Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. In the Weight Loss chapter of your book so say that for weight loss one should restrict fats by eating lean meat and having one tablespoon of oil per day for cooking. Is the coconut oil used during the intermittent fast included in that? If not, how much additional coconut oil daily do you recommend as a maximum?

  2. Paul or anyone, have you had any experience with this product. I know you have to be careful when it comes to HGH, but…


  3. Anyone want to share how they incorporate egg yolks into their menu(aside from fried eggs, omelets etc.?)
    Similarly to Paul, I tend to throw out the whites so my top three so far are…
    1. Whisk into hot bone broth(avoiding cooking it to the point of solidifying) and then adding diced green onion to make a sort-of-soup.
    2. Stir into mashed sweet potatoes, add cinnamon, cloves and kerrygold butter.
    3. Stir into a stir-fry.

    Anyone have other ideas of how to incorporate yolks into your PHD menu?


    • Hi Jonathan,

      I asked this question on a recent thread. I can’t find the link, but from memory some of the suggestions besides what you’ve mentioned are Bi-Bim-Bap, fried rice, homemade caesar dressing, or dessert items like custard, creme brulee, ice cream.

      I typically start the day off with a three-egg omelette with vegetables — and a side of potatoes fried in coconut oil. I treat this like medicine and if I don’t eat it, I’m definitely worse off for the rest of the day in terms of hunger/blood sugar/cravings.

      If I can’t get my omelette, I drop three egg yolks into a smoothie with a banana, coconut milk, and frozen berries. If I can’t get that either I take a choline supplement.

      I found a great recipe for tomato soup with egg yolks added at the end — it’s a Jamie Oliver recipe from Food Revolution, I think. The book 12 Months of Monastery Soups also has a lot of recipes that incorporate eggs.

  4. Does anyone have experience with the PHD and teenagers. I have a 14 year old with diagnosed insulin resistance who is already 110kgs. Is there anything different from the PHD I should follow for her?

  5. I was heartened when my eldest son remarked that he was reading more of PHD, which I gave him for Christmas. Yesterday he said that he could see why I am so enthusiastic about it, as it is fascinating information. He confessed that the science sometimes bogs him down (he’s a humanities and computer tech guy), so he hurries past it. My love of science did not rub off on my sons :(. But he commented that the talk of evolution is troubling to him. I did raise my sons with liberal views — believing in a very old earth with life forms that have evolved and adapted down through time, while also believing in God and Jesus Christ.

    Paul, you let your beliefs be known here, and do not allow our questions to turn this PHD blog into something else; however, can you give me the right response when my sons ask about the “evolutionary evidence” and other references to evolution?

    Thank you. Blessed Eastertide to all.

    • Hi Lana,

      First, I might try this argument: All truths are God’s truth, including scientific truths; and God is not a deceiver. If he had created the earth recently, he would not have littered the earth with fossils that appear to be very old in order to deceive us of the nature of reality. If he had created the earth without an evolutionary process, he would not have made all animals share many genes, and to create an evolutionary process which we can observe directly in microbes and short-lived animals, and even in humans now that we can sequence DNA from ancient skeletons. Why did God make it look as if the earth is old and evolved, if it did not?

      Second, he might look into the sociology and history of the evangelical opposition to evolution. In the early days of evolutionary science, Christians were among its strongest supporters. But by the late 19th and early 20th century, a lot of political extremists including American Progressives made the claim that evolution supported their views: that evolutionary science refuted Christianity and that it obliged us to support evil practices like the killing of the disabled and eugenics — even, as the Nazis held, the killing of inferior races or ethnicities. Some of the most famous American Progressives, such as Margaret Sanger, were eugenicists and euthanasia supporters and hostile to Christianity (http://www.youtube.com/watch?feature=player_embedded&v=nZdwpjArFjg#!). Evangelicals improperly gave the Progressives credit for representing the science correctly, and extended their opposition to eugenics, euthanasia, and atheism to opposition to evolution. That was a mistake. To help understand the environment of the time, a similar recent propaganda effort would be the claim that science has proven global warming and obliges us to turn our lives upside down to avoid carbon dioxide release. The scientific claims were wrong in both cases, and evangelicals were right to reject these false claims attributed to science and the vicious doctrines claimed to derive from them, but they were wrong to reject science in toto.

      It is time for evangelicals to find the truth about evolution for themselves and cease letting their atheist opponents determine their views for them by simply adopting whatever view they think is the opposite of what the atheists are saying.

      God bless,


      • Sometimes it’s more effective when you let others make the argument for you, after all, no man is a prophet in his home town. Another book you may want to give your sons is, “The Language of God” by Francis Collins, a renowned Christian scientist(geneticist)who also supports evolutionary theory and has contributed much to his field in this regard.

        • Thank you, Jonathan. This morning I found a 2-hour lecture plus Q&A with Francis Collins and enjoyed it immensely. Great recommendation!

      • Thank you, Paul, for your thoughtful reply. I have shared your thoughts with my son, via email. Hope that this spring break will give me some time to chat with him. I am so glad he’s reading the book and becoming more interested.

  6. I should have added that my sons are college educated, with master’s degrees, who married very conservative Christian women and, understandably, they have embraced their wives more conservative views, which include a very negative visceral reaction to the idea of evolution.

  7. Hello Dr.jaminet.

    Are you familiar with the Marshal protocol? It is a protocol that treats autoimmune disorders by using Olmesartan (Benicar)to stimulate the innate immune response to kill pathogens. It is used in combination with antibiotics and works by activating the vitamin D receptors.
    It is said to have had success with fibromyalgia among other things.
    The theory is compatible with much of your discourse as it attributes these diseases to dysbiosis and chronic infection.

    • I just saw a post by dr.mercola who opposes the Marhsall protocol however.

    • Hi Marcus,

      Yes, I am. I think it’s wrong, and does considerable harm in the long run. Benicar is not an adequate ligand for the Vitamin D receptor and it is not an adequate substitute for vitamin D.

      I have heard many anecdotal reports of patients who tried the Marshall Protocol, seemed to feel better temporarily, and then got dramatically worse in year 2.

      There is really no scientific basis for the low vitamin D and Benicar treatment recommendations.

      I do think they are right that chronic diseases are often the result of chronic infections, and that it’s quite plausible that some of these infections have evolved ways to disturb vitamin D pathways, which are so important for immunity. But the treatment recommendations I think are inappropriate.

  8. Since transitioning from super low carb GAPs to PHD in September 2012 (I am now up to about 120-130 grams starchy carbs from yams, potatoes, occasional white rice all backloaded with dinner) my stomach seems bloated much of the time, with an extra 1/2″ gained around my waist in particular. Could this be my body still adjusting to the carbs, or is it an indication of infection and I should possibly lower the carbs again?

  9. Hi Paul,

    I left another question on another feed.. Sorry for doubling up on you, but sometimes these things come to me all at once! I am wondering if you know or have read anything about Herpes Zoster. I tend to be really healthy despite my inability to respond well to stress which is what I believe caused my Shingles outbreak about 7 months ago. The resulting nerve pain has come and gone and I can feel another outbreak coming soon. With a little online research it seems to me that recurring Shingles is shockingly common in young women. Of course regular medical doctors just sort of brush me off, that it was a fluke, etc. I wonder if following general anti-viral strategies would be a good method for controlling Herpes Zoster or if that strain is somehow different because it lays dormant in most people’s bodies?

    The cancer-virus connection has me concerned as I clearly have a known viral problem in Zoster.

    Thanks for your thoughts.


    • Cancer-virus connection? Great, I wasn’t aware of this. I’ve been getting a shingles outbreak 1-2x a year since I was 8. I’ll be interested to hear Paul’s response. Thanks for bringing this up.

      • Ha! Sorry to alarm. If you review Paul’s posts on cancer you will see that he is of the mind that many cancers are viral in origin. I don’t know that there is a specific connection to Zoster, but I hope he can shed some light on the issue.

        • Ha ha, no hard feelings Lindsay. It’s better to be aware of potential problems ahead of time. After all, an ounce of prevention is worth a pound of cure.
          I think Paul did mention before that the best strategy for viral immunity is autophagy by means of ketogenic fast(I’m sure your familiar with the 8-hour window for eating). The added benefit of using coconut oil to promote ketosis is that it contains lauric acid which has antiviral properties. Viral infections are tricky because they are typically intracellular.

          • Hi Jonathan,

            I do practice IF and have, more often than not, for the past 2 years. I tried the ketogenic variety just for fun last summer. It was a bit messy… The fat made me feel a little wacky. I think it was most likely because I was under a lot of stress at the time and fasting was likely not the best idea.

            Have you tried keto fasting for Shingles? I guess the issue still remains from my original question. In other viruses, say a different type of Herpes, not everyone is infected and I can see targeting it with something like keto dieting, but with something so ubiquitous will keto dieting (or any other dietary approach) work? I just can’t seem to understand why some people get outbreaks from earlier chickenpox and some don’t. I think the general theories of low immunity and what not are fine and good, but what about the rest of us?

          • Jonathan,

            As a fellow Shingles sufferer I wonder if you have the resulting neuralgia? I seem to.. I am only 7 months out from the original outbreak and every now and then for a period of a few weeks the dermatome that was orginally affected will “freak out,” with tingling, shooting pains, numbness. I wonder if you have had this as well?

  10. Hi Paul,

    Since 3 months with PHD I hace noticed an increase of tartar in the back face of bottom front theeth. I can remove it with my nail or hard object but appears again the following day.

    I supplement with Magnesium, Vitamin D, K2 (LE Super K) Iodine, Copper and Zinc, according to your guidelines.

    What could it be?

    Thank you and sorry for my english

  11. Hi Paul!

    I recently just did FMT to help with my IBS. I was curious, after the procedure, is it okay to still take N-acetylcysteine? Or will that goof up my attempt to help the good flora colonize?


  12. The book mentions MCT a lot, but what exactly is an MCT oil?

    • Try google.

    • Medium chain triglycerides. It is beneficial to use during a ketogenic fast. That or coconut oil.

    • Hi there,

      I wondered this myself. I noticed in the local health food store a bottle of liquid coconut oil and it was labelled MCT oil, I guess because coconut oil is largely MCT oil and this liquid version was largely composed of medium chain triglycerides from coconut oil. It seems to me that MCT oil is medium chain triglyceride oil that is purified from other oils which have various ratios of MCT, saturated fat etc. It is sold with a label MCT oil. That’s what I’ve figured out anyway. I looked it up in Wikipedia too.

      Hope this helps a tiny bit.

  13. Hi Paul,

    I wanted to ask you about fat consumption. I know it’s great for us, but I seem to have a hard time digesting it, I think for two reasons:

    1. I used doxycycline (off and on) for years for rosacea. I think this seriously slowed my digestion as a result.

    2. I’m apoe4/4, and I understand we keep more fat in our bloodstream. Not sure if this has anything to do with fat digestion, just a thought.

    Given these two factors, do you have recommendations for repairing my gut flora so I can better digest fat, OR are there dietary changes I should make based on being apoe4/4?

    Thanks so much for your help. Your blog and book are excellent.

  14. Hi Paul,
    I apologize if this has been covered before but I am confused about whether to disregard all the other advice out there regarding following a “autoimmune protocol” paleo diet for hashimotos. I am particularly concerned about eggs and nightshades which all have nutrients I don’t want to miss out on. But it seems that my endocrinologist feels my thyroid meds are where they are supposed to be yet my body temp is still low, have cold hands/feet, tired, crabby, etc. I also have a fodmap intolerance (IBS) You have said before that tolerance of nightshades, etc. is based on symptoms but as a perimenopausal woman, symptoms of hormonal imbalance are moving targets so it will be hard to determine cause and effect of eating eggs, tomatoes and potatoes on my thyroid function when I can’t realistically monitor my blood tests week by week. Any thoughts to clear this up?
    With gratitude,

  15. Hi again, Paul,

    One other quick question: I’m planning to do a bentonite clay cleanse soon (using Somme’s no. 7). I’m concerned that with my slow digestion might cause all the bad stuff to stay inside longer than it should; am I worrying too much, or should someone with slow digestion not do such a cleanse?

    Thanks, so much, again. That’s all for now! 🙂

  16. Very sad to hear about Roger Ebert and author Iain Banks. I wonder if nutrition can help any.

  17. Hi Paul,
    I was wondering if it matters what type of potatoes we eat on the phd? White, Idaho, red?

  18. Simple question that may expose my ignorance but why does it matter if cooled starches have more resistant starch if after you eat them, the body warms up the food to 98 some odd degrees. Does the starch change again back to normal or does the act of cooling it permanently change the starch regardless of future preparations?

    PS, adding vinegar on a buttered potato is amazing! Great tip

  19. Hi,
    I try to follow the PHD and I’d like to do more morning fasting but I’m usually physically hungry in the morning, my stomach’s actually growling even if I’ve had starch and meat and veggies for dinner, usually around 6-8 pm. Almost always in the morning my body doesn’t feel like a heavy breakfast or anything like seaweed or broth or eggs, but I usually crave just fruit. To have something light I’ll usually make a spinach,banana smoothie or a bowl of banana w oranges and/or apples and a scoop of almond butter for a little protein and coconut flakes. I’m just wondering is that too much sugar w just fruit or is it ok if I add the almond butter? I’ve always craved fruit in the morning thats just when I usually have it, it doesn’t digest well with heavier foods for me and I’m dairy intolerant so I can’t have yogurt with it or anything like that. Thank you for your thoughts 🙂

    • HI Brie,

      I was the same way with morning sweet cravings and trouble skipping breakfast. I’d hold off fasting for a while and try to get rid of those morning cravings for fruit, which is just a sugar/carb craving in disguise. Try to eat more carbs, esp. potatoes. Potatoes really helped me.

      Also try cutting back on extra sweet fruits like apples and berries, or if you do eat them, only eat them with a meal, as dessert.

      You also might tolerate skipping dinner better if you can train yourself to be okay with eating breakfast. That’s what I do.

      Just some thoughts. Experiment, but, IMO, and others might have a different opinion, those morning fruit cravings are a sign that something is out of whack! At least that was true for me.

      • Thanks Elizabeth,

        I’ll do some more experimenting, I appreciate you taking the time.

        • Good luck! I’m curious to see what works for you. I love fasting now, and agree that it is a really useful protocol, but Paul has said in his interviews that it should be easy and painless.

    • Are you open to trying ways to make the fast work? I think that the fasting component of the diet is important enough to go through some trial and error.

      Some foods that are allowed on fast are:
      1. Fermented veggies
      2. Pure fats such as heavy cream and coconut oil. I alternate between the two. Cream works great stirred into coffee and coconut oil works great blended.
      *I see your dairy intollerant. Some with dairy intollerance are OK with full fat dairy such as heavy cream or butter. Some experimentation is required.

      Also, are you eating enough fat and have you had time to become fat addapted?

      • Thanks Jonathan,

        I appreciate your feedback. I’ve got some ideas to experiment with, we live 5 min walk from amazing food carts so its not easy being on it all the time, that’s probably a big part of it. But I would say I follow it for real 80%, even then that means when I have a chocolate cake at night I bet those next mornings are when I’m craving fruit the most. I’ll have to see about that. Thanks

  20. Having read that Gouda Cheese was high in Vitamin K2 I started eating some regularly.

    Does anyone know if the age of the Gouda influences the amount of K2? (there are Goudas aged a month or two and others up to 5 years)

    Does anyone know why Gouda has more K2 than other cheeses?

  21. Actually it looks to me like he is saying that Pecorino is high in CLA, especially if you follow the link he gives.

    But he does say that the more aged Gouda has more K2.

    Thanks for the link.

  22. Paul – A bit of a backstory and a question at the end…

    I was LC Paleo for 2 years, during that time I got very healthy and strong. I was previously pre-diabetic with FBG in 120’s. On LC paleo, FBG was in 90’s but crept up to 110’s for past year.

    Started PHD style eating 1 Jan. with lots of resistant starch. My FBG dropped to 100’s and 2-hr post-prandials are in the 90’s.

    In 3 months, I put on about 5 pounds, so I did one of my famous “Potato Diets” a couple weeks ago, lost 5 pounds and am now sitting very happy.

    While eating a mono-food potato diet at a huge calorie deficit, my FBG was in the 80’s. 2-hr post-prandials also in the 80’s.

    Upon resumption of the PHD, FBG jumped back to 100’s. As an experiment, I ate a huge protein dinner with well over a pound of meat eaten–FBG next day was 121. Then I did a couple days of low calorie, light protein dinners, and FBG is in the 80’s.

    It seems my improved FBG while eating just potatoes was not a function of the starch, but of the low calories/low protein.

    I have found if I keep my protein at dinner to under 30g, I can keep my FBG in the 80’s. Dinners with 40g+ protein raise it higher. Thinking back, my dinners almost always contain 50-100g of protein as I eat a very light lunch and no breakfast.

    Why would eating most of my meat at dinner cause my FBG to be close to pre-diabetic levels?

    Does this indicate some type of liver dysfunction?

    • Hey there Tatertot,

      Just a few thoughts I had when I read your post: Doesn’t protein cause as much of an insulin response as carbs, but without the glucose to “moderate,” the insulin? Or maybe it’s more.. I can’t remember, but it is as least the same amount of insulin response. Do you eat these high protein meals without carbs? If so I think that could partly explain. Otherwise wouldn’t that be more of a pancreas problem than liver considering insulin and glucagon are products of the pancreas?

      These aren’t answers I know.. Food for thought at least.

      • When I was LC Paleo, dinners were meat and LC veggies with lots of butter/CO. For the past 3 months, dinners have been about 3/4 pound of meat, big serving of starch, little fruit and maybe some cheese/nuts/chocolate/supp foods.

        Definitely having a low protein day, 30g or less, causes my FBG to be in the 80’s.

        A higher protein day, over 60g, puts my FBG in the 100-120’s.

        I can’t put my finger on it, but for some reason, it seems the higher protein is causing my liver to dump glycogen during the night.

        Here’s another symptom: On days I wake up with high FBG, I wake up at 2-3am and have trouble sleeping til my alarm goes off at 6am. On days I wake up with lower FBG, I sleep soundly through the night.

        It’s almost as if the liver dump of glycogen is starting at 2-3am, and it wakes me

        High FBG and waking during the night are both very common paleo complaints, I think I’m closing in on the answer to why these happen, at least for me.

      • I’m thinking the implications of this could be huge! If too much meat, or meat at the wrong time, is causing high BG, it would also cause an insulin response.

        Insulin in the blood stops fat burning, so I’m told. This could be the reason why many paleo folks can’t lose the last 10-20 lbs.

    • Hi tater,

      Very interesting experience. Offhand I don’t know the answer. I’ll have to think about that.

      • I have 200 test strips! I want to try a bunch of combinations and see how it effects FBG, but I’m thinking if there is a way to eat that keeps FBG low and sleep good–that is the best.

        I have noticed in the past, if I eat mainly protein and fat, my BG stays around 100-120, never dropping. As soon as I added in starch, I started seeing BG spikes to 180 right after eating with drops to 80’s 2hr pp.

        • I am interested in your experiments with FBG. I think I read some people eat a small amount of carbs before bedtime to give their liver a rest from releasing sugar during the night. I have never experimented with this but I would love to have an explanation of how this works. I too have BG and sleep issues. PHD has helped but I would like to know what helps you. thanks for sharing….

          • You are welcome. Sharing is what it’s all about.

            I was really amazed to see my FBG drop so much when eating just potatoes, which was about 1000 calories/day at 92% carb, 7% protein, 1% fat.

            I have never had FBG in the 80’s, and I have always eaten a lot of protein at dinner. I’m kind of thinking that for some people, a slow transit time with protein at night turns the protein to glucose or causes liver to dump glycogen at night–either way, it results in excess insulin, poor fat regulation, and disrupted sleep.

            Next week, I am going to try a few days of 50g meat and veggies for lunch and 100g fat, potatoes and no meat for dinner.

          • Tater, this is of great interest to me too. My blood sugar and sleep issues are similar. Thanks for posting such helpful info.

          • This is unbelievable timing, but Guyenet put this up this week: http://wholehealthsource.blogspot.com/2013/04/glucagon-dietary-protein-and-low.html#more

            It’s almost what we are talking about here, and he even uses the Potato Diet as an example, but I think he has it a bit wrong.

            I think it will turn out to be lowered BG and les overall insulin in bloodstream that is causing the rapid weightloss on the potato diet.

            He says: “Beyond the metabolic/hormonal effects of low-carbohydrate or high-protein diets, these diets may also be effective because of changes in the reward and palatability value of the diet (and food variety, a related factor). Getting rid of pastries, donuts, soda, fries, and pizza goes a long way, and taking one or more items off the table (e.g. bread) tends to reduce total food intake even if everything else remains the same. The potato-only diet is a good example of this. Over on Mark Sisson’s forum, a number of people have been repeating Chris Voigt’s experiment of eating nothing but potatoes, with similar weight loss results (21). To be clear, I’m not recommending this approach, but it certainly illustrates the power of a monotonous diet. Interestingly, besides being extremely filling per calorie, potatoes are also one of the most insulin-stimulating foods, according to the paper cited above.”

            If high FBG and weightloss stalls at the final 10-20 pounds weren’t so common on paleo, I wouldn’t give any of this a second thought–but those two things are the bane of this diet.

  23. Isaac Knoflicek

    Is there anywhere on this site where all the tables from the book are laid out in one place? Like the fat types in various meats, oils, and nuts, along with the potassium to fructose ratios of fruits and vegetables? I’m thinking that’d be real useful to have as a quick reference like when I’m at the grocery store.

    I’d put one together myself but I got the Kindle version of the book and it won’t let me copy and paste.

  24. Hi Tater,
    Well, don’t you think it’s the large amount of protein in one sitting causing the higher FBG? Maybe spreading out your protein intake throughout the day would be better.

    • I intend to try that and test. Maybe this will turn out to be the downside of IF’ing (by skipping breakfast for most people). Maybe it’s better to eat most protein early in the day so it has time to transit the digestive system well before bedtime.

      I’m still not convinced it’s entirely a protein issue, it could be a sheer calorie thing as well, making eating earlier in the day preferable to eating a big meal in the evening.

      I almost always allow 4-5 hours between dinner and bedtime, but maybe that’s not enough.

  25. The safe starches chart on pg 100: are those weights for cooked or pre cooked product? Thanks, kevin

  26. Sorry i left this in the wrong discussion, so a repeat: i have been dxd w a rash called Interstitial GranulomaAnnulare after biopsy. Derm only offers toxic treatments. I’m 64 yr female w hx of CAD, bypass graft in 2005, and colon cancer rt hemicolectomy same year. Started primal gluten free 2 yrs ago and went off ppi’s after 10 years of a high dose for silent reflux. ND says severe leaky gut. Mega dose of niacin 2 grams a day for high # ldl small dense particle size.
    I have the rash since winter of 2012 and its spreading all over legs and torso, not itchy but very disfiguring. Went off niacin, coffee, all dairy, eat meats fish vegies, homemade coconut milk and fruit/ vegie smoothies. Help dont know what to do

  27. I am really struggling with my health. I am almost 48 and eat a very clean diet, I have been under a tremendous amount of stress. I have adrenal fatigue and leaky gut( I think) undigested food particles in my stool. My iron leve keeps dropping – my ferritin was 5 in Dec. got it up to 19 in Jan. through supplements (30-60mg of elemental iron) really hard on body. When I cut back ferritin drops. Just completed a liver detox and prior was getting my perirod every two weeks. Look back at medical records – ferritin has always been an issue even when periord was not regular – taking 2-4 TBS of ground flaxseed per day — Please HELP!

    • Hi Sandy, this sounds very much like what I struggled with for a long time before finally figuring it all out. I experienced all you describe plus the onset of IBS-like symptoms after a lifetime of no issues. After more tests and procedures than I care to think about, my gynecologist suggested an ultrasound to see if I might have uterine fibroids. Sure enough, there were numerous fibroids – one fairly large one that was causing most of the trouble, pressing on the bowel and causing irregular and often very heavy bleeding. I just had a laparoscopic myomectomy two months ago and it seems like a miracle. Iron panel back to normal, IBS symptoms gone. Not one of the other doctors considered fibroids as a cause, but they are actually quite common. It may be worth checking out. Best of luck to you!

  28. I’m having bad symptoms of (I think) leaky gut – toxins floating around my body. I’m 34 years old, currently on antibiotics and acid blockers for H pylori and mycoplasma. This feeling of toxins is part of what drove me to the doctor, and the medicine did initially help. Now after a week it seems to be returning. Could the acid blockers be making digestion difficult and doing more harm than good? The antibiotics do seem to have helped with an area of inflammation I had in my right side (maybe an ulcer or pre-ulcer, not sure.)

    Does anyone have website recommendations? Is PHD still best, or should I drop/add certain things based on this problem? As sandy says above, “please help!” It’s making me desperate, feeling this way.

    • Hello Tim,
      I am sure the regular contributors to this blog would prefer I not go into my adventures with H. pylori, again, so I won’t. Also, a rare dry day and I must get to my yard.

      I was diagnosed with HP last August, but had none of the expected symptoms. Got tested only because of Paul’s adamant stand that “everybody gets chronic infections.”

      Doc did not want to put me through the antibiotic ordeal since I had no known symptoms. So I started on an herbal mix and also did a ton of reading on the web. Most helpful was Amy King’s site: http://amyking.wordpress.com/2009/02/20/im-so-happy-i-have-h-pylori/

      Best advice I can give is go to that site, select all, then search for “elena,” “ettinger,” and, if you want my story, “lana.” Copy the things you find and print them up so you have a handy protocol and shopping list. Valentine’s Day was the end of my saga, after three different protocols. I have read the horror stories of the antibiotics and am so glad I did not go that route.

      The “return,” as people call it, is simply the HP emerging from its biofilm to continue life in your stomach or duodenum. You MUST get rid of the biofilm. When I did that, I found that Ettinger is quite right – not hard to kill the bugger. It’s their protective biofilms that will trip you up. I suspect that Amy’s was not a longstanding infection, as she does not seem to have taken the biofilm disrupting protocol. Elena describes what she did and that’s what I did. It’s a combo of Amy’s protocol and Dr. Ettinger’s. However, if I were to do it again I would call Ettinger directly and sign on as a distance patient because he’s honed his approach and knows the latest. You can google Ettinger and find him. Chiropractor in San Diego.

      I frequently read that H. pylori goes hand-in-hand with leaky gut. My symptoms were two years of intensely itching eyes, serial sneezing, large itching hives on my backside, and decades of chronic back pain. I can’t explain the back pain, but lots of HP sufferers have this. I suspect the other symptoms had to do with debris floating in my blood and exciting my immune system.

      All is calm now, however, so there is hope. 🙂 I recently had a leaky gut test done through Cyrex labs. The result was pretty good. There are two ways the gut can be leaky – when the tight junctions between cells break down, and when the cells actually split and allow leakage. My test showed that, at this point, it is my tight junctions that are broken down. On a scale of toxic significance of 2 to 5, my number was 2.5. Too bad I don’t have a before number to see how getting rid of HP may have helped.

      Strongly believe that my regular bone broth continues to be helpful. My doc says that curcumin, glutamine, and probiotics will heal the gut, but Paul believes that glutamine benefits the bad guys too, so I stopped that. I do take the curcumin and lots of kefir. Be careful of the kefir, though, it will make an HP sufferer terribly, terribly sick. I know this firsthand. But now I can drink it all day and am fine.

      I wrote a lot but not much is repeated from before. 🙂 Much luck and great care, Tim.

      • Thanks lana, I will definitely check out that link and the items you cite.

        To update where I’m at- I had an epiphany yesterday that the feeling of “toxins” floating around my body may have been largely stress- and anxiety-induced. I do wonder though if some of my own attempts at breaking up bio-films may have triggered die-offs that provoked the anxiety? For instance one night I had a clove of raw garlic and put lots of ginger on some food, and had a bad night afterwards. I’m not sure about the effects of fighting the bio-films while on antibiotics/acid blockers?

        I also took some 50B CFU probiotics (2/day) for a couple days, and had more (what I now see as) anxiety-induced pain — perhaps that’s similar to the problem you mention about kefir and HP, since kefir has probiotics? Then again, maybe I can try the 50B probiotics again now that I’m more alert to recognizing anxiety-induced symptoms.

        I do still have this area of inflammation (or whatever it is) in my right side, that sort of ebbs stronger or weaker from day to day. It goes down for a while, then starts coming back. The meds have not destroyed it, and I only have a few more days on them. Anyway, I’m sure that link will be helpful, best of health to you as well. 🙂

  29. Just wanted to add – my lab showed somewhat high cholesterol/LDL levels. It may be because I was VLC for 6 months a year or so back. And even after I changed to low or perhaps moderate carb, I was adding a lot of butter/ coconut oil to foods. I also had some difficulty when I tried raising iodine supplement levels – had to quickly retreat, IIRC, from the 1.5 mg level. So wondering if all that could add up to hypothyroidism or something.

  30. Hi !

    I would be happy to read your comments about the following article on “Does adding fat to a carby meal lowers the insulin response” :


    Thx and have a good week end.

    Kind regards,


  31. “The 5 Rules of the Leptin Diet”. Seems like ok advice.


  32. update on the high FBG issue:

    Yesterday, my only protein was 2 cans of sardines (40g protein) at 11am along with a big potato and veggies. Dinner at 5 was 1 can of coconut milk (nearly 100g fat), an avacado, 1 oz macadamia nuts, and 3 egg yolks. Nothing else.

    FBG this morning was 118.

    So maybe it appears it’s the fat late in the day causing this.

    Today will be a low fat day, under 25g. I will retest tomorrow.

    • HI tatertot,

      This is so interesting to me. It makes me think of this book I read years ago called Potatoes, Not Prozac. This woman thought that you could end depression by controlling your blood sugar and your serotonin uptake and all that. (not so unusual now).

      Anyway, her protocol was to eat three meals a day with no snacking and then stop eating about four hours before you went to bed and then just before bed eat a potato. The potato could have something like salsa or spices on it, but no fat or protein. Anyway, just sharing this idea that what you eat directly before bedtime affects your blood sugar and your serotonin uptake. anyone else remember this book?

      • Here’s a page with the “7 steps” from her system. http://www.radiantrecovery.com/7steps.htm

      • Yes I do and was going to mention it when Tater started this conversation, but never got around to it.

      • just reading, ‘eating a potato’ step from that link,

        it seems to make a point of mentioning (three times) to make sure the potato skin is eaten as well.
        which as we know for PHD, is were the toxins may lie, so if eating the skins remember to avoid any discoloured areas.

        • typo…which as we know ‘from’ PHD,…

          • Hey Darrin,

            The reason she says this is she is because a potato with skins is lower on the glycemic index than without. She countering worries of blood sugar spiking.

            I think the book came out at a time when potatoes were really getting a lot of bad press for being high on the index. Or perhaps the demonizing of potatoes is perennial.

          • thx elizabethe

      • Hi everyone,

        We moved to a new server last night and it looks like two comments got lost in the shuffle. They were:

        Tatertot wrote at 9:25 pm:

        I can see why eating a potato at bedtime could be good. It should cause a rapid increase in blood glucose followed by an insulin surge. The blood glucose level would quickly be returned to normal and glycogen stores topped off for a good night’s sleep. I may have to start trying this.

        When I eat nothing but potatoes for 1 or 2 days, I have the lowest BG of my adult life, 80-85, which is considered a perfect range.

        elizabethe wrote at 9:31 pm:

        I’m glad I’m not the only person who thought of it. I was debating if I was crazy to post about it or not. =)

        My apologies for any confusion!

  33. Hi Tatertot,
    I’m also interested in what you’re finding. Haven’t been to Guyenet’s site for a while, so followed the link and then couldn’t leave. I noticed the link to April Fools articles, and was nicely entertained.

    Here is that link: http://wholehealthsource.blogspot.com/search/label/April%20fool%27s

  34. I’m going to figure this thing out! Today, my FBG was 118, all I’ve eaten so far today is 2 cans of sardines in water, and my BG is staying elevated around 115. After the meal it didn’t change and 2 hours later basically the same.

    In a couple hours, I’m going to eat a bit of lean meat (shrimp) and a couple big potatoes. I’ll bet tomorrow my FBG will be low.

    On potatoes and prozac–you know potatoes contain one of the highest levels of natural lithium, right? Maybe that has something to do with it.

    Next week, I am going to try to eat most of my fat at lunch and go very lean, and starchy for dinner.

    I just can’t help but thinking that walking around day after day with BG in the 110-120 range is not a good thing. If I can manipulate the macros to keep it in the 80’s, wouldn’t that be best.

    When I’ve tracked at 15 minute intervals after eating a big potato, I watched my BG spike quickly to 200 in 15-30 minutes, then plummet to 70 in the next hour, leveling out at 85 before 3 hours and staying there–even if my starting BG was 120.

    We’ll get it figured out!

    • Hi Tatertot-

      Just curious…Any mood or energy swings with the BG swings?

      • Hi TR,

        Tatertot answered as follows:

        Not really any energy or mood swings to note. I can say definitely that when I wake with high FBG, my sleep was bad.

        I don’t think it’s bad sleep causing high FBG, I think it’s an overload of fat and/or protein late in the day causing something to happen that wakes me and causes high BG.

        I think this pertains to a LOT of people eating paleo.

        Unfortunately the comment got lost during our move to a new server last night.

        Best, Paul

    • Tater,

      I am not so sure that going to extremes(long term) to stay in the 80’s is best if it means throwing other nutrients too far off balance. 90’s or even up to say 105 may be good enough

      This experiment of yours will be very telling, but even so I think that ultimately we each have to assess how broken our glucose regulation is and balance the “fix” for that will everything else. some of us may not be able to get back to normal/optimal and may have to settle for “good enough”

      I am guessing that you will find that if you just slightly skew your macros at each meal based on your findings in this experiment you will get the best results overall.

      • Yes, people with FBG in the 90s actually have lower mortality than people in the 80s. Of course elderly people are a bit different and tend to have higher glucose … so 85 in a younger person is very good … but there’s no good reason to adopt an unusual diet to push FBG down to 85.

        • I have to accept that I am in that “ederly” category. UGH! But the interestng thing to me is that when I started PHD at least two years ago I could not get my FBG below 105 no matter what I did and often it was 115. I kept going lower and lower carb. But no cigar. Then when i started PHD I just kind of accepted that I am older and have messed up glucose regulation and just was thankful that I was not diabetic and was learning how to manage it with diet before too much harm had been done. I stopped testing all the time. Just once or twice every few months

          Two years later on PHD (no measuring or weighing food) I find my FBG is mostly in the high 90’s, and occasionally low 90’s. (Happy dance and huge thank you Paul and Shou-Ching)

          My long term really really bad sleep disruption was hugely improved when I got my blood sugar on an even keel with low carb pre PHD. But I do still have occasional nights of waking in the middle of the night so I am eager to see what Tater learns. He has inspired me to do some very moderate, casual experimenting myself and so far it seems that just having a bit less carb at lunch and more at dinner helps, or it may be as simple making sure I have the full amount at dinner. In the past I may have eaten enough starch, but not enough, or any, sugary veg. Also I think that IF is a stress for me that will cause hormonal disruption and show up as sleep disturbance. So I am now trying to be very consistent with an early breakfast and seeing if I can stretch out the between meal time a bit longer a la the leptin guy.

          In case case it is a joy to be in the position of fine tuning!

        • I did a few days of higher fat and protein and way less than PHD amount of starch to see effect on my BG.

          Yesterday FBG was 115, just before bed still 115. FBG today was 120.

          Today I had 2 slices of bacon, 2 egg yolks and 1 pound of potato for first meal. 3 hrs pp, BG was 97.

          Second meal was 1/3 pound chicken breast, 1/2oz hard cheese, 1/2oz 90% dark chocolate, 2 cups spinach, and 1 pound of potato. 3 hrs pp, BG was 89, 5 hrs pp, BG was 91.

          This coming week is going to be an exercise in eating at least one potato with each meal, no snacking, and macros about 40-30-30 (FPC), without being too anal–just watching extra fat from things like nuts and dairy.

          I have noticed that if my BG is high going to bed, it will be high in morning. Some have mentioned a potato before bed–I can def see why this might have been good advice, but I also think eating PHD with an extra focus on starch in the evening meal and no snacking after dinner would be more effective.

          I’m almost positive I can keep my BG in the 85-95 range eating lots of starch. Will report more later this week.

    • hi tater,could you explain everything you eat and drink when you are on your 1 or 2 day potatoe diet. i would like to get a FBG of < 90. if only for a short time. thk's alfred

      • breakfast: black coffee, stevia

        lunch: 1/2 – 1 pound of potatoes, salt, pepper, vinegar as desired

        dinner: 1-3 pounds of potato, salt, pepper, vinegar as desired

        That’s the potato diet! Do it for a couple days, or up to week or two and you should lose 1/2 – 1 pound a day without much hunger.

        Eating just potatoes lowers my FBG like nothing else, I’m working hard to figure a way to keep it low while adhering to the PHD principles.

        • did/do you eat the skins as well tater?

          • If they are potatoes I grew, I eat the skins mostly. Store bought I peel. When potatoes are processed for storage, they are treated with several things I don’t want to eat, such as fungicide and sprout inhibitor. These things are supposedly safe to eat, but make sure you scrub with a brush and wash well if you eat peels. There is nothing in the peel naturally that make them undesirable to eat (unless they have turned green or begin to sprout).

        • hi tater, i don’t need to loose any wieght, but my FBG has crept up to 126 from 100 since i have added one pound of potatoes to my diet.
          my recovery after meals is good, possibly helped by a chromium and herb suppliment. is there any point in doing the potatoe thing if you can’t continue with it. thks alfred

          • The potato diet is for weight loss only. Not particularly healthy, but not too unhealthy as potatoes are a complete package of most nutrients and all the amino acids you need.

            If you wanted to see what happens to your BG, there would be no harm in eating only potatoes for a couple days–people fast that long.

          • Anyone have any gas pains or bloating after eating only potatoes? I attempted to start the “tater hack” but had some pretty significant tummy pains a few hours later. I’m assuming it’s because I rarely eat them?
            Tatertot- where do you grow your potatoes? I would LOVE to grow my own. FYI – I love ALL your comments and input on this tater hack thing. I really like potatoes but have avoided them for so long because of too many carbs, nightshades (I have Hashi’s), etc etc. Sad, since I’m from Irish immigrants :-(.

          • My first ‘potato diet’ was after a nearly 2 year abstinence. I did have some upset stomach/gas issues the first couple days, but it went away and hasn’t returned, although I now eat potatoes almost every day. Maybe start slower, eat potatoes with meals for a while before jumping in to hardcore consumption. The ‘Potato Diet’ was actually just a gimmick to lose weight fast, it works, but it’s not as smart as adopting a long-term Perfect Health Diet with plenty of potatoes in it.

            I grow potatoes on my hobby farm and sell them at farmer’s markets and give a lot away.

            Potatoes are easy to grow, even in containers if you don’t have much garden space. Now is the time to plant! Go to a local garden supply store and ask for seed potatoes and growing tips for your area.

            Nightshade intolerance is a real concern, but potatoes should not be avoided simply because of their ‘evil carb’ status, but rather embraced as a ‘safe starch’.

          • When I tried the potato diet I had some gas and a gurgly tummy, but nothing bad and it passed after a couple days.


            You are in Oregon right? What farmer’s markets do you sell at? (I’d love to find a good local source for potatoes.)

        • How much vinegar do you think you use? I find myself using A LOT and a ton of salt on my potatoes too.

          • I normally use maybe a tsp or less a day, I have never measured, just a couple squirts from the bottle. I like either Braggs ACV or Heinze Malt Vinegar.

            For salt, same thing just a few shakes, not what I would consider ‘A LOT’.

  35. I’d like to know if your explanations of the changes in your supplement recommendations are available anywhere else? Your updated ones differ greatly from my copy of your book, but i cannot afford to purchase another book for a small section. I’d like to find out why you’re no longer even recommending a multi or selenium, etc. & i’d love to understand why you’re not recommending lithium & silicon. I was disappointed you didn’t have a glossary to look up items to re-fresh my understanding on. Also I wanted to look up specific recommendations for arthritis. Anyway you provide a lot. Wish you’d dealt with hormones more as they’re really not separate from nutrition.

    • Hi Elle,
      Not Paul here, but if I get your meaning correctly, you have not purchased the new book. If you have not, then I highly recommend you do. The new book is vastly more helpful than the first one. It is not a matter of “a small section.” Even the unchanged information is presented in a much better format. There is a very helpful index which includes several references to pages with information about arthritis.

      Frankly, the best thing I ever did for my arthritis was give up omega 6 oils and cereal grains.

      Best of luck

    • Hi elle,
      The new recommendations are explained in the Scribner edition. There’s quite a bit of new material in the new edition, roughly half the book is new. The lifestyle section is greatly expanded, as is the evolutionary biology section, as is the weight loss material. There is a menu plan and an index.

      The multi was pretty easy to drop as that can easily create an excess of some things — manganese is the biggest concern. Selenium — I develop excess selenium with daily supplementation, and upon looking in the literature I realized that the selenium content of food is extremely variable, so food can easily have much more selenium than the USDA database says. This makes supplementation much more risky than I had realized.

      We are positive toward lithium and silicon, but the nutrient databases don’t have good values for the food content of these nutrients, so we don’t have a good feel for how much PHDers are getting from food. That is the main reason they are “optional.” Also, you can get an excess of lithium, so be cautious with it.

      In general we don’t have space to treat specific diseases, like arthritis, in the book. That is better done on the blog where we have unlimited space.

      Hormones can be a complicated as their levels are highly context dependent.

  36. Hi Paul & All, yet another article linking red meat to heart disease hit the New York Times not 10 minutes ago, and I wondered what your take would be. Of course the source of the meat was not mentioned, but the research is targeting a bacteria as the culprit instead of immediately jumping to saturated fat, cholesterol, etc., as is so often the case. I’m not sure if I can post a link to the article here or not, but I’ll give it a try:http://www.nytimes.com/2013/04/08/health/study-points-to-new-culprit-in-heart-disease.html?hp


  37. Hey!

    Knowing that the best way to get a healthy gut flora and reduce exposure to toxins is to have a diversity of plant foods, I was curious to know how diverse ones diet should be. My current carb sources are Starch plants: rice, white potato, sweet potato. Sugary plants: banana, papaya rasberries/blueberries, carrots and onions. Veg: broccoli, spinach, brussel sprouts. Should I make an effort to add in more variety..It’s just easier to stick to the same foods sometimes, laziness gets the best of us!

    • Hi Jessica,

      I think that’s good. I might recommend adding beets and seaweed. But you’ve got a good diversity of plant food types. You might try a new plant food each week as an experiment.

  38. Hi–I have been on the PHD for about 3 weeks and am enjoying many benefits. One thing I’ve noticed is dry skin, intermittent dry mouth, and other signs of mild dehydration. I used to be near vegan so the shift to much more meat has been marked. I don’t think I am drinking less water. Is it possible that eating more meat means I need to drink more water? Thanks for your opinion.

    • Hi Noelle,

      Some possibilities include:
      – Not eating enough carbs. You need carbs to make mucin which is an ingredient in tears, saliva, and mucus. Try eating more starch.
      – Not enough electrolytes. Potassium is a likely candidate; try eating more tomatoes and potatoes. Salt is a possibility. Bone broth soups a few days a week are also desirable.
      – Eat salmon/sardines once a week for omega-3 fats.
      – Vitamin C can help too.

      I suppose water could be an issue, but I think it’s more likely to be one of the above.

  39. All this talk about FBG makes me wonder if I should be checking mine. Long ago I had hypoglycemia and “treated” it by keeping a container of cottage cheese handy on my many activities with young children.

    I am eating more potatoes than I ever did before, so I am beginning to wonder. No way to check that at home without purchasing a meter. No signs of sudden falling glucose level.

    • The BG monitors are cheap, under $25. The strips are about $1 each. A $50 investment is cheap insurance.

    • Sometimes you can get a meter almost for free at Walgreens or
      Walmart. They offten have deals on certain brands because They want to hook you on their test strips. That’s where they make the real money. But if you only test a few times it isn’t gonna cost you much

  40. Dear Dr. Jaminet:

    This study reported on in the New York Times is probably worth looking into, as it points to carnitine rather than saturated fat as the culprit in red meat’s link with heart disease:
    I don’t know enough to judge whether the study is a good one. Any thoughts?

  41. Hi Paul,
    Any tips on how to reverse multi-drug resistance? To Dilantin specifically…
    God bless you,

  42. On the subject of potatoes (and sleep), i see from a link given earlier (thx Carol),
    it talks about potatoes raining serotonin levels.

    I wonder if they raise GABA levels as well…
    I will have to do some google research.

    I’m pretty sure i have low GABA levels & am looking for ways to raise them, particularly during the night.

    I fall asleep fine, but wake in the early hours & cannot fall back to sleep (easily) as my brain is too active, too many thoughts and ideas.
    The only way back to sleep at the moment is through meditation of sorts, i kind of overload my brain with ‘happy thoughts’. This takes time & is not always successful.

    When i wake up in the night, i am Not sweating, Not hungry, my heart rate is normal, physically all is good, its just my brain/mind that is over-active…
    Hence my self-diagnosis of low gaba.

    It has been like this for me all my life, even as a child, independent of work (play), diet, locale, sleeping hygiene etc

    Any help/ideas would be appreciated

    I expect i will end up going a sleep study, which may give me a diagnosis. but i still want to try & fix it naturally.

    • I just saw this today – just minutes ago!


      Facinating. Left to my own devices – I sleep about four hours, then read, or tinker with my computer for an hour or two, and then easily go back to sleep for a couple more hours. One days without that luxory, I try to ‘meditate’ myself back to sleep, too. Sometimes it doesn’t work.

      • personally i’m not a fan of the divided sleep is normal pov (at least not for me personally).

        In the rare instances that i have slept right thru the night (~ 8 hrs of uninterrupted sleep). I feel like superman the next day…ie. great.
        So i know i personally function better with a solid nights sleep.

        I wonder if some of the divided sleep that some people see as normal (& good), is actually due to waking at the ‘top’ of the 2nd or 3rd sleep cycles.
        Assuming a sleep cycle of 90 mins, this would mean waking at 3 or 4.5 hrs after falling a sleep.

        Apparently waking earlier increases as we age. This is discussed here,

        The article linked also has a good graphic depicting sleep cycles, worth a look just for the graphic.

  43. Hey, guys – I hi-jacked one of Paul’s old posts about potatoes so we’d have a place to talk tubers. I plan on putting my blood glucose experiments and such there. Come on over and subscribe if you have any questions of want to follow.

    This fast-moving thread is hard to keep up with. nice and quiet over here: http://perfecthealthdiet.com/2010/10/everything-you-might-want-to-know-about-the-potato/comment-page-1/#comments

  44. Hey all,

    I have left this question on a few forums and even called a lab and no one seems to be able to answer my question! Hopefully someone who frequents this blog will be able to help. I want to get the MMA test to confirm a functional B12 deficiency, but have been supplementing B12 for a few months. How long do I need to abstain from supps before testing, if at all?

    Thank you!


    • Paul,

      I will just dovetail off this last question since it pertains. I mentioned that I was diagnosed as having a functional B12 deficiency and that I had been supplementing B12 and Methyl Folate for a few months. Upon further investigation yesterday, I discovered on my 23andMe profile that I am compound hetero for the 2 major MTHFR mutations. Oy!

      In addition I have a few other glitches in my methyl cycle, one pertaining to a hetero mutation for the less bad CBS gene. Via Amy Yasko’s site I understand that she recommends limiting sulfurous and protein foods for like 6 weeks before starting the methyl supps. This seems crazy to me and would in turn eliminate most of what is healthy in the diet; eggs, meat, dairy, garlic, etc. Any thoughts on whether this is really necessary for someone that is not Autistic (as that is mostly what she works with)? My main symptoms are numbness, tingling, itchy skin and occasional irritability.

      I thought my B12 issue was due to my years as a vegetarian (15) and then vegan (2) and excessive partying (alcohol), but maybe I would have been fine had I not had underlying mutations?

      Do you have any knowledge, Paul, about MTHFR? I wonder if it is possible to silence the mutation via excellent nutrition.. epigenetics? In other words, supplement B12, folate and supporting nutrients, but otherwise follow PHD? I guess I am mostly concerned because I am interested in having a child in the next 6 months. I have read some frightening accounts of multiple miscarriages in women with the compound hetero MTHFR mutations.

      As always, thank you!


      • Hi lindsay,
        sorry i cannot answers your questions,
        but out of interest i was wondering what your Serum B12 results are like…

        Mine always sit just above the normal lab range, but i do supp with B12 so it is not a concern

      • …ps,
        the reason i ask was because i was wondering what the serum B12 numbers might look like for someone in the circumstances that you described


        • Hey there,

          I think my serum test was like 1200 which is about 300 above range. And I wasn’t supplementing.

          • thx Lindsay, interesting,
            so you can have a functional B12 deficiency and still test with a high serum B12.

            That would seem to suggest that the serum b12 test is worthless…?

          • Darrin,

            I think the hallmark of functional B12 deficiency is testing slightly high on the serum test. It indicates that you have the B12, but it is not being used for whatever reason. Chris Kresser has some decent posts on the B12 issues.

            I think the serum test is pretty useless unless you have a straight forward case of deficiency. And even then, medical doctors seem to not take it too seriously.

            I guess the real tests are MMA and homocysteine. If MMA tests high that means you have a functional deficiency.

  45. Any advice on sleep maintenance? I have been eating a Paleo/Primal diet for over 3 years now. I have adrenal fatigue, despite my best efforts to take it easy and heal with recommended supplements. I am now starting to wonder if not enough carbohydrate intake is causing this. I wake up anywhere from 1 hour to 5 hours after I finally fall asleep. I have tried eating protein/fat before bed and have also tried eating a little fruit with the protein and fat before bed, but to no avail. I need to sleep! Anyone had this problem and been able to fix it?

    • When I wake up hungry, I have about 50 calories of cold potato, and that puts me out. Last night I did it twice, and I feel good today.

  46. Dear Paul and dear PHD followers,

    I started PHD about two weeks ago and I am not feeling much better. I’m still often fatigued and very hungry with cravings of sweets.
    I never ate super unhealthy meaning processed foods but I used to eat wheat and I tried to avoid fat. I’m not overweight but would like to loose some pounds.
    I have a little bit of a hypothyrodism (TSH 0.38) and am taking medication for it.

    I would be very happy if you could give me some advice! Maybe someone has experienced similar symptoms?

    Thank you!

    • Hi Gracia

      Two weeks is not very much time, but I have to ask if you’re eating enough carbs? I used to have huge sweet cravings before PHD, but they’ve gone away for the most part as long as I eat enough starch.

  47. Thank you, Peter!
    I think I’m eating enough carbs though…. I don’t know what’s wrong with me, I’m feeling so tired and exhausted. I get a foggy ‘brain’ and am feeling cold easily. I’m having chronic back pains, too.


    • HI Gracia,

      I struggle a lot with sweet cravings, fatigue, and that foggy brain and feeling cold. Others may have more medical/pathogen suggestions for you, but here are some just plain diet things that have helped me. These may not help you, but they helped me.

      When I have that this is typically what is wrong with me.

      1. not eating enough carb. It’s easy to undereat carb even if you think you are eating enough. I eat nutrient dense carb like potatoes and avoid white rice. How much carb are you eating?
      2. Eating too much fructose (I’m supersensitive to fructose). I cut way back on fruits, avoid high fructose fruits especially apples, don’t eat honey.
      3. In the beginning I had a long period of wheat/sugar withdrawal, this might be it. Eating enough carb helped me, more carb than I thought I needed.
      4. I believe I have an strong auto-immune response to wheat that caused my cravings and fatigue. But as mentioned on this web site there are several things that can trigger the opiod receptors the same way wheat does that makes your body think it’s wheat. Coffee and heavy cream are two of them. I found it easier to get over the wheat addiction by cutting out those two things for a while. I still eat them very sparingly. I also find I have a craving/fatigue response to non-wheat breads and baked goods, so I just avoid them now.
      5. Paul always says hunger and cravings are a sign of malnutrition. I had a long history of dieting and it took me several months of eating PhD before my body starting to really feel well-nourished. When I ate the bone broths, egg yolks, liver, green veg, enough carbs on a regular basis, I started to feel better. Eating lots of coconut oil helps. I eased into the fasting, starting with just a 13 hour fast.

      Sorry for the long answer, but what you described sounds just like me. I hope this helps.

      • Hi elizabethe,

        Thank you very much for your response!
        I’ll try that. Could be that I have too much coffee and not enough carbs and good fats!
        Took some coconut oil this morning and was less hungry later on. Also I had the impression that iodine helped?!
        Now, in the evening I am craving again even though my stomach is full and bloated.

        I will try to carry on and be more patient 😉
        I hope you’re feeling well today!

  48. Hi PHD community,
    I wonder if anyone can out there an perhaps help.
    I know we need to eat eggs. My questions is must they be cooked or is raw ok ?
    I don’t like the taste of egg, so I don’t mind eating it as long as I can’t taste it. SO, if I make a homemade mayo with egg and a bit of olive oil for my salads, is that ok ?


  49. Hi Paul,

    About two months ago and over a year on PHD my blood lipids were: tot: 8.3 ldl: 5.9 hdl: 2.23 trig: 0.50 mmol/l. Your advice was to optimize copper, iodine and selenium levels and eat more carbs. However after two months and another test i basically just saw the benefits of higher saturated fat intake being rewersed: tot: 8.6 ldl: 6.2 hdl: 1.98 trig: 0.80 mmol/l.

    All changes i made during those two months was to replace some of the saturated fat with carbs as well as continuing the complete PHD supplement protocoll. This had no impact on my performance and i kept feeling good as usual. We follow the same diet with my fiancé and her cholesterol is almost too low: tot: 147 ldl: 83.6 hdl: 55 trigs: 42 mg/dl, so fat intake is unlikely the cause which i what the first doctor presisted on.

    My question is if these results can help with the diagnose? Im seeing an internal medicine doctor soon and anything that could speed up the process would be helpful. Also are there any other dietary interventions i could try to heal/diagnose what´s going on? Do you think there any other useful tests i could run except for liver and kidney tests?

    Thank you

    • Hi olio,

      Based on that, I would say it is not a nutrient deficiency and is a combination of hypothyroidism and endotoxemia from a gut infection/dysbiosis possibly compounded by a leaky gut.

      I would get any hypothyroidism treated and work on diagnosis of what’s going on in the gut (eg stool test) and improving gut flora with eg fermented foods and good nutrition. You might try reducing supplements and going food only as supplements may nourish whatever is in your gut.

      Your wife probably also has some sort of gut infection, probably some sort of parasite. I would suggest a stool test for her too.

      • Thanks for the advice,

        I have done a stool test though which tested for Shigella, Salmonella, Yersinia, Campylobacteria and parasites. It was the most comprehensive test they had available at my local health care centre here in Finland. Do you think this is enough or should i keep looking for sth more comprehensive?

        • Hi olio,

          The first group usually generate acute disease (food poisoning), not chronic issues. Parasites usually generate low LDL, so this test would probably have been a good one for your wife, though not for you.

          In your case it might be some sort of bacterial overgrowth, eg SIBO, maybe a liver infection, maybe an unusual pathogen.

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