Category Archives: Book Reviews

Paleofantasy and the State of Ancestral Science

NOTE:  PaleoFX is coming up quickly and my talk will be related to some of the issues discussed below. It’s going to be a fun meeting. If you’d like to attent, buy a ticket or try your luck in FastPaleo’s PaleoFX ticket giveaway.

Marlene Zuk is an evolutionary biologist at the University of Minnesota, and her Paleofantasy: What Evolution Really Tells Us about Sex, Diet, and How We Live is an important milestone for the Paleo movement: professional evolutionary biologists and anthropologists are now responding to Paleo ideas.

I haven’t yet read Paleofantasy but I have read:

Of the reviews, John Hawks in Nature is the most useful. Most Paleo community members have taken the term “Paleofantasy” as an attack upon the Paleo diet and lifestyle – as an assertion that our views conflict with reality – but Hawks suggests another take:

Zuk’s use of the term ‘fantasy’ is just an emphatic way of describing the hypothesis-forming that is essential to evolutionary science. We play with hypotheses, explore their predictions and try very hard to falsify them. So it is, in a way, unremarkable that so many hypotheses proposed by anthropologists about ancient environments now seem to be wrong — and, in a few cases, even ridiculous. [1]

The title “Paleofantasy” may sell more books than “Paleohypothesis,” but the latter is undoubtedly more accurate. The Paleo movement is based on a scientific hypothesis, and exploring its validity is a very reasonable thing for an evolutionary biologist to do. The ancestral health community should be flattered, not offended, that its science is being engaged by other scholars.

The Paleo Hypothesis

What is the Paleo hypothesis? The original version was expounded by Melvin Konner, Boyd Eaton, and others in the 1980s and 1990s. Here is Melvin Konner’s (2001) summary:

One approach, applied by Eaton and colleagues since the mid-1980s, is to consider the environment of evolutionary adaptedness for our species and to view it as the shaper of the latest draft of our genome…. This approach leads us to the discordance hypothesis, which attempts to assess the disjunction between those environments and the ones we live in now … [S]everal important chronic degenerative diseases have been interpreted as “diseases of civilization” because they appear to result from this disjunction. [2]

I’ve bolded the key ideas: that humans have an “environment of evolutionary adaptedness” approximately represented by the Paleolithic, and that multiple diseases result from a discordance between the modern and Paleolithic environments.

To operationalize the Paleo hypothesis, one must identify a modern implementation of the Paleolithic diet and lifestyle – not necessarily a complete re-enactment, but mimickry in essential elements. The most influential operationalization was created by Loren Cordain in The Paleo Diet (2002) and subsequent popularizers such as Robb Wolf tracked his diet closely. Their advice can be found on Cordain’s “What to Eat” and Wolf’s “What is the Paleo Diet?” pages: eat meat, fish, eggs, nuts, fruit, and vegetables; eschew starches, dairy, and some other foods.

A Target-Rich Environment

Both the Paleo hypothesis and its popular operationalization are vulnerable to challenge.

Most vulnerable is the operationalization by Cordain. It consists of an odd mix of foods. The meats, in accordance with archaeological evidence, derive mostly from grassland herbivores, while the plant foods – nuts, fruits, and vegetables – come largely from forest plants – trees. It is almost as if the evolutionary picture was that humans are chimps who learned to hunt, and our ancestors would dwell in the forest like chimps when foraging for plants but commute to grasslands to hunt animals.

This view drives Paleo toward a low-carb diet, since modern domesticated fruits and vegetables generally have only 50 to 200 carb calories per pound, and Paleolithic fruits and vegetables had even less. It would not have been easy for Paleolithic hominids to gather and eat many pounds of forest plant foods per person per day – especially when bipeds are not suited for getting fruit and nuts out of trees, and much of the band would have been hunting animals in a sparsely-treed semi-open grassland!

Not surprisingly, anthropological evidence has found that Paleolithic diets were quite different from the meat, fruit, and vegetables diet. There is little doubt that in the Paleolithic, starchy plants were a more important source of carbohydrates than fruits, just as they are among modern hunter-gatherers.

What is interesting about Zuk’s work is that she takes on the theoretical part of Paleo – the hypothesis of modern discordance with an environment of evolutionary adaptedness. Many in the Paleo movement take this as foundational, so if it were rebutted then one might think it would call into question the whole ancestral health movement.

Zuk’s Critique of the Paleo Hypothesis

Zuk’s critique strikes me as sound but disappointingly unambitious.

The Chronicle excerpt focuses on the persistence of evolutionary change:

[I]t is easy to assume that evolution requires eons. That assumption makes us feel that humans, who have gone from savanna to asphalt in a mere few thousand years, must be caught out by the pace of modern life …

[D]iscoveries like [the timing of the development of lactase persistence] make it clear that we cannot assume that evolution has stopped for humans, or that it can take place only ploddingly, with tiny steps over hundreds of thousands of years. In just the last few years we have added the ability to function at high altitudes and resistance to malaria to the list of rapidly evolved human characteristics …

Gregory Cochran and Henry Harpending even suggest that human evolution as a whole has, on the contrary, accelerated over the last several thousand years …

In one way Zuk is understating her point. Human genetic change did accelerate significantly over the last 10,000 years, due to rising populations which introduce new mutations to the human genome more frequently [3], and due to changes in selection pressure resulting from the establishment of large-scale societies following the domestication of animals.

Yet in another respect she is exaggerating it. The time required for favorable mutations to spread through the human population hasn’t shortened much since the Paleolithic. Even the most strongly selected recent mutations, such as that for lactase persistence, have spread only partially through the world’s peoples. There has certainly been insufficient time for the rest of the genome to evolve to an equilibrium with recently introduced mutations.

Yet, in the Paleolithic, the ancestral diet was probably similar in general outline for at least 2 million years: it consisted largely of meat, marrow, and plant foods collected from open woodlands and tree-spotted grasslands. There was sufficient time for new mutations to appear and rise to fixation, and then new mutations to appear and reach fixation against this new genetic background, and so on for many cycles. It is certainly possible that humanity became adapted to this (slowly changing) Paleolithic diet, and that the genetic variety introduced in the Holocene has been insufficient to destroy our fitness for a diet like that of the Paleolithic, and insufficient to make us well adapted to new Neolithic diets.

This point – that the relevant time-scale for assessing adaptedness may be the time for the genome to reach equilibrium, not merely the time for new point mutations to appear and grow to regional prominence – is an elementary one in evolutionary biology, one that is made in our book on pages 4-6, but from the Chronicle excerpt and various reviews (including this Amazon reader review), it appears that Zuk does not acknowledge this reason why treating the Paleolithic as an environment of evolutionary adaptedness may be a “Paleoinsight,” not a “Paleofantasy.”

Nor is it necessarily the case that adaptedness to the modern environment is assured by rapid recent evolution. To illustrate my point: a diet of Twinkies and Coca-Cola could never be healthful, and could never become our optimal diet, no matter how many billions of years we spent adapting to it. It simply lacks the nutrients needed to support sophisticated life.

So Zuk’s major points – that evolution has been a process of continuous change, never reaching a stable equilibrium; and that Paleolithic environments were diverse, making it difficult to specify an environment of evolutionary adaptedness or establish modern discordance with it – do establish that the Paleo hypothesis is not automatically trustworthy and needs to be supported in any given application by specific evidence. But she did not prove that it is never useful. It may guide us to a better diet and lifestyle.

Entertaining, But Unambitious

From reader reviews, the verdict emerges that Zuk wrote an entertaining book, using “Paleofantasies” as hooks on which to hang interesting facts, observations, and insights from evolutionary biology.

But most Paleo readers seem to have wanted a more ambitious undertaking. Most Paleo reviewers seem to agree with Theodore Roosevelt, who taught that in science

It is not the critic who counts … The credit belongs to the man who … strives valiantly, who errs and comes up short again and again, … who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly … (“Citizenship in a Republic,” speech at the Sorbonne, Paris, April 23, 1910)

Evolutionary biology has much to teach us about how we should eat and live for best health. It would be good for evolutionary biologists to spend themselves for the worthy cause of identifying those truths.

What Does the Paleolithic Tell Us About Our Optimal Diet?

Coincidentally I came across a TEDx talk on Paleo diets by archaeologist Christina Warinner that makes a creditable effort at providing an alternative operationalization of a “Paleo diet.” Ignore the first three minutes in which she calls Paleo a fad diet based on meat; the latter part of the talk is excellent.

She makes the excellent point that domesticated plants have been bred for reduced toxicity. We may now be able to eat a much healthier diet than was possible during the Paleolithic, thanks to reduced-toxicity plant foods.

Warinner suggests the following modern operationalization of the “Paleolithic diet”:

  1. Eat a diet high in species diversity. Do not, as Americans do, concentrate plant consumption among a mere three species: corn, soy, and wheat.
  2. Eat fresh foods. Stored food loses nutrients and spoils; preservatives that inhibit microbial growth may disturb our gut microbiome.
  3. Eat whole natural foods; avoid refined processed foods. Natural foods have a full package of nutrition and healthful fiber. We should not indulge our new-found ability to consume sugar far more rapidly than would have been possible in the Paleolithic.

These are all points we make in Perfect Health Diet:

  • The benefits of diets high in species diversity are discussed in chapter 24 – because “the dose makes the poison,” diverse diets prevent toxins from becoming poisons.
  • The benefits of eating “recently living plants and animals” rather than processed foods constructed of purified nutrients are discussed in chapters 2, 8, and 23.

Warinner’s three recommendations are an excellent start toward a healthy diet. It’s good to see a scholar venturing to make prescriptive suggestions.

Yet I think that evolutionary biology can tell us much more than this. To see what it teaches, we have to broaden our perspective beyond the Paleolithic and the original “Paleo hypothesis,” and venture into biology.

Maybe “Paleo” Should Stand For Paleozoic Diet

One of the novel insights of Perfect Health Diet is that the evolutionary roots of the optimal human diet are ancient – they extend back to the start of the Paleozoic Era 541 million years ago when a great flourishing of multicellular life took place.

The rise of multicellular life depended on the use of carbohydrates to glycosylate membrane proteins and to form a carbohydrate-rich extracellular matrix to support multicellular structures. This increased use of carbohydrate was the last major change in the macronutrient composition of life. As life feeds on life, it represented the last major change in food.

In Perfect Health Diet, we discuss a number of evolutionary patterns determined by evolutionary selection and indicative of our optimal diet:

  1. Until bodily protein is depleted, all animals tolerate fasting quite well. This is because the composition of the body closely resembles the composition of our optimal food, so that self-cannibalization is nourishing.
  2. Breast milk has a similar composition in all mammalian species. This is because all mammalian species – whether herbivore, carnivore, or omnivore – need the same nourishment.
  3. Evolution doesn’t modify the body’s composition in order to exploit a new environmental niche, but rather modifies the digestive tract’s ability to transform novel foods into the desired nutrient mix. Herbivores, carnivores, and omnivores have similar nutritional needs and similar bodies; only their digestive tracts differ. The digestive tract is evolutionarily “plastic” in a way the rest of the body is not.
  4. In humans, the brain’s food reward system is an important guide to our most healthful diet. As dominant hunters and skillful foragers, ancestral humans had their choice of foods. Mankind’s Paleolithic evolution developed a food reward system that helps us choose an optimal mix of foods, and that brought us a diet that required minimal transformation by the digestive tract, enabling digestive organs to shrink. This is Aiello and Wheeler’s “expensive tissue hypothesis” [4], re-interpreted.

From this perspective, the optimal human diet was determined 541 million years ago, at the start of the Paleozoic, when the composition of animal flesh was more or less fixed. From that point forward, it was evolutionarily inevitable that as soon as a creature became able to “rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground” (Genesis 1:26), so that the whole world became its buffet table, this creature would lose its expensive digestive tract and gain a brain capable of guiding it to a healthful pattern of eating.

Our optimal diet is deeply constrained by our biology; it does not vary in any environment. Environmental changes that bring a new dietary niche force evolutionary changes to our food reward system and our digestive tracts, but they do not change the optimal human diet – one that, like breast milk, is little altered by evolutionary change. Because our body composition is evolutionarily stable, the mechanisms by which we select our foods and transform imperfect diets into something better are changed; not the mix of nutrients we need.

I like the name “Ancestral health movement” better than “Paleo” because it is less specific about whether there was a specific time of evolutionary adaptedness, or when that was. In truth, different organs of the body reached evolutionary adaptedness at different times – some as far back as 541 million years ago.

But from another perspective, “Paleo” is quite fitting. The Perfect Health Diet is truly “Paleo” – in the sense of Paleozoic, not Paleolithic.


The Ancestral Health Society is forming a new scholarly journal, The Journal of Evolution and Health, to complement its annual Symposium.

It is coming at a good time: when scholars have begun to appreciate the significance of the Paleo/Primal/PHD/Ancestral movement, yet remain unfamiliar with its recent scientific and intellectual developments.

Yes, the scientific hypotheses on which “Paleo” began were flawed (though insightful and scientifically productive); but a newer and better scientific foundation has been developed.

The Ancestral health movement has become popular because it works: it truly does heal and prevent disease, and millions have experienced its benefits. So it is no fad diet, and will not fade away.

I hope that scholars like Zuk and Warinner will continue their engagement with the ancestral health movement, and help us refine the science still more.


[1] Hawks J. Evolutionary biology: Twisting the tale of human evolution. Nature. 2013;495(7440):172 – 172.

[2] Konner M. Evolution and our environment: will we adapt? West J Med. 2001 May;174(5):360-1.

[3] Hawks J, Wang ET, Cochran GM, Harpending HC, Moyzis RK. Recent acceleration of human adaptive evolution. Proc Natl Acad Sci U S A. 2007 Dec 26;104(52):20753-8.

[4] Aiello LC, Wheeler P. The expensive tissue hypothesis: the brain and the digestive system in human and primate evolution. Current Anthropology 1995 Apr;36(2):199–211.

Reader Feedback: A Roundup with My Reflections

We were very curious to see how readers would react to the new edition. Some of the reactions I think are interesting.

How Paleo is PHD? How PHD is Paleo?

One of my New Year’s resolutions is to do more on social media. Google+ has “communities” now and a few days ago I started a Perfect Health Dieters community just to see what it’s like. Paul Halliday, proprietor of Living in the Ice Age, left this note:

I bought your book since you were pointed out as someone who was more favourable about the role of carbs and very very much enjoyed the read.

My preconception about the PHD being a pro-carb diet were stopped in their tracks. In fact, the PHD is not a pro-carb diet at all. I read the book as very much a straight down the line paleo book with the inclusion that we need carbs to keep a number of basic bodily functions working as expected.

Two years ago it was totally shocking that a Paleo diet could include white rice (a grain! milled at that!), dairy, and other Neolithic foods. Now we’re “straight down the line paleo.”

In recent weeks, Robb Wolf has endorsed carbs and starches (part 1, part 2, part 3). Terms of our coinage, like “safe starches” and “supplemental foods” (meaning foods that one should eat on a regular schedule for their micronutrients, as people take supplements) have entered the Paleo vernacular. (See, for example, Mark Sisson’s recent post on supplemental foods.)

We couldn’t be happier about this. Not only is it progress toward better health, it is flattering to us.

I think the shift toward less restrictive diets speaks to the maturation of the ancestral health movement. Paleo is becoming a diet that is healthier, tastier, and more accessible and convenient to the general public; and gurus are following the evidence to more scientifically sound recommendations. That bodes well for our movement’s chances to become mainstream.

Responses to Our Obesity Ideas

A fair part of the new material in the book has to do with weight loss and obesity (see What’s New in the New Edition, 2: How to Lose Weight). I’m happy to see that a number of readers found the discussion illuminating.

Mark Lofquist, for instance, paraphrased an important observation from our book:

“Telling an obese person not to eat too much is as effective as telling a person with a cold not to cough too much.” (/paraphrased) -Dr Paul Jaminet

The original line can be found on page 176. Our position is that weight loss results from improved health combined with an energy deficit; eating less food generates an energy deficit but doesn’t necessarily improve health. In fact, if the previous diet was malnourishing, then eating less will make it more malnourishing and therefore will worsen health. The result will often be yo-yo weight regain and obesity that is more severe and intractable than before.

For effective weight loss, therefore, it’s inadequate to tell a person “Don’t eat too much.” You have to tell them how this may be accomplished in a healthful, satisfying way. This is what we try to do.

In fact, it’s best to focus on health first, and then the weight loss becomes easy. In an intelligent Amazon review, Navy87Guy notes:

I think it’s very telling that only a short chapter is actually devoted to the discussion of weight loss — because it is based upon all of the other principles that have already been outlined. The discussion in the weight loss chapter on the scientific origins of obesity is fascinating and sobering at the same time.

Great observation! Little needs to be said about weight loss once it has been explained how to be healthy. Good health leads to easy weight loss.

Have we succeeded in enabling weight loss? On Facebook, Henrik Johnsen shared some good news:

Today I can once again fit 3 pairs of pants that gave up wearing about 8 years ago. I’ve been losing weight steadily for the past 5 months by switching to Perfect Health Diet by Paul Jaminet and I’ve never eating so much fat and tasty food before in my life! Every meal’s a banquet! Thanks Paul! 😀

Kendal Lenton said:

Last week I decided to change my life, been eating great, and already down 8 lbs. Thank you Mark’s Daily Apple and Perfect Health Diet for helping me change my life.

Meanwhile, Laura at This Felicitous Life would like to lose a few pounds, but has been maintaining her weight. She has an idea that may fix that:

I’ve given it a lot of thought and done some scientific research and have come to a very cutting-edge hypothesis:

Maybe I should stop drinking 1/4 cup (or more) of heavy whipping cream in my coffee every day.

Heh. Yes, some people can lose weight eating whatever they want; just choosing healthy foods in the right proportions is enough. Others have to watch portion sizes or, as we discussed in Perfect Health Diet: Weight Loss Version, trim the fat.

It’s sad, but we can’t always have everything we want!

The Healer’s Perspective

One of my recent projects has been helping the Ancestral Health Society set up a new journal, the Journal of Evolution and Health. We have chosen a platform, are about to start editorial operations, and the first issue may appear as early as summer.

One goal of this journal is to document the successful health improvements that are often brought about by ancestral diets and lifestyles. Doctors and other clinicians are the best sources for that information, since they can see how multiple patients respond to the diet, and see negative as well as positive responses. To help bring Perfect Health Dieters and healers together in sufficient numbers to create a critical mass of knowledge, I’ve created a Healers page, and I invite healing professionals who would like to investigate the value of the Perfect Health Diet to list themselves there.

One medical doctor who has been recommending our book to patients is Dr. Shira Miller of The Integrative Center in Los Angeles. She wrote recently to say that “my patients are loving the book.”

Over at Amazon, Dr. Verne Weisberg says our book is “seriously important” and writes, “As a physician who treats obesity, I highly recommend that anyone looking to correct any of the multitude of ailments that stem from diet give careful consideration to what they have to say.”

I really liked the Amazon review from Denise Baxter, a certified health coach:

My clients are overjoyed with the changes they are experiencing in their bodies and their minds. They find their meals more enjoyable and easier to prepare. They appreciate being able to fix one meal for the entire family. One of my diabetics was able to lower her insulin yet again, and reduce her blood sugars even further by adding some safe starches. Although she had a great deal of trepidation about doing so, she loves the results.

This book is a gem and has answered many of my long standing questions. Paul and Shou-Ching Jaminet have made an enormous contribution with their many years of work. I will not be surprised to see their work make a significant difference in the health of our nation.

Other Amazon Reviews

R.U. Kidding-Me made me laugh:

As I read through this book there were quite a few what I like to call “Holy s*** moments” where I was so happy to read things that actually make sense.

In the end, even if you did not agree with or understand all of it, you emerge from this book like one does from a fog and you realize that you are definitely smarter than the person sitting next to you 🙂 Whoa! Mind blowing!!

Justin Sutherland:

Despite being full of research, the book is a pleasure to read and is easy to follow. I kept turning pages and saying to myself, “well, when you put it that way, of course!”

T., Quinton left a heartfelt review:

Although I wouldn’t wish illness on anyone, I’m grateful that the Jaminet’s were able to contribute immensely to society as a whole while conquering their own illnesses…. I have lost weight even though I’m not trying to, and am rarely hungry.

Navy87Guy has a complaint:

My only complaint is that they use the word “diet” in the title. While they use it in the academic sense (i.e., the foods that you habitually eat to provide sustenance), too many people only think of “diet” as a restriction in your food intake to promote weight loss. I prefer to think of the authors’ book as a “lifestyle”, rather than simply a prescription for changing your food intake. That view is reinforced by the holistic treatment of the impacts of circadian rhythm disruption on health – a fascinating chapter that probably could have as much impact on your overall health as your choice of food!

TMac had the same thought: “It pains me that the Jaminets decided to call their plan the Perfect Health Diet, rather than the Perfect Health Lifestyle.”

We liked G. Nesta’s comment:

When something just makes sense and seems right, you know it. I am basically back to the diet of my parents and grandparents who lived into their 80s and were active and happy their entire lives. This is my favorite diet/health book that i have read.

Our thanks to everyone who has left an Amazon review!

Vegetarian Concerns

I’m planning a post or series of posts looking at the healthfulness of vegetarian diets. Recently Beth, a vegetarian considering a switch, asked about T. Colin Campbell’s claim that protein causes cancer. Elyse L offered some good advice for former vegetarians considering PHD:

Many folks following PHD (and Paleo) are former vegetarians or vegans. For me, I started digging into all of the information out there pro and con and finally decided to just give it a try and see how I feel. For me, I had immediate relief from lethargy, allergies and arthritis. What’s the worst that can happen? Give it a few weeks and see how you feel. If you listen to your body it will tell you what’s best.

The commenters on Allison’s post

Allison’s tale of her ongoing recovery from panic disorder, OCD, and chronic fatigue brought fascinating comments from readers who are addressing similar chronic diseases.

Jennifer has benefited from homeopathy and PHD:

The Perfect Health diet helped me in many ways. I lost weight that I could never lose and improved my cognition and memory. I also felt more together and calmer than I ever had in my life but I still had panic attacks. I had certain triggers that couldn’t be erased. So when my daughter got PANDAS, I did a lot of research and read a lot of accounts of children being helped by homeopathy (I know….I hear the collective groans of disbelief)….. My daughter and I have been going to [a practitioner of the heilkunst method of homeopathy] once a month since September. Most of her issues have been completely resolved and I am completely panic free and my insomnia (which I had for over a year…could not sleep without drugs) is completely resolved. I have inner strength that I have never had and I sleep like a baby…. I know many people are skeptical about homeopathy or know little about it but I am proof that it works … I do credit the Perfect Health diet for allowing homeopathy to work as spectacularly as it has for me since I think my issues would remain chronic if I weren’t on an optimal diet.

We believe chronic infections are an under-recognized cause of disease, and Hunter’s wife illustrates that thesis. She benefited from antiviral treatments:

Allison, everything you describe sounds like you could be my wife Tiffany in another life!

A couple years ago Tiffany decided to stop taking birth control and her health took a turn for the worse as those hormones were apparently helping to keep her “functioning” all the previous years and she suddenly developed amenorrhea and hypothyroidism. Finding an endocrinologist who would actually agree that she was hypothyroid was impossible but we kept trying until she eventually progressed to be so bad that she was officially diagnosed but after trying many different thyroid medications, none ever helped her “feel” better and no one could find the cause of her thyroid issues. We finally came across an ad in the paper for a chiropractor who said he specialized in thyroid disorders and chronic fatigue syndrome so we went to see him and he ordered hundreds of blood tests looking for infections. In the end he diagnosed her with a chronic viral infection of Epstein-Barr Virus (mono) among a couple others and he told us that he has seen this in multiple patients and Epstein-Barr is always related to chronic fatigue and thyroid issues. Chiropractors cannot prescribe medicine in the state of Florida so he transferred her to a semi-retired infectious disease specialist who he had worked with for previous patients, Dr David Reifsnyder in Lakeland, FL. Dr Reifsnyder agreed that Epstein-Barr is the main cause of her hypothyroidism and chronic fatigue and told us how he has treated hundreds of patients for this throughout his career and that they always have active Epstein-Barr infections but that most doctors don’t know how to test and diagnose an active chronic Epstein-Barr infection, even before he could test for the virus he said that he discovered patients with these symptoms would respond to antiviral treatment, and that Tiffany would have to take antivirals daily for the next 2-4 years but that he was sure this would eventually clear up all of her issues, however recovery would be a slow process as her HPA axis recovered and got “back into sync”.

We noticed her improving almost immediately after starting the daily antivirals and it’s now almost 1 year later and she’s stopped taking antidepressants and just seems to have no desire to visit psychiatrists any more, something she had been doing for all of her adult life, I think they had tried putting her on every antidepressant possible over the years. She has also stopped taking thyroid medications and her body has normalized her thyroid levels on its own. She doesn’t have fatigue issues any more, she wakes up feeling more refreshed in the mornings and doesn’t want to sleep all day any more, she’s even started wanting to exercise and go jogging, something she enjoyed as a kid on the school track team but had given up as she got older and dealt with these issues. And after 1.5 years with a complete absense of her menstrual cycle her female sex hormones have normalized on their own and her regular menstrual cycle returned.

Jo had also suffered from panic disorder and other problems, but is doing better after getting antimicrobial treatment and eating PHD:

My life has been marked by fears – they literally dictated most of my choices. Finally, a diagnosis of autoimmunity that triggered an 8-year long search for remedies. I started addressing gut infections – gut imbalances and H.Pylori – then herpes viruses, then mono then, under Paul’s suggestion, I requested a course of fluconazole for a fungal skin condition that might actually be systemic. I saw improvements only when I addressed these infections together with a PHD compliant diet. The tics are still with me and are cyclical – which makes me think of some parasite I have not identified yet. But many other symptoms disappeared and for the first time I have a different perspective in life. In addition to infections I had several nutrient deficiencies – I was prone to break bones and hurt myself continuously, partly because of an anxious behavior and partly because of low vitamin D. I know very well what you mean about overcoming the memories and the habit of living life to cater fears. Plus, I spent so much time finding a psychological cause, torturing myself with any possible technique to train my mind…I wish I had known.

There is a great need for better diagnostic tools, better treatments, and more doctors who are willing to investigate and address chronic infectious conditions. But hopefully these stories will help move medicine in the right direction.

Last But Not Least

In my New Year’s Day post I quoted Jennifer Fulwiler to the effect that she was having a comfortable sixth pregnancy:

I have been following the PHD for this pregnancy. The results have been amazing. In fact, with all five of my previous pregnancies I had debilitating, severe morning sickness. On the PHD, I had almost none!…

[A]fter I had my fifth child I found myself tired, achy, and 35 pounds overweight. Thanks to the PHD I lost all the weight, and when the show was filmed, in my first trimester of pregnancy with my sixth child, I weighed the same as I did the day I got married, and felt better than I ever had in my life.

Fortune being fickle, soon afterward Jennifer experienced shortness of breath and checked into a hospital. Pregnancy is a risk factor for clotting, and Jennifer is homozygous for a mutation which leads to overproduction of Factor II (prothrombin). Her clotting disorder, which is shared by about 1 person in 10,000, was discovered during her second pregnancy when she suffered deep vein thrombosis. This time around the clotting caused pulmonary embolisms.

It’s impossible to know whether it contributed, but a few weeks before symptoms began Jennifer began taking a multivitamin with a number of coagulation-modulating ingredients. I may as well reiterate here for those trying to follow our diet without reading the new edition: One of the updated bits of advice is that we now recommend AGAINST taking a multivitamin, even in pregnancy.

Jennifer is at home and has resumed blogging, but I know she would appreciate prayers.

Herb-Encrusted Salmon Cakes with Lemon Juice

We’ve been looking at cookbooks lately. We recently acquired The Garden of Eating by blogging stars Chef Rachel Albert (The Healthy Cooking Coach) and Don Matesz (Primal Wisdom).

The first thing one notices about this book is the impressive amount of effort that was put into it – 7 years, I’m told.  At 8.5” by 11”, 582 pages, it’s full of great recipes. Most pages present a single recipe plus variations.

The Garden of Eating synthesizes Paleo dieting with the foodways of traditional cultures. It begins with a discussion of Weston A Price’s survey of traditional cultures. From the Perfect Health Diet point of view, there are a few missing ingredients. There are recipes with potatoes or sweet potatoes, but no rice or taro. There are recipes with butter, but no cream. Still, potatoes and butter are a big step forward over some Paleo meal plans!

There are plenty of great dishes. We looked first for recipes with key Perfect Health Diet foods:

  • Salmon and beef are favored in our diet for their low omega-6 content;
  • Coconut milk and oil are favored for their ketogenic short-chain fats;
  • Lemons are favored for reasons I’ll discuss in an upcoming series on dietary ways to enhance immune function;
  • Herbs like oregano are favored for their antimicrobial activities in the gut.

We chose a recipe, “Herbed Salmon Cakes with Citrus,” that has a lot of these ingredients. Here is how we made it.

The Recipe

We doubled the size of the recipe, from 2 pounds salmon to 4 pounds, because we had a few college students at home for the holidays.

The recipe begins by pulverizing the fish in a food processor and combining it other ingredients in a bowl. We used a wok and here is the salmon with onion:

Other ingredients include fresh parsley leaves, minced celery, grated carrot, eggs, minced dulse leaf, herbs (basil, rosemary, thyme, oregano, lemon pepper), lemon zest, some starch, and some broth.

We made two substitutions: for the starch we used tapioca starch, while the recipe calls for shan yao, arrowroot starch, or powdered rolled oats; and we used lemon juice in place of the broth, where the recipe calls for chicken broth or filtered water.

Here are the ingredients mixed in our wok:

The next step was to divide into portions, form into balls, and press into patties. The patties are then covered and refrigerated overnight, or at least for several hours.

The recipe calls for lining a 13x9x2 baking pan with unbleached parchment or using muffin tins, and arranging the patties on a lightly oiled surface. We used aluminum foil on a cookie sheet and greased it with butter:

We cooked for 15 minutes at 350ºF until the patties were opaque throughout. Here’s how they came out:

It appears our mix was a little too watery and bled a bit. Maybe the tapioca starch isn’t right for this recipe; or maybe we didn’t use enough seaweed. One of the variations was to replace the dulse with sea salt; we had a shortage of dulse and forgot to put in the sea salt, so perhaps that was the cause.

No matter; it tasted great. Here it is on a serving plate:

The recipe suggests dipping the cakes in one of the cookbook’s many sauces: Cajun Ketchup, Better Barbecue Sauce, herb infused Mayonnaise, or Tahini Tartar Sauce.

We found the cakes to be addictive:  the more you ate the more you wanted another.

There’s a lot to be said for this recipe, apart from its healthy ingredients. The marinade takes away most of the fishy flavor, and the herbs cover the rest, so this may be palatable even to those who dislike salmon. Also, the cakes are a very portable form of salmon, easy to pack for lunch at work; they can be eaten as finger food.


We give two thumbs up to the recipe and the cookbook. Here’s a link to its Amazon page:

A Nice Comment to Wake Up To

Patrik left a very nice comment this morning:

Having just read the PHD-book, I feel quite happy to say it is the most concise and insightful book on diet I have ever read. Coming from a Kwasniewski/OD background I feel it takes his concepts forward in very important ways (food toxins, O6 avoidance etc) while maintaining ODs fundament (like the starch-recommendation to just barely use the GNG mechanism). As a software-developer I appreciate that this leads to a diet that is fault-tolerant and have redundancy in achieving good nourishment.

Thank you Patrik! That’s about as concise and generous a review as an author could hope for.

Framing everything in terms of toxicity and nourishment is the major innovation of our book. Thinking in those terms is especially important, I believe, for weight loss — this week’s topic. More on that shortly.