Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Hi Paul,
    I just got a wok for Christmas and am learning about seasoning it before I use it. It’s a typical carbon steel, unseasoned wok. What’s your opinion on the type of oil used to season a wok (or cast iron pan, etc)? Do you think it’s not too bad to use a high-Omega 6 oil for this? I ran out of coconut oil but had a large container of grapeseed oil that I don’t use at all, so I decided to use that. I know it’s unhealthy, but do you think it’s ok for seasoning a pan? Or will damaged omega-6 oils go into the food too much whenever I cook with it?
    What do you think?

  2. Hi Paul,
    Thank you so much for all the work you do. I have been following your diet for 6 months now and have both editions of your book which have helped me with so many symptoms, notably brain fog and depression. Prior to PHD I have been gluten free for 10 years and a vegetarian and/or vegan for 2 years. I’m 46 years old, 5’6 and weigh 135 pds.

    I have a couple lingering issues that I can’t seem to clear. My biggest problem is severe, chronic constipation which nothing has ever helped me except massive amounts of magnesium 1200mg (600 in am and 600 in pm). The addition of white rice has helped a small amount also. I’m hypothyroid and take Levoxyl and Citomel which also help a minor amount. I take 5mg of evening primrose oil which helps with scalp psoriasis and constipation but I’m trying to wean myself off of it based on your recommendations. I’m not able tolerate coconut oil (although I LOVE it), psoriasis gets much worse and I tend to get so dry while taking it I get rough patches on my elbows among many other symptoms. I also have so many food allergies it’s easier to list what I can eat instead of what I can’t; I’m especially sensitive to wheat and fructose. I’ve tried NAC however every time I take it I get a cold or flu within a week and I usually don’t get sick. I’ve also tried the other supplements you suggest but they aren’t making a difference and have at times made me worse. I took antibiotics and Accutane about 20 years ago (when I was 26) for severe acne and feel I may need oils in my system due to the Accutane, but, I had constipation even prior to that. I guess my question is twofold then, do you think I need to supplement oils and would MCT oil help if coconut oil doesn’t? Do you have any other recommendations and advice on what could be causing the constipation?
    Thank you Paul!

    • Hi Gracie,

      First, have you tried the various ideas in our constipation post? http://perfecthealthdiet.com/category/disease/constipation/

      If you benefit from evening primrose oil, it’s likely you have high levels of oxidative stress and that supplementation of antioxidants such as NAC and extra vitamin C will help you. Since oxidative stress can promote constipation, this is a good lead to follow.

      If coconut oil worsens symptoms, it’s possible you have some sort of parasitic or fungal infection. You could try diagnostic testing such as a stool test.

      The cold or flu after NAC might indicate that it is doing you good. Try also taking a tablespoon of bentonite clay first thing in the morning during your fast.

      I would expect MCT oil to have the same effect as the coconut oil.

      I would basically explore the possibility that you have some sort of fungal or maybe protozoal/parasitic infection which expanded when you took the antibiotics 20 years ago and hasn’t been beaten back yet.

      Spinach salads with sulfur rich vegetables like onion and garlic, plus olive oil and vinegar dressings, are a good antifungal food. There are other ways to modulate the digestive tract flora, eg digestive enzymes and other compounds. But the best thing would be to get a solid diagnosis through a doctor and then discuss treatments with the doctor.

      Best, Paul

      • Hi Paul,
        Thank you so much for your response, I sincerely appreciate your time. I have just started to look into oxidative stress and I’m surprised at how much this matches me – you are AMAZING! I will also look into the stool test myself since my conventional doc isn’t willing and my insurance won’t cover naturopaths. Thanks again Paul!! BTW – I also bought your book as a Christmas gift for my dad who suffers from diverticulitis and I’m excited for him to start seeing the results!

  3. Isaac Knoflicek

    My sister just posted this on the Facebook. I’m curious what you’re take is on this study that 30-35 BMI increases longevity:


    • Hi Isaac,

      I saw that. The study isn’t yet on Pubmed so I haven’t read it yet. But I have it in my notes to look at.

      • They did indicate it was not statistically significant:

        Mild obesity (those with a BMI between 30 and 34.9) brings a 5 per cent lower premature death rate, according to the study. Although this was not statistically significant, it suggests there is no increased risk of premature death attached to that weight range.

        They also indicated they didn’t measure health … is it quality life?

        We were only looking at mortality – not health

        I’d also be curious to know the weight over time – 30 years of overweight, or weight at death?

  4. Hey Paul, is it required to get have extra virgin or virgin coconut oil or can normal coconut oil be fine too. The virgin one is expensive. If you have 2tbsp of it while having 600carb calories will you still benefit from it and help mental conditions? Thanks a lot for your great work.

  5. Paul
    Thank You so much for all the work you do and answering all our Q&A.
    Is it possible to have some kind recommendations say for 1) Fungal Infection 2) Bacterial 3)Viral infection.
    I have a history of Fungal Infections and High LDL and sometime i’m confused about the Carb intake and if i should follow a Ketogenic diet. I have the kindle version of your book and I wonder if some pages are missing.


    • Hi Tessy,

      Compiling general recommendations for fungal, bacterial, and viral infections is no easy task and is sort of an ongoing project of this blog. I don’t have such a set of recommendations yet but will keep working.

      If there are specific locations where material may be missing from the Kindle, please let me know. I haven’t copyedited the Kindle file myself.

  6. ok, so I have given thought to what you responded Paul and my tongue is driving me crazy. It fells weird having all this white gunk on my tongue like something is weighing it down. I also think the stuff is in my throat but everyone I go to says they see nothing…I think it’s possible they say that just becuase they don’t know what it is.
    I am going to continue what I am doing but I do have an old prescription of nystatin. I have really resisted using this but I really want to see if it will resolve the issue at least temporarily so at least I will know what it is. Is this a terrible idea or ok? How long would nystatin be used to eradicate the issue.

    • Hi Lauren,

      Nystatin is pretty safe so give it a try. It isn’t always effective but it is worth a try. I don’t know how long you should use it for.

    • Hi Lauren,
      I don’t have answers for you, but I can share a bit of my experience. Metametrix testing showed a very large HP infection and my doc started me with an herbal concoction from Thorne. Many things cleared up while on this formula — itching eyes, chronic back pain, and white coating on my tongue. When I stopped this I had a breath test within a few hours and it came back negative, however, in a few days the back pain was back as was the tongue coating. The itching eyes have returned only occasionally and very briefly. Doc put me on another product designed to break up biofilms and another to kill the HP. Tongue coating disappeared and back pain improved. When I went off this one back pain returned and was quite bad. I am now on Marcus Ettinger’s protocol and will stay on it for the two months he recommends. Have been doing this for about two weeks now and back pain is completely gone, as is tongue coating. My point is…I have read that many people have little confidence in the HP breath test. If you, at one time, did have HP and don’t now, then it was some kind of spontaneous healing. From all that I’ve read, it is hard to believe that that bacteria just goes away. A speaker at Wise Traditions ’12 did say that if copper and zinc are balanced that HP will just leave. As I understand it, HP loves the stomach environment and can adapt survival techniques to evade the immune system.

      I will let this forum know if the current protocol gets rid of HP once and for all. In the meantime, I just returned from the doc where they did a blood draw for a leaky gut test with Cyrex Lab. Good candidates for this test include people with food allergies and intolerances. Cost me $200, but my food allergies have been as much a nuisance to my family as to me. The doc said that he believes leaky gut is widespread so isn’t keen on testing for it. But I am ever the armchair scientist and would like a baseline before I begin the gut healing protocol.

      That’s my 22 cents.

      One more thing, consider that when you take care of your own health, you care for those close to you who will be left tending you when you are sick or disabled. I say, it’s your money, your time, and your health, and you have every right to be as well as possible.

  7. Hey Paul,

    Would coconut oil taken rectally go to the liver and generate ketones? It gives me severe indigestion when taken otherwise.

  8. Hi Paul,

    I was reading your post on constipation. My question is what is your definition of constipation? “Infrequent” bowel movement or “difficult to pass” stools?

    Also, is it abnormal to have bowel movement every 5-8 days? What is the ideal time frame… daily?

  9. Hi Paul,
    i have a Rice question (which hopefully should not take up much of your time).

    Which is the more PHD preferred rice when given the option;
    1. ‘sticky’ rice (aka glutinous rice), think Chinese, Japanese, Thai dishes
    2. non-sticky rice, think Indian dishes, ie. basmati rice

    I sometimes buy cooked rice from the local shops & i can buy either type of rice dish.
    There are some good food courts where i live with all sorts of dishes and rices from around the world.


    • i am just talking good old steamed rice btw

    • They’re both fine, maybe Basmati is a bit better due to low glycemic index, but that is meal/context dependent.

      • Paul, but does not Basmanti have more amylose and therefore more difficult to digest?
        Would not you recommend sticky rice for people with GERD lets say?

        • Hi Stort,

          Yes, it’s good, the high water content makes them easier to digest also.

          • Now I am confused. Which is better, basmati or jasmine? Or are they similar and something else is better?

          • Jeri,
            basmati & jasmine are both long grain rices, so i am guessing they are pretty similar.

            the point Stort was making is that the resistant starch (RS) content (in the form of amylose) varies between shorter grain & longer grain rices.

            So someone with digestive issues may do better with shorter grain rice varieties (less amylose).

            The higher amylose rices (longer grains) have a lower glycemic index (GI) by themselves, so may be better for diabetics*

            *however, the GI will be reduced when eating as part of a balanced meal.
            & Paul has said before “you might want to add vinegar and vegetables to the rice to help reduce the glycemic index.”

            from wiki;
            “High-amylose varieties of rice, the less sticky long-grain rice, have a much lower glycemic load”

            “(Glutinous rice) is distinguished from other types of rice by having no (or negligible amounts of) amylose, and high amounts of amylopectin (those are the two components of starch).
            Amylopectin is responsible for the sticky quality of glutinous rice.”

          • Thanks, Darrin….that helps!

          • Jeri said…”Googled Basmati vs Jasmine.
            Basmati is about half the GI as Jasmine. Hmmm, interesting. Who would have thought white rice could be so different? Loving my Jasmine…tomorrow I am going to get Basmati.

            Hi Jeri,
            from reading that link, it seems like Jasmine is more like a sticky rice & a shorter grain that Basmati.

            if your digestion notices any difference, you will have to report back. 🙂

          • Haha lets break this down:

            Jasmine=stickier rice, less resistant starch, better for those with digestive issues.

            Basmati=more resistant starch, low glycemic index, better for diabetes

            Ultimately both are similar and probably fine for most people on PHD unless you are super sensitive, in which case experimentation is in order correct?

  10. paul and everyone,
    ok, so I keep writing on here and obsessing about my geographic tongue. I have a myriad of other small problems, but I may or may not have just had an epiphany! I have had very heavy periods (4 years) and slightly below “normal” platelets (2 yrs). I keep insisting that something is wrong but I go for test after test and everything is normal. I have been taking a variety of supplements for several months and I am not sure what is the one thing that gave me one normal cycle this past month. In addition to working out and my supplements, in the last several weeks, I took some time for myself and went to this chinese bodyworks massage place. I live in NYC and these places are a dime a dozen and usually are not that good. This one however is. The last several weeks I saw this lady and I complained of neck pain and she was kind enough to indulge me, but she also did this weird massage thing near my trachea. It hurt a little and I thought it was weird but the rest of the massage was so amazing I over looked it. So coincidentally, this month my tongue was great and my period was normal. One of the supplements I take is called matrigen and is for hormaonal imbalance and I have been rinsing my mouth with a probiotic.. The matrigen, I have been taking for months but no change although these things can take time. But today when I had another woman indulge me in the massage, she didn’t do the same thing and I thought about thyroid and iodine and paul and the perfecthealth diet. Is it possible that the massage massaged the thyroid that may be underactive and caused my period and tongue to improve drastically?? Or is this a coincidence? hmm…thoughts?

  11. Michael Theroux

    Hi mr jaminet;

    I had an interesting blood test today with an “alternative medicine” doctor. He pricked my finger and placed a smear sample under a microscope. He then started pointing out various features of my blood and explained what problems he could see.

    He quickly identified these white spots and identified them as candida- in the blood stream.

    I’m not sure how legitimate this test is, I’ve always been told candida is very hard to diagnose. I’ve also read that candida reaching the blood is a very serious condition that causes sepsis, necessitates ICU care and can have a 70% death rate. If I have candida I’ve had it for months and I certainly don’t feel that bad


    • Hi Michael,

      Candida cells are quite a bit smaller than white blood cells, so individual cells would be unobservable in an ordinary low-power microscope. Not sure what the white spots could have been. If they can identify candida infections, conventional medicine is unaware of it.

  12. healthyengineer

    Do you guys have any idea how carb cycling/ketogenic cycling might work to promote leanness?

    I’ve tried both very low carb (VLC) paleo, and PHD with about ~150g/day of carbs, and was weight stable at a ‘normal’ weight. Now, after 5 months of carb cycling (VLC paleo + weekly 1 hour extreme carb feed) I’m extremely lean- visible abs, etc. This seems like a common method used by bodybuilders to gain fat and lose muscle simultaneously, but there doesn’t seem to be any convincing information about how and why it works so well.

    I am considering going back to the normal PHD with daily starches instead of carb feeds, but worried I won’t be able to maintain as low a body fat % as I did with carb cycling.

    Also, might a weekly carb feed avoid some of the ‘low carb dangers’ you mentioned in the context of an otherwise very low carb diet?


    • Hi healthyengineer,

      Yes, it should relieve most zero-carb dangers.

      I’m not sure why it works but we are finding that variability is often helpful in biology.

      • healthyengineer

        Thanks! Of course I meant ‘gain muscle and lose fat simultaneously’ rather than ‘gain fat and lose muscle simultaneously’ (for that one could use the SAD).

  13. I’m new to The Perfect Health Diet having ran across it while researching gluten free information. I have a lot of health issues including being obese. Sorting through all the the online information is like pulling threads apart and trying to putting them back together to make sense health wise. I started out looking for information on why I had thyroid antibodies of 548 a few years ago when they shoudn’t have been over 34. As you probably know it’s been interesting to say the least. I believe that your diet is my best chance to become healthly. I don’t think I’ve been healthy since I was about 12. I am also very interested in diatomaceous earth and would like to know what your opinion is on it’s merits. I know from previous experience that going gluten free makes me feel much better on it’s own.
    I would really like to know why it doesn’t seem to be possible to find an accurate list of acceptable foods for your plan? I’m a little (Ok a lot) OCD and would really feel much more comfortable with a list than a picture. I waited until your new book came out and when it came I went thru it looking for a list alas no such critter. I think your apple picture is great for a quick reference but really doesn’t give enough information. I found an older list on line that purports to be yours but it seemed too free with the information about what to avoid. It states to avoid or “restrict” such things as bread. Can you please provide a list or at least point me toward someone elses list that most closely matches yours.
    Thank you both for your hard work and going against the grain (pun intended). I have also lost my parents too soon. My dad at age 66 from heart disease and my mom at age 72 of pancreatic cancer.

    • Hi Sandy,

      We’re working on a cookbook but basically, every natural whole food that is commonly eaten is fine except for cereal grains (other than rice), beans and peanuts. Processed foods are generally to be avoided, but especially vegetable seed oils, wheat flours, added sugars, and ingredients with complex chemical names.

      That said, for meals the focus should be on a starch, a meat/fish or egg, vegetables, and healthy oils and acids for flavor.

      There are a lot of choices so it’s hard to make a list of foods you can eat! We emphasize proportions more than most diets.

  14. Hi Paul,

    I fast for a 16 hour window, and in the morning I like to combine some coconut oil and coconut milk as a smoothie. Do you think a medium size banana at ~27g carbs would have any effect on autophagy or disrupt the benefits of the fast in any way? I also believe i shouldn’t be concerned with the the very low omega-6 content of coconut oil combined with ~7g of total fructose, is this true? Thank you so much.

    • Hi Derrick,

      A banana and coconut milk is certainly a healthy breakfast. You needn’t be concerned about the fructose or omega-6. It will diminish autophagy, but you can extend the fast a bit to counteract that if autophagy is important to you.

  15. Do you have any thoughts on supplemental vitamin C and its impact on insulin and blood sugar levels? I recently got a high result 2hrs post, with a drop by 2.5hrs, so I started to wonder if my insulin release was delayed and whether it was a concern or a reflection of the supplementation. I currently eat PHD and take daily vitamin D, butter oil for K2, iodine, magnesium, vitamin C, and the weekly B’s and zinc. I take 1-3gram vitamin C per my doc and ND’s recommendation to help adrenal function.

    Thank you for all you great info!

    • Hi Tania,

      Well, you didn’t give any numbers, nor compare any results with or without vitamin C, so it is hard to say anything. Vitamin C does interact with thyroid hormone with some effect upon metabolism, but I am not sure what it might be doing to your glycemic control.

      • My lunch numbers were 154 2hrs post and 102 2.5 hrs post.
        My numbers tonight were 145 1.25 post prandial and 109 1.5hrs post.

        After you mentioned results without vitamin C, I tried to find some of my old numbers pre-supplementation. I am not diabetic that I know but I have tested in the past to sort out my fatigue issues (and to stay on top of a family history of diabetes). I believe I was not supplementing earlier this year when I had a 113 1hr post, 105 2hrs post (the only notation I could find). I need to find my old notes, but my other numbers from earlier this year fell into a good pattern (<140 at 1hr, <120 at 2hr).

        I saw this after a quick search, but I need to read it after the kids are in bed.

        • Do you take the vitamin C with food? You might do better taking it while fasting, or 2 hr after meals. Also, have you lowered your carb intake in that period?

          • I take the vitamin C in divided doses throughout the day, sometimes with meals and sometimes not. This morning, I took vitamin C a little before lunch and had another hit sometime after lunch. I had none the rest of the day.

            I believe my carb intake has been relatively stable for the last couple of years, following what would be mostly PHD through that time(I am assuming you were asking if I lowered my carb intake from earlier this year, when I wasn’t supplementing yet).

  16. Michael Theroux

    Hi Paul, thanks for your reply

    ( i was the question about the blood test and seeing the candida with a microscope)

    You said a low powered microscope wouldnt be able to detect candida cells…this one would very clearly make out red blood cells with great detail- each white “candida cell” was about the size of a small pea on the screen, and the red blood cells were the sizee of of a dime

  17. Hi Paul,
    Thanks so much for your quick reply. I get it. I think that after about 35 to 40 years of going on and off diets and losing over 100 lbs twice and gaining it back and then some it’s time to get over my constant obsession with food. The diet mind set of I blew it so might as well eat everything I’ve been wanting in one night and start fresh the next day. I’ve slowly and painfully come to realize that I need to eat to live not live to eat as the saying goes.
    I’ve went gluten free for 1 year from 2011 to 2012 and then we had custody of our grandchildren for 9 mos which gave me an excuse to go off GF as “it was to complicated” with a 2 and 3 yr old in the house.
    I was surfing to see what was new in the GF arena as it had made me feel so much better for the year I was doing it. I tried not to get caught up in the trap of if it was GF it was ok to eat. I think I did pretty well, definately enough to effect my health in a positive way and brought my thyroid antibodies down over 350 points even though my PC Dr said there was no conection. I have known from my “research” on line that almost all of my health issues were being caused by my diet.
    The PHD diet caught my attention as it combines the “eating around the outer walls” of the grocery store with the GF diet and puts the pieces together. I feel like the puzzle is almost complete now. I need to get a handle on the supplements. Before the grandkids came my husband and I were taking quite a few supplements including fish oil and CQ10 etc etc. The PHD seems to require a lot less supplementation due to getting what we need from the quality foods on the plan. And you’re right about there being so many choices. It’s easier to tell us what we shouldn’t eat than what we should.
    When my mom was diagnosed with PC I surfed for hoursat a time “looking ouside the box” for something better than chemo until you can’t stand it anymore or you die. My mom wouldn’t here of anything other than what the Dr said. I realized during that timeframe how our health and lack there of. Was effected by what we ate . I tried to get mom to stop eating sugar and aspartame and to try some tumeric etc. I know now that it was too late at that point but I was so fruatrated by the “system”. We live on the gulf coast of FL near a very Famous cancer center where she was “treated”.
    My mom was less than 20 years older than I me. I’ve decided to go forward and regain my health to learn from what she went through so it wasn’t for nothing.
    I have to tell you that when I read what you wrote about most cancers being caused by infections that were for the most part caused by diet it really hit home as that reinforced what I came to believe while I was trying to find some way to help my mom. I was nowhere near as detailed about the situation as you are but the seed (no pun intended) had been planted and kept me looking for confirmation. I looked at the paleo diet but although I agreed with the concept Ithought it was slightly unrealistic. I know there is a Great deal of cross over between the Paleo and the PHD but the starch and heavy cream etc make the PHD much more user friendly.
    When I was GF I ate Bob’s Redmill GF oatmeal with no decernable (sp?) Problems. I had asked it my first post your opinion of DE as I have been taking a TBS a day in oatmeal which disguised the taste. It made me feel better even while I wasn’t eating “clean” yet. I think that it could be a viable supplement as within just a few days of taking it my bowels were regulated and I felt somewhat more energetic??
    So I guess a lot of the above boils down to the questions about the DE and the GF oatmeal. If you have no strong objections to either or of them do you think it’s acceptable for me to use them. Or at least the DE and some suggestions on how to disguise the taste. I have a very accute sense of smell which means if I can smell it I can stilltaste it. The oatmeal also covered up the texture. I think it was cleaning some parasites out of my digestive system as well.
    BTW I’m currently dealing with GERD, Fibromyalgia, GAD, hypertension and most likely Hashimoto’s as the antibodies went down while GF and haven’t had them checked in a long time. Also possibly Diabetes as I had been just over the borderline and had brought the A1C way down to a safe level while GF.
    Thanks again for your work and your courage. I know the prevailing attitude is still “whole grains”. Etc as I saw the Dr down the yellow brick road pushing them just today.

    • Hi Sandy,

      Sorry to hear of your mom’s cancer. I don’t think cancer treatment centers are as much use as a good diet and regular walks in the sunshine.

      I am not sure what DE is but if a tablespoon per day of oatmeal helps you, then I support it. You may find that potatoes are just as good, they have highly beneficial fiber and can help keep you regular.

      It is good that you are working on your diet now. It should be possible to fix the hypertension fairly quickly, that would be the first thing I would watch for. Try to get daily walks in the sunshine, that is important.

      Best, Paul

  18. I left out that I had my gallbladder removed at 28 years old and about 4 years ago had 6 inches of my bowel resected due to diverticulitis along with my ovaries at the same time due to cysts. I had previously had a hysterectomy due to fibroids. I’m set on using the best information available to become healthy and hopefully extend my life with quality health years. As of right now you have the best thing going. I use the heavy cream only for coffee, I can go without the sweetener but not without the cream.
    BTW I’m a terrible speller (as if you hadn’t noticed by now) and am sorry as my phone does not have a spell check.
    Thanks again,

  19. I’m following the diet but have concerns about white rice. I’ve read that white rice consumption is a risk factor for developing diabetes. Here’s a link to an article that talks about studies that have shown this correlation. http://www.trimdownclub.com/research-white-rice-may-increase-risk-of-diabetes Your thoughts on this please?

    • Hi Deane,

      I commented on that study here: http://perfecthealthdiet.com/2012/03/red-meat-and-white-rice-oh-my/

      I also corresponded with author Qi Sun of the Harvard School of Public Health about it afterward.

      In general, higher rice consumption is associated with lower rates of diabetes. You have to correct for a lot of confounding factors in order to reverse the sign of the correlation.

      The trouble with these analyses is that there are many ways to perform them, which lead to different answers.

      I think the only thing we can say for sure is that if someone has diabetes, then the more carbs they eat, the more likely they are to be diagnosed. Since rice is the staple carb in many countries, diabetes diagnoses can correlate with rice consumption, even if the disease incidence does not (or if appropriate amounts of rice are protective against diabetes).

  20. Hi Paul,
    DE is diatomaceous earth (food grade!). It is a kind of chalky textured
    powder. It is the fossils of microscopic diatomes that are cylindrically shaped with sharp edges. It is a multi use product. It will cut/scratch open the shells of any bug with an exoskeleton such as fleas and roaches. It can be given to pets as a natural wormer and put on them as a flea killer.
    Taken internally it is suppose to clean out your digestive tract using it’s negative charge to attract and capture bad bacterias and slice up parasites as it goes by. Eventually the slicing effect will kill such things as any worms you may have in your system and clean them out. I had only been taking it for a week or so and believe it was doing exactly that. I was taking a TBS of DE in a serving of GF oatmeal. (About 3/4 cup). It also helped with the neuropathy in my feet. Being GF also helps the neuropathy so I thought the two together would be like a one-two punch. If you google it you will find a lot of positive info on it and very little negative.
    Sorry to be beating this subject to death but if DE does for others what I’ve experienced with it, it’s good information for others in my same situation.
    I will take it with my serving of GF oatmeal and let you know how it works out good or bad.

    Thanks for letting have so much of your very valuble time.

  21. Paul – You mentioned the Shagri-La diet in your book, and now I’m seeing it sprinkled throughout your website…

    I find the SLD a very fascinating phenomenon, eat some flavorless calories and reset your weight.

    Have you done any hard looks at the diet, compiles anecdotal reports, tried it yourself, or written more in-depth?

    I recently started PHD after several years on Primal Blueprint. I’m going to give PHD a couple months without much tweaking and let my weight stabilize, then try the SLD for a couple months.

    I think this will be very telling for me if it works as advertised. I’d love to read all you’ve written on the subject.

    • Hi Tim,

      Shangri-La is not really a distinct diet, and it combines naturally with PHD, just take a bit of flavorless calories during the daily fast.

      It’s interesting. Some people’s appetite regulation doesn’t work as well as others, and SLD seems to help re-set it / normalize it. It still surprises me that it’s so effective. Fascinating discovery by Seth.

  22. I know people ask these questions all the time, but other than following PHD and iodine supplementation, what can one do for hypothyroid?

    • Hi Lauren,

      Circadian rhythm enhancement.

      Anti-infection nutrition, eg vitamin D, vitamin A, vitamin C, NAC.

      Iodine cofactors — optimize (neither excess nor deficiency) selenium, magnesium, copper, iron.

  23. Hi Paul!

    I recently started your recommended supplements for constipation (although I had the opposite problem). It seems to be working quite well. I was just curious, is it meant to be done for a short period of time, or can I continue it indefinitely?

    Also, I have had a problem with a malfunctioning Illeocecal valve for two years. Taking Chlorophyll seems to help calm it down. Is it safe? (Also if you have any recommendations for Illeocecal valve problems it would be much appreciated!!!)

    Last question: Have you found that some people can’t tolerate both sweet potatoes and regular potatoes? It seems that eating white potatoes regularly is causing quite a bit of gastrointestinal upset. Worse than sweet potatoes…


    • Hi Claire,

      Constipation/diarrhea is caused by a bad mix of gut flora. If you eat a good diet and maintain good immune function, the flora should gradually normalize and that will allow you to stop the extra supplements. I don’t know how long that will take. Just try dropping the extra supplements from time to time and see how you do. I think all the supplements we suggested are safe so it’s not a problem to take them for a long time, just a nuisance.

      Chlorophyll is nutritious, sometimes it is accompanied by immunogenic compounds if it is derived from algae, so some people are sensitive to it. I would not care to generalize but the chlorophyll itself is healthy.

      White potatoes have a lot of fiber so they feeds whatever microbes are causing your IBS-like symptoms. You may benefit from a low-fiber diet until you fix your gut flora.

      Thank you!

      Best, Paul

  24. Hi Paul,

    Happy New Year! I’ve been devouring your new book happily 🙂 Well done and thank you for doing it!

    Have you seen this study? http://diabetes.diabetesjournals.org/content/58/7/1509.long

    It’s a few years old but this got my attention:

    “CONCLUSIONS Dietary supplementation of butyrate can prevent and treat diet-induced insulin resistance in mouse. The mechanism of butyrate action is related to promotion of energy expenditure and induction of mitochondria function. ”

    It’s a funny thing but my gut dysbiosis is marked by poor blood sugar control – something I’ve battled all my life, such as the dysbiosis. I wonder if my gut biome (and consequently butyrate production) was better how much better my blood sugar and insulin control would be…

    Have you come upon any other research that makes these links?


    • Oops, I meant to say “Have you come upon” not “Have you come up with”.


    • Hi Andrea,

      Thanks for the link. We have a discussion of the benefits of butyrate on pp 161-2 of the book, you can find the papers we cite here: http://perfecthealthdiet.com/notes/#Ch14.

      That particular paper isn’t cited but it would be a good one to join note 16, http://pmid.us/12231422, in showing the benefits of butyrate for diabetes.

      Good point about low butyrate possibly contributing to poor glycemic control. It could also be inflammation in the small intestine affecting the pancreas.

      • Thx for the references. This is endlessly fascinating to me – I suppose it’s common thing when it rules so much of your life as it has mine.

        I didn’t know about small intestinal inflammation affecting the pancreas. Do you have any more info I could look into for this?

        I have chronic inflammation all throughout my GI tract – with an IBS, not IBD, diagnosis from the gastroenterologist. I’ve tried all matter of things to bring down this inflammation… Omega 3 (in oil AND fresh seafood form), melatonin, slippery elm, help to a certain degree but nothing seems to stick. I’ve written on your Q&A pg before and I’m very grateful for the kind help you offer us all.

        Every time I think I make sense of this it throws me for another loop. I’m down to eating homemade white sushi rice with very well cooked veggie/meat stews. I’m grateful to consume this with some success bc there are times where nothing feels remotely ok in my system. My list of allergies/intolerances is a mile long, no surprise for a person who became intolerant to her mother’s breast milk at 1.5 month of age 🙁

        Do you think a fecal transplant from a good donor would be able to help correct the inflammation and underlying issues? I’ve been treated for parasitic infections, etc, the healing part is what I struggle with.

        Thanks very much 🙂

        • Hi Andrea,

          Well, your conditions are among the most difficult to fix. Chronic infections can take root and be very difficult to expunge.

          I do think a fecal transplant might be a big help. There are no guarantees however.

  25. Post inflammatory hyper pigmentation: what are your recommendations to get rid of it?

  26. Hey Paul,

    I gave your new book to a good friend who is very health conscious but was totally on the low fat, whole grain band wagon. She is currently reading the book and the first issue was fish oil tablets being rancid, as she knows the importance of Omega 3’s. I suggested find a good source for fish oil supplements such as Mercola and try to add thru diet, tastier fish recipes, egg yolks, grass fed beef etc.. Her next issue was that she just got her daughter off of lunchmeat and now she eats PB&J on whole wheat for lunches. She hasn’t gotten around to the chapter on beans but she asked what is wrong with beans?? The Cancer Project at http://pcrm.org/health/cancer-resources/ just loves beans for protein. They say following their diet gives you a 40% reduction in the likelihood that your cancer will spread. I could drop the hammer on her for these questions with the PHD arsenal but was curious how would you respond in a tactful and scientific way as she is genuinely interested. Thanks for your input.

    • Hi SC,

      For the omega-3s freshness is critical and the freshest way to get them is fresh or frozen-at-harvest fish.

      Beans have a variety of toxins, as do peanuts, not all of them known. Tree nut butters are generally healthier than peanut butter, so if she could give her daughter cashew butter or almond butter or macadamia nut butter instead that would be an improvement. (I know they are more expensive.) Gluten-free breads would be better than whole wheat bread.

      Beans do contain some compounds that inhibit cancer growth, but so do other vegetables, so that is not a strong reason to include beans in an anti-cancer diet. The evidence that beans actually help against cancer is not nearly as strong as is often suggested; that “40% reduction” number is not solid, it could be zero effect or a harmful effect as well. Always in biology, one has to compare any particular diet with the alternative, just because something appears beneficial compared to soda and cookies does not mean it is the optimal food.

      I hope to blog more about anti-cancer dieting this year and will try to address the bean question in more detail then.

      • Paul,

        For convenience and cost, I regularly eat canned wild salmon (brand is Wild Planet). Any concerns with canned? Thanks.

        • Hi Frank,

          It’s not as desirable as fresh or frozen, but I think it’s better than not eating any marine fish at all.

          Some people worry about BPA, aluminum, etc. It’s hard to pin down exactly how risky those are.

      • Paul, well stated, just what I was looking for. Thank you!

      • Just came across this this AM and we’ve been 99.95% GF for one year today 01/06/13 and it is a matter of choice for us not Celiac driven – http://goo.gl/IqcMP

        There are so many options when it comes to alternatives and most major cities have more than one GF bakery. We enjoy GF pizza shells – bagels – hamburgers – etc. no pain no (weight) gain!

  27. Hi Paul,

    Just got the second edition of the PHD book and am really enjoying it. I read the first edition when I was still trying to sort out my health foundations and it helped me uncover several infections which seem now more under control (it is SO true that infections play a big role in our health! Thank you for being an advocate of it). I am now ready to dig deeper into certain issues, especially right doses of nutrients. In the book you say that the purpose of the PHD is to get enough of each nutrient but not too much of any of them. I am currently supplementing with vitamin D3 5000 every other day, vitamin K2 MK7 100 mc each day and trying to up my vitamin C (am still around 300-400 a day). I’d like to try iodine/selenium but have a history of hyperthyroidism and know that I need to be very careful. Should I start with very low doses of liquid iodine (and how much exactly?) and slowly increasing while taking 200 selenium – or should I start with low doses of selenium as well and increase them both at the same time? I am still taking some very very tiny amount of anti-thyroid medication (metimazole) and LDN and my antibodies are still positive though 10 times lower than in the past. I am also preparing for a pregnancy. Is this the right time to experiment with iodine? I tried seaweeds but I do not digest them very well and then you say it might be better to take pure iodine/potassium iodine. I am also eating less than 3 egg yolks a day – more about 10 eggs a week, maybe I should discard the albumen and eat only the yolks to eat more of them? I still feel uncomfortable eating so many eggs – culturally I guess, since my family has always eaten very few eggs per week. Shall I supplement with choline? I eat beef/lamb liver and my copper and zinc are good, perhaps copper/zinc ratio a bit on the higher end but well within the range. I supplement with magnesium oil (a few sprays a day) since I do not stand oral magnesium very well and am planning to use butter oil to increase k2 even further.
    I have also implemented a variation of intermittent fasting and was wondering if this can be ok: I eat 2 main meals a day, one around 12:30/1:00 and another at 8, with little or no snacking in between but in the morning around 9:00 I have a green juice with just wheat grass, 1 lemon and 1/2 a small green apple. Am I breaking the fasting in this way?

    Thank you so much Paul for helping us figure out the various aspects of the diet!


    • Hi Jo,

      I would just start with seafood (shrimp, shellfish, seaweed) and see how that goes. If you don’t notice a hyperthyroid effect, then get the 225 mcg tablets and cut them with a razor blade into eighths so you have fragments of maybe 20-40 mcg. Try one of those a day and see if you tolerate that OK.

      You want to go very slowly and not become hyperthyroid.

      You can follow our selenium recommendations from the start – basically, PHD is a selenium rich diet, so no supplementation or once a week is fine.

      You might find that a low dose of lithium can replace your medication.

      I wouldn’t experiment with any substantial doses of iodine. Just tiny doses will do. The iodine is probably delivered to the baby via thyroid hormone and you want normal levels of that.

      Yes, I think choline supplementation is a good idea.

      Yes, that’s a fine eating schedule. It is not a very strenuous fast but that’s OK.

  28. Hi Paul, sorry about double pasting this, I am just still confused of what is the benefit of staying in that middle carb range(60-100g) and avoiding Ketosis? I understand why 150g of carbs is more beneficial.

    But do you agree with this, that Ketostix are useless more or less.

    This Video explains why people get great Ketosis reading when they do high carb.

    But basically the Ketostix only show you ketones and not if you are Ketogenic, if you eat a lot of carbs, your body does not have much to do with Ketoes and you pee them out, that is why you get a high reading. But it also happens in the morning and after exercise.

    here is the link

  29. Thank you, Paul. Perhaps I can cook the seaweed in broth and discard them after they have soaked in the broth long enough to release minerals. Or I can eat a small amount every day hoping to get used to them – I must missed the digestive enzymes to fully process them in my GI track!
    I looked into lithium and it is considered a class D drug (legal during pregnancy but might cause birth defect). Methimazole is the same class D and I suspect that in small doses they are both fine. Will ask my doctor what he thinks about lithium, thank you for your idea, it opens up new possibilities.

    And happy new year!


    • Select your dried seaweed and quickly rinse it to remove any dust, dirt or sand and then soak it for half an hour or so in not too much water… heat organic chicken broth (or make a bone broth from Chicken feet and a carcass from yesterday’s chicken) swirl in (egg drop style) an egg or two and finally add the seaweed and soaking liquid to the broth and enjoy. Shredded spring onions, celery mince, chopped cilantro all modify somewhat the overall flavour. You will find the balance that suits you.

  30. Study Guide?
    Hello PHD community. This evening, while visiting only briefly with my 14 year-old granddaughter we were looking through the copy of Nourishing Traditions I gave her mother for Christmas. I commented, “None of the recipes in this book call for vegetable oils.” She immediately replied, assertively, “My health teacher says those oils are good for us.” I grabbed the copy of PHD which I had given her dad (my son}, and opened to the “Devil Oils” page and asked her to read the chapter title. She did, with a giggle and substituting the word “angel” for the “d” word. I chuckled and said that I had contemplated giving a copy to her and her brother and offering to pay them to read it. Her eyes grew instantly wide as she begged, “Yes! Yes! Dad! Dad! Grandma is going to pay me to read that book!” She needs the dough for a church trip and she’s a crackerjack reader. I told her that if it was okay with parents I would consider a plan to hold her responsible for the information in pieces, possibly chapters; and would make it worth her while monetarily.

    So now, I’m wishing I could download a study guide. Surely, don’t expect Paul or Shou-Ching to answer the call. Ideas anyone? Thinking I will create a list of questions for each chapter (’cause my full time job in a public school doesn’t keep me at all busy, don’tcha know?) Where’s the emoticon for foot in mouth or sunburned tongue? 😕

    • Lana –

      I think it’s great to encourage your granddaughter…but I’d be a bit concerned about possible “frustration” in trying to get through a fairly academic book at her age. I’d suggest providing her with some targeted reading assignments (by page number) that focus on the key principles/messages of PHD but avoid some of the fairly esoteric (but important and interesting, to me) scientific discussion. (Honestly, there were some parts that I skipped because the scientific info seemed superfluous since I was already a believer in the point they were making.) There’s probably 30-40% of the book that might cause her to start “skipping” parts of the book because it’s boring and/or difficult to understand.

      That said, if you DO come up with a study guide then I’m sure it will become quite popular!


      • Thanks, Jim. Targeting certain sections of the book is what I’m thinking. She is highly bright, advanced in all areas at school, but, alas, no real interest in science beyond getting an “A” and moving on.

        I showed her the nice diagram I have of leaky gut and told her my doc said that if we get my gut healed my food allergies, for the most part, will disappear. She confidently asserted, “I don’t have any food allergies.” True she doesn’t seem to, but I do wonder what’s in her future. She has a lovely fourteen year-old figure, and there is no obesity in the family. So, statistics about obesity will be meaningless to her. She frequently eats sugary baked foods and I’ve seen her down 8 slices of toast within the time it takes to get the bread toasted. That, in addition to the bread at every meal, suggests she likely does have gut permeability issues that have not been made manifest yet. I suspect she may be very hard to convince, given that her health, at present, seems to defy the PHD message.

        The intermittent fasting info may be of interest to her because, not surprisingly, she is very opposed to “bugs” living inside her. “Good bugs” would, of course, be dead bugs (this came up in our discussion of yogurt). Here’s an article I just found. http://theprimalparent.com/2011/05/27/intermittent-fasting-safe-children/

        If I come up with anything to guide her through any of the book, I’ll let you know. I’m curious to see if she revisits the offer.

        Thanks again, Jim.

    • Hi Lana,

      A study guide is a very cool idea. If anyone does create a draft, please send it to us and we’ll publish it on the site and/or edit/expand/revise it. We could also make a community project out of it — a wiki?

      Jim’s point is good, it is a challenging book for a 14 year old, but she could learn a lot and maybe develop an interest in science. It might be good to have a discussion with her after every few pages. Science is meant to be a social activity, not solitary study.

  31. 🙁 I’m afraid that the authors use of calories, is most confusing. calorie counting went out with the stone age.
    If only these interesting authors could have used grams of Pro and Cho, I would have been happy.
    calories are meaningless when taken in the context of combining fat with carbs,.where the gi is concerned. That is not meaningless is it?
    Dr Neil

    • Hi Neil,

      We use calories rather than grams because with grams people get confused between weight of food and weight of specific nutrients. We think calories of macronutrients and grams of food avoids confusion.

      This usage is not meant to promote calorie counting. It’s meant to facilitate a clear understanding of the scientific discussions.

  32. Hello;

    I have a question- if one feels better while extended water fasting, does it rule out the possibility of candida overgrowth? By feeling better I mean more energy, clearer mind, less tired, less abdominal symptoms, etc

    • Hi Peter,

      I would say it indicates a (probable) bacterial problem. It does not completely rule out candida because co-infections are common, but it suggests your main symptoms are due to bacteria or some other carb-dependent microbe.

  33. Paul,

    Seems that PHD is on the other side of the diet (hate using that word – “diet”, i rather use eating style as diet seems like something temporary) spectrum than the SAD. Perhaps if PHD was a benchmarked at 100, would you say that SAD would be a 5-10% compliant with PHD?

    On such a scale, where would you put SKD and SJD or SPD on such a compliant scale with PHD? (meaning if you just followed these would it be quite close to PHD?

    SKD: Standard Korean Diet (rich in beef, very little chicken, seafood, seawead, safe carbs, no veggie oils….etc)
    SJD: Standard Japanese Diet (iodine rich, similar to SKD)
    SPD: Standard Philipino Diet (animal parts, cooking in coconut oils, heavy use of coconut milk/cream, white rice, taro, plantiens, rice flour….)
    SCD: Standard Chinese Diet (animal parts, rice, no diary, similar to Philipino.

    • Hi Evan,

      About 65% of the calories consumed on SAD are forbidden by PHD, 35% approved, so I would say 35% as a ballpark.

      By the same measure the Asian diets were probably 90% PHD compliant 30-40 years ago and 70% compliant today. They’ve all migrated toward more sugar, wheat, and vegetable oils.

      I’m not familiar enough with country-to-country differences to say which is best.

      • Paul,

        Yes I agree, approx 90% for an Asian diet a generation or so ago.

        The closer I adhere to PHD the more my wife keeps repeating, “that is what I grew up on in the Philippines”. I was pleasantly surprised to see all the safe starches to be the mainstay starches in the SPD of yesteryear.

        Perhaps my wife is always right. She seems to think so.

  34. Hi Doctor Jaminet,

    What are your thoughts on eating conventional raised Stop&Shop Butter as one’s main fat source? Any issues that come to mind?

    Coconut oil isn’t always an option for me becuase of its higher price

    Thanks again for all the help,


  35. Hi Paul,

    Is it okay to go below the 600 carb + protein threshold by limiting protein on days when not exercising. When you say protein restriction, how low can one go on any given day? Or is a 600 carb + protein minimum always the rule?

    • Hi Andrew,

      Then it becomes a fast, not a healthy long-term dietary routine.

      Fasting is healthful, just know what you are doing and that you need to make up for lost nutrients later.

      The 600 calorie minimum is an average, it’s not necessary to respect it every single day but if you dip below one day you need to get more another day.

  36. One last thing before I get to my busy weekend. Again I have read a reference to H. Pylori having benefits. The article is here: http://tinyurl.com/avo2lqy

    A quote from this article, seeming to defend some presence of HP in humans:
    This is a lot of antibiotic exposure for our younger generations and the implications for those children who don’t acquire H. pylori due to excessive antibiotics appear to be dramatic with a higher risk for both allergies and asthma…Blaser’s research group has also observed that lack of H. pylori in the human body affects the production of ghrelin and leptin, 2 hormones that play a factor in weight gain.

    • Hi Lana,

      Thanks for the link. The effects of H pylori are complex. I have seen the claim that we need two distinct types of H pylori to avoid ill health effects from it, but many people who have it only have one of the types.

  37. The GAPs diet recommends “painting” on iodine on the skin. The idea is that the body will naturally take up what it needs. The suggestion is to apply it daily until you can see residue from the iodine (however faint) the next day. Then apply weekly for maintenance. In the PHD book, you recommend liquid or tablets and increase to a daily dosage. Are both methods acceptable? Thanks.

  38. thank you for your response Paul, to my calorie question. You deserve a medal for your tireless (?) dedication.
    I am puzzled by your support of both potatoes (cho dense) which are part of the nightshade family, and WHITE rice,.rather than the usually-touted Brown and Basmati rice. Eating a pound of potatoes is more than I could manage in one day and there seem to be few alternatives, given one’s avoidance of fructose.

    • Hi Neil, These are discussed in the book, I believe. Potatoes do not express many toxins if well handled post-harvest, and white rice is lower in toxins than brown rice. Basmati is fine. We do list a number of safe starches, but repetitiveness in starches is not something we consider a problem. There are many ways to create distinct flavors in a meal using other ingredients.

  39. I feel a little silly asking this but…after about 1 year of very clean eating, (PHD with no nuts, chocolate, fruit, or dairy but butter) naturally I still sometimes crave old foods that I no longer eat. The strongest craving I still have is for peanut/nut butters and trail mixes I used to binge on (particularly combos of chocolate, dried fruit, and nuts). Could there be any particular reason for this, or could it just be a mental comfort food/hyperpalatable combination for me?

    • Hi Elyse,

      Well, we do support eating tree nuts, tree nut butters, chocolate, and fruit, so there’s nothing wrong with eating those things in moderation. It sounds like you no longer binge on them, which is good. I don’t think it’s wrong to desire these things, they are delicious. I would say that if you find yourself bingeing on them, don’t make them too readily available.

      For a while Shou-Ching was putting a bowl of nuts and chocolate on my desk every day and I found I was eating too much of them, so I asked her to stop. It can be a little too easy to satisfy cravings in today’s world.

      • Yeah I dont eat them anymore because it’s too easy for me to binge on them…even just plain unsalted nuts! But I still find that my cravings for them are much stronger than most other foods I miss…which some people believe may be some sort of sign of a deficiency but it’s probably just because they are so delicious haha. Oh well!

  40. Hi Paul,

    I’m a little confused… When doing some sleuthing about GERD/Reflux I am finding conflicting opinions. Of course the mainstream ideal is that it is caused by too much acid and therefore antacids are the answer, but this has proved untrue for me.

    I searched this site for some answers, but noticed that you haven’t done a post on the topic specifically (not that I found anyway), but you do link to a Mark Sisson article that seems to place much of the blame on grains which would obviously include rice… which you recommend and which I eat a lot of.. So, please help me figure this out. Should I cut out rice? Eat smaller meals? Go strict paleo (as Robb Wolf recommends)?

    I should mention that this severe reflux just started a few weeks ago after many months of excessive travel/stress and less than optimal eating. So, I am wondering if it will sort itself out once I get back into a routine or if, like the mainstream medical advice suggests, anyone who suffers from heartburn several times a week has GERD? Also, I have had a metametrix test which showed no infection or H. Pylori (which Sisson also claims is a common cause).

    I have upped my probiotic intake, fermented veg and dairy, and tried to get lots of sleep.. but it doesn’t seem to be helping. Any further advice? If it is faster please do just link me to other areas where you have commented on this very issue.

    Thank you,


  41. I have just enthusiastically started the PHD after many years of Nourishing Traditions eating and 7 months of modified paleo. I had gained 25 unwanted pounds, as well as having high fasting blood sugar and very high lipids (330 total cholesterol). I lost the pounds easily on a moderately low carb (40-50 gms, no starches, little fruit) paleo with fermented dairy diet and IF (5-6 hour window). The dyslipedemia and high blood sugar are still with me. However, I was feeling really great, and then suddenly got the absolute worst cold, bronchitis, sinus infection I’ve ever had in my 60 years. I am still not totally recovered after almost a month. It was shocking and depressing. Was I malnourished from the dieting, would the weight loss itself have compromised my immune system? I ate plenty of vegies, fermented foods, supplements and bone broth. Fruit seemed to send my blood sugar spinning so I avoided it. Any comments on immune system strengthening would be appreciated. Also, what is your opinion on the recent arsenic scare in rice? One more question, if one hasn’t eaten starches in a long time should you build up to it slowly? I noticed I was gas/bloating free on low carb but sweet potatoes and fruit ended that. Thanks so much. This is a great service.

    • Hi Santafiora,

      When did you gain the 25 pounds? Am I reading you right that that was on Nourishing Traditions/ WAPF and then you lost it on Paleo? Then the cold developed on Paleo?

      That pattern is not uncommon, the grains on WAPF make it easier to gain weight and while low-carb Paleo is good for weight loss, it isn’t necessarily optimal for immunity.

      I don’t think weight loss itself inherently suppresses immunity, but low-carb does suppress some kinds of immune function, and there are many slow-developing kinds of malnutrition that take months to have effects.

      The dyslipidemia and high fasting blood glucose give us two targets to aim for. I suspect if you fix those then your immunity will improve and you’ll be much less likely to get sick.

      The bad response to fruit suggests some sort of small bowel infection and fructose malabsorption. Have you looked into SIBO testing with your doctor?

      Some of the advice I just gave Dede about her husband applies to you: http://perfecthealthdiet.com/q-a/comment-page-48/#comment-114547. You should read our LDL category for causes of high LDL that you can address, get any hypothyroidism treated even if it is subclinical, and get the likely bowel infection/dysbiosis diagnosed and treated if possible.

      You’ll also have to experiment a little to find which carbs work best for you. You want to get adequate carbs but without stimulating the bowel infection that you seem to have. Try them in small quantities at first, you may have difficulty finding some that don’t give you trouble. Also search for our post “What’s the Trouble with Sweet Potatoes” for some possible ideas for why sweet potatoes give you trouble.

      Eat white rice from Asia or California and the arsenic danger isn’t great. But it has put us off brown rice syrup as a sweetener.

      Hope this gives you some guidance; keep me posted.

  42. Hi, Paul!

    Just some musings for a Sunday morning. My wife and I love the book and the blog, and appreciate all you and Shou-Ching are doing to improve everyone’s health!

    Here are a couple of things for you to consider as PHD continues to gain steam and acceptance:

    – List of Acronyms. One of the first things I noticed about PHD is that it is acronym heavy — it’s inevitable given the nature of the science behind it. I think the book (and the website) would benefit from a list of acronyms to help readers keep the alphabet soup straight.

    – Forum or Expanded Q&A. I enjoy the Q&A section, but it contains a LOT of information and it’s not particularly user friendly when it comes to searching for info. Have you ever considered starting a forum section (something similar to MDA or other fora)? It would help focus readers to particular areas, and having post subjects would make it easier to find/read topics of interest. I realize that brings some additional overhead — and I can completely appreciate that may be more than you’re ready to take on right now. If a forum is too much, then perhaps just creating different Q&A areas, such as Diseases, Food/Nutrition, etc. might be a potential compromise. I find that I scan the Recent Posts column and that the ones that are tagged to particular topics (Supplement Recs, What’s New in the Second Edition, etc.) tend to draw my attention more quickly.

    Again, these are just some thoughts from a contented user…if you never change another thing about the blog, the user community will still be healthier and happier for all of your hard work!

    Thanks for listening!


    • Hi Jim,

      Thank you! Great ideas. I am working on a forum but I may need to refrain from answering questions for a few days to get it going. It is hard to make time for everything. I agree that the Q&A thread has gotten unworkably/unsearchably large and all of this material should be on a forum.

  43. Hello and help!

    I just bought your book and it makes good sense. However, right now, I have no energy. 2012 was a challenging year. I have always struggled with low energy in the winter months but this year it’s really wiping me out! What is this easiest way to start on the diet? Are there any doctors/healers in the Boston area you would recommend who might help me get started.


    • Hi Donna,

      I would say, take a look at our Recipes page and pick some meals you’d like to try making. Try to follow the meal plan template in the book for a few weeks.

      Don’t worry about being fully compliant, any dietary change requires changes to how you shop, cook, and live, so it is hard to implement everything at once. Get some rest, get some sunshine, some sleep, and try to learn how to make tasty and nourishing food that fits in your lifestyle. Then when you’re comfortable, revisit the book and try to implement things more fully.

  44. Hi Paul, my husband and I have been eating PHD since November 1st. Of course, tweaking the diet as we understand portions, so may not have been optimal, and still might not be. My husband has a tendency to over eat carbs and protein, and I may in the beginning before you helped me understand fat ratios served him too much fat. He is trying to not over-eat now that he received his test results back. He, like me came from a mostly vegetarian diet prior to November. He ate a LOT of quinoa and sprouted corn and wheat products on his version of veg diet. We have since found out he is gluten intolerant, so he took the grains out (except PHD white rice). Anyway, he is 56 years old, thin, a BMI of 20 (5’11 145 lbs). His Glucose just came back high at 107, his lipid panels just came back, also very concerning:
    Total chol: 273
    Trig: 45
    HDL: 71
    LDL: 193
    His Vit D was 49.8.
    TSH: 2.82
    Free T4: 1.19
    Triiodothyronine free serum: 2.9

    His doc wants to put him on statins right away and says he is pre-diabetic. His lipids were never this high before, but he hasn’t been tested in over 6 years. He he has real concern about the new PHD plan (despite his overeating sometimes that I reminded him of) We are wondering if you might have some insight as to why his levels might look like this. Can we tweak something with supplements/food to help? I read the section in your book and see the copper, iodine, etc., but we are on all supplements except lithium; our iodine intake is currently @ 675 mcg.

    One thing to note, he did have 4 drinks (more than his usual) the night before these tests. Could that have anything to do with glucose etc.? He fasted, of course and had his last drink at 10:00PM, test at 9AM the next morning. I will appreciate as always your time in looking at this, he is pretty freaked out right now. Thank you so much Paul.

    p.s. I re-posted this in Q&A from Reader Results after reading that is best if there is a concern when one implements the diet.

    • Hi Dede,

      It does sound like he was overeating. Our food is tasty so some people are tempted to do that, especially at first. I think as nourishment improves then appetite decreases.

      Vitamin D is good. TSH is high and T4 is low, suggesting hypothyroidism which is a primary cause of high LDL.

      So it looks like there is a combination of overeating which generates insulin resistance and high blood glucose, plus often high LDL; and hypothyroidism which generates the high LDL; possibly metabolic syndrome is involved too, see in the new book the discussions of metabolic endotoxemia for what causes that.

      Alcohol raises fasting blood glucose in diabetics and pre-diabetics (http://diabetes.webmd.com/drinking-alcohol) but not in healthy people. So it could have been a factor.

      You should read the various “high LDL on Paleo” posts in this series: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

      I think a likely possibility is that recent increases in iodine intake may have contributed to a reactive hypothyroidism. I would keep iodine intake steady or maybe lower it a bit until you sort out these issues and blood glucose and lipids are normal.

      Overall I think he mainly needs some modest tweaks to the diet and possibly some thyroid support by getting his doctor to prescribe a low dose of thyroid hormone. Find the lowest dose that makes him feel good. I do not believe statins are a good idea. Rather you want to solve the underlying dietary and thyroid issues and let serum cholesterol be an honest marker that tells you whether your changes are working or not.

      Best, Paul

      • Hi Paul, sorry for another question on my husband’s blood panel, but all of the results had not come in yet on his thyroid panel when I posted last. His T3 uptake came back at 37. So, all numbers together again are:
        TSH: 2.82
        T3 Uptake: 37
        Free T4: 1.19
        Triiodothyronine free serum: 2.9

        Does the T3 Uptake mean anything more than what we have discussed?

        Thank you kindly again for your time.

        • Hi Dede,

          I think you have to go largely by symptoms. Based on the numbers, I would say he looks somewhat subclinically hypothyroid, since TSH is high. But symptoms are a better guide.

          T3 uptake doesn’t mean much to me, the more iodine you supplement the lower it will go, I don’t know how to match numbers to his situation.

          • He doesn’t have a single symptom of hypothyroidism. Such a mystery. He feels good, sleeps well, very strong nails, etc. has good energy, enough to ride his bike when weather permits 10- 20 miles at a time (has been doing so for 25 years). So, we don’t know what to think. He is thin; not the “usual suspect” of what we think of being pre-diabetic. I think I’ll tweak the diet some more by removing dairy fats (sour cream, cheese and sheep’s yogurt) as well as as fruit to see if that helps him. Thank you Paul.

          • Is 107 the fasting blood sugar level? If it is, it is too high, but it is an unreliable test and you should check blood sugar levels yourself this way:
            -> test blood sugar in the morning
            -> eat a large baked patato (over 300g) in the morning with little to no fat
            -> check blood sugar 1,2, and 3 hours after eating (do not check before 1 hour!)

            It is likely to be too high. The value should not exceed 140 mg/dl at any time.

            If it is, he has to cut back on the carbs and try to find out through rigorous testing which foods are okay. (maybe small amounts of rice with a lot of fat etc.)
            If he does not and especially if he overeats, he might get full-blown diabetes.

            If he feels great and does not have any symptoms of hypothyroidism, the values might have changed because of iodine/selenium consumption. So it doesn’t necessarily have to be a bad sign. There are also critics of treating thyroid disease based on lab tests, e.g. David Derry.

  45. Thank you so much Paul, and my husband just cannot believe how kind and generous you are of your time, he sends his gratitude, as do I.

    I will keep you posted of his progress; sounds like we can fix this. I’ll lower his iodine back to 450 mcg and keep it there until we know more about his thyroid status. WIll be difficult to get thyroid hormone from a doc who says his thyroid levels are “normal”, but, we’ll see. He has a follow-up with her Tuesday morning for a Berkley heart lab test. If it were you, would you limit alcohol consumption?

  46. Just came across this this AM and we’ve been 99.95% GF for one year today 01/06/13 and it is a matter of choice for us not Celiac driven – http://goo.gl/IqcMP
    There are so many options when it comes to alternatives and most major cities have more than one GF bakery. We enjoy GF pizza shells – bagels – hamburgers – etc. no pain no (weight) gain!

  47. Hi Paul,

    Do you have any recommendations for someone who seems to be having yeast issues? Probiotics and garlic make my yeast symptoms worse. Starches have definitely helped as fruits only made things worse.

    I react to apple cider vinegar and fermented garlic sauerkraut or kimchi makes me react very badly, I believe they are known to be high in yeast.

    Is there anything I can do to kill the yeast off? I’m not sure that’s a good idea, so I was thinking maybe supplement Saccharomyces Boulardii and maybe other good yeast strains if I could find any.

    Any thoughts?


    • Hi kimanyd,

      If fruit gives you trouble, then you have some sort of dysbiosis in the upper digestive tract which is not good. This area should be fairly antiseptic / clear of microbes.

      Assuming your diagnosis of a yeast overgrowth is correct, there is no consensus on the best way to address it. At a minimum, I would suggest taking NAC to support immunity and detoxification and taking betaine hydrochloride with meals and extra salt to support stomach acid production and help prevent yeasts from the oral cavity or sinuses from propagating to the small intestine.

      I would not supplement Saccharomyces Boulardii if you have yeast overgrowth; it can make it worse. If you have bacterial overgrowth, it can help.

      • Thanks for the reply!

        In that case should I avoid probiotics till I get this under control?

        I’ve read that NAC can feed candida, which is a yeast or a fungus. Would you still recommend trying it?


        • I think NAC will do more good than harm, yes.

          Probiotics might do harm if your problem is SIBO. I think it’s OK to avoid probiotics, they’re not that helpful for this particular problem.

  48. Hi Paul,
    Do you have an idea why more than a small amount of dextrose gives me a burning sensation in my throat? I’m trying to up the dextrose and decrease starches for a period to see if that helps with digestive issues.
    Thanks again,

    • I meant to say the sensation subsides afterwards, it is only during the consumption of the meal.

    • It is probably stimulating acid reflux. Try taking it with more food and water.

      In general, foods are better digested and less likely to cause reflux than purified nutrients like dextrose. However, foods are digested lower in the digestive tract, so they are more likely to cause problems in the colon, eg if you have ulcerative colitis or something similar.

      • Thanks Paul, that makes sense. It is actually acid reflux that I’m trying to get on top of at the moment. I’m trying the dextrose to see if that reduces my burping which I’m assuming is caused by bacteria digesting the starches and am hoping that will sort out the acid reflux. Does that path make sense as long as I dilute the dextrose more?

  49. Hi… Question for anyone familiar with female hormones…

    My blood test results are in. I’m 25 y/o. Have not had a period for 3 months. I have a history of infrequent periods. I’ve also been getting pimples that leave red marks.

    Question: My results are within the lab’s normal range, but sometimes lab ranges are too broad. Are there other “normal ranges” out there? I read elsewhere that normal Free Testosterone for women is .7 to 3.6 so can my result of 2.5 be considered the high end and thus no period?

    Are there other tests I should ask for?

    Testosterone total 26 (2 – 45 ng/dL)
    Testosterone free 2.5 (0.1 – 6.4 pg/mL)
    Progesterone <25 (no lab range ng/dL)
    Prolactin 6 (3 – 30 ng/mL)

    • Hi Monnyica,

      I’m not knowledgeable about these issues, but another possibility to consider is the “athlete triad” which can occur in non-athletes due to stress and undernourishment. See http://perfecthealthdiet.com/2012/10/very-low-carb-dieting-are-the-hormonal-changes-risk-free/

    • Hi Paul,

      Thanks for the link. I’m not sure if I’m under/over eating because I could possibly be miscalculating the weight of my food.

      My diet is fruits at 10am, lunch 12pm, dinner 5pm: 3-4 cups White Rice, 2 Fruits, 3 cups Veggies, 2 Yolks, 1 lb of Meat/Fish/Oysters. (Waiting for Metametrix results before I become 100% PHD because afraid of triggering a skin reaction.) After reading your link, I’m wondering… is eating 10am-5pm everyday causing me to be in starvation mode?

      Also, extra info: I only exercise 30 min per day (light jogging and crunches). I have normal TSH and FT4. And planning to get checked for Endometriosis and Pelvic Inflammatory Disease.

      • Hi Monnyica,

        That sounds like sufficient food. I don’t think the intermittent fasting would cause problems unless you have pre-existing adrenal fatigue in which case you might want to put a snack in there.

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