Q & A

Q & A

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

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

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

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

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

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

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

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

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

Warmest Regards,

A

Hi A,

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

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

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

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

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

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

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

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

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

Best, Paul

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

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

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

G

Hi G,

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

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

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

Lupus

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

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

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

Please advise. — S

Hi S,

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

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

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

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

Best, Paul

Depression


Jersie wrote:

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

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

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

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

Hi Jersie,

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

I would interpret it this way:

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

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

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

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

Please let me know how things go.

Leave a comment ?

10,095 Comments.

  1. Hello! What changes should a 20-year old boy make in the diet, who is diagnosed with ulcerative colitis?

  2. Hey Paul, is there any definite benefit to the liver in Tauroursodeoxycholic Acid supplements or Schisandra? Any conclusive studies?

  3. Hi Paul,

    a hypothetical question of course;)

    Once you’ve had a couple of glasses of wine (more than usual) is it better to not eat at all or to have a regular PHD low PUFA meal?

    • I don’t know but if you drink on an empty stomach, the gastric emptying will cause the alcohol to be absorbed faster and reach the blood sooner. The body has better means of detoxifying it when it arrives slowly. This is an argument for avoiding drinking alcohol alone. And you make a very good point of avoiding polyunsaturated fat when drinking alcohol

  4. Hi Paul,

    What is your opinion on Alpha Lipoic Acid supplement? Would you recommend taking it daily, or you consider it a therapeutic supplement for some situations?

    Thanks

  5. Hi Paul

    I just wanted to thank you for this amazing book, probably the best I have read on Nutrition. I have a question regarding the chapter on SaFA and MUFA. I’m an athlete, and I need to increase my calorie intake, and I will do so by manipulating these two Fatty Acids. am I understanding well there is no a ratio or particular percentage for these these two Fatty Acid? do I need to keep MUFA intake higher than SaFA or the opposite can be fine as well?

    thank you

  6. Hello there ,

    in case of an hiv positive patient do you think a ketogenic diet would be beneficial ? or just the standar phd diet

  7. Hi Paul,

    I’ve suffered from chronic depression for years and have finally managed to convince a doctor to prescribe doxycycline to see if it offers any relief. I’ve read through your recommendations on this site, and looked at the protocol on cpnhelp.org. I’ve been on PHD for years, but with varying degrees of strictness. Leading up to starting the doxy I’ll be strict with it. Then during the doxy I’ll do the keto version per your recommendations. I just wanted to let you know I was going to give this a try and see if you had any further recommendations for how to implement it. Should I continue eating fermented vegetables to protect my gut during the doxy? (I assume I should). Also, if you want to offer any guidelines to use my experience as a mini experiment, or one patient study, I’d be happy to track my efforts.

  8. Hi Paul,

    Is it possible to reverse Stage 3 Chronic Kidney Disease? Conventional medicine thinks it is not possible to reverse it. If you think it is reversible, what should be done?

    Thank you.

  9. Paul, back in February you stated in response to a question,” It was always optional, as a way to generate ketones which could be beneficial in some circumstances. However ingesting calories ends the fast and a shorter fast may have less benefits. It is a balance. I may be less optimistic that ketosis is beneficial than I was at times in the past.“

    Could you please elaborate more on why you are less optimistic that ketosis is beneficial? Personally, I have been beginning to think the same way but would really like to hear your reasoning on this topic.

    Thanks

  10. Hi Paul, my name is Sarah, I am a 23 yr old female. I am thin and very fit, but i had a health crisis last year involving a difficult parasite issue that was (finally) treated, a long period of active mono with it, mold exposure, all during and after excessive antibiotic use from acute infections (strept, uni). I also took doxycycline for 4 years which ended in 2015 and then got symptom (severe gerd GI distress) relief. However, now after the parasite, virus, etc. I have severe constipation (i have tried all your protocols for this) and gastroparesis, so my stomach doesn’t empty and i vomit almost everyday. Do you have any tips for the gastroparesis? I also may have an underlying fungal issue (I’ve gotten some relief from a week of diflucan) but I’m not sure. Thank you so much!!!

    • Hi Sarah,

      It sounds like you’ve made significant progress. Fungal infections are very likely, these are very common especially when people have taken long courses of antibiotics, but are generally undiagnosed and untreated. I would focus on improving immune function.

      Some keys: (1) circadian rhythm entrainment — define a 12 hour day and 12 hour night year round (e.g. 7:30 am to 7:30 pm day); get bright white light (5000 K color temperature) all day and orange light all night (no blue/green in the light); start each day with exercise, sunshine, and breakfast; finish eating calories as early in the day as you can with peak food intake around mid-day; no exercise, stress, or calories at night. (2) intermittent fasting, see above. (3) vitamin A, D, K2 optimization per the book. (4) Vitamin C, apple cider vinegar, 3 egg yolks per day, extracellular matrix. (5) Try 3-5 g glycine at end of day and 1 g taurine at start of day. 500 mg – 1 g NAC with food. (6) zinc and copper optimization per the book.

      Gastroparesis is a little mysterious in that it always seems to start with an infection in the small intestine / upper digestive tract but doesn’t always clear when the infection is cleared. But, start by clearing the infection and see how much it improves.

      Once you have infections cleared and immunity well nourished, you can consider trying probiotics in moderation. A strain that helps calm the immune system, e.g. L. reuteri, may be most likely to help.

      Best, Paul

      • Hi Paul,

        Thank you so so much for your time, response, and suggestions. For some reason I didn’t see your response- strange!

        So it turns out i have a gastro-vascular compression syndrome, called SMA Syndrome, where a part of my small intestine is compressed between an artery and aorta. It is extremely rare, and I need to find a surgeon to fix it, and will likely have to travel east to find one (john hopkins has one who is familiar with this). Please keep me in your prayers. Liquid and soft foods are all I can tolerate, and for some reason sugar and fructose make me feel very ill. It is unlikely the i will regain the fat pad between the artieries, as i have been symptomatic even at a healthy bmi. I’ve probably had this for 7 years! with it getting worse with any weight loss. I am not encouraging anyone with gastroparesis to look into it just in case because it is definitely misdiagnosed and under diagnosed !

    • oops i meant to say ****and then got symptom relief from a paleo/ PHD diet. I’ve been following this diet since 2015.

  11. Does this diet also work for reversing heart disease or are there additional guidelines?

  12. Gianluca Bonetti

    Paul, I finished your book, and I really enjoyed it. I had followed also Lauren Cordain work on the Paleo diet. He mentions, how potatoes contains lectins and saponins, and how dangerous these compounds are for health. He does consider sweet potatoes safe. Why do you consider potatoes safe if they contain these compounds?

    than you for the amazing work

    • The lectins are mainly produced when the potato receives sun or damage. If you buy fresh potatoes that have been well stored, they should be low in those toxins. Avoid sprout potatoes. Then, check for green skin; that is the chrolophyll that is produced at the same time that the toxins. So if you see green, don’t buy. If you already bought, discard that part. If it’s very green, don’t eat that potato.

      Also, most of those toxins are in the skin and 1-2 mm under it. Peel the potato.

      And finally, if you want, cook the potato in a pressure cooker if you are worried. The combination of pressure and eat may denature the lectins better and render them inofenssive. I’m not aware if it’s the case specifically for the potato though, but it’s a thing with some compounds and probably also happens here. I have also read that some methods are better than others to eliminate those lecthins, but can’t recall them. Maybe microwave was good at it, search for it.

      If after all this you notice sensivity to the potatoes, and you can discard a carbohydrate sensivity, you may do better excluding it. If it’s the case check for sensivities towards tomatoes, peppers, and eggplants since all are part of the nightshade family and share characteristics.

      Regarding the sweet potatoes, actually anybody could develope a sensivity towards almost any food in the world. All the plants have lots of different compounds that we can be sensitive (although obviously there are foods much proner to it than others). Precisely, on this blog Paul wrote about someone who had problems with sweet potato.

  13. Sherill Polescu

    Hi Paul, I always took Vitamin D – 10000 IUs, maybe with a teaspoon of butter. Now I hear it is dangerous to take D without Vitamin K. Does it really bring calcium to arteries and one should always take it with Vitmain K? Is it enough Vitmain K in a teaspoon?

    • 10,000 IU may be too much in the long run. Paul recommends to reach 4,000 IU in total accounting for both food intake and sun exposure. Check blood level, don’t supplement blindly.

      I think vitamin A, vitamin K and magnesium must be in certain balance. Vitamin K protects against vitamin D toxicity. The book talks about it. Chris Masterjohn also offers good information on this topic and even published a paper on it.

      You may take vitamin d in the morning and vitamin k2 (probably mk-7 is best, but it’s up to discussion) in the afternoon.

  14. Hi Paul,

    Do you agree or disagree with Ray Peat about Nitric Oxide? He says it speeds up aging and it should be kept low. I’m guessing Ray Peat would not recommend doing things such as eating beets and using MotherDirt AOBiome Mist, but you recommend them, so it looks like you disagree, what do you think he is getting wrong about NO?

    Thank you.

  15. Hello, Paul,

    In your book you indicate the sweet spots for nearly all macro variables in excellent detail, but I didn’t get as clear of an idea the extent that Cholesterol as a nutrient can be optimized, and if it, like SaFa & MuFa, essentially had no upper limit or if your research did discover a point where cholesterol was too much. I imagine this may have something to do with the fact that cholesterol is generally lower than other fats and as a companion needn’t be addresses when the other fats are already elaborated on in the same fashion. I was appreciative into your insights surrounding cholesterol deficiency in formula. I actually discovered you through researching the Optimal Diet, and as there is an emphasis surrounding organ consumption my curiosity still exists on the extent at which it ceases to be healthful. You mentioned copper toxicity with liver and I imagine with nearly all organ meats that would occur before cholesterol as a variable ever became relevant. I just wondered if there was a more established understanding of an upper limit where cholesterol ceases to be healthy.

    Also your book is by far the most precise & illuminating book and healthy eating I’ve encountered, thank you for your contribution!

    • Hi Jay,

      As far as I can tell, the literature indicates that dietary cholesterol is inconsequential for health. It is highly produced in the body and tightly regulated so dietary cholesterol doesn’t have much impact on humans. Rabbits can get an excess however.

      Best, Paul

      • Thank you for the prompt response!

        I am a little confused though, in your book you assert that formula lacking cholesterol was a marked mistake in design, as that deficit of cholesterol in formula interferes with childhood development, due to a cholesterol deficiency in those children. Does this value of cholesterol cease after a certain age then?

        As a side note I have been consuming pig brain as an alternative source of DHA (Omega 3). Would you advise against that? I also drink around 3 cups of heavy cream a day, not sure sure if that’s excessive. Last thing, I work in a warehouse where I am constantly power walking and pulling carts, for about 7 hours of the day. I wasn’t sure how to calculate this in relation to carbs, so I added 2 lbs of potatoes on top of 1 lb of potato and .7 lb of banana recommended. Would you recommend less, or more?

        Thanks again!

  16. Hi Paul, after 2 stents, I was put on Statins for life. Just found your great book. What would you recommend while taking statins? Anything protective that can be done? Would it be better to not take them at all? or month on and month off?

  17. Hi Paul,

    Ray Peat says that low body temperature and pulse are good indicators of hypothyroidism. He doesn’t have a lot of faith in blood tests (TSH, T4 etc.) for assessing thyroid function, although he favors very low TSH. Do you agree?

    He recommends taking 10-25 mcg T3 spread through out the day along with T4 for hypothyroid people. Do you agree with this amount or do you think it is too much?

    Thank you

    • Hi John,

      I’m not Paul but I’ve read that he does think that low TSH is important to health. The current reference values in most laboratories are way too broad, there is no doubt about it. He talks about these things both in some articles and the comments, you may be able to find it. I think he said TSH is good when lower than 1, but also keep in mind that TSH gets higher when we age, so in the elderly a value lower than 1.5 may be great (those are just gross references).

      Yes, I think T3 with T4 instead of only T4 may be better, because if you only take T4 you can’t be sure the conversion is working efficiently on your system. But that question is very related to pure medical advice. My mom has Hashimoto’s so I know that the T4 dosage depends on the person, and can change over time, so doctors should keep a regular track of it specially at the beginning to adjust it and avoid the patient become hyper.

      Hope it helped?
      Best regards

      • And yes, lots of doctors just pay attention to TSH. I don’t know if they are educated to do so or because they are obliged to reduce cost by the assurance. However, thyroid pannels are much larger than only TSH and several patterns can indicate that there is something wrong. You miss this information if you only measure TSH. So if your TSH is fine but you still have hypo symptons, maybe it’s good to pay a full pannel to check reverse T3 and such things.

  18. Hi Paul, I was wondering if you had any recommendations for people fighting an eating disorder. I am caring for a teenager with one (had a diagnosis and is receiving help from mental health professionals) and would like to include foods that are higher in essentials for better brain function and healing, as quantities are a problem at the moment.We are trying to do as much fish and rice as possible, potatoes etc. Any magical high value food ideas? Thank you

    • Hi S.R.,

      Fish, rice and potatoes are a good start, add milk, eggs, shellfish, fruit and berries. Hew close to PHD. Try some natural umami flavorings (with nucleotides) along with healthy acids. Emphasize saturated fat sources like milk, butter, coconut milk. Occasional nuts. Focus on circadian rhythm entrainment, try to start every morning with bright light, exercise, and breakfast on a routine schedule, switch to orange lights in the evening.

      Best, Paul

  19. Hi Paul,

    Now we know that a major factor in Crohn’s disease is an innate inmune deficiency that impairs the bacterial clearance in the bowel tissues. There are multiple papers on this, e.g.:

    https://pubmed.ncbi.nlm.nih.gov/20860961-barrier-and-autophagic-functions-of-the-intestinal-epithelia-role-of-disturbances-in-the-pathogenesis-of-crohns-disease/
    https://pubmed.ncbi.nlm.nih.gov/31136040-studies-on-patients-establish-crohns-disease-as-a-manifestation-of-impaired-innate-immunity/
    https://pubmed.ncbi.nlm.nih.gov/16503465-defective-acute-inflammation-in-crohns-disease-a-clinical-investigation/

    And it has been proven that strategies that enhance innate immune response may be helpful. E.g. https://pubmed.ncbi.nlm.nih.gov/17106921-crohns-disease-innate-immunodeficiency/. (However, please caution: even if this is true, it can be harmful to stimulate immune system during a flare because it can lead to more damage to the tissue).

    I already follow the PHD principles as much as I can. During flares, the CDED (‘Crohn’s Disease Exclusion Diet’) is very helpful and recommend it to any Crohn’s patient. Indeed, it is compatible with PHD because it is largery based on potatoes, chicken breast, bananas, apples, and eggs; and excludes offenders (such as cereals except rice; legumes; alcohol; etc), high insoluble fiber, and limits fat (except whole sources as yolks and avocados).

    So when the damage to my bowels is not extensive yet, diet alone can stop the flare. This is not just my impression, but has been proven by my doctor’s test two times already.

    However, I keep relapsing easily, and I have to avoid lots of foods to prevent it. It is my belief that it will keep like this until my bowel is 100% healed. Why? In my previous experience when I was on inmmunosuppresants (adalimumab), after 1 year my bowel was 90% better according to the colonoscopy, but there were still some injuries – and if it weren’t for the immunosuppressant, those injuries would make me very vulnerable to further relapse, just as I am at this moment.

    As someone who has a perfect background on how lifestyle can help to enhance immune system, and currently being a researcher against cancer (which has a lot to do with the immune system), what would your advice be?

    In advance, as a reader of this blog, I guess good nutrition (as the PHD) and entertaining Circadian rhythms are key aspects. Intermitent fasting to promote autophagy, in those whose bodies can handle it, will be helpful against intracellular infections too and will limit faeces stream thereby limiting the tissues being exposed to further particles and bacteria.

    Is there anything else you would add? And what specific aspects would you insist on the most (e.g. key nutrients, strategies, supplements, whatever)?

    Thank you very much in advance, your advice is greatly appreciated.

    • Hi Hector,

      The perspective you describe makes a lot of sense, and suggests a number of avenues for improvement. First, improving antimicrobial peptide and defensin production should be beneficial, as these will mitigate bacterial activities but not generate tissue damage. Vitamin A, vitamin D, and N-acetylcysteine are importnat nutrients for these.

      Intermittent fasting, circadian rhythm entrainment, good bile support (vitamin C, glycine, taurine, egg yolks), and healthy food flavoring acids (e.g. apple cider vinegar, lemon juice) should all be helpful in clearing bacteria.

      Extracellular matrix from soups/stews and shellfish will support healing and tissue repair.

      Those would be my top suggestions.

      Best, Paul

      • I just read your answer. Thank you very much Paul! I’ll follow your advice. At first I was worried that NAC may be helpful but at the same time it’s a mucolytic that may harm. Ulcerative colitis patient’s have defects on their mucous, but not the case for Crohn’s patients. So if someone is not deficient on carbohydrates, it should not be a problem. And probably NAC is absorbed before reaching the ileum. So I agree it may help in reasonable doses.

        As you say it does seem that there are a lot of avenues for improvement. I hope it soon leads to better lives for Crohn’s sufferers!

        Thank you again.

    • *I meant circadian rhythm ‘entrainment’ in my comment, not ‘entertaining’. I’m always confusing those words!

      I researched on the bibliography in the past, and will keep adding advice to help any Crohn’s sufferer:

      — reduced gluthatione supplementation should be very helpful because it protects the bowel from oxidative damage. There are papers that show that Crohn’s patients are deficient on it (e.g. https://www.sciencedirect.com/science/article/abs/pii/S0261561498800307 or https://pubmed.ncbi.nlm.nih.gov/24151379-concepts-of-oxidative-stress-and-antioxidant-defense-in-crohns-disease/?from_single_result=Concepts+of+Oxidative+Stress+and+Antioxidant+Defense+in+Crohn%27s+Disease)

      — avoiding microparticles may be helpful if you’re on a flare; so watch out for additives, tooth paste, maybe calcium supplements (it forms natural microparticles inside our gut, and it also helps pathogenical bacteria to build biofilms, so I think in general it may be a bad idea to supplement calcium during a flare), and charcoal or bentonite clay (which sometimes are used on bowel diseases, but can be very harmful in Crohn’s).

      — In general avoid additives, but specially avoid emulsifiers such as carrageenan and carboxymethylcellulose, they seem to be disturbing to our intestinal barrier. (E.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410598/)

      — Avoid probiotics unless you’re in deep remission (i.e. your doctor did a colonoscopy and you know that all your injuries are closed). It can increase the inflammation. I don’t know the explanation, maybe it’s because it adds to the bacterial load in the faecal stream, or maybe because the probiotics are very immunogenic. In avy case, avoid them. The dysbiosis seems to be a consecuence of the intestinal inflammation, that allows some bacteria to thrive on it, and not the opposite. So we can’t build a good microbiota until we are in remission anyway. Avoid xantham gum too.

      — Be sure to wash well your dishes, avoid soap residues which can be extremely disturbing to our intestinal barrier. Or avoid the soap in the first place.

  20. Hi Everyone

    I’ve just read the book and im starting to implement the diet. Is their a search function for past comments rather then me asking questions that have already been answered ? Ive tried the search bar on the top right of the page but it just takes me to a snap shot of the comment and when I go to the link it takes me to the beginning of the topic again. Im on a Mac using google.

    Many Thanks

  21. Hello Paul,

    I am very confused about what type of light bulb to buy for daytime use. I guess the healthiest choices are Incandescent and Halogen bulbs. Looks like CFLs are bad because of excessive unnatural blue frequencies, and most LEDs are also bad for the same reason I think? Is it possible to get healthy LEDs? Can you please tell me what I should look for? For daytime use, should I look for the 5000K+ Full Spectrum LED bulbs?

    I found two products (links below), can you please tell me your opinion of them?

    https://www.waveformlighting.com/full-spectrum-led-lighting

    https://norblighting.com/smile/

    Thank you.

  22. Hi Paul,

    Is freeze-dried non-defatted liver supplement a good substitute to eating liver? Is the vitamin A damaged in any way in the freeze dried liver?

    https://ancestralsupplements.com/desiccated-liver

    Thank you

    • Hi,

      This video by Chris Masterjohn may help you: https://www.youtube.com/watch?v=edUAw2rs54I

      I tend to trust him as a source of reliable information and good advice.

      He concludes “I don’t recommend anyone who would otherwise eat liver stop eating liver and take the capsules, but I do recommend the people who won’t eat liver take the capsules. I think it’s a nice thing to do”.

      Regarding the vitamins being damaged in frozen foods: I have heard about folate being degraded in frozen vegetables, but being stable in frozen liver. But I have never heard about vitamin A being degraded in such conditions. Actually, the case for folate seems a exception rather than something common. I have heard that even immunoglobulins, which are pretty complex proteins, are fully functional even years after being in the frozen.

      So I don’t think it’s a problem to freeze liver, but I don’t have real proof; but freezing vegetables for long time is a problem, because folate will keep degrading over time (to be clear: if the veggies were frozen two days ago, they still have folate; if they were frozen one year ago, they won’t have any).

  23. Hi,

    I’m posting here something intriguing to see if Paul or any reader have an explanation or a theory.

    My mother (58 years old, obese) had been suffering from sudden pain in her upper chest in the past. It seems that after doing some tests, the doctor diagnosed it as anxiety, and prescribed diazepan or something like that. It worked well to cease the pain during those episodes, but the pain would return milder after about four hours.

    For some time now, the pain has greatly reduced the frequency with which it appears. I can’t really say what has helped it, because during these months (especially the last two months) she has improved her diet and lifestyle. But apparently, the biggest change on this may have been the supplementation of sublingual methylcobalamin.

    I suspect that he was deficient in B12 in the past because she had been suffering from a lot of memory loss that has subsided when she started the B12. After being supplemented for two months or so, she was tested a month ago and his B12 level came back as correct (600 pg/ml), so I removed the methylcobalamin supplement to see what happened.

    So, it has been two or three weeks now that she didn’t take any B12 pills. And today the pain came back; quick enough she asked me for a pill of methylcobalamin and it subsided.

    Maybe sublingual methylcobalamin has some therapeutic effect unrelated to any deficiency; or maybe it’s the methylcobalamin form.
    – For example, in one study it appears to be a painkiller under some conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888748/
    – Or maybe it’s not the B12 itself, but the methyl group.

    But I must add something else. From our observations, it may be that methylcobalamin supplementation not only helps acutely during the onset of pain, but may also have preventive value, since when I was taking it I often did not have these episodes. This is a clue to speculate mechanisms.

    Finally, another possibility is that the pain is caused by hypertension. In fact, his hypertension has been greatly improved by the PHD recommendations. In other words, both hypertension and pain have improved from the past to the present. Today I measured your blood pressure when you had this pain, and it was 150/90, which is now an exception because most of the time it is 120/75. Still, vitamin B12 would have some role, since it is therapeutic as I have reported. Or maybe it’s a very large placebo effect, which I don’t know if it’s another possibility, but as a precaution I won’t check.

    In any case, I lack the training to find this out for myself; it’s like trying to hit the lottery by playing in binaries. For the moment, I will try to boost methylation and glycine to see if the pain returns; if it returns, I will keep treating it with methylcobalamin rather than diazepan, but it’s just a guess. (She won’t take more than 3g methylcobalamin per week divided in three doses, so the dosage isn’t that high and doesn’t worry me.)

    If anyone can contribute anything, I am very grateful.
    Kind regards

    • Sorry, Paul if you read it, please may you delete the message? Some typos may make it difficult to understand, so I’ll post it again.

  24. Hi,

    I’m posting here something intriguing to see if Paul or any reader have an explanation or a theory.

    My mother (58 years old, obese, improving now) had been suffering from sudden pain in her upper chest in the past. It seems that after doing some tests, the doctor diagnosed it as anxiety, and prescribed diazepam or something like that. It worked well to cease the pain during those episodes, but the pain would return milder after about four hours.

    For some time now, the pain has greatly reduced the frequency with which it appears. I can’t really say what has helped it, because during these months (especially the last two months) she has improved her diet and lifestyle. But apparently, the biggest change on this may have been the supplementation of sublingual methylcobalamin.

    I suspect that she was deficient in B12 in the past because she had been suffering from a lot of memory loss that has subsided when she started the B12. After being supplemented for two months or so, she was tested a month ago and his B12 level came back as correct (600 pg/ml), so I removed the methylcobalamin supplement to see what happened.

    So, it has been two or three weeks now that she didn’t take any B12 pills. And today the pain came back; quick enough she asked me for a pill of methylcobalamin and it subsided.

    Maybe sublingual methylcobalamin has some therapeutic effect unrelated to its deficiency; or maybe it’s the methylcobalamin form.
    – For example, in one study it appears to be a painkiller under some conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888748/
    – Or maybe it’s not the B12 itself, but the methyl group.

    But I must add something else. From our observations, it may be that methylcobalamin supplementation not only helps acutely during the onset of pain, but may also have preventive value, since when she was taking it she seemed not to have these episodes. This is a clue to speculate mechanisms.

    Finally, another possibility is that the pain is caused by hypertension. In fact, her hypertension has been greatly improved by following the PHD advice. In other words, both hypertension and pain have improved from the past to the present in a reasonable time overlap.
    Today I measured her blood pressure when she had this pain, and it was 150/90, which is now an exception because most of the time she is at 120/70 – 130/80. Still, vitamin B12 would have some role, since it is therapeutic as I have reported. Or maybe it’s a very large placebo effect, which I don’t know if it’s another possibility, but as a precaution I won’t check it.

    In any case, I lack the training to find this out for myself; it’s like trying to hit the lottery by playing in binaries. For the moment, I will try to boost methylation and glycine to see if the pain returns; if it returns, I will keep treating it with methylcobalamin rather than diazepam, but it’s just a guess. (The pain isn’t common now so likely she won’t take more than 3g methylcobalamin per week divided in three pills in the worst scenario, so the dosage isn’t that high and doesn’t worry me.)

    If anyone can contribute anything, I am very grateful.
    Kind regards

    • *I meant 3000 mcg, not 3g. Grams of B12 would be huge!

    • Hi Hector,

      Serum B12 is not a very sensitive indicator of B12 deficiency. What is her urinary methylmalonic acid excretion without B12 supplementation?

      Best,
      -Eric

      • Hi Eric,

        I appreciate your insight. I was overlooking that fact. I’ve dedicated some time to consider that hyphotesis.

        It would be helpful to know if a sudden intake of B12 can, in a matter of minutes, provide relief in a B12 carency. If that is plausible, this idea would be the most likely.

        We can’t test for other tests, sadly. Her doctor was somewhat reductive in testing her vitamin B12 level, so it required a bit of insistence on my part, despite it being a very common and justified test… So you can imagine!

        However, I checked some other markers, but couldn’t drawn any conclusion. I think we are lacking information here, I will share it in my next message below, and maybe some more trained eyes can detect something.

        My only thought so far is that my mother may be missing something, maybe iron, maybe some B-vitamin, maybe copper, but probably the deficiencies are combined so that they aren’t straightforward to detect… I don’t know. But she’ll eat some liver from now on, and that may help.

        Kind regards,
        Hector

        • Those are the numbers on her blood!

          Instead of writing the numbers, I have uploaded a picture with the table, so they are easier to read:

          https://i.imgur.com/EcaKyXF.jpg

          Any clue? I don’t have much more, not homocysteine or much else…

          The last point seemed strange, with high hematocrit and hemoglobin. Maybe she was dehydrated when they extracted the blood?

          • (I know that if all you have is a hammer, everything looks like a nail… But it is interesting to consider if it could be a deficiency, since it seems likely, and the benefit/cost ratio is very favorable, besides it would be easy to fix).

  25. Hey guys,

    I’ve recently started fasting 16:8 and I’ve noticed over the past week I’ve had excess phlegm build up in my throat during the fast. It goes away once I break fast and start eating again. Is this a common occurrence or could it be something underlying like a flu that just hasn’t taken hold?

    Any advice is helpful.

    Thanks!

  26. Hi Paul,

    Here we are, in the throes of a coronavirus pandemic and the resultant COVID-19 illness. I was wondering if you or Shou-Ching have anything to add to your chapter, “A Strategy for Immunity,” that can help people resist the virus or lessen the severity of COVID-19 if they do become infected.

    Thank you so much.

  27. Hi Paul,

    https://bmjopen.bmj.com/content/10/3/e033741

    This new study observed that people who consumed whole or full milk had 3.4 years lower EAD (expected age of death) compared with those consuming skimmed milk.

    Since the PHD considers the milk fat healthy do you have a quick guess why they might have observed such outcome?

    Best
    Mark

    • The fundamental problem is that we cannot do science by using epidemiological studies, because there are cofactors that cannot be isolated

      For example, meat-eating enthusiasts are also more likely to smoke, to lead more sedentary lives, to eat more sugar

      On the other hand, people who are more health conscious tend to follow the official advice, which is lacking, so whoever picks up wholemeal bread at the supermarket is likely to follow other recommendations such as exercising and eating more vegetables and fruit. They may also have access to better education, and are likely to be better off financially and therefore have better access to healthcare, live in safer places with more comfort, maybe less stress, etc.

      So, if we do a population study and we see that those who eat wholemeal bread have better health, is it thanks to wholemeal bread, or is it in spite of wholemeal bread? That’s the point.

      A final example: observational studies consistently found that the higher the consumption of beta-carotene, the lower the cancer rate. However, when clinical interventions were performed (in which one group was given beta carotenes and the other was not) the opposite relationship was found.

      • (Epidemiological studies are useful and inexpensive, relatively easy to do. They provide clues and new ideas that may deserve further exploration. But when I say they are not useful for doing science, it is because no real conclusions can be drawn from them. Only speculation at best. Unfortunately in nutrition they are misused all the time).

  28. Hey Paul, Chris Masterjohn just sent out his Coronavirus recommendations. He does not recommend taking Vitmain D or A since they increase ACE2 and that the virus could utilize to get us infected. He does recommend NAC though.
    Can you argue with this?
    Maybe you can post some of your recommendations?

    From his guide, “Vitamin D is a vitamin that we can obtain from food, or by exposing our skin to sunshine, and is
    essential to life. Vitamin D is not as critical to the immune system as vitamin A, but it does help
    us make virus-busting weapons and it does seem to reduce the risk of the flu (although during
    the swine flu pandemic of 2009, all it did was delay catching the flu by a month). However, like
    vitamin A, vitamin D increases the amount of ACE2 on our cells and this could increase our risk
    of getting infected with the new coronavirus.”

    • Hi Magda,

      I think that’s very doubtful advice. The upregulation of ACE2 is protective against acute lung injury/ARDS and some scientists have proposed using the drug Losartan which does the same thing as a treatment in coronavirus patients to prevent ARDS. So that aspect of vitamin A/D could be beneficial or harmful, I think the answer is unclear. But the other effects of optimizing vitamin A/D should be clearly beneficial. I would just try to optimize them per standard PHD advice.

      Best, Paul

      • Hi Paul,
        CM’s advice also recommends not getting anymore than about 156 mg of vitamin C, and best to get it only from food. High dose vitamin C has helped me with so many issues. I try to keep it to just under bowel tolerance. Is there so much mystery about this “novel” virus that we can’t trust anything we “knew” before?

  29. Lana-
    I would trust Paul on this. I would think his advice on C would hold as well. China is performing a trial on iv C right now, at extremely high doses. I don’t think they are interested in doing lung damage in the process. I purchased the protocol as well, out of curiosity, but I 100% disagree with his recommendations on A/D. It’s a theory, that’s it. And btw- I like Chris. Sorry for jumping in, but I couldn’t help it. Paul has always made very reasonable, safe, and well thought out recommendations. Good sleep, sun if possible, try and manage stress, practice excellent hygiene, and cover your bases through PHD. Sounds like an excellent approach to me. And Paul, I miss your updates. Hope you are well!
    Take Care-

    • thanks Chris! Lana, I agree with Chris above, not CM, vitamin C is likely to be beneficial and it’s hard to see downside from it, unless you get too close to bowel tolerance and disrupt the gut microbiome. Some coronavirus can go down the esophagus instead of the lungs and if it’s not digested by sufficient stomach acid, can infect the intestine to cause diarrhea. A healthy gut microbiome should be protective against gut infection. This would also be relevant if you are eating uncooked food that carries virus, e.g. sandwiches or salads made by an infected person.

      Generally, standard PHD advice is optimal for coronavirus. All natural health remedies such as supplements are popguns against a battle tank in this coronavirus. It will need vaccines and pharmaceutical therapies, but not getting infected is the best path. Wear masks, wash hands, and stay safe. Circadian rhythm entrainment with morning exercise and sun is most important after masks and hand washing.

      Best, Paul

  30. Hey Paul,

    I’d love to hear your thoughts on COVID-19 and the best way to deal with it. I’ve been thinking about a theory that I have no real basis for, but would be curious to know if you think it might have any truth to it. The areas hardest hit by the virus so far in terms of deaths, seem to be areas where wheat is a major staple of the diet. In Wuhan I believe wheat noodles are the most common breakfast item, and fried dough is very popular as well. Italy obviously loves wheat. Same with New York. Japan, at this point (still to early to know for sure) seems to not be getting hit as hard. Also South Korea had a surprisingly low death rate for the number of cases that it had. I believe it was 0.7% as opposed to 2-3%. Correct me if I’m wrong, but cytokine storms seem to be the basis for a deadly immune reaction to the virus. Is it possible that cultures that consume too much wheat (or non-safe starches) are predisposing themselves to cytokine storms (or malfunctioning immune responses)? Like I said, this is just a theory, but I couldn’t help but notice the differences in diets between these locations where the virus has spread.

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