Supplements

This page lists our supplement recommendations with links to products at Amazon. By purchasing via links on this page, you support the blog at no cost to yourself. Thank you for supporting our work!

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 to 5000 mg per week (higher doses may be therapeutic for small intestinal or systemic infections)
  • 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
  • Best is to take 1 mg per day; 5 mg once or twice per week is next best
  • 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 for healthy persons
  • 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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Leave a comment ?

4,222 Comments.

  1. What’s the suggested amounts/frequency for fermented foods?

  2. What are your suggestions, if any, for supplementation while following a ketogenic PHD? Your book mentions electrolytes, and BCAA but no specifics. Thanks for any help.

  3. I have a question about iodine supplements. I can’t take potassium iodine because of another medication I am on that I can’t take potassium with. So I’ve been taking organic kelp in pill form, 225mcg a day. But on a recent trip to Florida, I ate lots of shrimp, crab and other seafood (while still supplementing the kelp) and I ended up getting hives from overdosing on iodine (runs in my family). I was hoping supplementing iodine throughout the year would prevent this from happening to me. Do you recommend I continue to supplement or should I stop? Thanks!

  4. Hi Paul,
    I have been doing PHD for about 2 1/2 years. I was a early 50s guy becoming limited physically due to inflammation. Now my health is better in so many ways, and I feel more like I did in my 20 and 30s.
    My blood test results recently had mostly good numbers but blood platelets were 143 the suggested good range was 150 to 450. I do bruise easily sometimes.
    Do you have any suggestions for upping platelets?
    Also is it OK to take a large dose of vitamin D once a week or better to spread it out over the week? Thanks.

  5. PAUL >>>
    Is there a specific supplement company that you recommend?

    • Never mind Paul >>> I had my Adblocker on and it did not load the recommendations you had there. 😳 Sorry 😳 😀 😛

  6. Paul,

    Do you have any thoughts on substances like NMN, resveratrol, metformin, and rapamycin that are said to effect certain longevity pathways?

  7. Paul,
    Do you have particular recommendations for supplements to take and ones to avoid for someone who is on chemotherapy for breast cancer? My best friend just started chemo. Both she and I follow PHD but we were wondering if the supplements you recommend should be taken while she is on a six-month course of chemotherapy. Thank you.
    Mary

  8. Hi Paul,
    I have seen a study which correlates choline supplementation to higher levels of TMAO and blood clotting. They suggest that choline-rich foods, like eggs would have the same effect. What is your opinion?
    https://www.webmd.com/dvt/news/20170424/common-food-nutrient-tied-to-risky-blood-clotting#1
    Thanks!

  9. Hi Paul,

    I am a bit confused about the logic behind the suggested dose for supplemental B12.

    Since PHD suggests animal foods with every meal, I assume that healthy individuals would have no trouble obtaining sufficient B12 from food on PHD. (Certainly, blood tests indicate that I have no trouble obtaining sufficient B12 from food.) Most of the benefit of supplemention would thus be seen in the nontrivial fraction of people (several percent) with B12 malabsorption.

    So how much B12 is needed in cases of malabsorption? The following is taken mostly from [1]:

    One common cause of B12 malabsorption is pernicious anemia, in which active transport (about 50% efficiency) is impaired, and B12 can only be absorbed via passive diffusion. From experiments with radiolabeled B12, passive diffusion has about 1% efficiency on average — but individual variation is significant and absorption rates around 0.5% are not rare. Note that these figures for passive diffusion assume supplemental B12 is taken while fasted; if supplemental B12 is taken with food, absorption rates via passive diffusion are about 30% lower.

    This has two effects:

    * B12 absorption declines by a factor of 50 on average, but sometimes by as much as 100.

    * The requirement for absorbed B12 is roughly doubled, since B12 loss during enterohepatic circulation jumps from roughly 50% to roughly 99%.

    So in theory, requirements for dietary B12 in pernicious anemia are raised by roughly a factor of 100 on average, but sometimes by as much as 200. This suggests doses of 100 x RDA ~ 250 mcg/day ~ 2 mg/wk would be necessary for the average person with pernicious anemia; doses as high as 500 mcg/day ~ 4 mg/wk would be necessary for some such people; and it looks probable that 5 mg/wk is high enough to ensure adequate B12 status in all cases of B12 malabsorption. (At least if taken on an empty stomach — if taken with a meal, a bit more, perhaps 7 mg/wk, would be needed.)

    Note that such doses are readily available in the form you recommend (sublingual methylcobalamin):

    https://www.amazon.com/Jarrow-Formulas-Methylcobalamin-Supports-Lozenges/dp/B0013OQGO6/ref=sr_1_3?crid=21NBUGKHWSY10&keywords=methylcobalamin+b12+5000+mcg&qid=1554700268&s=gateway&sprefix=methylcobalamin%2Caps%2C215&sr=8-3

    In practice, to quote [1]:

    “…Heinrich… discusses the suitable daily maintenance dose and finds 300 mcg daily to be adequate. Statistically this is correct, because this dose results in an absorbed and retained average quantity of approx 3 mcg, or slightly more than the normal daily turnover. However, considering the variations in absorption, a wider safety margin seems to be appropriate… Heinrich’s figures, as well as ours, show some absorption values far below average, and in our experience low values are found rather constantly in certain individuals. Heinrich refers to clinical trials, published by others, indicating that 300 mcg daily might be sufficient. Our more comprehensive material, followed up for a much longer period of time, showed that 500 mcg daily, although in general adequate, may give borderline serum B12 values in a few cases. In these patients normal values were rapidly restored by 1000 mcg daily.”

    How would these doses effect healthy individuals?

    Milligram doses of B12 are far above the saturation point for active transport, which typically is about 2 or 3 micrograms — so only roughly 1% of the dose (on average) would be absorbed, i.e. about 10 mcg for 1 mg/wk, or 50 mcg for 5 mg/wk. For comparison, typical absorption of B12 from food on PHD would presumably be almost 20 mcg/wk (two meals per day that saturate active transport). And if suggestions on intermittent fasting were disregarded, and B12-rich foods like liver were spaced out carefully over the enlarged feeding window to maximize B12 absorption, you could probably absorb almost 40 mcg/wk from food alone.

    So a single dose of 5 mg/wk would result in more B12 absorption than one could get from food… but not by that much! (And the suggested dose of 1 mg/wk would result in significantly less B12 absorption than a healthy person would get from food.)

    Now, most of these studies are with oral cyanocobalamin, rather than sublingual methylcobalamin. However, sublingual B12 does not appear to be significantly more bioavailable than oral B12: [2] suggests no significant difference in absorption between oral and sublingual cyanocobalamin, and [3] suggests no significant difference between oral and sublingual methylcobalamin. Unfortunately, I could not find any studies directly comparing the bioavailability of methylcobalamin to cyanocobalamin in the regime where absorption is dominated by passive diffusion. If there is a difference in bioavailability in this regime, my guess would be that methylcobalamin would be less bioavailable, on account of its significantly higher number of rotatable bonds [4, 5, 6]. But methylcobalamin appears to work as a treatment for pernicious anemia at doses similar to cyanocobalamin, at least in a couple of patients [7], so I presume the difference in bioavailbility cannot be too large.

    Am I missing something here?

    Best,
    -Eric

    [1] https://www.ncbi.nlm.nih.gov/pubmed/5751528.

    [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884303/

    [3] https://www.ncbi.nlm.nih.gov/pubmed/17109579?dopt=Abstract

    [4] https://www.ncbi.nlm.nih.gov/pubmed/12036371

    [5] http://www.chemexper.com/search/cas/68199.html

    [6] http://www.chemexper.com/search/cas/13422554.html

    [7] https://www.ncbi.nlm.nih.gov/pubmed/11979747

    • Hi Eric,

      Thanks for this analysis. I don’t think you’re missing anything in terms of understanding the papers … but if you assume a bit of uncertainty in all of the numbers, then it may be easier to understand the rationale. The idea is essentially that B12 is very safe so any excess is not harmful, while deficiencies can be a problem. If there were certainty that absorption from food was 50% while absorption from a supplement was 1%, then yes, you’d conclude that we should just get it from food and not worry about supplementing. But if you factor in a possibility of poorer absorption from food or better absorption from supplements, coupled with a risk from deficiency but no risk from excess, then it will make sense to supplement occasionally (once a week or once every two weeks).

      Best, Paul

      • Hi Paul,

        My interpretation of these papers was that a supplemental dose of 1 mg/wk would be insufficient for most people with B12 malabsorption.

        On the other hand, a dose of 5 mg/wk would be sufficient for almost everyone with B12 malabsorption — and harmless for healthy individuals.

        So why recommend 1 mg/wk rather than 5 mg/wk? (The same company whose 1 mg tablet you suggest also makes a 5 mg tablet.)

        Best,
        -Eric

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