Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

10,240 Comments.

  1. Paul,

    Regarding circadian rhythms, going to bed and waking up at the same time is great when my 8 month old will allow it, however that’s spotty at best.

    Is there any information out there about napping and circadian rhythms? Or how to make up sleep in general if you lose some, or if you should make it up?

  2. Hi,

    What’s your opinion on the health benefits of fasting? I’ve been reading very positive anecdotes and would like to try a 14 day water only fast. Is this dangerous? What benefits, if any, will I see?

    Thank you

    • Hi Floyd,

      It’s discussed in detail in our book. We support intermittent fasting but not long fasts. Yes, it’s dangerous.

    • well, maybe not SO dangerous. There is a detailed article n Harper’s Magazine (March 2012) describing a fast of several months. I recommend the article, but I can only paste in the link to the title, you must be a subscriber, or go to your library and find the back issue. I suppose I could mail you a copy.

  3. Sarah Berkshire

    Hi!

    I’ve been a paleo dieter for a while and love it. I avoid ALL grains and legumes, as the mantra in the paleo camp seems to be that anything that isnt a meat, vegetable, fruit, egg or nut should be avoided.

    So I’m surprised that you include white rice and potatoes in your phd- it goes against everything I’ve read on nutrition ( which had admittedly been limited to “paleo purism.”

    I’d love to add a little bit of rice and sweet potatoe to my diet. Can you maybe briefly explain why these foods are in fact healthy?

    Thank you so much!

    • Hi Sarah,

      The book discusses this in detail. A few points:
      – Paleolithic peoples ate a lot more starch than fruit or nuts.
      – Starch is good for us – both the glucose and the fiber (resistant starch).
      – Eaten properly they don’t produce dangerous swings in blood glucose.

  4. Michael McDonald

    Hi Paul;

    I’m wondering if you can help me with something I’ve been musing over

    If you eat 50 carbs worth of cabbage, is it the same as 50 carbs from bread?

    Would 50 carbs from cabbage be the same as the sugar you’d get from 50 carbs of candy?

    Is the sugar in something like red cabbage the same as the sugar in soda? Would too much sugar from red cabbage have the same health detriments as too much sugar from soda and junk food?

    Are there any foods where 50 gs of carbs is essentially 50gs of sugar? Do all carbs equal sugar, or is there a difference between food types?

    Thanks!

    • Hi Michael,

      No, it’s not the same, because the cabbage requires a lot more work (and glucose) to digest.

      No.

      It’s similar. No.

      Lots of plants contain sugar. But the quantities are usually small compared to the mass, so the proportions are totally different. Starch and sugar have important differences. See our book for some of them.

  5. Hi Paul,

    Have you found Peter Attia’s Ketosis blog. I thought it might be interesting for you, he also has some good writing on Cholesterol. I think he has been in Ketosis for over a year.

    http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-ii

  6. Hi paul

    Iv had many benefits from the PHD diet, lifestyle but Iv recently been having adrenal fatigue like symptoms and have lowered iodine and stopped intermittent fasting to lower the stress. I just have a few questions on the fasting:

    Is fasting essential for circadian rhythm therapy and in general is it compulsory or is it just a tool in the toolbox. Would sticking to the PHD guidelines and eating breakfast consistently at around 7am and dinner no a later than 7 or 8 be as good and still be good for immunity as fasting would?

    If the only time you can exercise is in the morning and you have to have breakfast before if your not fasting, would the exercise still benefit as your not in a fasted state. In your book it says that it should be done in a close to fasted state. Maybe a low carb breakfast such as 3 eggs would be better off than eggs with sweet potato or banana?

    NAC should be taking during the fast but if your having breakfast should it just be taken before any food enters your stomach, say right before breakfast and the other supplements?

    Can you still lose fat and build muscle without intermittent fasting?

    Thanks in advanced. Keep up the great work. God bless!

    Adam

    • Hi Adam,

      No, fasting is not necessary. It is a tool. I agree with eating breakfast if you have adrenal fatigue. Also, eating more carbs and protein, and eating immediately after exercise, can help.

      You can try to wash the NAC through your stomach by drinking a full glass of water.

      You can lose fat but I wouldn’t focus on that until your adrenal stress is gone.

  7. Okay that makes a lot more sense now. Awake at 7, exercise from 8-9 then eat something straight after, like 2 bananas for example gets the best of training on a empty stomach with minimal stress if not eating dinner past 8pm the previous night. Thats only a 12-13hr fast which shouldnt stress the adrenals much. Or would you reckon to eat 3 eggs upon waking at 7 then continue with the exercise and carbs post workout ?

  8. I keep seeing adrenal fatigue mentioned. What does that mean? How is it manifested?

    Thanks….

    Oh, btw…changed to Basmati rice…don’t really notice the difference in the glycemic index.

    • Hi Jeri,

      It mainly means the adrenal glands are failing to maintain a proper release and circadian rhythm of hormones like cortisol. Manifestations may range from increased appetite and weight gain to low back pain to erratic blood sugar to decreased stress tolerance. It is usually associated with hypothyroidism and other energy regulation disorders, and/or inflammatory conditions.

  9. Hi Paul
    Thank you for the great book I have found it really helpful and informative. I have had a mystery illness for 7 years now and none of the doctors I have seen have been able to diagnose what the problem may be. The closest one doctor has come is to a chronic chlamydiae pneumonia infection and high antibodies of these and candida. He also found that my blood type is an O with non-secretor status which he said makes it hard for me to clear infections. I have tried antibiotics on a number of occasions but not much has improved. I am very conscious of diet and try to eat foods and herbs that my help. I am going to start your diet to see if this may help but am wondering about whether or not to consider antibiotics again as I don’t like being on them long term. Also do you have much information about non-secretors and the use of your diet. Sorry about all the questions and thanks ahead for your comments. Kind regards Annie

    • Hi Annie,

      I wouldn’t start antibiotics quickly, I favor getting as far as you can with diet since improving your diet may clarify symptoms and aid with diagnosis, and will make antibiotics much more effective if you do proceed to them.

      Based on http://www.ncbi.nlm.nih.gov/pubmed/21625510, non-secretors have an altered gut flora with less Bifidobacteria and may be more vulnerable to certain issues, but the mutation is so common that it can’t be all bad. It appears to help against viral infections, including HIV and norovirus. I wouldn’t assume that having that mutation means you need to make major alterations to your approach.

  10. Hello Paul,

    I am a college student into health and fitness. I picked up your book, LOVE the science, and I’m pretty much eating as prescribed (sans broths and fermented vegetables)and supplementing.

    I want to get started with intermittent fasting but I often become the hunger beast 🙂 — it’s tough for me to go more than 3-4 hrs without eating in the day, in fact. Your guys’ reasoning is that as one becomes better nourished one may not have as strong an appetite, but does this effect take a while? I’m healthy, just want to add muscle but also drop a little fat at 5’7, 150-55 lbs.

    Thoughts?

    Thanks,

    Josh

    • Hi Josh,

      Normally higher-fat lower-carb diets make it easy to fast. If fasting is really intolerable, it could indicate any number of issues, from thyroid problems to glucose regulation issues to gut dysbiosis/infection. If doctors don’t recognize anything, tests are normal, and you feel good, I’d just try adjusting the diet a bit and see how your body responds. It might also be interesting to invest in a blood glucose monitoring kit and see what your blood glucose is doing when you get hungry.

  11. Hi Paul,

    I’m not yet ready to dive into supplements, but I’m curious, will I get enough magnesium from an Epsom Salt Bath? Or will I only be absorbing a negligible amount?

  12. Hi,

    I’m wondering, how long can you fast without going into ketosis? I have candida and would like to practice calorie restriction as much as possible.

    Thanks!
    ty

    • also, whats the minimum amount of calories i can eat while on a candida diet?

    • Hi Tyler,

      I would recommend keeping fasts under 20 hours and doing them frequently if you want to fast.

      If you do have Candida, you don’t want to restrict calories as it will suppress immunity more than it suppresses Candida. Are you trying to lose weight?

      • but with candida would it still be ok to do the 20 hour fasts? say do al my eating between 8pm and midnight?

        not trying to lose weight, just trying to improve health and cure acne.

        its frustrating because im not positive i even have candida in the first place.

        i dont really have the unbearable sugar cravings people describe, and the “symptoms” are intermittent- there are times where i feel fine.

        ive wanted to try a longer 2 week fast to see how i feel, i assume that if i feel better fasting it means i can forget about candida and then fast and eat healthy, which is what i really want to do.

        sometimes i go off my diet completely and eat junk for a month, and my candida never really gets any worse- if fasting is only equally as bad as eating sugar, i wouldnt mind it. i actually just broke a 3 day fast today with junk food, and felt better- what does that sound like it is?

        ive been struggling with this for 6 months and just wish i had an answer

        • 20 hour fasts are fine as long as you eat enough food in the remaining 4 hours.

          Eating 8 pm to midnight is not a good feeding schedule. See the book chapter on circadian rhythms. You want food to align more with daylight, and get daytime sun exposure.

          I don’t think a 14-day fast is likely to be health improving. As I scientist I encourage curiosity and experimentation, but as a health advisor I would not expect this to be beneficial; frequent shorter fasts would be better.

          If you feel tempted to go off your diet and eat junk food for a month, then your diet probably isn’t that good. Healthy diets are delicious and satisfying.

      • Out of curiosity, are you saying that restricting calories reduces immunity or intermittent fasting specifically does? I remember you had a portion about autophagy in the book so I assumed that IF would be beneficial for immunity provided enough food is being eaten.

  13. Hi Paul,
    yes another question (sorry),
    i know you talk about the toxins in potato skins (& any dark areas just below the skin as well),

    do you know of any other safe starch vegetables were the skins should be avoided as well.

    I ask because i had some cooked pumpkin today from a takeaway shop as part of my lunch.
    Usually the cooked pumpkin i buy comes with no skin, but the place today included the skin.
    Thinking of potatoes, i avoided eating the skin to be on the safe side.

  14. Hi Paul
    Thank you very much for answering my questions. I am looking forward to trying the diet in the hope that finally something may help!
    Cheers Annie

  15. Hi Doctor Jaminet,

    I’m 18 years old. At certain times throughout the last 5 or so years I ate a diet that was very restricted in calories and the calories I was consuming were toxic and not nutritious- whole grains, granola bars, soy, etc. I did this because I wanted to look thin/healthy (it didn’t usually work by the way). This was before I realized that things like wheat were contributing to my large gut. I have also been sleep deprived throught the past few years at times as well.

    Because I was growing/developing these past years, I am wondering if a calorie restricted diet with very few nutrietns and lack of sleep could have been/is causing some problems I have- fatigue, rosacea or acne (not really sure which), Attention deficit disorder, a depressed feeling, PTSD (I’m wondering if my body went into a panic mode because it was not being provided for nutritionally. I’ve also realized other things that are definitely contributing to the PTSD, but just thought the malnutrition may be contributing as well.)

    Thanks for all the help Doctor Jaminet.

    Keep on,

    J

    • Hi J,

      Certainly severe calorie restriction can cause problems. We give some reasons and examples in the book. Among them, it suppresses immunity and promotes growth of some infections; it depletes liver and kidney of protein impairing detoxification; malnutrition inhibits wound healing and gut maintenance.

      Sleep and circadian rhythm maintenance are also important. I would suggest reading our book.

      Best, Paul

      • Doctor Jaminet,

        Thanks for the response. I’ve actually read the book and been eating the Perfect Health Diet for about 6 Months. It has definitely played a role in helping me get it together and think a bit clearer.

        Another question- I notice on days when I eat white rice as safe starch instead of sweet potato I can’t seem to satisfy my appetite even when I eat the same number of calories of each food. Could this be because Sweet potato has more nutrietns than white rice?

        J

        • Also, I would like to be tested by my doctor for infections and get a blood test. What infections ashould I ask about? What are the most common ones? What should we look for in the blood results?

          • Hi J,

            For general fatigue and no obvious infectious origins I think a stool test to look at gut microbes would be the most plausible starting point.

            I don’t know why white rice is less satisfying, it could be due to the lack of fiber, or it could be that you have some sort of SIBO and quick-digesting carbs feed it.

  16. victoria forsyth

    Hi dr.jaminet. I was just wondering if you had any thoughts on the scare over arsenic contamination in rice? I live in Australia so I think my soils are less contaminated with arsenic.THanks!

    • Hi Victoria,

      Yes, the biggest problem is in the American South where arsenic was used as a boll weevil pesticide to defend cotton crops. Arsenic concentrates in the bran so brown rice is worse.

      Just eat white rice from areas that didn’t use arsenic as a pesticide (Asia, Australia, California) and mix it up with other safe starches so you’re not too reliant on rice, and arsenic levels should be safe.

  17. Hi Paul,
    I’m currently in chapter 35: Choline and Folic Acid and had a question… On pg. 319, in the Science of the PHD box, it talks about gene dysregulation from folate (is this over-methylation of DNA?). Wouldn’t the choline have the potential to do the same? Or does our body have a much higher capacity for choline, so no worry about gene dysregulation with choline? I remember watching the video about the mice, which was amazing, but I can’t remember the details of it…
    Thank you!
    KH

    • Hi KH,

      It’s not the same pathway so there’s no reason for choline to have that effect, and there isn’t yet evidence that choline does.

      There is undoubtedly a possibility that one can get too much choline, but it doesn’t seem like anyone is doing that so far as we can tell.

      • Ok, thanks for clarifying… I think I just assumed that possibility since both Choline and Folate can contribute to methylation of DNA, if I’m understanding correctly. But again, this is way out in left field for me, and I really don’t know a thing about methylation. Very fascinating though!
        Thanks Paul!

  18. Paul,

    You say food toxins are one of the most important factors contributing to chronic illness. How do you know that microbe generated bio toxins and environmental toxins are less important?

    • Hi Andrew,

      Microbe generated biotoxins are extremely important but we fit them in the general categories of infections and/or diet — eg we talk about metabolic endotoxemia in the book and some foods that induce it.

      Environmental toxins — we cite Bruce Ames and Lois Gold on the relatively low salience of environmental toxins. Of course it is possible these are important, and in some places they surely are, but in general there has been a concerted effort to minimize environmental toxins and levels are mostly low in advanced countries.

      • Thanks Paul, I’m not familiar with Bruce Ames and Lois Gold, will look into it.

        Could it be the people with weak detox genes are the ones that develop chronic illness? So regardless of exposure, even if it is relatively low, one might still bio accumulate mercury, lead, aluminum etc…
        perhaps through epigentic changes to the methylation cycle… ie (if Mom had mercury fillings, or was very stressed)
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862635/

        not to mention possible mercury transmission transplacentally?

        My health problems have been a big puzzle and I enjoy your input!

  19. Hi Paul!

    Quick question, and I’m sorry if you get it all the time:

    I’m interested in trying the Shangri-La Diet. I would usually use Coconut oil but it has not been sitting well with me lately. Would it be along the PHD guidelines (or safe for that matter) to have two tablespoons a day of light olive oil?

    Thank you!!!!

    • Hi Claire,

      Yes, it’s fine. But may I put a word in for MCT oil? It’s tasteless and usually better tolerated than coconut oil. I think the tasteless part should make it even more effective for Shangri-La Diet purposes than olive oil. As a ketogenic oil, it may support neuronal health better than olive oil as well.

  20. Hi Paul,

    Pg 85 you say to consume at the most 100 fructose calories per day. If an apple has 100 calories…is that 100 fructose calories?

    You get the patience of the year award….and our gratitude for anwering all our questions.

    Thank you!

  21. I have been trying to implement a PHD for my children as well as myself, but it is a lot harder to adapt this diet to foods they regularly eat. I’ve eliminated grains (cereal, bread etc), added sugar, and vegetable oils and have replaced some staples like bread with homemade gluten free bread and rice pasta.

    I noticed you have recently mentioned that children can have more desert type foods and less protein. Besides this suggestion, how can I adapt this diet to maximize nutrition for my children’s needs, but not leave them feeling deprived? Do your supplement recommendations apply to children as well?
    If my child is overweight, should the focus still be on nourishment 100% or also on weight loss?

    Sorry for all of the questions. I will appreciate any response.

    Erika

    • Hi Erika,

      We do need to do some research as far as children’s supplementation is concerned.

      As far as diet, to a great extent you can just make available to them PHD-compatible whole foods, and let them choose quantities.

      If your child is overweight, the keys are good nutrition and keeping omega-6 fats and sugar down. Then exercise and circadian rhythm therapies — be sure they get outdoors into the sunshine for 2 hours per day!

  22. Hello;

    I’ve been reading the above posts on intermittent fasting and calorie restriction. I’d really like to try it for the anti aging benefits, but I really don’t want to restrict my daily calorie intake any further, and I like eating everyday.

    I like the sound of having a 4 hour eating window everyday, I can definitely manage that. But will sucha plan still yield anti-aging benefits if you still eat a the normal amount of calories, just in the intermittent manner?

    Thanks,
    Jordan

  23. My health problems have unfollded like an onion. An injury led to dx of prostatis treated unsuccessfully with months of abx which led to digestive problems, later found multiple infections which I am working on now with parasite drugs + nutrition.

    I tried GAPS diet, taking ‘detox baths’. Got much sicker. After months, by luck, discovered massive toxic mold overgrowth behind bathtub tiles. Dx’d biotoxin illness. Then more complications which have baffled physcians. Notably testicular atrophy.

    The hypogonadism is possibly autoimmune.

    After a month or so on the diet (some workarounds for food sensitivies), GI symptoms are improved but the testicular wasting continues.

    My plan is:
    1. Treat infections found in stool
    2. Try to stop gonad tissue loss, at least so far as to temp restore fertility to bank a specimen.

    I am using your diet as the platform.

    I’ve found little mainstream help for the tissue loss. Any advice? Is tissue regeneration possible? My doc says no. I’ve read ‘eat that that ails’? Could consumption of bovine testicles benefit me? Could it hurt if my rancher will sell em?

    2012 was a difficult year, healthwise. My troubles feel unpleasant to speak of but I’m trying my best with the cards I’ve got.

    Thanks for any thoughts.

    • Hi Alex,

      It’s a good start. I would try to get plenty of collagen / extracellular matrix material to support tissue regrowth. Joint broths are a good source.

      You may benefit from detox aids like glutathione/NAC, vitamin C, taurine, glycine, possibly bentonite clay.

      Not sure what else to do unless diagnostic testing reveals something.

    • Alex,

      You may want to give Tamara a call at Internal Balance http://www.internalbalance.com/ for a free consultation. She endorses the PHD diet and routinely works with situations like yours where ones health has gone off the rails due to environmental toxins.

      Best,
      SC

  24. Any opinion on Konjac root or Shirataki noodles? They taste similar to rice noodles but are very low in carbohydrate, and very high in gulcomannan, a soluble fibre.
    They are made from the Asian vegetable Konjac, and are sold in Australia as “Slimpasta”. Sou-Ching may have tried these.

    Thanks, love the new book- will post results in a few months.

  25. Hello Paul,

    I have recently read your book and have been implementing your suggestions. I have been Paleo for the last year and also fasting every other day. I am a member of a forum that practices the Johnson Alternate Day Fast, where we have very low cals EOD, alternating with regular cals. I am trying to understand your guidelines for the 16 hour fast and the protein fasting.

    Several of the women on this forum have read your book and we are anxious to know if when you speak of fasting for 16 hours, does this period include the fasting of protein? Or do we need to abstain from protein during the eating window as well?
    I am 54 and have lost weight by following Paleo plus the IF, but would like to be able to change to the 16 hour plan with PHD.

    One more question, when fasting if you take MCT oil instead of CO, should it only be a small amount such as 1 tbsp and do these cals need to be calculated. I eat 1600 on Up Day and 400 on DD.

    Thank you!

    Ray

    • Hi Ray,

      There are many varieties of fast and different protocols may be optimal for different situations.

      That said, I start from a baseline perspective of getting a normal amount of calories every day. The fasting period could be anywhere from 14 to 23 hours, but if the feeding period is very short it’s hard to eat a normal amount of calories. I think a 16 hour fast with two meals in an 8 hour window fits pretty comfortably into most people’s lifestyle, and isn’t too strenuous.

      To make it more strenuous and thus potentially more therapeutic, you could either lengthen the daily fast or introduce alternate day fasting as in the Johnson protocol by reducing total calories one day and increasing them the next to compensate.

      In general, I think the eating window should have normal amounts of protein regardless of what you are doing. Even if you do the Johnson style alternate day fast, I think doing it more protein sparing modified fast style, with normal protein but reduced carb and protein, makes more sense than cutting all macros equally. This is because we have a minimal protein reserve in the body, but a few days carb reserve in glycogen and many days fat reserve in adipose tissue.

      MCT oil can be taken 1 tbsp during the fast to implement the Shangri-La Diet for weight loss, or can be taken in greater quantities spread over the day to make the diet ketogenic as therapy for certain neurological conditions such as epilepsy. However, it is not required by any means.

      Hope this helps.

      • Thank you for the quick response! I still have about 20 lbs to lose and am considering transitioning to the PHD w/ the 16 hour overnight fast only. We have already noticed a remarkable difference adding bone broth and potatoes.

        It is rather tricky to keep the 65/20/15 F,C,P ratio and do very low calorie EOD, I highlighted in the book and quoted to the forum excerpts from Chapt 40 on fasting & autophagy. Most of us are also trying to arrive at optimal weight and have a few pounds to lose, although some would like to transition to doing PHD and eating regular calories every day.

        I am enjoying learning from your site and will be reading here more often. I also would love to purchase your book on Audio so that I could listen to it again while driving/working. Is this a possibility?

        • Hi Ray,

          Scribner has no plans to do an audio version, they say this sort of book (presumably more technical/scientific books) don’t do well in audio format. If the book does very well then maybe they will.

  26. I bought the book through Amazon, but noticed that audio is not available.

  27. I ve been following your PHD for over a week. Prior to this I was paleo, reasonably low carb for the past year. I have long term problem of early waking(3am) and often not being able to get to sleep. I’ve started taking melatonin , 2mg, and this has helped so now most nights I get 7 hours , mostly straight but know feel and feel good but know I feel great with 8 plus hours. Is there anything more I can do to get more sleep? Also have long term problem with overtraining and and adrenal fatigue type symptoms. I have cut back a lot and after big break, for past year only doing 3 weights sessions and a bit of walking and this was going fine until past few months when I’m finding I’m exhausted and grumpy after anything beyond a walk! I’m not sure what’s happened . Any supplement or general suggestions would be appreciated. Should I ask for any testing regarding this?

    • Evie,

      I am by no means Dr. J, but can say I suffer similar sleep disruptions as you and supplementing magnesium at night tremendously helped. I take two 250 mg of magnesium citrate (within an hour or two of bedtime). Make sure you take the melatonin 20-30 minutes prior to going to sleep. It seems to have an opposite effect of traditional sleep aids if taken sooner in night.

      Hope you find relief soon!

    • Hi Evie,

      Some other tips:
      – All of the circadian rhythm strategies discussed in Chapter 42 of the book will improve sleep, including sun exposure, exercise, bright lights in day time, meal timing, social interactions (real or simulated) in day time, no bright lights and limited social interactions and limited food at night, etc.
      – Extra carbs at dinner often improves sleep.
      – As Elizabeth says, magnesium in the evening can have a calming effect and improve sleep.

      The circadian rhythm therapies would be my top recommendation.

      Re the fatigue, a lot of things can cause fatigue, including hormonal disruptions (thyroid, adrenals) but most commonly immune activity of some kind, possibly due to food sensitivities or gut dysbiosis. You could ask for a stool test which sometimes turns something up. There are a lot of posts or comments on this blog dealing with similar problems. It usually takes some time and experimentation and testing to track down the cause, but it can be done. See Allison’s story for example: http://perfecthealthdiet.com/2013/01/a-tale-of-recovery-from-panic-disorder-and-ocd/

    • My problem was going to bed too soon after eating carbs (plus a 2nd meal at 3am). In the middle of the night, I was dehydrated, my blood pressure was lower, and my heart rate sped up. All I had to do was wait 3-4 hours after eating, to get enough water, and go to sleep. Then I was good. At least that’s my current thinking.

  28. Dear Paul,
    thank you for your fantastic work.

    Unfortunately, I am quite anxious. I was strict paleo for over a decade and VLC (and high fat) for the past 4 (!) years. Very happy and healthy, and thin. But also acne, constipation and then weight regain. 37 year old female.
    For the past 2 months I have been religiously PHD (after a few false starts). At first very happy. Cleaned up acne, keratosis pilaris (I think due to K2 supplementation) and constipation. No more weight gain either.
    But for the last 2 weeks waking up multiple times per night, not sleeping after 4 or 5 am, night sweats, a headache (very unusual for me), higher heart rate.
    Is it my blood sugar? I am eating a pound of potatoes or rice a day, all the PHD foods, but limited added fat for the weight loss version. Taking the supplements.
    I think I may need to see a doctor, but perhaps you have an idea?

    • Hi Kathryn,

      I would start by stopping the supplements and adding them back in one at a time to see if one of them is causing the symptoms.

      Two months is a plausible time frame for some sort of nutrient excess to develop. It’s also possible that some supplement is not being absorbed and is feeding a gut dysbiosis.

      Another possibility, since you’re restricting fat, is some sort of fat-soluble nutrient deficiency. You could try delaying the weight loss and eating more nourishing fats, like egg yolks.

      Let me know how it goes.

      • Thank you very much.
        I will stop supplementing vit. D (was at 5000 IU), Life Extension super K (was taking it almost daily) and the 200 mg Mg citrate. Will continue 0.5 mg iodine and 1g C.
        I eat 2 yolks most days, as well as cheese and weekly fish roe,liver and kidney, so the fat-soluble nutrients should be ok.
        Will report back in a month or so.

        • Hi Kathryn,

          Be sure to test stopping the iodine and C also. All five of those are normally fairly safe, so you might stop them individually and see what happens. Since thyroid/HPA axis is so important, iodine is definitely one to test out.

          • Well, it seems to be the K2. As soon as I take it I wake up in the night with a racing heart. No problems if I take the other supps. I suppose I am getting enough K2 from food.

          • K2 is very similar to Co-enzyme Q10 both structurally and in its potential mitochondrial action (not proven in humans but in some cells).
            Could K2 either displace CoQ10, or overdrive its action? Perhaps some people are sensitive to a CoQ10-potentiating effect of K2.

  29. Hi Paul,

    I have been diagnosed with a skin condition called Lichen Sclerosus. It mostly affects females but some men get it too. It results in white patches in an area men are very protective over!

    I own the first edition of your book and am looking to start to try and combat this through diet. I have read a lot about the Paleo Autoimmune Protocol in various places, some are more restrictive than others and pretty much leave only meat and vegetable to eat and water to drink.

    I have also had years of intermittent neurological symptoms (numbness etc) but had many tests at hopsital (MRI etc) and was told nothing is wrong.

    I am just looking for some advice from you on where I should start? Would I be better off starting out with standard PHD diet (moving from SAD) or go straight in with the fully restrictive AI Protocol?

    • Sorry, forgot to say that Lichen Sclerosus is thought to be caused by autoimmunity by a lot of people.

    • Hi Jonny,

      I generally recommend going with standard PHD first, seeing what issues clear up, and then proceeding to more restricted diets to see if they help. The trouble with restricted diets is they have the potential to cause problems as well as cure them, so they can give you a distorted view of what’s going on.

      Since you have multiple symptoms of unknown cause which may be related, I think our baseline diet, which is generally designed to eliminate causes of disease, is the best starting point. Once you stabilize, experiment from there.

  30. Hi Paul,

    I finished reading your new book and I find it intriguing and looking forward to starting the diet. Mainly weight loss (15-20 lbs) is my goal.

    A couple of questions. One, I didn’t see any info in the book about amount of water to drink daily? Does it matter with this diet? I have been drinking half my body weight in ounces that I had read from another source should be our daily intake. Your thoughts?

    Two, to get the intermittent fasting straight, I count the 16 hours from the time I go to bed into the next day (retire at 10pm, first meal then at 2pm next day). Then the 8-hour window to eat the day’s meals starts 2pm and goes until 10pm? It just seems like its pretty late in the day to be eating. Unless I am misunderstanding the fasting itself?

    I appreciate any clarification you can provide.

    Have a great day,

    Alanna

    • Hi Alanna,

      You should drink if you’re thirsty. I think it’s good to get into the habit of listening to your body.

      Our foods are water-rich (see the discussion in our Muffins post, http://perfecthealthdiet.com/2013/01/muffins/) and we recommend bone broth soups regularly, also fluids like vinegar, coconut milk, etc in sauces which we recommend using liberally. So it’s not nearly so important to drink water as it would be if you were eating conventional breads, cakes, cookies, muffins, bagels, etc.

      The 16 hours is from last food of the night to first food the next day. Ideally, the last food of the day would be around sunset (given work schedules maybe it will be 8 pm in practice for most people) and thus first feeding would be 8 hours earlier or about noon. Retired people may prefer a morning-midday feeding schedule such as 8 am to 4 pm. Adjust feeding times to meet your schedule, but ideally they should match up with your main social interaction times and also your sun exposure / bright light exposure times.

      • Thanks Paul for clearing up the fasting schedule for me! I am off to the grocery store to shop for food and supplements after cleaning out my cupboards 🙂

  31. Ok I got a regular stool test with my general care, and H Pylori came back negative and here is my lipid profile:

    Total cholesterol 343
    Triglyceride 47
    HDL cholesterol 145
    LDL Calculated 189
    Cholesterol to HDL Ratio 2.4

    I’m 26 female, 5’5, 110 pounds. Remaining symptoms after strict GAPs since March 2012 followed by transition PHD August 2012 include facial acne, amenorrhea, difficulty tolerating FODMAPs/raw veg, occasional fatigue/moodiness after eating, varying acidic feeling/lump in throat/post nasal drip sometimes after eating. What does this leave me with? Is it possible that I am just taking a long time to heal and continuing PHD will improve my conditions?

    • Hi Elyse,

      Well, that’s a very unusual lipid profile – I don’t think I’ve ever seen HDL so high in a PHD reader, though levels up to 270 mg/dl have been reported in the literature. LDL is high too.

      Very high HDL can be associated with dietary factors and also with certain infections; I touched on the issue here: http://perfecthealthdiet.com/2011/04/hdl-higher-is-good-but-is-highest-best/. Also see Chris Kresser’s comment http://perfecthealthdiet.com/2011/04/hdl-and-immunity/comment-page-1/#comment-20843. High HDL can also be caused by eating lots of coconut oil or MCT oil so I would consider cutting those back if you’re in that category.

      We’ve done a number of high LDL on Paleo posts, you can find them in this category: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

      I’ll have to research your situation when I get time, offhand I don’t know the causes.

      You said you got a stool test – do you know what kind? Did it only look for H pylori?

      • It was a regular stool test through my general care practitioner which only looked for H Pylori and the only results were “negative”. Thanks Paul!

    • Hi Elyse,

      I can relate to your symptoms (aside from the high cholesterol). I have oligomenorrhea. I’m not sure if this is helpful info, but just throwing it out there…

      My gyno doc said sometimes gaining a few pounds will bring back the periods. Perhaps you could be slightly underweight especially since you are 5’5? I believe 110 lbs is ideal for someone shorter. (Google for a BMI chart to be sure.) And Paul mentioned this to me in a comment:

      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/

      Also, do you have PCOS? I wonder if PCOS and high cholesterol are related?

      • Hi Monnyica,

        Yeah I saw your post and noticed the similarities! I have been trying to put on weight and am slowly gaining a few pounds. I have never been diagnosed with PCOS. I just keep hoping that more time on a diet like PHD will slowly resolve my symptoms. Since our issues are similar, would you like to exchange emails particularly if any useful information is discovered? Mines tailypoe3@gmail.com. =)

    • Hi Elyse,

      just wondering if you have any thyroid numbers? metametrix stool test? you’re taking all the supplements, doing the fast 1 day per week with coconut oil, etc.?

      • Hi LJ,

        No on the thyroid and metametrix, I did a regular stool test with my GCP and got a negative on H Pylori. I IF at least 14 hours every night, usually eat at least 1-2 tablespoons coconut oil a day, and I’m taking: vitamin C, magnesium, NAC and D almost daily, zinc, chromium, and a B mix once or twice a week, along with 5 ounces beef liver, about 12 eggs, and a pound of salmon a week.

  32. Hi paul

    From the book I understand we have to cook starches gently as to not cause new toxins and kill pathogens. Is microwaving similar to high temperature processing in that it will cause toxin formation and not kill pathogens. I usually wrap my potatoes in kitchen tissue and microwave for about 7-10minutes. I guess the steam buildup from the tissue helps cook the potato but I’m not sure.

    Jessica

  33. Paul, would you happen to have any suggestions on raising body temperature. I seem to have cold hands and feet and be cold intolerant.

    I feel your future forum is gonna get very widespread and spread positive health ideologies globally! Excited to see things change as I just can’t seem to find healthful food travelling out and about at restaurants! 😆

    Sincerely, Tim

    • Sorry I just forgot to add in, I recently got some tooth discoloration. I think it may be fluorosis, iodine expelling fluoride in the body maybe? Do you know what could be possible causes and cures for teeth health/colour.

    • Hi Tim,

      First, how much iodine are you taking? I would stop increasing it and maybe decrease it if recent changes have impaired temperature regulation.

      Nutrients for tooth whitening include collagen (bone and joint broth), calcium (bone broth), magnesium, potassium, salt, vitamin A, vitamin D, vitamin K2, vitamin C, sulfur. It could be thyroid related too.

      You might want to read our hypothyroidism category, see if it suggests anything: http://perfecthealthdiet.com/category/disease/hypothyroidism/

      • Im taking 225mcg, increased to 450 for a week but then reduced it back down because I felt dizzy when standing up.

        Good list of nutrients there! and all the ones in the basic phd recommendations. Im going to try for more bone broth.I dont think i make it properly. I boil lamb neck meat with the bones in water with herbs and onions,but need to include joint material for collagen.

        I don’t get the part about creating a first soup and second soup. Simmer bones for three hours to get first soup, do I discard the soup keeping the bones in the pot and then add more water and vinegar to simmer for another 3-8hours to get another liquid soup which I can use throughout the week which will have high levels of calcium and phosphorus? Sorry for not quite understanding!

        • Hi Tim,

          If 450 made you dizzy maybe 225 is too much also. Check whether you have any symptoms of hyperthyroidism.

          What we do is a quick simmer (~40 minutes) and discard the water. At this point blood will have come out and turned brown. After rinsing and replacing the water you shouldn’t have a scum on top in the next batch, rather clean fat. This one you may cook for 3 hours and eat. Then you can re-use the bones for another 3-4 hour batch.

          • Great i will try that. If tooth discoloration can be caused by thyroid issues maybe it’s because i’m not getting enough selenium to balance iodine too and I used to smoke a few times a week but i’v stopped that habit now completely. I have 1/4 lb liver, and 1/2 lb kidney, 1 lb salmon a week and the rest of the time 3 eggs daily and two other protein serving of lamb,beef,or chicken, so about 3/4pound meat fish eggs daily, but I don’t supplement selenium or have brazil nuts because of the omega 6. Living in the UK I’m not sure if I’m getting enough to be honest.

  34. Hi
    I am new to the perfect health diet and about half way through the book! You recommend coconut oil for its short and medium chain fats. I have access to cobnut oil but can find no evidence of its makeup in the way you describe. Is it as beneficial as coconut oil and the other plant oils?
    Thanks

  35. synthetic “poop” to cure intestinal infections…

    http://www.eurekalert.org/pub_releases/2013-01/uog-sc010713.php

  36. Hi Paul,

    Good news! I got my Metametrix Microbial Ecology stool test results!! I feel like I am one step closer to finding the culprit to my health miseries. My goal for 2013 is to be able to post a success story on Reader Results. Hopefully soon! Thank you for encouraging stool testing!

    So far, what I understand is that I am positive for “Parasite present; taxonomy unavailable” and negative for Yeast/Fungi. I’ve been scouring google on how to interpret my results and reading the Metametrix Interpretive guide, but I’m still a little confused. I have a few questions…

    1. Does a PPTU result rule out all the common parasites that Metametrix tests for? So is it a good thing that I got PPTU result? Does this tell me anything about whether it is harmful or not?
    2. Am I negative for Pathogenic Bacteria?
    3. Does any of my results look abnormal? Are the Good Guys in the right amount?

    Here is a link to my results:

    http://s1.postimage.org/70efzehjj/Metametrix_010813.jpg

    Here is some extra info:

    Improvements
    -Energy improved in mid-December (had fatigue for a few years)

    Symptoms
    -Constipation (bowel movement 1-2 times a week, pellets, stools contain mucus and tiny amount of blood)
    -Diarrhea (occasional, last diarrhea was Jan 8, 2013)
    -Gas (just a few farts in the morning)
    -Acidic/warm stomach 2-3 hours after dinner (sometimes)
    -No period for 3 months (history of infrequent periods)
    -Pimples (was acne-free)
    -Hive-like blemishes that leave pinhole scars (unsure if due to newly developed food allergy)
    -Orange tinted skin around mouth (since 2010?), similar but not neon like this man

    http://www.medhelp.org/posts/Undiagnosed-Symptoms/Yellow-skin-around-mouth-and-nose/show/654497

    Bloodwork from Sept 2012
    Normal Thyroid, Liver, RBC, Hormones.
    Only thing abnormal was WBC:
    Neutrophils 1.5_____(2.1 – 7.7)
    WBC 2.9___________(3.5-12.5)
    Lymphocytes 40%___(13 – 46 %)

    • Hi Monnyica,

      It does seem like you have a lead. You do have symptoms of an infection and the test suggests the infection may be parasitic. The bacterial part looks good.

      I guess the next step would be to talk to your doctor.

    • Hi Paul,

      Just to clarify, when you say “the bacterial part looks good” …do you mean the “Pathogenic Bacteria” or “Predominant Bacteria”?

      One quick question. Below is my result for Clostridia sp. Can you tell me what the “L” and 1.2 and >=1.0 mean?

      Clostridia sp. 1.2 L –l-o-l–l–l–l–l– >=1.0

      Link to my results:
      http://postimage.org/image/bmak7r32j/full/

      • I’m guessing “L” means low and >=1.0 means it should be greater than 1.0, which it is. So you are on the low end of the normal range. … I am not very knowledgeable in interpreting these things, but you were low in all the pathogenic bacteria and in the normal range for the predominant types, though perhaps the ratios were a little distorted.

        • Thanks Paul, that helps! If you happen to have ideal ratios for Predominant Bacteria, I’d to take a look to compare my results.

  37. For intermittent fasting (16hr/day), do you need to do it everyday to get the benefit or could you do it (1) a couple of days/wk or (2) every day for a week every few months.

  38. Hi Paul,
    I’ve noticed the importance to eat bone broth soups. I have to admit I’ve got no materials to cook at home. I can only use a common electric source of energy to cook and it costs a lot to prepare meals requiring long time cooking… (the veggies broth are ok to implement because they are efficient and tasty on a shorter cooking period). Would you have some tip to replace or cook those joint broth (that seemed so delicious !! ) quickly and let them still be “nourrishing” ?
    Another question about intermittent fasting. I feel much better with IF in the morning, but need to drink some home made lime or lemon juice with tea or sometimes some veggies broth when I get up (I mean during the IF period). Are those fruit juice or veggies broth breaking the fast ?
    Concerning fungal infections or candida, what do you think of using colloidal silver ? http://www.naturalnews.com/034904_colloidal_silver_MRSA_candida.html

    Thanks for all your work !

    July

    • I’m not Paul :), but you might want to look at using a slow cooker, if that’s an option for you. They are very inexpensive, use very little energy (at least my model), and make excellent bone broth.

    • Hi July,

      It takes a few hours at least to cook joint material. So you have to find the time. You can set a slow cooker going without needing to tend it.

      Lemon or lime juice and tea are fine during a fast.

      So many metals are harmful that I would need very convincing evidence before loading myself with silver. I don’t think it exists.

      • Thomas, Ellen and Paul,many thanks for your friendly answers !!
        So is a slow cooker the same as a pression cooker ..? Sorry for this question, but leaving in Europe, am not used at all with those “terms”..:) If not how long does it take to make some delicious broth in a slow cooker..? And Paul do you recommend pressure cooking (probably the most efficient one method in my case? Time/cost) ? Best , July

        • No, a pressure cooker is different

          http://www.hippressurecooking.com/p/the-basics.html?m=1

          The instant pot is an electric pressure cooker that is also a slow cooker as it will do other things as well, like steaming and sautéing and will automatically go into keep warm mode when done if you are not around.

          I think the slow cooker application of my innstant pot works better than the slow cooker I already have…it goes to a slightly lower temp so it does not get to a boil.

          I make broth both ways. Not really sure if one is “better” than the other nutritionally speaking, but it is great to have some broth ready in an hour rather than waiting 10 hours.

          • Thanks a lot Ellen !! Marvellous explanation, really ! I know NOW what ‘s the difference…for sure, I’d prefer using a pressure cooker for bone broth…^^ We can suppose the pressure helps the minerals being “squezzed” out of the bones.? Anyway, thanks again a lot. Pleased to meet you ! 🙂

          • July,

            Glad that helped. Some people, such as Sally Fallon still do not recommend a pressure cooker. No real solid reasoning there. Just that they do not feel it is traditional and it ” denatures” the proteins.

            But recently there have been a number of people such as Mark Sisson, Stephan Guyanet and the Food Renegade blog saying positive things about it. So I feel pretty good about using it. but I still would love to hear Paul’s take on the food science…does it denature our foods anymore than regular cooking. Or in any way that would be harmful? Or perhaps it is more beneficial. Food Renegade says it is not so much the higher heat that damages foods but the longer cooking time. So therefor pressure cooking is safer.
            In any case, having broth on hand makes life so much better

  39. Paul,

    What about flouride in toothpaste? Absorbed by the throid displacing iodine?

    • If you have sensitivities/allergies because of a leaky gut, avoid it.

      Paul mentions in several posts on here (which I am too lazy to find but believe it is in one of the posts on biofilms) that he brushes his teeth with a combination of turmeric, apple cider vinegar, baking soda, milk and maybe something else.

      Also, to several commenters (or maybe one?) he says that fluoride from toothpaste can cause perioral dermatitis (basically near the mouth – chin, lips, nose), etc.

      If you do a search on fluoride you can find the second comment, a search on turmeric will lead you to his post on his toothpaste, eventually.

      • Hi LJ,

        I tried homemade toothpaste for a time but now I’ve gone back to regular toothpastes, just because they are less messy.

        • Funny, I’ve gone the other way. I used a mix of baking soda and cinnamon and now I mostly brush with just water. I brush until my teeth feel super smooth as they usually are since PHD.

        • Ha! I have gone from messy ( dark herbal powder) to extremely messy recently. Activated charcoal is what I have been using because I was told it is a good whitener. So far, not only are my teeth whiter, but it seems the charcoal is getting rid of tartar .

  40. Paul,

    What about flouride in toothpaste? Absorbed by the thyroid displacing iodine?

  41. Hello;

    I’m trying PHD for candida, but I’m having trouble figuring out the appropriate fat ratio. You say fat should be about 55% of calories if I’m not mistaken, but I don’t see how I can manage this as the fattiest grass fed meat I can find is 85% lean.

    I thought about just adding some olive or coconut oil, but that just doesn’t sound healthy.

    How do I get enough healthy fats?

    Thanks

    • Hi Jamal,

      I don’t understand. 85% is quite lean, and even that is majority fat by calories. See, eg, http://nutritiondata.self.com/facts/beef-products/6201/2.

      If you flavor starches with some butter or sour cream, and eat fatty/moist meats, then you should get half of calories from fat. If the meat is very lean then it’s OK to add some fat on top, eg sour cream on beef. You can follow your taste preferences, usually you will prefer meats in which half or more of calories are from fat.

    • the nutrition info is interesting, when you (I) think 85% lean beef, i kinda think 15% fat 85% beef (aka protein).
      But actually the 85% beef is 56% water, 28% protein & 1% ash (for that particular example).

      & in calorie terms for 100 grams;
      fat 15 g x 9 = 135 cals
      prot 28 g x 4 = 112 cals

      guess what, calories from fat, in this example: 55%

  42. fellow inhabitant of planet earth

    Would eating extra vitamin A be helpful for reducing acne? Also, is there an effective difference between retinol (liver, eggs) and beta-carotene (carrots, spinach)?

    • Hi fellow,

      Yes, it often helps. The retinol (liver) will be more effective but has more risk of overdose at high intakes. Carotenoids will help prevent a vitamin A deficiency but won’t raise levels much; however they can provide antioxidant functions that may help acne.

  43. Hi Paul,

    I spoke to my doctors and they have not read your book yet. They don’t offer dietary strategies as specific as yours, but they want me to pursue your ideas and report back to them.

    They believe the toxoplasmosis infection should be addressed first. Assuming this is correct…
    If toxo uses ketones to drive their growth but are weakened with autophagy, should I completely avoid ketosis and focus on triggering autophagy by doing alternate day protein restriction and avoiding BCAAs and MCTs.

    Would something like this be the safest why to inhibit ketone production while maximizing autophagy?

    Day 1
    High fat
    400 carbohydrates
    100 protein
    light exercise

    Day 2
    High fat
    400 carb
    400 protein
    resistance exercise

    • Hi A,

      I wouldn’t restrict calories or protein. Both are important for immune function. Rather I would simply do daily intermittent fasting to promote autophagy.

      Why not daily 500 carb / 300 protein calories plus fat to taste.

      The exercise schedule looks good.

  44. Hi Paul,
    My husband suffers from restless leg syndrome which interferes with sleep. I keep reading that the most likely cause of RLS is iron deficiency. Do you think it’s possible that this could be the cause of RLS in a male? His dad had the same problem. I have read that it can be hereditary. Is it possible that they may both have difficulty in absorbing iron. His blood tests are low normal, which from my own experience can still mean a deficiency. Any thoughts?

  45. Hey Paul

    I just have two questions about circadian rhythms. If you live close to the northern hemisphere in areas like Canada or UK, you can’t get much sun exposure in the morning as will help with circadian rhythms so we need to supplement Vitamin D to reach optimal levels. So because we need to supplement Vitamin D, the morning hours is more beneficial than afternoon or evening for circadian rhythms and we need to take it with fat because its fat soluble but if your fasting from say 11-7 or 12-8 you have no choice to have it in the afternoon because your not having any fat in the morning hours during the fast Or is it fine to supplement from morning to afternoon, and becomes worse after about 3pm going into the evening.

    The second question is, a 8 hour feeding window during daylight hours is good for circadian rhythms but should we also go as far as to eat fat and protein only during daytime when we break the fast at 11 with a snack and at lunch, and have our carbs and fat for the afternoon snack and dinner to release leptin. Or is eating equals amounts of carbs okay, so 50grams of fruit carbs as a snack to break the fast around 10-11am, 50grams of starch carbs at lunch, and 50grams of starch carbs at dinner around say 7pm.

    Love the book!

    • Hi Abu,

      I do think that if you take lower doses of vitamin D they should be at the first meal. Absorption is worse if you take it without food so then you would need a slightly higher dose.

      If the first meal is late in the afternoon then I would take D in the morning while fasting.

      I think in general all meals should be somewhat balanced, ie having carbs, protein, and fat together. You can just bias protein toward first meal and carbs toward last meal a bit.

  46. Paul, I have sent several variations of the same comment regarding pressure cookers several times…maybe it is in the spam folder?

    Ellen

    • Thanks Ellen for letting me know. I’ve pulled one from the spam folder. Let me know if there are any more.

      • Thanks Paul

        So what IS your take on pressure cooking?

        • Hi Ellen,

          We just bought one and are starting to try it out. We’ll probably blog about it when we have more experience.

          • Nathan Myhrvold, author of Modernist Cuisine, the cookbook on every professional chef’s wish list, prefers pressure cookers for broth. From what I recall from a gander at the bookstore, he uses one lb. of meat per cup of water (with an equal mix between joints and muscle meat), precooks the meat/joints (roasted or boiled and drained), adds aromatics, and pressure cooks for 90 minutes.

            I tried a non-Michelin star version of my own: two pounds of chicken feet pre-boiled and drained, cooked with water up to the pressure cooker’s fill line. The amount of flavor/gelatin was astonishing.

            http://www.amazon.com/Modernist-Cuisine-Home-Nathan-Myhrvold/dp/0982761015/ref=sr_1_1?ie=UTF8&qid=1357836712&sr=8-1&keywords=myrvold+cookbook

            You’ll also find that the pressure cooker makes a perfect risotto without stirring. We make veggie soups too: potato, broccoli, cauliflower, asparagus, pea, thickened w/rice or potato starch.

          • For example, Cream of Veggie Soup:

            Lightly saute an onion
            Stir in and lightly saute a tablespoon or two of potato starch/rice flour
            Add about 1.5 pounds veggies/3 cups broth
            Pressure cook one minute/quick release
            Blend (we have immersion blender)
            Add cream to taste, maybe 1/2 cup
            Delicious!

          • Thanks Ellen ! I was wondering so whether Paul had read my question about pressure cooker for bone broth. 🙂
            @ Shawn your experience seems interesting for quick and delicious bone broths ! The book reference is appealing ! 🙂 So are your recipies !

  47. Thanks Shawn. I have beeN wondering about thickening. Last night I added 2 T potato starch to a bit of water then stirred that into the liquid in which I cooked the lamb shoulder. I was worried about doing the thickening atthe start of a fairly long time under pressure

    Here is some information on how to boil very fresh eggs so that they are easy to peel. Great for making deviled eggs .

    http://www.hippressurecooking.com/2011/04/hip-modernist-soft-medium-and-hard.html?m=1

    • Thanks Ellen. My wife loves egg-salad sandwiches, which I rarely make because of egg-peeling frustration. Will report back results . . .

      Sounds like your thickening worked. I usually saute the starch before adding liquid, although it hardly results in anything resembling the color/texture of a proper roux.

  48. Since HSV-1 blocks autophagy does that mean is does me no good at all to fast?

    • Hi Steve,

      It may mean it does you more good. The more starved the HSV is, the less able it is to block autophagy, and the more cells are promoting it.

      • Thanks, that’s motivation enough for me to stick to the 16-hour fast.

        In the meantime I’ve freaked myself out a bit reading about HSV-1 & Alzheimers & brain damage. Is there anything special I should be doing besides following the book? I get a cold sore every 4 months.

        (You mention the HSV is more starved when you fast. Any idea how to starve it long enough so that it dies?)

        • Hi Steve,

          Unfortunately there’s very little research on dietary therapies for infectious diseases, so we don’t really know what the optimal approach is.

          If you’ve read the new edition you know we think daily intermittent fasting is a moderate approach which is likely to be generally good. More strenuous daily fasting, like 20 hours, could be considered; or alternate day reduced and increased calories. That’s if making the fast more stressful is beneficial, which we don’t know.

  49. Hi Paul,

    I am under the impression that “Parasite present taxonomy unavailable” is either nothing to worry about or false negative where anther lab detected Giardia. I read in a forum that “You are not going to receive a taxonomy unknown for a helminth”. Is this a fact? So am I left with either 1) a protozoan or 2) something minor/just some foreign thing that I ate?

    However, symptom-wise, since Sept 2012 I developed food allergies that cause skin reactions, and in recent months I noticed mucus and traces of blood in my stool. Do these symptoms warrant another parasitology stool test from a different lab? Or do these symptoms sound more like a gut dysbiosis (since I am low in some of the Predominant Bacteria: Bacteriodes sp., Clostridia sp., Bifidobacter sp., E. coli)? Your advice is very much appreciated.

    Link to my results:
    http://postimage.org/image/bmak7r32j/full/

    • Hi Monnyica,

      I think you were right on the other thread: it means there is DNA from one or more parasites there, but the parasites are not among the types they directly tested for. It could be parasites in food that were killed in cooking or digestion, or it could be live parasites in your gut. So you have to step back and look at which possibility your symptoms support — and you have symptoms that might plausibly be explained by a parasitic infection.

      I think you should talk to your doctor about what the right next steps are — perhaps further testing, but perhaps trying treatment and seeing if it helps.

      • Thank you for taking the time to reply Paul! It really does help me make sense of all this. Before I ask my doctor about my results, I have a quick question about past food poisonings.

        (a) Vomit
        Jan 2012: Vomit 11x within a 2 hour time frame after eating pork from restaurant (was properly refrigerated/reheated). Vomit contained black blood (imagine papaya seeds). Afterwards, I experienced chills and extreme thirst. Does black blood indicate whether vomit was due to bacteria, virus, or parasite?

        (b) Vomit-Diarrhea
        mid-2012: Vomit –> Diarrhea –>Vomit –> Diarrhea (alternating immediately after each other within 15-30 min time frame). Does alternating vomit and diarrhea indicate bacteria, virus, or parasite?

        • Hi Monnyica,

          Both those episodes increase the likelihood that you still have an infection, since many pathogens cause acute symptoms and then lower-level persistent chronic symptoms.

          I don’t know enough about the possibilities to say that those symptoms indicate parasites specifically. But I think with the Metametrix test they support the idea of trying some sort of treatment for a parasitic infection, or at least further diagnostic testing.

          • Hi Paul,

            Thanks, I think with my symptoms and your comments, I feel more confident ordering additional testing. The only other lab testing I know of are: Genova, Doctors’ Data, Diagnostechs, and ParaWellness Research. How would you rank these? Which ones do you consider superior (in terms of accuracy/quality of diagnosis)?

  50. Hi Paul,

    What do you attribute to often mouth sores and if you have any clue about geographic tongue?

    I have to say, I have fixed my constipation with your advise of iodine/selenium/choline and liver once a week.

    Do you coat the liver in flour before you prepare it?

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