Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

10,240 Comments.

  1. I have loved the freedom of enjoying butter, yogurt, creme fraiche, coconut oil, and sour cream whenever I feel my food needs it. A few months ago I noticed a couple of yellowish smudge type spots on the tender skin below one eye. Kind of just below the lower eyelid. At first glance, it appears that I need to wash away the “sleep” dripped down from my eye. I feel this looks like something on “old lady” might have. Granted, if you knew my age, you would say, “Uh…well…” There are people who know this “lana,” and I don’t want my age advertised around my school building, as I hope to work as long as possible. Trust me, I am old enough to be considered “elderly,” but, so far, I am never treated as if I am.

    These two spots looked, at first, like make-up I had not smoothed. But rub as I may, the spots do not go away. Does anyone know what they are and if I can get rid of them? Are they (as I suspect) related to my increased SF intake?

    Thank you for whatever light anyone can shed on this puzzle.

    lana

    • Google “xanthelasma”.

      • Thank you. So, now, what to do. I don’t recall a family history. One definition said the condition is “terminal.” Apparently, it can indicate a liver problem.

        Paul, if you have a couple minutes to consider my fat numbers from last summer. This was the metametrix GI profile.
        Digestion:
        Elastase 1 186 (L)
        Triglycerides 139 (H)

        Absorption:
        LCFAs 5.9
        Total Fat 11.8
        Cholesterol 168 (H)

        My saliva adrenal function test indicated slightly low output throughout the day. Doc put me on support supplements, including DHEA. However, I promptly began getting painful pimples inside my nostrils, so I stopped the supplements. Will see him later this month.

        What tests would you think I need to get?

  2. I just got back results from Metametrix as well (I think I read about it here first) and wondering if anyone knows good resources for deciphering it? They have a PDF pamphlet, but it is concise.

    The main out-of-whack results it appears are:

    Yeast/Fungi; taxonomy unavailable +4 => 100000 pg DNA/g specimen

    LCFAs 11.3
    Total Fat 14.5

    Brief history: A few months back I tested pos for H pylori and did 2 weeks of antibiotics/PPIs; then switched to alternative treatments (the Ettinger Protocol, and blogger Amy King’s treatment — http://amyking.wordpress.com/2009/02/20/im-so-happy-i-have-h-pylori/ — as recommended by a poster here.)

    The Metametrix GI Effects was neg for H pylori (though it is not a conclusive test.) My main gut symptoms now are bloating, occasional dull pain/discomfort in right side, possibly near the duodenum.

    I know I have seen Paul’s advice about fungal infections somewhere; I have the book (first version) so I will check there. Any other resources anybody can suggest?

    Thanks,
    Tim

    • Hi Tim, I did the triple antibiotic therapy for H Pylori too and felt horrible for a long time after. Aquaflora for Candida helped with the tongue coating and nausea but not the bloating (it’s homeopathic so it won’t hurt). The only thing that seems to help is Align probiotic. I think once the flora is messed up (by the antibiotics) it takes a really long time to normalize itself. I did not have the pain you describe.

      • Vartouhi- Aquaflora and Align are both new to me, so I will look those up. I was thinking about trying Theralac (after not seeing noticeable results from VSL-3 or NOW Foods Probiotic 10), but reading online reviews of mixed results, it makes me wonder if probiotics are more of a placebo than anything. In Paul’s gut series he seems to downplay their effectiveness, IIRC, saying they don’t provide the broad spectrum of bacteria of a real healthy gut. (And they’re expensive too…)

        • TimR – I know some swear by it, but VSL 3 made my bloating much worse. I do take Theralac once in a while and TruFlora (same company) but Align is specific to bloating, it has B. Infantis – I suppose if if it’s a placebo effect it might as well be a specific placebo 🙂 I also take L-Glutamine (Source Naturals) to help heal the gut. I wish were successful at fermenting veggies to get my probiotics as nature intended, but apparently Nature has not given me the talent – I fail miserably every time I try to make them.

          • Okay, you’re starting to convince me. 🙂
            I might have to try Align.

            On the fermentation, have you seen Sandor Krautz’s site? I found the directions on this page very clear and successfully made some kraut:
            http://www.wildfermentation.com/2012/04/

            But I’m not sure it’s done much for my gut, other than taste good.

        • Probiotic supplements have made a huge difference in my gut health. I take Mercola’s (mercola.com) who is fastidious about the development of his products. He evidently based them on what he has seen as clinically the most beneficial to most people in his years of practice.

    • Hi TimR,
      It was likely my post about Amy King and Ettinger. I don’t know what your bloating and pain is about, but recall that I did have a worm living in my duodenum, and experienced some of that a few years ago. Would you mind telling me what your pylori number was? Mine was 7.2E+005. I think mine is under control, but I continue to take HCl, water kefir and every few days I take a half dose of monolaurin. The stories about the antibiotics that are prescribed for HP are so scary I would wonder if that is most of your issues now. But HP is said to damage the stomach and it takes time to heal. My test results indicated fungi at a +1 => 100. My doc was more focused on the high HP numbers.

      Thanks for sharing your information.

      • Hi lana- Yes it was your post, thanks again for pointing me to them — their treatments have been very helpful, even if I still have some lingering (or perhaps new) issues.

        As far as the pylori number, the Metametrix report I got just lists it as “negative.” In their pamphlet they explain “The
        cutoff for clinical significance for … pathogens [has been set at] at 1E3 (1 x 103).” However, I read on scdlifestyle.com that H pylori can be present without showing up in all stool samples; so you would have to do a test that takes stool samples over several days to have a conclusive negative.

        When I first tested positive several months ago, it was by a blood test at an urgent care clinic, and just listed as “positive,” I think, no number attached.

      • I also have very strong discomfort/pulling (no pain) in the right side. The more I am constipated the worse. No bloating though but it is sometimes that bad that I cannot sit still to get that pulling away.

        Lana, what worm did you have and how did you treat it?

        You can see my Metatmetrix test result here: https://dl.dropboxusercontent.com/u/15813135/GI%20Effects%203.jpg

        But I am rather on my own. I also wonder about the H pylori since I had some sample tissues taken at a Endoskopie which didn’t show any infection and a regular stool test didn’t show H pylori as well.

        • How I wish I knew something about that worm! I was at work when I passed it and at first it looked like the usual stuff with large white discs on it. Silly me, I thought this was biofilm breaking up. But then I learned that biofilm is a mucus type of substance and the enzymes I was taking would likely turn it to liquid. Paul wondered why I was not thinking it was a parasite. Then, I examined that imprint on my abdomen and saw that it did, indeed, hold the shape of a curled up worm. I am now certain the thing I passed was a worm, partially covered in the usual stuff. Sadly, the toilet was a high tech, auto-flusher and before I had my wits about me, it was whisked away. Later that day I passed the usual stuff with white chunks the size of corn kernels. Even then I was still thinking it was biofilm, so flushed it away. About 5 days later I had some intense itching at about where I imagine its mouth was — just outside my stomach. I suspect it had sunk its fangs in me and hung out for at least 9 years. That’s when I first noticed the shape on my abdomen. Still have the shape, but it has collapsed into wrinkles.

          What I was taking: It was the second try at ridding the H. pylori. Interfase Plus to break up the biofilm and Undecylex to kill the HP. Started taking it on Saturday morning — two doses a day, I think — and passed the worm on Monday. I’m hoping to speak with someone at the University of Washington to see if they can help me narrow down what the thing was. I have found a description of a worm that hangs out in the duodenum and the male flips its tail over on its back — the shape on my belly. But this critter is supposed to die after two years. I had it for at least 9 years. Asked the ND what it was and she waved it off saying it was nothing. I have since sent her a rather terse letter. Meanwhile, as we know, living things eat and eliminate. So, without a doubt, it was collecting the best from my stomach and defecating its waste into my small intestine where said waste surely passed through my leaky gut and into my blood stream. My poor body had been fighting this for well over 9 years. Had lots of stomach stuff 15 to 20 years before this. Was that the beginning? Who knows? Lived in Libya for a year and a half from ’66 thru ’68. Visited Mexico for a few days 35 years ago (drank the water). Raised farm animals for ten years when my kids were growing up. If I learn anything, I’ll sure post it here.

          One more note — I’ve told this story to many people, including my sons and their wives. They all reacted with shock and horror, but not a one has gotten tested.

          By the way, the Metametrix showed only the protozoan parasite, taxonomy unknown. I would guess this thing was polished smooth by the time the test was done, so likely sloughed nothing. As Paul says, that test measures only what is in the large intestine. Also, I had had two endoscopies in previous years and no HP was detected

          Needless to say, the Jaminets are saints in my book. I would not have learned any of this had I not attended Paul’s talk in Dallas.

          If you decide to take the Interfase Plus and Undecylex, I would suggest staying around home for a few days so that you can monitor what you pass.

          Care, lana

          • @lana & david

            Thanks, sounds indeed a bit scary. I have this pulling along with constipation for 4 years now. Recently I had a methane breathing test and it showed a high baseline of methane. Maybe its because of that. But on the other side I don’t get bloated from sugars. My case doesn’t make very much sense in many ways…everything is non textbook and it could be everything and nothing…frustrating. Oh, I actually had a gastroscopy (not a endoscopy as I wrote before), so the tissue example was from the upper intestines.

            Do you know an informative info site about Interfase Plus and Undeclyex? I am from Germany and I haven’t heard about it yet. Problem is that since I have this pulling I am also reacting to supplements with drug like symptoms which are hard to bear. So I became somewhat untreatable.

            My dad used to have chronic stomach pain and then got tested positive for HP. He got metronidazole and is pain free ever since. But because HP never showed up in my tests or tissue example I don’t get a prescription for antibiotics. Doctors don’t take the Metametrix test serious because they don’t know it.

        • Chris,
          Your Metametrix profile show a lot to deal with and HP is quit high.

          Re- endoscopies:
          I’ve had like 4-5 endoscopies in the last 3 years showing no HP!!! while all the members of my familly had HP discovered by stool. Poor performed endoscopies or stool sample are very common.

          I’ve discovered it by changing labs and tried also blood antigen or antibodies soemthing. I also have some parasites in that area but cant diferentiate between HP symptoms or parasite more EXCEPT when i eat i feel them coming in the right side.

          Also it seems that HP is present in many people BUT in lower numbers without creating problems. I guess Lana is right trying to get it under control is a fair goal.

          Good luck

    • Hi Tim, you are right to question the effectiveness of probiotics. They do work, but unfortunately our understanding of the human microbiome is in it’s infancy at this stage and we have not isolated the many diverse bacteria species that are needed for a healthy gut.
      The only treatment I know of which has a proven cure rate for IBS, gut infections and chrohn’s is Fecal Microbiota Transplantation. Essentially this procedure involves taking a fecal sample from a healthy person’s colon and transplanting it into the patient’s colon, at which point your digestive system will be colonized by a plethora of bacterial species from the healthy fecal sample.
      That’s the only way I know of to restore the gut from disbiosis.
      Ideally this treatment should be combined with the GAPS diet, which is also effective; however a modified gaps diet which includes safe starches is probably better.

  3. Paul, congrats on launching PHD health resort, exciting stuff!

    Do you know of any disadvantages, nutritionally speaking, with using a pressure cooker to make broth?

  4. Paul? Are you around? Know you’re headed off to Atlanta. Have been hoping you would weigh in on the issue of xanthelasma. This morning I noticed that one of the spots under my eye looks bigger than before when I first wrote. There was some reference to a thyroid connection. I’m wondering if I should cut down on my saturated fat intake??

    • Lana what is your cholesterol and triglycerides like now and what was it like before you started eating saturated fats? That might give us some clue as to whether or not you should cut back.
      BTW you can also have xanthelasma surgicaly removed if the cosmetic effects are your main concern.

    • You should also have your thyroid tested as thyroid deficiency impairs LDL receptor sensitivity, causing an abnormal build o circulating LDL cholesterol.
      Do you have a family history of high cholesterol? Genetics may also predispose you to impaired LDL receptors.

      • I have a doc appointment this month and am making a list of things to ask. Your notes will help with that. Thank you.

        I don’t remember my blood cholesterol results. The metametrix test was the fecal profile, and I’m not sure what that means compared to blood profiles.

        Doc did a thyroid test and assured me all was good. I told him that Paul had said such results are not necessarily conclusive. He then said the test included a number assuring him of the results. ??

        No family history of cholesterol issues.

        So far these are flat. Make-up doesn’t cover them well. Seems they can become larger and come back after removal. Since going on PHD I stopped daily centrifugal juicing of veggies and I do wonder if that may be the issue. Paul has indicated the veggies I was using should not carry a large toxin load, so I need to get back to it. Just hard to work everything into the day. Thanks marcus.

        • Ok, make sure you ask your doctor for a copy of the blood test results and also ask him to print you a copy of your thyroid results and your old cholesterol/triglyceride results.
          Once you have all the numbers you can show them to Dr.Jaminet and see what he thinks. Doctors will interpret the numbers differently to Dr.Jaminet and other integrative medical thinkers.

          For example you may have a subclinical thyroid problem that can be improved by iodine supplementation.

          P.S Why did you stop juicing? Vegetable juice is fantastic for your health, keep it up.

  5. I’m part way through your book and it has prompted a couple of questions. By way of context I live in an area of mild winters but even so my lower legs dry out to the point that I scratch them until they bleed. I also suffer badly with night cramps in my legs and feet. Has the experience of those on the PHD been that these issues might dissipate?

    • Hi Ralph,

      I too had dry legs (and elbows) as well as some night cramping. The cramping in my case was settled by taking extra magnesium, and the dryness seems to correlate with vitamin D and omega 3 intake but that is from self-experimentation. In winter I still get some dry skin, even though I try to supplement enough VitD so it’s probably not the whole answer.

      So yes, expect at least some amelioration when going PHD.

      • Ralph and Wout-
        I still get the dry skin also in the Colorado winter. Another great use of coconut oil though. A thin layer works great and the coconut smell dissipates rather quickly.

      • Hi Ralph
        Back when I used to eat SAD diet, my lower legs and some other parts of my body would get dry and itchy to the point where I would scratch them til they bled. For me, I think it was something to do with simple carbs. In any case, I haven’t had it at all since I started PHD. Not sure if that’s the same thing as you.
        Best of luck

    • Thanks to all for your feedback. Much appreciated. This is obviously a very active community and speaks well of the program and mutual support. Next chapter, please.

    • just some food for thought…

      an Iron deficiency can lead to itchiness (pruritus) or an urge to scratch…
      http://en.wikipedia.org/wiki/Iron_deficiency_anemia#Signs_and_symptoms

  6. Hello Paul,

    I have hormonal acne (I’m 25, female) around my jaw that I cannot get rid of. I’m eating and supplementing as recommended in your book, and I have eliminated all dairy and all added sugar except for a small amount in my 70% dark chocolate and the occasional bottle of kombucha. I am careful to always eat starches at mealtimes with fat, vegetables, and usually an acid to try to mitigate acne-related insulin issues. I take a pro-biotic and eat raw fermented foods like sauerkraut.

    I was on antibiotics and anti-androgens plus retinoids for the acne for several months, which helped a lot but never completely cleared it up, and the side effects worried me, so I stopped the meds. I have managed to control the acne as well (if not better) with the PHD minus dairy, but I still have constant, though much milder, breakouts.

    Any suggestions? I have considered supplementing vitex herb (chastetree berry, also known as “Agnus Castus” in some parts of the world) and/or maca to help balance my hormones, but I don’t know if it’s a good idea or if there’s something better I could do. I really hate this!

    Thanks so much to you and Shou-Ching for your wonderful book and the work you do.

  7. I have a new email address.

  8. I got a stool analysis back. Looks like I don’t digest fats well, and I’m low in good bacteria. My dr is going to try some enzymes and probiotics, and was also thinking of an antidepressent to help me relax and gain weight. Any comments from anyone?

    • Sure, what type of antidepressant is s/he thinking of? Have you tried alternative methods of antidepressants or just natural methods in general – like yoga and meditation?

  9. I’ve been eating approximately PHD for at least a year, with the supplements for a couple of months. In the past few weeks I noticed I was getting odd headaches, sometimes with mild nausea or brain fog, especially in the evenings. Now I realize it happens after consuming something sweet (I often have a little homemade ice cream or tea in the evening). Today, I was feeling great until I ate one fresh strawberry. 15 minutes later I had a headache!

    Anybody know what could cause this sudden problem with sugar? Rice doesn’t seem to be a problem, so I assume it must be the fructose, except one strawberry has so little fructose by itself. I’m wondering if I might have some kind of gut dysbiosis or infection, though I don’t know what to do if that’s what’s going on.

  10. H. pylori
    I am so sorry to report to this fine group of caring people that I am certain I am experiencing a return of H. pylori. Some weeks ago I noticed that the nagging back pain was returning, intermittently. This week it has returned and lasted throughout the day. In addition, I have had the early morning sneezing, which had disappeared as soon as I began treating the HP. I tried taking a scoop of Lauricidin and it did nothing to relieve the back pain. Next day I took a couple caps of enzymes leftover from the first go; then a half hour later, took the Lauricidin, and I got relief. Yesterday, I felt the “pulling” that others have described. It was mostly on my left side.

    I must confess that the first time I did not follow Amy King’s and Ettinger’s follow-up procedure of taking the mastic gum for several months, as well as the Lauricidin.

    Today I happened on this site. Author is quite young and seems amazingly dedicated to the research. Her site is a bit distracting because she needs to do some editing (i.e.: “30 hours before breakfast”). http://www.mygutsy.com/is-h-pylori-the-cause-of-allergies-brain-fog-hypothyroid-autoimmune-disorders-adrenal-fatigue/

    On this site she has links to two videos, one is nearly 2 hours long. This is not information I had found before, and is quite packed with information that I cannot assimilate casually. I need to simply focus on what the doctor is saying.

    There are these comments that are electrifying, like ketosis leads to psychosis (?). My computer is acting up and I’m having trouble searching back in this video to recheck what she said. I suspect this doctor is speaking to parents of autistic children.

    Anyway, I will go back on the protocol I did before and will continue as Ettinger and Amy King recommended.

    Care to all

    • Hi lana
      So sorry to hear about about that! I was following your progress through your posts here and was wondering if you finally get rid of it.
      Could you guess why is this “come-back” happened? You’ve said maybe not long enough tretament? Did you change diet or something? Besides Enzymes and Lauricidin would you mind sharing the other supplements you are taking? like probiotics vitamins or stuff…
      And also what did not worked for you? Have you been able to folow diet recommandations.
      Re- mastic gum Ive read on several websites that for SIBO could be problematic. I also have chronic HP (and my whole familly has it but Im the only one wanted to eradicate it) yeast overgrowth and parasites but did not start dr.Ettinger protocol yet although seems promising.
      Clean acidophilus and organic coconut oil help me to keep it in control.
      Thanks and keep “fighting”!
      Dave

      • Thanks for your concern. I after two minimally effective programs, I went on what “elena” did. You can find her if you google “amy king so happy I have h pylori”; then search for “elena.” What I did not do was continue the mastic gum for several months after the two month treatment, nor did I take the broccoli extract after treatment. I have always had a problem remembering to take special things when I am symptom free.

        I just noticed this update on Ettinger’s site and have sent him an email to see if he will take me as a distance patient. http://www.advancedhealing.com/biofilm-and-h-pylori-treatment-update-09-july-2013/

        I have no choice but to treat the HP because when I first began treating it longtime health issues cleared up — thirty years of minor back pain, ten years of itching eyes, five years of serial sneezing every morning, and two years of large welt type hives all over my lower buttocks.

        I have a personal belief that once you start the war with this organism, if it can survive the torment, it will dig in and come back more aggressively. With this recent comeback I had the itching eyes and morning sneezing which was the first clue. But the back pain has come back with a vengeance. A month ago there were twinges, and I feared it was back. Last Friday, on a walk with my grandson, I had to struggle to hide the pain from him.

        I am now prepared to take
        the “maintenance” supplements throughout my life, if need be.

        In my mother’s last years, she complained often of terrible back pain. Now I have to wonder, and I feel so bad I didn’t know enough to help her beyond helping her with her heating pad.

  11. Hello Paul !

    What do you think of carbonated water (Perrier,etc…) ? Can it be included in regular PHD ?
    Thanks ! Best, July

  12. Hi Paul,
    I’m hoping you can offer some advice on how to proceed with my reflux. I recently had a gastroscopy and they found an “Irregular Z-line”. After years of varying my diet and frustration I seem to have finally found relief by going extreme low fat PHD. I dropped egg yolks and only eat boiled chicken breast or boiled lean kangaroo meat with vegetables and safe starch, so I couldn’t really get any less fat if I tried. I’m guessing that maybe the fat coats the LES resulting in reflux? If this solves my reflux then I would eat this way forever but it doesn’t sound too healthy to me given the PHD’s emphasis on healthy fats. What would you consider to be the minimum fats I should try to add back in? And what types of fats should be the priority? Any other thoughts or advice greatly appreciated. Thanks for everything you do 🙂

    • Hi Adam,

      So basically your stomach acid damaged your esophagus? http://answers.yahoo.com/question/index?qid=20071004122940AAp7g8l

      Have you tried supplementing betaine HCL? Check out http://chriskresser.com/get-rid-of-heartburn-and-gerd-forever-in-three-simple-steps

      I used to have some reflux every once in a while before going PHD, but now I only get a mild version when I overdo it on omelette, and once I had some “bio-dynamic” ice cream with “bean extract” as a thickener and I had awful reflux for a day-and-a-half. It seems that for me reflux is triggered by some proteins.

      • Hi Wout,
        Thanks for your reply. Sorry, I should have said that I’ve tried HCL and every other suggestion in the paleosphere multiple times over the last couple of years with no result. The only thing that has helped is very low fat. So, I’m really looking for advice on what the minimum amount of fat is that I need to incorporate back in to be safe and any other thoughts Paul may have.

    • Hi Adam,

      At a minimum, supplement choline. I disagree with the low-fat diet decision. In fact egg yolks would probably help your reflux.

      • on your weight loss regimen, where you say “miniscule” amounts of fat are required, what would you say is the least # of fat calories needed? and minimum of carb + protein calories?

        • I don’t say miniscule amounts of fat are required. I recommend about 500 calories a day from fats, chosen for high nutrient density. Carb+protein calories around 800 calories/day is good.

  13. Hi Paul-

    I have a question that may be considered slightly off the beaten path for you or others viewing, but was curious if you had any insight into the topic.

    I have found through your diet and through the use of coconut oil, IF, and the ketogenic version that I have found the sweet spot of where I feel physically the best, my long standing acne clears, fat melts away and virtually all digestive trouble is gone.

    My question has less to do with the physical and more to do with the meta-physical… Do you think that it could stand to reason that if cognitive function is improved on a ketogenic diet, then a person’s ability to develop their psychic/intuitive senses could also be enhanced on a ketogenic diet?

    I find little/no discussion about this topic (other than in Yoga circles that say vegetarianism is the best vehicle for this) anywhere so I was wondering if you had any insight into this…

  14. Hi Paul-

    I have a question that may be considered slightly off the beaten path for you or others viewing, but was curious if you had any insight into the topic.

    I have found through your diet and through the use of coconut oil, IF, and the ketogenic version that I have found the sweet spot of where I feel physically the best, my long standing acne clears, fat melts away and virtually all digestive trouble is gone.

    My question has less to do with the physical and more to do with the meta-physical… Do you think that it could stand to reason that if cognitive function is improved on a ketogenic diet, then a person’s ability to develop their psychic/intuitive senses could also be enhanced on a ketogenic diet?

    I find little/no discussion about this topic (other than in Yoga circles that say vegetarianism is the best vehicle for this) anywhere so I was wondering if you had any insight into this…

    Thank you!! 🙂

  15. Hello, I have just ordered your book and can’t wait for it to arrive! Do you have any thoughts on whether or not a toxic/hot thyroid adenoma of 12 years duration might be helped by dietary or any other measures? Thanks so much.

  16. Hi Dr.Jaminet just wondering what your current stance is on glycation? Do you still believe that high carb diets increase HBA1C? Or is it only the non-safe starches like wheat and refined sugar? Thanks.

    • HbA1c is increased to pathological levels in prediabetes and diabetes which aren’t primarily diseases of high carb intake, though once you have them high carb diets can exacerbate the conditio.

  17. Hi Paul,
    Been Paleo for 2yrs-lost extra weight(26lbs) particularly around middle (1lb per day) stabilized at 98lbs. So not overweight.
    Followed PHD last 8months.
    What concerns me is Fibrinogen level,last yr abn high 5.5 this yr 5.3g/L and yet APTT(clotting) is 30.8secnds.
    Also my ferritin levels which are connected have gone up from 99 to 141ug/L far too high.
    My question is should I cut back on iron rich food/donate blood regularly? Or is it due to RA/inflammation and so possibly effect of hepcidin,and so my stored iron is not getting into cells.
    To be honest I walk my dogs a lot and have always been surprised that I don’t feel fitter and breathing heavier when walking small hills. If the iron is not getting into my cells, what can I do about it? Probably no point asking my doctor(UK)for further testing if there is nothing that can be done.
    Thank you for your time

  18. Hi Paul,
    I’ve been Gluten free for just over 2 weeks now and am also reading/listening to PHD as recommended by doc and really enjoying it.

    My daily “IBS” and facial rash have cleared after just a few days on gluten free. (: My vitamin D was VERY low, so I am also on a prescription VIT D for a few weeks and then we will retest.

    I have relied on vegan protein shakes for a while now, not as a meal replacement but as an additional meal/snack as I have a crazy schedule, work out a lot and tend to get low blood sugar if I don’t eat every 3 hours -but the PHD CD seems to have a negative opinion of shakes – wondering what you thought of them as a “snack” vs trying to get all my nutrition from them.
    like this one
    http://www.vitacost.com/sunwarrior-classic-protein-raw-vegan-gluten-free-chocolate

    Also is there a good place to find out why white rice over brown? Thanks!

    • btw -to clarify, I am not vegan
      have just been using vegan shakes to avoid as many allergens as possible.
      Was previously diagnosed with dairy and soy allergies, but after cutting down on them for years my last test was no longer positive for “allergies”. Which is what led doc to suggest getting rid of gluten and that has as I said made a HUGE difference.

    • Hi Anne,

      Wheat impacts Vitamin D levels, so going gluten free may help.

      PHD doesn’t promote higher protein consumption as you are doing with your vega shakes.
      If you are hungry during the day, consider taking some boiled eggs with you and a baggy with salt/pepper; peel an egg and shake it in the baggy. Boiled potatoes are good too although I never tried that. If I did I would probably cook them unpeeled and peel them when I want to eat one.

      Blood sugar issues can happen due to a lot of things; tatertot over at http://perfecthealthdiet.com/2010/10/everything-you-might-want-to-know-about-the-potato/comment-page-1/#comment-146641 has been successfully experimenting with resistent starch intake. Read the last page of comments as well for the current state of affairs.

      Personally I have normal glucose levels but sometimes when my diet isn’t all that I get hypoglyceamic-like symptoms. When I eat PHD-levels of safe starches (especially potatoes seem to agree with me well) and avoid fructose (sugar!) and alcohol the problems go away in a day or two.

      Brown rice is ok but does contain some toxins; white rice is almost pure starch and therefore safer. Use the google search box at the top of the page for a lot more discussions on the site.

      • Along with the resistant starch from potatoes
        Eating plenty of good fats like butter and sour cream will help stabilize your blood sugar.

    • hi anne,

      if your doctor has prescribed (& you are taking) Vitamin D2 (ergocalciferol),
      then your vitamin D test result (assuming ’25-hydroxyvitamin D’ aka 25(OH)D test), will probably not rise by much,
      you need to be taking Vitamin D3 (cholecalciferol), which is easy to get from health shops & chemists/pharmacies.

      google if you need refs,
      here’s one
      http://ajcn.nutrition.org/content/84/4/694.full

  19. Hi Paul:

    My wife has high triglycerides. I’m confused on implementing parts of the PHD:

    She is limited to 1 tbsp of coc oil/day. Can she eat other fats (avacado), egg yolks, and bone broth during the 16 hour fast? What if she doesn’t like the taste of bone broth?

    I’m confused on veggie intake. How are you supposed to eat plants like, collard green, kale, swisschard? Is it bad to blend these and other veggies in a blender and then drink (oxilates) with no fruit? It tastes nasty too. How would you recommend we eat a variety veggies if we don’t like bone broth soup? How much veggie intake do you recommend?

    • Eddie, most of the veges you eat should be well-cooked; sauteed, cooked in stews and casseroles, steamed, and so on. They lose little or none of their nutrition this way and are much more digestible, meaning you can get more in your diet.
      If you consume calories outside the 8 hour eating window, fat calories like those you suggest will do less to break the fast than if you ate carbohydrate or protein.

    • Hi Eddie,

      If she is hungry during the fast, I would suggest eating a small breakfast including some protein (eg eggs) and potassium (eg tomatoes or potatoes). If she is not hungry, there is no need to eat fats.

      If she doesn’t like bone broth, you are probably not making it properly. Try “cleaning” the bones with a brief simmer after which you discard the water and start with fresh water.

      Then, mix the completed broth, which should have a mild flavor, into foods. Use it wherever water or liquids might be called for in a recipe.

      It’s OK to juice vegetables.

      I don’t have a specific vegetable recommendation but it’s good to eat some with every meal. Cooked is better than raw.

  20. Hi Paul,

    I have just finished reading your PHD book… thank you very much, it makes so much sense and I plan to make this a way of life.

    I’ve been wondering for some time about the daily water consumption requirements and the wisdom of current, widely spread recommendations (e.g. at least 2-3 litres per day, or 1 litre per 23kg body weight – depending on the theory). This may be counter-intuitive to the hunter-gatherer and I’m not convinced that this much water would have been drunk per day.

    What is your view on daily water consumption requirements for a healthful body?

    Many thanks,
    Jodie

    • Hi Jodie,

      The key thing to be aware of is that our foods can contain a lot of water. If you’ve made rice in a rice cooker, you know it absorbs a lot of water, about 2/3 of the weight of white rice is water, thus it has 500 calorie per pound compared to about 1500 calories per pound from dry foods like flour products, bread, noodles. Similarly with potatoes (500 calories per pound), fruit (200 calories per pound), vegetables (cook them and watch the water come out). So in a natural whole foods diet we get a lot of water from food and don’t need to drink much. On processed food diets you typically need to drink a lot.

      The best thing to do is listen to your body, sample water from time to time and if it feels refreshing, drink more. When people become water-deficient on a whole foods diet, it is commonly due to electrolyte deficiencies, intense exercise, or drinking diuretics like alcohol, tea, coffee.

  21. Dear Paul,

    I used to be overweight ( 5’9 210 lb on SAD) and brought it down through a variety of means (first eschewing meat and losing all my muscle to 176, then VLC/semi-primal aside from PB and cheese to 157). I’ve read a lot of posts on your blog and they seem to make sense – and I do have a lot of trouble sleeping sometimes, but it’s usually in unfamiliar circumstances. I keep carbs around 50-80g and don’t really go higher than that these days, but nonetheless, I’d like to try transitioning into your diet for maintenance / reducing the last few pounds and gaining some muscle.

    Unfortunately, I’m on an extreme budget. Currently trying to save up as much as possible, so I make some less-than-ideal nutrition choices (cheese, PB). My usual food is like so:

    Breakfast – 2 eggs (hard-boiled, switched to pastured from local FM), 2/3 cup full fat greek yogurt, green tea with coconut oil, and half of a Damascus Flax Wrap with some cream cheese + bruschetta.
    Lunch – Two carrots, meal replacement drink (coconut milk, 2/3 of an avocado, 1 serving PB)
    Dinner – Texas chili on kale or spinach, 4 oz cheese (usually cheddar), sometimes orange or 1/2 cup frozen blueberries.

    I also exercise thrice a week according to PB recommendations – 2 sessions of 30-minute bodyweight exercises and 1 HIIT.

    What sort of substitutions could I make to optimize my diet in accordance with the recommendations you make? I was thinking swap out the cheese and PB for some cassava/yams/plantains/bananas, something like that. What do you say? Thanks for your time!

    (PS: I do intend on buying the book, but only after this summer semester stops breaking my head!)

    • Hi Aaron,

      The team over at MDA have blogged about eating healthy on a budget multiple times, here’s a good one: http://www.marksdailyapple.com/healthy-budget/

      I don’t think that flax wrap or the bruschetta is doing you any favors. Your lunch seems boring to me, are you doing the drink because of time constraints? It seems to me that there are nutrient-dense whole food alternatives that are just as quick to eat.

      chili are beans and thus not that great. When you say cheddar cheese, do you mean the industrial looks-like-rubber stuff? Some cheese is fine, but preferably aged cheese from raw milk.

      You don’t seem to eat much vegetables… Those are cheap and filling…

      Since you don’t have to lose weight any more, I think following the PHD principles of eating highly nourishing foods to appetite will help you maintain easily.

      • Hi Wout,

        Yeah, I’ve cut out the wrap and the bruschetta was just a novelty sort of thing. Yes, time constraints – usually I eat lunch during the year on a rapid basis so I can get more work done at work (teacher, don’t want to take TOO much grading home), and I can make a big load of the smoothie in one day and then drink it for a week, so it’s a big help.

        Texas-style chili is just beef, tomato paste, and chili powder + misc other spices. If you cook beans in texas-style chili, then they’ll probably tar and feather you.

        Adjusted menu is:
        breakfast:
        1/2 pound sweet potato / potato
        3/4 cup yogurt + 1 tbsp coconut oil
        2 eggs.

        lunch:
        coconut + avocado + blueberry + cocoa powder smoothie
        1 can of sardines or 1 salmon burger (sometimes: sprinkled feta)
        2 carrots (the big ones. I might up the dosage of these to 4, not certain)
        An orange or banana

        dinner:
        1/2 pound sweet potato / potato
        texas chili on top of kale (about 2 cups worth of kale) or spinach ( depending on cost; kale is the cheapest organic thing I can find at trader joe’s so I stick with it generally).

        Coconut oil or butter is often added to the potato, and coconut oil to the smoothie as needed.

        Thanks for your advice. It’s a good link.

  22. Hello, I am a long time follower of your blog and both of your books. I am finally in a good place in my life where I have the time and energy to work on my weight. I have played around with Paleo and other lower carb diets but I have found that my body seems to be craving exactly the percentages of protein/safe carbs/ fats that the PHD suggests. I need to get a significant amount of weight off quickly (around 100lbs.) for insurance reasons. I am working out quite a bit and now I need to seriously address my nutrition. After reading PHD advice to dieters, I am starting to think that I could actually join Weight Watchers and successfully use your plan. I would do so because I need to the emotional support to lose weight. I was wondering what your thoughts are on this combining of plans? Weight Watchers has recently created a whole foods component to their program and they promoter lower fat eating which agrees with your diet advice. I would love to hear anyone’s feed back on this issue! Thank you very much for taking the time to read this and comment!

  23. Hi Paul,
    I’ve been reading your book and am intrigued! I am starting to follow your recommendations for eating and hopeful that I can follow them faithfully!

    I’m wondering if you or any of your readers could recommend a protocol for starting the supplements you recommend? I wouldn’t want to start taking them all at one time, would I?
    Thanks,
    Sara

  24. Hi Paul, what do you think for Foie Gras? Is it equivalent to beef liver?
    Would you suggest cooking with duck fat or is that too high in Omega 6s?
    Do you think that sweetbreads help Thyroid on Ketogenic diet?

  25. New to PHD and SO confused about Omega 6 Oils!
    For years I have been taking fish, flax, and recently lineloic and Krill to help with eczema, dry eyes etc…I thought they are supposed to be ANTI inflammatory miracle pills… Not INflammatory and toxic
    I even put fish oil on my dog’s food to help with her allergies…
    Now I am afraid I have been poisoning myself and even worse my dog.
    It seemed like they helped my dog at least and the flax did seem to help with my dry eyes…
    should I cut them out altogether? It is so contrary to all I have been told/read that I am completely confused… 😥

  26. Are there any food tracking tools that users might recommend to help me monitor what I eat?

    Thanks!

  27. Dear Ann, Are you still there? I have an interesting web site for you: http://www.FastTractDigestion.com. They evaluate ‘fermentation potential’ for different foods. Jasmine rice is supposed to be very low, which is good.The interesting thing that I didn’t know is that cooking rice and potatoes ahead of time and cooling them causes something called resistant starch, which is fermented in the small intestine if you have sibo more than freshly made. I’ve been doing that since I’ve been trying the PHD.[cooking rice ahead and refrigerating it]
    Also, rice syrup may be a fermented product and be high in amines.Best wishes Natalie

    • Natalie, thank you so much for thinking of me. I will definitely explore this new source. Yikes on the rice syrup, which seems like it should be so easy on the digestion. I’m confused about the resistant starches…is refrigeration then bad for SIBO type issues? Ill get the book and learn..
      Interesting stuff… I’m actually about back to normal except for extreme constipation. I’ve finally got things moving by taking 600 mg of magnesium a day. Yikes, again. That is about three times what I could tolerate before this latest disaster I created through my experiment with fermentations. 🙂

      Take care, Ann C.

  28. Hey Paul. Maybe you’ll find this an interesting question. What would a person do to himself if he was accidentally on some diet that was low in potassium for a year, to the point of losing like .8 lbs a week?

  29. Hi Paul, I’ve been on the PH Diet for about a year now and eating more fat than usual, as well as recently 1-2 oz of liver x 2 / week and a couple of eggs a week, a tiny amount of regular fat cheese, butter, yogurt, all of which I had previously been avoiding. A year ago, an abdominal ultrasound of my gall bladder was normal. I am experiencing pain in the gall bladder area for the last few days (never before and I’m 61) and ultrasound just showed adenomyomatosis of the gall bladder (wall thickening and cystic spaces). Could this be due to the PH diet? Seems like a strong coindicence. I’m the same Donna whose cholesterol levels (LDL, oxidized LDL) went through the roof since being on this diet. Comments greatly appreciated.

  30. Hi paul
    i was wondering if youve had a chance to see this study. here is the conclusion they draw:
    “Our findings suggest that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease”. I mean who isnt??!!:)
    I’m eating 3 yolks per day as per PHD …is that wrong?

    http://www.atherosclerosis-journal.com/article/S0021-9150(12)00504-7/abstract

    • Hi David,

      I disagree. Egg yolks are fairly high in omega-6 as conventionally produced, so in the context of a high omega-6 diet they will add to the harm, but on a low omega-6 diet they should be quite good for you.

      • Thanks for your feedback Paul,

        “so in the context of a high omega-6 diet they will add to the harm” – it makes sense.

        It seems we should take some studies conclusions with a grain of salt. I remember also the fish oil increase prostate cancer study…

  31. Hello,

    just wanted to say I bought the book and I loved it but I did have one question?

    For the eggs (where we should eat 3 yolks a day) does it matter if they are cooked or does that ruin the effect?

    Thanks!
    Chris

  32. I just got the edition of the PHD with the weight loss advice. It was very interesting and I am going to start changing my diet right away. One thing I was so excited to see was that Bibimbap was recommended as a daily dish. My tutoring student who happened to be from Korea took me out to lunch at Christmas and introduced me to Bibimbap. It was literally the best thing that I have ever tasted and I felt oddly nourished while eating it. It was only after I devoured it that I got terribly ill from it due to the Gochujang sauce not being gluten free (I have Celiac Disease). So I am wondering does anyone have a gluten free Gochujang recipe?? And, can anyone tell me if all Gochujan sauce needs to be fermented for 6 months? I am excited to start eating it and 6 months is a long time to wait. Thank you so much for your help!!!

  33. Lithium for my insomnia experiment/trial update:
    ( originally discussed here http://perfecthealthdiet.com/q-a/comment-page-63/#comment-209793 )

    so i took 1/2 tab lithium (2.5 mg) around 11 am every day for 18 days (on days 2,3&4 i took 5 mg).

    i saw no change (good or bad) to my insomnia (sleep maintenance issues), so i am now looking elsewhere.

    i recently tested with high (above range) blood histamine, so i am delving in to that rabbit hole.
    i’m pretty sure i have elevated cortisol levels around the 24 hrs a day (had 4 x saliva & AM& PM blood cortisol test).
    So i am now thinking this could be because cortisol is trying to lower my histamine…24 hrs a day.

    So i am now looking at ways to lower my blood histamine levels,
    if i fix that, then maybe my cortisol may resolve itself & start following a good daily rhythm.

    • things i am currently looking at to lower high histamine (also called Histadelia & sometimes labelled as UnderMethylation);

      supplement with: Methionine, Inositol, Vitamin C, Calcium, Zinc, Magnesium, B6 (& p5p), TMG, Kava Kava,

      & Avoid/restrict: Choline, Lecithin, Folic acid, Histidine, dmae,

  34. Hi Paul & co,

    Do you have any dietary advice for prostate health?

    What could one do to reduce an enlarged prostate?

    Thanks

    Rick

  35. I use to be sort of strict Paleo and then I learned about the PHD. Lately I have gotten used to the idea if something is gluten free then it must be good for me which got me eating different gluten free breakfast cereals. http://www.kindsnacks.com/products/kind-store/healthy-grains/cinnamon-oat-clusters-with-flax-seeds.html I think it might have been a mistake because I seriously think it’s giving me leaky gut and I never got that even when I use to eat wheat. Are any of these good for you? Flax seed, amaranth, quinoa, oats, millet, sorghum and buckwheat. Also if I can find a cereal that does have good things that are approved the diet is gluten free rice milk and almond milk good?

    • Hi Keith,

      gluten free doesn’t necessarily mean good for you. To give just one example, the gluten free cookies in my supermarket use soybean flour instead. Yey.

      As to all of the “cereals” that you mention, the jury is still out. Typically these were eaten after a long soaking and souring, which we don’t do nowadays. Millet is goitrogenic BTW, and oats can also cause allergic reactions (probably everything in that list can). I like to make buckwheat pancakes every so often. I don’t think you should make any of these staple foods.

      Over at marksdailyapple.com there’s often “is it primal” articles describing what’s good or bad about certain foods. Non-sweetened almond milk was deemed ok iirc.

  36. Hi Paul:

    What are your thoughts on Ubiquinol supplementation and 100% pure camu camu fruit power containing:

    vitamin C – 120 mg
    quercepin – 20mg
    rutein- 30mg
    ellagic acid – 25mg

  37. Hello Paul,

    Recently, I’ve added Kombucha in my PHD routine. Anyway, I’ve experienced some weird weight gain, a lot of bloating, and some particular “toxic” fare…without anyelse food modification ,excepted kombucha.
    Could it be the bacteria in Kombucha that is not convenient to me ? I remember having read through the comments Q/A people talking about specific bacteria in gut that could cause weight variations ? I would really appreciate your advice, Paul. Thanks,

    Maya

    • Hi Maya, Kombucha is fermented with yeast and the fungi might be an issue for you. I’m not sure why some people will gain weight from kombucha and some not — have you had yeast infection problems?

      • Thanks Paul for your answer. No kind of yeast infection known…?!
        Do you think this gained pounds can be lost if Kombucha is stopped ..? I mean, do you think the previous gut flora can be normalized when kombucha is not drunk anymore. Thanks in advance.
        Maya

      • Yes, the perfect question to ask! A cautionary tale: After three full years of being completely symptom free of chronic yeast issues that led to vulvodynia and interstitial cystitis (treated for three years before that with weekly diflucan and etc.) I read the importance of fermented foods for the gut and started drinking kombucha as well as eating many other types of fermented foods. Within ten days I had a massive flareup (I had blood in my urine my bladder was so inflammed.) Anyway…long story short, those with yeast histories have to be very careful of increasing their fermented foods. Had another minor flareup by eating a very high quality, small organic farm’s yogurt, so even changing brands can have an impact.
        Ann C.

        • Hi Ann and Maya,
          And the same here. My indulgence in fermented foods (kombucha, yoghurt, kefir, pickles and kraut – all home made) ended up in massive yeast infection. It took a very strict diet, with very little carbohydrates and many antifungal remedies to control it. Now, I am working on finding out the causes of my poor digestion and chronic problems with yeast infections. It appears that it will be a long road and I am not certain that the carbohydrates allowed on PHD serve me well during the flare ups.

          • Dora, my story exactly. I saw the best specialists available and they had no clue how to help me other than diflucan treatments. Keeping oxalates relatively low was another important change I made as well as a moderately low carb diet for a long time. However, too low on the carbs and I do not feel well, light headed, dizzy, washed out…its a balancing act. Best of luck to you…chronic pain and itching “down there” is an incredibly hard way to live.

  38. Hi Dr.Jaminet,
    Since you have changed your stance on some of the purported risks of high carb diets since the release of your first book, I was wondering where you now stand on Glycation? Do you still believe that high carb diets necessarily raise HBA1C and glycation end products? OR is it only the non-safe starches like sugar and wheat?
    And do you think high carb diets necessarily raise fasting insulin too? Thanks.

  39. Dear Dr. Jaminet,
    I am just transitioning off 16 months on GAPS Diet for SIBO, disbiotic colon and effects of long term, undiagnosed Celiac Disease. I have also been diagnosed with chronic Lyme Disease, Epstein Barr related chronic fatigue and Fibromyalgia.
    My question relates to the effects of diet on atrial fib. Unless I have been on a low complex carbohydate diet, I have not had atrial fib. However, over the years I have tried Protein Power and Fat Flush diets for weight loss. Each time the intro protocol has led to atrial fib. I informed my doctor of this but went on GAPS anyway. After 2 months on GAPS and since I have atrial fib at least some of every 24 hour period. I have had a complete work up by a naturopathic cardiologist and am taking 1000mg of fish oil per day to keep my blood thin while I wait to see if my heart rhythm will return to normal as I add back rice, sweet potatoes, etc. into my diet. My doctors have never heard of this situation. Can you shed any light on it. I am hoping PHD will return me to a normal heart rhythm.
    Many Thanks. Your book is enlightening.
    Sharon

  40. Paul, was hoping you could respond. Sending this question again. Thanks, Donna
    Hi Paul, I’ve been on the PH Diet for about a year now and eating more fat than usual, as well as recently 1-2 oz of liver x 2 / week and a couple of eggs a week, a tiny amount of regular fat cheese, butter, yogurt, all of which I had previously been avoiding. A year ago, an abdominal ultrasound of my gall bladder was normal. I am experiencing pain in the gall bladder area for the last few days (never before and I’m 61) and ultrasound just showed adenomyomatosis of the gall bladder (wall thickening and cystic spaces). Could this be due to the PH diet? Seems like a strong coindicence. I’m the same Donna whose cholesterol levels (LDL, oxidized LDL) went through the roof since being on this diet. Comments greatly appreciated.

    • Google “liver flush”.

    • Donna,
      In the course of my own research I have begun to find it plausible that some people may be able to handle high intakes of dietary cholesterol every day over a long period, and that hepatobiliary complications may be among the results. There are benefits of being cholesterol-replete but perhaps not everyone conjugates and excretes cholesterol to the same extent. I get a sensation of tightness in the gall bladder and an elevated bilirubin and ALT count, but I can relieve this by supplementing quite small amounts of taurine – 500mg 2-3x daily. I can also relieve it by having a day eating only low-cholesterol, high fibre foods, though I prefer the taurine.
      Some of the research that led me to this conclusion is in the last 5 entries of my blog here http://hopefulgeranium.blogspot.co.nz/
      It may also be that milk products irritate the gall bladder in your case; certainly gluten sensitivity can cause gall bladder inflammation, and casein milk protein shares similarities.
      If taurine and/or cutting down on cholesterol relieves the pain, it is almost certainly due to cholesterol not being adequately eliminated, perhaps due to a reduced ability to synthesise taurine. Magnesium should also be supplemented.

      • Indeed, adenomyomatosis is cholesterol accumulation in the wall of the gall bladder itself, and though benign accompanies cholecystitis and gall stones.
        It really does look like something that can be relieved by taurine and temporarily resricting dietary cholesterol.

      • Thanks for this info, George. Interesting. I’ve been on a supplement for a few years now (CardioRhythm) that has about 800 mg of taurine in it (as well as Mg) and still developed this problem. I’ll increase the taurine and see if this helps. Sounds like you think I should avoid egg yolks for a while (? – I’ve only been have a couple a week), and avoid liver (I added it recently 1 1/2 oz x 2 wk)?? I have recently started a choline supplement & iodine supplement. I have eaten only small amounts of butter on PHD, changed from fat free to 2% yogurt (maybe a cup a day); added 1-2 oz cheese; but maybe I’ll try eliminate the dairy. I’ve been eating a little more beef on PHD but still less than 1 lb / week. I eat quite a lot of vegetables but added some potato, rice, and other root vegs on PHD – about 2-3 cups total a day. My ND has me on NAC (1,800 mg for a while – I’m to increase to 3,000 now) and she suggested I add Lecithin (nonGMO soy – what do you think?), Phosphatidyl Choline, Chanca Peidre, and Gold Coin Grass to flush the gall bladder. Paul still hasn’t responded – I would be interested to have him weigh in. Do you know any particular place I could re send my email that he will see it? Thanks.

        • Paul is very busy. I’m guessing he answers the easy ones and/or the most urgent ones and will get to yours when he has time. Good luck.

        • Hi Donna,

          I think NAC and lecithin are likely to be helpful. Lecithin has phospholipids and choline which should help export fats from the liver/gallbladder complex. NAC will help against SIBO and will also preserve vitamin C. I would test vitamin C to bowel tolerance and take about 1/10 that daily.

        • A couple of eggs – that’s not much. Eggs are a food where cholesterol is balanced with choline. Cottage cheese (and presumably similar plain, moist cheeses like feta and paneer) seem to be the best food sources of taurine.
          There is not a lot of cholesterol in your diet now you spell it out, I wouldn’t think that small amount could be problematic (sorry, I thought you’d been eating standard PHD for a year, but it’s more like you’ve been trying to get into it).
          So this is more of a mystery than I thought it was, with Paul’s suggestion of SIBO and infection making sense, as well as the supplements.

          • Thanks for you reply – No, you were right George. I did start out with full PHD (more eggs, saturated fat). As I just replied to Paul: I was on ‘full out’ PHD for about 8-9 months then reduced dietary fat and cholesterol because of sky high cholesterol & stalled weight loss, and added liver, Zn, choline, Brazil nuts, iodine about 6 months ago. Gall bladder pain just started 2 weeks ago. Now eating about 1200-1300 Cal, weight barely dropping (not even a lb / month), not hungry, still IF 8/24, about 2-3 cups of safe starch and fruit. Can only take small amounts of Vit C (500 mg daily divided with food) because of stomach issues. Stomach sensitivity improved a lot a few years back when I quadrupled probiotics – before than, zero tolerance for B or C supplements, citrus, pineapple, vinegar. Allergic to vinegar (mold). Otherwise no current digestive issues. Gluten free 6 years. To the outside observer of cause and effect, it sure seems like the increased dietary saturated fat and cholesterol has lead to the higher cholesterol (LDL and oxized LDL) and gall bladder thickening/cysts/pain. Pain is settling down in the last week with phosphotidlycholine, lecithin, chanca piedre. Have been on NAC for a year 1,800, increased to 3,000 about a month ago (for relentless hot flashes). Just too taurine up from 800mg/day to 2,500.

          • Some thoughts Donna – if serum LDL is high, this is cholesterol the liver (and gallbladder) is not taking up. You could lower it with more PUFA (maybe) but this would mean more being collected by the liver and going to the gallbladder. I don’t think saturated fat is responsible, but if the sources are high-cholesterol (like butter) this could add to the load. I’d be tempted to use high-MUFA, low-PUFA oils (with no cholesterol) like olive and avocado more, to keep bile flowing without contributing more cholesterol; and I’d also experiment with fish oil or cod liver oil – not PDH-spproved but this might be a stuation where it’s therapeutic.
            “Omega 3 fish oils – Fish oils reduce the formation of gallstones by enhancing bile flow and blocking cholesterol formation in the bile. A combined EPA-DHA fish oil supplement should be taken by anyone with gallstones, or risk factors for the development of gallstones.”
            http://www.drlisawatson.com/gallstones

            Or see here for more scientific explanation:
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC295492/
            I am not sure if this would help the condition you have but it might be worth assessing how much DHA and EPA you are getting.

          • Interesting. I’m just remembering that one other change I had made when I started the PHD was to pretty much stop taking the relatively large (2-3 tsp/day) Carlson’s fish oil (EPA + DHA) that I had been taking for years (opting for salmon once or twice a week instead). Perhaps I will add some back in. The oils / fats I’m having now (in small amounts) are olive, macadamia, avocado, a little coconut and butter, a little almond butter, and a (Mercola) Krill oil capsule. My ND has said she would like me to add in more fish oil as she doesn’t think there is enough in the Krill cap. I’m wondering if this change may also have contributed to the very recent gall bladder issue.

    • Hi Donna,

      My apologies for the late reply.

      First, to help with bile flow, I would supplement higher doses of vitamin C plus taurine and maybe glycine. For vitamin C, buy an ascorbic acid powder and mix it with water. You might do a test of bowel tolerance

      Second, to help with liver management of fats, I would supplement choline since you don’t eat many eggs. Try 650 mg/day.

      The usual reason LDL levels go up is eating too low carb. Be sure you get sufficient carbs in the diet. The other likely possibility is some sort of mineral deficiency, eg zinc, copper, selenium, iodine.

      Finally, the last reason for both high LDL and gallbladder issues is a SIBO or infection of the small intestine that has spread to the gallbladder. You generally want to improve digestive tract integrity by eating bone/joint/tendon soups and stews, taking vitamin C, and eating liver and getting sun or vitamin D from supplements for vitamins A and D (mucosal immunity).

      • No problem, Paul – I can imagine how busy you are. I was on ‘full out’ PHD for about 8-9 months then reduced dietary fat and cholesterol because of sky high cholesterol & stalled weight loss, and added liver, Zn, choline, Brazil nuts, iodine about 6 months ago. Gall bladder pain just started 2 weeks ago. Now eating about 1200-1300 Cal, weight barely dropping (not even a lb / month), not hungry, still IF 8/24, about 2-3 cups of safe starch and fruit. Can only take small amounts of Vit C (500 mg daily divided with food) because of stomach issues. Stomach sensitivity improved a lot a few years back when I quadrupled probiotics – before than, zero tolerance for B or C supplements, citrus, pineapple, vinegar. Allergic to vinegar (mold). Otherwise no current digestive issues. Gluten free 6 years. To the outside observer of cause and effect, it sure seems like the increased dietary saturated fat and cholesterol has lead to the higher cholesterol (LDL and oxized LDL) and gall bladder thickening/cysts/pain. Pain is settling down in the last week with phosphotidlycholine, lecithin, chanca piedre. Have been on NAC for a year 1,800, increased to 3,000 about a month ago (for relentless hot flashes). Just too taurine up from 800mg/day to 2,500.

  41. Dear Paul,
    I have a question on intermittent fasting and pregnancy. I’ve been practising intermittent fasting (16/8) for about 10 months now and it’s been easy and feels good. I’m now pregnant (very happy!) and am wondering, if this should change my fasting habits – so…
    1) Should I stop intermittent fasting and eat when I’m hungry? or
    2) Can I go on with intermittent fasting?
    3) If I go on intermittent fasting, would it be wise to eat when hungry or, as until now, ignore it and break fast after 16 hours? (I normally get a bit of hungry after around 12 hours fasting, which I take as a sign for my body then switching over to using excess food still available…)
    I haven’t found a hint in your pregnancy articles and discussions, therefore I’d be very greatful to know…
    Thanks a lot and all the best!

    Marion (from Berlin, Germany)

    • I’d be very interested to know about this as well. If I get hungry (not just “food sounds like it’d be fun to eat” but feeling some genuine, physical hunger), I take that as a sign that my body is switching *off* burning excess and needs more food again.

      Congratulations, Marion! I doubt that it would be advisable to fast during pregnancy, in part because it sounds exceptionally uncomfortable, but then I have wondered why there seems to be a modern “need” to eat frequently while pregnant. It just doesn’t seem like that should be necessary, so I wonder if perhaps it isn’t for somebody adequately nourished.

    • I’m interested in any insight Paul has on this as well. Just anecdotally, I did intermittent fasting while I was pregnant with no problems. But mostly it’s because I find eating this way to be natural and comfortable. If I eat two good meals with the supplemental foods then I simply am not hungry for dinner. If I was truly hungry for food, then I would eat a meal, but that very rarely happened.

      It’s not really “fasting” as we usually think of it because you’re not limiting calories, you’re just confining those calories to a specific time period.

      You might be interested in Jen Fulwiler’s post on how eating PHD got rid of her morning sickness.

      http://www.conversiondiary.com/how-i-mostly-cured-morning-sickness

      • Thanks, Elizabeth for your link! Very interesting…

      • elizabethe, that makes a whole lot of sense. Being able to tolerate reasonable periods without food is a sign of being well-nourished, so that probably confirms that you were eating great. I’m encouraged to hear that it’s possible to feel that way during pregnancy.

        • Amelia, it was a totally different experience from my first two pregnancies, when I wasn’t eating PHD. I was hungry all the time then. Eating PHD made a huge difference.

          • That’s wonderful. I’m nursing my first right now and still having to eat snacks between meals sometimes, though I’ve been eating PHD or close to it for quite a while. I really want to try IF to see if it helps with the extra weight gained from eating all the time when I was pregnant. Perhaps I have lingering nutrient deficiencies or something. I am transitioning to the high side of the recommended supplements and taking most of the optional ones, so perhaps that’ll resolve things over time.

  42. Paul – any plans to put out a PHD app for iPhone or iPad to help us track carbs, fats, etc? Thank you for all your great work!

  43. Hi Paul,
    I refer to your book that I bought last Dec, all the time and I have refined my Paleo approach to your recommendations.I have Rheumatoid Arthritis(never taken meds)I feel that I have thyroid issues as my TSH has gone from 1.6 to 2.5 12mnths later. So make sure have rice or sweet potato with eve meal and banana and 3 brazil nuts for an afternoon snack adding samphire a sea veg to my bone broth and homemade soup. I am 100%PHD,8hr eating period. I want to get better. Since May I have started with inflammation of the mouth, tongue,gums lips etc (Possible connection with thyroid?) and my RA is worse. I don’t know whether to look at food sensitivities and do an elimination/auto immune or GAPS intro diet. But really worry re lack of carbs. CKresser 30 day challenge takes out eggs, I eat 2 pastured duck eggs a day(relying on for choline etc) and nuts (selenium) I am also really skinny, can do without losing weight. Can you offer any advice Paul.
    Thanks Lynne

    • Hi Lynne,

      I do think it is important to eat sufficient carbs. We recommend about 1 pound of safe starches per day (eg white rice, white potato, taro). If you are worried you are too low-carb, you probably are. Thrush in the mouth is a frequent symptom of being too low carb. It may also reflect a vitamin C deficiency, so I would get powdered vitamin C and mix that into water to drink.

      Pastured duck eggs should be pretty good for you, if you are sensitive to them you should notice it after meals.

      Be sure to eat saturated fat, eg butter or beef fat or coconut milk, and do daily exercise. Tend to circadian rhythms as in our book.

      Best, Paul

      • Hi paul thanks for your reply.
        Yes, I will have been too low carb before I read your book but now do everything that you recommend – Thank you your book is a life saver. Circadian rhythms is the hardest change for me to address.
        Thanks for the reassurance re eggs. I never have digestive issues my problem is inflammation pain and swelling re the RA and now this burning mouth syndrome which I am sure is not thrush, rather burning inflammation which I presume is my immune system flaring and now causing a problem in my mouth and throat which is also now making RA joint symptoms worse. Just when I felt that I was on the up and feeling some control.
        That was why I was thinking maybe still had leaky gut and some food was an issue.
        But these challenges to identify food issues cut out the rice, potatoes banana etc. which if I do have a thyroid issue will make it worse. For vit c, apart from grapefruit and kiwi I take spoonful of camu camu berry powder(5grms) reported to be 20% vitc.
        I live on veg soups,bone broth, butter, coconut oil, solid bar creamed coconut, pastured waterbuffalo etc.
        I am a typical, total cholesterol risen dramatically over a couple of years from 174 to 275 my HDL is 95, trig 97 which I think makes my LDL approx 160 – too high so LDL hanging around not being cleared poss because needs to be attacking bacteria or thyroid hormone not making LDL receptors? since last yrs test my TSH has risen from 1.5 to 2.5. + some hair loss and now this burning mouth.
        Not sure how to progress.
        Have just started to take vit B12 oral spray as on lowish side, and take CoQ10, Prescript Assist probiotics and curcumin. lots of MSM powder and camu berry.
        My ferritin has gone from what I thought was high at 99 to 141, way too high and
        fibrinogen at an awful 5.5 Only way I see it is way too much inflammation affecting all markers
        I love my diet and eat positively from what I have read is nutritious re PHD.
        Paul I notice your book is now for sale in the UK. I ordered mine from US-no problem. But will leave an excellent review on amazon.co.uk
        If anyone needs help with meal breakdown of carbs, fat protein. google Livestrong.com my plate and enter food items eaten, excellent, couldn’t be simpler.
        Thanks for your time and any help appreciated.

        • Hi Lynne,

          More carbs will help with the LDL. So will some iodine (225 mcg/day) and other minerals – zinc and magnesium are probably the most likely to be deficient.

          I am not sure what is driving the RA so I would focus on the things that you know are wrong first. Be sure to normalize vitamin D levels, and tend to circadian rhythms.

          • Thanks for your time Paul,
            My vitD I think is ok at 127 (around 50 US measurement)it used to be low at 50mmol/L a couple of yrs ago and I took a supplement which included high doses of vitD and it shot up to 265mmol/L – I presumed from that experience that I didn’t have a problem absorbing vitamins. I will address the zinc and throw more sea veg in the pot.
            I had been concerned re iodine with autoimmune as thought may focus thyroid a target for immune attack – any thoughts?

  44. Hi Paul
    I was wondering what you make of a high fat’s det tendency to increase insulin resistance. As you may be aware the likes of Dr Banard have found that reducing fat allows insulin to do its work, this has to do with the level of ‘Intramyocellular lipids’.
    For a while, on a high fat, high carb diet, I found I’d suffer from candida/thrush on the tongue. This could be cleared in two ways, either I would need to cut out all sugars and most complex carbs or I would have to cut out all fats.
    More recently I found that if I cut out wheat and rice, I can eat more fats. Like fruit in the mornings, followed by a paleo diet for the rest of the day.
    On a low fat diet (say McDougall style) I find I’ll have more energy. On a low carb det however, I gain much more mental clarity.
    So both ends of the spectrum have their advantages.
    Then there is also the brachial artery reactivity test (BART) which show that a higher fat diet impedes circulation. Certainly the low fat vegans seem to have a glow about them suggesting more oxygen in the blood.
    So my question is what you make of all this? I’d hoped to find a middle ground but have yet to do so.

    • Hi Craig,

      “High fat diet” covers a multitude of diets, some good, some bad. It is really the obesogenic, diabetes causing diets, like the standard American diet, which elevate intracellular lipids and cause insulin resistance. PHD should minimize calorie intake and intracellular lipid content and make you fairly insulin sensitive if you consume our recommended amount of carbs.

      I wonder about the quality of your high-fat, high-carb diet if it gave you thrush. Your experiences on extreme diets are interesting but the benefits may not endure if you continued to eat that way for long; it takes many months for nutritional deficiencies to develop. The flow-mediated dilation studies I would say are hard to interpret because the meaningfulness of this biomarker has not been established, nor any connection to disease.

      I think PHD is the health-improving middle ground.

      • Yes, it may well be a middle ground. Sure the candida was worse on the relatively good SAD, but will also occur on a whole foods diet.
        Thanks

  45. Just wondering if Paul or anyone else can help clarify the fish oil situation.
    Even when I search the site I keep coming up confused?

    Krill oil Supplements – good or bad?

    I have been taken fish oil and/or flax oil for a while for various issues – most related to my chronically over zealous inflammatory response -skin, joints etc…I had always though they reduced inflammation…now I feel like I read they can CAUSE it? I also give my dog grizzly salmon oil on her food and it seems to help her coat and skin, but don’t want to keep using it if it is dangerous…
    should we not do ANY supplementation ? krill? Flax?
    any thoughts or points to links explaining all this would be much appreciated! thank you in advance (:

    • Hi Anne,

      Like anything else, they’re good for you up to a point and then too much can cause harm.

      We recommend eating salmon and other ocean fish because the fats are usually fresher than in capsules or bottles. Krill oil is among the best of omega-3 rich oils, but freshness is probably more important than source.

      I wouldn’t categorically say you shouldn’t supplement. Some people have an elevated need and some don’t like oily fish. But if you eat salmon and liver, I don’t think it’s necessary to supplement. And if you have an elevated need, you should address it as much by antioxidant supplements (zinc, vitamin C, vitamin E) and addressing sources of inflammation as by extra fish oil.

      Best, Paul

  46. Hi Paul,

    I have been going through your book and there is one question that I would greatly appreciate your help. It’s been bugging me for a while and I want to get the most out of my health. I am professional athlete and am willing to go above and beyond the level reached by normal people. I was wondering if you think the science of food combining really has benefits and is/will continue to help me get the most out of my food or do you think the high bouts of insulin from eating carbs alone is more detrimental in nature?

  47. Dr. Jaminet, can you comment on the purpose and how strict the intermittent fasting should be? Is it ok to have Dave Asprey’s version of coffee (~12 oz of coffee mixed with about 50g of grass-fed butter and 1 tbsp of MCT oil) first thing in the morning and then not eat until around noon? Coffee prepared that way is actually quite delicious and I’ve become accustomed to having it in the morning.

    If the purpose of IF is to stay in a state of ketosis for 16 hours then it would seem the coffee should be fine because it is high fat but almost no protein and no carbs. However, if there is some other metabolic advantage to a complete lack of all nutrients for that 16 hour period then maybe the coffee would not be recommended.

    Thanks for your time, your book, and the explanation of the science!

    • Hi Karl,

      The purpose of intermittent fasting is twofold, by confining food to an 8 hour daytime window it accentuates the circadian rhythm influence of meals (which are a powerful zeitgeber), and by transiently producing energy deprivation in cells it promotes autophagy which is a key element of immunity and longevity.

      The purpose of IF is not ketosis. If you want ketosis then you can eat an MCT oil rich diet (but doesn’t have to be taken during the fast).

      I support drinking coffee during a fast, but for most people I would recommend one with less fat than the bulletproof recipe. We add a bit of cream.

      • Thanks for that reply. I’m still reading through your book but have listened to almost all the podcasts you’ve been on and your ideas definitely make sense to me.

        I’m currently trying to transition from a year of a very low carb diet to a PHD version for various reasons (mainly it wasn’t working as well and my fasting glucose has been steadily increasing as you predicted it would). I know you said that you typically don’t eat until noon or 1pm but I find myself getting very hungry (and almost weak) by around 10am (that’s with drinking the high fat coffee). Usually I have a handful of Macadamia nuts and that sometimes helps although sometimes it makes me worse. So what else can I do to get me until noon? Should I just get up from my desk and go take a short walk in the sun? Luckily I live in Hawaii so that’s pretty easy for me to do 🙂

        • Hi Karl,
          I also could not tolerate morning fasting. Skip dinner instead. Big breakfast, big lunch, afternoon snack. I don’t eat after four. This just works better for me.

          If Paul wants to weigh in on this I’d love to here if there’s a reason to prefer to skip breakfast instead of dinner. But for me it’s skip dinner or don’t fast at all I simply get too hungry. If your been blc for a long time your body may be in serious crisis mode and really guarding against malnutrition,

          From reading these comments and listening to Paul’s podcasts you should always treat hunger that you can’t ignore as a strong signal that you need something,

          • Hi Elizabethe, I’ve experimented with morning fasting before and I’m wondering if it’s not more related to my high fat coffee or just a lack of movement. I’ve actually gone on a hike in the morning and seemed to do just fine (but no coffee that day). But sitting at my desk at work I tend to get hungry and sometimes even get a stomach ache along with it.

            But yes, I’ve been vlc (well under 50g/day) trying to maintain ketosis for about a year. But I had a very hard time keeping my blood ketone level over 1 mmol/L, possibly from eating too much protein. So while there are certain things I do like about a ketogenic diet, I’m starting to wonder if maybe it just doesn’t work for me (or more likely, I didn’t do it properly) because I just wasn’t feeling good. Hard to explain, but I just felt like something wasn’t right. So now I’m transitioning to the PHD method to see how my body reacts.

            And for the record, I just started adding starches in 3 days ago so I’m still in the early stages but my body is definitely reacting. Without getting into many details, I’ll just say my stool hasn’t been the same but hopefully that is just from the transition as my body adjusts.

  48. What is thought of about sequential eating ideas?

    Thoughts appreciated…

    • I find this an interesting topic, too. I came across Dr.Bass and its findings about sequential eating. Very interesting but would love to hear someone with a more scientific background. Paul? :mrgreen:

  49. After listening to this: http://www.youtube.com/watch?v=m5ppuzNUzsc

    I’m considering getting the Cyrex cross-reativity test. I have been gluten-free for 20 years, but who knows where something has passed without my realizing it. But, certainly, largely gluten-free but still have some joint pain. Foods included on the possible cross-reactivity list are potatoes, rice, and eggs.

    Question for Paul: Can you make suggestions for the numerous people with problems with these foods? How do we get those nutrients if we are advised to avoid those foods? Hoping such a restriction would be temporary.

    Question for Paul: Did you see my question about xanthelasma? Ideas about prevention? It is a recent phenomenon, maybe associated with my increased saturated fat intake.

    thanks 😎 Sunglasses hide the two spots of xanthelasma 🙂

    • Lana,

      Have you tried going nightshade free for the residual joint pain?

      • Yes, and it did help; but then, too, for a long time potatoes did not bother me. I’m thinking it is more the cross-reactivity thing than the nightshade thing.

        I’m typing a reply to you heberden’s nodes post, so watch for it. 🙂

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