Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


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

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

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

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

Warmest Regards,


Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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


Hi G,

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

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

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


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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?


  1. Hi Paul,

    I wanted to mention 2 supplemental foods, maybe you might want to consider adding these to your lists. Even though they are sugary, they are whole foods and are rich sources of potassium and calcium.

    1-Blackstrap Molasses. The Wholesome brand’s molasses has 730 mg Potassium and 115 mg Calcium in only 1 tablespoon.

    2-Coconut Water. 8 oz of it contains 540 mg Potassium


  2. Hi Paul,

    I seem to have something called Grover’s Disease, aka acantholytic dermatosis. I get itchy bumps on my trunk that come and go. Sweat is definitely the main trigger. In December I began working out at the gym after a long hiatus, and am having a flare up. I took a weeklong break from the gym and the bumps subsided. Now back at the gym and itchiness is back. I think winter dry skin is also a factor. Dermatologists don’t know what causes it and prescribe steroid creams. I wondered if you had any thoughts from a PHD point of view. Fortunately my case is quite mild. Some people suffer terribly with it. Still, it’s irritating.


  3. Paul, I’d like to get your input about this. Let me say first that I’m not much interested in lab-cultured meat, and I don’t have a problem with humanely raised and slaughtered animals. But some others seem to think this type of product will be great, and I have my doubts about whether for them, this will really match the nutritional profile of meat from a genuine, well fed and raised animal. What if any problems or potential do you see with this concept?

  4. Hello Paul,

    What is your opinion on the idea of food combining? Especially some say that starch and protein should not be combined, and also, is combining sugary foods such as fruits with protein/starch/fat problematic?

    Thank you,

  5. Hi Paul,

    When the potatoes start to sprout or discoloration starts, is it okay to still eat them after completely peeling those sprouted and discolored areas from the potato?

    Thank you,

  6. Hi Paul,

    I read that you recommend calorie restriction for weight loss by restricting fat. But I also heard from you that Intermittent Fasting provides the same benefits as calorie restriction. Does this mean if I’m doing Intermittent Fasting, I do not need to restrict calories by reducing fats in order to lose weight?


    • Hi Ben,

      Calorie restriction has more benefits than just weight loss; from wikipedia (https://en.wikipedia.org/wiki/Calorie_restriction): “…Calorie restriction without malnutrition has been shown to work in a variety of species, among them yeast, fish, rodents and dogs to decelerate the biological aging process, resulting in longer maintenance of youthful health and an increase in both median and maximum lifespan…”

      I’m pretty sure Paul said these benefits of calorie restriction can be obtained from intermittent fasting.

      However to loose weight, you will still need to restrict calories, preferably by reducing fat. Of course intermittent fasting will make it easier to restrict calories; but if you fully compensate for the shortened eating window by eating more during the feeding window, so as to achieve the same caloric intake as before, you probably won’t loose weight.


  7. Hello Paul,

    I almost never saw you talk about insoluble fiber, whether it’s beneficial or not, what is your view on it? You only talk on the benefits of soluble fibers (resistant starch etc.) I know you view cereal grain roughage as unhealthy, but roughage also exists in vegetables, is that not the same thing? Is insoluble fiber not necessary for regularity, to keep the bowels moving? I understand that we may not need too much of it as conventionally recommended, but don’t we need some of it? I heard that it’s best to eat insoluble fiber with meat, since it will cause the meat to move through the intestines faster, and if insoluble fiber is not eaten along with meat, the meat goes much slower in the intestines, starts to rot, and release toxins. What is your opinion?

    Thank you for your time

  8. Hello,

    I see that you now recommend 50,000 IU Vitamin A weekly (from cod liver oil) for people who do not eat liver, can you please check the link if the product is acceptable? It has 25,000 IU Vitamin A in each capsule from “fish liver oil”, I am guessing that’s retinol right? Is it a good strategy to take 2 capsules of this, once a week? I could not find any other cod/fish liver oil product that would provide 50,000 IU Vitamin A weekly.


    Thank you so much,


  9. Hello Paul,

    In the book, one of the reasons why you recommend avoiding brown rice is because of phytates “Phytin is responsible for the observed poorer mineral balance of subject fed brown rice diets in comparison to that of subjects fed milled rice diets” Does this mean phytic acid binds to minerals in the foods we eat and that’s why it causes mineral imbalances?

    Yet I have also read from you that phytic acid in foods already come bound to minerals, and does not bind to any other extra minerals in the foods we eat, the only thing it does is it does not give away the mineral it is already bound to to the body, it does not chelate additional minerals, and therefore you mentioned it does not cause significant issues.

    This is confusing and contradicting, can you please clarify?

    Thank you

  10. Hello Paul,

    Even though you recommend drinking bone broth as a source of calcium, I’m now reading everywhere that bone broth actually contains very little calcium, is this true?

    • Also, are you not concerned about lead in bone broth?

      Thank you

    • Hi Nicole,

      I think it depends on how it is made. The data is inconsistent. People have gotten calcium poisoning from too much in bone broth, and there have also been batches measured to have very little calcium.

      • Thank you for your answer!

        So how do we make sure that the broth has enough calcium then? How does it need to be made? And meanwhile, how do we avoid huge amounts of calcium in the broth in order to not get calcium poisoning?

  11. Hi Paul,

    When supplementing Choline, which form would you recommend the most? It is somewhat confusing, phosphatidylcholine is the form found in foods, and for that reason I believe it might be the most suitable form to supplement. How would you compare this to Choline Bitartrate?

    Many other sources recommend using Alpha-GPC or Citicoline, these forms of choline are very bioavailable and pass the blood-brain barrier directly, rapidly increasing acetylcholine levels, and that’s why they recommend these forms over other forms. But since this is not a very natural way to give choline to the body, I’m not sure if this is a good thing in the long term, providing choline to the brain directly might create side effects in our brain chemistry in the long term.

    Could you please share your opinion?

    Thank you

  12. Hello Paul,

    Do you think calcium (limescale) rich water is harmful for health?

    Thank you in advance

    • Well, most people are slightly deficient in calcium, but limescale could easily lead to an overdose. Commercial mineral waters such as Gerolsteiner have just the right amount of calcium to optimize calcium status.

  13. Hello Paul,

    My diet is not rich in selenium-rich foods you mentioned, for fish I only eat salmon twice a week for omega-3, almost no shellfish, almost no eggs (I supplement choline instead), and no kidneys. Do you think I should supplement Selenium more than once a week, or is that sufficient? Would 200mcg/day supplementation be too much?


  14. Hello Paul,

    Regarding your recommendation on lowering mammalian meats for people with Hashimoto’s because of Neu5gc, I got a little confused, did you mean they should lower mammalian meats temporarily (only for a few months) or they should lower/eliminate them for life?

    Thank you

    • Hi Alex,

      No, you should reduce them until the SIBO or gut microbiome overgrowth/infection that caused the hypothyroidism is gone. That could be months or it could be years on PHD; it would probably be never on standard diets and lifestyles.

      Best, Paul

      • Thank you for your reply.

        Do you think Fecal Transplants could cure this infection/microbiome overgrowth very rapidly?

  15. Paul, r
    Following up on your response to Alex about Hashi’s and mammalian meats…

    If someone has SIBO and is sub clinically hypo (TSH is ~4.5, some hypo symptoms like heat dysregulation, but other thyroid test numbers are not compelling) but does NOT have Hashi’s, what is the recommendation?

    Normal PHD vs. more modest mammalian meats and dairy vs abstinence? Which approach is recommended?
    Thank you!

  16. Hi Paul,

    Are you familiar with the so called Wilsons’s Syndrome? The proponents of it believe that temporary T3 hormone supplementation will fix thyroid issues. Could you share your opinion?

    Thank you

  17. David Andrews

    Paul, I’m asking for a friend whose adult daughter has a bad case of scleritis, possibly autoimmune. They have tried a variety of approaches, lately using rituxan. Do you have any suggestions? They are getting desperate, as you can imagine.

  18. Hi Paul,

    In your supplemental foods list, there is:

    “¼ lb beef or lamb liver, weekly (copper, vitamin A, folate, choline). If you like, substitute ¼ lb chicken, duck, or goose liver weekly plus 30 g 85% dark chocolate daily”

    Does this mean if one is eating 1/4 lb beef liver weekly, one should limit their chocolate intake because of possible copper toxicity? You do not mention that I believe and it confused me. What would be the limit? I am also taking 15 mg Zinc daily, so do you think the additional copper from chocolate will still cause issues?

    Thank you

  19. I need to be on a gluten-free diet. I can’t find any mention of one of my staples– quinoa; as well as chia and some of the other ancient grains. Can they be eaten in moderation? I find rice bread almost like cardboard.

    • I think in the western culture we are used to eating bread but many cultures eg in Asia didn’t eat bread. Eg a Korean friend of mine said her breakfast was dumplings and lunch and dinner was rice based. No bread. A Philippino I know refuses sandwiches for lunch to work and brings a rice dish instead. He didn’t grow up eating bread. When I started improving my diet I found bread needed to go. When I need to make packed lunch I make a rice meal and put in a thermos.
      Regarding grains I have read Paul say buckwheat is OK on occasion. And to make bread PHD it doesn’t need to be just rice flour. Add potato and or tapioca starch which Paul approves of. It really improves the texture of bread or cakes. The gluten free flour I buy contains a mix of the 3 flours I mentioned but baked goods are a rare treat rather than a daily staple.

  20. Hi Paul,

    Which form of Vitamin C do you recommend? Ascorbic Acid?

    I’m currently taking a whole food Vitamin C supplement (made from berries). I take 1.5 tsp daily which provides 720 mg Vitamin C. Do you believe the bioflavonoids are beneficial and have synergistic effects with Vitamin C? Could you please tell me if this is good to take or should I switch to pure ascorbic acid?


    Thank you

  21. Hello Paul,

    Do you consider cruciferous vegetables essential (broccoli, brussel sprouts etc.) because of their unique phytonutrients? Is it okay if I do not eat them?

    Thank you,

    • Hi Orhan,

      You want to eat a diversity of vegetables, but it’s OK not to eat cruciferous vegetables as long as you get a diversity of other types.

      • Thank you for your answer Paul,

        The vegetables I consume regularly are:

        -Green Onion
        -Red/Green Bell Peppers
        -Dill pickles (fermented)

        I also eat a variety of fruits, berries, herbs, and spices. Do you consider this list diverse enough?

  22. Paul,

    What are your thoughts on Pyroluria? Is it a real condition and what is the best way to treat it? I know the standard protocol calls for large amounts of supplemental zinc, B6, and GLA. Can this disease be treated with diet alone?


  23. Dr. Jaminet,

    I have been reading about Leptin recently and feel that I may be Leptin resistant. I see that there is a program on Dr. Jack Kruse’s website for a Leptin-reset diet involving a BF of at least 50 grams of protein, spacing meals about 5 hours apart, eating less than 50 grams of carbs a day, and no eating after 7 p.m. In the past I have practiced IF only eating a lite lunch ocassionally and a large supper. But, on this program IF is discouraged until Leptin sensitivity returns and even then it is recommended to not skip BF. What is your opinion on this and what different tips would you offer if any.


  24. Has anyone outhere followed PHD and gotten help with Epstein Barr Virus by way of less flare-ups?

  25. Hello Paul,

    I’m a little confused about the difference between fermented and pickled vegetables, are they the same thing? If not, what is the difference? Do both have lactic acid?

  26. Hello Paul,

    How often do you suggest donating blood in order to control iron levels? Also, is this a suggestion for everyone (including healthy people), or only for some people with certain conditions?

    Thank you

    • My personal experience- I donated blood 9 times in 18 months. I had an iron test done as part of a physical and was near anemic. I started with a ferritin close to 260. I plan to donate twice a year at this point. You may want to test your ferritin level before you start, and then test it after a few donations to see where you are at.
      I suspect I had iron stores built up over years on the SAD, and since going gluten free and eating a better diet, I am consuming less iron.

    • My personal view, to be safe, do not rely on the ferritin test alone,
      get an iron panel done as well.
      High ferritin can also indicate inflammation,
      so it is possible to have high ferritin, but also be iron deficient/anemic

    • Just a crazy side note here…a friend (not on PHD) has Crohn’s and has been experiencing neuropathy, weight loss and loss of appetite and running every test under the sun, including MRIs, etc. Only thing that came up on her tests as abnormal was high iron, like up around 500-600. No one could explain that and I suggested that she might look into whether she has hemachromatosis and should donate blood regularly since she appeared to fit the profile. She didn’t, but soon thereafter she caught herself eating a handful of dried apricots, which had been one of the only things she’d desired to eat — for weeks. So she called her Dr and asked if that could cause a temporary rise in Iron, and of course he said yes, and to stop eating them! She retested 1 week later, and her iron had dropped down to the mid-normal range. Just in case anyone was wondering, your food and supplement intake can definitely skew test results!

  27. If one can’t eat liver is a desiccated liver supplement acceptable?

  28. Any suggestions for dealing with Mastocytosis? My 30 yr old niece was just diagnosed with that, Celiac Disease and Barrett’s Esophagus with cancer cells present. She’s still waiting for bone marrow results for specific type of Mastocytosis. It first turned up in skin biopsies. She said the diet they gave her was meat and some vegetables. Apparently she can’t take anything at all for pain, severe headaches including for bone marrow retrieval!

  29. Paul:

    Would you please expound upon any benefits and drawbacks associated with consuming raw, organic seeds, specifically pumpkin and sunflower? If there are any other seeds that you would particularly recommend or avoid?

    Many thanks in advance of your reply,

    • Hi Chris,

      In general, PHD recommends avoiding seeds, which are often rich in toxins like omega-6 polyunsaturated fat (e.g. pumpkin seeds, sunflower seeds, sesame seeds, or walnuts), antinutritional factors (e.g. wheat, corn, or soybeans), or both.

      The two exceptions are:

      1. Cooked white rice. From the Food and Agriculture Organization of the United Nations (http://www.fao.org/docrep/t0567e/T0567E0g.htm#Antinutrition factors):

      “Antinutrition factors in the rice grain are concentrated in the bran fraction… [and] are subject to heat denaturation

      …Steaming rice bran for 6 minutes at 100°C inactivates the trypsin inhibitor…

      …Rice-bran [haemagglutinin-] lectin… sharply loses activity after 30 minutes at 80°C or 2 minutes at 100°C…”

      Milling plus cooking effectively destroys rice toxins; rice should not be eaten raw, but cooked white rice is safe.

      2. Certain tree nuts like macadamia nuts, which are low in omega-6 polyunsaturated fat and probably also low in antinutritional factors.

      There would be no benefit here to consuming them raw. And there is probably more risk; the complete list of antinutritional factors in tree nuts is not known, and as suggested from the above example of rice, cooking may help detoxify them.


  30. Hi Paul,

    Are you familiar with Kosher/Halal meat? In Jewish and Islamic traditions, during slaughtering, first the animal is drained of all blood (with a cut in the neck) before cutting. Do you believe this removal of blood might have any health benefits?

    Thank you

  31. Julie Couillard

    Good Morning – I order prepared meals from a delivery service that has Paleo and very healthy meals. They use grapeseed oil in their preparations. Can you advise if this is acceptable as part of the PHD diet plan. My doctor has put me on this plan to get my health and energy back in line.

    Thank you, Julie

  32. Richard Vermeulen


    What do you think of powdered egg yolk (spray dried) are they acceptable, even if not as good as fresh?

    Kind regards


  33. Hello Paul,

    I have recently bought your book and am very interested in introducing safe starches back into my diet after almost four years of ‘yo-yo low-carbing’. I have experienced the good effects from low-carb eating after having lowered my HBa1c from 6.0 to 5.5 since I had been diagnosed in 2012 and managed to shed 45-50 lbs.

    However, I have been experiencing some recent problems that I can no longer ignore. For starters:
    *1 – I suspect I have some kind of pernicious electrolyte imbalance as my heart’s pounding in my chest, general weakness, anxiety, headaches, and (just five mins ago) toe cramps.
    *2 – In the past I have been diagnosed with GERD but back then I was eating more grain-based products so no surprise! However, a month ago, I had started regaining some weight after ‘overdosing’ on nuts, nut butters and dark chocolate, and to counteract that I was eating nothing but eggs, bacon, other meat, and a sprinkling of vegetables.
    *3 – I joke to myself that I’m a reptile since I’m usually the coldest in a room, but recently I’m starting to wonder if my thyroid is caput since I’ve been having dry skin, general weakness, etc.

    I reintroduced potatoes into my diet three days ago (about 330g), and while I have seen some improvements (heart palpitations died down for the most part) I’m not sure I feel better on it. I feel more tired than ever, feel bigger than ever, and now wake up with headaches.

    I believe my body naturally wants to head in the lower-carb version of the PHD, but I am terrified of becoming diabetic by reintroducing starches. What would your recommendation be for a woman in her mid-twenties who is of Caribbean heritage, still in the obese range– I’m 5ft 4in, pre-diabetic (though in normal range as of Jan 2016) and has a history of gut issues and hypothyroid symptoms (despite being in the ‘normal’ range as of Jan 2016).

    Sorry for the long post and I understand if you can’t answer in specifics.



    • Hi SS,

      I do think you need more carbs. It is essential for overall immunity and health of your gut and the gut microbiome. So you will need the carbs for healthy long-term weight loss.

      You will not feel better until your gut health has improved. Headaches are an inflammatory symptom. Getting rid of the gut inflammation will take a little time, but you can fix that.

      Try these interventions along with the carbs: 3 egg yolks per day, 2-4 tbsp vinegar per day mixed on meals, 1 g taurine per day, 5 g glycine per day, 2-4 g vitamin C per day, iodine 225 mcg/day, vitamins A, D, an K per PHD recommendations, intermittent fasting, circadian rhythm entrainment. See our book for the last.

      The “normal” range of TSH is too broad and you will probably benefit from treatment with levothyroxine if your TSH is 3 or higher. Look up symptoms of hypothyroidism and tell your doctor which you have in order to get a prescription.

      Best, Paul

      • Dear Paul,

        Thank you for your response! I did some additional tests today so I will be following up with my doctor once I get my results. I’ve had gut issues since I can remember but I definitely understand the role my gut plays in my overall health and well being. As for your other suggestions, I will be following up on them.

        Thanks again for your detailed advice!!

        SS 😀

  34. I’ve been supplementing with choline and inositol the past week and I feel GREAT. The brain fog, fatigue and low motivation are pretty much gone, but I’ve just been told that choline supplements aren’t a good idea when you have a peptic ulcer because it increases stomach acid. I wonder how true that is. 🙁

  35. Hi Paul,

    Do you have any estimates for the peak health ranges of the various B vitamins? (I couldn’t seem to find this information in the book…)


    • …My reason for asking was that the book says it should be possible to be optimally nourished on food only; yet the recommended B-vitamin supplements work out to around 10 times the RDA per day for B1/B2/B6, 30 times the RDA for biotin and B12, and 100 times the RDA for pantothenic acid; in comparison, even with extremely careful food selection, I doubt you would be able to attain more on PHD than about double the RDA for B1, about triple for B2 and pantothenic acid, about 5 times for biotin and B6, or about 20 for B12. Except for B12, these doses are fairly far apart, especially for B1 (2x versus 10x) and pantothenic acid (3x versus 100x).

      Does that mean there are no benefits to supplementation beyond double or triple the RDA for most of the B vitamins, and supplements are intended just to ensure this level of intake (so with careful food selection — especially when it comes to B1 and pantothenic acid — there would be no reason for supplements)? Or there are no benefits for healthy individuals, but potential benefits in disease conditions and a low enough risk that everyone should supplement even with careful food selection? Ot could be a mix — the first for some B vitamins, and the second for others. But which fall into which category? And are there nutrient-nutrient interactions which would make it safest to supplement more of them?

      B12 malabsorption — affecting absorption of protein-bound B12 from food, but not free B12 from supplements! — looks common enough and serious enough that the benefits of B12 supplements probably outweigh the risks even for those obtaining 20 times the RDA from food alone. So I assume B12 at least would belong in the second category.

      If pantothenic acid belongs to the second category, then nutrient-nutrient interactions would probably put biotin there too — since biotin and pantothenic acid compete for absorption, supplementing biotin + pantothenic acid would probably be less-risky than supplementing just pantothenic acid.

  36. Is there a post anywhere explaining what aspect of the diet are crucial during pregnancy, and what changes. I have seen the post about limiting protein, and other articles under pregnancy.

  37. Paul, do you still believe that carbs are essential to overall good health, and the lack thereof could result in some cancers down the line? Dr Mercola has seemingly to a shift back to no starchy carbs and pro keto from what I can see. I follow your diet to a T, I just have a few issues I know go away with a keto approach.

    • Yes, carbs are essential to long-term good health. Keto diets can be therapeutic but it’s generally best to do keto intermittently, much as you do fasting intermittently.

  38. Hi Paul, I have been taking magnesium bis-glycinate, which has stearate as a non medical ingredient.
    Dr Mercola has just come out with a recommendation against mag with stearate and recommends L-Threonate. Any comments please, if you would change to this one what dose

    • Yes, Paul, I’d love to hear you weigh in on the magnesium l-threonate. I’ve tried the elemental ionic ReMag (Carolyn Dean) and the l-threonate, but can’t tell the difference in daily life. Thanks!

  39. There are rumours that there is a lot of arsenicum in all kinds of rice, due to the use of pesticides which worsened the soil condition.Is this true and is rice still safe to eat?

  40. Hi,

    Anyone know anything about getting hives while breastfeeding? I’d love to get rid of them without having to take Claritin (my doctor’s suggestion). There is anecdotal evidence of them happening on forums, but I can’t find much in the way of treating naturally or with diet. Help! It makes for a very uncomfortable experience that should be about bonding.

  41. My thyroid numbers are good but I have a multi-nodular goiter. Is there a way to improve or heal this naturally?


  42. Diane Stegmaier

    I have signed up for the newsletter and never received it. I thought perhaps I forgot to sign up, but when I tried again today a screen told me I was already signed up. I do not know how else to contact you except on this comments page.

    • Hi Diane,

      I have been too busy to create issues of the newsletter, also new blog posts. Don’t worry, when I have time to send something out, you’ll get it.

      Best, Paul

  43. Hey Paul,
    My friend is Zack’s mother he uses this diet bc of nbia, could this diet help anyone who has epilepsy??

  44. What is your opinion about wheatgrass juice? I am concerned about your statements about toxins that were developed as defense mechanisms by grasses.

  45. HI Paul,

    I’m taking a 5-day course of a sulfa antibiotics for a staph infection. I wanted to forgo them, but my doctor was persuasive. Is there anything I can do to protect my good gut flora? I keep hearing that probiotics don’t actually have much effect. Any suggestions you have would be very much appreciated.

    All best,

  46. Hello Paul,

    Is it best to take NAC on empty stomach (while fasting)? Just like you would with glutathione for example.



  47. Hi Paul,

    I have high TSH (changes between 4.7 – 7) I just started taking levothyroxine, how much levothyroxine would you recommend I take? I also recently started PHD. I’m very overweight [275 lbs (190 lbs lean body mass)], and my height is 6’1, and I’m male. I’m currently taking 50 mcg a day, do you think this is too little for my size? Some online sources calculated my daily need to be around 130 mcg by considering my weight and so on, is that too much?

    Thank you,

    • Find the lowest dose that relieves symptoms. It will usually lead to a TSH around 2.0.

    • Circulating serum TSH alone is not sufficient to set up a diagnosis and decide upon a therapy. Some labs may be able to measure bioactive TSH separately. Others can give you a fuller picture of thyroid function by measuring free T4, free T3, reverse T3, TPO antibodies, TGAB etc. Treatment options may include levothyroxine-only treatment, a combined levothyroxine-triiodothyronine treatment, or natural desiccated thyroid.

      Prescribing levothyroxine only, based on TSH alone, is common but not the best practice.

      You can read about this in more detail here:

      • Fantastic reply, Zoltan. There is enough evidence and patients’ feedback to know that TSH lab test and Levothyroxin only as a treatment does not serve a great number of people.
        Dissapointing that Paul is repeting the conventional medicine party line.

  48. Paul,

    If one is Leptin resistant is it best to hold off on intermittent fasting until Leptin sensitivity is regained?


  49. Sabreen Abu Qandil

    Dear Paul,
    I am Sabreen, 23 years old from Nazareth. I started reading PHD book a few weeks ago. First of all thank you for writing such an easy to understand book, which contain a lot of beneficial information about the relationship between our diet and our body health.
    When I bought the book I only thought about losing weight, but I was surprised by many reports, which contain responses from people who tried your diet and was healed from various illnesses.
    In relation to that, I suffer from several health problems such as inflammation of the cartilage (in the shoulder and neck area), Constipation and acne. I tried a lot of medicine but it only had temporal results.
    I am looking forward to finish reading the book and start with the diet that at the beginning of the book you mention that bread and any kind of grain shouldn’t be eaten. This is a huge challenge, because bread is an essential part of my daily routine. In other words, I eat bread with every meal and I find it challenging to remove it entirely from my diet. I hope that you might help with a piece of advice.

    • Hi Sabreen,

      Try implementing the diet with the single difference of including bread among your safe starches. The biggest benefits of PHD come from improving nutrition and those benefits do not depend on total exclusion of bread. once you have implemented the rest of the diet, if your health is still not right then try an experiment replacing bread with natural whole food starches like potatoes, rice, and well prepared lentils, chickpeas, and beans.

      Best, Paul

  50. Hi Paul, what would you recommend for someone who is suffering with runny nose, feeling run down etc after starting work at a building site where there is dust, toxic glues and paints. Do you think extra doses of Vit C would help for detox or something else? And tips greatly appreciated. Thank you

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