Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Paul
    Thanks a lot.
    My son had a few brown worm like strands in vomit 4 days back. But no vomitting after that. We took a picture to show the doc. He saids its blood 🙁
    And that viral infection cud have caused it. He wants him to take lanzol and vitamins.

    I am now confused if I shd give him PPI as we dint have any vomitting after that? I wanted to give him natural food based multivitamin but it has l sporogenes

    • Did he say why he wants him to take the PPI? If there’s no more vomiting or blood or stomach pain then I don’t know why that would be desirable.

      I think B coagulans / L sporogenes should be fairly safe, especially at the low levels it will have in a multivitamin.

  2. Thanks Paul. My doctor said that some people just happen to have low WBC. Is this true?

    I’m trying to figure out what caused me to develop new Food Allergies that show up as face red blemishes/pinhole scars. After 2 months the scarring stopped, but still get 1-2 blemishes. I want to be able to eat without being afraid of triggering another blemish (flat, not itchy, unrelated to acne).

    Food Allergy (Started 9/1/2012, 90% Cured 10/31)
    -Jan 2012: Eliminated Gluten in attempt to cure Eczema, but occasionally ate Barley, Dumplings, Cake, Soy Sauce.
    -Sept 2012: Ate big bowl of Wonton Noodles with 1 tbsp Chili Oil from restaurant. 1 hour later 3 hives appear on face, which left 3 pinhole scars.
    -Face blemishes/scarring continued for 2 months, reacted to food that never caused problems: Banana, Orange, Garlic, Oolong Tea, Avocado, Olive Oil. Bone Marrow caused a 3-day blemish on face.
    -90% Cured 10/31/2012!! Credit to 2 weeks of Sun (didn’t get sun for 1 year)? Or 2 weeks of Bone Broth? Or 2 days of eliminating Veggies? Or gut simply healed itself?

    Could any of the following cause problems with the gut despite occurring 8+ months beforehand?

    Food Poisoning v.s Internal Bleeding (Jan 2012)
    -Vomited 11x within 2 hrs after eating reheated pan-fried pork from restaurant (It was properly refrigerated)
    -Vomit looked like coffee grind/papaya seeds
    -Culprit: because maybe swallowed sharp bones from pork damaged GI Tract thus vomit because of internal BLEEDING and NOT food poisoning? Because reheated meat is hard to digest?
    -Unlikely to be contaminated because everyone else was fine. I was the only one that vomited. I rarely vomit.

    Viral Infection, possibly Strep Throat (July 2011)
    -Took 14 Tylenol and 1 Advil over 3 days, for painful Icepick Headaches. Could this have affected my gut flora?

    Wart (2009)
    -I had a cut on my finger that grew into a Wart. Could this have affected my gut flora?

    Antibiotics (2001)
    -Antibiotics for face Eczema. Fixed Eczema, but continues to reappear. This was last time I used Antibiotics.

    *Since Oct 7, 2012, daily:
    Sun (30-60 min) last time I got sun was summer 2011
    Cardio (10 min) sedentary for 2 years
    Diet (1 Fruit, 2 meals of White Rice, Fish/Meat, Veggie)
    -Water (1.5-2 L unfiltered tap, boiled)
    -Bone Broth (300 ml)
    -Iodized Table Salt (1/4 tsp)
    -Kiwi (2)
    -Chard, Collards, Broccoli, or Cabbage (4 cups, cooked til soft)
    -White Rice (3-5 cups)
    -Meat (1lb): Oyster, Chicken/Pork, Salmon
    -Recently: 2 Yolks daily, 4 oz Beef Liver weekly.

    *Since 2011: Eliminated Grains, Sugar, PUFA Oils, Caffeine, Junk.
    *Jan-Aug 2012: Pinto/Split Peas (3 cups daily)
    *May-Aug 2012: 1 tsp Dulse, 1 cup Irish Moss
    *Summer 2012: Brown Rice from Texas, possible Arsenic (3 cups daily)
    *Summer 2012: Fruits (3-4 daily, Avocado, Banana, Orange, Mango)

    1. What do you think caused the new Food Allergies? Likelihood of Leaky Gut? Gut Pathogen? Something else?
    2. Can eliminating veggies improve the gut?
    3. Are these correct conclusions?: Strep/Warts affect the gut flora? Vomiting blood indicates damaged gut thus can cause Leaky Gut even 9 months later?

  3. Hi Paul,

    Last time I posted, you recommended adding NAC when I’ve reached a plateau. I have a really good doctor who is well informed and recommended I take GI revive. Are you familiar with the product? It has 1500mg glutamine (which I know you are not crazy about), 1000 mg NAC, 1000 mg citrus pectin and a few other things that are in much smaller doses. Any thoughts on this? I’ve been taking it for a week and it seems good so far.

    Also, I was reading a post in which you responded to someone asking about a rash. I have a spot on my chest just that has been itchy for quite a while. I put cortizone cream on it and it healed in a few days. A few weeks later, I had the same type of itch on my nipple. I went to the doctor and she prescribed cortizone. Now, the rash has returned again near my cleavage area on my chest. I feel really good and I don’t notice anything else that is strange….

    • Hi Lauren,

      Well, the glutamine sometimes helps and sometimes doesn’t. The other ingredients sound good. It seems like a reasonable product, I’m glad it’s helping you.

      I don’t want to try to guess what’s causing the rash, I’ll leave that for your doctor. One possibility though is that the NAC is improving your immune function. Whenever I’ve been recovering from an infection, I tend to get skin rashes, I think from cell wall components of dead microbes making the immune system jumpy. So the rash could actually be a sign of healing. If so it will go away as you continue to heal. Taking bentonite clay during your daily fast may help clear any immunogenic compounds a bit faster.

      Best, Paul

      • Thanks again Paul.
        I have made so much progress, it is almost funny how nit picky I can be now. I truly am healing, I can feel it! I will give the rash some time. I truly thank you for all your work from the bottom of my heart. You changed my life. I feel good so much of the time now, I had no idea what I was missing out on in life feeling so poorly for the last 20 years. Removing gluten was my first step and everything else is icing on the cake. Thank you, thank you!

        • My 5 year old daughter wasn’t thanking me today at a birthday party when I said no to pizza, cupcakes and birthday cake-but hopefully she will one day! She has some health issues, so I know she will be thanking me one day! 🙂

        • That’s wonderful, thank you for saying it! Bless you little girl, hopefully everything heals for her.

  4. Hi, Paul. If a person merely has a conversion issue but has had a decades+ long stretch of every single hypothyroid symptom, would taking a glandular thyroid supplement suppress natural thyroid function or make matters worse for other possible scenarios such as Hashi’s or true hypothyroidism? I’ve heard arguments for both sides. Along the same lines, does prescription T3 suppress one’s own thyroid?

    I’m wondering if the same concept may or may not apply to the adrenals – would a glandular adrenal supplement negatively affect one suffering from adrenal fatigue? Given the relationship between the thyroid and adrenals, I’m hesitant to do anything other than dietary/supplementation/lifestyle practices which support both glands until I know more about how natural (but well educated and researched) self-treatment may potentially do more harm than good. Already following your diet, for starters!

    • Hi Jen,

      Hormones are highly regulated but have significant fluctuations along circadian and other rhythms. One risk of taking thyroid supplement is that you give an unnaturally large dose at one moment in the day, then it gradually disappears, so you are imposing an unnatural rhythm on the body. This can have negative effects.

      The effects are larger with higher doses. So you always want to take the minimum dose that leaves you feeling acceptably well.

      Glandular/natural supplements will vary in the doses and they’ll have the more powerful T3 hormone, so the risk of taking too much increases.

      Prescription T3 works the same as T3 from natural sources.

      Adrenal hormone supplements would have the same issues – maybe worse because I think the variability in adrenal hormone levels is greater.

      I think replacement hormone in hypothyroidism can be highly beneficial, but the doses must be kept low, and decreased as health improves. The hormones themselves don’t heal, so diet and nutrition are keys to healing.

  5. Update for you Paul: your last post to Jen about hashis hit home. Since I last wrote to you I had an experience where nature throid was causing me hyper symptoms, internal shakiness, heart palps increased (I have MPV and believe it was aggravated by the thyroid hormone), temperature was 99.9 at waking and very high all day. I went OFF nature throid (was only on 11/2 grains) with approval of my doctor after I insisted I wasn’t doing well on it. Day one off thyroid meds: normal temps all day with mid day average of 98.5-98.6, joint pain has lessened and palps are almost gone. My gluten soy free unrefined Whole food diet with safe starches has been in effect over a year now, adding iodine seemed to have opened receptors to thyroid and things seem to be better OFF thyroid meds. One question for you: my FREEs t3 and t4, are low normal. Is it possible the blood levels jut hasn’t caught up with the symptoms I was having OR could this be Low T3 syndrome Chris kresser talks about? Thank you!!

    • Hi Carmen,

      Congratulations, that is an important milestone, to improve thyroid function and nutritional status enough that you can get off medications.

      Low normal thyroid hormone levels are still normal, especially if TSH is low; you can raise them with more calories/carbs, but of course we debate what the optimal level of carbs/thyroid hormone is. You might experiment and see what level of carbs makes you feel best.

  6. Thanks Paul… Watching things closely and not getting hopes TOO high but happy all the same that things are better so far.

  7. Hi Paul,

    I’ve tried to convnce my father to eat a PHD diet. Not so easy for an old european man to be involved in dietary concerns.. anyway..my father is suffering from a myeloma. In this particular state,would you recommend to take NAC ? If not, what kind of supp. or PHD formula would you recommend ? Thanks so much.Best,
    PS : Glad Sandy kept you safe. Do you have some news of Erp family’s issues ?

    • Hi Maya,

      Hmmm, good question.

      I don’t know whether NAC would help or not. Myelomas are probably viral in origin in most cases, and NAC helps against some viral infections but not others, eg http://www.ncbi.nlm.nih.gov/pubmed/19732754. On the other side, NAC tends to enhance immune activity and with an excess of poorly functioning white blood cells that could be bad or good (or both at once).

      Looking in Pubmed I didn’t see any papers evaluating whether NAC helped or hurt myeloma patients, except for one showing that it can be helpful to protect normal cells from the effect of an anti-myeloma drug, if taken after the drug: http://www.ncbi.nlm.nih.gov/pubmed/21526377. However with other drugs it might protect the myeloma cells from the drug, by acting as an antioxidant: http://www.ncbi.nlm.nih.gov/pubmed/17051330.

      In short, I don’t think anyone knows the answer to that question. If it were me I might try taking it intermittently — say, a hefty amount one day per week.

      Best, Paul

      PS – I haven’t heard from erp in a while. I know her daughter and son-in-law have a very long recovery ahead of them.

      • Thanks a lot Paul. Your answer is very helpful because I had read so much about NAC, I was a little bit upset…
        I was afraid his recent monoclonal spike was due to this supp. I suggested him to take for his chronic bronchits… 🙄
        Thanks again.
        Concerning the PHD formula you recommend, should he modify any kind of the ratio carb/prot/fat you recommend ?


        • Hi Maya,

          Well, if taking NAC is followed by a rise in WBC, then it may be protecting them from death and might be a bad idea. Is he on drugs? He should discuss the NAC with his doctor. I hope it helped his bronchitis.

          I can’t think of any reason to modify the PHD diet.

          • Hi Paul,
            My dad was on drugs one year ago. Then, hematologist conseidered he could stop the drugs.He is just under reguar blood tests since then. Right now, the last blood test indicate high WBC… I assume it’s the NAC ..?! . so sorry for that. 😕 He is so confident in the supp I can recommend him..Anyway, NAC helped him with chronic bronchitis ; better breathing, less tiredness..

            Thanks a lot Paul for taking care of each of us the way you do. So grateful for the time you spent on it.

            Best for you and all of yours,Maya

    • maya, thanks so much for asking. they are both doing very well. our daughter is in rehab and our son-in-law who was more badly burned is a couple weeks behind her. i credit their amazing recovery to their fabulous medical teams and the prayers and well wishes of caring compassionate people and we thank you from the bottom of our hearts.

  8. Hi Paul,

    First of all – thank you. I started on the PHD a couple of years ago after buying one of the earliest copies of your book (you were kind enough to ship it to New Zealand). I’ve found it extremely successful, with a couple of nagging issues (rosacea for example) resolving totally. I also noticed greatly increased energy.

    I wanted to ask for an opinion on how you’d adapt the diet (if at all) and supplement recommendations for a young child who needs an immune system boost. My son (2 years old) gets very frequent colds and a very, very persistent cough. I haven’t tried any supplements yet, however will start D3 – and was hoping for any thoughts you had on what might be effective.

    Many thanks – and thanks again for making such a contribution to my health!

    • Hi Conor,

      Glad to hear you’ve done well!

      Two years old is old enough that the diet should basically be similar to adult PHD, only with a bit more carbs, a bit less protein proportionately.

      Respiratory infections may be due to lack of vitamins A, D, or K2 — A and D are important for mucosal immunity, and K2 collaborates with them. So I would optimize his D, supplement some K2, and feed him liver, egg yolks, carrots, and sweet potatoes.

      Also, bone broth soups, shellfish for zinc, beef liver for copper, would do him good. Magnesium supplements once in a while.

      You could also ask the doctor to check his iron levels, make sure they’re not high. Hemochromatosis, which can arise from any number of common genetic mutations, leads to high iron and poor respiratory immunity. If so he could have phlebotomies/blood donation until iron is normal. Also, check his lipids, make sure they’re optimal (TC 200-240 mg/dl = 5.2 – 6.2 mmol/l). If that is off it could impair immunity.

      Best, Paul

  9. Hi doc,

    if someone has a stool test that reveals healthy levels of good bacteria, would that effectively rule out a case of candida overgrowth?

  10. Wild-caught seafood like shrimp can be hard to eat ethically due to the trawling and side catch of other fish. Do you have any recommendations?

    • Hi Molly,

      I don’t want to get into ethical recommendations. All I can say is that it’s very difficult to find foods to eat that don’t have some flaw somewhere in the food production system, either morally or in healthfulness.

      So we just have to do the best we can according to our own judgment of what is right and what is important. It helps to be an informed consumer, to know your local farmers and food producers, but in the end there’s only so much most people can know.

  11. How much added fat is ok in the form of oils outside of what is in meat/fish? I am eating more protein than you recommend (about 25-35%) because I have a hard time getting enough calories without it, unless I add a ton of oil. I would say on average I already eat 4-5 tablespoons of added oil in the form of coconut oil, olive oil, and minimal butter. I don’t do any other dairy and I particularly struggle on days that I eat something low in fat like shrimp.

    Also what is your opinion on fermented food making SIBO worse? I strongly believe I have some form of SIBO. Thanks!

    • Hi Elyse,

      I’m surprised you need 4-5 tbsp of added oil to get adequate calories. You didn’t mention carb intake — are you eating our recommended 1 pound per day of safe starches, plus 1-2 pounds of other plants, plus “supplemental foods” like 3 egg yolks per day?

      If you are well nourished and still hungry, then there’s nothing wrong with getting more fat.

      The interaction of fermented food with SIBO is complex. It could help or hurt. It is more likely to help the colon than the small intestine, which is a relatively antiseptic environment if you’re properly producing stomach acid, pancreatic enzymes, and bile.

      In SIBO it’s important to focus on oral health, stomach acid (maybe take betaine HCl with meals), and bile production (taurine, vitamin C).

      I think fermented foods are probably more likely to improve SIBO than not, but there’s no guarantee.

  12. Hi Paul,

    I don’t eat 1 pound every day…I carb cycle with an average of 50G most days with 1 refeed a week. Veggies are limited because I’m avoiding FODMAPs, but I get at least 30-50G from those most days. I wrote to you previously about coming off of GAPs and my acne getting worse after adding starches which is why I’m not doing a pound yet.

    I feel better physically, but my skin is still suffering, some acidic feelings in my esophagus returned, and I still have issues with constipation. I will try HCL, but I noticed the one I purchased has maltodextrin, is that ok? I also just got some NAC. I think I might stop taking Biokult and just do homemade ferments? I have always been on and off with Biokult. I’ve been taking a little once a day this past week and I havn’t had a BM in 5 days!! =( Thanks as always. Your book is going to be gifted a lot this holiday.

    • Hi Elyse,
      I just wanted to say that I’ve stopped using Biokult because just one capsule is enough to make me constipated for a few days. I really don’t think it has anything to do with die-off but rather with the quality of the probiotic supplement. I’ve heard from others who had problems with Biokult as well. Maybe you could try a different probiotic to see if it works better for you.

      • Thanks Erik. It’s so confusing because the GAPs community will have you believe that all negative reactions are some form of die-off and to push through it…but I have a hard time believing that. I like how Paul advocates listening to your body.

    • I think the maltodextrin in the tablets is fine.

      Stopping Biokult sounds like a good idea. I think homemade fermented vegetables are a better probiotic.

  13. Hi Paul,

    What do you think of Almond Flour(100% almonds) pancakes lets say once or twice a week? It comes out with a perfect PHD ration with 2-3 eggs and 1 cup milk mixed in but obviously maybe high in Omega6s?

    Also which sweetener do you prefer, is Xylitol ok for cooking?

    • Hi Steven,

      I think once a week is OK if you tolerate almonds well. Remember all nuts have some toxins so they are pleasure foods not staple foods.

      Sweetener – dextrose powder or safe starch syrup or low-fructose honey.

      Don’t know if Xylitol is safe in cooking.

      • xylitol in excess can cause diarrhea…I have sprinkled it on my cereal, and 3 hours later, you need to rush to the bathroom…on the other hand, it is IDEAL for gum or mouthwash.

      • Hi Paul,

        What about Stevia?

        My local farm has these organ meats, Is there any real difference and what are the benefits?
        Lamb Liver(Any difference from Beef Liver?)
        Lamb Heart
        Lamb Kidneys
        Beef Tongue

        Beef tongue has Calorie breakdown: 65% fat, 7% carbs, 28% protein.
        So this is almost a perfect superfood right for PHD?

        • Hi Steven,

          Stevia is OK as a sweetener, I don’t know about cooking it.

          Lamb liver is almost identical to beef liver.

          Liver – rich in vitamin A, folate, copper, other nutrients
          Kidney – rich in selenium
          Heart – generally nutritious

          I wouldn’t say tongue is a superfood but it’s certainly a healthy, beneficial meat. It takes a little more effort to cook (boil it, remove the skin, slice thinly) but it is quite tasty.

      • Steven,

        Have you tried making the pancakes with a mix of almond and other flours such as white rice, tapioca, potato etc?

        • I actually have potato flour, that is a good idea maybe I will try. But it is not necessary to have any flour, if you just add eggs and no water the consistency is pretty good.
          I think I will just buy coconut flour and this way avoid and toxicity. Probably can make them much more often.

  14. Hi Paul/Steven,

    Hope Paul will not be upset cause I give an answer 😉 . I’ve read somewhere that cooking or baking with xylitol not a good idea. don’t exactly remember the site it was a dr.wright or something. i think was just an opinion not scientifically proved but…


    • What about Stevia? Dextrose is all glucose but still very high on glycemic index. It seems empty carbs with no nutrition. I would rather have a baked potatoe, but still need to sweeten pankaces somehow 🙂

  15. Paul, can you remind me of the levels of cholesterol, HDL, LDL, Trigs, etc you’d expect to see in someone on the PHD? I think it was in your book, but after I ordered the new edition on Amazon, I gave my copy to the local library!

  16. Hi Paul, I’m still having symptoms of low HCL even though I’m taking HCL and enzyme supplements. On top of that I become very fatigued, congested(sinus) and depressed after every meal(eating PHD foods). Is it safe to assume I have a leaky gut? If so, should I follow some type leaky gut protocol such as GAPS diet for a bit to see what kind of results I get? I was thinking also about just eating broth and marrow for a week.

    • Hi Jonathan,

      At this point I would test removing foods and food types to get an idea of the cause.

      First, how do the symptoms depend on carb intake? If you go very low-carb do the symptoms go away?

      Second, how do they depend on protein intake? Stomach acid is mainly important for protein digestion. If you eat extra protein, do you have more trouble?

      Third, if you minimize toxic/immunogenic foods that may be causing food sensitivities are you better? Plant proteins are the major source of toxins. Ordinarily they are degraded in digestion and not a problem, but with poor digestion they may cause a surge of immune activity after meals. If you cut out immunogenic foods like dairy, egg whites, nuts, and many vegetables are you better?

      Fourth, if carbs are a problem, is it only a specific type of carbs? Can you eat simple sugars like dextrose without difficulty? Is it only fiber and starch that give you trouble? Or do fructose sugars give you trouble? FODMAPs? This can tell you whether it is a small bowel problem or a large intestine problem.

      After experimenting I’d probably go to a doctor and ask for appropriate diagnostic testing. Eg, for a small bowel issue SIBO and H pylori testing; for a large intestinal issue a stool test.

      A little experimenting will tell you what kind of diet will minimize problems, and will provide clues for helping you utilize your doctor.

      Broth and marrow could be a good part of a very low-carb diet test.

      Best, Paul

    • as i side note on the HCL pills,
      i was reading anecdotes on paleohacks or iherb (or both) that betaine hcl in tablet form did not work (in these particular anecdotes), whereas betaine hcl in Capsule form did tend to have some effect/work.

      just thought i’d mention this in case you had betaine hcl tablets, if so it may be worth trying again with capsules instead.

      all the best

      • Thanks for your recomendation. Actually, I did try the capsule form by now foods(super enzyme) but I just didn’t see any results. There’s got to be more going on, I’m going to experiment according to Paul’s recomendations and hope for the best. THanks again.

  17. Keep us updated Id like to hear what you find!

  18. Hi Paul,

    Does “coffee grind” vomit ONCE in Jan 2012 count as a symptom of Ulcers/H. Pylori? I don’t have any other symptom of Ulcers/H. Pylori, so I was thinking of crossing it off as a possible condition. But is it common to be asymptomatic?

    Also I was reading on a thyroid forum… “functional ranges” according to Dr. Kharrazian:
    TSH 1.2 uIU/mL (functional range 1.8-3.0) thus low
    FT4 1.1 ng/dL (functional range 1.0-1.5) normal

    Would you agree/disagree/indifferent with his ranges? Do you have thyroid ranges that you consider ideal? Should I be concerned about a TSH of 1.2?


    • oops sorry double-posted. There’s no reply button up there…

      Anyhoo, YAY for normal/almost perfect TSH!!

      Sorry wasn’t clear “coffee grind” vomit is what vomit looks like when it contains blood.

  19. Dear Doctor Paul:

    I went to a top gastroenterologist today for worsening digestive issues. for the last few months ive had brain fog, abdominal pain, abnormal bowel movements, faigued, etc.

    I strongly suspect candida overgrowth, as many symptoms match and I have a history with antibiotics.

    the doctor, while seemingly very knowledgable, completely dismissed candida as a “quack theory.” he theorized that I might have SIBO, and whats me to do a bacterial breath test. he says if the tests are positive, he’d like to start me on a new course of anitbiotics.

    obviously, this makes me very concerned as i believe candida may be the source of the problem.

    i have a very strong (225 billion CFU) probiotic that i take daily, so im tempted to think a course of antibiotics would be ok if i kept up the regular course of probiotics, but knowing the true nature of candida makes me extremely reluctant to even consider it.

    also, id like your opinion on whether daily dosing of probiotics would affect a breath test for bacterial overgrowth?

    thank you very much

    • bill, I had the same symptoms – especially the brain fog. The symptoms all went away when I added more carbs back into my diet (I was eating low-carb paleo).

      Hate to say it but might be worth adding more rice, starches and even some pasta back into your life.

    • Hi Bill,

      Re Syl’s suggestion, I would try eating according to the PHD food plate for a while if you aren’t already, that often clears up many issues.

      I think there’s nothing wrong with having diagnostic testing for SIBO which is a possible explanation for your symptoms. Then you can decide about the antibiotics.

      Probiotics don’t prevent antibiotics from reducing the diversity of gut flora. On the other hand, you can knock down SIBO with a shorter course than would be required to eradicate other species, so it shouldn’t cause undue problems if you do try the antibiotics.

      Doctors are quite unwilling to consider the fungal possibility, it’s just a community blind spot and they all herd together. Lack of good diagnostic tests makes it hard to change their minds. At the same time, fungi tend to be pretty low-symptom infections until they become disseminated. So I wouldn’t expect a fungal infection to account for your symptoms unless it was also causing hypothyroidism, which you should be able to see in thyroid tests.

      Also worth considering is a stool test such as Metametric microbial ecology profile. That would be good at detecting infections, especially in the large intestine.

      You can also do diagnosis with food. Start with basic PHD and vary it — I gave some tips to Jonathan the other day: http://perfecthealthdiet.com/q-a/comment-page-41/#comment-98755.

      I think once you get a better diagnostic picture it will be easier to find an effective path forward.

      Best, Paul

  20. Hello, I have purchased and read your book and am now looking for a good source of cheap supplements. Unfortunately the supplements you recommended do not ship to my country (australia) Do you know any good companies with international shipping? THank you.

  21. Dear doctor paul.

    I would like to thank you very much for your eye opening book. I have been an avid reader of mercola.com and am a huge fan of Sally Fallon and Gary taubes, so I was surprised to see somebody top them with new insights!

    I have suffered from a chronic pain condition for about 6 years now and have also had irritible bowel syndrome for almost 10 years (since I was 16). I manage my pain condition with a pwoerful Tens device, which I need to use for a few hours every night.
    I have tried exhausted almost every resource thusfar to no avail and was wondering if you could provide any insight? I am currently following a hybrid between your diet and the GAPS nutritional diet, which advocates lots of home made broths and fermented beverages to heal the gut lining.
    The pain condition is particuarly confounding because I cannot get a clear diagnosis or cause. It is similar to fibromyalgia, in the sense that it is generalised pain, but it lacks some of the classical symptoms of fibromyalgia.
    the pain is best releived when I treat my neck, tmj and legs with the tens device.

    Thank you for your time.

    • Hi Marcus,

      I don’t know what is going on, but I generally suspect chronic infections in such conditions.

      You might look for diagnostic testing, eg a stool test such as Metametrix Microbial Ecology profile sometimes turns something up. Also, other symptoms (do you have subclinical hypothyroidism? acne? etc) can provide clues.

      You might benefit from reading patient forums, such as cpnhelp.org, and seeing if other people with similar symptoms have insight.

      Also, be sure to promote immunity with circadian rhythm strategies (discussed in the new edition) and other tactics like intermittent fasting; and arrange to be well nourished, but not excessively overnourished.

      Have you ever tried antibiotics?

      Best, Paul

      • Paul,

        You advise her to not be overnourished.. and I have often wondered about that.. such as when I add pats of grass fed butter to bone broth soups, chased with cod liver oil and a higher dose of d for the day, for example. I sometimes wonder if I am doing too much. Does nourishment follow a U shaped curve?


        • Hi Lindsay,

          Well, fat is fairly benign, it doesn’t circulate at high levels and feed pathogens, but gets stored in adipose tissue, so if you’re not gaining weight it’s OK.

          I was thinking more of minerals and some B vitamins.

          Yes, in biology most things follow a U curve.

      • I have not tried antibiotics for the pain condition specifically, though I am on a very high homemade probiotic diet at present (I drink 5 cups of whey strained from home made kefir a day), and that appears to be helping with my IBS symptoms. I might try that test you mentioned and see where I go from there, thanks.

      • I havn’t tried antibiotics specifically for pain treatment but I am on a high probiotic diet, drinking 4 cups of kefir whey a day.
        I have also noticed mucus in my stool since adding whey to my diet. Is that normal? Thanks.

  22. Hi Doctor Jaminet,

    I am wondering about carbohydrates for breakfast. I have read in various places that Carbs are not a good breakfast food because of increased insulin sensitivity at that time of day.

    However, I remember reading in your book that Fruit is best consumed in the morning.

    What are your thoughts on carbs for breakfast? Are carbs from fruit different from those in safe starches?

    Also, I have a very hard time fasting through the morning so this is not an otpion for me.



    • Hi Jackson,

      Fruit is a good snack so you can have it any time of day, but generally not at meals.

      Since we recommend intermittent fasting, breakfast if it happens at all is usually a sort of snack, so a banana or such is not out of place. But protein is probably more important than carbs at breakfast. So a boiled egg or two would be better, alone, or with the piece of fruit.

      Carbs later in the day tend to help sleep, so in general we would bias carbs toward the evening rather than the morning.

  23. Firstly, thanks for the book, a very good read.

    I’ve suffered from Colitis and IBS (sometimes the boundaries seem to blur between digestive disorders) for over 10 years now, almost definitely as a result of over subscribed antibiotics as a teenager. Many years ago I instinctively found that gluten was especially problematic and after further researching I came across ‘breaking the vicious cycle’ by Ellaine Gottschall. Following the SCD did help but the recovery process was a long one with plenty of ups and downs. I had a big breakthrough when I took part in a trial for the probiotic VSL#3 which really seemed to help and I still take it today.

    Unfortunately over the years, thinking I was completely healed, I stupidly lapsed back into my old eating habits consuming sugar and gluten weekly and drinking plenty of beer. After a few months of this the digestive problems would start once again. During my last few flare ups (bloating, gas, diarrhea multiple times every day)I further researched diet and finally stumbled across Paleo and in particular Robb Wolf’s page. However, to keep my calories up I was eating a LOT of meat (over 1kg/2.2lbs of meat, poultry and fish)as fat seemed to go straight through me, as did healthy veg like spinach and carrots. I was so centred on zero carbs that I didn’t realise that the excess protein could also be causing problems. I instictively added sweet potatoes and ripe mashed bananas back into my diet and things settled and I got well again. Having read your book recently the information ties in with my experience that having some moderate safe carbs in my diet makes my body function much better than going super low/zero carb.

    I still have a long way to go as I find it hard to digest red meats, too much fat and veg. My ‘recovery’ diet is based at the moment on fish, poultry, olive oil, omega 3 oil, bananas and sweet potato. Hopefully in time as my digestive tract heals I can replace some of the poultry with more grass fed beef/lamb and also introduce some veg and coconut oil.

    My main question is with regards to Omega 3 oil as a supplement to reduce inflammation. Your diet seems to agree pretty much with Robb Wolf’s paleo ideas, except that he recommends very high doses of omega 3 oils in cases where inflammation is a problem, whereas the PHD recommends no more than 4% of daily calories. I’m currently taking 6-8g daily of EPA+DHA to help with inflammation issues. This is less than Robb Wolf recommends but still way more than allowed in the PHD. Do you think this level of supplementation would benefit me in the short term? Could it cause problems even if this high dose is only used for a month or so? I do also eat about 1lb of salmon a week also.


    • Hi Rob,

      A problem with red meat may indicate that you have an iron excess — in that case iron is not absorbed well but it nourishes pathogenic microbes in the gut. So I would get iron levels tested and donate blood as necessary to get them down. Another possible reason for beef intolerance is allergy (actually a tick allergy that cross-reacts with beef sugars). It would be good to fix this and lowering iron levels will probably help you regardless of whether it lets you add beef.

      You didn’t make clear why you can’t reduce omega-3 now. Can you eat butter or sour cream? That would be better than olive oil, probably, because you want to minimize omega-6 rather than increase omega-3. Macadamia nut oil might be a good alternative.

      I don’t believe it’s healthful to have so much omega-3, but it is immunomodulatory and can tamp down symptoms. If that’s the case, you might try alternatives like low-dose aspirin to see if they work as well.

      Best, Paul

  24. Hey Paul,

    When I eat sweet potatoes, and the purple variety too, I get a lot of gas and my gut just doesn’t feel 100%. White rice doesn’t cause the same sort of thing… maybe a VERY MILD version of it.

    Would this indicate more of a problem in the large intestine rather than the short intestine (eg SIBO) do you think?

    I kind of think I might have some SIBO thing going on as I have Rosacea and there seems to be a strong connection between SIBO and rosacea. Here is a scientic study for example: http://www.metsol.com/wp-content/uploads/2011/02/Rosacea-SIBO.pdf

    Any thoughts?

    Thanks, Kristopher

    • Hi Kristopher,

      Sweet potatoes give a lot of people trouble, see http://perfecthealthdiet.com/2011/01/what%E2%80%99s-the-trouble-with-sweet-potatoes/.

      How do you do with white potatoes? They have more fiber than rice but fewer of the problematic compounds that sweet potatoes have. That would help narrow down the problem.

      It’s common to have SIBO and rosacea together but I’m not sure that SIBO directly causes rosacea. Rosacea could be due to circulating toxins from the gut, but may also be a disseminated infection, or something present in the oral cavity as well as the gut that can infect the vasculature and/or subcutaneous fat.

      • Paul,

        So Rosacea is not just subclinical hypothyroidism? Is subclinical hypothyroidism the main cause that make you more prone to infections?

        • I think the same things that cause rosacea will generally also cause hypothyroidism, and that thyroid disorders contribute to the redness. Not the same thing but closely related.

          • So generally that infection/virus/toxin is what causing hypothyroidism right? What would you test, white blood cell count and subclinical hypothyroidism?

      • Thanks for taking the time to reply Paul =)

        I guess it’ll all be in the new PHD book, but

        1. When it comes to Oral Cavity health, what do you recommend apart from diet/supplements? For example, I brush my teeth with a Coconut Oil and Bi Carb Soda mixture. Is this good?

        2. Do you recommend flossing? Any kind of natural mouthwath you recommend?

        I have found I got a lot of plaque since I started eating Paleo. Not sure what thats about.

        I’m really sick of this rosacea and acne!

  25. Paul, my cholesterol numbers were ok with your limits, but my Trigs were178…any idea why, or how I could lower them?

  26. Hi Paul,
    I would like to know what your thoughts are on taking fermented cod liver oil for vitamins D and A? Thank you! Jamie

    • Hi Jamie,

      I recommend other sources: liver and egg yolks for A, sunshine and supplements for D.

      Cod liver oil is a possible backup source, personally I would prefer fresh to fermented, I am not completely convinced fermented is safe.

  27. Hello there

    I have been experementing with your diet for some time after being a long term vegan and have some very encouraging signs .
    I was diagnosed with HIV more than 10 years ago and was in general terms doing great while following a diet with mostly raw greens and vegetable fats.However there was a time when i was eating a lot of fruits and my health decline and i end up getting Kaposi sarcoma.While getting on antiviral therapy the KS somehow stopped growing but the pigmentation and some tumors are still there . It seems to me that KS is a viral disease but can’t be 100% sure. Scientists believe that a type of herpes virus is responsible for it .I seem to get better on a ketogenic diet but i have become more sceptical about being on a low carb diet for long term since reading your research about very low carb diet and fungus infectios.Intermittent fasting is one that for sure works but can you help concerning the amount of protein i shoud take?I need to get sufficient protein for immune function but not get too high or too low as i did in the past .How many grams of protein whould you suggest ? Is it also safe in my case to add the starches you mention ?
    Thank you ! 😀

    • Hi Kostas,

      Kaposi’s sarcoma is caused by human herpes virus 8 (HHV8), see http://en.wikipedia.org/wiki/Kaposi%27s_sarcoma.

      Your case is interesting. It sounds like HHV8 must flourish on a vegan diet. All extreme diets favor some pathogens and disfavor others. I haven’t researched HHV8 and can’t tell you if a ketogenic diet might be helpful.

      In general PHD is a neutral diet which focuses on nourishing the human body as well as possible. It is a good diet against a wide range of pathogens, but not necessarily optimal when you know a specific pathogen that is causing you trouble.

      Again, I haven’t researched HHV8 to find a specific recommendation for protein intake, but as a general rule, low protein is more likely to be helpful against viral infections. It slows down viral replication and upregulates autophagy which may kill the viruses.

      However, you want to be sure you eat enough protein to support healthy immune function and other bodily processes. So don’t let yourself be hungry.

      I would say something like 0.8 g protein per kg body weight would be a reasonable choice. But again, I haven’t researched this and that could easily be wrong.

      Yes, I do think eating some starches is desirable. Experiment with from 200 to 500 starch calories per day. At the lower end you can still be ketogenic if you eat MCT oil. I think 200 starch calories + 250 protein calories + a few other carb calories + MCT oil for ketosis is an extremely minimal carb+protein intake, I wouldn’t go lower than that; and 500 starch calories + 250 protein calories would be a normal PHD type diet.

      • Thank you for your recommendations.

        I do not know if it is the vegan diet but a diet high in sugars even from fruits can make this condition to get ouf control for sure .I have witness that several times .

        Being on the diet for a month or so 2-3 of the lesions have gone almost completely something that did not happen in the past eventhough on antiviral therapy .So far the only carbs i eat are vegetables but now i will try adding some safe starchesn but again i will keep the low.I will stick to 200 calories .

        I also have a feeling that there are some bacteria involved in this pathology beside HHV8.Ofcourse i can never know that . HHV8 seem to look a lot like EBV.I am thinking also to add some antiviral herbs and may also use antiviral medication like Valtrex along too.I see some people are using this along with similar diets to combact EBV .

        Anyway thanks again and i will post again in the future about how things develop .

  28. Hi Paul,
    I have Fibro and IBS. I’ve done the cpn protocol for a year and that really helped with my fibromyalgia (thank you for that information). Unfortunately, I think it worsened my pre-existing digestive issues.
    Over the past few months, my digestive health has worsened. Anything I eat causes inflammation, joint pain, bloating, abdominal distention and pain, numbness and tingling in my arms and legs. All these sx become worse after eating. At this point, I can tolerate some bone broth with meat and some ghee with a boiled zucchini and .5 carrot mashed up in the soup. I still get some bloating and other sx with this but for less time and with less intensity. I had earlier been eating meat and starch predominantly per the PHD recommendations. Rice in particular really helped my constipation issues. I have had to stop all starches including brown rice syrup. I am able to tolerate .5 tsp of honey every day (which helps significantly in the morning with feeling exhausted). Any thoughts on what is going on?
    My doctor is finally willing to prescribe the Metametrix test. However, she has also recommended the “leaky gut” test (which is based on a urine sample). Any ideas/thoughts if that test is useful?

    • Hi Radhika,

      I think the diagnostic testing for the gut is the best next step, so I’m glad you’re doing that. The leaky gut test is fine but since you get bloated after meals it’s almost certain to be somewhat leaky; I’m not sure you’ll get actionable information. The Metametrix may show you a treatable pathogen.

      I’d guess that you need to gradually replace the missing probiotic bacteria that got killed by antibiotics, treat any non-bacterial microbes that got abundant in the gut when you were on antibiotics, and gradually restore foods to nourish the healthy bacteria.

      After the diagnostic testing, possible strategies could range as far afield as fecal transplants.

      • Thanks for the quick reply Paul. Appreciate it. Given the sx, I was wondering if I had SIBO. My sx also become worse after taking probiotic capsules and I don’t tolerate cabbage well (so fermented cabbage isn’t a good idea). I have been thinking about fecal transplants but am not sure they are helpful for this.

    • BTW, the worsening of digestive sx happened after 6 months of stopping the CPN abx. Just realized I had not said that.

  29. Hi Doctor Jaminet,

    I am considering switching to eating fish as my only animal food (I feel guilty eating cows, pigs, chickens and don’t think I would be able to kill them myself).

    Are there any risks involved with doing so? Would this cause an excess of PUFA intake? I would eat about 3/4 LB of fish per day and aim for sources with low mercury content like salmon.

    Thanks for considering my question,

    • Hi Rob,

      There’s nothing wrong with eating fish as the only animal food (but you should eat egg yolks and dairy as well).

      Salmon once a week and less oily freshwater and marine fish and shellfish the other six days would be a good choice.

  30. Hey Paul,

    One more question… you may not have any experience in this to form a solid opinion, but if someone has thyroid issues, skin issues, etc that point towards a probably infection of some sort, would a fecal transplant be of significant help?


    • Hi Kristopher,

      If the infection is confined to the gut, then it will likely help a lot.

      If the infection is disseminated, then it probably won’t help.

      I would do diagnostic testing of stool to establish the presence of a colonic infection before considering a fecal transplant.

  31. Hi Paul,
    What are the additions in the new edition of the book? Just wondering if it is much different from the old one.

    • Hi Steven,

      There are many additions, it is about 50% longer; also some corrections/refinements. Notable new material:
      – Introductory section on evolutionary indications of the optimal diet is greatly expanded, includes a discussion of food reward;
      – Chapters on the causes of obesity are included, including our theory of nutritional leverage;
      – A chapter on alcohol is new;
      – Sections on toxins induced in cooking and in the industrial food system are new or greatly expanded;
      – Micronutrient section expanded and advice substantially revised;
      – Healing and preventing disease section greatly expanded with discussions of microbial nutrition and risks of overnourishment or undernourishment, serum lipid optimization, and circadian rhythm management through lifestyle including diet, exercise, light exposure, sleep/melatonin, social connections.
      – Meal plan template.

  32. Hi Paul,

    I’m requesting SIBO/Stool Test, but wondering if I need additional tests to address my other problems? Since blood test was normal, my GP was unconcerned about my symptoms, but I’m positive something is abnormal. I noticed orange tinted skin on my chin in 2010. (Eyes are white. Rarely eat carrots.) I read that this indicates Anemia, Liver, Hypothyroid, or some kind of skin condition. Taking into account my other symptoms, which condition can I rule out? Which to get additional tests for? Anemia? Liver? Thyroid? (Difficult to request loads of tests.) I believe this is an external symptom of an internal problem, which can clue me in to my other problems (mainly energy, bowel movement, gas, skin, cysts, vision).

    NOT neon yellow like this man:


    SIMILAR to this woman, but mine is a deeper orange/yellow/greenish:


    Bowel Movement (Once a WEEK. Bristol 1/2/5. No straining), Trapped Gas, Tongue slightly white (yellow when wake up), Acidic/Warm Stomach.
    Eczema, Dry Skin, Orange Chin, Swollen lymph nodes under Jaw. Low Energy (sometimes decent energy).

    Always (Since Aug 2012)
    -Skin peeling off fingertips
    -Blurry vision (at a distance in right eye) sudden onset Aug 2012
    -Cysts in breasts (decreased, but still 5-10) sudden onset Aug 2012
    -Tiny Cysts that disappear/reappear on eyelash line (popping with clean tweezer releases a liquid, possibly cholesterol cysts)

    Odd Recent Problem
    Heart Palpitations (Aug 2012, Nov 2012)
    -Aug 2012: 3 days of Palpitations. This is when first noticed breast cysts. Nov 2012: 1 day of Palpitations.
    -Occurs 1 week after Period. Accompanying Symptoms: Sensation in ovaries; Post-Period Spotting; 2 weeks of low-grade pain lasting 5 sec (comes and goes) mostly left side of left breast, sometimes inner side of left arm, and sternum.

    -Improved, recent Food Allergy/Blemishes due to Wonton Noodles (9/1/2012 to 10/31)
    -Cured, Hair Loss (Once age 13, Again Sum 2012)
    -Cured, Cyst in Finger (2011): disappeared in 1 week.
    -Cured, Cysts in right and left sides of Neck (Kid/Teen): disappeared/reappeared over the years.

    Age 25. Body Temp 98.1 with normal Breathing, Hearing, Sinus, Weight.
    Thyroid: FT4 1.1 (0.8–1.7) TSH 1.2 (0.1–5.5)
    Liver: ALT 10 (< 36)
    Anemia: RBC 4.3 (3.6–5.7) Hgb 12.8 (11.5–15.0)

    1. Does any of the following symptoms offer insight to another problem (anemia, liver, thyroid, hormones, etc)? Orange chin, Swollen lymph nodes under jaw, History of cysts. Recent sudden onset of Palpitations, breast cysts, blurry vision.
    2. Likelihood of symptoms due to Thyroid if TSH (1.2) FT4 (1.1), 98.1 body temp, no weight issues? I was not allowed a full thyroid blood test, but what is the likelihood of problems due to FT3/RT3/Antibodies?
    3. Likelihood of Liver problems (re: orange chin)?

    Your input is very much appreciated!

    • Hi,
      I just wanted to let you know that chocolate gives me terrible heart palpitations. It did not used to be that way, but it happened after my exposure to Lyme. It doesn’t take much chocolate, either, for symptoms to occur.

    • Hi Monnyica,

      The swollen lymph nodes and other symptoms sound like some kind of infection, but it is impossible for me to diagnose this. It is a problem for a doctor.

      Our best advice is to follow the diet and lifestyle recommendations in our book, then hopefully some of these issues will clear or diminish, and see a doctor about the rest.

  33. Hello Paul,
    Question on olive oil and omega 6.
    Hearing great things about olive oil (good ratio of omega 3 and 6) I use it with red wine vinegar as my go to salad dressing. However, I can enjoy my salad just as much with just red wine vinegar alone or white vinegar alone. Would I be technically better off ditching the olive oil on salads to cut out the omega 6 from it.


  34. Hi paul;

    I’d really like to do a brief 5 day water fast before thanksgiving for my skin….I find fasting is a really good quick fix for skin care.

    However, I have a lactulose hydrogen breath test for SIBO tuesday morning. My concern is that fasting for 4 days prior might temporarily beat back the bacteria and give me a falsely negatively reading- I know fasting is excellent for bacterial overgrowths.

    If I do have SIBO, I’d like the test tuesday morning to reveal it to it’s ful extent.

    What should I do? Would starting a fast today be ok?

  35. Hi Paul,

    I had a few questions. I apologize if you have answered them before:

    1) I had terrible IBS for years. Upon recently beginning to take Vitamin D, the majority of my symptoms seemed to go away, which has been wonderful. However, for about 7 or 8 months I have been taking 5mg of Biotin a day, which also made me feel much better during rough IBS flare ups. I’m not sure why it has helped. I’d like to keep taking it, but I know you mention taking too many B vitamins is not a good idea. I was wondering if it’s okay to keep in my daily supplements, or if I should remove it and only take it once per week?

    2) I am just beginning to eat within the guidelines of the PHD diet. I, however, have found that regardless of what I eat, during the second half of my cycle (two weeks before my period) I crave chocolate so intensely it’s actually distracting from daily life. I literally dream about it. It is frustrating, but obviously not a huge issue. I just added your daily supplements a few days ago, but was wondering if it is a sign of mineral deficiency? Are there any foods you can recommend that could maybe be a substitute?

    3) I was wondering if you had any general advice for managing PMS. I have horrible cramps, moodiness, heavy periods, sharp breast pain, and unreasonable food cravings. I recently started taking evening primrose which seems to take some edge off, but was wondering if you had any other suggestions?

    Thank you so much for your time and for this wonderful website.


    • Hi CB,

      Biotin is safe, I don’t believe there are any negative health effects from taking 5 mg/day. However, its effects (biotinylation) saturate as the amount of biotin goes up, so you may not get any benefit from taking so much. We recommend 5 mg once per week which is plenty for most people. If you’d like to save a bit of money, you might try twice a week and see if you notice any IBS problems on the 3rd/4th day.

      The chocolate cravings in sync with the cycle are interesting. I’m not sure what to make of it; possibly some of the women in the audience will have insight. Let me know if it changes after you add supplements. Chocolate is rich in copper which is important for blood vessels and there is a lot of blood vessel formation in the latter half of the cycle, so beef liver or copper supplements might fix it.

      For PMS, I would just try our diet and supplements for a while. Cramps often indicate magnesium deficiency. Food cravings are often nutrient deficiencies. Heavy bleeding could be consistent with copper deficiency. You just don’t know until you eat well and see if they go away.

      Best, Paul

      • CB,

        I’m going to go out on a limb here and guess that many of your issues are stress related. IBS, is generally linked to stress as are cramps, cyclic breast pain and cravings. There seems to be some complicated interaction between the stress response and hormones, especially in women.

        I too have mild symptoms of IBS, but only when stressed and during those times I also have a marked increase in breast pain. I have yet to find anything that works… no amount of diet or supplements have completely solved the puzzle. My IBS symptoms can be kept mostly at bay with high doses of probiotics, but the cyclic breast pain is a mystery. The only thing that really calms my stress and keeps me pain free is intense exercise many times per week.

        I know, this is not helpful, but sometimes it is nice to know you’re not alone! Hormones are so complicated.. and implicated in so many issues. Good luck! Do let us know if you find something that really works.

        PS. I should note that I am going to start taking ground flax seed on a regular basis and see if that helps with the cyclic breast pain. According to PubMed it is really the only proven relief for hormonal disturbances related to the cycle.



    • I definitely think you will see improvements with your PMS by following the PHD Diet. It might take time but I think you will find that an increase in good fats and proteins will improve your hormones.

    • Hi CB,
      I think you’ll feel much better with the PHD diet. Per the PHD diet, it’s really important to make sure you’re not getting too much PUFA (flaxseeds, chicken, salmon)(I would avoid flaxseeds) and make sure you’re getting enough saturated fat. Personally, I feel much better following the PHD diet and my PMS symptoms have been reduced greatly! Don’t have cramps anymore. I also eat raw carrots as a snack on an empty stomach per Ray Peat and I think that has helped too. http://mamanatural.com/a-carrot-a-day-keeps-pms-at-bay/

      I still get some chocolate cravings and want to eat a little more during my PMS week – like clockwork, but it’s very slight and manageable. Good luck to you!

  36. Hi CB, I can share with you some experiences I have had with cramping through my journey with different diets. When I was eating a SADdiet, before April 20111, my bleeding was very heavy, and dark. My cramping was terrible! After I started eating a no grain/no legume/no nuts & seeds vegetarian diet with daily raw vegetable juicing and weekly colonics, my cramping was barely detectable. The flow was a bright red also. I went through a stressful time and started cheating on my diet with almost daily Kettle potato chips and the cramping started to be intense again. Now that I am eating a diet with more organ meats, (animal fats and protein in general), my cramping is back to a minimum again. I have never stopped my weekly closed gravity method colonics and daily vegetable juicing, by the way. I don’t really see a pattern with the examples I just gave you, but maybe in some way, it can help.

  37. Hi Paul,

    My wife’s getting several mercury fillings removed. Is there anything she can do to detox ? The dentist recommends high-dose C following the procedure. I’m thinking bentonite clay might be a good idea too.

  38. Hi Paul,

    I started to experience severe issues having been on a VLC diet for about 1.5 years including breathlessness, panic attacks, worsening constipation, fatigue, dry eyes, bleeding gums and what felt like electrolyte imbalance.

    Having reintroduced starch many of these issues are better, although it will take some time to fully adjust I feel as I also have hypoglycemia.

    I don’t do well with fruit due to bowel issues, or nightshades. Rice is too much of a hit to my blood sugar at the moment. This leaves me with sweet potato’s and squash which has been tolerable, despite some effects on my bowels having not eaten starch for years. However I have noticed joint ache almost exclusively in my fingers since reintroducing the sweet potato’s. This worries me as I’m somewhat limited in other carb choices and am concerned joint ache is not a typically temporary reintroduction symptom.

    1) I’ve been eating them a week. Is it something that may pass?

    2) If rice, fruit, white and sweet potato’s are out are there any other options that might not give me joint ache?



    • Hi Matt,

      It sounds like you have some nutrient deficiencies in addition to being too low carb. Bleeding gums and dry eyes suggest you need vitamin C. You are probably low in electrolytes too. Read our post on constipation for what that indicates (search on “Cures for Constipation”).

      Poor glucose regulation could be due to mineral deficiencies including magnesium and chromium. Also, you need to eat starches as part of a balanced meal. See our post “How to Minimize Hyperglycemic Toxicity.”

      Sweet potatoes have some compounds that give some people trouble, search for our post “What’s the Trouble with Sweet Potatoes?”

      In short, 90% of the problems you are having are common issues on VLC diets and I had many of them, which is what prompted us to develop our diet. I would just implement our diet and supplement program and see if the joint ache is still there after a few months.

      Best, Paul

    • Hi Matt,

      I also have joint problems with white and sweet potatos and rice does not help with constipation.
      My safe starch of choice is Yucca. A bit more work to prepare than potatos or rice, but I have grown to love it. I prepare 2-3 at a time: Peel, cut into thirds, boil until soft, remove string from middle and dice. I place this in a container in my fridge and pull out a serving for most meals.

  39. Hello Paul

    All else being equal, tuna from the can packed in water or oil.

    Historically a big water packed eater but saw the omega 3 sales pitch on the can.


  40. This question is for either Paul OR anyone else who is relatively knowledgeable about iodine supplementation.

    My girlfriend and I have both experienced a worsening of hypothyroid symptoms with relatively modest supplementation of pure potassium iodide–she’s up to 1 mg iodine from KI, I’m up to 3 mg.

    Today, for example, we both experienced a wave of fatigue after taking our daily dose of iodine. Neither of us have Hashimoto’s. However, I do have a chronic H. pylori infection, and given our degree of intimacy I think it’s likely that she does too.

    Here are my theories:

    1. Perhaps the selenium balance is off. Neither of us take supplements, but we do eat salmon and beef.

    2. Both of us only recently increased our iodine dosage. Maybe our thyroids are still adjusting.

    3. Is it possible that the increase in iodine dose leads to increased die-off of H. pylori? That would also explain the wave of fatigue.

    Is there anything else I’m missing?

    • The only modern iodine supplementation protocol I’m aware of with a solid scientific basis and an impressive track record of safety and success in thousands of people is the one developed by Dr. Guy Abraham.

      Your approach differs substantially from the Abraham iodine protocol. For example, you are only taking iodide, instead of iodide plus iodine. You’re also not supplementing with selenium, unrefined salt, and the other “companion nutrients” highly recommended for safe iodine orthosupplementation.

      As a long time hypothyroid myself, I would also point out that “hypothyroid symptoms” can be very nonspecific. The problems you are experiencing may not be from hypothyroidism at all. Bromide detox is a very real possibility, even though you’re taking a pretty low dose of iodine compared to those found to be needed for effective detox by Dr. Abraham and his collaborators.

      Here are a few sources for more information:


  41. Oh, and another one:

    4. Maybe bromine and other halides are being mobilized too fast for us to excrete them. I didn’t think of this at first, because I’ve always associated bromine detox symptoms with acne, and both of us are acne-free.

    Could bromine detox cause hypothyroid symptoms, especially fatigue?

    • Hi Brendan,

      All of these are possible, but the most likely is that the recent increase in iodine has caused a reactive hypothyroidism.

      I would try supplementing selenium a few days a week and sticking with the same iodine dose for several months.

  42. Thanks, Paul.

    If the increase in iodine has indeed caused a reactive hypothyroidism, would you expect thyroid function to return to normal after a few weeks on a stable iodine dose?

    In other words, are there any permanent consequences of that situation?

    • Hi Brendan,

      Normally there aren’t any enduring consequences and the thyroid adapts.

      However, sometimes there can be situations where the thyroid has difficulty adapting to higher iodine doses. There may be nodules that generate excess thyroid hormone when iodine is available, causing hyperthyroidism; there may be an old thyroiditis or infection which prevents adaptation; selenium could be off.

      In such cases the thyroid will return to normal when iodine is reduced, but it may never be entirely normal on the high dose, unless the underlying problem is fixed.

      If you were better on a previous dose of iodine it may be better to go back to it and stay there a while. You can take salt, water, and vitamin C to help excrete bromine, and check that the thyroid adapts properly before trying bigger doses.

      In the new book we recommend 1 mg/day for most people. Higher doses may be therapeutic but we don’t routinely recommend them any more.

  43. One more brief question for you, Paul:

    I’m pretty sure that I originally developed hypothyroidism due in part to the increased demand for iodine caused by the immune response to the H. pylori infection. You’ve mentioned that chronic extracellular infections can cause iodine-deficiency hypothyroidism.

    Given that eradicating my H. pylori is still a work in progress, what do you think would be a reasonable minimum of iodine intake that would provide enough for the thyroid and the immune system to share?

    • Hi Brendan,

      Well, no one really knows what level of iodine is optimal for H pylori. I think the level you’re at is pretty good. The most important thing is to have sufficient iodine to support thyroid hormone production, since immune cells can take iodine from thyroid hormone.

      Chlorine is also helpful against H pylori, so be sure to get enough salt.

  44. Hi Paul,

    I’ve read your constipation blog post.

    Do you have any specific dietary or other recommendations for someone with a redundant and slightly twisted colon?

    Thank you,


  45. Hello Paul, its me again.

    I have read “Is High LDL Something to Worry About?” and nearly all the Q&A, because the exact same thing happened to me.

    Like we discussed I take nearly all the supplements and the 3-4 egg yolks a day – even thought I wasn’t far off on items – except I was low on iodine.

    The macro changes I made were:

    1. adding rice, 1-2 cups a day
    2. Cu, Se, I, etc
    3. NO nuts. I was eating between 40-80 almonds a day
    4. elimination of post workout “fat shake”, 8 oz of almond milk plus 4 oz of heavy cream.
    5. big reduction in goitengenic foods (almonds, broccoli, cauliflower, cabbage)

    Question: Of the 5 big changes, which do you think will make the biggest difference? (as I didn’t want to run thru 5 scenarios of eating – as it would take me many many months.

    My guess the high O6 may have caused inflammation, hence spike in LDL, is O6 a possible toxin? Or do I need nuts to keep HDL up high? I ask, as I note the article and Q&A focuses mainly on Cu, being hypo (hence Iodine), and adding carbs….while in the back of my mind my high O6 makes me wonder.

    thank you.

    • Hi Evan,

      All of the changes you’ve made are improvements, and all will help your LDL levels.

      Which is most important for you would depend on which was most deficient earlier – so I can’t say. But I’m pretty sure you’ll be in much better shape now.

  46. Hi Paul,

    I was wondering if you have any ideea if “cooked” butter feeds bacteria or candida. “cooked” = used in cooking from the beginning not added at the end like when I prepare boiled brussels and butter togheter from the beginning.

    When I eat “cooked” butter my mouth/teeth feels like having sands in it/on them, i feel tingling in the gumms and “fullness” in the sinusues. And some in the abdomen/bowel.
    When it’s not “cooked” I think it’s better? Do you know if it changes his properties or something during cooking/heating?

    And the same with “half-prepared” egg yolks => instant “sand” feeling in the mouth/teeth.

    Thanks for your insight,

    • Hi Dave,

      Clarified butter is certainly better for cooking than ordinary butter with its sugars. But I’m not sure what’s causing that reaction. Do you have dairy and egg sensitivities?

      • Hi Paul,
        Thank you for answering so quick. I wasn’t aware butter has “sugars” 😐 . No allergies that I know except bananas. One blood test done in Germany shown no real allergies but 2″pseudo-allergies” to nuts familly and citrus 🙄 ? I have chronic giardia which might give lactose/diary intolerance but not for 80% fat butter which has no lactose i guess.

        I was guessing maybe proteins in butter and yolks favorites some bacteria or something?
        I’ll try ghee or coconut oil.


    • It doesn’t sound bacterial to me – too sudden. More like an allergy (sinus is classic dairy allergy), there are milk proteins in butter and cooking them will change them, same with egg yolk (though white is the usual allergen).
      You could be allergic to the heated protein only. Does it happen with clarified butter?
      I don’t think blood tests for allergies are reliable for diagnosing every possible sensitivity, or for telling what’s actually important to you, though they can catch some problems they can also misdiagnose. Actual symptoms are a far better guide to what foods affect you, when they are linked to the food as here. You may have been tested for dairy, but cooked butter could be different enough to be missed by that.

      • Hi George,

        Thanks for your opinion 🙂 .
        I tested more and it’s the same sand feeling in the mouth with oils except virgin coconut. in the same time I notice some “feelings” like tingling also in the abdomen when eating cookedbutter or eggs yolks.

        My history includes Hpilory, giardia, enterobacter, strep and candida plus (don’t know if active) CMV and EBV.
        I thought maybe some of then are feeding with this “easy to eat” proteins. Doesnt happen with chicken for example.

        Anyway, kind of strange…

        I’m more than positive something is benefiting from but not sure what exactly…


  47. Hi, Paul,
    A couple months ago I was diagnosed with Grave’s Disease (auto-immune hyperthyroid as I’m sure you know) and now that the worst of my symptoms are under control with nutrient IV therapy and meds, my ND and I are looking for the underlying cause. There were no red flags from my Metametrix stool test even though I’ve had digestive problems for quite some time (though the digestive problems could have been from excess thyroid affecting my liver over time). Surprisingly, my results looked pretty good even. Do you know of any types of chronic infections that are especially associated with Grave’s?

    Based on my symptom history, my endo figures I’ve probably had subacute/sub clinical Graves for many years with flair ups 12 and 10 years ago with my pregnancies. A mix of the iodine I had been taking for the past year and a couple little life stresses were probably what tipped me into moderately acute. Anyway, that I’ve probably had this for a while, I think, points to the chronic infection theory. Do you recommend any other tests for helping find out what that might be?


    • Hi Angie,

      It’s certainly possible. A variety of fungal infections can cause a chronic thyroiditis that can appear as hyperthyroidism, for instance. I had somewhat similar effects from a fungal infection — chronic subclinical hypothyroidism with one known flare into hyperthyroidism — and fluconazole treated it successfully. I would expect that other infections can have a similar effect so I’m not saying you necessarily have a fungal infection, but I would definitely look at possible infectious causes.

  48. Paul, I have a friend who is getting 1/2 of his pancreas removed due to cancer. His prognosis is excellent but he may be an instant diabetic after the surgery. Would eating cow pancreas be beneficial for him in his recovery? I believe you mentioned in another post to eat what is ailing you.

    • Hi SC,

      Eat what ails you, yes, but I’m not sure in this case. Pancreases have lots of enzymes/hormones and those may not be desirable to eat in large quantities; also eating a part that has cancer might promote cancer growth.

      So I don’t know, but my inclination would be to eat a normal PHD-style diet, maybe slightly lower carb.

  49. Hi Paul — I have Hashimoto’s and am wondering if I should skip the goitrogenic veggies (broccoli, cabbage,kale, bok choy). The problem is, I live in Florida and these are the veggies I can get fresh and local from farmers. I always cook the veggies, though I have also wondered if they would be okay fermented (kimchi or sauerkraut) as you have said that would be a good source of probiotics. Can you please shed some light on this for me? Thanks!

    • Hi Kathy,

      I think the main thing is to keep the amount down, and to always eat them cooked or fermented, not raw.

      I would try to keep the amount under a half pound a day.

      If you are getting sufficient iodine and selenium the risk is lower, so consider supplementing those at low doses.

      • btw, “google” is telling me that fermentation does not reduce goitrogens.
        (not sure if you were implying that or not Paul).

        that said, the good outweighs any bad imo. & fermented foods are more of a condiment anyway, eaten in limited amounts.

  50. Paul,

    I am interested in the fungal hypothesis for Graves disease. I have it under control but each time I try to go off medication it flares back – even when taking a lot of supporting natural medications/supplements. I have a skin condition that the doctor thought was fungal but they tested some tissue and it did not show any fungus/parasite. Doctor was puzzled. Shall I ask to be treated for the fungal condition anyway? Maybe trying and seeing what happens? I have been taking Lauricidin for a while and saw some benefits. Maybe this would be enough? Thanks so much – by the way I loved your post in psychology today!


    • Hi Jo,

      Personally I think fluconazole is fairly safe and if you have multiple indications of a fungal infection — like thyroiditis and skin manifestations — then I would give it a try. But most doctors are reluctant.

      I found that NAC works well against fungal infections too, so I would take that also.

      If you have a fungal infection that is causing thyroid issues, it is one of the species that is adapted to living inside the body, and so it may not be culturable or removable by a skin scraping even if it is causing the skin symptoms. Some fungi infect subcutaneous fat and you can see a grimy biofilm on or under the skin but you can’t scrape or clean anything off. … This is different from a species like Malassezia that infects the skin only and produces dandruff or dermatitis.

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