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. It says that legumes are rich in toxins, particularly if they are not soaked and cooked for long periods (which still does not remove all toxins). They believe there is little reward and much risk to eating beans and peanuts. And that there are much safer starches (like potatoes and white rice). Green beans and peas are ok though.

  2. Here is a nice clip of a 98 year old lipid researcher who came to the conclusion years ago that cholesterol is generally nontoxic (except when oxidized). He was on to the damage caused by trans fats years ago:

    https://www.youtube.com/watch?v=l0g7zpOg8M0&feature=c4-overview&list=UUh3w59evaUoKZ44JMrxKU2w

  3. Good Day Paul-
    Is it unusual to have a high(PHD defined) TSH and normal T3 & T4? I am trying to address my high LDL. My selenium intake is good, but am very low with iodine intake. That changes tomorrow with a daily intake of iodine 200mcg.

    The Numbers:

    TC. 260
    HDL 46
    TRG 109
    LDL. 192
    ApoB100. 138. mg/dL
    FT3. 3.0. pg/mL
    FT4. 1.2. Ng/dL
    TSH. 1.73. uIU/mL

    I am VERY PHD compliant, but the daily recommended iodine slipped by me. Also a bit curious if this explains my slowing weight loss……15 to go.

    Thanks!

    • Hi TR,

      Yes, hypothyroidism can raise LDL and hinder weight loss, but it’s not obvious from the numbers that you’re hypothyroid. Iodine should help, but unless you have hypothyroid symptoms, I’d guess the more likely issue is in the gut.

      Be sure to eat liver for vitamin A optimize vitamin D for immunity, and eat collagen sources and supplement vitamin C for gut barrier integrity. Try vitamin C powder in water and test for bowel tolerance.

      Best, Paul

      • Excellent. Thanks Paul. I’m not really experiencing the hypo symptoms, but the TSH had me concerned. Complying with all your daily & weekly recommended supps. Lots of Vit D in the Colorado sunshine. Eating beef liver, but not once a week. Will fix that. Bone broth 1-2 times a week. Will increase that as well. 1-2g Vit C per day. Will do the tolerance test. Very grateful for your insights!

  4. I’m in the same situation. Too high TSH, normal free T3/T4, high LDL, even oxidized LDL(but high HDL and low TG which is good). I too boosted my iodine and the TSH came down a little in 3 months. I’m wondering if it has to do with something I read (Dr. Brownstein) that even if you don’t have a problem converting T4 to T3 (which was my problem so I take a compounded T4 T3 medication which normalized T3), evidently one can have a problem with getting the T3 into the cells. If that is the case (and I’m not sure how to fix that), then TSH would still be high I’m guessing??

    • Hi Donna,
      Chris Kresser wrote a post called ‘5 Thyroid Patterns That Won’t Show Up On Standard Lab Tests’
      here’s the link http://chriskresser.com/5-thyroid-patterns-that-wont-show-up-on-standard-lab-tests

      Take a look at patterns 4 & 5,
      & see if one (or both?) of those may be applicable to you.

      …let us know what you think

      For ref, copy of text below for patterns 4 & 5 (but go to source to get extra links);

      4. Hypothyroidism caused by decreased TBG:
      This is the mirror image of the pattern above. When TBG levels are low, levels of free thyroid hormone will be high. You might think this would cause hyperthyroid symptoms. But too much free thyroid hormone in the bloodstream causes the cells to develop resistance to it. So, even though there’s more than enough thyroid hormone, the cells can’t use it and you’ll have hypothyroid – not hyperthyroid – symptoms.

      With this pattern, TSH and T4 will be normal. If tested, T3 will be high, and T3 uptake and TBG will be low.

      Decreased TBG is caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. Reversing insulin resistance and restoring blood sugar balance is the key to treating this pattern.

      5. Thyroid resistance:
      In this pattern, both the thyroid and pituitary glands are functioning normally, but the hormones aren’t getting into the cells where they’re needed. This causes hypothyroid symptoms.

      Note that all lab test markers will be normal in this pattern, because we don’t have a way to test the function of cellular receptors directly.

      Thyroid resistance is usually caused by chronic stress and high cortisol levels. It can also be caused by high homocysteine and genetic factors.

      • Thanks Darrin…..much appreciated.

      • Thanks Darrin. Informative and helpful. Given that my thyroid antibodies are normal, it must be Thyroid resistance. I do have very high serum cortisol levels; even though I’m not feeling stressed (the least stress I’ve ever had in my life now and for at least a year). But the last time they did saliva cortisol, it was rock bottom, even when serum was so high. I’m about to have cortisol and thyroid hormones measured with a 24 hr urine test, which evidently is the perferred way to measure now. We’ll see if that shed any light. I’m guessing, though, that if it is pattern 5, increasing meds may not be recommended or helpful? I know they have concerns about having me on too much thyroid meds due to very low bone density and other possible negative effects.

      • And forgot to mention, I do have issues with very high cholesterol, LDL and oxidized LDL – all of which worsened significantly on the PHD diet (on it over a year now). I’m on the liver, selenium, fewer egg yolks, low fat/weight loss, IF version now. We’ll see if that helps. I’m still resisting the statins…I have been slowly recovering from CFS / high viral load (on high dose antiviral)and fibro, because I have been told statins usually aggravate fibro and may cause other problems. Had an 8 yr old root canaled tooth removed a few months ago (turns out it was still abcessed)- seems to now be helping a lot with my energy & exercise tolerance, and general calming of my nervous system.

      • I am just wondering, why only white rice. Is brown rice not good?

  5. Hi. Just started PHD after 4 months of Paleo. Was diagnosed with ankylosing spondilitis in March. I am 29, cooking for husband, 3 yr old and Nanny. I was wondering if there were any specific instructions or insights on my specific diagnosis. finding this difficult… yet inspiring …

  6. Hi Paul,

    Just started the PHD diet to address issues with my Alopecia Areata. What do you think is key within our diet to stop patchy hair loss. (not male pattern baldness)

    Best

    T

  7. 😳 I have both versions of your book. Recently I have been doing an elimination diet of bone broth, meat/seafood, and cooked spinach, carrots and zucchini. With the help of Prescript Assist probiotics I became regular for the first time in my life! I started reintroducing food this week and in alignment with PHD, I wanted to add carbs! So I did sweet potatoes for the past two days. And I have been constipated for the past two days. From Princeton Online I learned that starchy foods can be constipation. …. Do you have any recommendations for other carb-y food? Thank you

  8. Thank you. Any general guesstimate on how long it might take? And at what point I should try reintroducing starch? (I miss good carbs)!

  9. And I am eating 4 ounces of liver a day. So I assume I should still take 30 mg zinc and 3 mg copper until my gut heals and then go to your regular supplament suggestions of 50 mg zinc a week and no copper since I eat liver….

  10. Liver should be 4 ounces a week! Yikes, not a day!

  11. I have just read your book and have found it to be the most inspiring nutrition book I’ve read in years. I look forward to experimenting with the diet for myself and my patients. One suggestion I have for people who have difficulty digesting the starches is to start with a white rice congee. Put 7-8 cups of water in the slow cooker with 1 cup of rice and let it cook overnight. In the morning you have a delicious, very easy to digest porridge. This is a traditional remedy for poor digestion in China and medicinal congees (with added herbs) are frequently used in Chinese medicine.

  12. Hi Paul,
    Finished your book, nice work, and now implementing it. Had good experience with a Paleo diet years ago but feel even better about you research and approach. Question. I am 47 year olds, active and in good health except for morbid obesity (375Lbs currently) but all other issues are clear so far (blood good, mobility good, etc). I would normally burn close to 4K cals a day even without exercise. I swim or walk for 1 hour a day 4-5 days a week. Trying to figure out total intake. Keep carbs at 600 cals, protein at 500 cals and the rest in fats? Correct? If so, how much? I would normally go to about 2,000 to 2,200 cals and lose about 2-3 lbs a week. Does that sound right? I am focused on the overall health benefits but want to get the mixture right given my higher than normal calorie burn given my size. Any suggestions?

  13. A quick question I have is what are the nutritional benefits of eating brains – are we speaking about cow brains? My site identifies some additional dieting tips: http:dieting.ciajusa.com

  14. I find your approach very, very interesting and quite well researched. My question has to do with increasing the use of coconut oil or MCT oil and the gastro distress that seems to cause? Why is that? Is one often less likely to cause distress? I would like to supplement these MCTs to help with neurological challenges, “brain fog”, but seem to get more bowel stress when adding these oils. Is there an easier way to get these MCTs while minimizing gut stress? Thank you, and very good work! Please keep it up.

  15. Hello Paul. I’m reading your book and on the section for losing weight, you suggest about 500 cals. for both fat and carbs and about 300 for protein. This breaks down to roughly 40% carbs/fat and 20% protein. This doesn’t really follow the logic of the book itself and I was wondering why you wouldn’t advise the same ratios for fat/carbs as for non-dieters? As long as the calorie count is the same, does it matter if fat is as high as 60%? LOVE THE BOOK!! I always knew it was about digestion but I’ve NEVER seen it as informative as in your book. –Thanks.

    • hi Rayca,

      the ‘rest’ of the fat % is coming from your bodies fat stores. that’s how the weight loss is working, instead of the fat % all coming from what goes in your mouth, its coming from your body.
      As you approach or reach your maintenance weight you move towards the non-weight loss PHD nutrient ratios (mainly by increasing your fat intake).

      you still need to eat enough calories, carbs, proteins & good fats (just less fats), so you do not feel overly hungry (& stress your system). being hungry is likely a sign you are missing or short of something.

  16. This is what Paul suggested for me. “I recommend about 500 calories a day from fats, chosen for high nutrient density. Carb+protein calories around 800 calories/day is good.”

  17. Eggs are being blamed for prostate cancer, according to a guy in my raw milk/eggs co-op who said he read it in recent news. Have you heard this?

    • What I mean is, my friend said he read news that research has been published showing the diets of men with prostate cancer tend to include high egg consumption.

  18. It is my understanding that it’s not clear what causes prostate cancer. Some cells in your prostate become abnormal.It’s a slow progressing disease. I’ve heard that 80% of all men in their eighties had prostate cancer when they died, yet no one knew.

    Age, race, nationality, family history, genes, obesity, smoking, infection and inflammation of the prostate are all risk factors of prostrate cancer. You mentioned diet; I’ve heard that men who take in a lot of dairy foods and calcium might have a higher risk of advanced prostate cancer. But, most studies have not found this link. In any case, if someone suspect that they might have prostate cancer they should check with their primary care physician.

  19. I have found non-gluten oats recently and have a wonderful seed nut bread made with oats. Wondering if these would be okay according to your recommendation?

  20. Hi Paul,

    I have a question on autophagy and exercise. I read in your book that intermittent fasting turns on autophagy when your glycogen stores start getting low. I enjoy competing in triathlons and work out 1-2 hours a day, typically first thing in the morning and before having breakfast. I am wondering if this is sufficient to get the benefit of intermittent fasting, since my exercise should be using up glycogen stores. Thanks.

  21. Hello,

    I just had a question regarding a recent study regarding full fat dairy and the cancer recurrence and mortality of breast cancer survivors. Some seem to point to the estrogen in dairy fat as a potential culprit for the poorer outcomes (although the data was self reported which may not be as reliable).

    http://www.ncbi.nlm.nih.gov/pubmed/23492346

    Breast cancer runs in my family – my mom is a survivor (not estrogen receptor positive), so I want to do what I can to reduce my risk. Do the protective qualities of dairy fat outweigh the risks? It is all quite confusing!

    Thanks,
    Penny

    • Hi Penny,

      It is confusing. Depending on how dairy cows are managed, there may be up to a 10-fold increase in hormone levels (see eg http://www.news.harvard.edu/gazette/2006/12.07/11-dairy.html). If cows are not milked or bred as aggressively, the milk will have lower hormone levels. However, even with the aggressive western dairying practices, milk still only accounts for about 2/3 of dietary estrogen intake, and dietary intake is generally much smaller than a woman’s natural production. So I don’t believe the risk is that high. However, if you already have breast cancer, it may be good to give up dairy, or to get dairy from a farm that uses natural husbandry practices.

      • Dear Paul,

        Thanks so much for your response. Thankfully I am healthy, but it is certainly something to think about. I will certainly share this info with the mom, although thankfully she is several years in remission 🙂 For me, I think moderation will be the best choice.

        Kind regards,
        Penny

  22. Hi, First time visitor and I haven’t read your book yet. I’m intrigued because some folks have found relief from migraines with your approach. However, your dietary recommendations terrify me and here’s why: many of the foods on your list give me migraine. Eggs, coconut, fish, beets, dairy, to name a few. Some of your recos do ring true for me, the avoidance of grains and sugar, for example.

    Are the listed foods absolutes or can I tippy-toe thru the diet until I am migraine-free and can eat all reco’d foods?

    I’ve heard of KD before (’70s Atkins), but never as a possible solution for migraine. Looking forward to giving it a try.

    Thanks.
    M

    • Hi M,

      Our diet is general advice for everyone. Then with specific health conditions you may need to tweak the diet a bit.

      Typically, food sensitivities tend to disappear after a time on our diet, as the gut barrier and digestive tract heal. This may require a period of months. You may find that many of those foods may cease to give you migraines after a time.

      But yes, it’s fine to restrict foods that give you problems. You should look for substitutes for the nutrients you may lose, eg liver or choline supplements for the eggs.

      Best, Paul

  23. Hi, Paul,
    Thanks for the reply. I’ve been to the diet rodeo a few times so I’m not expecting instant results, but any improvement would be welcome. After a bad experience with vegetarian/vegan diets, I’ve gained greater appreciation of nutrient balance which is what prompted my question.

    Thanks again.
    M

  24. Hello! I have a weird question for you if you don’t mind. Can saturated and monounsaturated fat turn into polyunsaturated fat during high heat cooking?

  25. This diet has led me to some great health, and seems to deliver what it promises: a diet which leads to a long, good life. But I have a big question: legumes. Soaking them overnight is not unreasonable for me even as busy as I am, and reading of the Ikarians and other blue-zoners, they eat a ton of beans. Also, many of the longest-lived people (Ikarians and the Hunza) eat whole-wheat bread and patties with everything.

    I would very much like clarity on the issue of beans and legumes, as well as on the findings relating longevity to these foods. As a Crossfit coach and a careful dieter, I have wanted to ask this question a long time!

  26. Hi, the one size fits all approach to diet doesn’t seem to square with the fact that some people thrive on a high carb/low fat diet and others on paleo. Isn’t this best explained by differences in digestion, hormones etc due to blood type or something else? Can I ask for your view of the work of Dr D’adamo (blood type/genotype diets)?

    Thanks 🙂

    • Hi cmp,

      I think all healthy people will do very well on PHD and can tolerate a wide range of diets, though their health will get slightly worse as the diet deviates farther from optimum.

      I think that intolerance of diets usually reflects health conditions, ie diabetes makes one intolerant of high-carb diets, and infections can make one intolerant of either high- or low-carb diets depending on the pathogen and site of infection. So dietary intolerance is diagnostic for disease.

      I don’t believe that the optimal diet depends on blood type. It does depend on digestive tract differences but these variations are fairly small in humans. Similarly genetic variations in optimal diet tend to be small unless the genotype lead to major health impairment (as in neurological impairments which require a ketogenic diet), since most metabolic functions have been evolutionarily constrained for a very long time (> 500 mn years).

  27. been on a ketogenic diet for about 5 months, lost about 18 lbs.( 179lbs now) would like to lose about 10 lbs. more, i’m 64 yo male 5’7″…I also started using coconut oil about 3 tablespoons a day plus oil pulling every morning, what is it that you don’t like about keto diets…its almost the same! right

    • Hi Frank,

      I like ketogenic diets, we have a chapter on them in our book, they are essential therapies for some health conditions. But I don’t think they’re optimal for weight loss. It’s a challenge to get adequate nutrition on ketogenic diets and calorie restriction plus ketosis isn’t a great mix for long-term health. They do work for weight loss in the short term but I think it’s very important to follow a sustainable long-term approach.

  28. Hi Paul,
    I’ve adopted a paleo scd diet since two years ago after developing a chronic gastritis, before i could eat whatever i wanted, but know i don’t tolerate coconut products, which cause horrible heartburn, nor dairy, even ghee which gives me reflux.
    What do you think may be the cause?
    Thank you

    • SIBO. Check out avoiding high FODMAP foods to tweak diet.

      • Yes I’ve read about sibo, the proposed diet in the website siboinfo.com is scd. And I’ve tried oregano oil, but it seems nothing work, i intermittent fast for Monday to Friday, i am so skinny and unable to gain weight and with reflux and heartburn.
        This is a really though illness.
        Thank you

  29. Hello Paul,

    Can mushrooms being considered as safe foods and a part of a daily diet with candida or yeast issue ?
    The same question for vinegar, red wine ..?

    Thanks a lot,

    Best,

    Maya

    • Thanks Donna for your answer. I don’t know what Paul would say about this question. Maybe it has been answered somewhere on this blog, if so, some help is welcome. I feel it’s important for some of us to know whether candida issues require mushroom, vinegar, wine and other yeast fermented products. Thanks everyone ! Best, Maya

  30. As an aside to whatever Paul answers…make sure you do not have a mold allergy. If you do, my allergist told me many foods need to be avoided until/unless it resolves – wine, beer, vinegar, soy sauce (except Braggs unfermented), many cheeses, cantelope, raw grapes, raw strawberries,mushrooms – an usually corn (not on PHD anyway) or anything derived from corn.

  31. Does anyone know if it is safe to consume Palm Olein oil? it seems as if Palm oil gets separated into liquid and solid, the liquid part being Olein, which is then used for frying chips, etc., as it is heat stable. I only ask because I found some organic root veggie chips in the supermarket and they are cooked in this stuff. Thanks 🙂

  32. Can you give me some guidelines to using PHD for children. My son is 9 and has been on the GAPS diet. He’s still very skinny. I think for his age he needs 2000 calories a day?? What would be an example of a typical day on PHD for a child his age. I’m a little confused about the amount of protein for his age. Carbs I assume would be 40%(800 cal)? Please help.

    • Hi Angelique,

      He can eat quite similar to an adult diet on PHD. Children need slightly more carbs and slightly less protein on a relative basis, so he will seem like he has more of a liking for carbs or sweets than an adult, but at age 9 it’s not a huge difference. If you make adult PHD foods that will be good for him. Children generally don’t need to supplement, though vitamin D in the winter is probably a good idea. Yes, 40% carbs is a good target.

  33. Having always been thin (1.72 m, BMI 22, 60 y) I’m more interested in maximum health than weight loss. Thin people might benefit from specific guidance on this.

    The omega-6 content of almond butter looks similar to peanut butter. On this basis, aren’t they more equal in their merits? The costs are very different, of course.

    There’s also some evidence from animal studies that low-methionine diets are good for longevity. Legumes are the only major food group supplying protein but low in methionine. Do you think this could turn out to be as significant as the evidence base against a high carb. intake and against too many O-6 PUFAs?

    • Hi David,

      The concern is the atherogenicity of peanut oil. There’s a cite in the book about this, peanut oil but not tree nut oil causes atherosclerosis in monkeys.

      Low methionine does support longevity, but I would rather supplement glycine and BCAAs than eat legume protein.

      • re: Methionine & longevity…

        Hi Paul,

        Do you recognise (for want of a better word) that there is a condition (chemical imbalance?) called undermethylation (sometimes aka histadelia).
        Tests apparently show low levels of serotonin, dopamine, and norepinephrine and high whole blood histamine in undermethylators.

        So, to my query,
        One of the supplements recommended to undermethylators is methionine,
        Any ideas if methionine in this situation (for undermethylators) would be bad for longevity?

  34. Hello Paul?
    I have your book and I have searched the website for your take on seeds, like pumpkins seeds.
    Can you help?
    Cheers,
    Stephen.

    • Hi Stephen,

      Seeds range from relatively benign pleasure foods (akin to tree nuts) to forbidden foods, eg the seeds of grains and legumes. Pumpkin seeds I would say are OK in moderation.

  35. Dear Paul,

    After reading so much I can officialy say I am going crazy on one issue: fruit.

    1. I am using fruit as a post work out glycogen repletion. I have been reading that it is not as efficient as your “safe starches” are for this task. Is this correct?

    2. I have been told now that I should use fruit as immediate pre work out because insulin release is blunted when strength training.

    3. Also that the only fruits that I should consume outside the pre workout period are berries because of the low GI, is this correct?

    • Hi Alan,

      No need to go crazy. Fruit favors glycogen in the liver, starch favors glycogen in the muscle, it is good to have some of each.

      I don’t understand #2. It’s good to eat some protein and starch pre-workout because amino acids and insulin both promote workout gains.

      Berries are the best but other fruits are OK. All fruits have low GI.

      • Paul, thanks for the reply.

        So where should the glycogen be to maximize muscle growth and maximize fat burn before and after workout, liver or muscle?
        Before and after WO should be both fruits and starches? Or is one preferred for pre and another for post?

    • I calculated the % omega 6 fats for pumpkin seeds and tahini from nutrtiondata. They are as follows:
      1. pumpkin seeds; 45%
      2. Tahini: 43%

      I remember Paul saying to avoid anything with omega 6 >30%

      My thoughts were that these would be two seeds that you would avoid?

  36. Paul,
    Ive been following a paleo/Atkins low-carb diet for about 8 months now, with hopes of better managing cholesterol levels that have always been high despite 30+ yrs of eating low fat, whole grain diet. I exercise regularly 4-5x per wk running, spin, weight lifting, tennis, etc. the diet has helped me lose 5 pounds and 1-2 inches on waist (Never overweight – have athletic, muscular build). Primary foods in my diet are olive oil, coconut oil, avocados, almonds, grassfed beef, organic chicken, eggs, full fat greek yogurt, organic berries, almond/coconut milk, kale, spinach, broccoli, sweet potato. I supplement with 6g fish oil daily. Despite this, i have seen My LDL and total cholesterol levels go way up. Had recent VAP – total 312, LDL 232, vldl3 12. HDL and Tg are good at 61/74. Reading through numerous blogs (Kessler, masterjohns, here), I suspect it may be due to micronutrient deficiency or too few carbs. I’ve also read that you have helped identify this in others and correct through diet/supplementation. Any suggestions? ALT has also slightly increased.

    • i seem to recall Paul saying (in a comment i think) that fish oil could raise liver enzymes (ast & alt?). Tho i cannot find that comment now, it was a very long time a go.

      Do you know if your LDL was actually measured by the Lab, most often they just calculate LDL (costs more to actually measure it).

      If interested, here is an online calculator you can use, from this you will be able to tell if your ldl was measured or calculate.
      http://homepages.slingshot.co.nz/~geoff36/LDL_mg.htm

  37. Hi Paul,

    I was wondering what your take is on remineralizing one’s teeth. I’ve read the book Cure Tooth Decay by Ramiel Nagel and he generally goes along with your recommendations, with the exception that he highly suggests one drink a couple glasses of raw milk per day. Would increased amounts of bone broth not be sufficient instead? What are your thoughts on this, and on remineralizing teeth in general?

    Take care,
    Dawn

    • Hello Dawn,
      Weston A. Price has addressed these issues a long time ago: vit A, D and K2 are THE vitamins for optimal mineral absorption. And you can help further by using a sweetener called xylitol. I eat some K2 rich foods (butter, egg yolks, etc) and supplement with D. For A, I have always been a fan of liver and meat so no prob here. I also like xylitol a lot for many good properties, and one of it is its prebiotic effect in the colon. But for the teeth, it is really the mirror image of sucrose!

  38. very similar diet to Dr. Seignalet´s. Should read his book.
    He cured hundreds of patients with autoinmune diseases.
    http://seignaletdiet.wordpress.com/diet-basis/

  39. Hey,
    Could you comment on the research being put forward by Dr. Perlmutter in the Grain Brain? He discusses the deleterious effects of carbohydrates and fructose on the brain and the creation of Advanced Glycation End products.

  40. Hi, Paul,
    Wanted to post an update on my initial experience following a low carb diet. I chose to try this diet because of migraine and reports that migraines were diminished by restricting carbs. Over the past 15 years I’ve had a minimum of 12 migraine days per month, with both food and hormonal triggers. Today is Day 16 on the diet and I feel fantastic. I’m 55 and mentally, energetically, and psychologically I feel 35. Happy. Had only one (1!) migraine day on Day 4. I’ve read elsewhere on your site, Paul, about a “low carb flu.” I believe I experienced something similar from Day 6 to 13. I had aching pains in my arms, legs, and back. Felt yucky all over. I almost threw in the towel thinking the low carb approach was not for me. Day 14 was the big turning point. I felt, for the first time in several years, energetic, mentally focused. I was excited about cleaning out my studio, which had become the Orphan Shipping Box Storage Facility. “Excited” and “cleaning” are two words I have never, ever used together. I now believe my lifelong lethargy and apathy may have been a symptom of excessive carb intake. I was drugging myself and just didn’t know it. I’m also more assertive and less eager-to-please in all my relationships. Cleaning out, indeed. The only negative has been a return of my acid reflux symptoms. I manage that with magnesium glycinate, increased water consumption, DGL, and zinc lozenges. I may add supplemental hydrochloric acid, which I’ve used in the past. It has only been two weeks so I remain cautiously optimistic going forward, but at least my studio is *clean*.

    • Hi M,

      That’s great!

      Be sure to read our headache/migraine category and some of the accounts about ketogenic dieting curing migraines. Intermittent fasting and eating coconut milk/oil may be as important as carb restriction.

      I’ll be doing an acid reflux post soon but be sure to get choline, vitamin A, vitamin D.

      I’m glad you are better, keep me posted!

      Best, Paul

    • Hi! could you please share your experience with me? I’ve done a thousand things for my migraine go away, by chance I found this website because in an attempt to lose weight you did aketogenic diet 5 days a week, weekends after ate other things … but I noticed that while in ketosis not had a headache. Mariet.rojas.hurtado@gmail.com

  41. Hi Paul,

    I seem to have problems digesting meat protein, I think I have low stomach acid though I haven’t been tested. Is it ok to reduce my protein level below 10% of calories if it feels comfortable? Another option would be to take digestive enzymes for a while – what is you view of those? Btw are we talking about combined protein from all food sources because of course grains and tubers contain protein too.

    Thanks!

    • Hi cmp,

      I think reducing protein below 10% of calories is a bad idea. Digestive enzymes and possibly betaine hydrochloride before meals would help. Also thorough chewing, and simmering meat until tender in acidic broths — check out some traditional south/southeast Asian recipes — or at least marinading it for extra tenderness.

  42. so what about milk and cheese?

  43. Hi Paul,

    Apologies for another question but this one is really puzzling to me. When I have omega 3 in any form (salmon, cod, basa, flax, eggs from flax fed hens, fish oil) it has a very strong effect on me which feels for all the world like excess intake- spaced-out, irritability, a kind of mental apathy, increased pulse- all from very moderate doses. I have the same reaction to vitamin supplements to the degree that I can only take one b-complex per week and even that gives me strong mental and physical effects such as making my skin look unbelievably young! I’m 38 but no exaggeration I’ve been asked if i’m over 21 and I gets lots of comments about this and stares (it looks weird). If I don’t take vitamins for a few months this goes away. I haven’t found anyone who can shed any light on this? Do you have any idea what could be happening?

    Many thanks!

    • Hi, I am not Paul but I have similar problems. Omega 3 makes me feel weird. Some health writers such as Ray Peat believe that Omega 3 is just as bad as Omega 6 and should be avoided…it can easily oxidize, or something like that. You might want to google it.
      Do you have any problems with other protein sources?
      I’ve also had comments about looking young for my age, particularly when I’ve been fasting. It feels good 🙂

      • Hi PC, thanks for replying 🙂
        Do you mean fat sources? No problem with saturated fat but slight issues with olive oil. I’ve eaten a huge amount of wheat every day for most of my life so maybe I have leaky gut…I’m starting the PHD this weekend though which I’m excited about!

  44. I have been primal for three years but still had gas/bloating issues. So I decided to do an elimination diet for five weeks and then after I started The PHD by slowly adding foods in. In the past six weeks since doing the PHD I have gained eight pounds….I am obviously not thrilled with that. I am doing the recommended supplements, which I love (everyone in my family got a cold but me!). I am also taking the ones for constipation but after a month of them things are only getting worse on that front…
    does this mean I am insulin resistant? My blood work is good – fasting is 85 and hba1c is 4.9. All the weight seems to have gone to my stomach. I am not over weight either. Any recommendations? Thank you

    • Hi Diane,

      The gas/bloating signifies a gut dysbiosis / overgrowth of bad bacteria and dearth of good ones. When you add carbs the bad bacteria get to multiply and that causes inflammation and causes adipose cells to add fat.

      Nevertheless, the key is to change the gut flora and when you fix the gut flora the weight loss will come. Low-carb impairs immunity and mucus production and doesn’t feed good bacteria well, so even though it starves the bad bacteria and reduces symptoms it isn’t the best solution.

      I would take extra vitamin A / liver, vitamin D / sun, joint-based soups and stews for collagen, vitamin C, and zinc, all will support immune function especially mucosal immunity. Tend to circadian rhythms. Get fermented probiotic foods. Get a good mix of fiber, resistant starches like potatoes and fruits and vegetables. Do intermittent fasting. Work steadily on the gut flora.

      You can reduce fat a bit to prevent weight gain, as Donna suggests below, but the main path to healing is fixing the gut flora and doing more exercise, circadian rhythm entrainment, and intermittent fasting.

      Best, Paul

      • Thank you for responding. If I tell you the doses I currently take of what you just recommended, can you please tell me how much I should increase those doses…right now I take

        Vitamin A – 4 ounces of beef liver a week. A teaspoonful of fermented cod liver oil a day. 3 egg yolks a day

        Vitamin D – from the fermented cod liver oil and I live in Phoenix. I had my levels tested and last year was 90! Now down to 43

        Bone broth soup every day

        Vitamin c – 1500 mg a day. Right now in the form of palmatic acid.

        Zinc – 30 mg a day

        Right now I also take one Prescript Assist probiotic a day, a cup of homemade saurktaut and 16 ounces of kombucha a day.

        So what can I do? Thank you

        • Hi Diane,

          If the cod liver oil has ~5000 IU per teaspoonful, that is plenty of A. You shouldn’t need any more.

          D — sounds like you are good there, if the units are ng/dl.

          Bone broth — good.

          Vitamin C — I would get plain ascorbate powder and flavor water with it and test how much you need to reach bowel tolerance.

          Zinc — 30 mg/day is too much, most likely, unless you are getting a lot of copper.

          It sounds like you are good with micronutrition, if you are not supplementing iodine I would do that at 225 mcg/day.

          Best, PAUL

          • Thank you again. I am taking copper with zinc as per your protocol for constipation. I also supplament with iodine. I am actually working on increasing it beyond the 225 because I don’t like seaweed or sea vegetables. I will change the vitamin C. How long should all this take. It has been six weeks now…

          • Hi Paul, regarding Vit C and herpes simplex. I remember that taking vit C lozenges always caused cold sores for me. When I take (swallowable) Vit C supplements, I get gut pain. I very likely have HSV 1 of the gut. Do you think Vit C could be irritating to my stomach because of this viral infection? If so, suggestions? IV vitamins are expensive I know. (I also have herpes virus in spinal nerves which causes spinal pain, muscle weakness; and likely some joints e.g. base of thumbs – deQuevain’s like symptoms).

        • Hi Diane,

          My situation is similar to what you describe – did the protocol end up working for you? Just wondering!

          Thanks –

          Debbie

  45. I gained weight at first too. Too many fat calories. Paul advised me 1300 calories, no more than 500 from fat; the rest from safe starch and protein (a bit more from proteing than carb). Then I lost weight.

  46. Paul,
    Can you provide a brief answer to what might seem like an overly simplistic question? Sometimes, especially when I am traveling, I have to make some decisions about things I will have to eat that are not on this plan. I try to make decisions about what is “less bad” than some other thing. So, if I have to eat something off plan, which of the bad things is less bad. Can you provide a simple, general ranking of off-plan foods from the worst to the less-worse? I’m talking about wheat, sugar, corn, oats, beans/legumes, vegetable oil, etc. I know it is all contextual, but if you had to rank them on general terms, what would they be? Thanks!

  47. Hello!

    I’m having trouble figuring out proper portion size and there is a decent chance I am making some poor science/math assumptions so any help is greatly appreciated.

    The PHD recommends 3 lbs of plant food per day, including “about 1 pound [0.45 kg] of sugary in-ground vegetables (such as beets or carrots), fruits, and berries.” Isn’t that a large amount that is way more than the average of 600 calories from carbs that comprises the PHD? I had figured that 1 lb of safe starches alone would get you to that 600 calorie point.

    I have had great results following a Paleo-style diet for about two years now (150lbs lost and med free for 1 1/2 years with a diagnosis of ulcerative colitis) and feel like the PHD is a good lifelong approach. I’ve had tendencies to over eat (hence the former morbid obesity) and want to keep a close eye on correct ratios and proportions of macronutrients since I often lead myself astray.

    Thanks for any advice!

    • Same here about the math. It is a hindrance to me, especially since I’m too busy to think that hard about what I eat at present. I’ve done specific diets before, and the break-in phase was a few weeks; after that, it was a bit second-nature to just eat. But I can’t get to that point with PHD. Read the book. Am now reading little bits of website comments, waiting till magically I get time to train myself to follow the guidelines.

      But concentrating on learning PHD? for someone who is so not mathy? Daunting.

    • Hi Matt W,

      I’m not good with math either, but I do enjoy food journaling. It’s easier to know when you’re making progress and what may be blocking the results you desire. You’ll quickly learn which combination of foods works best for your situation. You don’t mention if you’re weighing/measuring your food or not. Highly recommend a scale showing both ounces and grams. There are several good sites showing nutritional makeup of foods. Just search “nutrition content of food” or similar. For hard to measure foods, i.e. carrots, the site I use shows raw and boiled. For my food journal, I use the listing for raw 100g. That makes the math super easy. If there’s info on a label, then I use that.

  48. Hello Paul

    You say to avoid grains. How about Buckwheat. Its not really a grain and falls closer to the grass familly I believe. Would it be okay to eat a lot of this. I am type 2 and so far I have brought down my levels from 300 fasting to 130-140 but have plateaued there. I think this might have to do with the fact that I was consuming a lot of honey.

    In terms of rice is brown okay or should it be white. Unless i take a walk whenever I eat any carbs like potatoes my readings will remain in the 160’s 2 hours after a meal. If I walk they drop down to 100.

    Any suggestions will be appreciated thanks for the work you put out

  49. Dear dr. Jaminet,

    As I see in your graphics, you avoid legumes, but in our country we use to eat a lot of chikpeas & lentils, as they contain minerals, proteins & fiber. As they as bad to be avoided completely, although we soak them overnight before cooking? Ore once a week are ok?

    thank you! your advice will help me very much to plan our family meals!

    Best regards,
    Blanca

  50. Hi Paul:

    I thought you might be interested in this article, and study recently conducted in Europe, concerning the ‘Stone age, hunter gatherers’ not being interested in agricultural advancements.

    http://www.cbc.ca/news/technology/stone-age-hunter-gatherers-lived-beside-farmers-didn-t-interbreed-1.1991430

    Keep up the good work Paul!
    Thanks,
    Lawrence

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