intake. I sometimes eat more than when I did karate although I am not that big. I have wondered if I am processing all the food I am intaking, so I will think about the malnutrition angle.
        Thank you again, for the references and your time.

        • An update and a couple of questions…

          I spent a few days figuring out where I was deviating from PHD and started working towards all PHD. I am currently supplementing with D3, C, and magnesium daily (I plan to add others in time).

          On Sunday, breakast was egg yolks and strawberries. Lunch was sardines, salad greens, homemade dressing with olive oil, potatoes with butter, small bowl of homemade cream of broccoli soup (made with bone broth). Dinner was chicken, potatoes with butter, kale sauteed with coconut oil, banana. Snack was macadamia nuts and 87% dark chocolate. My changes from my regular diet were subtle, but there were changes…possibly a little more fat and less protein and slightly less carb.

          Lunch was around 130. Yesterday afternoon, I found myself tired and unmotivated by 4 (not necessarily unusual, but less frequent than it used to be 2 years ago). I went to lay down. Around 430, I tested my blood sugar and it was low 70’s. I retested after a little while longer and it was 61. I ate dinner around 530. My blood sugar seemed fine 1 hr post (120something). I had my final snack of nuts and a bit of chocolate at 730.

          I was planning on trying 16 hr fast, but I woke up at 3am having difficulty sleeping. In the later morning, I was wondering if I wasn’t ready for IF. I didn’t feel shaky, but I was wondering about my experience the previous afternoon.

          I have some cortisol dysregulation based on saliva testing, but I have never been able to correlate random afternoon sluggishness to blood sugar level until yesterday. I have the glucometer because I spent some time trying to sort that out several months ago.

          Do you have any thoughts?

          Also, I am wondering on whether I should even try to IF. I keep reading conflicting info about differences between men and women, and people with adrenal fatigue.

          • Hi Tania,

            Thank you, this is useful information.

            It appears that your body is having trouble maintaining blood glucose levels. This could be due to getting too little carbs and protein. You don’t say how much fat you are adding but it sounds like it could be substantial (egg yolks at breakfast, olive oil and butter and cream at lunch, butter and coconut oil at dinner), or how much potato and meat you are eating (does it provide 1 lb potato and 1/2 lb meat daily?).

            If you are having difficulty regulating blood glucose, then I would be cautious about fasting. Don’t let yourself become hypoglycemic; and if you are hungry, eat.

            This difficulty maintaining normal blood glucose is concerning. Has your doctor investigated the causes? You may want to look into possible small bowel / pancreatic / liver infections.

          • Yesterday, it was slightly under a pound of potato and about 1/2 pound of meat (I was measuring for a few days to get a sense of portions). I entered the info into Fitday and came out to about 1800 calories, 56% fat, 15% protein, 29% carb.

            My doctors have not investigated the causes as they have never seen the dysregulation (although my last fasting lab level was 68 and the ND just mentioned to watch it). I have randomly monitored because my family has a history of diabetes and my afternoon fatigue was intense a couple of years ago, but I never was able to get a low reading and relate it to my lethargy. My ND ran a salivary cortisol test and I showed low levels in the morning, normal for midday, and higher than normal at night and mentioned that cortisol would impact blood sugar levels.

            I have an appointment with my family doctor in 2 weeks and will mention my experience. For now, I will avoid IF and probably just eat a little more protein/carb and less fat, but keep the supplements and the overall PHD foods. Thank you.

          • Hi Tania,

            Normally cortisol is high in the morning, low in the evening. Your cortisol circadian rhythms are suppressed — you have more uniform levels of cortisol through the day.

            This is a common pattern which is associated with a lot of negative health outcomes. (Here for instance is a paper linking it to cancer risk: http://jnci.oxfordjournals.org/content/92/12/994.full.)

            So one thing I would work hard on is circadian rhythm enhancement: sun and bright light exposure during the day, physical activity during the day, rest and dim light at night, concentrating meals in the latter half of the day, sociability in the day.

            You might try time release melatonin at bedtime, sometimes that helps.

            I would also pursue any leads on possible chronic infections that might contribute to your symptoms.

            Best, Paul

          • Hi Paul,
            do you have any references relating to
            “concentrating meals in the latter half of the day”
            with respect to diurnal/circadian &/or cortisol rhythms.

            this is the way i eat, btw

          • thx Paul,
            one of your earlier posts i see.
            which prompted me to go looking for your 1st post on this site, which looks to be 25th June 2010.

            keep up the good work

  44. Hi Paul,

    In the above you say Triglycerides in the 30s is low. Is a Triglyceride of 43 considered low?

    Also do you recommend a diet including Yolks and Meat for a person with the following results:

    Glucose, fasting 90___(60 – 99 mg/dL)
    Cholesterol 188_______(< 239 mg/dL)
    LDL 122_______________(< 129 mg/dL)

    The results are normal but high. Does this mean I am dealing with borderline Pre-Diabetes and High Cholesterol? Does this contribute to breasts cysts?

  45. Thank you so much, I will start the phd tomorrow.

    Still wondering, does it sound like id have candida, or not? Would eating sugar make someone with candida feel better or worse?

  46. thanks for all your help, this blog is awesome!

    ive been thinking about it- why dont doctors and modern medicine know or care about systemic candida? why are they in denial? it seems strange that the only community unwilling to embrace the possibility is the community of professional medicine.

    what do your wife’s colleagues at harvard medical say?

    • Hi Jimmy,

      She’s in a different field, vascular biology and cancer, so I doubt she’s ever spoken to them about candida.

      It is odd, the ignorance about fungal infections and eukaryotic (protozoal/parasitic/fungal) infections generally.

    • When I read this q&a, I often think, where are the doctors? How many of them think to test for candida or mold?

      • Hi tam,

        I think a big part of it is, there aren’t good diagnostic tests, nor wholly safe treatments, and also the pharma companies don’t push anything because there’s no money in it. It would take a big effort on the part of a doctor to even know what to do. Some do it, like Ritchie Shoemaker, who traced a great many problems in his Maryland practice to fungi, but not many.

  47. Paul
    Is L .sporogenes a safe strain of probiotics for kids? I bought rainbow light organic multivitamin for my 4 yr old and it has this strain in it. Kindly advise

    Do you think kefir is fine for a parasite infection?

    My kid had stomach ache and some blood stained vomit with fever. The doc wants him to take PPI lanzoprazole. I am totally not for it. Could it be GERD due to parasitic infection like me ? Did i pass it on to him 🙁

    Thanks in advance
    Koki

    • Hi Koki,

      Bacillus coagulans (the modern name for L. sporogenes) (http://en.wikipedia.org/wiki/Bacillus_coagulans, http://www.biomedsearch.com/article/Bacillus-coagulans/286390908.html) has a “qualified presumption of safety” from the Europeans. Some related spore-forming bacteria like Bacillus subtilis do create acute infections, but this is less likely with Bacillus coagulans. It tends to leave the body in about 7 days.

      It is reported to promote the resolution of acute GI tract bacterial infections (http://www.biomedsearch.com/article/Bacillus-coagulans/286390908.html), but this is in the intestine, it passes through the stomach in spores so it wouldn’t be likely to heal stomach wounds. If it causes problems, it could be by stirring up some other microbes that were there.

      I don’t know what the cause is but any time there is internal bleeding the condition could be serious. PPIs should be avoided as long-term treatments for GERD, but in this case probably your doctor is imagining using it for only a few days to avoid irritating the ulcer/wound that is bleeding and give it a better chance to heal. Not sure if this is the right prescription or not, as stomach acid might be helpful in fighting an infection, but your doctor undoubtedly has a lot more experience with this than I do about it.

      Kefir should be fine but you might minimize the probiotics while he has internal bleeding. Any microbial load that enters the general circulation will burden his immune system.

      GERD is a persistent problem and I don’t think you would assume it was GERD until it lasted more than a few days. All you really know is he has some kind of acute infection that is causing the fever, vomit, and bleeding.

      Best, Paul

    • GERD due to a parasitic infection? I’ve been off this site for the last couple of weeks — did I miss something.

      Also, thanks to George a while back for recommending “Epidemic of Absence” an extraordinary text.

  48. Hi Paul,

    As always, thank you for your reply. I’m glad to hear that my cholesterol/glucose results are good. I want to make sure that I’m not misinterpreting my other test results… I’d appreciate if you could scan through my below results for abnormalities despite being “in-range”? I’m hoping that it could explain some of my health problems.

    1. Can I conclude that my Thyroid and Liver are normal? Or need additional tests?
    2. Could I be borderline Anemic?
    3. Does Lymphocyte of 40 indicate an active viral infection? What does it mean to have abnormally low WBC/Neutrophils?

    THYROID
    Free T4 1.1_______(0.8 – 1.7)
    TSH 1.21__________(0.10 – 5.50)

    LIVER
    ALT 10____________(< 36)

    ANEMIA
    RBC 4.31__________(3.60 – 5.70)
    Hgb 12.8__________(11.5 – 15.0)
    Hematocrit 39_____(34 – 46)
    MCV 91____________(80 – 100)
    RDW, RBC 13_______(12.0 – 16.5)

    IMMUNE SYSTEM
    Neutrophils 1.5___(2.1 – 7.7)
    WBC 2.9___________(3.5-12.5)

    Lymphocytes 40%___(13 – 46 %)
    Monos 7%__________(4 – 12 %)
    Eosinophils 2%____(0 – 4 %)
    Basophils 1%______(0 – 1 %)

    • Hi Monnyica,

      Yes, thyroid and liver results are normal. Your blood test results don’t look anemic. And the low white blood cell count is something you should take up with your doctor. I believe they would normally re-test to see if the low count was persistent or just a temporary thing.

  49. Can canned water chestnuts be considered a safe starch?

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