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. I am following a “parasite cleanse” using an expensive product. So I want to follow their directives, but when I saw their list of foods to avoid and “red meat” was on it, I started reading other people’s lists.

    Every parasite protocol has its variation of foods to avoid during a cleanse. Meat is not always on every list. HOWEVER, many exclude dairy. My product’s box doesn’t list dairy. Now I am wondering whether my homemade dairy kefir is detrimental?

  2. Hi my fellow Bostonian. I am a 32 year old male and I really need your help. I started allergy shots June 2015 and they haven’t helped much, I am allergic to trees, grass, weeds, mold, cats, dogs, I still get them every 3 weeks. Then 6 months after that my dermatologist prescribed me antibiotics for Hidradenitis suppurativa which I was only on for 2 months before getting off of them January 2016.

    In mid January 2016 I started getting crepitus in my knees with every step, then a few months later in my neck, then shoulders, elbow, wrist, ankle. All in the span of 6 months. Do you think the allergy shots are causing this? If so I’d want to get off right away or do you think it was the antibiotics that gave me candida? I also have joint pain in my hands and neck and numbness in calf, hands, chest, back on and off.

    I saw orthopedic doctors and I don’t have arthritis. I saw a Rheumatologist and I don’t have an autoimmune disease. I’ve been tested for lyme 3 times this past year and don’t have that either. Had emg tests and all my nerves are fine. Really don’t know what’s causing this. What do you think it is and better yet can I fix things? I’d really would like to try your diet for the joint issues and allergy and acne ones, but should I do the candida diet first? Please help me out I feel like I’ve lost control of my life and am really depressed about it.

    I will say I am also obese at 6ft 315 pounds and I gained about 80 pounds in the last 4 years so maybe it’s the weight ruining my joints. No idea I just really need your help.

    • Hi Ryan,

      There’s a lot going on and it’s impossible to make a specific diagnosis, but you should eat PHD and live our lifestyle (read the book), also be sure to eat three to five egg yolks a day, 1/4 lb liver per week, and supplement glycine, N-acetylcysteine, taurine, vitamin c, vitamin D in winter, and molybdenum weekly.

      Best, Paul

      • Thank you so much. I’m going to follow the PHD diet and take those supplements and let you know how things go. My diet has been terrible lot of fast food and processed food, not many veggies. I’m motivated to change now since I feel so bad and am going to get my life back.

  3. Hi Paul, what is your view of the use of Tauroursodeoxycholic acid (TUDCA) for Liver Health?

  4. Hi, Paul!

    I wondered if you are able to give me some advice. I have been following your diet, lifestyle, and supplement recommendations for years now (with two exceptions: I don’t eat liver and I do have whey protein isolate shakes a few times a week after weight training sessions). I have made great improvements in my thyroid numbers and sleep–thank you so very much!!

    Perhaps my issue is unrelated to diet, but I’m unsure. A year ago I got horrible eczema on my shins and my hands (pompholyx) for the first time in my 47 years of life. I have been suffering from this daily since then and it often keeps me up at night. I’m so over the steroid creams I was prescribed and have decided to just “live with it.”

    I have read you believe eczema can be due to a high level of immunity and/or oxidative stress. Is there a test you would recommend or an obvious change in my diet/lifestyle/supplements you believe I should attempt? (As an aside, I did eliminate all dairy and the whey for a month with no improvement.) I’m just grasping at straws here and wondered what you would do in my situation.

    Thanks for all you do!

    • Hi Laura,

      Be sure to eat 3-5 egg yolks per day. Make sure you are getting adequate vitamin A — if you aren’t eating liver you need to supplement, on the order of 30,000 IU per week of preformed A, preferably extracted from cod liver oil, plus eat lots of carotenoid rich plants eg carrots and green leafy vegetables. In addition, you need to support antioxidants. Again, if you aren’t eating liver you probably need to supplement copper. Then glycine, taurine, N-acetylcysteine, vitamin C, and vitamin E would all be useful supplements. Also, optimize vitamin D if you aren’t already.

      Try those and let me know how it goes. Also, read this: http://perfecthealthdiet.com/2012/01/around-the-web-why-i-blog-edition/.

      Best, Paul

  5. Hi Paul,

    According to the USDA’s website, 1/4 pound (113g) beef liver contains about 29,479 IU Vitamin A, but you said it contains about 45,000-50,000 IU. Could you please clarify?

    You can check here:



    • Hi Jana,

      I think what I said is that if you eat 1/4 lb liver per week then you don’t need to supplement vitamin A. You will get the remainder of A needs from the rest of your diet, especially if you eat abundant colored vegetables. 45,000 IU/week is a reasonable target for the diet as a whole.

      Best, Paul

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