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. Hi Paul,

    My mother’s yearly health check shows always elevated bilirubin. She does have slightly yellow eyes sometimes and is quite tired in the evenings (though working full time and seems quite normal to her). Not able to drink lot of alcohol without getting sleepy.
    In her early twenties she had tuberculosis of the lung badly and she thinks (not sure if a doctor told her) that this might be a consequence of the massive medicaments she had to take back then.
    I haven’t convinced her to PHD yet, but do you think this might have a dietary cause?

    All the best
    Chris

    • Hi Chris,

      I think PHD would help. It is good for liver function and typically good bile flow will help clear any gallstones or sludge that may be preventing bile release. She should supplement NAC and vitamin C and try to get lots of citric acid — lemons, lemon juice, grapefruits, grapefruit juice, limes. Try supplementing taurine as well.

      Also get her iron checked and if she has an excess than ask her to give blood.

      The alcohol suggests some sort of liver problem. Has she been looked into for hepatitis?

      Doctors can usually track down the cause of high bilirubin. She should ask them to do so.

      • Thanks Paul.

        Yes, she got checked for hepatits. Her doctor found no cause. Her liver seems to be pretty sensitive in general. When she has to take medications from time to time like antibiotics her liver enzymes often are elevated then.

        I remember she has done a stool analysis years ago and her sIgA was very low (like myself) and some lack of bifido and lacto bacteria.

        Actually her diet is not too bad, I will try to convince her to PHD. Which is not a easy matter (there is a saying that someone would rather change religion than diet). A German version of PHD might help 😐

        Another thing: She is a stutterer from birth on with good and bad phases. Are you aware of certain foods that might have an influence on that? She says she is sure that alcohol makes her stuttering more.

        All the best
        Chris

        • In Gilbert’s syndrome bilirubin is elevated benignly, in fact the antioxidant properties of this elevated bilirubin may be protective.
          http://en.wikipedia.org/wiki/Gilbert's_syndrome

          Several analyses have found a significantly decreased risk of coronary artery disease (CAD) in individuals with GS.[10][11]
          Specifically, people with mildly elevated levels of bilirubin (1.1 mg/dl to 2.7 mg/dl) were at lower risk for CAD and at lower risk for future heart disease.[12] These researchers went on to perform a meta-analysis of data available up to 2002, and confirmed that the incidence of atherosclerotic disease (hardening of the arteries) in subjects with GS had a close and inverse relationship to the serum bilirubin.[10] This beneficial effect was attributed to bilirubin IXα which is recognised as a potent antioxidant, rather than confounding factors such as high-density lipoprotein (HDL) levels.[12]
          This association was also seen in long-term data from the Framingham Heart Study.[13] Moderately elevated levels of bilirubin in people with GS and the (TA)7/(TA)7 genotype was associated with 1/3 the risk for both coronary heart disease and cardiovascular disease as compared to those with the (TA)6/(TA)6 genotype (i.e. a normal, non-mutated gene locus).

          • “Gilbert’s syndrome has, however, been linked to an increased risk of gallstones.”
            Gilbert’s syndrome is fairly common and the symptoms do seem to fit your mother. I think PHD would help, and magnesium in a PDH context might help with stuttering if alcohol worsens it.

          • “Gilbert’s syndrome has, however, been linked to an increased risk of gallstones.”
            Gilbert’s syndrome is fairly common and the symptoms do seem to fit your mother. I think PHD would help, and magnesium in a PHD context might help with stuttering if alcohol worsens it.

          • Sorry for the late reply. Just want to say thanks, George. Great help!

      • Regarding supplements: Is ox bile okay too?

  2. Hi Paul,

    Thank you so much for writing PHD! I have learned much from reading it!

    I have Hashimoto’s, Adrenal exhaustion (much better now), gut inflammation, insulin resistance (I gain very easily from carbs) and excess weight that I am having a tough time removing. My diet is excellent- already in line with PHD, but my question is how many carbs do I need to support my thyroid and my adrenals? I want to eat enough to heal the issues I have, but also drop the excess weight.

    My other question: do you think I’d be better off getting my carbs from yams and fruit until my insulin resistance has improved significantly? Rice just seems to cause an immediate gain.

    Thanks so much for all that you do!

  3. If eating vitamin c or something high in it like 2 oz of a red bell pepper quickly raises and lowers my pulse to say 120 after swallowing, and I probably have candida, does that mean it’s feeding it, or killing it? Does that reaction strain adrenals? It happens worse with acetyl-glutathione.

  4. Open question: do bones have caloric content? I ask in reference to statement below (and above, on p.61 :P) suggesting they are a source of fat. Thanks to anyone who can maybe shed some light.

    ‘Hi alfred,
    The first thing to look at it total calorie consumption. Intermittent fasting and reducing oils (search our custom search box for “weight loss version”) and getting fat from nutritious foods, eg egg yolks, nuts, avocados, seafood, beef/lamb and organ meats, bones (marrow and bone fats are released in first cooking), coconut milk, etc, not nutrient-free purified oils…’

    • There is quite a bit of fat in a whole bone, and also a fair bit of protein comes out if it is cooked with vinegar. I don’t have any measurements though. From a beef thighbone I can get about 2 oz marrow, I think, which is a mixture of fat, water and protein.

      • Hi George, indeed, thanks for tip. I’m not sure about the bone itself though; are you talking about the caloric yield of a bone that has say just been roasted (with marrow) or one that has been boiled for a long time or pressure cooked so as to be edible?

        I’ve been eating a fair bit lately and they seem filling (the latter bones that are boiled). I’m wondering whether this is due to fat content- I was under impression a lot of it was indigestible material…

  5. Obesity
    Wow, I’ve been so busy lately I feel like a stranger back here. On the way out of our building this evening I stopped in to say goodnight to my favorite math teacher, Gene, who has been extremely overweight most of his life. Around Christmas time I told him a bit about PHD, but he said he knew he wouldn’t read a book. Pretty much blew me off, but politely. An hour ago I asked if he had special plans for the summer and he replied that he was going to come to school twice a day, all summer, to walk around the track and try to get some weight off. He was fighting tears as he shared that in the last few months he has gained more weight. I gently asked if he would let me talk to him about PHD. He said that what he needed was a better insurance plan that covers gastric bypass so that he can get the surgery that his dad, brother, and uncle got. I pulled up Jaybird’s story, and Gene was mildly impressed but cautious, as he does not trust testimonials. Several weeks ago, I sat in an evening class with him and watched as he repeatedly rose to visit the cupcake plate. Grains are a big part of his life.

    I showed him the PHD apple and gave him a brief description of food toxins. He struggled to make sense of the toxin bit. A single guy, he eats nearly every meal at the local grocery store deli, so his diet has to be toxic.

    Back in December I told him my H. pylori story, along with the worm story, yet he reacted as others do — shook his head and said he didn’t want to hear it. This time he listened. I said nothing of fecal transplants, as that would have driven us back to square one.

    I have one more copy of PHD and will give it to him tomorrow (like me, he’s in school a lot). The reason I’m writing is in hopes that people who have successfully used PHD to address issues of excess weight will share any tips they picked up as they improved their health. I come from a long line of rather thin people, and Gene knows I don’t know his experience. He is convinced it is genetics and the surgery is what he needs. I have little credibility with Gene in this department.

    After my own experience, I fear that he has an infection, such as H. pylori, and if he goes through with his plan to refi his house to get the $50,000, he will go ahead with the surgery, and make it nearly impossible to get rid of something like HP.

    Gene risked so much today as he wept through his words of discouragement and lost hope. I hope someone can help me help this good man and, by the way, fantastic math teacher.

  6. Hi Paul,

    Today i went to another nutriotionist which i was assigned to meet by a doctor because of my high cholesterol. My earlier question is here: http://perfecthealthdiet.com/q-a/comment-page-58/#comment-147664

    I feel better after following your advice of eating kimchi or fermented vegetables each morning during the faste and reducing supplements. On the other hand this nutritionist had advice to give which sound dangerous. She adviced to cut out all eggs, all organ meats, all coconut and red palm oil and replace them wih canola oil, oats and low fat proteins. Also all supplements except from vitamin D are unnecessary according to her.

    Unfortunately she also concluded that that my cholesterol is caused by my diet and thus no further testing is needed and forwarded this statement to the internal medicine doc who im seeing later this week. The doc could have issued some useful tests like a complete thyroid panel and iron levels but will now be discouraged to do so. However I told her about perfect health diet and some reasons to follow it, with the great results I had with it so far, but she didnt agree with your views on healthy fats. Although she is a caring person, im afraid her misinformation might just prolong the correct diagnosis.

    So my qustions are the following: How much worse might any underlying health issue causing high ldl become following her advice? Is there something else I could try to reduce cholesterol?

    Thank you for any thoughts

  7. Hi Paul,

    What do you think if taking diflucan for systemic candida?

    Thanks, Eric

  8. Gregory H Hoeper

    Paul and Shou-Ching,
    Love the book, really eye opening. I have a few questions though. I have been largely paleo for about 3 years, lost 90 pounds. It seems whenever I incorporate carbohydrates into my diet, I become leaner. I have been IFing for a bit, so my question is this: I have calculated I need 3000 calories a day (180lbs muscular and active) to maintain my current weight (which I am enjoying). That means 2000 of my calories should come from fat. So, how do I get there? Assuming I eat 2 tbsp coconut oil or MCT in my coffee, 3 eggs and a small portion of meat at lunch, that is 55 of my 200g of fat for the day. Where would I start getting that?

    • put butter on your vegetables! find a full fat yogurt.

      • Also fatty meats. Things like braised short ribs done in a slow cooker are not much work at all, can provide several days worth of meals, and get better over time. Buy chops and steaks with a good layer of fat and eat it all.

  9. I’ve been reading some of your recipes as I try to follow the recommendations of the book and found your use of rice syrup as a sweetener very strange. With its links to arsenic, why do you eat it?

    I’m looking for an acceptable sweetener because I like to bake, I’ve tried Stevia and will soon also try xylitol.

    Are stevia and xylitol compatible with PHD?

    Thanks so much! EH

  10. Hi Paul, What do you think of Just Like Sugar as a sugar substitute (I use it for baking / cooking)? Donna

  11. Hi Paul,
    First time poster and just want to let you know that I love your book. I recently have been experimenting with diets and got two sets of blood lipids that are wildly contrasting and want to get your thoughts.

    First some background: I did a low fat vegan experiment (about 90% compliant with mostly raw fruits and some cooked low fat dishes) from August 2012 to March 1 2013. Then from March 2, 2013 to now, I gradually switched to PHD becoming nearly fully compliant by about mid-April. In addition, I take two tablespoons of MCT oil per day and drink Asprey’s Bulletproof coffee with about 1/3 stick of butter per day. I also started intermittent fasting around mid-April and eat mostly during an 8 hour window.

    Anyways, onto the results. The first column is the latest blood test (covers March 2 to June 11 on PHD). The second column is from March 1, right after completing my vegan experiment:

    Triglycerides: 57/108
    HDL: 68/45
    LDL: 265/113
    Cholesterol: 344/180
    Fasting glucose: 80/87

    Needless to say, I love the Triglyceride to HDL ratio. Never dreamed it could drop from 2.4 to 0.87 in only three months.

    But I am concerned about my high Cholesterol level. I read some of your previous posts about cholesterol and your book talks about troubleshooting high cholesterol by increasing iodine/selenium/sun exposure/copper.

    However, I am curious if this applies to my case since my total cholesterol was really low (180) on March 1, but off the charts now. And I started to partially supplement iodine and copper starting around late March after reading your book (I take copper and iodine once every other day). I also eat Brazil nuts (about 2 to 3 every third day) for the seleniuim. My sun exposure has not changed. I guess I can increase copper/iodine supplements to daily rather than every other day but I can’t help but wonder if this is the answer since my total cholesterol was 180 on March 1 when I did not supplement at all.

    So I am wondering if you have any thoughts for me on what self-experiment I might try next.

    I appreciate all the time you give to your readers.
    Steve

  12. Bobby McCauley

    Dear Paul,

    I’ve read your book and enjoyed it thoroughly. I have hypothyroidism, as well as hypogonadism. I am also suffering from anxiety and depression, likely due to the hormonal imbalances. I have tried eating a nutritious diet, however, certain healthy foods and supplements continue to give me problems. Beef and calf’s liver, betaine hcl, and vitamin c all greatly increase my fatigue and depression for a whole day after eating them. Starches also cause bloating and constipation. Unfortunately, the only foods that seem to cause me no issues are yogurt/kefir, ice cream, and fruit. I can tolerate moderate amounts of meat, fish, and vegetables. Sometimes, I do alright with shellfish and other times I do not. I am at a loss. I am currently taking slow-release T3, and it has helped my blood test numbers a bit, as well as helped a little bit with appetite. However, I find it hard to go higher than 10 mcg or else I get extreme anxiety, depression, and fatigue. I have already tried Synthroid, but that’s what caused my fatigue and digestion issues in the first place, as my body was not converting the T4 to the T3. I lost almost 50 pounds (mostly muscle) on Synthroid and I ended up getting reactive hypoglycemia. Sorry for the long post, and I know you probably can’t help, but just curious if you had any pointers or ideas.

    Thanks, Bobby

  13. What is the best protocol to heal a leaky gut or inflammation in the intestines?? Can PHD accomplish this or is it best to look at a low carb Paleo, GAPs or an anti-inflammatory diet.

    • hello? anyone??

    • Hi xtine,

      I think PHD is excellent for it — better than those others. Be sure to optimize vitamin D, eat liver for vitamin A, eat bone and joint stock soups to support gut barrier integrity, eat fermented vegetables and cooled cooked starches for healthy gut flora, and a balanced nourishing diet. Do intermittent fasting and support circadian rhythms. See our book for details.

  14. Hello,

    I am a bit discouraged, I have been on the PHD diet a week and I have gained half a pound. I was wondering if this is normal? Here were my habits this week.

    -ate instant mashed potatoes, with butter
    -ate minute white rice with sour cream
    -ate about 2 bananas a day
    -usually one or 2 servings of meat a day, (beef chicken or salmon)
    -ate 2 to 3 eggs a day, scrambled and microwaved
    -ate some cashews every now and then
    -ate carrots with most meals
    -ate 2 protein shakes a day with milk, whey and creatine (no sugar added in the whey and creatine)
    -had one mess up meal where I ate some grahm crackers
    -have been lifting weights 3 days in a row
    -have been drinking water by thirst
    -been taking a vitamen d, fishoil, and magnesium suppement each night
    -played tennis 3 times this week
    -plenty of sleep, start eating in the moning and not eating anything after dark
    -have not been counting my calories, have been eating till full

    Just wondering if I could get a diagnosis of what might be going wrong, or do you think the lifting weights is adding muscle and its counteracting the fatloss. Please note that I have not read the book I just used the online notes. I much appreciate your help, thank you.

    • oh yeah i forgot to mention I am on three medications for depression and schizophrenia. Seroquel, Abilify and Lexapro. I can not stop taking any of them unfortunatly.

      • Cody, you might want to checkout the book Why Isn’t My Brain Working?: A Revolutionary Understanding of Brain Decline and Effective Strategies to Recover Your Brain’s Health
        Dr. Datis Kharrazian

      • Hi! I really think you should read the book. You are missing some really big parts of the puzzle. Avoid protein shakes/powders- they tend to have preservatives and may not be a complete protein source. Milk, too, is not good. The protein in it, casein, has been implicated in increasing cancer risk. Someone else mentioned instant potatoes and instant rice- again, not good. Avoid anything that comes in a box. It sounds like you need way more vegetables and fruits to round out your meals. IF is a big part of the program too, so go 14-16 hours between dinner and breakfast, and only eat if you’re hungry. That may mean only 2 meals a day. Also, waiting until you’re thirsty to drink isn’t so good. By the time you are thirsty, you are already dehydrated, so up the water. Finally, unless you are working different muscle groups each day, alternate cardio and strength training. I do 3 days a week of cardio and 2-3 days a week of strength training, and I have lost 15 lbs in 3 months with an increase in muscle mass.

    • Some things that stood out to me:
      – instant mashed potatoes are not great. They’re a highly processed food and probably lead to big blood sugar spikes, butter or not. If you don’t want to cook your own potatoes, how about pre-boiled potatoes as sold in the fridge section of the supermarket?
      – Not sure about minute white rice but the same might apply
      – Lifting weights every day may be counterproductive
      – fish oil is not a recommended supplement, fatty cold ocean fish is. See the supplements section for what is recommended.

      Finally, I don’t know what your current state is, but half a pound is basically measurement error and a week is a short time. Don’t expect rapid weight loss if you’re not counting calories – anyway rapid weight loss is probably not healthy to begin with. Just feed your body what it needs and trust it to figure things out by itself.

      I’ve been following the PHD for 2 years now and I’m weight stable at around 96-97kg, so around 1% fluctuation day to day. I’m 195cm so still lean at that weight and I actually have abs showing. I don’t do any exercise apart from biking to the train station every day, about 25min total.

      I’d say that a week is not long enough to draw any conclusions. Keep doing what you’re doing. Also, read the book, it’s awesome. 🙂

    • Hi Cody,

      As others have said, one week is not enough time to make a significant change, especially since you haven’t fully implemented either our diet or lifestyle advice. It would be good to be more patient, read the book, and steadily introduce more elements of our advice. Every little bit helps, and it does take time to change one’s life habits.

      It also takes time to become well nourished. Also, in diseases like depression and schizophrenia, you will need to do some personal experimentation to see if adjustments to the diet are needed. For instance, ketogenic diets often help with neurological disorders. But you shouldn’t experiment with one until you have followed regular PHD for a while, become well nourished, and given your gut flora a chance to evolve.

      Cooking for yourself would be a great advance. It is good to eat whole foods, rather than processed foods or purified nutrients. Thus, it would be good to replace the protein shakes with meat or fish and the instant mashed potatoes with real mashed potatoes.

      We don’t recommend fish oil supplements, rather eat oily fish like salmon. Vitamin D should be taken during the day. A number of other supplements may be helpful.

      Best, Paul

  15. Hi Paul, I was wondering if you’re getting many reports (I see some have written in) of people having their cholesterol skyrocket on your diet (like me)? Is it possible, for some people it will have that effect (genetic differences)and that such people will have to watch their saturated, coconut oil and PUFA fat intake? What do you know about particle numbers (along with partcle size) for LDL? Thanks, Donna

    • Hi Donna,

      That’s not common on PHD but is quite common on low-carb Paleo. It commonly indicates mineral deficiencies (zinc, copper, iodine, selenium) or choline/phospholipid deficiency or protein deficiency.

      I would suggest eating fewer oils and more whole foods. If you are not eating enough carbs, add some.

      The other possibility is that your cholesterol was low and is normalizing. Healthy cholesterol levels are 200 to 240 mg/dl for total cholesterol; healthy LDL is about 130 mg/dl.

      There’s plenty of further information in this category: http://perfecthealthdiet.com/category/biomarkers/hdlldlcholesterol/

      Best, Paul

      • My cholesterol has been high for a long time(the LDL, even the oxidized lipoprotein b portion). I have always declined statins. I tried the minimal starchy carb approach 2 years ago (whole foods) – lost a little weight, cholesterol dropped only slightly, 55 years of psoriasis cleared; but I couldn’t maintain the no starch diet and regained the weight when I went off of it. Changed to PHD about a year ago, very healthy whole foods, added about 2 cups of starchy carbs (wasn’t eating any or minimal before) and a little more fat than I had been eating – still eating a good amount of green vegs/salads. Lost some weight (yay!)- but my LDL cholesterol went sky high (from 212 to 302) and a teensy bit of psoriasis returned. I just recently added liver, eggs/choline, Brazil nuts, Zn & iodine supplements (will measure cholesterol again – how long should I wait to see a potential + effect from these changes?. But I wasn’t on these things before so rationally it doesn’t make any sense to me that my LDL would be going up because of a change to the PH Diet (just adding some safe starchy carbs, slightly less protein [had been on about 30% Cal from protein so a little less now) and a little more fat – not oils). I’m on the lower cal version now with not much fat because my weight loss stalled and I still have about 10 lbs to lose, mostly the waist line. Doing about 600-800 cal from starchy carbs and protein, the rest from fat (eggs yolks, liver, 2 Brazil nuts, a few macadamia nuts, tiny bit of butter, MCT/coconut oil, avocado, a tiny bit of olive oil (to about 1300-1400 total cal). Total cholesterol went from 297 to 392. (I’m Canadian – using 38.7 conversion). My HDL and TG are good – just the LDL that is a problem. Hx – I’m on T3 & T4 compounded meds. TSH 5 if I don’t take am dose before measuring; about 1.2 if I do take it a couple of hours before measuring. I have been gluten free for 7 years (positive tissue transglutaminase; negative bowel biopsy). Have had CFS/fibro/MCS for 7 years – steady improvement, not bad now. Menopause 10 years ago – still about 15 hotflashes/day even on bioid HRT and more recently NAC which has helped the hot flashes a bit (used to be hotter at night and have aboat 20hot flashes/day – before HRT, 25-30 and vertigo. On acylovir for 6-7 years – without it, cold sores ++ and spinal pain. I have severe osteoporosis since menopause. Had a long hx of very sensitive stomach, but have managed to get off meds and now can keep stomach pretty comfortable with careful eating, zero alcohol, vinegar, fermented soy (mold allergy) and supplements (probiotics++, enzymes, DGL, slippery elm, etc.).

        • Hi Donna,

          Various infections can cause high LDL and it sounds like that’s the likely explanation in your case. It’s likely that adding back carbs has fed some sort of infection and that raised the LDL.

          But your body needs carbs, so it’s not clear what the right course of action is.

          A few tips for healing gut infections: http://perfecthealthdiet.com/q-a/comment-page-62/#comment-195230

          It sounds like you’ve been making progress against your multiple chronic infections, so maybe time is the most important thing you need.

          • Hi Paul, I’ve been thinking more about my CFS and viral (spinal and probably GI herpes) issues and autophagy (acyclovir for 6+yrs, high dose for 10 months now which helps – PHD diet for about a year). Given the competing demands of needing safe starches for energy but not for pathogens, and the need for autophagy from intermittent fasting, what do you think the optimum calories from starch would be for me (on a 1300 Cal/day diet for weight loss); and the optimum (minimum)# of hours a day for eating? Also optimium distribution of starch intake throughout the day/hours that I am eating? ie. any point in restricting the hours I eat starch to, say 4 or even fewer hours? Thanks, Donna

      • Hi Paul,

        To be honest, I think it’s not that uncommon to have high cholesterol on a higher fat diet, regardless of whether it’s PHD or low carb Paleo. It’s likely genetic and I’m not talking about FH.

        I experienced this myself, with TC measured as high as 396, despite my efforts to increase starchy carbs and reduce fat in the form of oils. I was well nourished, exercising by lifting weights three times a week, playing regular table tennis and just in overall good health at age 28. I eventually had to reduce the total amount of SFA in my diet (to around 50g a day) and also reduced the amount of carbs I was consuming, while increasing MUFA intake. It took a while but I got my TC down to 262. This is the lowest I’ve ever had it measured. My HDL was 68 and Trigs at 71.

        I think we have far from solved the issue of high cholesterol by eating a higher fat diet which is reported by MANY people here and other Paleo/LC forums. Very few people, who get elevlated cholesterol by eating higher fat as PHD suggests, actually achieve normal cholesterol levels by adding supplements and carbs as you suggest. Most continue to have elevated cholesterol. I say this not to renounce your efforts, but to acknowledge that this is a problem with an as yet unknown solution. Just go through the number of posts by people complaining of higher cholesterol. There might be some improvement in their numbers but there can be no doubt about the fact that they have not returned to normal as long as they eat higher fat. I know you personally did not see a rise in TC/LDL by going PHD and it is normal for one’s personal experience to drive one’s philosophy. But we can’t ignore everyone else and just that optimizing a few minerals and eating more carbs is the solution.

        Regards

        • *just that optimizing a few minerals and eating more carbs is the solution.

        • *just say that optimizing a few minerals and eating more carbs is the solution.

        • Hi PHDer,

          Well, I think we need more data. I’ve known of three cases of high LDL who tried all the things I suggested and kept me updated, and in all three cases the LDL levels came down. Being too low carb was the #1 issue and low iodine, copper, and methionine/choline also had an impact. I think a few others like zinc, iron, sulfur, and selenium may matter too. Three is too small to detect a subset of the population with a genetic proclivity to high LDL on high-fat diets, and you could be right about that; but I think Occam’s Razor suggests going for the simpler explanation that everyone has similar biology until proven otherwise.

          Of course, when people add carbs they reduce fat a bit, but I think it is the extra carbs more than the smaller decrement in fat that matters — conservation of glucose downregulates thyroid hormone and therefore LDL receptor levels. I think the specific effects of saturated fat arise from higher ROS production interacting with a deficiency or imbalance of the antioxidant minerals, zinc and copper especially.

          In your case, if the lowest TC you ever had was 262, I could readily believe that you have some sort of genetic tendency to higher LDL. Most people will be in the 200-240 range.

          I do agree that this is an interesting and open question, one that has not been researched satisfactorily since it is specific to low-carb dieters.

          Best, Paul

          • Not to beat a dead horse here, but I was going through the same high ldl problem with low carb paleo. What I believe made the biggest correction in my ldl was the addition of 30-50g/day of fermentable fiber in my diet, mainly by targeting foods high in soluble fiber and resistant starch and also supplementing with a few spoonfuls of potato starch on days when I didn’t eat as many fibrous veggies as I should have.

            I think if everyone implements the PHD as it is written, with a focus on getting the veggie portion every day, and especially choosing veggies high in fiber and oligosaccharides (raw onion, garlic, leeks, jerusalem artichokes, etc…) and eating much of the safe starches in a cooked and cooled condition, this will provide enough dietary fiber in the right proportions of soluble fiber and resistant starch to correct any cholesterol deficiency that is not familial in nature.

            People eating the PHD should be eating lots of vegetables. I think that the veggie portion is the hardest to adhere to as it requires much more thoughtful and frequent shopping unless one has access to a fully stocked salad bar every day. A side salad with iceberg lettuce and a few cherry tomatoes doesn’t cut it! I try to eat 15-30 different plants every day–it’s easier than you’d think–total weight of these veggies (including fruit and starches) is about 3 pounds, and rarely do I eat lettuce.

            I think the veggie portion, not the fruit, starch, or meat, is the biggest factor in cholesterol management–skimping in this department is doing yourself a disfavor!

          • Good thoughts tatertot, thank you.

          • Wanted to share my experience regarding LDL.

            I seemed to be genetically predisposed to higher LDL and I cannot seem to achieve PHD recommended lipids eating PHD recommended foods/supplements. Independent of PHD, eating the same foods as other people, my LDL is always higher. My thyroid tests are fine. I don’t think I’m nutrient deficient. All my bio markers are very good except LDL. BMI 21.

            The things that make the biggest difference for me are dietary cholesterol and saturated fat. All the others are just small and don’t make nearly same change for me.

            Eating 3 eggs/day, my LDL is 224. Just removing eggs, my LDL is 150.

            I do not have Familial Hypercholesterolemia, but I am ApoE4,E3. I have a couple other genes that are associated with ~6.8 higher LDL, which is relatively insignificant compared to increases with dietary cholesterol, saturated fat.

            I currently suspect ApoE4 is the biggest difference and I’ve found this to be anecdotally confirmed. The cases I’ve heard ApoE4 having lower cholesterol, they’re taking thyroid and/or gender hormones or vegan. ApoE4 is associated with higher LDL and hyper responders to dietary cholesterol, saturated fat:
            http://www.bhlinc.com/clinicians/clinical-references/reference-manual/chapter19

            For a low cholesterol example, Chris Masterjohn tends to have very low cholesterol (TC 160) eating plenty of eggs, animal. My guess is he cannot reach the PHD recommended TC level of 200-240.
            http://www.cholesterol-and-health.com/Vegetarianism.html

            It makes me believe diet is genetically dependent. Some do better with higher dietary cholesterol and saturated fat and some do not.

  16. I would love to add potatoes, but seem to have at least a mild nightshade sensitivity (achy joints after potato starch, for example.) Are there variations among potatoes, so that one type might be less likely to trigger the reaction? I wonder about purple potatoes, for example. I do eat sweet potatoes, too many plantains, and plenty of winter squash as safe starch so can live without potatoes if need be.

    • Hi Rona, when you say you get achy joints from potato starch, do you mean raw potato starch?

      If so, the achy joints may be due to gut flora activity, not necessarily nightshade toxins.

      I’m also not sure that potato starch contains that much toxins – it is refined after all…

      • The starch I tried was Bob’s Red Mill Potato Starch, Unmodified. It is not clear to me whether that is raw. It has certainly been dried, if nothing else, as it’s a white powder. Also not clear to me that processing a potato would necessarily remove nightshade issues. But I also imagine you’re right about gut flora issues. That’s a major reason I’m interested in RS and following PHD.

        • Raw means not warm in this case.

          I checked Wikipedia and it seems that the starch is washed out of the potato mash and then filtered. The filtering works because the granules are big. This removes almost everything else, so unless the saponins are inside the granules I think they’re mostly gone too.

  17. Hi Paul,
    I just want to get a quick clarification on your copper and zinc recommendations in the supplements section.

    1. In the zinc recommendation, you say “Do not supplement copper if you eat one of the above food combinations.” I do not eat liver regularly but I do eat dark chocolate daily. Since dark chocolate is indicated as a source of copper, does this mean I should not supplement copper?

    2. Should I always supplement copper and zinc together? And if I don’t supplement one, should I also not supplement the other? In your zinc recommendation, you seem to link zinc to copper. Also, on my bottle of copper, it warns to also supplement with zinc.

    Thanks again
    Steve

    • Hi Steve,

      30 g/day 85% or unsweetened chocolate provides about 1 mg copper. We want you to get 2-3 mg/day. Some duck/chicken/goose liver would do it, also a diverse diet including a few nuts and plenty of vegetables. I don’t think you should supplement copper but I do think you should try to eat liver.

      No, I think copper is best obtained from foods but there are few food sources of concentrated zinc — oysters, but not many people eat oysters regularly. I think it’s OK to supplement zinc while getting copper from food.

      Yes, you should supplement zinc if you take copper.

      • I have an extreme form of histamine intolerance so unable to get copper through food. I’m having trouble deciphering how to properly supplement and balance with zinc.
        1) Is the proper ratio 2 mg copper and 15 mg zinc?
        2) Should copper zinc be balanced daily or is it okay to do over course of week. I have zinc capsules that are 50mg. Okay to have those twice per week and 2 mg copper daily?

        Thank for your willingness to answer so many questions!

      • Thanks Paul. You are very generous with your time and I appreciate it.

        BTW, Peter Attia has written a few articles at The Eating Academia discussing the importance of LDL-P rather than LDL-C in predicting heart disease. Since measuring LDL-P requires a fairly fancy blood test, I’m wondering if there is still some inference we can draw from a standard blood panel. For instance, is there any relationship that you are aware of between LDL-P and being in the optimal range for total cholesterol?

  18. I have hashimotos, practice a paleo primal lifestyle and do walking and 4 days a week I power lift. I have a normal adrenal profile according to diurnal testing. I had a sex hormone profile with a little higher progesterone and estrogen numbers. I take nature throid and my Free t4 and Free t3 are in the upper 1/8 range and my tsh is .006. I take 3.0 LDN nightly. I have good energy and eat about 2,000 calories per day. I am 42 years old, 5 foot 61/2 and weigh 130. My question: Would a suppressed tsh cause me to NOT lose weight? I have NO hyper symptoms and feel good on my 2.5 grain dose of NDT but my belly won’t budge. Am I not eating enough carbs? I rarely eat fruit and eat VERY little sweet potatoes or root veggies. Seems contradictory to EAT carbs to lose weight but with thyroid issues? Maybe that is possible? Thank you for your time.

    • Forgot this: I had a vitamin D level of 95 in february…(I since quit taking supplements), is this indicative of a healthy digestive system?

    • Hi Carmen,

      Yes, excess thyroid hormone can produce weight gain. You should cut back on the nature thyroid extract. That’s especially so if you are low-carb. Low-carb and excess thyroid hormone is a very bad idea.

  19. Paul,

    Do you just mix raw yolks with coconut milk and drink it straight?

  20. Hi Paul:

    I’m thinking about adding ubiquinol to my supplement regemine. Thoughts on the supplement?

  21. Selenium question for the experts here.
    If I am taking a 12.5 mg Iodoral daily, what are most PHD’ers recs on how much selenium daily?
    200mcg sound O.K. daily for that much iodine?
    I am eating 2 Brazil nuts per day plus the eggs I eat.
    I am a 52 year old male, 6’2′ and 250lbs.
    My TSH is in the low normal range.
    Thanks….

    • Hi Peter,

      I think PHD foods (seafood, ruminant meats, eggs) plus Brazil nuts should be sufficient. If you supplement, don’t take more than one or two selenium 200 mcg tablets per week.

      • O.K. thanks Paul. I was getting curious if I should take a supplement of selenium in conjunction with what I was getting in my diet. I will continue to monitor how I feel combined with annual blood tests.

  22. Connie Warner

    Hi! This is really a comment, not a question. Cut back this week on carbs and calories and fat because my weight was creeping up. (I was eating 1-2 sweet potatoes a day along w/ probably too much fruit.) Amazing that the bloating is gone! Wondering if I have SIBO. Also, just found out my well water has coliform bacteria (an indicator that other bad stuff might be there too)(don’t have e. coli though), so stopped drinking that. And I am amazed that my bloating is GONE! Feel like a new person!!! I’m getting plenty of good bacteria with kimchi and also drinking kombucha.

    • Hi Connie,

      That’s great! Good thing you tested the well water. Congratulations!

    • Water is becoming a topic of considerable interest for me. After listening to Pam Killeen talk about the inadequacy of filters and reverse osmosis, last November I began buying bottled water. About this time the pain in my thumb joints returned. As I usually do, I focused on the food I was eating. Recently I obtained a water distiller and for the past few weeks have used only distilled water. Pain in my thumb joints improved then disappeared completely. Last night, at a party, I did eat a small amount of organic ice cream and this morning the pain is back, but in a small way. I think it’s the lactose. Lots of things seem to trigger pain at the base of my thumbs, so that vigil must be constant. But I do believe there is something about that water — C****** G*****.

      • I used to get frequent episodes of pain at the base of my thumbs – thought it was De Quervain’s syndrome. When I went on antiviral meds (for cold sores and spinal pain) no more thumb pain. so it looks like for me, it was viral.

  23. Jo Robinson – “Breeding the Nutrition Out of Our Food”

    http://www.nytimes.com/2013/05/26/opinion/sunday/breeding-the-nutrition-out-of-our-food.html?src=me&ref=general&_r=1&

    She has a new book. It will hurt your brain trying to remember which vegetables and fruits are the most nutritious.

  24. Not sure why my post keeps getting missed. I posted earlier. Paul please take a peek.

  25. Current Errata?
    I am gifting a copy of the book to a friend and want to give him a printed errata, but I’m not finding it. Can someone please help me expedite the search? I’m certain it is right under my nose, as I have used it before.

    thanks for whatever help 🙂

  26. I’ve just got the Hungarian version of the book and I ‘m wondering about a term: “high-fat yoghurt”. Not sure about American brands, but in Hungary we have no “low fat” vs. “high fat” yoghurt versions. The regular non-sweetened plain yoghurt and kefir has 3-4% fat. Is that okay or should I keep looking for higher fat yoghurt products?

  27. I have been temporarily experimenting with a keto-version of PHD. My goal was to do a “spring cleaning” of sorts from some unhealthy eating habits and increase my mental sharpness for a large work project. I’ve been drinking a lot of bullet proof coffee, eating eggs, butter, coconut oil, some meat, and few veggies. Also, some heavy cream. I’m on day 8 of fewer than 50 grams of carbs. On nights 6 and 7 I had SEVERE night terrors. They even got physically violent (so says my wife.) With a little research, I found a potential link with night time hypoglycemia.

    Any thoughts? Should I be concerned? Should this pass as my brain becomes more keto adapted? Should I ditch keto and just eat the 100-150 grams of starch? Could this be a symptom of something else?

    Thanks for any help.

    • Patrick,

      I would read what Paul has to say about ketogenic diets in the book and on posts here.
      http://perfecthealthdiet.com/category/diets/ketogenic_diet/

      ..a PHD version of a ketogenic diet has you consuming at least 200 carb calories daily, but eliminating fructose

      • I was going to say the same thing Ellen said. Back before I started PHD I used to get those night terrors all the time and it took a while before I discovered that they were hypoglycemia related. The new book has a short section on Ketogenic diets that you should definitely read.

    • Hi Patrick,

      You can still be ketogenic while eating adequate amounts of starch. You don’t want to starve yourself of carbs, that can have all sorts of negative consequences, as you’ve experienced.

  28. I have found a source for pickled veggies that is really extraordinary. These folks come to our local Farmers’ Market, but they also do mail order. I am addicted to their pickled garlic. have no idea if that is a “PHD-Preferred” food, but OH MY!

    http://mainehomesteadfarm.com/

  29. Hello Paul,
    i just ordered your book but they are on a strike at amazon, so i have to wait.
    You told us in an older post that you had rosacea and you fight it with antifungals.
    Which did you take and did it help?
    What else but avoiding the triggers is useful to fight this sh…?
    Frank

    • Hi Frank – personally for me, the PHD helped quite a lot in reducing rosacea. Wouldn’t say it ‘cured’ it, but it did fade after a number of months. As far as antifungals, I got into some herbal remedies – actually I don’t drink much ‘straight’ water these days, I do decoctions (teas) of different herbs, and tinctures I’ve made. Warning – it’s tons of fun and a bit of an addiction. Mountain rose herbs probably has a plaque on the wall of their #1 customer :-). There are too many herbs and too much theory to go into here, but I stick mostly to the tonic adaptogenic herbs, which are quite safe. If you’re on meds for anything, do your homework. Over the last year, I’d say those two factors have cleared my skin about 98%. Good luck.

      • thanx marc,
        no homework, im not on meds,maybe i just have to wait and give this diet a longer time to help me

  30. Paul, I’ve enjoyed some wonderful improvements from PHD, but I still suffer terribly from rhinitis caused by environmental allergies such as dust mites, grass, etc. The sinus pain and pressure I have from this is 24/7 all year.
    Do you have any suggestions? At this point I’m even thinking about giving helminth therapy a go. Any advice would be greatly appreaciated.

  31. Hi Paul,

    I have recently implemented the principles from the perfect health diet which has definitely improved my health condition, most notably my eczema. Along with your diet protocol I have also experimented with food combining which stresses eating foods in certain combinations. This also seems to be improving my health as well. Despite this I still have a hard time adhering to food combining due to its restrictive nature (e.g. avoiding eating starch and protein together, not being allowed to have peanut butter with an apple.)

    The theory behind food combining though seems to make sense as it argues that different foods digest at different rates and through different pH environments. Therefore I was wondering what were your thoughts on food combining. Is food combining superior to “normal” eating habits? Do certain foods really rot or ferment if eaten in the wrong combinations? Does food combining make enough of a difference in one’s digestive health in the long run? Thank you very much for your time and feedback. I do greatly appreciate it!

    -JB

  32. Benjamin Stone

    Hello Paul,

    I have been following the diet with complete adherence to the recommended macro ratios. My only variance would be a specific increase in brassica and other veg in general, including more greens, mushrooms, and garlic/onions than probably most eat based on my anecdotal observations.

    In general I am very pleased with the results on PHD. I fall into the quantified self philosophy so I plan on electively running thorough labs in the coming days to track various health parameters.

    As an ectomorph, I was already lean before adopting PHD and I am concerned about holding mass with Intermittent Fasting. I undertake IF 3-4 times a week as a way to address my concerns regarding avoiding weight loss. It is hard to keep calories constant with non IF in an eight hour window. Any folks out there with IF experience who are not interested in weight loss, and in fact may even seek moderate weight gain?

    The only negative symptoms I have observed are bowel movements (to reference Bristol stool scale, I seem to have dropped to a 2 from 4-5). I was previously vegan so have been looking to decrease stool bulk and frequency, but this seems suboptimal. I do supplement with 200mg magnesium glycinate and cannot fathom a way someone could eat more non grain/legume fiber than I do already. Anyone else experiencing that?

    I also have seen an increased urinary frequency, in particular night waking to urinate, which was never an issue for me before. I have no food or fluids after 6:30 and I am in bed at 10. Would welcome feedback on this as well!

    Thanks in advance.

  33. Sevral small Q’s. I have been on your diet for a fortnight now in an attempt to work on my IBS (started when i was 20, 35 now), and my severe allergies that cause me to lose my voice from throat swelling for 4 months of each year. there’s i few poins in the book i was hoping to clarify.

    – egg yolks are almost always specified: does this imply that it is preferred to discard the whites most of the time?
    – dry lean meat is listed as a food to avoid. I eat lots of kangaroo but cook it in stews or with lamb tallow skimmed off my bone broths. Is this acceptable?
    – i notice that you mention soy sauce in your mussles recipe – does this mean that you consider soy ok if fermented, or is it because the quanity is so small?
    – What do you think of Weston Price and Sally fallon’s approach to dealing with grains and legumes?
    – if i dont eat starchy carbs at breakfast (i.e the example breakfasts that you provide of berries and yoghurt), i feel weak, often loose in the bowels, and can’t stop thinking about eating until i do eat some starch. even then it fels hard to make up for it. can you think why this might be?
    – i seem to have a slight acid reflux reaction to more than a tiny bit of coconut products. Any thoughts on this?
    Really hoping for some response to these, as they are hampering my use of the diet a little. Also i’d like to mention that really respect the thoroughness of your work in an age when people are so confused about what to eat and why!

    • Hi Annie,

      Paul has addressed most of these questions in some form or another on the site, I encourage you to go through the Q and A and see if any of them speak to your issues.

      In general, here’s what I recall the answers are:

      egg yolks are the part with the important nutrients. You don’t have to discard the egg whites if you don’t want to. But some people might want to if they have an egg white allergies, or if they are getting enough protein from another source that day. I tend to eat a daily omelette, so I eat egg yolks and whites.

      Paul has said elsewhere that using lean cuts of meat and adding a different form of fat is an okay strategy (look for a recent post on chicken and omega 6 fats).

      On legumes, Paul has said that it might be somewhat okay to eat legumes if you use the traditional methods of very long soaking and long cooking times, but that we also just don’t know how many of the toxins remain even after those methods. In general, I gather that he thinks you can eat legumes in moderation appropriately cooked if you really want to, but why would you want to since there are so many better forms of protein out there that don’t require 3 days of preparation and that we are certain aren’t toxic and don’t have all the attendent bowel issues that beans have?

      In general Paul has said that if you are avoiding toxic foods and limiting yourself to PHD compliant foods you should follow your taste because your taste/cravings are designed to lead you to eat things your body needs. So, if you are craving a soda and candy bar, don’t follow that craving; but craving potatoes and rice, eat potatoes and rice! It takes a while for your gut to heal and malnutrition issues to resolve, so give it several months before you try to start really pinpointing problems. Paul has a lot of good posts with strategies for healing the gut that it seems would be good for you.

      re: coconut oil. This is all IMHO. You don’t need to eat coconut products if you don’t want to. Coconut products enjoy a certain fetishized status in the paleo community, sometimes it’s like they are treated like a “fourth macronutrient”, and don’t get me wrong, they are a good food. But if they cause you problems, then don’t eat them for a while. It may be that after your gut heals more you’ll be able to tolerate them. I stopped eating coconut products because I noticed I was getting an autoimmune/allergic response from them (sore throat the instant I took coconut oil, fatigue, getting sick if I ate too much oil, etc.)

    • Hi Annie,

      – My preference is to get protein from meat, fish, and shellfish, and discard the egg whites. But there’s nothing wrong with eating the whites. If you prefer a higher protein intake then keep the whites.
      – Similarly to the egg whites, lean meat is fine but raises the protein fraction of the diet. If you combine the lean meat with egg yolks, avocados, macadamia nut butter, or some other source of fat, it will be fine. Similarly, in stews it is fine. Consider adding egg yolks to the stew.
      – Yes, fermentation and small quantities both minimize toxin risk.
      – You can greatly reduce toxicity by soaking, sprouting, fermenting. Most people don’t have time for it, and it is only a partial solution for wheat and most other grains. Commercial products don’t use these methods. I think if you are willing to follow Sally’s methods those foods are probably not that bad but I don’t think many people are willing. In any case there are healthier alternatives.
      – Most likely your IBS is increasing your carb needs or impairing digestion. If you feel similarly when fasting, it could be that you did not eat enough carbs the previous day or have not yet adapted to a lower carb intake; or (most likely) that your IBS is increasing your carb needs.
      – Some people do have difficulty digesting coconut products. Acid reflux may be caused by a choline deficiency so eat liver and egg yolks.

  34. Hi Paul,

    Thank you for your advice for my 16 year old granddaughter, she is following your recommendations and will keep you posted on results.

    Have you changed your recommendations regarding rice syrup? Since reading that you have switched to honey and dextrose because of concern about arsenic I am very worried for my two year old grandchildren who have been eating rice syrup since they were babies. All my family and grandchildren have consumed quite a bit of rice syrup in the last two years since giving up sugar completely. We buy Wattle Grove brand which is made in Australia. Could Australian rice syrup be safe or should we stop eating it?

    Also, can you recommend anything which may help with severe Dupuytren’s Contracture?

    Thank you again for your help.

    • Hi Francesca,

      It’s probably safe.

      I don’t know much about Dupuytren’s but since liver disease is connected to it, I might supplement NAC and eat extra liver to improve glutathione status and liver function.

  35. Hi Paul

    I am 60% through your book. Excellent resource! Thank you and your wife’s research and for sharing your knowledge.

    I have already started to incorporate aspects of the PHD and recommended supplements (magnesium, vitamin D and C, but have not managed to find a chemist that sells vitamin K yet) into my daily life.

    I just wanted to check whether white sticky rice (popular in Asian cuisine) is a healthful and safe starch like white rice, potato, taro etc? Or should I be avoiding it?

    Thank you.

  36. Hi Paul,

    My name is Rhidian and i have cystic fibrosis, which is the most common caurcasion hereditary disease. I messaged you a few months back regarding possible aids to help with my CF, Thanks for replying once again! I have reasonable high hopes as a dietary intervention on CF hasn’t really been done to the extent of PHD, the doctors only see diet as a means of weight gain with the odd supplement thrown in here and there but certainly the diet aspect is overlooked. I adopted using ox bile to help my fat digestion, however this doesn’t appear to have worked. I have no quantitative way of studying my feacal fat, without laboratory intervention. But i base it off what my stool looks like and whether i get stomach cramps and blockages. Unfortunately i still get bad gut blockages even with the bile and enzymes. Also i do not feel full after eating lots of fat which i guess might suggest my adsorption is not high enough to sustain energy levels. So, i have opted to eat higher clean carb with high potassium (potatoes) (athough this increases mucous production which is bad for me). I still have butter or coconut oil with every meal to lower the GI of my high carb diet and 3/4 eggs a day and lots of veg with every meal too, so nutritionally i should be okay. Is the high fat requirements a real health isuue? I am in the process of adopting all your supplement recommendations. I have a question about lithium orotate. I think the tablets are 125mg Li orotate but you only get 5mg of Li from the tablets? I am just wondering if that sounds right as there is no leaflet with the Dr’s best tablets I bought. Li seems to be something you want to be very careful with so obviously i want to get the dosage right.Also, i could only find 25mg Si tablets, should i take one every other day to lower the dose? i am not sure how the body stores Si, so if a 25mg tablet every other day is equivalent of taking 12.5mg everyday. I have been taking NAC, but not sure if its making me tired, although side effects in the trial done were minimal, I am going to stop it for a bit to see the effects. I think Li and idodine and selenium, and high potassium (as you suggested to me) could be beneficial and something the doctor’s haven’t focused on.

    sorry for rambling, i think i put a couple questions in there. 🙂

    P.s. I love the book! i just have to learn it now. 🙂 I am on a mission to get my whole family onto it, extended and all. But i think i am going to rephrase how i market it. Maybe, the most scientifically thorough researched diet of modern Day Man!

    Take Care,

    Rhidian

  37. Opps, i forgot o also ask if its important to separate your carbs and fats, to optimise fat usage, i.e by preventing insulin release. Or is it the ratio of your diet between fats:carbs:protein that is important and determines how your body utilizes the fat rather than the time periods of when you take them. I am trying to help my cousin get into it but i don’t want to give her poor advice and make her gain weight! 🙂

    Sorry for the extra post.

    Cheers,
    Rhidian

  38. Hi Paul and Shou-Ching
    Thank you so much for your wonderful book. I am enjoying many benefits from following your program including vastly better energy and a natural leanness I hadn’t experienced before.
    I am interested to understand further your view on 2 products, neither of which I can find much data on on this site.
    The first is seeds (as opposed to seed oil). I make my own muesli every morning. It contains pumpkin seeds, sunflower seeds, chia seeds, LSA meal, shredded coconut, goji berries, sesame seeds, almonds plus grass fed full fat yoghurt , organic honey and a banana. It’s very yummy and together with a bulletproof coffee keeps me satiated and focused until lunchtime.
    I would be very interested in your thoughts please?
    The other is tinned tuna. It makes a very easy source of protein at lunchtime a couple of days per week. (I try to ensure I always get enough protein in order to support 4 decent body weight workouts per week.) I eat it with some olive oil, salad and potatoes etc. – so trying to get good balance of all 3 macro-nutrients. We buy a good quality brand but I notice the fish are caught in the waters around Thailand.
    Can’t wait to hear your opinions and thanks again!
    Kind regards
    Paul

  39. Hi Paul
    Do you have any thoughts about honokiol? There’s some research showing it to be helpful when inflammation is present in various conditions. I was considering taking it to help keep benign prostate hypertrophy at bay. Here’s one reference
    http://www.sciencedaily.com/releases/2012/03/120319094803.htm

    • Actually that ref. relates to Alzheimer’s – but it’s supposed to be good for prostate health as well.

    • I’d never heard of honokiol, so I don’t have an opinion. But it sounds promising.

    • pumpkin seed oil seems to get pretty to get some pretty good wraps for prostate related ‘things’.

      …google for refs/studies

      • …oops typo, a bit of repetition in there

      • Yup, thanks. I’m going to be taking that also – Life Extension Ultra Prostate formula has 320 mg. which is the studied dose. That will help modulate benign hypertrophy (by what mechanism remains unknown). Meanwhile honokiol has some other interesting properties for cellular health with probable implications for cancer, Alzheimer’s, inflammatory conditions, etc.

  40. Dear Paul,
    Thank you for a wonderful book. I am planning to re-read it and keep it as a resource material.

    Risking pounding the topic to death, I wonder if you could comment on the use of microwaves in the food preparation. You mentioned that your research on this topic brought no concern.
    Today I came across this article and wonder, and worry…
    http://preventdisease.com/news/13/062013_If-You-Dont-Mind-Cancer-Causing-Radiation-Passing-Through-Your-Food-Keep-Using-Microwave.shtml

    Will you study the topic further? Please, comment.

    • Hi Beata
      I don’t think Paul would want to take time to study this article. I scanned it, and have enough science background to be able to tell you that it’s full of malarkey. Microwaves are a certain wavelength range of electromagnetic radiation, like visible light is. If they remain inside the oven, they can’t hurt you. They pass through the food and jiggle (not damage) the water molecules. That jiggling of the molecules is what heat is, whether it’s caused by microwaves or by a flame under a pot or hot air inside a food dehydrator. Living things put inside a microwave oven would be hurt of killed by the heating, just as they would in any oven. Microwaving healthy food in a modern microwave oven, in glass or ceramic containers, should not pose any more health risk that other cooking methods, and in some ways pose less.

      • Sorry for all the typos

      • Hi Jack,
        Thank you. It is very kind of you to reply to my concerns. It is rather difficult to sift through all the misinformation, especially from well meaning but often uninformed people.

        I have done some more research since and it seems that the urban legend about the dangers of microwaves spread like a wild fire.

        Best wishes,

  41. Hi Paul,

    Thank you for your prompt reply re Dupuytren’s. There is no liver disease, alcoholism or any other connected diseases in our family, but our hands are very severely affected and my parents and four siblings have had multiple unsuccessful operations. My parents, I and three of my siblings have been non-drinkers, the two siblings who are drinkers are no more badly affected. Do you think it is worth supplementing NAC when there is no connection to liver disease? I have been eating 5-7oz of lamb’s liver per week for the past year and a half but it hasn’t helped.

    It is supposed to be genetic, so it is puzzling that no grandparents, great-grandparents, aunts, uncles or cousins had the condition. Our father developed it mildly in late life, almost as if he caught it from our mother who developed it in her forties but otherwise had great health.

    Although Dupuytren’s is not painful it makes many things very difficult, so any suggestions would be greatly appreciated.

    • Just an idea: please, check your Vitamin D /K status. I read that this condition may be related to a low Vitamin D.

      The medical test is:
      25 hydroxy vitamin D

      • Another correlation is blood sugar. I would check your post meals blood sugars since they can be running high enough t o do damage for many years befor you’re fasting blood sugar raises alarms.

      • Another correlation is blood sugar. I would check your post meals blood sugars since they can be running high enough t o do damage for many years before your fasting blood sugar raises alarms.

      • Another correlation is blood sugar. I would check your post meals blood sugars since they can be running high enough to do damage for many years before your fasting blood sugar raises alarms.

  42. My temperature upon rising is 98.1. One hour after taking one grain of thyroid medicine my temperature dropped to 97.7. Why would this happen???

  43. Dr. Jaminet,

    I know oatmeal is considered a grain, however, what if someone has no noticeable digestive issues consuming organic gluten free oatmeal. Could it be used as a carbohydrate source? If there is no gluten in the oatmeal, what other toxins are there to worry about?

    Thanks,
    Mike

  44. Hi Paul;

    Is it ok to have one cheat day a month into PHD when treating candida? It’s a special occasion, lots of sodas and junk food type things.
    I’m very strict and would resume immediately after.

    Thanks!

  45. Hi Paul,

    thank you for continuing to to take the time to to respond to folks’ individual questions. I have poor thyroid and adrenal function. My question is do you still recommend fasting with poor adrenals?

    Thank You for your thoughts

    • Not if it is causing you stress. But you can minimize stress and still have a mini-fast by eating a small breakfast of protein, potassium (eg tomato), salt, and water. It needn’t be a full meal.

  46. Greetings Paul,

    I follow your diet and lifestyle to the letter, and have reaped very positive benefits from it. Thank you.

    I have one complaint – I awake in the middle of the night. This “side-effect” was not addressed in your book, and I am wondering what you propose as a solution to restore deep sleep. This issue developed almost immediately upon adopting PHD.

    Thank you in advance.

    James

    • Did anyone get back to you about this insommnia problem? I’d be interested….Donna

      • I am curious as to what James may have stopped eating when he switched to PHD.. I wonder if he had been eating a lot of beans or something that cpntained resistant starch.

        I would suggest that he be sure to eat some potato salad and rice salad and some not very ripe bananas for the resistant starch. Even a spoonful or two of potato starch stirred into water, yogurt, or kefir if he is still not sleeping.

        See all the info Tatertot posted on “everything You Want To know
        About Potatoes”

        Sleep improvement seems to be the result everybody notices

    • Hi James,
      just a thought,
      have you been eating potatoes in the evening & is this an addition from your previous diet?

      contrary to most people (from what i have read), if i eat potatoes in the evening then my sleep is worse than normal, i am restless & my brain/mind is too active, too many thoughts etc. I may fall asleep, but i will wake in the early hours & then not get back sleep (at least not quality sleep).

      for me it just seems to be potatoes, i am ok with other safe starches such as white rice, sweet potatoes, rice vermicelli/noodles. & potato starch is not an issue either.

      when i have eaten potatoes, they have had some skin on them, but no dark spots. so it could possibly be the skins that are the problem for me. but as yet, i have not been ‘brave’ enough to retest with skinless potatoes.

      • Darrin

        In “potatoes not prozac” the author recommends a potato with fat but no protein before bed to enhance sleep. However, she also talks about dosing. Having weird dreams and waking are symptoms of too much. It is also a sign of over supplementing melatonin, so she may be onto something. Have you tried 1 small potato?

      • Thanks Trina, you could be on to something here.

        When i have eaten potatoes in the evening, it has definitely be more than 1 small spud.

        What could i be getting “too much” of by over-doing the potatoes.

        • I suspect the alkaloids in the skin. I get similar sleep issues whenever I ingest something toxic, i.e. too much Vitamin A. Have you tried taking NAC to see if that helps?

        • I think she was attributing it to the carbs themselves stimulating tryptophan already in the blood to cross the blood brain barrier, as the proteins compete with each other to cross and the carbs give the tryptophan an edge. She also thought that potatoes with skin were the best carb source for the purpose, but I don’t remember why. So by flooding the brain with too much tryptophan you would over produce melatonin, hence the waking and weird dreams. I think that was her theory, I might be misrepresenting it.

  47. Thanks Paul. Finished your book!

    I have been looking for Vit K tablets for over a week in Sydney (I have already started on the magnesium and Vit D). Today, a chemist told me he doesnt know any pharmacy in Sydney that stocks this product anymore (due to low sales). I tried to buy from the link provided on your website but unfortunately Amazon would not ship to Sydney.

    I am therefore looking for it on Australian websites and have found this one:
    http://www.puritanspride.com.au/k-vitamins-cid-535/vitamin-k-100-mcg-sku-003070.html

    The ingredients section says the product also contains: Dicalcium Phosphate, Cellulose (Plant Origin), Vegetable Stearic Acid, Croscarmellose, Vegetable Magnesium Stearate.
    Are these ingredients toxic?

    Another site which stocks a number of Vit K products that ships to Sydney is:
    http://aussie-well.com/c/256283/1/vitamin-k.html

    It seems some of the products are in liquid form. Do you recommend this over the tablet form?

    If you had to pick a product, which would you go for?

    Thank you!!!

    • G, the Mercola brand of Vit K2 is available in Melbourne at a health food store so you could probably find it in Sydney too. If not, they could order it for you or you might be able to go direct to mercola.com

      • Mercola seems to be recommending 100 mcg Vit K for every 1000 IU of Vit D you take. So, for eg., if I take 5000 IUs of D, I would need 500 mcg of K. I know of no one else suggesting that high a dose of K. Anyone aware of whether such a high dose is good? safe?

    • puritans pride actually sells out of the US (so international shipping).

      iherb.com seems to be the cheapest for shipping to Aus that i have found. & quick if you use DHL.

      for the K vit, i take one of these every other day,
      http://www.iherb.com/Life-Extension-Super-K-with-Advanced-K2-Complex-90-Softgels/46675

  48. Hi Paul, one more question … I also had trouble finding Iodine tablets in pharmacies.

    I came across this product Vit D & K with sea Iodine product online which caught my eye:
    http://aussie-well.com/p/8642888/life-extension-vitamins-d-and-k-with-sea-iodine-60-capsules.html

    Am I correct in thinking this is probably not suitable as the iodine level seems a bit high for me to consume this product on a daily basis?

    Thank you in advance.

  49. Starting with a bit of background: I’m 24 and found out at age 20 that I have Celiac disease, so I’ve been strictly gluten free since then and eating paleo/WAPF-ish for nearly as long. My Celiac symptoms were first severe when I was 14 but go back at least until age 11. I stopped growing by 14 but suddenly added a full inch of height after I stopped eating gluten! As my Celiac went undiagnosed so long it got fairly advanced; my symptoms were pretty nightmarish by my late teens and I still had a borderline-positive biopsy eight months after going gluten-free (intestinal damage is apparently supposed to be gone by six months and sub-diagnosable before that).

    I’m also four months postpartum and breastfeeding. I have a good 30 lbs. still to lose, but over the past three months I’ve lost only 7 lbs. My appetite became ravenous during pregnancy and remains pretty high. I never really feel satisfied after a meal the way I always did before. I recently tried eating somewhat less, particularly of less-micronutritious fats, but after about a week of that my milk supply tanked, so for now I eat to appetite. Pre-pregnancy, I effortlessly maintained my weight (I arguably had some to lose, but I wasn’t overweight by BMI) and was fine on three meals per day without cravings.

    All this to say, I’m wondering if I seem to have lingering nutrient deficiencies or show signs of anything else. My concerns are healthy weight loss and being well-nourished for breastfeeding and future pregnancies (my husband and I are hoping for a large family and I don’t want to gain 30 lbs. for each kid!). 7 lbs. lost in three months just seems too slow, especially after gaining a high amount during pregnancy. We eat pretty close to PHD guidelines – I can give details, but I’m trying not to write a book here :). I’ve started taking most of the recommended supplements as well. I am very grateful for any suggestions!

    • Hi Amelia,

      I struggle with similar things. Mad cravings during pregnancy and nursing, struggling to lose weight. Being well-nourished.

      What helps me:

      1. Get all the supplemental foods Paul recommends.
      2. As low fructose as possible. I have 1 or two low fructose fruit a day (no apples, few berries, mostly oranges or a banana), very few of the sweet in ground plants Paul talks about — some onions for flavor mostly.
      3. Fermented foods everyday. I do yogurt, this great fermented saurkraut I found, kombucha, kefir and pickles (I hate kimchi).
      4. Intermittent fasting — key to weight loss for me. I skip dinner.
      5. Potatoes.

      I wouldn’t look for a fast weight loss until you have the cravings under control. However, I will say that when I do the perfect health diet perfectly, I have very good weight loss — I just keep getting into situations (staying at relatives, business dinners, traveling, etc) where I can’t control my food so well and wind up having too much sugar and baked goods. But even then, my weight remains stable. I haven’t had a gain since I started PHD.

      • Elizabethe,
        Thank you! Those are some good ideas. I’ve been meaning to do more fermented foods since we want the little one to eat plenty once he’s on solids, so there’s more motivation for me to incorporate them.

  50. Judy:
    What brand of MCT oil are youusing and how
    would you describe the taste?

    Paul:
    Will MCT oil increase cholesterol??

    Thank you both.
    Linda

    • great advice– can i just add?? the last 10-15 lbs never left me until i weaned. not suggesting that you wean now! i nursed each of my 3 kids for around 2-2.5 years. for me, it just seemed like something hormonal which kept the weight on for me.

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