Supplements

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Supplemental Foods

We recommend eating these “supplemental foods” on a regular schedule:

  • 3 egg yolks daily, 5 yolks daily for women who are pregnant or planning to become pregnant (for choline, folate, vitamin A)
  • A bowl of soup made from bone, joint, tendon, foot, or hoof stock, 3 days per week (for calcium, phosphorus, and collagen)
  • Fermented vegetables such as kimchi, sauerkraut, or fermented mixed vegetables (for nucleotides, probiotic bacteria, and vitamins K2 and B12), and other vegetables such as tomato, avocado, potato, sweet potato, banana, green leafy vegetables, and seaweeds such as dulse, daily (for potassium)
  • ¼ lb beef or lamb liver, weekly (copper, vitamin A, folate, choline). If you like, substitute ¼ lb chicken, duck, or goose liver weekly plus 30 g 85% dark chocolate daily
  • fish, shellfish, eggs, and kidneys, weekly (for selenium)

Daily Supplements

These are supplements we recommend be taken daily:

  • Sunshine and vitamin D3 as needed to achieve serum 25OHD of 40 ng/ml.
  • Vitamin K2 100 mcg or more
  • Magnesium 200 mg
  • Iodine 225 mcg
  • Vitamin C 1 g
  • Pantothenic acid (vitamin B-5) 500 mg
Vitamin D3
  • Seek total dose from sun, food, and supplements of 4,000 IU/day
  • Adjust to 25OHD level of 40 ng/ml (whites/Asians), 30 ng/ml (blacks)
Vitamin K2
  • Recommended dose: 100 mcg MK-7
  • Pharmacological, possibly therapeutic doses: 1000 mcg to 5 mg MK-4
Magnesium
  • Use chelate (e.g. glycinate) or citrate
  • Daily dose 200 mg
Iodine
  • Recommended dose 225 mcg/day (one tablet)
  • Nori sheets have about 50 mcg each; 2-4 per day replaces supplements
  • Supplementation is to prevent lengthy iodine droughts
Vitamin C
  • Low dose: 500 mg – 1 g per day
  • Under stress or viral infections, more may be needed
  • Powder is least expensive way to get large doses
Vitamin B-5 (pantothenic acid or pantethine)
  • 500 mg per day; we suggest daily due to its extreme safety
  • Acne/skin blemishes or low energy/endurance are symptoms of deficiency

Weekly Supplements

These are supplements we recommend be taken once a week:

  • B vitamins:
    • 50 to 100 mg each of B1, B2, and B6
    • 5 mg biotin
    • 500 mcg B12
  • Zinc 50 to 100 mg
  • Boron 3 mg
B1 (thiamin)
  • 50-100 mg weekly
B2 (riboflavin)
  • 100 mg per week
B6
  • For those who don’t take a B-50 complex
  • We recommend 50 mg to 100 mg per week
Biotin
  • We recommend 5 mg once per week
B12
  • We recommend 500 mcg to 1 mg once per week
  • Sublingual methylcobalamin is preferred
Zinc
  • We recommend about 50 mg per week
  • Be sure to follow our copper recommendations as copper-zinc balance is crucial
Boron
  • The 3 mg dose can be taken one to three times per week

Prenatal Supplements

The most important prenatal supplements are:

  • Extra duck, goose, or pastured chicken liver.
  • Extra egg yolks.

The following supplements may also be helpful during pregnancy or in the months leading up to conception. Note: We do not recommend prenatal multivitamins.

Choline
  • Not necessary if you eat enough egg yolks and liver
  • But extremely important during pregnancy, and safe
Inositol plus Choline
  • Not necessary if you eat enough egg yolks and liver
  • If supplementing choline, good to mix in some inositol
Iron (optional)
  • About 30% of pregnant women develop iron deficiency anemia
  • Don’t guess, test; blood tests will indicate if you need iron supplements

Optional Supplements


These supplements may be helpful for a significant fraction of the population. Experiment to see if they help you:

  • Probiotics
  • Chromium, 200-400 mcg per week (not necessary if you cook in stainless steel pots) and (optional) vanadium, 25 mcg per week
  • Lithium 5 to 10 mg per week
  • Silicon 5 mg to 25 mg daily
  • FOR PEOPLE WHO DO NOT EAT LIVER: Copper 2 mg per day
  • FOR PEOPLE WHO DO NOT EAT LIVER: Vitamin A from cod liver oil, 50,000 IU/week
  • FOR PEOPLE WHO DO NOT EAT MAKE BONE STOCK OR DRINK MINERAL WATER: Calcium up to 400 mg/day
  • B-50 complex (as a substitute for individual B supplements if you prefer fewer pills
  • Molybdenum 150 mcg per week
  • Taurine 500 mg per day
  • Selenium 0 or 200 mcg per week depending on selenium content of food (if food is produced in dry, flat areas = high selenium, no supplements; rainy, well-drained areas = 200 mcg/wk)
Probiotics
  • Bifidobacterium spp can help with leanness and weight loss.
  • Lactobacillus spp can help with acid reflux, bloating, SIBO, prediabetes, high triglycerides
More Probiotics
  • Bifidobacterium spp can help with leanness and weight loss.
  • Lactobacillus spp can help with small intestinal issues
More Probiotics
  • VSL#3 is a good mix for inflammatory bowel diseases.
  • Prescript Assist includes soil-based organisms that are a little riskier and should be taken only occasionally, not continuously, for therapeutic reasons.
Chromium
  • If you don’t cook in stainless steel, we recommend 200 mcg chromium one to three times per week
  • Stainless steel pots may release 88 mcg chromium per day of use
  • Optional: vanadium 25 mcg one to two times per week
Lithium
  • 5 mg or 10 mg per week
  • Ideal dose would be 1 mg per day, but that dose is not available
  • Caution: too much lithium can exacerbate hypothyroidism and increase potassium excretion
Silicon
  • Up to 25 mg per day
  • Most people would benefit from more silicon
  • Seaweed is a good food source
Copper (Only If Liver Is Not Eaten)
  • Target of 2-3 mg/day can be met by eating 1/4 lb beef or lamb liver per week
  • Do not supplement copper if you eat liver
Vitamin A (Only If Liver Is Not Eaten)
  • Target of 50,000 IU/week with remaining A needs met from carotenoids (green leafy vegetables and orange plants like carrots)
  • Do not supplement vitamin A if you eat liver, unless for therapeutic reasons
Calcium (If No Mineral Water or Bone Stock)
  • PHD foods may fall short of calcium target by up to 400 mg/day
  • Standard PHD prescription is to make up the difference with bone stock and/or mineral water
  • These supplements also replace magnesium supplement; aim for 300-500 mg calcium and 150-250 mg magnesium per day
B-50 complex
  • An alternative to the other B vitamins for those who prefer to take fewer pills
  • Not recommended more than once per week due to folic acid and niacin content
Molybdenum
  • We recommend 150 mcg to 1 mg per week
Taurine
  • We recommend 500 to 1000 mg weekly
  • Supports production of bile salts
Vitamin E
  • Red palm oil is a good food source
  • If supplementing, take mixed tocopherols and tocotrienols

Therapeutic Supplements

These supplements are unnecessary for healthy people but may be helpful in various disease conditions.

N-acetylcysteine
  • Precursor to glutathione
  • Recommended dose is 500 mg
  • Can take more in cases of severe chronic infection
Glycine
  • Supports collagen production, bile conjugation, and glutathione production
  • Desirable if you don’t eat daily extracellular matrix (bones, joints, tendons, skin, hooves)
  • Up to 2 teaspoons (10 g) per day
Creatine
  • Supports muscle growth and preservation; especially valuable for the elderly
  • Up to 1 teaspoon (5 g) per day
Melatonin
  • An important sleep hormone, deficient in many brain diseases, has antimicrobial activity
  • Take 1 mg sublingually just before bedtime
  • For larger doses, combine 5 mg time-release with 1 mg sublingual
Detoxification Aids
  • These can help bind toxins and excrete them in feces, preventing them from being re-absorbed in the colon
  • Likely to be helpful for most people suffering from chronic infection or environmental mold.

Miscellaneous


These items may be helpful in implementing Perfect Health Diet and Lifestyle advice.

Pill boxes
  • Set out pills once per week, aids remembering to take them
Pill cutter
  • For cutting tablets to reduce the dose

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3,924 Comments.

  1. Paul, thank you for your work and for continuing to answer questions. I found your book after years of low carb and more recently vlc eating have led to many health problems and malnutrition. I’ve started PHD and am slowly getting back to normal. I have to admit that I nearly abandoned it because of weight gain, but after reading and multiple rereadings, I’m going to stick with it and hope restoring good health restores my physical fitness in the long run.

    Now, my question.

    I’m 52 and 10 pounds overweight. I’m deficient in B12 and D and not at optimal range for most micronutrients. In addition, my total cholesterol is low and has been low for many years. Sometimes looking back, as low as 145! (Doctors used to congratulate me on my lipids.) My numbers as of last year are:

    Total Cholesterol 188
    HDL 99
    LDL 75
    Triglicerides 69

    I’m waiting for more recent results on tests last week.

    I’ve been experiencing most hypothyroid symptoms, from weight gain to hair loss to dry skin to constipation, etc., all of which I hope will improve with the diet. I’m writing today though about my tinea versicolor and the cholesterol connection.

    After reading your posts on cholesterol and some other articles about cholesterol sulfate’s role in melanin production, I’m wondering if my low cholesterol and vitamin d suppressed cholesterol sulfate to my skin (because cholesterol was more needed elsewhere in my body), leaving my skin vulnerable to fungi overgrowth, and if so will TV improve with circadian rhythm training + increasing my total cholesterol level and vitamin D?

    I’d like to avoid taking anti-fungal medication recommended by my derm. I’m also worried about the advice to stay out of the sun. I do understand that the spots that have no melanin are vulnerable, but how to temper that with the need for sun on my skin to improve vitamin d.

    Do you have any advice?

    -Sally

    • Hi Sally,

      First, regarding weight, watch my talk on weight loss: http://perfecthealthdiet.com/2014/08/ancestral-health-symposium-tak-weight-loss/. Note that there are health improving causes of weight gain so it’s important to prioritize health over weight.

      Your low LDL is an important clue. Normal is 130. Your levels commonly indicate iron deficiency anemia, less commonly hyperthyroidism or parasitic infections. You should get a thorough checkup including tests of iron and thyroid status.

      Fungal infections are common when too low carb and malnourished, but should go away on their own with better nutrition. Likely to help are carbs, vitamin a, vitamin d, vitamin c, iodine, salt, magnesium, chromium, copper, taurine, glycine, N-acetylcysteine.

      Best, Paul

    • Sally your lipids are similar to mine.

      I note you are B12 deficient as I was.

      I have B12 injections every 3 months as I live in UK.

      I am not clever enough to offer advice but getting my B12 up did make a big difference to my health.

  2. Thanks so much. I really appreciate your advice.

    I had just read about N-acetylcysteine and have it on order. I was diagnosed with Dupuytren’s and now I’m getting nodules in my feet, rather painful, which would indicate Ledderhose disease – rare in women. No one in my family that we know of had either. I plan to have DNA testing done.

    I’m already supplementing D – 1,000 units a day. I’ll add C and A, chromium, glycine now.

    Re: Iodine, I changed my salt to iodized salt when I first read the book. Is that sufficient? I rarely eat seaweed, but I can make the effort if it’s needed.

    For magnesium, I just started a TBSP of magnesium sulfate every night both to help with constipation (and hopefully it will help with the circadian rhythm training). Is that sufficient for magnesium intake?

  3. Hey Paul! Thank you for all your work. My wife and I have been trying to conceive for quite some time now (2 yrs). We are very disciplined in our eating, however we are dealing with some issues (PCOS) that require even more diligence in our efforts. I would like to know what you might recommend for male supplementation when trying to conceive?

  4. Dr. Paul,

    Is there a relation between copper and estrogen/estradiol? I have high E2 levels and seem to be this way naturally, and have noticed some anxiety and depression with copper (Thorne, 2 mg). After some studies it seems that excessive serum copper could result in anxiety / depression disorders, and even Alzheimer’s. Further reading led me to some studies suggesting that high estrogen may actually increase copper.

    • Hi Andy,

      Copper and zinc need to be in balance, and high copper can induce a zinc deficiency, which is associated with anxiety and depression, see http://www.ncbi.nlm.nih.gov/pubmed/23946656 and http://www.ncbi.nlm.nih.gov/pubmed/23946658.

      So you might try getting more zinc as well as reducing copper intake for a bit.

      Best, Paul

      • Speaking about copper/zinc-balance. This is my main issue as well and I don’t know how to tackle it.

        My lab work shows:
        Low-normal serum copper
        Low-normal serum zinc
        Low-normal ceruloplasmin
        Low RBC-copper
        Normal RBC-zinc
        High hair copper
        High-normal hair zinc

        Other related issues that I have are anemia, fatigue and dysbiosis/yeast overgrowth.

        My diet is similar to PHD with lots of soups and stews made with bone broth but I don’t eat as much carbohydrates and vegetables as you advice because I don’t tolerate them very well.

        With regards to lifestyle practices I try to manage my circadian rhythm as much as possible and do intermittent fasting 14:10 daily.

        I currently take all of the supplements you recommend, although I take vitamin A as palmitate from Thorne weekly instead of vitamin A from Cod liver oil. In addition I also take extra molybdenum, NAC, liposomal glutathione, liposomal vitamin C and probiotics since I don’t eat/tolerate fermented foods.

        Obviously there’s something wrong with the bioavailability of copper but I don’t know how to correct it. I’ve been thinking about adding a copper supplement and/or to start eating liver again but previously when I’ve eaten liver I have felt somewhat anxious and mentally “out of balance”.

        In any case, something needs to change since I’m not going anywhere with what I’m currently doing and I’ve been dealing with this for several years.

        What do you think Paul?

        Any advice would be greatly appreciated!

  5. Does anyone have trouble with the once a week dosing of the B vitamins? When I do this I seem to be OK on the day I take them, although sometimes they can make me a bit tense and give me trouble sleeping, even when I take them in the morning. The next day though I often feel horrible.

    I’ve done this several times in a row so I know it is the B vitamins doing it.

  6. Hi,

    We recently moved to Okinawa, Japan and no longer have access to pastured liver of any type. We’ve been taking copper and Vitamin A as recommended, but I recently came across grass-fed liver capsules. Since whole foods are better than supplements is there a reason why liver capsules aren’t recommended instead of copper and A? My inclination is that you’d get some of the other nutrients from liver by doing the capsules vs the other way. I’ve looked around and bit and didn’t see an answer so I hope this isn’t redundant.

    If it matters, I’m currently 12 weeks pregnant.

    On an unrelated note, how do people get their yolks in? I hate to throw away food away, so I typically eat a couple of whole eggs each day. I seem to remember reading know that eating eggs regularly increases the likelihood of developing a sensitivity to them.

    Thank you for your help!

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