Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

9,701 Comments.

  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:

    https://ndb.nal.usda.gov/ndb/foods/show/3789?man=&lfacet=&count=&max=&qlookup=&offset=&sort=&format=Abridged&reportfmt=other&rptfrm=&ndbno=&nutrient1=&nutrient2=&nutrient3=&subset=&totCount=&measureby=&Qv=1.13&Q7111=1&Qv=1.13&Q7111=1.5

    Best,
    Jana

    • 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

  6. Hi Paul,

    How much fruit should a 3-year-old child consume a day? I ask because the recommendation from the USDA is 1-1.5 cups and my 3yo daughter, who eats PHD and no added sugars, eats twice that much. (I don’t follow USDA dietary advice but a friend brought this up and we are now curious about your advice.) Many thanks!

    Thank you!

    • Hi Bella,

      Your girl is doing perfectly. In general, a 3 year old will eat about half the calories of an adult, but with higher carb needs, so about 2/3 or 3/4 the amount of carbs. We recommend 3 or more pieces of fruit per day (about 3 cups) for adults and so for her 2 would be our recommended minimum. It’s OK to eat more and desirable to eat more if she doesn’t eat vegetables.

      The most important thing is to eat natural whole foods, not crackers and cookies, so good for her!

      Best, Paul

  7. Hi Paul,

    I cannot tolerate the taste of liver, so I found this solution; I cook the liver, cut it into tiny pill-size pieces, freeze them, and swallow 16 grams (all at once) daily (which adds up to 1/4 pound a week). And my questions is, do you think swallowing frozen liver will cause any type of digestion issues? Especially since I take it with my meal, will it effect the proper digestion of the meal in any way because I’m swallowing something frozen?

    Thank you
    Joe

  8. hi Paul,

    I hope you’re well.

    I usually sleep great. But I just started following your advice on circadian rythmns – bright lights in morning, blue blocking at 8pm etc along with PhD food.

    I usually go to sleep around 11pm.

    I had been worried about a new job starting this morning.

    I also did meditation around 8pm to counter this. And took doc parsleys sleep supplement around 9.45 (melatonin, phGaba, 5htp, magnesium)

    As a result I was so tired I could barely focus so I went to bed

    But lay there for hours – unable to sleep

    I eventually did after a few hours I think.

    But my question is why, when I followed all your advice , is the knowledge of starting a new fairly easy job enough to stop it all working. And is there a solution to this stuff.

    Thank you in advance

    Best
    Nick

    • Hi Nick,

      It’s impossible to tell what happened from a single day’s experience. But I would avoid supplemental melatonin, GABA, and 5HTP.

      Best, Paul

      • Thanks Paul,

        Can I ask why you suggest avoiding these relaxation aids?

        My Doc recommended, so would appreciate to hear your reasoning.

        Many thanks in advance,

        Nick

  9. Is it important to eat carbs seasonally, that is eat more of a ketogenic diet in the Fall and Winter? Also, I see some studies that getting most of are carbs in the morning is better and others in the evening; is this an n=1 thing or is there evidence pointing heavily one way or another that I’m not seeing? I’m carbed-confused right now! Lol

    • Hi Michael,

      No, it’s not important to eat carbs (or fat) seasonally. Humans evolved in the tropics where there is limited seasonality.

      Time of day is more significant but the state of our knowledge is not yet secure about optimal timing. In general more protein earlier in the day, more carbs and fat later in the day, is optimal.

      Best, Paul

  10. Also, do fats need to be eaten seasonally? Is it ok for example to eat coconut oil year round?

    Thanks

  11. Thanks Paul! I appreciate your input.

    How important are carbs when it comes to having proper T-levels in men?

    Thanks!

  12. Thanks Paul,
    Can I ask why you suggest avoiding these relaxation aids?
    I sleep better with them.
    L-Trytophan, GABA (as phGABA), 5-Hydroxytrytophan, Melatonin

    My Doc recommended, so would appreciate to hear your reasoning – before I decide to stop.
    Many thanks in advance,
    Nick

    • If you sleep better with them, then maybe they are good for you. But in general, the body becomes resistant to hormonal supplements like melatonin or GABA, so you can end up no better or even worse after a long time taking them. For most people, they are best reserved for transient use in situations like travel across multiple time zones.

      However, your doctor knows your case best.

      Best, Paul

      • Hi Paul,

        On this topic, do you have any thoughts about taking magnesium and/or taurine at bedtime?

        I ask because I’ve noticed that magnesium makes me sleep more deeply when I take it at bedtime. And I suspect taurine might too — at least, I noticed that taurine had a perceptible relaxing effect when I tried it; I haven’t (yet) tried taking it daily at bedtime to see if that translates to better sleep (or rather, as you remark above, to better sleep over a short-term experiment); do you know of any risks of doing so?

        Thanks!
        -Eric

        • Hi Eric,

          Magnesium and taurine are two of my favorite supplements — also glycine which can also help sleep. I think these are safe, primarily because most people are deficient.

          Best, Paul

          • Hi Paul,

            This makes me wonder — in general, what do you think is the best way for most people to optimize magnesium, taurine, and glycine status?

            – Supplements in addition to food sources (i.e. some leafy greens for magnesium, shellfish for taurine, and extracellular matrix for glycine); or

            – Food alone (i.e. these same food groups in larger quantities).

            On one hand, getting nutrients from food instead of supplements generally seems to be a good idea, so I assumed the second was optimal, while the first was a good compromise, and that most of us should at least strive to eat more leafy greens, shellfish, and extracellular matrix.

            But on the other hand, these supplements could be taken at bedtime to enhance sleep (while eating any foods at bedtime would be counterproductive) — which is an advantage of the first strategy.

            What do you think?

            Thanks again!
            -Eric

          • Hi Eric,

            Other food sources include heart (organ meats) for taurine, and magnesium-rich mineral water if you can find it. Extracellular matrix is key for glycine and also conserves taurine by providing sulfate. I would say that organ meats, extracellular matrix, and hard water were probably the key differences between ancestral diets and modern ones that lead to these deficiencies.

            I personally don’t mind a little supplementation to enable a bit more convenience in cooking and shopping, so I supplement magnesium and taurine rather than eat heart or try to find sufficient food sources of magnesium. I think extracellular matrix is important enough that one should try to get it in food.

            Best, Paul

          • Hi Paul,

            It sounds like you’re saying that the benefits of getting these nutrients entirely from food — definitely for glycine / extracellular matrix, probably for taurine and magnesium too — outweigh the benefit for sleep that taking these as supplements at bedtime would offer (which seems reasonable in light of ancestral diets).

            However, while it seems possible to get the amount of magnesium and taurine you recommend supplementing from food alone, I find it difficult to eat enough extracellular matrix to reproduce the 10 g / day you suggest on the “recommended supplements” page. Indeed, since collagen is 22% glycine by weight, this works out to over half your daily protein intake from collagen — about half a pound of beef tendons or 1–2 liters (depending on how concentrated it is) of joint stock per day. That seems like a lot… but I think your 10 g / day figure is probably right — given that:

            – Working backward from collagen synthesis needs, glycine requirements seem to in fact be that big (https://www.ncbi.nlm.nih.gov/pubmed/20093739).

            – High doses of glycine extend lifespan in animal studies (http://www.fasebj.org/content/25/1_Supplement/528.2?related-urls=yes&legid=fasebj;25/1_Supplement/528.2);

            So shall we all eat that much extracellular matrix? If not, is there a lower amount of extracellular matrix which would be sufficient to provide all the other matrix components besides glycine, which could then be combined with a lower supplemental dose of glycine?

            I know that I definitely haven’t gotten close to that much from food alone — I only eat around 2 liters per week of joint stock, plus a few servings per week of higher-glycine meats like oxtail and shellfish — so I’ve been adding 5 g / day of supplemental glycine, which I take at the end of the feeding window, sprinkled on some berries as a dessert.

            By the way, do you have a reference for heart being high in taurine? The only source I could find (http://www.vetmed.ucdavis.edu/vmb/labs/aal/pdfs/spitze.pdf) put heart at 652 mg taurine / kg wet weight — in comparison to much higher values for shellfish (8270 mg / kg for scallops, 5200 mg / kg for clams, or 6550 mg / kg for mussels).

            Thanks again!
            -Eric

          • Hi Paul,

            The above-mentioned paper giving 10 g / day for glycine (which I assume is where you got your 10 g / day figure from originally?) obtained this as 11.5 g / day (estimate of optimal glycine intake) – 1.5 g / day (minimum amount of glycine one might get from diet, noting that a better diet would probably provide about 3 g / day).

            I will note that the 11.5 g / day figure is expressed to many more significant digits than it deserves to be — it is based on a wild guess (95%) for the efficiency of glycine recycling from collagen breakdown:

            “…much of the glycine produced from collagen breakdown and from the procollagen cycle must be recycled, more than 98%, if there is to be no deficit at all. It is very unlikely that the proportion can be as high as this, however, especially as the large increases in collagen production that follow administration of extra amino acids (Babraj et al. 2005) imply that collagen production is affected by the diet. Moreover, the measured value for cysteine reutilization is only 85% (section 4.1.4), and although the rate for glycine may be higher, there is no reason to suppose it is so much higher.”

            Now, given that about 1/3 the protein in the human body is extracellular matrix, it seems reasonable that 1/3 of dietary protein intake from extracellular matrix would provide a sufficient amount of most matrix components. Assuming 75 g / day protein, that would give:

            3 g / day glycine with no extracellular matrix eaten
            8 g / day glycine with 1/3 dietary protein from extracellular matrix.

            If the 11.5 g / day figure were accurate, then we would be short of optimal glycine intake by ~3.5 g / day (~0.7 tsp) even if 1/3 of dietary protein comes from extracellular matrix (and what fraction of people on PHD do you think obtain at least 1/3 of dietary protein from extracellular matrix?).

            Also, glycine seems at least like a reasonable candidate for a nutrient likely to show benefit for above-ancestral consumption — glycine promotes methionine clearance, and sensing methionine levels (https://en.wikipedia.org/wiki/Mechanistic_target_of_rapamycin) appears to be the major input to the body’s decision to invest in current fertility versus longevity. That is, low methionine levels lower growth hormone, promote autophagy, etc., and thus there is reason to expect disconnect between what optimizes longevity, and what evolution has selected for.

            So, does it make sense for most people to take 1 tsp / day (0.7 tsp / day plus room for error) of supplemental glycine even if sufficient extracellular matrix is eaten, and 2 tsp / day if not? Or do you think there is no benefit of going above 1/3 of protein from extracellular matrix, and that higher glycine consumption is not worth the risk?

            Such a glycine supplement could be take with dessert (using the glycine as a sweetener), which would presumably also help with sleep.

            Best,
            -Eric

          • Hi Eric,

            The 10 g is not a recommendation but a maximum (“up to 10 g”). Also, glycine is in the “Therapeutic Supplements” category meaning it’s not for everyone. With good diet it shouldn’t be necessary to supplement glycine at all (which the .

            However, glycine is safe in high doses so 10 g shouldn’t be harmful either. It can aid in bile conjugation and glutathione formation. People with gut issues or immune deficits may be deficient in glycine, so it’s worth taking some supplementally.

            Thanks for your detailed analysis. I would say healthy people should focus on getting abundant extracellular matrix in the diet, and that should be enough.

            Best, Paul

      • Thanks Paul.

        Sorry to be a pedant, but isn’t GABA a neurotransmitter?

        And, to be honest, my Doc is far too liberal with these things so I’ll follow your advice 😉

  13. Hi Paul,
    I have had IBS 32 years, chronic fatigue, fibromyalgia for 20 years. Hypothyroidism for 26, celiac for I don’t know how long. I have been doing paleo off and on for about 3 years. When I’m off I’m really off; terribly addicted to sugar and dairy which I think I’m allergic to. Struggled for many years with depression.
    I want to have hope for healing but it is hard to keep hoping. As soon as I start paleo strictly I start to lose weight and feel extremely weak and go through much digestive distress. Adding rice to my diet is very appealing but I’m afraid my sugar “dragon” will rise up again. When I’ve tried to eat rice I want more and more.
    My main question is do you think someone can so damage their body with autoimmune issues that they can not recover?

    • Hi Melissa,

      Eating the right amount of natural whole foods carbohydrates, with starch and sugar in the right proportion, will make you feel much better. Any hunger for starch will be temporary, it arises because you’ve been too low carb for too long and your body senses a need for carbs. Don’t worry, within a month that craving will be gone.

      If you are alive and able to post on web sites, you can recover.

      Best, Paul

  14. Paul,

    What are your thoughts on the benefits if any in taking regular ice baths?

    • I’m not aware of benefits and it’s not without risks. If you want to try temperature extremes likely to be beneficial, I would recommend alternating saunas and cold showers.

      Best, Paul

      • Thanks Paul. Do you like the far or near infrared saunas? Is there a particular time of day that is best to use them with regards to circadian rhythms?

        Thanks

      • What would be some of the risks involved with the ice baths? Also, is it best to do the sauna first and then the shower or vice-versa?

        Thanks

        • Hypothermia and frostbite, to begin with. I don’t think the order matters.

          • Thanks Paul. I am buying a copy of your book for my doctor. I think she will love it and recommend it to her patients.

            Some of what I read in your book concerning intensity cycles in exercise reminds me of the work from Scott Sonnon from RMAX. He utilizes a 4×7 protocol in harmony with the Fibonacci rhythm. He is a mobility genius and has a lot to offer for all fitness fitness levels. Though he trains some elite level athletes he operates from a health first perspective. He’d be great to have at one of your retreats. I’m not in anyway affiliated with him but have benefited greatly from his work over the years and just thought I’d share.

            Thanks again for your time sir!

  15. Hi Paul,

    I only eat one kind of fermented vegetable, which is dill pickles. I do not eat mixed fermented vegetables as you recommend, is this a problem? Is it preferable to eat mixed fermented vegetables instead of one kind because maybe different kinds of vegetables will increase the variety of bacterial strains?

    Thank you

  16. Hi Paul,

    we have a 2.5 year old son with cystic fibrosis. He is doing very well so far. His treatment includes inhalations (NaCl 6% and a few drops Salbutamol) and a course of antibiotics roughly every 3-6 months (mostly after they find staph. aureus after a routine smear). He is also taking pancreatic enzymes (Kreon) and the fat-soluble vitamins (1000 I.U. vitamin D, vitamin A and vitamin K1).

    We see a lot of potential in nutrition and diet to support his general health, immunity and to fight the chronic inflammation that can be part of cystic fibrosis. Your book and the resources on this site have been very inspirational for me and I wonder if you could give us some advice concerning nutrition and supplements (either general advice for a child of his age or advice specific to his condition).

    Thank you, jpf

    • Hi jpf,

      Sorry to hear of your son’s condition. I’m afraid I really don’t know how the diet should be altered for cystic fibrosis. I would probably recommend most strongly intermittent fasting and circadian rhythm entrainment, perhaps drinking decaf coffee during the fast, to promote movement of any excess mucus down the digestive tract. Vitamin A and D are crucial (as you seem to know) to support mucosal immunity. Immune support should help, perhaps extra vitamin C, taurine, and N-acetylcysteine.

      Best, Paul

      • Thank you for your quick reply! How would one scale any supplement recommendations for a 2.5 year old? A few more specific questions:

        – Do you think 1000 I.U. Vitamin D (living in Germany) is enough?
        – How much Vitamin K should he get and is Vitamin K1 okay or would you recommend some form of K2?
        – Is there anything to help with the impaired production of glutathione? Bone Broth? Vitamin C?

        IF and circadian rhythm is an interesting advice. Can you explain your reasoning behind that?

        Again, thank you very much for taking the time!

    • jpf,

      Many years ago I met a brilliant political scientist who had two boys with CF. She made a heroic effort to understand the current research on CF to see if she could learn anything that would help her boys, and did. I checked to see what has come of it, and there are still studies being done on her work. I believe this link summarizes the protocol:

      http://uvicf.org/researchnewsite/glutathionenewsite/protocol.html

      If you search google “valerie hudson cf” you can read more about the story.

  17. Paul,

    While IF’ing during the 8 hour feeding window is it ok to eat as often as you like or is it best to just have 2 meals spaced a few hours apart?

    Also, is there any benefit over skipping breakfast over skipping dinner? I find that if I skip breakfast I can’t fall asleep early enough at night. If it is best for me to skip breakfast will my sleep onset eventually improve? I use blue blockers at night and zero calories after 6:30.

    Thanks!

    • It’s fine to snack continuously or eat on any schedule within the feeding window.

      Generally, you’ll be prone to sleep 12 hours apart from your feeding window. If you want to sleep 11 pm to 7 am, then make your feeding window 11 am to 7 pm. If you want to sleep 9 pm to 5 am, make your feeding window 9 am to 5 pm. Light exposure should shift in sync with daytime light exposure beginning 2-3 hours before the feeding window.

      Best, Paul

      • Thanks Paul.

        • Paul,

          Is 30 minutes of a.m. sunlight 2-3 hours before the start of the feeding window sufficient to entrain ones circadian rythym?

          Thanks

          • Hi Shane,

            It’s a terrific start. You do need continuing exposure to bright light for at least several hours interspersed over the rest of the day. If you can’t get outside, try getting bright 5500K bulbs at home and work.

            Best, Paul

  18. Paul,

    What’s the minimum amount of a.m. sunlight that you’d recommend to help set our circadian clocks?

    Thanks!

    • Thanks Paul. I apologize for the duplicate post. When I checked later to see if my original post had been replied to I didn’t see my post so I wrote a similar one to replace it.

      Would the light coming they my office window suffice? I usually can get outside on average for an hour during the work day plus at least the first 30 minutes of sunrise.

  19. Hi Paul,

    I did a DUTCH test and my doctor says my Estrogen levels are sky high.

    My testosterone levels are high/good but it seems I am aromatizing it into Estrogen.

    Aside from following the weight loss version of the diet (I’m 22.5% body fat) do you recomend anything to combat the estrogen.

    I added 200mg of DIM to supplements and was thinking of adding IC3 and Calcium D Glucorate

    Would love your advice

    Warm regards

    Nick

  20. Hi Paul,

    I eat Korean style glass noodles made from sweet potato starch, and I was wondering if potato starch is a good source of potassium like regular potatoes, and also, do potato starch noodles contain resistant starch like regular potatoes when cooked and cooled?

    Here is the link to the sweet potato noodles if you are interested, they are very good:

    https://shop.crazykoreancooking.com/products/korean-glass-noodles

    Best,
    Joe

  21. Hi Paul,
    Thanks for all of your work! For most of my life, I’ve been susceptible to skin immunity issues, including dandruff, athlete’s foot, jock itch, mild seborrheic dermatitis on chest and face, as well as acne. I’ve been doing varying levels of PHD and supplements for a couple of years.

    I’m wondering if you have any suggestions of supplements or foods to focus on (or avoid) to help with skin immunity? Thanks!

  22. Hi Paul,

    I just started the Paleo diet this year, and I found it nourishing and satisfying, but it came to a point where I found it unsustainable. I then came across the PHD, which seemed to be referenced to a lot in the Paleo community, and the less stringent rules backed by science and evolution really opened my eyes to a new way of eating, so thank you.

    I do have a question about dairy specifically, though. You mention that dairy is a pleasure food in your book and that milk should only be drank as a child in the form of breast milk, but you repeatedly recommend sour cream, butter, and aged cheese. Is there a difference between types of dairy, I’m guessing it is due to gut bacteria / probiotics? I’ve tried researching but I cannot find anything specifically. Your direction would be much appreciated, as I would love to justify a dollop of sour cream on my sweet potatoes tonight. Thanks!

    • Hi Rob,

      Generally, dairy protein is hard to digest and potentially immunogenic, while the sugars (galactose) are potentially toxic in high doses in adults, however dairy fats are quite healthy and fermented dairy as in cheese is also generally beneficial. So, sour cream is fine, go ahead!

      Best, Paul

  23. Hi Paul,

    Do you think the enzyme inhibitors in foods can be overcome with digestive enzyme supplements to some extent?

    Thank you,
    Joe

    • Hi Joe,

      If you are eating raw nuts and seeds in moderation, I don’t think you need to worry about enzyme inhibitors in food. Either cook nuts and seeds, or don’t eat large quantities.

      Enzyme supplements are not a solution because they will also cleave human proteins.

      Best, Paul

  24. Paul,

    I have been having Rosacea breakouts on my forehead and cheeks for about a year now. My doc has only provided me with a steroid gel and it is only slightly helpful. Is there anything you’d recommend for this?

    Thanks!

  25. Hi Paul,

    What kind of water do you drink? Filtered tap water or something else? Do you have a recommendation?

    Best,
    Joe

  26. Please Help. I have been following your diet and feel so much better and have lost 45 pounds. However, I just found out I have b6 toxicity which is giving me hands and leg numbness and burning/tingling. I was only taking b-100 complex once or twice a week as recommended. But I was taking other supplements like Turmeric and Garlic which I know find out have B6 in them also eating foods with b6. The doctor said my b6 levels are twice the normal high range. Can you give me advice on how to lower b6 as quickly as possible? Does exercise help? Sauna? Also are any of the vitamins I take possible contributing to the high levels? Please advise I would appreciate it so so much. Thank you.

    The supplements I take Daily.
    Vitamin d3 – 2000ui
    Turmeric – 800-1200mg (stopping today)
    Garlic Pills- 600mg
    Ginger Root – 550mg
    phosphatidyl-choline – 420mg
    Alpha Lipoic Acid – 500mg
    Coq10 – 200mg
    Cetyl Myristoleate Complex – 1520mg (20% cetyl mristoleate)
    Vitamin C (a ascorbic acid) 1000mg
    Biotin – 5,000 mcg
    Caprylic Acid – 600mg
    Olive Leaf extract – 680mg
    Vitamin E Mixed Tocopherols – 400ui
    MK-7(k2) – 100mcg
    10 Strain Probiotic (15 billion cultures)

    Taken Weekly
    B-100 (stopped 1 week ago was only taken 1-2 a week)
    Molybdenum (1000 mcg)
    Collagin with Amino Acid Powder

  27. Hi Paul,

    Thanks so much for the opportunity to leave a comment.

    I have been struggling to lose weight since I was a teenager (I’m 46 now). I have Hashimoto’s and am also now in surgical menopause. I could write a book on all the various approaches I have tried. At any rate, I’ve been paleo for a few years but mostly low carb, and would like to try PHD (with an AIP approach). My question is, you did not specifically mention limiting fats in your interview here: https://liveto110.com/68-perfect-health-diet-weight-loss-dr-paul-jaminet/, as you do in your book and on your blog. I was wondering why that was. Your recommendations haven’t changed, have they?

    Thanks much!

  28. Oh, I also meant to ask…what tests would one obtain to check for infections that might contribute to obesity, as you mention in your book? And then how would a person treat them?

    Thanks!
    Erica

  29. Dear Paul,

    I have been on the weight loss version of the diet for 3/4 weeks.

    I have gone from 94kg to 90kg so far.

    However, I’m definitely losing muscle.

    I am relatively sedentary due to long office hours.

    Can I gain muscle back while continuing to lose fat? If so, what exercise do you recommend I do? (It will have to be in evenings or weekends)

    THanks in advance,

    nick

  30. Dear Paul,

    as I have been suffering from sleeping problems, frequent headaches and a general lack of energy for several years now, I read your book and it was a real eye opener! The problem I am facing at the moment, is that I have been a vegetarian since I was 5 years old (i.e. for 22 years now) and it is very very hard for me to eat meat at all ( I did try, but I can’t get over myself). I am currently trying to slowly add more and more fish to my diet, as that is the most bearable for me and was therefore very interested in the short passage about the Kitavan diet, as there was no meat included in that one.

    All this leads to my questions: Would it be possible for me to simply exchange meats like beef and pork for Salmon, Tuna and white fish in phd recipes, provided that I supplement organ meats?

    Thanks a lot in advance!

    • Hi Lucas,

      Fish and shellfish are a great way to start. Yes, you can replace beef and pork with fish and shellfish. I would still try to get a 1/4 lb liver per week and 3 egg yolks per day, however.

      Best, Paul

    • Hi Lucas, you can buy dessicated liver and grass fed gelatin to get benefits without actually eating flesh.

  31. Hello Paul,

    I’m a 23 year old male, and I just got my Serum Ferritin results and it’s 556 ng/ml. I will donate blood soon. I was wondering if it is normal to have such high levels of iron or do I have some kind of genetic dysfunction that makes my body absorb excess Iron? And if I have such a dysfunction, how often do you suggest I donate blood?

    Can you please tell me what the maximum Serum Ferritin number should be? Also, do you agree that the maximum number increases with age? My father (age 60) also got a blood test for Ferritin, and the lab said, because of his age, his standard range is 50-530 ng/ml, whereas my range is 38-270 ng/ml.

    Thank you,
    Joe

    • Hi Joe,

      No, it’s not normal. It could be genetic (there are common genetic variants which lead to iron overload) but it need not be. Donate blood as often as the Red Cross allows. I aim for serum ferritin between 50 and 150.

      Best, Paul

  32. Dear Paul, am losing muscle on weight loss version. Can I regain muscle while continuing to lose fat. I have not worked out for a month and have 24% body fat
    Thanks

    • Hi Nicholas,

      If you “have not worked out for a month” and are restricting calories, you are guaranteed to lose muscle. Try exercising daily, including some resistance exercise, and eating more calories. Your weight loss may be slower but it will be healthier.

      Best, Paul

  33. Hi Paul,

    Is there any issue with using Whey protein a few times a week in place of meat? (E.g. for my lunch protein I take Whey and for dinner I have meat/fish). It allows me to do much less cooking.

    Also, at the moment I’m trying to lose weight, and I was wondering if there is any benefit or risk to walking in the mornings in a fasted state (walking before eating any calories), and also, how about doing some high intensity training in a fasted state in the mornings (sprinting/strength training)? Any benefits or risks as far as weight loss is concerned?

    Best,
    George

    • Hi George, Natural whole foods are always better, as they have a host of micronutrients in more or less the proportions needed to support life, whereas whey protein powder has nothing but amino acids, which are easy to get from food and are rarely or never deficient.

      Best, Paul

  34. Hi Paul,

    I am 25 years old and have been struggling with debilitating brain fog, fatigue, insomnia, heart palpitations, and bloating for years. I constantly feel stressed out. My stool tests seem to show no infections, and my doctors claim that my blood tests are normal. My white blood cells are slightly low at 3.5 and my TSH is slightly over 3 which I think is high. I have been eating the Phd for several months after experiencing a worsening of my symptoms on a very low carb paleo diet. I have been entraining my circadian rhythms, but I still experience poor sleep and fatigue/brain fog throughout the day. Could this be SIBO or a leaky gut? Any advice?

    Thank you in advance,
    Markus

    • Hi Markus,

      Yes, your TSH is high, you should ask your doctor to prescribe levothyroxine, and supplement iodine at a low dose. You have a neutropenia/leukopenia, those are often due to viral infections. You might try supplementing lysine and vitamin C, 5 g per day each or more. Also make sure vitamins A and D are optimized, you do intermittent fasting, and entrain circadian rhythms. The brain fog is typically due to inflammation from the gut and/or a leaky gut, so you are right to consider addressing gut issues. Eat lots of extracellular matrix, supplement taurine and glycine with vitamin C, eat 3 egg yolks per day and 2 tbsp vinegar, and follow the other steps outlined above.

      Best, Paul

  35. Hello Paul,

    Is it not preferable to eat vegetables and fruits seasonally? Any validity in this idea?

    Thanks

    • Hi George, I don’t think so. There is very little evidence for circumannual cycles in humans; we evolved in the tropics which had little seasonality; and restricting fruits and vegetables by season impairs nutrition for no known benefit.

      Best, Paul

  36. Hi Paul,

    I’m Portuguese and I got the book recently.

    After a few failed attempts without diagnosis – the doctors diagnosed me vaguely as anxious and with IBS – I did some tests that point to a materialistic diagnosis. My problems are, basically, brain fog (24 hours / day), allergies and some (slight) abdominal malaise, but with swelling present. For the past two years my food has been so restrictive, eliminating all possible carbohydrate, feeding me only meat and fish and fats. That is, two years in ketosis. As a result, my immune status decreased, my leukocytes, for example, decreased (from 4.4 to 3.1), such as thyroid. Consequently, some viruses appeared positive (IGG and IGM fraction): Epstein-Barr and HSV-1.

    I was underweight (I lost 20 kilograms), so I reintroduced carbohydrates in the food and I follow their recommendations. Some tests have sought to clarify what the physiological problem is:
    The doctor’s data revealed * many * yeast (microscopic) and sub optimal amounts of Bifidobacteria and Lactobacillus (both 2+). Negative respiratory (glucose) test for SIBO. My thyroid is, according to the biomarkers, optimal. Sub optimum are some nutrients, so I will try to solve this problem.

    I added a supplement regimen that includes: NAC, Glycine, Taurine, the recommended minerals in PHD and Vitamin C. But also some Chinese herbs and adoptogenics. I look forward to probiotics: VSL # 3 and a Bio Cándea.
    I try to ingest above 100 grams of carbohydrates daily. Exercise, outdoors in the early hours. Circadian rhythms, 9 hours of sleep.

    I li tried it fluconozal and another (I believe it used to pet). Your opinion seemed to me positive. Would recommend? What I would add in this protocol.

    Thanks

    • Hi Francisco,

      I think you are doing well. Circadian rhythm entrainment and NAC, taurine, and glycine are good. Be sure to eat 3 egg yolks per day and 2 tbsp vinegar; extracellular matrix in soups and stews; optimize vitamin A (liver, carotenoids) and D (sunshine, supplements); do intermittent fasting; balance zinc and copper; supplement a low dose of iodine daily; treat hypothyroidism. A high fiber diet will help you excrete fungal cell wall components which are highly inflammatory.

      Fluconazole is risky, it should be taken only in severe cases. Nystatin is safer. Either way, you need to optimize diet and lifestyle if the effects are to be more than temporary.

      Best, Paul

  37. Paul,

    What are your recommendations to optimize liver function?

    Thanks!

    • Hi Shane, Just regular PHD – the same things that optimize the body as a whole will optimize the liver.

      Best, Paul

      • Simple enough! Thanks Paul!

      • If one had NAFLD would you recommend any specific supplements?

        Thanks!

        • Hi Shane,

          Pantothenic acid, vinegar, egg yolks, and the bile and glutathione supports glycine, taurine, and N-acetylcysteine will help. But the most important intervention is to minimize omega-6 fats, avoid fructose and alcohol, and make one’s fat intake saturated fat heavy. So relative to normal PHD, you would, for example, avoid olive oil and avocado oil and instead use butter and coconut milk/oil, and switch from other nuts to macadamia nuts.

          Best, Paul

          • Thanks Paul!

            I will definitely be avoiding fructose! I recently experimented with high fructose consumption and it did NOT go well! I felt great initially and then a few days later I started having panic attacks again! My blood pressure and pulse are STILL elevated. It also feels like my cortisol levels may be very high.My stress tolerance is notably much lower. I still cannot believe the negative reaction I had to that much sugar, mostly OJ and milk.

            Thanks for your time Paul!

          • Sounds like a flirtation with Ray Peat. Hope you feel better soon.

            Best, Paul

          • What would the impact be of eating PHD, but replacing starches with fruits at most meals?

            “Fructose consumption at moderate levels of intake do not adversely effect body weight or blood chemistry based on the current data. Obscenely high levels of intake (>150 grams per day) may have undesirable health effects.”
            http://sciencedrivennutrition.com/fructose/

            Here’s a new article, “Fruit May Have Been The Making of Mankind”:
            http://www.telegraph.co.uk/science/2017/03/27/would-adam-eve-fruit-may-have-making-mankind/

  38. Hello,
    Thanks so much for the excellent resources and the book. Fantastic analysis of some great science! I regularly use ground cacao, typically in my coffee. You recommend some dark chocolate consumption, and although that is occasionally in my diet, I do try to avoid sugar unless it is in the form of a whole fruit. Would ground cacao have similar effects as chocolate?
    Thanks so much for your thoughtful work!

  39. Hi Paul,
    I have been a strict follower of everything PHD for the last three years with great results. Recently I read an article entitled “To Live Longer, Cook This Way: Reduce AGES In Your Food” by Helen Vlassara,MD Mt Sinai School of Medicine. The article outlined ways to reduce AGE consumption including eating less fatty meats and avoiding high heat methods of preparing foods. I was under the assumption that saturated fats such as animal fats and cocconut oil was heat stable and less likely to cause problems when using it to cook with. In order to keep my fat consumption in the 55% range, I rely on the use of such fats for preparing various dishes. Am I at risk of higher levels of advanced glycation end products by using animal fats and cocconut oil to fry foods?
    thanks
    Denny

    • Hi Dennis,

      Here is what Paul and Shou-Ching write in their book:

      “A variety of toxins can form when foods reach high temperature… Acrylamide is formed… with roasting, grilling, or frying but not boiling… The health effects of eating food cooked at high temperatures are measurable. A 53 percent carbohydrate diet of grilled, fried, and roasted foods was compared to a similar diet of steamed foods. After one month, the high-heat diet reduced insulin sensitivity, increased triglyceride levels, and lowered serum levels of omega-3 fatty acids and vitamins C and E.”

      Keep in mind that cooking food by boiling or steaming doesn’t mean you need to give up your animal or coconut fats. For example:

      – You can add butter or sour cream to steamed potatoes after cooking, instead of frying them in butter.

      – Rather than frying scallops and shrimp in coconut oil, you can boil them in a soup with coconut milk. See for example: http://perfecthealthdiet.com/2012/02/tom-kha-shrimp-and-scallop-thai-soup/

      Best,
      -Eric

  40. Hi Paul,

    Is it alright to microwave vegetables and potatoes, rather than boiling or steaming them? I’m new to the PHD diet but am having good results so far.

    Thanks,
    Robin

  41. Thank you, Paul, but I can’t find the blog. Is that the Newsletter?

    Thanks,
    Robin

  42. Hi Paul,

    With careful food selection, I can obtain 750 mg of vitamin C; 175% RDA for thiamin, 250% RDA for pantothenic acid, and over 250% RDA for the other B vitamins that you recommend supplementing.

    These amounts vary from somewhat less than the recommended supplement (e.g. 750 mg versus 1000 mg for vitamin C) to quite a bit less (e.g. 250% RDA versus 10000% RDA for pantothenic acid).

    Are these lower amounts sufficient to achieve all benefits of the supplements? Or would supplements be advisable even with this level of intake?

    Thanks!
    -Eric

    • Hi Eric,

      Probably yes they are. The logic for higher doses isn’t that it’s optimal – we don’t know – but that deficiencies are extremely harmful whereas excesses seem to be mostly inconsequential, thus the risk-reward is good. The optimum is probably a very flat very broad range. Your intakes would appear to be in that optimal range, so no need to supplement.

      Best, Paul

  43. hi Paul
    i am about to embark on a process of bulking up and increasing muscle mass, i want to stick to the PHD but struggle to see how i can increase SaFA and MUFA calories to optimize muscle gains without consuming an enormous amount of dairy, any advice would be much appreciated

  44. Hello,

    I just accidentally found this site and am totally intrigued.I am post-menopausal and am hypothyroid. I exercise and can’t seem to lose weight. I am trying a ketogenic diet and am learning that it might not be good for me. I was wondering if the Perfect Health Diet deals with these issues.

    • Hi Terri,

      You’ve found the right place. We’ve had great success healing hypothyroidism and supporting weight loss. We’ve also been a leading source on the risks of being too low in carb consumption.

      Best, Paul

  45. hi Paul
    i am about to embark on a process of bulking up and increasing muscle mass, i want to stick to the PHD but struggle to see how i can increase SaFA and MUFA calories to optimize muscle gains without consuming an enormous amount of dairy, any advice would be much appreciated

    • Hi Aaron,

      Carbs and protein support muscle mass, so there’s no need to change anything about the diet, just eat more calories.

      You could try a few tweaks: try eating a small amount of carb and protein before exercise, e.g. a small potato and a bit of fish; try eating the same as a small breakfast at the start of day, say 8 am, and get 10 minutes of light activity outdoors to start the day.

      Best, Paul

  46. Is there a nutrient deficiency that would cause loss of balance? I’ve gone to the dr twice and they test hA1c, glucose, cortisol, folic acid & b12 levels, thyroid everything but it all comes back normal. what would loss of balance/dizziness be and what should be taken to fix it? any advice is appreciated.

    • Hi S, Hard to say but I would tend to phospholipids (egg yolks, liver), electrolytes (potassium, calcium, magnesium, salt, iodine, lithium) and immunity (vitamins A, D, C, zinc, copper, glycine, taurine, NAC, iron).

      Best, Paul

      • I just thought I would post an update in case anyone else had this. I still have the episodes of loss of balance. I did see my doctor again and did more research and found that copper deficiency can cause symptoms of ataxia, as well as manganese deficiency, and biotin deficiency. My serum copper and ceruloplasmin levels were normal; serum manganese was normal. He did not test biotin (I even printed an abstract of a young woman who had symptoms of Multiple Carboxylase Deficiency- ataxia adult-onset- and improved with biotin supplements. I previously tried biotin but the OTC dosages did not make a difference. OTC biotin is in mcg and pharmacological dosages are in at least 100 mgs).

        I do notice that the episodes seem to be more frequent/worse after drinking caffeine. Caffeine is antagonistic to biotin and probably other minerals as well, so I think this is the answer, but have nothing on a piece of paper to confirm it. I eat eggs with the yolks, so it is not a dietary deficiency.

        My vitamin D levels had been low in the past and I had been taking 800 IU of D3 daily, but stopped because I was having extreme loss of balance issues at the time and thought the supplement may have been causing it (I react to many supplements with dizziness/loss of balance).

        Holding back on caffeine does not completely eliminate it, but helps somewhat.

        • Hi S,

          Thanks for the update! Be sure to get adequate copper, either from ruminant liver or chocolate and nuts. The OTC 5 mg biotin pills should be more than adequate taken once per week. I do recommend avoiding caffeine, I drink decaf coffee myself.

          Best, Paul

  47. Hi Paul,
    What is your take on homeopathic remedies? Are they safe? worth trying?
    Thanks

  48. Hi Paul, I hope this finds you all well. My mom just got blood work back: TC: 209 TRIGS: 198 LDL: 96 HDL: 73 Her blood work before that had TRIGS at 98 (while at a higher dose of statins). She lowered her dose and it went to 198. She survived a heart attack 10 years ago. She is PHD compliant. Only she may under eat, as she is 71 and doesn’t have a large appetite. She does IF, but has heavy cream with coffee. Her A1C was 5.6. I read through your comments and found high trigs may be: small intestine infection (she had yeast infection in esophagus (cleared), as well as years of anti-constipation meds (no longer). Also, read it could also be thyroid or metabolic syndrome. Only real sugar she has is sweet wine. Would it be worth pursuing Xifaxan to see if that clears the small intestine? Any other ideas? With many thanks for your consideration

    • Hi Helena,

      Here LDL is still low so it would be good to reduce her statin dose further, in my view. It would be good to switch to black coffee if she can, to reduce calories during the fast and enable her to eat more whole foods during the feeding window. To reduce trigs, focus on the small intestine (vitamin A, D, C, glycine, taurine, 2 tbsp vinegar and 3 egg yolks per day, 1/4 lb liver weekly, iodine). Extracellular matrix would help. Really, cutting cream from her coffee and sweet wine at night, replacing them with food during the feeding window, might be the most helpful interventions. At most one glass of wine with dinner, but cutting alcohol would probably help.

      The yeast infection may still be present in the small intestine, so you definitely want A, D, C, intermittent fasting, circadian rhythm entrainment, iodine, and vinegar. I wouldn’t recommend antibiotics at this point as reducing bacteria would promote a fungal infection.

      Best, Paul

  49. Kevin Thofern

    Dear Paul,

    I’ve been following the PHD guidelines for over a year now and feel great.
    In July i plan doing a long Hike in the Spanish Pyrenees where i need to carry food for ~10 days that wont go bad unrefrigerated.
    Basically i am wondering if one can maintain a healthy gut without a refrigerator?
    Pemmican (made of tallow and jerky) would be a obvious choice. BUT you cant buy it in Spain, in Supefmarkets.
    Do you have any suggestions what to do without the possibility to cool food?

    Kind regards,
    Kevin

    • Trail mix (nuts and dried fruit) is pretty good. I wouldn’t try to rigidly maintain PHD guidelines on a trek like that. Sounds great, have fun!

      Best, Paul

      • Kevin Thofern

        Thank you very much!
        I am afraid of bowel problems on the Hike.
        One year ago, before i started implementing the PHD, i was doing a similiar off the grid hike and ate mostly oats, chocolate, trail mix, rye bread and peanut butter. I had some serious bowel problems. Usually people say “a calorie is a calorie”, but i think with a diet like this, high in food toxins, a lot of calories are undigested (or am i wrong and it is just the micronutrients that are missing on a diet like this?)

        My Hikes usually last ~30-60 Days and i resupply every 5-15 days, depending on the region i am in. I always carry some kind of stove in which i can cook rice.
        Still wondering if you got some more tips or answers to my questions.
        Do you think a probiotic supplement would be beneficial on such long hikes?
        When i am resupplying i could also buy some fresh organ meats, eggs and fish.
        Bone Broth is hard to make while hiking as it requires a lot of time and
        Fuel. But i would definately consider preparing some Broth when i am resupplying.

        Or do you really thibk all this concerns are false economy and i should just eat whatever has the most calories to weight and taste? Again in a diet like this i would be afraid of digestion problems and then suffering of bad mood, low energy and a higher risk to get a flu or whatever.

        Thank you very much in advance, Paul. What you do really is a great act of love and giving to people. I am so happy that you answered my question so fast. If i was living in america (i am from germany) i would definately take part in a retreat and have some more in depth discussions with you.
        Again, thank you!

        -Kevin

        • Kevin Thofern

          By the way i thought of carrying rice, butter, dry ham, some dark chocolate and very few nuts.
          Maybe olive oil, tomato paste and some spices.
          When available more dried fish or meat.

          So Breakfast and Dinner would be rice with butter and meat.
          Lunch would be chocolate with nuts.

          Every 5-15 days i would eat liver and eggs.

          What do you think? Is this okay or not much better than eating a standard “trail diet”?

          • Hi Kevin,

            This is a good diet, so if it’s feasible to carry it, then I would applaud you for eating it. Good luck with your hiking!

            Best, Paul

  50. Paul I really need your advice.

    I have been following PHD and have read the book and have lost 67 pounds going from 350 to 283 in about 10 months. I am 32 years old. Even with weight loss I still am having a lot of issues with symptoms of Low T such as weakness, fatigue, bones cracking cause I’ve been told Testosterone isn’t enough to support them, foggy brain, poor memory. I know I still have a lot of weight to lose.

    Back in January at around 300 pounds I had blood work and had low Total Testosterone but my Free Testosterone was in range. The endocrinologist said that it is because I’m overweight and hormones are greatly affected when a person goes above 30% BMI and that my testosterone will improve greatly when I reach below that BMI which is 215 pounds for me. That if I went on Testosterone replacement therapy it would be bad long-term cause my body would stop naturally producing it. I am 32 years old.

    Here are my blood Levels from January weighing 300

    Testosterone Total – 214
    Range 250 – 1100 ng/dl
    Free Testosterone 51.1
    35.0-155.0 (pg/mL)
    FSH – 1.9
    1.6-8.0 (miu/mL)
    LH – 2.6
    Range 1-5-9.3 (mIU/mL)

    In your book to raise T you mention high fat diet/low carb which is what I have been doing. You also briefly mentioned fasting for raising T. Should I be doing intermediate fasting only 8 hours a day or even less? Right now I eat between 9-7pm so taken it down 2 hours would that help? Your friend Mark Sisson mentioned on a podcast that fasting after exercise can help raise Testosterone this seems like a difficult thing to do. Also do any supplements help raise testosterone like DHEA or are they ineffective?

    Finally looking at my blood work do you recommend that I do get Testosterone replacement therapy because my numbers are so low that it is urgent?

    I appreciate your help and your book so much thank you for all you do.

    • Hi Patrick,

      First, congratulations on your progress. Losing 67 pounds in 10 months is great.

      You have some sort of inflammatory condition which is causing the brain fog, poor memory, and also causing you to hold on to weight. You’ll have to fix that to reach your target weight.

      I think you should be eating the standard PHD. This is higher fat than conventional diets, but for weight loss you don’t want to go too high in fat. Eat just enough to be well nourished (e.g. eat 3 egg yolks per day), but let your adipose stores supply the fat that your cells burn for energy. You don’t need to eat a lot of fat, just be well nourished. Going too low carb will suppress immunity and hinder your progress.

      I wouldn’t fast after exercise, I’d exercise fasted and then eat immediately afterward.

      Yes, you should be doing intermittent fasting, 16 hours fasted / 8 hours feeding every day. Eliminate calories from the fasting period, e.g. drink black coffee or tea or water flavored with vinegar or lemon juice. Intermittent fasting will help you a lot, including with testosterone.

      Don’t focus overly on testosterone. Every aspect of health is important. For example, I’d be curious to see your LDL, HDL, triglycerides, TSH, and iron levels. These are all important parameters which may help you improve.

      No, I think your doctor was correct about avoiding exogenous testosterone. You should heal (and raise testosterone) naturally.

      I can give further advice but why don’t you try to implement the book’s advice more thoroughly, including eating in food plate proportions and doing the intermittent fasting and circadian rhythm entrainment of part V, and then let me know your medical lab values after those changes.

      Best, Paul

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