Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

9,730 Comments.

  1. When I read your book I understood not to sprout alfalfa seeds anymore but I was not sure if other sprouted seeds would be OK? Also what about tahini?
    Thanks for your work!

  2. How much magnesium supplementation is necessary for atrial fibrillation which is linked to deficiency? Is 200 mg daily enough? Do you know of any research on this? Thanks for your time.

  3. Hi, I am just starting my supplements today. I think I have hypothyroidism (very high TSH and all the other symptoms), I am going to start Iodine supplments as described 225mg then increasing monthly. I eat meat every night and eggs a few times a week. Do I need to supplement Selenium any more than once per week or should this be enough? Is there a way to tell if I am out of balance of selenium, as my preference is to get it from food. Thanks 🙂

    • Hi Amanda,

      Since beef, lamb, seafood, and eggs are all fairly rich in selenium, I think if you focus your meats on those then it shouldn’t be necessary to supplement selenium more than once a week. You can eat kidney once in a while to get extra selenium, that would replace supplementation. ~2 Brazil nuts per day could also replace supplements.

  4. How does supplementing K2 MK-4 compare to Mk-7 in terms of dosage and efficacy?

    Thanks!

    P.S. Looking very, very forward to your acne series 😛

  5. Hi Paul,

    I’ve just seen a pearl of a question (imo) on paleohacks…
    & thought it would be good one for you Paul, right up your alley (i hope)…

    What are you thoughts on UHT (ultra high temp) coconut milk. which usually can be bought in cartons (or tetra pak’s).
    They are preservative & additive free & have a long shelf life (because of the UHT thing).

    now i know UHT (& similar) is bad for dairy milk, but wonder if coconut may be a different kettle of fish.

    i don’t expect it to be better than fresh coconut milk, but is it ‘dangerous’ or would it still have most (possibly all?) of benefits of the fresh stuff.

  6. I’ve wondered this as well. And I wonder how high “ultra high” is?

  7. Hi Paul and all, I have a question about diet, blood fats and blood clots, if you will indulge me 🙂

    What is your opinion on diet and blood clotting risks? I’ve read that there may be acute benefits of a high fat diet but the effects long term on coagulation are more unclear, and there indeed may be heighten risks of one contracting clots.

    I’ve been favouring saturated fat over others for a while now, as per PHD principles, but the issues here are particularly relevant for me as I’ve had a DVT (it was ostenisbly exercise and anatomy induced). After recently coming all medication (aspirin, following warfarin), I’ve been reading somewhat more extensively about foods/nutrients that affect coagulation – eg fish oil, coumarins in cinnamon have anticoagulant properties, while saturated fats appear to increase risks of one contracting a clot (the risks for people who’ve had one are already higher than for people who haven’t…). I’m a 21y/o and like many want to have a sort of diet that won’t risk triggering anything I might be predispoed to getting (in my case now, blood clots). After coming off aspirin, which was like a security blanket while the stent I had put in vein ‘bedded in’, I have been looking at meat fat a bit differently to the way I so often have…

    I welcome anything anyone could chip in about this (generally, or specifically about food, clotting etc), anything you think is relevant.

    Thanks for reading.

    Michael.

    PS I few of the things I’ve read…

    http://fanaticcook.blogspot.com.au/2009/02/meals-high-in-saturated-fat-raise-risk.html

    http://donmatesz.blogspot.com.au/2011/06/diet-effects-on-blood-coagulation.html

    http://www.independent.ie/lifestyle/health/fatty-splurge-may-reduce-heart-risk-26723456.html

  8. I have been low carbing to lose weight and get better control of my diabetes with a lot of success. I have been reading the book and I am wondering do people really eat 3 pounds of your recommeded veges per day? That seems like a lot.

    • It’s easy to do if you eat starches (potatoes are heavy) and sugary root plants (beets, carrots etc). Throw in some tomatoes, fruit and fermented veggies and it’s quite easy to hit the 3 lb mark.

  9. I’m poly-infected (protozoal, fungal) with gut and gallbladder issues. I started antifungal medication this week and also re-started an herbal (wormwood, black walnut, etc) treatment for parasites.

    I’ve developed burning, stabbing pain in my neck. I got two week old labs results the other day — TSH bloodwork came back high at 4.2, had been 2-3.25 rangebound for a while — but I haven’t yet discussed results with my doctor.

    After a serious mold exposure my T3 plummeted for a time so I have some T3 Rx hormone but I’ve never taken it. I’ve been 2x tested for Abs but none yet … I’d ramped iodine to 550mcg over 10 weeks. Selenium status is good, backed off supplementation couple weeks ago b/c diet seemed sufficient to needs. Been taking clay 4x a day.

    I will talk to the doctor on the Monday, but could antimicrobials spark some immune attack on the thyroid? Could it be infected or am I suffering an AI response? So frustrating to become symptomatic during the weekend.

    Anyone dealt with thyroid ‘attack’ pain? Thanks for any feedback, Paul or PHD readers.

    • I stopped the wormwood and the neck pain backed off as well. My doctor ran my blood Monday and my TSH came back at 2.4. I think I was overflowing with toxicity due to constipation.

      My BMs were already suboptimal and supplementl clay caused major stoppage.

      After stopping wormwood, I still experienced headaches, confusion, blood-red/itchy eyes, reflux pain and vocal hoarseness until a BM relieved the burden.

      I realize now that things must keep moving.

      After reading the recommendations for constipation induced by fungal infection (in Pauls linked comment below), I plan to try adding them to my protocol.

      http://perfecthealthdiet.com/2011/04/causes-and-cures-for-constipation/comment-page-2/#comment-25832

  10. If you induce ketosis with coconut oil and still eat more carbs than on a ketogenic diet does the body use the ketones for energy first? The body will always use ketones first in preference to available energy from carbs? Will the body then keep burning fat as long as you do not eat too many carbs, around 50 grams of carbs from safe starches (you say 200 calories in the book)? This is the level of carbs you can eat on a low carb diet and induce ketosis, how is adding coconut oil and eating this many carbs any different? Eating low carb vegetables as much as you like won´t add up to enough carbs to stop ketosis? I am trying to understand this issue. I have been losing weight low carbing but am reading your book. I don´t think I can eat that much safe starch it normally raises my blood sugar too much if I ate that much in one day. I have recently added coconut oil and will experiment with the safe starches later after I have implemented PHD as much as I can. Do you have any other advice for type II diabetics using diet and metformin to control blood sugar. Thanks so much for your time. It is all so complicated

    • Hi Rebecca,

      Ketones will tend to reduce blood glucose levels as the brain downregulates energy into itself. So the carbs will be utilized by cells instead and this will be good for you.

      Type II diabetics have varying severities of disease so there’s no one carb prescription that is perfect for every diabetic. Still, most will probably do best eating around 20% carbs.

  11. Hi Paul ! I’m a little bit confused, and worry about sudden heart arrhytmia after eating my evening PHD meal (generally the most carby one : white potatoes,tomatoes,veggies,some egg yolks or fish or meat leftovers,and sometimes some berries in the late evening..). As I cannot cook on midday for PHD meal, I carry on with me some leftovers of bimbap and some cold meat, but never do experience such arrhytmia ith this meal.. what could cause in the evening meal ingrédients (hope it’s not a food sensitivity to nightshades ?!) such a higher heart rate ?
    Could this be a deficience in some mineral , or enzymes ..or …?
    Best, Thanks for your helpful answer.

    July

    • Maybe Paul has a smarter answer, but I think it could be too much potassium (low blood pressure/higher heart rate), especially if you have a lot of potatoes as your starch, and not enough sodium. This often happens to me if I don’t have any processed food.

    • Hi July,

      Tam’s idea is a good one. You could try adding salt, plus vinegar to slow down digestion.

      • Thanks Paul and Tam !

        It’s about 2 days I’ve been adding some vinegar and salt with potatoes , and the heart rate has calmed down !! 😀 Thanks again a lot !!
        Best,

        July

  12. Does a vegetarian diet protect against Alzheimer’s?

    “…there is three times the risk of developing Alzheimer’s in meat eaters as opposed to vegetarians.”

    http://www.ncbi.nlm.nih.gov/pubmed/15694685

  13. hi Paul,
    both my wife and i have a problem that started after starting PHD [ with less than the full amount of starches] we also take all the suppliments. befor we both had regular stools 2-3 times /day. now we both have type 1 or 2 stools per the bristol stool chart. only going every second or third day. we have sour krout with every meal and yogurt each day.
    we have started to take psyllium husks with not much improvement, and now i read where this could be dangerous causing pressure against the obstruction. following your supplement rec’s which includes 4000 iu D3. please comment thks alfred

    • Hi Alfred,

      Try cutting out supplements and fermented foods and see if things get better. Sometimes supplements disturb the gut flora; also it’s possible your method of making fermented foods is creating a poor mix of species.

      Check out our constipation post for some other ideas.

      • Paul.not making my own but buying saurkraut from store. will try withholding all supplements. please see my post further down re: magnesium Bis-Glycinate. thks alfred

  14. Hi Paul,

    Besides PHD, are there any other dietary changes one should implement while taking antibiotics? Would it be better to do more of a Keto diet? Besides probiotics, would taking maybe the yeast boulardii would help?

  15. hi Paul (or anyone who can answer the question),
    is wild rice or black rice the same as Brown rice with regards to not being as good as white rice?

  16. Hi Paul,
    What are the downsides for my daily carb intake coming almost exclusively from dextrose?
    I appreciate that the goal is always to heal and to continue to try to gradually reintroduce other sources. But what if this takes a very long time or I never succeed? Am I missing out on anything compared to those who eat white rice and potatoes?
    Thanks again,
    Adam.

    • Hi Adam,

      Dextrose lacks fiber and lacks micronutrition. Generally only plants have potassium, for instance, and we need to eat ~3 pounds of plant foods per day for optimal potassium. If you eat pure dextrose for carbs you will have a hard time getting appropriate plant-derived nutrients.

      • Is it really true that ‘generally only plants have potassium’ ?
        As far as I can tell milk and meats have significant potassium content as well – I was kind of surprised when you didn’t include that in you calculations in your book – is there something I am overlooking?
        CRON – O – meter says:
        1 pound of 95% lean beef contains 1574 mg potassium
        1L whole milk – 1320 mg
        1L whole milk yoghurt – 1550 mg

        • Hi Erik,

          Yes, it’s true, good point. But in order to get to optimal levels of potassium one needs to eat plant foods.

          • but – just to clarify (and I am not arguing that one should not eat plants, or that dextrose is as good as potatoes) – was there some reason you chose not to take into account potasium from meat/milk in your book?

          • Hi Erik,

            No, just an oversight. I have to look back to see what we said. It will be corrected in the paperback edition.

        • John Ashcroft

          Indeed you would expect animal flesh/products to use the sodium-potassium pump in a similar way as we do.

          I know my sardines come with 200mg sod + 300mg potassium per 3 ounces, salmon has more, and there’s a ~1:2 ratio or better in most of the seafood nutrition facts I find. Plant foods definitely provide more, but it all adds up.

          It’s unfortunate you don’t get much of that dairy potassium left over in cheese.

          I found this page to provide a good quick reference (see the table): http://www.krispin.com/potassm.html

  17. Paul,

    Reading through the new edition, I’m working to get a better handle on my macronutrient ratios. Do you think the protein or fat in my homemade bone broth is notable or negligible? I’ve been considering it 5g/protein 3g/fat per cup, which can add up some days so I don’t want to short myself on nutrients. I pull out the fat that floats to the top and use it for frying, and I make the broth out of marrow beef and lamb shank bones, with plenty of meat attached, with some apple cider vinegar and vegetables thrown in, and I simmer it in my slow cooker for 24 hours. It’s fairly gelatinous, like almost-ready jello.

    Thanks!
    Matt

    • Hi Matt,

      Yes, the protein can be significant … but I generally don’t worry about protein because appetite is such a reliable guide to protein needs. If you are getting more protein from broth than you’ll eat less meat.

      If you’re really getting a lot of protein from broth, then I’d worry you’re getting too much calcium. 3 to 5 bowls of bone broth per week is about optimal.

  18. Here is an interesting article suggesting that celiac is actually caused by too clean of an environment, or lack of exposure to microbials.
    http://www.nytimes.com/2013/02/24/opinion/sunday/what-really-causes-celiac-disease.html?pagewanted=all&_r=2&

  19. Paul, could you better define the volume in a bowl please. thks alfred

    • Just my opinion but your probably splitting hairs. If your consuming broth with soup, just eat as much as you normally would. If your consuming it by itself as a tea or tonic, I think a large coffee cup would be sufficient.

      Even if Paul was able to come up with a minimum effective dose, you’d never hit it consistantly due to fluctuations of nutrients in your broth due to variables such as amount of bones used, quality of bones/animal(pasture vs factory farm),types of bones used, quantity and quality of vinegar used to extract minerals, temperature, cooking duration, health of animal etc.

      Hope this helps!

    • By the way, I made an assumption that your were asking about bone broth supplementation. I hope I was right. 😉

  20. Hello,
    I’m not sure if you didn’t answer me before because I should have been able to figure it out from your book…but I can not seem to so I am asking again please for some help…..I understand not to sprout alfalfa seeds because of the legume connection but are other sprouts (radish,brassicas, etc.) toxic or healthy enzyme rich additions to a diet? Also I am still wondering about sesame seeds? gomasio, tahini, etc. Thanks for your work!

    • Hi there,

      I’m not Paul, but maybe I can be helpful. PHD, as you mention, recommends against seeds/legumes which are generally the things that people sprout. However, sprouting does make the nutrients present in the seed/nut/legume more bioavailable. While I would not make sprouts a large part of diet they aren’t harmful in small doses… as with everything.

      It is important to remember that PHD as specified in the book is a blueprint for a diet. You, as an adult, can add/remove things from the diet that work better for you. Make smart changes as you see fit.

      Hope that helps,
      Lindsay

  21. hi Paul, i have just read where you recommend magnesium citrate for constipation. the mag i have been useing is Bis-Glycinate have recently upped my dose to 400/day. should i change type. thks alfred

  22. Hi folks, does anyone recall Paul’s suggestions for SIBO diagnostics and healing?

    If I recall correctly, protocol is to eliminate starches and fruit from diet(I guess similar to SCD) and use dextrose powder as a carb source since it’s digested prior to small intestine. This should limit energy source for bacteria in small intestine and kill them over time. If symptoms improve, add potentially offending foods such as fruit and starches one by one to assess reaction. Antibiotics may be necessary.

    Do I have it right? I’m getting tested for sibo and leaky gut today but I am thinking about starting a sibo/leaky gut diet prior to results to get a head start.

    Thanks,
    Jonathan

  23. Hi Paul,
    I suspect my sister may be having the kynurenine issue. Taking tryptophan and 5HTP seems to make her already terrible sleep worse, plus chronic depression, confirmed Lyme and possibly other infections. We are trying to address the big picture but in terms of immediate help with her sleep, do you have any suggestions in terms of lowering tryptophan conversion to kynurenine? I read on one research abstract that possibly niacin could help, although I recall you had other reasons for not recommending niacin supplementation.

    • Hi Grace,

      Ketogenic dieting and intermittent fasting help. She could try intermittent fasting with lots of coconut milk.

      • A couple other complications… She has multiple food allergies and not a great tolerance of coconut, though she does do some coconut oil, but too much coconut milk makes her dizzy… also pretty bad hypoglycemia. She did pretty low carb (though not low protein) for a while and has felt generally better in terms of blood sugar with adding back more carbs. So I’m reluctant to go back and advise cutting carbs again. But perhaps worth a try? Any other thoughts? Thanks.

    • Niacinamide (nicotinamide) is the form of niacin that specifically prevents degradation of tryptophan to kynurenine. I would use it in preference to tryptophan or 5-HTP. These are unreliable for long-term use because of their metabolites whereas niacinamide conserves tryptophan and allows serotonin levels to normalise without adding more to the body. Niacinamide is antiinflammatory (e.g. in arthritis) yet improves immune function (e.g. against MRSA).

  24. Hi,

    What do you think of this.

    The Institute of Medicine (a division of the National Institutes of Health) defines Vitamin D Deficiency based on the level of serum 25-hydroxyvitamin D (25OH Vit D) as follows:
    a. Risk/deficiency = 30 ng/ml
    e. Cause for concern >50 ng/ml

    They base this on a lot of research and refute that higher levels of vitamin D has any greater benefit.

    • Hi Rebecca,

      That’s not far off from our analysis. We think 40 ng/ml is typically optimal. There’s not a lot of evidence about higher levels so the concern is a bit speculative, but it’s clear that we evolved mechanisms to resist increases above about 45 ng/ml, so presumably there’s some harm there.

  25. Paul and PHDers

    This is Koki here. I am not sure if you remember me so summarizing my history here for guidance and support.
    I quit using sugar and veg oils by 2010-11
    I ate mainly a grain included vegetarian diet with occasional chicken. during my second pregnancy my doc advised no rice but more veggies, meat with little whole wheat bread as my diet. I did not gain excessive birth weight just the right amount. I delivered in June 2011.
    In oct I started slowly transitioning to a grain free real food diet including lots of eggs dairy chicken n fish. All was well until horrible stomach pain started killing me in May 2012. Weeks of doctor visits, a week of antibiotics , scans and endoscopy diagnosed it as Gastritis /GERD.
    As usual I was prescribed PPIs and laxatives for constipation. Doc was uninterested in finding the root cause. I refused at first but pain won and I took PPIS for a week and stopped it
    I switched to naturopathy and felt better. I got a Metametrix done. It said “Parasitic infection- ingested protozoan with unknown taxonomy”
    We had to return to India in Oct 2012.
    My GERD is under control by diet and homeopathic medicines. Diet excludes Spicy food Dairy Gluten Sugar and veg oils.
    The problem is I am consistently loosing weight and do not have a proper formed stool( it’s like a paste 🙁 ). I was 139 lbs in May ’12 and now 116 lbs 🙁
    On a PHDer friend from India’s advice I increased my rice and ghee consumption and included white sugar freee sweets. That helps gain weight but if I miss the sweet or ghee I loose a pound or two immediately:( I have leg cramps
    I also have vir D deficiency

    I still nurse my toddler. Docs i meet here laugh when I ask them to treat the parasitic infection they say the problem is in my mind and that I should take PPIs 🙁 I am sure they will not even think about a fecal transplant.

    Not sure what to do. Helppp plz

    • Hi Koki,

      If you have vitamin D deficiency you should get more sun and supplement D if that is impossible.

      Leg cramps usually indicate that you are low in potassium, magnesium, possibly salt. Try eating tomatoes and potatoes daily, taking a magnesium supplement (not too much, but 100 mg/day would relieve any deficiency), and eating sufficient salt if you aren’t already.

      Have the doctors checked your thyroid status? No hyperthyroidism? You might try our suggested lithium supplements along with the magnesium.

      If you want to experiment with antiparasitic medicines, I’m sure you can get ivermectin or some such drug from sources like magicpharma.com. I think they’re based in India.

      I would focus on a balanced nutrient-rich PHD diet, and the lifestyle / circadian rhythm strategies we suggest in our book. It sounds like thyroid and anti-parasitic medicines would be the logical things to ask doctors about.

      • Thanks a lot Paul
        Here is my blood work results

        WBC 6050 cells/c.mm
        RBC 4 million/c.mm

        Hemoglobin 12.2 gm/dl

        Lipid 
        Serum cholesterol 222 mg/dl
        Tg 94
        Hdl 49
        LDL 112
        VLDL 18
        CHO/HDL 4.5
        LDL/HDL 2.2

        Immuno Assay
        Free T 3 2.8 pg/ml
        Free T 4 0.97 ng/dl
        TSH 1.07 

        Vitamin

        25-Hydroxyvit D 20.69 ng/ml

        I don’t seem hyperthyroid so not sure abt the weight loss part 🙁

        Will exposing to sunlight be enuf to handle vit D issue? If not what is the safest dosage?

        Is my high serum cholesterol indicative of some issue? Will saturated fats hurt my situation?

        Paul ivermectin is it for protozoan infection ?Is it safe during nursing?
        I had taken albendazol twice without any positive results. Not sure if I lost the gut flora to it 🙁
        If I take ivermectin will probiotics be needed along with it?

        Kindly advise.

        Thanking you
        Koki

        • Hi Koki,

          Everything looks normal except the vitamin D. You don’t have high serum cholesterol, that is normal. Check our cholesterol biomarker category. Ask your doctor about drugs. I don’t think you would need probiotics with ivermectin.

          • Thanks Paul. What is thr dosage for vit D that is safest? I am scared of calcification in serum or arteries due to vit D suplementation

          • As long as serum 25OHD is at or below 40 ng/ml, supplementation should be safe. Find a dose that works for you, but it will be higher in the winter than the summer.

            Personally I average about 2500 IU per day.

          • Thanks Paul. Will try sun and supplements for vit D. I have carlsons 4000 IU per drop

            Paul is ivermectin safe during nursing? Does it work for protozoa infections too

  26. Dumb question here. I read the posts regularly so don’t want to get them by email. I post infrequently, and not always intelligently, so I do want to get just any questions or comments people may have about my own posts by email, just in case I miss them on the site. But when I try to set this up on the subscription page I end up either getting all Q&A posts emailed to me or, now at my latest attempt, all of Paul’s responses to Q&As.
    ??

    • Hi Jack,

      As far as I know you’re subscribed only to Q&A comments, and my replies are emailed to you because they count as Q&A comments.

      • Thanks Paul I was just wondering if it’s possible to have only responses to my own posts emailed to me? Not that I’m not getting amazing benefit from the site already! – just checking. I think I may be misinterpreting the instructions on the subscription management page.
        In any case, thanks again for the blog. Very, very helpful.

        • Hi Jack,

          I think there is a “replies only” option which is supposed to do that. Try clicking the manage subscriptions link and see if that works.

          • That’s what I did, and then started getting only your replies to all Q&As.

          • Ha. Well, that’s a curious way to implement that feature. Sorry, I’ll look to see if more powerful comment tracking widgets are available, but for now I guess those are your only choices.

          • Jack, if you use IFTTT.com with its Feed channel set to the Q&A RSS feed and choose the Keyword search for your own name (assuming it is distinct enough), you can have IFTTT email you relevant comments.

  27. A poorly controlled study shows the superiority of the Mediterranean diet to a conventional diet:

    I assume you’ve probably seen this article or even read the underlying study (and perhaps commented on it somewhere):
    http://www.nytimes.com/2013/02/26/health/mediterranean-diet-can-cut-heart-disease-study-finds.html?pagewanted=all&_r=0

    They tried to compare the effects on a sick population (smokers, diabetics, heart disease patients) of a Mediterranean diet rich in olive oil, nuts, fish, legumes, fruits, vegetables and white meat (and a minimum of baked goods, processed meats and dairy) as compared to a low-fat diet, but people had trouble staying on the low-fat diet and instead would up eating a conventional American diet. The Mediterranean diet proved far superior. My own thoughts are that, of course, the Mediterranean diet full of good fats from olive oil, nuts and fish and low in gluten and sugar is going to be far superior to an American diet, so I’m not sure what this really shows. They weren’t really trying to find an optimal diet the way you are but simply picked the Mediterranean diet based on the fact that it’s conventionally thought of as healthy, and it did prove healthier than a diet full of gluten, soda and processed foods. If you have any thoughts, they’re welcome, naturally.

  28. Hey, stupid question for others, not sure it belongs here, but can’t figure out where else to ask.

    When people are talking about coconut milk that they drink, do you use the stuff from a can? Or the boxed non-dairy milks they sell in the milk section? I want to start drinking more coconut milk and less cow milk but notice most of those box milks have wacky stuff in them.

    thanks,
    elizabethe

  29. Hi Paul,

    What are your thoughts on potatoes that have sprouted? Is it okay to pick off the sprouts and still cook and eat them? Or toss them?

    Here’s April S. thoughts from PaleoHacks … she claims the starch has converted to sugar.

    http://paleohacks.com/questions/182580/what-about-eating-potatoes-on-paleo/182582#182582

    I think it’s generally okay to eat potatoes that have sprouted so long as they are FIRM and you twist the sprouts off them (you can save these for planting!). The thing about sprouted potatoes is that most of the starch has converted to sugar. DO NOT EAT if the sprouts are GREEN.

    Thanks,
    Mark

  30. Hello again readers,
    A question regarding vitamin D via outdoors… Is it affected by sunblocks?

  31. Paul, what do you think about adding a pinch of organic soil from my garden to my jars of fermenting veggies to get some soil based organisms.

    • Hi Jonathan,

      I don’t think I would do that myself, but I think it would probably be as likely to help as harm. Might increase the variance of outcomes … so I’d be more inclined to do it if my health was poor than if it was good.

  32. Hi Paul,
    I get eggs from a local farmer and she informed me that she does feed her chickens a protein based food. Is that alright?
    Thanks, Syl

    • Hi Syl,

      Protein is essential for chickens. In the wild they get it mainly from insects and worms. In commercial operations they usually get it from soybeans, which is problematic because the soy proteins often go into the eggs. You might ask her what her protein source is.

  33. Hi readers,
    The PHD book refers to egg yolks more than eggs. At the moment I don’t separate my eggs, but wondered if I’m supposed to be separating some of my eggs to reduce the egg white consumption?

    As always thanks for the advice given.
    Regards,
    E

  34. This article in the NY Times is I guess a step, if not in the right direction, at least not away from it. Before doctors learn something about nutrition they need to admit their current state of ignorance. But I’d ask the doc who says, re diet advice, ‘we need to tell them something’ to consider the Hippocratic Oath.
    http://www.nytimes.com/2013/03/03/health/experts-want-more-studies-of-mediterranean-diets-role-for-the-heart.html?partner=rss&emc=rss

    • Hi Jack,

      It’s good that they realize that diet matters and that they don’t know much about it! It’s sad though that they think 50 years of clinical trials is what we need to figure diet out.

  35. Firstly, thank you! I read about PHD just over a week ago in the Australian Woman’s Weekly, and have been reading your website ever since. After 8 days of a new PHD lifestyle change we are doing really well and loving it…have looked everywhere for info on pine nuts – are they an ok addition in small quantities. Also, have you heard of organic coconut sugar and is this an acceptable sweetner? Big thanks, Esther in NZ 😛

    • Hi Esther,

      Welcome! Pine nuts are 45% omega-6 fats by calories, so they can be used in limited quantities for flavor, say 20-30 nuts per day, but not as a food. Coconut sugar is mostly fructose so we don’t approve; try honey before that, or dextrose powder.

  36. This is a pretty good way to formulate a meal. one ounce of protein for every ten carbs: http://mdwellnessmd.com/fundamental-diet/

    • i love the clear concise way it is layed out.
      have you noticed haw many people have difficulty understanding portion size.

  37. Hi Paul, Are there any supplements you would suggest while on antibiotic Doxy? I would think NAC and ALA would help right?
    Should I eat PHD but with much more coconut oil as you suggest in the book?
    This is for Prostatitis, I was not abelt of ind any write up on your site for it.
    Thank you for all your help.

    • Probiotics are the primary extra supplement. NAC will support immune function so may be beneficial. ALA – not sure if you mean lipoic acid or linolenic acid – I don’t generally supplement.

      • Paul,

        This is just an idea, but it makes sense in theory.
        What about taking L-Glutamine while on atibiotics. Since you say Glutamine can predispose you to overgrowth of certain bacteria, while on antibiotics that should not be a problem and this way you can heal your gut with large doses. I have read most studies suggest around 50g a day to heal the gut, is that safe?

  38. Hi Paul,
    Do you know anything about a condition called KPU?
    http://www.ncbi.nlm.nih.gov/pubmed/18383989

    It seems to be fairly common among people with psychiatric illness. The treatment requires high dose zinc manganese b6 and other nutrients to counter high levels lost in urine. Based on your research this could be very dangerous especially if one mistakenly believes she has the condition,
    but it would seem to preclude getting well if the issue is not addressed! There isn’t much agreement on the matter albeit a few doctors working alone.

    Your thoughts here would be sincerely appreciated.

    • This line in the abstract jumped out at me: “Antibiotics reportedly reduce HPL in urine, suggesting an enterobic role in production.”
      High dose B6 as pyridoxine is dangerous and I would use the P-5-P form if treating KPU.

      http://hopefulgeranium.blogspot.co.nz/2013/02/pyridoxine-toxicity-and-deficiency-and.html

      • Yes George, there is a doctor treating this condition who believes it can be triggered by microbes. (see his lecture below) Would make sense as nutrient losses of this type and severity would probably make one an easy host for all types of bugs.

        a beautiful 2 hour lecture on KPU can be viewed here
        http://www.youtube.com/watch?v=-z3kRDYcvhA

        Paul, is this on your radar at all?

        It’s such an obscure topic yet it seems that it could be a very overlooked and vital issue for people with chronic illness. The research was done decades ago by orthomolecular psychiatrists treating schizophrenic patients, among them Abram Hoffer.

        Because many of these nutrients are toxic at high doses, unless one of course has deep deficiencies, self experimentation is probably a bad idea. The test for this compound is also very unreliable which just adds to the mystery of it.

        Paul would you say alkaline/phosphatase is good indicator of zinc status?

        At the least, if there were more of an awareness/discussion on this topic, I might get better sleep at night; even if somebody refutes the issue, tell us why. It seems too important to ignore.

  39. I’m very interested in your work, and I’m reading the references listed in Ch. 24. They don’t seem to line up with the footnotes. Footnote 1 (Taro), talks about lectins in taro (not about safe preparation). 2 (white vs brown rice), I don’t find that comparison within the reference. 3 (rice toxitiy vs wheat) doesn’t talk about wheat but says rice is “a significant trigger of FPIES. Paediatricians should be aware that rice not only has the potential to cause FPIES, but that such reactions tend be more severe than those caused by cow’s milk/soy.” Can you clarify? Thanks!

    • Hi Amanda,

      Note 1 does discuss preparation; it compares two uncooked forms of taro lectin (crude and purified) with cooked (autoclaved) taro lectin and with a control. Mice eating the control or autoclaved lectin grew normally, mice eating the crude or purified taro lectin did not. See Table 1 of the cited paper.

      Note 2 cites a monograph on rice and the relevant passage is actually quoted in the book. It can be found at this location: http://www.fao.org/docrep/t0567e/T0567E0g.htm#Antinutrition%20factors.

      I apologize that the purpose of Note 3 was unclear; I’ve put up a correction to the text on p 233 in the Errata, http://perfecthealthdiet.com/notes/#Errata. The correction moves note 3 to the previous sentence where it supports the potential toxicity of rice protein. The last sentence should have used the word “auto-antibodies” rather than “antibodies”; the point is that rice cannot cause the equivalent of celiac disease. Our general point is that all plants have toxic proteins, including rice, but that rice is hypoallergenic meaning we do not normally develop antibodies to it, if we do they are not auto-antibodies so that diseases comparable to celiac disease are impossible, and finally that the toxicity of (cooked) rice proteins is generally not that severe. Note 3 cites the worst known toxicity reaction to rice; FPIES is not an antibody-mediated condition, it occurs only in infants younger than 6 months, and can be triggered by any food including meats and vegetables. Perhaps we should add a note to the other sentence in that paragraph to support the relatively low risk from rice. Possible sources on that include http://www.ncbi.nlm.nih.gov/pubmed/21888532 and, with a direct observation showing that raw rice can be allergenic, but cooked rice has greatly reduced ability to bind antibodies, http://www.ncbi.nlm.nih.gov/pubmed/16948355.

  40. Hello, I am wondering what your recommendations are if you accidentally eat gluten containing products while taking the iodine and other supplements? me and my husband went out to eat over the weekend, and I am sure I got “glutened” lol.
    thanks

    • Hi Stephanie,

      No recommendations, just let your body deal with it. You must rely on your body’s normal detoxification methods to eliminate the gluten and other wheat compounds.

  41. Hi Paul and others,
    Any ideas/ thoughts on this?
    For the past few weeks I seem to be hungry and eating more than before, but I’m slowly losing weight. Doesn’t sound good! The bad thing is that i dont really track calories, etc. My only thoughts (which I don’t like to think, but have to consider…) are:
    1) parasite infection
    2) recently increased metabolism from iodine (I’m still at the low end though–since January I’ve been taking the NOW brand Potassium with Iodine- 1 tablet per day (225mcg) and went down to only half a tablet for the past few days to see if it gets better…
    3) some tumor? I didn’t want to even consider this terrible one, but when I thought about how good my blood sugars have been and was reading how tumors feed on sugar, I wondered if something like this could be what has been removing extra sugar from my blood.??

    Separate question… don’t know if anyone is familiar with this area…
    Does taking insulin injections predispose me to possible tumor growths (because of the Insulin-like growth factor) in the areas where I often inject? I don’t really know what I’m talking about here, sorry… just a few things I read recently got me thinking along these lines, but I’m really in unfamiliar territory.

    Thanks!
    KH

    • Forgot to mention that my TSH was 1.1 uIU/mL on last blood work (Jan 28, 2013).
      I have also had more frequent BMs daily (usually normal form), which I’ve read can be a symptom of hyperthyroidism.
      ?

    • Hi KH,

      It’s hard to guess at anything from a distance. Just losing weight will tend to make you hungrier, as your brain will not want to see your body wasting away. So it could be as simple as you haven’t been eating enough food.

      I would go to the doctor and voice your concerns. Blood tests should tell whether there was hyperthyroidism, or elevated insulin levels or other hormones from some sort of endocrine tumor. A stool test might identify any parasitic infection.

      Best, Paul

      • Ok, well, today I started tracking my food again on the livestrong app to get an idea of my calorie intake, so I’ll look into that first. Then I’ll see if the doctor can run some tests for me.
        Thanks Paul!
        KH

  42. Hello,

    The last three days (I am 21) I have gotten cluster headaches (the description fits perfectly with what I have). I have never had them before but my sister has gotten them all her life (I assume somewhat genetic). I am not sure what to do to get rid of them or what triggered it to begin with. I ate eggs which I had not eaten in a couple months and the next day they appeared. I had also lifted weights (I thought it was an exertion headache but now I wonder if it was the beginning of a cluster). Thoughts on what could have caused it? I eat a PHD diet and am very particular on eating what makes me feel good. Eggs were the only thing out of the ordinary.

    Thanks,
    Jared

  43. Hi Paul, if SIBO is suspected, should I follow your version of the ketogenic diet as outlined in your book or completely starve the system of carbs with the exception of dextrose? Thanks.

  44. Hello Paul,organic sprouted corn and properly prepared beans acceptable?Also i love to eat platains and sweet pots but i do get a little bit gassy when i eat them.Is this because they’re a resistant starch or is this something that my body can’t handle? Thanks

    • Hi Frankie,

      It could be something else, like oxalates or FODMAPs or fructose malabsorption. Try rice and white potatoes and see how you do. Corn and beans are not PHD approved but with proper preparation (soaking, sprouting, thorough cooking in water) might not be harmful.

  45. Hi Paul:

    1. Can we rely on table iodized salt instead of supplements (we don’t like seaweed)?

    2. I have a 3 yr old and 7 yr old. I’m thinking about supplementing them ONLY with this with tyring our best on food: What are your thoughts?

    Vitamin C: 250 mg/d
    Vit. D: 1000 IU/d
    Magnesium: 30 mg/d (too be on safe side incase grandma gives themvitamin fortified kid juices with 50%DV magnesium.
    Vit. K2: 100 mcg/d

    • Hi Eddie,

      1. Add in seafood (marine fish & shellfish 2-3 times per week) and it will be enough.

      2. Yes, I think that’s good. Try to get them in the sun in the summer to replace the D. Vitamin C doesn’t need to be every day. I think you have all the most important bases covered.

  46. Paul – If you ever decide to up your recommendations for resistant starch, I recently came across the motherlode.

    Raw, green plantains are about 50% by weight RS. An average plantain weighs about 200g, so that’s nearly 100g RS in one plantain! http://ift.confex.com/ift/2004/techprogram/paper_24360.htm

    Here’s the problem: NOBODY could eat a raw, green plantain and say they liked it. When cooked, nearly all the RS disappears.

    Solution: Cut a raw, green plantain into thin slices and dry in oven on very, very low or (better yet) in a dehydrator. When all the moisture is gone, they taste like communion wafers or unsalted pretzels. Toss these dried chips in a bit of olive oil and seasalt and the taste and texture is exactly like thin, crispy pretzels.

    I plantain can easily be sliced into 30-40 slices, eating 10-15 of these gives you nearly 30g of RS and I have noticed absolutely no stomach distress.

    I’ve been trying to get 10-20g/day of RS but it is very hard with safe starches, you have to eat almost all your potatoes cold, and some raw to get close.

    In the two months I’ve been doing this I have noticed a definite decrease in FBG, better bowel consistency, and my weight is very, very stable. Now with the plantain RS bombs, I will be able to hit my target much more easily and may even up it to 30g/day as this is the amount used in most studies on the efficacy of RS.

    The only other PHD food that comes close is raw potato starch, but that can only be eaten as an addition to a smoothie, which I don’t do very often.

    • Thanks for tis tip. I love the green plantain chips recipe. I am definitely going to make these. Sounds like a good cracker replacement.

      • Yes, a perfect cracker replacement. Plain, they taste like a salt-free soda cracker. I like the taste. They are even better with some salt, taste just like pretzels. It’s kind of hard to get the salt to stick, but if you toss them very lightly with olive oil and salt quickly some will stick. Maybe you can figure out something better–or just eat them plain or with almond butter or something (pate?).

        They dry out really fast, next time I make some I’m just going to set out over night, they don’t need any heat at all.

        If you make some, try a bite a various stages of dryness…at first the are just plain nasty, make your mouth pucker like alum. As they dry, they lose all that and juct get crumbly/crispy depending on thickness.

    • hi Tatertot. could you share with us more detail on your FBG numbers and times to achieve them. thks alfred

      • 3 years ago I was prediabetic w/FBG over 120 consistently. Started eating paleo a la Mark Sisson’s Primal Blueprint, low carb, no starch, and FBG dropped to low 90’s, but crept up over 2 years into the 110’s. Started PHD starch recommendations on 1 Jan this year. FBG was in 110-120 range for first few weeks, then I started targeting RS and it’s down to low 90’s within a month.

    • Hi Tater,

      Clever idea! Maybe we’ll give it a try ourselves.

      • If you can figure out a way to get salt to stick to them you’ll be my hero!

        • just a thought on the salt thing…
          you could give this a go (experiment)…

          cover (or shake in bag? brown paper bag?) the freshly cut slices in salt straight after cutting,
          the theory being that the salt will stick to the moist chips and then dry them.
          The salt should absorb all the moisture, think salt dried fish.

          hopefully you will end up with salted dried plantain chips.

          if you do get it to work…let us know details

    • Hi Tatertot,

      I’m curious if you’ve also tried dehydrating cooked and cooled potatoes?

      Not so much for RS, but rather more from a taste and texture perspective.

      • I tried raw potatoes…no good, they get really hard. The plantains get crispy. Never tried cooked and cooled.

        • I’ll sometimes grate a cooked and cooled potato to get a hash consistency and then microwave them. I’m amazed at how well they keep moisture even after microwaving hot.

          Again, I’m not viewing it from a maximize RS perspective, but interested in a dry, crisp type starch alternative to say brown rice crackers.

        • Interesting ! I’m wondering whether it’s not the fructose content of the plantains that make them get crispy..?
          And Tatertot, what about the potato starch we can find in powder ?C

          • oups.. just submit the reply before the ending.. !
            So Tatertot, you said you target RS?? do you mean you replace potatoes or safe starches with the amount of RS you mentionned ?
            Thanks for your comments ! Wise and practic

          • oups.. just submit the reply before the ending.. !
            So Tatertot, you say you target RS ?? do you mean you replace potatoes or safe starches with the amount of RS you mentionned ?
            Thanks for your comments ! Wise and practical !Best, July
            PS : on traditional chinese med. it’s recommended not to eat too cooled.. for organs and digestion mechanism… so, what it raises a dilemma between the all benefits of RS (assuming it has to be cooled or eaten cooled to be efficient.) and the chinese medicine point of view… What’s the point on this..? Can Paul or Sou-Ching comment the chinese medical recommendation ?..

          • http://ift.confex.com/ift/2004/techprogram/paper_24360.htm

            It looks to me like there is less than 1% fructose and glucose in a raw, green plantain. A quick taste confirms!

            Until I found out how high plantains were, I was getting my RS from green bananas (5-15g depending on size and ripeness), and potatoes.

            A raw potato has a lot of RS, but who wants to eat raw potatoes? A cooked potato has very little RS, a cooked and cooled potato has a bit more.

            When I prepare potatoes (almost daily) I would eat a slice or two raw, then cook and eat hot. Lefteovers were cooled and eaten cold the next day. This method gets you about 10g RS from an average (1/2 lbs) potato.

            Green bananas are not very good, and as they get riper the RS disappears and is replaced by sugars, but green bananas are a good source of RS for the average person.

            By contrast, the SAD provides about 2-5g of RS, a no-starch paleo diet provides about 0g. The PHD can contain as much as you want.

            Re: Potato Starch – as long as it is ‘unmodified’ it is a good source of RS. Has to be eaten in it’s cold, powder form, though. I have a bag of Bob’s Redmill Potato Starch that I add to a smoothie, but I am just not that into smoothies. Maybe do more of them this summer when more fruit is in season.

            The dried plantain chips contain a huge amount of RS and are easily eaten. Dried, they are close to 90% RS by weight. It doesn’t take to many to make 10 or 20g. They could even be crumbled into a salad or eaten in many ways as long as they are not heated above 120 degrees or so.

  47. A primary symptom of mine is stiffening/inflammation of blood vessels, most noticeably in the extremities. I take antifungals and earlier this year I raised carbs (mainly rice) to ~600 carb.

    My vascular problems are definitely worse today, though high dose oral C relieves the vascular tension temporarily. I looked through my notes and the carb increase is the most obvious change.

    Could a bacterial infection cause this? It seems like a sort of blood vessel hardening or vasoconstriction?

    Thanks,
    Alex

    • Hi Alex,

      I don’t know. What do the doctors say?

      What supplements do you take? Do you eat a source of nitrates, like beets or green leafy vegetables?

      • I’ll see my doctor today. I take the recommended supps plus choline since eggs are problematic lately.

        I also take anxiety medication and started tapering diazepam. I’ve noticed worsening vascular symptoms around these dose reductions.

        The pain/vasoconstriction is horrible, especially in sex organs. Honestly, unbeliavble.

        I hope my discussion with my physician generates some ideas.

        And I do eat both beets and spinach. Since my ordeal started I’ve also had irresistible almond butter cravings.

        • To update my case:

          Testing shows elevated ochratoxin levels. Stool continues to show unknown fungal infection. I was exposed to toxic levels of mold, which I discovered in my home last August, and my doctor believes I’ve been colonized in a noninvasive manner, perhaps by an aspergillus species. I am on an anti-fungal Rx protocol + a mycotoxin binding protocol.

          My detoxification organs, genitourinary tract and blood vessels are all affected. I suffer cognitive and digestive problems as well.

          I’ve been to lucky to have found a doctor experienced in treating cases like mine. Treatment, evidently, involve much trial and error. As the patient, trial and error is not fun or providing of reassurance.

          I have talked about diet with the doc and she believes it critical since many foods contain mold toxins or feed fungus. Unfortunately, she is not a nutrition expert.

          I’m negotiating to find the best foods for me right now. Some PHD-approved foods seem disagreeable. Dried spices, coffee/tea, garlic, & eggs have been problematic so I am learning as I go.

          Your site is a great aid and helps to maintain the hope.

          Alex

  48. hi Paul and Shou-Ching,

    Do you have anything currently available (maybe a table or list of some kind) that summarises essential nutrients, their food sources and recommended dosage… i don’t know if this is a silly question or something that you may have or may consider including on your site??

    regards.

  49. Thank you, Paul for answering my question. One suggestion on a good research paper I would like to see on this blog:

    I.A PHD for kids regimine
    A. What’s the current state of health for the majority of kids in America versus other countries?
    B. What diet recommedations exist for kids that is similar but not the same as adults?
    C. What supplement regimine do you recommend for kids and how to immplement such a strategy?

    I am sure there are thousands of readers who would like to see a book or paper of some sort that would include: A Perfect Health Diet for Kids. Thought this would be a neat idea for you and your wife to work on. 🙂

  50. Hi Paul!

    I recently started taking n acetylcysteine after reading your blog posts about IBS and bowel disease. For the past two years I’ve been in pain, had irregular bowel movements, basically everything that goes with IBS. However, after starting NAC, I HAVE NO MORE IBS AT ALL!!!!!!!!!!!!!!

    THANK YOU! THANK YOU! THANK YOU!

    I’m stunned. I was hoping to understand why on earth this has helped so greatly? I don’t understand what it “fixed?”

    The PHD book and this blog have literally saved my health and my sanity. I am eternally grateful.

    Claire

    • Hi Claire,

      That’s great!

      I don’t know why it helped, but here are the two leading possibilities:
      – NAC is a glutathione precursor and glutathione is arguably the most important cellular antioxidant. The IBS was probably causing a lot of oxidative stress, and the function of gut cells was impaired because of it. Damaged by the stress, they were unable to repair the gut properly. Adding antioxidants restored normal function.
      – NAC supports immune defense via glutathione; is antimicrobial by breaking disulfide bonds between microbial cell wall components; and is also mucolytic which changes the gut environment. This change to the environment may have disfavored a microbial species that had overgrown and enabled restoration of normal flora.

      IBS is a little mysterious as you know so we may never know why things work.

      I’m very happy for you!

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