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. Thoughts on xantham gum and guar gum? They are in a lot of products that are otherwise PHD complaint.

  2. Hi Paul,
    I am 41 and recently got a few tests done for the first time including lipid profile. My LDL has come at 160 (total at 230). I bought and read your book first time in 2013 and since then we switched to cooking with saturated fat at home (we do eat out but not very often). Also, we are vegetarians so our diet is high carb (we do eat eggs and dairy). What can I do to reduce LDL?

    • Hi Pawan,

      The common causes of high LDL are (1) metabolic endotoxemia, i.e. too much entry of fragments of cell walls from dead gut bacteria into the body, possibly caused by poor gut barrier integrity and/or small intestinal bacterial overgrowth and/or inflammation in the gut from pathogenic microbes; (2) hypothyroidism or iodine or selenium deficiency — note both deficiencies are common on vegetarian diets, though eggs will help with selenium, and hypothyroidism can be treated by replacement thyroid hormone; (3) excess iron which can be relieved by donating blood.

      PHD eating, intermittent fasting, circadian rhythm entrainment, egg yolks, vinegar, and extracellular matrix (shellfish, bones/joints/tendon soups) will help with (1). Can you add shellfish or bone/joint/tendon stocks to your diet?

      Best, Paul

  3. Hi Paul,

    How long can fermented vegetables stay in the fridge without going bad? Should I go by the smell?


  4. Hi Paul,
    Any additional thoughts on OCD and anxiety? I have heard brain health comes 85% from gut health. I started a strong probiotic, but am wondering about additional diet changes or supplements.

    Also, where can I find thoughts on ingredients such as xantham gum, guar gum, lactic acid, etc.?

  5. Sooo appreciate this site–thank you! If you have time, would you please share your take on longer fasting (24hr up to 2 weeks). Have looked at Fung’s approach and since I am morbidly obese and have prediabetes, I’m wondering about the efficacy of combining PHD with longer fasting.


    • Hi Connie,

      Longer fasting may have some benefits, but I think the crucial thing is to set up a good daily rhythm that properly entrains circadian rhythms every day. Consistency is important. Try to finish eating as early as possible in the day, and don’t eat at all at night (only calorie-free beverages like water or herbal tea). Have a 12 hour night in which you get no blue or white light exposure, install two sets of lights in your home with orange bulbs for night use. Then, rigorously cut out omega-6 fats from your diet.

      An overnight 16 hour fast is perfect and something you should be able to do every day. Then, if you want to throw in occasional longer fasts, go for it.

      Best, Paul

  6. Any suggestions on substitutions for soy sauce? It compliments many Asian dishes so nicely, but I know we are supposed to avoid soy.

    • Hi Sara,
      Soy sauce is made from fermented soybeans, so not so bad.
      But wheat is also an ingredient.
      Tamari is a wheat/gluten free soy sauce. But confirm this on label before buying, as some inferior products may still include some wheat/gluten.

      Or, a soy free alternative you can try is Coconut Aminos… give it a google.

    • Soy or tamari sauce is fine. We’re not worried about soy proteins in the quantity you get in soy sauce.

      Best, Paul

  7. Paul,

    My sister in law is expecting a baby any day, and has been feeling dehydrated (also possibly associated with recently moving from Texas to the Southwest elevation about 4000 ft). The symptoms, dry sinus, mouth, and lungs haven’t been helped by drinking copious amounts of water. But, her OB prescribed 1 liter of saline in an IV, at her request, and it helped noticeably but only for two days.

    My question, do you have any idea why saline IV would help when drinking plain water (and some “Pedialyte”) didn’t? Can you think of any mineral waters or electrolyte drinks that might help her? She eats a typical American diet unfortunately (in spite of having received a copy of PHD as a gift two years ago), and is somewhat overweight but healthy otherwise. We are working encourage her to follow your recommendations in the book.


    • Hi David,

      In order to be hydrated, you need electrolytes (sodium and potassium primarily, also chlorine, iodine, and others may matter). If you don’t have the electrolytes in your body, any water you drink will be peed away, because the body has to maintain a fixed ratio of water to sodium and potassium. She should eat lots of fruits and vegetables (tomatoes, bananas) and some salt along with water. Try salted tomatoes.

      If she is low-carb, eating more carbs will also help.

      For weight loss, minimize omega-6 fats and entrain circadian rhythms are the two most important steps.

      Best, Paul

  8. Hello,
    I am reading your book for the very first time and I was wondering about your recommended dosage of safe starches. Are the weight units you mention (for example 2.7 pounds of sweet potatoes) supposed to be when the starches are cooked or raw. I’d really appreciate your help. Thanks so much. Kali from Germany

    • Hi Kali,

      That is “moist weight” or weight after gentle cooking. Harsh cooking dries out the starch and reduces the weight. Generally, boiling or steaming constitute gentle cooking. Weight after gentle cooking is usually the same as raw weight, except in the case of dehydrated foods like rice which gain water during cooking.

      Best, Paul

  9. Clare Boldurmaz

    Hi Paul,
    I hope I’m not being greedy here asking 3 questions! They’re just things that nutritionists have told me in the past so I thought I’d ask 🙂

    1) I was told it’s good to eat protein away from starchy carbs, and that not it’s good for the gut – I imagine that you would not agree with that as I don’t think I’ve seen references to it in the PHD diet?
    2) also from a nutritionist: vitamin C is important to have with iron source (i.e meat) for iron absorption. Is that the case, you may have mentioned in your book ?
    3) is it worth making your own fruit / veg juices for extra vitamin consumption? Have a juicer, trying to decide whether to keep it!

    Many thanks, as ever, so grateful for the time you give up to do this!


    • Hi Clare,

      I don’t agree that protein and carb should be separated. Vitamin C helps iron absorption so if you are prone to iron deficiency anemia it’s good to combine them, but if your iron is normal then you don’t need to worry about it. There’s no advantage to juicing over simply eating vegetables. However if juicing enables you to eat vegetables, it could be beneficial. I personally find juicing to be more work.

      Best, Paul

  10. Hi Paul,

    My mother in law recently had brain surgery to clear a subdural hematoma. The neurosurgeons said that this often occurs in the elderly because of a loss of brain volume that puts stress on the veins in the dura which allows them to tear and bleed more easily. Are there any nutritional/supplemental steps that will slow or possibly reverse age related brain volume loss? Thank you!


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