Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,


Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?


Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.


I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?


  1. Thanks for doing this, Paul. I hope your answer can shed some light on my problem and hopefully help others.

    I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.
    When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.
    I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.
    These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

  2. Hi Paul,

    You have provided great insight for me in the past so I am hoping you can do so again. In the past 3 weeks my partner has been diagnosed with stage 3 breast cancer. She is 28 and there is no family history. Of course, her doctors reassure her that they have absolutely no idea how or why this could have happened. However, you have mentioned many times that you believe chronic infections are at the root of most diseases. Also, in the reader comment above you site viral infection as a possibility for Leukemia. Can you point me to studies or other materials that outline this mechanism?

    Due to the aggressiveness of her cancer she has already begun round one of chemo so I don’t really have the luxury of experimenting with her in tip top shape. Do you have suggestions aside from vit d and green tea that might be therapeutic? At this point really I have little control over her treatment, but would like to at least get a sense of the root cause.

    In my mind she simply needs to be extremely well nourished, but that is proving tricky due to nausea. I made a batch of chicken broth the other day and the smell alone sidelined her. Any thoughts on a way to sneak in dense nutrients without a strong odor? And on the days she is feeling well should I just aim for macronutrient density like pasture butter, bone broth, etc?

    At this point any thoughts or resources you have are appreciated. Thanks for your time.


  3. Paul, Shou-Ching, thanks! i really like the idea of this page.

    i just started reading “Wheat Belly”, and wondered about your opinion of it…?

  4. Hi, Jersie. I’ve come to this diet in the hopes that it will cure my depression/anxiety.

    Like you, I’ve had mixed results with a VLC diet. Sometimes it seems to help, other times it doesn’t.

    About 6 years ago, I started having problems with anxiety. I switched to a paleo diet (one like Cordain advocates — high protein, moderate fat, low saturated fat, lots of fruits and vegetables). My anxiety cleared up. But then, last winter, my depression resurfaced, along with anxiety.

    I just started eating the PHD about a week ago. I do feel better. But I still experience a little mild depression/anxiety here and there. I’m going to stick with it, and begin supplementing, as Paul recommends. Maybe all those years of eating a high-protein paleo diet (without any supplements other than Vitamin D) caused a nutrient deficiency (magnesium, calcium, ?) that brought back the depression/anxiety.

    Also while on the paleo diet, I experienced a lot of noise sensitivity (perhaps from a lack of magnesium?). And a very annoying problem where a few toes would experience involuntary muscle twitching/ticklish sensation. This usually happened at night, while trying to sleep. That has mostly went away, I believe from a few weeks of supplementing with calcium/magnesium, but I can’t be sure.

    I’ll be sure to post my progress here.

  5. Hi Paul,

    I have a question about safe starches, I’m not sure if this is the right place for it, since it’s not a personal health question. My wife and i like to eat buttered steamed beets (I’m Ukranian, what can i say). I think this is a ‘starchy” root veggie, do you consider it a safe starch according to your criteria?

    Thanks for all your help,

  6. Paul,

    Thanks for all your work. I met you and your wife at AHS and was very pleased to see you both in person. Quick question: I started supplementing with iodine (kelp tabs at 350 mcg per tab). I began with 1 tab per day, but about 3-4 hours post ingestion, I would get cold-clammy sweats regardless of the temperature of my environment. I Googled and this seems to be a symptom of hyperthyroid induced by iodine? So I backed off the dose to 1/5 of a tab (about 60 mcg I suppose) and I still get the clammy sweats, only to a slightly lesser degree. Should I keep supplementing and wait for my thyroid to adapt? Or is this a sign to back off? Thanks!

  7. Hi Jersie,

    I replied on the main page, http://perfecthealthdiet.com/?page_id=4228#Depression.

    Hi Lindsay,

    Cancer demands a more detailed answer than I have time for at the moment, but I will put one up. Re the infectious causes of cancer, Wikipedia has a decent post: http://en.wikipedia.org/wiki/Infectious_causes_of_cancer.

    Hi tess,

    I haven’t read Wheat Belly yet, but I do read Dr Davis’s blog. I’m anti-wheat as you know, so I’m sure to be sympathetic to his thesis, but might not buy into everything.

    Hi Scott,

    Thanks for coming, please do keep us posted on progress. My reply to Jersie may give you some further clues on things to try for depression.

    Hi Dan,

    Beets are sugary rather than starchy, but still a great food. With butter, even better!

    Hi Josh,

    Yes, it does sound like an iodine reaction. It means you are probably severely deficient in iodine, but you need to increase very slowly. Start at the 60 mcg dose for 2-3 weeks, after the reaction has disappeared for a week edge up the dose slightly (to 1/4 tablet, then 1/3, then 1/2, then 1). Rough rule of thumb: stay for a month at a dose before doubling it.

  8. You’ve posted about this before, but is there anything else I can do about dry eyes? For several months now I’ve been taking 1 gram of Vitamin C a day and, while I don’t measure my food, eating starch in the form of rice, yuca, plantains and potatoes with most meals. I haven’t been low carb for at least a year and even when I was I never went down to ketogenic levels. It’s gotten to the point that I can’t wear contacts at all, though fortunately I don’t feel any discomfort otherwise.

    Any supplements I should be taking? I already take D3, magnesium, K2 in addition to C.

    And on a non-health related note…sill a digital version of PHD be coming out anytime soon? I’d love to read it on my e-reader.

  9. Hi Paul – Question about Fasting and Diarreah

    First of all, I love your blog and book, and your unique way of looking at health issues.

    I have done several 36 hour fasts, basically skipping one full day of eating (I know that is longer than you recommend). But in any case, every time I do this, I end up with severe diarreah. Do you have any idea what could be causing this? It usually appears the morning that I break my fast (before eating) and subsides by the end of the day.

    I have a few theories:
    1. My gut flora is starving and dying off, and my body is getting rid of the dead bacteria.
    2. My intestines are taking advantage of its downtime, and shedding damaged cells or mucus lining.
    3. My liver, with its reduced work load, is taking the opportunity to expel toxins, or other unwanted material.

    Background on me… I eat paleo with small amounts of dairy, and occasional cheats, with moderate to low carb intake. 39 years old, male, 180 pounds, 5’8″, no major health problems, take advair for asthma, and zoloft for anxiety. Supplement with magnesium, Vit D, A, and K2, but not while fasting.

    Thanks! Looking forward to more posts on chronic infections!

  10. Hi Paul,
    I too would love it if you would read wheat belly and comment on it. I havent read it yet but have listened to Robb Wolf’s and Jimmy Moore’s interviews with Dr.Davis. Looking back on my mothers side of the family it is somewhat evident that wheat has played some role in disease whether by allowing infection to take hold or whether by something inherent in the wheat itself or perhapse by nutritional deficiency because so much of the daily calories are empty nutritionally. To make a long story somewhat short, despite the fact that many of my relatives lived long lives, they ALL suffered for years from MANY diseases of civilization especially arthritis, gerd & other digestive disorders, low thyroid, osteoporosis, some had type 2 diabetes, lung disease in a non-smoker, two cases of breast cancer and most everyone had high blood pressure and died of heart attacks or strokes or heart disease.( 7 relatives) Only my great grandmother, one of my great aunts and her two daughters were obese. Luckily ALL have avoided any type of dementia or mental disorders except another great aunt who has just now developed it at age 102. My mom who is 5’0 and weighs 108 lbs and is 65 yrs old has high blood pressure, osteopososis, is on a statin even though her cholesterol is just over 200, and has recently started treatment for low thyroid and pounding/skipping heartbeats. I’m 41 and at age 27 started on synthroid after my thyroid bottomed out (TSH was sky high) about a year after the birth of my first daughter. Several years ago was treated for an esophageal ulcer,suffered with gerd off and on, watched my weight and blood pressure start to rise, had watched the beginnings of metabolic syndrom, suffered from annoying muscle aches and pains and had started with the abnormal pounding/skipping heart and also with anxiety and panic attacks. (POTTENGERS CATS??…everything starting younger and younger as the generations go on.. I fear for my children as my ten year old who is tremendously active and fit has had blood sugar readings of 145-180 after carby (wheat) meals and craves sweets and bready stuff. My sister has issues with her children as well, reflux and ADHD and ear throat and lung infections quite often. For the most part I have been 90% or so paleoish since January and most health issues have gone away or diminished in severity. Why do I think wheat plays a role in all this??? My relatives were fairly active, rarely ate out or bought processed foods ( I spent a lot of my childhood around them ) But they were Italian and they made homemade fresh baked breads and doughs and homemade pastas for almost every meal. They did bake some sweet stuff and drank lemonaid and ice tea and some milk, but pop, juice and store bought processed stuff was minimal. There was meat or eggs daily, but not a lot of veggies or fruit. My mom loves her toast and baked goods, but not much sugar other than that. I too stopped drinking calories in high school, but had lived on cereal and bread and pizza for much of my life with minimal veggies and fruits. I’ve been following your blog and read your book and follow many blogs in the paleosphere. I am amazed at how well just eating real food works to conquer disease and I’m hoping to an extent it will stave off disease in my children as we continue to strive for a cleaner and cleaner diet at home and especially away from home. It is becoming a bit overwhelming following all the ideas out there, but just wanted to give an n=1 account of wheat and my family.

  11. Hi Paul, I have not seen this addressed anywhere in the paleosphere and was curious as to if you think it could have an infectious component. Most of the info I find is that it is caused by “ear rocks.”
    Off and on for 4 years now I have had bouts of occasional vertigo lasting from several weeks to several months at a time. During these times I usually experience from one to several episodes a day although none are ever that severe. Only twice has it ever knocked me to my knees and caused nausea. Most of the time its a subtle feeling of continuation of motion after I’ve moved my head, although sometimes I swear it happens just with eye movement. Haven’t gone to a doctor about this yet because it doesnt look like there is much you can do about it other than some head repositioning exercises or tilt table therapies. Just curious as to if you know anything about this?
    Thanks for your time,

  12. Paul,

    Thanks for your terrific website. I have been reading it for several months. I would appreciate any general thoughts you can offer on my situation. I know that you cannot give medical advice over the Internet.

    I am a 6’2″, 155 lbs. male in my 30s in generally excellent health. However, I have a body type that is very much on the Ehlers-Danlos/Marfanoid end of the spectrum. Even though I eat a Paleo diet and work out with weights 2x/week, I have osteopenia as determined by a DEXA scan and various other connective tissue issues (e.g., cataracts, tendon tears, etc). I have been supplementing with 2,000 IU of Vitamin D and 250 mg of magnesium each day.

    I have three questions:
    (1) My doctor recently recommended that I add 500 mg of Calcium supplements 2x per day due to the osteopenia. I have read your post cautioning against calcium supplements (risk of heart problems, etc.). Do you have thoughts about whether it is worth it in my situation due to the osteopenia? I already eat what I believe is the “right” diet and lift weights — but the osteopenia has gotten worse in the last couple of years anyway.

    (2) Would you recommend other adjustments to diet that might be helpful for someone with an Ehlers-Danlos type connective tissue disorder/hypermobility?

    (3) If I follow the right diet and exercise program, would you expect that lifespan and functionality could be maintained in “normal” levels even with connective tissue troubles. I worry about what will happen in later years.

    Thanks for any thoughts you may have.


  13. As a college kid, i’m often finding myself tired when pursuing my heavy workload (reading, papers..etc) and I often resort to overeating as a means of boosting my mental energy. Problem is it lasts for maybe 10-15 mins (the eating “high”) and then I turn to crap, in every way figuratively possible. I’ve experimented and discovered that eating high fat/low carb gives me steady energy but lacks the sharpness I receive with eating carbs. A high carb, low fat meal just leaves me unsatisfied. The aforementioned examples are produced with whole foods, not the synthetic kind that you use just to achieve a certain macro ratio ;). Any advice as to macro ratio’s, specific helpful foods, and maybe timing if that plays any part. Thanks again to any and all advice or time you can spare.

    P.S. Blog rocks, can’t wait for any and all upcoming posts!

  14. Hi Paul, thanks for the wonderful blog. I guess my concerns pales in comparison with many of the questions on this page, but in any case I am curious about your answers.

    Is eating about 2 dozens of eggs a week bad for you? Reason I’m asking is because I eat eggs as main protein source on most days. I like them because they’re versatile. I do eat meat and also seafood but I’ve noticed that I don’t seem to digest them as well. Anyways my protein sources tend to be eggs, nuts,and fish. I don’t have any health problems, if anything I’ve never had weight issues except being perhaps too thin at times. I do occasionally go back to bad eating habits from my ED (eating disorder) days when I was either anorexic or had exercise bulimia. When it happens it’s usually due to stress, as I’m currently in a Ph.D program in Health Policy Management while working 60 hours a week as an ICU RN.

    Also I’ve recently cut dairy out of my diet because of IGF-1 as a promoter of cancer. Do you have any positions on dairy? I seem to veer back and forth on dairy, as I do love it but not enough to risk increasing cancer risk.

  15. Hi Paul,
    I’ve got microscopic colitis and associated arthritis. I had some success with the Specific Carbohydrate Diet when I followed it strictly for 6 months. For the last couple of years I’ve edged away from SCD, concentrating more on avoiding fructose, and not worrying about occasional starches. I’ve not been consistently well and have continued looking for a healthy way of eating.
    I haven’t finished reading your book yet but have read all of your blog. I deliberately and enthusiastically added “safe starches”. Over 4 days I ate a potato, a sweet potato, a yam and some rice. After one day I noticed increased joint pains and stiffness. After 3 days I had diarrhea. On the 5th morning I struggled to get out of bed because my back was so stiff.
    I concluded that the safe starches unfortunately weren’t working for me. Wondering why, I read Carol Sinclair’s “The Low Starch Diet for IBS”:
    I was very interested in Alan Ebringer’s work on the role of a low starch diets in decreasing klebsiella levels in patients with ankylosing spondylitis. It may be that there is molecular mimicry between klebsiella antigens and the HLA B27 antigen. This site provides a brief summary:
    I am HLA B27 negative, although my brother has reactive arthritis, so I think we still have some genetic predisposition to seronegative arthritides.
    I’m coming to believe that the Specific Carbohydrate/GAPS diet may be beneficial for conditions
    that have bacterial gut dysbiosis at their heart, although it requires considerable suspension of disbelief for me to actually stick with these diets. I’ve found that there’s a lot of overlap with the low starch diet. Testing foods for starch with iodine has backed up some SCD ideas on safe/not safe foods.
    I wonder if you would agree that the safe starches can be detrimental as food for bad bowel bacteria, to put it very simply.
    I’m eating over-ripe bananas, grapes and honey as my carbohydrate sources at the moment. Do you have other suggestions?
    Thank you for any thoughts about my experience.
    Best wishes,

  16. Hi Paul,

    What a nice idea to do a page like this! It will certainly make it easier to search for your valuable advice per condition. Maybe useful for others -up until now I have used google site search to find relevant comments on your blog by typing this into the search field on google.com: SITE:perfecthealthdiet.com < condition / symptom name / keywords >.

    Now for my questions. My stepfather has been diagnosed with Parkinson’s. His symptoms at this point are not debilitating. He is following the PHD and taking recommended supplements. He is also doing intensive sports regularly as recommended by his doctor. I was wondering if you know of any specific supplements he should be taking? I was thinking of co-enzyme Q10, however the most recent research has shown no benefit for Parkinson’s patients. (But also no negative effect). Any ideas are welcome 🙂

    My second health question is about my own condition but I wil post this separately because its a long story.


  17. Hi Paul,

    I have posted before about my digestive problems, but I am posting again because my path and your advice may be helpful for others and I still have a long of groundwork to get better – so who knows maybe new helpful advice will come of this :).

    My symptoms are daily to weekly episodes of vomiting/reflux, swollen lymph nodes, bloating/burping/gas, constipation/loose high fat stools and every couple of months intense abdominal pain which keeps me in bed all day. Many tests have been done – no celiac disease, colitis, chron’s, allergies or parasites. I was diagnosed with slow stomach emptying (gastroparesis) and IBS. I followed your advice and had stool tests done. The outcomes were: greenish stool with undigested food, above average undigested fat content, significantly low levels of Enterococcus spp. and significantly high levels of C.glabrata and R.ruba. I have had 2 rounds of antifungals, first 1 week of nystatin and second a week of terbinafine. Nystatin initially cleared the white coating on my tongue and Terbinafine the athlete’s foot. But neither had an effect on the digestive symptoms and I got a bad cold a few days after starting each. My doctor does not seem willing to prescribe further antifungals unless there is an obvious external infection.

    As far as diet is concerned I have tried everything – the most recent being PHD and SCD/GAPS – which are of course similar except for the sources of glucose. I have times where I can last a week or two without vomiting – these are either on liquid diets including tea with raw honey and homemade broth OR low/mod carb paleo consisting of fresh pressed fruit/veg juice and 2 salads a day with chicken/fish and olive oil based salad dressing – on these days I still have bloating and abdominal distress, but I function quite well. I don’t know why but I haven’t lasted more than 2 weeks without vomiting – it usually starts with a swollen belly and intense cravings for carbs or fats and then it doesn’t seem to matter what I eat, it just all goes wrong until I can manage a 16+ hr liquid fast.

    These are some things I’ve noticed about the effects of what I eat. High protein meals cause constipation and abdominal pain (liver/gall bladder area). Nuts cause intense abdominal pain. Higher carb days where potatoes or rice form the basis of my meals leads to brain fog and I feel depressed – rice seems worse than potatoes and leads to vomiting about 85% of the time. Strangely enough I don’t seem to have this problem with tea with raw honey or soft drinks (from health food store made with unrefined sugar). I have read a comment on this blog from someone with fungal problems who also tolerated raw sugar/honey and just now I saw Chloe’s SCD post above. I am also thinking that the simple sugars may be less detrimental to gut dysbiosis.

    Some of the things I notice with natural antifungals, probiotics and enzymes are:
    * garlic & onion (cooked) seem to go ok
    * goats milk yogurt/kefir leads to immediate vomiting
    * water kefir has mixed effects – it seems the longer the fermentation (> 1.5 days) the greater chance of vomiting
    * probiotics are hard to test – some seem to have little effect (e.g. yeast free threelac called symbion) or cause constipation (e.g. biokult). I think the trick with probiotic foods and pills is to introduce them slowly – even though this is easier said than done! I have noticed that since including more probiotics in the form of pills and water kefir I have fewer “allergic” reactions and cravings.
    * Betaine HCL seems to help with meals with protein and mixed enzymes may help with other meals.

    I really wish I could find a diet and supplement regime I could stick to that can provide longer relief for the stomach/abdominal stress. Sometimes I just want to fast, I always feel better when I do but I can’t seem to stick to it as I end up getting hungry/cravings for solid food. Any ideas/advice are very welcome.

    all the best,

  18. Paul,

    I am male – age 64. 5’11”, 200 lbs. I exercise regularly – Aerobics 3x week & weight train 2x week. I am in good shape for my age except for hypertension. I eat mostly grass fed beef, fish, green leafy vegetables, white rice & potatoes. Very little fruit.

    My question is are there any foods I should avoid (or eat more of) to help get my blood pressure back to normal. Also would any supplements help me?

    Thank you

    T. O.

  19. Hi Paul, I’ve just ordered the book and am looking forward to receiving it and learning more about the diet in detail. After reviewing the info on this website and seeing the diet summary, I’m a little worried already that I’m not going to be able to stick to the diet 100%. As a busy working mom and business owner, sometimes it’s a challenge in our house to stick to rigid dietary regimens. So my question is this, we will still receive benefits from the diet if we only follow it 80% of the time, or even how about 50% of the time?

  20. Hi Lena,

    Omega-3 fats can help dry eyes — I would get them from foods, eg salmon, sardines, and maybe flaxseed.

    Electrolytes are also necessary. Make sure you get plenty of salt, potassium, and water. Calcium along with magnesium is another possibility.

    I’d look for antioxidant minerals like selenium, zinc and copper to go with the vitamin C. You might try N-acetylcysteine.

    Lastly I’d consider whether you have any signs of epithelial infections in or around the eyes.

    Hi macoda,

    Some pathogens induce diarrhea opportunistically. When they have a good home, they cooperate it, but when it becomes unpleasant for them (eg they think their host is starving/dying) they induce diarrhea so that they can spread to a new host.

    So, I would say your gut is infected by one of these pathogens and you need to replace it with better gut flora. The infection could be connected to your asthma and anxiety.

    Eat a good diet, lots of fermented vegetables and probiotics, and hopefully you will improve the gut flora over time. You could consider antibiotics and polysaccharide digesting enzymes as well to help clear out the old bacteria.

    Hi shelley,

    Great story, thanks for sharing it. It does indeed sound like Pottenger’s cats! I think most of us would be OK with developing dementia at 102. 112 would be better, but 102 will do.

    I agree, wheat is awful stuff, and worse for some than others.

    I don’t know much about vertigo, and had to Google “ear rocks” to find out what it meant. It sounds like the Epley maneuver actually works for some people, see http://www.npr.org/templates/story/story.php?storyId=103463398. You can probably do it yourself at home, here’s a how-to video: http://www.youtube.com/watch?v=pa6t-Bpg494.

    I would think it could be infectious, but I would try exercises like the Epley maneuver first since that is so risk-free.

  21. Hi Frank,

    1) I would consider 500 mg calcium a reasonable daily supplement for anyone. 1 g/day I think is too much in normal people, the question is whether you are different. Without any knowledge of the particular genetic changes that may be causing your issues, I would be hesitant to suggest such a high calcium dose.

    2) Mainly I would focus on collagen-promoting foods and supplements. That means: (a) high vitamin C – to bowel tolerance; (b) high intake of gelatin / cooked collagen — lots of bone broth soups; (c) lots of minerals for mineralization of what collagen you do have; (d) good amounts of vitamins A, D, and K2; (e) possible — I’m not recommending it, but something to experiment with after you’ve tried the others — lysine and proline supplementation.

    3) Afraid I don’t know the answer to that one.

    Hi Jane,

    Your pattern is very characteristic of brain bacterial infections. The bacteria create a hypoglycemia in the brain, and intense mental activity aggravates that. Eating sugar/carbs relieves the hypoglycemia and temporarily makes you feel better, but also feeds the bacteria and increases their activity, which causes them to release toxic products which make you feel worse. Eating fat doesn’t feed the bacteria, keeps blood sugar levels stable, and so keeps the brain situation stable.

    Two things to try are:

    1) Ketogenic dieting. Eat MCT oils to supply the brain with ketones — your neurons can use these but bacteria can’t. This should make you feel better without feeding the infection.

    2) Antibiotics. Protein synthesis inhibitors should impair bacterial activity and help you recover.

    Intermittent fasting is also therapeutic. You should follow our diet.

    Please keep me posted on what happens.

    Hi Genia,

    24 eggs a week is fine. I eat about that many yolks (3-4/day) but usually discard the protein. Egg white protein is pretty innocuous/benign after cooking but I prefer lower protein dieting.

    I favor fatty dairy, butter, cream, fermented dairy eg yogurt. I don’t drink much milk but am willing to drink whole milk especially if it’s raw/fresh from a good source. I eat cheese occasionally, sour cream occasionally. I wouldn’t go overboard on dairy but you may notice it’s one of the “Pleasure Foods” on our food plate.

  22. Hi Chloe,

    Yes, I agree that in some cases of gut dysbiosis starches are intolerable and promote disease.

    In such cases you have to avoid starch, and work hard to fix the gut flora. Good substitutes for starch are glucose-based sugars, eg rice syrup or dextrose.

    Bananas are good as a fruit, because they are relatively glucose rich (2:1 glucose:fructose). Grapes and honey, not so good, because fructose rich.

    I would look for glucose-dominant fruits, eg bananas, plums, a few others, and glucose based sugars and dairy sugars if you are lactose tolerant.

  23. Hi Claire,

    I’m sorry to hear you’re still struggling!

    Re your dad’s Parkinson’s, mitochondrial support supplements are well supported. CoQ10, lipoic acid, vitamin C, selenium, NAC.

    Creatine and leucine are probably beneficial. See eg http://www.ncbi.nlm.nih.gov/pubmed/21448659.

    Intermittent fasting with some coconut oil or MCT oil during the fast, should be very helpful.

    Melatonin should be taken just before bed.

    Choline should be good, but phosphatidylserine is bad and inositol could be bad. He might try our therapeutic B vitamins also.

    He should eat lots of salmon.

  24. Hi Claire (continued),

    Well, you’re still a difficult case. I’m glad you got the stool test done because it gives some clues.

    I’m not sure the fungal infections are responsible for many or most of your symptoms, but they give something to treat.

    Rhodotorula infections are not something I’m familiar with, but Mycology Online says it can cause peritonitis, fungemia, endocarditis and meningitis. Meningitis is significant because the vomiting may have a nerve component.

    Enterococcal meningitis causes vomiting (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC547911/).

    Probiotics and fermented vegetables would be my #1 recommendation and it sounds like you’ve gotten benefits from them so far. So I would keep going down that track.

    I’d also try periodic antifungals and maybe give penicillin a try, which is used for Enterococcal infections (http://www.uptodate.com/contents/treatment-of-enterococcal-infections). For antifungals, if you have access to a Chinese herb shop Chinese medicines might be helpful. It worked well for me.

    Fasting is of course a temporary solution at best but eating a fat-rich diet is a good start.

    Does ketosis make you worse or better? If worse that would suggest the fungi are causing symptoms, if better then probably bacterial or viral. Try MCT oil or coconut oil for a while until you know.

    Best, Paul

  25. Hi T.O.,

    Blood pressure usually normalizes rapidly on our diet and supplements. Vitamin K2 is important, so are the anti-oxidant minerals selenium/zinc/copper, and vitamin D.

    Hi Donna,

    Our diet is not a rigid regimen, as you’ll see the book explains the logic behind a healthy diet but leaves you many options for how to implement it. But 80% or even 50% is OK, certainly better than 0%. I think you may find after a little experimentation that 100% is easy, inexpensive, and enjoyable. Try browsing our “Food” category for some ideas.

  26. I’m curious what you think of the recent study putting Type 2 diabetics on a very low calorie (600/day) diet for 8 weeks . . . and in 8 of 11 cases apparently eliminating diabetes (i.e., the pancreas functions normally–presumably because fat in the pancreas is reduced). Find the study here: http://www.diabetologia-journal.org/Lim.pdf

    As a type 2 diabetic (A1c staying OK for some time with metformin), I’m curious if it would be worth trying. My blood sugar is higher than I’d like and I’d love to follow the Perfect Diet, but right now even that amount of carbs is too much if I’m to keep blood sugar anywhere close to the levels that Richard Bernstein suggests.

    It’s a very small study, of course, but I’d love to see Paul and others with much better scientific knowledge than I look at the study and also think about this study with regard to your own researches and knowledge.

    Thank you.

  27. Hi Richard,

    I thought it was an interesting study. At 280 carb calories and 195 protein calories, it was about 20% below our recommended carb+protein minimum. Total calories were more severely restricted than I think appropriate too. Personally, I would favor rather more calories, and take a bit longer to work the cure, with intermittent fasting and a better nourishing diet. But overall the approach they used is not far in spirit from what I recommend for obesity/diabetes, just much more extreme.

    I think as far as blood sugar goes the goal should be to keep it under 150 mg/dl postprandially, and to keep total carbs under 600 calories/day. I am backing away a bit from the Bernstein ketogenic diet recommendation. It looks like that may not be necessary, and it has some risk of negative effects. I think intermittent ketogenic fasting with glucose not too far from utilization is probably better.

  28. Hi Paul, I was wondering what you thought about Candida. I’ve heard that it can often be used as a fallback diagnosis. What’s the best way to identify ths type of infection? Is it possible for a Candida infection of the skin to cause psoriasis? Could an infection of the brain cause depression? For true Candida infections what do you think is the best treatment? Do you know of any good resources on this topic?

    Best Regards, Chris

  29. Hi Paul,

    Kindly note – some blabla first. Then the question below under the heading “Question – do you stand by 40 ng/ml as desired vitamin D level?” If you publish the question on the website – please delete the blabla. Thanks.

    I am extremely grateful to you and Shou-Ching. Your book and this website has helped me tremendously. I had soft tissue recovery issues, joint inflammation, skin issues etc. After endless doctors visits, a smart dermatologist suggested I had a leaky gut and gluten sensitivity. At one point Hashimoto was also thrown into the mix. Paleo and GAPS took care of most of the joint inflammation and skin problems, but my T3 and some of my thyroid symptoms got worse while I was on the (unintentional) ketogenic healing diet. Your posts on this issue have been helpful, and I am now upping my carb intake.

    I have bought the book to a few people in my family and my best friend. I made a four page summary of the recommendations in my native language, adapting the presentation to the typical diet of my native country (Norway). My 64 year old mother has now cut all grains (except for rice which she does not eat a lot of anyway) from her diet and is trying to implement the other recommendations as well. It is an accomplishment for someone who has eaten bread with marmelade for breakfast for the last 40 years. I am so happy.

    Another curiosa is that I got in touch with Gregory Barton after seeing his post on your website. I live in Bangkok and have been looking for goats milk without success. Now will get some from Gregory´s farm outside Pattaya : )

    On top of the leaky gut, gluten sensitivity and autoimmune thyroid I am quite sure I have some type of chronic low grade inflammation from an infection. I am trying to educate myself on how to address this through this website. At this point, my question relates to vitamin D.

    Question – do you stand by 40 ng/ml as desired vitamin D level?

    I have had a number of conditions (Hashimoto, gluten sensitivity, joint inflammation, skin flare ups) and my blood work end of June revealed low vitamin D (25 OHD of 23 ng/ml). As I live in Thailand and get short but regular sun exposure, infection had obviously drained my vitamin D stores, or something was wrong with my vitamin D synthesis. I started supplementing with 5000 IU per day mid July and on 2 September when I had a retest done, my level was up to 30 ng/ml.

    My question is what the optimum level is. In your book you say about 40 ng/ml is desired. I listened to the video broadcast of Richard Jacobson´s talk on vitamin D at the AHS 2011. He is insisting that the desired level is between 60 and 80. Chris Kresser´s recommendation is more in line with yours, saying that 45 is good and that there is research indicating that a level above 60 might not be desirable.

    Do you still stand behind 40 ng/ml as an optimal level? At 30 ng/ml I continue to take 5000 IU per day along with your other supplement recommendations.

    Thank you for putting your brain to work for the improvement of the health of so many people.

  30. Hi Chris,

    1) Symptomatically. It typically infects inner epithelial surfaces (mouth, sinuses, digestive tract, urinary tract, vagina) and the vasculature. It releases a lot of toxins, usually causing skin symptoms such as acne and substantially reducing athleticism, strength, and ability to build muscle.

    2) I haven’t heard of Candida causing psoriasis, but a Candida infection will suppress anti-fungal immunity and make you more vulnerable to the skin-flourishing fungi like Malassezia or Pityrosporum.

    3) Yes, infections of the brain do cause depression. Not sure how common Candida specifically is as a cause of depression.

    4) Antifungals (eg Chinese medicine, nystatin, fluconazole), probiotics, fermented vegetables, polysaccharide digesting enzymes, antifungal foods. A long-term project.

    Hi ET,

    Thanks for all the “blabla,” I love hearing that.

    I do stand by our vitamin D recommendations. For healthy people, 40-50 ng/ml is best for Europeans and 30-40 ng/ml for Africans – though more data is needed, especially for tropical peoples.

    In disease, it’s less clear where the optimum may be. Read http://perfecthealthdiet.com/?p=421, http://perfecthealthdiet.com/?p=448. As you’ll see, in infectious diseases often 25OHD is low (as you’ve experienced) while 1,25D is high. The cause of this pattern is poorly understood, and it’s not clear whether anything should be done about it.

    So I would be cautious about going over 5,000 IU/day D supplementation even if 25OHD remains low. Anything above that is a pharmacological dose and you are altering your body’s evolved vitamin D levels. It might help, but be aware that there’s little evidence on what is optimal and you are experimenting.

    The vitamin D pattern does support your self-diagnosis of a chronic infection, so the next step should be diagnosing the pathogen involved and treating it with antimicrobial drugs. You might consider a 1,25D test just to confirm the pattern. If 1,25D were also low, then vitamin D supplementation would have more to recommend it. If 1,25D is high, I would look for antibiotics/antimicrobials.

  31. Hi Paul,
    in a recent post you explained – and it seems plausible – that you cannot really count carbs from vegetables as they are digested by gut bacteria. You further explained that this applies to the “first 80 or so calories”. I am a person who counts calories. Do I have to count those from vegetables as there carb content doesn`t count? And as only the “first” 80 calories are concerned and I eat vegetables two times/day does it mean I can have 160 extra calories a meal (from vegetables)? This really confuses me but I like to be accurate with calories…
    Thank you so much!

  32. Hi I.P.,

    Just to review: (1) The digestive tract consumes about 40-50 calories glucose to digest a pound of vegetables; (2) typical vegetables contain about 80 carb calories per pound, half from glucose and half fructose; (3) gut bacteria can intercept some of the calories, especially the fructose which is less easily absorbed than glucose; (4) absorbed fructose may be turned to fat rather than glycogen. So all in all, the net contribution of vegetables to the body’s daily glucose supply is negligible.

    Since our purpose for counting calories is to avoid a glucose deficiency / optimize glucose intake, there’s little reason to count vegetable calories, unless you eat a lot of calorie-dense vegetables like beets, carrots, etc.

  33. <>


    Thanks for your response!

    I suppose the question is whether the “cure” will come without the (admittedly!) more drastic calorie restriction of the study. Will it work the same way to get the fat out of the pancreas and have beta cells return to normal function? Of course, it’s much more challenging.

    So another question is, what are the possible negative effects of such a restrictive diet for the relatively short period of 8 weeks?

    And if one did intermittent fasting twice a week, 840 calories/day would amount to the same total calories as 600/day for seven days each each week. Would that make any difference?

    Or would your version of ketogenic fasting, which involves (if I remember right) 12 tbl. of coconut oil each day have the same effect? What effect would such MCT fats have on fat in the liver/pancreas? None?

    And further, if one was to do a restrictive diet such as this, short term, what would be the best source of glucose? They used (I believe) Optifast, or some such meal replacement shake. I would contemplate something more like Mark Sisson’s protein shake which, while expensive, has better fats, I’m sure (coconut oil), some fiber (5 gms/serving), and possibly better quality protein. However, it doesn’t have the same level of glucose. What would be the best source for the extra glucose? Small amounts of rice? Banana? Other?

    I find the results of the study fascinating. Of course, many more studies will be necessary. Are the results perhaps just from weight loss? If so, can your suggestion of a more gradual approach do the same thing, just over a longer period of time?

    Or is there something to the much more extreme restriction that reduces fat in the pancreas in such a way as to restore beta cells to normal function?

    I’ve read many of the current crop of Paleo books (Sisson, Wolf, DeVany, etc.) and quite a few of the blogs. For long-term health, your Perfect Diet seems to make the most sense to me. The question for me is whether a program similar to the study would give me, metabolically speaking, a “reset” of sorts, to more normal reaction to carbs.

    I still have much bodyfat to lose–probably on the order of 50-60 pounds. Would a more gradual approach do the same thing? Or could this reset make a faster transition to the PHD and eventually getting where I’d like to be?

    And thanks also for your words about Bernstein’s recommendations. Are the negative effects of his very low carb approach the same as in your book for any such continually low carb diet?

    Thanks again for all the work you’re doing!

  34. Hi Paul,

    I have a question for you about acne. I am a 41 year old female, and have struggled with acne off and on as an adult (did not have issues as a teen). Several years ago I went through Accutane treatment, which was very successful. Then I started having some breakouts, although not nearly as bad as before, and my MD put me on Aldactone, which worked wonderfully. However, I got tired of the side effects, and stopped taking it. Since then, following a very vegetarian/vegan leaning diet, I would go for months without a breakout. Then, staring this April (6 months ago now) I have been following a PHD/Primal blueprint type of diet. I feel better in every possible way (had to cut my thyroid hormone for Hashimotos’ supplement in half), and my skin tone is so much better. But the one thing that is plaguing me is acne! In my searches I ran across a comment that maybe it could be related to higher levels of testosterone from eating more meat. Because of my success with acne on aldactone, this caught my eye. But I don’t want to take aldactone again. Any thoughts?

    Thanks you so much!

  35. Hi Richard,

    I think the study was biased toward an extreme diet because it is more likely to produce an effect, and because people are more likely to comply with an extreme (thus clear) short-term intervention than a moderate long-term intervention.

    But biologically, all of the likely mechanisms should work just as well with a more moderate diet complied with for a longer period. And a more moderate diet is safer and more pleasant. I think in general it will be even more effective, just slower.

    In general, I would favor diets with real plant and animal foods rather than concoctions of nutrients. Especially on calorie-restricted diets, I wouldn’t take protein shakes.

    Hi Stefanie,

    There are so many possible causes of acne, including nutrient deficiencies, infections, and circulating toxins, that it’s hard to make a specific diagnosis.

    One possibility is sulfur deficiency. Try dissolving a few tbsp epsom salts in half-cup water and spreading the solution on your skin once a day. That should fix both magnesium and sulfur/sulfate deficiencies. You might also try eating more sulfur-rich vegetables like onions.

    If that doesn’t work, come back and I’ll give more ideas.

  36. Hi Paul,
    Fungal, sleep-deprived, teeth grinder here again. Have read PHD and am now going through your website posts, including comments (through July 25,2010 so far). A wealth of information. A few things have clicked, for instance nearly every winter for the last 25 years I come down with a head and chest cold. After 5 days or so my temperature peaks, I break out in a rash, and start feeling much better except for a cough that lasts two months. Could this be a bacterial infection (Cpn) which you connected to teeth grinding?
    Anyway, I’ve lowered coconut oil consumption to <1 tsp/day since I can't sleep if I take more than that; upped carbs by eating the whole potato or sweet potato rather than just ½, have berries, plus a banana, or an apple from my tree each day; use plenty of butter, tallow, and raw cream (love cream); quit drinking kombucha and kefir and drink water with a pinch of sea salt, coffee with lots of cream, bone broth, wine, the occasional glass of raw milk (easy access to raw dairy here in WA); eat cooked vegies, raw salads, elk, salmon, raw cheeses, eggs from my own free-range chickens… Definitely living in the land of milk and honey! Basically tweaked the last 8 years of a WAPF diet (on which my foot/nail fungus grew and expanded) to a PHD and loving it. My husband does, too. I've been taking most of PHD's recommended supplements for a couple weeks (multi-vit, selenium, vitamins C, D, K2, iodine, chromium). Been taking magnesium for last 8 years as it is the only thing to help with life-long tendency toward constipation.
    Last week added 2mg copper, 1 Primal Defense Ultra probiotic, and charcoal. And once again could not sleep, like I'd taken a stimulant before bed. After three nights (it takes me awhile) wondered if it could be the copper. I quit all supplements except charcoal and that night had a nice six hour sleep from the moment my head hit the pillow. Your post of April 04, 2011 suggested to add iodine after adjusted to selenium, copper, and magnesium supplementation, so I should quit iodine until adjusted to copper then reintroduce iodine at low dose. Do I have that right? Any other ideas? Still looking for a doctor for stool test and other diagnostics. My brother-in-law suggested going to a vet. He was serious. The only recent "health" numbers I have are: Cholesterol 246, HDL 100, tryglicerides <45, fasting blood glucose 83, BP 120/70, resting heart rate 90, weight 135, ht 5'3'', age 52. Probably not very helpful.

  37. Hi Kathy,

    The copper may have been a bit much, or there may be a zinc deficiency (they have to be in balance). I would just drop the copper supplements and keep the rest for a bit, maybe include some zinc. If you eat 1/4 lb beef liver per week that will prevent a copper deficiency.

    Copper in excess can give hyperthyroid symptoms including difficulty sleeping. I think iodine deficiency may lead to copper sensitivity also.

    With evidence that your thyroid is sensitive, be sure to start small with iodine and increase it gradually.

    Heh. Vets are in many ways better than human doctors — more practical, less “politically correct” or forced to adhere to consensus practices that don’t work.

    Your numbers are all fine.

  38. Paul,

    Thanks, will leave off the copper and go slow with iodine.

    Yeah, I figured my numbers were fine, but thought they’d be of no help diagnostically. I didn’t word it correctly.

    Appreciate this new venue and all you do.


  39. Hi Paul,
    I saw on your supplements section a recommendation for using bentonite clay. I got very interested in it and did a lot of online research. I have ordered some edible clay from greenclays.com. My question is I have read that having a fatty diet can be a contraindication for doing clay detoxing (ingesting). Just wondering if you think I should cut down my fats while taking the clay? I currently use a lot of butter, raw milk, cheese, olive oil, etc.

  40. Would love to know what you think of this:


    n a provocative editorial published this week in Nature, Martin Blaser of New York University’s Langone Medical Center argues that antibiotics’ impact on gut bacteria is permanent — and so serious in its long-term consequences that medicine should consider whether to restrict antibiotic prescribing to pregnant women and young children.

    Early evidence from my lab and others hints that, sometimes, our friendly flora never fully recover. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fuelling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.

    Among the findings he cites in support: The population-level observation that the incidence of infection with H. pylori, the bacterial cause of gastric ulcers, has declined over decades just as the incidence of esophageal cancer has risen. In addition, he offers his own research group’s observation that children who don’t acquire H. pylori are at greater risk of developing allergy and asthma, and their findings that eradicating H. pylori affects the production of the two hormones, ghrelin and leptin, that play a role in weight gain.

  41. Hi Paul,
    A few questions:

    1) I am wondering about the protein content of meat/bone broth. Trying to minimize protein to deal with infections and wonder if broth is protein heavy, or mostly minerals?

    2) I have been drinking cucumber/celery/ginger juice in the mornings and wonder if that interferes with the fast? Also sometimes Aloe juice and unsweetened cranberry juice.

    3) 12 Tbsp of coconut oil is a lot. I put a couple in a mostly fat/coconut milk/eggyolk smoothie, but how can someone ingest so much? I prefer to use Ghee for cooking and on foods. Also, how do you feel about Ghee?

    Thanks so much.

  42. Hi Lisa,

    I don’t think I would change my diet composition, but (a) I would combine the clay with intermittent fasting and use it during fasts, (b) I would add some bile support supplements since clay binds bile and causes it to be excreted, so extra cholesterol, vitamin C, and taurine are probably in order.

    Hi Ellen,

    I don’t see how the antibiotic effect can be permanent. Infants come into the world with a bacteria-free gut and populate it fresh; sometimes they are colicky for a time but often it works.

    I can readily believe however that (1) with bad adult diets, many adults fail to repopulate their gut with good bacteria and allow bad flora to take hold; and (2) contemporary medicine fails utterly at helping people recover from a bad gut floral population.

    I see the data they report as an indictment of modern diets and modern medical practice.

    Hi Alison,

    1) Broth has some protein but it’s good protein, from collagen, not “complete” protein, and won’t promote infections.

    2) I think that’s fine. None of those are calorie rich. I would eat cranberries and spinach at the end of some of my fasts, to help modulate gut flora, I think that’s fine even though the cranberries have some sugar.

    3) You don’t need 12 tbsp … that may be needed to help prevent neuronal starvation in severe brain infections, but for most people it’s too much. For ordinary people I would recommend at most 2 tbsp per day. For those on therapeutic ketogenic diets, it’s experimental based on how you feel, but ~5 tbsp might be good. MCT oil can substitute. Ghee is great, less ketogenic but more nutritious.

  43. Hi Paul,

    I’ve had a lifelong sinus problem and I wonder if you have any thoughts about it. Basically, I have a stuffy nose every single day. Without exception. I sniffle a lot in between blowing my nose at least once an hour. I sneeze anywhere from once or twice, to dozens of times a day, even when I have no other symptoms. I have never bothered to have an allergy workup because it’s too constant. It doesn’t matter if I’m indoors or outdoors. It doesn’t get worse or better by the season. The only thing I’m positive ever makes it worse is that I’m specifically allergic to most cats. I am trying to figure out whether to see a specialist, and who to see, based on whether I’m likely dealing with an allergy, an infection, a mechanical obstruction, or something else. Here are more details:

    Eyes: My eyes tend to be a little itchy, but not so much that I notice much of the time. At the end of the day or occasionally earlier, and particularly after taking out my contacts (but this has been the case all my life, and I only began wearing contacts in 2002 at age 19) I have a tendency to vigorously rub my eyes — they may only feel a little dry (I produce plenty of tears though), not particularly itchy, but this is an almost uncontrollable urge; if I avoid it before going to sleep, I will wake up in the middle of the night doing it! My vision is poor, and has gotten worse continually all my life; currently -8.5 diopter correction in both, and astigmatism on the right.

    Nose: I have a mild (maybe 10-15 degrees?) angle of the nose toward the left. This does seem to relate to the right side having a tendency to be stuffiER, but it’s not huge difference. It does lead me to be more comfortable sleeping on my right side, with the more open nostril on the top. I used to get nose bleeds in elementary school, but rarely now.

    Treatments: I have tried to treat it with many kinds of allergy meds (dimetapp, Benadryl, Claritin, Zyrtec), which either put me to sleep or make me feel just weird, and only mildly or moderately influence symptoms. Nasal sprays (Afrin, Flonase) also have a mild effect, but give me nosebleeds after about a week of use. I’ve done netipots diligently for as long as a month, which reduced the proportion of congestion relative to runniness of the nose. My diet has changed many times: through adolescence it was all over the board, with homemade reasonably-PHD dinners almost daily but LOTS of junk food aside; later, ramen/instant/boxed/canned/frozen food malnourishment in college; then super conscious organic-grain-bean-soy-rice-greens vegan (eliminated meat and dairy); now nine months into making great efforts to follow the PHD (reasonably successful in eliminating grains, beans, vegetable oils). This has not changed my symptoms in any way that I can tell. There’s also been no consistency I can think of in any products/chemicals I have used on a daily basis through my whole life.

    I feel like your chronic infections theory fits best, but I am wondering if you can think of anything else I haven’t yet. (I suspect that something, maybe this, bogs me down in general — that I ought to feel more energetic than I do, though I don’t feel “bad” per se most of the time.) Or if you know something specific that I should start investigating first. Thanks for your help!

  44. Hi Stephanie,

    Well, chronic inflammation like this can be infections, allergies, or both (eg you become allergic to proteins from a mild infection). When it is chronic and little-changing over long periods of time, I tend to suspect any infection may be fungal, since bacterial infections tend to be more variable. Allergies and weakened immunity can both be brought about by nutritional deficiencies. Nutritional deficiencies can persist for years or decades too.

    Key nutrients for allergies include vitamin D, zinc, sulfur/sulfate, some B vitamins, vitamin C and glutathione, and the standard supplements we recommend. Are you taking our recommended supplements, and especially optimizing vitamin D status? If so I would look to add some zinc, epsom salt baths for sulfate, B1, B2, B6, and pantothenic acid (maybe biotin and B12 also), and extra vitamin C and NAC. Also, get lots of potassium rich vegetables – tomatoes, potatoes, bananas, spinach, etc.

    Then, as a diagnostic experiment, I would try cholestyramine (prescription) or bentonite clay or activated charcoal, along with drinking lots of water with extra salt in the diet. This is good for clearing toxins, including environmental mold toxins which often cause allergic symptoms. The C/glutatione/NAC also helps clear toxins.

    After that I would try some kind of antifungal medication, or get tested for allergies.

    Any kind of immune activity will make you tired, so I’m not surprised that you have less energy than you should.

  45. Hi Paul,

    Thank you so much for the advice for my dad – he was very pleased with the info!

    Also thank you so much for your compassion and helping me get this figured out.

    You asked whether ketosis made it better? I think so! Vomiting seems to stop with a diet of veggies, eggs, fish/chicken and raw butter/coconut/olive oil (red meat doesn’t usually go well so I avoid it). A daily glass of grapefruit juice goes ok too. But I haven’t lasted longer than 2 weeks at a time with this diet because I get incredibly tired with uncontrollable cravings for carbs and constipated (despite extra vit c and mg). If I add a spoon of raw honey or a bit more fruit a day it is far more manageable and the vomiting occurs approximately once a week.
    Nuts or yogurt/cheese make my symptoms worse. Adding rice or potatoes almost never pan out well. So basically I am constantly trying to do the above-mentioned diet, but then after a few days I feel good and strong but get major cravings and stupidly think this time potatoes, rice, dairy or nuts will go ok (sometimes it does, but 75% of the time it doesn’t) and then get sick (vomiting, abdominal pain) again for 3 days.

    So I think you may be right that there is something aside from fungal infections going on. My blood work repeatedly points to a light infection (at the level of a cold according to my doctor, which is not considered serious enough to prescribe something). I always have swollen lymph nodes around my throat but not in other places. Obviously I have general gut dysbiosis (gas,pain,diarrhea/constipation) which as I’ve read in the comments above is difficult to resolve.

    Please correct me if I’m wrong, but if the main cause was fungal then I would do better with carbs right? I also can’t imagine its protozoal – because that would mean reinfecting myself repeatedly for years, whereas my partner hasn’t gotten sick. Would a virus or bacteria mean occasional fever? I don’t have this. Usually my body temp is on the lower end of the spectrum. The bacterial brain infection theory you proposed (with neural component causing vomiting) sounds quite plausible. I will try and find a way to test this.

    I am luckily otherwise quite strong/healthy! I just wear out more easily than other people my age, but that’s logical given the circumstances. Even though if I had to I could continue live with this but vomiting so often really cannot be good for me and it is very limiting in all aspects of my life. I have truly motivated not to give up. I figure if people I know can heal from cancer then surely I can beat whatever is causing my digestive distress!

    I think I’ve optimized my diet as best I can (but am open to suggestions). I take betaine HCL with protein rich meals which I find helpful. I include fermented veggies and water kefir with each meal. My supplements right now are probiotics, l-gluatmine, vitamineral green as multivit, 2x 1000mg vit C, 2x 250mg Mg, 1x green pastures fermented cod liver oil + butter oil and high dose b6+b12 every other day. I also practice yoga (15min nearly daily – http://www.ncbi.nlm.nih.gov/pubmed/17149454) and have recently started hypnotherapy for IBS (http://www.ncbi.nlm.nih.gov/pubmed/15754863). Tomorrow I see an expert in Chinese medicine to help me with the antifungal herbs 🙂 So hopefully things will improve some soon!

    Thanks for “listening” 🙂
    Best, Claire

  46. Hi, Paul. I’ve been reading your book, and learning so much! I have a question, if you have time.

    On page 217 you describe the problems that can arise from consuming too much vitamin A and beta-carotene: “A review and meta-analysis of 7 high-quality clinical trials…found that supplementation with beta-carotene and vitamin A together increased mortality by 29%; beta-carotene alone increased mortality by 5%.” You then talk about the importance of maintaining a healthy vitamin A to vitamin D ratio (of 3 IU to 1 IU) and recommend that “since optimal vitamin D provision…is about 4,000 IU/day, vitamin A intake should be limited to 12,000 IU or less.”

    But just one medium-sized sweet potato contains nearly 22,000 IU of vitamin A (according to NutritionData).

    Is the high beta-carotene content of sweet potatoes just as potentially harmful as the beta-carotene found in supplements?

    As you mention in your section “Traditional Pacific Islander Diet”, the traditional diets of the Okinawans, Kitavans and Hawaiians all included plenty of sweet potatoes, and they seemed to be quite healthy people.

    Thanks for your time, Paul!


  47. Hi Paul, I’ve been re-reading your book to find new tips – especially step 4: heal and prevent disease. Its really great b/c of your question about if I do better on a ketogenic diet and my ‘yes guess’ has me reading from a totally different perspective. I was thinking the main cause was fungal or at least extracellular b/c its all gut related. But, now it seems that intracellular may be the more dominant since I do better on low carb. I basically follow all 11 points you mention except maybe high-dose iodine (I do eat seaweed daily). But maybe I am having so much trouble with the ketogenic diet because I am not eating enough fats. I always cook in coconut oil and may have a tablespoon on its own, but I think increasing this – especially during fasting (from 8pm to noon) may prevent the cravings for foods that make my symptoms worse. So the steps I will take now are chinese antifungal herbs and more coconut oil and see where it takes me the coming weeks 🙂 All the best, Claire

  48. Hi Scott,

    Carotenoids are not necessarily converted to active vitamin A, usually not, so I wouldn’t worry about them. It’s an excess of active A that you have to avoid. Thus, large doses of cod liver oil are more of a danger.

    Hi claire,

    Ketosis is good for neurons, it’s neuroprotective and reduces excitotoxicity, so that may be a mechanism by which it makes you feel better.

    I was not thinking so much of a brain infection as an infection of nerves, especially the vagus nerves and the cluster of nerves around the small intestine / stomach / pancreas / bile duct which serves as a mini-brain to manage the digestive tract.

    But the basic strategy for a brain infection should be the same for nerve infections.

    Chronic infections generally don’t produce fever, so lack of fever is not a clue. Indeed, chronic infections more often produce hypothyroidism and lowered temperature (or reduced cold tolerance).

    Protozoal infections can persist for decades without re-infection.

    Have you tried rice syrup to see if you tolerate that better than rice? Sometimes the faster-digesting sugars are much more tolerable. If so that would be a clue to the problem, and also would give you a glucose source which I think would help you.

    Re your supplements, I would worry about glutamine (are you sure it helps you?) and would suggest maybe more minerals. The magnesium you might wish to get (some or all) from Epsom salt so that you get some sulfate too, I’ve found that helpful personally.

    Do keep in touch, I’m sure we can track this down and fix it sooner or later!

  49. Paul, you caution against cod liver oil which I understand. What is your stance on “X-Factor High Vitamin Butter Oil” which is a WAPF highly recommended supplement as well? It seems to be quite high in Vitamin A but I didn`t find anything about the Vit A/Vit D ration…

  50. It’s good. Butter oil has only a little over 3 IU/calorie so even if you got all your daily calories from butter oil you would be getting roughly the proper amount of vitamin A.

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