The Diet

The Perfect Health Diet

Here’s our Perfect Health Diet food plate:

PHD_Apple_plate cropped

NOTE: This is our new food plate, updated 2015. Foreign translations of the original food plate may be found here.

We recommend:

  • About 3 pounds [1.4 kg] of plant foods per day, including:
    • About 1 pound [0.45 kg] of safe starches, such as white rice, potatoes, sweet potatoes, and taro;
    • About 1 pound [0.45 kg] of sugary in-ground vegetables (such as beets or carrots), fruits, and berries;
    • Low-calorie vegetables to taste, including fermented vegetables and green leafy vegetables.
  • One-half to one pound [0.25 to 0.5 kg] per day of meat or fish, which should include organ meats, and should be drawn primarily from:
    • ruminants (beef, lamb, goat);
    • birds (especially duck and wild or naturally raised birds);
    • Shellfish and freshwater and marine fish.
  • Low omega-6 fats and oils from animal or tropical plant sources, to taste. Good sources include:
    • butter, sour cream, beef tallow, duck fat;
    • coconut milk or oil
    • palm oil, palm kernel oil, olive oil, avocado oil, macadamia nut butter, almond butter, cashew butter
  • Acids to taste, especially citric acid (lemon juice, lime juice, orange juice, grapefruit juice), lactic acid from fermented or pickled vegetables, vinegars, tannic acids from wine, and tomatoes.
  • Broths or stocks made from animal bones and joints.
  • Snacks or desserts from our pleasure foods: fruits and berries, nuts, alcohol, chocolate, cream, and fructose-free sweeteners like dextrose or rice syrup.

By weight, the diet works out to about 3/4 plant foods, 1/4 animal foods. By calories, it works out to about 600 carb calories, primarily from starches; around 300 protein calories; and fats supply a majority (50-60%) of daily calories.

In the shadow of the apple are foods forbidden because of their high toxin content. Notably:

  • Do not eat cereal grains — wheat, barley, oats, corn — or foods made from them — bread, pasta, breakfast cereals, oatmeal. The exception is white rice, which we count among our “safe starches.” Rice noodles, rice crackers, and the like are fine, as are gluten-free foods made from a mix of rice flour, potato starch, and tapioca starch.
  • Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded. Beans might be acceptable with suitable preparation, but we recommend avoiding them.
  • Do not eat foods with added sugar or high-fructose corn syrup. Do not drink anything that contains sugar: healthy drinks are water, tea, and coffee.
  • Polyunsaturated fats should be a small fraction of the diet (~4% of total calories). To achieve this, do not eat seed oils such as soybean oil, corn oil, safflower oil, sunflower oil, canola oil, or the like.

We highly recommend certain foods for their micronutrients. These include liver, kidney, egg yolks, seaweeds, shellfish, fermented vegetables, and bone broths.

We also recommend augmenting the diet with certain supplements. See our Supplement Recommendations page. These nutrients are deficient in modern diets due to removal of minerals from drinking water by treatment, depletion of minerals from soil by agriculture, or modern lifestyles that deprive us of vitamin D by indoor living.

We recommend tweaking the diet for certain diseases. Neurological disorders often benefit from a diet that is ketogenic; other conditions may benefit from lower carb diets. These variations are discussed in the book:


See the “Buy the Book” page for other purchase options.

Leave a comment ?

3,179 Comments.

  1. I cannot understand from everything I have read how to get 50-60% of calories from fat. I know a lot comes from the protein, but how do I know how much more fat to eat. Can you really get enough fat from a couple of tablespoons of butter or coconut oil? What about cream? And do I count yoghurt as a protein or dairy?

    I am losing weight on a keto diet and don’t want to gain it back if I go with this plan. I am also afraid of ending up with too few calories and ending up messing up my metabolism, so I am concerned to get enough fat in my diet.

    • Hi Kate,

      Many whole foods recommended on PHD are rich in fat. A days worth of protein from meats would provide 200–400 fat calories (up to 600 if fattier cuts are selected all the time); three egg yolks would provide 100 fat calories; half a large avocado would provide 130 fat calories; two tablespoons of coconut milk (not oil) would provide 50 fat calories; half a teaspoon of red palm oil (useful for vitamin E) would provide 20 fat calories; fermentation of vegetable fiber into short chain fats by the gut microbiome would provide about 50 fat calories. So far, we’re at 450–650 fat calories (up to 850 if fatty meats are selected all the time) without adding any oils or butter.

      The 50–60% of calories from fat is for individuals who aren’t trying to loose weight; see “Restriction of SaFA and MUFA for Weight Loss” (page 141 of the book). For individuals who are trying to loose weight, about 500 fat calories are suggested. Comparing that with the numbers above, that means you should select leaner meats most of the time and not eat added fats like butter or coconut oil (which are not necessary if you cook food by boiling or steaming).

      If you’re not trying to loose any more weight (just trying to not regain it), there are many other potential sources of fat: For example, an ounce of macadamia nuts provides about 200 fat calories; an ounce of chocolate provides 100 fat calories; an additional 1/4 cup of coconut milk or sour cream provides 100 fat calories; a tablespoon or butter or coconut oil provides 100 fat calories.

      If you added each of those (choosing one where I said “or”), that would bring you to 950–1150 fat calories (i.e. 48–58% of calories on a 2000-calorie diet), which is about right for PHD. Alternatively, you could skip some of the added fats while eating fattier cuts of meat all the time.

      So I doubt you’d need to eat more than a tablespoon or two of butter or coconut oil.

      Best,
      -Eric

    • This has been a sticking point for me too Kate, as the fat section of the book seems to be the only one without specific amounts per day. The diet is described as a moderate to low carbohydrate one and it recommends an average person needs about 160g of carbohydrate per day. So if 160g of carbohydrate is low/moderate, then do we need to double this amount of fat to get our 50-60% of calories from fats? Is that 320g of fat per day? Or, if fat has 4 times the amount of calories per gram do we only need 40g of fat per day? I’m loving the diet and I am basically using fats to fry in and adding butter to my mashed potato’s etc and using full fat yogurts, sour cream in dressings and eating fatty meats and fish. I see the book recommends microwaving food too?…..I thought this was a general no-no too?

      • People tend to overcomplicate this stuff. It’s not that hard. Carbs and protein have 4 calories per gram, while fat has 9, roughly the double, not four times. Generalizing:

        1g carb = 4 calories
        1g protein = 4 calories
        1g fat = 9 calories

        Say you want to eat 2000 calories and have half of them coming from fat. You’d need 1000 fat calories. That’s about 115g of fat (115*9 = 1035).

        160g of carbs = 640 calories
        75g of protein = 300 calories
        115g of fat = 1035 calories

        1975 calories in total. Play around with those numbers, add some chocolate or something else and you’ll get to the elusive 2000.

        • Thanks for the reply….. now, if what you have just written was included at the end of the fat section in the book then people like myself and Kate wouldn’t be over complicating things…. we’re just trying to make sure we do things right. Also, I don’t know about other people, but I’m struggling to eat a pound of vegetables on top of the 450 g of safe starches and another 450g of sugary foods and my fats. I definitely feel fuller for longer though. I have one last question if you can help at all? On page 103 under ‘eat vegetables but don’t count them as carbohydrate sources’ do I count onions and carrots? as they are listed in the nutritional content of sugary foods table…. thanks for any help….again! Regards, Mark

          • I know it can be confusing. Even in bodybuilding circles, where they’re all about counting calories and tracking macros, some people have a hard time figuring out that stuff.

            I think you should eat vegetables to taste, follow your apetite and also ask yourself what are your goals. Vegetables are a great source of micronutrients, and while they offer a lot of bulk, which can be very useful when pursuing weight loss, they are not a significant source of calories. Back in the day I was eating tons of raw big ass salads on top of the starches and sugary foods. I felt misserable and was bloated all the time. I realised that massive amounts of uncooked plant matter don’t agree with me. Now I probably eat a bit less, add them to stews, combine them with rice or steam them. My digestion is much better than before.

            Answering to your last question. Carrots, yes, since they’re basically sucrose and have a little starch; just keep in mind that they’re still low calorie. Onions, I guess you could if you want to micro manage to such an extent and are eating a kilo of them every day, but I personally don’t bother. They’re usually just a garnish, not the main component of a meal and certainly not a significant energy source. In either case, I don’t freak out if I get an ‘excess’ of carbs because of an additional carrot I ate on a particular day.

          • Hi Shizuka, and thanks again for the reply…. i think it is going to be easier for me to just follow the 160g carb/75g protein/115g fat per day to be honest, because i am now confused about raspberries.They are listed on page 101 in the ‘Nutritional content of sugary foods’ table and they too have less than 40 calories of glucose per 450g (which is the same as most vegetables) and page 103 tells us not to count vegetables with this amount of glucose as carb calories….so are low glucose fruits like raspberries also to be ignored as carb calories like low glucose vegatables? If so, why are raspberries included as part of the breakfast on Monday in the weekly meal planner? And, speaking of the meal suggestions on the meal planner, i struggle to see where the 1lb of sugary foods/fruits and berries are each day? and where the 100 fructose calories are? as well as the 1lb a day of other vegetables?In general it looks like sound advice re avoiding veg oils, grains, high levels of omega 6’s etc, but practically the advice looks confusing and it just seems to advise far too much plant food, which isn’t replicated on the meal planner as far as i can see.
            I definitely don’t want to come across as having a go at the advice, because i have been a low carb eater for 20 years and including more starchy foods is definitely making me feel better, it’s just that i don’t see the same amounts of foods being eaten on the meal planner as is advised on the healthy eating plate diagram at the top of the screen??? I guess if you stick to the carb/protein/fat ratio’s above, and eat natural foods and avoid the bad guys,then you can’t go far wrong.
            Best,Mark

          • A pound of raspberries has 98 carb calories, that is if you don’t count the fiber at all, evenly split between free fructose and glucose. Fructose is still a sugar that in large amounts contributes to energy balance. Now, why count the fructose content in berries and not in tomatoes? Because the amount of fructose in the latter is nelegible, while in the former is rather high.

            I think the one big problem with PHD is the lack of more didactic material. For one reason or another (the retreats and Paul and Shou-Ching’s endevours in cancer therapy) the cookbook has been postponed for a long time. Some people just need a visual approach.

            I suggest you to check Russ Crandall’s blog, The Domestic Man. It’s pretty much PHD: thedomesticman.com

            Ten Minute Meals, while not longer updated, is a good place to get ideas: https://10minutemeal.com/

            Someone posted this some time ago: https://www.evernote.com/shard/s3/sh/977c4dcf-c53a-4eef-ae32-f2505ea777e1/2fb9ba8f69d4cb7f
            It’s a good example of what a PHD day of eating would look like, albeit a little too low carbish for my taste. Keep in mind that Paul no longer recommends eating spoonfuls of coconut oil anymore, and I wouldn’t encourage that either. I never believed in BP coffee anyway, not even in my keto days, and I was basically a zero carb zealot (I also nuked my thyroid in the process, but that’s another story).

          • After reading PHD I wanted to better understand carb quantities, so I made this chart.

            Each food listed is 50g of carbohydrate or 200 carb calories, about 1/3 of daily.

            It demonstrates as PHD advises, vegetables are not a serious source of carbs. Even potato or sweet potato (we call kumara) one needs to eat a fair amount.

            Turned out I had been VLC for years despite eating a lot of vegetables.

            The bottom chart shows the modest amount of butter or coconut oil required to balance out the carbs, keep fat in the 50% range.

            https://www.dropbox.com/s/0nhcksyjxthce5y/PHD%20carbs.jpg?dl=0

    • These are some of the fats that I like to consume and recommend to patients when appropriate: Olives and Olive oil
      Coconuts and coconut oil
      Butter made from raw grass-fed organic milk
      Raw nuts, such as, almonds or pecans
      Organic pastured egg yolks
      Avocados
      Grass fed meats
      Palm oil
      Unheated organic nut oils

      • Hey Shizuka,

        It’s been awhile but can you write a little about your keto days and how it nuked your thyroid.

        I’ve been keto for quite awhile and I notice I’m much more sensitive to carbs now. I feel hypoglycemic type of responses when I eat them: headache, dizziness, etc…

        I’m consider perfect health diet and wanted a Ketoer’s perspective on it. How long have you been PHD and do you feel your metabolism is repaired, it that’s possible?

        Thanks for any feedback.

        • Hi Jeremy,
          I have this issue as well. Maybe this is a sign of health. I have read about priming your insulin response with a low fructose intake a little bit before eating.

  2. My thoughts exactly Kate, I love the book but fat seems to be the only grey area regarding actual grams per day. The amounts of carbs, starches and protein per day are clearly laid out, but like you I was left thinking, so I only need two tablespoons of butter/lard/tallow per day? And this I is a high fat/moderate carb eating plan?! It’s the only ‘fault’ I can find really and not a major criticism, I just think the information in Eriks reply could have been more clearly made in the fat section of the book itself. So red meat, egg yolk, avocado, full fat dairy, nuts and chocolate will provide ample fat with possibly the two tablespoons per day? The thing is, I don’t see all this amount of food in the daily eating menu plans either?! I’m sure I will get there in the end however. I have been a low carb eater for years and simply adding safe starches and honey (which were previously unheard of for me) has made an immediate improvement to my energy levels. Brilliant book in general. Every schoolchild should be given a copy!

  3. Hi. I have just discovered and read your book. I understand one should limit to their fructose intake to just 100 calories per day, but what if you get less or none – is there any danger to this? I have removed table sugar from the diet, would rarely eat honey and only have say a couple of pieces of fruit a week. I am not an athlete, just would be lightly to moderately active.

    • Hi Pat,

      Some fructose is helpful for glycemic control. Also sweet plants — especially beets, carrots, parsnips, and other sugary in-ground vegetables — are fantastic sources of potassium and other important micronutrients. So while excessive fructose is problematic, some is better than none.

      Best,
      -Eric

  4. Kindly tell me why white rice on the PHD as opposed to brown rice? I was always under the impression that brown is much healthier. Thanks.

    • Hi Arlene,

      To quote from from “Rice in Human Nutrition”, published by the Food and Agriculture Organization of the United Nations (http://www.fao.org/docrep/T0567E/T0567E0g.htm#Antinutrition%20factors):

      “Antinutrition factors in the rice grain are concentrated in the bran fraction (embryo and aleurone layer). They include phytin (phytate), trypsin inhibitor, oryzacystatin and haemagglutinin-lectin…

      …Phytin is located in 1- to 3-µm globoids in the aleurone and embryo protein bodies as the potassium magnesium salt. Its phosphate groups can readily complex with cations such as calcium, zinc and iron and with protein. It is heat stable and is responsible for the observed poorer mineral balance of subjects fed brown rice diets in comparison to that of subjects fed milled [white] rice diets

      …Steaming rice bran for 6 minutes at 100°C inactivates the trypsin inhibitor…

      …Rice-bran [haemagglutinin-] lectin… sharply loses activity after 30 minutes at 80°C or 2 minutes at 100°C…

      …Oryzacystatin is a proteinaceous (globulin) cysteine proteinase inhibitor (cystatin) from rice seed and is probably the first well-defined cystatin superfamily member of plant origin (Kondo, Abe and Arai, 1989). Incubation at pH 7 for 30 minutes at 100°C had no effect on its activity but inhibition decreased 15 percent at 110°C and 45 percent at 120°C…”

      Best,
      -Eric

  5. Hi.I have a serious question regarding the advice in the book to base most meals on red meat ruminants and restrict chicken and pork. Now i understand that in our evolutionary past we had to eat animals daily to obtain our complete protein, which is obtained by vegetarians through eating a combination of grains, peas, beans and legumes. My question is whether or not the meats we ate were mainly lean, white, low iron content meats, or fattier, high iron content red meats? I ask this because i am reading a fascinating article on the freetheanimal website (which, by the way is where i found the recommendation and link to purchase this very book….and i did) about iron overload and the potential serious health implications of it. The evidence looks very convincing and just by looking at the famous ‘Blue Zone’ diets e.g we see a very fit and healthy set of peoples who consume very little heme iron. I then look at the RDA’s for iron here in the UK and see adult males require 8mg of iron per day and females a whopping 18mg per day. I really struggle to see how on earth we can achieve those amounts eating low iron lean meats. However, the Blue Zone populations don’t consume this much and don’t have signs of iron deficiencies. As you will all know, The Perfect Health Diet book advises basing most meals on red meat, high iron ruminants (beef, lamb and goat) and limiting lean meats like pork and chicken (basically the complete opposite of the advice on the iron overload article/blog!) so i am now very confused! So, finding out if the meats we ate were mainly high iron reds, or lower iron whites would be a massive help as this seems that getting our iron intake right is very very important stuff. Thanks in advance if anyone can help

    • Hi mark,

      Getting the right amount of iron from food is not important enough to dictate what meats we should eat. Because you can regularly monitor iron stores (with the ferritin blood test), and donate blood if your iron stores are too high (or supplement if they are too low).

      Best,
      -Eric

    • You can also pair high iron food with dairy, coffee, tea and green stuff such as cilantro. All of those are iron chelators, so you won’t absorb all of it. If you do eat properly prepared legumes, it’s a good idea to eat them along with meats. Phytic acid is not the devil many paleos claim. Also, ditch iron cookware.

      In any case, the biggest problem here is fortification.

      • Thanks for the replies. I do believe that fortification is the major contributor with regards to iron overload, so eating red meat every day shouldn’t be a problem. The blue zone populations still nag away at the back of my mind however, and with all due respect Eric, donating blood and having ferritin blood tests just doesn’t seem a very biological approach if you know what I mean? I would rather try and take in similar amounts of iron that our ancestors did, but it appears I am at a bit of a crossroads here. The book recommends high iron from mainly red meat sources, the blue zones and blog advise the opposite……sigh….. lol. Oh well, thank you both for your thoughts on the matter….looks like I will just have to try each and see how I go….
        Best, mark

  6. Ok, just looking at the meal planner guide in the book and I am sorry if I am missing anything here, but I am sure the advice is to eat 450g of safe starches and another 450g of sugary plants/fruits per day and 115g of fats per 2000 calorie day? Yet I can only see mention of sugary plants or fruits on Monday and Saturday and not a lot of fat mentioned on any day…..especially not 115g worth. As regards calcium alone, the book mentions bone broths as the best source then doesn’t mention them at all in the meal planner! Where are the fruits and sugary plants every day? Where is the calcium every day? Where is the iron on Wednesday and Friday? and if ruminants are the main source of iron how does a woman get 18mg of iron a day if she only absorbs a third of iron per meal and only has one main meal a day?! Ah, I’m just getting myself more and more confused the more I read….. sorry folks, I’m going for a lie down….sigh…..

  7. Hi, I am currently 8 weeks pregnant and have been on the perfect health diet for the past 3 months. Previously, I had been on a really low carb diet and when I got a sinus infection began to have panic attacks in the middle of the night and extreme anxiety all day. I found the Perfect Health Diet and slowly upped my intake of starches which after a month or so helped eliminate the anxiety. Now I am pregnant and having severe nausea day and night. I have developed an extreme aversion to the sweet potatoes I had been consuming as my safe starch and gag when I try to swallow them. The only thing I can swallow and does not make me gag is white string cheese. I have only been able to eat that in the last 48 hrs. Yesterday, I began to feel the anxiety once agin and finally tonight around 4 a.m. I woke up with the same panicky feeling I used to get on my low carb diet. I am at a loss as to what to do. Could it be a glycogen issue already due to me only being able to eat the cheese for the past three days? I just started taking vitamin b6 yesterday to see if it helps with the nausea. Any recommendations on what to do? Also, I see prenatal vitamins are not recommended but since I am not able to swallow liver etc. for now what would be the best way to handle this?

    • Hi Sarah,

      The nausea is a sign of malnourishment. Eating only white string cheese is going to make it worse – and it has, based on the anxiety coming back. You need to be eating lots of egg yolks (aim for 7 per day) and a great deal more carbs to begin with. Try eating rice or white potatoes in quantity, a pound per day as a minimum. Also, supplement (or eat nutrient-rich foods) for the most important prenatal supplements including iodine, vitamin K, vitamin A, vitamin D, phospholipids/choline, iron (get that tested), zinc, copper, taurine, calcium, magnesium, vitamin C, plus a B-50 complex with extra B12 at least once per week.

      Best, Paul

      • Thank you so much for your response. It means so much! I am now worried about the fact that this extreme nausea and gagging reflex points to malnourishment and the impact that could be having on the baby. I am praying that God intervenes and I can start eating what you have recommended as soon as possible. I was eating 400 grams of safe starch ( cooked sweet potatoes) before the morning sickness started. If I understand correctly I should shoot for at least 453 grams rice or potato ( cooked weight) daily. Is this correct? Also, if I add the grassfed beef liver, chicken liver ,egg yolks and grassfed butter to my diet in sufficient quantities; would I still need to supplement? I have your book but need to go over it again to see if recommendations for pregnancy are outlined. Thank you again, Sarah

        • Catherine Hinchcliff

          I have heard that morning sickness is related to magnesium defficiency, and indeed when i upped my magnesium during my pregnancy myself, the nausea went away.

  8. Paul,
    I hope all is well with you and your family!! I was wanting to ask if you still believe in and practice intermittent fasting? I have seen people like Bill from calories proper come out against it here lately. I know I feel best when doing intermittent fasting but was curious as to the effects of 2 pound Meals twice a day?

  9. Hi I’m in a transition from a low carb Paleo to PHD and so far feeling more energy and a big reduction in cravings so all good ! Can you confirm for me if Quinoa is allowed on PHD, I see its classed as a seed not a grain but I’m still unsure if I can use it as a safe starch . Thank you Jane

  10. Dear paul,
    I have been with your blog and diet for several years now, but need some help. I am very active at my job and I like to work out some too, and really need more calories. I am eating around 2100 calories a day and have dropped down to 127 being a 5f9in man I really can not lose anymore. What would you add to your daily 1 pound of potato and some fruit to best add calories. I eat a few ounces of droid coconut for added calories and a little olive oil. At least 2 ounces of almonds. Avocado, ;eggs daily. 4to6 ounces of meat a day. Would adding more carbs hurt or more fat? How would you do it.. I was eating a 90%dark Choco bar a day but stoped because I was thinking I was eating too much fat

    • Hi Keven,

      The specified amounts are not meant to be a precise prescription, but are the amounts that add up to a 2000 calorie reference diet. Generally men will need to eat more than that, women a bit less. You should eat the right amount for you by avoiding hunger.

      Is something preventing you from eating more? I would recommend that you keep PHD proportions and add more food.

      Best, Paul

      • Nothing is stopping me from eating more necessarily, I was just trying to follow plan. I have 2 2pound meals a day and was not sure if more than that at one time would be bad. Also,I was thinking half pound potato at time would be all the carbs that would be optimal.
        SuppVersity, has put out a lot of info that says higher fat diet causes insulin resistance coupled with carbohydrates in the diet,, is this true?? Would adding back my chocolate bar be ok

  11. Hi Paul,
    Ray Peat has stated it’s very important to have a calcium/phosphate ratio that is in favor of calcium. Do you have an opinion on this?

    A diet that provides enough calcium to limit activity of the parathyroid glands, and that is low in phosphate and polyunsaturated fats, with sugar rather than starch as the main carbohydrate, possibly supplemented by niacinamide and aspirin, should help to avoid some of the degenerative processes associated with high phosphate: fatigue, heart failure, movement discoordination, hypogonadism, infertility, vascular calcification, emphysema, cancer, osteoporosis, and atrophy of skin, skeletal muscle, intestine, thymus, and spleen (Ohnishi and Razzaque, 2010; Shiraki-Iida, et al., 2000; Kuro-o, et al., 1997; Osuka and Razzaque, 2012). The foods naturally highest in phosphate, relative to calcium, are cereals, legumes, meats, and fish. Many prepared foods contain added phosphate. Foods with a higher, safer ratio of calcium to phosphate are leaves, such as kale, turnip greens, and beet greens, and many fruits, milk, and cheese. Coffee, besides being a good source of magnesium, is probably helpful for lowering phosphate, by its antagonism to adenosine (Coulson, et al., 1991).

    Dr. Peat recommends dairy over muscle meat: dairy contains calcium whereas muscle meat contains high levels of phosphate.

  12. Dear Paul,
    Do you still eat starch daily?? And if so, do you still eat a pound a day roughly??
    I know you do not have a lot of time to post updates to new science, so just wondering if this is still ideal?

  13. My husband has lost 45 lbs during recovery from benzo drugs. He titrated off of klonopin 5 months ago and the weight loss is a threat as he now weighs 126 lbs. We are trying to do a paleo diet but he needs to be able to gain weight so am looking for ways to increase calories. He is resistant to white rice and tapioca- he has been consuming coconut oil and butter from grass-fed cows. Is trying to cut back on dairy because of increased calcium levels. What do you recommend? I am in favor of anything to get his weight up because it seems that it is the thing impacting him the most at this time. His main problem is his digestive tract so we try to reintroduce foods slowly and watch for reactions to them.

  14. I am just getting started on this program and find it difficult to know how much to eat. Is there a calorie intake recommendation for women?

    • Hi Suzie,

      No, you should eat to appetite. We generally recommend intermittent fasting (16 hr fast / 8 hr feeding window daily) and eating enough so that you are not hungry, or only mildly hungry, at the end of the fast. Keep the proportions of our food plate but your personal quantities may vary +- 20%, usually on the low side for adult women.

      Best, Paul

  15. Paul,
    Any thoughts on how to cure acid reflux?? I have been having some bad reflux lately. Not really heartburn but reflux and bits of food coming back up into throat. I eat 100% PHD

    • Any thoughts would greatly be appreciated from knowledgeable group..
      Thanks a lot

      • Hi Keven,

        I also had acid reflux despite PHD. Two other minor symptoms proved key to resolving the acid reflux: (1) I also had persistent tenderness in my right abdomen that radiated into my right leg, and (2) When standing upright, the bottom of my right rib cage was visibly lower (more than an inch) than the bottom of my left rib cage.

        The psoas major muscle is an abdominal muscle that runs from the spine around the base of the rib cage to the upper leg (https://en.wikipedia.org/wiki/Psoas_major_muscle). It also interdigitates with the diaphragm, and can pull the diaphragm out of position when tight; note that the diaphragm needs to contract around the lower esophageal sphincter to keep acid in the stomach.

        Injection of lidocaine (https://en.wikipedia.org/wiki/Lidocaine) at several points along the psoas major muscle (including both attachment points) instantly eliminated 95% of the reflux (frequency of reflux incidents went from ~10x/day to ~3x/week), caused my right rib cage to come into alignment with my left, and eliminated 90% of the tenderness in my right abdomen. That was a year ago; stretching several times per day has kept symptom frequency from rising.

        Other things that seemed to slightly help (although I am less certain here since the effects were not nearly so dramatic) included:

        (1) Optimizing zinc:copper ratio (should be around 7:1 — mine was much lower). I suspect this is because zinc restriction reduces expression of carbonic anhydrase (https://en.wikipedia.org/wiki/Carbonic_anhydrase) in the esophageal lining, leading to reduced resistance to acid.

        (2) Trying to obtain nutrients from food, instead of supplements, when possible. I suspect this helps promote better gut flora.

        (3) Elevating the head of my bed to help acid flow back to the stomach while sleeping.

        (4) Supplementing DGL. This may help by enhancing mucus production, thereby increasing esophageal resistance to reflux.

        Anyway, I hope this gives you some food for thought.

        Best,
        -Eric

  16. A digestive supplement such as “Super Enzymes” by Now vitamins that contains HCL, as well as other helpful enzymes that break down the food that is sitting in the stomach. Probiotics help build up the good bacteria in your gut and reduce food residue, and ACV (Apple Cider Vinegar, with the Mother) also helps. Drink 1 Tbsp vinegar in a glass of water 15-30 min. before your meal.

  17. Paul, what do you make of this study? It’s quite shocking!

    http://www.nature.com/nature/journal/v541/n7635/full/nature20791.html

    Thanks for your time!

    • Hi Jorge, it’s interesting but I wouldn’t alter my diet because of it. Cancer is a heterogeneous thing and all macronutrients promote its growth – yet we need them.

      Best, Paul

  18. It says you cannot have grains, but then it lists the safe starches. Is rice not considered a grain…

  19. i just purchased your book.My problem is that i eat only chicken fish eggs and prawns.No red meat porc or beef.How can i replace the meat.For breakfast will a smoothy of yogurt ansd fruit do? PLEASE HELP;

    • Yes, you can replace the red meats with fish, shellfish, birds, and dairy. Pulses should be well cooked, ideally in a pressure cooker or for many hours as in traditional Indian cooking.

  20. What about pulses like moongao or otht pulses.I am indian and we eat alot of pulses with rice.Is the association ok?

  21. THANK YO;wILL KEEP IN TOUCH;is curd with fruits as a shake ok for breakfast?

  22. Is using stevia as a sugar supplement ok.I canoot have my tea coffee or shake without little sugar but have discoverd ctevia as natural sugar.Is it better to use it or sugar?

  23. Paul,
    Do you think a avocado everyday is ok??

    • Paul,
      I also eat around 3 oz of nut butters a day almond, cashews ,macadamia for the calories because I have lost too much weight… is that safe.

      • Hi Keven,

        The avocado plus the 3 oz of nut butters you mention (assuming 1 oz of each) combined contains about 85 calories of omega-6 PUFA. But the suggested daily limit of omega-6 PUFA is 4% of calories (which would be 80 calories on a 2000 calorie diet). So once you include the omega-6 PUFA from the rest of your diet, you’re surely over 4% of calories, even if you eat more than 2000 calories.

        Why not make macadamia nut butter your main nut butter (much less omega-6 PUFA than almonds or cashews), having almond and cashew butter a bit less frequently; and/or reduce your whole avocado to half an avocado?

        Best,
        -Eric

  24. Hi, I’m wondering if there is a diet app you recommend to track daily eating on the perfect health diet? I currently use MyFitnessPal. Also in tracking my macros, would I just set my calories for the day, set my fat percentage to 50%, my carbs to 25%, and my protein to 25%? Also I’m trying to loose weight for now, once I loose some weight then what would I set my macros to? Thanks!

  25. I was wondering if this diet works just as well if you only have a partial thyroid. I had a portion of my thyroid removed by RAI 14 yrs. ago. I just can’t seem to stop gaining weight. I’ve counted calories, my carbs and proteins. I’ve gone gluten free; which helped with my fibromyalgia and migraines. Not with my weight however. Any suggestions would be greatly appreciated.

  26. What about tempeh. It is fermented but is soy.

  27. just wondering if it helps fibromyalia

  28. Are split peas the same as regular peas or are they more legumish?

  29. Hi I bought the book in 2014 and loved it but life got in the way (working/raising two under 5s) and I fell into bad habits again and convenient/beige food that my picky toddlers would actually eat. Now I’m reading the book again and determined to follow it properly now I have more time and am no longer sleep deprived. I’ve got a couple of questions if anyone can help?

    1. My book’s food plate says 1lb of starch, 1lb meat and veg to taste. The food plate on this website has been updated to include a 1lb of sweet plants and 1lbveg. Is there an article explaining the rationale for this development? Is it essential to include those categories/proportions. And where do veg like peas/parsnips/butternut squash/swede (rutabaga) fall – starch/sweet plants/veg? And am I getting too hung up of specifics – is dividing your plate into 1 part meat/fish, 1 part starch and 2 parts veg sufficient?

    2. Does anyone have experience or advice about how to vary the portion size according to size/activity level? My husband is 5’7″ and 168lb and works in a very physical job as a gardener and is always complaining of fatigue and hunger. I am 5’3″, 135lbs and fairly sedentary. Our children are just turned 2 and almost 5. I struggle to know how much food to make at mealtimes.

    Thank you in advance!
    Katy, UK

    • Hi Katy,

      Do you have the 2010 edition? You would do well to obtain the extensively revised 2012 edition from Scribe UK. https://www.amazon.co.uk/d/Books/Perfect-Health-Diet-regain-health/1922247014/

      The revisions to the food plate were part of the 2012 edition, and were based on additional research conducted 2010-2012, much of it on this blog. It is desirable to keep the current food plate proportions.

      A good dividing line between vegetables and sweet plants is based on how many carb calories they have — a good threshold is around 180 calories / pound = 40 calories per 100 g. Anything over that is a sweet plant, under is a vegetable. Carrots are about 200 calories/pound so a sweet plant. Peas and winter squash would be sweet plants, parsnips and rutabaga vegetables. You can always have a piece of fruit for dessert as the sweet plant part of the meal.

      We solve the portion problem by making more than enough and eating the leftovers for lunch. Your husband should eat to appetite. He shouldn’t be hungry. Appetite will self-regulate eating good foods.

      Best, Paul

      • Hi Paul,

        I think you have carrots and parsnips backwards — from experience, parsnips definitely taste sweeter than carrots; nutritiondata.self.com puts carrots at about 150 carb calories per pound, parsnips at 300 carb calories per pound:

        http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2383/2

        http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2514/2

        Best,
        -Eric

      • Hi Paul

        Thanks so much for replying, I really appreciate it.

        That is the edition I have (Scribe,2012), I was confused because the food plate diagram only specifies the weight of starches and protein and not sweet plants or other vegetables. I’ve almost finished reading the book now and see that those weights are specified in the text.

        I’m finding the chapter about meal preparation extraordinarily helpful and would be really keen to buy your cookbook when it’s available. Do you have a publication date in mind for that?

        I also wonder if you would update us on how feeding Luke is going as he grows (although I totally appreciate if you’d prefer to keep his and your private life, private). I think he may be a similar age to my son (2) and after eating absolutely anything whilst weaning both my children now push vegetables to the side of their plate and crave beige packaged frankenfood. It’s also really difficult keeping them on the straight and narrow when daycare/school seem to have no qualms about feeding them a majority processed diet. I don’t keep any processed food in the house and I send them both in with lunchboxes and it’s disheartening to see that we’re the odd ones out and seen as weird or precious by others.

        Thanks again for all your hard work, it’s helping so many of us out here and we really appreciate it. My husband hasn’t complained of hunger or gone rooting through the fridge at night in the last week since I started providing PHD meals and he’s politely declined all the cakes/cookies/chocolate bars that his customers frequently offer him during his breaks at work.

        Best wishes
        Katy

        • Hi Katy,

          There’s no publication date in mind for the cookbook, as we’ve been fully occupied by our biotech company, Angiex.

          Luke’s favorite food remains a mixture of our PHD baby food (search for recipe) with whole cow’s milk. He does eat a variety of foods, although like yours he used to eat everything and now he has definite preferences. We’re lucky, his daycare provides only natural whole foods, no crackers or such.

          Best, Paul

          • Thanks Paul, I’ll check out the PHD baby food recipe now, and the other recipes on the site. Shame about the cookbook but Angiex is an infinitely more important project! I wish you all the best with that.

            Best wishes,
            Katy

            Ps. Very jealous that you have daycare that serves natural whole foods, no such thing in the North of England it seems. There is a severe lack of understanding about healthy food. My daughter’s school is very proud of their healthy breakfasts – ‘no junk’, the kids get weetabix or cornflakes and toast with jam and fruit juice. 🙄

  30. Hi Paul-

    Is the creation of amyloid plaque in the brain multi-factorial? What is the leading cause? Along with the PHD diet, is there a necessary supplement to help prevent it?

    Best Regards,

    TR

    • Hi TR,

      Almost everything in biology is multi-factorial. I think the leading cause is the antimicrobial functions of amyloid, certain infections lead to plaques. Intermittent fasting and circadian rhythm entrainment would be the most important steps to add to PHD.

      Best, Paul

  31. Hello Paul

    I think I know the answer but I’ll ask anyway-
    I have SIBO, same diet, same rules?

    • Hi Noah,

      Yes, but you may benefit from some therapeutic supplements (extra vitamin C, taurine, glycine, N-acetylcysteine, vinegar, extra egg yolks) and intermittent fasting and circadian rhythm entrainment are especially important.

      Best, Paul

      • Regarding SIBO and vinegar:

        As I understand, you recommend vinegar in PHD with carbs and fats. What about vinegar with water some time before eating? Do you think that would provide any benefit for folks with SIBO problems?

        I just see how popular these “cleanse fasts” that seem to often include water with ceyanne, vinegar, ginger, etc. It makes me wonder if the popularity is due to an actual benefit against SIBO, since according to estimates, many people suffer from it.

        • Hi David,

          Vinegar with water is fine. Yes, those “cleanse fast” ingredients would help, as they are antimicrobial, plus the vinegar with acetate promotes bowel motility.

          Best, Paul

  32. Hello Paul,

    Is it possible to gain weight on the PHD? Ever since I cut out all grains, except rice, and all sweets I’ve lost about 20 lbs. Now for most people that would be something to get exited over but for me it’s a problem. I was already thin when I started this program, so I cannot afford to lose any more weight.

    Any suggestions?

    • Hi Rudy,

      Generally, PHD will normalize weight, so will help the underweight gain weight. A few things to check: You should not be restricting calories; be sure to eat to appetite. Remember the food plate quantities are for a 2000 calorie reference diet and are generally too low for men, too high for women. Be sure to flavor your food with saturated fats (butter, cream, coconut milk). Be sure to get extracellular matrix (shellfish, or bones, joints, tendons cooked in soups and stews) in your diet. Eat 3 egg yolks per day. Entrain circadian rhythms.

      Best, Paul

  33. Hi Paul,

    Is beef gelatin still ok when you don’t eat bone broth ? And kind of supp or food could I advise my wife for estrogen dominance ?
    Thanks for your answer.
    Best,

    John

  34. Hi there Paul,
    I just have a quick question regarding the sugary plants (carrots) allowed on the diet. The table on page 101 lists a number of sugary plant foods (including carrots) but on page 103 there is an outlined piece which says ‘Eat vegetables but don’t count them as carbohydrate sources’. My question, therefore is, do I count carrots towards my sugary plant carb intake allowance or not??? I enjoy them and eat them almost daily but I’m not sure if they count towards my carb intake?
    Thank you very much for any advice,
    Best,
    Steve

    • Hi Steve,

      That means not to count low-calorie vegetables like spinach or broccoli as a carbohydrate source. Sugary vegetables like beets or carrots count in the “sweet plants” category, not the “vegetables” category.

      Best,
      -Eric

      • Hi Eric, thank you for the reply. I have one last question to ask if that is ok? I just wanted to ask if I should include dairy proteins from cheese and yogurt etc as part of my protein allowance? I ask because in the protein section of the book dairy is not mentioned/ recommended and if I consume 300g of meat or fish, this gives me roughly 60g of protein, then my 450g of potato adds another nine and if I then add the protein from dairy (which I am using as my main calcium source) then I will be adding at least another 20g of protein which takes me up to 80g a day, which I feel is on the high side. So is it ok to substitute some of the meat and fish protein for the dairy protein? Thanks again for any thoughts/advice
        Steve

        • Sorry, the dairy would take me up to 90g not 80! It’s still early here in the U.K., forgive my poor maths!

        • Hi Steve,

          PHD recommends dairy only in moderation; 20 g of protein from dairy is a lot.

          If you want to eat that much dairy, then yes, you should keep meat/fish intake near the bottom of the suggested range to avoid excess protein. Around 300 g of meat or fish would be fine; I just wouldn’t eat too much more in addition to that much dairy.

          Best,
          -Eric

          • Hi Eric, apologies for my late reply. Will do, and I just have one last question if I may? I have just found out that I ADORE sweet potatoes! Can you believe I have never had them before? Now, I have been trying to work out a suitable amount to eat per day as the recommended 450g per day will not provide enough glucose calories. I notice on page 102 of the PHD book on the ‘combining starchy and sugary plants’ section that 1.2kg is the recommended amount. I don’t think I could eat this much sweet potato per day, so I was thinking of combining it with rice or white potato in my other meals in the day. However, I now see you can develop carotenosis from eating too much beta carotene (of which sweet potato has an enormous amount) so do you know if there is a ‘safe’ amount of sweet potato a person can eat daily before potentially developing orange skin?!
            Many thanks again,
            best, Steve

          • Hi Steve,

            No, I don’t know how much sweet potato you can eat daily before developing orange skin.

            I will remark that it’s only the orange-fleshed sweet potatoes that are rich in beta carotene.

            Best,
            -Eric

  35. Hello PHD family. I’ve been PHD for 12 months, 3 months paleo before I started. I’m 51 and in better shape than I was in my 20’s. I was strong at 218, and now even stronger at 182 pounds this morning. I just put up 300 pounds on the bench press which I haven’t done since I was 21. I had diarrhea which I finally attributed to heavy cream and loose dairy products. I was taking a great probiotic but it was getting me a little bloated. I recently started having grass fed organic plain yogurt 1.5 cups daily with melon and pineapple and since then I’ve been dropping even more body fat. I’ve also added apple cider vinegar two tablespoons at night taurine and glycine. I was stuck at 192-195 and now 10-12 pounds off! Everything else the same. Just what I have noticed hope this helps

    Bob

  36. Angela McBirney

    I’m hoping someone can help me. I started the PHD a few days ago, I’m actually feeling a little better already after some initial dire bowel problems.
    Among other things, I have IBS; I’ve been following a low FODMAP diet for some time which has helped a great deal. I’m really struggling to eat enough vegetables: I have no problem with the protein and starch requirements but the volume of vegetables is overwhelming and causes bowel issues. Any suggestions?
    Also, I have chronic fatigue/fibromyalgia; some days I am simply too exhausted to prepare any food and clean up afterwards. I need some ideas for really simple meals that require little preparation and no chopping for when my hands are painful. I don’t do well with raw vegetables

    • Hi Angela,

      You can reduce vegetables for a time while you are reshaping your gut microbiome. As your gut improves you’ll want to include them.

      Some tips: Include the therapeutic supplements glycine, taurine, N-acetylcysteine; be sure to optimize vitamin A, vitamin D, zinc, copper per the book; eat 3 egg yolks and 2 tbsp vinegar per day; do intermittent fasting and circadian rhythm entrainment; take extra vitamin C; check for hypothyroidism and get it treated if present.

      To ease cooking, get an Instant Pot electronic pressure cooker. You can pre-cook vegetables before chopping them, they’ll be easier to cut after some cooking. Pressure cooking is easy and healthy. It’s great for making potatoes, sweet potatoes, rice, meat, vegetables, stews, and many other foods.

      Best, Paul

      • Angela McBirney

        Hi Paul, thank you for your time and prompt reply, I appreciate how busy you are.

        I am taking Synthroid for hypothyroidism and the levels look good. I’ll implement your suggestions for supplements with the caveat of doing research on the amino acids; I take Lamotregine and Gabapentin for Bipolar disorder and want to be cautious.

        The Instant Pot sounds great, I’ll certainly follow up on that.

        Once again, thanks for your time

        Regards, Angela

  37. Is it possible for. Vegetarian to do your diet. It seems to be heavily based round animal products, which ethically I wiukd not touch. I eat organic eggs and a little feta cheese. Please advise how I could do the PHD diet.

    • Hi Fiona,

      We don’t recommend vegetarianism, as it is difficult to be well nourished as a vegetarian. However, there are PHD vegetarians. Some keys are to eat 3 egg yolks per day plus dairy, and to eat diverse natural whole foods, not flour-based products or sweets/oils. Fatty plants should come from the tropics. You can relax macronutrient guidelines somewhat as a vegetarian.

      Best, Paul

  38. how are the egg yolks best taken?

  39. Angela McBirney

    Help, I’m confused! I’ve calculated my macros based on the articles here on obesity, so I’m following the recommendation to keep fat lower than the regular diet, about 1 tablespoon a day.

    The safe starches are sorted; I’m building up gradually with the other vegetables as advised by Paul,due to irritable bowel.

    My problem is with protein. Consuming 300 cal of protein allows only a small amount according to my calculations- I’ve eaten 4oz of chicken and 3 eggs, that’s already over 500 calories. I realise that part of the nutrient value in these foods is from fat, and I don’t want to over-think things, but but if the recommendation is to eat 1/2-1lb …what am I doing wrong?

    • Hi Angela,

      To get 300 calories of protein, you’re only supposed to count the calories from protein in those foods. For example, 4 oz of chicken plus 3 eggs is about

      500 calories = 225 calories from protein + 275 calories from fat + 0 calories from carbs.

      So you’re only at 225 protein calories so far.

      Best,
      -Eric

    • Hi Angela,
      Are you perhaps confusing protein calories with meat calories?

      consulting a nutrition database:
      8oz rib eye steak (trimmed of fat) 547 calories total
      42.4 g protein, at 4 calories /g –> 170 protein calories (~21 protein calories / oz)
      42 g fat, at 9 calories / g —> 378 fat calories

      So, 300 protein calories from rib eye steak * 1 oz rib eye/ 21 protein calories —> 14.3 oz rib eye
      So nearly a pound of rib eye to get the 300 protein calories.

      –Randy Siler

      • Angela McBirney

        Ah, that makes more sense! I was going by the meat calories! I have bookmarks in so many pages, was definitely confused. The way you’ve explained it (which is probably in the book) is clear. Now I wish I could afford rib eye…
        Which database do you use? I generally buy beef mince, it’s the cheapest

        • I’m going to try pasting this table I made in Excel, pretty much expecting that it will turn into a mess, but just in case it works, I’ll give it a try…

          • Food Calories / pound % of calories % of calories  Omega-6 Omega-3 Fat Calories Protein calories per pound Protein calories / ounce
             as Fat as Protein as as per pound
            % of Fat % of Fat
            Bacon 2,420 70 30 10 0 1694 726 45
            Chicken breast, skinless  749 21 79 17 2 157 592 37
            Mussels 780 28 72 1 19 218 562 35
            Ground beef (85%) 1,164 55 45 2 0 640 524 33
            Chicken breast, meat and skin 837 38 62 18 1 318 519 32
            Chicken leg 866 41 59 19 2 355 511 32
            Chicken liver 781 36 64 1 0 281 500 31
            Ribeye steak 1,202 59 41 3 1 709 493 31
            Salmon, Atlantic (wild) 825 42 58 3 32 347 479 30
            Prime rib 1,321 64 36 3 1 845 476 30
            Tilapia 581 19 81 11 9 110 471 29
            Cod 477 8 92 1 21 38 439 27
            Herring 921 53 47 1 19 488 433 27
            Pork, country ribs 1,490 71 29 7 0 1057.9 432 27
            Ham 807 47 53 13 3 379.29 428 27
            Shrimp 449 10 90 2 33 45 404 25
            Eggs 704 65 35 11 1 458 246 15

          • Well, just as expected. Totally incomprehensible. Sorry all–I had to try.

        • I used an application I bought for my iPad (called Nutrients) but you can easily find online databases for free if you search around (http://nutritiondata.self.com is one).

          Beef mince is another name for ground beef, right? If so, I’m surprised: I can usually buy a beef roast cheaper that ground beef and I feel better knowing they didn’t sneak something into the mix.

          But anyway, if I had been able to paste the spreadsheet you’d see that most meats have about 30 protein calories per oz. (the range is roughly 27-37).

          –Randy

          • Angela McBirney

            Thanks for all your help, I’ll check out the website.
            I live in New Zealand, meat is really expensive here! Our beef mince has no additives fortunately, just the meat and nothing else. Even our NZ reared lamb is a ridiculous price, it can be bought cheaper overseas..ah well. Still, mince is versatile!

  40. In terms of chocolate, should it be milk chocolate or dark chocolate? A high quality organic chocolate would be the best option I suppose like Green & Black’s Organic.

  41. Angela McBirney

    Apologies for asking another question, but I really want to be successful with this diet.The list of recommended supplements is quite daunting; for a person of limited means, what would be the most important ones?
    I have chronic fatigue/ fibromyalgia, IBS and am bipolar. I’m already taking vit C and a good quality multivitamin. I’ve been able to increase vege intake, no where near 500g yet but getting there. I’m doing 3 egg yolks daily and have started using apple cider vinegar and sauerkraut, I have some kimchi fermenting on the kitchen bench.
    I am already feeling more energetic and focused, in spite of the autumn sore throat and ears; my hands are stronger and I can chop veges now

  42. Awesome & delicious Perfect Health Diet food plate.
    Easily follow this diet plan.
    Thanks for sharing

  43. These are some of the fats that I like to consume and recommend to patients when appropriate: Olives and Olive oil
    Coconuts and coconut oil
    Butter made from raw grass-fed organic milk
    Raw nuts, such as, almonds or pecans
    Organic pastured egg yolks
    Avocados
    Grass fed meats
    Palm oil
    Unheated organic nut oils

  44. Any recommendations on a H.Pylori bacteria?

  45. What types of rice are considered “white” rice? Does basmati or jasmine rice count as “white” rice?

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