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. 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?

  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?


  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.


  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

  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?

  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!

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