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:


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Leave a comment ?

3,841 Comments.

  1. Would coconut water be acceptable during a morning fast or is it too sweet?

    • I’ve often wondered if coconut water is a good PHD drink (even if not in the fast). Apparently it has high potassium levels but I have not heard you mention it for this purpose…

    • I think that the idea of IF is to ideally consume zero calories to get the full benefit. In the past he has recommended to me clear stock (no fat) with a pinch of salt and a small amount of low cal veggies like spinach and a bit of tomato for electrolytes, if needed. This was because I’m headache prone. Coconut water is not high calorie, but his clear soup recommendation would be even lower, plus the added benefit of no sugar rush. I think the idea is both for weight loss and maintenance by managing insulin, but also the idea that zero cals for 16 hours ideally allows for maximum autophagy to avoid/overcome chronic infections and illnesses. I think that’s why Paul stopped putting cream in his morning coffee and only drinks it black now. Someone correct me if I’m wrong on any of this z 🙂

      • thanks susan, that is helpful. I am only about a week into the IF and trying to figure what works best for me. I have noticed a good increase in energy and the hunger I had the first few days has diminished considerably. I have a few sips of coffee/cocoa/stevia drink when I feel a little hunger pang and that helps though I have needed less of it as the days have gone by. I wonder if a couple blueberries or raspberries would be ok during the fast.

        • We’ve been having a cup of Bulletproof coffe (butter coffee) each morning during the IF and stay in mild to moderate ketosis. I make it with the high octane coconut oil and grassfed Ghee. We have lots of energy and mental clarity with this plan and it makes 16 ur IF most enjoyable. Sometimes not eating lunch until 1-2 o’clock with no hungry pains at all.

  2. ❓ Thank you so much for answering so quickly my question re zucchini as a fermented vegetable.

    Have recently received my own PHD book, though I read a friend’s first.

    I haven’t read everything available, but was wondering about your take on microwave ovens. I have purposely not used one over the years, but realize how much easier it would be to implement the PHD using a microwave.

    Comment: Cooking a whole chicken and eating chicken once a week per PHD recommendations means a lot of this dish in the freezer. Should last months. Does eating chicken once a week mean for 2-3 meals that day?

    Further comment: Haven’t worked up to full-time PHD diet yet, but notice I’m not ravenous at mealtimes, as I used to be.

  3. If arterial inflammation is the primary cause of heart disease, I wonder about the advisability of consuming lots of eggs (AA) and (grass fed) meats (AA), although that’s what I’m doing.

    I’m also eating salmon and sardines every week and taking vitamin K2.

  4. do you have any comment on using the following supplements?
    1. strontium for bone health
    2. acetyl l carnitine along with alpha lipoic acid. (marketed by dr. weil as Juvenon – was developed by Bruce Ames.)

  5. do you have a comment on why low fat and vegan diets have been so popular and seemingly successful, for example dr. ornish and bill clinton with his diet change after his heart attack. This is still what is recommended by heart assoc. etc. and they show studies to back up their position – are they completely misreading the studies or is something else going on?

    • Ralph, I’m not Paul, but FYI, it’s my understanding that Pres. Clinton lost weight but that his health was not good on a vegan diet. His new doc as of about 2 years ago is Dr. Mark Hyman who advocates healthy eats and fats and no processed foods. He is one of the leaders in functional health, and there are many overlaps with PHD in his suggested way of eating and living. There are a few differences in the areas of grains, legumes and dairy, perhaps, but most everything else is more similar than different.
      As someone who at one time was vegetarian, and at another was vegan, at first it felt pretty good, but overtime not good. I think that this is what we see so many well-intentioned people who have started out that way, later change over to more of an ancestral diet. Many/most paleo or ancestral eaters who I know are used-to-be-vegetarians/vegans. We all agree that morally/ethically those two diet styles draw wide appeal for people (including me) who love animals (live ones).

      • hi Susan, thanks so much for the reply – it is great to get some feedback. I also was a mostly vegetarian for over 30 years though I did always eat fish, eggs, cheese and yogurt or kefir but for years tried to eat low fat versions and minimize eggs and cheese because of the “mainstream medical consensus” that low fat was the best diet. I gave up low fat just a year ago and read PHD a couple months ago and have been trying to get closer to it for a month now, adding more coconut oil, meat, eggs and cheese. I also started skipping breakfast to implement the 16 hour fasting. Since starting the fasting I am amazed at how much better I feel, with much more energy. Hard to know if it is the fasting or the diet or a combination but it is great. It is still confusing to me that there still does seem to be so much controversy over fat especially in the nutrition community. I see on Dr. Hyman’s site that he is having a “Fat Summit” in a few days with many speakers including mostly paleo type speakers like Chris Kresser but also Dr. Ornish and Dr. Fuhrman both of whom advocate low fat, no oils etc. It will be interesting to hear. Ornish’s site still says he is an advisor to Clinton.

      • here is a quote from an article that sums up my confusion:

        …it seems strange that Clinton, who suffers from cardiac disease, ended up with two doctors who have diametrically opposed beliefs about the dietary causes of heart attacks… If Bill Clinton—an extremely smart man who has had access to the best medical minds in the world—can’t decide which diet is best, then what hope is there for the rest of us?

        https://newrepublic.com/article/117776/bill-clintons-vegan-not-diet-proves-hes-baffled-we-are

  6. I am about a 1/3 of the way through the book & feeling overwhelmed…reading comments tonight has helped. My problem is I have severe IBD … Also Hashimotos,PMR, & I am Celiac. I have had 2 food poisoning events in the 90’s, and then I had C diff twice over 5 years and so my gut is trashed. I have tried low carb, Paleo, then Plant Based diet ( made me sicker) now doing AIP….but most foods I react to, especially veggies. I try to stick to soluble fiber ones but even they cause a reaction. I’m 76 and have lost so much weight that I am skeletal. My doctor say it doesn’t matter what I eat, but I know that it does! She says I have to stop losing weight, but has no idea how I can do that!
    Right now I am eating broth, beef, shell fish, chicken ….not good to only eat proteins I see after reading PHD! Each plan seems good as I start , but the proof is in the results….my hubbie thinks this is another fad diet I’m on. Is there anyone in the community who has IBD who has been helped by PHD who can give me some pointers? Hoping….

  7. I’ve reduced my saturated fats a little in favor of olive oil and fish. I have atrial fibrillation and my long-time control drug (recently increased) is not as effective now. But this fatty acid change may have helped. No episodes for six days now.

    I remembered a study from about 15 years ago:

    Saturated fats were more highly associated with afib than polyunsaturated (omega 6), which were more highly associated than fish oil.

    So I add olive oil to my morning eggs rather than butter, and pour off any excess fat from my grass-fed ground beef. Still eat full-fat milk/cheese.

    This probably won’t matter to most PHDers and probably won’t help afib that isn’t mainly drug-controlled. It just provides, at best, an incremental improvement.

  8. Paul,

    I have a radiated thyroid. With all things remaining the same, no change in thyroid meds, what would cause tachycardia? A selenium/iodine imbalance? My T4/T3 is actually in low mid range, but that would more likely cause brachycardia, not the reverse.

    Thanks,
    Amy

  9. Paul,
    Before i found out that i had hashimotos i used to fast a lot. I was on 16/8 fasts and sometimes I would do 24h. It became my life style and my fasting glucose was 92-94. In my last test it was 100 with no fasting. So I started to fast again and 1 month after the fasting glucose 98 and it got me thinking if I should start fasting again. My antibodies are almost gone tpo 40 (was 496) so I wonder if fasting could help anyhow. After I read your book I am thinking maybe fasting is good even if you have autoimmune disease?
    What is your opinion about fasting and autoimmune disease like hashimotos?

  10. Paul,

    Does PHD conflict with research on TCF7L2 gene otherwise known as Transcription Factor 7? I am homozygous for this gene and I wonder, since it operates via impaired glycagonlike peptide 1 secretion which is stimulated more by fat than carbs, if making adjustments to the diet would be a good idea. If so, what do you think the healthiest percentage of fat would be for those of us who are high risk for this form of type 2 diabetes (which my mother has). It also leaves you vulnerable to excessively high sugar levels during sleeping hours, which I have experienced before, and always finish eating dinner early.

    Thank you,
    Amy

  11. Hi,
    I’m considering the book/diet but have a question. Why is white rice ok? I thought white rice comes from the nutrient-deficient portion of the wheat plant and like many other white products, it is so processed that it ends up being like sugar and spikes your glycemic levels.

    On the other hand, brown rice has fiber and is less processed. Please clarify for me.

    • White rice is not a good source of micronutrients, but it is a reasonable source of starch, which is one desirable nutrient. Not every food we eat needs to be nutrient-dense as long as the overall diet is nutrient-dense. If white rice is cooked then refrigerated overnight, it forms some resistant starch fiber, so it is not void of fiber. Brown rice is acceptable but has some compounds in the bran which we do not think are desirable.

      • Good to know, thanks. But since white rice is a simple/refined carb why isn’t it on the avoid list or at least only eat occasionally list?

        “Refined carbohydrates are those that have been stripped of other nutrients and have had their structure altered so they enter the bloodstream like an injection of sugar. This injection triggers the release of insulin which converts sugar into stored fat rather than energy”

        Given all that, I don’t understand how white rice is ok for anything other than the occasional serving.

        Please enlighten me 🙂

        • Safe starches are one of the pillars of this diet. Perhaps you should read the book. But this blog post encapsulates a lot of Paul’s thoughts on the matter.

          http://perfecthealthdiet.com/2011/10/jimmy-moore’s-seminar-on-“safe-starches”-my-reply/

        • This is discussed in the book. You can reduce the GI of foods like white potato and rice by combing them with acid, fibre, fats and I think salt. So, eating a meal consisting of these things and also white rice is not the same thing as eating a bowl of white rice on it’s own.

        • BTW, he lists it as a safe starch, but not necessarily the very best one; I seem to remember that most recently he has said something along the lines of occasionally (i.e., not daily), as you suggest. I actually only eat it occasionally for that reason, no more than 1-2 times per month on average. I love the other safe starches more and find them far more satisfying too, and I have the time to shop for and prepare them.

          Of course some people have food allergies, intolerances or other reasons that rice is one of the only safe starches that they can tolerate. And others who have busy lives opt for it because it’s so inexpensive and convenient — shelf stable and so easy to prepare.

          But for most of us, it is more preferable to more regularly consume the A rated ones that offer more nutrition, like potatoes, sweet potatoes, taro, winter squash, plantain, etc., and to vary them frequently.

          And like Paul says, to get the full benefit of the fiber (resistant starch) in rice and potatoes, they should be cooked in advance with a gentle cooking method and then refrigerated for 12+ hours and gently reheated. Also, they should not be eaten on their own, but rather, within the context of a whole meal of protein, greens, fat and acid, in order to promote proper digestion, maximum absorption and to dramatically reduce their glycemic load, thus avoiding the otherwise sugar spike.

  12. here is an interesting review of your book that you may not have seen – mostly positive, but has some negative things to say about the studies that you chose to include or ignore. He says “This book has a very consistent pattern of making a strong claim, citing one study that supports their claim, and failing to mention that there have been many more much larger studies since then that have come to the opposite conclusion.”

    http://slatestarcodex.com/2014/03/04/book-review-the-perfect-health-diet/

  13. Phd allows eggs. What is your opinion about arachidonic acid in egg yolks.

    • I bet you have been listening to the fat summit too – that was Barry Sears who mentioned that today about arachidonic acid in egg yolks – he said he eats 8(!) egg whites for breakfast to avoid the yolks, just the opposite of PHD. Sears also said to avoid chocolate and cocoa because of heavy metal contamination – that was disappointing to hear too. Maybe Paul will comment.

      • Barry Sears also says to avoid carrots and cranberries (http://www.amazon.com/gp/product/B000FC2P60/). I don’t think he’s a credible judge of foods.

        • Yes i did. After listening to fat summit the PHD follower can get so confused. Eggs, cheese, meat? I don’t even know anymore.

          • The thing that appeals to me about the PHD plan is that it makes good common sense… and… it follows the way that my family ate when I was a child growing up in the 50s…. a time when obesity was uncommon and we were generally healthy.

            i.e. look at the overall picture…. follow the main principles and don’t sweat the small stuff.

            Based on paleo/primal/PHD, I eat:

            good quality protein

            lots of different veggies

            some fruit

            safe starches – potatoes, sweet potatoes, white rice

            leafy greens

            “good” fats – butter, coconut oil, avocado

            drink sufficient water

            and eat occasional treats or “off plan” foods….. like 2 slices of bread to make a sandwich once a week. Or a piece of homemade apple pie. Or some frozen yogurt at the local TCBY. Not all of that every week… but just saying that I eat a couple of “treats” a week.

            Anyway… my point is…. stick to the basics – meat, potatoes and vegetables. Real whole unprocessed foods.

            And don’t sweat the small stuff – that way lies madness 😎

          • Also, it’s important to follow what your body is telling you. For instance, I can no longer eat dairy – it affects my skin (rashes) and my intestines (gas and bloating.) I also can’t eat tomatoes (skin issues). I have learned that over time.

          • I know, but as some of the speakers said, everyone is different and you have to experiment on yourself and try things till you find what works, not that easy I know, but I have definitely noticed positive changes since PHD. still not “perfect” but I am still “tweaking” and trying different things and foods. Even Dr. Hyman admitted several times of being confused and unsure, but you can tell from the proportion of pro fat interviews and the name of his new book what side he leans toward. I taped the audio of all the interviews so if you want to listen again just send me an email and I can share the link where I posted them with you.

          • Every body is different. PHD is a template. You might try reading Chris Kresser’s book too, which talks about a paleo template approach, both due to genetics and epigenetic factors. Some of us have ancestry predominantly from groups that were more lactose intolerant than others, for example. Equatorial groups ate largely, if not exclusively, tropical based foods. And most of us have mixed ancestry which makes it really hard to figure out what is textbook “right” and also what feels right.
            Like others have said, you have to be the final judge of what feels good for your own body, mind and spirit, and this happens instantly in the case of certain foods, and perhaps more subtly and slowly for other foods — and those foods are the hardest ones to figure out.
            IMO Dr. Hyman was just endearing himself to the speakers by not taking “sides”, and was trying to refrain from telling them what he thought was right or wrong, especially whenever his interviewee had a different approach than his own (i.e. non-confrontational). You have to remember that he was interviewing everyone from Chris Kresser, Dr. Permutter, to the extreme opposites like Ornish, Fuhrmann and Barnard.
            We also have to remember that most, if not all, of the anti-meat and anti-fat studies were not focussed on grass fed, organic meats and undamaged fats. As Dr. Hyman mentioned a few times, those details REALLY matter, including making the difference between weight gain and disease and weight loss and health.

          • Also, I subscribe to Dr. Hyman’s newsletter. Here is an excerpt from today’s email from him:

            What Fats and Oils Should You Eat?

            What types of oils and fats should we choose that protect our heart and brain and reduce inflammation? I prefer traditional fats, such as:

            Extra-virgin, cold-pressed, organic coconut oil – my personal favorite because it is excellent cell fuel, is highly anti-inflammatory, and may help with improving your cholesterol panel
            Extra-virgin, cold-pressed, organic olive oil
            Avocados
            Grass-fed meats
            Grass-fed butter
            Nuts—walnuts, almonds, pecans, macadamia; not peanuts
            Fatty fish—sardines, mackerel, herring, and wild salmon—that are rich in omega 3 fats
            My upcoming book, Eat Fat, Get Thin, uproots the lies we’ve been told about oils and fats, defining which foods cause disease and illness. I’ve created a plan that helps you achieve optimal health while providing you with studies and research to prove that certain foods, which have been long demonized, do belong in our diet.

            ***

            There is more overlap than not with PHD. I believe that 2 differences are that he recommends no dairy and he may be eating legumes (I think that he does).

          • Yes. His diet guidelines are close to Phd.
            Brown rice, legumes, beans, quinoa, buckwheat and oats are still on my I don’t know list. I follow phd but I wish that more research will be conducted to prove some allowance of above.

          • Bart, I eat buckwheat too, in small quantities, and preferably sprouted. I will also on rare occasions eat quinoa and lentils, again preferably sprouted. PHD does not say to avoid these like the plague, but rather to give preference to the other starches. The main reasons they aren’t endorsed more strongly is that either 1) more nutrition and benefit is available elsewhere for the same calorie load, 2) not enough info is available to emphatically determine them “safe” and/or 3) simply because most people will not take the time to properly prepare, i.e., long soak and sprout followed by long slow cook. I will also consume a dish that contains beans or brown rice (when I have no choice, like dinner at a fixed menu event) but will only eat a small amount and just pick thru the rest of the dish. I do not eat oats because unlike quinoa, buckwheat, etc, they are a grain and still contain a different type of gluten, but I’d guess that many PHDers occasionally consume it. Also for brown rice, I might occasionally consume a tiny bit in a cracker or two or in a rice cake.
            So you don’t have to look at these things as black and white, although when you’re new to PHD it’s a good idea so that you can get more use to the overall eating approach. But over the long haul, many say that 80/20 is a good rule. My worst case days are 80/20, but on average throughout the year I’m closer to 95/5.
            I’ve been gluten free and on PHD for 2+ years, but if I go to France some day, I’m going to eat a French pastry or two or three…over the course of the trip.

          • Bart, also, if you listened to the Chris Kresser interview, Dr. Hyman and he see things very eye-to-eye.

    • I’m guessing Paul’s response would be similar to this one: http://www.marksdailyapple.com/arachidonic-acid/

  14. I just made an amazing pizza using The Domestic Man’s recipe and it was absolutely the best gluten free pizza I ever had! The food is so good on this diet!

  15. I have a question about portions. Your guide doesn’t seem to lay out if people who are larger should eat more or people who are smaller in stature should eat less. Is there a way to calculate this?

    • We recommend calibrating food consumption to appetite. In the end, there’s no better guide than to listen to your body — you just need to get close enough to the optimum so that your body is giving you the right signals.

      The best approach is to do intermittent fasting, 8 hour feeding window and 16 hour fast, and eat enough in the 8 hours so that you are barely beginning to get mildly hungry at the end of the 16 hour fast.

  16. Along the lines of portions, would you please provide some real-world amounts (like how many ounces of meat/fish, how many tablespoons of healthy fat, how many grams of protein and carbs per day)? The numbers don’t have to be exact, even just a range is fine.

    The palm-size and thumb-size thing doesn’t really help me.

    • Phd specifies exactly how much food you should eat.
      Just look at the apple above.
      All you have to do is adjust up or down.

  17. I have finally perfected a chicken liver recipe and a method to only prepare 4 oz per week. It’s really good! I would be happy to share this if anyone is interested 🙂

  18. Ok well here it is! After quite a few trials this one was perfect and easy. I got the pound of chicken livers from Whole Foods and portioned out 4 oz in bags for the freezer and kept 4 oz out to prepare. The meat guy at Whole Foods said chicken liver once cooked does not freeze will and won’t have the right flavor or texture and to freeze raw in portions. So I sautéed onions in olive oil, then removed the onion and sautéed the 4 oz of chicken liver with salt and pepper. When done I transferred them to the bowl where I had the onions. Then I added one hard boiled egg and put in the fridge to cool. In a little while I put the whole thing in a small container that came with my immersion blender and at the suggestion of the guy at Whole Foods who is also a chef, I added a little organic cream and pureed it with the blender! I put it in a little bowl and covered it with chopped fresh parsley and chilled it. Then that was my Super Bowl dip with gluten free rice crackers and carrots. It was really good!! My dog was going crazy though she wanted it! Haha I always gave it to her when it didn’t come out 🙂 I feel like a total chef now!

    • Sounds very nice but I just wanted to say I have successfully frozen raw liver and also the cooked pate. I make up a large batch of pate and put into little ramekins. Once cooled I cover the ramekins with cling wrap and freeze them. Take out the night before you want them and defrost them in the fridge. I’ve even defrosted in the microwave with no loss of texture or taste.
      Ps adding Apple cider vinegar to the pate mixture gives it a nice tang.

      • Thanks for sharing that Nancy! I’ll have to give that a try with veal liver. Those pre made dips are fantastic.
        Though, like Shuna, I haven’t had any problem with preportioned frozen cooked liver. I use the Jacques Pepin recipe, then divide it in quarters and freeze 3 of them. Although I still dislike the process of cutting and cooking it (a bloody mess even though I soak it in milk first).

    • What I usually do is just blend the raw livers with butter and sauted onions, strain the mixture through a sieve to remove any bits of gristle then pour it into ramekins and cook them in the oven in a water bath. I add a layer of melted butter over the top, chill and then freeze them. I find sauteing the liver to be too time consuming, although it will probably taste better. I always go for high yield/low effort cooking methods. It still tastes really good though and I’m not really keen on the taste of liver. The trick is to add loads of butter.

      • Do you have a dedicated blender for this? I’m afraid to put those flavors and fats is my Vitamix for fear that I won’t be able to get that smell or flavor out of it — especially the lid.

        • Well the machine I have has 2 compartments, it has a blender you would use for smoothies and stuff like that and it also has a food processor you can attach a bigger blade to. I use the 2nd one for blending up curries, pate, chopping veggies, stuff like that. I can’t say I notice any smell or taste that transfers after washing it. Maybe it’s not worth risking on a vitamix.

          • Thanks for that. Yes, part of the problem with a Vitamix is the blender container doesn’t disassemble. I’m wondering if my food processor would work, but it may not produce silky smooth as well as a blender would. I also have a meat grinder attachment for my Kitchenaid mixer, but I fear that with raw liver the blood may splatter everywhere. But I suppose that I could sauté it first before brinding and freezing. Putting some melted butter on top is a great idea. They have tiny freezable jars that could work well for this frozen pate idea.
            My go-to veal liver recipe uses butter, shallots, lemon juice, capers and the magic ingredient….fresh tarragon. My husband doesn’t like liver, but he asked for seconds with that recipe.

    • Does anyone have a cooking method for (buffalo) heart? I thought it would arrive sliced, but it came in tact, 3+ lbs.

  19. Is parboiled rice a safe starch? It looks like white rice but I don’t know how the Parboiling process affects the toxins.

  20. Can you please tell me if there is a limit to how long one can follow your ketogenic diet guidelines from the PHD book? Is there an issue with eating large amounts of coconut oil over a long period of time?

  21. Thanks for the research and this amazing book. I’ve been reading it for 5 weeks and still trying to digest it, figure out which supplements to take, when to eat, to exercise, etc., but I’ve been having fun doing it. That is revolutionary in and of itself. I’m enjoying food more than I remember doing in the past, I feel better both when I eat and when I don’t, and I feel hope for the first time in a long time as I fight the inflammation that seems to be devouring my body in the form of hypothyroidism, frozen shoulders, digestive issues, back pain, hip pain, and skin issues. I have only been free from gluten for 6 weeks, but already I’m noticing some improvement. I will turn 50 later this year, and I would like to bring a level of healthy to my 50s that I haven’t enjoyed since 39.

  22. Hi Paul,

    What do you think about the AIP Paleo diet. Do you also recommend people with leaky gut or autoimmune disease to avoid egg whites, nightshades, nuts, seeds and so on? Also can caffeine make leaky gut worse?

    P.S. Could you maybe write a blog post with recommendations for people with severe gut symptoms and possible leaky gut?

    Best,
    Disa

    • Disa….I would also like to have some answers about those of us with severe gut problems, autoimmune diseases, & leaky gut.Ive been following the AIP diet with some improvement in symptoms.

  23. Hello Paul,
    what you think about book William Wolcott Metabolic Typing Diet?
    Best regards
    Adam

  24. Hi Paul,

    Is lactose free dairy healthier than regular dairy?
    For an example lactose free yogurt and lactose free sour cream?

  25. Hi paul, just purchased your book. Can’t wait to get it so i can start reading! I have some confusion about whether using whole milk or half & half is better to use in coffee. I only drink coffee in the morning(2 cups) and have quit putting sugar in, but milk has alot of sugar. I see that dairy is a pleasure food on the apple, so i hope its okay.

  26. Can I please clarify that the weights of foods recommended are raw weights and not cooked? Confused ❗

  27. Hi Paul, my doctor suspects an immune disorder (hypothyroidism most likely, or Hashimotos) but the standard tests we run here (Oz) aren’t conclusive and I know Hashimotos is notoriously difficult to diagnose. I have tried thyroid medication, but the results were horrible – at first fine, then I flipped into Hyper with al the associated anxiety etc. I have tried all sorts, including acupuncture but am getting worse – crashing at least weekly, with extreme fatigue, low grade fever, depression, gravelly voice, etc…. So I am returning to the PHD but would like to tweak it for Hashimotos as it sounds the most likely diagnosis. I have the book and have noted the advice to bring in iodine only after a few months on the diet, but I note also that perhaps birds rather than red meat, may be the best choice for folk such as me. I’m sorry if this info is somewhere else in the website – but it is a huge repository and I’m often confused by the science (yeah, brain fog too)

    • Hi Fran,

      Yes, for Hashimoto’s avoid mammalian meats and dairy. See http://perfecthealthdiet.com/2015/02/neu5gc-autoimmunity-hashimotos-hypothyroidism/.

      Best, Paul

      • I also have been following your advice regarding mammalian meats in addition to PHD. I do have some aged cheese or little sour cream from time to time. Is that ok or it should be completely restricted? I don’t have any hashimotos symptoms except cold hands when it is cold outside or sometimes I get Reynolds in one finger when I expose my hands to cold. My tsh seems to go back and forth between 3.5 – 6 depending on my zinc status and my antibodies are 40TPO now and 2 TGab. In the past they were around 496TPO and 12TGab. Do you think that Hashimotos might go away after sometime. I am not talking controlling it, but really getting rid of it for ever. If one does not have symptoms but blood work marks for TPO and higher TSH how do we diagnose an improvement?
        Also, do you believe that iodine could help healing hashimotos?
        At what point it would be safe to add iodine to the diet and how much?

        • Yes, you can get rid of Hashimoto’s. Yes, you should be taking a low dose of iodine (225 mcg/day) as this is best for health of the thyroid gland and immunity. As in other kinds of hypothyroidism, the best way to monitor improvement is by the dose of levothyroxine you need to optimize well-being – this should steadily decline over several years. Generally speaking, the best dose will lower TSH to about 2.0.

          Best, Paul

          • This is interesting. I am a similar case. Not many symptoms but higher TSH and Thyroid antibodies. I had EBV virus that is gone now thx to vitamin c and the monolaurin protocol. My TSH is still higher depending on the day of the test. Sometimes 3.5, sometimes 5.0-6.0. My t4 and t3 look normal. I wonder if adding 225mcg iodine could help lower my TSH? My doc says that iodine is very risky when it comes to hashimotos and advices against it and says that most studies show Hashimotos and iodine supplementation don’t go together. You mentioned levothyroxine. I personally don’t take anything besides most of the supplements you recommend. If t4 and t3 are within normal range is levothyroxine required with Hashimotos? Would you recommend to take the iodine deficiency urine test first to be on the safe side?

  28. how do I unsubscribe to comments email alerts?

  29. Hello Everyone,

    Thanks Paul – For Everything. I spent the last week researching every angle on the Keto/PHD topic.

    I decided to transition into PHD and it’s amazing. The first two days of slowly adding white potatoes I dropped weight and started feeling better.

    PHD seems to add up to about 1800cals according to:

    “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”

    Should I not get more specific in my requirements: 5’10” Male, 175lbs, Moderate Activity?

    Yesterday I tried eating by intuition without tracking. The day ended at around 2300cals and I again noticed a reduction on the scale. Not sure if that will continue as I would like to lose about 10 more lbs.

    But most of all I enjoyed it. Potatoes with a little butter with each meal. 🙂

    Thanks again.

  30. Hi Paul,

    I came across this Potato Diet / Potato Hack over at Richard’s blog Free the Animal.

    What are your thoughts on this?

    http://freetheanimal.com/2016/02/the-potato-diet-practicalities-dropping-big-weight-fast-with-high-energy-and-without-hunger.html

    Thanks.

  31. does Paul or anyone have a comment on the sept 2015 study from dr. hu at harvard “Butter is not back: Limiting saturated fat still best for heart health”

    http://www.hsph.harvard.edu/news/press-releases/butter-is-not-back-limiting-saturated-fat-still-best-for-heart-health/

  32. Paul,
    If I suffer from fungal infection, is it Ok to do fasting in the morning with some coffee and coconut oil?

  33. Hi Paul, I’ve been experimenting with adding exogenous ketones to my morning fasting routine (espresso, MCT, ketones) and then shifting to eating more RS starches towards the latter and end parts of the day. It’s been great for workouts and high level functioning.
    Question: Generally do you have thoughts positive or negative about adding ketones into diet and more specifically would my morning routine put an abrupt stop to any of the prophylactic benefits of intermittent fasting?
    Thanks so much,
    Steve E

    • Well, they are empty calories, so there is always concern about how they may impact the body, which is dependent on the context of the rest of the diet. Ketones do provide neuronal energy which can inhibit autophagy, although ketones also stimulate autophagy so the net effect is unclear. I prefer pure fasting myself.

  34. Thanks much Paul, I’ll use them experimentally on my food mornings for training etc but not on fasting mornings.

  35. Hi Paul,

    Apparently, “cocoyam” is actually an ambiguous term which can refer to either:

    – Genus Xanthosoma (known as “new cocoyam” or “chinese taro”); or

    – Genus Colocasia (called “old cocoyam” or “taro”).

    Are they both safe starches? (Or is only the latter safe?)

    Thanks!
    -Eric

  36. Paul,
    Is it a good idea to take prescription drugs like Pidotimod to boost immune system besides following PHD?
    I suffer from weak immune system, and cant recover some certain infections easily.

  37. Hello Paul,

    I have transitioned to the PHD from a ketogenic diet because of the many reasons you’ve stated in various articles and podcasts.

    My one issue, and only complaint from keto, I was hoping to resolve with The Perfect Health Diet, is my disturbed sleep. Ironically when I am eating a SAD way of life, with high-carbs and processed foods, I sleep soundly through the entire night. Literally within a couple of days of starting my program I have trouble getting more than 3 or 4 hours.

    I have been following PHD for quite some time now with no relief. I wake up every night around 2:00am and toss and turn for the rest of the night. My only guess, since safe starches did not solve the issue, is the caloric deficit. I am only -500 calories below my requirements for the sake of weight loss.

    I am hoping you have some advice. I am following circadian principles (in bed ~10:00, minimizing blue light, magnesium, potassium, sodium) and I’m not sure what else to do.

    Otherwise I am enjoying the addition of potatoes and rice. 🙂

    All the best,
    Ermias

    • On a side note I am also intermittent fasting from around 1:00 in the afternoon to 8:00pm.
      Thanks again.

      • Are you saying that you only eat in the morning? Why do you fast this way?

        • Hey Peter,

          I’m really just skipping breakfast. I eat my first meal around 1:00pm and a second meal in the evening 7:00 or 8:00.

          It works out for me: both physically and convenience wise. I also prefer to have two nice sized meals versus three or four small ones.

    • Hi Ermias,

      Try adding more carbs until your sleep gets better. Not only starches, but also have a piece of fruit with every meal and a sweet dessert (either a piece of fruit, or a glass of milk with honey and turmeric) at the end of your feeding window.

      Good sleep is more important for weight loss than calorie restriction, so don’t hesitate to add carbs for sleep even if it means adding calories.

      If extra carbs aren’t enough, you might have developed hypothyroidism or adrenal issues while on the keto diet. If so, have your doctor check you for hypothyroidism and get it treated with levothyroxine if there; and try getting extra electrolytes, e.g. a salted tomato before bed and in the morning.

      Best, Paul

      • Thanks Paul,

        I appreciate the direct reply, it’s an honor, since I’m a real fan. I’m on standby for PHD products, restaurants, cafes,… 🙂

        I don’t feel that I have hypothyroidism. I have none of the associated symptoms and I lose weight at a fast pace when I’m at a deficit. It’s just that the deficit is the only common denominator in regards to my disturbed sleep. Nevertheless, I will follow your instructions as outlined.

        To be fair to The Perfect Health Diet; I can’t honestly say that I’ve directly adhered to it for more than 30 days.

        I really miss my full nights of sleep, so if coming “out of ketosis” is necessary than that’s what it’ll be.

        Thanks again and keep up the good work,
        Ermias

        • From your “salted tomato before bed and in the morning” instruction I am assuming you feel its best to ease off of intermittent fasting. I have no problem with that since last night was so bad sleep wise. I feel great during the day but I think I slept an hour – two at the most.

          I got out of bed this morning and went straight into the kitchen for a salted tomato. I then proceeded to change my macros to 30% carb, 55% fat and 15% pro. I still can’t get over not counting calories so I have them at 1800?

          I am now following textbook PHD.

          Thanks again. All the best to you and Shou-Ching.

          • I was also having trouble sleeping – after being a deep sleeper all my life. I am now sleeping very well.

            Here’s what I eat each day:

            3 eggs

            10 ounces of protein (beef, chicken, shrimp)

            16 ounces of safe starches (baked potato, sweet potato, winter squash, white rice)

            12 ounces of other vegetables (a good variety of all others)

            a handful of lettuce (either in a salad or as a snack while I cook)

            2 servings of fruit (either grapefruit or berries)

            2 – 4 TB of fat (in cooking and/or on potatoes and/or on salads) (butter, coconut oil, olive oil)

            3000 mg of sodium/salt. Too little salt is just as bad as too much. I don’t eat any processed foods, which is where everyone gets too much salt/sodium on a regular SAD way of eating. So when I switched to paleo/primal and then to PHD, I wasn’t getting enough salt and that was causing heart palpitations and restlessness and trouble sleeping.

            IF you are eating any processed foods, then obviously you would not use as much salt as I do. But this is something to consider… where are you getting your sodium from (processed foods?) or do you need to make sure you get enough in cooking and sprinkling on foods.

            Water – I drink 32 ounces of plain water every day. Dehydration causes all kinds of problems also.

            That’s my plan. I am not a doctor. Just sharing what has worked for me within the structure of PHD.

          • Thank you Susan,

            I appreciate your response.

            There wasn’t a reply button on your message for some reason. Hope you get this.

            I logged my mfp today and it was pretty much exactly as you outlined.

            I eat zero processed foods and get my salt from cooking and sprinkling like you said.

            Do you just weigh your food and not worry about calories or are you at the point where you can just eyeball it?

            Your ‘I am now sleeping very well’ sentence sang to me.

            Take care

          • Ermias – I weigh some of my food. I found a small scale at amazon.com that works well.

            I’m not fanatic about weighing and can eyeball some of it now, but I do weigh my protein and safe starches.

            I do not count calories.

          • One more thing – each morning I put 3/4 teaspoon of salt in a salt shaker. My goal is to use most of that during the day. I find that I need between 1/2 tsp and 3/4 tsp of salt every day.

            I believe that it is getting enough safe starches (16 oz), eating some fruit, drinking water and getting enough sodium is what is working for me. That.. and enough protein.

          • Last thing 🙂 I need to lose about 20 pounds, but … for now… I’m not even thinking about that.

            I want to be steady, steady, steady on my eating plan and feeling all of the health benefits of PHD and keeping to a regular pattern of eating (3 meals a day between 8 a.m. and 6 p.m.) and sleeping (going to bed at the same time every night 10 p.m.).

            Later, I shall worry about losing weight. I think that it will drop off slowly without any focus on it on my part.

          • You’re definitely on the right track Susan. Health first and everything else will balance out.

            I’m on board with you now. I’m not gonna worry about fasting for certain hours. I figured if I could dedicate to intermittent fasting and keeping carbs under 20 grams then I surely could do it for PHD. It’s the perfect balance all around.

            Most of all I’m looking forward to sleeping again.

            I’m thinking I use more than a tsp of salt, seems like I’m constantly sprinkling it, but I’ll measure and see.

            So if you’re last meal is at 6:00 you’re going to bed slightly hungry.

            Good luck with everything.

          • Hi Susan B,
            We’ve talked about salt before and I owe a debt of gratitude to you because sea salt has really curbed my headaches. But it’s interesting that we’re talking about sleep because it has not improved my sleep. I am a poor sleeper — sometimes trouble falling asleep, but more often it’s a wake up around 3-4 am and unable to go back to sleep problem. I usually wake up to use the bathroom and then that’s the end of my good sleep.

            One other thing on the salt quantities — it doesn’t sound like you eat sauerkraut, etc. I do (homemade, of course) and that can make it hard to track my salt. I have just added less or none if I’m eating sauerkraut.

            I eat about 5-6 oz of meat/day, plus 3 eggs, plus maybe 1 oz cheese and 1/2 cup yogurt, so probably a little less protein than you. I eat carbs with each meal and most are at night. I don’t/can’t intermittent fast; it just doesn’t work for my body — it really stresses me out and feels very forced — I’ve tried several times. And it doesn’t make any of my health issues feel better.

            Ermias, you probably realize this, but the tomatoes and salt are for potassium and sodium (electrolytes), not as much for the carb, though there is some there and low calorie.

          • Have we talked before? 😳
            Well I’m glad I was helpful 😕

            I’ve been meaning to make sauerkraut but I always put it off. I just mentioned it yesterday and I’ll take you bringing it up as another sign. This weekend!

            I know with keto they stress the use and even over-use of salt. It may need to be a bit more balanced with PHD

            Your sleep is improved now though right: or are you still waking up at 3 or 4?

            I was going to skip the tomato tonight. Reminding me that it’s about the potassium is making me realize that I I should have it.

            Do you peel your potatoes? And do you do the cook, cool and reheat thing? I have been but today I had my roasted sweet potato right out of the oven. Mmm with a little butter and cinnamon. 😉

          • Hi Ermias, no we haven’t chatted…I happen to also be a Susan B but I’m shown here as just “Susan” because “SusanB” beat me to the punch, bless her heart 😀

            So my salt comments were aimed at her because I wasn’t adding enough and I’ve suffered from headaches and migraines for decades, so she told he she had too and that she wasn’t adding enough salt and urged me to use more…thus my thanks and comments to her about salt and sauerkraut. My question about her consumption or not of sauerkraut is that she measures her salt consumption daily to make sure that she gets enough, but she doesn’t do any batch or advance cooking with salt or eat any prepared foods, so the salt is easier to track. But if you’re cooking dishes, soups, making sauerkraut, etc, and using them over the course of several days, weeks, it’s harder to track the daily amount. That’s why I asked if she ate sauerkraut; it sounds like she may not. I’m just asking her for clarity and perhaps guidance because I can’t figure out how to measure the salt per serving. For sauerkraut it might be a bit easier since you usually need to add very little brine since the cabbage self-brines, but for other fermented veggies (like pickles, daikon spears, onions) I’d think a lot of the salt still sits in the brine which I don’t usually drink or use.

            The only comment that I really aimed your way was in response to your post about the tomatoes and salt. Sorry for the confusion. In any case, I’ve had exchanges with Paul about the same issues and difficulties with IF, and mid- sleep insomnia, etc. and he suggested a similar approach to the tomatoes and salt. He even suggested that if getting to the full 16 hours of fast was too hard, to try some clear broth with a bit of spinach and tomato and salt (magnesium, potassium, sodium, no-calorie protein from the stock (gelatin)) to keep me from feeling depleted.

            Regarding your questions about potatoes: I NEVER peel them, and I use a very wide selection of varieties and types (colors, regular and sweet). I usually either steam them or bake them, usually whole. Once in a while I might make oven “fries” using avocado oil, rosemary and or thyme, cayenne and S&P. Sometimes I steam and mash and add a bit of milk/cream/sour cream and butter. But MOST of the time I steam up a bunch of them whole in advance and I might have a few right then and refrigerate all of the rest. I’d say 75% of my consumption is as cooled and reheated. I nearly always squirt lemon juice on top and add a bit of fat, unless they already have a bit of fat (like the “fries” or the mashed) or if I’m eating them alongside a more fatty cut of meat or other fatty food in the meal. I never eat my starch as a standalone meal or snack. Rather, always in the context of a PHD apple diagram with all 4 components. I just go a bit heavier on protein and a bit lighter on starch at lunch, and then I reverse that ratio at dinner — that was also Paul’s suggestion to me to enhance sleep. My last meal goes from 7-8pm.
            I hope that this helps.

          • Ermias – I think Susan was referring to me – SusanB. She and I had “spoken” before and I gave her my Salt Lecture 🙂

            Susan – I’m so glad that adding salt has helped with your severe headaches !!!

            I would not do well on the amount of protein that you are eating. I need my 10 oz of meat plus the eggs. I can’t do dairy, so I don’t.

            Ermias – I started with paleo/Primal about 2 years ago and followed the general guidelines about 80% of the time, but something didn’t feel right with me. It wasn’t until I found PHD and added in the 16 oz of carbs that I felt like I had finally found the eating plan that works for me.

            However, no one (that I know of) in the Paleo/Primal/PHD world emphasizes that IF you give up all processed foods, then you need to add adequate salt/sodium or you risk serious health issues. As Susan found out with her severe headaches. Too little salt is just as dangerous as too much salt. The Heart Association and others seem to recommend about 2500 mg of sodium per day which is just over 1 teaspoon of salt per day (a tsp of salt contains about 2325 mg of sodium).

            But that is total sodium – what you cook with, what you sprinkle on your food and what you get in processed food or… as Susan points out – homemade food like sauerkraut (which I don’t eat… LOL)

            I seem to feel good on about 3/4 teaspoon of salt which would be about 1800 mg of sodium per day. I may try to up it to 1 teaspoon per day and see how that works.

            I forgot to mention before… I do take a magnesium supplement – right after dinner. That may be helping with sleeping well also.

          • As per this post, a salted tomato will not affect your fast too much. You can still consider it fasting:

            http://perfecthealthdiet.com/2012/03/food-for-a-fast/

          • Ermias – I do not peel my potatoes – there are lots of vitamins and minerals in the skin of a potato. I usually bake my Russet potatoes and my sweet potatoes and eat them hot with butter. Yummy !! One of my favorite foods. Also keep in mind that there is more potassium in a potato than in a banana (the food most often recommended for potassium). If you eat a large baked potato every day (10 – 11 oz) you’ll be getting a good bit of your daily potassium requirement.

            Susan – I don’t eat sauerkraut for one reason – I don’t like the taste of it.

            I do not … generally.. batch cook. I like simple foods cooked fresh. So I’ll have a small steak and a baked potato (with butter) and some steamed broccoli and some blueberries and that’s one of my favorite meals. So I don’t have the problem of having to figure out how much salt is in a large batch of food. That would be difficult with a food with brine – as you said. I don’t know how you would calculate that…..

          • Susan x 2,
            Thank you both.
            And here I was thinking to myself: “yeah, I think I do remember a Susan…” lol

          • Thanks susan,

            It was conflicting. Thanks for you explanation. I’m learning a lot from you, SusanB and PeterC. I am literally applying all these things down to the letter. I’m copy/pasting you guys’ notes into a PHD doc.

            So just to clarify we should have the tomato with salt outside of the window? I am totally fine without it and I’m well adjusted to my IF window. I would be doing it simply for the benefit of helping me sleep. It’s 3:00am as I type this. 😕 I would normally stay in bed, resting and even more so tossing and turning, but last couple of nights I’ve been figuring I could use this time to catch up on my learning and reading. Today was my first day introducing starches so I’m not expecting any miracles (well I was 😀 but I’m also patient ). I could also just have a salty tomato or two during me eating window.

          • hi Ermias,
            supplementing with melatonin may be worth a try, if you have not tried already.
            Paul is not against this, & he has a few product links on the http://perfecthealthdiet.com/recommended-supplements/ page.

            you will likely need to experiment a fair bit with the type & dose.

            good luck with it all anyways.


          • & if you do tried a timed release version (which i have had no success with),
            i would start off with smaller doses, say 3mg or even 1mg, & not the 5mg TR that Paul has linked (initially anyway).

          • I think you misunderstand.

            If you read the post I linked to, Paul says it’s permissible to have certain foods as part of a fast.

        • Thanks for that Peter. That brings some light to what I’ve been questioning all day. I also noticed that Paul mentioned a cherry tomato; unlike the nice-sized tomato I had this morning. 🙂

          • Ermias, just an FYI…that link to the food-for-a-fast article written by Paul is very dated (i.e., 4 years). PHD has evolved over the years, and the Jaminets have modified their recommendations whenever they’ve reached new conclusions based on new research or studies and their own experience.

            My understanding is that currently Paul does (and generally recommends) a pure zero calorie/zero nutrition 16 hour IF with only black coffee or water/mineral water. Up until about a year or so ago he took cream in his morning coffee and used to recommend that to others, but he doesn’t anymore in order to optimize the benefits of IF. It’s usually only when someone is having symptoms like you’re experiencing (or like I have) that may be exacerbated or caused by a pure IF that I’ve seen him recommend modifications along the lines of those discussed in that 2012 article. (I wanted to point that out, because otherwise this may all seem like conflicting info to you.)

          • I don’t believe that is true Susan. Paul has always recommended a zero-food fast but indicates that certain foods will not not inhibit fasting benefits such as autophagy too much.

          • Paul has modified his guidance slightly re fasting in recent times,
            there are more details in some comments by Paul from April 2015,
            start reading here;
            http://perfecthealthdiet.com/2015/04/new-the-human-experience-podcast/#comment-1666588


          • & make sure to read the following comments as well,
            the latest (as i type) from Paul is dated Jan 2016

          • Darrin – Thanks for the tip. I know about melatonin. I remember trying it years ago. It did work but I always have the feeling that I’m masking the symptom of something. I know it’s natural, but you know what I mean? When it comes to sleep I have always been a really great, deep sleeper. I should have it on my resume – it’s one of my strong points. 🙂 So when it’s not happening I want to know why.

            PeterC – I’m sure what you’re saying is right. Paul mentions a cherry tomato, that’s a half a bite for me, and I definitely don’t see that inhibiting the effects of fasting. But, if it’s all the same, it would be great to keep the window clear. On the flip-side: if IF may be the cause of my sleep issue and that salted tomato outside of the window will resolve it – then I’m in.

          • PeterC,

            I just read the stream of comments as you suggested. You are right, Paul does recommend salted tomatoes for those that may be suffering sleep issues. He mentioned the premier cause may be under-eating carbs (which is likely my case seeing that I just keep from Camp Keto).

            I’ll see what this week brings with the addition of the safe starches and two fruits per day. If I don’t see any improvements I’ll have two salted tomatoes per day, before bed and as soon as I wake up.

            Thanks again. You’re awesome by the way. The way you answer questions with links to the relevant information is great. It’s a big help for me because I’m giving it 100%. I’m kind of like susan in that I’ve placed my health a step above losing my last 15lbs in order of priorities.

          • Ermias,
            hope you get to the bottom of your sleep issues,
            when you do, please post back with your findings,
            may be of help to others
            🙂

          • Definitely will Darrin,

            I plan on doing everything right – at least what I know of, without any shortcuts – so let’s see how it goes.

            I’m sure adrenals may have something to do with it. I read some symptoms that sound/feel familiar: sore feet, a little anxiety here and there, and of course waking up at 2:00am.

            My third day doing text book PHD. Sleeps actually gotten worse :), but I’m sure theres an adjustment period. I brought the bulk of my caloric intake earlier into the day (still within IF window of 12:00-8:00), and try to have more carbs in the last meal as suggested. I’m also in bed before 10:00pm. As of last night I decided to not get up if I can’t sleep: turn lights on, catch up on work, etc…

          • Ermias – there is definitely an adjustment period to all of this. You have made a lot of big changes, so your body needs time to adjust.

            I recommend that you decide on a plan and stick with it i.e. eat your meals at the same time (roughly) each day and go to bed at the same time every night and stick with your food plan. And then be patient and let your body adjust. If you keep changing and tinkering, your body will never be able to adjust.

            Also, my motto is Keep It Simple.

            I eat 3 meals a day of real food at approx the same times – 8 a.m., 12:30 p.m. and 5:30 p.m. I have protein and safe starches at each meal. I don’t try to fast. I prefer to space my meals out a bit more because eating all of the food on the PHD is a lot of food. I can’t imagine trying to eat all of that in 2 meals per day or meals that are so close together if you are doing an 8-hour window of IF. It does not seem natural to me .. at all. I know that Paul recommends it, but it doesn’t work for me.

            Anyway, my 2 main points: Keep it simple and don’t sweat the small stuff. And… second… stick to a routine – for meals, for food plan and for a particular bed time. And then patiently wait (for a month or more) for your body to adjust.

          • Also – you will get contradictory advice from not only regular people here and on other websites – but also from the paleo/primal/PHD gurus and well-known bloggers.

            Within the general PHD “structure” (which I have found to be the very best plan for me), you need to adjust it for you. We are all different. I can’t do IF. I can’t eat dairy, so I don’t. I find that I do better eating more sweet potatoes and winter squash for my safe starches than baked potatoes or white rice – although I do eat all of them…. I just have more winter squash and sweet potatoes and less white rice and white potatoes.

            But don’t keep reading and tweaking your plan and worrying about micronutrients and all of that minor stuff. It will drive you crazy.

            Stick with the main principles. Eat a wide variety of whole/real foods. Have a schedule and stick to it. Relax !!!!

          • Thanks Susan. You’re advice is well taken. I’ll chill.

            The main reason IF works for me is because it controls my intake. I’m always hungry. If I try to space out my food throughout the whole day it’ll be torture. With IF I can have two or three decent sized meals. Even if I ate 2000 calories, a day, that’s less than 700 per meal. A snack in my opinion!! I haven’t quite got my head around the “eat til satisfied” thing; it would be close to 3,000 a day for me.

            Your salt experiment taught me something. I put a teaspoon to the side and found out I was only using about a 1/2 per day.

            Overall I feel good and I’m also patient.

      • Paul,

        Hows a good way to treat adrenal issues??
        Does drinking coffee every morning have anything to do with it also?

        Thanks

  38. Very helpful! Mostly everyone knows about healthy food, but always confused that at what quantity should it include in food plate per day.

  39. Hiya, are there any particular foods I need to take out if I have fibromyalgia? I’ve completely cut any Gluten foods which has helped tremendously but wondering if there is anything else. thanks

  40. Paul, what is your opinion on all the controversy surrounding dairy. I know lactose should be avoided generally, so butter, most cheeses, cream, yogurt, etc are still on the menu, but what about the whole casomorphin theory (not sure if it is fact or theory quite frankly), that in some individuals or everyone possibly, casein does not get fully broken down by enzymes and ends up as this opiate compound that crosses the blood brain barrier which is linked with all sorts of issues including autism. I don’t know the exact science behind this and it would be interesting to hear your opinion as I don’t think it’s a question that has come up on before on this site as far as I can tell.

    • I’m not Paul, but I don’t think he’s ever advised (in his book or here) to generally avoid lactose as a rule. In fact he’s written that sometimes he has a glass of milk with honey after dinner, as a dessert, and I understood him to mean dairy milk. PHD categorizes full fat dairy as a pleasure food “if tolerated”, not a staple of the PHD diet. I think that full fat just means not skim (i.e., whole milk vs skim milk).

      • Ah, maybe I am thinking of someone else, but generally what I have observed is that most of the strict paleo or paleo “template” diets advised by the likes of chris kresser, mark sisson and robb wolff advise to avoid lactose due to many people not producing the lactase enzyme required to break it down, or they say to at least go off dairy for 30 days and then try out different kinds starting with the least likely to cause a reaction like ghee and work your way up to higher lactose dairy and watching for any symptoms. I didn’t realize PHD advocates milk? I just assumed was only fermented and/or low lactose content diary.

        Anyway, I am more interested in the casomorphin thing than lactose. As the GAPS diet talks about this in detail and the GAPS diet is generally regarded as scientifically well founded.

        • Hi Iain, yeah, PHD isn’t paleo. Strict paleons don’t eat white potatoes and some not chocolate, along with some other things. It’s hard to label these things but PHD is probably closest to “ancestral” than any other label, although WAP includes several things that PHD excludes like most grains and legumes.

          (BTW, Chris Kresser doesn’t say to avoid dairy either. He says eat based on a paleo template plus or minus what works for you. CK is one of my personal clinicians, so in addition to what I’ve read of his, he’s also a personal health advisor.) I don’t know where Sisson or Wolff stand on dairy/lactose specifically at this point, but I’d say that among all of the paleo gurus out there, those 3 are closest to PHD in approach.

          There are ancestral cultures that consumed a lot of dairy and some have high lactose tolerance, but many/most did not. So like most things, it comes down to your own personal tolerance as determined by n=1, genetic testing, etc. And tolerance can also change over the course of one’s life due to various factors.

        • Perfect Health Diet does not advocate milk but says if you want to have some and your body is OK with it, then you can indulge in moderation.

          Iain, I recommend searching on the site for ‘casein’. Paul has talked about it many times before.

      • While Paul is not entirely against dairy, for full fat dairy he prioritizes butter, sour cream and yogurt. See http://perfecthealthdiet.com/2013/02/three-new-podcasts/#comment-131053

  41. Hi I have a question… I got a water diffuser, you can put lemon and other fruit in there and it diffuses flavor to the water. Does that ruin the fast? or is it ok..?

  42. Andrea Montoya

    Dear Paul,
    Please advise or tell me how to best reach you. i am not rich but would gladly pay for in-depth advice. I have ankylosing spondylitis. Ive been gluten free and started the low-starch/no starch diet 16 weeks ago (starving the klebsiella theory). No I have extreme muscle weakness and they thing i have polymyositis. I am slowly reading your book. I feel weak and am being told I need to take tons of prednisone for a minimum of one year. I feel terrible on even 10 mg. I’m not asking you to contradict my doc’s advice. I am just looking confused about eating starches versus the low starch diet approach.
    Thank you kindly for any insight you may have to offer.
    Andrea

  43. Hi everyone,

    I’m completely new to the diet and to cooking in general so I have a quick question. Do you use the weight before or after cooking as your guideline? For example, am I supposed to weigh out a pound of rice, then cook it and eat it all? Or cook up some rice, weigh out a pound and eat it? I only ask because I weighed out a pound of rice before cooking it and was shocked at the volume. Thanks!
    James

    • Hi James, don’t worry, this question arises frequently here:
      For rice it’s cooked.
      The general gist is:
      For most things vegetable and animal it’s raw, although they usually don’t vary a lot in weight between raw and cooked, so the difference shouldn’t be dramatic anyway.
      But if it’s something that expands in cooking, like rice it’s usually cooked.

  44. Hi Paul,
    I follow PHD quite closely, but I do have a question on LCHF/PHD that has been nagging at me for quite some time and would like your insight.
    
Heart disease is the number one killer in America and there are multiple arguments for the reduction of cholesterol, blood pressure, diabetes, etc., that may reduce the risk of a cardiac event. I will ask about the number one killer that bothers me most regarding LCHF and its association: heart disease. There is a perpetual argument that LCHF reduces most if not all markers of heart disease. I believe this to be true. Here is my problem with LCHF, and it conflicts dramatically with the prominent low fat high carb science and its relationship to heart disease and markers thereof. It’s the word “markers” that bother me and an absence of one very important statement. The LCHF community never mentions if their method of eating stops the progression of heart disease or reversal. Since LCHF/PHD may reduce total cholesterol dramatically, increase HDL and bring total cholesterol levels into the 180-200 range, or so – which is good according to most medical professionals, but is somewhat the average levels where heart attacks do occur. So what good are the levels if LCHF does not stop the progression? Whereas, the Pritikin Program, Dr. Caldwell Esselstyn, Dean Ornish and a couple other extreme low-fat proponents claim a stoppage and reversal of heart disease if followed diligently. True or not? I would like to see evidence that a committed LCHF or PHD diet will stop the advancement or reversal of heart disease. If not, and the ultra-low fat claims are true, and there is no corroboration of reversal of heart disease on LCHF or PHD, then stating that the markers are brought to normal levels on LCHF have no meaning to me if there is no reversal or progression

    • Yes, and look at Nutrition Facts.org (Dr. Michael Greger) March 22, 2016 email on dietary saturated fat and cholesterol

      • Thank you Donna for your insight on Dr. Greger’s site. I have posed this question on LCHF before on other sites and to this day have never got a response one way or the other.

        • Yes, I would love to see a debate between Greger & Jaminet. They both present compelling butconflicting data. I have contacted both with this suggestion, but so far they have not addressed each other’s data. I’m am wrestling with sky high cholesterol that wasn’t as high before PHD. I may be an outlier though :). I eliminated beef/red meat 4 months ago, and grossly reduced diary fat and egg yolks, and managed to get my cholesterol down from 10 to 8 so far (Canadian #s). I have a family hx of very early death (father, 34)from MI.

          • have you checked the type and size of your cholesterol? see
            http://drhyman.com/blog/2011/01/28/seven-tips-to-fix-your-cholesterol-without-medication/

            here is one part of the article:
            “While measuring cholesterol particle size is a simple blood test that can be done at Labcorp, most doctors do not look at it, even though it is the only meaningful way to evaluate cholesterol numbers. You can have a LDL cholesterol that looks normal, like Jim did at 101, but you may have over 1,000 small LDL particles which are very dangerous.

            On the other hand, you can have the same LDL number of 101, and it may be made up of 400 large particles which cause no real health risk. Your health risk has less to do with your cholesterol numbers than it does the quantity and size of your cholesterol particles.”

          • Yes, Ralph. On the PHD, every parameter worsened in my cholesterol profile – LDL, small particle/oxidized LDL, even TGs which had been very low before. And even my (good) HDL lowered a little.

          • hi donna – it is interesting and upsetting that your cholesterol numbers got worse. If you want to post what you are eating I am sure you would get some feedback from others on this site. Also can you translate the canadian numbers into american for us? I only started PHD 6 months ago so I will be interested to see what my numbers are when I get a blood test soon. I have noticed more energy though since I started eating more fat (I was semi vegetarian for 30 years though I did eat fish and some eggs and cheese) I just started eating meat less than a year ago and gave up pasta and bread which had been my staples for years. As you say, everyone is different and has to find what works for them individually. I am trying to make a list of what I normally eat each day to post here for feedback. Even if Paul doesn’t respond to you it is nice to have all the other members inputs. Other than the numbers how do you feel on the different diets?

          • Conversion factor is 38.7 (so Canadian TC of 10 is 387). I have run the diet by Paul and followed all his PHD suggestions to no avail. He was very good about getting back to me at the time. I feel well eating on the PHD diet with IF (8 hour window). I also feel well since I eliminated the saturated fat/dairy fat, egg yolks, meat, liver, coconut oil, and eating low fat as well. I particularly like the IF. I keep to about 60-70 grams of protein, 2 cups of starch, a little fruit (mostly berries), a little fat from a few nuts, avocado or macadamia nut oil, & avocado, & lots of vegetables, salads and bone broth. No gluten. Minimal grains except rice. I eat legumes soaked 12 hours and pressure cooked as research seems to show they lower TC. I take a little red rice yeast to tolerance (mold allergy; mold & yeast give me joint and GI pain). The eliminations, red rice yeast, legumes have got it back down to about 8 instead of 10, so far. I don’t drink (GI can’t tolerate any alcohol). I take a little mineral supplement weekly.

        • You might want to check out Denise Minger (used to be raw food vegan). She has an idea that *either* very low fat (65%) could be healthier than the vast in between:

          http://rawfoodsos.com/2015/10/06/in-defense-of-low-fat-a-call-for-some-evolution-of-thought-part-1/

          or a 34-minute video from Ancestral Health Society presentation 2014,
          https://www.youtube.com/watch?v=KFfK27B_qZY

  45. Hi. I am trying to manage my ankylosing spondylitis (AS)with this diet; bought the book and just starting. I have been eating the low starch/no starch diet for 18 weeks (starving the gut Klebsiella theory). I have recently developed extensive muscle weakness. They are evaluating me for polymyositis but so far the blood tests haven’t found that, yet (hooray)! Is eating PHD, with the starches and recommended, ok for AS? Please advise. I am very concerned about these very really darn diseases that are plaguing me. Side notes: have been gluten free for years. Never drink alcohol, no refined sugar or food and lots of veggies have been my standard diet for a long time. Long history of eating brown rice, tons of seeds (especially on the low starch diet). Thank you kindly. All comments welcome. Sincerely, Andrea.

  46. yes, I would love to see Paul”s response to some of dr. greger’s extensive site which gives the comprehensive exact opposite to paleo advice with tons of references. an example is below

    http://nutritionfacts.org/2014/09/23/will-the-real-paleo-diet-please-stand-up/

    today’s paleo eaters tend to include more meat than did early humans, ignoring the impressive evidence linking meat consumption to risk of chronic disease. Grains and legumes are dispensed with, even though these foods have a long and impressive track record as valuable sources of calories and protein for the world’s population. The value of legumes and grains in the human diet is validated by people of the Blue Zones – the longest lived, healthiest populations in the world – all of whom consume legumes and grains as part of their traditional fare. Modern paleo advocates claim that these foods weren’t part of Paleolithic-era diets, but new research challenges that assumption.5

    • I have cut my fat intake substantially over the past couple months and have lost weight and generally feel quite well following a somewhat vegan diet. I have been LCHF or PHD for many years but have since morphed over to the 10% low fat diet for a couple reasons (weight being the biggest). I had hoped that Paul would have responded to Donna’s question as to why her sky high cholesterol levels didn’t move downward on PHD and to my question on the stoppage or reversal of heart disease on an ultra-low fat diet (10% fat) as claimed by the Pritikin Program, McDougall Program and in Dr. Michael Greger’s book “How Not to Die.” Also, the question of whether a higher consumption of protein on the Paleo diet is at odds with the supposed lower consumption during actual paleo times.
      A debate would be essential between Dr. Greger or Dr. Caldwell Esselstyn and Paul as that may squash these lingering questions on LCHF diet efficacy. Any results has to follow the science of whether LCHF/PHD or the 10% low fat claims work to prevent heart disease, and must be measured as such as that is all we followers of various diets can understand. We want to know what the science says; not the markers.
      Four questions for Paul: 1) Can a LCHF/PHD diet either stop or reverse heart disease 2) Are the ultra low-fat diets such as those claimed by Dr. Esselstyn in his book “Prevent and Reverse Heart disease” true 3) Why does sky high cholesterol stay high on PHD or LCHF? 4) Would you initiate a debate with any of the ultra low-fat proponents on the reversal of heart disease on either diet to set this to rest.

      • I agree it would be great to see a debate – this seems to me to be the largest area of nutrition controversy there is now. How can all these scientists be reading the same studies and not just disagreeing a little but be 100% polar opposites? WTF is going on?? Paul is not the only one, there are many others saying high amounts of the right kind of fats is good. Google Dr. Mark Hyman (director of functional medicine at the Cleveland Clinic), Dr Ludwig, Dr. Perlmutter, and many others all agreeing with Paul. And then as you say many others still saying low fat. Come on guys – talk to each other and figure it out!

        • They don’t seem to be reporting the same studies. At this point, I am finding Greger’s data to be quite extensive and compelling, and it seems to be the data that the others should be refuting. Greger does do some of that; e.g., the egg study (evidently funded by the egg industry; the explanation for the data that half of all people having cardiovascular events don not have “high cholesterol”, etc. There is also the distinct possibility that there are individual differences, or different subtypes in terms of what is good, or what can be tolerated without harmful effects, in terms of diet.

      • Agree, Byron. A debate is needed. My cholesterol didn’t just not got down on PHD, it went signifcantly higher. Dr. Greger’s data also addresses endothelial/arterial health and dietary saturated fat and cholesterol (harmful)which affects cardiovascular health – his data is extensive.

        • do you know if greger’s data is recent studies? I thought a lot of the older studies on saturated fat have been discredited and some newer ones show no harm or even benefit and that it is not the fats but the carbs that cause higher amounts of the bad type of blood cholesterol. But again, if the experts can’t figure this out then what hope is there for the rest of us?

          • His data spans the years and is usually done like a decision tree – very analytical. Go to his site and do a search on saturated fat – if you watch even 2 or 3 of is little 2-4 minute videos, you will have a good sense. E.g., his video today was on plant based diets and artery function. March 11, 2016 was on Alzheimer’s and saturated fat. You can also search cholesterol, eggs, etc. If you subscribe to his daily e-newsletter (free) you will see the title each week day, and decide if you are interested enough in the topic to spend 3 minutes on it.

          • google NutritionFacts.org Oct 3, 2014 on eggs. Would like to hear comments on that research from anyone….including Paul?? thanks, Donna

      • Of course everyone is different and it is possible that some people don’t do well with high fat (and others don’t do well with low fat) because of individual differences. There are so many variables – what kind of fats, what kind of carbs, what exercise you do, what kind of microbiome you have etc.

  47. I am doing the diet for the last week. Not really fully doing it, but have eliminated the grains, veg oils, and sugars. I have Multiple Sclerosis. I can tell this is making me feel better already. Thank you so much.

    I have a question. Should I stay on the ketogenic diet indefinitely? I was wondering if there will be a time to do the regular diet. I read about the concerns, but did not notice anything about duration. Thank you.

  48. I did intermittent fasting while following the PHD diet last year (12-8 eating window, I’m a 32yo woman). After a couple days of IF I would start to get diarrhea very late morning, either before or after eating my first meal of the day. This is the run to the bathroom kind of diarrhea, or else you leak into your pants. It started happening more once I began keeping my caloric intake lower for weight loss. If I ate more food in the window, I was less likely to get diarrhea.
    I have seen many complaints on this same issue online, some of them from alternate day fasting people, but some just daily IF people. I have also done ADF in the past and the same thing occurred after eating the first meal on feed day. There is only ever conjecture online and I have never seen a good explanation for it. Some people call it starvation diarrhea, but esp on the PHD I was not starving or hungry at all.
    I would love a real explanation for this and how to prevent it. Surely there must have been some one at a perfect health retreat that experienced diarrhea due the intermittent fasting? I don’t have a gallbladder, but it seems that many have this issue that do have their gallbladder.
    If I spread my calories throughout the day, then I am fine. If I only do IF a couple times a week, I am fine, but it is difficult to do it on an irregular schedule. I have considered increasing the feeding window, but then I am going to have 3 meals a day instead of 2 which defeats the purpose for me. Thanks

    • seems more likely to me that it has something to do with what you are eating rather than the if schedule. Maybe you would want to post what you eat and see if anyone has any suggestions. I know my digestion is very affected by eating certain foods especially certain fruits. It is hard to figure out for sure though. You might also try acacia (heather’s tummy care) which is supposed to help digestion problems.

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