Curing Arthritis and Depression with Diet and Antibiotics

Most chronic diseases are considered incurable. But if cures are rare, it may only be because doctors and patients rarely try the proper dietary and antibiotic therapies.

Two smart commenters who figured out how to make progress against their own chronic diseases refute the notion that disease progression is inevitable.


First, Michelle cured her arthritis with diet and antibiotics:

I’ve successfully put RA into remission using low dose, pulsing antibiotics, based on the work of the late rheumatologist Dr. Thomas McPherson Brown. I’ve been a low dose of Doxycycline, 100 mg, on MWF, for a little over two years now. My joints are no longer reminding me of my arthritis daily.

For background reading, check out “The New Arthritis Breakthrough” by the late Henry Scammell. “Why Arthritis?” by researcher Harold Clark is good too.

A few months before my arthritis reared its ugly head, I gave up gluten. In the last year, I’ve weaned myself off the myriad GF products such as GF cookies, bread & pasta. We’re buying meat from healthy animals a local farm. I’ve gotten reacquainted with butter, cream, and I avoid PUFAs like the plague.

I’m keeping an eye on my fluctuating thyroid function, and fluctuating progesterone levels (I’m 47). Taking probiotics. Checking Vit. d levels.

I’m sure all the positive changes have contributed to the remission, but I feel certain the low dose pulsing antibiotics got me over the hump.

I noted that many if not all cases of arthritis are caused by infections, with C. pneumoniae probably the most common agent, and Michelle replied:

Yes, I had a panel of tests done at The Arthritis Research Center (

The lab checked for strep, plus mycoplasma (M. hominis, M. fermentans, M. salivarium, & M. pneumonia), plus chlamydia (C. pneumoniae, & C. trachomatis).

Ding! Stealth infections!

Michelle’s infections included M. hominis, C. pneumoniae, and C. trachomatis. It’s quite common to have multiple infections, even in the general (“healthy”) population as we noted in this post. So it’s no surprise there was more than one.

Michelle’s doctor recommended low-dose doxycycline (100 mg three days a week), which took 2+ years to cure the arthritis. She might have been cured quicker with a larger dose. As she describes the issue:

I understand there’s controversy about stealth infections. Some say they are very difficult to treat, and one needs to throw the kitchen sink at them— high doses, daily dosing, rotating various antibiotics. My MD felt that many people were having trouble with stealth infections because they were over-treating. High, daily dosing makes the situation worse for many.

When I questioned this, he reasoned that we can always raise the dose later, or switch up antibiotics later. As it turned out, I made progress on a small dose. It was slow going, but 2+ years later, I no longer worry about being crippled by arthritis.

Dosage is a tricky issue.

  • Higher levels of antibiotics are more likely to denude the gut of probiotic bacteria, and populate it with pathogenic species that shelter from the antibiotics in biofilms, or with fungi that are immune to the antibiotics. The loss of probiotic species in the gut can lead to new infections; immune cells go to the gut to fight pathogens there, get infected themselves, and then go to joints to fight infections there, and spread their pathogens into the joints. Thus, there is a potential to add new pathogens to the joint infection, compounding the arthritis.
  • On the other hand, lower levels may be insufficient to clear the infection, or may take inordinately long to do so. If the duration of antibiotics is longer, gut problems may be as severe on low antibiotics as on high.

My own prejudice is “go as fast as you can but no faster,” but clinical experience will teach us the best course in different diseases. In more severe diseases – multiple sclerosis, for instance – low-dose monotherapies have no chance and high-dose combination protocols are needed.

The potential for antibiotics to backfire is why you want to adopt all the dietary and nutritional steps first (in our book Steps 1, 2, and 3), then pursue antibiotics and therapeutic diets (Step 4 in the final version).


Second, Winalot has made progress against depression and suicidal tendencies by eating a ketogenic diet:

I’m zero-carb as I’ve found Ketosis has greatly reduced my depression / suicidal tendencies, however I do worry that this might not be “healthy”.

You mentioned “some mental health and neurological disorders, may benefit from very low-carb “ketogenic” diets” and I was wondering if there’s any more advice you can give on finding that sweet spot?

Ketosis hasn’t cured me, I still have bad days and take SSRI’s but it’s certainly better than boatloading carbs for “serotonin” like I used to.

It’s very smart of Winalot to have found the ketogenic diet. A ketogenic diet has two major benefits for infectious brain diseases:

  1. Ketones induce neuronal autophagy, which means they upregulate the primary intracellular immune defense mechanism against bacterial infections.
  2. Ketones are neuroprotective. One mechanism: They are an alternative energy substrate for neurons. Bacteria steal pyruvate and other glycolytic products for their own energy metabolism, depriving neurons of their main energy source and inducing the cognitive symptoms of hypoglycemia in the brain. But bacteria cannot consume ketones. If ketones are supplied, neurons do not starve. Starvation is probably the main cause of neuronal death in many of these diseases. If you don’t wan’t to suffer the shrinking brain that is so common in Alzheimer’s, multiple sclerosis, and other infectious brain diseases, a ketogenic diet is prudent.

Winalot asked for a “sweet spot” and I gave the following advice:

In general, I recommend 200 starch calories a day. This will not prevent generation of ketones if you take a lot of ketogenic short-chain fats and will protect you against glycoprotein deficiencies leading to bowel cancers and other nasty long-term side effects, not to mention impaired immunity against extracellular pathogens.

This should be accompanied by a boatload of coconut oil for those ketogenic fats. I suggest about 1500 calories / 6 fluid ounces / 12 tbsp coconut oil per day. This sounds like a lot, I know, but it is therapeutic.

Also, get 400 protein calories per day. This is higher than our normal protein recommendation.

Finally, I highly recommend antibiotics, since I believe bacterial infections of the brain (leading to tryptophan sequestration by interferon-gamma and IDO) are far and away the most likely cause of your depression and serotonin deficiency. I would start by assuming this is C. pneumoniae, the most common brain pathogen, and take the Wheldon protocol antibiotics. You can find a good guide at

Tryptophan sequestration is a primary intracellular defense against bacterial infections, and bacterial theft of tryptophan from serotonin also tends to denude infected cells of serotonin. We regard serotonin deficiency symptoms as prima facie evidence for a bacterial infection of the brain. C. pneumoniae is the most common bacterial pathogen in the brain, so antibiotic strategies that are proven against C. pneumoniae are a good place to start against depression.

Doxycycline is a good first antibiotic; it enters the brain well and is active against C. pneumoniae. The response to doxycycline also has diagnostic value. If you don’t have an infection, usually there is no obvious effect to the antibiotic. If you do, there are usually clear effects, either good or bad:

  • Good, because doxycycline is a protein synthesis inhibitor and will slow down bacterial activities that may be damaging you, including tryptophan theft. You may experience euphoria for a few days, followed by richer emotions and relieved depression.
  • Bad, because it may produce either toxicity effects from bacterial die-off (endotoxins and porphyrins) or other side effects. For instance, C. pneumoniae inhibits apoptosis (cell death) of immune cells, and inhibition of protein synthesis will stop this and may be followed by the immediate suicide of most white blood cells. This sudden drop in white blood cell count could lead to a surge in fungal or other infections, lasting several weeks until new white blood cells can be manufactured.

If you notice such effects, continue the doxycycline, but modulate doses so that the bad effects are not too severe. Other antibiotics can be added in combination once the bad effects are modest.


The thesis of this blog is that most chronic diseases can be cured in a two-part process:

  1. Good diet and nutrition should be used to eliminate toxicity syndromes and empower the immune system.
  2. Antibiotics can then be brought to bear against entrenched infections to work a cure.

Diet and nutrition should be the first step. A good diet will clarify symptoms and help diagnose pathogens; minimize antibiotic doses and duration needed for a cure; and minimize die-off effects from bacterial endotoxins and porphyrins during antibiotic treatment.

It’s great to hear from people who are making progress against their diseases. Hopefully, our book and blog can generate many more such cases. Abundant cures will do more than billions in research funding to teach doctors and scientists how to treat these diseases.

Leave a comment ?


  1. Hi Paul,

    As much as I’d love a cure the important point here is “making progress”, which I never did on the SAD.

    As I mentioned, I still have very bad days but these are now in the minority vs. before.

    Thanks once again for your time and valuable insight.


  2. Paul –

    You say “I believe bacterial infections of the brain (leading to tryptophan sequestration by interferon-gamma and IDO) are far and away the most likely cause of your depression and serotonin deficiency.” Can you say anything more about what leads you to the belief that depression likely results from infection? I’ve always understood there to be a strong genetic component to susceptibility to depression (several members of my family have suffered from depression), which would suggest a non-infectious cause — though of course there could be genetic susceptibility to having that particular reaction to a common infection like C. Pneumoniae. Are there any studies showing a strong association between infection and depression, or (say) showing relief of depression when people are being treated with antibiotics for other reasons?

  3. I don’t have any specific disease I am concerned about, but I might be infected and not know about it. Do you recommend a health conscious individual be tested for various infections as a precautionary step? if so, how would I go about being tested?

    Also, the following comments were made by Anthony Colpo recently on his site, about ketogenic diets.

    Among this population, adverse affects of ketogenic diets have been widely reported and include cardiomyopathy, dehydration, nausea/vomiting, bruising, diarrhea, constipation, gastritis, hyperuricemia, various infectious diseases, hypoglycemia (low blood sugar), hyponatremia, hepatitis, acute pancreatitis, persistent metabolic acidosis, osteopenia, kidney stones, and severe vitamin and mineral deficiencies. In some instances these adverse effects have proven fatal. As one doctor commented in a 2005 journal article on ketogenic diets, “tolerability and complication-related issues are the rule, not the exception … medical surveillance must be maintained throughout the entire period of dietary treatment.”

    Hoyt CS, Billson F. Optic neuropathy in ketogenic diet. British Journal of Ophthalmology, 1979; 63: 191-194.

    Kang HC, et al. Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia, 2004; 45 (9): 1116-1123.

    Best TH, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology, 2000; 54: 2328-2330.

    Ballaban-Gil K, et al. Complications of the ketogenic diet. Epilepsia, July 1998; 39 (7): 744-748.

    Berry-Kravis E, et al. Bruising and the ketogenic diet: Evidence for diet-induced changes in platelet function. Annals of Neurology, 2001; 49: 98–103.

    Duchowny MS. Food for thought: The Ketogenic Diet and Adverse Effects in Children. Epilepsy Currents, July 2005; 5 (4): 152–154.

    Hahn TJ, et al. Disordered mineral metabolism produced by ketogenic diet therapy. Calcified Tissue International, Dec, 1979; 28 (1): 1432-0827.

    Kelb SA, et al. Nephrolithiasis associated with the ketogenic diet. Journal of Urology, Aug, 2000; 164 (2): 464-466.

  4. Jeremy –

    Everyone is infected by these pathogens, it’s unavoidable. The key point is which side of a tipping point you are on. If your immune system has the upper hand, the infection can be suppressed and may never generate any symptoms. If the pathogen gets the upper hand, even locally in a specific tissue, you can get a disease.

    If you have no symptoms I wouldn’t be tested. The diagnostic tests for intracellular pathogens are very unreliable and in someone without overt symptoms especially so.

    Re ketogenic diets, the problem is not the ketones but all the things that are missing in the clinical ketogenic diets — notably carbs, protein, and micronutrients.

    We recommend including 200 starch calories, 400 protein calories, and various supplements in any ketogenic diet implementation. This is only a minor modification to the regular Perfect Health Diet — 200 calories less carbs and a lot more coconut oil.

    It’s common for epileptic children on ketogenic diets to put on zero-carb, excessively low protein, vitamin-deficient regimens. They commonly develop scurvy and experience growth retardation and bruising / slow wound healing; glutathione deficiencies and impaired immune function or autoimmunity; and other problems.

    In the final version of the book we extensively discuss evidence from mammalian biology that ketogenic diets, properly implemented, are safe. We even call the ketogenic diet by the name “Herbivore Strategy” diet.

    I do agree that a ketogenic diet is riskier than the regular diet and therefore we only recommend it for people with certain diseases, especially those with neurological issues.

    Best, Paul

  5. Straw –

    People with chronic infectious diseases commonly experience depression. This is a known comorbidity with MS, Alzheimer’s, and other brain/neurological conditions that I believe have an infectious origin.

    Also the symptoms of depression bear a close resemblance to the cognitive symptoms of (a) serotonin deficiency and (b) hypoglycemia, and taking glucose products and tryptophan are the main activities of bacteria.

    Moreover, the genes which indicate susceptibility to most brain disorders are genes involved in the immune response. This suggests that mutations are impairing immunity and increasing the likelihood of infectious disease, not inducing the disease directly.

    Familial associations do not necessarily imply a genetic cause, since pathogens and diets tend to be shared among family members.

    A long blog post (or several) would be needed to fully respond to your question, and evaluate the evidence in an even-handed way. I am confident that brain infections induce depression, but I am not sure what fraction of cases of depression are infectious in origin.

  6. Interesting,

    might this explain why I have so much problems with fasting ? After 3-4 days of water, fresh lemon juice and virgin coconut-oil only fasts, I get nasty rashes and serious headaches and kidney pain. I have to stop. Could this be the parasites dying off ?

    Reading the research, I think most people would benefit immensely from going into deep ketosis for twice a year for 2 weeks. Not longer then that. Taking antibiotics for years might have a similar effect on parasites elimination but not on cancer prevention.

    What do you think ?

  7. Hans,

    It could be pathogens dying off, but it could also be extracellular pathogens proliferating for lack of glucose in immune cells to fight them; and hypoglycemic headaches. Have you had a doctor look at the rashes? Have you checked blood sugar levels on the 3rd day? Various vitamin or mineral deficiencies can induce similar symptoms and may be contributing factors. These kinds of symptoms are too complex to diagnose from afar. If you intend to continue such fasts you should definitely ask a doctor to help you troubleshoot.

    I don’t think people need to go into ketosis for 2 weeks at a time. Occasional fasts or ketogenic diet days should do the trick. Of course this might add up to 14-28 days per year (1-2 days per month), so we’re talking similar degrees of ketosis.

    Since autophagy is effective against all cancers whereas antibiotics would only be helpful against bacteria-induced cancers, which are probably rare, I would agree that antibiotics wouldn’t be as helpful against cancer as diet-induced autophagy.

  8. Well, I think the transition from mainly glucose metabolism to mainly ketone metabolism only happens slowly, also it takes at least 1 week to 10 days for full tumor apoptosis, cell autophagy and killing of parasites.

    Are you familiar with the work of Boston College professor and cancer researcher Thomas N Seyfried ?


    Anyway, reports indicate that the body will control the fast itself. After a certain period (typically more then 1 week, less then 3 weeks), you will start to go hungry again and your tongue will turn pink again.

    This also seems the evolutionary rule where food scarcities used to happen a few times per year.

  9. Hi Hans,

    Yes, I’m a fan of Seyfried’s work and am planning eventually to do a series on diet as an adjunct therapy to cancer.

    But I haven’t seen papers arguing that 10 days continuously is substantially better than 10 days dispersed. Do you have a cite?

    Also, why does ketosis have to be limited to 4 weeks per year? Any papers on that?


  10. Paul
    Michell said “A few months before my arthritis reared its ugly head, I gave up gluten”; this strikes an echo in my case. I came to a diet very close to the diet you advocate through the back door, I tried to control rising BP (mild) with a “healthy” diet ie lower fat/higher carbs on my MD’s advice but the results were clearly in the wrong direction. The main marker was significant worsening in my periodontal disease. Apart from the 2 problems above I was in very good health (I’m 71 yo) and not overweight.I have improved my BP (115/75) and BG is normal (110 1hr postpradial) Previously I would occasionally get mild complaints from my knees, say after 6 hrs of hiking or downhill skiing. But 2-1/2 months after my LC (75gm/day?) diet my knees began to bother me on challenging hikes. Now,ie 4 months after the diet change I get odd,brief attacks in my joints eg small finger, little leauge elbow etc. As well there seems to be a heightened sensitivity to dairy, of which I consume very little (yogurt, hard cheese). In your experience are the joint aches a common reaction to the diet?
    Very much enjoy your balanced, clear posts.

    • Hi Morris, This is a tough one because the origins of these conditions is hardly settled science on any diet.

      First, I would like to make sure that when you say 75 g carbs you mean digestible-to-glucose carbs, i.e. 300 calories glucose. That is sufficient to rule out glucose deficiency issues which might explain it, since the joint lubricants are all made from glucose. After that, I would look closely at nutrition first, because it is so easily remedied. We know that malnutrition can cause osteoarthritis over long periods of time, as in the moose of Isle Royale ( It can also stress immune cells and cause autoimmune-type symptoms. Those kinds of effects can arise in a matter of days, but can also take months to develop after the diet changes if you are gradually losing a key nutrient with significant cellular stores like vitamin C. Vitamin C deficiency is associated with autoimmune reactions. Vitamin D also needs to be normalized to minimize autoimmune issues.

      If these quick fixes don’t work then we would have to look at infections. While low-carb diets help against bacterial infections, some infections become more serious on low-carb diets, esp. fungal infections. Candida infection of joints can cause arthritis, e.g. Also Candida growth in the gut can have long-distance effects promoting joint inflammation, e.g. So I would look toward anti-Candidal steps, such as high-dose iodine supplementation, probiotics (e.g. ThreeLac), whey protein supplements, antifungal herbs like kolorex/horopito, and maybe antifungal drugs, though you would need a much better indication than just our speculation to justify that.

      So, no, joint aches are not a common reaction to the diet, but they’re hardly an impossible one. It may take some detective work to track this down and fix it. Good luck and keep me posted.

  11. Hi Paul, great information here. Thanks for sharing it.

    I’m planning on implementing a ketogenic diet once a week as you recommend. You mentioned coconut oil many times, but I just happen to dislike the taste of it, and also get abdominal disconfort. I love beef back fat though, can I eat a high amount of it instead of coconut oil? I know the fatty acid composition is different being back fat not that high in MCFA. It would be like 400cal protein, 200cal starch and let’s say 1600cal of back fat.

    Just a little background. (I’m Brazilian) I’m one of those skinny guys, I can eat as much as I want and don’t get fat ever. I used to be addicted to sweets. I have always had neurological problems though. I am extremely shy, and don’t seem to be able to comunicate well, even with family members. Oddly enough after stressfull situations these symptoms would sometimes vanish and my self confidence would skyrocket. And I would talk to anyone effortlessly. These symptoms are slowly getting better since I switched to a zero carb high protein and fat diet a year ago. I’ve been eating close to 900 grams of lean beef and lots of back fat every day in two meals. Do you thing pathological bacteria is at the base of my problems? Would you recommend a ketogenic diet? (My current zero carb diet consists of almost a kilo of protein, so I suppose its not ketogenic)

  12. Interesting, Paul.

    Dr. Brown said that depression and fatigue were the early warning signs of rheumatoid disease.

  13. Cristiano – The beef back fat is very healthy but it’s not ketogenic.

    You are in fact on a ketogenic diet, just one that is a little unsafe due to the reliance on protein. There is a risk of glucose deficiencies and potentially dangerous long-term effects on zero-carb diets.

    I am a little confused by some of your statements, i.e. a kilo of protein is a huge (poisonous) amount, I assume you mean kilo of fatty meat, which is still a lot of protein.

    Your mood and communication symptoms aren’t something I recognize. Possibly our occasional psychiatrist visitor, Dr. Emily Deans, might recognize a syndrome that produces these symptoms, but I don’t. I am glad that the low-carb diet is helping, but low-carb diets help all kinds of situations so that doesn’t really tell us a lot.

  14. Hi Paul
    Thanks for the prompt reply. I do not want to clutter your blog with personal dignostics but here are some additional data, perhaps it may be of interest to other bloggers. My caloric intake from carbs is in the range of 200-400 (established by a weekly accounting) and 300 on average. I do not believe I have a nutrient deficientcy as I eat a variety of vegetables. I am on supplements for Vit-C and probiotics as my BM regularity which was clockwork perfect (high fibre irritation?)now requires a little help; still regular but not as forthcoming. I do not have reasons to suspect the thyroid as I am less sensitive to cold and my heart rate has increased slightly (65 to 75). I do detect an increase in the amount of “foam” in my urine, which I suspect is an indicator of ongoing inflammation reactions. I will pursue the anti-fungal connection. Thanks again.

  15. Paul,

    You are quickly walking to be one of the best health blogs, if not the best!

    Something, besides diet and antibiotics, and much, much, much more safer than antibiotics is LDN (low dose naltrexone, There are various groups on Yahoo. In one that I participate, there were, along these years, various personal reports on hepatitis B and C. Something like pre-LDN viral load of 1,280,000 and pos (9 months) of 18,729. Another one reported: pre 9,400,000, one month pos-LDN 5,000,000, two months pos-LDN 980,000. And many others. Dr. Bihari, that discovered LDN, used to treat AIDS with LDN.

    A brief description on how LDN works:

    “The brief blockade of opioid receptors between 2 a.m. and 4 a.m. that is caused by taking LDN at bedtime each night is believed to produce a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production. Normal volunteers who have taken LDN in this fashion have been found to have much higher levels of beta-endorphins circulating in their blood in the following days. Animal research by I. Zagon, PhD, and his colleagues has shown a marked increase in metenkephalin levels as well. [Note: Additional information for Dr. Zagon can be found at the end of this page.]

    Bihari says that his patients with HIV/AIDS who regularly took LDN before the availability of HAART were generally spared any deterioration of their important helper T cells (CD4+).”

  16. Thanks, Mario. I owe a post on LDN, it is a fantastic story. I avoid recommending anything I haven’t tried, but it may be worth making an exception in this case.

  17. Thank for the quick reply.

    When I said “almost a kilo of protein” I meant lean meat(I buy back fat separately), so it’s actually 220g of protein. I’m a little confused as you said back fat is not ketogenic and then stated my current ZC diet is ketogenic. I was under the impression my intake of protein would supply all the glucose needed.

    Even though I’m feeling much better after adopting this ZC diet, it think it’s best to add carbs back for the reasons you mentioned. I’m afraid I might have some kind of metabolic syndrome or pre-diabetes though. Before switching diet I was always hungry and needed sweet stuff. It’s now way better in this regard, but I still have to control my self not to overdo on protein and limit it to the afore mentioned kilo of lean meat. To put it simple, if I eat a little protein (300g max of lean meat) I can carry on for many hours. Though if I eat a lot of meat I get hungry again in a matter of few hours. I believe carbs will make it worse. What do you think is the best approach in my case? I guess low protein, low carb and plenty of fats is what I should aim for. But aparently its hard for me to limit protein, and even harder to do so with carbs.

    • Hi Cristiano,

      Yes, do add at least 200 calories of starches, fruits, and berries back in.

      Also, try to eat fatty meat instead of lean. You don’t need nearly as much protein as you’re getting. A kilogram of lean meat is about 1200 calories protein, which is a toxic amount. 220 g / 880 calories is higher than we recommend, marginally toxic, but not as alarming.

      Hunger on abundant calories indicates a nutrient defiency. In your case it’s probably glucose, maybe vitamin C, maybe potassium. Regardless, on a healthy diet you should never (or almost never) feel hungry.

      At this point I wouldn’t limit anything other than cutting meat to a half kilo per day. It seems one or more things are missing from your diet. You need to replace those.

      About ketogenicity: Ketones can be generated from either protein or fats. Some amino acids are ketogenic, e.g. leucine. Some fats are especially likely to be converted to ketones — these are the short-chain fats. The reason is that they have no structural use in the body, so the liver has to dispose of them by oxidation, and rather than get an overload of ATP or heat, the liver only partially oxidizes them and sends the remainder out as ketones.

      But if you go zero-carb, your body will follow its starvation response to conserve glucose, and replace glucose with ketones. In your case, most of them are probably made from protein.

      It is much, much safer to make the ketones from short-chain fats than from protein. That’s why I recommend 200 carbs and coconut oil, not zero carb and protein, as the best implementation of a ketogenic diet.

  18. I had severe rheumatoid arthritis, eliminated trigger foods for complete remission, and finally cured myself following Dr. Ayers’ advice on Cooling Inflammation. I would be loathe to use antibiotics and destroy bacteria necessary for a strong immune system and good health.

    • Hi Happy,

      Yes, it’s always better to try diet first. That often cures the problem. Since so many different pathogens can cause arthritis, any specific antibiotic may be ineffective as well as cause gut problems.

  19. Hi Paul,

    I haven’t found any paper references, but
    in interviews Seyfried talks about the 10 day fast :


    He advises water (only) fasts which are … hard. You can speed things up and make it easier by adding easy digestible, fast acting MCT calories in the form of coconut oil + you get the added benefit of it’s anti parasitical properties.
    Also, then your body is not so stressed by the sudden drop in calories.
    With this 10 day fast, you go into DEEP ketosis and there is NO glucose left any more. It is only after a few days the body accepts this new equilibrium.

    I think extended (year-round) ketosis is probably hard on the adrenals and not very good in the long run.

  20. See below interesting study re antibiotic consumption and gut flora composition (referred to by sparkofreason Twitter feed):

  21. Mario,

    thanks for pointing me towards LDN, that is REALLY interesting and confirms a lot of what is being said on this blog.

    Check out this quote from Jaquelyn McCandless, M.D. at :

    “A significant proportion of children upon starting LDN show not only some increased hyperactivity and sleep changes, but a bout of what seems like “viral activation” in the form of a cold, fever blister, and other infections. These are usually short-lived, followed by a burst of improved language, cognition, and socially seeking behavior.”

    I get the exact same thing when taking larger doses of Vitamin D3 / Fish oil and Gelatin protein.

  22. Hi Paul,

    My six jars of coconut oil arrived this week, so let’s see what happens! Currently I’m up to 5 tablespoons a day in addition to what I used to consume.

    I know this protocol is for a specific goal/illness but what are your thoughts on the following coconut concerns;

    1. Dr Harris from PaleoNu

    We don’t really know that much about any unique consequences of eating the MCTs in coconut and their first pass metabolism through the liver.

    Adding coconut fat to a diet without changing the carb fraction increases the level of blood ketones independent of the CHO fraction, because of this first pass metabolism. What does this mean if you are not a kitavan eating CHO of 60-70%? We don’t really know. It could be good or bad, but etiher way it is probably more outside our evolutionary experience than eating the ruminant fatty acid profile.

    Coconut has zero n-3 fatty acids. Coconut has no vitamin K2 or CLA or carnitite or B12.

    I am not wary of eating coconut fat, but there is no way I would consider it superior to fat from ruminants.

    2. A commenter on Peter Hyperlipid;

    “But it does show us that, when everything they eat and drink is seriously contaminated with fructose and sucrose, even MCTs cannot prevent the fibrosis of a mouse’s liver.”

    I know you have some lingering concern about MCTs, due to their extremely rapid processing by the liver. Couldn’t this study be interpreted as evidence of the harmfulness of MCTs? Are there studies with this level of fructose doing equivalent damage without the other known agents of hepatic damage?


    If it helps with my depression I don’t really care, but I’d value your thoughts 🙂



    • Hi Winalot,

      Re Dr Harris’s concern, this is more fully addressed in the final version of the book than in the June e-book. Most herbivores get 60-70% of calories from short-chain fats, and to me that is validation that a diet heavy in coconut oil is safe, as long as adequate nutrition is obtained from other sources.

      In humans, it’s not like the Kitavans are the only coconut eating population in the world. Across the Pacific, southeast and south Asia there are hundreds of millions of people for whom coconut oil is the primary dietary fat. Sri Lankans, who consume a lot of coconut oil, are unusually healthy, for instance. Coconut oil has also been used in parenteral nutrition with good results.

      Coconut oil indeed has fewer nutrients than beef tallow or dairy fats, but it has a major advantage over ruminant fats in that it is highly ketogenic. This may not be that important for people with great health, but for 10-20% of the population who have certain health problems, ketones add substantially to health and for them (including you) coconut oil could bring major health improvements that ruminant fats wouldn’t.

      The statement on Peter’s blog that EVEN coconut oil may not prevent sugar toxins from damaging the liver doesn’t argue for avoiding coconut oil, but for avoiding fructose. Coconut oil like other saturated fats helps mitigate the damage of sugar toxins.

      The shunting to the liver of MCT’s occurs because they lack a functional role in cell membranes — they are too short and fluid to enable cell membranes to isolate the cytosol and lodge transmembrane proteins. So, lacking a role in the body, they have to be disposed of in the liver. But this does not mean they are toxic.

      I’m glad you’re increasing the coconut oil, please let us know if it relieves your depression! If it does, please try experimenting with different doses and let us know what level of intake gives maximum relief of symptoms.

      Best, Paul

  23. Hi Paul,

    Thanks for taking the time to reply whilst working, really appreciate it.

    I’m going to give the coconut oil a serious go and although I’m looking forward to your non-carb posts I’ll remain ZC for the moment and just add the coconut oil in addition to my prior consumption. Will definitely let you know how I get on.

    So as I didn’t quote Dr Harris out of context here’s the other post from the same thread which expands his thoughts. He’s not bashing coconut consumption, just relaying it’s not superior to ruminant fat. Thought you’d find it interesting on the adaptation time angle as well.


    The history of coconut consumption as a significant fraction of caloric intake is much shorter than ruminant fat consumption – it is a relatively recent adaptation that is on the order of a few thousand years or less

    Do you recall seeing many coconut palms in central africa or or northern europe?

    I don’t

    You are perhaps in love with the noble savage myth of the tolelauans, imagining they have a half-million year old culture? Do you think modern primitives in marginal locations are highly representative of the whole of human evolution? How prevalent have coconuts been during human evolution?

    Come to think of it, northern europeans may have been eating MILK PRODUCTS as long as any other culture has eaten non-trivial amounts of coconut.

    Once again, butter contains no lactose, and traditional cultures other than the masai don’t drink much fresh milk, just like I don’t. They ferment it or make butter.

  24. I think Dr Harris is way too tough on coconuts! I have little doubt they have been a staple of the southeast Asian diet for at least 50,000 years, while of course milk entered the diet c. 6500 BC at the earliest.

    As for the superiority to ruminant fat, they each have their place. Ruminant fat is nutritious, but coconut oil is unique in its ability to produce ketones and ketones are an extremely important nutrient in many common diseases.

    I don’t think a foodstuff has to have been evolutionarily important to be a healthy part of the diet. The healthiest foods never required any evolutionary changes.

  25. Hi Paul,

    Just finished my first jar of coconut oil and so far so good!

    I had some GI distress in the beginning, but I think this is because I was adding the coconut oil to my existing meals instead of replacing something, so some meals were very high fat.

    For example, my breakfast is 8 whole eggs and 50g butter. I then added 6 tablespoons of coconut oil to this and it upset my stomach (diarrhea) for a couple of days until I got used to it; now there’s no problem with this fat feast.

    Ketostix show no great increase in ketones in urine so I’m hoping any increased ketosis is being used by my body/brain as is the plan.

    No major mood changes, which in itself is good as I’m pretty stable right now. In the middle is fine for me as euphoria or blackness both have their own issues.

    One negative I’ve noticed is an increase in an OCD habit I’ve had most of my life. Might be coincidence but I have a case where I bite the inside of my mouth, gums, cheek soft tissue and this has got worse since this diet addition.

    I’ve had this as long as I can remember, but sometimes (willpower) I can stop it and other times (like now) it’s quite agressive.

    When it’s bad I undermine the skin structure and get acne on the outside skin so I’m trying hard to get it back under control.

    Any ideas why this might be exasperated? As mentioned it could be coincidence, but I’m wondering whether as I’m still ZC if adding some carbs in might help with serotonin release, etc.

    Sorry to ramble on, I did say I’d keep you posted on the ketosis experiment!

    Looking forward to the book release and ZC posts. Keep up the great work!


    • Hi Winalot,

      Thanks for the update!

      Yes, too much fat at once is hard to digest, and short-chain fats may be particularly hard to handle. If you include some starches and vegetables to help slow down digestion, it might be more comfortable.

      It would be best to have some surplus ketones, you don’t want to be starved of energy substrates. I do think adding some carbs would be good for you. But I don’t know what causes the OCD symptom, so I don’t know what would fix it.

  26. Hi Paul,

    Thanks for the reply. GI distress only lasted a few days and now it’s fine.

    Tonight I had broccolli, leaks and lettuce with my main meal (pork, butter and coconut oil)so getting there. I know it’s not real starchy carbs but it’s a start for me and we’ll see what happens. Wind I expect 🙂


  27. Hi Paul,

    I should clarify the Ketostix showed no change in ketones *since* consuming coconut oil (no more, no less); I do have some ketones and always have as I’ve been ZC.

    I always show Ketostix at 1.5 mmol/L (15 mg/dL).

    Is this OK? Should I be deeper than this? Should the CO be increasing it?

    I’m sticking with it, am up to 10 tbsp of CO per day and still eating broccolli, leeks and lettuce. Might be brave enough for a sweet potato soon! 🙂


  28. Hi Winalot,

    Oh, I am glad you have some ketones, I was wondering what was going on there.

    The coconut oil is helping even if ketones don’t increase, because it is relieving your glucose deficiency and sparing protein and liver function.

    I think the full benefit of the coconut oil will come after you add some starch to your diet. Right now you are starved for energy so your ketone level is going to stay low, neurons and other cells are grabbing it rapidly.

    I think 10 tbsp per day coconut oil is enough. Please add the sweet potato and a banana and let us know the results!

    Best, Paul

  29. Hi Paul,

    I think the fat fest has got the better of me this past week 🙁

    Have had an uncomfortable stomach, as if digestion is difficult, for most of the day and night. As mentioned I’ve levelled off at 10 tbsp of coconut oil in addition to what I was eating. I’ll plough on though and see what happens.

    The other change is I’ve got some added lower abdominal fat. As a pretty lean person I notice even small changes and this may be due to the extra 1000 calories from CO or just cortisol as I’ve had poor sleep lately (which could also explain the poor digestion above).

    What are your views on Bodfyfat % / BMI? As someone who’s always been thin / lean / lightweight, albeit more muscular now I’m in my 40s, sometimes I think more “robust” can have its advantages.

    On a side note; you discuss in the book about lowered protein requirements for muscle building, longevity, etc.

    One thing I’ve observed about bobybuilders is that even though science says what they advise is wrong, they’re typically right! Although they’re often not the healthiest group and sometimes use chemical assistance, if they say increased protein builds muscle I believe them.


  30. Hi Winalot,

    I think you’re right that the bodybuilders are usually right and the scientists/doctors lag several decades behind them!

    On BMI, I suspect about 24-5 is optimal for a sedentary 6′ person who exercises twice a week, 21-22 for a 5’3″ person. A good diet should produce a fairly lean, muscular build with good bone density. Slender waist, big open chest with good posture, strong butt muscles.

    Abdominal fat is not very desirable, but having a little come on during periods of overfeeding and then come off during periods of fasting or calorie restriction is normal and healthy. Resistance exercise will help move the fat into muscle.

    Re the “protein builds muscle” debate, we refined this a little in the final version. There’s a certain substitutability between carbs and protein, and you need at least 600 calories a day carbs+protein to avoid cannibalization of muscle. More promotes muscle building.

    This is one reason I’m trying to get you to eat some carbs, if you restrict protein and aren’t getting any glucose calories you’ll be cannibalizing muscle. That’s not good. It also means you are losing fat reservoirs and the unburned fat has to go to the abdomen.

    So I would say, get your carb+protein intake up to adequate levels, preferably with at least 200 calories from safe starches, in order to stop movement of fat from muscle to adipose cells. You want the fat to move in the other direction.

    Best, Paul

  31. Hi Paul, thanks for your reply. I weight train 4 times a week and carry more muscle now than I did in my twenties. I don’t think I have a shortage in protein intake, but I will pursue adding a glucose source. I’m just getting used to eating veg!

    Today I weighed out my CO intake; I’m thinking your 12tbsp were level? Well I’ve been heaping them out the jar so I’ve probably doubled the requirement on calories and fats! Neat, think I might scale back a bit and eat that sweet potato soon. Thanks for your time and support, enjoying the snook on my iPhone 🙂

  32. Snook=book, btw, thanks iPhone!

  33. Interesting reading. I’ve been attempting to add more coconut oil to my diet (relatively low-carb) and have found myself having horrible bouts of insomnia. They’re not digestive in nature, as far as I can tell. I just wake in the wee hours with my mind absolutely racing in a way that is very unusual for me. I’m wondering if coconut oil might be a bad idea for me. Not sure if it’s the coconut itself I’m reacting to or to increased ketones running around. Is there anything other than coconut oil that might have the same benefits?

  34. Hi Winalot,

    Yes, 12 tbsp is intended to be level. If you were actually taking 24 tbsp that would be 3100 calories which is quite a lot!

    Hi Sue,

    That’s interesting, I haven’t experienced that. I wonder if anyone else has.

    I would suggest eating the coconut oil in the morning, not at night, and see if that helps. The ketones should be gone by the time you sleep.

    Alternatives: Well, you could try relatively ketogenic proteins, like whey powder, for ketone production. Niacin has the HDL-raising effect of coconut oil, and hits at least one ketone receptor. But those aren’t close matches. Palm kernel oil would be an alternative source of short-chain fats, but presumably it would have the same effect.

  35. Hi Paul,

    I may have experienced something like Sue, though I am not yet certain.

    I’ve been taking coconut oil at night right before bed, with a raw egg yolk, some magnesium, and some time-release melatonin. My hope with this is that the protein and fat will help keep my blood sugar stable, that the magnesium will help to relax my musculature, and that these combined with the melatonin will help me sleep well through the night. Sometimes this ends up being the case. Sometimes not.

    Based on this experience and some things you’ve written earlier, I’ve been wondering: since coconut oil is anti-microbial, do you think it’s possible that people with chronic bacterial infections (i.e. C. Pneumoniae, Lyme, etc.) could experience a temporary die-off/herxheimer reaction/worsening of symptoms after taking coconut oil?

    IF this is likely, then it leads me to wonder:

    1. How long after taking coconut oil would die-off symptoms be a problem? (i.e. minutes? hours?)

    2. Should large amounts of coconut oil be followed shortly after by a chelator of some sort for people who are trying to eradicate chronic infections?

  36. Hi Sam,

    I don’t think you’re going to see systemic die-off symptoms from coconut oil. The only place coconut oil could be killing off microbes in quantity is the bowel. Then the fat could be carrying in fat-soluble lipopolysaccharides from the gut microbes into the body. Presumably the flux of LPS into the body would last hours (= the period of fat digestion). So you could see some LPS toxicity, but I haven’t heard of this being in common. I know people who have reported die-off effects from lauricidin, so it’s possible, but not common.

    Chelators I don’t recommend in general, except for specific biofilm-based gut infections.

    Chronic pathogens like C. pneumoniae and Lyme are mostly intracellular and (a) aren’t exposed to the coconut oil and (b) wouldn’t be affected by a chelator.

    In general I don’t think it’s a good idea to eat right before bed. You’re more likely to get digestive upset, acid reflux, those sort of things.

  37. Hi Paul,

    Yes, cock up on my part there! As the CO is solid I just spooned out 10 chunks per spoonful. Probably treble if all added up. Oops, the jars were going fast 🙂

    FWIW my sleep is worse the past couple of weeks but that maybe due to CO overdose!


  38. Hi Paul, You said above that “chronic pathogens like C. pneumoniae and Lyme are mostly intracellular and … wouldn’t be affected by a chelator.” Does this mean that you wouldn’t recommend chelators to Lyme patients? I’m a little confused because so many Lyme doctors recommend using chelators as part of their protocols. As I understand it, the recommended process is:
    1. Try and breakdown biofilm
    2. Use antimicrobials to attack the pathogens
    3. Use chelators to prevent herx reactions to bacterial/fungal endotoxins and exposure to heavy metals
    4. Re-establish healthy gut flora

    Do you disagree with step 3? Or any of the other steps for that matter?

  39. One more question, I’ve been trying to increase my CO intake but I do feel like I experience some kind of die-off. Could this be due to some other kind of parasite or fungal infection or something? (I know I have roundworm, and have tested positive for Lyme, Bartonella and Erlichia.)

  40. Hi DeNon,

    Chronic disease patients often have multiple infections, and often have gut dysbiosis or disease that generates a leaky gut through which intracellular pathogens like C. pneumoniae can enter the body.

    Gut infections are generally in biofilms, and may benefit from chelators. But those are different pathogens than the intracellular ones.

    Lyme doctors have to treat the patients they have, and chelators can help against biofilm-based infections in two ways. One, the chelator binds to the biofilm and poisons it, chasing the bacteria out into a more vulnerable planktonic state. Two, as biofilms dissolve their metals are released, and in severe disease this can create heavy metal poisoning. Chelators can bind to the metal in the gut and help to remove the metal in the stool before it enters the body.

    So I don’t disagree with any of the 4 steps … in patients who need those steps. Everyone’s disease needs to be individually diagnosed and treated.

    Coconut oil has a mild but broad-spectrum activity against a lot of organisms. I don’t think we can guess what is infecting you from your reaction to coconut oil. It sounds like you have a full house of pathogens!

  41. Hi Paul, my wife marvelled at my tea last night; roast chicken, skin, bones, cartilage, etc. all pretty normal, except for … 200g of sweet potato, hehe! It’s probably been over a year or more since I had some carbs like that. See what you’ve done to me 🙂 Hoping it helps with the mental stuff as its been rearing its head lately. Thanks for your advice and support. WP

  42. Good luck, winalot! I think we’re going to have to explore infectious etiologies with you before this is done, but it’s good to optimize the diet first!

  43. Paul, thanks for getting back to me. I have a lot more to learn about intracellular and extracellular infections. I’m checking out right now. I think this site will help me out a lot.

    I’ve been on a cocktail of oral antibiotics, antimicrobials for over a year now. Started with Doxycycline for 4 weeks, then Biaxin and Plaquenil for 6 months, followed by 6 months of Azithromycin, Plaquenil, and a slow ramping up of Rifampin (now at 900mg a day). This protocol ends in a couple of weeks. Doxy should’ve eradicated Erlichia, Biaxin should’ve killed the Lyme and the Rifampin was suppose to knock out Bartonella. Sadly, though, I still have symptoms of arthritic pain in my hands and feet, a lot of stiffness, extreme fatigue, and depression. Like you said, I have a whole host of pathogens! It’s hard to know what to treat and when to treat it. Over the past year my diet went mostly Primal (with a stint of GAPS intro diet for 5 weeks). I’m wondering if taking a break from antibiotics to focus on healing the gut would benefit me. My MD has advised me to continue with Azithromycin and Plaquenil. I’m worried about this whole leaky gut situation. Any thoughts on this?

  44. Hi DeNon,

    There’s no clear answer as to when and what order to take antibiotics in … It could work to focus on the gut first but on the other hand the intracellular pathogens all have ways to sabotage the immune system and it could be that an infected immune system won’t heal the gut properly … Most people go after both gut and systemic infections at the same time. But then it can be hard to interpret what’s going on.

    I think you should be cautious about supposing any of these pathogens have been eradicated. It’s hard to get rid of them. Most can hibernate in cryptic states where it’s very hard for the immune system to find them. You’ve probably beat back the infections, but they are probabliy not cured.

    I think curing these diseases is always a process of self-experimentation. Get diet and nutrition right, and then experiment with antibiotics and bowel disease fixes (see our bowel disease series). It takes time. But you can feel what’s going on, so you’re in the best position to judge what’s working. These diseases are very variable, every case is unique in some respects, so it’s really up to you to figure out how to cure yourself.

    It’s good to read sites like, get familiar with others’ experiences. Learn what die-off symptoms feel like, that will help you get on the right track – sometimes when you feel miserable, it’s working.

    Best of luck. I’ll help however I can, but once you reach a certain level of sophistication it’s up to you and your doctor to experiment your way to a cure.

    Best, Paul

  45. Thanks so much Paul. I’ll keep tackling this! I’ll reread your bowel disease series along with your other suggestions. Really appreciate your help. Thanks again.


  46. Hello Paul

    Last year a friend who suffers from ankylosing spondylitis told me about the eminent British immunologist Professor Alan Ebringer’s successful treatment of AS patients with a low/no-starch diet.
    I think I am right in saying that it was Ebringer and his colleagues who discovered that Klebsiella infection is the root cause of this autoimmune disease. I could not see any mention of AS or Ebringer in your posts or comments and thought I would mention them in case anyone is interested.
    Of course, his diet is not a ‘cure’ for this condition but it does seem to have caused a great improvement of symptoms for many people, as long as the disease has not advanced too far.
    The diet is also effective in treating IBS (of physiological rather than psychological origin), according to Carol Sinclair, who wrote the book ‘The IBS Low-Starch Diet’ with foreword by Professor Ebringer.

  47. Hi Elima,

    Thanks! I’m familiar with Dr Ebringer’s work thanks to Peter at Hyperlipid and this post:

    Starches have certain forked structures that are indigestible to humans and can feed both probiotic and pathogenic species. If you have an overgrowth of a pathogenic species that feeds on this starch structure, removing the starch can starve the pathogen.

    Prof Ebringer’s work is very important, but it remains to be determined how widespread this situation (and treatment) is.

    In general, anyone with IBS should try removing various carb-containing foods and seeing which affect the condition. Sometimes it is sugars, sometimes fiber, sometimes starch. That has diagnostic as well as therapeutic value.

    Best, Paul

  48. Hi Paul,

    I’m wondering if there are any natural antibiotics you can recommend that could take doxycycline’s place? Or is doxycycline superior and more effective?

    My naturopathic doctor suggested olive leaf extract, as it works quite well as a natural antibiotic for a lot of people. He says I’ve already been exposed to a lot of antibiotics growing up, which has done a lot of harm, and going on another one would just do more harm by destroying my “good bacteria.” Also, I personally don’t like the idea of going on pharmaceutical antibiotics if I really don’t have to. But I really want to get to the root cause of my chronic headaches and depression. Just so you know, I’ve already been on intermittent fasting and the ketogenic version of your diet for a few weeks now.

    Thanks for any advice,

  49. Hi James,

    I don’t recommend specific pharmaceutical therapies to people as this is the responsibility of doctors.

    Different antibiotics go to different places in the body and work on different pathogens, so the therapy really has to be matched to the individual case.

    I think if you have a bacterial brain infection, you need antibiotics, and the gut can be tended to with probiotics and fermented vegetables and, if necessary, antifungal medications (natural or pharmaceutical). It does you no good to have a healthy gut but a degenerating brain.

    Best, Paul

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