Experiences, Good and Bad, On the Diet

A number of people have now given us feedback after starting the diet, and I think this is a good time to review the effects, good and bad, that people have experienced.

In upcoming posts, I’ll discuss the negative experiences further and explore possible causes.

Positive Experiences

It’s gratifying that most people who have tried our diet have reported very positive experiences. Those who read the comment threads or Amazon reviews will have seen some of them; I get others via email.

Here are two from Amazon reviews:

I have battled Celiac disease for some time and got about 80% better with a Paleo diet… but the Perfect Health Diet was the first book that could finally answer that last 20% with science based logic. (Jordan Reasoner)

UPDATE: Jordan has an e-book, SCD Lifestyle: Surviving to Thriving, which looks great for bowel disease sufferers. He gives us an update on his personal progress in the comments.

I can’t believe how much better I feel!…

I had been eating (very) low-carb and high-protein for the better part of a decade – and I had gotten a lot of practice arrogantly dismissing suggestions (from any source) that I should change anything about my diet….

Results: (after 1.5 months or so.)

  1. I’m no longer “brain-dead” and unable to think in the evenings after work.
  2. I no longer have fruit or chocolate cravings.
  3. I’m much happier, and wake up looking forward to the day.
  4. I’ve been much more social.
  5. The extra starch has not resulted in weight gain. (I always gained weight when eating carbs before.)
  6. It looks like the fasting (which I’ve never tried before) is helping my alertness and also contributing to healthy weight loss.

It took less than a week for me to notice dramatic changes….

I can’t recommend this book highly enough. (gp2x)

Here are two from the last few days’ comments.

Yours is by far, the best Paleo / Ancestral diet that makes sense….  I was very strict Paleo for a good 8 months, and yes felt fantastic and lost 10ks etc.  But then started feeling tired, moody.  Enter some carbs (from the suggestion of your book) in the source of potato and rice and taro – and now I’m feeling a whole lot better.  Did I put on weight.  Of course not!  Essentially now I eat what my body craves.  I can listen to it now and it responds accordingly.  It knows when it needs more carbs (eg., after exercise).  And it knows how much as well. (Lisa Weis)

Since reading Gary Taubes’ Good Calories, Bad Calories my life has been transformed. Who knew that butter was a healthy food.  Previous to reading GCBC I was a fruit fiend.  I ate bowls and bowls of cherries this past summer and wondered by I could not lose weight.  I reached my weight loss goals by eliminating grains and limiting dairy to butter and cream and reducing fruit intake.  That said, over the last month or so, I was wondering why my body seemed to be drying out from the inside out.  I want to tweak my diet to optimum health and found your book. The information about the importance of mucin was helpful.  What was missing in my diet was the carbs that you and the missus recommend.  Sweet potatos, white rice etc.  Maybe less protein than I’ve been eating and more saturated fat.  (I’m alarmed by the stomach and other cancers suffered by long term adherence to the Optimal diet …)  I’m having better results every day.  I am fascinated that I have a laboratory of my own body to put your ideas to a test and have them show positive results.  Thank you both so much for your work and above responses to questions and comments. (Doris)

I think these positive experiences are impressive considering that most of our readers have come from the low-carb Paleo community. Low-carb Paleo diets are far healthier than the Standard American Diet, and so improving health further is quite an accomplishment.

Another group that we are trying to help are people with chronic diseases. Probably most readers who did not arrive from the low-carb Paleo community have come from the chronic disease community. It’s a little early to report results, but at least some people are finding promise in our diet. Natalie wrote:

As someone dealing with chronic disease (a very unfun combination of Lyme, Babesia, and Bartonella), I know I’m always looking to find out more of what has worked and what did not work for others.

This blog along with many of the readers of this blog have been a tremendous help to me personally.  For example, I now know I can avoid the daily “coma naps” if I don’t go crazy on the carbohydrates.  I’ve actually received some excellent diet advice from my doctor, but he never told me to chill on the carbs!  (Natalie)

Ketogenic diets are frequently mentioned by us as potentially therapeutic for many diseases. I’ve blogged previously about Claire’s discovery that ketogenic diets help her gastroparesis and Rob’s suppression of his lifelong migraines through fasting and ketogenic dieting.  

As more chronic disease sufferers try the diet – for instance, Darren who has Lyme disease – we hope to prove that the Perfect Health Diet in conjunction with antibiotic therapies can lead to cures for these difficult-to-treat conditions.

Negative Experiences

So far, all the negative experiences I am aware of have come from low-carb dieters who had difficulty after adding carbs and/or cutting protein.

Don Matesz is an interesting case, because his own diet was already a “Perfect Health Diet.” His diet, if I’m not mistaken, was in the low end of our carb range and high end of our protein range. As a test he reduced protein and added carbs, heading toward the high end of our carb range and low end of our protein range. He didn’t like the results:

Just to experiment, for a couple of days Tracy and I reduced our meat intake by half.  I reduced my meat intake from more than a pound daily to just about one-half pound, and, as the Jaminets suggest, replaced the protein with starchy carbohydrates (potatoes and sweet potatoes).  For both Tracy and I, this resulted in a noticeable decline in mood and a dramatic increase in hunger and intestinal gas, along with a disruption of bowel function….

UPDATE: Don says that he does best eating above the bottom end of our optimal carb range, but that for years he has gotten into trouble whenever carbs reach 100g/day (the middle of our optimal range). It sounds to me like an unresolved gut dysbiosis.

Don’s commenter SamAbroad had a similar experience with reducing protein intake:

But I’ve also been following the PHD, and to be honest, I am so hungry and cranky when I restrict protein.

UPDATE: SamAbroad turns out to be our Sarah, and she says that the Perfect Health Diet “has been one of the best things I’ve ever done for my health.” Maybe we should move her to the Positive Experiences group!

I’m still following the diet, I eat circa 100g carbs from starch a day not including veg and this has been one of the best things I’ve ever done for my health along with including a vitamin C supplement. My low-level depression and anxiety have completely disappeared and the diet is considerably more varied and easier to stick to than VLC.

Sarah’s issue is that she needs to eat at least the midrange of our carb+protein “plateau range,” for reasons as yet unknown.

Chris Masterjohn had trouble with sweet potatoes:

Although sweet potatoes are considered a safe starch on the Perfect Health Diet, they are not very safe for me. When I discovered how yummy sweet potato fries are, I started eating several sweet potatoes per day. Within a few days, I was limping and my neck was stiff. By the end of the week, my limp was extreme. I looked online to see if I was eating anything high in oxalates, and sure enough, sweet potatoes are loaded with them. My symptoms dramatically improved after one day off sweet potatoes and were gone the second day.

Chris’s commenter Lisa also had trouble with sweet potatoes:

I’ve been very achy since I started eating sweet potatoes daily. Why would some of us be maladapted to oxalates?… I’m wondering if after a long stint of LC/paleo eating I’ve become intolerant to oxalates or to starch in general.

UPDATE: We discuss possible reasons for problems with sweet potatoes here.

Several people have gained weight after starting the diet. This Amazon review doesn’t come right and say that the reviewer experienced weight gain, but I’m guessing that was the case:

It is worth emphasizing what another reviewer noted: The Perfect Health Diet is not focused on weight loss. In fact, if you are coming to the diet from a zero-carb or very-low-carb regimen, you can count on an immediate and substantial weight gain if you suddenly adopt the recommended intake of “400 carb calories [100 grams] per day of starchy tubers, rice, fruit, and berries.” (K. Hix)

From the comments, Maggy reported weight gain:

Following your advice, I added back a bit of “safe starch” last week, and decreased protein intake, keeping sat fat and MCF pretty high. Well, I got on the scale today and have managed to put on 5 pounds! I’m trying to figure out what is going on and what I need to tweak. I do need to lose a good 20-30 lbs, and while I don’t want to compromise health, I also don’t want to put back on what I managed to lose doing a VLC diet.

Is this an adjustment period I need to get through? Maybe I’m one of those broken metabolism folks who has to stick with VLC? (Maggy)

These negative experiences will be the subject of my next few posts.

Because individuals are so variable, it is often not possible to figure out what is going on without experimentation with different dietary variations and considerable communication. Therefore, I’m most grateful to people like Maggy who are willing to experiment and share their experiences with us.


It’s interesting that the same dietary change – adding “safe starches” to a low-carb Paleo diet – made some people feel better and others worse.

This series may also lead us into the question of trade-offs in diet. These trade-offs may cause different people to prefer different diets. For instance:

  • Shifting from lean-meat-and-vegetables to starches and fats may increase the pleasure of eating and improve health in some, but promote weight gain in others.
  • Higher protein may promote athleticism and fertility, but shorten lifespan (as it does in some animals).

In writing our book, we tried to present the evidence underlying all of our recommendations, and provide healthy ranges for the various nutrients with explanation why the reader might prefer to be at the high or low ends of the range. Our goal was to empower each reader to find his or her own “perfect health diet,” not to rigidly prescribe a specific way of eating.

But negative experiences on a diet can also have diagnostic value. For instance, when I first adopted a low-carb Paleo diet I developed severe fungal skin infections. The new diet revealed an infection I hadn’t known I had. For this reason, even negative experiences can be beneficial, as they may open a path to curing an underlying but hitherto concealed health problem.

We see this blog as a communal enterprise, in which we and our readers together try to discover the truth about diet and health. Therefore, we hope that anyone who does have negative experiences on the diet will not hesitate to report them in the comment threads and work with us to discover the cause.

Leave a comment ?


  1. Hi Perry,

    Another possibility, since you’ve reported systemic fungal infections in the past, is that you’ve had a flare of your fungal infection, or perhaps die-off.

    I’ve had peripheral numbness, especially in the pinkies (5th fingers), in the late stages of severe fungal flares. I’ve also had leg cramps.

    I’ve seen numbness and neuropathy listed as side effects of Candida, e.g. here: http://www.ra-infection-connection.com/YeastInfection.htm

    Neuropathy sometimes occurs when taking anti-fungal medications, e.g. http://www.ncbi.nlm.nih.gov/pubmed/15616259. Perhaps this is a die-off effect.

    Anyway, something to consider.

  2. Hi Perry,

    Sorry to hear of your troubles. Regarding your suspicion that iodine supplementation contributed to your problem, I have a possible practical suggestion. As you may know, there are several doctors who have experience treating thousands of patients with iodine, at far higher doses than you took. It might be possible to consult with one of them to see if your situation rings any bells.

    My thought would be Dr. Jorge Flechas (http://cypress.he.net/~bigmacnc/drflechas/index.htm). I have had contact with his office because I’ve used his lab for 24-hour iodine loading tests. My own doctor has consulted with him regarding my results. My impression is that he is quite accessible. I would think he would be very interested in hearing of a possible adverse effect, and he might have some useful advice. I’m not certain he would speak with you if you haven’t used his lab, but it might be worth a try. I have heard a number of his interviews and he seems like a truly great doctor.

    Another possibility for tapping into the collective experience with iodine supplementation would be to inquire at the Yahoo iodine group (http://health.groups.yahoo.com/group/iodine/). I would caution you, however, that this group is composed of absolutely committed iodine enthusiasts, so keep that in mind if you go there for advice. They typically attribute any reported problems with iodine to coincidence or to bromine toxicity. The latter could be a possibility in your case, I think; I myself had classic bromine detox symptoms when I upped my dose of iodine. Neurological symptoms, though not exactly what you’re experiencing, figure prominently in the common lists of bromine toxicity symptoms (e.g.,http://www.breastcancerchoices.org/bromidedetoxsymptomsandstrategies.html).

    Despite my misgivings about their uncritical advocacy, the Yahoo group is a tremendous source of practical experience that might be of benefit to you. The list owner is also a personal friend and collaborator of Dr. David Brownstein, another doctor highly experienced with iodine and author of the best-known book about it. If she took an interest in your story, it’s conceivable she would ask him about it. She is a newly minted naturopath herself.

    None of this is meant as an alternative to the suggestions made by Paul. Just another possible angle for you since you seem pretty convinced the iodine has played some kind of role in your problem.

    Good luck and I hope you feel better soon!


  3. Hi Paul,

    Thought about this protein restriction thing again recently and thought I’d update you.

    I tried the protein cycling you suggested, with mixed effects. Some days I felt great on <30g protein with about 200g day starch, other days I would get shakey hypoglycemic-like attacks, I suspect this is probably from insufficient fat.

    What I have learnt is to become way less regimented and listen to my body. Sometimes I will feel like a load of protein for a few days and I indulge myself, I'll keep carbs to about 60g during this time, eaten in one go with my evening meal. The freedom to eat rice and potatoes is still amazing for me!

    Then I get 'proteined out', others may recognise this as when protein just stops filling you and you have a constant need for 'something', that's when I switch to high carb low protein for a few days.

    I find it much easier to IF on protein low carb days.

    At the moment I'm averging about 4 days high protein followed by 3 days high carb low protein. Which fits nicely with my working week. Carbs are always more fun on the weekends..

    Also, I asked you re: vitamin E a while back and wanted to let you know my experiences. I replaced my supplement with red palm oil which I use to cook with and in stews. Definite difference in mood and skin. I have a feeling it may be a slightly neglected nutrient.

  4. Hi Sarah,

    Thank you, those are very interesting experiences. I tried red palm oil, and didn’t care for the taste, but the mixed vitamin E components ought to be healthful.


  5. “Higher protein may promote athleticism and fertility, but shorten lifespan (as it does in some animals)”

    I think that is a conclusion I will keep in mind. I am basically following a Primal diet (Mark Sisson) because it feels great and because I am trying to overcome my PCOS. And I am spending a lot of (too much) time trying to understand what should be my precise objectives in terms of Fat/carbs/protein percentage, trying to reconciliate very different data/studies.

    I guess that is because I am trying to reconciliate the impossible : the best diet for optimal fertility (and a toned body) at 30 years old (20% protein, 20-25% carbs/100g of carbs from veggies mostly, and the rest of fat) and the best diet for a longer life with minimized risk of stomach/colon.. cancer (15% protein, 25-30% carbs from veggies and starch, the rest of fat).

    I guess i will do the second in due time, but right now I will keep on trying to minimize my insulin levels while I try to conceive. What do you think?

  6. Hi again,

    just noticed from the thread, that this is actually a very civilized blog where people actually greet each others, and I just bluntly commented and throwed a question in the air 🙂

    Sorry about that ! And as I am rewritting I will take the opportunity to thank you for your blog: just came from Mark’s list of blog to visit and I am very happy I found a new source of excellent info to confront my paleo/Gary Taubes influenced positions. It makes me think a lot.


  7. Hi Anais,


    Adding starch normally enhances fertility.

    Of course, insulin resistance is a problem in PCOS. The key to curing it is avoiding food toxins like grains and vegetable oils. Modest amounts of safe starches will exercise insulin pathways and tend to improve insulin sensitivity … So they may be beneficial. I would not rely on vegetables alone, but would ease in some safe starches like white rice, potatoes, taro, sweet potatoes and see how my body responds to higher levels.

    Are you obese? Are you trying to lose weight?

    Best, Paul

  8. Hi Paul,

    Thank you both for the book and this blog. I have already given a copy of the book to a friend dealing with serious chronic illness.

    I have been eating very low carb, high good fats for several years now trying to lower my A1c. But in fact my Alc has crept up from 5.3 to 5.8. So I have been experimenting and for the last several weeks I have added about 200 calories from safe starch….mostly white rice. I look forward to seeing if this will make a positive change in my next test. I hope so because I sure am enjoying the rice.

    I have added some of your supplements and been experimenting with my coconut oil intake. I have eaten a lot of it in the past, mostly in the form of deserts of homemade candies made with mixing the CO with chopped nuts, shredded coconut and either stevia or a tiny bit of honey or maple syrup, and sometimes, cocoa or tahini. But, both because I want to reduce my nut intake and would like to completely avoid sweeteners I decided not to have them for a while. Instead I am taking the coconut oil in my tea throughut the day.

    I have noticed several things so far:

    1) Since adding the rice, I do not have that craving for a little something for dessert. So it has been easy to give up the coconut candies.

    2) Not surprisingly, I am not as hungry for my meals ( i eat twice a day) when I have had several tablespoons of CO in my tea between meals as opposed to being incorporated in the dessert candies.

    3) I seem to sleep better if I have some CO in my tea in the evening. ( Staying asleep has been a problem for me for years. Low carb and a few other things helped considerably. But still some inconsistency. I sure hope this continues to be the case. It would be lovely to know I can count on staying asleep.

    4) Energy and mental function are much better on about 4 to 6 tablespoons spaced throughout the day.

    5) Since the CO seemed to have a positive effect, I thought more might be even better but found on several occasions that more than 6 Tablespoons has given me really vile, horrendous acid reflux. This is something I have never experienced, even mildly before. I remember years feeling slightly nauseous from even a tablespoon of it. I slowly built up my tolerance. But this is something else entirely.


  9. Hi Ellen,

    Very interesting, thanks for sharing.

    I wouldn’t worry much about A1c, Stephan’s was 5.8 and mine was 5.4 a year and a half ago, the only time I had it measured. Other factors like red blood cell turnover affect it, so it is not a pure measure of average glucose level. But more starch should lower it.

    I have come to the belief that mild ketosis is very beneficial, especially to the nervous system, but that high ketone levels are undesirable because they can promote certain infections. I think your experience supports that.

    A little bit of coconut oil provides some ketones for the brain, helps reduce glutamate levels, nourishes infected neurons, and improves innate immunity. Since the greatest benefits will be in the neurons, effects like improved sleep and mental function are to be expected.

    Acid reflux is always a hard one to interpret, since it can have many causes. One possibility is a small bowel infection.

    Does the reflux occur immediately following coconut oil consumption, or is it delayed? Does it persist through the day?

    Ketones are beneficial to fungi and protozoa. So Candida would be a possibility. Coconut oil is more anti-bacterial than anti-fungal, so too much might help promote Candida colonization of the digestive tract. Let me know if you get any skin, oral, or vaginal symptoms.

    I would make sure to eat plenty of vegetables, especially sulfur-containing vegetables like garlic and onion; and get plenty of potassium, since low potassium seems to make these conditions worse. You might try supplementing NAC. Eat plenty of salt.

    You might experiment with other therapies for acid reflux, like betaine hydrochloride for stomach acid, and choline/B6/B12 for methylation status. If the betaine hydrochloride helps, you might get checked for H pylori.

    Let me know how things go!

    Best, Paul

  10. Thanks Paul,

    By the way, I meant to include Shou-Ching in my thanks for all the work.

    It is reassuring to be told not to worry so much about Alc.

    The reflux was delayed both times. Just suddenly having burning horrid fluid in my mouth in the afternoons of days when I had had about a table spoon every hour or so.

    I was planning to just keep my coconut oil consumption at the lower level because I have never had reflux of any kind before.

    But you seem to be saying that it would be wiser to find whatever is preventing my from being able to comfortably consume more CO. I do think this reflux is indicative of something and would like to get to the bottom of it. Most of my symptoms ( see below) are so mild, that doctors are not interested, but I have long felt they are all connected to the sleep and energy/ mental focus problems that I have long struggled with and the doctors also couldn’t take seriously, cause I look fine when they see me. But the pattern has been so much like my mother who ended up with dementia at age 70 that I have been working hard to change course. ( I am 68)

    I think the fungal connection seems more likely. Especially since lowering carbs has been positive and I never had any reflux except with the high consumption of straight CO, unmixed with other foods.

    And I do have something going on with my skin. Along with a forty year long toenail and foot fungus (much improved by low carb, but not resolved) and… A rash near my mouth or sometimes around my eyes that has come and gone several times over the last 5 years. The rash is more red at night, itches only slightly and is somewhat scaly in the morning. There is also a very, really very mild redness on my cheeks that has a very definite line along the outside of my cheeks..where it stops and normal skin appears. That is barely visible… only when i apply heat or oil. Perhaps a very mild form of rosacea? I could never be sure and it is so pale that I haven’t even mentioned it to any doctor.

    Initially the dermatologist said the rash was perioral dermatitis, and at least had the grace to admit that so called diagnosis was only a name and meant they really didn’t know what it was but that antibiotics might help, although it might return later. And that is what happened. So when it came back I did not take antibiotics a second time and after about a year it went away again. Then a year or so later, it came back again several months ago. The only food connection I can make is with fermented dairy products, either raw milk kefir or well fermented cheese.

    So I will increase all veggies, especially the sulfur and potassium containing one, as well as salt and will try the NAC, if you are saying that would help with the fungal connection. Anything else I could do to pin down the fungal connection?


  11. Hi Ellen,

    Since you do have a long-time fungal infection, and the ketosis and low-carb will make that worse, I’m much more confident now that the acid reflux is due to a fungal infection, probably Candida. For fungal rosacea see my response to Todd, http://perfecthealthdiet.com/?p=269&cpage=2#comment-22709.

    I’m going to have to do a post on this, but quickly:

    1. Keep the coconut oil down … 2 tbsp per day should be enough. Olive oil is good if it’s fresh.
    2. Immunity: Selenium, NAC, beef gelatin or bone broth soups for glutathione, vitamin C, sunshine / vitamin D, thyroid optimization, some iodine but low enough and slow enough that you don’t mess up the thyroid, nitric oxide precursors (spinach, arginine), sufficient dietary starch, lots of potassium (bananas, tomatoes, potatoes, seaweed, etc.), a “mopper” such as chlorella (or charcoal or cholestyramine) to clear fat-soluble toxins, turmeric, vinegar, garlic, oregano, thyme.

    You might try a turmeric / black pepper / milk or white vinegar facial on the redness. You can use the same paste as a toothpaste. Probiotics, fermented foods, and an oral probiotic like Blis K12 are helpful. Good oral hygiene is important.

    Kefir and many fermented cheeses have yeast/fungi and can exacerbate these infections. I would stay away from yeast fermented products, use bacterially fermented products only.

    Best, Paul

  12. I’ve also been suffering from acid reflux and cutting out sugars (propably just FODMAP sugars) gave me a huge relief. But im still suffering from mild acid reflux occasionally and been suspecting coconut products for it. I consume coconut milk/oil about 1500kcals/day. My symptons comes about 2-3 hours after a meal.

    Im also suffering from acne which was my main reason to start reading about health about two years ago.
    I also have bloating and dandruff. It seems pretty clear that these all are somehow related together.
    Sometimes it just feels pretty depressing that I still after two years of eating pretty much “perfectly” compared to 90% of people have worse skin than the 90% of people. Maybe my gut flora is just in so bad shape after having several antibiotic regimens for my acne a few years ago. At the time I also had Somac for my acid reflux which obviosly was epic fail also. But how could I have known then.

    I’ve been adding a lot of rice syrup and white potatoes to my diet lately and been doing pretty good with them. Except a few new symptons.
    Im sleeping very restlesslly and waking up all the time. This is very new to me since I used to sleep like a baby. And sleeping restlessly seems to effect my acne negatively. It’s propably due the lack of nightly melatonin surge which somehow might imrove acne. Or then im not digesting some critical micronutrients so effectly after adding more starch which would be needed to stay asleep.
    Other new thing is stomach pains. Never had them before. It feels like it’s caused due the excess gas.
    Still wondering is it all starch or only white potatoes or rice syrup.

    It all starts to feel too complicated. Once you find a solution to one sympton you soon get another. An it doesn’t make it any easier that you basically have to selfexperiment all these things at the moment since there seems so be no medical tests available. And it takes years because there are so many variables from single micronutrient to stress, exercise and sleep.

  13. Thanks so much. One more question, if I may:

    You said:
    “Kefir and many fermented cheeses have yeast/fungi and can exacerbate these infections. I would stay away from yeast fermented products, use bacterially fermented products only.”

    So which fermented foods would that be? I eat miso and homemade lactofermented vegetables made with just salt and veggies. Would they be okay? Would there be some cheeses that would be acceptable?


  14. Hi jvn,

    I sympathize about the lack of medical tests and need to self-experiment. It’s true.

    My advice to you would be the same as what I just said to Ellen. You’re eating a lot of coconut oil so you’re on a highly ketogenic diet. Fungi can feed on ketones even better than they can on glucose. Generating more ketones than your body needs tends to promote these infections.

    Dandruff is usually caused by Malassezia, a fungus. Bloating is often caused by Candida.

    All of the advice I gave Ellen will help with these. Lots of vegetables, potassium, cysteine, nitrates, garlic etc.

    Acne, the sleep problem, and the starch intolerance are trickier. I would address the fungal stuff first as I think that’s probably the most serious issue and these other things might clear up if that is taken care of. At least the symptoms may clarify.

    Best, Paul

  15. Hi Ellen,

    I would do Google searches, but many cheeses are fermented with Lactobacillus – most of the probiotic capsule bacteria are used in dairy fermentation. Blue cheeses / moldy cheeses are to be avoided.

    Kimchi, sauerkraut, pickled vegetables are all good.

    Best, Paul

  16. Thanks for advices. But if I keep my coconut concumption down (which is now about half of my daily 3000kcals), how do I fill up the gap? Even if I ate the maximum 1200 kcals of carbohydrates and protein I’d still need 1800 kcals from fat. And dairy, except butter, isn’t an option because of the negative effect to acne and acid reflux.

    Maybe I should try a Kitavan like approach and eat plenty of starch instead.

    I always thought that coconut was one of the few safe foods for anyone. It feels like I’ve now seen it all.

  17. Hi jvn,

    Can’t you eat fatty meats? Egg yolks?

  18. Hi Paul

    I am implementing your suggestions Made on May 11 and doing well so far. (No more reflux.)

    As for “mopping up” what do you thing of the clay products for this purpose, such as Edible Earth or Pascalite? I have these on hand.


  19. Hi Ellen,


    I don’t have personal experience with those clay products but I expect they would work.

    Best, Paul

  20. Hi Paul,

    Im a bit worried about my blood sugar levels, more specifically fasting blood sugar which is about 5.5 (100). I eat about 150g carbohydrates a day, 200g of fat and 80g of protein.

    My postmeal blood sugar patterns seems a bit weird also, here are some examples. Every meal is about 800 calories, ingredients are same, just different macronutrient ratios. Carbohydrates are a mix of white potatoes, sweet potatoes and white rice. I experimented to eat a high carb low fat diet a couple of days also.

    Meal 1: 65% fat / 50g carbs
    One hour: 6,3 (113)
    Two hour: 6,4 (115)

    Meal 2: 60% fat / 80g carbs
    One hour: 6,3 (113)
    Two hour: 6,9 (124)

    Meal 3: 20% fat / 140g carbs
    One hour: 6,4 (115)
    Two hour: 6,2 (111)

    Then after a fast nothing but 60g of rice syrup:
    One hour: 8,0 (144)
    Two hour: 5,2 (94)

    I’ve tested these several times and the results are always similar. It seems that if I want to keep my post meal bloog sugar under 6,5 (117) I can’t eat anymore than 50g of carbs per meal eating a high fat diet. If I eat over 50g my one hour reading is still good but two hour reading is too high.
    But if I eat low fat diet I can eat at least 150g carbs per meal and keep my readings under 6.5 at all times. Why does fat make this delayed rise and is this normal? Also why are my two hour and fasting readings that high? Only time I’ve seen it go under 5.6 (100) is when I did the rice syrup test. On the other hand it rarely goes over 7 (126), only if pure glucose is eaten or if a lot of fat and carbs are eaten together.

    Eating a low fat high carb (70/20) diet as a experiment taught me a few things. To meet my calorie needs I had to eat a huge amount of starchy tubers per meal. The amount is physically so big that it is almost impossible to eat too much calories even if I tried. If some of the tubers are replaced by rice it’s much easier to overeat as it’s very easy to eat too much fat. I don’t have weight issues but if I had I definitely would consider this type of a diet. Just starchy tubers (not rice), a little animal protein and a little bit of coconut milk for example, just like Kitavans do. This also offers a lot of micronutrients (especially if sweet potatoes, taros and yams are eaten) and should keep blood sugar pretty low due the low GI nature of these foods. I found the food pretty unrewarding, I had no cravings for anything after a meal. Even a rice combined with butter feels pretty rewarding to me not to mention rice syrup. That’s why I’ve decided to stay away from these eventhough in theory they are safe in moderation. For me the only problem with this type of diet was the higher soluble fiber content which makes my acid reflux worse. What are your thoughts?


  21. Hi jnv,

    First, your numbers are normal. Rice and rice syrup are high glycemic index so they’ll tend to produce a quick up and then a quick down in blood sugar. The tubers digest more slowly and raise blood glucose less but for a longer period.

    The blood glucose response to tubers is preferable and I agree, tubers are a good strategy for weight loss.

    One thing to keep in mind in interpreting these numbers is that higher carb intake generally leads to lower fasting glucose and to lower blood sugar rises after a carb-rich meal. This is due to glucose conservation measures that kick in on low-carb diets. Low-carb dieting usually does not lower blood sugar, but it does lower glucose within certain cell types, and also makes long fasts more tolerable.

    If I eat 50g carbs per day my fasting blood sugar is about 100, similar to yours, if I eat 100g it goes down to the low 90s and at 200g probably into the 80s.

    I also go up to about 140-145 with a rice oral glucose tolerance test.

    Best, Paul

  22. An update.

    After eliminating the all the molds, which included not just miso, kefir and the blue and bloomy cheeses, but all cheeses, because no cheesemaker I contacted could completely assure me that mold did not enter the long aged cheeses through the air, my rash was greatly reduced. But would not completely disappear. Putting turmeric in my food seemed to help. So then I started taking a curcumin supplement, Meriva-SR by Thorne, and voila, rash gone!

    But I am curious because now I am remembering that the first time I had this rash the dermatologist gave me Tetracycline. I had to take a larger dose than he intitially perscribed and take it for twice as long. But it did finally do the trick. But if it responded to an antibiotic then and antifungal tactics now, what does that say about the actual nature of the infection? The rash is gone but I still have sleep disruption and hangover like brain fog and exhaustion from eating even slightly more than 200 cal of safe carbs. And I suspect this is related to the rash.


  23. Hi Ellen,

    Does the clay help clear up the sleep disruption and brain fog? If it’s not working you might ask your doctor for cholestyramine, it’s very effective.

    I think you need a lot of probiotics and continued antifungals to rebuild the gut flora and drive out remaining pathogens. Don’t be shy about taking 6+ probiotic pills a day. I like Primal Defense for the wide range of species, also L reuterii and some of the anti-fungal species like Bacillus subtilis. Kimchi is also helpful. It might take months before your gut is fixed and you can tolerate starches well.

    I think there’s rarely only one pathogen involved. Candida and bacteria can form biofilms and support each other. Also, tetracycline is anti-inflammatory as well as antibiotic, so that could be the mechanism. I think your experience is fairly common but the researchers haven’t figured it out yet.

    Best, Paul

  24. Ah! biofilms. That makes sense. As does the mechanism of inflammation. But I am learning to be happy with finding what works, even if I never fully understand why.

    I am eating lots of Kinchi and homemade 24 hour raw milk yogurt. All your supps, and taking a probiotic: Doc’s Friendly Flora which does contain Bacillus subtilis. But not the L. reuterii, which doesn’t seem to be in the Garden of Life either.

    Where do you get the L. reuterii?

    Probably would be a good idea for me to switch off between G of Life and the one I am taking.

    I will see if i can get some cholestryamine.

    The really bad sleep disruption and hangover/brain fog seems only to happen with the higher carbs, especially, but fruit,and even so I do seems to have some degree of blood sugar dysregulation

    I find myself between a rock and a hard place: I can only have bareley accepatble numbers on a ketogenic diet, which will then kick off the fungus. If eat the minimum of the safe starches as I have been doing for the past two months, my fasting goes up to around ll5. If I eat any more I can easily have a fasting around l125

    I am going to try Metformin if I can get the doc to perscribe it.

    I am also experimenting with taking a second Circumin capsule at night, which “seems” to help the sleep.. It also has been giving me more vivid, memorable dreams (mine are usually a complete blur)


  25. Hi Ellen,

    Here’s a source of L. reuteri: Nature’s Way Primadophilus Reuteri, 90 Vcaps

    Unfortunately when you have 2 or more problems it’s not always possible to optimize simultaneously for both. You have to pick your poison, try to fix one, and then move on to the others.

    I think the metformin is a good idea, I would probably accept a slightly elevated blood glucose and try to get rid of the fungus. But that’s just a guess.

    Best of luck,


  26. Ever since reading the book (I was already mostly Paleo before), I stopped looking for and asking for the lean cuts of meat. In fact I have been seeking outer fattier cuts (rib eye and the like) and have been enjoying eating the fat (TREMENDOUSLY). I just want to make sure I am in compliance with the diet.
    Also, I used to suppliment with flax seed oil and have completely stayed away from flax and fish oils since reading the book. I assume your take on flax seed is that it is way too high in PUFA?
    Lastly, I am an endurance athlete. There are days I can burn upwards of 2000 calories. On those days I am mostly aerobic, but do spend time in my anaerobic zones as well. Should I be consuming more than 600 carb calories on those days? Same with after races when I can go for over two hours completely anaerobic?
    I am really enjoying this journey even though, my family thinks I am crazy because this is a complete swap in diet from where I was in the past. I am thoroughly enjoying the cream cheese (which I had not eaten in years), heavy and sour cream and high fat foods!
    Thank you!

  27. Hi Eliot,

    Sounds like you’re doing great!

    Flax seed is fine but I wouldn’t recommend eating huge amounts.

    As an endurance athlete, you’ll probably benefit from somewhat more carbs. I suggest estimating how much glucose you utilize, it should be about 600 calories + 100-400 calories per hour of training depending on intensity, you can estimate glucose utilization using heart rate as percent of maximum and tables you can find by Google. Typically glucose utilization might be 30% of total calories expended during training.

    Once you estimate how much utilize, the basic version of the diet would be to eat 200 calories less carbs — maybe 400 calories less if you eat more protein and coconut oil.

    If you’re burning 2000 calories in training, and 30% are glycogen derived, then daily glucose need is about 1200 calories and the basic diet would be 1000 carb calories plus 400 protein calories per day.

    This formula emphasizes longevity and immunity to bacterial and viral infections, and will tend to promote fat metabolism over glycogen metabolism. If you want to emphasize athleticism/speed/power more, then eat more carbs than that. Nothing wrong with eating 1200 or 1500 carb calories a day. It might help you recover faster from training and gain muscle.

    You can also vary carb intake, less carbs sometimes when training to promote fat metabolism and high carbs at other times during training to promote glycogen metabolism and before events (carb loading is a good idea).

    Please let me know your experiences, I’m curious how endurance athletes do on our diet.

    Best, Paul

  28. Thanks. I ordered the the L. reuteri.

    Do you get a percentage from anything I buy on Amazon if I get there through your website? Or only the things listed in your recommended supplements?

  29. Hi Ellen,

    I get about 7% of anything you buy from Amazon, if you get there from a search box on my site.

    Thanks for supporting us!

  30. Hi Paul,

    I’m feeling a tad overwhelmed. I‘m a 55 yr old female. I have Graves‘ and Hashimoto‘s; although I still have antibodies, I feel that I have managed my thyroid condition well (I still have my thyroid despite many endocrinologists suggesting otherwise). I‘m on 3 grains of Armour a day. My TSH is usually .0something. I come from many years of paleo/primal, low carb, and WAPF, so your recommendations are just a tweak that are not hard to implement. The good news: My constant sinus drip, drip, drip seems to be abating. Nose sores are healing although not all together gone yet. My sleep is a little better, but I’m still waking up around 2 am every morning usually because of a wicked hot flash, although I’m now able to get back to sleep. New symptoms are appearing that are worrisome: Both of my thumbs are “clicky” and sometimes I have to pull on a thumb to realign it (if that makes sense). I think its RA, but not sure. Because I no longer do very low carb (loving the safe starches btw), my blood sugar is up (typical fasting is 113) as is the tingling in all my toes. I’ve put on 10 lbs. I’m not too concerned with the weight; I know it will come off when I address my health issues. I burp a lot (not too ladylike!) and I also believe I have a UTI that I’ve been keeping at bay using D-Mannose supplements. I feel like I’ve taken 3 steps forward, and then two steps back!

    Currently I am talking all the supplements that you recommend on your website and in the book. I’m eating between 200 and 300 carb calories (white rice, potatoes, sweet potatoes and berries). I keep protein to ½ lb to 1 lb (big change for me coming from paleo/primal, no grains). I consume approximately 1 to 2 tbsps of coconut oil, and most days 4 to 6 oz of organic heavy cream from Trader Joe’s. I also eat my veggies. I eat two meals a day in an 8 hour window. I eat raw sauerkraut when I think of it. Recently I started tracking the foods that I eat on fitday. Total calories are coming in at around 2500 (or more), with the majority of them being fat calories. I’m 5’8”, and moderately active.

    Any suggestions would be greatly appreciated.

    Thank you!


  31. Hi Teri,

    Graves and Hashimoto’s — quite the combination! Good for you, resisting the surgeons and the radioactive therapists.

    Let’s start by trying to understand the infections. You have some kind of gut infection that causes the burping. There’s a good chance it’s the same pathogen(s) as in the urinary tract. The weight gain is probably in part because of the gut infection, various inflammatory cytokines released by immune activity in the gut cause the neighboring adipose cells to add fat. When you have immune activity against pathogens, you get die-off toxins. The joint pain can be either caused by direct infection, by circulating toxins that collect there, or by immune activity against the pathogens and toxins. Same with the neuropathy. The pre-diabetes I think we should worry about after the infections; if you fix the infections it might clear up on its own. Bacterial endotoxins / lipopolysaccharide can cause pre-diabetes. They should also elevate liver enzymes – are yours high?

    The first thing I would do is to try to figure out what the pathogens are. There are various tests your doctor can order on urine and feces to determine the pathogens in your gut and urinary tract. I’ve linked before to this one: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects. DNA testing is better than culturing the stool. Do you have a cooperative doctor?

    If you can figure out the pathogens then you should get antibiotics which target that pathogen. Diagnostic testing is a better way to start because choosing the wrong antibiotics can do more harm than good.

    I would focus on the gut because if you can fix that everything else will probably clear up.

    Probiotics, enzymes, fermented vegetables can all help.

    Another thing to consider are aids to help remove circulating toxins. I had a big benefit from cholestyramine, which binds bile and carries fat-soluble toxins into the feces instead of allowing them to be re-absorbed with the bile and circulate indefinitely, as they can do. Cholestyramine requires a prescription, but over the counter alternatives are bentonite clay, activated charcoal, and chlorella. Chlorella didn’t work for me but I probably wasn’t taking enough.

    Also, getting lots of salt with your food and drinking lots of water will help remove water-soluble toxins. Salt can also improve the microbes of the upper digestive tract.

    Hope that helps. Keep me posted.

    Best, Paul

  32. Hi Paul,
    I thought i might give the bentonite clay.
    I saw this stuff;
    “Hydrated Bentonite 964ml. Each 15mL dose contains:
    730mg microfine bentonite clay suspended in purified water”
    in the local shop, is it the right thing?

    product link:

  33. Hi!

    Just wanted to say how much I enjoy this blog. And y’all are the nicest people! (I truly appreciate how diplomatic and friendly you are in your posts, even when disputing points, because on some blogs it gets really ugly between the blogger and the criticizing poster – for some reason, that makes me uncomfortable. Possible throwback to my Asian culture of “everyone needs to play nice”?) Anyway, I was trying to email you this question, but I couldn’t find an address, so I figured I should post a comment here. I am Korean, which means rice is a big part of my diet, although I don’t eat it all the time, but it’s hard to stay away from it (especially when eating traditional Korean foods, rice is like the background on which all the side dishes are presented against). I also get Dr. Mercola’s emails and he had an interesting article regarding rice (among other things, like potatoes and tomatoes). He states that rice has chitin binding lectins similiar to wheat lectin. (http://articles.mercola.com/sites/articles/archive/2011/07/05/other-nonwheat-grains-can-also-hurt-your-health.aspx) Just wondering what your opinion is on this, since you consider rice to be more benign than wheat, but it seems Dr. Mercola is saying it’s no good, and he’s against carbs that are not from veggies. Anyway, keep up your good work! I am about to order your book from Amazon and am excited to read it. I think the whole “paleo” movement is heading in the right direction, but it seems there are always variations on what’s “correct” for every person. I am trying to gather as much info as I can and do lots of n=1 experiments to see what works for me. Thanks for helping me on that journey.

    Take it easy,
    Su Jin

  34. Hi Su Jin,

    Thanks! Of course we have the nicest commenters, so it’s easy to be friendly.

    When you look at the references, the only mention of rice is in this paper: http://www.ncbi.nlm.nih.gov/pubmed/17769370. It says that the antigenically similar rice lectin is only found in the coleoptile (http://en.wikipedia.org/wiki/Coleoptile) (shoots) and the roots — not in the grain.

    In any case I believe rice lectin is destroyed in cooking.

    I wouldn’t worry about rice until there’s actual evidence of danger. All plants have toxins, so just the presence of a toxin in some part of a raw plant is not enough to prove that a specific part is dangerous after cooking.

    Best, Paul

  35. @jvn

    I thought I would let you know about my wife’s experience with acne in case it helps. She has suffered with it since puberty. Going low carb definitely helped, as it did with her reactive hypoglycaemia, but it seems to have worsened again, despite her staying low carb paleo(ish).

    2 months ago we started her on daily supplementation of 2g vit C, 1g morning and night, and this has greatly improved her acne. I’m not sure what the biology behind this would be (and we actually did it for histamine reduction reasons) but it’s a nice side effect!

    All the best


  36. Hi Roger,

    Thanks. Fascinating about the vitamin C and acne!

  37. HI Paul

    It was a surprising outcome, but I just realised that we started supplementing a Quercetin/Bromelain combo at the same time, at around 500mg Quercetin per day, which conflates it a little. We will probably stop the quercetin shortly and see what happens.



  38. Hi Paul,
    I have read on the wheat belly site that tapoica starch,potato starch as well as rice starch can raise glucose levels higher than gluten foods…I’m confused…is this true or did I missunderstand?

  39. Hi Lisa,

    Check out this post: http://perfecthealthdiet.com/?p=4937.

    It’s about glycemic index, which is to what degree a given amount of these foods will raise blood sugar. The bottom line is that if you’re eating these as part of healthy meals, as you should be, instead of in isolation as snacks (eg cookies or cakes), then they won’t raise blood glucose much.

  40. How Does a Cell Avoid Obesity? | Perfect Health Diet - pingback on May 28, 2012 at 5:34 pm
  41. Hi Paul,
    Good stuff here. Glad I found it if not a little late and I missed it in the book. I’ve had a known fungal issue, probably for years, got food poisoning last year and have had a tougher time getting things to normal after that. My practitioner thought I probably had EBV, from hears of off and on lymph node swelling, etc and I thought I had the fungal thing under control…but I went keto on the diet and the last month has been terrible…just found this today and what a great reminder to make adjustments. One quick question that I could not find the answer to…whey protein…is it a problem with a fungal infection? I’ve enjoyed Mark Scisson’s but it caused bloating, Mercola’s did not, but maybe it’s causing other issues?

    Thanks for all that you do!


  42. Hi Paul,
    Thank you…I agree not absolutely necessary but I sure like some of the combinations and it’s a good way to get the chocolate fix:)

    One thing I wanted to pass along to you…I have been using a product called Syntol. It’s a combination of various strains of probiotics, prebiotics, and enzymes and it’s worked well I think when I’ve used it. I fell off the routine when I felt better after a few months, but as you noted, it may take longer than that to get a fungal infection under control.

    Thanks again,

  43. Hi Paul.
    What’s your take on brewers yeast powder as a healthy source of b vitamins,chromium and selenium?
    Thankyou and a happy new year to you and Shou Ching

  44. Hi Paul,

    This string of commentary has stirred some good ideas on what I might do to improve this dual infection (virus and fungal). You said in the book that most people have both types as you categorized them. So my main question is what can one do to work against both? I’m assuming just work to build the immune system?

    Earlier you suggested Iodine sups but where does one start on this if your thyroid is doing fine? If you do too much what happens?

    On a blog today, someone mentioned Apple Cider Vinegar works on fungal infections. Your thoughts?

    What about fasting, or intermittent fasting. Is this good for fighting any infection?

    And finally this is probably a dumb question but what’s the best way to avoid ketosis so as not to feed fungal growth?

    Thank you again for your time and help, I very much appreciate it.

    • Hi Mark,

      The advice in our book is what we have confidence in. That will answer most of your questions.

      I am not aware that apple cider vinegar is an effective antifungal, but it is a healthful food in moderation.

      Fasting is good for many infections, as long as calories are not overly restricted.

      The main requirement for avoiding ketosis is to obtain adequate calories including adequate carb and protein, and not to eat too much MCT oil.

      • Thank you Paul. I continue to refer to the book and keep discovering something new…so much to cover there. I think I went off track a bit on the MTC oil. Love the stuff, but the fungal infection did too apparently.

        I also discovered something else which you note in the book. I don’t know if this applies in my case, but I realized I may have taken the primal thing too far. I felt pretty good right off, but over the last months things just declined and in the last month I’ve been sick more than not…just getting over the flu now.

        In early november a blood test showed things looking good. Serum Glucose was 90 mg/dl but I don’t know if that means anything in terms of how one feels. I eliminated starch pretty much other than having rice maybe once a week at best. I just feel that my immunity dropped badly, yet wouldn’t the glucose reading be lower than this? Just trying to figure out where I got so far off.

        Once I get things corrected and feel well again, I’ll come back and try so summarize things and what worked the best.

        Thank you again!

  45. I have been reading through all your old blogs this weekend, I can’t believe how you keep up with answering the comments,,,wow.

    I have something to say about this post in particular. I tried adding in some safe starches last year and immediatelt started gaining weight, so i quit after week or two and said ‘never again’. I was fully behind Kruse and Eades that you were a quack and no starch was safe.

    Now, a year later, and after ‘discovering’ potatoes, I find I can add safe starches at your recommended rate and have experienced no weight gain, in fact, maybe some loss.

    I wonder if the dieting body goes through phases where someone (like me) coming from severe metabolic syndrome, needs a period of low carb and has trouble tolerating starches, but after a year or so, can once again include safe starches in their diet.

    Last year, I had terrible gut function–a banana would give me gas for days. Now, I can eat cabbage, kimchi, bananas, etc.. with no gas whatsoever.

    Whatever the answer is, you are definitely leading us out of the dark and into a better way of eating. Going from primal Blueprint to PHD 2012 edition was as easy as adding 2 potatoes and cutting meat by about 1/3. Just doing this I am seeing better sleep and not wanting to snack in the evening.

    The sleep improvement is the most noticeable improvement–I was jolting awake every night 4-5 hours after going to sleep for over a year. I had convinced myself this was normal ‘bi-phasic’ sleep, even though I knew it was wrong. It is very bizarre to wake up 2-3 minutes before my alarm goes off like I used to do when eating SAD.


    • Hi Tater,

      Thanks for sharing your experiences. They’re very interesting.

      It does sound like you had some sort of gut dysbiosis / SIBO that made carbs hard to handle, and that the low-carb diet got rid of it. Chalk one up for low-carb.

      But as you’ve found, the healthiest thing is to cure the gut issue and then eat a moderate carb diet, rather than stay low-carb forever. I’m glad you found your way!

      • The transition into adding carbs is what kills Atkins for most people–it is so very hard to know when, how much, etc…and when people see a single pound of weight regain they jump straight back to ‘induction’ level carbs.

        I think most people who are doing the PHD are starting from LC Paleo and not SAD so you have an easier task with these people, but anyone going from SAD to PHD may have completely different experiences.

        If someone told me a year ago I’d be eating a pound or more of potatoes a day, I’d call them crazy!

  46. Hi Paul,
    I’ve been suffering from recurrent yeast infections. Some of my symptoms were constipation, acne, pms, foggy brain, sugar cravings, insomnia, etc. I’ve been following your diet from the past 6 months. Basically, eating sweet potatoes, coconut oil, minimising protein, and taking the supplements. My skin has cleared up, but I’ve experienced recurrent die-offs: basically diarrhea. Certainly my condition improved, but I still had bad carb cravings, sleeping disorders and bad pms symptoms. I read last week about the anti-fungal properties of pumpkin skins. So, I tried some last week, and experienced a massive die off two days after: diarrhea, stomach cramps, etc. But, foggy brain and sleeping disorders appeared to be gone. It might have been the pumpkin skin, because other than that, my diet has been the same. I just wanted to share with other followers of your blog. Probably, they find it helpful. All the best,

  47. An article about the antifungal properties of pumpkins

  48. Hi Paul,

    I have been on the Perfect health plan (don’t want to call it a diet) for about a month and my energy and foggy thinking are soo much better. I still have carb craving mid month about day 15-19 of my cycle. Any thoughts on this? Also is it okay to eat brewer’s yeast? I can’t seem to get enough of it…


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